An Online Pediatric Palliative Care Education and Mentoring (Project ECHO) in Nepal: A Program Implementation Case Study and Assessment of Changes in Healthcare Providers' Knowledge, Confidence, and Attitudes.

OBJECTIVES: The goal of this implementation study was to describe the implementation and evaluation of the impact of an online pediatric palliative care training program in Nepal, using the Project ECHO model. METHODS: The study used mixed methods, including a program case study describing the online learning program and before-and-after surveys of program participants, assessing learning through changes in knowledge, comfort, and attitudes. An end-of-program survey was used to evaluate participants' overall experiences with the learning program and use of the learning resources. RESULTS: A literature review, stakeholder surveys, and expert input informed the design of the intervention. The course used the Project ECHO model of online education, with modifications based on the leadership team's previous ECHO experiences and local stakeholder input. The intervention occurred over 9 months, with 22 online teaching sessions. Each session consisted of a didactic lecture, case presentation, and interactive discussion with expert clinical teachers. Fifty-five clinicians in Nepal participated, including physicians (47%), nurses (44%), and psychotherapists (5%). Clinicians reported improvements in knowledge, skills, and attitudes after program participation. Program acceptability scores were high, with 93% of participants reporting that the course provided effective learning. CONCLUSIONS: Project ECHO can be successfully implemented to deliver continuing professional development in Nepal. Delivering palliative care education online using the Project ECHO model, leads to improved knowledge, skills, and attitudes for clinicians. Project ECHO suggests an innovative solution which can provide training and support to clinicians in settings where educational opportunities in palliative care are limited.

Biodistribution Analysis of Peptide-Coated Magnetic Iron Nanoparticles: A Simple and Quantitative Method.

Biodistribution tracks compounds or molecules of interest in vivo to understand a compound's anticipated efficacy and safety. Nanoparticles deliver nucleic acid and drug payloads and enhance tumor permeability due to multiple properties such as high surface area to volume ratio, surface functionalization, and modifications. Studying the in vivo biodistribution of nanoparticles documents the effectiveness and safety of nanoparticles and facilitates a more application-driven approach for nanoparticle development that allows for more successful translation into clinical use. In this study, we present a relatively simple method to determine the biodistribution of magnetic iron nanoparticles in mice. In vitro, cells take up branched amphiphilic peptide-coated magnetic nanobeads (BAPc-MNBs) like their counterparts, i.e., branched amphiphilic peptide capsules (BAPCs) with a hollow water-filled core. Both BAPc-MNBs and BAPCs have widespread applications as a nanodelivery system. We evaluated the BAPc-MNBs tissue distribution in wild-type mice injected intravenously (i.v.), intraperitoneally (i.p.), or orally gavaged to understand the biological interactions and to further the development of branched amphiphilic peptide-based nanoparticles. The magnetic nanoparticles allowed collection of the BAPc-MNBs from multiple organs by magnetic bead sorting, followed by a high-throughput screening for iron content. When injected i.v., nanoparticles were distributed widely to various organs before elimination from the system via the intestines in feces. The spleen accumulated the highest amount of BAPc-MNBs in mice administered NPs via i.v. and i.p. but not via oral gavage. Taken together, these data demonstrate that the magnetic sorting not only allowed quantification of the BAPc-MNBs but also identified the distribution of BAPc-MNBs after distinct administration methods.

Broad-Scale Assessment of Methylmercury in Adult Amphibians.

Mercury (Hg) is a toxic contaminant that has been mobilized and distributed worldwide and is a threat to many wildlife species. Amphibians are facing unprecedented global declines due to many threats including contaminants. While the biphasic life history of many amphibians creates a potential nexus for methylmercury (MeHg) exposure in aquatic habitats and subsequent health effects, the broad-scale distribution of MeHg exposure in amphibians remains unknown. We used nonlethal sampling to assess MeHg bioaccumulation in 3,241 juvenile and adult amphibians during 2017-2021. We sampled 26 populations (14 species) across 11 states in the United States, including several imperiled species that could not have been sampled by traditional lethal methods. We examined whether life history traits of species and whether the concentration of total mercury in sediment or dragonflies could be used as indicators of MeHg bioaccumulation in amphibians. Methylmercury contamination was widespread, with a 33-fold difference in concentrations across sites. Variation among years and clustered subsites was less than variation across sites. Life history characteristics such as size, sex, and whether the amphibian was a frog, toad, newt, or other salamander were the factors most strongly associated with bioaccumulation. Total Hg in dragonflies was a reliable indicator of bioaccumulation of MeHg in amphibians (R2 ≥ 0.67), whereas total Hg in sediment was not (R2 ≤ 0.04). Our study, the largest broad-scale assessment of MeHg bioaccumulation in amphibians, highlights methodological advances that allow for nonlethal sampling of rare species and reveals immense variation among species, life histories, and sites. Our findings can help identify sensitive populations and provide environmentally relevant concentrations for future studies to better quantify the potential threats of MeHg to amphibians.

Biodistribution Analysis of Peptide-Coated Magnetic Iron Nanoparticles: A Simple and Quantitative Method.

Biodistribution is the tracking of compounds or molecules of interest in the subject which is integral to understanding their anticipated efficacy and safety. Nanoparticles are highly desirable delivery systems which have the ability to deliver higher nucleic acid and drug payloads and they have enhanced tumor permeability due to their unique properties such as high surface area to volume ratio. Studying the biodistribution of nanoparticles is crucial to understand their effectiveness and safety in vivo, facilitate a more application driven approach for nanoparticle development which will lead to their successful translation into clinical use. In this study, we present a relatively simple method to determine the biodistribution of magnetic iron nanoparticles in mice. Branched Amphiphilic Peptide coated Magnetic Nanobeads BAPc-MNBs like their counterpart i.e., Branched Amphiphilic Peptide capsules (BAPCs) with a hollow water-filled core, are readily taken up by cells in vitro and have widespread application as a nanodelivery systems. We evaluated the BAPc-MNBs tissue distribution in wildtype mice injected intravenously (i.v.), intraperitoneally (i.p.) or orally gavaged to understand the biological interactions of the peptide nanoparticles and to further the development of branched amphiphilic peptides-based nanoparticles. BAPc-MNBs were distributed widely to various organs when injected i.v. and were eliminated from the system via the intestines in feces. The spleen was found to accumulate the highest amount of BAPc-MNBs in mice administered the NPs i.v. and i.p. while they were not absorbed into the system via oral gavage. This study not only presents a relatively simple quantification method to determine in vivo biodistribution of magnetic iron nanoparticles that can be widely applied but also demonstrates the potential of Branched Amphiphilic Peptides in the form of BAPCs or BAPc-MNBs as a delivery system.

[Empowering yourself to better participate in feedback: a new cognitive-behavioural model for medical learners]. / S'outiller pour mieux participer à la rétroaction : Un nouveau modèle cognitivo-comportemental destiné aux apprenants en médecine.

Sharing formative feedback is inherent in the supervision process and the acceptance of feedback by learners is an essential step in learning. However, receiving feedback from the supervisor evokes emotions and accepting it is not easy. Several recommendations guide preceptors on how to share feedback with learners and all emphasize the importance of encouraging the learner to actively interact in the feedback process. Although studies point to the positive effect of informing and training learners about feedback, few focus on their responsiveness to feedback. Under the rubric of developing a personal skill to better accept feedback, we propose a new behavioral model, called H.O.S.T., which aims to guide learners to approach feedback with a personal growth mindset associated with the learning position. Specifically, the model presents an interdependent set of attitudes and behaviors that aim to facilitate emotional management and engagement in the feedback process, in order to initiate the reflective process necessary for learning and to enable the acquisition of targeted skills. The acronym H.O.S.T. reminds students of the four essential elements of the behavioral model: humility, openness, shared explicitness and tenacity. Based on the positive psychology movement, each element is defined and justified by known theoretical concepts. In order to better assimilate the components of the model, the use of internal dialogue is adopted to facilitate the training and adoption of behaviors. The essence of the model is discussed in light of the feedback literacy dedicated to learners.

Statins for primary prevention in multimorbid patients: to prescribe or not to prescribe? A qualitative analysis of general practitioners' decision-making processes.

INTRODUCTION: A better understanding of the determinants involved in general practitioners' (GPs) decision-making processes when it comes to prescribing statins as primary prevention in patients with multimorbidity could provide insights for improving implementation of primary prevention guidelines. METHODS: We conducted a qualitative study using a deductive framework-based and inductive analysis of GPs' semi-structured interviews verbatim, from which expertise profiles of prescribers were also drawn. The analytical framework was built from a pragmatic synthesis of the evidence-based medicine, Modelling using Typified Objects (MOT) model of clinical reasoning processes, Theoretical Domains Framework, and shared decision-making frameworks. RESULTS: Fifteen GPs were interviewed between June 2019 and January 2020. Diabetes seemed to represent a specific motivation for deciding about statin prescription for primary prevention purposes; and in situations of multimorbidity, GPs differentiated between cardiovascular and non-cardiovascular multimorbidity. Expert prescribers seemed to have integrated the utilisation of cardiovascular risk calculation scores throughout their practice, whereas non-expert prescribers considered them difficult to interpret and preferred using more of a "rule of thumb" process. One interviewee used the risk calculation score as a support for discussing statin prescription with the patient. CONCLUSION: Our results shed light on the reasons why statins remain under-prescribed for primary prevention and why non-diabetic multimorbid patients have even lower odds of being prescribed a statin. They call for a change in the use of risk assessment scores, by placing them as decision aids, to support and improve personalised shared decision-making discussions as an efficient approach to improve the implementation of recommendations about statins for primary prevention.

[Drugs: minors and harm reduction?] / Drogues : mineur-e-s et réduction des risques ?

The use of controlled substances (narcotics and psychotropic substances) poses increased risks for minors. However, minors are generally excluded from existing harm reduction services (e.g. drug consumption rooms, drug checking, exchange of consumption material). Based on public health considerations, the authors recommend the establishment of harm reduction services for minors.

La consommation de substances soumises à contrôle (stupéfiants et substances psychotropes) présente des risques accrus pour les mineur-e-s. Pourtant, ces derniers sont généralement exclus des offres existantes de réduction des risques et des méfaits (par exemple, locaux de consommation, drug checking, échange de matériel de consommation). Sur la base de considérations de santé publique, les auteurs recommandent la création de services de réduction des risques dédiés aux mineur-e-s.

Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review.

The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.

Heterogeneity of definitions and measurements of binge drinking in research on adolescents and young adults.

INTRODUCTION: Binge drinking is a widespread health compromising behaviour among adolescents and young adults and is one of the leading causes of mortality and injuries among this population. The definitions and measurement methods of binge drinking are heterogeneous but constitute a crucial component in the literature on associated factors related to binge drinking. This study focused on how binge drinking is defined and measured in the literature exploring its associated risk factors among adolescents and young adults. METHODS: The databases PubMed, Embase, PsycINFO and Social Care were searched for articles published between 1 January 2006 and 30 April 2020 using 3 concepts: binge drinking; risk or protective factors; and adolescents/young adults with respective key words. Data were extracted on the main characteristics of studies and the parameters of binge drinking measurements. RESULTS: 173 studies were included, mostly cross-sectional (61 %) and longitudinal (38 %). Only 23 % of the studies explicitly referred to a standardised definition of binge drinking even though 76 % of the studies used a consensual threshold of 5 drinks or more for men. A lower threshold for women was applied in 26 % of the studies. Recall periods ranged between 2 weeks and 1 year in 85 % of the studies and only 16 % presented binge drinking in terms of frequency and/or quantity of drinks. CONCLUSION: Our results highlight the heterogeneity in the definitions and measurements of binge drinking, raising concerns for meaningful comparisons between studies focused on factors associated with the behaviour. The scientific community needs to be aware of these variations and address the gap of poor stratification and inconsistencies in binge drinking reporting.

Child-centred harm reduction.

Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority - both relating to their own use and the effects of drug use among parents or within the family - are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as 'child-centred harm reduction'. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.

Effect of proton pump inhibitors and other commonly prescribed drugs on rescanning of patients undergoing myocardial perfusion imaging: a case-control study.

OBJECTIVES: Proton pump inhibitor use is associated with increased gastric wall activity on myocardial perfusion imaging; however, the clinical impact is unknown. We sought to determine the association of the use of proton pump inhibitors and nine other commonly prescribed classes of medications on the risk of rescanning patients undergoing myocardial perfusion imaging. METHODS: A matched case-control study was performed including 337 rescanned cases and 337 same-day controls from a total of 5432 patients undergoing myocardial perfusion imaging (MPI) over a 4-year period. RESULTS: The odds of rescanning was higher in patients taking a proton pump inhibitor than those not [adjusted odds ratio (OR), 1.6; 95% confidence interval (CI), 1.1-2.2] and in those taking an angiotensin-converting enzyme inhibitor than those not (adjusted OR, 1.5; 95% CI, 1.0-2.2) adjusted for age, sex and BMI category. Eight other commonly prescribed medications showed no associations with rescanning. Among the cases of rescanning, the culprit organ site of extracardiac activity was the left lobe of the liver, 48%; gastric wall, 31%; gastric lumen, 12%; spleen, 7% and bowel <1%. Proton pump inhibitor use was strongly associated with rescanning due to gastric wall uptake (adjusted OR, 6.3; 95% CI, 2.8-14.1) but not the other causes of rescanning. CONCLUSIONS: Proton pump inhibitor use and angiotensin-converting enzyme inhibitor use are associated with an increased risk of rescanning of patients undergoing MPI. Gastric wall activity is likely to account for the excess cases of rescanning in those taking a proton pump inhibitor.

Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France.

Background: Statins are a first line, evidence-based yet underprescribed treatment for cardiovascular primary prevention. In primary care settings, multimorbidity is a complex situation which makes it difficult to apply prevention guidelines. Aim: To assess the associations between multimorbidity and prescription of statins in accordance with the 2016 ESC recommendations ("appropriate prescription"), and to identify the factors and conditions associated with these prescriptions. Design and setting: Cross-sectional prospective study in the French region of Rhône-Alpes among 40 general practitioners and their patients. Methods: We examined the association between appropriate statin prescription and several patient characteristics, including multimorbidity, using multivariate logistic regression models. Results: Between August 2017 and February 2019, 327 patients were included in the study. Seventy-four (22.6%) were on statin medication and 199 (60.9%) exhibited multimorbidity, defined as ≥2 diseases. Only 22.5% of eligible patients were prescribed statins for primary prevention. Diabetes was most strongly associated with appropriate statin prescription (aOR 8.10, CI 95: 3.81-17.80). Multimorbidity was not associated with appropriate statin prescription (aOR 1.31, CI 95: 0.54-3.26), except in the presence of diabetes which defined diabetic multimorbidity (aOR 10.46, CI 95: 4.87-23.35). Conversely, non-diabetic multimorbidity was associated with lower odds of being appropriately prescribed a statin (aOR 0.26, CI 95: 0.12-0.56). Conclusion: Multimorbidity, in itself, does not seem to be a determinant factor for appropriate statin prescription. The latter appears to be determined by a patient's type of multimorbidity, especially the presence or not of diabetes. Differentiating between diabetic and non-diabetic multimorbidity may be a pragmatic way for GPs to improve primary prevention in a patient-centered and shared decision-making approach.

Exploring Health Professionals' Experiences With a Virtual Learning and Mentoring Program (Project ECHO) on Pediatric Palliative Care in South Asia.

Project ECHO (Extension of Community Healthcare Outcomes) is an innovative model of online education which has been proposed to enhance access to palliative care in resource-limited settings. There is limited literature describing how health care providers in low-and middle-income countries benefit from and learn from this type of training. This qualitative description study explores the learning experiences of participants in a Project ECHO program on pediatric palliative care in South Asia through focus group discussions. Discussions were transcribed, coded, independently verified, and arranged into overarching themes. We identified learning themes including the importance of creating a supportive learning community; the opportunity to share ideas and experiences; gaining knowledge and skills, and access to additional learning materials. Designing future programs to ensure a supportive and interactive learning community with attention cultural challenges may enhance learning from future Project ECHO programs.

Synthesis and conformation of backbone N-aminated peptides.

The chemical modification of peptides is a promising approach for the design of protein-protein interaction inhibitors and peptide-based drug candidates. Among several peptidomimetic strategies, substitution of the amide backbone maintains side-chain functionality that may be important for engagement of biological targets. Backbone amide substitution has been largely limited to N-alkylation, which can promote cis amide geometry and disrupt important H-bonding interactions. In contrast, N-amination of peptides induces distinct backbone geometries and maintains H-bond donor capacity. In this chapter we discuss the conformational characteristics of designed N-amino peptides and present a detailed protocol for their synthesis on solid support. The described methods allow for backbone N-amino scanning of biologically active parent sequences.

Complement Initiation Varies by Sex in Intestinal Ischemia Reperfusion Injury.

Intestinal ischemia reperfusion (IR)-induced tissue injury represents an acute inflammatory response with significant morbidity and mortality. The mechanism of IR-induced injury is not fully elucidated, but recent studies suggest a critical role for complement activation and for differences between sexes. To test the hypothesis that complement initiation differs by sex in intestinal IR, we performed intestinal IR on male and female WT C57B6L/, C1q-/-, MBL-/-, or properdin (P)-/- mice. Intestinal injury, C3b and C5a production and ex vivo secretions were analyzed. Initial studies demonstrated a difference in complement mRNA and protein in male and female WT mice. In response to IR, male C1q-, MBL- and P-deficient mice sustained less injury than male WT mice. In contrast, only female MBL-/- mice sustained significantly less injury than female wildtype mice. Importantly, wildtype, C1q-/- and P-/- female mice sustained significant less injury than the corresponding male mice. In addition, both C1q and MBL expression and deposition increased in WT male mice, while only elevated MBL expression and deposition occurred in WT female mice. These data suggested that males use both C1q and MBL pathways, while females tend to depend on lectin pathway during intestinal IR. Females produced significantly less serum C5a in MBL-/- and P-/- mice. Our findings suggested that complement activation plays a critical role in intestinal IR in a sex-dependent manner.

Detaining people who use drugs in Cambodia: A dual-track system.

Reports focusing on drug detention centres in Cambodia have predominantly been concerned with documenting conditions and human rights abuses in the government centres, while highlighting the failure of the Royal Government of Cambodia (RGC) to adopt a human rights and public health-based approach to substance use issues. They have not focused as extensively on the underlying institutional, legal and regulatory reasons that help explain, though not justify, the RGC's law-enforcement-based approach to illicit substance use in Cambodia. Therefore, this policy analysis examines Cambodia's legal and regulatory set-up, in particular how the criminal provisions of the laws governing substance use combined with the administrative mechanisms in place shape the county's drug-related practices. This paper is based on a wide-ranging literature review of primary legislative and interpretive material; international human rights, public health and drug control instruments; research papers and international reports from multilateral agencies, international non-governmental organisations, civil society and academic experts. Qualitative interviews were also carried out with key international agency, national and international NGO officers. By examining the Law on the Control of Drugs (2012), the RGC's main law covering substance use, as well as relevant administrative provisions, it becomes apparent that there are two parallel systems in place for sending people to drug detention centres in Cambodia: one based on criminal law and the other through an 'alternative' administrative avenue. This division constitutes a structural fragmentation, or two 'parallel tracks', that provide law enforcement and other relevant RGC agencies with a wide sphere of discretion for how to address drug-related issues. The result is an enhanced risk of serious human rights violations for people who use drugs in Cambodia.

Using Virtual Learning to Build Pediatric Palliative Care Capacity in South Asia: Experiences of Implementing a Teleteaching and Mentorship Program (Project ECHO).

Palliative care is an important component of pediatric cancer treatment that provides holistic support for children and their families. In low- and middle-income countries, where 98% of the children needing palliative care reside, access to palliative care services is often very limited. Training opportunities for healthcare professionals are essential to improve access to palliative care in these settings. Virtual learning, which brings training and mentorship directly to learners, can improve access to educational opportunities for staff in resource-limited settings. In this report, we describe a novel and evolving model of building pediatric palliative care (PPC) capacity in South Asia. We describe the design, implementation, challenges, and subsequent modifications of our program, as well as the impact of the program for participants and for PPC service delivery in South Asia. Our teleteaching and mentoring program (Project ECHO) [Extension for Community Healthcare Outcomes] consisted of biweekly videoconference sessions with didactic teaching and case-based discussions. The program focused on engaging participants in meaningful learning by focusing on opportunities for participant interaction through teachings and case discussions. Participants identified the program as particularly beneficial for improving their knowledge and confidence in managing seriously ill children. Project ECHO is a novel model of building PPC capacity that is suitable for resource-limited settings. Key modifications to the Project ECHO model include a course-specific leadership team, developing learning plans to address the specific learning needs of participants, focusing on ensuring learner participation during sessions, and using social media and electronic resources to create opportunities for further learning outside of ECHO sessions. These adaptations may improve the efficacy of Project ECHO and others using virtual learning programs in resource-limited settings.

Monitoring wetland water quality related to livestock grazing in amphibian habitats.

Land use alteration such as livestock grazing can affect water quality in habitats of at-risk wildlife species. Data from managed wetlands are needed to understand levels of exposure for aquatic life stages and monitor grazing-related changes afield. We quantified spatial and temporal variation in water quality in wetlands occupied by threatened Oregon spotted frog (Rana pretiosa) at Klamath Marsh National Wildlife Refuge in Oregon, United States (US). We used analyses for censored data to evaluate the importance of habitat type and grazing history in predicting concentrations of nutrients, turbidity, fecal indicator bacteria (FIB; total coliforms, Escherichia coli (E. coli), and enterococci), and estrogenicity, an indicator of estrogenic activity. Nutrients (orthophosphate and ammonia) and enterococci varied over time and space, while E. coli, total coliforms, turbidity, and estrogenicity were more strongly associated with local livestock grazing metrics. Turbidity was correlated with several grazing-related constituents and may be particularly useful for monitoring water quality in landscapes with livestock use. Concentrations of orthophosphate and estrogenicity were elevated at several sites relative to published health benchmarks, and their potential effects on Rana pretiosa warrant further investigation. Our data provided an initial assessment of potential exposure of amphibians to grazing-related constituents in western US wetlands. Increased monitoring of surface water quality and amphibian population status in combination with controlled laboratory toxicity studies could help inform future research and targeted management strategies for wetlands with both grazing and amphibians of conservation concern.

What Can Be Learned from the Early Stages of the COVID-19 Vaccination Rollout in Australia: A Case Study.

This paper addresses the SARS-CoV-2 vaccination progress in Australia. Globally, Australia was initially praised for its national COVID-19 response, reflecting well with regard to case numbers and mortality rates. However, Australia's progress with its vaccine rollout has come under scrutiny. When compared globally, it fares very low in terms of the number of vaccine doses administered. This paper discusses the first three months of the vaccination process, and the challenges Australia faced during that time. Through an extensive literature review, data was collected on relevant topics concerning all aspects of the Australian COVID-19 situation. The following key points are discussed: the specific COVID-19 organisation at the federal vs. the state government levels, the Australian economy, the vaccine supply strategy, and the vaccine priority roll out. In conclusion, we highlight the impact of Australia initially relying heavily on the AstraZeneca vaccine, which subsequently came under fire regarding safety issues likely linking the vaccine to thrombosis with thrombocytopenia syndrome (TTS).

Prognostic importance of coincidental coronary artery calcification on FDG-PET/CT oncology studies.

Coronary artery calcification (CAC) on body CT imaging is considered a coincidental finding in cancer patients. In order to determine the significance of CAC in cancer patients we evaluated the prognostic utility of CAC detected on oncology FDG-PET/CT studies. A retrospective study was performed of consecutive FDG-PET/CT studies from January to March 2011. CAC was identified on the CT portion of FDG/PET-CT studies. Chart review documented statin use, the Framingham risk score (FRS) (includes age, diabetes, hypertension, dyslipidemia and smoking), the primary malignancy and metastases. The primary end point was a composite of death and cardiovascular (CV) events (non-fatal myocardial infarction (MI), PCI or coronary artery bypass surgery (CABG)). 266 patients had a median follow up of 41 months (95% CI 31-56 months). CAC was noted in 140 patients. Based on CAC, potentially 84 patients would have had a change in statin prescribing (p < 0.01). CAC was associated with the primary end point on univariable and multivariable analysis (OR 2.6 (95% CI 1.42-4.77) (p < 0.01). On univariable Kaplan-Meier survival analysis, CAC was associated with decreased survival only in the absence of metastases (p < 0.01). Cox proportional hazard modelling demonstrated CAC was associated with mortality and cardiac events in patients without metastases, whereas FRS was not (For CAC: HR 1.69 (95% CI 1.22-2.35), p = 0.002). CAC is commonly detected with oncology FDG-PET/CT. In cancer patients CAC was associated with an increased risk of clinical events. CAC reduced survival free time in patients without metastases. CAC might therefore be considered more than a coincidentaloma in patients without metastases.