scholarly journals Omalizumab Reduces Unplanned Healthcare Interactions in Irish Patients With Chronic Spontaneous Urticaria

2021 ◽  
Vol 2 ◽  
Author(s):  
Katie Ridge ◽  
Vyanka Redenbaugh ◽  
Niall Conlon

Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder associated with impaired quality of life and psychological comorbidity. Symptoms can be difficult to control and many individuals will not respond to first line treatment. Due to the chronic and unpredictable nature of the disorder, patients frequently have repeated healthcare attendances. Despite this, little is known about healthcare resource utilization internationally. Furthermore, there is no Irish data to inform fundholding decision makers. Omalizumab is an anti IgE monoclonal antibody used in refractory urticaria. It is a comparatively high cost medicine and access to this treatment can be challenging. Recent assessments of omalizumab compared with usual care suggest that omalizumab is a cost-effective treatment for refractory urticaria. We carried out a retrospective review of 47 patients commenced on omalizumab. We evaluated unplanned primary and secondary care attendances and urticaria symptomatology before and after treatment. As expected, patients with refractory disease that were commenced on omalizumab had objective improvements in urticaria symptoms. Importantly, we show that this is reflected in a dramatic reduction in unplanned healthcare interactions at primary care and emergency departments. These data suggest that omalizumab may benefit these patients by reducing disease activity and thereby reducing the need for unplanned healthcare interactions.

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.


2015 ◽  
Vol 40 (4) ◽  
pp. 298-305 ◽  
Author(s):  
Yoshitsugu Obi ◽  
Rieko Eriguchi ◽  
Shuo-Ming Ou ◽  
Connie M. Rhee ◽  
Kamyar Kalantar-Zadeh

Background: The 2006 Kidney Disease Outcomes Quality Initiative guidelines suggest twice-weekly or incremental hemodialysis for patients with substantial residual kidney function (RKF). However, in most affluent nations de novo and abrupt transition to thrice-weekly hemodialysis is routinely prescribed for all dialysis-naïve patients regardless of their RKF. We review historical developments in hemodialysis therapy initiation and revisit twice-weekly hemodialysis as an individualized, incremental treatment especially upon first transitioning to hemodialysis therapy. Summary: In the 1960's, hemodialysis treatment was first offered as a life-sustaining treatment in the form of long sessions (≥10 hours) administered every 5 to 7 days. Twice- and then thrice-weekly treatment regimens were subsequently developed to prevent uremic symptoms on a long-term basis. The thrice-weekly regimen has since become the ‘standard of care' despite a lack of comparative studies. Some clinical studies have shown benefits of high hemodialysis dose by more frequent or longer treatment times mainly among patients with limited or no RKF. Conversely, in selected patients with higher levels of RKF and particularly higher urine volume, incremental or twice-weekly hemodialysis may preserve RKF and vascular access longer without compromising clinical outcomes. Proposed criteria for twice-weekly hemodialysis include urine output >500 ml/day, limited interdialytic weight gain, smaller body size relative to RKF, and favorable nutritional status, quality of life, and comorbidity profile. Key Messages: Incremental hemodialysis including twice-weekly regimens may be safe and cost-effective treatment regimens that provide better quality of life for incident dialysis patients who have substantial RKF. These proposed criteria may guide incremental hemodialysis frequency and warrant future randomized controlled trials.


Author(s):  
Steven Wilcox ◽  
Richard Wilkins ◽  
Martin Lyons

Many organisations are currently dealing with long standing legacy issues in clean up, decommissioning and demolition projects. Industry is required to ensure that all bulk articles, substances and waste arisings are adequately characterised and assigned to the correct disposal routes in compliance with UK legislation and best practice. It is essential that data used to support waste sentencing is of the correct type, quality and quantity, and that it is appropriately assessed in order to support defensible, confident decisions that account for inherent uncertainties. AMEC has adopted the Data Quality Objectives (DQO) based methodology and the software package Visual Sample Plan (VSP) to provide a better, faster, and more cost effective approach to meeting regulatory and client requirements, whilst minimising the time spent gathering data and assessing the information. The DQO methodology is based on a scientific approach that requires clear objectives to be established from the outset of a project and that there is a demonstration of acceptability of the results. Through systematic planning, the team develops acceptance or performance criteria for the quality of the data collected and for the confidence in the final decision. The systematic planning process promotes communication between all departments and individuals involved in the decision-making process thus the planning phase gives an open and unambiguous method to support the decisions and enables the decision-makers (technical authorities on the materials of concern) to document all assumptions. The DQO process allows better planning, control and understanding of all the issues. All types of waste can be sentenced under one controllable system providing a more defensible position. This paper will explain that the DQO process consists of seven main steps that lead to a detailed Sampling and Analysis Plan (SAP). The process gives transparency to any assumptions made about the site or material being characterised and identifies individuals involved. The associated calculation effort is reduced using the statistically based sampling models produced with VSP. The first part of this paper explains the DQO based methodology and Visual Sample Plan and the second part shows how the DQO process has been applied in practice.


2012 ◽  
Vol 5 ◽  
pp. JCNSD.S6691 ◽  
Author(s):  
Anna C. Shier ◽  
Thomas Reichenbacher ◽  
Harinder S. Ghuman ◽  
Jaswinder K. Ghuman

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that can result in significant functional impairment, and if not adequately treated can lead to impaired quality of life. Pharmacotherapy is considered the first-line treatment for ADHD in children and adolescents. We review both recent literature and seminal studies regarding the pharmacological treatment of ADHD in children and adolescents. There is ample evidence for the efficacy and safety of both stimulants and non-stimulants in the treatment of ADHD. We review important aspects of evaluation and assessment and discuss first-line pharmacological treatments and as well as when to consider using alternative pharmacological agents. Treatment approaches to manage frequently seen comorbid disorders with ADHD are also covered.


2019 ◽  
Vol 31 (5) ◽  
pp. 1013-1016
Author(s):  
J.B. Veeramalini ◽  
B. Bharathiraja ◽  
S. Raghu Vinayak ◽  
R. Vignesh ◽  
S.K. Raghul

In present work, water treatment processes is carried out by an affordable, readily usable and non-chemical method. This study involved the process of water may reduce the concentration of particulate matter that includes suspended particles, micro organisms, a range of dissolved and particulate material derived from the surfaces. The substances used in this work were coarsely blended with each other and a special composite fibre filter was made. Several processes variables of quality of waste are also measured before and after the treatment. Results show that the water quality has been enriched in several ways such as reduction in the dissolved solids, pH has been controlled, deodorization and prevention of microbial growth. Hence use of this work has been utilized as a “Homemaker Model” and act as an alternative method for wastewater treatment in a cost effective way.


2018 ◽  
pp. 172-175
Author(s):  
Z. S. Kotova ◽  
T. Yu. Semiglazova ◽  
I. A. Baldueva ◽  
D. H. Latipova ◽  
D. O. Yurlov ◽  
...  

The aim of this study is to analyse the efficacy of efferent therapy (hemosorption) as part of drug treatment in patients with metastatic colorectal cancer (mCRC) based on the use of standard first-line chemotherapy combined with the bevacizumab biosimilar. The study included 54 patients with histologically verified mCRC who received the first-line FOLFOX + bevacizumab therapy in combination with and without hemosorption. All patients of the FOLFOX + bevacizumab (+) hemosorption group (n = 32) received the hemosorption using Hemophoenix apparatus on Day 4 of the cycle during the first 6 cycles. A total of 182 hemosorption procedures were performed. The control group included 22 patients receiving the FOLFOX + bevacizumab regimen without hemosorption. The bevacizumab biosimilar was introduced in both groups throughout the treatment at standard doses once every 2 weeks. There was no statistically significant difference between the study groups in the main clinical, pathomorphological, molecular genetic characteristics (sex, age, ECOG status, localization of primary tumor, tumor differentiation, RAS, BRAF mutations, microsatellite instability, etc.).Blood sampling to evaluate the effect of hemosorption on the pharmacokinetics (PK) of bevacizumab biosimilar was performed during the 2nd cycle before (PK1) and after (PK2) hemosorption procedures. The bevacizumab biosimilar concentration in the blood of patients before and after hemosorption showed no statistically significant difference (p = 0,423).The use of pharmaceutical treatment in the FOLFOX + bevacizumab (+) hemosorption group contributed to the achievement of an objective response (OR) in 62% of patients (p = 0.001). Median progression-free survival (PFS) was 10 ± 0.9 months [95% CI 8.3-11.7] in the FOLFOX + bevacizumab (+) hemosorption group, and 7 ± 0.5 months [95% CI 4.4-11.6] in the FOLFOX + bevacizumab (-) hemosorption group. There was no significant difference in PFS between the groups of patients treated with FOLFOX + bevacizumab regimen with and without hemosorption (p = 0.445).There were statistically significant differences in the frequency of nausea, diarrhoea and asthenia in the FOLFOX + bevacizumab (+) hemosorption group. The analysis of the dynamics of the quality of life (QoL) level before and after treatment showed that QoL level related to health (p = 0.0001) as well as the emotional (p = 0.0001) and social (p = 0,04) functioning increased in patients receiving the FOLFOX + bevacizumab regimen in combination with hemosorption, 0,039).Thus, the addition of hemosorption to the first-line drug treatment according to the FOLFOX + bevacizumab regimen does not affect bevacizumab pharmacokinetics, increases the frequency of objective response, reduces toxicity of the therapy and improves the quality of patients’ life indicators.


Phlebologie ◽  
2017 ◽  
Vol 46 (02) ◽  
pp. 60-62 ◽  
Author(s):  
R. D. Murena-Schmidt

SummaryUltrasound guided sclerotherapy (UGFS) of varicose veins is a worldwide spread method, in many countries recognized by guidelines. Important for the outcome is the patients history, clinical investigation and a detailed colour coded ultrasound mapping previous to UGFS.In previous studies varicose small saphenous vein (SSV) treatment with UGFS were reported to have worse results compared to GSV. Other studies report good outcome after UGFS of SSV varicose veins up to 12 months follow up.In my experience UGFS of insufficient SSV is safe and effective with high patient‘s satisfaction, good longterm results and improvement in quality of life. UGFS can be used in all age groups. UGFS has the additional benefit that repeated treatments are easy to perform if needed and that this method is very cost effective. Treatment sessions last 20 to 30 minutes so that patients do not need significant time off work.


2020 ◽  
Author(s):  
Aloysius Chow ◽  
Sok Huang Teo ◽  
Jing Wen Kong ◽  
Simon Biing Ming Lee ◽  
Yee Kiat Heng ◽  
...  

BACKGROUND Teledermatology is a cost-effective treatment modality for the management of skin disorders. Most evaluations use quantitative data and far less is understood about the patients’ experience. OBJECTIVE This qualitative study explores patients’ perceptions of a teledermatology service linking public primary care clinics to the national specialist dermatology clinic in Singapore. A better understanding of patients’ experiences can help refine and develop the care provided. METHODS Semi-structured in-depth interviews were conducted with patients who had been referred to the teledermatology service. Interviews were digitally recorded and transcribed before undergoing thematic content analysis. RESULTS Twenty-one patients aged between 22 and 72 years were recruited. Three themes were identified from the data of patients’ experiences: positive perceptions of teledermatology, concerns about teledermatology, and ideas for improving the teledermatology service. Patients found the teledermatology service convenient, saving them time, expense and liberating them from the stresses incurred when making an in-person visit to a specialist facility. They valued the confidence and reassurance they gained from having a dermatologist involved in their management plan. Their concerns included data security and the quality of the images shared. Nonetheless, they were keen to see the service expanded beyond the polyclinics. Their experiences and perceptions will inform future service refinement and development. CONCLUSIONS This narrative exploration of users’ experiences of teledermatology produced rich data enabling a better understanding of the patient’s journey, the way they understand and interpret their experiences, and ideas for service refinement. Telemedicine reduces travelling and enables safe distancing, factors that are much needed during pandemics.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5034-5034
Author(s):  
Francesca Pierdomenico ◽  
Antonio Almeida

Abstract Abstract 5034 Background: Azacitidine is a hypomethylating agent indicated for treatment of higher risk Myelodysplastic Syndromes (MDS). A recently published phase III trial demonstrated improved overall survival (OS) of MDS patients treated with Azacitidine compared to those receiving conventional care regimens, thus establishing this treatment option as first line therapy in those patients for whom bone marrow transplantation is not an option. Standard regime has been 75 mg /m2/day during 7 days; however several other treatment schedules have been explored that may have equal efficacy and tolerability though being more cost-effective. Aims: Evaluate the efficacy of Azacitidine regimen in terms of transfusion independence (TI), overall response (OR), AML transformation and tolerability in patients with higher risk MDS and AML with dysplasia. Methods: Higher risk (IPSS INT-2 and high risk) MDS patients were treated at a single institution with Azacitidine with a dosing regime of 500 mg/m2 every 4 weeks administered over 5 days. The total dose was adjusted so that entire vials were used. OR, including complete response (CR), haematological response (HR) and partial response (PR) and TI, defined according to the 2000 International Working Group Criteria (IWG), were assessed by blood and bone marrow examination. Treatment cycles were repeated until toxicity or disease progression. Results: A total of 38 patients were treated with Azacitidine between January 2007 and December 2010. Mean age was 68 years old (range 85–33) and male sex was predominant (M:F of 1.5) Fifteen patients had refractory anaemia with excess blasts, eleven had AML with dysplasia, five had chronic myelomonocytic leukaemia, tree had refractory cytopenias with multilineage dysplasia and four had acute erythroblastic leukemia. Most patients were high risk according to IPSS scoring (82%). Azacytidine was used as first line therapy in 32% and as second line in 61%. An average of 5 cycles (1–22) per patient were administered. The TI rate was of 45%, with average response duration of 6.5 months. OR rate was of 32% (9 CR, 1 HR and 2 PR). Twenty-two patients died during the follow-up period. Six patients progressed to AML: five of them had never shown any response to Azacitidine, while the other one had obtained TI. Median survival from diagnosis was of 22 months, while median survival from beginning of treatment was of 12 months. Tolerability was good, mainly grades I and II gastrointestinal and skin toxicity. Eleven patients (26%) had Grade III haematological toxicity and four (11%) suffered Grade IV haematological toxicity. The Azacitidine schedule using 500 mg/m2/4 weeks with the total dose adjusted across the 5 days in order to avoid wastage, instead of 75 mg/m2/day during 7 days, allowed for significant costs reductions. Conclusion: The efficacy of Azacitidine in achieving TI and prolonging survival in MDS is well recognized. In this study, Azacitidine improved quality of life and overall survival regardless of the quality of response. Treatment was well tolerated, with limited toxicity. Our results, though coming from a small group of patients, were comparable to what reported in the literature in terms of efficacy and tolerability, and we showed that it is cost effective to use our schedule regime. Disclosures: Almeida: Celgene: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; BMS: Speakers Bureau.


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