Industry perspectives on the global use of validated blood pressure measuring devices

A group of experts from reputable blood pressure measuring device (BPMD) manufacturers was invited to provide industry perspectives on the global use of validated BPMD. The authors support the recommendations of (1) using the consolidated universal ISO 81060-2:2018 in all future validation studies to ensure consistent and trustworthy quality standards; (2) validation studies to be led by investigators independent from the manufacturer; (3) validation study results to be published in peer-reviewed journals with an independent investigator as the corresponding author; and (4) validated BPMDs to be listed on validated device registries such as STRIDE BP, Validated Device Listing (VDL), and others that are backed by acknowledged scientific associations. The authors call for public awareness of the existence of legally marketed consumer BPMDs that lack sufficient evidence of clinical accuracy. Other important issues and future considerations were discussed, including the need: for awareness building and promoting the use of validated BPMDs among practitioners; to identify a non-mercury sphygmomanometer based reference device to validate BPMDs; to include all cuffs available for use with each BPMD in the validation study; for the promotion of validation studies for special patient populations; for validated wrist BPMDs as an alternative for some patients; for technical innovations to help reduce limitations related to the human aspect of validation studies; for validation of cuffless BPMDs; for validation through equivalency to validated base models; and to use validated BPMD in remote patient monitoring programs. A future collaborative to find solutions to support the use of validated BPMD is envisaged.

Focal therapy for prostate cancer: Making the punishment fit the crime

BACKGROUND

Focal therapy is recently gaining popularity as an intermediate option between active surveillance and whole-gland treatment for localized prostate cancer.

OBJECTIVE

This comprehensive review aims to present the different focal therapy technologies available to date while tackling the rationale for focal treatment, its indications, principles and outcomes of each technique.

EVIDENCE ACQUISITION

A comprehensive review of the PubMed, Embase, and Web of Science was done. Keywords used for research were: "prostate cancer"; "focal therapy"; "focal treatment"; "High-Intensity Focal Ultrasound"; "cryotherapy"; "photodynamic therapy"; "focal laser ablation"; "irreversible electroporation"; "focal brachytherapy" and "gold nanoparticle directed therapy". Accepted languages were English and French.

EVIDENCE SYNTHESIS

Choosing the best candidate for focal therapy is crucial (localized small to medium sized Gleason≤7 lesions). Focal high-intensity focal ultrasound has shown excellent survival rates at 5 years, while maintaining good functional outcomes (urinary continence and erectile function). Focal cryotherapy, one of the oldest focal treatments for prostate cancer, has shown good oncologic outcomes, with good continence rates and fair erectile function rates. Focal laser ablation seems a safe and feasible technique, with promising results. Irreversible electroporation has demonstrated good survival outcomes with no biochemical recurrence or disease relapse in the preliminary studies. Focal brachytherapy has a good toxicity profile, a good biochemical outcome, and gives a sustained quality of life. Finally, gold nanoparticle directed therapy is safe and is being studied in current trials.

CONCLUSION

While proven to be safe in terms of continence and sexual aspects, the challenge remains to better assess oncological outcomes of these techniques in randomized longer follow-up studies.

Biomarkers in renal cell carcinoma: Towards a more selective immune checkpoint inhibition

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Multiple prognostic markers are capable of predicting prognosis in mRCC.

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Biomarkers capable of predicting immune treatment efficacy in mRCC are needed.

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TIM-3 can have both a prognostic and predictive value.

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Integrating biomarkers to the trials of combination therapies is essential.

Immune checkpoint inhibitors such as programmed death protein 1/programmed death-ligand 1 and cytotoxic T-lymphocyte–associated protein 4 inhibitors are already playing a central role in the treatment of metastatic renal cell carcinoma. However, they seem to be only effective in a subset of patients, with a high risk of innate and adaptive tumor resistance. Consequently, biomarkers capable of predicting immune treatment efficacy in advanced renal cancer are needed both in the clinical and the experimental setting. We hereby present a brief summary of evidence on the most studied biomarkers in metastatic renal cell carcinoma with a focus on the possible future place of T cell immunoglobulin and mucin domain-3 (TIM-3).

Re: Updates in the management and future landscape of urothelial carcinoma

Immunotherapy is gradually revolutionizing bladder cancer treatment. In this extensive review published by Hanna et al. in your journal, the authors presented recent studies that are trying to challenge the standard platinum-based chemotherapy as first-line treatment of metastatic bladder cancer by chemoimmunotherapy. However, upfront pembrolizumab, atezolizumab and durvalumab association with standard of care chemotherapy did not improve overall survival when compared to chemotherapy alone.We hereby highlight a study that was not included in this review, the INDUCOMAIN trial, by discussing its results and its future implications on immunotherapy for metastatic bladder cancer.

Pelvic lymph node dissection in prostate cancer: Laparoscopy is not dead

CONTEXT

Pelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse.

OBJECTIVE

To perform a review in order to compare the effectiveness of the different PLND approaches.

ACQUISITION OF EVIDENCE

A search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("French"[Language] OR "English"[Language]) AND ("1990"[Date-Publication]: "3000"[Date-Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis.

EVIDENCE SYNTHESIS

Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach.

CONCLUSION

Concerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists.

A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement

: In the last 30 years, several organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and the International Organization for Standardization (ISO) have developed protocols for clinical validation of BP measuring devices. However, it is recognized that science, as well as patients, consumers and manufacturers would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Therefore, an international initiative was taken by AAMI, ESH and ISO experts who agreed to develop a universal standard for device validation. This statement presents the key aspects of a validation procedure, which were agreed by the AAMI, ESH and ISO representatives as the basis for a single universal validation protocol. As soon as the AAMI/ESH/ISO standard is fully developed, this will be regarded as the single universal standard and will replace all other previous standards/protocols.

A Universal Standard for the Validation of Blood Pressure Measuring Devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement

In the past 30 years, several organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring, and the International Organization for Standardization (ISO), have developed protocols for clinical validation of BP measuring devices. However, it is recognized that science, as well as patients, consumers, and manufacturers, would be best served if all BP measuring devices were assessed for accuracy according to an agreed single validation protocol that had global acceptance. Therefore, an international initiative was taken by the AAMI, ESH, and ISO experts who agreed to develop a universal standard for device validation. This statement presents the key aspects of a validation procedure, which were agreed by the AAMI, ESH, and ISO representatives as the basis for a single universal validation protocol. As soon as the AAMI/ESH/ISO standard is fully developed, this will be regarded as the single universal standard and will replace all other previous standards/protocols.

A technology-supported collaboration between a health plan and a community pharmacy to improve blood pressure control

OBJECTIVES

To assess the impact of a health plan and community pharmacy partnership to improve blood pressure control.

SETTING

A midwestern health plan and a regional community pharmacy chain.

PRACTICE INNOVATION

Health plan members with a hypertension diagnosis and attributed to the pharmacy chain based on prescription claims were invited to participate. Interested patients enrolled in the program at their pharmacies and were assigned a "smart card" for use with a blood pressure kiosk in the pharmacy. When the card was used at the kiosk, individual patient readings were linked directly to their electronic pharmacy record and an online patient portal. Pharmacists intervened with patients and prescribers as necessary to address adherence issues and adjust therapy as needed.

EVALUATION

Before and after blood pressure readings were assessed to determine the impact of patient self-monitoring and pharmacist intervention for patients with 1) uncontrolled blood pressure at first reading and 2) multiple readings throughout the pilot period.

RESULTS

Fifty-six of 276 eligible patients (20%) were enrolled in the program. Fourteen patients qualified for before and after assessments, having uncontrolled blood pressure on initial reading and multiple readings throughout the pilot. These patients demonstrated a mean reduction in systolic blood pressure of 12 mm Hg and diastolic blood pressure of 8 mm Hg. Nine of 16 eligible pharmacy locations enrolled patients at their sites. Challenges faced in the initiative included gaining adequate pharmacist and patient engagement.

CONCLUSION

The pilot demonstrated promising early results in a model that has potential to improve blood pressure monitoring and management in a community pharmacy setting.

Specific anchoring modes of two distinct dystrophin rod sub-domains interacting in phospholipid Langmuir films studied by atomic force microscopy and PM-IRRAS

Dystrophin rod repeats 1-3 sub-domain binds to acidic phosphatidylserine in a small vesicle binding assay, while the repeats 20-24 sub-domain does not. In the present work, we studied the adsorption behaviour of both sub-domains at the air/liquid interface and at the air/lipid interface in a Langmuir trough in order to highlight differences in interfacial properties. The adsorption behaviour of the two proteins at the air/liquid interface shows that they display surface activity while maintaining their alpha-helical secondary structure as shown by PM-IRRAS. Strikingly, R20-24 needs to be highly hydrated even at the interface, while this is not the case for R1-3, indicating that the surface activity is dramatically higher for R1-3 than R20-24. Surface-pressure measurements, atomic force microscopy and PM-IRRAS are used in a Langmuir experiment with DOPC-DOPS monolayers at two different surface pressures, 20 mN/m and 30 mN/m. At the lower surface pressure, the proteins are adsorbed at the lipid film interface while maintaining its alpha-helical structure. After an increase of the surface pressure, R1-3 subsequently produces a stable film, while R20-24 induces a reorganization of the lipid film with a subsequent decrease of the surface pressure close to the initial value. AFM and PM-IRRAS show that R1-3 is present in high amounts at the interface, being arranged in clusters representing 3.3% of the surface at low pressure. By contrast, R20-24 is present at the interface in small amounts bound only by a few electrostatic residues to the lipid film while the major part of the molecule remains floating in the sub-phase. Then for R1-3, the electrostatic interaction between the proteins and the film is enhanced by hydrophobic interactions. At higher surface pressure, the number of protein clusters increases and becomes closer in both cases implying the electrostatic character of the binding. These results indicate that even if the repeats exhibit large structural similarities, their interfacial properties are highly contrasted by their differential anchor mode in the membrane. Our work provides strong support for distinct physiological roles for the spectrin-like repeats and may partly explain the effects of therapeutic replacement of dystrophin deficiency by minidystrophins.