Current treatment options for recurrent nasopharyngeal cancer

Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1–T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation

Medication adherence perspectives in haemodialysis patients: a qualitative study

Background: End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients. Methods: A qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia. Patient self-reported adherence was measured using 4-item Morisky Green Levine scale. Interview transcripts were thematically analysed and mapped against the World Health Organization (WHO) determinants of medication adherence. Results: Participants were 44–84 years old, and were prescribed with 4–19 medications daily. More than half of the participants were nonadherent to their medications based on self-reported measure (56.7%, n = 17). Themes mapped against WHO adherence model comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/ healthcare team related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/ economic factors (access to medicines, and relative affordability). Conclusions: Patients expressed a number of concerns that led to nonadherence behaviour. Many of the issues identified were patient-related and potentially modifiable by using psycho-educational or cognitive-behavioural interventions. Healthcare professionals should be more vigilant towards identifying these concerns to address adherence issues. Future research should be aimed at understanding healthcare professionals’ perceptions and practices of assessing medication adherence in dialysis patients that may guide intervention to resolve this significant issue of medication non-adherence

Framingham risk score but not framingham stroke risk profile is an independent predictor of impaired cognitive function among older people, free of cardiovascular disease

#nofulltext#Background: Vascular risk factors contribute to cognitive impairment, which may be the earlier manifestation of vascular brain injury. This study examined the relationship between 10-year risk for coronary heart disease (CHD) or stroke and cognitive function in older people, free of cardiovascular disease. Methods: Participants were consecutive attenders of a “primary vascular prevention clinic”, between 2009 -2010. The Framingham Risk Score (FRS) and Framingham Stroke Risk Profile (FSRP) were used to assess 10-year risk of CHD and stroke, respectively. Cognitive function was measured with Montreal Cognitive Assessment Scale (MoCA). Cognitive status (CS) was categorized as impaired (MoCA<=21) vs. normal as previously validated in the Turkish population. Correlations between cognitive status and FRS or FSRP were analyzed with multivariate logistic regression analyses. Age, gender, education level, other potential correlates of cognitive ability (depression, physical activity, obesity, alcohol consumption, family history of dementia) and treatment for hyperlipidemia and diabetes were included in the analyses. Results: The sample consisted of 167 individuals (40 men and 127 women). Mean age was 68 (SD: 6 Range: 28). Mean FRS and FSRP were 8(3-20) and 7(4-11) respectively. Fifty five individuals (%33) had impaired CS. Individuals with higher FRS (increment by 10% in FRS) had more impaired CS (adjusted OR:1,669, 95%CI 1,038.to2,682). No association was shown between FSRP and CS. Higher age, lower education level, absence of alcohol consumption and absence of treatment for hyperlipidemia were the other independent predictors of impaired CS. Conclusion: Our findings indicated that in older individuals, free of cardiovascular disease, global vascular risk is associated with impaired cognitive function which was accounted for by FRS rather than FSRP. This association was demonstrated with the use of a simple and standard neuropsychological test in routine clinical setting

SELF-EFFICACY IN HAEMODIALYSIS PATIENTS: A QUALITATIVE AND QUANTITATIVE APPROACH

WOS: 000306695401015