Almotriptan in Triptan-Naïve Patients: New Evidence of Benefits

Cephalalgia ◽  
2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 14-20 ◽  
Author(s):  
J Pascual
Keyword(s):  
Treatment Plan ◽  
Symptom Control ◽  
Standard Of Care ◽  
Time Interval ◽  
Inadequate Response ◽  
Stratified Care ◽  
Care Approach ◽  
Step Care ◽  
Step Care Approach ◽  
Post Hoc

Although triptans represent the standard of care for migraine that is severe, disabling and/or suboptimally responsive to migraine non-specific analgesia, they are often underused in clinical practice. Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to triptans at the end of the traditional ‘step-care’ approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical ‘trial-and-error’ search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are triptan candidates. The alternative approach of ‘stratified care’, in which medication is prescribed according to the severity of symptoms, enables triptans to be used earlier in the treatment plan, especially when triptan candidates are given a choice between simple analgesic/NSAID and triptan medication from the start. This raises the question about the efficacy of triptans in triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of almotriptan 12.5 mg in TN patients ( n = 342) with that in triptan-experienced patients ( n = 237). Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of almotriptan in TN patients, notably for sustained pain freedom (SPF) and SPF plus no adverse events. Moreover, both headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific analgesia to treatment with almotriptan and support the earlier use of triptans in line with the stratified care paradigm.

Overview: The allergic reaction and site-based therapy

1992 ◽  
Vol 107 (6_part_2) ◽  
pp. 828-830 ◽  
Author(s):  
Richard L. Mabry
Keyword(s):  
Allergic Reaction ◽  
Environmental Control ◽  
Allergic Patient ◽  
Control Measures ◽  
Rational Approach ◽  
Upper Respiratory Tract ◽  
Mediators Of Inflammation ◽  
Care Approach ◽  
Step Care ◽  
Step Care Approach

The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step-care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well-known symptoms of allergic rhinitis. Treatment should consist of a step-wise, rational approach that includes site-based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.

Hypertension: Current Trends and Choices in Pharmacotherapeutics

1992 ◽  
Vol 3 (2) ◽  
pp. 507-526
Author(s):  
Judith Hopfer Deglin ◽  
Stuart Deglin
Keyword(s):  
Health Care Professionals ◽  
Organ Damage ◽  
Emergency Situations ◽  
Current Trends ◽  
Care Approach ◽  
Step Care ◽  
Hypertensive Crises ◽  
Step Care Approach ◽  
Special Patient

Many new choices exist in the management of hypertension. Armed with a basic understanding of the definition and causes of hypertension, the pharmacotherapeutics, and special patient populations, health care professionals should be able to optimally educate, treat, and follow up patients with hypertension. In the step-care approach, four different classes of agents may be used as Step 1 choices. Selection is determined by concurrent illnesses, patient age, or concomitant drug therapy. In emergency situations, additional choices exist. Tailoring therapy in hypertensive crises may prevent or minimize end-organ damage. These areas are reviewed, and guidelines for patient assessment and education are presented

scholarly journals Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients

2021 ◽  
Author(s):  
Frederik L. Giesel ◽  
Clemens Kratochwil ◽  
Joel Schlittenhardt ◽  
Katharina Dendl ◽  
Matthias Eiber ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Standard Of Care ◽  
Blood Pool ◽  
Tracer Uptake ◽  
Time Interval ◽  
Tumor Uptake ◽  
Primary Tumors ◽  
Individual Comparison ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Purpose FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of 68Ga-FAPI versus standard-of-care 18F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. Material and Methods This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both 68Ga-FAPI and 18F-FDG PET/CT within a median time interval of 10 days (range 1–89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). Results A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. 68Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for 68Ga-FAPI than 18F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, 68Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. Conclusion Quantitative tumor uptake is comparable between 68Ga-FAPI and 18F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for 68Ga-FAPI. Thus, 68Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological 18F-FDG uptake.

scholarly journals Factors Influencing Care Pathways for Breast and Prostate Cancer in a Hospital Setting

2021 ◽  
Vol 18 (15) ◽  
pp. 7913
Author(s):  
Ornela Bardhi ◽  
Begonya Garcia-Zapirain ◽  
Roberto Nuño-Solinis
Keyword(s):  
Prostate Cancer ◽  
Treatment Plan ◽  
Specific Antigen ◽  
Hospital Setting ◽  
Care Pathways ◽  
Health Records ◽  
Care Processes ◽  
Care Approach ◽  
Centered Care ◽  
Breast And Prostate Cancer

Breast cancer (BCa) and prostate cancer (PCa) are the most prevalent types of cancers. We aimed to understand and analyze the care pathways for BCa and PCa patients followed at a hospital setting by analyzing their different treatment lines. We evaluated the association between different treatment lines and the lifestyle and demographic characteristics of these patients. Two datasets were created using the electronic health records (EHRs) and information collected through semi-structured one-on-one interviews. Statistical analysis was performed to examine which variable had an impact on the treatment each patient followed. In total, 83 patients participated in the study that ran between January and November 2018 in Beacon Hospital. Results show that chemotherapy cycles indicate if a patient would have other treatments, i.e., patients who have targeted therapy (25/46) have more chemotherapy cycles (95% CI 4.66–9.52, p = 0.012), the same is observed with endocrine therapy (95% CI 4.77–13.59, p = 0.044). Patients who had bisphosphonate (11/46), an indication of bone metastasis, had more chemotherapy cycles (95% CI 5.19–6.60, p = 0.012). PCa patients with tall height (95% CI 176.70–183.85, p = 0.005), heavier (95% CI 85.80–99.57, p < 0.001), and a BMI above 25 (95% CI 1.85–2.62, p = 0.017) had chemotherapy compared to patients who were shorter, lighter and with BMI less than 25. Initial prostate-specific antigen level (PSA level) indicated if a patient would be treated with bisphosphonate or not (95% CI 45.51–96.14, p = 0.002). Lifestyle variables such as diet (95% CI 1.46–1.85, p = 0.016), and exercise (95% CI 1.20–1.96, p = 0.029) indicated that healthier and active BCa patients had undergone surgeries. Our findings show that chemotherapy cycles and lifestyle for BCa, and tallness and weight for PCa may indicate the rest of treatment plan for these patients. Understanding factors that influence care pathways allow a more person-centered care approach and the redesign of care processes.

scholarly journals Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion

Stroke ◽  
2021 ◽  
Author(s):  
Ghada A. Mohamed ◽  
Hassan Aboul Nour ◽  
Raul G. Nogueira ◽  
Mahmoud H. Mohammaden ◽  
Diogo C. Haussen ◽  
...  
Keyword(s):  
Scale Score ◽  
Standard Of Care ◽  
The United States ◽  
Outcome Data ◽  
Large Vessel ◽  
Time Interval ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Previously Treated

Background and Purpose: Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO. Methods: This is a retrospective multicenter cohort of patients who underwent rMT at 6 tertiary institutions in the United States between March 2016 and March 2020. Procedural, imaging, and outcome data were evaluated. Outcome at discharge was evaluated using the modified Rankin Scale. Results: Of 3059 patients treated with MT during the study period, 56 (1.8%) underwent at least 1 rMT. Fifty-four (96%) patients were analyzed; median age was 64 years. The median time interval between index MT and rMT was 2 days; 35 of 54 patients (65%) experienced recurrent LVO during the index hospitalization. The mechanism of stroke was cardioembolism in 30 patients (56%), intracranial atherosclerosis in 4 patients (7%), extracranial atherosclerosis in 2 patients (4%), and other causes in 18 patients (33%). A final TICI recanalization score of 2b or 3 was achieved in all 54 patients during index MT (100%) and in 51 of 54 patients (94%) during rMT. Thirty-two of 54 patients (59%) experienced recurrent LVO of a previously treated artery, mostly the pretreated left MCA (23 patients, 73%). Fifty of the 54 patients (93%) had a documented discharge modified Rankin Scale after rMT: 15 (30%) had minimal or no disability (modified Rankin Scale score ≤2), 25 (50%) had moderate to severe disability (modified Rankin Scale score 3–5), and 10 (20%) died. Conclusions: Almost 2% of patients treated with MT experience recurrent LVO, usually of a previously treated artery during the same hospitalization. Repeat MT seems to be safe and effective for attaining vessel recanalization, and good outcome can be expected in 30% of patients.

Abstract T P276: Transient Ischemic Attack Clinic Drives Superior Patient Outcomes While Reducing Cost

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jim Woodard ◽  
Shelby Haschker
Keyword(s):  
Average Cost ◽  
Treatment Plan ◽  
Cost Effective ◽  
Clinic Visit ◽  
Fiscal Year ◽  
Time Interval ◽  
Short Time Interval ◽  
Emergency Rooms ◽  
High Satisfaction ◽  
Ischemic Attack

It is estimated that 40% of all individuals that experience a TIA will ultimately suffer a stroke. As many as 50% of these patients will have a stroke within one week post TIA. Given the short time interval between TIA symptomology and stroke onset, immediate treatment is warranted. Historically treatment of TIA patients has taken place in emergency rooms and as hospital inpatients. A TIA clinic was established in 2011 as an alternative option to traditional TIA treatment. This clinic was designed to expedite diagnosis and treatment while reducing cost. Utilizing the ABCD2 tool, emergency department clinicians, PCPs and ophthalmologists referred low risk patients to the clinic. Clinic patients were scheduled to be seen in the clinic within 24-48 hours. All testing, stroke/TIA education, neurological consultation and secondary treatment plan were completed during the clinic visit. To date, the clinic has evaluated 137 patients. There have been no reports of stroke 90-days post clinic visit. Stroke rates post TIA are estimated to be as high as 17% after 3 months. This data supports the TIA clinic’s success in secondary stroke prevention. Patients seen in the clinic reported high satisfaction scores with the clinic and the care they received. It was initially hypothesized that the TIA clinic would provide care in a more cost effective way. A cost analysis was performed comparing TIA clinic costs and the cost of treating patients admitted to the hospital. Using fiscal year 2014 data, the average cost for treating a patient in the clinic was $423. The average cost for admitting a patient to the hospital was $1,464 per patient. The TIA clinic has shown that patients can receive timely treatment in a setting that produces the highest clinical outcomes, maintains patient satisfaction and reduces cost by 70%.

Perinatal palliative care

2021 ◽  
pp. 325-331
Author(s):  
Áine Ni Laoire ◽  
Daniel Nuzum ◽  
Maeve O’Reilly ◽  
Marie Twomey ◽  
Keelin O’Donoghue ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Management Strategies ◽  
Models Of Care ◽  
Multidisciplinary Teams ◽  
Care Approach ◽  
Perinatal Palliative Care ◽  
Limiting Condition ◽  
Multidisciplinary Model ◽  
Bereavement Care

Perinatal palliative care (PNPC) is a holistic multidisciplinary model of care for both baby and family in the event of a perinatal diagnosis of a life-limiting condition. It aims to provide optimal symptom control and end-of-life care to the baby as well as specialized support to families from diagnosis through to birth, death, and bereavement. This chapter aims to address the challenging clinical, ethical, and practical issues specific to perinatal palliative care. It describes antenatal life-limiting diagnoses, the role of anticipatory bereavement care, a palliative care approach to pregnancy, and outlines the complex planning and models of care required to optimally provide for the baby, mother, and family throughout. This chapter ultimately aims to provide management strategies to guide multidisciplinary teams (MDT) to deliver high-quality PNPC to the family as a whole.

Sign in / Sign up

Export Citation Format

Share Document