Steinmetz T.,Outpatient Clinic for Oncology and Haematology |
Tschechne B.,Klinikum Neustadt am Rubenberge |
Harlin O.,Vifor Pharma |
Klement B.,Vifor Pharma |
And 5 more authors.
Annals of Oncology | Year: 2013
Background: Intravenous (i.v.) iron can improve anaemia of chronic disease and response to erythropoiesis-stimulating agents (ESAs), but data on its use in practice and without ESAs are limited. This study evaluated effectiveness and tolerability of ferric carboxymaltose (FCM) in routine treatment of anaemic cancer patients. Patients and methods: Of 639 patients enrolled in 68 haematology/oncology practices in Germany, 619 received FCM at the oncologist's discretion, 420 had eligible baseline haemoglobin (Hb) measurements, and 364 at least one follow-up Hb measurement. Data of transfused patients were censored from analysis before transfusion. Results: The median total iron dose was 1000 mg per patient (interquartile range 600-1500 mg). The median Hb increase was comparable in patients receiving FCM alone (1.4 g/dl [0.2-2.3 g/dl; N = 233]) or FCM + ESA (1.6 g/dl [0.7-2.4 g/dl; N = 46]). Patients with baseline Hb up to 11.0 g/dl and serum ferritin up to 500 ng/ml benefited from FCM treatment (stable Hb ≥11.0 g/dl). Also patients with ferritin >500 ng/ml but low transferrin saturation benefited from FCM treatment. FCM was well tolerated, 2.3% of patients reported putative drug-related adverse events. Conclusions: The substantial Hb increase and stabilisation at 11-12 g/dl in FCM-treated patients suggest a role for i.v. iron alone in anaemia correction in cancer patients. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
Eizayaga J.E.,Maimónides University |
Waisse S.,Outpatient Clinic
Homeopathy | Year: 2016
Background and objectives: Parental refusal to vaccinate is a cause of serious concern. Use of homeopathy is believed to be a relevant reason for parents to refuse to vaccinate. However, vaccination is one of the main gaps dividing between medically qualified or not homeopathic practitioners. The present study sought to investigate the attitude of homeopathic doctors towards vaccination and associated variables. Methods: An international online survey was conducted with homeopathic doctors by means of an anonymous self-reported questionnaire in Portuguese or Spanish. Questions investigated sociodemographic and professional characteristics, overall opinion on vaccination and on some specific vaccines. Results: A total of 512 responses were obtained, 77.5% of respondents were from Latin American countries, 16.8% from Spain, with small numbers from several other countries. About 75.6% of the respondents considered vaccination safe, effective and necessary, while 12.5% stated they would not recommend vaccination under any circumstance. The variables significantly correlated with positive attitude towards vaccination were: working in the public health system (p = 0.04) and homeopathy not the main medical activity (p = 0.005). Homeopaths from Brazil, where homeopathy is officially accredited, were more favorable to vaccination compared to respondents from countries where homeopathy has inferior status (p < 0.001). Conclusion: The results show that there is no contradiction between homeopathy and primary prevention by means of vaccination. © 2015 The Faculty of Homeopathy.
Vikan A.,Norwegian University of Science and Technology |
Hassel A.M.,St Olavs Hospital |
Rugset A.,Students Health Care Services |
Johansen H.E.,Outpatient Clinic |
Moen T.,National Institute of Technology
Nordic Journal of Psychiatry | Year: 2010
Background: Shame is an acknowledged part of several psychopathological conditions, but is underrepresented in clinical research. Cook's Internalized Shame Scale (ISS) is the most promising measure, but has mostly been used for testing small clinical samples biased toward depressive pathology and female participants. Aims: To contribute to establishing indicators of pathological shame in outpatients with depression and anxiety disorder, and to contribute to establishing norms for the ISS in Scandinavia. Method: The ISS was administered to n= 200 gender balanced non-patient and outpatient samples. A total of 100 patients each were diagnosed as suffering from a depression or anxiety disorder. The diagnoses were supported by Beck's Depression (BDI) and Anxiety Inventory (BAI). The analyses used were the principal component analysis (PCA) and confirmatory factor analysis (CFA) for item structure and sample equivalence, ANOVAs, t-tests and MannWhitney non-parametric statistics for index scores, and the receiver operating curve (ROC) for break-off. Results: Patients' ISS score were similar to the results from previous research, the effect size of patientnon-patient difference was 0.68, correlations indicated a higher level of shame in depression than in anxiety, and the BDIBAI correlation was 0.56 for both clinical samples. The PCA showed three factors that were identified as: "Inadequacy", "Emptiness", and "Vulnerability". Conclusions: The ISS is a viable instrument, which indicates a widespread shame pathology in both depressive and anxious out-patients. The instrument may not be uni-dimensional, but exploration of factor variation may be a promising goal for further research. Clinical implications: Assessment of shame should be included in diagnosis and treatment of emotional disorder. © 2010 Informa UK Ltd.
Seibert J.,Outpatient Clinic |
Tracik F.,Novartis |
Tracik F.,Heinrich Heine University Düsseldorf |
Articus K.,Novartis |
Spittler S.,Alexianer Krefeld
Neuropsychiatric Disease and Treatment | Year: 2012
Background: Oral cholinesterase inhibitors at doses efficacious for the treatment of Alzheimer's disease (AD) are often prematurely discontinued due to gastrointestinal side effects. In controlled clinical trials, transdermal rivastigmine demonstrated less such effects at similar efficacy. The current study aimed to verify the validity of this data in daily practice. Methods: This was a prospective, multicenter, observational study on transdermal rivastigmine in Germany. Eligible patients were those with AD who had not yet been treated with rivastigmine. Outcome measures were changes in clock-drawing test, Mini-Mental State Examination (MMSE), Caregiver Burden Scale, Clinical Global Impression (CGI), physicians' assessments of tolerability, and the incidence of adverse events (AEs) over 4 months of treatment. Results: In 257 centers 1113 patients were enrolled; 614 women and 499 men, mean age 76.5 years. In 58% of patients AD was treated for the first time and in 42% therapy was switched to transdermal rivastigmine, mostly due to lack of tolerability (13.6%) or effectiveness (26.9%). After 4 months, 67.4% of patients were on the target dose of 9.5 mg/day and 21.8% were still on 4.6 mg/day. MMSE significantly improved in patients with and without pretreatment (ΔMMSE, 0.9 ± 3.4 and 0.8 ± 3.4, respectively, both P, 0.001); the CGI score improved in 60.9% and 61.3% of patients, respectively. Overall 11.7% of patients had AEs, mainly affecting the skin or the gastrointestinal tract; in 1.1% of cases AEs were serious; 14.7% of patients discontinued therapy, 6.0% due to AEs. With rivastigmine treatment the percentage of patients taking psychotropic comedication decreased, particularly in first-time treated rivastigmine patients (from 27.1% to 22.6%; P, 0.001). Conclusion: Results were in line with data from controlled clinical trials. Switching from any other oral acetylcholinesterase inhibitor to transdermal rivastigmine may improve cognition. © 2012 Seibert et al, publisher and licensee Dove Medical Press Ltd.
Sypniewska G.,Nicolaus Copernicus University |
Pollak J.,Nicolaus Copernicus University |
Strozecki P.,Nicolaus Copernicus University |
Camil F.,Nicolaus Copernicus University |
And 5 more authors.
American Journal of Hypertension | Year: 2014
background The mechanism that underlies the association between low 25-hydroxyvitamin D [25(OH)D] and hypertension is not well understood; it seems to involve regulation of the renin-angiotensin-aldosterone system and the impact on endothelial function, cardiac remodeling, and subclinical organ damage. Vitamin D supplementation presents an ambiguous effect on endothelial function and arterial stiffness. We assess serum 25(OH)D3, biomarkers of endothelial dysfunction (soluble intercellular adhesion molecule [sICAM], C-reactive protein [CRP], homocysteine [Hcy]) and subclinical organ damage in adults with newly diagnosed untreated hypertension. methods Patients were classified based on ambulatory blood pressure monitoring: 98 had hypertension, whereas in 60 persons BP was normal. Laboratory assays including serum 25(OH)D3, hsCRP, Hcy, sICAM, glucose, insulin, lipids, echocardiography, pulse wave velocity (PWV), intima-media thickness (IMT), and left-ventricular mass (LVM) measurements were performed. results 25(OH)D 3 was significantly lower in hypertensive patients. The logistic regression analysis indicated that 25(OH)D3 reduced the probability of hypertension occurrence after adjusting for body mass index (BMI). 25(OH)D3 in those with hypertension correlated significantly with systolic BP (SBP; r = -0.39), PWV, IMT (r = -0.33), and diastolic BP (r = -0.26). Multiple regression analysis in patients with hypertension revealed that 25(OH)D3 and sICAM accounted for up to 27% of SBP variation after adjusting for age, BMI, and smoking. 25(OH)D3 and either PWV or IMT accounted for 23% of SBP variation. The impact of 25(OH)D3 was 10%. conclusion The impact of 25(OH)D3 on SBP variation, mediated by its effect on endothelial dysfunction and subclinical organ damage, is modest but significant. © American Journal of Hypertension, Ltd 2013.
Celakovska J.,University of Hradec Kralove |
Ettlerova K.,Outpatient Clinic |
Ettler K.,University of Hradec Kralove |
Vaneckova J.,University of Hradec Kralove |
Bukac J.,University of Hradec Kralove
Journal of the European Academy of Dermatology and Venereology | Year: 2015
Background A few reports demonstrate the relationship between IgE sensitization to aeroallergens in atopic dermatitis (AD) patients and other allergic diseases and parameters. Objectives The objective of this study was to evaluate, if there is a significant relationship between the sensitization to common aeroallergens in AD patients and the occurrence of asthma bronchiale, rhinitis and other atopic parameters. Methods Sensitization to dust, mites, animal dander and bird feather was examined (skin prick test, specific IgE) and the relationship with the occurrence of asthma bronchiale, rhinitis, duration of AD, family history and onset of AD was evaluated. Results Two hundred and eighty-eight patients were examined - 90 men and 198 women. According to our results, IgE sensitization to animal dander, dust and mites may increase the risk of developing asthma or rhinitis. Persistent lesions of AD occur more often in patients with sensitization to animal dander, mites and dust. Patients with the sensitization to bird feather have the onset of AD more often above 5 years of age and in these patients, there is no relationship with the positive data about atopy in the family history. Conclusion There is a greater likelihood of developing other allergic diseases in atopic dermatitis patients who suffer from sensitisation to animal dander, mites, and dust. Thus, prompt management of atopic dermatitis and allergy to inhallant allergens that develop in early infancy may be a successful method for preventing of atopic march. © 2015 European Academy of Dermatology and Venereology.
Celakovska J.,University of Hradec Kralove |
Ettlerova K.,Outpatient Clinic |
Ettler K.,University of Hradec Kralove |
Vaneckova J.,University of Hradec Kralove
International Journal of Dermatology | Year: 2011
Objective The aim of this study was to evaluate the occurrence of egg allergy in patients over 14years old suffering from atopic eczema and especially to evaluate if egg allergy can deteriorate the course of atopic eczema in this group of patients. Materials and methods Altogether 179 patients suffering from atopic eczema were included in the study: 51 men and 128 women, with an average age of 26.2years (SD 9.5years), with median SCORAD 31.6 (SD 13.3) points. A complete allergological and dermatological examination was performed on all patients, including diagnostic work-up of food allergy to egg [skin prick tests, atopy patch tests (APTs), measurement of specific IgE level to egg yolks or whites]. Open exposure test (OET) with egg was performed in patients with positive results in some of these diagnostic methods. Food allergy to egg was determined according to positive results in the OET or according to sufficient anamnestical data about the severe allergic reaction after the ingestion of an egg. Results An allergy to egg was confirmed in 11 patients out of 179 (6%). Of these patients, only six (3.3%) had a clear improvement in the SCORAD after the elimination of egg. Other triggering factors may cause exacerbation of the atopic eczema in the patients enrolled in the study. Twenty-eight percent of patients were only sensitized to egg without clinical symptoms. ATPs were a useful tool in the diagnosis of food allergy to egg in patients without IgE reactivity. Conclusion Egg allergy may play an important role in the worsening of atopic eczema acting as a triggering-exacerbating factor in a minority of patients. The diagnostic work-up may comprise the challenge tests to confirm the food allergy to egg. © 2011 The International Society of Dermatology.
News Article | November 8, 2016
SAN ANTONIO, TX--(Marketwired - November 08, 2016) - The Department of Veterans Affairs (VA), Office of Construction and Facilities Management, Office of Real Property (ORP), Washington, DC, is conducting market research/seeking capable sources from bondable and experienced Service-Disabled Veteran-Owned Small Businesses (SDVOSBs) or Veteran-Owned Small Businesses (VOSBs) that are interested in a forecasted lease project for a 190,800 square-foot Community-Based Outpatient Clinic in San Antonio, Texas. The NAICS Code is 531120 - Lessors of Nonresidential Buildings (except Miniwarehouses), and the small business size standard is $38.5 million. The VA, in the Sources Sought notice it published on November 8, said it anticipates the construction/buildout for each project to be between $50 million and $100 million. VA makes monthly lease rental payments in arrears upon facility acceptance and may elect to make a single lump-sum payment or amortize over the course of the firm term for specified tenant improvements. VA makes no progress payments during the design or construction/build-out phases of the project. The ORP seeks information from Offerors who are capable of successfully performing a lease contract, including design and construction of the 190,800 square-foot facility, on a VA pre-approved site for a term of up to 20 years, inclusive of all options, as well as all maintenance and operation requirements for the duration of the lease term. SDVOSB and VOSB firms interested in the opportunity are invited to submit a Capabilities Statement that must include: Companies interested in this opportunity must submit their Capabilities Statement by no later than 4 p.m. EST on November 29, 2016 to LeasingSourcesSought@va.gov. To receive the contract, contractors must be registered with the System for Award Management (SAM) database, and have as part of the Registration all current Representations and Certifications. US Federal Contractor Registration, the world's largest third-party government registration firm, completes the required Registrations on behalf of its clients. It also makes available information about opportunities like this, as well as training on how to locate, research, and respond to opportunities. For more information, to get started with a SAM registration, or to learn more about how US Federal Contractor Registration can help your business succeed, call 877-252-2700, ext. 1.
PubMed | University of Bonn, Oncological Center, Hemato Oncologic Clinic, Paracelsus Medical University and 5 more.
Type: Journal Article | Journal: Clinical colorectal cancer | Year: 2016
Studies have demonstrated that body surface area-based dosing of chemotherapy drugs leads to significant individual exposure variability, with a substantial risk of under- or overdosing. The present study was initiated to validate the use of therapeutic drug management (TDM) to personalize 5-fluorouracil (5-FU) dosing in patients with metastatic colorectal cancer treated in routine clinical practice.A total of 75 patients with metastatic colorectal cancer from 8 German medical centers received 6 administrations of infusional 5-FU according to the AIO (folinate, 5-FU; n= 16), FOLFOX6 (leucovorin calcium [folinic acid], 5-FU, and oxaliplatin; n= 26), or FUFOX (oxaliplatin plus 5-FU/folinic acid; n= 33) regimen. Initial infusional 5-FU dosing for all patients was determined by the BSA. Individual 5-FU exposure (area under the curve [AUC]) was measured using an immunoassay of a blood sample taken during each infusion. To achieve a target AUC of 20 to 30 mg h/L, subsequent infusional 5-FU doses were adjusted according to the previous cycles 5-FU AUC. The primary objective was to confirm that TDM of infusional 5-FU resulted in an increased proportion of patients in the target AUC range at the fourth versus the first administration. The secondary objective was to determine whether 5-FU TDM reduced the treatment-related toxicities compared with the historical data.The average 5-FU AUC at the first administration was 18 6 mg h/L, with 64%, 33%, and 3% of the patients below, within, or above the target AUC range, respectively. By the fourth administration, the average 5-FU AUC was 25 7 mg h/L (P< .001), with 54% of patients within the target 5-FU AUC range (P= .0294). The incidence of 5-FU-related grade 3 and 4 diarrhea (4.6%), nausea (3.4%), fatigue (0.0%), and mucositis (0.2%) was reduced compared with the historical data, despite 55% of the patients receiving increased doses.Personalization of 5-FU dosing using TDM in routine clinical practice resulted in significantly improved 5-FU exposure and suggested a lower incidence of 5-FU-related toxicities.
Valdes-Stauber J.,University of Ulm |
Vietz E.,Outpatient Clinic |
Kilian R.,University of Ulm
BMC Psychiatry | Year: 2013
Background: In recent decades, increasing attention has been paid to the subjective dimension of cancer, especially to psychosocial screening procedures, major psychiatric disorders but also psychological and psychosocial distress, and finally to met needs of oncologic patients. This study aims first to describe cancer patients in a rural hospital attended by a psycho-oncological consultation-liaison team, second to assess predictors for psychological distress in cancer patients, and finally to identify predictors for recommendation of further psychosocial support.Methods: The sample (n = 290) comprises a full survey of patients at breast and bowel cancer services (n=209) and patients referred by other medical and surgical services because of psychosocial impairment (n = 81). All patients were assessed by means of the PO-Bado (Psycho-Oncological Basic Documentation) expert rating scale. Assessment of predictors for psychological distress was conducted by multivariate regression models and assessment for predictors for need for outpatient psychosocial support by a logistic regression analysis. All analyses were conducted using STATA 12.Results: Most members of the assessed sample (average age 65, 82% women) were not severely impaired from a functional and psychological point of view. A total of 14% had received psychiatric treatment before. Mood swings, anxiety, grief, and fatigue were the most important distress symptoms. Selectively referred patients vs. full survey patients of cancer centres, as well as bowel vs. breast cancer patients show a higher level of psychological and physical distress. Fatigue, assessed metastases, and functional limitations were the best predictors for psychological burden. Referral mode, gender, age, family problems, fatigue, and previous psychiatric treatment were associated with further need of psychosocial support.Conclusions: Psycho-oncological consultation and liaison services may offer support to patients in an early stage of cancer, especially in cancer centres. Because of selectively referred patients show a higher burden, the use of basic screening instruments could be meaningful. Fatigue, metastases status, and functional limitations may better predict psychological distress than pain, duration of illness, psychosocial conditions or previous psychiatric treatment. More attention has to be paid to outpatient follow-up with older cancer patients, those with family problems, and those suffering from significant fatigue. © 2013 Valdes-Stauber et al.; licensee BioMed Central Ltd.