Resection of colorectal carcinoma liver metastases: A population-based study in outcomes and factors associated with recurrent disease.

OBJECTIVE: To assess the hepatic disease-free survival (HDFS) and overall survival (OS) of patients who underwent resection of colorectal cancer liver metastases (CRCLM) in our population, and evaluate what factors are associated with these outcomes. METHODS: Patients with resected non-mucinous CRCLM between January 2013-February 2020 were retrospectively identified. Dates of diagnosis, surgery, and, if applicable, death were recorded. HDFS and OS were calculated using a census date of 24 September 2022. Separate Cox multivariate regression analyses were performed to evaluate for association between HDFS and OS and the following factors: pre-operative imaging interval (<4 weeks vs. ≥4 weeks); pre-operative imaging modality (CT only vs. MRI+CT); extrahepatic disease at time of hepatectomy (yes vs. no); tumor burden score (TBS, where TBS2 = (largest axial dimension of CRCLM)2 + (number of CRCLM)2); pT and pN; and neoadjuvant chemotherapy. RESULTS: 137 subjects (mean age, 61 ± 11 years, 86 males) were included. Associations with recurrent hepatic disease were found with chemotherapy (HR 2.11[95 % CI = 1.13-3.92]), TBS (HR 1.30[95 % CI = 1.17-1.45]), MRI+CT (HR 2.12[95 % CI = 1.29-3.48]), and extrahepatic disease at hepatectomy (HR 2.16[95 % CI = 1.08-4.35]). For mortality, associations were found with TBS (HR 1.22[95 % CI = 1.09-1.37]), pT (HR 1.45[95 % CI = 1.05-2.00]), and extrahepatic disease at hepatectomy (HR 2.10[95 % CI = 1.31-3.36]). CONCLUSION: In our population, non-imaging related factors TBS, neoadjuvant chemotherapy, pT and presence of extrahepatic disease at time of hepatectomy were associated with HDFS and/or OS. The preoperative imaging interval and use of preoperative MRI were not associated with improved patient outcomes.

Cultural competence knowledge and confidence after classroom activities.

OBJECTIVES: To determine change in cultural competency knowledge and perceived confidence of second-year pharmacy students to deliver culturally competent care after completing a required cultural competency curriculum. DESIGN: Cultural competence material was covered in the second-year PharmD curriculum through lectures, laboratories, and an experiential/out-of-class assignment. ASSESSMENT: Eighty-five second-year (P2) pharmacy students completed a survey which assessed influence of classroom activities related to cultural competence. Mean values for knowledge and perceived confidence were significantly higher for posttest compared to pretest (p < 0.01), after cultural competency activities. Focus groups were used to solicit students' opinions on instructional effectiveness, relevance of activities, and areas for enhancement. CONCLUSION: The cultural competency curriculum increased pharmacy students' awareness of and confidence in addressing cultural diversity issues that affect pharmaceutical care delivery.

The mandatory residency dilemma: parallels to historical transitions in pharmacy education.

OBJECTIVE: To review recent literature regarding mandatory residencies in the perspective of the historical entry-level degree debate. DATA SOURCES: Articles were identified through searches of MEDLINE/PubMed, national pharmacy association Web sites, and a review of the references of related literature. STUDY SELECTION AND DATA EXTRACTION: Several studies, commentaries, and reviews are examined to discuss viewpoints from both the entry-level degree and mandatory residency debates. Similarities were observed between the 2 debates in regard to objectives and rationale for change, educational issues, pharmaceutical care issues, and economic issues. DATA SYNTHESIS: Fewer than 10 years ago, after many years of debate, colleges of pharmacy made the transition to offering the PharmD degree as the sole entry-level degree for licensure as a pharmacist. Similar debates have taken place over the past several years and continue to take place regarding the necessity for residency training. One key 2006 document by the American College of Clinical Pharmacy calls for mandatory residency training for entry into pharmacy practice by 2020. CONCLUSIONS: In parallel with the entry-level degree debate, consensus has yet to be reached among pharmacists and pharmacy organizations, but several have shown support for mandatory residency training for all pharmacists involved in direct patient care. Many questions have yet to be answered regarding the timeline, economics, and feasibility of such a mandate.

Identifying factors that affect patients' willingness to pay for inhaled insulin.

UNLABELLED: Predictors of patients' willingness to pay for inhaled insulin are unknown. This study found patients with higher annual household income and those who were dissatisfied with their current insulin therapy were willing to pay for inhaled products. BACKGROUND: Not all diabetes patients are receptive to taking injectable insulin and may therefore be noncompliant. Inhaled insulin has been shown to be as efficacious as subcutaneous insulin, but determinants of patients' willingness to pay (WTP) for inhaled insulin are unknown. OBJECTIVES: The objective of this study was to determine the relationship between various patient characteristics and patient satisfaction variables with WTP for inhaled insulin. METHODS: Exploratory cross-sectional study using a random sample of patients with diabetes from a national database. Data were collected using a mailed survey focusing on patient satisfaction with current insulin therapy, WTP, and general patient information. Any WTP (categorical) and the amount (continuous) patients were willing to pay were the 2 dependent variables in the study. Data were analyzed using SPSS v.15.0. Descriptive statistics as well as linear and logistic regression analyses were conducted. RESULTS: One hundred twenty-eight patients responded. The logistic regression analysis indicated that annual household income (P=.038) and patient satisfaction (P=.002) predict WTP. Additionally, the current cost of insulin therapy (P=.009) and annual household income (P=.049) were found to predict the amount patients were willing to pay. On average, patients were willing to pay $55.49 out of pocket for inhaled insulin per month. CONCLUSIONS: The out-of-pocket cost that patients were willing to pay was the same as the amount patients pay presently for their insulin and syringes. Although Exubera is no longer on the market, the study findings can have an impact on pharmaceutical companies working on new inhaled insulin products in their efforts to care for patients with diabetes.

Tumor progression associated with erythropoiesis-stimulating agents.

OBJECTIVE: To evaluate, characterize, compare, and critique trials reporting increased tumor progression in patients with cancer who are receiving erythropoiesis-stimulating agents (ESAs) that led to Food and Drug Administration (FDA) actions for black box warnings and labeling changes. DATA SOURCES: Literature was accessed through MEDLINE (1950-August 2008) and PubMed (1975-August 2008) using the search terms recombinant erythropoietin, darbepoetin, epoetin, anemia, neoplasms, and disease progression. Articles cited in MedWatch alerts, Oncologic Drugs Advisory Committee meeting briefs, and bibliographies from identified articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All studies published in English with data suggesting increased tumor progression or death due to disease progression in patients receiving ESAs were included. DATA SYNTHESIS: ESAs are approved for treatment of anemia in several different disease states, including chemotherapy-induced anemia. Ten trials investigating off-label use of ESAs in patients with cancer have reported an increased risk of tumor progression and/or treatment-associated death. Two of these trials reported worse overall survival with ESA treatment compared with placebo (28% vs 23% and 21.9% vs 16.4%), while another trial reported shorter time to death with treatment (68 vs 131 days; p = 0.04). Many of these studies had important limitations, including imbalanced groups at baseline and poor design. Moreover, none of these trials was designed to detect a statistically worse outcome with ESAs; thus, absolute conclusions regarding tumor progression cannot be drawn. As a result, better designed trials with safety as the primary outcome are ongoing. CONCLUSIONS: Additional studies are needed and being undertaken to qualify and quantify the possible risk of tumor progression with use of ESAs. Prudent practice dictates that until results of these trials are available, ESAs should be used in accordance with FDA labeling.