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1
Holmes, Cat, John Guenther, Gavin` Morris, Doris O'Brien, Jennifer Inkamala, Jessie Wilson, and Rasharna McCormack. "Researching School Engagement of Aboriginal Students and Their Families from Regional and Remote Areas Project." Australian and International Journal of Rural Education 34, no. 1 (March 22, 2024): 145–51. http://dx.doi.org/10.47381/aijre.v34i1.730.
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Over the last few years, attendance rates in remote schools have fallen, and Year 12 completions have also dropped. We are not sure why this is, though events like COVID-19, floods and other natural disasters have not made it easy. The case study presented here was part of a bigger project that sought to understand what people in remote schools and the communities they are in think makes a difference to attendance and Year 12 completion. This case study outlines the findings specific to one of the four case study sites, namely, Yipirinya School on Arrernte Country in Mparntwe (Alice Springs). The overarching finding of the study indicates that attendance alone cannot be the primary measure of school success; rather, engagement needs to be the focus. To tease out this finding, the three main themes: relationships, purpose, and cultural safety, are identified as factors that made a difference at Yipirinya School.
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Murphy, Karen J., Kathryn A. Dyer, Belinda Hyde, Courtney R. Davis, Ella L. Bracci, Richard J. Woodman, and Jonathan M. Hodgson. "Long-Term Adherence to a Mediterranean Diet 1-Year after Completion of the MedLey Study." Nutrients 14, no. 15 (July 28, 2022): 3098. http://dx.doi.org/10.3390/nu14153098.
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Mediterranean populations enjoy the health benefits of a Mediterranean diet (MedDiet), but is it feasible to implement such a pattern beyond the Mediterranean region? The MedLey trial, a 6-month MedDiet intervention vs habitual diet in older Australians, demonstrated that the participants could maintain high adherence to a MedDiet for 6 months. The MedDiet resulted in improved systolic blood pressure (BP), endothelial dilatation, oxidative stress, and plasma triglycerides in comparison with the habitual diet. We sought to determine if 12 months after finishing the MedLey study, the participants maintained their adherence to the MedDiet principles and whether the reduction in the cardiovascular disease (CVD) risk factors that were seen in the trial were sustained. Participants completed a food frequency questionnaire, and a 15-point MedDiet adherence score (MDAS; greater score = greater adherence) was calculated. Home BP was measured over 6 days, BMI was assessed, and fasting plasma triglycerides were measured. The data were analysed using intention-to-treat linear mixed effects models with a group × time interaction term, comparing data at baseline, 2, 4, and 18 months (12 months post-trial). At 18 months (12 months after finishing the MedLey study), the MedDiet group had a MDAS of 7.9 ± 0.3, compared to 9.6 ± 0.2 at 4 months (p < 0.0001), and 6.7 ± 0.2 (p < 0.0001), at baseline. The MDAS in the HabDiet group remained unchanged over the 18-month period (18 months 6.9 ± 0.3, 4 months 6.9 ± 0.2, baseline 6.7 ± 0.2). In the MedDiet group, the consumption of olive oil, legumes, fish, and vegetables remained higher (p < 0.01, compared with baseline) and discretionary food consumption remained lower (p = 0.02) at 18 months. These data show that some MedDiet principles could be adhered to for 12 months after finishing the MedLey trial. However, improvements in cardiometabolic health markers, including BP and plasma triglycerides, were not sustained. The results indicate that further dietary support for behaviour change may be beneficial to maintaining high adherence and metabolic benefits of the MedDiet.
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Foley, Michael Paul, Scott Michael Hasson, and Eydie Kendall. "Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study." Integrative Cancer Therapies 17, no. 2 (September 20, 2017): 337–49. http://dx.doi.org/10.1177/1534735417731514.
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The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant ( P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant ( P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant ( P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS’ emotional well-being compared to later participation.
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Asriyah, Faiqotul. "Upaya Meningkatkan Prestasi Belajar IPA melalui Model Pembelajaran Kooperatif Tipe Group Investigation di MIN 5 Gunungkidul." Jurnal Pendidikan Madrasah 6, no. 2 (December 14, 2021): 201–6. http://dx.doi.org/10.14421/jpm.2021.62-12.
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This research aims to find out the improvement of IPA subject learning achievement through a Group Investigation type cooperative learning model. The study was conducted at MIN 5 Gunungkidul with the research subjects of students of class VI of the 2017/2018 School Year. The study uses class action methods including planning, execution, observation, test and documentation activities. The results showed the use of the Group Investigation model can improve IPA learning achievement as evidenced by the average grade in the student class in pre-cycle activities of 69.47 with learning completion of 46.67% with sufficient criteria increased to 74.93 with learning completion by 60% including high criteria in cycle I, and increased to 84.93 with 86.67% learning completion including very high criteria in cycle II. The Group Investigation model can be applied to students at MIN 5 Gunungkidul.
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Lamb, Stephen. "Completing School in Australia: Trends in the 1990s." Australian Journal of Education 42, no. 1 (April 1998): 5–31. http://dx.doi.org/10.1177/000494419804200102.
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AFTER a period of dramatic growth in school completion in Australia, rates of school retention have begun to decline. At its peak in 1992 the national rate of retention to Year 12 was approximately 77 per cent. By 1995 the rate had fallen to 72 per cent. The aim of this paper is to document state, system, and social differences in the recent downturn in school completion rates in Australia. Data from the Australian Bureau of Statistics and from the Australian Youth Survey are used to look at patterns across states, school systems, geographical locations, social backgrounds, and by sex. The results suggest that during the 1990s the downturn in completion has been uneven and some groups of users which had come to rely on schooling during the 1980s for their future economic security are now turning away from school. The findings indicate a continuing need to monitor the numbers of young people completing school and their backgrounds.
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McKay, Rana R., Kathryn P. Gray, Julia H. Hayes, Glenn J. Bubley, Jonathan E. Rosenberg, Philip W. Kantoff, and Mary-Ellen Taplin. "Results of a phase II trial of docetaxel (DOC), bevacizumab (BEV), and androgen deprivation therapy (ADT) for biochemical relapse (BCR) after definitive local therapy for prostate cancer (PC)." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 54. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.54.
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54 Background: Despite primary treatment for localized PC, 20-30% of men experience a BCR, detected by a rise in prostate-specific antigen (PSA). Though 30% of these patients develop metastatic disease, the optimal treatment of men with BCR has yet to be determined. In this trial, we evaluate the efficacy of DOC, BEV, and ADT for men with BCR after local therapy for PC. Methods: 41 men with a BCR and PSA doubling time of ≤10 months (mos) were enrolled. Patients received 4 cycles of DOC (75 mg/m2) every 3 weeks, 8 cycles of BEV (15 mg/kg) every 3 weeks, 18 mos of a luteinizing-hormone releasing hormone (LHRH) agonist, and 15 mos of bicalutamide (50 mg daily) beginning after completion of DOC. The primary endpoint was the proportion of patients free from PSA-progression 1 year after completion of ADT. Secondary endpoints included PSA response, testosterone recovery, and toxicity. Results: Median follow-up was 27.6 mos. Median age at diagnosis was 58 years. Median PSA at diagnosis was 6.7 ng/mL, with the majority of patients (59%) having Gleason 7 disease. Most patients underwent radical prostatectomy +/- radiation therapy (n=36). At baseline, 33 men (81%) had a normal testosterone (> 240 ng/dL). The table describes the PSA responses for the entire cohort. 10 men (28%) had a normal testosterone 6 mos after completing ADT. 17 men (47%) had a normal testosterone 12 mos after completing ADT, of whom 5 (29%) had a PSA <0.2 ng/mL at that time. There were 15% grade 1, 34% grade 2, 39% grade 3, and 12% grade 4 adverse events (AEs). The most frequent grade 3-4 AEs included neutropenia (24%), febrile neutropenia (11%), and hypertension (9%). Conclusions: DOC, BEV, and ADT for BCR resulted in complete responses in 16 men (44%) 1 year after completion of therapy. Longer follow-up is needed to determine the efficacy of this regimen. Clinical trial information: NCT00658697. [Table: see text]
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Scott, Anthony M., Matthew C. Callier, Madison Lashley, David A. Cole, and Paul S. Dale. "A 12-Year Single-Institution Experience with Accelerated Partial Breast Irradiation." American Surgeon 84, no. 8 (August 2018): 1261–63. http://dx.doi.org/10.1177/000313481808400832.
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Accelerated partial breast irradiation (APBI) using the implanted brachytherapy device MammoSite® was approved for routine use by the Food and Drug Administration in 2002. The American Society of Breast Surgeons MammoSite® Breast Brachytherapy Registry served as a guideline for our institution to begin offering this treatment in 2005. This report reviews our available data to provide an analysis of patient outcomes over 12 years of use at a single institution. A retrospective review was conducted of records of 150 patients who underwent APBI or attempted APBI after breast-sparing surgeries between 2006 and 2017. These charts were analyzed for documentation of patient age, cancer stage, incidence of recurrence, and posttreatment complications. Of the patients evaluated, 99 per cent (149/150) completed treatment. The median time since treatment completion is now 8.9 years. One hundred eleven patients (74%) are now greater than five years posttreatment. Ipsilateral breast recurrence was found in 2.7 per cent of patients (4/149), and 1.3 per cent of patients (2/149) developed new primary breast tumors. Acute complications, mostly skin erythema (21%), were uncommon and self-limited. Subacute effects were generally fibrosis (13%) and mild local pain (9.4%). APBI for breast cancer after breast-conserving surgery continues to be used at our institution for select patients with good outcomes. Local control and toxicity are similar to that reported in the literature. Five-year local recurrence rates compare favorably with national trials. Occasional complications included fibrosis, persistent pain, and skin irritation.
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Khan, Imran A., Parthasarathi Ramakrishnan, Rajapandian Subbaiah, Senthilnathan Palanisamy, Nalankilli Palanisamy, Senthil K. Ganapathi, Bharath K. Murugan, and Chinnusamy Palanivelu. "Stump appendicitis single centre experience: a retrospective study." International Surgery Journal 7, no. 6 (May 26, 2020): 1899. http://dx.doi.org/10.18203/2349-2902.isj20202403.
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Background: Appendicectomy is the most common surgical procedure done for acute appendicitis worldwide. However, one among 50000 appendicectomy patients may present with recurrent abdominal pain, requiring hospitalization as stump appendicitis and may need completion appendicectomy. There are a few reports addressing management of stump appendicitis in the literature. Here we present our experience of laparoscopic completion appendicectomy over ten-year duration.Methods: A retrospective evaluation of records of appendicectomy from January 2008 to December 2018. All patients who had stump appendicitis as diagnosis and those who underwent completion appendicectomy were included. There were no exclusions. Details pertaining to presentation, duration of symptoms, records of previous surgery, perioperative and postoperative data was recorded, including follow-up of at least six months.Results: All 15 patients were managed by laparoscopic completion appendicectomy. Patients age range from 12 to 58 years, 12 were males and 3 female, duration of symptoms was from two to ten days, previous appendicectomy was done 4 to 84 months before, nine were diagnosed by ultrasonography of abdomen and six by CT scan, stump size ranged from 1 to 3.6 cm, mean operating time was 86.4 mins (range, 60-120 minutes). Duration of hospital stay was 3 to 5 days. There were no perioperative morbidity or mortality.Conclusions: Laparoscopic approach of completion appendicectomy is safe for management of stump appendicitis.
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Datta, Diva, Shivani Goyal, Robin Kaushik, and Simrandeep Singh. "Completion cholecystectomy for residual gallbladder: A re-emerging problem in the era of safe cholecystectomy." Hellenic Journal of Surgery 93, no. 2 (October 3, 2023): 91–93. http://dx.doi.org/10.59869/23017.
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Incomplete gallbladder removal usually leads to residual gallbladder, which can act as a nidus for stone formation in later life. Stump cholecystitis is a condition in which, such a large gallbladder remnant left after subtotal cholecystectomy becomes inflamed. When this happens, a completion cholecystectomy is advised. We present a rare case of residual gall bladder in a 44-year-old woman who underwent a subtotal cholecystectomy procedure 12 years ago.
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Kirwan, Morwenna, Kylie Gwynne, Thomas Laing, Mellissa Hay, Noureen Chowdhury, and Christine L. Chiu. "Can Health Improvements from a Community-Based Exercise and Lifestyle Program for Older Adults with Type 2 Diabetes Be Maintained? A Follow up Study." Diabetology 3, no. 2 (May 19, 2022): 348–54. http://dx.doi.org/10.3390/diabetology3020025.
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Background: Older people consistently report a desire to remain at home. Beat It is a community-based exercise and lifestyle intervention that uses evidence-based strategies to assist older people with type 2 diabetes mellitus (T2DM) to improve physical and functional fitness, which are crucial to maintain independence. This follow up, real-world study assessed the efficacy of Beat It and whether older adults with T2DM were able to maintain improvements in physical activity, waist circumference and fitness one year post completion. Methods: We have previously reported methods and results of short-term outcomes of Beat It. This paper reports anthropometric measurements and physical fitness outcomes of Beat it at 12-months post program completion and compares them to validated standards of fitness required to retain physical independence. Results: Improvements that were observed post program were maintained at 12 months (n = 43). While the number of participants who met fitness standards increased post program, not all increases were maintained at 12 months. Conclusions: This study provides promising early evidence that an eight-week, twenty-hour community-based clinician-led exercise and lifestyle program can improve health outcomes in older adults with T2DM which were retained for at least a year after program completion.
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Lindberg, Louise, Martina Persson, Pernilla Danielsson, Emilia Hagman, and Claude Marcus. "Obesity in childhood, socioeconomic status, and completion of 12 or more school years: a prospective cohort study." BMJ Open 11, no. 3 (March 2021): e040432. http://dx.doi.org/10.1136/bmjopen-2020-040432.
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ObjectivesChildren with obesity achieve lower educational level compared with normal-weight peers. Parental socioeconomic status (SES) impacts both a child’s academic achievement and risk of obesity. The degree to which the association between obesity and education depends on parental SES is unclear. Therefore, the primary aim is to investigate if individuals with obesity in childhood are less likely to complete ≥12 years of schooling, independently of parental SES. The secondary aim is to study how weight loss, level of education and parental SES are associated.DesignNationwide prospective cohort study.SettingSwedish national register data.ParticipantsChildren aged 10–17 years, recorded in the Swedish Childhood Obesity Treatment Register, and aged 20 years or older at follow-up were included (n=3942). A comparison group was matched by sex, year of birth and living area (n=18 728). Parental SES was based on maternal and paternal level of education, income and occupational status.Primary outcome measureCompletion of ≥12 years of schooling was analysed with conditional logistic regression, and adjusted for group, migration background, attention deficit disorder with or without hyperactivity, anxiety/depression and parental SES.ResultsAmong those with obesity in childhood, 56.7% completed ≥12 school years compared with 74.4% in the comparison group (p<0.0001). High parental SES compared with low SES was strongly associated with attained level of education in both children with and without obesity, adjusted OR (aOR) (99% CI)=5.40 (4.45 to 6.55). However, obesity in childhood remains a strong risk factor of not completing ≥12 school years, independently of parental SES, aOR=0.57 (0.51 to 0.63). Successful obesity treatment increased the odds of completing ≥12 years in school even when taking parental SES into account, aOR=1.34 (1.04 to 1.72).ConclusionsIndividuals with obesity in childhood have lower odds of completing ≥12 school years, independently of parental SES. Optimised obesity treatment may improve school results in this group.
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Fujiki, M., S. Miyamoto, S. Zenda, and M. Sakuraba. "Longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction." Journal of Laryngology & Otology 130, no. 9 (August 17, 2016): 865–72. http://dx.doi.org/10.1017/s0022215116008720.
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AbstractObjective:This study evaluated the longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction.Methods:The study comprised 16 patients who had: undergone glossectomy and tongue reconstruction with free flap transfer, received adjuvant radiotherapy, and survived without recurrence for at least 1 year. Swallowing function, as indicated by tolerance of oral intake, was evaluated before radiotherapy, at radiotherapy completion, and at 6 and 12 months after radiotherapy completion.Results:Before radiotherapy, all patients could tolerate oral intake. At radiotherapy completion, only three patients could consume all nutrition orally. However, swallowing function improved over time, and by 12 months after radiotherapy completion it had returned nearly to that before radiotherapy.Conclusion:Acute dysphagia due to radiotherapy after tongue reconstruction is severe, but can improve gradually. Multidisciplinary support of patients during percutaneous endoscopic gastrostomy dependence is important to improve long-term functional outcomes.
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Boyle, Jemma Megan, Angela Kuryba, Thomas E. Cowling, Jan van der Meulen, Nicola S. Fearnhead, Kate Walker, Michael Braun, and Ajay Aggarwal. "Real-world survival outcomes associated with completion of adjuvant chemotherapy for stage III colon cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 3596. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.3596.
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3596 Background: The optimal duration of adjuvant combination chemotherapy administered to patients with stage III colon cancer is debated. Our study assessed the effect of completed chemotherapy cycles on 3-year colon cancer-specific mortality, as well as the effect of dose reduction and early discontinuation of oxaliplatin in patients with 100% completion, within a real-world population. Methods: 4,147 patients undergoing major resection between 01 June 2014 and 30 April 2017 with pathological stage III colon cancer in the English National Health Service were identified. Chemotherapy data were obtained from linked administrative hospital records and a national chemotherapy dataset. Patients were stratified according to completion of < 50% ( < 6 FOLFOX cycles or < 4 CAPOX cycles), 50-92% (6-11 FOLFOX cycles or 4-7 CAPOX cycles) or 100% of cycles (12 FOLFOX cycles or 8 CAPOX cycles). Competing-risk regression analysis for 3-year colon cancer-specific death was performed with adjustment for patient, tumour and hospital-level characteristics to estimate subdistribution hazard ratios (sHR) as a measure of relative risk. Results: Patients included within our study were less fit and had increased rates of high-risk disease (T4 and/or N2 pathological staging) compared to the IDEA study. For FOLFOX, the 3-year cumulative incidence of colon cancer-specific death in patients completing 100% of cycles was 15.1% (95% CI, 12.8% to 17.6%), 18.2% (95% CI, 15.3% to 21.3%) for 50-92% of cycles and 26.4% (95% CI, 20.6% to 32.5%) for < 50% of cycles. For CAPOX, this was 12.0% (95% CI, 10.2% to 14.0%) for 100% completion of cycles, 18.2% (95% CI, 15.6% to 21.0%) for 50-92% of cycles, and 19.8% (95% CI, 15.8% to 24.1%) for < 50% cycles. Compared to 100% completion of FOLFOX cycles, colon cancer-specific death was higher in patients recorded as completing < 50% (sHR 2.17; 95% CI, 1.56 to 3.03; P = < 0.001) and 50-92% of FOLFOX cycles (sHR 1.40; 95% CI, 1.09 to 1.78; P = 0.007). Compared to 100% completion of CAPOX cycles, colon cancer-specific death was higher in patients recorded as completing < 50% (sHR 2.02; 95% CI 1.53 to 2.67; P< 0.001) and 50-92% of CAPOX cycles (sHR 1.63; 95% CI 1.27 to 2.10; P< 0.001). Dose reduction and early discontinuation of oxaliplatin did not have a statistically significant effect on mortality. Conclusions: Patients within the real world setting were more likely to have poor prognostic factors. Those who completed adjuvant chemotherapy for stage III colon cancer had improved survival rates regardless of dose reduction or early discontinuation of oxaliplatin.
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Bakhai, Smita, Aishwarya Bhardwaj, Parteet Sandhu, and Jessica L. Reynolds. "Optimisation of lipids for prevention of cardiovascular disease in a primary care." BMJ Open Quality 7, no. 3 (August 2018): e000071. http://dx.doi.org/10.1136/bmjoq-2017-000071.
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The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines focus on atherosclerotic cardiovascular disease (ASCVD) risk reduction, using a Pooled Cohort Equation to calculate a patient’s 10-year risk score, which is used to guide initiation of statin therapy. We identified a gap of evidence-based treatment for hyperlipidaemia in the Internal Medicine Clinic. Therefore, the aim of this study was to increase calculation of ASCVD risk scores in patients between the ages of 40 and 75 years from a baseline rate of less than 1% to 10%, within 12 months, for primary prevention of ASCVD. Root cause analysis was performed to identify materials/methods, provider and patient-related barriers. Plan-Do-Study-Act cycles included: (1) creation of customised workflow in electronic health records for documentation of calculated ASCVD risk score; (2) physician education regarding guidelines and electronic health record workflow; (3) refresher training for residents and a chart alert and (4) patient education and physician reminders. The outcome measures were ASCVD risk score completion rate and percentage of new prescriptions for statin therapy. Process measures included lipid profile order and completion rates. Increase in patient wait time, and blood test and medications costs were the balanced measures. We used weekly statistical process control charts for data analysis. The average ASCVD risk completion rate was 14.2%. The mean ASCVD risk completion rate was 4.0%. In eligible patients, the average lipid profile completion rate was 18%. ASCVD risk score completion rate was 33% 1-year postproject period. A team-based approach led to a sustainable increase in ASCVD risk score completion rate. Lack of automation in ASCVD risk score calculation and physician prompts in electronic health records were identified as major barriers. Furthermore, the team identified multiple barriers to lipid blood tests and treatment of increased ASCVD risk based on ACC/AHA guidelines.
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Haidar, Cyrine E., James M. Hoffman, Roseann S. Gammal, Mary V. Relling, and Kristine R. Crews. "Development of a postgraduate year 2 pharmacy residency in clinical pharmacogenetics." American Journal of Health-System Pharmacy 74, no. 6 (March 15, 2017): 409–15. http://dx.doi.org/10.2146/ajhp160174.
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Abstract Purpose The structure and development of an innovative, ASHP-accredited postgraduate year 2 (PGY2) clinical pharmacogenetics residency program are described. Summary A 12-month PGY2 clinical pharmacogenetics residency was created at St. Jude Children’s Research Hospital in accordance with the ASHP standards for advanced practice residencies. The purpose of this 12-month residency program is to prepare pharmacy residents to implement pharmacogenetics in clinical practice. The program helps residents develop expertise in the science of pharmacogenetics as well as an understanding of translational research, innovative pharmacy practice model development, and clinical informatics. The resident learns to optimize patient outcomes through the expert provision of evidence-based, patient-centered precision medicine as an integral part of an interprofessional team. After completing the program, residents are expected to have the clinical skills necessary to practice in the field of clinical pharmacogenetics and independently implement pharmacogenetic testing in other health-system settings. Because implementation of pharmacogenetics requires collaboration across many disciplines, residents works within an interprofessional team of physicians, nurses, informatics specialists, pharmacists, and clinical laboratory personnel to achieve program goals. Since the first resident graduated in 2012, the program has graduated 1 resident each year. Graduated residents have accepted pharmacogenetics positions at major academic medical centers and community hospitals, as well as academic and research positions with a pharmacogenetics emphasis. Conclusion A PGY2 clinical pharmacogenetics residency was successfully developed at St. Jude in 2013. After completion of the program, residents are equipped with the clinical skills and necessary experience to drive precision medicine forward and lead the implementation of pharmacogenetic testing in other healthcare settings.
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Leung, Jessica, Elizabeth B. Gray, Tara Anderson, Sarah M. Sharkey, and Kathleen L. Dooling. "07. Recombinant Zoster Vaccine (RZV) Second-Dose Completion in Adults Age 50‒64 Years in the United States." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S127. http://dx.doi.org/10.1093/ofid/ofab466.210.
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Abstract Background In 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV, Shingrix) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥50 years, with the 2nd dose recommended 2–6 months after the 1st dose. Among Medicare beneficiaries, 2-dose series completion 6 months and 12 months post initiation was 78% and 86%, respectively. Here we estimate the proportion of adults age 50–64 years who completed the 2-dose RZV series within 6 or 12 months after receiving their 1st dose, by using two administrative claims databases. Methods We used medical and pharmaceutical claims data from October 2017‒March 2020 IQVIA® PharMetrics Plus and October 2017‒October 2020 IBM® MarketScan® databases. RZV vaccination was defined using Current Procedural Terminology and National Drug Codes. We allowed for sufficient follow-up time by examining 1st doses given at least 6 or 12 months prior to the end of the study period in both databases. Place of administration was available in IQVIA data. Results Among persons age 50‒64 years, in IQVIA and MarketScan, 70% and 68% received their 2nd RZV dose within 6 months, respectively, and 79% and 81% received their 2nd dose within 12 months, respectively. The median age of 1st dose of RZV vaccination was 60 years and ~60% were female [Table 1]. When the 2nd dose was administered within 12 months, the median interval between 1st and 2nd doses was 104 and 98 days in the IQVIA and MarketScan databases, respectively. Characteristics by age, sex, or region were similar in persons who received 1 RZV dose vs. 2 RZV doses [Table 1]. Among those who received only 1 RZV dose with at least 12 months of follow-up time, 55% of vaccinations occurred at ambulatory medical provider offices and 40% at pharmacies; among 2 doses recipients, 33% of vaccinations occurred at provider offices and 62% at pharmacies. Conclusion Among 50‒64-year-olds, 2-dose RZV series completion was ~70% within 6 months and 80% within 12 months of initiation. The findings were similar across two administrative claims databases. Availability of RZV at pharmacies has potentially helped to increase RZV 2nd dose completion rates. Disclosures All Authors: No reported disclosures
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Callander, Emily J., Deborah J. Schofield, Rupendra N. Shrestha, and Simon J. Kelly. "Sufficient education attainment for a decent standard of living in modern Australia." Journal of Social Inclusion 3, no. 1 (June 14, 2012): 7–20. http://dx.doi.org/10.36251/josi39.
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Education attainment will impact upon an individual’s capacity to engage in the labour force, their living standards and hence their poverty status. As such, education should be included in measures of poverty. However, it is not known what a sufficient level of education to have a decent standard of living is. Using the 2003 Survey of Disability, Ageing and Carers different levels of education attainment were tested for their association with labour force participation and income. Based upon this, it was concluded that Year 12 or higher is a sufficient level of education attainment for 15 to 64 year olds; and Year 10 or higher for people over the age of 65 years. This is in line with current government policies to improve Year 12 completion rates. Knowing what a ‘sufficient level of education attainment’ is, allows education to be included in multidimensional measures of poverty that view education as a key dimension of disadvantage.
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Kennedy, Mary A., Lauren V. Fortington, Matt Penney, Nicolas H. Hart, Pierre A. d’Hemecourt, and Dai Sugimoto. "Running Marathons in High School: A 5-Year Review of Injury in a Structured Training Program." International Journal of Environmental Research and Public Health 20, no. 5 (March 1, 2023): 4426. http://dx.doi.org/10.3390/ijerph20054426.
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Objective: The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. Design: This study is a retrospective clinical audit. Methods: Injury reports from high school students (grades 9–12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. Results: Program completion was 96% (n = 448/469). Of all participants, 186 (39.6%) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38%) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2%) and 84 boys (48.8%)). More than half (n = 113, 55.1%) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9%) and were of a minor nature (n = 181, 90%), requiring only 1–2 treatments. Conclusions: There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1–2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended.
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Thies, Wolf-Ruediger, Thomas Breymann, Dietmar Boethig, Ute Blanz, Hans Meyer, and Reiner Koerfer. "Results of staged reconstruction for hypoplasia of the left heart: an experience of 12 years from one institution." Cardiology in the Young 13, no. 6 (December 2003): 509–18. http://dx.doi.org/10.1017/s1047951103001094.
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Background:We reviewed our 12-year experience with staged reconstruction for hypoplasia of the left heart, examining the results of each surgical step and the impact of the year of the Norwood operation on survival. We compared survival of patients with hypoplasia of the left heart subsequent to completion of the Fontan circulation to survival of patients with a dominant left ventricle undergoing a Fontan procedure.Patients:Between 1989 and 2001, we performed a first stage procedure in 89 patients. Their median age was 9 days, with a range from 2 to 140 days, and the median weight was 3.4 kg, with a range from 2.4 to 5.4 kg.Results:Survival at 1, 4, and 10 years was 55%, 49%, and 49%, respectively. We experienced 23 early deaths (26%), and 12 deaths between the stages of the Norwood cascade. Of our patients, 42 underwent the second stage, and 30 the third stage. Prior to the first stage, symptoms of necrotising enterocolitis, and of obstructed pulmonary venous return, influenced survival significantly. The latter was eliminated as risk factor when surgery was performed within the first week of life. During the later part of our experience, survival at the first stage operation improved significantly, with survival at 3 years increasing from 42% to 75% for the patients at standard-risk (p = 0.017), and from 17% to 42% for those deemed to be at high-risk (p = 0.1). No deaths occurred in 23 patients older than 3 years of age, all of whom had proceeded through the third stage. After completion of the Fontan circulation, the survival of the patients with hypoplasia of the left heart at 4 years was comparable to the survival of patients undergoing the Fontan procedure with a dominant left ventricle (88% versus 90%, p = 0.8).Conclusions:Early and intermediate survival has improved significantly over the period of 12 years. Late death has been uncommon, and none of our patients are listed for cardiac transplantation.
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Becktell, Kerri, Rachel Phelan, Debra Schmidt, Lynnette Anderson, Julie Nichols, Pippa Simpson, and Kristin Bingen. "Developmental differences in health-related quality of life (HRQL) in adolescent and young adult (AYA) survivors of childhood cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e21524-e21524. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e21524.
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e21524 Background: AYAs experience many distinct periods of developmental transition within this life stage. AYA survivors of childhood cancer are at risk for chronic physical and psychosocial health conditions due to treatment-related exposures. Few studies have evaluated HRQL differences that may exist among developmental subgroups of AYA cancer survivors. This study examined HRQL differences across AYA developmental subgroups (early teens 12-14 years; late teens 15-17; emerging adults 18-24; young adults 25-39) of long term childhood cancer survivors. Methods: Cancer survivors ages 12-39 years who were seen in a long term follow up clinic at time of survey completion (as part of larger HRQL study) and completed therapy ≥2 years ago were included. HRQL was assessed using PedsQL (< 18) and FACT-G (> 18) measures. Demographic and treatment data were obtained from EMR. Analyses compared HRQL measure scores among AYA age subgroups and investigated predictors of HRQL outcomes. Results: A total of 155 patients were included in analysis. Mean age at survey completion was 17.9 [range 12-33] years. PedsQL school functioning was significantly lower for 15-17 year-old compared to 12-14 year-old survivors (M = 77.60, p = 0.01). There were no differences between 18-24 and 25-39 year-old survivors on the FACT-G. PedsQL school functioning was significantly lower for survivors (< 18) compared to normative data (p = 0.004). FACT-G scores for survivors were significantly higher compared to population norms in all domains (p≤0.001) except emotional well-being. Regression CART analysis indicated survivors who were ≤15 years-old and had not relapsed and survivors who were > 15 years old and had ≥2 late effects had lower PedsQL scores. Survivors who were ≥21 years-old had lower FACT-G scores compared to < 21 years. Survivors who were < 21 years-old, > 7 years-old at diagnosis, and > 6 years from end of treatment had lower FACT-G scores. Conclusions: Adolescent survivors may be at risk for school problems years after cancer treatment. Young adult survivors may be at greater risk of poor HRQL. This study highlights potential developmental differences in HRQL predictors and outcomes in long term AYA cancer survivors.
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Patterson, Brandon J., Chi-Chang Chen, Catherine B. McGuiness, Lisa I. Glasser, Kainan Sun, and Philip O. Buck. "17. Assessment of Recombinant Zoster Vaccine Second Dose Completion in the United States." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S31. http://dx.doi.org/10.1093/ofid/ofaa439.062.
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Abstract Background Recombinant Zoster Vaccine (RZV) was licensed in the United States (US) in October 2017 for the prevention of herpes zoster in adults ≥ 50 years of age (YOA). The vaccine is administered in a two-dose sequence with a 2- to 6-month interval; however, the Center for Disease Control & Prevention has advised against restarting a series after the prescribed window. This study describes an assessment of 2nd dose completion and compliance of RZV in the US. Methods Primary analysis was conducted on a cohort ≥ 50 YOA who received an initial RZV dose between October 2017 and September 2018 as indicated in the IQVIA longitudinal prescription claims or medical claims databases. Subjects were required to have ≥ 1 year of observable time post initial dose. A sensitivity analysis was conducted using all eligible subjects regardless of observable time post initial dose. Endpoints of analyses were monthly and cumulative 2nd dose label-compliant proportions at 6 months and completers by 12-month intervals and time to completion from initial RZV vaccine administration with stratifications by age, sex, claim source and payer type. Results The primary sample included 1,225,088 subjects, while the sensitivity analysis included 7,097,441 (Table 1). Overall, 2nd RZV dose completion was 70.4% within 6 months and 81.8% within 12 months. Minimal variation for 12-month completion was demonstrated across age (77.2–84.5%), sex (81.7–81.9%), and Commercial vs. Medicare (80.9–83.0%). However, larger variations were seen across claim sources and other payer type, with medical claims (64.9%), Medicaid patients (72.8%) and Cash patients (74.7%) having lower rates at 12 months (Table 2). Overall, the average time to completion was around 4 months regardless of stratification except by claims source, with medical claims taking 5 months on average to complete. The sensitivity analysis of the variable follow-up cohort demonstrated findings consistent with that of the primary sample. Conclusion Assessment of RZV suggests high levels of completion across age, sex, payer type and claim sources. More effort is needed to understand barriers to completion rates in Medicaid patients and settings where vaccination claims are processed outside of the vaccine recipient’s pharmacy benefit. Disclosures Brandon J. Patterson, PharmD, PhD, GSK (Employee, Shareholder) Chi-Chang Chen, PhD, MSPharm, GSK (Research Grant or Support) Catherine B. McGuiness, MA, MS, GSK (Research Grant or Support)Pfizer (Shareholder) Lisa I. Glasser, MD, GSK (Employee, Shareholder) Kainan Sun, MS, PhD, GSK (Research Grant or Support) Philip O. Buck, PhD, MPH, ORCID: 0000-0002-3898-3669, GSK (Employee, Shareholder)
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Henrikson, Nora B., Weiwei Zhu, Lauren Baba, Matthew Nguyen, Heidi Berthoud, Gabrielle Gundersen, and Annika M. Hofstetter. "Outreach and Reminders to Improve Human Papillomavirus Vaccination in an Integrated Primary Care System." Clinical Pediatrics 57, no. 13 (July 13, 2018): 1523–31. http://dx.doi.org/10.1177/0009922818787868.
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This study evaluated the impact of health system–based outreach and reminders on human papillomavirus (HPV) vaccine series initiation and completion. Parents of 10 to 12 year olds (n = 1805) were randomized to receive either (1) an outreach letter and brochure recommending HPV vaccination followed by automated HPV vaccine reminders or (2) usual care. We interviewed a subset of 50 parents to assess program acceptability. Outcomes were HPV vaccine initiation during the study period and on-time series completion. Rates of HPV vaccine initiation during the study period (July 2015 to August 2016) were similar between the intervention and control groups, but initiation within 120 days of randomization was higher in the intervention group (23.6% and 18.8%, P = .04) as was completion during the study period (10.3% vs 6.8%, P = .04). Reminders for doses 2 and 3 did not affect completion. The program was acceptable to parents. This study provides evidence that health system–based outreach and reminders can improve HPV vaccination.
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Mertin, Peter, Caroline Dibnah, Vivienne Crosbie, and Richard Bulkeley. "Using North American Instruments with British Samples: Norms for the Revised Children's Manifest Anxiety Scale in the UK." Child Psychology and Psychiatry Review 6, no. 3 (September 2001): 121–26. http://dx.doi.org/10.1017/s1360641701002520.
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The Revised Children's Manifest Anxiety Scale is a widely used assessment tool, but it is questionable whether the North American norms are applicable to a British population. The scale was administered to 575 English children aged 8–12 years. Means were computed by age and gender and compared to the published North American norms. English males reported less anxiety than American males in most age groups, while 8-year-old English girls reported less anxiety than 8-year-old American girls. The language used in the Scale caused some difficulties, suggesting that the Scale might be better used in a structured interview rather than as a self-completion questionnaire.
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Németh, Erzsébet, and Botond-Géza Kálmán. "A gyerekkori pénzügyi személyiség előre definiált faktorai: I.rész, belső konzisztenciavizsgálat." PedActa 13, no. 1 (June 30, 2023): 9–16. http://dx.doi.org/10.24193/pedacta.13.1.2.
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In 2018, the Money Compass Foundation has published an online financial personality test for 12-14 year olds in Hungary. Completion is voluntary, and after completing the test, respondents receive an immediate assessment of their financial personality traits based on a predefined framework. The purpose of the testing is to learn about and develop young people's self-knowledge and financial awareness. The evaluation highlights the beneficial behaviours of the respondent and draws attention to the areas where the achieved results can be further improved. The test was completed by 15,933 respondents until February 2022. In Part I of the study, the authors examine the internal consistency of the four pre-defined financial personality structures - Frugal, Diligent, Conscious and Moderate - built up from the questions in the questionnaire.
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Agana-Norman, Denny Fe G., Monica Martinez Martinez, Manjushree Shanmugasundaram, and Abbey B. Berenson. "Understanding Barriers to Human Papillomavirus Vaccination among Parents of 9–10-Year-Old Adolescents: A Qualitative Analysis." Vaccines 12, no. 3 (February 27, 2024): 245. http://dx.doi.org/10.3390/vaccines12030245.
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HPV vaccination rates remain low among US adolescents, with only 54% completing the series in 2019. The vaccine is recommended at age 11–12 but can be given as early as age 9. Although it has been found that offering the vaccine earlier improves completion rates by age 13, parents remain reluctant to allow their younger children to initiate this vaccine. The purpose of this study was to better understand parental beliefs regarding receipt of the HPV vaccine among their children at ages 9–10. A 40 min phone interview was completed with 21 participants who were asked about their vaccine viewpoints. Even after receiving one-on-one education from a patient navigator, many caretakers expressed inadequate knowledge of the HPV vaccine and limited exposure to both positive and negative influences. The biggest concern was vaccine side effects, often resulting from a lack of medical understanding. Most parents were reluctant to vaccinate their children at a school-based clinic or pharmacy and believed that the government should not mandate HPV vaccination for public school attendance. Our study provides insight into parental beliefs and attitudes about HPV vaccination at age 9–10 years and barriers that need to be addressed.
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Burykin, Alexey A. "Календарный 12-летний животный цикл в фольклоре калмыков и других народов Азии." Монголоведение (Монгол судлал) 12, no. 4 (December 17, 2020): 679–91. http://dx.doi.org/10.22162/2500-1523-2020-4-679-691.
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Introduction. The work deals with folklore stories about the 12-year animal calendar cycle once adopted by Kalmyks and other peoples of Asia, such as Mongols, Buryats, Altaians, Tuvans, etc. Goals. The paper focuses on the shaping of the 12-year-old animal cycle and roles played by traditional folklore animal characters in its formation. The paper defines impacts certain supreme characters made on the establishment of such calendar, the one for Mongols being the Buddha himself. Another distinctive feature of narratives about animals’ participation in the completion of the calendar is that special attention be paid to the camel, whose inclusion therein was hampered by the mouse’s trick. The plot about relations between camel (sometimes deer) and mouse was borrowed even by nations that do not use a 12-year-old animal calendar, and no Asian folklore tradition contains any story about relations between other calendar-included animals. Conclusions. The study concludes the narrative about emergence of a 12-year-old animal cycle is an etiological myth developed from plots depicting controversy between the animals after the calendar was adopted by Mongols in the early 13th century. Folklore materials in the form of other calendar-related plots partially included in the animal epic indicate arrivals of the calendar and writing are somewhat temporally correlated, and delineate potential historical ties between the animal calendar and divination practices.
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Strickland, P. Andrew, Scott M. Bisping, and Hunter R. Hatcher. "Validation of Annulus Formation in Golden Shiner Otoliths." Journal of Fish and Wildlife Management 11, no. 1 (January 31, 2020): 258–62. http://dx.doi.org/10.3996/082019-jfwm-069.
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Abstract Golden Shiner Notemigonus crysoleucas is found in many lakes and ponds across the southeastern United States. Though it is a common species, otolith age validation methods have not been published. The objective of this study was to confirm annulus formation in lapillar otoliths of Golden Shiners collected monthly from September 2015 through August 2016 in Lake Jackson, Florida (Leon County). We collected at least 12 individuals each month of similar length (168–249 mm; presumably of the same cohort) to document annulus formation throughout the year. We sacrificed a total of 177 individuals from the 2013 year class, and we used their lapillar otoliths for marginal incremental analysis to calculate an index of completion and validate annulus formation. The monthly index of completion was highest from January through March and lowest in May and June, indicating that annuli were deposited once per year and confirming that lapillar otoliths are a valid age estimation structure for Golden Shiners.
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Opneja, Aman, Amit Rout, Joseph Abraham, Gurkirat Gill, and Kenneth David Miller. "Implantable intravenous devices (“ports”) as a survivorship issue." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 9. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.9.
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9 Background: Women with early stage breast cancer often receive chemotherapy through implantable intravenous access devices (ports). There is little information on the duration of port use for breast cancer patients who have completed treatment. Methods: The EMR was searched for women who received adjuvant chemotherapy using a port for Stage I-III breast cancer between 2007- 2012. Data abstracted from the EMR included demographics, duration and type of chemotherapy, duration of port use and complications. Results: During the years 2007-2012, a total of 167 patients qualified for the study. 28 (16.8%) patients were excluded as complete data was not available. The Mean age of the remaining 127 women was 60 (SD: 1) years. The distribution of cancer stage was 18.1%, 59.1%, 22.8% of stage I, II, and III respectively. The median total length of duration of indwelling port was 506 days and median duration from chemotherapy completion to port removal was 299 days. The duration of time after completing treatment that the port remained in place was 0-6 months (31.5%), 6-12 months (25.2%), 12-24 months (24.4%), and > 24 months (18.9%). Patients with stage III cancer had significantly longer time to port removal relative to patients with stage I and stage II cancer (p < 0.005). Complications of ports (n = 4), all occurred during active treatment and included non-functioning/mispositioning (n = 2), and thrombosis (n = 2). Assuming the cost of port maintenance was $225 per visit and port maintenance was required every four weeks, the estimated average cost of maintaining the port after the completion of chemotherapy was $3,494 for this group of patients. Conclusions: Oncologists typically do not use the word “cure”; maintaining a port in place after chemotherapy may reinforce concerns about the risk of recurrence. This is highlighted by the fact that treatment type and hormone receptor status were not significantly associated with time of port removal. We found that 43% of patients still have their port in place one year after completing treatment and almost 19% of patients have their port in place greater than two years after completing treatment. The high cost and the possible psychological impact of leaving a port in place for long periods of time needs further study.
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Nakonechnyi, R. "Efficiency of tactical training of football players 11-12 years old using interactive tasks." Scientific Journal of National Pedagogical Dragomanov University. Series 15. Scientific and pedagogical problems of physical culture (physical culture and sports), no. 9(154) (October 3, 2022): 67–74. http://dx.doi.org/10.31392/npu-nc.series15.2022.9(154).16.
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In the article, a comparative analysis of tactical training programs for football players aged 11-12 years (at the stage of preliminary basic training) is carried out using traditional (training program for football players of the "Rukh" Lviv Academy) and author's approaches (experimental program for tactical training of football players using interactive tasks) to build them content. The author's program of tactical training of 11-12-year-old football players is generally created on the basis of preliminary research. In particular, the data obtained: before the beginning, during and after the completion of the pedagogical experiment with 11-12- year-old football players, who play in the youth sports center of the Rukh Lviv football club, were analyzed. An analysis of modern foreign scientific literature on football was carried out, which describes the tactical training of football players in the early stages of multi-year sports improvement. Conducting a pedagogical experiment made it possible to testify that 11-12-year-old football players are quite capable of effectively performing tasks of a tactical nature in "one-on-one" and "two-on-one" situations while playing football. Also, the players of both studied groups demonstrated sufficient results when performing complex group interactions, namely: "two against two" and "three against two". However, the superiority of the players of the experimental group over the football players of the control group was recorded in virtually all the control tests that took place after the end of the pedagogical experiment. Therefore, it is worth considering that due to the selection of rational methods and means, it is possible to purposefully and effectively influence the tactical preparedness of young Ukrainian football players starting from the early years of playing football (in particular, from the age of 11-12).
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Gallagher, A., J. Sheridan, G. Doherty, H. Mulcahy, and G. Cullen. "P301 Outcomes following colectomy for patients with Ulcerative Colitis, ten years of data from a tertiary referral centre." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i445—i446. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0431.
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Abstract Background Patients who undergo subtotal colectomy for Ulcerative Colitis (UC) have a persistent risk of colorectal cancer (CRC) in the retained rectum and this increases overtime. There are currently no guidelines for rectal surveillance in this group. We aimed to assess the outcome following colectomy for patients with UC over a ten year period. Methods We conducted a retrospective analysis of patients with UC who underwent colorectal surgery in a tertiary referral centre. The Hospital In-Patient Enquiry system and the St Vincent's Hospital IBD Database were used to identify patients. Patients with colorectal cancer were excluded. Results In a six year period one-hundred and seventy six bowel surgeries were carried out for patients with Inflammatory Bowel Disease. Sixty five of these procedures were performed on patients with UC, eight of which would subsequently be re-diagnosed with Crohn’s Disease. 73.6% (n=42) had a completion proctectomy within ten years, 12% (n=7) were lost to follow up and 5% (n=3) died from non-gastrointestinal disorders. 8.7% (n=5) retained their rectum after ten years. For patients who had a completion proctectomy the median time to surgery was two years. Most of these patients did not have surveillance within the twenty four month time frame. Patients who had a completion proctectomy between three and ten years underwent surveillance endoscopy on average two occasions. All patients in the retained rectum group had surveillance proctoscopy with a median frequency of 2.4 years. The risk of further surgery was a factor for two patients due to obesity and decompensated liver disease. A third patient had an ileorectal anastamosis abroad and continues to have active rectal disease. Dysplasia was found in the rectum of the fourth patient thirteen years post colectomy. The final patient refused surgery but agreed to endoscopic surveillance. A rectal adenocarcinoma was diagnosed ten years post-operation. Conclusion Despite the absence of guidelines for completion proctectomy and/or surveillance of the retained rectal stump, three quarters of our UC patients had undergone completion proctectomy within ten years. A small but significant number of patients have a residual rectal stump after ten years, they require CRC surveillance and clear guidelines on this are needed.
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Koczwara, Bogda, Shahid Ullah, M. Nazim Abbas, Alex Scott-Hoy, Fiona Young, Ganessan Kichenadasse, Christos Stelios Karapetis, et al. "A prospective study of anti-mullerian hormone (AMH) as a predictor of chemotherapy-induced menopause." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23076-e23076. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23076.
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e23076 Background: Chemotherapy-induced premature menopause is a distressing side effect of cancer treatment. Currently there are no validated tools to predict the loss of ovarian function. Anti-Mullerian hormone (AMH) in healthy women correlates with ovarian reserve and predicts menopause but its utility in chemotherapy-treated patients is underexplored. We examined the utility of AMH levels as a predictor of chemotherapy-induced amenorrhea at 1-year post chemotherapy - a reliable surrogate for chemotherapy-induced menopause. Methods: Premenopausal women, 45 years or younger, about to receive curative chemotherapy for breast cancer or lymphoma, without ovarian suppression, were assessed for menopausal symptoms using Menopausal Symptom Score (MSS), quality of life (QOL) using EORTC – QLQ-C30 questionnaire, and had serum AMH, oestradiol, FSH, LH collected prior to first chemo, and at 3 and 6 weeks, at completion and 12 months after chemotherapy. Results: Twenty-two premenopausal women, median age 40.5 (37-43) were enrolled. Twenty became amenorrhoeic during chemotherapy and four had return of menses at 1 year after treatment completion. Median AMH level at baseline was 12.9 pmol/L (IQR 5.2 – 26.5), fell sharply following first chemotherapy and remained low at < 3pmol/L (IQR < .3 ) at 1 year with only 2 subjects with AMH levels above 3 pmol/L. Women who regained menses at 12 months had higher baseline AMH than those who remained amenorrheic (p < 0.001). Older age was associated with lower AMH at baseline and at 1 year. Median MSSs increased significantly at 1 year: 0.8 (IQR 0.5-1.8) versus 0.3 (IQR 0-0.4) (p = 0.5). While there was no significant change in QOL scores between baseline and 1 year, there was a significant negative correlation between menopausal symptom score and QOL at 1 year (p = 0.03). Conclusions: In this small study, pre-treatment AMH correlated with amenorrhea at 1-year post chemotherapy suggesting potential role of AMH levels in counselling women regarding their reproductive potential post chemotherapy. Further research in a larger sample of women is needed.
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Haydek, J., A. Oonk, D. Cheng, W. Ahmed, B. Click, B. Fennimore, M. Gerich, J. Hou, and F. Scott. "P691 Disparate care: rates of treat to target among patients with inflammatory bowel disease." Journal of Crohn's and Colitis 17, Supplement_1 (January 30, 2023): i821—i823. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0821.
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Abstract Background Inflammatory bowel diseases (IBD) therapies are limited by low response rates and risks of loss of response. Treat to target (T2T) algorithms aim to maximize the benefit of therapies by establishing a framework for assessing patient reported outcomes, biochemical evaluation (C-reactive protein (CRP) or fecal calprotectin (FC)), and structural assessment via endoscopy or enterography. There are limited data on adoption rates of T2T in real-world clinical practice. We aimed to describe rates of T2T utilization in a large regional medical system in the United States. Methods A retrospective cohort study was conducted from 2015-2021. Individuals with IBD starting a new biologic therapy were identified. Collected data included demographics, laboratory data, current medications, and procedure and imaging data. Patients were categorized based on whether they completed T2T, defined as CRP or FC testing at 2-4 months after starting a new therapy, and structural assessment, defined as colonoscopy, sigmoidoscopy, capsule endoscopy, or enterography within 6-12 months after starting a new therapy. Complete adherence was defined as both of these criteria being met. Social deprivation index (SDI), with higher values associated with higher rates of social deprivation, was derived using mail codes. T-tests, Pearson chi-square tests, ANOVA and multivariable logistic regression were used for comparisons. Results 7,962 patients were identified (Table 1). Rates of T2T were low; only 7.81% of patients completed biochemical monitoring at 2-4 months (0.83% FC, 8.65% CRP, 1.76% both), 9.80% completed structural assessment, and 3.43% completed both. In univariable logistic regression, higher age (OR 0.98, p<0.01), IBD type (UC OR: 0.69, p<0.01), having no insurance (OR 0.84, p=0.02) and low social deprivation index (SDI) (OR 1.004, p<0.01) were associated with lower T2T completion rates. In multivariable logistic regression, ulcerative colitis (UC), younger age, and lower SDI score were significantly associated with likelihood of completing any T2T (Table 2). When considering biochemical monitoring at 2-4 months, Asian race, UC diagnosis, age, SDI score and year were significantly associated with completion (Table 3). UC diagnosis, year and age were significantly associated with completion of structural assessment (Table 4). Conclusion Treat to target completion rates among patients with IBD starting biologic therapies were low in this large cohort. Age and UC diagnosis were negatively associated with completing T2T. Social deprivation score was positively associated with biochemical monitoring. Further research is required to understand barriers to T2T monitoring.
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Humphreys, Leanne, John Westerink, Leah Giarratano, and Robert Brooks. "An Intensive Treatment Program for Chronic Posttraumatic Stress Disorder: 2-Year Outcome Data." Australian & New Zealand Journal of Psychiatry 33, no. 6 (December 1999): 848–54. http://dx.doi.org/10.1046/j.1440-1614.1999.00640.x.
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Objective: The present study evaluates the efficacy of a closed-cohort treatment program for chronic posttraumatic stress disorder (PTSD). Method: The treatment orientation was a combined approach involving cognitive behaviour therapy and pharmacotherapy. Treatment involved an inpatient phase of 4 weeks, with group and individual follow-up sessions of at least 6-month duration. The treatment population consisted largely of Australian Vietnam veterans. Standardised psychometric measures were obtained pre-treatment, on completion of the residential phase; and at 6, 12 and 24 months post discharge from the residential program. Results: The results obtained from 64 patients demonstrate significant reductions in depression, anxiety and PTSD symptoms, maintained at 2 years post discharge from the residential phase of the treatment program. Conclusions: This paper presents encouraging findings for treatment with this troubled population.
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Ashina, Messoud, Caroline Roos, Lily Qian Li, Mika Komori, David Ayer, Dustin Ruff, and John Henry Krege. "Long-term treatment with lasmiditan in patients with migraine: Results from the open-label extension of the CENTURION randomized trial." Cephalalgia 43, no. 4 (March 23, 2023): 033310242311617. http://dx.doi.org/10.1177/03331024231161745.
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Background Following the CENTURION phase 3 randomized controlled trial’s four-month double-blind phase, this 12-month open-label extension collected data for up to one year about dose optimization, patterns of use, migraine-related disability, and quality of life during lasmiditan treatment. Methods Migraine patients ≥18 years completing the double-blind phase and treating ≥3 migraine attacks could continue into the 12-month open-label extension. The initial oral lasmiditan dose was 100 mg; the dose could subsequently be adjusted to 50 mg or 200 mg at the investigator’s discretion. Results 477 patients entered and 321 (72.1%) completed the extension; 445 (93.3%) treated ≥1 attack with lasmiditan. Of 11,327 attacks, 8654 (76.4%) were lasmiditan-treated (84.9% of these involved moderate or severe pain). By study end, 17.8%, 58.7%, and 23.4% of patients were taking lasmiditan 50, 100, and 200 mg, respectively. Mean improvements were observed in disability and quality of life. The most common treatment-emergent adverse event was dizziness (35.7% of patients, 9.5% of attacks). Conclusions During this 12-month extension, lasmiditan was associated with a high rate of study completion, most attacks were treated with lasmiditan, and patients reported improvements in migraine-related disability and quality of life. No new safety findings were observed with longer exposure. Trial registration: ClinicalTrials.gov (NCT03670810); European Union Drug Regulating Authorities Clinical Trials Database (EUDRA CT: 2018-001661-17).
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Singh, Itu, Madhvi Ahuja, Mallika Lavania, Vinay K. Pathak, Ravindra P. Turankar, Vikram Singh, Utpal Sengupta, Loretta Das, Archana Kumar, and Geeta B. Saini. "Efficacy of fixed duration multidrug therapy for the treatment of multibacillary leprosy: A prospective observational study from Northern India." Indian Journal of Dermatology, Venereology and Leprology 89 (September 30, 2022): 226–32. http://dx.doi.org/10.25259/ijdvl_915_2021.
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Background: In endemic regions of several countries, the prevalence of leprosy has not come down to the level of elimination. On the contrary, new cases are being detected in large numbers. Clinically, it is frequently noted that despite completion of multibacillary multidrug therapy for 12 months, the lesions remain active, especially in cases with high bacteriological indices. Aim: The present study focused on finding out the viable number of Mycobacterium leprae during the 12-month regimen of multibacillary multidrug therapy, at six and 12 months intervals and, attempting to determine their role in disease transmission. Methods: Seventy eight cases of multibacillary leprosy cases were recruited from leprosy patients registered at The Leprosy Mission hospitals at Shahdara (Delhi), Naini (Uttar Pradesh) and Champa (Chhattisgarh), respectively. Slit skin smears were collected from these patients which were transported to the laboratory for further processing. Ribonucleic acid was extracted by TRIzol method. Total Ribonucleic acid was used for real-time reverse transcription-polymerase chain reaction (two-step reactions). A standard sample with a known copy number was run along with unknown samples for a reverse transcription-polymerase chain reaction. Patients were further assessed for their clinical and molecular parameters during 6th month and 12th month of therapy. Results: All 78 new cases showed the presence of a viable load of bacilli at the time of recruitment, but we were able to follow up only on 36 of these patients for one year. Among these, using three different genes, 20/36 for esxA, 22/36 for hsp18 and 24/36 for 16S rRNA cases showed viability of M. leprae at the time of completion of 12 months of multidrug therapy treatment. All these positive patients were histopathologically active and had bacillary indexes ranging between 3+ and 4+. Patients with a high copy number of the Mycobacterium leprae gene, even after completion of treatment as per WHO recommended fixed-dose multidrug therapy, indicated the presence of live bacilli. Limitations: Follow up for one year was difficult, especially in Delhi because of the migratory nature of the population. Patients who defaulted for scheduled sampling were not included in the study. Conclusion: The presence of a viable load of bacilli even after completion of therapy may be one of the reasons for relapse and continued transmission of leprosy in the community.
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Sellar, Christopher M., Gordon J. Bell, Robert G. Haennel, Heather-Jane Au, Neil Chua, and Kerry S. Courneya. "Feasibility and efficacy of a 12-week supervised exercise intervention for colorectal cancer survivors." Applied Physiology, Nutrition, and Metabolism 39, no. 6 (June 2014): 715–23. http://dx.doi.org/10.1139/apnm-2013-0367.
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Exercise training improves health-related physical fitness and patient-reported outcomes in cancer survivors, but few interventions have targeted colorectal cancer (CRC) survivors. This investigation aimed to determine the feasibility and efficacy of a 12-week supervised exercise training program for CRC survivors. Feasibility was assessed by tracking participant recruitment, loss to follow-up, assessment completion rates, participant evaluation, and adherence to the intervention. Efficacy was determined by changes in health-related physical fitness. Over a 1-year period, 72 of 351 (21%) CRC survivors screened were eligible for the study and 29 of the 72 (40%) were enrolled. Two participants were lost to follow-up (7%) and the completion rate for all study assessments was ≥93%. Mean adherence to the exercise intervention was 91% (standard deviation = ±18%), with a median of 98%. Participants rated the intervention positively (all items ≥ 6.6/7) and burden of testing low (all tests ≤ 2.4/7). Compared with baseline, CRC survivors showed improvements in peak oxygen uptake (mean change (MC) = +0.24 L·min−1, p < 0.001), upper (MC = +7.0 kg, p < 0.001) and lower (MC = +26.5 kg, p < 0.001) body strength, waist circumference (MC = −2.1 cm, p = 0.005), sum of skinfolds (MC = −7.9 mm, p = 0.006), and trunk forward flexion (MC = +2.5 cm, p = 0.019). Exercise training was found to be feasible and improved many aspects of health-related physical fitness in CRC survivors that may be associated with improved quality of life and survival in these individuals.
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Watson, Jane, Suzie Wright, Kim Beswick, Jeanne Maree Allen, Ian Hay, and Neil Cranston. "Community Beliefs about Rural and Regional Education and Students' School Completion." Australian and International Journal of Rural Education 27, no. 3 (July 24, 2022): 55–72. http://dx.doi.org/10.47381/aijre.v27i3.185.
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School completion to the end of Year 12 in rural, regional, and disadvantaged communities is an acknowledged challenge in Australia and internationally. This research reports the beliefs of 86 rural and regional community leaders in the Australian state of Tasmania. A survey on issues associated with students' school completion was designed specifically for community members, and responded to by the study participants. Findings that emerged from the data analysis included that participants were on average quite positive about the capability of students in the community and the potential for business/organisation links with schools. Some concern was expressed, however, about bullying in schools and students having well-formed plans for their futures after finishing school. This study provides a benchmark for future research with community members on their beliefs about issues related to students' educational aspirations and students' continuation in school. It has implications for policy makers, school leaders, and teachers at a national and international level.
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Santos, Marisa D., Manuel T. Gomes, Filipa Moreno, Anabela Rocha, and Carlos Lopes. "17-Week Delay Surgery after Chemoradiation in Rectal Cancer with Complete Pathological Response." Case Reports in Surgery 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/816491.
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Neoadjuvant chemoradiation (CRT) followed by curative surgery still remains the standard of care for locally advanced rectal cancer (LARC). The main purpose of this multimodal treatment is to achieve a complete pathological tumor response (ypCR), with better survival. The surgery delay after CRT completion seems to increase tumor response and ypCR rate. Usually, time intervals range from 8 to 12 weeks, but the maximum tumor regression may not be seen in rectal adenocarcinomas until several months after CRT. About this issue, we report a case of a 52-year-old man with LARC treated with neoadjuvant CRT who developed, one month after RT completion, an acute myocardial infarction. The need to increase the interval between CRT and surgery for 17 weeks allowed a curative surgery without morbidity and an unexpected complete tumor response in the resected specimen (given the parameters presented in pelvic magnetic resonance imaging (MRI) performed 11 weeks after radiotherapy completion).
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Hand, C. J., and G. E. D. Howell. "Three Year Review Following Bone Anchor Repair of Acute Biceps Tendon Insertion Rupture." Journal of The Royal Naval Medical Service 87, no. 2 (February 2001): 113–15. http://dx.doi.org/10.1136/jrnms-87-113.
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AbstractThree patients with acute biceps brachii tendon insertion ruptures were treated (less than 7 days post injury) using bone anchor anatomical repair. Dynamometer assessment of strength in both limbs was performed after completion of rehabilitation and again at 3.3 years after surgery.All patients were male, age 34, 35 and 53 years. Early isokinetic assessment was performed at 6, 7 and 12 months post surgery and medium assessment at 3.3 years post surgery. A full range of movement was achieved at early assessment and maintained into medium term assessment. All patients returned to their full premorbid occupation and sporting activity. Dynamometer strength of a repaired dominant limb equated to two thirds of a normal non dominant limb at early assessment, equal power was found at medium term assessment and a measurable increase in strength in both affected and unaffected arms was seen.
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Hand, C. J., and G. E. D. Howell. "Three Year Review Following Bone Anchor Repair of Acute Biceps Tendon Insertion Rupture." Journal of The Royal Naval Medical Service 87, no. 2 (February 2001): 113–15. http://dx.doi.org/10.1136/jrnms-87-113.
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AbstractThree patients with acute biceps brachii tendon insertion ruptures were treated (less than 7 days post injury) using bone anchor anatomical repair. Dynamometer assessment of strength in both limbs was performed after completion of rehabilitation and again at 3.3 years after surgery.All patients were male, age 34, 35 and 53 years. Early isokinetic assessment was performed at 6, 7 and 12 months post surgery and medium assessment at 3.3 years post surgery. A full range of movement was achieved at early assessment and maintained into medium term assessment. All patients returned to their full premorbid occupation and sporting activity. Dynamometer strength of a repaired dominant limb equated to two thirds of a normal non dominant limb at early assessment, equal power was found at medium term assessment and a measurable increase in strength in both affected and unaffected arms was seen.
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Marcotte, Lauren, Cindy Barha, and Teresa Liu-Ambrose. "CARDIOVASCULAR RISK MODERATES THE EFFECT OF RESISTANCE TRAINING ON PHYSICAL PERFORMANCE IN OLDER ADULT WOMEN." Innovation in Aging 3, Supplement_1 (November 2019): S645. http://dx.doi.org/10.1093/geroni/igz038.2396.
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Abstract We aimed to examine whether the Framingham Cardiovascular Risk Profile Score (FCRP) moderates the effect of progressive resistance training (RT) on mobility in older adult women. This is an exploratory analysis of a single-blind, 12-month randomized controlled trial in 155 omen, aged 65 to 75 years old, who were randomized to: 1x/week progressive RT; or 2x/week progressive RT program; or 2x/week balance and tone (BAT). At baseline and trial completion, mobility was measured using the Short Physical Performance Battery (SPPB). The SPPB is a composite measure of usual gait speed, standing balance, and sit to stand performance; scores < 9/12 are indicative of functional decline. Baseline 10-year cardiovascular risk was calculated using the FCRP. Participants were classified as either low risk (<16.5% FCRP score; LCVR) or high risk ≥16.5% FCRP score; HCVR). A complete case analysis (n=126) was conducted using a two-way analysis of covariance (ANCOVA) to evaluate the interaction effect of group by FCRP risk on SPPB scores at trial completion; baseline SPPB scores and age in years were entered as covariates. There was a significant interaction effect (F(1,126)=3.74, p=0.027). At trial completion, both 1x/RT and 2x/RT participants with HCVR demonstrated greater SPPB scores than those with LCVR (11.59 vs. 11.38 for 1x/week; 11.86 vs 11.46 for 2x/week). In contrast, BAT participants with HCVR demonstrated worse SPPB scores than those with LCVR (11.18 vs 11.66). Our data suggest that RT may be more efficacious for improving mobility in older women with higher cardiovascular risk than women with lower risk.
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Rojanasarot, Sirikan, Angeline M. Carlson, Wendy L. St. Peter, Pinar Karaca-Mandic, Julian Wolfson, and Jon C. Schommer. "Translational Effect of Provider-Focused, Multi-State, Multi-Clinic Asthma Care Quality Improvement Program on Patient-Level Health Care Costs." Journal of Primary Care & Community Health 12 (January 2021): 215013272110002. http://dx.doi.org/10.1177/21501327211000246.
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Introduction/Objectives: Enhancing Care for Patients with Asthma (ECPA), a year-long provider-focused, multi-state, multi-clinic quality improvement program, decreased avoidable utilizations among patients with asthma, but its effects on health care expenditures were not determined. This study examined the translational and sustainable effects of improved care through ECPA on individual-level total health care costs due to asthma. Methods: We conducted a retrospective pretest-posttest quasi-experimental study in which attributed 1683 patients in a 12-month pre-ECPA implementation period served as their own control. We constructed the total annual asthma-related health care costs per patient occurred during pre-ECPA implementation, ECPA implementation, and post-ECPA completion. We used 3-level generalized linear mixed models (GLMMs) to estimate the ECPA effect on the annual health care costs and account for correlation between the repeated outcome measures for each patient and nested clinic. All costs were adjusted for inflation to 2014 U.S. dollars, the last year of program observation. Results: Total asthma-related health care costs among the 1683 included patients decreased from an average of $7033 to $3237 per person-year (pre-ECPA implementation vs implementation). Using the cost data from the 12-month pre-ECPA implementation period as a reference, GLMMs found that the ECPA implementation was associated with a reduction in total annual asthma-related health care costs by 56.4% (95% CI −60.7%, −51.8%). During the 12-months after ECPA completion period, health care costs were also found to be significantly lower, experiencing a 57.3% reduction. Conclusions: The economic benefits of ECPA provide a justification to adopt this quality improvement initiative to more primary care clinics at a national level.
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Ghia, Paolo, William G. Wierda, Paul M. Barr, Thomas J. Kipps, Tanya Siddiqi, John N. Allan, Zoë Hunter, et al. "Relapse after First-Line Fixed Duration Ibrutinib + Venetoclax: High Response Rates to Ibrutinib Retreatment and Absence of BTK Mutations in Patients with Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) with up to 5 Years of Follow-up in the Phase 2 Captivate Study." Blood 142, Supplement 1 (November 28, 2023): 633. http://dx.doi.org/10.1182/blood-2023-187128.
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Background: CAPTIVATE (PCYC-1142) is a multicenter phase 2 study of ibrutinib + venetoclax as first-line treatment for CLL/SLL in 2 cohorts: minimal residual disease (MRD)-guided randomized-discontinuation (MRD cohort) and Fixed Duration (FD cohort). Results from the FD cohort with 4 years of follow-up (Barr, ASCO 2023) showed 4-year progression-free survival (PFS) and overall survival (OS) rates of 79% and 98%, respectively. After completing fixed-duration treatment, ibrutinib-based retreatment was allowed per protocol in patients with an indication for treatment after experiencing progressive disease (PD). Here, we report retreatment outcomes in patients from the FD cohort or the MRD cohort placebo arm, as well as updated results with an additional year of follow-up (up to 5 years) from the FD cohort. Methods: Patients aged ≤70 years with previously untreated CLL/SLL received 3 cycles of ibrutinib, then 12 cycles of combined ibrutinib + venetoclax (ibrutinib, 420 mg/day orally; venetoclax, standard 5-week ramp up to 400 mg/day orally). Response was assessed by investigators per International Workshop on CLL (iwCLL) 2008 criteria. Duration of response (DOR), PFS, and OS were estimated using Kaplan-Meier methodology. Per protocol, on-study retreatment included single-agent ibrutinib; patients with PD >2 years after treatment completion could be retreated with the FD regimen (3 cycles of ibrutinib + 12 cycles of ibrutinib + venetoclax). Results: Of 202 patients treated with fixed-duration ibrutinib + venetoclax in the FD cohort (n=159) or the MRD cohort placebo arm (n=43), 53 have had PD to date (Table 1), with PD occurring >2 years after completion of treatment in the majority of patients (33/53 [62%]). Of the 40 patients with available samples at PD, one had an acquired resistance-associated mutation in BCL2 (A113G); no other patient had clinically relevant mutations in BTK, BCL2, or PLCG2. A total of 22 patients have initiated retreatment on study with single-agent ibrutinib. With a median time on retreatment of 17 months (range, 0-45), overall response rate (ORR) in 21 evaluable patients was 86% (with best responses of complete response [CR], n=1 [5%]; partial response [PR], n=17 [81%]; PR with lymphocytosis, n=1 [5%]; stable disease, n=1 [5%]; PD [Richter transformation], n=1 [5%]). The most frequent adverse events (AEs; occurrence ≥10%) during single-agent ibrutinib retreatment were COVID-19 (n=6, all grade 1/2), diarrhea (n=5), hypertension (n=4), and pyrexia (n=3). No dose reductions or discontinuations due to AEs occurred among retreated patients. Eighteen patients have not received subsequent treatment, 7 patients have initiated other subsequent therapies, and 6 patients have started retreatment with ibrutinib + venetoclax (time on retreatment, 5-15 months). Best responses in patients retreated with ibrutinib + venetoclax are CR, n=2; PR, n=3; and SD, n=1. Response data for the patient with BCL2 (A113G) is pending. To date, with a median time on study of 56 months (range, 1-61) for patients in the FD cohort, the 54-month PFS and OS rates were 70% (95% CI, 62-77) and 97% (95% CI, 93-99), respectively. Best response rates remained unchanged from the 4-year follow-up analysis (CR, including CR with incomplete bone marrow recovery [CRi], 58%; ORR, 96%). In patients who achieved CR/CRi (n=92), median duration of CR/CRi was not reached; 90/92 patients (98%) achieved durable CR/CRi (lasting ≥12 cycles). PFS in patients with high-risk features was promising (Table 2), but it was numerically lower in the subset with del(17p)/mutated TP53 (54-month rate, 45% [95% CI, 25-64]). Serious AEs considered related to study treatment and second malignancies continued to be collected after completion of fixed-duration treatment. One AE of basal cell carcinoma occurred during this additional year of follow-up. In total, second malignancies have occurred in 8% of patients since completion of ibrutinib + venetoclax treatment. Conclusion: Ibrutinib-based retreatment results in the CAPTIVATE study show promising responses in patients needing subsequent therapy after receiving this all-oral, once-daily fixed-duration regimen for first-line treatment of CLL/SLL. With up to 5 years of follow-up, fixed-duration ibrutinib + venetoclax continues to provide deep remissions with clinically meaningful PFS, including in patients with high-risk genomic features.
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Roxburgh, Campbell SD, Paul Strombom, Patricio B. Lynn, Philip Paty, Jose G. Guillem, Garrett Michael Nash, Jesse Joshua Smith, Iris H. Wei, Julio Garcia-Aguilar, and Martin R. Weiser. "Influence of timing of surgery on perioperative morbidity after neoadjuvant therapy for locally advanced rectal cancer." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 754. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.754.
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754 Background: Timing of surgery following completion of neoadjuvant therapy (NT) for locally advanced rectal cancer (LARC) has important implications for treatment response. However, it was recently reported in the GRECCAR 6 trial that delayed surgery beyond 8 weeks from completion of NT is associated with increased complications. Within a cohort of LARC patients treated with NT (CRT alone, Total NT (TNT) and chemotherapy alone) we examine perioperative complications based on time from NT to surgery. Methods: Patients with Stage II/III LARC ≤15cm from the anal verge who received NT from 06/01/09 – 03/01/15 were identified and preoperative morbidity collected on those undergoing rectal resection. Patients were grouped according to time of surgery from completion of NT (5-8 weeks – early surgery / 8-12 weeks – late surgery). Results: 798 patients were identified and 547 underwent rectal resection within 12 weeks of completing NT (440 LAR and 107 APR). Surgery was performed 5-8 following NT in 252 pts and 8-12 weeks following NT in 246 pts. 204 patients (41%) had a post-op complication: 53 (10%) Grade 3-5 complication and 83 (17%) SSI. There were no statistically significant differences in rates of all complications (44% vs 38%), grade 3-5 complications (9% vs 11%), SSI (17% vs 17%), and LOS (median 6 days vs 6 days) between the early and late surgery groups. Similar results were obtained when evaluating the subgroups by type of NT (CRT alone, chemo alone or TNT), surgical approach (open vs minimally invasive and sphincter preservation vs colostomy), post-treatment TNM stage and year of treatment (all NS). In addition, we did not observe differences in rates of downstaging responses: T downstaging (63% vs 64%), N downstaging (61% vs 54%), > 95% regression (34% vs 34%) or pCR rates (18% vs 18%) between the early and later surgery groups. Conclusions: In patients undergoing radical surgery for LARC post NT, we do not observe an effect of timing of surgery on surgical complications. Although timing of surgery is reported to influence response rates, we did not reproduce these findings, likely as a consequence of the high rate of deferral of surgery/ non-operative management in this cohort.
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Yamada, Takeshi, Keiji Koda, Hiroshi Yoshida, Kohji Tanakaya, Keiichiro Ishibashi, Kazuhiko Yoshimatsu, Chihiro Kosugi, et al. "Occurrence of irreversible sinusoidal obstruction syndrome during adjuvant chemotherapy for colorectal cancer using oxaliplatin: A multi-center study." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 546. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.546.
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546 Background: Oxaliplatin reduces the recurrence rate after curative surgery for stage III colorectal cancer. However, it can cause hepatic sinusoidal obstruction syndrome (SOS), an adverse effect that creates morbidity after liver resection for recurrence. SOS has conventionally been diagnosed by liver biopsy, which is invasive. We have reported that a 10% increase in splenic volume (SV) indicates SOS (J Surg Oncol 2017). In this multi-center study, we measured SV to evaluate SOS caused by adjuvant chemotherapy. Methods: This multi-center study included the participants of the FACOS study, which included patients with Stage III colon cancer. Participants received 12 cycles of mFOLFOX6 or eight cycles of XELOX as adjuvant chemotherapy. We used multi-detector raw CT to measure SV three times; before surgery, on completion of adjuvant chemotherapy, and 1-year after completing adjuvant chemotherapy. CT images were taken in 5-mm slices. SV was calculated by using a volume calculator SYNAPSE VINCENT v3.0(Fujifilm, Japan). Results: The FACOS study included 130 patients, 16.9% of whom discontinued treatment. The mean relative dose intensity (RDI) of oxaliplatin was 80.3%. Grade 3 neutropenia, thrombocytopenia, and neuropathy were observed in 28.5%, 6.2%, and 4.6% of patients, respectively. The 3 year DFS was 82.2%. We analyzed data of 75 patients (57.7%) for whom the three CT studies were available. SV on completing chemotherapy (median 181 cm3) and SV 1-year after completing chemotherapy (141 cm3) were significantly higher than that before surgery (128 cm3) (P < 0.001). SV increased by more than 10% after chemotherapy in 72% and was still increased 1 year after chemotherapy in 51% of patients. Conclusions: In our previous single center study, SV had increased in 84% on completing chemotherapy and was still increased in 47% 1 year after completing chemotherapy. Adjuvant chemotherapy without oxaliplatin induced SV increases in only 20% of patients on completing chemotherapy. Thus, these results are reproducible and show the potential of oxaliplatin to induce SOS. Oxaliplatin frequently induces SOS and this SOS persists for over 1 year in half of affected patients. Clinical trial information: UMIN000005427.
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Jabeen, Irum, Asim Khurshid, and Tariq Aziz. "Steroid sensitive nephrotic syndrome in children: Frequency of relapse during the first twelve months after completion of six months steroid therapy." Professional Medical Journal 27, no. 03 (March 10, 2020): 558–62. http://dx.doi.org/10.29309/tpmj/2020.27.03.3571.
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Objectives: Nephrotic syndrome (NS) is described as the existence of nephrotic-range proteinuria along with edema, hyperlipidemia and hypoalbuminemia. NS is estimated to be 15 time more frequent in children as compared to adults. Relapse is a major problem while managing nephrotic children. This study was aimed to find out the frequency of relapse in children with first episode of steroid sensitive nephrotic syndrome (SSNS) during the first 12 months, after completion of 6 months steroid therapy. Study Design: Descriptive case series study. Setting: Department of Paediatric Nephrology, The Children’s Hospital & the Institute of Child Health, Multan. Period: From February 27, 2018 to February 27, 2019. Material and Methods: A total of 55 children, aged 1 to 10 years, diagnosed with SSNS, 1st presentation of NS (based on history) and who successfully completed 6 months steroid therapy, were enrolled. They were taught to check proteinuria at home by dipstick method and enter daily results on the follow up card provided from the Nephrology department of the hospital. The outcome variable, that is relapse, was noted on the Proforma. Results: Amongst 55 children, gender distribution showed 38 (69.1%) male and 17 (30.9%) females. Children with body weight <20 kg were 33 (60%) and those having ≥20kg were 22 (40%). Patients with age <6 years were 54.5% and patients with age ≥6 years were 45.5%. Mean age was 5.93± 3.36 years. Frequency of relapse was noted to be 78.2% and patients who did not relapse within 1 year of completion of treatment were 21.8%. Conclusion: Nephrotic syndrome is a common presentation of childhood renal problems and is major cause of morbidity in our set up. Relapses are frequently associated with SSNS and most of the patients relapse within 1 year of completion of treatment. Relapses are more common in male children as compared to female children.
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Pilloni, Andrea, Matteo Saccucci, Gabriele Di Carlo, Blerina Zeza, Marco Ambrosca, Michele Paolantonio, Gilberto Sammartino, Claudio Mongardini, and Antonella Polimeni. "Clinical Evaluation of the Regenerative Potential of EMD and NanoHA in Periodontal Infrabony Defects: A 2-Year Follow-Up." BioMed Research International 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/492725.
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Introduction.The aim of this retrospective study was to compare the clinical efficacy of four different surgical techniques in promoting periodontal regeneration in patients with infrabony defects: open flap debridement, application of enamel matrix derivatives (EMD), nanohydroxyapatite (nanoHA) application, and combined nanoHA and EMD application. Probing attachment level (PAL), pocket depth (PD), and position of gingival margin at completion of therapy (REC) were measured.Materials and Methods.Data were collected from 64 healthy patients (34 women and 30 men, mean age 37,7 years). Clinical indices were measured by a calibrated examiner at baseline and at 12, 18, and 24 months. The values obtained for each treatment were compared using nonparametric tests.Results.All treatments resulted in a tendency toward PD reduction over time, with improvements in REC and PAL. The differences in PD, REC, and PAL values at baseline compared with values after 12, 18, and 24 months were statistically significant for all treatments. Statistically significant differences in PAL and PD were detected between nanoHA and nanoHA + EMD at 12, 18, and 24 months.Conclusion.In this study, EMD and nanoHA used together in patients with infrabony periodontal lesions had better clinical efficacy than nanoHA alone, EMD alone, or open flap debridement.
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Zhu, Yujun, and Susan Enguidanos. "Advance Directive Completion and Hospital Out-of-Pocket Expenditures." Innovation in Aging 5, Supplement_1 (December 1, 2021): 568–69. http://dx.doi.org/10.1093/geroni/igab046.2185.
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Abstract Healthcare costs remain high at end of life. Although advance directives (AD) have been shown to improve care congruence with patients’ preferences and lower cost of healthcare services, little is known about the relationship between AD completion and hospital out-of-pocket costs. This study examined whether AD completion was associated with lower hospital out-of-pocket spending at end of life. We used the Health and Retirement Study participants who died between 2000 and 2014 (N=9,228) to examine the association through the use of a two-part analytic model that has been widely used in health economics. We controlled for socioeconomic status, death-related characteristics, and health insurance coverage and imputed missing data using multiple imputation by chained equations. Of the 43.9% of decedents who completed an AD, 90.7% chose to limit care or to be kept comfortable; 78.8% indicated that they wanted to withhold treatment, and 5.6% wanted to prolong life. Having an AD was significantly associated with $632 (95% CI: [-$1,116.47, -$146.71]) lower hospital out-of-pocket costs, with greater savings among younger decedents, dropping from $1,560 (95% CI: [-$2,652, -$268]) at age 50 to $230 (95% CI: [-$445, -$14]) at age 110. Decedents who completed an AD 12 months or less before death had higher out-of-pocket spending ($1,591 on average) than those who completed more than a year before death ($1,001 on average). Our findings have policy implications for physician-patient communication about costs of care and may provide an opportunity for physicians to involve cost-sharing discussions when completing ADs with patients.
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Yamamoto, Hiromasa, Junichi Soh, Norihito Okumura, Hiroyuki Suzuki, Masao Nakata, Toshiya Fujiwara, Kenichi Gemba, et al. "Randomized phase II study of daily versus alternate-day administrations of S-1 for the elderly patients with completely resected pathological stage IA (tumor diameter > 2 cm)—IIIA of non-small cell lung cancer: Setouchi Lung Cancer Group Study 1201." PLOS ONE 18, no. 5 (May 19, 2023): e0285273. http://dx.doi.org/10.1371/journal.pone.0285273.
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Background It is shown that the postoperative adjuvant chemotherapy for non-small cell lung cancer (NSCLC) was associated with survival benefit in an elderly population. We aimed to analyze the feasibility and efficacy of alternate-day S-1, an oral fluoropyrimidine, for adjuvant chemotherapy in elderly patients with completely resected pathological stage IA (tumor diameter > 2 cm) to IIIA (UICC TNM Classification of Malignant Tumours, 7th edition) NSCLC. Methods Elderly patients were randomly assigned to receive adjuvant chemotherapy for one year consisting of either alternate-day oral administration of S-1 (80 mg/m2/day) for 4 days a week (Arm A) or a daily oral administration of S-1 (80 mg/m2/day) for 14 consecutive days followed by 7-day rest (Arm B). The primary endpoint was feasibility (treatment completion rate), which was defined as the proportion of patients who completed the allocated intervention for 6 months with a relative dose intensity (RDI) of 70% or more. Results We enrolled 101 patients in which 97 patients received S-1 treatment. The treatment completion rate at 6 months was 69.4% in Arm A and 64.6% in Arm B (p = 0.67). Treatment completion rate in Arm B tended to be lower compared to Arm A, as the treatment period becomes longer (at 9 and 12 months). RDI of S-1 at 12 months and completion of S-1 administration without dose reduction or postponement at 12 months was significantly better in Arm A than in Arm B (p = 0.026 and p < 0.001, respectively). Among adverse events, anorexia, skin symptoms and lacrimation of any grade were significantly more frequent in Arm B compared with Arm A (p = 0.0036, 0.023 and 0.031, respectively). The 5-year recurrence-free survival rates were 56.9% and 65.7% for Arm A and B, respectively (p = 0.22). The 5-year overall survival rates were 68.6% and 82.0% for Arm A and B, respectively (p = 0.11). Conclusion Although several adverse effects were less frequent in Arm A, both alternate-day and daily oral administrations of S-1 were demonstrated to be feasible in elderly patients with completely resected NSCLC. Trial registration Unique ID issued by UMIN: UMIN000007819 (Date of registration: Apr 25, 2012) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009128. Trial ID issued by jRCT: jRCTs061180089 (Date of registration: Mar 22, 2019, for a shift toward a “specified clinical trial” based on Clinical Trials Act in Japan) https://jrct.niph.go.jp/en-latest-detail/jRCTs061180089.
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Taylor, Jennie, Michael Rabow, Susan Chang, Nicholas Butowski, Jennifer Clarke, Margaretta Page, Rosemary Rossi, W. Patrick Shibley, and Brook Calton. "QOLP-12. EMBEDDING OUTPATIENT PALLIATIVE CARE INTO NEURO-ONCOLOGY CLINIC – RESULTS FROM A ONE YEAR PILOT." Neuro-Oncology 22, Supplement_2 (November 2020): ii177. http://dx.doi.org/10.1093/neuonc/noaa215.737.
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Abstract BACKGROUND Glioblastoma (GBM) patients fall within NCCN and ASCO guidelines for early palliative care (PC). However, data suggests they are less likely than systemic cancers to be referred to PC and often later in their illness. This results in potential missed opportunities, both for improving symptom control and earlier completion of important tasks, like advance care planning. Data on how to best incorporate comprehensive PC into routine neuro-oncology (NO) patient care is needed. METHODS We piloted a program embedding a PC physician into UCSF’s NO clinic one half-day per week. NO physicians were encouraged to refer GBM patients within 3 months of diagnosis and other patients with PC needs. PC visits were offered in-person, by telemedicine, or at home. PC physician and NO social worker made joint visits when possible; chaplaincy support was available by telemedicine. Data was collected using Palliative Care Quality Network (PCQN) database and patient satisfaction survey. RESULTS To date, 37 patients have been referred resulting in 103 visits (average 2.8 visits/person): 25% in-person; 68% telemedicine; 6% at home. PC physician and NO social worker met jointly with 46% visits. Median age was 58 years, 41% female, 81% non-Hispanic white, 84% GBM, median 9 months from diagnosis, and 73% receiving first line treatment. Interventions addressed across visits: 94% non-pain symptoms, 76% psychosocial needs; 71% pain; and 70% GOC. Results from satisfaction survey demonstrated 79% would recommend seeing PC embedded in NO to others and highest benefits were attention to practical considerations to staying healthy at home, discussing preferences for future medical care, and help with coping. CONCLUSIONS Embedding PC into NO clinics is a unique model for addressing symptoms and GOC early, is well received by patients and caregivers, and provides opportunities for collaboration and PC physicians to specialize in caring for needs of NO patients.