Investigation of gastrointestinal stromal tumor (GIST) care management in GIST patients (pts) receiving short-term versus long-term imatinib (IM) adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 195-195
Author(s):  
Anthony Paul Conley ◽  
Annie Guérin ◽  
Medha Sasane ◽  
Geneviève Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Profile ◽  
Prescribing Patterns ◽  
Community Practice ◽  
Short Term ◽  
Online Data ◽  
Kit Mutation ◽  
Nccn Guidelines

195 Background: Although optimal duration of adjuvant IM therapy in Kit+ GIST pts is unknown, the NCCN guidelines recommend treatment for ≥36 months in high-risk pts based on clinical trials showing reduced risk of recurrence and mortality in pts receiving long-term adjuvant IM. The objective of this study was to investigate clinicians’ recurrence risk assessment and GIST management in patients receiving adjuvant IM for short- (6-12 months) vs. long-term (≥24 months) in community practice. Methods: GIST-related and treatment characteristic information on adult pts with primary resectable Kit+ GIST initiating IM ≤84 days after surgery (short-term: 411 pts; long-term: 408 pts) was collected from 320 U.S. oncologists using an online data collection form. In addition, physician prescribing patterns and perception of risk assessment and IM duration were collected. Results: Indicators of risk (tumor size, mitotic count, and tumor location) were significantly associated with IM treatment duration. Tumor rupture status did not impact IM duration, except when unknown, in which case pts had longer IM duration. About 50% of pts had not been tested for Kit mutation; 31% of physicians reported that it would not have changed therapy/management or were not aware of how results should have impacted GIST management. Among short-term pts for whom physicians reported a reason for IM discontinuation, main reasons included non-severe adverse events, completion of the 1-year treatment scheduled, economic constraint/health plan coverage change, and pts’ preference. Overall, 77.8% of surveyed physicians reported that pt risk profile drove their decision of continuing IM over an extended period of time. However, in practice 39.9% of the short-term pts and 48.8% of the long-term pts had a high risk profile as assessed by Fletcher classification; suggesting a lack of consistency between treatment related opinions and practice. Conclusions: These observed discrepancies highlight the need for standardization of risk assessment practices and education among community oncologists and pts.

Characteristics of gastrointestinal stromal tumor (GIST) patients receiving short-term versus long-term imatinib (IM) adjuvant therapy: A chart review analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10094-10094
Author(s):  
Annie Guerin ◽  
Anthony Paul Conley ◽  
Medha Sasane ◽  
Genevieve Gauthier ◽  
Frances Schwiep ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Clinical Information ◽  
Extended Period ◽  
Risk Profile ◽  
Prescribing Patterns ◽  
Short Term ◽  
Online Data ◽  
Chi Square ◽  
Post Surgery

10094 Background: In clinical practice, significant variability is seen in duration of adjuvant IM use. The objective of this study is to compare characteristics of GIST pts receiving adjuvant IM for a short (6-12 months) vs extended period (≥24 months) to better understand factors that may influence treatment (trt) duration decisions. Methods: Physician prescribing patterns and clinical information on adult pts with primary resectable Kit positive GIST initiating IM ≤84 days post-surgery was collected from 248 U.S. oncologists using online data collection forms. In addition to physicians’ perception of short- vs long-term use, pts’ risk assessment, trt, demographics, and comorbidities were collected for 246 short-term and 395 long-term IM pts. Characteristics were compared using Wilcoxon and Chi-square tests. Results: While pts were similar in age [59.0 vs. 58.1, P =.23], ethnicity, and region of residence, the short-term group included fewer males (57.7% vs 69.6%, P <.01) and had a higher prevalence of cardiovascular (11.4% vs 5.8%, P = .01) and ischemic heart diseases (5.3% vs 1.5%, P<.01). Differences were also observed in indicators of pre-treatment risk profile (tumor size, location, and rupture during surgery, mitotic count, and Miettinen score) (Table). Findings were consistent with main reasons reported by physicians for prescribing adjuvant IM over longer duration; in addition to pt risk profile (76.6%), tolerability (70.6%), younger pts (59.7%), safety (39.1%), trt response (29.8%), and economic reasons (26.2%) were other reasons impacting trt decisions. Conclusions: Pt risk is an important factor in physicians’ decisions to prescribe adjuvant IM for extended duration. However, age, tolerability, and comorbidities, also play an important role. [Table: see text]

scholarly journals Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
R Zhang ◽  
ZX Cai ◽  
KF Dou
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
Short Term ◽  
Bleeding Events ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the benefits and risks of extended-term (&gt;12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT &gt; 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction &gt; 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

scholarly journals Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy

2019 ◽  
Vol 17 (12) ◽  
pp. 1497-1504
Author(s):  
Lucas K. Vitzthum ◽  
Chris Straka ◽  
Reith R. Sarkar ◽  
Rana McKay ◽  
J. Michael Randall ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Short Term ◽  
Combined Androgen Blockade ◽  
Significant Difference ◽  
Androgen Blockade

Background: The addition of androgen deprivation therapy to radiation therapy (RT) improves survival in patients with intermediate- and high-risk prostate cancer (PCa), but it is not known whether combined androgen blockade (CAB) with a gonadotropin-releasing hormone agonist (GnRH-A) and a nonsteroidal antiandrogen improves survival over GnRH-A monotherapy. Methods: This study evaluated patients with intermediate- and high-risk PCa diagnosed in 2001 through 2015 who underwent RT with either GnRH-A alone or CAB using the Veterans Affairs Informatics and Computing Infrastructure. Associations between CAB and prostate cancer–specific mortality (PCSM) and overall survival (OS) were determined using multivariable regression with Fine-Gray and multivariable Cox proportional hazards models, respectively. For a positive control, the effect of long-term versus short-term GnRH-A therapy was tested. Results: The cohort included 8,423 men (GnRH-A, 4,529; CAB, 3,894) with a median follow-up of 5.9 years. There were 1,861 deaths, including 349 resulting from PCa. The unadjusted cumulative incidences of PCSM at 10 years were 5.9% and 6.9% for those receiving GnRH-A and CAB, respectively (P=.16). Compared with GnRH-A alone, CAB was not associated with a significant difference in covariate-adjusted PCSM (subdistribution hazard ratio [SHR], 1.05; 95% CI, 0.85–1.30) or OS (hazard ratio, 1.02; 95% CI, 0.93–1.12). For high-risk patients, long-term versus short-term GnRH-A therapy was associated with improved PCSM (SHR, 0.74; 95% CI, 0.57–0.95) and OS (SHR, 0.82; 95% CI, 0.73–0.93). Conclusions: In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone.

Fathers' Hospital Visits to Their Preterm Infants as a Predictor of Father-Infant Relationship and Infant Development

PEDIATRICS ◽  
1990 ◽  
Vol 86 (2) ◽  
pp. 289-293
Author(s):  
Rachel Levy-Shiff ◽  
Michael A. Hoffman ◽  
Salli Mogilner ◽  
Susan Levinger ◽  
Mario B. Mogilner
Keyword(s):  
Weight Gain ◽  
Longitudinal Study ◽  
High Risk ◽  
Preterm Infants ◽  
Infant Development ◽  
Short Term ◽  
Development Data ◽  
Hospital Visits

This short-term longitudinal study assessed the degree to which the frequency of fathers' visits with their preterm infants in the hospital was associated with the quality of ongoing and long-term fathering and infant development. Data on fathering and infant development were collected during the hospital stay, at discharge, at 8 months of age, and at 18 months of age, using both questionnaires and observational schedules. The frequency of visits was significantly correlated with more extensive and positive patterns of fathering at discharge and later periods. It was also associated with more positive perceptions of the infant, as well as with weight gain during hospitalization and psychosocial aspects of later infant development during the first 18 months. The discussion emphasized possible ways in which early paternal contact in the hospital might influence fathers, mothers, and infants. The frequency of paternal visits was highlighted as a variable useful in predicting high-risk parenting.

PD66-05 USE OF INTRAOPERATIVE MANNITOL DURING PARTIAL NEPHRECTOMY FAILS TO PROVIDE SHORT-TERM OR LONG-TERM RENAL FUNCTION BENEFIT – EVEN IN HIGH RISK POPULATIONS

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Jeremy Reese ◽  
Julein Dagenais ◽  
Matthew Maurice ◽  
Pascal Mouracade ◽  
Onder Kara ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Partial Nephrectomy ◽  
Short Term ◽  
High Risk Populations

scholarly journals Fetal Vibroacoustic Stimulation in Computerized Cardiotocographic Analysis: The Role of Short-Term Variability and Approximate Entropy

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Maria Laura Annunziata ◽  
Mariamaddalena Scala ◽  
Natascia Giuliano ◽  
Salvatore Tagliaferri ◽  
Olga Carmela Maria Imperato ◽  
...  
Keyword(s):  
High Risk ◽  
Perinatal Outcomes ◽  
Approximate Entropy ◽  
Computer Assisted ◽  
Short Term ◽  
Fetal Movements ◽  
The Impact ◽  
Short Term Variability

The aim of this study was to evaluate the impact of vibroacoustic stimulation (VAS) on computerized cardiotocography short-term variability (STV) and approximate entropy (ApEn) in both low- and high-risk pregnancies. VAS was performed on 121 high- and 95 low-risk pregnancies after 10 minutes of continuous quiet, while their FHR parameters were monitored and recorded by cCTG analysis. Fetal heart rate was recorded using a computer-assisted equipment. Baseline FHR, accelerations, decelerations, STV, long-term irregularity (LTI), ApEn, and fetal movements (FMs) were calculated for defined observational periods before VAS and after 10 minutes. Data were also investigated in relationship with the perinatal outcome. In each group of patients, FHR after VAS remained almost unmodified. Fetal movements significantly increased after VAS in both groups. Results show that only in the high-risk pregnancies, the increase of STV and the decrease of ApEn after VAS were significantly associated with favorable perinatal outcomes.

Introduction

2017 ◽  
Author(s):  
Igor Galynker
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Suicide Risk ◽  
Assessment Methods ◽  
Suicidal Patient ◽  
Clinical Settings ◽  
Short Term ◽  
Imminent Risk ◽  
Intended Use

One of the most difficult determinations a psychiatrist makes is whether the chronically suicidal patient is at risk for imminent suicide. The Introduction presents the challenges of the imminent risk assessment and explains the purpose of The Suicidal Narrative—the first clinical guide to such an assessment. It introduces the distinction between long-term and short-term suicide risk, highlights the lack of structured instruments for imminent risk assessment, and discusses the advantages of multimodal and multi-informant assessment methods. It then describes intended uses of the guide, lists its inherent limitations, and identifies possible areas of unintended misuse. The Introduction concludes by naming the main intended use of The Suicidal Narrative: as a roadmap for a comprehensive assessment of imminent suicide risk in diverse clinical settings.

Time preference and the life cycle: The logic of long-term high risk vs. short-term low risk

1989 ◽  
Vol 38 (3) ◽  
pp. 329-349 ◽  
Author(s):  
Robert U. Ayres ◽  
Shunsuke Mori
Keyword(s):  
Life Cycle ◽  
High Risk ◽  
Time Preference ◽  
Low Risk ◽  
Short Term

NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019

2019 ◽  
Vol 17 (9) ◽  
pp. 1032-1041 ◽  
Author(s):  
Samir Gupta ◽  
Dawn Provenzale ◽  
Xavier Llor ◽  
Amy L. Halverson ◽  
William Grady ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Hereditary Colorectal Cancer ◽  
Cancer Surveillance ◽  
Nccn Guidelines ◽  
Hereditary Syndromes ◽  
Hereditary Colorectal Cancer Syndromes ◽  
Cancer Syndromes ◽  
Familial High Risk

Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.

Sign in / Sign up

Export Citation Format

Share Document