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Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis

Support Care Cancer. 2021 Aug 20. doi: 10.1007/s00520-021-06494-1. Online ahead of print.

ABSTRACT

PURPOSE: To assess and summarize the effects of informational support on depression and quality of life of older patients with cancer.

METHODS: PubMed, MEDLINE, and Web of Science were searched to identify articles written in English and published until March 2021. Studies within 10 years period (2010-2021) were included. Randomized controlled trials were included if they evaluated the impact of informational support on depression and quality of life. All analyses were performed with Review Manager 5.3.

RESULTS: Twelve studies with a total of 2374 participants met the inclusion criteria. Our primary outcomes included depression and quality of life. (1) Depression: results indicated no statistically significant difference and low heterogeneity [SMD = 0.28, 95% CI (- 0.24,0.80), p = 0.45; I2 = 0%], (2) Quality of life: in the subgroup analyses of EORTC QLQ-C30, results indicated a significant effect of informational support on quality of life [SMD = 2.84, 95% CI (0.63, 5.05), p = 0.03; I2 = 79%]; in the subgroup analyses of FACT and SF-36, there were no significance.

CONCLUSIONS: Informational support could reduce depression and did improve the quality of life in older cancer patients with statistical significance. The findings suggested that informational support was an effective approach to improve depression and quality of life in older patients with cancer.

PMID:34415425 | DOI:10.1007/s00520-021-06494-1

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Return to sport following navicular stress fracture: a systematic review and meta-analysis of three hundred and fifteen fractures

Int Orthop. 2021 Aug 20. doi: 10.1007/s00264-021-05147-6. Online ahead of print.

ABSTRACT

PURPOSE: This meta-analysis aims to provide updated evidence on the success rate, return to play (RTP) rate, time to RTP, and complications of operatively and conservatively managed navicular stress fractures (NSFs) as well as delays in diagnosis while avoiding limitations of previous similar studies.

METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent team members electronically searched MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases throughout February 2021 using the following keywords with their synonyms: “Navicular stress fracture,” “return to play,” and “athletes.” The primary outcomes were (1) management success rate, (2) RTP rate, and (3) time to RTP. The secondary outcomes were (1) non-union, (2) time to diagnosis, (3) refracture, and (4) other complications. Inclusion criteria were clinical studies on NSFs reporting at least one of the desirable outcomes. Studies not reporting any of the outcomes of interest or the full text was not available in English, German, French, or Arabic were excluded. Case reports, case series with less than ten cases, and studies reporting exclusively on navicular non-union management were also excluded. The Newcastle-Ottawa scale was used for quality assessment while Review Manager (RevMan) Version 5.4 was used for the risk of bias assessment. Data were presented by type of treatment (surgical or conservative). If enough studies were present that were clinically and statistically homogeneous and data on them adequately reported, a meta-analysis was performed using a fixed-effects model. In case of statistical heterogeneity, a random-effects model was used. If meta-analysis was not possible, results were reported in a descriptive fashion. The need to explore for statistical heterogeneity was determined by an I2 greater than 40%.

RESULTS: Eleven studies met the inclusion criteria with a total of 315 NSF. Out of those, 307 (97.46%) NSFs were in athletes. One hundred eight (34.29%) NSFs were managed operatively, while 207 (65.71%) NSFs were managed conservatively. Successful outcomes were reported in 104/108 (96.30%) NSF treated operatively with a mean success rate of 97.9% (CI: 95.4-100%, I2 = 0%). Successful outcomes were reported in 149/207 (71.98%) NSF treated conservatively, with a mean success rate of 78.1% (CI: 66.6-89.6%, I2 = 84.93%). Successful outcome differences were found to be significant in favor of operative management (OR = 5.52, CI: 1.74-17.48, p = 0.004, I2 = 4.6%). RTP was noted in 97/98 (98.98%) NSF treated operatively and in 152/207 (73.43%) NSF treated conservatively, with no significant difference between operative and conservative management (OR = 2.789, CI: 0.80-9.67, p = 0.142, I2 = 0%). The pooled mean time to RTP in NSF treated operatively was 4.17 months (CI: 3.06-5.28, I2 = 92.88%), while NSF treated conservatively returned to play at 4.67 months (CI: 0.97-8.37, I2 = 99.46%) postoperatively, with no significant difference between operative and conservative management (SMD = – 0.397, CI: – 1.869-1.075, p = 0.60, I2 = 92.24). The pooled mean duration of symptoms before diagnosis was 9.862 (3.3-123.6) months (CI: 6.45-13.28, I2 = 94.92%), reported in ten studies. Twenty (23.53%) refractures were reported after conservative management of 85 NSFs, while one (1.28%) refracture was reported after operative management of 78 NSFs, with a significant difference in favor of operative management (OR = 0.083, CI: 0.007-0.973, p = 0.047, I2 = 38.78%).

CONCLUSION: Operative management of NSF provides a higher success rate, a lower refracture rate, and a lower non-union rate as compared to other non-operative management options. While not significant, there is a notable trend towards superior RTP rates and time to RTP following operative management. Therefore, we recommend operative fixation for all NSFs type I through III in athletes. Athletes continue to exhibit an alarmingly long duration of symptoms before diagnosis is made; a high index of suspicion must be maintained, therefore, and adjunct CT imaging is strongly recommended in the case of any work-up. Unfortunately, the published literature on NSFs remains of lower level of evidence and high-quality studies are needed.

PMID:34415421 | DOI:10.1007/s00264-021-05147-6

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Increased tumor-infiltrating lymphocyte density is associated with favorable outcomes in a comparative study of canine histiocytic sarcoma

Cancer Immunol Immunother. 2021 Aug 20. doi: 10.1007/s00262-021-03033-z. Online ahead of print.

ABSTRACT

Histiocytic sarcoma (HS) is a rare and aggressive tumor in humans with no universally agreed standard of care therapy. Spontaneous canine HS exhibits increased prevalence in specific breeds, shares key genetic and biologic similarities with the human disease, and occurs in an immunocompetent setting. Previous data allude to the immunogenicity of this disease in both species, highlighting the potential for their successful treatment with immunotherapy. Quantification of CD3 tumor-infiltrating lymphocytes (TIL) in five cases of human HS revealed variable intra-tumoral T cell infiltration. Due to the paucity of human cases and lack of current model systems in which to appraise associations between anti-tumor immunity and treatment-outcome in HS, we analyzed clinical data and quantified TIL in 18 dogs that were previously diagnosed with localized HS and treated with curative-intent tumor resection with or without adjuvant chemotherapy. As in humans, assessment of TIL in biopsy tissues taken at diagnosis reveal a spectrum of immunologically “cold” to “hot” tumors. Importantly, we show that increased CD3 and granzyme B TIL are positively associated with favorable outcomes in dogs following surgical resection. NanoString transcriptional analyses revealed increased T cell and antigen presentation transcripts associated with prolonged survival in canine pulmonary HS and a decreased tumor immunogenicity profile associated with shorter survivals in splenic HS. Based on these findings, we propose that spontaneous canine HS is an accessible and powerful novel model to study tumor immunology and will provide a unique platform to preclinically appraise the efficacy and tolerability of anti-cancer immunotherapies for HS.

PMID:34415404 | DOI:10.1007/s00262-021-03033-z

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Heavy metal contamination in wild avian species inhabiting human-modified habitats

Environ Monit Assess. 2021 Aug 20;193(9):588. doi: 10.1007/s10661-021-09387-2.

ABSTRACT

Health of birds and heavy metal toxicity are growing concerns in Pakistan because of irresponsible industrial waste management and farming practices. Eight species of common wild birds were studied from three different study sites which varied in the type of environmental pollution (Kasur: industrial waste, Lahore city: traffic pollution and Shahdara: mixed pollution of traffic, sewerage, and industry which the Ravi River accumulates). Heavy metal analysis of six heavy metals in the various organs of birds showed that there was no evidence of organ preference for metal accumulation in birds. Shahdara and Kasur with numerous industries both showed chromium concentrations above toxicity levels in 54.16% tissues of Granivorous birds, 60% of omnivorous birds, and 33.33% in tissues of carnivorous species. Statistical analysis proved that there is no correlation between weight of birds and accumulation of metals; it depends on food preference of birds and properties of the metals as bioaccumulators or biomagnifiers.

PMID:34415417 | DOI:10.1007/s10661-021-09387-2

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Forgotten fatalities: British military, mining and maritime accidents since 1900

Occup Med (Lond). 2021 Aug 20:kqab108. doi: 10.1093/occmed/kqab108. Online ahead of print.

ABSTRACT

BACKGROUND: Comparative long-term trends in fatal accident rates in the UK’s most hazardous occupations have not been reported.

AIMS: To compare trends in fatal accident rates in six of the most hazardous occupations (the three armed forces, merchant shipping, sea fishing and coal mining) and the general British workforce during peacetime years since 1900.

METHODS: Examinations of annual mortality reports, returns, inquiry files and statistics. The main outcome measure was the fatal accident rate per 100 000 population employed.

RESULTS: These six occupations accounted for ~40% of all fatal accidents in the British workforce. Fatal accident rates were highest in merchant shipping to 1914 (400-600 per 100 000) and in the Royal Air Force and sea fishing by the early 1920s (around 300 per 100 000). Since the 1950s sea fishing has remained the most hazardous occupation (50-200). Widespread reductions in fatal accident rates for each occupation have been greatest in recent years in the three armed forces and merchant shipping. Compared with the general workforce, relative risks of fatalities have increased in recent decades in all these occupations except shipping.

CONCLUSIONS: All six occupations still have high fatal accident rates. The greatly increased fatalities in sea fishing generally and in the Royal Air Force during its early years reflect, for different reasons, cultures of extreme risk-taking in these two sectors. Reductions in fatality rates in the armed forces over the last 20 years are due largely to decreases in land transport accidents.

PMID:34415338 | DOI:10.1093/occmed/kqab108

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Effects of a disposable home electro-stimulation device (Pelviva) for the treatment of female urinary incontinence: a randomised controlled trial

Arch Gynecol Obstet. 2021 Aug 20. doi: 10.1007/s00404-021-06179-4. Online ahead of print.

ABSTRACT

AIMS: To compare current General Medical Practitioner treatment as usual (TAU) for the treatment of female urinary incontinence with a novel disposable home electro-stimulation device (Pelviva).

METHODS: Open label, Primary Care post-market evaluation. 86 women with urinary incontinence were randomly assigned to one of two 12-week treatments: TAU or Pelviva for 30 min every other day plus TAU. Outcome measures included ICIQ-UI (primary), PISQ-IR, PGI-S / PGI-I and FSFI (secondary) at recruitment and immediately after intervention, 1-h pad test at recruitment and usage diaries throughout.

RESULTS: Pelviva plus TAU produced significantly better outcome than TAU alone: 3 versus 1 point for ICIQ-UI (Difference – 1.8 95% CI: – 3.5 to – 0.1, P = 0.033). Significant differences were also observed for PGI-I at both 6 weeks (P = 0.001) and 12 weeks (P < 0.001). In the Pelviva group, 17% of women described themselves as feeling very much better and 54% a little or much better compared to 0% and 15% in the TAU. Overall PISQ-IR score reached statistical significance (P = 0.032) seemingly related to impact (P = 0.027). No other outcome measures reached statistical significance. Premature termination due to COVID-19 meant only 86 women were recruited from a sample size of 264. TAU did not reflect NICE guidelines.

CONCLUSIONS: This study suggests Pelviva is more successful than TAU in treating urinary incontinence in Primary Care. The study had reduced power due to early termination due to COVID-19 and suggests TAU does not follow NICE guidelines.

PMID:34415401 | DOI:10.1007/s00404-021-06179-4

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Development and Piloting of a Patient-Centered Report Design for Stress Myocardial Perfusion Imaging Results

JAMA Netw Open. 2021 Aug 2;4(8):e2121011. doi: 10.1001/jamanetworkopen.2021.21011.

ABSTRACT

IMPORTANCE: The management of coronary disease epitomizes the call to better engage patients in shared medical decision-making. Myocardial perfusion imaging (MPI) is the foundation of diagnosis, risk stratification, and subsequent therapy; however, MPI reports are currently interpretable by specialists but not patients.

OBJECTIVE: To design and test a patient-centered report for stress MPI test results.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study of outpatients who underwent an MPI stress test and clinicians used a mixed methods approach. Phase 1 (December 2018 to July 2019) used qualitative methods to design a patient-centered reporting tool, with 5 focus groups with 36 patients and 2 focus groups with 27 clinicians. Phase 2 (June to September 2019) consisted of pilot testing the reporting tool with feedback from a structured survey given to patients who received MPI reports before and after implementing the tool.

MAIN OUTCOMES AND MEASURES: Key themes around patient experiences with the current MPI reporting and their desire for a more useful report were identified, which led to a sample reporting tool after serial iterations with feedback. Differences in patient knowledge and engagement were assessed between patients before and after implementation of the new reporting tool using χ2 tests.

RESULTS: From patient focus groups (26 patients; mean [SD] age, 66.3 [9.6] years, 9 [35%] women), 3 themes on the inadequacies of current MPI reporting were identified: (1) inconsistent delivery of results, (2) use of medical jargon, and (3) unclear posttest course. We identified 5 themes for a more patient-centered MPI report: desire for written information, discussion of the report with medical personnel, presentation of results in simple language with use of visual graphics, comparisons with normal results, and personalized risk estimates. In a pilot survey with 123 patients split into a pre-implementation group (69 patients; mean [SD] age, 68.2 [8.5] years; 27 [51%] women) and a postimplementation group (54 patients; mean [SD] age, 66.4 [8.7] years; 30 [56%] women), the patient-centered report led to more patients reading the entire report (45 [83%] vs 46 [67%]; P = .04) and improved knowledge of future risk of cardiac events (41 [76%] vs 20 [29%]; P < .001). There was also a numerically higher percentage of patients who found the report easy to read (45 [83%] vs 44 [68%]; P = .05) and understand (42 [78%] vs 43 [66%]; P = .16), although these results were not statistically significant.

CONCLUSIONS AND RELEVANCE: This study identified key elements of a patient-centered report design for stress MPI test results, which improved patient engagement and knowledge. These preliminary data support further implementation and study of a more patient-centered MPI report.

PMID:34415313 | DOI:10.1001/jamanetworkopen.2021.21011

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Variation in Management of Extremity Soft-Tissue Sarcoma in Younger vs Older Adults

JAMA Netw Open. 2021 Aug 2;4(8):e2120951. doi: 10.1001/jamanetworkopen.2021.20951.

ABSTRACT

IMPORTANCE: A large proportion of extremity soft-tissue sarcomas (ESS) occur among young adults, yet this group is underrepresented in clinical trials, resulting in limited data on this population. Younger patients present many complex challenges that affect clinical management.

OBJECTIVE: To investigate variations in treatment management in young adults vs older adults with ESS.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective cohort study used the National Cancer Data Base (NCDB) to identify patients 18 years and older with ESS who received definitive treatment (ie, limb-sparing surgery [LSS] or amputation) between 2004 and 2014. Data analysis was conducted in November 2019.

EXPOSURES: Treatment regimen received among young adults (aged 18-39 years) and older adults (≥40 years) after diagnosis with ESS.

MAIN OUTCOMES AND MEASURES: To detect unique factors associated with treatment decisions in young adults with ESS, multivariable analyses used logistic regressions for patterns of treatment and their association with demographic factors and tumor characteristics.

RESULTS: Overall, 8953 patients were identified, and among these, 1280 (14.3%) were young adults. From the full cohort, 4796 patients (53.6%) identified as male and 6615 (73.9%) identified as non-Hispanic White. More young adults than older adults underwent amputation (age 18-39 years, 104 of 1280 [8.1%]; age 40-64 years, 217 of 3937 [5.5%]; aged ≥65 years, 199 of 3736 [5.3%]), but the association was not statistically significant (age ≥65 years, odds ratio [OR], 1.49; 95% CI, 1.00-2.23; P = .05). Young adults were more likely to receive chemotherapy than older patients (age 40-65 years, OR, 0.52; 95% CI, 0.45-0.60; P = .001; ≥65 years, OR, 0.16; 95% CI, 0.12-0.20; P = .001). Conversely, young adults were less likely to receive radiation therapy compared with older patients (age 40-65 years, OR, 1.40; 95% CI, 1.22-1.61; P = .001; ≥65 years, OR, 1.33; 95% CI, 1.10-1.61; P = .003). Unique to younger adults, clinical stage II disease vs stage I and positive surgical margins were not associated with use of radiation therapy (stage II disease: OR, 1.25; 95% CI, 0.81-1.91; P = .31; positive surgical margins: OR, 1.43; 95% CI, 0.93-2.22; P = .11). White Hispanic young adults were less likely than non-Hispanic White young adults to receive radiation therapy (OR, 0.53; 95% CI, 0.36-0.78; P = .002).

CONCLUSIONS AND RELEVANCE: In this study, young adults with ESS were more likely to receive chemotherapy and less likely to receive radiation therapy than older adults. Further study is warranted to identify the clinical outcomes of these practice disparities.

PMID:34415314 | DOI:10.1001/jamanetworkopen.2021.20951

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New psychoactive substances, safety and mental health in prison officers

Occup Med (Lond). 2021 Aug 20:kqab113. doi: 10.1093/occmed/kqab113. Online ahead of print.

ABSTRACT

BACKGROUND: The use of new psychoactive substances (NPS) in UK prisons is believed to have increased substantially. As well as posing a significant threat to prisoners’ health, NPS use can trigger violent, unpredictable and aggressive behaviour. Dealing with the direct and indirect effects of NPS therefore has the potential to compromise the physical and psychological safety of prison staff.

AIMS: This study investigates prison officers’ perceptions of NPS use in their workplace and their risk of exposure. Relationships between NPS exposure, the workplace safety climate and mental health were also examined.

METHODS: We assessed prison officers’ perceptions of the prevalence of NPS use among prisoners in their workplace, their personal exposure and the safety climate in their institution through an online survey. The General Health Questionnaire-12 measured mental health. Descriptive statistics were used to assess officers’ perceptions of NPS use in their workplace and their personal exposure and correlations examined relationships between variables.

RESULTS: The sample comprised 1956 prison officers (86% male). Most respondents (85%) highlighted NPS as a serious cause for concern in their institution. Two-thirds (66%) reported being personally exposed to NPS at least sometimes, with 22% being exposed once a day or more. Significant relationships were found between officers’ perceived NPS exposure, assessments of safety climate and self-reported mental health.

CONCLUSIONS: Our findings highlight the need for urgent action to reduce the use of NPS among prisoners. This is likely to improve the safety climate of UK prisons and the mental health of staff.

PMID:34415337 | DOI:10.1093/occmed/kqab113

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Speech performance in adult patients undergoing Invisalign treatment

Angle Orthod. 2021 Aug 20. doi: 10.2319/122820-1037.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess speech performance of adult patients undergoing orthodontic treatment with Invisalign.

MATERIALS AND METHODS: Twenty-four adult patients with Invisalign (Invisalign group: 6 men, 18 women; average age; 34.88 years) and 20 adult patients with fixed labial appliances (fixed group: 5 men, 15 women; average age; 38.85 years) were evaluated. Speech was recorded immediately before delivery of the first set of clear aligners or bonding of labial appliances (T0), immediately after delivery or bonding (T1), and 2 months after delivery or bonding (T2). Speech was evaluated via a combination of three auditory analyses: (1) objective acoustic analysis through digital sonography, (2) semiobjective assessment by six speech and language pathologists, and (3) subjective assessment patient questionnaire.

RESULTS: The objective acoustic analysis showed a statistically significant difference over time from T0 to T1, T1 to T2, and T0 to T2 for Invisalign patients. The semiobjective analysis revealed a significant speech alteration from T0 to T1 and T1 to T2 for both groups, and from T0 to T2 in the Invisalign group. The subjective analysis showed a significant difference between means of Invisalign and fixed group patient perception at both T1 and T2.

CONCLUSIONS: Invisalign treatment significantly affected speech, and although patients experience some level of adaptation, speech does not return to normal after 2 months of treatment.

PMID:34415296 | DOI:10.2319/122820-1037.1