Tag: nevin manimala

JAMA Oncol. 2022 Oct 6. doi: 10.1001/jamaoncol.2022.3755. Online ahead of print.

ABSTRACT

IMPORTANCE: The pathologic complete response (pCR) is supported by regulatory agencies as a surrogate end point for long-term patients’ clinical outcomes in the accelerated approval process of new drugs tested in neoadjuvant randomized clinical trials (RCTs) for early breast cancer (BC). However, a meaningful association between pCR and patients’ survival has been proven only at the patient level (ie, significantly better survival of patients who achieved pCR compared with those who did not), but not at trial level (ie, poor association between degree of improvement in pCR rate and survival reported across trials).

OBSERVATIONS: We critically discuss the potential reasons of such discrepancy between pCR surrogacy value at the patient and trial level, as well as the relevant implications for both clinical research and drug regulatory policy. We also describe alternative surrogate end points, including combined end points that jointly analyzed pathological response and event-free survival data, or the assessment of circulating tumor DNA (ctDNA). Such proposed surrogate end points could overcome limits of pCR and provide a reasonable trade-off between the 2 conflicting needs to have access to effective therapies rapidly, and to reliably assess patients’ clinical benefit.

CONCLUSIONS AND RELEVANCE: Using surrogate end points to grant drug approvals is justified only when they can provide accurate prediction of a drug’s effect on the long-term patient outcomes. Evidence currently available does not support pCR used alone as a reliable surrogate end point in regulatory neoadjuvant RCTs for BC. The surrogacy value at trial level of potentially more robust surrogate end points needs to be urgently tested.

PMID:36201176 | DOI:10.1001/jamaoncol.2022.3755

Swiss Med Wkly. 2022 Sep 15;152:w30223. doi: 10.4414/smw.2022.w30223. eCollection 2022 Sep 12.

ABSTRACT

BACKGROUND AND PURPOSE: Culturally diverse countries such as Switzerland face the challenge of providing cross-cultural competent care. Cross-cultural competent care needs an understanding of a patient’s cultural context in order to provide safe and effective care. Therefore, we sought to examine cross-cultural competence of Swiss paediatric oncology care providers, and to explore their perceptions of barriers to and facilitators of cross-culturally competent care.

DESIGN AND SAMPLE: We conducted a cross-sectional study. The data collection period was three weeks. Providers were recruited through collaborators at the participating paediatric oncology centres. All occupational groups who are in direct contact with patients and involved in their care were eligible (e.g., physicians, nurses, social workers, occupational therapists and physiotherapists). Surveying providers online, we captured five subscales of their cross-cultural competence and their perceptions as to how to facilitate cross-culturally competent paediatric oncology care. We employed the Cross-Cultural Competence of Healthcare Professionals (CCCHP) questionnaire. Besides descriptive and inferential statistics, we performed content analysis.

FINDINGS: The response rate was 73.2% (n = 183/250). Analyses revealed differences in cross-cultural competence between occupational groups of paediatric oncology providers. Overall, social workers’ cross-cultural competence was higher than nurses’ or occupational therapists’ and physiotherapists’ cross-cultural competence. Physicians’ cross-cultural competence was higher than nurses (with no statistically significant difference identified between physicians, occupational therapists and physiotherapists). Furthermore, our results suggest noteworthy differences among the four main occupational groups on the five CCCHP subscales. Physicians and social workers declared more positive attitudes than nurses; occupational therapists and physiotherapists reported lower skills than the other three groups; social workers scored higher on the emotions and empathy subscale than the other three groups; physicians were more knowledgeable and aware than nurses. Most frequently mentioned barriers were: language barriers (68.5%), different culture and values (19.2%), different illness understanding (9.2%). Most frequently mentioned facilitators were: professional translators (47.2%), continuous training (20.8%), professional cultural mediators (8.8%).

CONCLUSIONS/IMPLICATIONS: Trainings and interventions are widely considered a principal strategy to advance providers’ cross-cultural competence. Our findings of differences in cross-cultural competence among occupational groups further underpin the need to adapt training programmes and interventions to the respective occupational group and the respective dimension(s) of cross-cultural competence. In addition, professional translators and cultural mediators should be used. Lastly, reciprocal supervision and the promotion of multidisciplinary teams is crucial to enable oncology care providers to learn from each other and this exchange could also help to reduce some of the differences between the various occupational groups.

PMID:36201172 | DOI:10.4414/smw.2022.w30223

Am J Speech Lang Pathol. 2022 Oct 6:1-12. doi: 10.1044/2022_AJSLP-21-00357. Online ahead of print.

ABSTRACT

PURPOSE: Although traumatic brain injury (TBI) has a disproportionate impact on older adults, there has been limited inclusion of these individuals in post-TBI cognitive-communication research. This study was undertaken to compare demographic and injury characteristics, speech-language pathology input, and broad outcomes for younger and older adults admitted to inpatient rehabilitation following TBI.

METHOD: A retrospective audit of first occasion adult TBI admissions in 2019 to inpatient rehabilitation in an Australian metropolitan subacute hospital was conducted via medical record data. Admissions were located using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) coding that aligned with TBI. Comparisons were made for younger (18-54 years) and older (≥ 55 years) adults.

RESULTS: A total of 114 admissions (51.75% older adults) were included. Patient age ranged between 18 and 90 years. Falls caused TBI in the majority of older adults, whereas transport-related accidents were the most common cause for younger adults. Age-based trends for intracranial injury were observed. Cognitive-communication difficulties were the most common speech-language pathology diagnosis with no significant difference in prevalence between younger and older adults. Age group was not significantly associated with length of stay or discharge home.

CONCLUSIONS: The implications of injury-related trends for older adults on post-TBI cognitive-communication are poorly understood. This lack of information is problematic given the frequency of cognitive-communication difficulties in this population. Research into cognitive-communication following new onset TBI in older adults is crucial to support rehabilitation service provision and improve outcomes for older adults.

PMID:36201170 | DOI:10.1044/2022_AJSLP-21-00357

Forensic Sci Med Pathol. 2022 Oct 6. doi: 10.1007/s12024-022-00520-2. Online ahead of print.

ABSTRACT

This systematic review aims to determine whether linear or morphometric analysis of paranasal sinuses can be used for accurate determination of gender and to appraise which sinus can be evaluated for accurate gender determination.A comprehensive search of the specialized databases (PubMed/MEDLINE, Science Direct, Clinical Key, ProQuest, Google Scholar, Epistomonikos, LILACS, OpenGrey) and other institutional repositories was performed for including the studies which assessed paranasal sinuses for gender determination. Quality assessment was carried out with the AQUA tool. The meta-analysis was performed with the eligible study data at 95% CI and p ≤ 0.05 in the random-effects model.Forty-six studies evaluating frontal sinus (13), maxillary sinus (26), frontal and maxillary sinus (5), or three paranasal sinuses (2) were included. All the included studies assessed height, length, width, and volume, respectively, and other additional parameters (area, perimeter) if wherever applicable. Frontal sinus had significantly higher values for males compared to females except for left height (LH) and left volume (LV). Maxillary sinus measurements were significantly higher in males contrasted to females except for LH. Sub-group analyses revealed that analyses involving the population had statistically significant results for all the measured parameters for both the sinuses (p < 0.05 and p = 0.00, respectively).Measurements obtained from assessing sinuses reveal that there are variations in size, among populations in different geographic regions. Hence, more studies with improved sample sizes and standardized measurement protocols should be carried out on different populations to see the diversity and their reliability.

PMID:36201147 | DOI:10.1007/s12024-022-00520-2

Breast Cancer Res Treat. 2022 Oct 6. doi: 10.1007/s10549-022-06738-6. Online ahead of print.

ABSTRACT

PURPOSE: Using real-world data, interstitial lung disease (ILD) prevalence before and after HER2-directed therapy was estimated. Potential ILD risk factors in patients receiving HER2-directed therapy for metastatic breast cancer (mBC) were evaluated.

METHODS: Adults with HER2-directed therapy for mBC initiated between September 25, 1998, and February 22, 2020 were, included. ILD was defined broadly as one or more of 64 lung conditions. Patients were followed until incident ILD, death, last contact, or study end.

RESULTS: In total, 533 patients were identified with median age at mBC of 57, 51% had de novo mBC, 43% were ever smokers, 30% had lung metastases, 9% had thoracic radiation, 6% had chronic obstructive pulmonary disease, and 16% had prevalent ILD. ILD cumulative incidence at one year was 9% (95% CI 6%, 12%), with a median follow-up of 23 months. Smoking (HR 2.2, 95% CI 1.1, 4.8) and Black/African-American race (HR 3.4, 95% CI 1.6, 7.5) were significantly associated with ILD; HRs for preexisting lung conditions (HR 1.8, 95% CI 0.9, 3.8) and thoracic radiation (HR 2.3, 95% CI 0.8, 7.1) were not statistically significant. Prevalent ILD was associated with 13-fold greater occurrence of incident ILD. 85% of patients with prevalent or incident ILD were symptomatic.

CONCLUSIONS: This real-world population of patients with mBC had a high prevalence of ILD prior to HER2-directed therapy, reflecting the multifactorial causation of interstitial lung changes. The cumulative incidence of ILD in patients receiving HER2-directed therapy for mBC augments prior reports. Symptomatic presentation suggests an opportunity for early intervention.

PMID:36201127 | DOI:10.1007/s10549-022-06738-6

Clin Rheumatol. 2022 Oct 6. doi: 10.1007/s10067-022-06394-7. Online ahead of print.

ABSTRACT

OBJECTIVE: Kidney biopsy is essential for the diagnosis and classification of lupus nephritis. Percutaneous biopsy has a risk of bleeding-related complications; however, data on the risk of percutaneous kidney biopsy in patients with systemic lupus erythematosus (SLE) are scarce. In this study, we aimed to investigate the rate of bleeding-related complications and to examine the risk factors for complications of kidney biopsy in patients with systemic lupus erythematosus (SLE). METHODS: We retrospectively reviewed the medical records of patients with SLE who underwent ultrasound-guided percutaneous kidney biopsy between 2002 and 2020 at a tertiary referral center. Minor complications were defined as hematoma and passing hematuria not requiring an intervention. Major complications included bleeding events that required interventions after the biopsy. Statistical analysis with a multivariate logistic regression model was performed.

RESULTS: In a total of 277 patients with SLE, the rate of overall bleeding-related complications after kidney biopsy was 19.9% (minor 13.0%; major 6.9%). Among patients with major complications, 84.2% needed blood transfusion alone without embolization or surgery, whereas the remaining three patients needed embolization for bleeding control. Multivariate analysis revealed that thrombocytopenia (odds ratio [OR] 7.186, 95% confidence interval [CI] 2.315-22.300), and low eGFR (OR 3.478, 95% CI 1.094-11.056) were significantly associated with the risk of major bleeding-related complications after kidney biopsy.

CONCLUSION: Percutaneous kidney biopsy is accompanied by the risk of bleeding-related complications; however, most events in our study did not require vascular intervention for bleeding control. Low platelet count and low estimated glomerular filtration rate (eGFR) significantly increase the risk of complications after kidney biopsy in patients with SLE. Key Points • The rate of overall bleeding-related complications after kidney biopsy was about 20% of patients with SLE. • The most commonly observed events were gross hematuria followed by blood transfusion. • Thrombocytopenia and poor kidney function areis an important risk of bleeding-related complications after kidney biopsy.

PMID:36201125 | DOI:10.1007/s10067-022-06394-7

Neurol Ther. 2022 Oct 6. doi: 10.1007/s40120-022-00409-w. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study was to evaluate the accuracy of automated software (iStroke) on magnetic resonance (MR) apparent diffusion coefficient (ADC) and perfusion-weighted imaging (PWI) against ground truth in assessing infarct core, and compare the hypoperfusion volume and mismatch volume on iStroke with those on Food and Drug Administration-approved software (RAPID) in patients with acute ischemic stroke.

METHODS: We used the single-volume decomposition method to develop the iStroke (iStroke; Beijing Tiantan Hospital, Beijing, China) software. Patients with ischemic stroke were collected from two educational hospitals in China with MR-PWI performed in the emergency department within 24 h of symptom onset. Infarct core volume was defined as ADC < 620 × 10^-6 mm²/s and hypoperfusion volume was defined as Tmax > 6 s. We compared the accuracy of infarct core volume using iStroke and RAPID (iSchema View Inc, Menlo Park, CA) software with ground truth.

RESULTS: We included 405 patients with acute ischemic stroke with MR ADC and PWI sequences. The infarct core volume on iStroke (median 2.43 ml, interquartile range [IQR] 0.60-10.32 ml) was not significantly different from the ground truth (median 2.89 ml, IQR 0.77-9.17 ml) (P = 0.07); Bland-Altman curves showed that the core volume of iStroke and RAPID software were comparable with each other on individual agreement with ground truth. The hypoperfusion volume and mismatch volume on iStroke were not statistically different from those on the RAPID software, respectively. In patients with large vessel occlusion (n = 74), the agreement between iStroke and RAPID was substantial (kappa = 0.76) according to DEFUSE 3 criteria (infarct core < 70 ml, mismatch volume ≥ 15 ml, and mismatch ratio ≥ 1.8).

CONCLUSIONS: The iStroke automatic processing of ADC and PWI is a reliable software for the identification of diffusion-perfusion mismatch in acute ischemic stroke.

PMID:36201112 | DOI:10.1007/s40120-022-00409-w

J Med Syst. 2022 Oct 6;46(11):77. doi: 10.1007/s10916-022-01867-3.

ABSTRACT

The rapid and continuous growth of data volume and its heterogeneity has become one of the most noticeable trends in healthcare, namely in medical imaging. This evolution led to the deployment of specialized information systems supported by the DICOM standard that enables the interoperability of distinct components, including imaging modalities, repositories, and visualization workstations. However, the complexity of these ecosystems leads to challenging learning curves and makes it time-consuming to mock and apply new ideas. Dicoogle is an extensible medical imaging archive server that emerges as a tool to overcome those challenges. Its extensible architecture allows the fast development of new advanced features or extends existent ones. It is currently a fundamental enabling technology in collaborative and telehealthcare environments, including research projects, screening programs, and teleradiology services. The framework is supported by a Learning Pack that includes a description of the web programmatic interface, a software development kit, documentation, and implementation samples. This article gives an in-depth view of the Dicoogle ecosystem, state-of-the-art contributions, and community impact. It starts by presenting an overview of its architectural concept, highlights some of the most representative research backed up by Dicoogle, some remarks obtained from its use in teaching, and worldwide usage statistics of the software. Finally, the positioning of Dicoogle in the medical imaging software field is discussed through comparison with other well-known solutions.

PMID:36201058 | DOI:10.1007/s10916-022-01867-3

Eur J Orthop Surg Traumatol. 2022 Oct 6. doi: 10.1007/s00590-022-03407-8. Online ahead of print.

ABSTRACT

BACKGROUND: Intracapsular femoral neck fractures are challenging to treat, with outcomes depending on the quality of reduction, and the stability of fixation. Cannulated cancellous screws (CCS) are the most commonly used implants to fix these fractures, but failure rates are significant. The recently introduced femoral neck system (FNS) may be a better option than CCS fixation and this review attempts to compare the results.

METHODS: Four electronic databases were searched for eligible articles that had comparative data on the outcomes of fixation of adult femoral neck fractures with FNS and CCS. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% confidence intervals.

RESULTS: Eight studies with 509 cases having a mean age of 50.8 years were included for final analysis. FNS was found to be associated with significantly reduced complication rates (p < 0.001), decreased incidence of postoperative femoral neck shortening (p < 0.001), quicker time to fracture union (p = 0.002), and better functional outcome scores (p < 0.001) compared to cannulated screws. FNS was also associated with a shorter operating time (mean difference 6.65 min) although not statistically significant (p = 0.24). CCS group had significantly reduced mean blood loss (p < 0.001).

CONCLUSION: The available literature supports FNS as a better option for adult femoral neck fractures, with a lower complication rate, quicker union, and better clinical outcomes.

LEVEL OF EVIDENCE: Level 3.

PMID:36201031 | DOI:10.1007/s00590-022-03407-8

Langenbecks Arch Surg. 2022 Oct 6. doi: 10.1007/s00423-022-02658-7. Online ahead of print.

ABSTRACT

BACKGROUND: Historically , liver metastases due to melanoma have been associated with dismal prognosis. Moreover, the actual survival benefit from the treatment of melanoma liver metastases is still controversial. Hence, this study aims to evaluate the difference in surgical versus non-surgical options for melanoma liver metastases.

METHODS: Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to July 17, 2022. Studies were included if they compared outcomes between surgical and non-surgical treatment for patients with liver metastases from resectable melanoma. Meta-analyses were performed for the outcomes of 1-year, 2-year, 3-year and 5-year OS. Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity. To account for possible moderators that might contribute to statistical heterogeneity, univariate meta-regression with mixed-effects models and subgroup analyses were conducted for the outcome of 2-year OS.

RESULTS: The search yielded 6610 articles; 13 studies were included in our analysis. Meta-analyses showed that survival outcomes were in favour of patients undergoing surgery as compared to non-surgery: 1-year OS (HR = 0.29, 95%CI 0.19-0.44, p < 0.00001), 2-year OS (HR = 0.19, 95%CI 0.09-0.38, p < 0.00001), 3-year OS (HR = 0.07, 95%CI 0.03-0.19, p < 0.00001) and 5-year OS (HR = 0.07, 95%CI 0.02-0.22, p < 0.00001). All included studies were of high quality. There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses. Subgroup analyses and univariate meta-regression revealed neoadjuvant therapy and age as statistically significant subgroup and moderator respectively.

CONCLUSIONS: This study suggests that surgical treatment of melanoma liver metastases could offer better OS outcomes compared with non-surgical treatment.

PMID:36201022 | DOI:10.1007/s00423-022-02658-7