China
Africa
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Peri-operative medicine
Published in Henry J. Woodford, Essential Geriatrics, 2022
For elective surgery, it is recommended to provide a medication review (including anticoagulants), exercise plan, dietary and smoking cessation advice.11 There is a window of opportunity to review the control of chronic medical conditions, but the time taken to achieve optimal health needs to be weighed against the disadvantages of delaying surgery.12
Health and urban living
Published in Ben Y.F. Fong, Martin C.S. Wong, The Routledge Handbook of Public Health and the Community, 2021
China and other emerging economies are undergoing rapid development with a pace that has never been observed in developed Western countries. This creates a window of opportunity to mitigate health inequities. Hong Kong itself may serve as an exemplar city to other parts of China and other emerging economies in this direction (Chung & Wong, 2017). Every effort should be made to address the issue of health inequity, as it is ultimately detrimental to all city dwellers.
The British dilemma
Published in Meads Geoff, Pat Gordon, Diane Plamping, Future Options for General Practice, 2018
Nevertheless, this is a time of unprecedented opportunity for general practice, and for general practice based primary care. Ministerial policy and central management have never been so explicitly supportive. Resources are flowing one way. The inevitable reactions in terms of more strenuous performance monitoring and quality assurance have yet to come. In short, a window of opportunity exists for the practitioners to decide what the future options for general practice should be.
Inducibility or predestination? Queries and concepts around drug-free remission in rheumatoid arthritis
Published in Expert Review of Clinical Immunology, 2023
Bernardo D’Onofrio, Annette van der Helm-van Mil, Tom W.J. Huizinga, Elise van Mulligen
International guidelines emphasize the importance to start DMARD therapy as soon as the diagnosis is made [5]. The concept of the ‘window of opportunity’ refers to the time span after symptom onset in which the disease progression is more susceptible to be modified and patients are more likely to obtain remission as well as anatomical and functional ability preservation. In the FINnish Rheumatoid Arthritis Combination therapy (FIN-RACo) trial, a delay of more than 4 months in initiation of therapy was the only predictor of not achieving remission among 195 RA patients who started a single disease-modifying drug [22]. Furthermore, a very early referral and subsequent intervention with a DMARD demonstrated to be of primary importance to reach the major outcomes in a large Italian multicenter study [23]. Collectively, data from clinical trials and observational cohorts nowadays indicate a 12-weeks-time as the optimal period in which treatment should be initiated in order to achieve better mid- and long-term outcomes [2,23,24].
Canakinumab for the treatment of adult-onset Still’s disease
Published in Expert Review of Clinical Immunology, 2020
Paolo Sfriso, Sara Bindoli, Andrea Doria, Eugen Feist, Paola Galozzi
Although there are no universal recommendations, the goals to reach with these treatments are to achieve complete remission of systemic inflammation and to lower the inflammatory indices. In spite of these major advances, many questions remain unsolved and would need further clinical investigations and consensus evaluation. First, it is not well known how to select and evaluate the correct drugs that can ensure a sustainable response. Second, the hypothesis of a ‘window of opportunity’ in early treatment that might alter the course of the disease needs prospective clinical study. In sJIA, Nigrovic observed indeed a favorably clinical response to early IL-1 inhibition, forestalling the development of chronic arthritis [23]. Third, a consensus on the definition of response to treatment is essential in order to make consistent reports, that can be compared across centers and declared valid and reliable. Finally, as the cost of biologics is very high, long-lasting prospective follow-up studies should be warranted as well as analysis of the socioeconomic repercussions.
Immune checkpoint inhibition for the treatment of mesothelioma
Published in Expert Opinion on Biological Therapy, 2019
Anna K Nowak, Alison McDonnell, Alistair Cook
Other considerations for immunotherapy clinical trials include the importance of collecting translational research samples, where possible, to inform future development of these therapies. For second-line therapy, contemporaneous pre-treatment tumor biopsies may have value, as archival biopsies represent the tumor state before first-line treatment. It is still unknown how first-line treatment, whether that be chemotherapy or combination therapies, may change the tumor microenvironment or potential biomarkers such as PD-L1 expression. Unfortunately, a single biopsy also has inherent limitations, as it is unlikely to fully represent the biomarker landscape of a large tumor involving multiple areas of the hemithorax. One way in which more nuanced post-treatment information can be obtained is through ‘window of opportunity’ trials. In this scenario, patients who are clinically appropriate for aggressive surgical resection would receive a biopsy prior to treatment, and then undergo immunotherapy or combination treatment on the clinical trial protocol. Following a defined period of treatment, usually two to three treatment cycles, surgical resection will be performed, and the entire specimen can then be examined, enabling a better understanding of the spatial heterogeneity of the tumor microenvironment and biomarkers. At least one such study, using pre-surgical pembrolizumab, is currently underway in the USA (NCT02707666).