Home visits made by general practitioners in the canton of Vaud between 2006 and 2015

AIM OF THE STUDY

Although physicians’ home visits are highly valued by patients, and are among the measures that contribute to maintaining elderly patients at home, their number is decreasing worldwide. We aimed to describe the trends in home visits made by general practitioners (GPs) in the canton of Vaud in Switzerland between 2006 and 2015, and to explore their associated characteristics.

METHODS

We retrospectively analysed billing data from family physicians (internists, generalists and practicing physicians) transmitted to the cantonal trust centre between 2006 and 2015. We explored physician and patient characteristics, first over the entire 10-year study period and then averaged by year. To explore factors associated with the number of home visits, we fitted a mixed effect negative binomial regression of the annual number of home visits per physician.

RESULTS

Over ten years, 631 physicians billed a total of 451,634 home visits, of which 19.8% (n = 89,966) were emergency visits, and 9.7% (n = 43,915) were over the weekend. Home visits represented 2.5% of all consultations. Although the average annual number of physicians doing home visits remained stable at around 400, the mean annual number of visits per physician decreased from 125 in 2006 to 75 in 2015, resulting in a 40% decline in the absolute number of visits. Male physicians undertook more home visits than their female counterparts did, although the difference diminished over time. Visits to elderly patients (65+) represented 84.2% of the home visits.

CONCLUSIONS

Although most physicians in the canton of Vaud continue to visit patients at home, the overall number of home visits is declining. Most home visits consist of routine visits to elderly patients. Physicians’ gender, age and specialty are associated with the number of home visits. In the rapidly evolving context of an ageing population and the development of home care, physicians’ role in home care provision should be revised, taking into account patient expectations and current health system constraints.

Abstract P6-14-07: Not presented

This abstract was not presented at the conference.

Citation Format: Lai J, Antill Y, Richardson G, Vereker M, David S. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-14-07.

Chemical strategies to unravel bacterial-eukaryotic signaling

The common language of bacteria and higher life forms is a lexicon of small molecules that the research community is only beginning to decipher. While many new signaling molecules have been discovered in recent years, the identification of their targets is mostly lagging. This review will focus on the latest chemical-probe based research aimed at understanding how bacteria interact chemically with mammals and plants. In general, chemical biology strategies remain under-utilized in this complex field of research, with a few key exceptions, and we hope that this review encourages others to implement these techniques in their research. Specifically, we highlight the chemical biology techniques used in recent studies, especially activity-based protein profiling, that have been applied to unravel the chemical mechanisms of interkingdom interactions.

Low genomic diversity of Legionella pneumophila within clinical specimens

Objectives

Legionella pneumophila is the leading cause of Legionnaires' disease, a severe form of pneumonia acquired from environmental sources. Investigations of both sporadic cases and outbreaks rely mostly on analysis of a single to a few colony pick(s) isolated from each patient. However, because of the lack of data describing diversity within single patients, the optimal number of picks is unknown. Here, we investigated diversity within individual patients using sequence-based typing (SBT) and whole-genome sequencing (WGS).

Methods

Ten isolates of L. pneumophila were obtained from each of ten epidemiologically unrelated patients. SBT and WGS were undertaken, and single-nucleotide polymorphisms (SNPs) were identified between isolates from the same patient.

Results

The same sequence type (ST) was obtained for each set of ten isolates. Using genomic analysis, zero SNPs were identified between isolates from seven patients, a maximum of one SNP was found between isolates from two patients, and a maximum of two SNPs was found amongst isolates from one patient. Assuming that the full within-host diversity has been captured with ten isolates, statistical analyses showed that, on average, analysis of one isolate would yield a 70% chance of capturing all observed genotypes, and seven isolates would yield a 90% chance.

Conclusions

SBT and WGS analyses of multiple colony picks obtained from ten patients showed no, or very low, within-host genomic diversity in L. pneumophila, suggesting that analysis of one colony pick per patient will often be sufficient to obtain reliable typing data to aid investigation of cases of Legionnaires' disease.

In Vitro and in Vivo Biocompatibility of Substituted Cellulose and Synthetic Membranes

Regenerated cellulosic membranes are held as bioincompatible due to their high complement - and leukopenia - inducing properties. Adherence of polymorphonuclear neutrophils and monocyte purified from normal human blood to the three membranes were evaluated in an in vitro recirculation circuit in the presence or absence of fresh, autologous plasma after recirculation in an in vitro circuit using minimodules with each of the three membranes. In in vivo studies, 9 patients were treated with conventional haemodialysis for 2 weeks with each membrane and 1 week for wash-out using haemodialysers with the following surface: 1.95 m2 for benzyl-cellulose, 1.8 m2 for acetate-cellulose and low-flux polysulfone. Measurement of leukopenia, plasma C3a des Arg and elastase-α 1 proteinase inhibitor complex levels as well as urea, creatinine, phosphate and uric acid clearances was performed. Plasma-free neutrophils adhered maximally to acetate-cellulose (65% remaining in the circulation), while there was no significant difference between low-flux polysulfone and benzyl-cellulose (80% circulating neutrophils, at 15 min, p<0.001 vs acetate cellulose). In the presence of fresh plasma, as source of complement, the differences between acetate cellulose vs polysulfone and benzyl-cellulose were even more evident, suggesting the role of complement-activated products in neutrophil adherence. A similar trend was observed for monocyte adherence with the three membranes in the absence or presence of plasma. In vivo studies showed that the nadir of leukopenia was at 15 and 30 min with acetate-cellulose (79%) and benzyl-cellulose (50%) (p<0.05 acetate- vs benzyl-cellulose) and at 15 min with polysulfone (24%) (p<0.01 vs acetate- and benzyl-cellulose). Plasma C3a des Arg levels arose to 2037 ± 120 ng/ml, 1216 + 434 ng/ml and 46 ± 55 ng/ml with acetate-, benzyl-cellulose and polysulfone, respectively. No pre- vs post-dialysis increase in the intracellular content of TNF-α was detected with any of three membranes. Clearance values of urea, creatinine and uric acid were superimposable for all the three membranes. However, benzyl cellulose had a significantly higher clearance for phosphorus (normalized for surface area) (p<0.01 vs acetate-cellulose, 0.001 vs polysulfone). These results implicate that synthetic modification of the cellulose polymer as for the benzyl-cellulose significantly reduces the in vitro adherence, delays the in vivo activation of “classic” biocompatibility parameters and notably improves the removal of inorganic phosphorus.

Predilution Hemofiltration. Clinical Experience and Removal of Small Molecular Weight Solutes

Over 1500 treatments of hemofiltration with on-line preparation of substitution fluid were performed in 16 patients. Two patients were treated for over 40 months. On-line preparation of the solution allowed use of bicarbonate as a buffer. 73-74 L/session were infused in pre-dilution modality, at a rate of about 370 ml/min, and the treatment length was above 4 hrs. The good quality of on-line prepared solution was confirmed by the negativity of microbiological tests and by the absence of clinical or sub-clinical reactions in patients. Urea clearance was calculated by equations considering either plasma flow or whole blood flow. Results were 196-197 ml/min and 186-183 ml/min, respectively. The latter was nearer to the value of directly measured clearance (182-173 ml/min). Kt/V urea was about 1 per session and PCR ranged between 1.3 and 1.4 g/kg/day. A high vascular stability was also observed. Since sodium balance may, at least in part, account for better vascular stability, sodium sieving coefficient was measured during the treatment. The sodium-retaining effect of the increase of protein concentration within the filter, due to the ultrafiltration, was less relevant in pre-dilution hemofiltration if compared to post-dilution hemofiltration. It has been calculated that to obtain a sodium balance similar to that of the hemodialysis (HD), the sodium concentration of infusion solution should be about 2 mEq/L higher than HD dialysis solution. However, difficulty in performing accurate balance studies prevents a general agreement on these conclusions.

Colorectal cancer and inflammatory bowel diseases: effects of diet and antioxidants

It is well established that oxidative stress is common in inflammatory bowel diseases (IBDs). Accordingly, antioxidants are recommended for treatment. The aim of this study is to compare the effects of antioxidants contained in the various types of tea on symptoms and evolution of IBD and colorectal cancer (CRC). Analysis of the literature revealed that the theaflavin-3, 30-digallate (TFDG) contained in black tea, and epigallocatechin-3-O-gallate (EGCG) contained in green tea have protective effects against oxidative stress. Moreover, these substances are involved in many biochemical processes responsible for inflammation and proliferation of cancer cells. It is documented that both TFDG and EGCG are able to reduce inflammatory phenomena and symptoms associated with IBD, as well as to reduce the proliferation of CRC cells. Most studies are performed in vitro or in experimental animal models. It is, therefore, advisable to formulate studies that could be carried out on humans or human samples, in order to develop the appropriate therapeutic strategies.

Colorectal cancer: an update on the effects of lycopene on tumor progression and cell proliferation

Colorectal cancer (CRC) is one of the most common cancers worldwide. Various factors, including oxidative stress, where excessive productions of reactive oxygen species (ROS) and reactive nitrogen species (RNS) occur, contribute to its pathogenesis. Numerous studies have investigated the effect of antioxidant substances derived from food such as fruits and vegetables; however, data on Lycopene are still rare. Studies on HT-29 colorectal cancer cells and on animal models have shown that lycopene has effects on cell proliferation and on the progression of the CRC by interacting with various cellular signaling pathways. This analysis of the literature focused on the antioxidant effect of lycopene, a substance that is found in the tomato.

Use of core biopsy in diagnosing cervical lymphadenopathy: a viable alternative to surgical excisional biopsy of lymph nodes?

OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy. In this study, we aimed to determine the efficacy of diagnosing neck masses. METHOD A retrospective analysis was performed of patients being investigated for a neck mass who were undergoing ultrasound-guided core biopsies of cervical lymph nodes over a 17-month period. The final histology report was scrutinised to assess whether adequate tissue was obtained to allow for full tissue diagnosis. RESULTS Over the 17-month period analysed, 70 patients with cervical lymphadenopathy underwent core biopsy. Of these, 63 (90%) were diagnostic for either lymphoma or other pathology and did not require further tissue sampling. Overall, 19 patients were diagnosed with lymphoma, of which only 1 required further biopsy due to inconclusive initial core biopsy. CONCLUSIONS Current guidelines for investigating lymphomas require that excisional biopsy be performed to obtain ample tissue to allow full nodal architecture assessment and ancillary investigation to reach an accurate histological classification. Within our head and neck multidisciplinary team, however, it is considered that results from core biopsies can be obtained in a more timely fashion and with histological accuracy equal to those of open biopsy. The results obtained demonstrate that core biopsy is an effective tool for investigation. We believe this should be the first-line investigation of choice, as it reduces the need for patients to undergo surgery, is more cost effective and offers a faster diagnosis.

[Home visits by GPs - Considerations in Europe and in Switzerland]

Home visits are essential for promoting the ability to remain at home and prevent nursing home admissions ; general practitioners play a key role in the development of this specific ambulatory care. Although the frequency of home visits seems to be overall decreasing in recent years, they remain essential, given the expected demographic changes. This is why education on home visits should be introduced in the training of our students during early years. However, there is a gap in literature regarding the optimal number and length of home visits, as well as the kind of groups most likely to benefit from them and thus more research is needed to enlighten these aspects of home visits.