Objective The management of hyperparathyroidism in hemodialysis patients involves the administration of phosphate binders, vitamin D receptor activators and calcimimetics. Intravenous paricalcitol has been preferred over oral calcitriol as it may cause less hypercalcemia and hyperphosphatemia. However, there is little data looking at the efficacy and tolerability of oral calcitriol in the calcimimetic era particularly in a real practice-based experience. The XXX free-standing dialysis center converted from routine intravenous paricalcitol to oral calcitriol due to pharmacy purchasing preferences. We report the efficacy, safety and cost of such a change. Setting XXX dialysis center Subjects 93 pre conversion intravenous paricalcitol and 91 post conversion oral calcitriol Intervention Conversion to in-center, pulse, oral calcitriol (0.25 mcg =1 mcg paricalcitol) 3 times a week from intravenous paracalcitol. Additional dose adjustments were made by the nephrologists based on clinical indications. Main outcome measure 5-month average serum calcium, phosphorous, and intact parathyroid hormone levels and cardiovascular events pre and post transition. Results There were 93 patients on intravenous paricalcitol between April 2013 and August 2013, of which 74 converted to oral calcitriol and were included in the post-conversion group evaluated between October 2013 and February 2014. An additional 17 new patients had initiated calcitriol such that 91 patients were on oral therapy in the post-conversion period. Sevelamer use increased from 41 (44.1%) patients pre-conversion to 48 (52.7%) post-conversion, while calcium acetate use significantly dropped from 62 (66.7%) to 46 (50.5%) (p=0.026). Cinacalcet use dropped slightly from 37 (39.7%) patients pre- to 35 (38.4%) post-conversion. Average serum calcium, phosphorus and intact parathyroid hormone levels remained unchanged after conversion. Percent of values within KDOQI guidelines were similarly maintained. Estimated vitamin D cost savings were $564 per person/year. No increase in the incidence of cardiovascular events was observed. Conclusions We conclude that in-center distributed pulse oral calcitriol may be an effective, safe and economical treatment option for the management of hyperparathyroidism in hemodialysis patients.

Purpose of reviewTo describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline.Recent findingsThere are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of the posterior knee, pectoral nerve blocks, quadratus lumborum and transversus abdominis plane block. New local anesthetics and adjuvants have been developed in recent years. However, the studies with even with the oldest one introduced Exparel is currently questioned, large future studies are needed to determine efficacy and safety profile and compared with conventional local anesthetics.SummaryNew regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.

Background:Lifetime incidence of low back pain is 50-70% and incidence of clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of the population. Low back pain and sciatica is major cause of morbidity throughout the world. There is only conservative treatment giving short-term relief in pain or surgical intervention with side-effect. There is need to find out quick relief from pain in today's era as it affects physical as well as mental and social life of patients. In Ayurveda, various modalities are given but Agnikarma and Siravedha are supposed to give instant relief from pain.Aims:To compare the efficacy of Agnikarma and Siravedha in the management of Griidhrasi.Materials and Methods:It's an open randomized parallel group trial. A total of 30 patients, divided randomly in two groups, were treated by Agnikarma in 19 patients and Siravedha in 11 patients. Agnikarama was done at lumbosacral spine and Achilles tendon region by Panchadhatu Shalaka. Siravedha was done from four Angulas below Janu Sandhi (Knee joint). Placebo starch capsules were given to all patients. Paired t-test applied for efficacy within the group and Chi-square test to compare the efficacy of two groups.Results:Individually both groups had given relief in cardinal symptoms of Gridhrasi. 68.42% patients showed marked improvement and 21.05% had complete relief after Agnikarma. In Siravedha, 72.73% patients had moderate improvement whereas 27.27% patient had marked improvement.Conclusion:Agnikarma gives better effect than Siravedha in management of Gridhrasi.

No abstract

This practice report, framed within transition pedagogy (Kift et al., 2010), seeks to offer suggestions to assist higher education educators and administrators to develop and apply policies to foster student belonging. The authors of this article are employed at an Australian university which offers alternative pathways for students to enter a mainstream university degree. The authors were part of a project sub-committee responsible for reviewing literature on the definition of, and approaches to, belonging and writing a report with suggestions to enhance student engagement and progression. The report concluded that belonging should be a “whole-of-institution” approach (TEQSA, 2020) where all aspects of a student’s journey are considered when developing and applying student success strategies. This practice report culminates past studies and offers belonging enhancing teaching advice, policy suggestions and learning tools to strengthen connections between students and the higher education institutions in which they are enrolled.