Is “Failure to treat” a Treatment failure?

Over-servicing in dentistry has been widely reported on and censured due to the potential physical, social and financial harms it can cause a patient. In contrast, under-treatment is less often noticed or raised as a concern as it seldom presents with overt signs of carelessness or disregard. In addition, it is usually not accompanied by any time or financial burdens, thus patients rarely complain about it. While some practitioners may argue that failure to treat is a form of negligence, this paper will explore if, and when it could be justified. While practitioners may never reach a consensus agreement, the ultimate message is that all treatment should be patient centred and should only commence following their educated, considered, autonomous, and voluntary consent.

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Association Between NR3C1 Mutations and Glucocorticoid Resistance in Children With Acute Lymphoblastic Leukemia

Frontiers in Pharmacology ◽

10.3389/fphar.2021.634956 ◽

2021 ◽

Vol 12 ◽

Author(s):

Haiyan Liu ◽

Ziping Li ◽

Fei Qiu ◽

Chunjie Li ◽

Xiaojing Lin ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Treatment Failure ◽

Lymphoblastic Leukemia ◽

Critical Role ◽

Dominant Negative ◽

Dominant Negative Effect ◽

Newly Diagnosed ◽

Loss Of Function ◽

Negative Effect ◽

All Treatment

Treatment outcomes in children with acute lymphoblastic leukemia (ALL) have been improved substantially, with a cure rate exceeding 80% using conventional therapy. However, the outcome for patients with relapsed/refractory ALL remains unsatisfactory, despite the fact that these patients generally receive more intense therapy. Glucocorticoid (GC) resistance is a leading cause of treatment failure and relapse in ALL. Abnormal NR3C1 transcription and/or translation is strongly associated with GC resistance, but the underlying molecular mechanism and the clinical value of NR3C1 alterations with GC resistance in ALL treatment remain unclear. This study applied panel sequencing to 333 newly diagnosed and 18 relapsed ALL samples to characterize the link between NR3C1 and ALL further. We identified NR3C1 mutations in three patients with newly diagnosed ALL (0.9%) and two patients with relapsed ALL (11.1%). Functional analyses revealed that four of these five NR3C1 mutations (p. R477H, p. Y478C, p. P530fs, and p. H726P) were loss-of-function (LoF) mutations. A drug sensitivity test further showed that LoF NR3C1 mutations influence GC resistance. Saturated mutagenesis of hotspot R477 demonstrated the importance of this residue for NR3C1 function. The dominant-negative effect of p. R477C and p. R477S and the non-dominant negative effect of p. R477H and p. Y478C suggests multiple mechanisms underlying GC resistance. Thus, primary or acquired genomic lesions in NR3C1 may play a critical role in GC resistance and contribute to ALL treatment failure and/or relapse.

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MRSA Common In Diabetic Foot Treatment Failure

Skin & Allergy News ◽

10.1016/s0037-6337(06)71667-9 ◽

2006 ◽

Vol 37 (11) ◽

pp. 32

Author(s):

Doug Brunk

Keyword(s):

Treatment Failure ◽

Diabetic Foot

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Atopy Treatment Failure? Consider Adherence

Skin & Allergy News ◽

10.1016/s0037-6337(10)70397-1 ◽

2010 ◽

Vol 41 (11) ◽

pp. 32

Author(s):

ROBERT FINN

Keyword(s):

Treatment Failure

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Risk Factors of Treatment Failure in Community Acquired Pneumonia: Implications for Disease Outcome

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70154-3 ◽

2006 ◽

Vol 2006 ◽

pp. 190-191

Author(s):

J.R. Maurer

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Community Acquired Pneumonia ◽

Disease Outcome

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Minimizing Carry-Over Effects After Treatment Failure and Maximizing Therapeutic Outcome

Zeitschrift für Psychologie ◽

10.1027/2151-2604/a000180 ◽

2014 ◽

Vol 222 (3) ◽

pp. 171-178 ◽

Cited By ~ 3

Author(s):

Mareile Hofmann ◽

Nathalie Wrobel ◽

Simon Kessner ◽

Ulrike Bingel

Keyword(s):

Treatment Failure ◽

Human Subjects ◽

Subsequent Treatment ◽

Clinical Samples ◽

Administration Route ◽

Healthy Human ◽

Negative Experiences ◽

Analgesic Treatment ◽

Balanced Design ◽

Carry Over

According to experimental and clinical evidence, the experiences of previous treatments are carried over to different therapeutic approaches and impair the outcome of subsequent treatments. In this behavioral pilot study we used a change in administration route to investigate whether the effect of prior treatment experience on a subsequent treatment depends on the similarity of both treatments. We experimentally induced positive or negative experiences with a topical analgesic treatment in two groups of healthy human subjects. Subsequently, we compared responses to a second, unrelated and systemic analgesic treatment between both the positive and negative group. We found that there was no difference in the analgesic response to the second treatment between the two groups. Our data indicate that a change in administration route might reduce the influence of treatment history and therefore be a way to reduce negative carry-over effects after treatment failure. Future studies will have to validate these findings in a fully balanced design including larger, clinical samples.

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