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OBJECTIVE: To describe the breast feeding experiences of mothers in New Zealand. DESIGN: Descriptive, qualitative study. After a previous quantitative analysis of a questionnaire, the open-ended responses by the women were examined using a thematic analysis approach. SETTING: Hawke's Bay, New Zealand. PARTICIPANTS: 153 primiparous and multiparous breast feeding women aged between 20 and 49 years, who had had a caesarean section or vaginal birth between 4 months and 3 years previously. FINDINGS: Themes identified during the data analysis are as follows: persistence, determination, confidence and satisfaction; pain and limitation of mothering activities; conflicting advice and professionalism; and others' expectations. CONCLUSIONS: Breast feeding experience could be detrimentally affected by physical factors, inconsistent health-professional support and others' expectations. Negative influences, however, were likely to be overcome by persistence, determination, confidence and satisfaction. IMPLICATIONS FOR PRACTICE: Implications for midwifery practice from the study iterate the importance of consistency of advice and skills of health professionals, of listening and understanding women's responses to early breast feeding assistance and giving continuous encouragement and support throughout their breast feeding experience. To meet these recommendations, breast feeding education for health professionals needs to include technical expertise and communication skills. Recommendations for further research from this study include investigations into why women commit to breast feeding and an exploration of women's perceptions of midwives' breast feeding support. [ABSTRACT FROM AUTHOR]

Vandetanib-eluting radiopaque beads (VERB) have been developed for use in transarterial chemoembolization of liver tumours, with the goal of combining embolization with local delivery of antiangiogenic therapy. The objective of this study was to investigate how embolization-induced hypoxia may affect antitumoural activity of vandetanib, an inhibitor of vascular endothelial growth factor receptor (VEGFR) and epidermal growth factor receptor (EGFR), in the context of hepatocellular carcinoma (HCC) treatment. We studied the effect of vandetanib on proliferation, cell cycle and apoptosis of HCC cells, in hypoxic conditions, as well as the direct effects of the beads on 3D HCC spheroids. Vandetanib suppressed proliferation and induced apoptosis of HCC cells in vitro and was equipotent in hypoxic and normoxic conditions. High degrees of apoptosis were observed among cell lines in which vandetanib suppressed ERK1/2 phosphorylation and upregulated the proapoptotic protein Bim, but this did not appear essential for vandetanib-induced cell death in all cell lines. Vandetanib also suppressed the hypoxia-induced secretion of VEGF from HCC cells and inhibited proliferation of endothelial cells. Incubation of tumour spheroids with VERB led to sustained growth inhibition equivalent to the effect of free drug. We conclude that vandetanib has both antiangiogenic and direct anticancer activity against HCC cells even in hypoxic conditions, warranting the further evaluation of VERB as novel anticancer agents., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Hyperkalemia is a common problem in hospitalized patients, especially those with underlying chronic kidney disease, but evidence-based guidelines for its treatment are lacking. Sodium polystyrene sulfonate (SPS), a cation exchange resin first approved by the FDA for the treatment of hyperkalemia in 1958, is frequently used alone or in conjunction with other medical therapies to lower serum potassium. Recently, the safety and efficacy of SPS have come into question based on multiple reported cases of bowel necrosis associated with SPS administration., Objective: The primary objective of this study was to evaluate the use of SPS for the treatment of hyperkalemia, at a large tertiary community teaching hospital, to determine its effectiveness and the incidence of related adverse side effects., Methods: A retrospective chart review was performed on all adult inpatients receiving single-dose SPS at a 466-bed tertiary community teaching hospital over a 3-year period., Results: 501 patients received SPS for the treatment of hyperkalemia during their index hospital stay. Serum potassium levels decreased by 0.93 mEq/L on average at first recheck after SPS administration, with or without additional medical treatments. Our study identified 10 cases of hypernatremia (greater than 145 mEq/L), 31 cases of hypokalemia (less than 3.5 mEq/L), and 2 cases of bowel necrosis related to the administration of SPS., Conclusion: Our results suggest a serum potassium reduction of less than 1 mEq/L after administration of SPS for the treatment of acute hyperkalemia. Additionally, this study offers some evidence that the use of SPS may be associated with harm. We further note the need for standardized guidelines for the treatment of hyperkalemia at our institution.