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1.
Am J Clin Oncol ; 47(9): 419-424, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38757577

RESUMO

OBJECTIVES: The use of immune checkpoint inhibitors (ICIs) as anticancer therapy across a variety of malignancies has led to durable efficacy in a subset of patients. However, associated side effects denoted immune-related adverse events (irAEs) have emerged and can result in substantial morbidity and mortality. Particularly early in the experience of using these agents, a lack of standardized education regarding irAEs among patients and clinical providers may have contributed to poor outcomes. Optimal management of these emerging toxicities depends on a coordinated institutional approach. We hypothesized that centralized educational programs and electronic health record (EHR)-based interventions, targeted both toward ICI-treated patients as well as patient-interfacing providers, would improve patient outcomes. METHODS: We created a multidisciplinary team of clinicians and associated staff to direct a coordinated approach to the education and management of patients receiving ICIs across our institution. A 3-tiered approach was designed: patient-centered, internally centered, and externally centered. Multimedia educational products were produced for patients to improve knowledge and awareness of ICIs and associated irAEs. An EHR-based banner was deployed to improve identification of patients receiving ICIs across disciplines. Tailored educational seminars were provided to clinicians who interact with ICI-treated patients at all levels. Educational seminars were also offered to local physicians and institutions. We assessed patient uptake of educational products and surrogate patient outcomes to measure the potential impact of our interventions. RESULTS: Fox Chase Cancer Center (FCCC)-specific ICI identification cards were created and distributed to patients. By the end of the investigational period, 98.6% of ICI-treated patients reported receiving a card. An ICI-focused on-line portal was created accessible only to ICI-treated patients, with 9.4% of these patients accessing the portal in the first 6 months without marketing promotion. Deidentified surrogate clinical endpoints of corticosteroid use, direct referral unit (DRU) visits, and hospital admissions all improved during the study period. CONCLUSIONS: Institutionally directed educational initiatives are feasible at a free-standing academic cancer center and may lead to improved outcomes in patients developing irAEs from ICIs. More granular patient-specific data and studies at other types of institutions are necessary to determine the applicability of similar approaches on a broader scale.


Assuntos
Inibidores de Checkpoint Imunológico , Neoplasias , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias/tratamento farmacológico , Masculino , Feminino , Educação de Pacientes como Assunto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Pessoa de Meia-Idade , Registros Eletrônicos de Saúde , Equipe de Assistência ao Paciente , Idoso
2.
BMC Ecol ; 7: 13, 2007 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-17967196

RESUMO

BACKGROUND: There is much debate concerning which ecological constraints are the most limiting factors to seedling recruitment in disturbed communities. We provide the first comparison between selective herbivory and plant competition effects among two post-mined forest ecosystems (primary succession) and one post-fire woodland ecosystem (secondary succession). Animal exclosure assessments of nine common species across eight sites were performed for comparison within three locations separated by up to 200 km. Additionally, we asked whether pre-browsed plants differed in nutrient content between or within species in the separate systems. RESULTS: Among the nine common species, seven of these were affected by mammal herbivory while five shared a similar vulnerability to predation regardless of system. One species was limited by competition (planting density). There was a strong linear correlation between herbivore selectivity (% browsed) and impact (biomass loss) on the fertilized minesites, but not post-fire sites. Phosphorus and potassium were higher for most species in the post-mined system. Principal components analyses revealed that nutrients in shortest supply may be the most likely components of selection within each system. Among all locations, species with highest levels of phosphorus, ADF and leaf water content were often favoured, while high tannins and nitrogen content were generally selected against. CONCLUSION: Herbivory, rather than seedling competition, was the limiting factor for plant performance among post-fire and post-mined reclamation areas. The post-fire seedlings were smaller and more water and nutrient limited, nevertheless browsing prevalence was equivalent at all locations with nearly all seedlings predated. Kangaroo density in the post-fire community declined from the beginning of the experiment, while numbers in the post-mined revegetation increased fourfold within one year. Differences in water and nutrient availability may explain why herbivores are more likely to be attracted to post-mined communities.


Assuntos
Ecossistema , Incêndios , Mamíferos/fisiologia , Mineração , Plântula , Animais , Biomassa , Comportamento Alimentar
3.
J Chem Ecol ; 29(12): 2621-35, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14969351

RESUMO

Preliminary studies indicate that western grey kangaroos browse seedlings of non-Myrtaceae species rather than Myrtaceae. Seven morphologically-matched species pairs of Myrtaceae/non-Myrtaceae placed at three field sites showed that kangaroos avoided the essential-oil-containing Myrtaceae, but readily consumed the matched essential-oil-lacking non-Myrtaceae. The one exception (Pittosporaceae) had limited herbivory and was later found to possess two essential oils in its leaves. Gas chromatography and mass-spectra showed the seven Myrtaceae plants contain between 2 and 9 essential oils in their leaves, particularly the highly volatile monoterpene, 2,5-dimethyl-3-methylene-1,5-heptadine. Three of the above species pairs were used to gauge their effectiveness as nurse plants for a highly palatable legume. Plants placed beside Myrtaceae nurse plants were less browsed than those placed beside non-Myrtaceae nurse plants. We conclude that western grey kangaroos use olfactory cues to avoid foliage containing potentially toxic essential oils, and that this also has implications for seedling recruitment patterns in regenerating communities.


Assuntos
Comportamento Alimentar , Macropodidae , Myrtaceae/química , Óleos Voláteis/análise , Olfato , Animais , Cromatografia Gasosa-Espectrometria de Massas , Óleos Voláteis/intoxicação , Plantas Comestíveis , Plântula/química
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