BackgroundSunitinib is an oral, multitargeted tyrosine kinase inhibitor that has been approved for the treatment of metastatic renal cell carcinoma. Although the majority of sunitinib-treated patients receive a clinical benefit, almost a third of the patients will not respond. Currently there is no available marker that can predict for response in these patients.MethodsWe estimated the plasma levels of NT-pro-BNP (the N-terminal precursor of brain natriuretic peptide) in 36 patients that were treated with sunitinib for metastatic clear-cell renal carcinoma.ResultsFrom the 36 patients, 9 had progressive disease and 27 obtained a clinical benefit (objective response or disease stabilization). Increases in plasma NT-pro-BNP were strongly correlated to clinical outcome. Patients with disease progression increased plasma BNP at statistically significant higher levels than patients that obtained a clinical benefit, and this was evident from the first 15 days of treatment (a three-fold increase in patients with progressive disease compared to stable NT-pro-BNP levels in patients with clinical benefit, p < 0.0001). Median progression-free survival was 12.0 months in patients with less than 1.5 fold increases (n = 22) and 3.9 months in patients with more than 1.5 fold increases in plasma NT-pro-BNP (n = 13) (log-rank test, p = 0.001).ConclusionsThis is the first time that a potential "surrogate marker" has been reported with such a clear correlation to clinical benefit at an early time of treatment. Due to the relative small number of accessed patients, this observation needs to be further addressed on larger cohorts. More analyses, including multivariate analyses are needed before such an observation can be used in clinical practice.
Purpose This study aimed to outline the changing forms of speech-language pathology practices, for both clinical services, as well as the profession's education and practicum training in the time of COVID-19 at the European University Cyprus (EUC). This study also aimed to document the steps taken to continue service delivery safely and effectively for both the EUC's Speech, Language and Hearing Clinic's clients and the speech-language therapy students completing their practicum. Method The steps for the access to and continuity of speech-language therapy services and education/training are outlined chronologically, throughout the different phases of the COVID-19 pandemic status in the country. The rise of telepractice, telesupervision, and distance learning, adapted as solutions to the obstacles caused by the pandemic, are explained in detail, while the benefits and limitations are discussed at each step. The professional development that had to take place before this rise is also described. Conclusions The utilization of online/telecommunication technology for education, practical training, and speech-language pathologist service delivery during the time of COVID-19 in Cyprus is here to stay and will probably affect the future of the profession's clinical practice, and consequently, training programs in Cyprus in the years to come. It is uncertain if the effects of such adaptations can generalize in other populations or countries, especially where regulations and policies are already in place, or where the technological foundation is not similar. Through the benefits and limitations presented, conclusions are drawn for the future applications of telepractice, telesupervision, and distance learning post–COVID-19. Suggestions are made for the possible areas of future research, concerning clinical practice and clinical practicum training, as well as for the need to define regulations and establish these types of services in the country. Supplemental Material https://doi.org/10.23641/asha.15057396
Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.
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