Consequences Of Long-term Therapy Research Articles

Consequences of long-term therapy with proton pump inhibitors

Introduction and purpose:
 Proton pump inhibitors (PPIs) were first developed in the late 1970s and introduced to the market in 1989. They are one of the most commonly prescribed medications worldwide.
 PPIs reduce gastric acid secretion in the stomach by inhibiting the hydrogen-potassium ATPase enzyme. They have revolutionized the treatment of diseases related to excessive stomach acid secretion. Among the drugs belonging to this class, we should mention omeprazole, esomeprazole, pantoprazole, lansoprazole, dexlansoprasole and rabeprazole. 
 A brief description of the state of knowledge:
 Since the 1990s, the use of proton pump inhibitors has been consistently increasing. Doctors prescribe these drugs more frequently, in higher doses, and for longer durations, although such practices are only sometimes fully justified.
 Although using them for a short period (less than eight weeks) is relatively safe, there is growing evidence of possible risks linked to their extended use. Many studies highlight the impact of long-term therapy on the development of tumors, deficiencies in micronutrients, the functioning of the skeletal, urinary, nervous, and cardiovascular systems, and the development of infections and diabetes. 
 Summary (conclusions):
 Indeed, long-term therapy with proton pump inhibitors has an impact on the functioning of the body. Considering the increasing popularity of proton pump inhibitors and their expanding use, it is worth contemplating a more prudent prescription of these drugs by doctors.
 It should also be noted that the majority of studies are based on prescription PPIs. Future researchers must also take over-the-counter (OTC) medications into account.

Standard set of network outcomes for traumatic spinal cord injury: a consensus-based approach using the Delphi method.

Consensus study. The purpose of this study is to define a standardized (network) outcomes set for traumatic spinal cord injury (t-SCI), covering the patient journey from acute to chronic rehabilitation phase, including patient-relevant outcomes, adequate measurement instruments, as well as case-mix and risk factors. Acute Spinal Cord Injury (ASCI) Unit Nijmegen, the Netherlands. A modified Delphi method was performed, including a multidisciplinary panel of 19 health-care professionals with experience in t-SCI management. Formal consensus was reached after two web-based surveys, a face-to-face meeting, and a final confirmation round (threshold consensus: 70%). In the first two Delphi rounds, 18/19 invited panelists (94.7%) responded and 10 panelists participated in the final meeting. The prefinal set was confirmed by all panelists. The standard set encompasses the three-tiered outcome hierarchy and consists of patient-reported and clinician-reported outcome domains and measurement instruments. Consensus was reached to include survival, degree of health or recovery, time to recovery, and return to normal activities, disutility of care or treatment process, sustainability of health and nature of recurrences, and long-term consequences of therapy. A measurement schedule was defined as well as for proposed casemix and risk factors, including demographics, clinical status, and treatment process. A standard set of network outcomes is developed that could be implemented in hospitals and rehabilitation centers involved in the treatment of t-SCI. Using this standard set, comparison of the quality of care is possible and prognostic prediction of outcomes of treatment is feasible, so that each patient receives the right care at the right time in the right place.

Late effects care for childhood brain Tumor Survivors: A Quality-Improvement Initiative

Childhood and adolescent brain tumor survivors are at risk for long-term consequences of therapy. We reviewed adherence to long-term follow-up (LTFU) guidelines, assessed provider perspectives, and studied the needs, experience and quality of life (QOL) of pediatric malignant brain tumor survivors in the McMaster Children’s Hospital Neuro-Oncology clinic. LTFU areas for improvement were evaluated using an anonymous health provider needs assessment questionnaire. The Cancer Care Experience Questionnaire (CCEQ), Cancer Worry Scale (CWS), Self-Management Skills Scale (SMSS), and PedsQL measured parents/patients’ needs and QOL. Individual care plans were based on the Children’s Oncology Group (COG) LTFU guidelines. Based on 17 responses, staff perceived areas for improvement included: increased multi-disciplinary participation, improved patient education and increased surveillance for therapy-related late effects. Thirty-two families participated, most felt they received high-quality care. Mean cancer worry scores were low (71.8 (± 28.4)). Survivors reported limited self-management skills (58.5 (±18.2)), requiring support with medical needs and activities of daily living. Overall median QOL scores were ‘good’ (parental report 72.3 (±17.7), survivor 68.2 (±16.6)). Utilizing survivorship guidelines and assessments from patients, caregivers and health providers, we implemented improvements in our provision of neuro-oncology survivorship care. Lessons learned may assist other LTFU programs.

To which extent do breast cancer survivors feel well informed about disease and treatment 5\xa0years after diagnosis?

ObjectiveIn this study, we investigated to which extent patients feel well informed about their disease and treatment, which areas they wish more or less information and which variables are associated with a need for information about the disease, medical tests and treatment.MethodsIn a German multi-centre prospective study, we enrolled 759 female breast cancer patients at the time of cancer diagnosis (baseline). Data on information were captured at 5 years after diagnosis with the European Organisation for Research and Treatment of Cancer (EORTC) Information Module (EORTC QLQ-INFO24). Good information predictors were analysed using linear regression models.ResultsThere were 456 patients who participated at the 5-year follow-up. They reported to feel well informed about medical tests (mean score 78.5) and the disease itself (69.3) but relatively poorly about other services (44.3) and about different places of care (31.3). The survivors expressed a need for more information concerning: side effects and long-term consequences of therapy, more information in general, information about aftercare, prognosis, complementary medicine, disease and therapy. Patients with higher incomes were better informed about medical tests (β 0.26, p 0.04) and worse informed with increasing levels of fear of treatment (β − 0.11, p 0.02). Information about treatment was reported to be worse by survivors > 70 years old (β -0.34, p 0.03) and by immigrants (β -0.11, p 0.02). Survivors who had received additional written information felt better informed about disease, medical tests, treatment and other services (β 0.19/0.19/0.20/0.25; each p < 0.01).ConclusionHealth care providers have to reconsider how and what kind of information they provide. Providing written information, in addition to oral information, may improve meeting those information needs.

Should Tocilizumab Be Used Routinely in New Patients With a Diagnosis of Giant Cell Arteritis?

Should Tocilizumab Be Used Routinely in New Patients With a Diagnosis of Giant Cell Arteritis?

Patient-Reported Outcomes for Breast Cancer.

Patient-reported outcomes (PROs) provide insight into how patients perceive health and treatment effects, how treatments impact outcomes, and are helpful in determining how disease and surgical interventions impact many aspects of a patients' life. Commonly utilized metrics include survival and disease control, degree of recovery and functional status, access to treatment, treatment-related complications, health-related quality of life, and long-term consequences of therapy. The key to value-based, patient-centered health care is systematically incorporating patient input into the measures that they consider to be the most important outcomes for a particular medical condition while minimizing costs of care. This manuscript reviews the development and validation of multiple available PROs in breast surgical oncology and reconstruction, their impact in improving patient-physician communication and treatment outcome, and potential for impacting reimbursement. The implementation of PROs can be complex and challenging and care must be taken to minimize the potential for survey fatigue by patients and the potential financial burden for implementation, maintenance, and analyses of collected data. Because there is an increased emphasis in providing high-value care for cancer patients, the widespread incorporation of transparent breast-specific PROs stratified by treatments received and disease stage will be essential in delivering exceptional quality care.

The delivery of value-based healthcare for children with osteosarcoma at Children’s Cancer Hospital Egypt.

e18310 Background: Aim of the study was to develop a system to measure the value of health care services delivered to osteosarcoma patients, through developing a standardized set of patient-centered outcomes for Osteosarcoma and using a consistent approach to measure the costs of Osteosarcoma care throughout all care cycles. Methods: The Porter’s Outcomes Measurement Hierarchy was used to define the domains of outcomes reporting for Osteosarcoma, which included three levels of measuring outcomes; health status achieved or retained, process of recovery, and sustainability of health. Time-driven activity-based costing (TDABC) approach was used a guide to determine the actual costs of healthcare services delivered to Osteosarcoma patients throughout their journey of cure. Results: Osteosarcoma outcome measurement tools and questionnaires were standardized based on the following domains: survival, degree of health or recovery, time to recovery and return to normal activities, disutility of care and treatment processes, sustainability of health and nature of recurrences, and the long-term consequences of therapy. The standardized outcome reporting tools under each domain included: toxicity reporting using NCI-Common Toxicity Criteria version 4.0, Pediatric Quality of Life Inventory (PedsQL) Cancer module, Musculoskeletal Tumour Society Score (MSTS) for functional outcome assessment, Palliative Care Outcomes Scale (POS). Process mapping was done for each step involved in the delivery of health care services to children with Osteosarcoma at Children’s Cancer hospital Egypt (57357 Hospital). Conclusions: Developing a standardized system for measuring the health outcomes of Osteosarcoma and the total costs for delivering the health care services is fundamental to measure and improve the value of health care delivered to Osteosarcoma patients.

Dose De-escalation in Human Papillomavirus-Associated Oropharyngeal Cancer: First Tracks on Powder.

Current radiation therapy (RT) treatment schedules for head and neck squamous cell carcinoma (HNSCC) are derived from a combination of rigorous radiobiology and data from prospective clinical trials. Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is now appreciated to be biologically distinct from the traditional type of HNSCC resulting from tobacco and alcohol use. Remarkably high 5-year survival rates, not previously observed in the head and neck cancer patient population, are observed among patients with HPV-positive OPSCC when treated with platinum-based chemoradiation therapy (CRT). Additionally, the patient population afflicted with HPV-positive OPSCC is younger, healthier, and far more likely to be alive to deal with the long-term consequences of therapy. Clinicians who treat HPV-positive OPSCC are now faced with the problem that current treatment paradigms were developed in an era when the traditional HNSCC patient (tobaccoand alcohol-related) predominated. This has led to an appropriate re-examination of treatment paradigms as applied to the HPV-positive OPSCC patient, as well as a new appreciation for the problem of chronic toxicity. We note that it is provocative (and frightening) to “mess with success.” For this reason, the proposition of dose deescalation (of chemotherapy and/or RT) or substitution with

Coupled agent-based and finite-element models for predicting scar structure following myocardial infarction

Following myocardial infarction, damaged muscle is gradually replaced by collagenous scar tissue. The structural and mechanical properties of the scar are critical determinants of heart function, as well as the risk of serious post-infarction complications such as infarct rupture, infarct expansion, and progression to dilated heart failure. A number of therapeutic approaches currently under development aim to alter infarct mechanics in order to reduce complications, such as implantation of mechanical restraint devices, polymer injection, and peri-infarct pacing. Because mechanical stimuli regulate scar remodeling, the long-term consequences of therapies that alter infarct mechanics must be carefully considered. Computational models have the potential to greatly improve our ability to understand and predict how such therapies alter heart structure, mechanics, and function over time. Toward this end, we developed a straightforward method for coupling an agent-based model of scar formation to a finite-element model of tissue mechanics, creating a multi-scale model that captures the dynamic interplay between mechanical loading, scar deformation, and scar material properties. The agent-based component of the coupled model predicts how fibroblasts integrate local chemical, structural, and mechanical cues as they deposit and remodel collagen, while the finite-element component predicts local mechanics at any time point given the current collagen fiber structure and applied loads. We used the coupled model to explore the balance between increasing stiffness due to collagen deposition and increasing wall stress due to infarct thinning and left ventricular dilation during the normal time course of healing in myocardial infarcts, as well as the negative feedback between strain anisotropy and the structural anisotropy it promotes in healing scar. The coupled model reproduced the observed evolution of both collagen fiber structure and regional deformation following coronary ligation in the rat, and suggests that fibroblast alignment in the direction of greatest stretch provides negative feedback on the level of anisotropy in a scar forming under load. In the future, this coupled model may prove useful in computational design and screening of novel therapies to influence scar formation in mechanically loaded tissues.

A Case of Renal Failure Requiring a Renal Transplant Secondary to Lithium Treatment

A Case of Renal Failure Requiring a Renal Transplant Secondary to Lithium Treatment

Reoperation of Deep Brain Stimulation in Patients with Essential Tremor

A s the number of patients with essential tremor (ET) who have been treated with deep brain stimulation (DBS) increases, the long-term consequences of therapy are eing realized. The classic target for ET during the last 2 decades as been the ventral intermediate nucleus (Vim) of the thalamus 4). In the present article, Blomstedt et al. describe five patients ith ET who had suboptimal responses to Vim DBS. In three atients who became refractory to long-term Vim DBS, these uthors describe the use of the caudal zona incerta (cZi) as an lternative target and show a modest benefit in tremor control. lomstedt et al. mention many important issues surrounding the fficacy of DBS in patients with ET, including the optimal target or DBS in ET, the short-term and long-term failure of DBS herapy, the natural history of the disease, and the effects of ong-term DBS on the brain. Most importantly, they also describe strategy to deal with the potential long-term failure of Vim DBS n patients with ET.

“Quality of Life (QoL) in the Randomised HD10-12 Trials of the German Hodgkin Study Group (GHSG): Sexual Functions (SX) in Hodgkin Lymphoma (HL) Patients Decrease by Disease Stage and Improve After Therapy Depending On Stage and Treatment Modality.”.

Abstract 896 Purpose:Current research in HL is focusing on long-term consequences of therapy. Among these, especially health related quality of life (HRQoL) needs thorough investigation since it becomes increasingly important for HL survivors. HRQoL is complex and incorporates different aspects such as general QoL, fatigue, emotional, physical, role, social, cognitive, and sexual functions. In this analysis, we focus on sexual functions (SX) in the HD10-12 trials of the GHSG and the influence of stage, treatment modality, social relationships (SF), and fatigue (FA). Methods:Between 1998 and 2002, the GHSG has conducted the fourth generation of clinical trials for the treatment of early favourable, early unfavourable and advanced stage HL (HD 10-12) involving a total of 4610 patients. Patients completed the QLQ-C30, the MFI20 and additional items for SX at the time of diagnosis, after chemotherapy, after radiotherapy, and at follow-up examinations. We describe SX with means and 95%-CI for each measurement point and compare them with t-tests when appropriate. In multiple regressions, we analysed the role of the following prespecified set of predictors on SX at baseline: sex, age, stage, FA, and SF. These predictors were also included in the analyses on SX 2 years after treatment and further supplemented with SX baseline score and treatment modality. Full information maximum likelihood estimations (FIML) were used to account for missing data. Results:QoL data from 919 patients in early favourable (HD10), 1065 patients in early unfavourable (HD11), and 1126 patients in advanced stages (HD12) were analysed. For patients included in HD10, mean SX before and after therapy were equally high in both treatment arms. Initial SX scores for patients enrolled into HD11 and HD12 were significantly lower than in the HD10 trial (p<.001). In HD11, the SX scores after 2 years remarkably improved compared to the initial values (p<.001) and, interestingly, reached the same level as in HD10. In contrast, SX scores in HD12 also significantly improved after two years (p<.05) but improvement was lower and did not reach the same level as in HD10 and HD11. With regard to the randomly assigned treatment modalities in HD10 (4xABVD vs. 2xABVD) and HD12 (8xBEACOPPescalated vs. 4xBEACOPPescalated + 4xBEACOPPbaseline), SX scores did not differ after 2 years. However, in HD11, the SX scores 2 years after 4xBEACOPPbaseline were significantly lower (p<.05) compared with 4xABVD after adjustment for sex, age, and initial SX scores. At baseline, SX was significantly related to age, sex and stage, as well as to FA and SF. For SX after 2 years, the initial SX scores, age, FA, and SF were the strongest, significant predictors. Conclusion:This large prospective study shows that sexual functions are influenced by the lymphoma itself, treatment modality, age, fatigue, and social relationships. Sexual functions significantly improved after 2 years compared to baseline. Thus, patients with HL can expect that their sexual life after therapy will at least be as satisfying as before. ABVD led to more favourable sexual functioning than BEACOPP, probably due to less therapy-induced gonadal toxicity. In further studies, we will investigate the impact of chemotherapy on sex hormon levels and their influence on sexual life. Disclosures:No relevant conflicts of interest to declare.

Hyperlipidaemia in children.

Hyperlipidaemia in children is most commonly expressed as hypercholesterolaemia. "Normal values" for serum cholesterol, if defined statistically, vary between communities, and levels of cholesterol in childhood above which an increased risk of coronary heart disease in adult life may be expected have not been firmly established. It is suggested that serum cholesterol concentration over 250 mg/dl (6.47 mmol/l) in a child over 1 year of age merits detailed investigation, including full lipoprotein analysis, and levels of serum cholesterol between230 and 250 mg/dl (5.95-6.47 mmol/l) should be repeated with further studies if indicated. Secondary hyperlipoproteinaemia rarely presents diagnostic problems but must always be excluded. The only primary hyperlipoproteinaemia likely to be encountered in childhood is familial hyperbetalipoproteinaemia in its common heterozygous form. The most effective means to date of lowering serum cholesterol in this condition is cholestyramine, but the long-term consequences of therapy are not known and treatment should at present be limited to children from high-risk families. Long-term follow-up is essential and until results of such studies are available population screening is unjustified.