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| 2. |
- Alenius, Malin, et al.
(författare)
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Knowledge and insight in relation to functional remission in patients with long-term psychotic disorders
- 2010
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 45:5, s. 523-529
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with psychotic symptoms often respond poorly to treatment. Outcomes can be affected by biological, physiological and psychological factors according to the vulnerability-stress model. The patient's coping strategies and beliefs have been correlated with outcomes. OBJECTIVES: To investigate the knowledge and insight in relation to treatment response. METHODS: A naturalistic study was performed using patient interviews and information gathered from patient drug charts. Apart from the rating scales used for classification of treatment response (CANSEPT method), the SPKS knowledge of illness and drugs rating scale was utilized. RESULTS: In the group of patients in functional remission (FR; n = 38), 37% had insight into their illness as compared to 10% among those not in functional remission (non-FR; n = 78; P < 0.01). As much as 23% of the non-FR group had no strategy for responding to warning signs versus 8% in the FR group (P < 0.05). CONCLUSIONS: Better treatment outcomes appear to be associated with better insight into illness, higher knowledge of warning signs and better coping strategies.
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| 3. |
- Escudier, Bernard, et al.
(författare)
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Multidisciplinary management of metastatic renal cell carcinoma in the era of targeted therapies
- 2012
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Ingår i: Cancer Treatment Reviews. - : Elsevier. - 0305-7372 .- 1532-1967. ; 38:2, s. 127-132
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Forskningsöversikt (refereegranskat)abstract
- The use of targeted agents to treat metastatic renal cell carcinoma (mRCC) has significantly extended progression-free and overall survival but raises issues relating to the long-term delivery of care and the sustained monitoring of efficacy and toxicities, certain of which have not previously been experienced. In this paper, an expert group of medical oncologists, urologists and oncology nurses and pharmacists review and make informal recommendations on the multidisciplinary management of mRCC in the light of progress made and problems that have arisen. Decentralisation of care, with a shift in emphasis from large to small hospitals and possibly to the community, may offer advantages of cost and convenience. However, the major responsibility for care should continue to lie with clinicians (either medical oncologists or urologists) with extensive experience in mRCC, assisted by specialist nurses, and working in centres with facilities adequate to monitor efficacy and manage toxicities. That said, the extended survival of patients emphasises the importance of compliance and the long-term prevention, detection and management of side effects. Much of this will take place in the community. There is therefore a need for multidisciplinary working to extend beyond specialist centres to include general practitioners, community nurses and pharmacists. Although this paper focuses on mRCC, many of the considerations discussed are also relevant to the management of more common solid tumours in the era of targeted therapy.
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| 4. |
- Honoré, Per Hartvig, et al.
(författare)
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Serotonin synthesis studied with positron emission tomography (PET)
- 2014
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Ingår i: PET and SPECT of Neurobiological Systems. - Berlin, Heidelberg : Springer Berlin/Heidelberg. - 9783642420146 - 9783642420139 ; , s. 687-709
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Positron emission tomography (PET) has the potential to study the biosynthesis and release of serotonin (5HT) at brain serotonergic neurons. PET requires probe compounds with specific attributes to enable imaging and quantification of biological processes. This section focuses on probes to measure seroonin synthesis rate. Knowledge of altered 5HT synthesis and release in disease states may furnish basis for effective pharmacotherapy that may improve the care of psychiatric and neurological disease. Validation of PET measurements of the two PET tracers using perturbation showed that 5-hydroxy-L-(beta-11C tryptophan) (5HTP) quantifies the activity of amino acid decarboxylase in the conversion to 5HT. On the other hand, alpha-methyl-tryptophan (AMT) measures the conversion to the corresponding 5-hydroxytryptophan analogue. The irreversible binding of the PET probe 5HTP in the monkey brain was lower in the presence of NSD1015 which was used to inhibit the decarboxylation step in 5HT synthesis. 5HTP seems thus to have potential for tracking changes in the activity of the biosynthesis enzyme. In contrast, the accumulation of 5HTP was unaffected by clorgyline used to inhibit the metabolism of the probe in the brain. This indicates that on a PET timescale, elimination of the main metabolite from the brain is negligible and would not alter calculation of 5HTP transfer to 5HT. The extent and distribution of irreversible binding of a substrate for the first enzyme in 5HT formation alpha-methyltryptophan AMT were different from those of 5HTP, suggesting that the two PET probes provide estimates related to the enzyme activity of different steps in the 5HT synthesis pathway. Applications of the two tracers HTP and AMT are reviewed. Up to now, 5HTP has mainly been used for the detection, staging and treatment evaluations of neuroendocrine tumours. Though, a few studies using 5HT have been conducted on CNS disorders. AMT-PET studies have mainly been confined to brain diseases causing various degree of neurodegeneration.
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| 5. |
- Krogh-Madsen, Mikkel, et al.
(författare)
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Population pharmacokinetics of cytarabine, etoposide, and daunorubicin in the treatment for acute myeloid leukemia
- 2012
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Ingår i: Cancer Chemotherapy and Pharmacology. - : Springer Science and Business Media LLC. - 0344-5704 .- 1432-0843. ; 69:5, s. 1155-1163
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Tidskriftsartikel (refereegranskat)abstract
- Interpatient variability in the pharmacokinetics (PK) of cytarabine, etoposide, and daunorubicin following body surface area-adjusted doses calls for studies that point to other covariates to explain this variability. The purpose of this study was to investigate such relationships and give insights into the PK of this combination treatment. A prospective population PK study of twenty-three patients with acute myeloid leukemia was undertaken. Plasma concentrations of patients were determined by high-pressure liquid chromatography. PK models were developed with NONMEMA (R); for daunorubicin, PK information from a prior study was utilized. Baseline white blood cell count (bWBC) influenced the PK for all drugs. A small, statistically insignificant improvement in model fit was achieved when a relationship between bWBC and daunorubicin central volume of distribution was included. The volume increased 1.9% for each increase in bWBC by 1 x 10(6) cells/mL. The clearances of etoposide and cytarabine were significantly increased and decreased, respectively, by increased bWBC. Tenfold changes in bWBC were needed for these relationships to have potential clinical relevance. A decrease in creatinine clearance of 60 mL/min resulted in a decrease in etoposide clearance of 32%. Population-based models characterized the PK for all three drugs. bWBC was a significant covariate for etoposide and cytarabine and showed a trend for daunorubicin. Linking the significant bWBC relationships and the relationship between kidney function and etoposide clearance to clinical end points would support dose individualization. Patients with above-normal creatinine clearances and high bWBC may receive sub-optimal treatment due to elevated etoposide clearances.
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