Significant Predictors Of Relapse Research Articles

Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study

Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.

Pattern of Relapse and Treatment Response in WNT-Activated Medulloblastoma

Wingless-activated (WNT) medulloblastoma have been identified over the past decade as being a candidate for therapy de-escalation based on their excellent survival, however a paucity of relapses in any single cohort have precluded any additional analysis of markers of relapse. To address this gap in knowledge, an international cohort of 91 WNT-MB was assembled where we identified 14 relapsed cases where five-year progression free survival was 0.84 (95% 0.763-0.925). Maintenance chemotherapy was identified as a strong predictor of relapse, where no relapses were observed in cases receiving high doses of cyclophosphamide or ifosphamide (p=0.0026). The location of relapse was metastatic in 10/14 of relapses, with 7/10 metastatic relapses presenting along the ependymal lining in the lateral ventricles. Maintenance chemotherapy, specifically cumulative cyclophosphamide dose is a significant predictor of relapse across WNT-MB. Future efforts to de-escalate therapy need to carefully consider not only the radiation dose but also the chemotherapy regimen, and the propensity to metastatic relapses.

Long-term survival and predictors of relapse and survival after liver transplantation for alcoholic liver disease

Objective: Studies of predictive factors of alcohol recidivism and survival post-LT are not up-to-date. With evolving LT activity and with longer-term outcomes becoming increasingly available, re-evaluating post-LT outcomes is imperative. We analyzed recent data on survival, alcohol recurrence and predictive factors.Methods: We compared long-term survival among 159 consecutive ALD patients transplanted 2003–2016 with 159 propensity-score matched controls transplanted for non-ALD. Alcohol ‘slips’ (occasional lapse) and relapse to moderate or harmful drinking were assessed from medical records and structured forms filled in by home-district physicians, and analyzed by competing-risk and multivariate Cox regression analyses.Results: Patient and graft survival at 10 years were 75 and 69% in the ALD group and 65 and 63% in the control group (p=.06 and .36). In ALD patients, the 10-year cumulative rate of alcohol slip was 52% and of relapse, 37%. Duration of pre-LT abstinence (HR 0.97, 95% CI 0.94–0.99) and a history of prior alcohol relapses (HR 3.05, 95% CI 1.41–6.60) were significant predictors of relapse, but failed to predict death/graft loss. Patients with <6 months abstinence relapsed sooner than those with 7–24 months abstinence, but 10-year relapse rates were similar (40–50%). Ten-year relapse rate with 2–5-year pre-LT abstinence was 21%, and with >5-year abstinence, 0%. In patients with <6 months pre-LT abstinence, years of heavy drinking, prior addiction treatments, and lack of children predicted inferior survival.Conclusions: Although 37% of our ALD patients relapsed to drinking by 10 years post-LT, 14-year survival was not significantly different from survival in non-ALD patients. Short duration of pre-LT abstinence and prior relapses predicted post-LT relapse.

Predictors of relapse in graves' hyperthyroidism after treatment with antithyroid drugs

Background: Choice of the treatment for patients with Graves' hyperthyroidism depends on local preference, the higher recurrence risk, comorbidities, and the patient's preferences. About half of the patients relapse after a course of a standard antithyroid drug (ATD) therapy for Graves' disease. Objectives: The objective of this study was to determine the clinical and biochemical features of Graves' hyperthyroidism that can predict the relapse of the disease after a standard course of ATD therapy. Patients and Methods: We conducted a retrospective 6-month study of 79 patients with Graves' hyperthyroidism who were treated with ATD (carbimazole) therapy for 12–18 months and went into remission for at least 1 year after ATD withdrawal. Results: The relapse rate in Graves' hyperthyroidism after 1 year in remission was 40.5%; patients with younger age (&lt;40 years) and with severe biochemical disease correlated significantly with relapse. Gender, presence of a palpable goiter, orbitopathy, and smoking habits were not significant predictors of relapse, perhaps because of the small sample size. Conclusions: Forty percent of Graves' hyperthyroidism relapsed after 1 year of remission. Younger age and severe biochemical disease at diagnosis predicted relapse.

Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse

Background/Aims: The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge. Methods: AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders. Results: Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up. Conclusions: In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up.

Three-Week Inpatient Treatment of Obsessive-Compulsive Disorder: A 6-Month Follow-Up Study.

Background: Specialized inpatient or residential treatment might be an alternative treatment approach for patients with obsessive-compulsive disorder (OCD) that do not respond satisfactorily to the standard outpatient treatment formats.Method: The aim of this open trial was to investigate the 6-month effectiveness of a 3-week inpatient treatment of OCD, where exposure with response prevention (ERP) was the main treatment intervention. The sample consisted of 187 adult patients with OCD, all with previous treatment attempts for OCD.Results: The sample showed significant reductions in symptoms of OCD and depression. The effect sizes were large for obsessive-compulsive symptoms and moderate to large for depressive symptoms. At discharge, 79.7% of the intent-to-treat (ITT) group were classified as treatment responders (≥35% reduction in Y-BOCS scores). However, some participants experienced relapse, as 61.5% of the ITT group were classified as treatment responders at 6-month follow-up. Antidepressant use appeared not to influence the outcome. Only pre-treatment levels of obsessive-compulsive symptoms emerged as a significant predictor of relapse.Conclusion: The 3-week inpatient programme produced similar treatment effects as previous inpatient and residential studies of longer duration (2 – 3 months). The results suggest that patients with severe OCD can be treated efficiently using this brief inpatient format. However, better relapse prevention interventions are needed.

Abstract P2-08-05: FOXK2 aberration in breast cancer

Abstract Background: Activation of oncogenes through DNA amplification/overexpression plays important roles in cancer initiation and progression. The chromosome 17 is a frequent site of cancer-associated genetic anomalies. This cytogenetic anomaly is strongly associated with poor prognosis and is a significant predictor of relapse in breast cancer. Previous studies of breast cancer have revealed the amplification of several genomic regions on 17q. These amplifications are typically discontinuous and complex in structure, suggesting that multiple oncogenes in this chromosomal segment may be co-selected during breast carcinogenesis. By integrative analysis of public genomic datasets of breast cancers from The Cancer Genome Atlas (TCGA), we have found that FOXK2 displayed frequent genomic amplifications and correlated gene expression changes in breast cancer. FOXK2 gene is located in 17q25 and encodes a transcriptional factor with a fork head DNA binding domain, but has not yet been reported to be associated with cancer-causal genetic aberrations. Gene amplification in the 17q chromosomal region is observed frequently in breast cancers. We hypothesize that FOXK2 is an important oncogene in breast cancer and it might be a novel therapeutic target and biomarker for breast cancer. Methods: The status of FOXK2 located at the Chromosome 17q25 was explored by mining the breast cancer TCGA datasets including 910 tumor cases and 981 normal controls. To determine whether FOXK2 amplification/overexpression is required for breast cancer cell proliferation, we assessed the effect of FOXK2 stable knockdown on proliferation and anchorage-independent growth in four cell lines with high FOXK2 expression status (MDA-MB-231, MCF-7, HCC1954 and MDA-MB-361) using lentivirus mediated shRNAs. The oncogenic activity of FOXK2 was assessed by colony formation assay.The potential interacting molecules/pathways were explored Results: Frequent genomic amplifications of FOXK2 were detected in breast cancers compared to normal controls in all subtypes of breast cancers classified by PAM50 by integrative analysis of public genomic datasets and its overexpression was associated with poor overall survival of breast cancer patients. FOXK2 knockdown in several breast cancer cell lines inhibited breast cancer cell proliferation and anchorage-independent growth. More importantly, overexpression of FOXK2 and oncogene RAS induced MCF10A cell colony formation, indicating that FOXK2 is an oncogene in breast cancer. Several pathways, including regulation of cell proliferation, regulation of cell division, cell adhesion and regulation of cell metabolism, were regulated by FOXK2 in breast cancer cells. Conclusion: Our data provide compelling evidence that FOXK2 is an oncogene in breast tumorigenesis, and it might be a novel therapeutic target and a biomarker predicting poor outcome. We are assessing the incidence of FOXK2 amplification in human breast cancer specimens using immunohistochemistry and FISH on TMA tissue blocks to determine the prognostic value of FOXK2 amplification for overall prognosis and treatment resistance. We are also validating the molecular mechanism of FOXK2 in breast cancer malignancy according to the identified potential interacting molecules/pathways by analyzing the RNASeq data of a breast cancer cell line with FOXK2 knockdown. Citation Format: Zhang H, Yu Y. FOXK2 aberration in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-08-05.

Strong Prolyl Hydroxylase Domain 1 Expression Predicts Poor Outcome in Radiotherapy-treated Patients with Classical Hodgkin's Lymphoma.

Hypoxia-inducible factors (HIFs) and prolyl hydroxylase domain (PHD) proteins control cellular oxygen homeostasis and a wide range of other processes. We immunohistochemically assessed the expression of HIF1α, HIF2α, PHD1, PHD2 and PHD3 in 115 cases of classical Hodgkin's lymphoma, all treated in the first line with doxorubicin, bleomycin, vinblastine and darcabazine (ABVD) chemotherapy. In advanced-stage patients treated with involved-field radiotherapy (IFRT), nuclear HIF1α expression in reactive cellular infiltrate predicted prolonged relapse-free survival (RFS) (p=0.026). Strong cytoplasmic PHD1 expression in Reed-Sternberg cells was associated with poor RFS among patients treated with IFRT and advanced-stage patients treated with ABVD and IFRT (p=0.0028 and p=0.0058, respectively). In Cox regression analysis, PHD1 was a more significant predictor of relapse (risk ratio=18.383; 95% confidence interval(CI)=1.521-222.246; p=0.022) than the International Prognostic Score. HIF and PHD expression appear to be novel prognostic biomarkers in classical Hodgkin's lymphoma.

Circadian Rhythm Sleep-Wake Disorders Predict Shorter Time to Relapse of Mood Episodes in Euthymic Patients With Bipolar Disorder: A Prospective 48-Week Study.

Circadian rhythm dysfunction has been considered to be common in bipolar disorder (BD) and plays an important role in mood dysregulation in this disorder. However, no study has investigated whether circadian rhythm dysfunction would affect the clinical course of BD. The aim of this study was to test the hypothesis that circadian rhythm dysfunction could be a predictor of relapse in euthymic BD patients. One hundred four euthymic outpatients with BD diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), participated in this prospective follow-up study from August 2014 to April 2015. At baseline, data on demographic variables and clinical descriptive variables of bipolar disorder were ascertained via clinical interviews. The diagnoses of circadian rhythm sleep-wake disorders (CRSWDs) were made based on participants' sleep logs for 4 weeks and according to the International Classification of Sleep Disorders, Third Edition (ICSD-3). The BD symptoms of the subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores every 4 weeks throughout the 48-week study period. Relapse of BD was defined as scores higher than the cutoff points (MADRS score ≥ 13 and YMRS score ≥ 7). The primary outcome was time to relapse of mood episodes. Thirty-four subjects met criteria for CRSWD at baseline, most frequently delayed sleep-wake phase disorder (n = 27). Of the total 104 subjects, 51 (49.0%) experienced relapse during the 48-week follow-up period. Multivariate Cox hazard regression analyses revealed that 2 or more previous mood episodes within the past year and comorbidity of CRSWD were significantly associated with the time to relapse of mood episodes (P < .001). Comorbid CRSWD, mainly delayed sleep-wake phase disorder, could be a significant predictor of relapse in BD patients.

Circadian rhythm sleep-wake disorders predict shorter time to relapse of mood episodes in euthymic patients with bipolar disorder: a prospective 48-week study

OBJECTIVE Circadian rhythm dysfunction has been considered to be common in bipolar disorder (BD) and plays an important role in mood dysregulation in this disorder. However, no study has investigated whether circadian rhythm dysfunction would affect the clinical course of BD. The aim of this study was to test the hypothesis that circadian rhythm dysfunction could be a predictor of relapse in euthymic BD patients. METHODS One hundred four euthymic outpatients with BD diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), participated in this prospective follow-up study from August 2014 to April 2015. At baseline, data on demographic variables and clinical descriptive variables of bipolar disorder were ascertained via clinical interviews. The diagnoses of circadian rhythm sleep-wake disorders (CRSWDs) were made based on participants' sleep logs for 4 weeks and according to the International Classification of Sleep Disorders, Third Edition (ICSD-3). The BD symptoms of the subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores every 4 weeks throughout the 48-week study period. Relapse of BD was defined as scores higher than the cutoff points (MADRS score ≥ 13 and YMRS score ≥ 7). The primary outcome was time to relapse of mood episodes. RESULTS Thirty-four subjects met criteria for CRSWD at baseline, most frequently delayed sleep-wake phase disorder (n = 27). Of the total 104 subjects, 51 (49.0%) experienced relapse during the 48-week follow-up period. Multivariate Cox hazard regression analyses revealed that 2 or more previous mood episodes within the past year and comorbidity of CRSWD were significantly associated with the time to relapse of mood episodes (P < .001). CONCLUSIONS Comorbid CRSWD, mainly delayed sleep-wake phase disorder, could be a significant predictor of relapse in BD patients.

Identification of the genetic and clinical characteristics of neuroblastomas using genome-wide analysis.

To provide better insight into the genetic signatures of neuroblastomas, we analyzed 500 neuroblastomas (included specimens from JNBSG) using targeted-deep sequencing for 10 neuroblastoma-related genes and SNP arrays analysis. ALK expression was evaluated using immunohistochemical analysis in 259 samples. Based on genetic alterations, the following 6 subgroups were identified: groups A (ALK abnormalities), B (other gene mutations), C (MYCN amplification), D (11q loss of heterozygosity [LOH]), E (at least 1 copy number variants), and F (no genetic changes). Groups A to D showed advanced disease and poor prognosis, whereas groups E and F showed excellent prognosis. Intriguingly, in group A, MYCN amplification was not a significant prognostic marker, while high ALK expression was a relevant indicator for prognosis (P = 0.033). Notably, the co-existence of MYCN amplification and 1p LOH, and the co-deletion of 3p and 11q were significant predictors of relapse (P = 0.043 and P = 0.040). Additionally, 6q/8p LOH and 17q gain were promising indicators of survival in patients older than 5 years, and 1p, 4p, and 11q LOH potentially contributed to outcome prediction in the intermediate-risk group. Our genetic overview clarifies the clinical impact of genetic signatures and aids in the better understanding of genetic basis of neuroblastoma.

P.1.k.015 - Mirror-image study of aripiprazole long-acting injectable for the treatment of psychiatric patients attended in community mental health team

Understanding the biological processes that underlie why patients relapse is an issue of fundamental importance to the detection and prevention of relapse in schizophrenia. Brain Derived Neurotrophic Factor (BDNF), a facilitator of brain plasticity, is reduced in patients with schizophrenia. In the present study, we examined whether decreases in plasma BDNF levels could be used as a biological predictor of relapse in schizophrenia. A total of 221 patients were prospectively evaluated for relapse over 30 months in the Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared to Injectables: eValuating Efficacy (PROACTIVE) study. Serial blood samples were collected at a maximum of 23 time points during the 30-month trial and BDNF levels were measured in plasma samples by ELISA. Receiver Operating Characteristic (ROC) curve analysis indicated that BDNF was not a significant predictor of relapse, hospitalization or exacerbation. Regardless of treatment group (oral second generation antipsychotic vs. long-acting injectable risperidone microspheres), baseline BDNF value did not differ significantly between those who experienced any of the adverse outcomes and those who did not. While contrary to the study hypothesis, these robust results offer little support for the use of plasma BDNF alone as a biomarker to predict relapse in schizophrenia.

Predicting relapse in schizophrenia: Is BDNF a plausible biological marker?

Understanding the biological processes that underlie why patients relapse is an issue of fundamental importance to the detection and prevention of relapse in schizophrenia. Brain Derived Neurotrophic Factor (BDNF), a facilitator of brain plasticity, is reduced in patients with schizophrenia. In the present study, we examined whether decreases in plasma BDNF levels could be used as a biological predictor of relapse in schizophrenia. A total of 221 patients were prospectively evaluated for relapse over 30months in the Preventing Relapse in Schizophrenia: Oral Antipsychotics Compared to Injectables: eValuating Efficacy (PROACTIVE) study. Serial blood samples were collected at a maximum of 23 time points during the 30-month trial and BDNF levels were measured in plasma samples by ELISA. Receiver Operating Characteristic (ROC) curve analysis indicated that BDNF was not a significant predictor of relapse, hospitalization or exacerbation. Regardless of treatment group (oral second generation antipsychotic vs. long-acting injectable risperidone microspheres), baseline BDNF value did not differ significantly between those who experienced any of the adverse outcomes and those who did not. While contrary to the study hypothesis, these robust results offer little support for the use of plasma BDNF alone as a biomarker to predict relapse in schizophrenia.

Expressed emotion and the course of schizophrenia in Pakistan.

Aim of the study is to evaluate the predictive power of Expressed Emotion in Schizophrenia relapse in Pakistan. A longitudinal study was conducted comprising 53 in-patients' sample diagnosed with Schizophrenia and their 101 key carers. Participants fulfilled DSM-IV-TR criteria for Schizophrenia based on Structural Clinical Interview for the DSM-IV diagnosis. Symptomatic status was measured through Brief Psychiatric Rating Scales-Expanded (BPRS-E). Caregivers' level of EE was assessed through Camberwell Family Interview (CFI). Patients were followed up for 9months after hospital discharge. Relapse rate for patients with high-EE household was 72% as compared with 36% in the low-EE household. Logistic Regression showed a positive relationship between high-EE and relapse (CI 0.06-0.80; p < 0.05). Both hostility and critical comments emerged as significant predictors of relapse. The odds ratio showed that a one unit increase in caregivers' score on the CCs and hostility scales were associated with a 1.29 (CI 1.06-1.56; p < 0.05) and 1.89 (CI 1.14-3.13; p < 0.05) times increased rate of relapse, respectively. Conversely, a non-significant relationship was observed between EOI and relapse. The findings from this study confirmed the validity of EE construct in predicting schizophrenia relapse in a Pakistani sample. However, medication compliance has not been experimentally controlled and that is one of the limitations of the study.

Is there a different dose–effect relation between the primary tumor and involved lymph nodes in locally advanced non-small-cell lung cancer? A hypothesis-generating study

Purpose: It is unknown whether the dose–response relation of the primary tumor in NSCLC is different from that of the involved lymph nodes (LN). As the recurrence rate is much lower in LN, we hypothesized that LN need a lower radiation dose.Material and methods: A retrospective analysis of prospective data was performed on patients with locally advanced NSCLC treated with (chemo)radiotherapy. The impact of EQD2,T prescription dose on relapse was analyzed using Cox regression modeling correcting for baseline diameter.Results: From 2006 to 2010, 75 consecutive patients were included, resulting in 142 lymph nodes in the analysis. Any relapse (locoregional/distant) occurred in 58 patients (77%), while involved nodal relapse (INR) was observed in 13% of patients. No dose–response relationship was observed for INR (p = .22). Primary tumor progression was seen in 40% of patients together with a significant dose–response relationship (p = .033). Baseline nodal diameter was not associated with INR (p = .76), while primary tumor diameter was a highly significant predictor for relapse (p = .0031).Conclusions: These results suggest that LN control may be achieved at lower radiation doses than needed for the primary tumor. Prospective dose de-escalation studies on LN are warranted to decrease the incidence of severe esophagitis without compromising local tumor control.

Elevated expression of miR-24-3p is a potentially adverse prognostic factor in colorectal adenocarcinoma

ObjectivesSeveral miRNAs are aberrantly expressed in cancer. miR-24-3p is involved in cancer-related cellular processes, including cell cycle control, cell growth, proliferation, and apoptosis. In this study, we examined the potential diagnostic and prognostic significance of miR-24-3p expression in colorectal adenocarcinoma. Design and methodsTotal RNA was isolated from 182 colorectal adenocarcinoma specimens and 86 paired non-cancerous colorectal mucosae. After polyadenylation of 2μg total RNA and reverse transcription into first-strand cDNA using an oligo-dT-adapter primer, miR-24-3p expression was quantified using an in-house–developed reverse-transcription real-time quantitative PCR method, based on the SYBR Green chemistry. SNORD43 (RNU43) was used as a reference gene. ResultsmiR-24-3p levels do not significantly differ between colorectal adenocarcinoma and non-cancerous colorectal mucosae. Thus, miR-24-3p expression cannot be used for diagnostic purposes. However, high miR-24-3p expression predicts poor disease-free survival (DFS) and overall survival (OS) of colorectal adenocarcinoma patients. Multivariate Cox regression analysis confirmed that miR-24-3p overexpression is a significant predictor of relapse in colorectal adenocarcinoma and that its prognostic significance is independent of other established prognostic factors and treatment of patients. Of note, miR-24-3p overexpression retains its rather unfavorable prognostic value in the subgroup of patients with advanced yet locally restricted colorectal adenocarcinoma (T3) and in those without distant metastasis (M0). Moreover, miR-24-3p overexpression is a potentially unfavorable prognosticator for patients who were not treated with radiotherapy. ConclusionsStrong expression of miR-24-3p predicts poor DFS and OS of colorectal adenocarcinoma patients, independently of clinicopathological parameters that are currently used for prognosis in this human malignancy.

Adherence to National Comprehensive Cancer Network® Guidelines for Testicular Cancer

Testicular cancer is the most common malignancy among young men and well established treatment guidelines exist to optimize outcomes. We characterized errors in the management of testicular cancer observed among patients seen at 3 referral centers in the United States. We retrospectively reviewed data from 593 patients presenting with testicular cancer to 3 academic medical centers from 2007 to 2016. Nonguideline directed care was defined as management differing fromNational Comprehensive Care Network guideline recommendations. Cases of nonguideline directed care were systematically described. Patient and tumorcharacteristics were compared between guideline directed care and nonguideline directed care. Multivariable logistic regression was used to identify predictors of nonguideline directed care, and Cox regression modeling was used to assess the association between nonguideline directed care and relapse-free survival. Nonguideline directed care was identified in 177 of 593 (30%) patients. Inappropriate imaging (44%) and overtreatment (40%) were the most common classifications. Misdiagnosis (24%) and under treatment (16%) occurred relatively frequently, while inappropriate treatment (6%) was rare. Multivariable Cox regression modeling controlling for race, tumor stage and tumor histology identified nonguideline directed care as a significant predictor of relapse (HR2.49, 95% CI 1.61-3.85, p <0.01). Nonguideline directed care of patients with testicular cancer iscommon, most frequently in the form of inappropriate imaging and overtreatment.Nonguideline directed care leads to delayed definitive therapy, unnecessary morbidity and higher rates of relapse.

Family Emotional Over-Involvement and Relapse among Inpatient Alcoholics in Nairobi, Kenya

Family interactional patterns have been proposed as significant in relapse of most psychiatric disorders. Many studies have demonstrated that patterns of interactions of family members affect the quality of relationships within such families. Research, particularly in Systems Theories, has also indicated that the ways in which family members interact with each other is cyclic and affect recovery and sustainability of treatment among psychiatric patients. Although the relationship between family communication dynamics and psychiatric relapse has received much attention, few studies have focused on such dynamics within alcoholic families. This study has examined one of the interactional patterns referred to as emotional over-involvement (EOI) among close family members with alcoholic patients. The study is underpinned by the Family Systems Theory (Minuchin, 1974), and views alcoholism as a „family illness‟. The study derived samples from inpatient alcoholics in rehabilitation centers (N=186) and their family members in Nairobi County, Kenya. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess for alcoholism, while a questionnaire was generated to assess family EOI. Interviews were also carried out and were corroborated with the questionnaires. Pearson correlations and regression analyses showed that EOI was statistically significant at p=0.000<0.05 and had a predictive value of .471. This meant that EOI expressed by family members was a very significant predictor for relapse among recovering alcoholics.

Colitis ulcerosa en remisión: mejora de la adhesión terapéutica desde una perspectiva multidisciplinar

IntroductionLack of adherence to treatment with 5-ASA is a significant predictor of relapse in ulcerative colitis (UC). This study was conducted in order to investigate the perception about ulcerative colitis that have the different health professionals who interact with the patient along the course of the disease. Material and methodsThe study was designed as a qualitative research through focus groups among primary care physicians (n=4), gastroenterologists (n=4) and gastroenterology nurses (n=4). ResultsAmong the potential reasons for poor adherence, this study identified: lack of awareness of the patient who has no symptoms, poor communication, and psychiatric conditions such as anxiety and depression. All professional groups thought that reducing the number of daily doses could contribute to greater adherence to therapy. All of them pointed out the lack of communication between them, especially between primary care physicians and specialized care, despite being aware of its relevance. ConclusionThe lack of adherence in ulcerative colitis is a complex problem that can involve many factors, such as the lack of patient awareness in the absence of symptoms, the fear of side effects or a deficient physician-patient communication. This study described fundamental aspects that could improve adherence, such as simplifying treatment to once daily doses, or fostering communication not only with the patient, but between different levels of care as well.

Partner expressed emotion and diabetes management among spouses living with Type 2 diabetes.

Expressed emotion has been consistently shown to be a significant predictor of relapse and poor disease management across numerous physical and mental health conditions, however very little research has been conducted on its relationship to the management practices of individuals living with Type 2 diabetes. This study examines the relationship between expressed emotion (EE) and diabetes management among couples where 1 spouse has Type 2 diabetes. The authors surveyed 106 couples where 1 partner was diagnosed with Type 2 diabetes. Partners without diabetes completed questionnaires about their level of criticism, emotional involvement, and warmth toward their partners. Partners with diabetes completed questionnaires on diabetes control, diabetes management practices and attitude toward their diabetes. The authors found that, individuals living with diabetes who had partners with high EE reported significantly poorer diabetes management in all areas (diet, physical activity, and attitude toward diabetes). Diabetes management was found to mediate the relationship between EE and diabetes control. Results suggest that partners with high EE may have a significant influence on diabetes management practices in their partner. These findings highlight the important role couple interactions may play in diabetes management. Findings also emphasize the potential benefit of conceptualizing diabetes management from a systems/relational perspective. In addition, greater consideration should be given to using family-based approaches for diabetes management and treatment among coupled individuals living with Type 2 diabetes. (PsycINFO Database Record