Benefits Of Treatment Research Articles

Modelling the epidemiological and economic impact of digital adherence technologies with differentiated care for tuberculosis treatment in Ethiopia

BackgroundDigital adherence technologies (DATs) with associated differentiated care are potential tools to improve tuberculosis (TB) treatment outcomes and reduce associated costs for both patients and healthcare providers. However, the balance...

Efficacy and safety of individual nutrition support in patients with hepatitis B virus-related acute-on-chronic liver failure at nutrition risk: a study protocol for a randomised controlled clinical trial

IntroductionMalnutrition is a common complication of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) typically associated with poor prognosis. Despite nutritional treatment, the outcomes for these patients are limited by the...

Development and validation of a scoring model for predicting surgical benefit in patients with Masaoka stage III/IV thymic carcinomas.

Thymomas and thymic carcinomas are rare and aggressive thymic tumors that are usually detected in advanced stages. Surgery is the mainstay of treatment; however, the role of surgery in advanced disease is controversial due to factors such as myasthenia gravis; thus, decisions about whether to perform surgical interventions are complex. Further studies need to be conducted to explore the potential benefits of surgery in the treatment of advanced thymic tumors. This study proposed a predictive surgical decision score (SDS) model to optimize patient prognosis by identifying the patients likely to benefit most from surgery. The study retrospectively analyzed the data of 1,207 patients with Masaoka stage III/IV thymic carcinomas from the Surveillance, Epidemiology and End Results (SEER) database and clinical records from The First Affiliated Hospital of Guangzhou Medical University. We assessed clinical factors including age, gender, tumor differentiation grade, tumor size, tumor-node-metastasis (TNM) stage, and metastasis locations. Surgical benefits were evaluated using propensity score matching (PSM) analysis to compare overall survival (OS) between the surgical and non-surgical groups. A Cox regression model was employed to identify independent prognostic factors. Kaplan-Meier curves were used to further analyze surgical benefits across different subgroups. Furthermore, we developed an SDS model, which was subjected to both internal and external validation to evaluate its accuracy and discriminative capacity in predicting the benefits of surgical intervention. In the SEER database cohort, 1,106 eligible patients were identified, with 61.8% undergoing surgery, resulting in a propensity score-matched cohort of 474 patients. Surgical resection was found to be an independent favorable prognostic indicator in advanced-stage thymus malignancies [hazard ratio (HR): 0.45, 95% confidence interval (CI): 0.34-0.58]. The optimal SDS model, which included histological subtype, grade of differentiation, tumor size, T stage, nodal involvement, and distant metastasis, had an Akaike information criterion (AIC) value of 816.382. SDS values ranged from -115 to 313 points. The internal validation cohort consisted of 186 males and 161 females, with 60.5% undergoing surgery, whereas the external cohort included 55 males and 46 females, with 65.3% receiving surgical intervention. The receiver operating characteristic (ROC) curve analysis of the SDS model revealed satisfactory predictive accuracy on both internal and external validation [area under the curve (AUC): 0.80, 95% CI: 0.75-0.84; and AUC: 0.73, 95% CI: 0.64-0.83, respectively]. Patients with high SDS values undergoing surgery exhibited superior survival compared to those with low SDS values not undergoing surgery (P<0.05). Surgical resection was independently associated with improved survival outcomes in patients with advanced-stage thymic malignancies. Additionally, we successfully developed an SDS prediction model to enhance the selection process for optimal surgical candidates, underscoring its potential clinical implications in guiding treatment decisions.

EPH266 An Economic Model to Assess the Costs and Benefits of Workplace Mental Wellbeing Interventions: A Flexible Tool for Employers and Decision Makers

EPH266 An Economic Model to Assess the Costs and Benefits of Workplace Mental Wellbeing Interventions: A Flexible Tool for Employers and Decision Makers

EE516 Non-QALY Benefits of Treatments of Alzheimer's Disease and Related Dementias

EE516 Non-QALY Benefits of Treatments of Alzheimer's Disease and Related Dementias

Integrated Analysis of Polymerase Family Gene Mutations in Acute Myeloid Leukemia: Clinical Features, Prognosis, and Bioinformatics Insights.

Background and Objectives: The long-term prognosis of acute myeloid leukemia (AML) is challenging due to limited understanding of the molecular markers involved in its development. This study investigates the role of DNA polymerases in AML to offer new insights for diagnosis and treatment. Materials and Methods: A retrospective study on pediatric AML patients with POL gene family mutations from 2021 to 2024 was conducted. Patients were categorized based on risk stratification criteria, and the DAH regimen was used for induction chemotherapy. Bioinformatics analysis integrated data from various databases to identify key genes and develop survival analysis plots and AUC curves. Results: The study included 59 pediatric AML patients, revealing no significant differences in demographic or clinical characteristics between those with and without POL family gene mutations. However, patients with POL gene mutations showed higher complete remission rates after initial DAH chemotherapy (91.67% vs. 59.57%, p = 0.03607), indicating a potential treatment benefit. High expression of four POL genes (POLD1, POLE, POLG, and POLQ) in bone marrow and immune cells suggests their crucial role in hematopoiesis and immune response. Survival analysis across different datasets indicated that AML patients with overexpressed POL family genes had significantly worse outcomes, proposing these genes as potential prognostic biomarkers for AML. Conclusions: This study on pediatric AML demonstrates that POL gene family mutations are associated with higher remission rates post-chemotherapy, indicating their potential as prognostic markers. Bioinformatics analysis emphasizes the significance of these mutations in AML, highlighting their impact on disease prognosis.

OVERTURE Phase 2 Clinical Trial MRI Outcomes Demonstrate Consistent Treatment Benefits in Subgroup Analysis

OVERTURE Phase 2 Clinical Trial MRI Outcomes Demonstrate Consistent Treatment Benefits in Subgroup Analysis

Fasting-mimicking diet potentiates anti-tumor effects of CDK4/6 inhibitors against breast cancer by suppressing NRAS- and IGF1-mediated mTORC1 signaling.

Fasting-mimicking diet (FMD) cycles, defined as 3-5 day periods of a calorie-restricted, low-protein, low-carbohydrate, and high-fat diet, have emerged as a dietary approach to delay cancer initiation and progression in both autograft and xenograft mouse models and as a safe and feasible approach to decrease risk factors for cancer and other age-related pathologies in humans. A substantial number of pre-clinical studies focused on various tumor types have shown that fasting/FMDs can potentiate the efficacy of various standard-of-care cancer therapies but also modulate the immune system to promote a T cell-dependent attack of tumor cells. Importantly, combining drug treatment with fasting/FMDs can overcome acquired drug resistance which frequently emerges and reduces long-term treatment benefits. However, the mechanisms by which the FMD reverts resistance to CDK4/6i remain poorly understood. Here, Li and colleagues provide evidence that FMD cycles act as a wild card to reduce the activity of a signaling network that includes IGF-1, RAS, AKT, and mTOR-S6K to delay cancer progression and reverse the acquisition of drug resistance. These findings expand the mechanistic understanding of the FMD-mediated increase in drug efficacy and provide further evidence to support trials combining hormone therapy, CDK4/6 inhibitors, and FMD in breast cancer treatment. These new results on FMD cycles add an optimistic outlook to extend the efficacy of standard-of-care drugs that eventually become ineffective because of acquired resistance.

Management of primary sclerosing cholangitis: Current state-of-the-art.

Primary sclerosing cholangitis is a chronic liver disease characterized by progressive inflammation and fibrosis of medium-large bile ducts, most commonly in association with inflammatory bowel disease. Most patients have a progressive disease course, alongside a heightened risk of hepatobiliary and colorectal cancer. Medical therapies are lacking, and this, in part, reflects a poor grasp of disease biology. As a result, current management is largely supportive, with liver transplantation an effective life-prolonging intervention when needed, but not one that cures disease. Emerging therapies targeting disease progression, as well as symptoms such as pruritus, continue to be explored. The trial design is increasingly cognizant of the application of thoughtful inclusion criteria, as well as better endpoints aimed at using surrogates of disease that can identify treatment benefits early. This is hoped to facilitate much-needed advances toward developing safe and effective interventions for patients.

Obese Patients Do Not Benefit from Bone Marrow Aspiration Concentrate Injection for Knee Osteoarthritis: A Prospective Cohort Study of 68 Patients.

Bone marrow aspirate concentrate (BMAC) is considered one of the biological treatments for knee osteoarthritis (KOA). Patient selection remains a key factor to ensure that optimal treatment benefit and body mass index (BMI) are one of the key factors to be considered. This study aims to evaluate the influence of obesity on the duration of treatment benefit of BMAC for KOA. This prospective cohort study enrolled 68 patients who underwent a single BMAC injection for early stage KOA. The patients were categorized based on their BMI into normal, overweight, and obese groups. Visual Analog Scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were the outcomes analysed. The duration of treatment benefit is estimated by Kaplan-Meier survival analysis. Sixty-eight patients (normal BMI = 43, overweight BMI = 15, obese BMI = 10) were enrolled in the study for analysis. While significant improvement in the outcome scores was noted compared to the baseline throughout the study period in the normal BMI and overweight group, the obese group returned to baseline parameters at 3months follow-up. Patients in the normal BMI group demonstrated significant improvement in VAS (p < 0.001) and KOOS (p < 0.001) outcomes compared to the overweight and obese group. Survival analysis demonstrated a significant decline in the mean treatment benefit of 9.8 (95%CI [6.151-13.431], p = 0.027) months in normal BMI group to 6.6 (95%CI [3.473-9.727]) months and 4.1 (95%CI [2.760-5.440]) months in overweight and obese groups, respectively. BMI is a significant factor that influences the benefit of BMAC injection for early knee OA. Hence, BMAC injection must be used with caution in individuals with high BMI.

A Review on Phytochemical Compounds Used to Treatment of Breast Cancer

Breast cancer remains one of the leading causes of cancer-related mortality among women worldwide. Recent research has highlighted the potential of phytochemicals, bioactive compounds derived from plants, in the prevention and treatment of various cancers, including breast cancer. This study reviews the therapeutic effects of specific phytochemicals-curcumin, resveratrol, quercetin, sulforaphane, and genistein-focusing on their anti-cancer properties, mechanisms of action, and potential applications. Using a systematic literature review, key studies involving in vitro, in vivo, and clinical research were analyzed to evaluate each compound's efficacy in inhibiting tumor growth, inducing apoptosis, and preventing metastasis. The findings suggest that these phytochemicals may offer significant benefits in breast cancer treatment through multiple mechanisms, including anti-inflammatory and antioxidant activities, hormone modulation, and inhibition of cancer cell proliferation. However, further research, particularly large-scale clinical trials, is needed to optimize formulation strategies and validate their efficacy in clinical settings.

Examining the efficacy of constructed wetland coupled microbial fuel cell to treat textile wastewater using local wetlands plant species.

Constructed wetland coupled microbial fuel cells (CW-MFC) offer a dual benefit of wastewater treatment and bioelectricity generation. While existing research predominantly emphasizes cell configuration, there is a limited exploration of the impact that various wetland plants may have on bioelectricity production in CW-MFCs. This research examined three distinct native wetland plants: Canna indica, Typha latifolia, and Eichhornia crassipes. The study centered on addressing textile wastewater treatment and assessing bio-electricity production. Over the course of 4weeks, regular assessments were conducted every 3rd day to monitor the alternations in the wastewater properties. The T. latifolia exhibited a chemical oxygen demand removal efficiency of 85.45%, surpassing that of E. crassipes (83.17%), C. indica (80.03%), mix culture (85.29%), and the control (unplanted) system (73.11%). Maximum removal efficacy of phosphate (96.84%) and nitrate (82.88%) was also achieved by the Typha plant in comparison to other plant species. An increase in both reactive biomass and chlorophyll content of Canna and Typha under single and mixed culture conditions was also observed. The highest current and voltage were obtained from T. latifolia plant species (1.04mA; 0.178V). Based on the findings of this study, T. latifolia emerged as the optimum wetland plant for bioelectricity generation and organic matter, phosphate, and ammonia removal among the examined plant species. Therefore, incorporating T. latifolia in the design of a CW-MFC is recommended for efficient textile wastewater and bioelectricity generation.

Development of a questionnaire to measure patient-relevant needs and benefits in the treatment of epilepsy (PBI-Epilepsy)

ObjectiveTherapeutic goals in epilepsy treatment may be highly individual. The aim of the present study was to develop a questionnaire assessing patients’ needs and benefits of epilepsy treatment, the Patient Benefit Index on Epilepsy (PBI-Epilepsy). MethodsWe recruited adult patients during their stay at a university based epilepsy centre. Patients completed a survey asking about their burden and treatment goals. Data were categorised using qualitative content analysis. The final category system was discussed in an expert panel. The questionnaire was pre-tested using cognitive debriefing and adapted until no changes were required anymore. ResultsIn the open survey, 25 people with epilepsy participated (60.0 % female, 33.2 years, 1–55 years epilepsy). The final category system included nine main categories (namely psyche, working life, seizures, therapy, leisure activities, social relationships, mobility, body, everyday life activities). From this, the expert panel developed a first draft of the PBI-Epilepsy. The questionnaire went through five rounds of cognitive debriefing with 29 patients (51.7 % female, 34.6 years, 2–37 years epilepsy). We decided to develop two versions of the questionnaire depending on the patient’s treatment (medical or surgical). A bipolar response scale was used in the part asking about treatment benefits, as epilepsy treatment can lead to both improvement and deterioration. The final questionnaire consists of two parts (patient needs and treatment benefits) each encompassing 21 items. ConclusionWe aimed to reflect the wide range of issues that are relevant for people with epilepsy while developing a questionnaire that is short and easy for patients to understand.

The Efficacy of Virtual Reality-Based Interventions on Pain, Anxiety, Depression, and Quality of Life Among Patients With Cancer: A Meta-analysis of Randomized Controlled Trials.

Although cancer patients are living longer, the numerous physical and psychological outcomes of cancer can still be burdensome. Pain, anxiety, depression, and decreased quality of life are symptoms that are highly impacted by cancer. The availability of modalities to cope with these symptoms is critical. Virtual reality-based interventions have been used among patients with cancer, but their effects on pain, anxiety, depression, and quality of life remain unclear. To determine the efficacy of virtual reality-based interventions on pain, anxiety, depression, and quality of life among cancer patients and to assess the efficacy of different contents and duration. Nine databases were retrieved from inception to July 31, 2024. The methodological quality was evaluated via the Cochrane Risk of Bias 2.0 tool. Data synthesis was conducted with Stata version 16.0, and sensitivity analysis and subgroup analysis were also performed. Virtual reality-based interventions can soothe pain and anxiety. Subgroup analysis revealed that interventions focused on playing games and watching videos were effective at reducing pain. In addition, enjoying landscapes, receiving treatment-related health education, and watching videos were effective at decreasing anxiety; moreover, short-term (≤6 weeks) interventions were effective at relieving pain. Virtual reality-based interventions are effective at decreasing pain and anxiety. The contents and duration of the intervention had an impact on their effectiveness. Symptom management is a paramount aspect of clinical cancer care. In daily oncology nursing, we encourage nurses to utilize the benefits of virtual reality-based interventions to improve cancer patients' experience with medical treatment.

Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics

ObjectivesThe potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation...

Open Microsurgical Versus Endovascular Management of Unruptured and Ruptured Brain Aneurysms.

Open microsurgical and endovascular techniques are the 2 primary strategies for treating intracranial aneurysms. Microsurgical clipping and adjuvant technical maneuvers are well-established techniques with a track record for high occlusion rates and durable repairs. Endovascular, endosaccular, and extrasaccular therapies are associated with lower peri-procedural morbidity but with generally higher rates of retreatment. We discuss key clinical and anatomic considerations in treatment decision-making and compare the risks and benefits of microsurgical vs endovascular treatment within each context.

Nutritional counseling's impact on muscle mass and quality of life in stage 4 chronic kidney disease malnourished patients

Background Chronic Kidney Disease (CKD) is a significant public health issue, affecting 37 million people in the United States. CKD often leads to malnutrition, particularly in advanced stages, contributing to muscle wasting, reduced quality of life, and increased healthcare costs. Objective This retrospective study aimed to investigate the impact of early nutritional intervention and counseling on muscle mass and quality of life in malnourished stage 4 chronic kidney disease (CKD) patients. Methods Clinical data from stage 4 CKD patients with concomitant malnutrition admitted to a single center from January 2023 to December 2023 were retrospectively analyzed. Patients were divided into a standard intervention group and an early nutritional intervention and counseling group. Baseline characteristics, muscle mass parameters, quality of life assessments, nutritional parameters, and adverse events were compared between the two groups. Results The baseline characteristics of the study participants were well-balanced between the two groups. The early nutrition intervention group demonstrated significant improvements in muscle mass parameters, including grip strength, skeletal muscle mass, muscle strength, calf circumference, and handgrip measurement, compared to the standard intervention group. Additionally, the early nutrition intervention group showed significant enhancements in several aspects of quality of life, including physical functioning, mental health, energy/fatigue, and general health scores. Improvements in nutritional parameters, such as protein intake, caloric intake, vitamin D levels, iron levels, and zinc levels, were also observed in the early nutrition intervention group. Notably, no significant differences in adverse events were found between the two groups. Conclusion The study highlights the significant benefits of early nutritional intervention and counseling for malnourished stage 4 CKD patients. Early nutritional support positively impacts muscle mass, quality of life, and nutritional parameters. These findings emphasize the importance of nutrition in CKD management and the need for comprehensive nutritional support as a key component of care. This research paves the way for further studies and clinical initiatives to enhance nutritional care and improve the standard of care for CKD patients.

Do Danish ICU Survivors Remain Employed After ICU Discharge? A Register-Based Longitudinal Cohort Study.

Admission to ICU is associated with long-term consequences for the survivors. The study explores whether Danish ICU survivors remain employed after ICU discharge. A longitudinal register study of 16,284 Danish ICU survivors 25-67 years old 1:1 sex- and age-matched with general population references. Weekly prevalence proportions (%) of employed, public benefits, and deceased individuals were calculated based on the Danish Register-Based Evaluation and Marginalization Database and the Danish Civil Registration System until December 31, 2019. Age- and multivariate-adjusted hazard ratios (HRs) with 95% CIs were determined by Cox and Fine-Gray models. Denmark has tax-funded healthcare and social security ensuring hospital treatment and social benefits free of charge for all Danish residents. The study included Danish residents acutely admitted to public ICU treatment for critical illness from 2010 to 2018. None. The prevalences of employed ICU survivors increased from 30% at 2-8 weeks to 56% at 52 weeks after ICU discharge showing minor delay in women. The prevalences declined by age being 63%, 58%, 55%, and 52% in ages 25-42, 43-52, 53-58, and 59-63 years, respectively, 52 weeks after ICU discharge. The prevalences of employed ICU survivors declined by level of comorbidity being 64%, 53%, and 37% in ICU survivors of Charlson Comorbidity Index score 0, 1-2, or greater than or equal to 3, respectively, 52 weeks after ICU discharge. ICU survivors had higher risks of becoming retired (HR, 14.86; 95% CI, 8.69-25.41) or sickness absent (HR, 7.56; 95% CI, 7.16-7.98) when accounting for competing risks compared with the general population references. About half of ICU survivors remained employed 52 weeks after ICU discharge. Age and comorbidity were effect modifiers.

Cannabis combined with oxycodone for pain relief in fibromyalgia pain: a randomized clinical self-titration trial with focus on adverse events.

We determined whether adding cannabis to oxycodone for chronic non-cancer pain management could reduce treatment-related adverse effects (AEs) while maintaining effective analgesia. In this open-label study, fibromyalgia patients aged ≥18 years were randomized to receive 5 mg oxycodone tablets (max. four times/day), 150 mg of inhaled cannabis containing 6.3% Δ9-tetrahydrocannabinol and 8% cannabidiol (max. times inhalation sessions/day), or a combination of both for 6 weeks. The primary endpoint was treatment-related adverse events, assessed using a 10-point composite adverse event (cAE) score; additionally, we recorded daily reported pain relief and daily tablet and cannabis consumption. In total, 23 patients were treated with oxycodone, 29 with cannabis, and 29 with the oxycodone/cannabis combination. Three patients from the oxycodone group (13%) and 18 patients from the cannabis groups (31%, 9 in each group) withdrew from the trial within 2-3 weeks because of the severity of AEs. There were no differences in treatment-related cAE scores among the three groups that completed the study (p = 0.70). The analgesic responder rate showed a ≥1- point reduction in pain in 50% and a ≥2-point reduction in 20% of patients, while 50% of patients experienced no treatment benefit. The combination treatment reduced oxycodone tablet consumption by 35% (p = 0.02), but it did not affect the number of cannabis inhalation sessions. Cannabis combined with oxycodone offered no advantage over either treatment alone, except for a reduction in opioid tablet intake; however, the overall drug load was the highest in the combination group. Moreover, cannabis was poorly tolerated and led to treatment discontinuation in one-third of participants treated with cannabis. The trial was registered at the WHO International Clinical Trials Registry Platform (trialsearch.who.int) on July 26, 2019, identifier NL7902.

Strategies for Recurrent Colorectal Liver Metastases Based on Prognostic Factors and Resectability: Potential Benefit of Multidisciplinary Treatment.

Colorectal liver metastasis (CLM) is classified into technical and oncologic categories, with recommended treatments for each resectability category. However, the classification of recurrent CLM has not been established to date. This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrence. Long-term outcomes and prognostic factors associated with recurrent CLM were investigated. From 949 patients who underwent an initial liver resection, the analysis included 392 patients with liver recurrence. Repeat liver resection was associated with a significantly longer prognosis than non-resection (5-year overall survival [OS] from initial liver resection: 66.3 % vs 27.2 %, p < 0.0001). Multivariable analysis indicated the following independent prognostic factors: four or more recurrent tumors (p = 0.015), tumor 5 cm or larger in size (p = 0.004), and presence of extrahepatic diseases (p = 0.003). The patients were stratified into resectable, borderline resectable, and unresectable recurrent CLM groups based on these criteria. The prognosis varied significantly across the groups, with 5-year OS rates of 67.3 % for resectable recurrent CLM, 30.8 % for borderline resectable recurrent CLM, and 2.6 % for unresectable recurrent CLM (p < 0.0001). Patients with borderline resectable recurrent CLM who did not receive adjuvant chemotherapy after initial liver resection had a positive prognostic impact of preoperative chemotherapy (p = 0.049). The significant independent predictors of recurrent CLM prognosis were four or more tumors, tumor size of 5 cm or larger, and the presence of extrahepatic diseases at recurrence. It is critical to onsider the current condition and tumor resectability at the time of recurrence, and tailored treatments could further improve recurrent CLM outcomes.