Impact of a single 10 min education session on asthma control as measured by ACT.

BACKGROUND: Aim: Despite the availability of effective treatments for asthma, many patients still suffer from uncontrolled asthma. This study evaluates whether a single educational session could improve asthma control assessed by Asthma Control Test (ACT) score as well as knowledge of the inhaler device, knowledge of medication and inhalation technique. METHODS: This prospective single blinded randomized controlled trial of 160 adults with asthma, examined the effectiveness of a single standardized, educational intervention, performed by a respiratory nurse specialist. The education provided to the intervention group consisted of basic information about asthma treatment and instructions on inhalation technique for about 10min. This additional education was not offered to the control group. In both groups ACT scores, knowledge of medication, knowledge of inhaler device and inhalation technique were assessed at baseline and after three months. Asthma was considered well-controlled when the ACT score exceeded 19. RESULTS: At baseline there were no significant differences in patient demographics, degree of asthma control, knowledge of medication or device and inhalation technique between the intervention group and the control group. In the intervention group the educational session resulted in a significantly higher proportion of well-controlled asthma patients with an ACT>19 (43% versus 77%) (p < 0.001) after three months. In the control group this proportion remained similar (57% versus 67%) (p > 0.1). We also observed improvements in knowledge of medication (p < 0.001), knowledge of device (p < 0.001) and inhalation technique (p = 0.004) in the intervention group and not in the control group. CONCLUSION: A single 10 min, educational session provided by a respiratory nurse specialist can substantially improve asthma control determined by the ACT score after three months.

Patterns of care for non-small cell lung cancer patients in Belgium: A population-based study.

Guidelines recommend surgery for Stage I-II, chemoradiation for Stage III and systemic therapy for Stage IV non-small cell lung cancer (NSCLC). However, patient related factors and patient preferences influence treatment decisions. We investigated patterns of care for Belgian NSCLC patients in 2010-2011, based on population-based data from the Belgian Cancer Registry and administrative databases. The relationship between patient characteristics, institutional diagnostic volume, type of treatment and survival was investigated. Overall, 20.8% of patients received no oncological treatment. 59% and 22.1% of Stage I-II patients received primary surgery or (chemo)radiation respectively. 34% of Stage III patients received chemoradiation and 17% of Stage IIIA patients had surgery. 70% of Stage IV patients received chemotherapy or targeted therapy. Moderate variability between centres was observed. For Stage IV, systemic therapy was less frequently used in higher volume centres and 1-year survival was lower in centres that had ≥ 50 new patients yearly. Although not all NSCLC patients received treatment as ideally recommended by guidelines, these results do not necessarily represent poor quality of care as patient characteristics and preferences need to be taken into account. Treatment options targeted towards patients with co-morbidity or unfit patients is warranted to improve outcomes of all NSCLC patients.

Beyond the Diketopiperazine Family with Alternatively Bridged Brevianamide F Analogues.

A method for the preparation of 3,5-bridged piperazin-2-ones from a tryptophan-proline-based diketopiperazine is described using diphosgene to induce the ring closure. Density functional theory calculations were conducted to study the mechanism of this C-C bond formation. Several derivatives of the thus obtained α-chloroamine were synthesized by substitution of the chlorine atom using a range of O-, N-, S-, and C-nucleophiles. This novel class of brevianamide F analogues possess interesting breast cancer resistance protein inhibitory activity.

Clinical factors predictive of long-term survival in advanced non-small cell lung cancer.

PURPOSE: While the overall prognosis of non-molecularly selected advanced non-small cell lung cancer (NSCLC) patients is poor, a subset of these patients has durable survival. We examined which clinical factors might be predictive for this favourable outcome. PATIENTS AND METHODS: Long-term NSCLC survivors (LTS, i.e. >2 years) were retrieved from all our out- and in-patient contacts in a 6 month period (March-August 2009). LTS records were compared with a group of short-term survivors (STS). Both baseline clinical factors (sex, age, smoking status, weight loss, performance status, co-morbidity, histological subtype, place and number of metastasis) and treatment-related features (number and type of therapeutic lines, response, duration of treatment-free interval) were compared. RESULTS: 31 LTS were retrieved (stage IV patients with potentially radical treatment options, e.g. solitary brain or adrenal metastasis, were excluded), and compared with 34 STS. In the LTS group, median survival was 53 months, with 47% of patients alive at 5 years, in the STS patients this was 9.7 months, with 24% alive at 1-year. Baseline factors had little predictive value, but response to 1st line therapy (P = 0.0001), response duration (P = 0.009), and the number of systemic lines (P = 0.0023) were of importance. CONCLUSION: These data confirm the existence of LTS in patients with advanced NSCLC. There are very little clinical factors at the time of diagnosis that help to distinguish future LTS from STS patients. Factors related to the effect of 1st line treatment are important, and further prospects of patients achieving a 2-year survival are in general quite good.

Vaccination therapy for non-small-cell lung cancer: review of agents in phase III development.

The historical results of cancer vaccination for non-small-cell lung cancer (NSCLC) were disappointing. In the current decade, however, new insights in the interaction between tumours and the immune system have led to the development of immunotherapy as a fundamentally new concept for the treatment of NSCLC. Modern NSCLC vaccine strategies rely on better identification of antigenic targets, addition of strong immunoadjuvants, and use of more efficient delivery systems. These treatments have convincingly demonstrated to elicit potent immune responses and have shown promising efficacy signals and excellent tolerability in phase II randomised studies. This-together with recent positive phase III data in indications other than NSCLC-has helped to establish the proof of principle for cancer vaccination. In NSCLC, ongoing phase III trials are investigating this approach in different treatment settings: the Melanoma AntiGEn A3 vaccine in resected early-stage NSCLC, the L-BLP25 vaccine in locally advanced NSCLC after chemoradiotherapy, and belagenpumatucel-L, the epidermal growth factor and the TG4010 vaccine in advanced stage, either as an adjunct to chemotherapy or as maintenance after completion of chemotherapy. Mode of action, development, available clinical data, and currently ongoing phase III studies are reviewed.

Observational Aranesp Survey to Investigate the Q3W Schedule (OASIS): a prospective observational study of treatment of chemotherapy-induced anaemia with every 3 weeks darbepoetin alfa.

INTRODUCTION: This prospective observational study examined the adherence to published European guidelines on erythropoiesis-stimulating agents (ESAs) and the pattern of use and effect of darbepoetin alfa (DA) 500 microg once every 3 weeks (Q3W) for the treatment of chemotherapy-induced anaemia (CIA). MATERIALS AND METHODS: A total of 293 patients were included (263 solid tumour, 30 haematologic malignancy). Their mean age was 63 years, 51% were male, 57% had platinum-based chemotherapy. DA was started at a haemoglobin (Hb) level between 9 and 11 g/dL in 82% of patients. RESULTS AND DISCUSSION: In an analysis correcting for transfusions, 55% of patients achieved > or =2 g/dL increase in Hb, and a Hb level of >11 g/dL was reached in 81%. Transfusion rate was 27%. Most patients (70%) were treated in a Q3W chemotherapy, and planned synchronisation of chemotherapy and Q3W DA could be maintained in 76%. CONCLUSION: Adherence to European guidelines for DA treatment was good, and Q3W DA treatment was in synchronisation with Q3W chemotherapy in the majority of the patients, thereby reproducing the findings of a recent phase III study.

Cheilitis granulomatosa.

Cheilitis granulomatosa is a rare inflammatory disorder with unclear aetiology. It is a disorder characterized by recurrent or persistent swelling of one or both lips that may be part of the Melkersson-Rosenthal syndrome or may be a manifestation of Crohn's disease. An overview of the clinical features, histopathology, differential diagnosis, management strategies and prognosis of cheilitis granulomatosa is presented and discussed with regard to the literature.

[Periodic fever due to hyper-IgD syndrome]. / Periodieke koorts door hyper-IgD-syndroom.

In a 45-year-old man who from early childhood had been suffering of periodic fever, which did not respond to any therapy attempted, the ultimate diagnosis was hyperimmunoglobulinaemia D syndrome (HIDS). HIDS attacks typically occur every 4-6 weeks and last 3-7 days. The most frequent symptoms are fever, diarrhoea, arthralgias, cold shivers, abdominal pain, vomiting and headache. Physical examination often reveals lymphadenopathy, skin lesions, arthritides, splenomegaly and serositis. Laboratory investigation includes an acute-phase response with granulocytosis and enhanced erythrocyte sedimentation rate. The serum concentration of IgD is increased as is the concentration of IgA. There is no causal therapy. A causative gene mutation was recently identified.

[Disease caused by lack of sunlight: rickets and osteomalacia]. / Ziek door te weinig zonlicht: rachitis en osteomalacie.

In three patients, a 12-year-old Muslim Moroccan girl with polyarthralgia and a wobbling gait, a 47-year-old emaciated Hindustani man with muscle weakness and on antiepileptic drugs, and a heavily-veiled native Dutch woman aged 34 years with polyarthralgia and psoriasis, clinical, laboratory and radiologic examination led to the diagnoses of rickets (the first patient) and of osteomalacia (the other two). They recovered after calcium and vitamin D suppletion. After the discovery of vitamin D and the beneficial effects of sunlight and cod liver oil rickets and osteomalacia became rare. Recently these diseases have to be considered more often again because of changes in the composition of the Dutch population: more immigrants and (institutionalized) elderly who are prone to develop a vitamin D deficiency. Dietary and clothing habits should be investigated when a patient complains about diffuse (bone) pains. In case of minimal exposure to sunlight and a diet low in vitamin D the symptoms may be explained easily by a vitamin D deficiency. Once hypovitaminosis D is diagnosed, the therapy is simple and effective.

Posterior sagittal anorectoplasty: functional results of primary and secondary operations in comparison to the pull-through method in anorectal malformations.

BACKGROUND: Control of defaecation after surgical correction of high and intermediate types of congenital anorectal malformations is difficult. The posterior sagittal approach with careful reconstruction of the external sphincter is postulated to give a better outcome than the pull-through operation. The functional results of these procedures performed in one centre were evaluated in order to identify prognostic factors. MATERIAL AND METHODS: Between 1979 and 1992 66 patients with high or intermediate congenital anorectal anomalies were treated in our centre. In 16 patients a pull-through operation (Kiesewetter-Rehbein) was performed. After 1984, the posterior sagittal anorectoplasty (PSARP) (Peña and deVries) was used in 35 patients as the primary operation. In 22 patients a PSARP operation was done as a secondary procedure, in one third of these patients after a previous pull-through operation in our centre. The functional results were analysed in retrospect. RESULTS: Sixty operations in 53 patients could be evaluated. The overall continence rate was 34%. After the pull-through operation six out of 15 patients (40%) were continent, after a primary PSARP 10 out of 25 (40%) and after a secondary PSARP operation five out of 20 patients (25%). Patients with a sacral defect were continent only in 16% as compared to 44% of the patients with a normal sacrum. Sex was also relevant: 67% of the girls were continent, compared to 30% of the boys. Ten out of 11 girls (90%) with a normal sacrum became continent. CONCLUSION: The PSARP for high and intermediate anorectal malformations does not give better functional results than the pull-through operation. The prognosis is determined by other factors than the type of operation, notably sex and the presence or absence of sacral defects.