The Impact of the Presence of an Erythematous Lesion : A Clinical Investigation Report Implemented at Our Outpatient Clinic

2021 ◽  
Vol 83 (5) ◽  
pp. 457-460
Author(s):  
Yuta KURASHIGE
Keyword(s):  
Outpatient Clinic ◽  
Clinical Investigation ◽  
The Impact ◽  
Investigation Report

scholarly journals Evaluation of the impact of pharmaceutical care for tuberculosis patients in a Secondary Referral Outpatient Clinic, Minas Gerais, Brazil

2017 ◽  
Vol 89 (4) ◽  
pp. 2911-2919 ◽  
Author(s):  
ANDREZA R.V. LOPES ◽  
SILVANA S. DE MIRANDA ◽  
MARIA DAS GRAÇAS B. CECCATO ◽  
MICHELINE R. SILVEIRA ◽  
NATÁLIA H. DE RESENDE ◽  
...  
Keyword(s):  
Pharmaceutical Care ◽  
Outpatient Clinic ◽  
Minas Gerais ◽  
Tuberculosis Patients ◽  
The Impact

Treatment of metastatic bladder cancer

2017 ◽  
Author(s):  
Fabio Calabrò ◽  
Cora N. Sternberg
Keyword(s):  
Bladder Cancer ◽  
Urothelial Cancer ◽  
Clinical Investigation ◽  
Good Prognosis ◽  
New Drugs ◽  
Urothelial Bladder Cancer ◽  
Urothelial Bladder ◽  
Molecular Patterns ◽  
The Impact

Although bladder cancer is considered a chemosensitive malignancy, the prognosis of patients with metastatic disease is poor, with a median survival of approximately 12–14 months in good prognosis patients and with cure in only a minority. The addition of new drugs to the standard cisplatin-based regimens has not improved these outcomes. In this chapter, we highlight the role of chemotherapy and the impact of the new targeted agents in the treatment of metastatic bladder carcinoma. A better understanding of the underlying biology and the molecular patterns of urothelial bladder cancer has led to clinical investigation of several therapeutic targets. To date, these agents have yet to demonstrate an improvement in overall survival. Urothelial cancer is extremely sensitive to checkpoint inhibition with both anti PD-1 and anti PDL1 antibodies. The future seems brighter with the advent of these new therapies.

scholarly journals The Impact and Consequences of SARS-CoV-2 Pandemic on a Single University Dermatology Outpatient Clinic in Germany

2020 ◽  
Vol 17 (17) ◽  
pp. 6182
Author(s):  
Rosi Wang ◽  
Charlotte Helf ◽  
Linda Tizek ◽  
Ruth Neuhauser ◽  
Kilian Eyerich ◽  
...  
Keyword(s):  
Health Care ◽  
Outpatient Clinic ◽  
Skin Diseases ◽  
Health Care Systems ◽  
Age Groups ◽  
Peak Time ◽  
Malignant Diseases ◽  
Inflammatory Skin Diseases ◽  
Care Systems ◽  
The Impact

The pandemic outbreak of coronavirus disease 2019 (COVID-19) affects health care systems globally and leads to other challenges besides infection and its direct medical consequences. The aim of this study was to investigate the impact of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic on the university dermatology outpatient clinic (UDOC) of the Technical University of Munich, Germany. We analyzed datasets from 2015 until 2020 extracted from the hospital information system database and our documented outpatient files regarding patient numbers, gender, age, and diagnoses. In 2020, case numbers of outpatient care declined significantly (p = 0.021) compared to previous years and was related to the timing of political announcements answering SARS-CoV-2 pandemic. Additionally, during calendar week 10 to 15—the peak time of the spread of COVID-19 in Germany—the proportion of patients missing their consultation was significantly higher in 2020 than in 2019 (22.4% vs. 12.4%; p < 0.001). Gender-associated differences regarding absences were not detected, but patients aged 85 years or older were significantly more likely to miss their consultation compared to all other age groups (p = 0.002). Regarding different disease clusters, patients with chronic inflammatory skin diseases and infectious and malignant diseases were more likely to miss their consultation (p = 0.006). Noticeably, less patients with malignant diseases, and particularly malignant melanoma, were registered during this pandemic. Our data support the hypothesis that medically constructive prioritization might not be implemented properly by patients themselves. Identifying missed patients and catching up on their medical care apart from COVID-19 will pose an enormous challenge for health care systems globally.

Initial evaluation of patients diagnosed with pancreatic cancer within a community health system.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 269-269
Author(s):  
Kathryn Tzung-Kai Chen
Keyword(s):  
Pancreatic Cancer ◽  
Emergency Department ◽  
Health System ◽  
Community Health ◽  
Outpatient Clinic ◽  
Care Center ◽  
Tertiary Care ◽  
Initial Evaluation ◽  
Entire Cohort ◽  
The Impact

269 Background: The management of pancreatic patients who are referred to a tertiary care center is well described. However, many patients receive their initial evaluation and care at community health systems. We sought to describe how patients present within the community, the patterns of initial evaluation, and the impact on management. Methods: In a period spanning 3 years (2010-2013), 82 patients were newly diagnosed with pancreatic cancer, as identified by a cancer registry at a community health system. Under IRB approval, data regarding patient characteristics, initial evaluation, and management were retrospectively collected from the electronic medical record (EMR) and analyzed. Results: Of the 82 patients, 68 patients had sufficient data available in the EMR for analysis. Thirty-two patients (47%) initially presented to outpatient clinic, and 36 patients (53%) presented to the emergency department. The presenting complaint was identified as abdominal pain in 33 patients (49%), jaundice in 20 patients (29%), and general malaise in 9 patients (13%). Patients who presented through outpatient clinic vs. emergency department received similar initial imaging studies upfront, including CT of the abdomen and pelvis (61% vs. 72%) and abdominal ultrasound (27% vs. 17%). Sixteen percent of those patients evaluated in outpatient clinic were subsequently admitted, compared to 94% of those patients evaluated in the emergency department. Finally, 31% of those presenting in outpatient clinic eventually underwent surgical resection, compared to 8% of those presenting through the ER, and the median time to surgery for the entire cohort was 1.1 months. Conclusions: Within the community, half of all patients present through the emergency department, and the majority of these are admitted for work up and management of symptoms. In contrast, those patients who present through outpatient clinic are less likely to be admitted, and are more likely to undergo definitive resection. This likely represents a disparity on several levels: the acuity of patients presenting to the emergency department vs. clinic, and how they are managed in each setting.

Tumor mutational burden (TMB) may be a promising predictive biomarker of response to PD-1/PD-L1 targeting in MSI-H colorectal cancer.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 43-43 ◽  
Author(s):  
Marwan Fakih ◽  
Jaideep Singh Sandhu ◽  
Ching Ouyang ◽  
Ethan Sokol ◽  
Jeffrey S. Ross ◽  
...  
Keyword(s):  
Clinical Investigation ◽  
Objective Response ◽  
Predictive Biomarkers ◽  
Progression Free Survival ◽  
Large Data ◽  
Predictive Biomarker ◽  
Continuous Variable ◽  
Data Set ◽  
Cut Point ◽  
The Impact

43 Background: PD-1 targeting with pembrolizumab or nivolumab leads to durable clinical benefits in patients (pts) with microsatellite instability-high (MSI-H) tumors. However, 30-35% of mCRC pts with MSI-H tumors will experience progressive disease (PD) as a best response when treated with anti-PD1 agents, highlighting the need of additional predictive biomarkers. Methods: We performed a retrospective multi-center clinical investigation to evaluate the impact of TMB, age, gender, stage at initial presentation, pattern of metastatic disease, tumor grade, and RAS/RAF status on response to anti-PD1/PD-L1 in MSI-H mCRC. TMB and MSI status were determined by hybrid capture-based next-generation sequencing (Foundation Medicine [FM]). The TMB distribution in MSI-H CRC was estimated from a large data set from FM. Results: 22 eligible MSI-H mCRC pts were identified across 5 cancer centers: 19 pts received pembrolizumab, 1 pt received nivolumab, 1 pt received nivolumab + ipilimumab, and 1 pt received durvalumab + tremelimumab. Among tested variables, TMB (as a continuous variable) showed the strongest association with an objective response (OR; p < 0.001). Also, both univariate and multivariate analyses supported that TMB serves as an independent prognostic variable in predicting progression-free survival (PFS; p < 0.001 and p < 0.01, respectively). Using log-rank statistics, the optimal predictive cut-point for TMB was estimated between 37-41 mutations/Mb to dichotomize pts into TMBhigh and TMBlow groups. All 13 pts (100%) with TMBhigh had an OR, while only 2/9 (22%) pts with TMBlow had an OR and 6/9 had PD. The median PFS for TMBhigh pts has not been reached (no progressors, median follow-up > 18 mos), while the median PFS for TMBlow pts was 2 mos. Amongst 821 MSI-H CRC cases tested at FM, the 25th, 35th, 50th and 75th percentile TMB cutoffs were 33.1, 37.4, 46.1, and 61.8 mutations/Mb, respectively. Our optimal TMB cut-point range suggests that MSI-H mCRC with the lowest 35th percentile of TMB have a low likelihood of benefit from anti-PD1. Conclusions: These TMB findings require validation in prospective trials and may guide the sequencing of PD-1 inhibitor monotherapy in MSI-H mCRC.

INDUSTRIAL ACTIVITY REVIEW OF THE FRENCH NETWORK OF PEDIATRIC CLINICAL INVESTIGATION CENTERS (FN-PCIC) 2008–2013

2015 ◽  
Vol 101 (1) ◽  
pp. e1.27-e1
Author(s):  
Elsa Maksooud ◽  
Evelyne Jacqz-Aigrain
Keyword(s):  
Clinical Trials ◽  
Clinical Investigation ◽  
European Medicines Agency ◽  
University Hospitals ◽  
European Regulation ◽  
Clinical Investigations ◽  
Number Of Patients ◽  
Inclusion Rate ◽  
The Impact ◽  
Drug Studies

IntroductionThe French Network of Pediatric Clinical Investigations Centers (FN-PCIC) created in 2000 includes today 16 CIC grouped under the auspices of the INSERM and the corresponding public university hospitals. In response to the European pediatric regulation published in 2007, all pharmaceuticals laboratories, in order to complete their drug profile, must conduct pediatric clinical trials according to the Pediatric Clinical Investigation Plan and validated by the European Medicines Agency (EMA). This network plays a major role in facilitating and optimizing the conduction of nation-wide pediatric clinical trials. Therefore, the PN-CIC plays a major role to response to this acute demand in the pediatric field. The purpose of this review is to sum up the activity of the FN-PCIC between 2008 and 2013 and to analyze the impact of the European regulation.MethodsOnly the industrial protocols will be analyzed, for every protocol a certain number of information was collected such as the pharmaceutical industry, the therapeutic fields, the phase of the study, the duration of the study, the methodology, and the number of patients needed.Results261 protocols were active during this period by 90 different sponsors. 218 were interventional studies and 43 were observational or non-drug studies (registers, post-AMM). The number of active studies was at 127 in 2013 compared to 76 in 2008. Furthermore, the total number of participations were 242 for 16 CIC in 2013 compared to 110 in 2008. The mean inclusion rate was 87%. The percentage of the common studies rises from 36% in 2008 to 50% in 2013. In addition, the feasibility study demands increased and were as high as 57, an average of one demand per week The inclusion percentage calculated using the data of the closed studies is at 87%. The therapeutic fields concerned were nephrology and oncology (15%), then neurology and pneumology (13%).ConclusionActivity increased, linked to the national coverage now including 16 centers and high quality procedures to perform pediatric research trials under high ethical and quality standards.

scholarly journals The role of matrix metalloproteinases in glaucoma pathogenesis

2015 ◽  
Vol 8 (3) ◽  
pp. 28-43 ◽  
Author(s):  
Inessa Stanislavovna Beletskaya ◽  
Sergey Yurievich Astakhov
Keyword(s):  
Extracellular Matrix ◽  
Matrix Metalloproteinases ◽  
Clinical Investigation ◽  
Experimental Studies ◽  
Glaucomatous Optic Neuropathy ◽  
Connective Tissues ◽  
Activity Impairment ◽  
Extracellular Matrix Components ◽  
The Impact

Matrix metalloproteinases belong to an enzyme family, which assure a proteolysis of practically all components of the extracellular matrix of connective tissues in normal and pathological conditions. At physiological conditions, there are evidences on the impact of this enzyme group in the embryogenesis, morphogenesis, angiogenesis, and tissue involution. The activity impairment of matrix metalloproteinases and of their specific inhibitors leads to the biosynthesis misbalance and to the degradation of extracellular matrix components; it plays a role in the development of such diseases as diabetes mellitus, rheumatoid arthritis, and arteriosclerosis. Laboratory tests and clinical investigation results confirm the role of these enzymes in tissue remodeling of different eyeball structures in glaucoma (in particular, of the trabecular meshwork and the optic disc); it leads to intraocular fluid outflow impairment and to the glaucomatous optic neuropathy development. In the review, the analysis of clinical and experimental studies is performed that are dedicated to the investigation of matrix metalloproteinases role in the pathogenesis of different glaucoma types, of the possibility to use them as biomarkers, as well as therapeutic action targets in this disease.

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