Clinical Utility of an AI-powered, Handheld Elastic Scattering Spectroscopy Device on the Diagnosis and Management of Skin Cancer by Primary Care Physicians.

BACKGROUND: Patients with lesions suspicious for skin cancer often present to primary care physicians (PCPs), who may have limited training in skin cancer diagnosis. OBJECTIVE: To measure the impact of an adjunctive handheld device for PCPs that employs elastic scattering spectroscopy (ESS) on the diagnosis and management of skin cancer. METHODS: Fifty-seven PCPs evaluated 50 clinical images of skin lesions (25 malignant and 25 benign), first without and then with knowledge of the handheld ESS device output, and in each case indicated if a lesion was likely to be benign or malignant. RESULTS: The diagnostic sensitivity of the PCPs with and without the use of the ESS device was 88% (95% CI, 84%-92%) and 67% (95% CI, 62%-72%), respectively (P < .0001). In contrast, no significant difference was observed in the diagnostic specificity. The management sensitivity of the physicians with and without the use of the ESS device was 94% (95% CI, 91%-96%) and 81% (95% CI, 77%-85%), respectively (P = .0009). Similarly, no significant difference was observed in the management specificity. CONCLUSION: The use of the ESS device may have the potential to help improve skin cancer diagnosis and confidence in management decision-making in a primary care setting.

Atrial fibrillation in older adults with cancer.

Cancer and atrial fibrillation (AF) are common co-morbid conditions in older adults. Both cancer and cancer treatment increase the risk of developing new AF which increases morbidity and mortality. Heart rate and rhythm control along with anticoagulation therapy remain the mainstay of treatment of AF in older adults with both cancer and AF. Adjustments to the treatment may be necessary because of drug interactions with concurrent chemotherapy. Cancer and old age increase the risk of both, thromboembolism and bleeding. The risk of these complications is further enhanced by concomitant cancer therapy, frailty, poor nutrition status and, coexisting geriatric syndromes. Therefore, careful attention needs to be given to the risks and benefits of using anticoagulant medications. This review focuses on the management of AF in older patients with cancer, including at the end-of-life care.

Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer.

The incidence of most cancers increases with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. The prevention and identification of cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This first of a two-part review addresses special considerations regarding cancer prevention for adults aged 65 and older. Screening decisions and the impact of limited life expectancy and an older adult's ability to tolerate cancer treatment are also addressed. Guidance is provided regarding the prevention and early identification of lung, colorectal, bladder, and kidney cancer in older adults. The prevention of breast, prostate, and female urogenital cancers are addressed in Part 2. J Am Geriatr Soc 68:2399-2406, 2020.

Cancer Prevention and Screening for Older Adults: Part 2. Interventions to Prevent and Screen for Breast, Prostate, Cervical, Ovarian, and Endometrial Cancer.

The incidence of most cancers increase with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. Although cancer is feared primarily because of premature mortality, for many older adults, preventing and identifying cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This is the second part of a two-part clinical review on cancer prevention and screening for adults aged 65 and older. Guidance is provided regarding the prevention and early identification of breast, prostate, cervical, ovarian, and endometrial cancer. The prevention of lung, colorectal, bladder, and kidney cancer is addressed in Part 1.

The Prevention of Cardiovascular Disease in Older Adults.

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098-1106, 2020.

Best practices in hospital end-of-life care.

The Connecticut Best Practices in End-of-Life Care project was initiated in response to the concern that Connecticut hospitals were not meeting the needs of dying patients. The records of 420 patients with a diagnosis of cancer or with an admission to an intensive-care unit were reviewed for the period 04/01/2000 to 03/31/2001. Utilizing a chart extraction tool, measures of "best practice" were developed as a means of assessing the quality of end-of-life care provided to the patient cohort. Some of the findings on the "best practice" indicators were as follows: 65 (15.3%) of the patient cohort died during their hospital stay. Three hundred forty (81.3%) had a pain assessment on admission. Three hundred eighty-six (92.6%) had a pain assessment on at least one occasion during their hospital stay. Two hundred forty-two of 397 (61%) patients who received an analgesic medication had their pain reassessed within fours hours of receiving the medication. One hundred ninty-five (46.4%) patients had their prognosis discussed with them. Eighteen patients (< 5%) were referred to hospice. Connecticut hospitals are doing well in assessing patient pain. However, they are doing poorly in discussing prognosis with sick patients and referring them to hospice.