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Somri F, Somri M, Gaitini L, Kharouba J, Gómez-Ríos MÁ. Exploring a novel scavenger for inhalational induction in pediatric anesthesia. A promising approach. J Clin Anesth 2024; 94:111375. [PMID: 38211372 DOI: 10.1016/j.jclinane.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Feras Somri
- Faculty of Medicine, Universita degli Studi "Gabrielr d'Annunzio" Chieti, Pescara, Italy
| | - Mostafa Somri
- Department of Anesthesia, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Luis Gaitini
- Department of Anesthesia, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Johnny Kharouba
- Department of Pediatric Dentistry, the Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manuel Á Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; Spanish Difficult Airway Group (GEVAD), Spain.
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Thomas-Joulié A, Tran S, El Houari L, Seyve A, Bielle F, Birzu C, Lozano-Sanchez F, Mokhtari K, Giry M, Marie Y, Laigle-Donadey F, Dehais C, Houillier C, Psimaras D, Alentorn A, Laurenge A, Touat M, Sanson M, Hoang-Xuan K, Kas A, Rozenblum L, Habert MO, Nichelli L, Leclercq D, Galanaud D, Jacob J, Karachi C, Capelle L, Carpentier A, Mathon B, Belin L, Idbaih A. Prognosis of glioblastoma patients improves significantly over time interrogating historical controls. Eur J Cancer 2024; 202:114004. [PMID: 38493668 DOI: 10.1016/j.ejca.2024.114004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common devastating primary brain cancer in adults. In our clinical practice, median overall survival (mOS) of GBM patients seems increasing over time. METHODS To address this observation, we have retrospectively analyzed the prognosis of 722 newly diagnosed GBM patients, aged below 70, in good clinical conditions (i.e. Karnofsky Performance Status -KPS- above 70%) and treated in our department according to the standard of care (SOC) between 2005 and 2018. Patients were divided into two groups according to the year of diagnosis (group 1: from 2005 to 2012; group 2: from 2013 to 2018). RESULTS Characteristics of patients and tumors of both groups were very similar regarding confounding factors (age, KPS, MGMT promoter methylation status and treatments). Follow-up time was fixed at 24 months to ensure comparable survival times between both groups. Group 1 patients had a mOS of 19 months ([17.3-21.3]) while mOS of group 2 patients was not reached. The recent period of diagnosis was significantly associated with a longer mOS in univariate analysis (HR=0.64, 95% CI [0.51 - 0.81]), p < 0.001). Multivariate Cox analysis showed that the period of diagnosis remained significantly prognostic after adjustment on confounding factors (adjusted Hazard Ratio (aHR) 0.49, 95% CI [0.36-0.67], p < 0.001). CONCLUSION This increase of mOS over time in newly diagnosed GBM patients could be explained by better management of potentially associated non-neurological diseases, optimization of validated SOC, better management of treatments side effects, supportive care and participation in clinical trials.
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Affiliation(s)
- A Thomas-Joulié
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - S Tran
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - L El Houari
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Unité de Recherche Clinique, F-75013 Paris, France
| | - A Seyve
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Bielle
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - C Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Lozano-Sanchez
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Mokhtari
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - M Giry
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - Y Marie
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - F Laigle-Donadey
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - D Psimaras
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Alentorn
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Laurenge
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Kas
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Rozenblum
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - M-O Habert
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Nichelli
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Leclercq
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Galanaud
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - J Jacob
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - C Karachi
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Capelle
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - A Carpentier
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - B Mathon
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Belin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France.
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Seidu S, Alabraba V, Davies S, Newland-Jones P, Fernando K, Bain SC, Diggle J, Evans M, James J, Kanumilli N, Milne N, Viljoen A, Wheeler DC, Wilding JPH. SGLT2 Inhibitors - The New Standard of Care for Cardiovascular, Renal and Metabolic Protection in Type 2 Diabetes: A Narrative Review. Diabetes Ther 2024; 15:1099-1124. [PMID: 38578397 PMCID: PMC11043288 DOI: 10.1007/s13300-024-01550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/06/2024] [Indexed: 04/06/2024] Open
Abstract
A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowing or preventing the onset of long-term cardiovascular, renal and metabolic (CVRM) complications, making their use highly applicable for organ protection and the maintenance of long-term health outcomes. SGLT2is have shown cost-effectiveness in T2DM management and economic savings over other glucose-lowering therapies due to reduced incidence of cardiovascular and renal events. National and international guidelines advocate SGLT2i use early in the T2DM management pathway, based upon a plethora of supporting data from large-scale cardiovascular outcome trials, renal outcomes trials and real-world studies. While most people with T2DM would benefit from CVRM protection through SGLT2i use, prescribing hesitancy remains, potentially due to confusion concerning their place in the complex therapeutic paradigm, variation in licensed indications or safety perceptions/misunderstandings associated with historical data that have since been superseded by robust clinical evidence and long-term pharmacovigilance reporting. This latest narrative review developed by the Improving Diabetes Steering Committee (IDSC) outlines the place of SGLT2is within current evidence-informed guidelines, examines their potential as the standard of care for the majority of newly diagnosed people with T2DM and sets into context the perceived risks and proven advantages of SGLT2is in terms of sustained health outcomes. The authors discuss the cost-effectiveness case for SGLT2is and provide user-friendly tools to support healthcare professionals in the correct application of these medicines in T2DM management. The previously published IDSC SGLT2i Prescribing Tool for T2DM Management has undergone updates and reformatting and is now available as a Decision Tool in an interactive pdf format as well as an abbreviated printable A4 poster/wall chart.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Vicki Alabraba
- Leicester Diabetes Centre, University Hospitals Leicester NHS Trust, Leicester, UK
| | | | | | | | - Stephen C Bain
- Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK
- Department of Diabetes and Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jane Diggle
- College Lane Surgery, Ackworth, West Yorkshire, UK
| | - Marc Evans
- University Hospital Llandough, Cardiff, UK
| | - June James
- Leicester Diabetes Centre, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Naresh Kanumilli
- Brooklands Northenden Primary Care Network, Manchester, UK
- Manchester University Foundation Trust, Manchester, UK
| | - Nicola Milne
- Brooklands Northenden Primary Care Network, Manchester, UK
| | - Adie Viljoen
- Borthwick Diabetes Research Unit, Lister Hospital, Stevenage, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, University of Liverpool, Liverpool, UK.
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Verbinnen I, Monte-Boquet E, Parow D, Lacombe F, Pothecary A, van Kuijk AWR, Harrington L, Müllerová E, Pinter A, Erstling U, Tomasini A, Helliwell PS. Elevating the Standard of Care for Patients with Psoriatic Arthritis: 'Calls to Action' from a Multistakeholder Pan-European Initiative. Rheumatol Ther 2024:10.1007/s40744-024-00664-3. [PMID: 38662145 DOI: 10.1007/s40744-024-00664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a complex, progressive, and often debilitating disease. Despite recent advances in treatment, numerous unmet needs in patient care persist. Rheumacensus is a multistakeholder, pan-European initiative designed to identify ways to elevate the standard of care (SoC) and treatment ambition for patients with PsA, using the perspectives of three key stakeholder groups: patients, healthcare professionals (HCPs) and payors. METHODS Rheumacensus followed three phases: an insights-gathering workshop to identify current unmet needs in PsA and an area of focus for the project, a modified Delphi process to gain consensus on improvements within the agreed area of focus, and a Consensus Council (CC) meeting which used consensus statements as inspiration to generate 'Calls to Action' (CTA)-practical measures which, if implemented, could elevate the SoC for patients with PsA. RESULTS The Rheumacensus CC consisted of four patient representatives, four HCPs and four payors. All 12 members completed all three Delphi e-consultations. The shared area of focus that informed the Delphi process was "patient empowerment through education on the disease and treatment options available, to enable patient involvement in management". Four key themes emerged from the Delphi process: patient empowerment, patient knowledge and sources of education, patient-HCP consultations, and optimal initial treatment. Statements within these themes informed 12 overarching CTA, which focus on the need for a multistakeholder approach to implementing a paradigm shift towards patient-centred care and improved outcomes for patients with PsA. CONCLUSION Rheumacensus has identified shortcomings in the current SoC for patients with PsA and provides a foundation for change through practical CTA. It is hoped that all stakeholders will now take practical steps towards implementing these CTA across Europe to elevate the SoC for patients with PsA.
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Affiliation(s)
- Iris Verbinnen
- Laboratory of Protein Phosphorylation and Proteomics, Department of Cellular and Molecular Medicine, Leuven Brain Institute, University of Leuven, Leuven, Belgium
| | - Emilio Monte-Boquet
- Pharmacy Department, Drug Clinical Area, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - Detlev Parow
- Formerly Department of Medicines, Therapeutic Appliances and Remedies, DAK-Gesundheit, Hamburg, Germany
| | | | - Andrew Pothecary
- Department of Rheumatology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Arno W R van Kuijk
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulrike Erstling
- Fachverband Rheumatologische Fachassistenz e.V., Bergisch Gladbach, Germany
| | - Andrea Tomasini
- National Association of People with Rheumatological and Rare Diseases, APMARR, Lecce, Italy
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Phoka A, van den Bemt BJF, Lubrano E, Singh I, Fernández-Carballido C, Parow D, Webb D, Lacombe F, Harrington L, Baraliakos X. Elevating the Standard of Care for Patients with Axial Spondyloarthritis: 'Calls to Action' from Rheumacensus, a Multistakeholder Pan-European Initiative. Rheumatol Ther 2024:10.1007/s40744-024-00663-4. [PMID: 38662146 DOI: 10.1007/s40744-024-00663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Several barriers to optimal care in axial spondyloarthritis (axSpA) exist, which is detrimental to patient outcomes. The Rheumacensus programme aimed to identify how the standard of care (SoC) and treatment ambition for patients with axSpA could be elevated, from the unique perspective of three key stakeholders from across Europe: patients, healthcare professionals (HCPs) and payors. METHODS Rheumacensus followed three phases: an insights-gathering workshop to identify current unmet needs in axSpA and an area of focus, a modified Delphi process to gain consensus on improvements within the agreed area of focus, and a Consensus Council (CC) meeting to generate 'Calls to Action' (CTA) to highlight the changes needed to elevate the SoC for patients with axSpA. RESULTS The Rheumacensus CC consisted of four patient representatives, four HCPs and four payors. All 12 members completed all three Delphi e-consultations. The shared area of focus that informed the Delphi process was patient empowerment through education on the disease and treatment options available, to enable patient involvement in management and ultimately increase treatment adherence. Four key themes emerged from the Delphi process: patient empowerment, patient knowledge, patient-HCP consultations and optimal initial treatment. These themes informed 11 overarching CTA, which demonstrate the need for a multistakeholder approach to implement a paradigm shift towards patient-centred care to elevate health outcomes in patients with axSpA. CONCLUSION Rheumacensus identified CTA to help bridge the disparities observed in axSpA care. It is now imperative for all stakeholders to take practical steps towards addressing these CTA to elevate the SoC and treatment ambition in patients with axSpA.
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Affiliation(s)
- Andri Phoka
- Axial Spondyloarthritis International Federation, Nicosia, Cyprus
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud UMC, Nijmegen, The Netherlands
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Campobasso, Italy
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
| | | | | | - Detlev Parow
- Formerly Department of Medicines, Therapeutic Appliances and Remedies, DAK-Gesundheit, Hamburg, Germany
| | - Dale Webb
- National Axial Spondyloarthritis Society, London, UK
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Godbout K, Kim H, Mayers I, Paterson J, Chan CKN. A survey of severe asthma in Canada: results from the CASCADE practice reflective program. Allergy Asthma Clin Immunol 2024; 20:31. [PMID: 38637825 PMCID: PMC11027544 DOI: 10.1186/s13223-024-00891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Since the last guidance was published by the Canadian Thoracic Society, there have been several advances in the clinical management of severe asthma. To gain a better understanding of the current standards of care and treatment patterns of patients, the CASCADE practice reflective program was established to conduct a real-world analysis of severe asthma management among specialists in Canada with a goal of identifying areas of opportunity to enhance patient management and outcomes. METHODS The CASCADE program was a two-part practice reflective and assessment program delivered through an on-line portal for selected specialists (Respirologists and Allergists) in Canada. The program consisted of a one-time overview survey of physician practice to establish overall practice parameters, followed by a review of at least 5 severe asthma patients to establish the current landscape of severe asthma management. RESULTS The program collected practice overview surveys from 78 specialists (52 Respirologists, 24 Allergists, and 2 General practice physicians with an interest in respiratory disease) in 8 provinces. Practices included a variety of types in both large metropolitan centres and smaller regional settings. There were 503 patients reviewed and included in the program. Most (65%) patients were currently using a biologic treatment, 30% were biologic naive, and 5% had used a biologic treatment in the past. Most patients (53%) were reported to have mixed allergic and eosinophilic phenotypes, despite a perception that allergic, eosinophilic and mixed phenotypes were evenly balanced in the physician practice. Overall, patients currently treated with biologic agents had parameters suggesting higher control and were more satisfied with treatment. However, there was less than optimal treatment satisfaction for more than half of all patients, particularly for those patients not treated with a biologic agent. CONCLUSIONS Phenotyping is hampered by poor availability for several assessments, and the full range of treatments are not currently fully utilized, partly due to physician familiarity with the agents and partly due to prescribing restrictions. Even when treated with biologic agents, patient satisfaction can still be improved.
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Affiliation(s)
- Krystelle Godbout
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Irvin Mayers
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Paterson
- Scientific Insights Consulting Group Inc., Mississauga, ON, Canada
| | - Charles K N Chan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Qvist T, Nielsen BU, Olesen HV, Mathiesen IHM, Faurholt-Jepsen D, Katzenstein TL, Helweg-Larsen J, Rönsholt F, Jeppesen M, Olsen MF, Buchvald FF, Nielsen KG, Jensen-Fangel S, Pressler T, Skov M. Close monitoring and early intervention: management principles for cystic fibrosis in Denmark. APMIS 2024; 132:223-235. [PMID: 38267398 DOI: 10.1111/apm.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
Cystic fibrosis (CF) care in Denmark has been characterized by close monitoring and pre-emptive treatment of lung disease and other CF-related complications. Continuous evaluation through data collection and commitment to clinical research has incrementally improved outcomes. This approach has been in line with best practices set forth by European Standards of Care but has also gone beyond Society standards particularly pertaining to early treatment with high-dose combination antimicrobial therapy. Despite a high prevalence of severe CF variants, lung function has been among the best in Europe. In this review, the Danish approach to management of CF prior to the introduction of new CF modulator treatment is explained and benchmarked. Downsides to the Danish approach are discussed and include increased burden of treatment, risk of antimicrobial resistance, side-effects and costs.
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Affiliation(s)
- Tavs Qvist
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bibi Uhre Nielsen
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Vebert Olesen
- Cystic Fibrosis Center Aarhus, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Hee Mabuza Mathiesen
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Terese L Katzenstein
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jannik Helweg-Larsen
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frederikke Rönsholt
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Majbritt Jeppesen
- Cystic Fibrosis Center Aarhus, Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Frahm Olsen
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frederik Fouirnaies Buchvald
- Cystic Fibrosis Center Copenhagen, Danish Pediatric Pulmonary Service, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Cystic Fibrosis Center Copenhagen, Danish Pediatric Pulmonary Service, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jensen-Fangel
- Cystic Fibrosis Center Aarhus, Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Tania Pressler
- Cystic Fibrosis Center Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Cystic Fibrosis Center Copenhagen, Danish Pediatric Pulmonary Service, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marianne Skov
- Cystic Fibrosis Center Copenhagen, Danish Pediatric Pulmonary Service, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Mateos MV, Weisel K, Diels J, Arribas A, Tamayo M, Schecter JM, Roccia T, Haddad I, Pacaud L, Moreau P. Characterization and Outcomes of Spanish Patients With Relapsed/Refractory Multiple Myeloma Included in the LocoMMotion Study. Clin Lymphoma Myeloma Leuk 2024; 24:224-231.e2. [PMID: 38212206 DOI: 10.1016/j.clml.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite advances in treatments for multiple myeloma (MM), most patients relapse and become refractory to standard drug classes including immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and anti-CD38 antibodies. The LocoMMotion study showed poor clinical outcomes in triple-class exposed patients with relapsed/refractory MM (RRMM) treated with real-world clinical practice (RWCP) therapy. Here, we report efficacy outcomes for Spanish patients receiving RWCP treatments in the LocoMMotion study compared with the full cohort. PATIENTS AND METHODS The prospective, noninterventional, multinational LocoMMotion study (NCT04035226) enrolled 248 patients who had received ≥ 3 prior lines of therapy (LOT), including a PI, an IMiD, and an anti-CD38 antibody, with disease progression during or after their last LOT. The primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). RESULTS Spanish patients (n = 24) had received a median of 4 prior LOT (range, 2-7). At 29.2 months median follow-up, patients had received 14 different treatment regimens used in RWCP during the study. Efficacy outcomes were consistent between the Spanish cohort and overall study population. The ORR was 29.2% (95% CI, 12.6%-51.1%). Median PFS and OS were 4.6 months (95% CI, 1.2-6.3) and 11.6 months (95% CI, 6.4-24.5), respectively. CONCLUSION Spanish patients from the LocoMMotion study demonstrated poor outcomes in response to RWCP treatments consistent with those of the overall study population, highlighting the need for access to new and effective therapies for patients with RRMM in Spain and globally.
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Affiliation(s)
| | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | - Philippe Moreau
- Clinical Hematology, University Hospital Hotel-Dieu, Nantes, France
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Cartmel B, Fucito LM, Bold KW, Neveu S, Li F, Rojewski AM, Gueorguieva R, O'Malley SS, Herbst RS, Toll BA. Effect of a Personalized Tobacco Treatment Intervention on Smoking Abstinence in Individuals Eligible for Lung Cancer Screening. J Thorac Oncol 2024; 19:643-649. [PMID: 37977486 PMCID: PMC10999350 DOI: 10.1016/j.jtho.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION To determine whether personalized gain-framed messaging and biomarker feedback related to tobacco cessation or reduction decrease smoking behavior in patients undergoing or eligible for lung cancer screening. METHODS Between 2016 and 2020, 188 patients were enrolled in a two-phase, sequential, randomized controlled trial. Phase 1 evaluated whether standard of care (SC) (five in-person counseling sessions and 8 weeks of nicotine patch) plus gain-framed messaging (GFM) versus SC would increase 8-week biochemically verified smoking cessation rates. In 143 participants randomized in phase 2, we tested whether feedback on smoking-related biomarkers would reduce 6-month self-reported number of cigarettes smoked per day compared with a no feedback control. Chi-square test and mixed effects repeated measures analyses were used to evaluate group differences. RESULTS Participants were 62.5 ± 5.6 (mean ± SD) years of age, had a 50.3 ± 21 pack-year smoking history, and were smoking 16.9 ± 9.9 cigarettes per day. At 8 weeks, there was no difference in quit rates between those randomized to SC plus GFM (n = 15 of 93, 16.1%) and those randomized to SC (n = 16 of 95, 16.8%), with p equals to 0.90. At the 6-month post-randomization follow-up, number of cigarettes smoked per day was similar in the feedback (least-squares mean = 7.5, 95% confidence interval: 6.0-9.1) and no feedback arms (7.7, 95% confidence interval: 6.2-9.3), with p equals to 0.87. CONCLUSIONS Gain-framed messaging and health feedback did not significantly improve quit rates relative to comprehensive standard of care. Nevertheless, the overall program achieved clinically meaningful smoking quit rates in this older high pack-year cohort, highlighting the importance of intensive tobacco treatment for patients undergoing lung cancer screening. CLINICAL TRIAL REGISTERED WITH CLINICALTRIALS.GOV: NCT02658032.
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Affiliation(s)
- Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
| | - Lisa M Fucito
- Yale Cancer Center, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
| | - Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Susan Neveu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Fangyong Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Stephanie S O'Malley
- Yale Cancer Center, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Roy S Herbst
- Yale Cancer Center, New Haven, Connecticut; Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin A Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina; MUSC Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Hübel K. Optimizing Real-World Outcomes in High-Risk Relapsed/Refractory (r/r) FL with CAR-T Cell Therapy: A Vodcast and Case Example. Oncol Ther 2024:10.1007/s40487-024-00269-4. [PMID: 38512599 DOI: 10.1007/s40487-024-00269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
Follicular lymphoma (FL) is often considered a chronic disease with frequent relapses, shortening both response duration and survival after every relapse. Selecting the most appropriate therapy at the right time within the treatment timeline is key to optimize outcomes. The aim of this vodcast, featuring Dr. Kai Hübel, is to outline the severity of FL by referring to a patient case as well as highlight chimeric antigen receptor (CAR)-T cells as an effective therapy in relapsed/refractory (r/r) FL. The patient was in their early 50s, diagnosed with FL in the early 2010s and presented with a third relapse. The patient complained of night sweats and fatigue but was still capable of self-care (Eastern Cooperative Oncology Group Performance Status Scale 2). The patient received eight cycles of rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone (R-CHOP), followed by irradiation and rituximab maintenance (first-line) and then received rituximab 4 × weekly, followed by rituximab maintenance (second-line). The patient relapsed during rituximab maintenance; the patient was rituximab refractory. The patient received six cycles of bendamustine/obinutuzumab followed by obinutuzumab maintenance. The patient relapsed during obinutuzumab maintenance, achieved a partial remission after irradiation and was switched to R/lenalidomide. Due to several high-risk features, CAR-T cell therapy was initiated. Dr. Hubel underlines how earlier treatment with CAR-T cell therapy would have been beneficial for this patient. Results of the ELARA trial as well as comparative studies have shown tisagenlecleucel to be more effective than standard of care in extensively pretreated r/r FL, including high-risk patients. In conclusion, CAR-T cell therapy is a promising therapy option for patients with multiply r/r FL. A vodcast feature is available for this article.
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Affiliation(s)
- Kai Hübel
- Department I of Internal Medicine, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
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11
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Ip A, Mutebi A, Wang T, Jun M, Kalsekar A, Navarro FR, Wang A, Kamalakar R, Sacchi M, Elliott B. Treatment Outcomes with Standard of Care in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Real-World Data Analysis. Adv Ther 2024; 41:1226-1244. [PMID: 38302846 PMCID: PMC10879405 DOI: 10.1007/s12325-023-02775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/15/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Despite new therapies for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), treatments with chemotherapy, single-agent rituximab/obinutuzumab, single-agent lenalidomide, or combinations of these agents continue to be commonly used. METHODS This retrospective study utilized longitudinal data from 4226 real-world electronic health records to characterize outcomes in patients with R/R DLBCL. Eligible patients were diagnosed with DLBCL between January 2010 and March 2022 and had R/R disease treated with ≥ 1 prior systemic line of therapy (LOT), including ≥ 1 anti-CD20-containing regimen. RESULTS A total of 573 patients treated with ≥ 1 prior LOT were included (31.2% and 13.4% with ≥ 2 and ≥ 3 prior LOTs, respectively). Median duration of follow-up was 7.7 months. Most patients (57.1%) were male; mean standard deviation (SD) age was 63 (14.7) years. Overall and complete response rates (95% confidence interval (CI) were 52% (48-56) and 23% (19-27). Median duration of response and duration of complete response were 3.5 and 18.4 months. Median progression-free and overall survival (95% CI) was 3.0 (2.8-3.3) and 12.9 (10.1-16.9) months, respectively. Patients with a higher number of prior LOTs, primary refractoriness, refractoriness to last LOT, refractoriness to last anti-CD20-containing regimen, and prior CAR T exposure had worse outcomes (i.e., challenging-to-treat R/R DLBCL) compared with those without these characteristics. CONCLUSIONS Outcomes in patients with R/R DLBCL treated with chemotherapy, single-agent rituximab/obinutuzumab, single-agent lenalidomide, or combinations of these agents remain poor, especially for those with challenging-to-treat R/R DLBCL. These findings underscore the unmet need for new, safe, and effective therapies, especially for challenging-to-treat R/R DLBCL populations.
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Affiliation(s)
- Andrew Ip
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Alex Mutebi
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA.
| | - Tongsheng Wang
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA
| | - Monika Jun
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA
| | - Anupama Kalsekar
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA
| | | | | | | | - Mariana Sacchi
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA
| | - Brian Elliott
- Genmab US, Inc., 777 Scudders Mill Road, Plainsboro, NJ, 08536, USA
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Kermanshahi N, Hamidi N, Weisberg J, Beg U, Dabrowski M, Padmanaban V, Betz J, Mansouri A. The Prevalence of Seizures in Brain Metastasis Patients on Anticonvulsant Prophylaxis: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 183:e613-e624. [PMID: 38199459 DOI: 10.1016/j.wneu.2023.12.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Brain metastasis (BM) prognosis is incredibly poor and is often associated with considerable morbidity. Seizures are commonly present in these patients, and their biopsychosocial impact can be dangerous. The use of antiepileptic drugs (AEDs) as primary prophylaxis remains controversial. This systematic review and meta-analysis aim to evaluate the efficacy of AED prophylaxis in patients with BM. METHODS MEDLINE via PubMed, Web of Science, EMBASE, and Cochrane were searched for articles pertinent to AED prophylaxis use in patients with BM. Patients with BM previously treated for cancer who were seizure naive at the time of inclusion were included. Data regarding patient characteristics, type of AED, prior treatments, and groups at a high risk of seizure were extracted. Seizure prevalence was obtained. RESULTS Eight studies were included in this systematic review and meta-analysis; 1902 total patients with BM were included, with 381 receiving antiepileptic prophylaxis, and 1521 receiving no prophylaxis. Although the odds of a seizure in the treatment group was found to be 1.158 times the odds of a seizure in the control group, the odds ratio was not statistically significant (t-statistic = 0.62, P value = 0.5543). CONCLUSIONS There was no significant difference in the odds of seizure development in control groups compared to patients receiving prophylactic antiepileptic therapy. As patients with BM present with heterogeneity in tumor characteristics and receive various treatment modalities, future research is needed to identify groups that may benefit more significantly from AED prophylaxis.
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Affiliation(s)
| | - Nima Hamidi
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Jake Weisberg
- Arizona College of Osteopathic Medicine, Arizona, USA
| | - Usman Beg
- Loma Linda University, Loma Linda, California, USA
| | | | - Varun Padmanaban
- Penn State Department of Neurosurgery, Hershey, Pennsylvania, USA
| | | | - Alireza Mansouri
- Penn State Department of Neurosurgery, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
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Abstract
This article briefly reviews a 4-step process for implementing shared decision-making (SDM) in pediatrics. The authors address difficulties with determining whether SDM should occur and comment on how the SDM process relates to, and may be conflated with, other decision-making models that leverage similar patient-centered and family-centered communication strategies.
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Affiliation(s)
- Kimberly E Sawyer
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital Palliative Care Team, 6621 Fannin Street, Suite W.1990, Houston, TX 77030, USA.
| | - Douglas J Opel
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, 1900 9th Avenue, JMB 6, Seattle, WA 98101, USA
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14
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Mei JY, Bernstein ME, Patton E, Duong HL, Negi M. Evaluating Standard of Care and Obstetrical Outcomes in a Reduced Contact Prenatal Care Model in the COVID-19 Pandemic. Matern Child Health J 2024; 28:287-293. [PMID: 37957413 PMCID: PMC10901916 DOI: 10.1007/s10995-023-03812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION We aimed to investigate the impact of reduced contact prenatal care necessitated by the COVID-19 pandemic on meeting standards of care and perinatal outcomes. METHODS This was a retrospective case-control study of patients in low-risk obstetrics clinic at a tertiary care county facility serving solely publicly insured patients comparing reduced in-person prenatal care (R) over 12 weeks with a control group (C) receiving traditional prenatal care who delivered prior. RESULTS Total 90 patients in reduced contact (R) cohort were matched with controls (C). There were similar rates of standard prenatal care metrics between groups. Gestational age (GA) of anatomy ultrasound was later in R (p = 0.017). Triage visits and missed appointments were similar, though total number of visits (in-person and telehealth) was higher in R (p = 0.043). R group had higher GA at delivery (p = 0.001). Composite neonatal morbidity and length of stay were lower in R (p = 0.017, p = 0.048). Maternal and neonatal outcomes did not otherwise differ between groups. Using Kotelchuck Adequacy of Prenatal Care Utilization index, R had higher rates of adequate prenatal care (45.6% R vs. 24.4% C, p = 0.005). DISCUSSION Our study demonstrates the non-inferiority of a hybrid, reduced schedule prenatal schedule to traditional prenatal scheduling. In a reduced contact prenatal care model, more patients met criteria for adequate prenatal care, likely due to higher attendance of telehealth visits. These findings raise the question of revising the prenatal care model to mitigate disparities in disadvantaged populations.
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Affiliation(s)
- Jenny Y Mei
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Megan E Bernstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Eden Patton
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hai-Lang Duong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Olive-View Medical Center, University of California, 14445 Olive View Dr, Sylmar, Los Angeles, CA, USA
| | - Masaru Negi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Olive-View Medical Center, University of California, 14445 Olive View Dr, Sylmar, Los Angeles, CA, USA.
- Shenandoah Valley Maternal Fetal Medicine, Valley Health, Winchester, VA, USA.
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15
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Kumar AKA. Endotracheal Cuff-pressure Monitoring in ICU: A Standard of Care Yet to be Standardized, and Often Neglected. Indian J Crit Care Med 2024; 28:8-10. [PMID: 38510767 PMCID: PMC10949284 DOI: 10.5005/jp-journals-10071-24624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
How to cite this article: Kumar AKA. Endotracheal Cuff-pressure Monitoring in ICU: A Standard of Care Yet to be Standardized, and Often Neglected. Indian J Crit Care Med 2024;28(1):8-10.
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Affiliation(s)
- AK Ajith Kumar
- Department of Critical Care Medicine, Aster Whitefield Hospital, Bengaluru, Karnataka, India
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Marsden J, Kelleher M, Gilvarry E, Mitcheson L, Bisla J, Cape A, Cowden F, Day E, Dewhurst J, Evans R, Hardy W, Hearn A, Kelly J, Lowry N, McCusker M, Murphy C, Murray R, Myton T, Quarshie S, Vanderwaal R, Wareham A, Hughes D, Hoare Z. Superiority and cost-effectiveness of monthly extended-release buprenorphine versus daily standard of care medication: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial. EClinicalMedicine 2023; 66:102311. [PMID: 38045803 PMCID: PMC10692661 DOI: 10.1016/j.eclinm.2023.102311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
Background Daily methadone maintenance or buprenorphine treatment is the standard-of-care (SoC) medication for opioid use disorder (OUD). Subcutaneously injected, extended-release buprenorphine (BUP-XR) may be more effective-but there has been no superiority evaluation. Methods This pragmatic, parallel-group, open-label, multi-centre, effectiveness superiority randomised, controlled, phase 3 trial was conducted at five National Health Service community-based treatment clinics in England and Scotland. Participants (adults aged ≥ 18 years; all meeting DSM-5 diagnostic criteria for moderate or severe OUD at admission to their current maintenance treatment episode) were randomly assigned (1:1) to receive continued daily SoC (liquid methadone (usual dose range: 60-120 mg) or sublingual/transmucosal buprenorphine (usual dose range: 8-24 mg) for 24 weeks; or monthly BUP-XR (Sublocade;® two injections of 300 mg, then four maintenance injections of 100 mg or 300 mg, with maintenance dose selected by response and preference) for 24 weeks. In the intent-to-treat population (senior statistician blinded to blinded to treatment group allocation), and with a seven-day grace period after randomisation, the primary endpoint was the count of days abstinent from non-medical opioids between days 8-168 (i.e., weeks 2-24; range: 0-161 days). Safety was reported for the intention-to- treat population. Adopting a broad societal perspective inclusive of criminal justice, NHS and personal social service costs, a trial-based cost-utility analysis estimated the Incremental Cost-effectiveness Ratio (ICER) per quality-adjusted life year (QALY) of BUP-XR versus SoC at the National Institute for Health and Care Excellence threshold. The study was registered EudraCT (2018-004460-63) and ClinicalTrials.gov (NCT05164549), and is completed. Findings Between Aug 9, 2019 and Nov 2, 2021, 314 participants were randomly allocated to receive SoC (n = 156) or BUP-XR (n = 158). Participants were abstinent from opioids for an adjusted mean of 104.37 days (standard error [SE] 9.89; range: 0-161 days) in the SoC group and an adjusted mean of 123.43 days (SE 4.76; range: 24-161 days) in the BUP-XR group (adjusted incident rate ratio [IRR] 1.18, 95% confidence interval [CI] 1.05-1.33; p-value 0.004). The incidence of any adverse event was higher in the BUP-XR group than the SoC group (128 [81.0%] of 158 participants versus 67 [42.9%] of 156 participants, respectively-most commonly rapidly-resolving (mild-moderate range) pain from drug administration in the BUP-XR group (121 [26.9%] of 450 adverse events). There were 11 serious adverse events (7.0%) in the 158 participants in the BUP-XR group, and 18 serious adverse events (11.5%) in the 156 participants in the SoC group-none judged to be related to study treatment. The BUP-XR treatment group had a mean incremental cost of £1033 (95% central range [CR] -1189 to 3225) and was associated with a mean incremental QALY of 0.02 (95% CR 0.00-0.05), and an ICER of £47,540 (0.37 probability of being cost-effective at the £30,000/QALY gained willingness-to-pay threshold). However, BUP-XR dominated the SoC among participants who were rated more severe at study baseline, and among participants in maintenance treatment for more that 28 days at study enrolment. Interpretation Evaluated against the daily oral SoC, monthly BUP-XR is clinically superior, delivering greater abstinence from opioids, and with a comparable safety profile. BUP-XR was not cost-effective in a base case cost-utility analysis using the societal perspective, but it was more effective and less costly (dominant) among participants with more severe OUD, or those whose current treatment episode was longer than 28 days. Further trials are needed to evaluate if BUP-XR is associated with better clinical and health economic outcomes over the longer term. Funding Indivior.
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Affiliation(s)
- John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Mike Kelleher
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Eilish Gilvarry
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Addictions Service, Newcastle Upon Tyne, United Kingdom
| | - Luke Mitcheson
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Jatinder Bisla
- King’s Clinical Trials Unit, Research Management and Innovation Directorate, King’s College London, United Kingdom
| | - Angela Cape
- King’s Clinical Trials Unit, Research Management and Innovation Directorate, King’s College London, United Kingdom
| | - Fiona Cowden
- NHS Tayside and Dundee Health and Social Care Partnership, Scotland, United Kingdom
| | - Edward Day
- Birmingham and Solihull Mental Health, NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Dewhurst
- Addictions Division, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Evans
- School of Health Sciences, Bangor University, Wales, United Kingdom
| | - Will Hardy
- Clinic for Health Economics and Medicines Evaluation, Bangor University, Wales, United Kingdom
| | - Andrea Hearn
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Addictions Service, Newcastle Upon Tyne, United Kingdom
| | - Joanna Kelly
- King’s Clinical Trials Unit, Research Management and Innovation Directorate, King’s College London, United Kingdom
| | - Natalie Lowry
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Martin McCusker
- Lambeth Service User Council, South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Caroline Murphy
- King’s Clinical Trials Unit, Research Management and Innovation Directorate, King’s College London, United Kingdom
| | - Robert Murray
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Addictions Service, Newcastle Upon Tyne, United Kingdom
| | - Tracey Myton
- Addictions Division, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Sophie Quarshie
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Addictions Service, Newcastle Upon Tyne, United Kingdom
| | - Rob Vanderwaal
- South London and Maudsley NHS Foundation Trust, United Kingdom
| | - April Wareham
- Patient and Public Involvement and Engagement Representative, United Kingdom
| | - Dyfrig Hughes
- Clinic for Health Economics and Medicines Evaluation, Bangor University, Wales, United Kingdom
| | - Zoë Hoare
- School of Health Sciences, Bangor University, Wales, United Kingdom
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Shah B, Chen JMH, Wu JJ, Feng C, Zhou L, Park JE, Hadjiivassileva T, Kerbauy FR, Wade SW, Keeping S. Matching-Adjusted Indirect Comparisons of Brexucabtagene Autoleucel with Alternative Standard Therapies for Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia in Adult Patients. Adv Ther 2023; 40:5383-5398. [PMID: 37801234 DOI: 10.1007/s12325-023-02662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/22/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Brexucabtagene autoleucel (brexu-cel), a CD19-directed chimeric antigen receptor T-cell therapy, is approved for relapsed/refractory B-cell precursor acute lymphoblastic leukemia in adults aged 18+/26+ years in the US/European Union (EU), based on efficacy results from the single-arm ZUMA-3 trial. This study aimed to estimate the relative treatment effects of brexu-cel versus inotuzumab ozogamicin (InO), blinatumomab (blina), and chemotherapies using unanchored matching-adjusted indirect comparison (MAIC) methods. METHODS Individual patient data from ZUMA-3 and published aggregate level data from two randomized controlled trials, INO-VATE (InO versus chemotherapy) and TOWER (blina versus chemotherapy), were used. Patient-level data from ZUMA-3 were weighted to match the mean of the following prognostic variables at baseline, which were pre-specified based on clinical input, for each comparator population: primary refractory disease, duration of first remission < 12 months, prior stem-cell transplantation, age, performance status, salvage status, bone marrow blast, complex karyotype, and Philadelphia chromosome status. The base case analysis was conducted using the modified intention-to-treat population (i.e., received brexu-cel) from ZUMA-3. Relative treatment effects for overall survival (OS) and event-free survival (EFS) were expressed as hazard ratios (HR) and differences in restricted mean survival time (RMST) with 95% confidence intervals (CI). RESULTS The base case MAIC results suggested brexu-cel improved OS and EFS compared to blina (OS HR 0.46 [95% CI 0.28, 0.75]; EFS HR 0.37 [95% CI 0.25, 0.56]) and pooled INO-VATE/TOWER chemotherapy (OS HR 0.32 [95% CI 0.18, 0.56]; EFS HR 0.27 [0.18, 0.40]). Brexu-cel also improved OS compared to InO (HR 0.45 [95% CI 0.24, 0.85]). The point estimate for EFS favored brexu-cel over Ino but the difference was not statistically significant (HR 0.67 [95% CI 0.41, 1.10]). Findings were consistent between the HR and RMST analyses. CONCLUSION Despite limitations, these MAIC results suggest that brexu-cel may improve OS and EFS versus currently used therapies in this population.
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Affiliation(s)
- Bijal Shah
- Moffitt Cancer Center, Tampa, FL, 33612, USA.
| | | | - James J Wu
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | - Lang Zhou
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | | | - Fabio R Kerbauy
- Federal University of Sao Paulo and Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Sally W Wade
- Wade Outcomes Research & Consulting, Salt Lake City, UT, USA
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Adams AJ, Frost TP. Implementation of the California advanced practice pharmacist and the continued disappointment of tiered licensure. Explor Res Clin Soc Pharm 2023; 12:100353. [PMID: 37965248 PMCID: PMC10641243 DOI: 10.1016/j.rcsop.2023.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
The Advanced Practice Pharmacist (APh) designation in California was created via legislation 10 years ago. California pharmacists who meet certain criteria can be designated as an APh and unlock additional practice authority. Just 1065 pharmacists, or 2% of licensed California pharmacists, have obtained the APh designation through 2022. APhs did not report benefiting from the designation as it relates to expanded scope of practice. This experience of low uptake and minimal benefit mirrors the tiered licenses created by three other states. More recent legislation broadened the independent prescriptive authority of APhs, but this increased value proposition aligns with the practice authority adopted by other states who have imposed fewer barriers to entry. Given the track record observed to date, we doubt that tiered licensure will ever prove successful in the pharmacy profession. Instead, state policymakers and pharmacy advocates should consider adopting a "standard of care" regulatory approach to improve patient access to safe and beneficial pharmacist services.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Eagle, ID 83616, USA
| | - Tim P. Frost
- Idaho Division of Occupational and Professional Licenses, Boise, ID, USA
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Scheier TC, Youssouf N, Mosepele M, Kanyama C, Adekanmbi O, Lakoh S, Muzoora CK, Meintjes G, Mertz D, Eikelboom JW, Wasserman S. Standard of care in advanced HIV disease: review of HIV treatment guidelines in six sub-Saharan African countries. AIDS Res Ther 2023; 20:83. [PMID: 37996881 PMCID: PMC10668471 DOI: 10.1186/s12981-023-00581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends an evidence-based package of care to reduce mortality and morbidity among people with advanced HIV disease (AHD). Adoption of these recommendations by national guidelines in sub-Saharan Africa is poorly documented. We aimed to review national guidelines for AHD management across six selected countries in sub-Saharan Africa for benchmarking against the 2021 WHO recommendations. METHODS We reviewed national guidelines from six countries participating in an ongoing randomized controlled trial recruiting people with AHD. We extracted information addressing 18 items of AHD diagnosis and management across the following domains: [1] Definition of AHD, [2] Screening, [3] Prophylaxis, [4] Supportive care, and [5] HIV treatment. Data from national guideline documents were compared to the 2021 WHO consolidated guidelines on HIV and an agreement score was produced to evaluate extent of guideline adoption. RESULTS The distribution of categories of agreement varied for the national documents. Four of the six countries addressed all 18 items (Malawi, Nigeria, Sierra Leone, Uganda). Overall agreement with the WHO 2021 guidelines ranged from 9 to 15.5 out of 18 possible points: Malawi 15.5 points, Nigeria, and Sierra Leone 14.5 points, South Africa 13.5 points, Uganda 13.0 points and Botswana with 9.0 points. Most inconsistencies were reported for the delay of antiretroviral therapy (ART) in presence of opportunistic diseases. None of the six national guidelines aligned with WHO recommendations around ART timing in patients with tuberculosis. Agreement correlated with the year of publication of the national guideline. CONCLUSION National guidelines addressing the care of advanced HIV disease in sub-Saharan Africa are available. Besides optimal timing for start of ART in presence of tuberculosis, most national recommendations are in line with the 2021 WHO standards.
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Affiliation(s)
- Thomas C Scheier
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nabila Youssouf
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Cecilia Kanyama
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Conrad K Muzoora
- Department of Internal Medicine Faculty of Medicine Mbarara, University of Science and Technology Mbarara, Mbarara, Uganda
| | - Graeme Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dominik Mertz
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sean Wasserman
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- Institute for Infection and Immunity, St George's, University of London, London, UK.
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20
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Pirtošek Z, Leta V, Jenner P, Vérin M. Should continuous dopaminergic stimulation be a standard of care in advanced Parkinson's disease? J Neural Transm (Vienna) 2023; 130:1395-1404. [PMID: 37930456 DOI: 10.1007/s00702-023-02708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
The standard of care is a term that refers to the level of care, skill, and treatment that a healthcare provider should offer to a patient based on the current scientific evidence and the level of medical knowledge available in the field. For Parkinson's disease (PD), the standard care is mostly considered to be oral treatment with dopaminergic drugs, particularly levodopa which remains the 'gold standard'. However, effective management with levodopa during the later stages of the disease becomes increasingly challenging due to the ongoing neurodegenerative process, the consequences of its pulsatile dopaminergic stimulation, and the gastrointestinal barriers to effective drug absorption. As a result, the concept of applying continuous dopaminergic stimulation has emerged with infusion therapies (continuous subcutaneous apomorphine, levodopa-carbidopa intestinal gel, and levodopa-entacapone-carbidopa intestinal gel infusion). These therapies seek to provide continuous stimulation of striatal dopamine receptors that is efficient not only in alleviating clinical symptoms, but also in delaying, reducing, and possibly preventing the onset of levodopa-related motor (fluctuations, dyskinesia) and non-motor complications; and they are also associated with clinically relevant side effects. Clinical studies and real-life experience support the notion that infusion therapies should be accepted as part of the standard of care for patients with advanced PD who have refractory, severe, and disabling motor complications that affect their quality of life. However, they should be considered based on the needs of individualized patients and the access to these advanced therapies needs to be made more accessible to the general PD population.
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Affiliation(s)
- Z Pirtošek
- Department of Neurology University Medical Centre and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - V Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto, Neurologico Carlo Besta Milan, Milan, Italy
| | - P Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 1UL, UK
| | - M Vérin
- Institut Des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT INSERM 1414, University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
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21
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Lupo C, García Bonetto G, Corral RM, Vilapriño Duprat M, Alessandria H, Kanevsky G, Perocco S. Treatment-Resistant Depression in Argentina: results from a longitudinal analysis of the TRAL Study. Vertex 2023; 34:32-44. [PMID: 37819065 DOI: 10.53680/vertex.v34i161.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 10/13/2023]
Abstract
Literature concerning patients with Treatment-Resistant Depression (TRD) treatment response and patient report outcomes (PROs) -such as QoL or disability- in Argentina is scarce. In the scope of the Treatment-Resistant Depression in America Latina (TRAL) study which previous results highlighted the burden of TRD compared to non-TRD patients as well as essential epidemiological data in the region, this paper reports on the outcomes of Standard-of-Care (SOC) over a 1-year follow-up of TRD patients in the subsample for Argentina. From a sample of 220 MDD patients identified in 5 sites in Argentina, 72 patients were diagnosed with TRD. Exclusion criteria included patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial. MADRS, PHQ-9 and PROs (EQ-5D and SDS) were used as outcomes. Patients’ mean age was 54.7 years and 70.3% of the patients were female. Around 61% of the patients achieved a response (reduction of MADRS score ≥ 50%), but over 33% did not achieve a remission (MADRS total score ≤12). Almost 67% of the patients still felt anxious/depressed at the end of the study (EQ-5D), while disruption affected patients in diverse areas -71% in work/school, 69.7% in social life/leisure and 66.6% in their family life/personal responsibilities. The burden of TRD is significant in Argentina, and more effort should be put in the implementation of treatment protocols with better outcomes.
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Affiliation(s)
- Christian Lupo
- Médica psiquiatra; Directora CIAP, Rosario, Provincia de Santa Fe, Argentina.
| | - Gerardo García Bonetto
- Médico especialista en Psiquiatría, Instituto Médico DAMIC - Hospital Neuropsiquiátrico Provincia de Córdoba, Argentina.
| | - Ricardo Marcelo Corral
- Médico especialista en Psiquiatría; Presidente Fundación Estudio y Tratamiento de las Enfermedades Mentales, Buenos Aires, Argentina.
| | - Manuel Vilapriño Duprat
- Médico psiquiatra; Centro de Estudios Asistencia e Investigación en Neurociencias (CESASIN) - Mendoza, Argentina..
| | - Hernán Alessandria
- Médico especialista jerarquizado en Psiquiatra, Fundador y Presidente de GlobalPsy, integración de redes y conocimientos en salud mental, Referente Disciplinar de Residencias de Psiquiatría de la Provincia de Buenos Aires, Investigador Principal Clínica Privada de Salud Mental Santa Teresa de Ávila, La Plata, Buenos Aires, Argentina.
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22
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Branch KR, Nguyen ML, Kudenchuk PJ, Johnson NJ. Head-to-pelvis CT imaging after sudden cardiac arrest: Current status and future directions. Resuscitation 2023; 191:109916. [PMID: 37506817 DOI: 10.1016/j.resuscitation.2023.109916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Causes for sudden circulatory arrest (SCA) can vary widely making early treatment and triage decisions challenging. Additionally, cardiopulmonary resuscitation (CPR), while a life-saving link in the chain of survival, can be associated with traumatic injuries. Computed tomography (CT) can identify many causes of SCA as well as its sequelae. However, the diagnostic and therapeutic impact of CT in survivors of SCA has not been reviewed to date. This general review outlines the rationale and potential applications of focused head, chest, and abdomen/pelvis CT as well as comprehensive head-to-pelvis CT imaging after SCA. CT has a diagnostic yield approaching 30% to identify causes of SCA while the addition of ECG-gated chest CT provides further information about coronary anatomy and cardiac function. Risks of CT include radiation exposure, contrast-induced kidney injury, and incidental findings. This review's findings suggest that routine head-to-pelvis CT can yield clinically actional findings with the potential to improve clinical outcome after SCA that merits further investigation.
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Affiliation(s)
- Kelley R Branch
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - My-Linh Nguyen
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | | | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Divsion of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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Graff SL, Yan F, Abdou Y. Newly Approved and Emerging Agents in HER2-Positive Metastatic Breast Cancer. Clin Breast Cancer 2023; 23:e380-e393. [PMID: 37407378 DOI: 10.1016/j.clbc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023]
Abstract
Human epidermal growth factor receptor 2-positive breast cancer (HER2+ BC) is an aggressive tumor type, accounting for 15% to 20% of the approximately 300,000 new BC cases in the United States each year. The goal of this review is to discuss the evolving landscape of therapies for HER2+ metastatic BC (mBC). Targeted therapies that have been the standard of care (SOC) for HER2+ mBC for almost a decade have greatly improved patient outcomes. The SOC for the first-line treatment of HER2+ mBC continues to be HER2-targeted monoclonal antibodies (mAbs) + a taxane, but recent updates in the second-line setting favor use of a newer HER2-targeted antibody-drug conjugate (ADC), trastuzumab deruxtecan, versus the prior SOC ADC, trastuzumab emtansine. Numerous options are now available in the third line and beyond, including tyrosine kinase inhibitor (TKI) regimens, newer mAbs, and other ADCs. The optimal course of treatment for individual patients can be guided by location of metastases, prior therapies, concomitant biomarkers, and monitoring and management of adverse events. Ongoing trials will further the evolution of the HER2+ mBC treatment landscape. Furthermore, next-generation ADCs, TKIs, and classes of drugs that have not been approved for the treatment of HER2+ mBC, including immune checkpoint inhibitors and cyclin-dependent kinase 4 and 6 inhibitors, are also being evaluated for their efficacy in the first and second line. Although the influx of new drugs may complicate treatment decisions for physicians, having a multitude of options will undoubtedly further improve patient outcomes and patient-centered care.
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Affiliation(s)
- Stephanie L Graff
- Ambulatory Patient Center, Lifespan Cancer Institute, Legorreta Cancer Center at Brown University, Rhode Island Hospital, Providence, RI.
| | - Fengting Yan
- Swedish Cancer Institute, First Hill-True Family Women's Cancer Center, Seattle, WA
| | - Yara Abdou
- UNC School of Medicine, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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24
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Xiong B, Stirling C, Martin-Khan M. The implementation and impacts of national standards for comprehensive care in acute care hospitals: An integrative review. Int J Nurs Sci 2023; 10:425-434. [PMID: 38020841 PMCID: PMC10667310 DOI: 10.1016/j.ijnss.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To synthesise current evidence addressing implementation approaches, challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals. Methods Using Whittemore & Knafl's five-step method, a systematic search was conducted across five databases, including Medline (EBSCO), CINAHL (EBSCO), Cochrane Library, Web of Science, and Scopus, to identify primary studies and reviews. In addition, grey literature (i.e., government reports and webpages) was also searched via Google and international government/organisation websites. All searches were limited to January 1, 2000 to January 31, 2023. Articles relevant to the implementation or impacts of national standards for comprehensive care in acute care hospitals were included. Included articles underwent a Joanna Briggs Institute quality review, followed by qualitative content analysis of the extracted data adhering to PRISMA reporting guidelines. Results A total of 16 articles were included in the review (5 primary studies, 5 government reports, and 6 government webpages). Three countries (Australia, Norway, and the United Kingdom [UK]) were identified as having a national standard for comprehensive care. The Australian standard contains a unique component of minimising patient harm. Norway does not have a defined implementation framework for the standard, whereas Australia and the UK do. Limited research suggests that challenges in implementing a national standard for comprehensive care in acute care hospitals include difficulties in implementing governance processes, end-of-life care actions, minimising harms actions, and developing comprehensive care plans with multidisciplinary teams, the absence of standardised care plans and patient-centred goals in documentation, and excessive paperwork. Implementation facilitators include a new care plan template using the Identify, Situation, Background, Assessment and Recommendation framework for handover, promoting efficient documentation, clinical decision-making and direct patient care, and proactivity among patients and care professionals with collaboration skills. Limited research suggests introducing the Australian standard demonstrated some positive effects on patient outcomes. Conclusion The components and implementation approaches of the national standards for comprehensive care in Australia, Norway and the UK were slightly different. The scarcity of studies found during the review highlights the need for further research to evaluate the implementation challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Melinda Martin-Khan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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25
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Parra E, Salgueira M, Portolés J, Serrano P, Bayés B, Estévez J, Pino MDD. Standardizing health outcomes for chronic kidney disease. Adaptation of the international consortium for health outcomes measurement standard set to the Spanish setting. Nefrologia 2023; 43:587-595. [PMID: 36564224 DOI: 10.1016/j.nefroe.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/19/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aim to adapt the International Consortium for Health Outcomes Measurements standard set for chronic kidney disease (CKD) patients to the Spanish setting and supplement it with those variables agreed upon through initiatives proposed by the Spanish Society of Nephrologists (S.E.N.). MATERIAL AND METHODS The working group defined a first standard set of variables based on a literature review. The S.E.N. members then assessed the suitability of each variable for inclusion (Consensus≥75%). A second draft of the standard set was generated and evaluated by the Patient advocacy group Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón (ALCER). Lastly, the working group established the final standard set of variables (Consensus≥75%). RESULTS The standard set targets patients with very high-risk CKD (G3a/A3 and G3b/A2-G5) in pre-end-stage kidney disease (pre-ESKD), hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT) or conservative care (CC). The essential follow-up variables agreed for all patients (All) were patient survival, hospitalizations, cardiovascular events, smoking status, health-related quality of life, pain, fatigue, physical function, daily activities, depression, renal function and hemoglobin. Additionally, it was agreed to collect PD survival (in PD patients), peritonitis (PD), infection/bacteremia (PD, HD, KT), vascular access type (HD), vascular access survival (HD), acute rejection (KT), post-transplant cancer (KT), albuminuria (KT) and kidney allograft survival (KT). The optional variables agreed were phosphorus (All), potassium (All), diabetes control (All with diabetes), and albuminuria (pre-ESKD). CONCLUSIONS This standard set may constitute a highly efficient tool allowing the evaluation of patient outcomes and helping to define strategies to enhance CKD patients' quality of care in the Spanish healthcare system.
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Affiliation(s)
- Eduardo Parra
- Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - Jose Portolés
- Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | | | - Joaquín Estévez
- Sociedad Española de Directivos de Salud (SEDISA), Madrid, Spain
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Arenas M, Piqué B, Torres-Royo L, Acosta JC, Rodríguez-Tomàs E, De Febrer G, Vasco C, Araguas P, Gómez JA, Malave B, Árquez M, Algara M, Montero A, Montero M, Simó JM, Gabaldó X, Parada D, Riu F, Sabater S, Camps J, Joven J. Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial. Strahlenther Onkol 2023; 199:847-856. [PMID: 37000224 PMCID: PMC10064634 DOI: 10.1007/s00066-023-02067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/19/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1‑month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1‑month mortality, and prolonged actuarial overall survival compared to SoC alone.
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Affiliation(s)
- M. Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - B. Piqué
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - L. Torres-Royo
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. C. Acosta
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - E. Rodríguez-Tomàs
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - G. De Febrer
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - C. Vasco
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - P. Araguas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. A. Gómez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - B. Malave
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - M. Árquez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - M. Algara
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Mèdiques, Barcelona, Spain
| | - A. Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - M. Montero
- Department of Radiology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - J. M. Simó
- Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain
| | - X. Gabaldó
- Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain
| | - D. Parada
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - F. Riu
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - S. Sabater
- Department of Radiation Oncology, Complejo Hospitalario de Albacete, Albacete, Spain
| | - J. Camps
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. Joven
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
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Haddad RI, Harrington K, Tahara M, Szturz P, Le Tourneau C, Salmio S, Bajars M, Lee NY. Managing cisplatin-ineligible patients with resected, high-risk, locally advanced squamous cell carcinoma of the head and neck: Is there a standard of care? Cancer Treat Rev 2023; 119:102585. [PMID: 37392723 DOI: 10.1016/j.ctrv.2023.102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/03/2023]
Abstract
For the past 2 decades, cisplatin-based adjuvant chemoradiotherapy (CRT) has remained the standard of care for patients with resected, locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) who are at high risk of disease recurrence. However, many patients are deemed ineligible for cisplatin-based CRT because of poor performance status, advanced biological age, poor renal function, or hearing loss. Because outcomes with radiotherapy (RT) alone remain poor, patients at high risk of disease recurrence deemed ineligible to receive cisplatin are a population with a significant unmet medical need, and alternative systemic therapy options in combination with RT are urgently needed. Clinical guidelines and consensus documents have provided definitions for cisplatin ineligibility; however, areas of debate include thresholds for age and renal impairment and criteria for hearing loss. Furthermore, the proportion of patients with resected LA SCCHN who are cisplatin ineligible remains unclear. Because of a scarcity of clinical studies, treatment selection for patients with resected, high-risk LA SCCHN who are deemed ineligible to receive cisplatin is often based on clinical judgment, with few treatment options specified in international guidelines. In this review, we discuss considerations related to cisplatin ineligibility in patients with LA SCCHN, summarize the limited clinical evidence for adjuvant treatment of patients with resected high-risk disease, and highlight ongoing clinical trials that have the potential to provide new treatment options in this setting.
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Affiliation(s)
- Robert I Haddad
- Department of Medical Oncology, Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Chiba Prefecture, Japan.
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France.
| | | | | | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
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Johnston JC, Sartwelle TP. Medical Malpractice and the Neurologist: Specific Neurological Claims. Neurol Clin 2023; 41:493-512. [PMID: 37407102 DOI: 10.1016/j.ncl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
This chapter highlights the most frequently encountered neurological malpractice claims. The format is designed to provide a rudimentary understanding of how lawsuits arise and thereby focus discussion on adapting practice patterns to improve patient care and minimize liability risk.
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Affiliation(s)
- James C Johnston
- GlobalNeurology, 17B Farnham Street, Auckland 1052, New Zealand; GlobalNeurology®, 5290 Medical Drive, San Antonio, TX 78229, USA.
| | - Thomas P Sartwelle
- Hicks Davis Wynn, PC, 3555 Timmons Lane, Suite 1000, Houston, TX 77027, USA
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Johnston JC, Sartwelle TP. Medical Malpractice and the Neurologist: An Introduction. Neurol Clin 2023; 41:485-491. [PMID: 37407101 DOI: 10.1016/j.ncl.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
This article provides an overview of current malpractice trends in neurology as well as non-malpractice and forensic liability concerns. It is more important for clinicians to recognize the common patient care scenarios that are likely to precipitate lawsuits rather than memorize arcane legal principles. Therefore, this article offers an introduction to malpractice jurisprudence as well as a general overview of current litigation trends and a review of the role and duties of a neurologist serving as an expert witness. The next article highlights mitigation strategies for the most prevalent neurologic misadventures.
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Affiliation(s)
- James C Johnston
- GlobalNeurology®, 52917B Farnham Street, Auckland 1052, New Zealand; GlobalNeurology®, 5290 Medical Drive, San Antonio, TX 78229, USA.
| | - Thomas P Sartwelle
- Hicks Davis Wynn, PC, 3555 Timmons Lane, Suite 1000, Houston, TX 77027, USA
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Kulesa R. Toward a Standard of Medical Care: Why Medical Professionals Can Refuse to Prescribe Puberty Blockers. New Bioeth 2023; 29:139-155. [PMID: 36315442 DOI: 10.1080/20502877.2022.2137906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient's well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria.
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Affiliation(s)
- Ryan Kulesa
- Middlebush Hall, University of Missouri, Columbia, MO, USA
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Go KJ, Hudson C. Deep technology for the optimization of cryostorage. J Assist Reprod Genet 2023:10.1007/s10815-023-02814-y. [PMID: 37171740 PMCID: PMC10371920 DOI: 10.1007/s10815-023-02814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
Cryopreservation, for many reasons, has assumed a central role in IVF treatment cycles, which has resulted in rapidly expanding cryopreserved oocyte and embryo inventory of IVF clinics. We aspire to consider how and with what resources and tools "deep" technology can offer solutions to these cryobiology programs. "Deep tech" has been applied as a global term to encompass the most advanced application of big data analysis for the most informed construction of algorithms and most sophisticated instrument design, utilizing, when appropriate and possible, models of automation and robotics to realize all opportunities for highest efficacy, efficiency, and consistency in a process.
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Affiliation(s)
- Kathryn J Go
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Nikiforow S, Frigault MJ, Frey NV, Gardner RA, Komanduri KV, Perales MA, Kebriaei P, Warkentin PI, Pasquini M, Aho JL, Levine BL, Heslop HE, Hlucky TL, Habucky K, Gharibo M, Jagasia M, Locke FL. Paving the Road for Chimeric Antigen Receptor T Cells: American Society for Transplantation and Cellular Therapy 80/20 Task Force Consensus on Challenges and Solutions to Improving Efficiency of Clinical Center Certification and Maintenance of Operations for Commercially Approved Immune Effector Cell Therapies. Transplant Cell Ther 2023; 29:228-239. [PMID: 36709800 DOI: 10.1016/j.jtct.2023.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
As the number and type of regulatory authority-approved cellular therapies grow, clinical treatment centers face a heavy burden of duplicative documentation around initial qualification, ongoing auditing, and reporting, with overlapping requirements from each manufacturer to ensure safe use of their specific product, which in the United States are stipulated under individual Food and Drug Administration (FDA) Biologic License Applications. The American Society for Transplantation and Cellular Therapy (ASTCT) convened the 80/20 Task Force to consider challenges and potential solutions to these issues. The Task Force proposed that 80% of manufacturers' requirements for onboarding and ongoing operations of commercially available products could be standardized and streamlined. Task Force members interviewed dozens of stakeholders, including clinicians at large academic medical centers already using commercial and investigational immune effector cell (IEC) products, regulators, members of accrediting bodies and professional cellular therapy societies, and manufacturers of IEC therapies for oncologic indications. In November 2021, the Task Force organized and led virtual discussions in a public forum and at a private ASTCT 80/20 Workshop at the online AcCELLerate Forum, a cellular-therapy stakeholders' meeting organized by the ASTCT, National Marrow Donor Program (NMDP), and Center for International Blood and Marrow Transplant Research (CIBMTR). At the workshop, approximately 60 stakeholders worked to identify and prioritize common challenges in onboarding and maintenance of operations at clinical sites for commercial FDA-approved and future IEC therapies and ways to streamline the process. It was agreed that standardization would improve efficiency of onboarding, allowing more cost-effective, sustainable growth of approved IEC therapies at treatment centers, and facilitate wider access while maintaining safety and clinical success. This early but extensive survey of stakeholders resulted in 5 overarching suggestions for both established and emerging treatment centers: (1) eliminate duplication in accreditation and auditing of clinical sites; (2) define expectations for the education about and management of CAR-T therapy toxicities to potentially replace product-specific REMS programs; (3) streamline current REMS education, testing, and data reporting; (4) standardize information technology (IT) platforms supporting enrollment, clinical site-manufacturer communication, and logistics of maintaining chain of identity/chain of custody across multiple transportation steps; and (5) encourage the use of universal nomenclature by cell therapy manufacturers. Future discussions need to engage a broader range of stakeholders, including administrators, pharmacists, nurses, data coordinators, surgeons, pathologists, and those developing promising cellular therapies for solid tumors, as well as teams from smaller academic or community cancer center settings. Continued collaboration with stakeholders outside of clinical sites will include accrediting bodies/auditors, established and emerging cell therapy companies, software developers, professional societies, and the patients who receive these therapies. Active dialog with government regulators remains essential. Such joint efforts are critical as the number of IEC therapies for myriad oncologic and nononcologic indications grows.
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Affiliation(s)
- Sarah Nikiforow
- Hematologic Malignancies, Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Matthew J Frigault
- Hematopoietic Cell Transplant and Cell Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle V Frey
- Medicine, Hematology Oncology, University of Pennsylvania, Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Rebecca A Gardner
- Dept Of Pediatrics, Division of Hematology/Oncology, Seattle Children's/University of Washington, Seattle, Washington
| | - Krishna V Komanduri
- Helen Diller Family Comprehensive Cancer Center and Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Partow Kebriaei
- Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Phyllis Irene Warkentin
- Pathology/Microbiology, University of Nebraska Medical Center and Foundation for the Accreditation of Cellular Therapy, Omaha, Nebraska
| | - Marcelo Pasquini
- Medicine, Hematology/Oncology, Center for International Blood & Marrow Transplant Research, Milwaukee, Wisconsin
| | - Joy Lynn Aho
- Product and Innovation, Provider Services, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bruce L Levine
- Pathology and Laboratory Medicine, Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen E Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Tracey L Hlucky
- Product Distribution Quality, Site Qualification, Kite Pharma/Gilead, Columbus, Ohio
| | - Karen Habucky
- US Oncology Medical, Cell & Gene, Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | - Mecide Gharibo
- US Medical Affairs, Hematology, Bristol Myers Squibb, Summit, New Jersey
| | - Madan Jagasia
- Medical Affairs, Iovance Biotherapeutics, San Carlos, California
| | - Frederick L Locke
- Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
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Koren J, Lambert JLW, Thomsen SF, McAteer H, Fabbrocini G, Corazza V, Jullien D, Augustin M, Warren RB, de Rie MA, Lazaridou E, Puig L, Guillevin L, Grosser M, Boehncke WH. Elevating the Standard of Care for Patients with Psoriasis: 'Calls to Action' from Epicensus, a Multistakeholder Pan-European Initiative. Dermatol Ther (Heidelb) 2023; 13:245-268. [PMID: 36484915 PMCID: PMC9734585 DOI: 10.1007/s13555-022-00846-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite advances in treatment options and the management of patients with psoriasis, considerable unmet needs remain. Our objective was to identify ways to elevate the standard of care for patients with psoriasis by combining the perspectives of three important stakeholders: patients, clinicians and payors, and define 'Calls to Action' designed to achieve the identified changes. METHODS Eight themes relevant to elevating the standard of care were identified from an insights-gathering questionnaire completed by all three stakeholder groups. A modified Delphi exercise gained consensus on statements informed by the insights. Statements were then used to inspire 'Calls to Action' - practical steps that could be taken to realise the desired changes and elevate the standard of care. RESULTS In total, 18 European experts (10 dermatologists, 3 payors and 5 patient representatives) took part in the Delphi process. Consensus was reached on statements relating to all eight themes: improve healthcare systems to better support multidisciplinary team working and digital services, real-world data generation and optimal use, improve patient access, elevate quality-of-life measures as the most important outcomes, involve patients in patient-centred and personalised approaches to care, improve the relevance and reach of guidelines, education, and multistakeholder engagement. 'Calls to Action' common to all three stakeholder groups recognised the need to capitalise on the shift to digital healthcare, the need for consistent input into registries to generate real-world evidence to support guideline development, and the necessity of educating patients on the benefits of reporting outcomes to generate real-world data. The enormous quality-of-life burden and psychological impact of psoriasis, as well as the clinical needs of patients must be better understood, including by healthcare commissioners, so that funding priorities are assessed appropriately. CONCLUSION This unique initiative identified a practical 'Call-to-Action Framework' which, if implemented, could help improve the standard of care for patients with psoriasis.
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Affiliation(s)
| | - Jo L W Lambert
- Department of Dermatology, Ghent University, Vijverpark Ingang 52 - UZ Gent, De Pintelaan 185, 9000, Gent, Belgium.
| | - Simon F Thomsen
- Department of Dermatology, Department of Biomedical Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Valeria Corazza
- Italian Psoriatic Association Friends of the Corazza Foundation (APIAFCO), Bologna, Italy
| | - Denis Jullien
- Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, 69003, Lyon, France
- INSERM U1111 - CIRI, Lyon-1 University, 69007, Lyon, France
| | - Matthias Augustin
- Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard B Warren
- Dermatology Centre, Manchester NIHR Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Menno A de Rie
- Amsterdam UMC, Department of Dermatology, University of Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth Lazaridou
- 2nd Department of Dermatology-Venereology, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Loïc Guillevin
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Marius Grosser
- German Psoriasis Association, Seewartenstraße 10, 20459, Hamburg, Germany
| | - Wolf-Henning Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Glemarec G, Lacaze JL, Cabarrou B, Aziza R, Jouve E, Zerdoud S, De Maio E, Massabeau C, Loo M, Esteyrie V, Ung M, Dalenc F, Izar F, Chira C. Systemic treatment with or without ablative therapies in oligometastatic breast cancer: A single institution analysis of patient outcomes. Breast 2023; 67:102-9. [PMID: 36709639 DOI: 10.1016/j.breast.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Local ablative treatment (LAT) is increasingly combined with systemic therapy in oligometastatic breast cancer (OMBC), without a high-level evidence to support this strategy. We evaluated the addition of LAT to systemic treatment in terms of progression-free survival (PFS) and overall survival (OS). Secondary endpoints were local control (LC) and toxicity. We sought to identify prognostic factors associated with longer OS and PFS. METHODS AND MATERIALS We identified consecutive patients treated between 2014 and 2018 for synchronous or metachronous OMBC (defined as ≤ 5 metastases). LAT included stereotactic body radiation therapy (SBRT) and volumetric modulated arc therapy (VMAT), surgery, cryotherapy and percutaneous radiofrequency ablation (PRA). PFS and OS were calculated, and Cox regression models analyzed for potential predictors of survival. RESULTS One hundred two patients were included (no-LAT, n = 62; LAT, n = 40). Sixty-four metastases received LAT. Median follow-up was 50.4 months (95% CI [44.4; 53.4]). One patient experienced grade 3 toxicity in the LAT group. Five-year PFS and OS were 34.75% (95% CI [24.42-45.26]) and 63.21% (95% CI [50.69-73.37]) respectively. Patients receiving both LAT and systemic therapy had longer PFS and OS than those with no-LAT ([HR 0.39, p = 0.002]) and ([HR 0.31, p = 0.01]). The use of LAT, HER2-positive status and hormone-receptor positivity were associated with longer PFS and OS whereas liver metastases led to worse PFS. CONCLUSIONS LAT was associated with improved outcomes in OMBC when added to systemic treatment, without significantly increasing toxicity. The prognostic factors identified to extend PFS and OS may help guide clinicians in selecting patients for LAT.
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Breuckmann F, Settelmeier S, Rassaf T, Post F, Haerer W, Bauersachs J, Mudra H, Voigtländer T, Senges J, Münzel T, Giannitsis E. Survey of clinical practice pattern in Germany's certified chest pain units : Adherence to the European Society of Cardiology guidelines on non-ST-segment elevation acute coronary syndrome. Herz 2022; 47:543-552. [PMID: 34755215 PMCID: PMC8577645 DOI: 10.1007/s00059-021-05079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/16/2021] [Accepted: 10/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to analyze the 2020 standard of care in certified German chest pain units (CPU) with a special focus on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) through a voluntary survey obtained from all certified units, using a prespecified questionnaire. METHODS The assessment included the collection of information on diagnostic protocols, risk assessment, management and treatment strategies in suspected NSTE-ACS, the timing of invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI), and the choice of antiplatelet therapy. RESULTS The response rate was 75%. Among all CPUs, 77% are currently using the European Society of Cardiology (ESC) 0/3‑h high-sensitive troponin protocol, and only 20% use the ESC 0/1‑h high-sensitive troponin protocol as a default strategy. Conventional ergometry is still the commonly performed stress test with a utilization rate of 47%. Among NSTEMI patients, coronary angiography is planned within 24 h in 96% of all CPUs, irrespective of the day of the week. Prasugrel is the P2Y12 inhibitor of choice in ST-segment elevation myocardial infarction (STEMI), but despite the impact of the ISAR-REACT 5 trial on selection of antiplatelet therapy, ticagrelor is still favored over prasugrel in NSTE-ACS. If triple therapy is used in NSTE-ACS with atrial fibrillation, it is maintained up to 4 weeks in 51% of these patients. CONCLUSION This survey provides evidence that Germany's certified CPUs ensure a high level of guideline adherence and quality of care. The survey also identified areas in need of improvement such as the high utilization rate of stress electrocardiogram (ECG).
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Affiliation(s)
- Frank Breuckmann
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Felix Post
- Department of Cardiology, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Harald Mudra
- Heart and Vascular Center Munich Maffeistraße and Nymphenburg (Klinikum 3. Orden), Munich, Germany
| | | | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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Ehrlich M, Hentschke C, Sieder C, Maier-Peuschel M, Reuter U. Erenumab versus topiramate: post hoc efficacy analysis from the HER-MES study. J Headache Pain 2022; 23:141. [PMID: 36380284 PMCID: PMC9664641 DOI: 10.1186/s10194-022-01511-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE HER-MES was the first head-to-head, phase 4 trial to assess the tolerability and effectiveness of erenumab against standard of care treatment (topiramate). This post hoc analysis compared the efficacy of erenumab with topiramate in patients who completed the trial on study medication. METHODS Post hoc sensitivity analysis was performed using the full analysis set. Outcomes assessed included the proportion of patients with a ≥50% reduction in monthly migraine days (MMD) from baseline (50% responder rate), over the last 3 months (months 4, 5, and 6) of the double-blind treatment phase (DBTP), the 50% responder rate during the first month of the DBTP, and change from baseline in MMD during the DBTP. Multiple imputation was done for efficacy values of patients who discontinued study treatment. RESULTS Patients (N = 777) were randomly assigned (1:1) to either 70 or 140 mg/month erenumab (N = 389) or 50-100 mg/day topiramate (N = 388). Of these, 334 patients (85.9%) receiving erenumab, and 231 patients (59.5%) receiving topiramate completed the DBTP on study medication. Patients on study medication until the end of the DBTP received a mean dose of 119 mg/month for erenumab and 92 mg/day for topiramate. At month 1, a significantly greater proportion of patients receiving erenumab (39.2%) reported ≥50% reduction in MMD from baseline compared with those receiving topiramate (24.0%; p < 0.001). In the last 3 months, a significantly larger proportion of patients receiving erenumab (60.3%) achieved ≥50% reduction in MMD from baseline compared with those receiving topiramate (43.3%; p < 0.001). Patients receiving erenumab demonstrated significantly greater reductions in MMD during the last 3 months from baseline versus those receiving topiramate (- 6.13 vs - 4.90; 95% CI: - 1.87 to - 0.61; p < 0.001). CONCLUSIONS This post hoc analysis demonstrated significantly superior efficacy of erenumab versus topiramate in achieving a ≥50% reduction in MMD with an early onset of efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT03828539 .
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Affiliation(s)
| | | | | | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitätsmedizin Greifswald, Greifswald, Germany.
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Napiórkowska-Baran K, Więsik-Szewczyk E, Ziętkiewicz M, Matyja-Bednarczyk A, Kołtan S, Bąkowska-Kocik N, Rosada T, Baranowska K, Alska E, Tykwińska M, Szynkiewicz E, Zacniewski R, Bartuzi Z. Protocols of Standard of Care for Adult Patients with Primary Antibody Deficiencies Will Improve Timing of Diagnosis, Survival, and Quality of Life. Iran J Allergy Asthma Immunol 2022; 21:374-387. [PMID: 36243926 DOI: 10.18502/ijaai.v21i4.10285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/20/2022] [Indexed: 06/16/2023]
Abstract
The majority of primary immunodeficiencies (PIDs) are antibody deficiencies (PADs), and not all of them are rare diseases; As an example, Caucasian individuals suffer from selective IgA deficiency at a frequency of 1:500. In addition to infections, symptomatic patients with PAD are more likely to develop neoplastic, autoimmune, and allergic diseases. In the event that PAD is neglected or delayed for more than ten years, complications develop, eventually resulting in death. No studies have been conducted to devise and report detailed ready-to-use protocols for managing PAD to date. This study aimed to propose protocols and guidelines for the adult PAD patients' standard care. Preparing the protocol, we considered the frequency and type of laboratory tests, imaging, endoscopic examinations, specialist consultations, and standardized recommendations for further care in the place of residence. As a result of the proposed monitoring scheme, patients can be provided with complete care in terms of their underlying conditions and comorbidities, as well as early detection of complications. This protocol will serve as a guide for physicians dealing with these patients and enable comparisons of patient groups across a variety of treatment centers, even far away from each other. A national consultant in the field of clinical immunology verified the protocol mainly developed by Polish experts from reference immunology centres for adults.
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Affiliation(s)
- Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland.
| | - Marcin Ziętkiewicz
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Gdańsk, Poland.
| | | | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Natalia Bąkowska-Kocik
- Department of Clinical Oncology, Franciszek Łukaszczyk Oncology Centre, Bydgoszcz, Poland.
| | - Tomasz Rosada
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Karolina Baranowska
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Ewa Alska
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Marta Tykwińska
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Ewa Szynkiewicz
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland AND Department of Preventive Nursing, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Robert Zacniewski
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
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Triche BL, Annamalai A, Pooler BD, Glazer JM, Zadra JD, Barclay-Buchanan CJ, Hekman DJ, Mao L, Pickhardt PJ, Lubner MG. Positive oral contrast material for CT evaluation of non-traumatic abdominal pain in the ED: prospective assessment of diagnostic confidence and throughput metrics. Abdom Radiol (NY) 2022; 47:2956-2967. [PMID: 35739367 DOI: 10.1007/s00261-022-03574-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Evaluate the impact of positive oral contrast material (POCM) for non-traumatic abdominal pain on diagnostic confidence, diagnostic rate, and ED throughput. MATERIALS AND METHODS ED oral contrast guidelines were changed to limit use of POCM. A total of 2,690 abdominopelvic CT exams performed for non-traumatic abdominal pain were prospectively evaluated for diagnostic confidence (5-point scale at 20% increments; 5 = 80-100% confidence) during a 24-month period. Impact on ED metrics including time from CT order to exam, preliminary read, ED length of stay (LOS), and repeat CT scan within 7 days was assessed. A subset of cases (n = 729) was evaluated for diagnostic rate. Data were collected at 2 time points, 6 and 24 months following the change. RESULTS A total of 38 reviewers were participated (28 trainees, 10 staff). 1238 exams (46%) were done with POCM, 1452 (54%) were performed without POCM. For examinations with POCM, 80% of exams received a diagnostic confidence score of 5 (mean, 4.78 ± 0.43; 99% ≥ 4), whereas 60% of exams without POCM received a score of 5 (mean, 4.51 ± 0.70; 92% ≥ 4; p < .001). Trainees scored 1,523 exams (57%, 722 + POCM, 801 -POCM) and showed even lower diagnostic confidence in cases without PCOM compared with faculty (mean, 4.43 ± 0.68 vs. 4.59 ± 0.71; p < 0.001). Diagnostic rate in a randomly selected subset of exams (n = 729) was 54.2% in the POCM group versus 56.1% without POCM (p < 0.655). CT order to exam time decreased by 31 min, order to preliminary read decreased by 33 min, and ED LOS decreased by 30 min (approximately 8% of total LOS) in the group without POCM compared to those with POCM (p < 0.001 for all). 205 patients had a repeat scan within 7 days, 74 (36%) had IV contrast only, 131 (64%) had both IV and oral contrast on initial exam. Findings were consistent both over a 6-month evaluation period as well as the full 24-month study period. CONCLUSION Limiting use of POCM in the ED for non-traumatic abdominal pain improved ED throughput but impaired diagnostic confidence, particularly in trainees; however, it did not significantly impact diagnostic rates nor proportion of repeat CT exams.
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Affiliation(s)
- Benjamin L Triche
- Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Arvind Annamalai
- Department of Radiology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | - B Dustin Pooler
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Joshua M Glazer
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Jacob D Zadra
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Ciara J Barclay-Buchanan
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Daniel J Hekman
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Lu Mao
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792, USA
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Sharma N, Arahna VP, Saxena S, Ateef M, Samuel AJ. Scoping out the scope of scoping reviews in neonatal and pediatric pain management: A scoping review methodological framework. J Pediatr Surg 2022; 57:1599-1608. [PMID: 34876296 DOI: 10.1016/j.jpedsurg.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This methodological framework was purposed to discuss the considerations for conducting scoping review for neonatal and pediatric pain management (NPPM) from the perspectives of Arksey and O' Malley and Joanna Briggs Institute (JBI) framework. Till now, there is no scoping review or standard methods are available for identifying, prioritizing, or reporting research gaps in the area of NPPM. METHODS AND RESULTS Scoping reviews were utilized to map the literature comprehensively across a range of study designs in a particular area. This methodological framework describes the methods used to identify, prioritize, and display research gaps in the area of NPPM. Different methods to determine research gaps have been described in this framework. This scoping review methodological framework also discussed methods for conducting scoping review in two levels with methodological considerations given by Arksey and O'Malley, and JBI Institute. Search terms and search terminologies are described to conduct scoping review effectively for NPPM. Through, this standard scoping review methodological considerations, the general understanding and current advances in NPPM can be widened. CONCLUSION This methodological framework describes the methods for conducting scoping review effectively in the area of NPPM. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Neha Sharma
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana 133207, India.
| | - Vencita Priyanka Arahna
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana 133207, India.
| | - Shikha Saxena
- School Based Rehabilitation Services, Physiotherapy Division, Communicare Therapy Inc., Ottawa , Canada.
| | - Mahamed Ateef
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia.
| | - Asir John Samuel
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana 133207, India.
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Martin A, Bessonova L, Hughes R, Doane MJ, O'Sullivan AK, Snook K, Cichewicz A, Weiden PJ, Harvey PD. Systematic Review of Real-World Treatment Patterns of Oral Antipsychotics and Associated Economic Burden in Patients with Schizophrenia in the United States. Adv Ther 2022; 39:3933-3956. [PMID: 35844007 PMCID: PMC9402774 DOI: 10.1007/s12325-022-02232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
Background Schizophrenia is a chronic mental disorder associated with substantial morbidity and mortality affecting 0.25–1.6% of adults in the USA. Antipsychotic treatment is the standard of care for schizophrenia, but real-world treatment patterns and associated costs have not been systematically reviewed. Objective We conducted a systematic review to summarize treatment patterns and associated costs related to oral antipsychotic treatment of patients with schizophrenia in the USA. Data Sources We searched Medline (via PubMed) and Embase to identify relevant observational studies published from January 1, 2008, to June 1, 2018; costs were converted to 2018 US dollars. Study Eligibility Observational, real-world studies reporting on patterns of treatment and/or associated costs for adult patients with schizophrenia treated with oral antipsychotics in the USA were included. Results Eighty-one studies were identified. Frequently prescribed oral second-generation antipsychotics were olanzapine (up to 50.9%), risperidone (up to 40.0%), and quetiapine (up to 30.7%). Suboptimal adherence was common across studies. Antipsychotic switching occurred in about half of patients, while antipsychotic combination therapy occurred in nearly 30%; all were associated with increased medication-related costs. Mean annual direct medical costs differed by treatment, with reported costs of $17,115 to $26,138 for patients treated with olanzapine, $18,395 for risperidone, and $17,656 to $28,101 for quetiapine. Limitations This systematic review is limited by the variations in definitions of schizophrenia-related clinical terms used between studies and by the inclusion of studies focused on only the US health care system. Conclusions In the treatment of schizophrenia, suboptimal adherence, antipsychotic switching, and antipsychotic augmentation were all associated with high costs of care in comparison to patients who were adherent and did not require antipsychotic switching or augmentation. These findings illustrate the need for the development of new treatments that address efficacy and adherence challenges of currently available therapies. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02232-z. Schizophrenia is a debilitating mental disorder that affects up to 1.6% of adults in the USA. Antipsychotic medications reduce symptoms of the disease, but many patients with schizophrenia are not fully adherent or choose to discontinue treatment entirely, increasing their risk of hospitalization. In others, efforts to achieve better symptom control or to avoid intolerable side effects may result in switching antipsychotic medications or adding additional medications, leading to higher medical treatment costs. The magnitude of these cost increases is unclear. This study sought to assess medical costs associated with antipsychotic treatment adherence, switching, and adding additional antipsychotics. We reviewed 81 studies published from January 2008 through June 2018 examining treatment adherence in patients with schizophrenia. We calculated rates of adherence, switching, and adding antipsychotics, as well as associated medical costs. Overall adherence to antipsychotic treatment was less than 50%, with up to 50% of patients switching medications and up to 29% adding an additional antipsychotic medication to their current treatment. Patients who were not treatment adherent incurred annual medical costs of $10,316 compared with $5723 in patients who were adherent. The costs of immediate or delayed switching of antipsychotic medications ranged from $21,922 to $28,232, while costs of adding an additional antipsychotic ranged from $24,045 to $29,344. These data suggest that suboptimal medication adherence, along with high rates of patient discontinuation and medication switching, lead to higher treatment costs in the management of patients with schizophrenia.
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Affiliation(s)
- Amber Martin
- Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA
| | - Leona Bessonova
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA
| | - Rachel Hughes
- Evidera, 500 Totten Pond Road, Waltham, MA, 02451, USA
| | - Michael J Doane
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA.
| | | | | | | | - Peter J Weiden
- Alkermes, Inc, 852 Winter Street, Waltham, MA, 02451-1420, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, 1600 NW 10th Avenue, Miami, FL, 33136, USA
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Fidahic M, Nujic D, Civljak M, Runjic R, Markotic F, Vidak M, Puljak L. Standard of care for COVID-19 in randomized clinical trials registered in trial registries and published in preprint servers and scholarly journals: a cross-sectional study. BMC Med Res Methodol 2022; 22:173. [PMID: 35715728 PMCID: PMC9205140 DOI: 10.1186/s12874-022-01646-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background The concept of standard of care (SoC) treatment is commonly utilized in clinical trials. However, in a setting of an emergent disease, such as COVID-19, where there is no established effective treatment, it is unclear what the investigators considered as the SoC in early clinical trials. The aim of this study was to analyze and classify SoC reported in randomized controlled trial (RCT) registrations and RCTs published in scholarly journals and on preprint servers about treatment interventions for COVID-19. Methods We conducted a cross-sectional study. We included RCTs registered in a trial registry, and/or published in a scholarly journal, and/or published on preprint servers medRxiv and bioRxiv (any phase; any recruitment status; any language) that aim to compare treatment interventions related to COVID-19 and SoC, available from January 1, 2020, to October 8, 2020. Studies using „standard“ treatment were eligible for inclusion if they reported they used standard, usual, conventional, or routine treatment. When we found such multiple reports of an RCT, we treated those multiple sources as one unit of analysis. Results Among 737 unique trials included in the analysis, 152 (21%) reported that SoC was proposed by the institutional or national authority. There were 129 (18%) trials that reported component(s) of SoC; the remaining trials simply reported that they used SoC, with no further detail. Among those 129 trials, the number of components of SoC ranged from 1 to 10. The most commonly used groups of interventions in the SoC were antiparasitics (62% of the trials), antivirals (57%), antibiotics (31%), oxygen (17%), antithrombotics/anticoagulants (14%), vitamins (13%), immunomodulatory agents (13%), corticosteroids (12%), analgesics/antipyretics (12%). Various combinations of those interventions were used in the SoC, with up to 7 different types of interventions combined. Posology, timing, and method of administration were frequently not reported for SoC components. Conclusion Most RCTs (82%) about treatment for COVID-19 that were registered or published in the first 9 months of the pandemic did not describe the “standard of care” they used. Many of those interventions have, by now, been shown as ineffective or even detrimental. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01646-1.
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Affiliation(s)
- Mahir Fidahic
- Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Danijela Nujic
- Department of Public Health, Faculty of Medicine, Osijek, Croatia
| | - Marta Civljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia
| | - Renata Runjic
- University of Split School of Medicine, Split, Croatia
| | - Filipa Markotic
- Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Marin Vidak
- University of Split School of Medicine, Split, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia.
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Zhao X, Karkare S, Nash AI, Sheehan JJ, Aboumrad M, Near AM, Banerji T, Joshi K. Characteristics and current standard of care among veterans with major depressive disorder in the United States: A real-world data analysis. J Affect Disord 2022; 307:184-190. [PMID: 35351492 DOI: 10.1016/j.jad.2022.03.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/04/2022] [Accepted: 03/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examined MDD treatment regimens received during the first observed and treated major depressive episode (MDE) among US veterans. METHODS This retrospective study, conducted using the Veterans Health Administration (VHA) database, supplemented with Medicare Part A/B/D data, included adults with ≥1 MDD diagnosis (index date) between 10/1/2015-2/28/2017 and ≥1 line of therapy (LOT) within the first observed complete MDE. Patient baseline (6-month pre-index) characteristics and up to six LOTs received during the first observed and treated MDE were assessed. RESULTS Of 40,240 veterans with MDD identified (mean age: 50.9 years, 83.9% male, 63.4% White, 88.6% non-Hispanic), hypertension (27.5%), hyperlipidemia (20.8%), and post-traumatic stress disorder (17.5%) were the most common baseline comorbidities. During the first observed and treated MDE, patients received a mean of 1.6 ± 1.0 LOTs, with 14.6% of patients receiving ≥3 LOTs. SSRI-monotherapy was the most commonly observed regimen in the first six LOTs, followed by SNRI-monotherapy in LOT 1 and antidepressants augmented by anticonvulsants in the remaining five LOTs. The antidepressant class of the previous LOT was commonly used in the subsequent LOT. SSRI-SSRI-SSRI was the most common LOT1-to-LOT3 sequencing pattern among patients receiving ≥3 LOTs. LIMITATIONS The study findings are limited to data in the VHA database and may not be generalizable to the non-veteran US population. CONCLUSIONS During the first observed and treated MDE, SSRI-monotherapy was the most common therapy in the first six LOTs. Cycling within SSRI class was the leading sequencing pattern of the first three LOTs among veterans who received ≥3 LOTs.
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Affiliation(s)
| | | | | | | | - Maya Aboumrad
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, Titusville, NJ, USA
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Gelfer Y, Davis N, Blanco J, Buckingham R, Trees A, Mavrotas J, Tennant S, Theologis T. Attaining a British consensus on managing idiopathic congenital talipes equinovarus up to walking age. Bone Joint J 2022; 104-B:758-764. [PMID: 35638218 PMCID: PMC9948433 DOI: 10.1302/0301-620x.104b6.bjj-2021-1687.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV. METHODS The consensus process followed an established Delphi approach with a predetermined degree of agreement. The process included the following steps: establishing a steering group; steering group meetings, generating statements, and checking them against the literature; a two-round Delphi survey; and final consensus meeting. The steering group members and Delphi survey participants were all British Society of Children's Orthopaedic Surgery (BSCOS) members. Descriptive statistics were used for analysis of the Delphi survey results. The Appraisal of Guidelines for Research & Evaluation checklist was followed for reporting of the results. RESULTS The BSCOS-selected steering group, the steering group meetings, the Delphi survey, and the final consensus meeting all followed the pre-agreed protocol. A total of 153/243 members voted in round 1 Delphi (63%) and 132 voted in round 2 (86%). Out of 61 statements presented to round 1 Delphi, 43 reached 'consensus in', no statements reached 'consensus out', and 18 reached 'no consensus'. Four statements were deleted and one new statement added following suggestions from round 1. Out of 15 statements presented to round 2, 12 reached 'consensus in', no statements reached 'consensus out', and three reached 'no consensus' and were discussed and included following the final consensus meeting. Two statements were combined for simplicity. The final consensus document includes 57 statements allocated into six successive stages. CONCLUSION We have produced a consensus document for the treatment of idiopathic CTEV up to walking age. This will provide a benchmark for standard of care in the UK and will help to reduce geographical variability in treatment and outcomes. Appropriate dissemination and implementation will be key to its success. Cite this article: Bone Joint J 2022;104-B(6):758-764.
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Affiliation(s)
- Yael Gelfer
- St George's Hospital, London, UK,St George's University of London, London, UK,Correspondence should be sent to Yael Gelfer. E-mail:
| | - Naomi Davis
- Royal Manchester Children's Hospital, Manchester, UK
| | - Jose Blanco
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | | | - Amanda Trees
- James Cook University Hospital, Middlesbrough, UK
| | | | - Sally Tennant
- Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Tim Theologis
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
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Solomon L, Emma M, Gibbons LM, Kusulas MP. Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation. Am J Emerg Med 2022; 58:16-21. [PMID: 35623178 DOI: 10.1016/j.ajem.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. METHODS A search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. RESULTS No cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DISCUSSION PoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.
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Affiliation(s)
- Linda Solomon
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America.
| | - Maggie Emma
- Risk Management, Northwell Health, New Hyde Park, NY, United States of America
| | - Lisa M Gibbons
- Claims Management, Northwell Health, Great Neck, NY, United States of America
| | - Matthew P Kusulas
- Departments of Pediatrics and Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
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Adams A, Zaryske LG. External Jugular Vein Peripheral Intravenous Catheters: An Emergency Nurse's Guide. J Emerg Nurs 2022; 48:303-309. [PMID: 35526875 DOI: 10.1016/j.jen.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
Insertion of a peripheral intravenous catheter into the external jugular vein is regularly performed in emergency departments to treat patients with difficult intravenous access. Although emergency nurses are experienced in inserting peripheral intravenous catheters, there is an inconsistent practice and a lack of education and training regarding the insertion of catheters in the external jugular vein. This manuscript provides a practical guide for emergency nurses to care for patients who require an external jugular peripheral intravenous catheter. Key information found in this manuscript includes indications for external jugular intravenous access, the nurse's role in performing external jugular peripheral intravenous catheters, and clinical considerations when caring for patients with an external jugular peripheral intravenous catheter.
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Singh JA, Kochhar S, Wolff J, Atuire C, Bhan A, Emanuel E, Faden R, Ghimire P, Greco D, Ho C, Moon S, Shamsi-Gooshki E, Touré A, Thomé B, Smith MJ, Upshur REG. WHO guidance on COVID-19 vaccine trial designs in the context of authorized COVID-19 vaccines and expanding global access: Ethical considerations. Vaccine 2022; 40:2140-2149. [PMID: 35248422 PMCID: PMC8882397 DOI: 10.1016/j.vaccine.2022.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/04/2023]
Abstract
While the degree of COVID-19 vaccine accessibility and uptake varies at both national and global levels, increasing vaccination coverage raises questions regarding the standard of prevention that ought to apply to different settings where COVID-19 vaccine trials are hosted. A WHO Expert Group has developed guidance on the ethical implications of conducting placebo-controlled trials in the context of expanding global COVID-19 vaccine coverage. The guidance also considers alternative trial designs to placebo controlled trials in the context of prototype vaccines, modified vaccines, and next generation vaccines.
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Affiliation(s)
- Jerome Amir Singh
- Howard College School of Law, University of KwaZulu-Natal, Durban, South Africa; Scientific Advisory Group on Emergencies (SAGE), Academy of Science of South Africa (ASSAf), Pretoria, South Africa; Department of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, WA, USA; Global Healthcare Consulting, Delhi, India
| | - Jonathan Wolff
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, Accra, Ghana
| | - Anant Bhan
- Department of Community Medicine and Centre for Ethics, Yenepoya University, Mangalore, India
| | - Ezekiel Emanuel
- Global Initiatives and Healthcare Transformation Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruth Faden
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | | | - Dirceu Greco
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Calvin Ho
- Faculty of Law and Centre for Medical Ethics, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Suerie Moon
- International Relations and Political Science Department & Interdisciplinary Programmes, Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Ehsan Shamsi-Gooshki
- Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Beatriz Thomé
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, Rua Botucatu,Sao Paolo, Brazil
| | - Maxwell J Smith
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross E G Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health University of Toronto, Toronto, Ontario, Canada
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Korenaga TK, Yoshida EJ, Pierson W, Chang J, Ziogas A, Swanson ML, Chapman JS, Sinha S, Chen LM. Better late than never: Brachytherapy is more important than timing in treatment of locally advanced cervical cancer. Gynecol Oncol 2021:S0090-8258(21)01608-5. [PMID: 34865860 DOI: 10.1016/j.ygyno.2021.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the utilization of brachytherapy and duration of treatment on overall survival for locally advanced cervical cancer. METHODS The National Cancer Database (NCDB) was queried to identify stage II-IVA cervical cancer patients diagnosed in the United States between 2004 and 2015 who were treated with definitive chemoradiation therapy. We defined standard of care (SOC) treatment as receiving external beam radiation therapy (EBRT) and concurrent chemotherapy, brachytherapy (BT), and completing treatment within 8 weeks, and compared SOC treatment to non-SOC. The primary outcome was overall survival (OS). We also evaluated the effect of sociodemographic and clinical variables on receiving SOC. RESULTS We identified 10,172 women with locally advanced cervical cancer primarily treated with chemotherapy and concurrent EBRT of which 6047 (59.4%) patients received brachytherapy, and only 2978 (29.3%) completed treatment within 8 weeks (SOC). Receipt of SOC was associated with significantly improved overall survival (median OS 131.0 mos vs 95.5 mos, 78.1 mos, 49.2 mos; p < 0.0001). Furthemore, in patients whose treatment extended beyond 8 weeks, brachytherapy was still associated with an improved survival (median OS 95.5 vs 49.2 mos, p < 0.0001). More advanced stage, Non-Hispanic Black race, lower income, lack of insurance or government insurance, less education, and rural residence were associated with decreased likelihood of receiving SOC. CONCLUSIONS Completing standard of care concurrent chemoradiation therapy and brachytherapy in the recommended 8 weeks was associated with a superior overall survival. Patients who received brachytherapy boost show superior survival to patients receiving EBRT alone, regardless of treatment duration. Disparities in care for vulnerable populations highlight the challenges and importance of care coordination for patients with cervical cancer.
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Abstract
Artificial Intelligence (AI) has been rapidly embraced by imaging fields and offers a variety of benefits in nuclear medicine; however, the biggest hurdles to AI in health care will likely not be technological but legal. What happens when an error occurs in the AI setting? A variety of legal causes of action, ranging from medical malpractice, to notions of vicarious liability/agency to products liability may come into play in an AI-related lawsuit. Physicians working with AI need to understand these causes of action, stay abreast of legal developments in AI, and advocate for appropriate guidelines and legislation.
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Affiliation(s)
- Jonathan Lee Mezrich
- Department of Radiology and Biomedical Imaging, Emergency Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
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Laura P, José A, Nikki A, Khaled A, Barret JP, Jeffery C, Shobha C, Jack CS, Scott C, Nadia D, Moustafa E, Liao J, Josef H, Briana H, Sunil K, Tetsuro K, Jorge LV, Gaoxing L, Hajime M, Ariel MA, Naiem M, Kiran N, Nawar A, Faustin N, Anthony O, Tom P, Liang Q, Man RS, Ingrid S, Ahmed T, Molina VLP, Shelley W, Mark F. Impact of COVID-19 on global burn care. Burns 2021; 48:1301-1310. [PMID: 34903416 PMCID: PMC8664090 DOI: 10.1016/j.burns.2021.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Abstract
Background Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pattern, and levels of specialization of the burn units affected reallocation of resources and access to burn care. Methods The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, χ2 or Fisher’s exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic. Results The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedicated nursing staff was reduced (<0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration between burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors. Conclusions During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.
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Affiliation(s)
- Pompermaier Laura
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
| | - Adorno José
- Burn Unit at Regional Hospital of North Wing, Brasília, Brazil
| | - Allorto Nikki
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa
| | - Altarrah Khaled
- Albabtain Center for Burns and Plastic Surgery, Alshuwaikh Specialist Health District, Alsabah Health Region, Kuwait
| | - Juan P Barret
- Department of Plastic Surgery and Burns, University Hospital Vall d´Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carter Jeffery
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chamania Shobha
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | | | - Corlew Scott
- Department of Global Health and Social Medicine Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Depetris Nadia
- Turin Burn Centre, Department of Anesthesia and Critical Care 3, Cittá della Salute e della Scienza di Torino, Torino, Italy
| | - Elmasry Moustafa
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Junlin Liao
- Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Haik Josef
- Tel-Aviv University, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel; National Burn Center, Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Tel-Aviv, Israel
| | - Horwath Briana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Keswani Sunil
- National Burns Centre Airoli, Sector 13 Samarth Ramdas Swami Marg, Airoli, Navi Mumbai, Maharashtra, India
| | - Kiyozumi Tetsuro
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama Prefecture, Japan
| | - Leon-Villapalos Jorge
- Department of Plastic Surgery and Burns, Chelsea and Westminster Hospital, London, UK
| | - Luo Gaoxing
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongoing, China
| | - Matsumura Hajime
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Moiemen Naiem
- Burns Centre, Birmingham Women's and Children's Hospital, Steelhouse Ln, Birmingham, UK; Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, UK
| | - Nakarmi Kiran
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal
| | - Ahmed Nawar
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Ntirenganya Faustin
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Rwanda
| | - Olekwu Anthony
- Department of surgery, Federal Medical Centre Owo, Adekunle Ajasin Way, Owo, Ondo state, Nigeria
| | - Potokar Tom
- Centre for Global Burn Injury Policy & Research, Swansea University, Sketty, Wales, UK; Interburns, Swansea University, Swansea, Wales, UK
| | - Qiao Liang
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Rai Shankar Man
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Kirtipur, Kathmandu, Nepal; National Academy of Medical Sciences, Kathmandu, Nepal
| | - Steinvall Ingrid
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tanveer Ahmed
- Burn and Plastic Surgery, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Vana Luiz Philipe Molina
- Divisao de Cirurgia Plastica e Queimaduras, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wall Shelley
- Pietermaritzburg Burn Service; Nelson Mandela School of Medicine, University of KwaZulu Natal, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, University of KwaZulu-Natal, South Africa
| | - Fisher Mark
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Miner MD, Bekker LG, Kredo T, Bhagwandin N, Corey L, Gray GE. Meeting report: South African Medical Research Council Standard of Care in Clinical Research in Low- And Middle-Income Settings Summit, November 2017. Trials 2021; 22:778. [PMID: 34742340 PMCID: PMC8572437 DOI: 10.1186/s13063-021-05754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure prophylaxis (PrEP) was recommended by the World Health Organization for persons at high risk of acquiring HIV, but not all countries immediately adopted those recommendations. The South African Medical Research Council (SAMRC) convened a summit to discuss issues relating to SoC and PrEP in HIV prevention clinical trials taking place in lower- to middle-income countries (LMIC). Policymakers, regulators, ethicists, experts in law, researchers, representatives of advocacy groups, and the HIV Vaccine Trials Network (HVTN) presented a framework within which SoC principles could be articulated. A group of subject matter experts presented on the regulatory, ethical, scientific, and historic framework of SoC in clinical trials, focusing on PrEP in South Africa. Summit participants discussed how and when to include new HIV treatment and prevention practices into existing clinical guidelines and trial protocols, as well as the opportunities for and challenges to scaling up interventions. The summit addressed challenges to PrEP provision, such as inconsistent efficacy amongst different populations and various biological, virological, and immunological explanations for this heterogeneity. Advocates and community members propagated the urgent need for accessible interventions that could avert HIV infection. The meeting recommended supporting access to PrEP in HIV prevention trials by (1) developing PrEP access plans for HIV vaccine trials, (2) creating a PrEP fund that would supply PrEP to sites conducting HIV prevention trials via a central procurement mechanism, and (3) supporting the safety monitoring of PrEP. This report summarizes the presentations and discussions from the summit in order to highlight the importance of SoC in HIV prevention clinical trials.
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Affiliation(s)
- Maurine D Miner
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, P.O. Box 13801, Mowbray, Cape Town, 7705, South Africa
| | - Tamara Kredo
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | - Niresh Bhagwandin
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa
| | - Lawrence Corey
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA
- Department of Medicine and Laboratory Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Glenda E Gray
- HVTN, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Mail-stop E3-300, Seattle, WA, 98109, USA.
- South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, Tygerberg, 7505, South Africa.
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