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Overview of Therapeutic Biomarkers in Cancer
Published in Sherry X. Yang, Janet E. Dancey, Handbook of Therapeutic Biomarkers in Cancer, 2021
Sherry X. Yang, Janet E. Dancey Treatment
Therapeutic biomarkers in clinical practice or have potential for clinical utility can be classified according to their applications (Table 1.2). They are exploited to identify responders and nonresponders to a treatment and adjust the dosage of drugs to optimize their efficacy and safety. The biomarkers can be classified as (i) clinical benefit or response, (ii) resistance to treatment, (iii) risk for cancer recurrence, and (iv) risk for adverse reactions or dosage and administration guidance. Therapy is categorized into four major ones: (i) molecularly targeted or genotype-directed therapy, (ii) immunotherapy, (iii) chemotherapy or radiotherapy, and (iv) combinations of immunotherapy or targeted therapeutics with chemotherapy. These will be introduced in greater detail in the following sections.
Infections and Their Mimics in Returning Travelers in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Elise Kochoumian, Jonathon Moore, Bushra Mina, Kevin Cahill
One of the most common reasons for admission to the CCU is respiratory failure, a phenomenon that occurs in about 1.5% of hospitalized patients with active TB. Respiratory failure can result from various developments of superimposed bacterial pneumonia, ARDS, or massive hemoptysis, among others. Management of these secondary processes involves directed therapy. For pneumonia, treatment consists of initiation of broad-spectrum antibiotics, which are promptly narrowed based on the data collected from sputum samples. In a patient with concomitant ARDS, standard mechanical ventilation strategies to reduce ARDS are appropriate, including lower tidal volumes and a conservative fluid strategy. In the case of massive hemoptysis, initial efforts should be directed at airway control, with the goal of maintaining adequate gas exchange, a process that typically requires endotracheal intubation and mechanical ventilation. Once the patient is stabilized, bronchoscopy should be performed to isolate the bleeding vessel, followed by treatment with topical epinephrine, among other things [72]. Mortality is high for patients with active TB and respiratory failure, with one study showing in-hospital mortality of 69% for patients requiring mechanical ventilation for treatment of TB. Risk factors for mortality in these patients include older age, duration of symptoms of more than 4 weeks, and multi-organ failure [77].
A Descriptive Study of Family Directed Therapy for Traumatically Brain Injured Persons
Published in Jerry A. Johnson, Laura H. Krefting, Occupational Therapy Approaches to Traumatic Brain Injury, 2013
Family directed therapy is important because professional services are discontinued, typically after the first two years after the injury, and any gains made after that are predominantly through the efforts of the family caregiver. As Kovich (1985) notes, the length of time spent in a medical facility may be minimal compared to the time the patient will spend recovering in the home. Family caregiving is also important because as Livingston, Brooks, and Bond (1985) state, in many cases new problems appear in the years following the injury long after rehabilitation services have stopped. For example, reactive psychiatric problems may develop in response to the long term nature of the disability. Families, then, are forced to use their own resources to address these new problems in addition to the residual limitations.
Molecular point-of-care testing in the community pharmacy setting: current status and future prospects
Published in Expert Review of Molecular Diagnostics, 2022
Michael Klepser, Renee R. Koski
The pandemic has reinforced that patients are comfortable utilizing pharmacists to screen and receive subsequent care for infectious diseases. Additionally, these models allow patients to have expanded healthcare access and receive directed therapy sooner. As needed, pharmacists can refer patients to emergency departments or provider offices, offer self-care recommendations, or, in some states, dispense antimicrobials. Recommendations for the use of CLIA-waived rapid molecular diagnostic tests and subsequent patient management by community pharmacists should be incorporated into clinical guidelines as an option for managing certain community infectious diseases. Such guidelines could serve as the basis for developing protocols or collaborative practice agreements. Evidence-based pharmacy-based care models have not only been demonstrated to be safe and well-received by patients, but they also result in reduced inappropriate antibiotic use. This could have a significant impact on antibiotic-related adverse events, inpatient antibiotic use for patients admitted from the community, and antimicrobial resistance.
Definitive therapy for squamous cell carcinoma of the anus with synchronous metastases – a report from the Danish Anal Cancer Group
Published in Acta Oncologica, 2022
Karen Lycke Wind, Eva Serup-Hansen, Birgitte Mayland Havelund, Lisbeth Riber, Camilla Jensenius Skovhus Kronborg, Anders Jakobsen, Karen-Lise Garm Spindler
When treating patients with synchronous mSCCA different approaches in the ‘oncological toolbox’ are available depending on the metastatic site, but very few studies exist to support treatment decisions. A literature search in PubMed revealed five publications on organ-directed therapy as part of a definitive treatment strategy for mSCCA [16–20]. Firstly, all publications were retrospective, and in contrast to our dataset, all five publications describe a pooled analysis of patients with both synchronous and metachronous distant metastases, rendering a direct comparison with our data difficult. Two publications on extended radiotherapy fields in cases of synchronous distant lymph node metastases were identified one being a retrospective study and one a prospective study [21,22]. In addition, in a publication on patterns of failure in a retrospective cohort, four patients with synchronous distant lymph node metastases were included and treated with extended fields [23]. None of these study patients received ICT.
Reducing treatment toxicity in Waldenström macroglobulinemia
Published in Expert Opinion on Drug Safety, 2021
Shayna Sarosiek, Steven P. Treon, Jorge J. Castillo
The purpose of this review was to delve into toxicity issues related to WM-directed regimens. As examples, rituximab can be associated with IgM flares and intolerance, alkylating agents and nucleoside analogs with secondary myeloid neoplasms, bortezomib with peripheral neuropathy, and BTK inhibitors with atrial arrhythmia and bleeding. Additonally, the risk of infections may be increased, particularly with chemoimmunotherapy and anti-CD20 monoclonal antibodies. As a summary, selected general and disease-centric adverse events associated with WM-directed therapy and the recommended management are shown in Table 1. However, several tools are available to better manage the adverse events related to WM-directed treatment, including switching agents, decreasing the number of cycles or the dose of the agent causing the event, or changing the route of administration, to cite a few.