5 research outputs found
Characteristics of Chemotherapy-induced Neuropathy: Clinical Studies on Cisplatin and Docetaxel
Peripheral neurotoxicity is an important side-effect of several
chemotherapeutic agents. These agents may cause a usually axonal
neuropathy, which may ultimately lead to severe and disabling symptoms
and signs. Besides describing in this review the pathogenesis, the clinical
presentation, the neurophysiological findings and the nerve biopsies, we also
recount the relation between cumulative dosage/dosage per cycle and
neuropathy for the cytostatic drugs for which neurotoxicity is an important
side-effect: cisplatin, vincristine, paclitaxel, docetaxel and suramin. With the
development of strategies to circumvent toxicities of other organs and \\vith
the use of combinations of neurotoxic agents such as cisplatinlpaclitaxel,
neurotoxicity is an important and dose limiting side-effect of many treatment
regimens. Detailed knowledge of the neurologic side-effects of these drugs is
essential for the management of their neurotoxicity. The review concludes
with a short discussion of neuro-protective agents. Although several nerve
growth factors, gluthation and ethiofos hold promise as possible
neuroprotective factors, the clinical data on these drugs are still limited. New
trials are needed to confirm the value of these drugs. If neurotoxicity can
indeed be prevented or delayed, this may lead to more effective treatment
regimens
Effect of an ACTH(4-9) analogue on cisplatin neuropathy of longstanding duration: A phase II study
The efficacy of Org 2766, an ACTH(4–9) analogue, on the recovery of cisplatin neuropathy of longstanding duration was investigated in a phase II study. Twenty-two patients were treated with Org 2766 during a period of 4 months and vibration perception threshold (VPT) and sum scores for neuropathic symptoms and signs were compared with pre-treatment values. No change in VPT could be detected. Although there was a small improvement of clinical measures for neuropathy, no clear evidence for repair could be obtained. These results indicate no beneficial effect of Org 2766 on recovery of a longstanding cisplatin neuropathy
Prevalence and risk factors of symptomatic carotid stenosis in patients with recent transient ischaemic attack or ischaemic stroke in the Netherlands
Introduction: Literature on prevalence of symptomatic internal carotid artery stenosis is scarce and heterogeneous. Prevalence may have decreased in recent years due to improved management of cardiovascular risk factors. We aim to estimate current prevalence and identify risk factors of ipsilateral internal carotid artery stenosis in patients with recent hemispheric transient ischaemic attack or isch
Value-based healthcare in ischemic stroke care: Case-mix adjustment models for clinical and patient-reported outcomes
Background: Patient-Reported Outcome Measures (PROMs) have been proposed for benchmarking health care quality across hospitals, which requires extensive case-mix adjustment. The current study's aim was to develop and compare case-mix models for mortality, a functional outcome, and a patient-reported outcome measure (PROM) in ischemic stroke care. Methods: Data from ischemic stroke patients, admitted to four stroke centers in the Netherlands between 2014 and 2016 with available outcome information (N = 1022), was analyzed. Case-mix adjustment models were developed for mortality, modified Rankin Scale (mRS) scores and EQ-5D index scores with respectively binary logistic, proportional odds and linear regression models with stepwise backward selection. Predictive ability of these models was determined with R-squared (R2) and area-under-The-receiver-operating-characteristic-curve (AUC) statistics. Results: Age, NIHSS score on admission, and heart failure were the only common predictors across all three case-mix adjustment models. Specific predictors for the EQ-5D index score were sex (β = 0.041), socio-economic status (β =-0.019) and nationality (β =-0.074). R2-values for the regression models for mortality (5 predictors), mRS score (9 predictors) and EQ-5D utility score (12 predictors), were respectively R2 = 0.44, R2 = 0.42 and R2 = 0.37. Conclusions: The set of case-mix adjustment variables for the EQ-5D at three months differed considerably from the set for clinical outcomes in stroke care. The case-mix adjustment variables that were specific to this PROM were sex, socio-economic status and nationality. These variables should be considered in future attempts to risk-Adjust for PROMs during benchmarking of hospitals