What Does a Cardio-oncology Service Offer to the Oncologist and the Haematologist?

Cardio-oncology is an emerging subspecialty arising from the need for multidisciplinary collaboration to address the increasing prominence of cardiovascular disease (CVD) among cancer patients. This overview outlines the case for establishing cardio-oncology services and defines the ways in which these services benefit cancer patients. The primary objective of cardio-oncology is to manage CVDs in order to allow cancer patients to complete the best cancer treatments safely and with minimal interruption. In the decades since the first discovery of heart failure induced by anthracycline chemotherapy, both cardiovascular and oncological science have advanced considerably. Cardio-oncology services aim to bring together expertise from these two fast moving fields in order to provide optimal evidence-based care for cancer patients with CVDs. Here we discuss the basis of cardio-oncology services by presenting their rationale and key components, as well as their essential roles in education, training and research. At each stage of the cancer care pathway, a cardio-oncology service can add value by ensuring cancer patients have timely access to specialist care backed up by cutting edge diagnostic tools and treatment options, as well as holistic supports. We highlight areas of recent and upcoming developments in the field that are likely to change established clinical practice. Improved cardiac imaging modalities can detect chemotherapy-related cardiac dysfunction earlier and are also essential for the prompt diagnosis of an expanding range of cardiovascular effects complicating newer cancer therapeutics, such as immune checkpoint inhibitors and other targeted therapies. Modern cancer therapy has dramatically improved cancer survival and as such CVD is becoming one of the principal determinants of overall outcome for cancer patients. A dedicated cardio-oncology service can facilitate the optimisation of cardiovascular treatment and enable the completion of cancer therapy. A multidisciplinary collaborative approach is key to achieving these objectives.

The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging.

OBJECTIVE: To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo (Spain). METHODS: Data were taken from the Toledo Study for Healthy Aging, a population-based study conducted on 2,488 individuals aged 65 years and older. Study participants were selected by a two-stage random sampling from the municipal census of Toledo, covering both institutionalized and community dwelling persons from rural and urban settings. Data were collected from 2006 to 2009, and included information on social support, activities of daily living, comorbidity, physical activity, quality of life, depressive symptoms, and cognitive function. In addition, a nurse collected anthropometric data, conducted tests of physical performance (walk speed, upper and lower extremities strength, and the stand-and-sit from a chair test) and obtained a blood sample. The diagnosis of the frailty syndrome was based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). RESULTS: In total, 41.8% (95% confidence interval [CI] 39.4-44.2%) of the study participants were prefrail, and 8.4% (95% CI 7.1-9.8%) were frail. There were no differences in the prevalence of frailty by sex, level of education, occupation, marital status, or place of residence. The frequency of the frailty syndrome increased with age, and was higher in those with disability, depression, hip fracture and other comorbidity, such as cardiovascular disease and disorders of the central nervous system. CONCLUSIONS: The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other populations in the Mediterranean basin.

Wave and sediment dynamics along a shallow subtidal sandy beach inhabited by modern stromatolites.

To help define the habitat of modern marine stromatolites, wave-dominated flow and sediment transport were studied in the shallow subtidal region (1-2 m depth) along the slightly concave, windward face of Highborne Cay, Exuma, Bahamas - the only face of the cay that includes a population of stromatolites concentrated near the region of highest curvature of the beach. Wave energy impacting this island's most exposed beach was driven by local wind forcing which increases largely in response to the passage of atmospheric disturbances that typically affect the region for periods of a few days. Although some wave energy is almost always noted (maximum horizontal orbital speeds at the bottom are rarely <10 cm s(-1)), wave conditions remain comparatively calm until local winds increase above speeds of approximately 3-4 m s(-1) at which point maximum wave speeds rapidly increase to 50-80 cm s(-1). Stromatolites, which are largely restricted to the shoreward side of a shallow platform reef, are sheltered by the reef beyond which wave speeds are one to four times higher (depending on tidal stage). Moreover, stromatolite populations are predominantly found along a region of this wave-exposed beach that experiences comparatively reduced wave energy because of the curved morphology of the island's face. Maximum wave speeds are 1.4 to 2 times higher along more northern sections of the beach just beyond the locus of stromatolite populations. A quantitative model of sediment transport was developed that accurately predicted accumulation of suspended sediment in sediment traps deployed in the shallow subtidal zone along this beach. This model, coupled with in situ wave records, indicates that gross rates of suspended sediment deposition should be two to three times higher northward of the main stromatolite populations. Regions of the beach containing stromatolites nevertheless should experience significant rates of gross suspended sediment deposition averaging 7-10 g cm(-2) day(-1) ( approximately 4-6 cm day(-1)). Results suggest that one axis of the habitat of modern marine stromatolites may be defined by a comparatively narrow range of flow energy and sediment transport conditions.