Thursday, February 26, 2015

Face Transplantation for Treatment of Severe Facial Deformity

Face Transplantation for Treatment of Severe Facial Deformity

Face transplantation surgery is the transfer of face tissue from a deceased human donor to a patient with a severe facial deformity. Face transplantation is an innovative reconstructive procedure that has the potential to significantly improve the lives of patients with severe facial injuries. The purpose of this study is to develop the best practices for facial transplantation that will improve the outcomes of future face transplant recipients.

Description

The United States Department of Defense (DoD) awarded Brigham and Women's Hospital (BWH) a research contract to fund 5 face transplantation surgeries.
The investigators are now actively seeking candidates for the procedure. The primary requirements to be considered as a candidate for face transplant surgery are: at least 18 years old; lost a major part of the face, such as the nose or the lips, or lost at least 25% of their facial tissue; and the facial injury cannot be treated acceptably by conventional reconstructive surgery. There are number of other factors that the investigators consider to determine who would be a suitable candidate.

From the time the investigators begin our search for a qualified face transplant recipient to the continuing care the investigators provide following surgery, a significant amount of time, expertise, and attentiveness is contributed toward making the procedure a progressive success. Below is an overview of what happens before, during and after a face transplant procedure.  ...

Patients should have right to choose where they die, says care inquiry

Patients should have right to choose where they die, says care inquiry


People nearing the end of their lives should have the right to choose where they die, says a report commissioned by ministers in England.
What’s important to me was written by representatives from charities, professional bodies, the NHS and Department of Health.
The Choice in End of Life Care review board recommended that dying patients’ choices and preferences on care and treatment be recorded in personal plans that are easily accessible electronically by health and social care professionals.
A named senior clinician should also be responsible for a dying patient’s care.
The review board said 24/7 end-of-life care for people opting to die out of hospital must be available to everyone in the last year of their lives within five years. Despite some “great strides forward”, far too many dying people still received inadequate or ill-suited care.
Claire Henry, the review board’s chair, said they had taken a “pragmatic” approach, sticking to realistic state funding increases of £130m a year from the next government’s first funding review after the election.
Almost half a million people die in hospital each year. To help reduce that number by a fifth, older people who have to contribute to their own care will have to pay more, while charities will also have to find more money.  ...

Study demonstrates significant survival benefit in patients treated with once-daily Advagraf over standard of care in liver transplantation

Study demonstrates significant survival benefit in patients treated with once-daily Advagraf over standard of care in liver transplantation

Results of a large observational study published in the American Journal of Transplantation (AJT) has demonstrated that early and sustained use of Advagraf, a once-daily immunosuppressant, offers a significant graft survival benefit in liver transplant patients over twice-daily tacrolimus (tacrolimus BID or immediate release).i Tacrolimus is currently the standard of care for the prevention of organ rejection in liver transplantation.
The results of the study showed a significant graft survival benefit of 8% at 3 years (p=0.01) in liver transplant patients on Advagraf versus tacrolimus immediate release.ii The study, a retrospective analysis, was conducted by the European Liver Transplant Registry (ELTR), one of the largest and most robust independent registries, that holds data for 98% of liver transplants conducted in Europe.iii
Whereas for a large number of diseases, such as cancer and diabetes, the standardised mortality rate is falling, for liver disease, mortality rates have been increasing over the past few decades.iv In addition, more than 500 patients are on the UK's active liver transplant list (as of March 2014), which is a 12% increase since 2013 and 880 transplants have taken place between 2013 and 2014 in the UK.v It is also estimated that over the past 20 years, the number of potential patients in the UK who could benefit from a liver transplant has increased by 90%, whilst the number of available donations has remained the same.vi
Both Advagraf and tacrolimus immediate release are immunosuppressants licensed for the prevention of organ rejection in patients receiving Liver and Kidney transplants. Due to its distinctive pharmacokinetic profile, Advagraf offers patients a more convenient reduced pill intake, as it permits once daily administration, over tacrolimus immediate release which is twice daily.vii

Dr Varuna Aluvihare, Consultant Hepatologist, King's College, London said: "A graft survival benefit means better patient survival, meaning that for every 13 patients treated with Advagraf, we could potentially save 1 life when compared to people being treated with the usual twice daily tacrolimus. Whilst we do not know the underlying reason for this benefit, it is exciting to speculate that this may due to some benefits inherent in this formulation of tacrolimus, as well as the undoubted fact that patients find it easier to take."  ...