scholarly journals Neoadjuvant cryotherapy improves dysphagia and may impact remission rates in advanced esophageal cancer

2019 ◽  
Vol 07 (11) ◽  
pp. E1522-E1527 ◽  
Author(s):  
Tilak Shah ◽  
Vladimir Kushnir ◽  
Pritesh Mutha ◽  
Mankanchan Majhail ◽  
Bhaumik Patel ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Advanced Cancer ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Synergistic Effects ◽  
Locally Advanced ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Dysphagia Score ◽  
Locally Advanced Cancer

Abstract Background and study aims Liquid nitrogen spray cryotherapy (LNSC) can provide rapid dysphagia relief, and is postulated to stimulate a local antitumor immune response. The aim of this prospective pilot clinical trial was to evaluate the safety and efficacy of LNSC when administered prior to chemoradiotherapy. Patients and methods Treatment-naïve adult patients with dysphagia at the time of biopsy-proven squamous carcinoma or adenocarcinoma of the esophagus were prospectively enrolled at two tertiary medical centers. Patients underwent a single session of LNSC. The primary outcome measure was change in dysphagia at 1 and 2 weeks post-cryotherapy. A secondary outcome measure was clinical complete response rate (CR) following chemoradiotherapy. Results Twenty-five patients were screened, of whom 21 patients were eligible and enrolled. There were seven with metastatic and 14 with locally advanced cancer. The primary outcome of dysphagia improvement of ≥ 1 point occurred in 15/21 patients (71 %) at 1 week, and 10/20 patients (50 %) at 2 weeks. The median dysphagia score improved by 1 at 1 week (P = 0.0003), and 0.5 at 2 weeks (P = 0.02). Six of nine patients (67 %) with locally advanced cancer who completed chemoradiation did not have residual tumor cells on mucosal biopsy, and five of nine patients (56 %) had a clinical CR. There were no serious cryotherapy-related complications. Conclusions LNSC provided safe and effective palliation for esophageal cancer patients who presented with dysphagia at index diagnosis. Its combination with chemoradiotherapy did not lead to any serious toxicity. Our study provides a scientific rationale for pursuing larger clinical trials addressing synergistic effects of combining LNSC with chemoradiation.

scholarly journals Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial

BMJ ◽  
2021 ◽  
pp. m4903
Author(s):  
James O’Hara ◽  
Deborah D Stocken ◽  
Gillian C Watson ◽  
Tony Fouweather ◽  
Julian McGlashan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Randomised Trial ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Double Blind ◽  
Significant Difference

Abstract Objective To assess the use of proton pump inhibitors (PPIs) to treat persistent throat symptoms. Design Pragmatic, double blind, placebo controlled, randomised trial. Setting Eight ear, nose, and throat outpatient clinics, United Kingdom. Participants 346 patients aged 18 years or older with persistent throat symptoms who were randomised according to recruiting centre and baseline severity of symptoms (mild or severe): 172 to lansoprazole and 174 to placebo. Intervention Random blinded allocation (1:1) to either 30 mg lansoprazole twice daily or matched placebo twice daily for 16 weeks. Main outcome measures Primary outcome was symptomatic response at 16 weeks measured using the total reflux symptom index (RSI) score. Secondary outcomes included symptom response at 12 months, quality of life, and throat appearances. Results Of 1427 patients initially screened for eligibility, 346 were recruited. The mean age of the study sample was 52.2 (SD 13.7) years, 196 (57%) were women, and 162 (47%) had severe symptoms at presentation; these characteristics were balanced across treatment arms. The primary analysis was performed on 220 patients who completed the primary outcome measure within a window of 14-20 weeks. Mean RSI scores were similar between treatment arms at baseline: lansoprazole 22.0 (95% confidence interval 20.4 to 23.6) and placebo 21.7 (20.5 to 23.0). Improvements (reduction in RSI score) were observed in both groups—score at 16 weeks: lansoprazole 17.4 (15.5 to19.4) and placebo 15.6 (13.8 to 17.3). No statistically significant difference was found between the treatment arms: estimated difference 1.9 points (95% confidence interval −0.3 to 4.2 points; P=0.096) adjusted for site and baseline symptom severity. Lansoprazole showed no benefits over placebo for any secondary outcome measure, including RSI scores at 12 months: lansoprazole 16.0 (13.6 to 18.4) and placebo 13.6 (11.7 to 15.5): estimated difference 2.4 points (−0.6 to 5.4 points). Conclusions No evidence was found of benefit from PPI treatment in patients with persistent throat symptoms. RSI scores were similar between the lansoprazole and placebo groups after 16 weeks of treatment and at the 12 month follow-up. Trial registration ISRCTN Registry ISRCTN38578686 and EudraCT 2013-004249-17.

scholarly journals Combining technology and research to prevent scald injuries: results from Cool Runnings randomised controlled trial (Preprint)

2018 ◽  
Author(s):  
Jacqueline Burgess ◽  
Kerrianne Watt ◽  
Roy M Kimble ◽  
Cate M Cameron
Keyword(s):  
Social Media ◽  
Young Children ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
First Aid ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Test

BACKGROUND New technologies, widespread availability of the internet, the rise of social media and increased ownership of smartphones provide new opportunities for health researchers to communicate and engage with target audiences. OBJECTIVE This new technology was used to recruit mothers of young children to a smartphone application (app) to increase their knowledge about childhood burns (specifically hot beverage scalds) and correct burn first-aid. This six-month intervention deployed on the Cool Runnings app, used gamification techniques to reinforce intervention messages and engage participants. METHODS A two-group, parallel, single blinded, randomized controlled trial (RCT) to evaluate the efficacy of a smartphone app-based burn prevention intervention. Participants were women aged 18+, living in Queensland, Australia, with at least one child aged 5-12 months at the time of enrolment. The primary outcome measure was change in knowledge around burn risk and correct burn first-aid assessed via two methods: overall score; and categorised as adequate (score =4) vs inadequate (score less than 4). The secondary outcome measure was the efficacy of gamification techniques (measured by: app opens, photo uploads, pop quiz completions and content views). RESULTS In total, 498 participants were recruited via social media and enrolled. At 6-month follow-up, 244 participants completed the post-test questionnaire. Attrition rates in both groups were similar. Participants who remained in the study did not differ from those who were lost to follow up on any characteristics except for education level. Although similar at baseline, intervention group participants achieved significantly greater improvement in overall knowledge post-test than control group participants on both primary outcome measures (overall knowledge intervention: mean=2.68± 1.00 vs control mean:2.13±1.03; intervention: 20.47% adequate vs control: 7.3%). Consequently, the NNT was 7.46. Logistic regression showed participants exposed to the highest level of disadvantage were 7.3 times more likely to improve overall knowledge scores than participants in other levels of disadvantage. There were also significant correlations between each of the four gamification techniques and knowledge change (p<0.001). In addition, participants with low/moderate ‘app activity’ were 8.59 times more likely to have improved knowledge between baseline and 6-month follow-up than those who had no app activity (95%CI=2.9-25.02); participants with high app activity were 18.26 times more likely to have improved knowledge (95%CI=7.1-46.8). CONCLUSIONS Despite substantial loss to follow-up, this RCT demonstrates the Cool Runnings app was an effective intervention for improving knowledge about hot beverage scald risks and burn first-aid in mothers of young children. The benefits of combining gamification elements in the intervention were also highlighted. Given the low cost and large reach of smartphone apps to deliver content to, and engage with targeted populations, results from this RCT provides important information on how smartphone applications can be used for widespread injury prevention campaigns, and public health campaigns generally. CLINICALTRIAL This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000019404)

Hypokalemia Measurement and Management in Patients With Status Asthmaticus on Continuous Albuterol

2022 ◽  
Author(s):  
Courtney Cox ◽  
Krishna Patel ◽  
Rebecca Cantu ◽  
Chary Akmyradov ◽  
Katherine Irby
Keyword(s):  
Potassium Level ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Status Asthmaticus ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Treatment Frequency ◽  
Care Costs

OBJECTIVE: Status asthmaticus is commonly treated in pediatric patients by using continuous albuterol, which can cause hypokalemia. The primary aim of this study was to determine if serial potassium monitoring is necessary by examining treatment frequency of hypokalemia. METHODS: This retrospective analysis was performed in 185 pediatric patients admitted with status asthmaticus requiring continuous albuterol between 2017 and 2019. All patients were placed on intravenous fluids containing potassium. The primary outcome measure was the treatment of hypokalemia in relation to the number of laboratory draws for potassium levels. The secondary outcome measure was hypokalemia frequency and relation to the duration and initial dose of continuous albuterol. RESULTS: Included were 156 patients with 420 laboratory draws (average, 2.7 per patient) for potassium levels. The median lowest potassium level was 3.40 mmol/L (interquartile range, 3.2–3.7). No correlation was found between initial albuterol dose and lowest potassium level (P = .52). Patients with hypokalemia had a mean albuterol time of 12.32 (SD, 15.76) hours, whereas patients without hypokalemia had a mean albuterol time of 11.50 (SD, 12.53) hours (P = .29). Potassium levels were treated 13 separate times. CONCLUSIONS: The number of laboratory draws for potassium levels was high in our cohort, with few patients receiving treatment for hypokalemia beyond the potassium routinely added to maintenance fluids. Length of time on albuterol and dose of albuterol were not shown to increase the risk of hypokalemia. Serial laboratory measurements may be decreased to potentially reduce health care costs, pain, and anxiety surrounding needlesticks.

Hwangryunhaedogtang (Huanglianjiedutang) Treatment for Pathological Laughter after Stroke and Importance of Patterns Identification: A Preliminary Study

2007 ◽  
Vol 35 (05) ◽  
pp. 725-733 ◽  
Author(s):  
Sang Pil Yun ◽  
Woo Sang Jung ◽  
Sung Uk Park ◽  
Sang Kwan Moon ◽  
Jung Mi Park ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Post Stroke ◽  
Pathological Laughter ◽  
Group A ◽  
Preliminary Study ◽  
Group B

This study was to test the importance of patterns identification (PI) and the effectiveness of Hwangryunhaedogtang (Huanglianjiedutang) (HT) treatment for patients with post stroke pathological laughter (PL). Fourteen subjects were enrolled. Eight subjects diagnosed with Yang Excess patterns (YEP) were assigned into group A and 6 subjects who had no YEP to group B. HT was administrated 3 times a day for 14 days to both groups. The duration of PL at one time, the frequency of PL in a day, and pathological laughter scale (PLS) were the primary outcome measures. Barthel index (BI) was the secondary outcome measure. The duration and the frequency of PL in group A were significantly decreased from 10.88 ± 4.67 to 6.63 ± 4.07 sec and from 6.38 ± 2.72 to 3.00 ± 1.77 times, respectively (p = 0.01) after 14 days administration of HT. PLS in group A was also significantly lowered from 9.13 ± 1.73 to 4.75 ± 0.71 points (p = 0.01). However, significant differences were not observed in BI in group A and in the primary and secondary outcome measures in group B. The duration and the frequency of PL and PLS were more markedly reduced in group A than in group B (p = 0.01, 0.02, and < 0.01, respectively). These results suggested that HT could be effective on subjects with post stroke PL diagnosed as YEP and PI, that prescription of herbal medications to such patients should be considered.

scholarly journals Dosimetric Comparison between High Dose Rate Brachytherapy Boost and Volumetric Arc Therapy Boost in Locally Advanced Cancer Cervix

2021 ◽  
Vol 07 (02) ◽  
pp. 085-088
Author(s):  
Hanady Hegazy ◽  
Neamat Hegazy ◽  
Maher Soliman ◽  
Amr Elsaid
Keyword(s):  
Small Bowel ◽  
Dose Rate ◽  
Advanced Cancer ◽  
Locally Advanced ◽  
Target Volume ◽  
High Dose Rate ◽  
High Dose ◽  
Cancer Cervix ◽  
Arc Therapy ◽  
Locally Advanced Cancer

AbstractConcurrent chemoradiotherapy is considered the standard treatment for the locally advanced cancer cervix (LACC). Radiotherapy is commonly administered by a three-dimensional conformal radiotherapy (3DCRT) approach followed by brachytherapy (BT). High dose rate (HDR) BT is commonly administered; however, several drawbacks exist including invasive technique, pain, requirement of anesthesia, and operative risks. We assessed the dosimetric difference between the HDR BT and the volumetric modulated arc therapy (VMAT) boost in those patients. Ten patients were selected retrospectively with LACC and all received whole pelvis radiotherapy followed by BT boost of 7 Gy in three fractions. The computed tomography (CT) image was transferred to the Varian system for the VMAT plan while the one with the applicator was transferred to the Sagi planning system and the high-risk clinical target volume (HR-CTV), bladder, rectum, sigmoid, and small bowel were delineate with a margin of 5 mm were added to the CTV to create the planning target volume (PTV). The D90 for the PTV in VMAT boost was lower than received by the HR-CTV in the BT boost. Mean volume of the PTV was higher than that of the HR-CTV. The D2cc was higher in VMAT for bladder, sigmoid, and rectum while the D2cc for the small bowel in BT was higher compared with the VMAT. The VMAT is an option that exists for patients who refuse BT or cannot tolerate it, or in case of nonavailability of BT or a nonworking machine.

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

scholarly journals Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

2021 ◽  
Vol 3 ◽  
Author(s):  
Moa Jederström ◽  
Sara Agnafors ◽  
Christina Ekegren ◽  
Kristina Fagher ◽  
Håkan Gauffin ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Sports Injury ◽  
Young Female ◽  
Older Age ◽  
Point Prevalence ◽  
Severe Injury ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Multiple Model ◽  
Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss &gt;21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p &lt; 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

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