[Implementation of a Geriatric liason team in coordination with Primary Care attending 60 nursing homes in the northwest community healthcare network of the Community of Madrid]. / Implantación de un programa de Geriatría de enlace coordinado con Atención Primaria en 60 centros sociosanitarios del área asistencial noroeste de la Comunidad de Madrid.

OBJECTIVE: To describe interventions included in the implementation of a multidisciplinary Geriatrics Program that gives support to nursing homes, in coordination with Primary Care and Public Health, in collaboration with other hospital departments. METHODS: An observational descriptive study was conducted in an area that includes 60 nursing homes with nearly 4600 residents from June 1 st, 2020 to October 1 st, 2021. The program consists of different interventions including Telemedicine and support of a Geriatric Consultation Liaison Team. An estimation of avoided costs through these interventions was carried out. RESULTS: The activity recorded was 11502 telephone calls, 2247 e-mails, 313 visits to these centres in where 4085 patients underwent comprehensive geriatric assessment. During this period of time 442 patients received intravenous therapy in their nursing homes, including 7541 different types of medication which 5850 of them were antibiotics. According to the Diagnosis-related-Group (DRG) of the patients that received intravenous treatment in their nursing homes, was estimated a cost reduction of 1,500,00€ and a total of 2800 days of hospital stay avoided. In the group of 198 patients that received video consultation was estimated reduction of costs of 37,026€. A hospital multidisciplinary care team focused on the nursing home patients was created. CONCLUSIONS: This program improves continuity of nursing homes patients care and to enhance communication and coordination among Primary Care, Hospitals and Public Health services and secondarily, reducing hospital costs.

Correction to: Predictive and prognostic clinical and pathological factors of nivolumab efficacy in non-small-cell lung cancer patients.

Clinical and Translational Oncology.

Predictive and prognostic clinical and pathological factors of nivolumab efficacy in non-small-cell lung cancer patients.

BACKGROUND: Immunotherapy increases overall response rate (ORR) and overall survival (OS) in patients with non-small-cell lung cancer (NSCLC). Prognostic and predictive factors are a high need. PATIENTS AND METHODS: Retrospective review of NSCLC patients treated with nivolumab was performed. Analyzed variables included age, sex, stage, performance status (PS), location of metastases, presence of tumour-related symptoms and comorbidities, number of metastasis locations, previous chemotherapy, anti-angiogenic and radiotherapy treatments, and analytical data from the standard blood count and biochemistry. RESULTS: A total of 175 patients were included. Median age was 61.5 years, 73.1% were men, 77.7% were ECOG-PS 0-1, and 86.7% were included with stage IV disease. Histology was non-squamous in 77.1%. Sixty-five received nivolumab in second line (37.1%). Thirty-eight patients had brain metastasis (22%), and 39 (22.3%) liver metastasis and 126 (72%) had more than one metastatic location. The ORR was 15.7% with median Progression free survival (PFS) 2.8 months and median OS 5.81 months. Stage III vs IV and time since the beginning of the previous line of treatment ≥ 6 vs < 6 months were associated with better response. PS 2, time since the previous line of treatment < 6 vs ≥ 6 months, and more than one metastatic location were independently associated with shorter OS in multivariable analysis (7.8 vs 2.7 months, 11.2 vs 4.6 months, and 9.4 vs 5.1 month). Finally, time since the previous treatment < 6 vs ≥ 6 months and more than one metastatic location were independently associated with shorter PFS in multivariable analysis (4.3 vs 2.3 months and 4.7 vs 2.3 months). CONCLUSION: Poor PS, short period of time since the previous treatment, and more than one metastatic location were associated with poorer prognostic.

Influence of Pectin as a green polymer electrolyte on the transport properties of Chitosan-Pectin membranes.

Novel blend membranes have been prepared from Chitosan (CH), Pectin (PEC) and their mixtures. The obtained samples were cross-linked and sulfonated before characterization. The results show that CH/PEC membranes display structural changes on the chemical and physical properties as a function of composition. DSC analysis reveals an endothermic peak due to the scission of the ionic pairs between carboxylic groups and ammonium groups, which produces a strong change on physical properties such as methanol permeability and proton conductivity. The methanol permeability decreases with the amount of Pectin from (4.24±0.04)×10-6cm2/s for pure Chitosan membrane to (1.51±0.03)×10-6cm2/s for blend CH/PEC membranes when the amount of Pectin is 50% (v/v). The proton conductivities of the blend membranes follow a similar behavior. For a pure CH membrane the conductivity is 2.44×10-3S/cm, decreasing with pectin content until the composition 50/50 (v/v), in which the conductivity drops almost one order of magnitude.

COMPREHENSIVE RADIATION DOSE MEASUREMENTS AND MONTE CARLO SIMULATION FOR THE 7Li(p,n) ACCELERATOR NEUTRON FIELD.

In order to investigate the radiation dose dependence on the incident proton energy, neutron and gamma-ray doses were measured using a tissue-equivalent proportional counter in the proton energy range of 1.95-2.50 MeV for the McMaster 7Li(p,n) neutron facility. Microdosimetric spectra were collected, and absorbed doses were determined at various positions inside the irradiation cavity, along the lateral axis and outside the shield to find out the spatial distributions of neutron and gamma-ray doses for each proton energy. In parallel with the absorbed dose measurements, MCNP Monte Carlo simulations were carried out and neutron fluence spectra were computed at various positions, which enabled determination of the neutron weighting factors. It was found that neutrons make a substantially dominant contribution to the total equivalent dose for most proton energies and positions. The effective dose for a human subject increased from 0.058 to 1.306 µSv µA-1 min-1 with the increase of proton energy from 1.95 to 2.5 MeV. It is expected that the reported data will be useful for 7Li(p,n) accelerator neutron users.

Evaluation of the photocatalytic activity of Ln3+-TiO2 nanomaterial using fluorescence technique for real wastewater treatment.

Evaluation the photocatalytic activity of different Ln(3+) modified TiO2 nanomaterials using fluorescence based technique has rarely been reported. In the present work, xmol Ln(3+) modified TiO2 nanomaterials (Ln = Nd(3+), Sm(3+), Eu(3+), Gd(3+), Dy(3+) and Er(3+) ions; x = 0.005, 0.008, 0.01, 0.02 and 0.03) were synthesized by sol-gel method and characterized using different advanced techniques. The photocatalytic efficiency of the modified TiO2 expressed in the charge carrier separation and OH radicals formation were assigned using TiO2 fluorescence quenching and fluorescence probe methods, respectively. The obtained fluorescence measurements confirm that doping treatment significantly decreases the electron-hole recombination probability in the obtained Ln(3+)/TiO2. Moreover, the rate of OH radicals formation is increased by doping. The highly active nanoparticles (0.02Gd(3+)/TiO2 and 0.01Eu(3+)/TiO2) were applied for industrial wastewater treatment using solar radiation as a renewable energy source.

Synthesis of highly active thin film based on TiO2 nanomaterial for self-cleaning application.

Highly active self-cleaning surfaces were prepared from hydrothermally treated TiO2 nanomaterials for different times (0, 12, 24 and 36 h) under acidic condition. TiO2 thin films were characterized by X-ray diffraction (XRD), transmission electron microscope (TEM) and scanning electron microscope (SEM). TiO2 thin film (hydrothermal 24h) exhibited hybrid morphology from accumulated plates, clusters, rods and spheres. The photo self-cleaning activity in term of quantitative determination of the active oxidative species (OH) produced on the thin film surfaces was evaluated using fluorescent probe method. The results show that, the highly active thin film is the hydrothermally treated for 24 h at 200 °C. The structural, morphology and photoactivity properties of nano-TiO2 thin films make it promising surfaces for self-cleaning application. Mineralization of commercial textile dye (Remazol Red RB-133, RR) from highly active TiO2 thin film surface was applied. Moreover, the durability of this nano-TiO2 thin film (hydrothermal 24h) was studied.

A health services research agenda for cellular, molecular and genomic technologies in cancer care.

BACKGROUND: In recent decades, extensive resources have been invested to develop cellular, molecular and genomic technologies with clinical applications that span the continuum of cancer care. METHODS: In December 2006, the National Cancer Institute sponsored the first workshop to uniquely examine the state of health services research on cancer-related cellular, molecular and genomic technologies and identify challenges and priorities for expanding the evidence base on their effectiveness in routine care. RESULTS: This article summarizes the workshop outcomes, which included development of a comprehensive research agenda that incorporates health and safety endpoints, utilization patterns, patient and provider preferences, quality of care and access, disparities, economics and decision modeling, trends in cancer outcomes, and health-related quality of life among target populations. CONCLUSIONS: Ultimately, the successful adoption of useful technologies will depend on understanding and influencing the patient, provider, health care system and societal factors that contribute to their uptake and effectiveness in 'real-world' settings.

American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures.

PURPOSE: The National Cancer Policy Board recommended the creation of quality measures and a national reporting system in 1999. Representatives from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) collaborated to create metrics suitable for national performance measurement. METHODS: Content and methodology experts nominated by ASCO and NCCN met to select and refine metrics for breast, colon, and rectal cancer based on National Initiative for Cancer Care Quality and NCCN measures and NCCN and ASCO guidelines. Measures were selected based on their impact on disease free and overall survival, the degree to which opportunities for improvement exist, and the feasibility of data collection. RESULTS: Three breast cancer measures and four colorectal cancer measures were chosen. Measures for breast cancer included adjuvant hormone therapy for hormone receptor-positive tumors, chemotherapy for hormone receptor-negative cancer, and radiation after lumpectomy. Colorectal measures included adjuvant radiation and chemotherapy for rectal cancer, and adjuvant chemotherapy for colon cancer. All but one were recommended as accountability measures and one for quality improvement (removal and examination of 12 or more lymph nodes in colon cancer). Specifications were developed for each measure using tumor registries as the data source. CONCLUSION: ASCO/NCCN measures can be implemented by health systems, provider groups or payors for improvement or accountability using local tumor registries to furnish data on staging and treatment.

Use of patient-reported outcomes in clinical oncology practice: a nonvisit approach to patient care based on the IOM report.

The Institute of Medicine report, Crossing the Quality Chasm, suggested some new ways of thinking about organizing care. This article describes how practices might create continuous healing relationships using methods that are independent of patient visits to monitor and address problems that may occur during cancer care. Such a system would be based on patient report, timely and useful, sensitive to change, and low burden for patients, clinicians, and administrative staff. Furthermore, it would be built into the delivery of care and be integrated with other data systems such as patient records, decision support, and community or other resources. Using reports for patients that are presented in a format that is easily understandable, patients should be able to monitor their own progress.

Taking stock of health-related quality-of-life measurement in oncology practice in the United States.

This article focuses on the routine use of patient-reported outcomes measures in oncology clinical practice to monitor patient progress and inform decision making; and in particular, on measuring patient-reported health-related quality of life (HRQOL). The article summarizes the current literature on the acceptability to patients and clinicians of HRQOL measurement and on the effectiveness of feedback to clinicians about their patients' concerns and quality of life. It also describes the experiences recounted by clinicians and researchers who have been implementing such efforts and concludes that in the United States, little HRQOL measurement occurs in oncology practice. That is, much methodological development has occurred, but many challenges to its widespread adoption exist. These challenges include limitations in knowledge about how to apply outcomes instruments, and clinician, patient-related, and health system issues. That effort deserves significant attention now. The way forward, however, does not lie simply in adding HRQOL measurement to other tasks that are part of everyday practice. Rather, attention to principles of effective dissemination and new information infrastructures and technologies, combined with redesign of care, should embed the routine use of patient-reported outcomes in the care process to provide timely response to patients' needs for information and services.

Outcomes research at the National Cancer Institute: measuring, understanding, and improving the outcomes of cancer care.

What is the National Cancer Institute (NCI) doing to enhance the state of the science for measuring and understanding patient-centered outcomes of cancer care and to make this information useful for improved decision making? The NCI has a new focus on research that describes, interprets, and predicts the impact of various influences, especially interventions, on end points that matter to decision makers. The research includes end points such as survival, health-related quality of life, satisfaction and patient experience, and economic burden. To further this work, NCI supports and conducts research to (1) identify valid, reliable, responsive, and feasible end-point measures; (2) collect high-quality evidence about the impact of interventions on the end points of interest; (3) improve our understanding of the effects of other factors that shape this interaction; and (4) expand our capacity to translate research findings into information that is useful to patients, clinical policy makers, payers, regulators, standard setters, and providers of cancer care.

Factors influencing the collection of peripheral blood stem cells in patients with acute myeloblastic leukemia and non-myeloid malignancies.

Factors influencing the collection of autologous peripheral blood stem cells (PBSCs) were studied in 182 mobilization procedures performed on 145 consecutive patients with acute myeloblastic leukemia (AML; n=67) and with various non-myeloid malignancies (NMM; n=78). PBSC were collected following mobilization with chemotherapy, treatment with granulocyte colony-stimulating factor (G-CSF) or chemotherapy plus G-CSF. Fewer colony-forming unit granulocyte-macrophages (CFU-GMs) were collected from patients with AML than from patients with NMM (P<0.0001), although there were no differences in the numbers of CD34+ cells collected between both groups. Multiple regression analysis showed that chemotherapy alone was predictive of a low CD34+ yield in patients with NMM (regression coefficient (RC)=-2.1; P=0.003). In addition, the interactions "diagnosis mutliple myeloma (MM)xmobilization with chemotherapy" (RC=2.9; P=0.004) and "diagnosis MMxmobilization with chemotherapy plus G-CSF" (RC=2.1; P=0.04) also remained in the model, both showing a favorable influence. In AML, mobilization with chemotherapy plus G-CSF was associated with higher CD34+ yields (P=0.003). In this subgroup of patients, multiple regression analysis identified the number of cycles of previous chemotherapy (< or =2 cycles; RC=1.3; P=0.03) and peripheral blood counts (WBC > or =1.5 x 10(9)/l and monocytes >20%; RC=0.8; P=0.02) as the factors most predictive of CD34+ cell yield. These findings emphasize the need to optimize harvesting technique to enhance safety and minimize morbidity and costs of this valuable procedure.

Early infections in adult patients undergoing unrelated donor cord blood transplantation.

Early transplant-related mortality after cord blood transplantation from unrelated donors (UD-CBT) is close to 50%, mainly due to infectious complications. We have studied the incidence and characteristics of early infections (before day 100) in a series of 27 adult patients (median age 30 years, range 16-46) undergoing UD-CBT at a single institution. All 27 patients experienced at least one infectious episode and 18 (66%) suffered a severe infection. Bacteremia occurred in 55% of patients (13 with Gram-positive and 11 with Gram-negative microorganisms). Eleven of 19 CMV-seropositive patients (58%) developed CMV antigenemia and one patient had CMV disease. Fungal infections were documented in three patients (11%), comprising invasive fungal infections in two cases and a localized esophagitis in one. Ten patients (37%) died before day 100 after transplantation. Infection was considered the primary cause of death in four patients (sepsis by Acinetobacter spp. bacteremia in three cases) and contributed to death in another four. The most striking findings in this series were the high incidence of, and mortality due to multiresistant Acinetobacter spp. and the low incidence of and lack of mortality due to CMV disease. This report confirms that infection is a major complication in adults undergoing UD-CBT.

Standardized, unrelated donor cord blood transplantation in adults with hematologic malignancies.

The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults remains unclear. This study reports the results of UD-CBT in 22 adults with hematologic malignancies following conditioning with thiotepa, busulfan, cyclophosphamide, and antithymocyte globulin in 21, with thiotepa, fludarabine, and antithymocyte globulin in 1, and graft-versus-host disease (GVHD) prophylaxis with cyclosporine and prednisone. Median age was 29 years (range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). HLA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases. Median number of nucleated cells infused was 1.71 x 10(7)/kg (range, 1.01 x 10(7)/kg to 4.96 x 10(7)/kg). All 20 patients surviving more than 30 days had myeloid engraftment, and only 1, who received the lowest cell dose, developed secondary graft failure. Median time to reach an absolute neutrophil count of at least 0.5 x 10(9)/L was 22 days (range, 13-52 days). Median time to platelets numbered at least 20 x 10(9)/L was 69 days (range, 49-153 days). Seven patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patients. Twelve patients remained alive and disease-free 3 to 45 months after transplantation. Disease-free survival (DFS) at 1 year was 53%. Age strongly influenced DFS (P =.01). For patients aged 30 years or younger, the DFS at 1 year was 73%. These preliminary results suggest that UD-CBT should be considered a reasonable alternative in young adults with hematologic malignancy and no appropriate bone marrow donor.