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https://www.readbyqxmd.com/read/29779416/long-term-triple-therapy-de-escalation-to-indacaterol-glycopyrronium-in-copd-patients-sunset-a-randomized-double-blind-triple-dummy-clinical-trial
#1
Kenneth R Chapman, John R Hurst, Stefan-Marian Frent, Michael Larbig, Robert Fogel, Tadhg Guerin, Donald Banerji, Francesco Patalano, Pankaj Goyal, Pascal Pfister, Konstantinos Kostikas, Jadwiga A Wedzicha
RATIONALE: There are no studies on ICS withdrawal in patients on long-term triple therapy in the absence of frequent exacerbations. OBJECTIVE: To evaluate the efficacy and safety of the direct de-escalation from long-term triple therapy to indacaterol/glycopyrronium in non-frequently exacerbating COPD patients. METHODS: This 26-week, randomized, double-blind, triple-dummy study assessed the direct change from long-term triple therapy to indacaterol/glycopyrronium (110/50μg once daily) or continuation of triple therapy (tiotropium 18μg once daily plus combination of salmeterol/fluticasone propionate [50/500μg] twice daily) in non-frequently exacerbating patients with moderate-to-severe COPD...
May 20, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29776750/safety-and-immunogenicity-of-a-vi-dt-typhoid-conjugate-vaccine-phase-i-trial-in-healthy-filipino-adults-and-children
#2
Maria Rosario Capeding, Samuel Teshome, Tarun Saluja, Khalid Ali Syed, Deok Ryun Kim, Ju Yeon Park, Jae Seung Yang, Yang Hee Kim, Jiwook Park, Sue-Kyoung Jo, Yun Chon, Sudeep Kothari, Seon-Young Yang, Dong Soo Ham, Ji Hwa Ryu, Hee-Seong Hwang, Ju-Hwan Mun, Julia Lynch, Jerome Kim, Hun Kim, Jean-Louis Excler, Sushant Sahastrabuddhe
BACKGROUND: Typhoid fever remains a major public health problem in low- and middle-income countries where children aged 2-14 years bear the greatest burden. Vi polysaccharide is poorly immunogenic in children <2 years of age, and protection in adults is modest. The limitations of Vi polysaccharide vaccines can be overcome by conjugation of the Vi to a carrier protein. A typhoid conjugate vaccine composed of Vi polysaccharide conjugated to diphtheria toxoid (Vi-DT) has been developed...
May 15, 2018: Vaccine
https://www.readbyqxmd.com/read/29774396/tumor-volume-as-a-prognostic-marker-in-p16-positive-and-p16-negative-oropharyngeal-cancer-patients-treated-with-definitive-intensity-modulated-radiotherapy
#3
Timo Carpén, Kauko Saarilahti, Caj Haglund, Antti Markkola, Jussi Tarkkanen, Jaana Hagström, Petri Mattila, Antti Mäkitie
PURPOSE: To investigate the impact of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) in oropharyngeal squamous cell carcinoma (OPSCC) and the difference in their role between human papillomavirus (HPV)-positive and HPV-negative patients. METHODS: The patient cohort consists of 91 OPSCC patients treated with definitive radiochemotherapy or radiotherapy using intensity-modulated radiotherapy (IMRT). All patients had a minimum follow-up of 31 months...
May 17, 2018: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
https://www.readbyqxmd.com/read/29769209/time-to-event-bayesian-optimal-interval-design-to-accelerate-phase-i-trials
#4
Ying Yuan, Ruitao Lin, Daniel Li, Lei Nie, Katherine E Warren
Late-onset toxicity is common for novel molecularly targeted agents and immunotherapy. It causes major logistic difficulty for existing adaptive phase I trial designs, which require the observance of toxicity early enough to apply dose escalation rules for new patients. The same logistic difficulty arises when the accrual is rapid. We propose the time-to-event Bayesian optimal interval (TITE-BOIN) design to accelerate phase I trials by allowing for real-time dose assignment decisions for new patients while some enrolled patients' toxicity data are still pending...
May 16, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29764265/use-of-methadone-to-reverse-opioid-escalation-in-a-patient-with-surgical-pain
#5
Muhammad Jaffar, Gwin Cunningham, Michael Chandler, Thomas Webb
Acute pain is a prevalent issue for patients recovering from surgical procedures. Methadone has been recognized as a unique option for treatment of surgical pain due to its multiple mechanisms of analgesia and its potential to decrease tolerance to other opioids. Studies of methadone use in postoperative settings are sparse in part due to safety concerns, such as complex pharmacokinetics, risk of respiratory depression, and association with arrhythmias. In this case study of a 70-year-old male with postsurgical abdominal pain, methadone utilization over a period of 9 days resulted in patient-reported analgesia and aided in de-escalating overall opioid use...
May 15, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29760141/efficacy-of-daptomycin-monotherapy-and-in-combination-with-%C3%AE-lactams-for-daptomycin-susceptible-enterococcus-faecium-harboring-liasr-substitutions-influence-of-the-inoculum-effect
#6
Razieh Kebriaei, Seth A Rice, Kavindra V Singh, Kyle C Stamper, An Q Dinh, Rafael Rios, Lorena Diaz, Barbara E Murray, Jose M Munita, Truc T Tran, Cesar A Arias, Michael J Rybak
Enterococcus faecium that harbor LiaFSR substitutions but are phenotypically susceptible to daptomycin (DAP) by current breakpoints are problematic since predisposition to resistance may lead to therapeutic failure. Using a simulated endocardial vegetation (SEV) PK/PD model, we investigated DAP regimens (6, 8 and 10 mg/kg/day) as monotherapy and in combination with ampicillin (AMP), ceftaroline (CPT) or ertapenem (ERT) against E. faecium HOU503, a DAP-susceptible strain that harbors common LiaS and LiaR substitutions found in clinical isolates (T120S and W73C, respectively)...
May 14, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29756637/withdrawal-of-immunosuppressant-or-biologic-therapy-for-patients-with-quiescent-crohn-s-disease
#7
REVIEW
Ray K Boyapati, Joana Torres, Carolina Palmela, Claire E Parker, Orli M Silverberg, Sonam D Upadhyaya, Tran M Nguyen, Jean-Frédéric Colombel
BACKGROUND: Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations...
May 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29749785/reducing-restrictive-practice-in-adult-services-not-only-an-issue-for-mental-health-professionals
#8
Greg Hext, Louise L Clark, Andreas Xyrichis
Reducing 'restrictive practices' is an issue of national importance, pertinent to all NHS sectors, yet there is poor awareness of the issue in mainstream adult services. Such practices potentially restrict a person's rights to choice, self-determination, privacy and freedom. Challenging behaviour is often the result of unmet needs, communication difficulties or diagnostic overshadowing, but there is a common misconception that patients exhibit such behaviours because of their impaired intellectual abilities or mental health problems...
May 10, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29748219/frequency-reasons-and-impact-of-premature-ticagrelor-discontinuation-in-patients-undergoing-coronary-revascularization-in-routine-clinical-practice-results-from-the-bern-percutaneous-coronary-intervention-registry
#9
Thomas Zanchin, Fabrice Temperli, Alexios Karagiannis, Christian Zanchin, Markus Räsänen, Konstantinos C Koskinas, Stefan Stortecky, Lukas Hunziker, Fabien Praz, Stefan Blöchlinger, Christina Moro, Aris Moschovitis, Christian Seiler, Michael Billinger, Dik Heg, Thomas Pilgrim, Marco Valgimigli, Stephan Windecker, Lorenz Räber
BACKGROUND: Although ticagrelor has improved clinical outcomes among patients with acute coronary syndrome compared with clopidogrel, adherence to this new antiplatelet agent in real-world practice has not been fully investigated. METHODS AND RESULTS: Between November 2011 and June 2014, 1278 of 4831 consecutive patients (26.5%) undergoing percutaneous coronary intervention at a tertiary care center were treated with ticagrelor. Premature ticagrelor cessation was categorized into (1) change, when ticagrelor was replaced by prasugrel; (2) de-escalation, when ticagrelor was replaced by clopidogrel; and (3) premature discontinuation, when ticagrelor was discontinued without P2Y12 inhibitor replacement...
May 2018: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29747905/prospective-evaluation-of-the-management-of-urinary-tract-infections-in-134-french-nursing-homes
#10
L Lemoine, C Dupont, A Capron, E Cerf, M Yilmaz, D Verloop, K Blanckaert, E Senneville, S Alfandari
OBJECTIVE: Prospective assessment of the management of urinary tract infections (UTI) in the nursing homes of the Hauts-de-France region. PATIENTS AND METHODS: A 50-question form had to be filled in for up to five consecutive residents treated for UTI in each nursing home. If necessary, diagnoses were reclassified according to the 2014 French Infectious Diseases Society guidelines. Analyses were presented per supposed (reported) and reclassified diagnoses. RESULTS: Of 397 contacted facilities, 134 participated and informed 444 UTI episodes...
May 7, 2018: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/29746978/clinical-studies-of-the-effectiveness-and-safety-of-antivenoms
#11
David J Williams, Abdulrazaq G Habib, David A Warrell
In the 1890s, hyperimmune sera proved effective in animals against challenge by the snake venom against which they had been raised. They were first used, apparently successfully, in a human patient in about 1895. Since then, antivenoms have become accepted as the only reliable specific treatment for snake-bite envenoming. Despite decades of accumulated clinical experience and a number of published randomised comparative and observational studies, the clinical effectiveness and safety of some antivenoms remain open to question, due to a lack of robust randomised controlled trial data...
May 7, 2018: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29744674/phase-1-study-of-seviteronel-a-selective-cyp17-lyase-and-androgen-receptor-inhibitor-in-women-with-estrogen-receptor-positive-or-triple-negative-breast-cancer
#12
Aditya Bardia, Ayca Gucalp, Noashir DaCosta, Nashat Gabrail, Michael Danso, Haythem Ali, Kimberly L Blackwell, Lisa A Carey, Joel R Eisner, Edwina S Baskin-Bey, Tiffany A Traina
PURPOSE: Seviteronel (INO-464) is an oral, selective cytochrome P450c17a (CYP17) 17,20-lyase (lyase) and androgen receptor inhibitor with in vitro and in vivo anti-tumor activity. This open-label phase 1 clinical study evaluated safety, tolerability, pharmacokinetics (PK), and activity of once-daily (QD) seviteronel in women with locally advanced or metastatic TNBC or ER+ breast cancer. METHODS: Seviteronel was administered in de-escalating 750, 600, and 450 mg QD 6-subject cohorts...
May 9, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29736976/antidiabetic-medication-de-escalation-following-bariatric-surgery
#13
Scott Martin Vouri, Jiajing Chen, Jayme Sparkman, Arghavan Salles, Scott T Micek
Approximately 216,000 bariatric surgery (BS) procedures were performed in 2016; an increase from 158,000 in 2011.1 This increase may be attributable to the rising awareness of beneficial effects on health and the improving safety profile of BS. According to the National Institutes of Health consensus criteria, patients qualify for bariatric surgery if they have a body mass index (BMI) ≥35 kg/m2 but <40 kg/m2 along with at least one obesity-related comorbidity or have a BMI ≥40 kg/m2 .
May 7, 2018: Journal of Diabetes
https://www.readbyqxmd.com/read/29733336/de-escalating-and-escalating-treatments-for-early-stage-breast-cancer-the-st-gallen-international-expert-consensus-conference-on-the-primary-therapy-of-early-breast-cancer-2017
#14
G Curigliano, H J Burstein, E P Winer, M Gnant, P Dubsky, S Loibl, M Colleoni, M M Regan, M Piccart-Gebhart, H-J Senn, B Thürlimann
No abstract text is available yet for this article.
May 3, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29731161/implications-of-improved-diagnostic-imaging-of-small-nodal-metastases-in-head-and-neck-cancer-radiotherapy-target-volume-transformation-and-dose-de-escalation
#15
REVIEW
Sven van den Bosch, Wouter V Vogel, Cornelis P Raaijmakers, Tim Dijkema, Chris H J Terhaard, Abrahim Al-Mamgani, Johannes H A M Kaanders
Diagnostic imaging continues to evolve, and now has unprecedented accuracy for detecting small nodal metastasis. This influences the tumor load in elective target volumes and subsequently has consequences for the radiotherapy dose required to control disease in these volumes. Small metastases that used to remain subclinical and were included in elective volumes, will nowadays be detected and included in high-dose volumes. Consequentially, high-dose volumes will more often contain low-volume disease. These target volume transformations lead to changes in the tumor burden in elective and "gross" tumor volumes with implications for the radiotherapy dose prescribed to these volumes...
May 3, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29729682/structural-covariance-and-cortical-reorganisation-in-schizophrenia-a-mri-based-morphometric-study
#16
Lena Palaniyappan, Olha Hodgson, Vijender Balain, Sarina Iwabuchi, Penny Gowland, Peter Liddle
BACKGROUND: In patients with schizophrenia, distributed abnormalities are observed in grey matter volume. A recent hypothesis posits that these distributed changes are indicative of a plastic reorganisation process occurring in response to a functional defect in neuronal information transmission. We investigated the structural covariance across various brain regions in early-stage schizophrenia to determine if indeed the observed patterns of volumetric loss conform to a coordinated pattern of structural reorganisation...
May 6, 2018: Psychological Medicine
https://www.readbyqxmd.com/read/29728843/advanced-imaging-and-hospice-use-in-end-of-life-cancer-care
#17
Michaela A Dinan, Lesley H Curtis, Soko Setoguchi, Winson Y Cheung
INTRODUCTION: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined. METHODS: We conducted a retrospective analysis of SEER-Medicare data on patients who died from breast, lung, colorectal, or prostate cancer between 2002 and 2007. Hospital referral region (HRR)-level use of computerized tomography (CT), magnetic resonance imaging, and positron emission tomography was categorized by tertile of imaging use and correlated with hospice enrollment overall and late hospice enrollment using multivariable logistic regression...
May 4, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29727386/entyvio-lengthen-dose-interval-study-lengthening-vedolizumab-dose-interval-and-the-risk-of-clinical-relapse-in-inflammatory-bowel-disease
#18
Webber Chan, Nicole Lynch, Peter Bampton, Jeff Chang, Alvin Chung, Timothy Florin, David J Hetzel, Simon Jakobovits, Gregory Moore, Paul Pavli, Graham Radford-Smith, Lena Thin, Brandon Baraty, Craig Haifer, Yunki Yau, Rupert W L Leong
BACKGROUND: Vedolizumab (VDZ), an α4β7 anti-integrin antibody, is efficacious in the induction and maintenance of remission in ulcerative colitis (UC) and Crohn's disease (CD). In the GEMINI long-term safety study, enrolled patients received 4-weekly VDZ. Upon completion, patients were switched to 8-weekly VDZ in Australia. The clinical success rate of treatment de-escalation for patients in remission on VDZ has not been described previously. AIM: To determine the proportion of patients who relapsed after switching from 4 to 8-weekly VDZ, the mean time to relapse, and the recapture rate when switching back to 8-weekly dosing...
April 30, 2018: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29726958/proactive-therapeutic-drug-monitoring-of-tnf-antagonists-in-inflammatory-bowel-disease
#19
Xavier Roblin, Pauline Riviere, Mathurin Flamant, Pauline Veyrard, Fabien Poullenot, S Paul, David Laharie
Background: Proactive therapeutic drug monitoring (TDM) to titrate tumor necrosis factor (TNF) antagonists has emerged recently as a tool to routinely monitor drug concentration to achieve target levels in patients with quiescent inflammatory bowel disease (IBD). Methods: The purpose of the present review article was to present available data exploring the concept of proactive TDM. Results: While several observational studies have identified an association between proactive TDM and better IBD outcomes, 2 randomized controlled studies did not confirm this advantage...
May 3, 2018: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/29722655/the-role-of-radiation-therapy-in-patients-with-relapsed-or-refractory-hodgkin-lymphoma-guidelines-from-the-international-lymphoma-radiation-oncology-group
#20
REVIEW
Louis S Constine, Joachim Yahalom, Andrea K Ng, David C Hodgson, Andrew Wirth, Sarah A Milgrom, N George Mikhaeel, Hans Theodor Eich, Tim Illidge, Umberto Ricardi, Karin Dieckmann, Craig H Moskowitz, Ranjana Advani, Peter M Mauch, Lena Specht, Richard T Hoppe
Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early- and advanced-stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood to maximize our success in treating these patients...
April 1, 2018: International Journal of Radiation Oncology, Biology, Physics
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