Losing Health Symbols Because of Nutrition-Related Problems in Advanced Cancer: An Interpretative Phenomenological Analysis

The outcome of stressors challenging well-being is mediated by the meaning attached to these stressors. Consequently, increased insight and knowledge about the meaning patients and family caregivers attach to nutrition-related problems is paramount to support nurses and other professionals in providing psychosocial assistance in couples facing nutrition-related problems in advanced cancer. In this qualitative study, 7 couples participated. Data were collected through in-depth interviews and analyzed by an interpretative phenomenological approach. Nutrition related problems among patients with advanced cancer are mostly perceived as a loss of one or more health symbols. The meaning that is attributed to a nutrition-related problem is individual and dynamic as it can change during illness trajectory. Nutrition-related problems inherent to advanced cancer are perceived as destroying health and leading to loss of physical, psychological and social health symbols. Since the meaning patients and family caregivers attach to nutrition-related problems is individual and dynamic, it is indicated to devote special attention to the issues on different occasions. Our findings can assist nurses and other professional caregivers in providing psychological support for dyads confronted with nutrition-related problems in advanced cancer. It is important to take into account the meaning patients and partners attach to these nutrition-related problems.status: publishe

Assessment of the one-year Efficacy and Safety of Tofacitinib in biologic-refractory patients with Ulcerative Colitis: a real-world Belgian cohort study

peer reviewedIntroduction: Tofacitinib, an oral Janus kinase inhibitor, has been approved in 2018 for the treatment of moderate to severe ulcerative colitis (UC) in Europe. Efficacy and safety data from long-term real-world studies are scarce. Aim: The aim of the study was to evaluate the real-world long-term efficacy and safety of tofacitinib in a Belgian cohort of patients with refractory UC who were exposed to both anti-TNF and vedolizumab. Methods: We performed an observational, national, retrospective multicenter study including all patients whith active UC who started on tofacitinib between November 2018 and August 2019 in 26 Belgian centers (Ethics Committee approval number P2019/429, date: 10/12/2019; amendment for study extension received on 16/07/2020). Data were prospectively collected and retrospectively analyzed according to intention-to-treat. Clinical response (decrease from baseline in partial adapted Mayo score (stool frequency and rectal bleeding) by ≥ 1 and ≥ 30%), clinical remission (Partial Adapted Mayo score ≤ 1), steroid-free clinical remission, endoscopic response (decrease from baseline in Mayo endoscopic subscore of ≥ 1), endoscopic remission (endoscopic Mayo subscore of 0), drug survival, need for colectomy and adverse events (AEs) were assessed at week 8, 16 and 52. Results: A total of 75 patients were included with a median follow-up of 45 weeks (IQR: 19-51). Patients were predominately men (59%), and median age at baseline was 44 years (IQR: 31-59). Median disease duration was 8 years (IQR: 4-17). Fifty-five percent had left-sided UC and 45% had pancolitis. Overall, 72 (96%), 51 (68%) and 6 (8%) patients were exposed to at least 1, 2 or 3 antiTNFs respectively, and 73 (97%) to vedolizumab. At baseline, 42 (56%) patients were under steroids. Median Partial Adapted Mayo score at baseline was 4 (IQR: 3-5), and median endoscopic Mayo subscore was 2 (IQR: 2-3). Thirty-nine (52%) patients required prolonged induction at 10mg twice daily for 8 additional weeks. Dose optimization was needed in 12 (16%) patients due to disease relapse after induction response, 9 (12%) of which could regain response. After 1 year, 52% and 43% of patients had experienced clinical response and clinical remission respectively, and 39% achieved steroid-free clinical remission. Endoscopic response and remission were observed in 37% and 9% of patients. Faecal calprotectin < 250 µg/g at week 16 (OR: 0.03(95%CI: 0.003-0.4)) was a positive predictor of clinical remission at week 52. Overall, 34 (45%) patients discontinued tofacitinib (22 due to primary non response, 11 due to secondary loss of response and 1 due to AE) during follow-up with a median exposure duration of 17 weeks (IQR: 11-42). Among these patients, 6 underwent colectomy for disease worsening after a median treatment duration of 15 weeks (IQR: 11-19) and a median follow-up of 20 weeks (IQR: 12-25) , while the others switched to another medical therapy. Forty AEs were reported in 25 (33%) patients, with only one (pneumonia) leading to treatment discontinuation. The most common AEs were arthralgia and lower respiratory tract infections followed by herpes zoster, urinary tract and upper respiratory tract infections. Two cases of prostate cancer have been reported. No opportunistic infection, venous thromboembolism, pulmonary embolism or cardiovascular event were reported. A statistically significant increase of 43% in the low-density lipoprotein (LDL) level was observed between baseline and week 52 among patients in clinical remission at week 52 , with no significant changes in total cholesterol and high-density lipoprotein (HDL). Conclusions: Tofacitinib effectively induced long-term clinical and endoscopic response and remission in a refractory cohort of patients with UC in a real-world clinical setting. During this one-year follow-up, tofacitinib was relatively well tolerated with respect to adverse events

Archeologisch booronderzoek Reitdiepwijken 3 te Groningen, gemeente Groningen (GR)

Voor het bureauonderzoek wordt verwezen naar MUG Publicatie 2009-23 (De Roller 2009) dat betrekking heeft op de aangrenzende noordelijke percelen. In de afgelopen twee jaar is de situatie niet zodanig gewijzigd dat er aanvullingen op het bureauonderzoek uit 2009 noodzakelijk zijn. Langs de Friesestraatweg loopt mogelijke een geul met bijbehorende oeverwallen. De oeverwallen zijn aantrekkelijke vestigingsplaatsen voor de mens omdat ze over het algemeen wat droger zijn en hoger liggen dan de omgeving. Uit het booronderzoek blijkt dat binnen het onderzoeksgebied een geul aanwezig is, die vermoedelijk rond de jaartelling zover verland is dat ze geen watervoerende functie meer had. Deels op de geulvulling en op de oeverwallen is een vegetatiehorizont aanwezig dat vermoedelijk uit de 3e eeuw stamt. In twee boringen zijn sporen van fosfaat aangetroffen. Het vegetatiehorizont en de fosfaatsporen zijn aanwijzingen voor menselijke activiteit in het onderzoeksgebied. Mogelijk horen de fosfaatsporen bij de nederzetting net ten oosten van het onderzoeksgebied. Deze nederzetting dateert uit het begin van de jaartelling (Hielkema & De Wit 2007). De terreinomstandigheden (oeverwal en de aanwezigheid van een vegetatiehorizont) binnen het onderzoeksgebied zijn zodanig dat er een goede kans is op menselijke sporen uit de periode ijzertijd-nieuwe tijd. Er wordt daarom aanbevolen vervolgonderzoek uit te voeren in de vorm van een proefsleuvenonderzoek waarbij duidelijk moet worden of er daadwerkelijk bewoningsresten aanwezig zij

Outcome of Pregnancies in Female Patients With Inflammatory Bowel Diseases Treated With Vedolizumab

Background and Aims: Vedolizumab is an IgG1 anti-α4β7 integrin antibody approved for the treatment of inflammatory bowel diseases [IBD], but without clear safety data during conception, pregnancy and nursing. Animal studies showed that mucosal vascular addressin cell adhesion molecule 1 [MAdCAM-1] is expressed by maternal vessels in the placenta and recruits α4β7-expressing cells that are considered important for maternal/fetal tolerance. Blocking this interaction by vedolizumab might affect this process. We aimed to evaluate pregnancy outcomes in vedolizumab-treated female IBD patients. Methods: We conducted a retrospective, multicentre Belgian observational study. Details on disease activity, prenatal complications, delivery and neonatal outcome were collected through a case report form. Results: Twenty-four pregnancies were reported. Five women had active disease at conception and one patient flared during pregnancy. There were 23 live births. Complications were observed in 25% of pregnancies [premature rupture of membranes, pre-eclampsia, miscarriage, elective termination and stillbirth] and in 35% of infants [prematurity, intra-uterine growth retardation, small for gestational age and congenital malformations including hip dysplasia, pulmonary valve stenosis and Hirschprung's disease]. Vedolizumab was continued throughout pregnancy in two females and stopped in the 1st and 2nd trimester in five and 16 patients, respectively. For live born children, the median [interquartile range] gestational age, weight and Apgar score 5 min after birth were 39 [37-39.6] weeks, 3270 [3080-3585] grams and 10 [9-10], respectively. Conclusions: Although several complications were observed, both in mothers and in newborns, no firm conclusions can be drawn. Awaiting prospective and controlled registries, vigilance and strict follow-up of pregnant patients treated with vedolizumab seems mandatory.status: publishe

Outcome of pregnancies in female patients with inflammatory bowel diseases treated with vedolizumab

Background and Aims: Vedolizumab is an IgG1 anti-α4β7 integrin antibody approved for the treatment of inflammatory bowel diseases [IBD], but without clear safety data during conception, pregnancy and nursing. Animal studies showed that mucosal vascular addressin cell adhesion molecule 1 [MAdCAM-1] is expressed by maternal vessels in the placenta and recruits α4β7-expressing cells that are considered important for maternal/fetal tolerance. Blocking this interaction by vedolizumab might affect this process. We aimed to evaluate pregnancy outcomes in vedolizumab-treated female IBD patients. Methods: We conducted a retrospective, multicentre Belgian observational study. Details on disease activity, prenatal complications, delivery and neonatal outcome were collected through a case report form. Results: Twenty-four pregnancies were reported. Five women had active disease at conception and one patient flared during pregnancy. There were 23 live births. Complications were observed in 25% of pregnancies [premature rupture of membranes, pre-eclampsia, miscarriage, elective termination and stillbirth] and in 35% of infants [prematurity, intra-uterine growth retardation, small for gestational age and congenital malformations including hip dysplasia, pulmonary valve stenosis and Hirschprung’s disease]. Vedolizumab was continued throughout pregnancy in two females and stopped in the 1st and 2nd trimester in five and 16 patients, respectively. For live born children, the median [interquartile range] gestational age, weight and Apgar score 5 min after birth were 39 [37–39.6] weeks, 3270 [3080–3585] grams and 10 [9–10], respectively. Conclusions: Although several complications were observed, both in mothers and in newborns, no firm conclusions can be drawn. Awaiting prospective and controlled registries, vigilance and strict follow-up of pregnant patients treated with vedolizumab seems mandatory.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Outcome of Pregnancies in Female Patients With Inflammatory Bowel Diseases Treated With Vedolizumab.

Vedolizumab is an IgG1 anti-α4β7 integrin antibody approved for the treatment of inflammatory bowel diseases [IBD], but without clear safety data during conception, pregnancy and nursing. Animal studies showed that mucosal vascular addressin cell adhesion molecule 1 [MAdCAM-1] is expressed by maternal vessels in the placenta and recruits α4β7-expressing cells that are considered important for maternal/fetal tolerance. Blocking this interaction by vedolizumab might affect this process. We aimed to evaluate pregnancy outcomes in vedolizumab-treated female IBD patients. We conducted a retrospective, multicentre Belgian observational study. Details on disease activity, prenatal complications, delivery and neonatal outcome were collected through a case report form. Twenty-four pregnancies were reported. Five women had active disease at conception and one patient flared during pregnancy. There were 23 live births. Complications were observed in 25% of pregnancies [premature rupture of membranes, pre-eclampsia, miscarriage, elective termination and stillbirth] and in 35% of infants [prematurity, intra-uterine growth retardation, small for gestational age and congenital malformations including hip dysplasia, pulmonary valve stenosis and Hirschprung's disease]. Vedolizumab was continued throughout pregnancy in two females and stopped in the 1st and 2nd trimester in five and 16 patients, respectively. For live born children, the median [interquartile range] gestational age, weight and Apgar score 5 min after birth were 39 [37-39.6] weeks, 3270 [3080-3585] grams and 10 [9-10], respectively. Although several complications were observed, both in mothers and in newborns, no firm conclusions can be drawn. Awaiting prospective and controlled registries, vigilance and strict follow-up of pregnant patients treated with vedolizumab seems mandatory

Outcome of Biological Therapies and Small Molecules in Ulcerative Proctitis: A Belgian Multicenter Cohort Study.

peer reviewedBACKGROUND & AIMS: Several advanced therapies (biologic therapies and small molecules) have been approved for the treatment of moderate-to-severe ulcerative colitis. The registration trials for these agents typically excluded patients with isolated proctitis, leaving an evidence gap. We evaluated efficacy and safety of advanced therapies in patients with ulcerative proctitis (UP). METHODS: This multicenter retrospective cohort study included consecutive patients with active UP (Mayo endoscopy subscore of ≥2, rectal inflammation up to 15 cm) initiating advanced therapy, after failing conventional therapy. The primary end point was short-term steroid-free clinical remission (total Mayo score ≤2 with no individual subscore >1). In addition, drug persistence and relapse-free and colectomy-free survival were assessed. Both binary logistic and Cox regression analyses were performed. RESULTS: In total, 167 consecutive patients (52.0% female; median age 41.0 years; 82.0% bionaive) underwent 223 courses of therapy for UP (38 adalimumab, 14 golimumab, 54 infliximab, 9 ustekinumab, 99 vedolizumab, 9 tofacitinib). The primary end point was achieved with 36.3% of the treatment courses, and based on multivariate analysis, more commonly attained in bionaive patients (P = .001), patients treated with vedolizumab (P = .001), patients with moderate endoscopic disease activity (P = .002), and a body mass index <25 kg/m(2) (P = .018). Drug persistence was significantly higher in patients treated with vedolizumab (P < .001) and patients with a shorter disease duration (P = .006). No new safety signals were observed. CONCLUSIONS: Advanced therapies are also efficacious and safe in patients with ulcerative colitis limited to the rectum. Therefore, the inclusion of patients with UP in future randomized-controlled trials should be considered

Outcome of biological therapies and small molecules in ulcerative proctitis : a Belgian multicenter cohort study

Abstract: BACKGROUND & AIMS: Several advanced therapies (biologic therapies and small molecules) have been approved for the treatment of moderate-to-severe ulcerative colitis. The registration trials for these agents typically excluded patients with isolated proctitis, leaving an evidence gap. We evaluated efficacy and safety of advanced therapies in patients with ulcerative proctitis (UP). METHODS: This multicenter retrospective cohort study included consecutive patients with active UP (Mayo endoscopy subscore of >= 2, rectal inflammation up to 15 cm) initiating advanced therapy, after failing conventional therapy. The primary end point was short-term steroid-free clinical remission (total Mayo score 1). In addition, drug persistence and relapse-free and colectomy-free survival were assessed. Both binary logistic and Cox regression analyses were performed. RESULTS: In total, 167 consecutive patients (52.0% female; median age 41.0 years; 82.0% bionaive) underwent 223 courses of therapy for UP (38 adalimumab, 14 golimumab, 54 infliximab, 9 ustekinumab, 99 vedolizumab, 9 tofacitinib). The primary end point was achieved with 36.3% of the treatment courses, and based on multivariate analysis, more commonly attained in bionaive patients (P = .001), patients treated with vedolizumab (P = .001), patients with moderate endoscopic disease activity (P = .002), and a body mass index <25 kg/m(2) (P = .018). Drug persistence was significantly higher in patients treated with vedolizumab (P < .001) and patients with a shorter disease duration (P = .006). No new safety signals were observed. CONCLUSIONS: Advanced therapies are also efficacious and safe in patients with ulcerative colitis limited to the rectum. Therefore, the inclusion of patients with UP in future randomized-controlled trials should be considered