Corticosteroids are used to treat immune-related adverse events (irAEs) associated with nivolumab. However, patients with non-small-cell lung cancer who are administered corticosteroids before the initiation of nivolumab treatment are commonly excluded from clinical trials. The appropriate timing for corticosteroid administration in relation to nivolumab treatment, effects of corticosteroids on the efficacy of nivolumab, and resulting adverse events are not clearly understood. In this study, the effects of differences in the timing of corticosteroid administration on nivolumab efficacy and the resulting adverse events were examined.
 
  A retrospective study was conducted with 109 patients who were treated with nivolumab at Sapporo Minami-Sanjo Hospital between December 2015 and March 2018.
 
  Of the 109 patients treated with nivolumab, 12 patients were administered corticosteroids before the first cycle of nivolumab (pre-CS), and 33 patients were administered corticosteroids after the first cycle of nivolumabcan be administered immediately for rapid treatment of irAEs.
  The COVID-19 pandemic has changed the delivery of primary care in the NHS. Consultations have largely moved from face-to-face to remote, forcing practitioners to modify the ways in which they deliver care to patients.
 
  In this study, we aim to investigate the appropriateness of antibiotic prescribing in tonsillitis during the COVID-19 pandemic.
 
  An observational quantitative analysis in the North Wales primary care setting.
 
  Retrospective review of computer records across 5 GP centers from March 2020 until the end of October 2020. Data was extracted and analyzed using chi-square or fisher exact rank and Mann-Whitney test.
 
  Our results have shown no significant difference in antibiotic prescribing behavior comparing face-to-face and remote consultations.
 
  Remote consultation is as effective as face-to-face consultation with regards to the assessment of tonsillitis and the appropriateness of antibiotic prescription in primary care.
 Remote consultation is as effective as face-to-face consultation with regards to the assessment of tonsillitis and the appropriateness of antibiotic prescription in primary care.Testing for direct oral anticoagulants (DOACs) in patient urine may facilitate medical treatment decisions. The aim of this study was to investigate interobserver variability by 2 independent observers compared to laboratory staff in the visual interpretation of factor Xa (DXI) and thrombin inhibitors (DTI) using the DOAC Dipstick test. We also examined whether test pads reacted to other anticoagulants and abnormal urine colors.  https://www.selleckchem.com/products/p22077.html  The colors of the DOAC Dipstick direct factor Xa inhibitor and thrombin inhibitor pads were interpreted with 100% accuracy (95% confidence interval 0.862 to 1.000) for urine samples from persons treated with apixaban (n = 26), rivaroxaban (n = 24), and dabigatran (n = 29) and without anticoagulant therapy (n = 29). The factor Xa and thrombin inhibitor pads did not interact with heparin, nadroparin, fondaparinux, or coumadin. One µg/mL r-Hirudin and 6 µg/mL argatroban interacted with the DTI pad; however, this is unlikely to cause clinical problems because dabigatran is unlikely to be administered together with r-Hirudin and argatroban in clinical circumstances. Abnormal urine color was reliably detected by the urine color pad, so can prevent false interpretation of the DOAC Dipstick pad colors. In conclusion, we have demonstrated that interobserver variability when interpreting the DOAC Dipstick test strip is low and that factor Xa and thrombin inhibitor pads do not react to other anticoagulants such as heparins and coumadin. R-Hirudin and argatroban can be detected by the thrombin inhibitor pad and abnormal urine colors can be detected by the urine color pad to prevent false interpretation of the results in patient urine samples.The "Train Your Brain" (TYB) cognitive intervention group program was developed based on previous research with the goal of remediating cognitive impairments for elderly Singaporean people with mild cognitive impairment (MCI). This study reports a pilot evaluation of feasibility (defined as participant attendance, retention rate, satisfaction and usefulness) and preliminary efficacy of the TYB program. Nineteen participants with MCI aged ≥ 50 years were recruited from a memory clinic in Singapore, with 14 receiving the TYB intervention. Participants were allocated in order of recruitment into consecutive identical groups for a 9-session program on brain health and cognitive training. Participants received pre- and post-intervention measures of cognition and completed feedback forms reporting on satisfaction with, and utility of, the TYB program. TYB was well attended (85% attendance for the first 6 sessions; 83% for the full 9-session TYB program). Participant satisfaction was high, with positive participant feedback reporting that TYB offered useful cognitive strategies which participants could implement in their daily life. Despite the small sample size and absence of control group, repeated-measures t-tests revealed significant pre- to post-intervention intra-individual improvement in global cognition measured by the Montreal Cognitive Assessment, and in executive function on the Brixton Spatial Anticipation Test. This pilot study provides supportive preliminary evidence for feasibility of TYB, with suggestions of efficacy of this program as a culturally and linguistically appropriate intervention for English-speaking older adults with MCI in Singapore.Patients with progressive hand weakness may be seen in ambulatory medical clinics or in emergency rooms due to direct effects on activities of daily living or inadvertent injury associated with overuse or attempts to maintain normal function. It is important to recognize potential cause(s) and perform appropriate diagnostic tests and referrals that aid guide appropriate treatment that may lead to good outcomes. Hirayama disease is an underrecognized disorder in young adults due to an asymmetric growth-associated cervical spinal cord compression injury. Awareness of this disorder by internists, emergency room physicians, and radiologists would prevent unnecessary tests and interventions that may contribute to disease progression by delaying appropriate treatments or treating inappropriately, with consequential effects on outcomes. In this article, we describe 3 Hirayama disease cases from a single tertiary care institution and demonstrate how delayed diagnosis affected outcomes in 2 patients and early recognition facilitated improved outcomes in a patient.