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1.
Br J Haematol ; 202(1): 116-121, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37096954

RESUMO

Improved maintenance treatments are needed for patients with relapsed/refractory aggressive lymphomas after autologous haematopoietic stem cell transplantation (ASCT). Several studies with lenalidomide have been found to have activity in the treatment of relapsed/refractory aggressive lymphomas. In the present phase I/II, single-arm, open-label study, 59 patients with high-risk relapsed non-Hodgkin lymphoma received pretransplant BEAM chemotherapy and ASCT followed by 12 months of maintenance lenalidomide once daily on Days 1-21 (28-day cycles) beginning at post-transplantation Day 100. The most common histologies were mantle cell lymphoma (56%) and diffuse large B-cell lymphoma (24%). The maximum tolerated dose in the dose-finding part of the study was 15 mg, but cytopenias led to the subsequent adoption of a 10 mg dose in the final study. Sixteen patients (27%) completed 12 cycles of lenalidomide maintenance. The most common reason for discontinuation was adverse events (31%). These were primarily haematologic, and 56% of patients experienced Grade 3-4 events. Two-year PFS rates (95% CIs) were 70% (56%-80%), 45% (19%-68%) and 81% (66%-90%); 2-year OS rates (95% CIs) were 91% (80%-96%), 93% (61%-99%) and 90% (76%-96%) in all patients, patients completing and patients not completing 12-month maintenance respectively. These results do not support the use of lenalidomide maintenance in this setting.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Linfoma Difuso de Grandes Células B , Linfoma de Célula do Manto , Linfoma não Hodgkin , Humanos , Adulto , Lenalidomida , Linfoma não Hodgkin/tratamento farmacológico , Linfoma de Célula do Manto/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante Autólogo , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Resultado do Tratamento
2.
Clin Teach ; 17(5): 526-530, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32040981

RESUMO

BACKGROUND: Family-centred rounds (FCRs) are common in paediatric inpatient medicine. FCRs lead to shorter hospital stays, improved communication, and improved patient and family satisfaction. Rounding structures can differ between institutions based on participants, the location of rounds and the role of trainees. The aim of our study was to compare walking hallway rounds with a new conference-room rounding style, as measured by learner perceptions of FCRs. METHODS: All students participating in FCRs on two hospitalist teams were included in this study. In October 2017, a family-centred conference-room rounding model was developed. Team A adopted conference-room rounds whereas team B continued to use hallway rounds. Student and resident evaluations were constructed using a nine-point Likert scale (1, strongly disagree; 9, strongly agree). Evaluations assessed various perceived components of rounding. RESULTS: There were statistically significant differences between the evaluation responses from student team A (n = 21) versus student team B (n = 32) regarding perceived comfort in presenting (A = 7.86, B = 6.56, t = 3.42, p ≤ 0.001), confidence talking to families about medical decision making (A = 7.19, B = 6.32, t = 2.57, p = 0.013), educational value of rounds (A = 8.05, B = 6.16, z = -4.39, p ≤ 0.0001), value as a team member (A = 7.38, B = 6.34, z = -2.22, p = 0.013) and preparedness to round (A = 7.76, B = 6.34, z = -3.67, p ≤ 0.0001). Among residents, there were statistically significant differences regarding the perceived efficiency of rounds (A = 6.69, B = 4.89, t = 2.09, p = 0.048) and family engagement (A = 7.81, B = 5.89, z = -2.67, p = 0.003). DISCUSSION: Compared with hallway rounds, students and residents had improved learner perceptions of FCRs when participating in conference-room rounds. Some component of conference room rounding may be beneficial to learners while maintaining family-centered care.


Assuntos
Atitude do Pessoal de Saúde , Visitas de Preceptoria , Criança , Comunicação , Humanos , Equipe de Assistência ao Paciente , Percepção , Satisfação Pessoal
3.
Int J Psychiatry Med ; 55(4): 249-254, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32046539

RESUMO

OBJECTIVE: Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. METHOD: An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. RESULTS: Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and "other" (.74). There was less agreement for depressive disorders (.55). CONCLUSIONS: Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.


Assuntos
Medicina do Comportamento/educação , Hospitais Gerais , Internato e Residência , Equipe de Assistência ao Paciente , Diagnóstico Diferencial , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Psiquiatria/educação , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e Questionários
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