Current Therapy Practice Research Articles

Pharmacoeconomic evaluation of first-line combination therapy with immunotherapy drugs and platinum-containing chemotherapy in adult patients with metastatic non-squamous non-small cell lung cancer

Objective: to evaluate the pharmacoeconomic efficacy of “atezolizumab + bevacizumab + paclitaxel + carboplatin” drug combination compared to “pembrolizumab + pemetrexed + carboplatin” combination in adult patients with non-small cell lung cancer (NSCLC) in the first line of therapy.Material and methods. The modeling was applied for cost minimization analyzis of using compared therapy regimens with comparable efficacy, and to estimate the impact on the healthcare budget when increasing the proportion of patients in the target population receiving “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination. Published adjusted indirect comparison data were used in modeling. The calculations were based on the registered prices according to the state register of maximum selling prices.Results. The use of “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination instead of “pembrolizumab + pemetrexed + carboplatin” combination will decrease the direct medical costs of therapy per 1 patient for 2 years by 28,165.00 rubles (–0.4%). The budget impact analysis showed that an increase in the proportion of patients receiving “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination from 50% (current therapy practice) to 100% (considered therapy practice) will reduce the budget load for the population of 6,240 patients over 2 years by 256.1 million rubles (–0.64%).Conclusion. The results of pharmacoeconomic analysis demonstrated that the use of “atezolizumab + bevacizumab + paclitaxel + carboplatin” combination in first-line therapy for metastatic NSCLC is economically feasible and reduces the load on the budget compared to “pembrolizu- mab + pemetrexed + carboplatin” scheme.

Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists’ perspectives

Study designQualitative exploratoryObjectivesRehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.SettingCanadian hospitals and community clinicsDesign/methodsSemi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists’ experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.ResultsFour physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.ConclusionCurrent knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.

Decoding hand and wrist movement intention from chronic stroke survivors with hemiparesis using a user-friendly, wearable EMG-based neural interface

ObjectiveSeventy-five percent of stroke survivors, caregivers, and health care professionals (HCP) believe current therapy practices are insufficient, specifically calling out the upper extremity as an area where innovation is needed to develop highly usable prosthetics/orthotics for the stroke population. A promising method for controlling upper extremity technologies is to infer movement intention non-invasively from surface electromyography (EMG). However, existing technologies are often limited to research settings and struggle to meet user needs.ApproachTo address these limitations, we have developed the NeuroLife® EMG System, an investigational device which consists of a wearable forearm sleeve with 150 embedded electrodes and associated hardware and software to record and decode surface EMG. Here, we demonstrate accurate decoding of 12 functional hand, wrist, and forearm movements in chronic stroke survivors, including multiple types of grasps from participants with varying levels of impairment. We also collected usability data to assess how the system meets user needs to inform future design considerations.Main resultsOur decoding algorithm trained on historical- and within-session data produced an overall accuracy of 77.1 ± 5.6% across 12 movements and rest in stroke participants. For individuals with severe hand impairment, we demonstrate the ability to decode a subset of two fundamental movements and rest at 85.4 ± 6.4% accuracy. In online scenarios, two stroke survivors achieved 91.34 ± 1.53% across three movements and rest, highlighting the potential as a control mechanism for assistive technologies. Feedback from stroke survivors who tested the system indicates that the sleeve’s design meets various user needs, including being comfortable, portable, and lightweight. The sleeve is in a form factor such that it can be used at home without an expert technician and can be worn for multiple hours without discomfort.SignificanceThe NeuroLife EMG System represents a platform technology to record and decode high-resolution EMG for the real-time control of assistive devices in a form factor designed to meet user needs. The NeuroLife EMG System is currently limited by U.S. federal law to investigational use.

An FPGA-Based Upper-Limb Rehabilitation Device for Gesture Recognition and Motion Evaluation Using Multi-Task Recurrent Neural Networks

Upper-Extremity motor impairment affects millions of Americans due to cerebrovascular incidents, spinal cord injuries, or brain trauma. Current therapy practices used to assist these individuals in regaining motor functionality often require extensive time at rehabilitation facilities with potentially prohibitive travel or financial costs. This work presents a mobile low-cost field programmable gate array (FPGA)-smart rehabilitation system that can be used in home environments. The prototype is a rehabilitation table instrumented with a capacitive sensor array (CSA) to track upper-extremity motions of the user through proximity or touch. In addition, inertial measurement units (IMUs) are placed on the affected upper limb and combined with the CSA data with our sensor fusion signal processing architecture. Motions are classified and evaluated using multi-task convolutional recurrent neural networks with three additional motion quality output classes to personalize recognition based on the particular motor skills of each patient. The prototype achieves above 99% accuracy with 32-bit fixed-point format implementation for recognizing dynamic motions and identifying unnatural characteristics (i.e., tremor or limited flexion and extension) in upper limb motions based on sensor values. The convolutional recurrent neural network (C-RNN) fusion classification network is implemented on a 200 MHz Zynq ZCU104 FPGA using an HLS-based design optimized with pipelining and parallelism techniques and achieves 5.4x speedup compared to ARM® Cortex-A53 implementation running at an operating frequency of 1.3 GHz. The prototype is also demonstrated to perform the machine learning classification in real-time.

PCN378 PHARMACOECONOMIC ANALYSIS OF ATEZOLIZUMAB PLUS NAB-PACLITAXEL IN THE TREATMENT OF TRIPLE-NEGATIVE BREAST CANCER

Breast cancer with a triple negative phenotype (TNBC) is aggressive form of the disease. The survival at stage 4 is 1 year at most. The goal of the study was assessment of a new option for inoperable TNBC (presence of PD-L1 ≥1%): atezolizumab in combination with nab-paclitaxel. A decision analysis model was used followed by Markov modeling. The cost-effectiveness analysis (CEA) with incremental cost-effectiveness ratio (ICER) calculation was performed. The combination of atezolizumab+nab-paclitaxel and nab-paclitaxel monotherapy regimens were evaluated. Overall survival (OS) was taken as an effectiveness criterion. Budget impact analysis (BIA) was performed with a one-year and three-year perspective in order to assess the difference in direct costs between the current therapy practice (excluding the use of the combination under consideration) and the expected practice (taking into account the use of the combination). TNBC therapy has a high cost in both combination therapy and monotherapy regimens. The use of atezolizumab plus nab-paclitaxel option increased the median OS from 15.5 to 25 months. At the same time, the total costs of using the combined regimen were €124,987 for two years, which is 2.6 times more expensive than nab-paclitaxel monotherapy. ICER for the combined regimen amounted to €8,155, which is significantly less than society willingness-to-pay threshold that equals €27,341 (triple GDP per capita). In addition, ICER value for atazodizumab+nab-paclitaxel is significantly lower than the incremental indicators for alternate therapeutic options used for other curable forms of breast cancer, e.g., trastuzumab emtansine in comparison with lapatinib+capecitabine (€272,669 for the LYG, and €329 475 for QALYs). BIA demonstrated the absence of significant impact on the level of costs for providing patients with breast cancer in general. The use of atezolizumab plus nab-paclitaxel for the TNBC treatment is an economically feasible option for patients with a poor prognosis.

Therapy for Open-Angle Glaucoma.

Review the clinical manifestations and treatment of primary open-angle glaucoma (POAG). Articles indexed in PubMed, Scopus, and Cochrane Library in the last 10 years using the key words "glaucoma," "open-angle glaucoma," and "'open-angle glaucoma' AND 'treatment.'" Primary sources were used to locate additional resources. ClinicalTrials. gov was used to locate unpublished studies. Eighty-one publications were reviewed and criteria supporting the primary objective were used to identify useful resources. The literature included practice guidelines, review articles, original research articles, and product prescribing information for POAG. The POAG optic neuropathies result in optic disk damage and visual field loss. Ophthalmic medication therapy retards glaucoma progression, but many older patients require multiple medications to preserve vision and quality of life. An agent from the ophthalmic prostaglandin analog class is used as initial therapy in current practice because of the convenience of once-a-day administration and lower incidence of systemic side effects and slightly increased efficacy compared with other available ophthalmic medication classes. The other ophthalmic medication classes used in clinical practice include the beta-adrenergic blocking agents, the alpha-2 adrenergic agonists, and the carbonic anhydrase inhibitors. Proper ophthalmic eye-drop administration and medication adherence are imperative for preserving vision in POAG. Selective laser trabeculoplasty is a viable alternative to ophthalmic medications either initially or if a patient experiences ocular or systemic side effects from medication therapy. A modified prostaglandin analog was approved by the Food and Drug Administration in November 2017; its role in clinical practice is still evolving.

Radiofrequency-based treatment in therapy-related clinical practice – a narrative review. Part II: chronic conditions

Background: Radiofrequency (RF)-based electrophysical agents (EPAs) have been employed in therapy-related clinical practice for several decades. They are used to reduce pain and inflammation and promote tissue healing. Although deemed less popular in current therapy practice, surveys suggest that some of these EPAs are still used reasonably widely.Objective: To review the evidence for the use of non-invasive low-frequency RFs (30 kHz - 30 MHz) for treating chronic therapy-related clinical conditions.Major findings: All relevant peer-reviewed clinical studies published in English, concerning low-frequency RFs were sought. Identified literature was stratified as ‘acute’ and ‘chronic’ based on their clinical area. The studies on chronic conditions were reviewed for this paper and analysed to assess the volume and scope of current evidence. Out of 120 studies identified, 90 related to chronic conditions. The majority of them (82 studies) employed shortwave therapy (SWT) in continuous (CSWT) or pulsed (PSWT) modes. Only eight studies employed frequencies other than shortwave. Overall 67 studies investigated conditions relating to ‘pain and inflammation’, 16 to ‘tissue healing’ and 7 studies to other less reported conditions.Conclusions: Evidence favouring and against RF-based EPAs is available. There is moderate evidence favouring the use of SWT (mainly PSWT) in knee osteoarthritis. Some evidence also exists for CSWT in chronic low back pain and PSWT for treating chronic wounds. Evidence for other conditions is insufficient and conflicting. A general lack of research emphasis in the non-shortwave RF band is evident. Further and wider research in this area is necessary.

Vertical Displacement of the Equine Pelvis When Trotting on an Aqua Treadmill

IntroductionHydrotherapy is increasingly applied within the equine industry for rehabilitation and therapy. Substantial anecdotal evidence exists suggesting the benefits of its application but while there is extensive literature on the use of aqua‐treadmills in humans and canines there is comparatively little in equines. Therefore, limited research exists supporting the role of the aqua‐treadmill in current therapy practices. This study aimed to investigate the effect of water depth on pelvic movement during aqua‐treadmill exercise.MethodsEight horses were trotted on an aqua‐treadmill at four water depths specifically measured to individual horses (P3, fetlock, MC3, carpus). Pelvic displacement was recorded using an optical motion capture system to collect coordinates from markers placed on the tuber sacrale, tuber coxae, withers and lumbar spine. Data were processed using custom written scripts (Matlab®) and ANOVA was performed.ResultsAll subjects demonstrated a significant increase in vertical displacement of the pelvis as water depth increased from P3 to carpus while displacement symmetry was not significantly altered with a change in water depth.ConclusionsThe common practice of increasing water depth to intensify the physical demands of the exercise while maintaining the desired movement symmetry is supported. Having knowledge of how a horse moves on an aqua‐treadmill is vital for tailoring specific therapy in order to most successfully rehabilitate the horse from injury. Investigation of the effects of increasing water depth on asymmetric horses should be carried out to further support its application as a tool for rehabilitation.Ethical Animal ResearchEthical approval was obtained from the Ethics Review Committee at Moulton College. Owner consent was granted for all subjects and all horses were handled in compliance with British Horse Society standards throughout the trials. Sources of funding: Thomas Harrison Trust at Moulton College. Competing interests: none.

Sudden cardiac death and the role of device therapy in dilated cardiomyopathy

Both nonischemic and ischemic dilated cardiomyopathy are associated with an increased risk of sudden cardiac death, most commonly as a result of ventricular tachyarrhythmias. The pathophysiology of sudden death is complex and results from the interplay of scarred myocardium with physiologic and environmental triggers. Clinical trials completed within the past decade have clarified the role of implantable defibrillators in prolonging survival and have expanded the indications for the use of these devices in patients with heart failure. This article examines the pathophysiology of sudden cardiac death and reviews the clinical trials that have defined the role of device therapy in current practice.

Micro Ruptures and Repairs in the Beginning Phase of Cross-Cultural Psychotherapy

The article discusses misunderstandings and misattunements that occur in the beginning phase of cross-cultural psychotherapy. Sources of micro ruptures are outlined, including client maladaptive patterns, therapist misunderstandings, cross-cultural misunderstandings due to cultural variations, and asymmetrical power relations involving the impact of prior experiences or current therapy practices. Multiple clinical vignettes illustrate the rupture/repair process, drawing on Safran and Muran’s (2000) list of direct and indirect techniques.

E2 Appropriate antihypertensive therapy in current practice. Results of a feasibility study

E2 Appropriate antihypertensive therapy in current practice. Results of a feasibility study

Increasing learning during the psychiatric residency

P OSTGRADUATE TRAINING in the field of psychiatry is currently in a state of flux, with vany fronts. Most institutions offering psychiatric residency training programs are in the process of painful reevaluation and change, attempting to integrate into their core curricula the disparate models associated with psychoanalytic psychology, community mental health, behavior modification, psychopharmacotherapy, family therapy, and a host of other models that reflect special interests of individual training centers. This situation was clearly apparent in a “white paper” of the Association for Academic Psychiatry’ which resulted from the 1973 meeting of Career Teachers in Psychiatry examining the goals, methods, and effectiveness of psychiatric residency training programs in the United States. In attempting to answer the questions, “What is a psychiatrist now? What should he be in the next decade?” it was stressed that the psychiatrist has and probably will continue to have multiple roles. He must not only have knowledge of prevalent theories of personality development and sociocultural determinants of behavior and of how to diagnose patients according to a descriptive nosology, but also know how to relate these to a theory of psychopathology. The Career Teacher Group specified that the psychiatrist should be able to do the following: “(A) He should be able to use the somatic therapies, including ECT and psychopharmacological agents. (B) He should know how to practice the various psychotherapies. He should be skilled in the forms of individual therapy in current practice that have some validity and be able to apply this ability to individuals and to work with larger social units. Training in individual therapy is essential; training in group therapy, family therapy, and behavior modification are desirable. (C) He should know the concepts and practices of community psychiatry, including consultative techniques and aspects of preventive psychiatry. (D) He should have the tools and motivation for continuing his own education after training. He should be familiar with diagnostic and therapeutic techniques with children and adolescents.“’ In the presence of such expectations, an emotionally charged problem has emerged for psychiatric residents that interferes with the teaching-learning process,” is increasing in frequency, is unrelated to training milieu (e.g. inpatient or outpatient settings), and can occur at any stage of residency training. The problem begins when the resident experiences the realities of current psychiatric practice that tend to clash with his preexisting concepts or fantasies.