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BACKGROUND: Outpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use. METHODS: This retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate. RESULTS: Of the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8-21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels. CONCLUSION: A structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.
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Neoplasias da Mama , Farmácias , Humanos , Feminino , Neoplasias da Mama/patologia , Letrozol/uso terapêutico , Fulvestranto/uso terapêutico , Quinase 4 Dependente de Ciclina , Estudos Retrospectivos , Inibidores de Proteínas Quinases , Assistência Centrada no Paciente , Protocolos de Quimioterapia Combinada AntineoplásicaRESUMO
OBJECTIVES: This study aimed to (1) document, globally and by domain, Canadian municipalities' level of age-friendliness, and (2) identify municipality characteristics most associated with age-friendliness. METHODS: A cross-sectional survey was sent to all Canadian municipalities (N=3406) with an online survey of 56 items from 9 domains providing age-friendliness scores. These scores were then crossed with the following municipality characteristics: percentage of adults aged 65 and older, population density, material deprivation, social deprivation, degree of metropolitan influence, implementation step of an age-friendly municipality initiative and geographic area. RESULTS: Nine hundred twenty-one municipalities completed the survey. Overall, municipalities' age-friendliness total score is good (58.4%). Four domains have high scores: Security (80.0%), Respect and social inclusion (65.0%), Outdoor spaces and building (62.2%), and Social participation (62.2%). Higher age-friendliness is associated with metropolitan municipalities, regions other than Prairies and Atlantic, higher residential density, greater proportion of older adults, greater social deprivation, lower material deprivation, and the last step of an age-friendly initiative. CONCLUSION: This portrait of Canadian municipalities' age-friendliness can be used to strengthen actions promoting active aging.
RéSUMé: OBJECTIFS: Cette étude visait à: 1) documenter, globalement et par domaine, le niveau de convivialité des municipalités canadiennes à l'égard des aînés, et 2) identifier les caractéristiques des municipalités les plus associées à cette convivialité. MéTHODE: Une enquête transversale a été soumise à l'ensemble des municipalités canadiennes (N=3 406) à l'aide d'un questionnaire en ligne composé de 56 énoncés répartis dans 9 domaines et permettant d'établir un score de convivialité à l'égard des aînés. Ces scores ont ensuite été mis en relation avec différentes caractéristiques des municipalités: pourcentage de personnes âgées de 65 ans et plus, densité de population, défavorisation matérielle, défavorisation sociale, degré d'influence métropolitaine, étape d'implantation d'une démarche Villes et communautés amies des aînés (VADA) et région géographique. RéSULTATS: Neuf cent vingt-et-une municipalités ont complété le questionnaire. En moyenne, les municipalités présentent globalement une bonne convivialité à l'égard des aînés (58,4 %). Les quatre domaines présentant les scores les plus élevés sont : Sécurité (80,0 %), Respect et inclusion sociale (65,0 %), Espaces extérieurs et bâtiments (62,2 %) et Participation au tissu social (62,2 %). Une convivialité à l'égard des aînés supérieure est associée aux municipalités métropolitaines, aux régions autres que les Prairies et l'Atlantique, à une densité de population élevée, à une proportion supérieure d'aînés, à une défavorisation sociale supérieure, à une défavorisation matérielle inférieure et à la dernière étape d'une démarche VADA. CONCLUSION: Ce portrait de la convivialité des municipalités canadiennes à l'égard des aînés peut servir à renforcer les actions favorisant un vieillissement actif.
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Envelhecimento , Participação Social , Idoso , Canadá , Cidades , Estudos Transversais , HumanosAssuntos
COVID-19/complicações , Surtos de Doenças/estatística & dados numéricos , Pacientes/psicologia , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/transmissão , Vacinas contra COVID-19/uso terapêutico , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Femoral nerve block (FNB) and adductor canal block (ACB) have been used increasingly for pain control during anterior cruciate ligament (ACL) reconstruction in adolescent patients. However, recent evidence suggests that the use of FNB may affect quadriceps strength recovery 6 months after surgery. PURPOSE/HYPOTHESIS: To compare postoperative isokinetic strength in adolescents who received FNB, ACB, or no block for perioperative analgesia during ACL reconstruction. We anticipated lower postoperative quadriceps and hamstring isokinetic deficits in adolescents who received FNB as compared with ACB. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were included in the study if they had undergone hamstring tendon autograft ACL reconstruction by a single surgeon from July 2008 to January 2018 and if they underwent isokinetic muscle testing at 4 to 8 months postoperatively. The participants were divided into 3 groups (no block, FNB, and ACB), and we compared the deficit in percentages between the affected and unaffected limbs as calculated from the isokinetic quadriceps and hamstring strength testing at 60 and 180 deg/s. Between-group analysis was performed using analysis of variance, with an alpha of .05. RESULTS: A total of 98 participants were included in the analysis (31 no block, 36 FNB, and 31 ACB). The mean ± SD age of the patients was 15.26 ± 1.15, 15.50 ± 1.42, and 15.71 ± 1.44, for no block, FNB, and ACB, respectively. At 5.61 months postoperatively, there was no significant difference across the 3 groups in isokinetic quadriceps deficits (P ≥ .99), and the only significant difference in isokinetic hamstring deficit was observed for peak flexion at 180 deg/s, in which the ACB group had lower peak torque than the FNB group (-9.80% ± 3.48% vs 2.37% ± 3.23%; P = .035). The ratio of participants with a deficit exceeding 15% did not differ significantly among the 3 groups. CONCLUSION: Contrary to previous research, our findings indicate only minimal difference in quadriceps strength among the 3 types of perioperative analgesia in adolescents approximately 6 months after ACL reconstruction. The only significant strength deficit was seen in the hamstrings of patients receiving ACB at peak flexion as compared with those receiving FNB.
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Optical coherence tomography (OCT) yields microscopic volumetric images representing tissue structures based on the contrast provided by elastic light scattering. Multipatient studies using OCT for detection of tissue abnormalities can lead to large datasets making quantitative and unbiased assessment of classification algorithms performance difficult without the availability of automated analytical schemes. We present a mathematical descriptor reducing the dimensionality of a classifier's input data, while preserving essential volumetric features from reconstructed three-dimensional optical volumes. This descriptor is used as the input of classification algorithms allowing a detailed exploration of the features space leading to optimal and reliable classification models based on support vector machine techniques. Using imaging dataset of paraffin-embedded tissue samples from 38 ovarian cancer patients, we report accuracies for cancer detection [Formula: see text] for binary classification between healthy fallopian tube and ovarian samples containing cancer cells. Furthermore, multiples classes of statistical models are presented demonstrating [Formula: see text] accuracy for the detection of high-grade serous, endometroid, and clear cells cancers. The classification approach reduces the computational complexity and needed resources to achieve highly accurate classification, making it possible to contemplate other applications, including intraoperative surgical guidance, as well as other depth sectioning techniques for fresh tissue imaging.
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BACKGROUND: To address the challenges of the global aging population, the World Health Organization promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components (i.e., policies, services and structures related to the communities' physical and social environments) should be designed to be age-friendly and help all aging adults to live safely, enjoy good health and stay involved in their communities. Although age-friendly communities are believed to be a promising way to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation and health equity, and their underlying mechanisms. This study aims to better understand which and how key components of age-friendly communities best foster positive health, social participation and health equity in aging Canadians. Specifically, the research objectives are to: 1) Describe and compare age-friendly key components of communities across Canada 2) Identify key components best associated with positive health, social participation and health equity of aging adults 3) Explore how these key components foster positive health, social participation and health equity METHODS: A mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include an age-friendly questionnaire targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, communication and information. The CLSA is a large, national prospective study representative of the Canadian aging population designed to examine health transitions and trajectories of adults as they age. In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation and health equity. DISCUSSION: Building on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help communities to promote age-friendly policies, services and structures which foster positive health, social participation and health equity at a population level.
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Envelhecimento , Promoção da Saúde/métodos , Saúde da População , Características de Residência/estatística & dados numéricos , Idoso , Canadá , Estudos Transversais , Feminino , Equidade em Saúde , Humanos , Masculino , Estudos Prospectivos , Participação Social , Inquéritos e QuestionáriosRESUMO
Heat and salt transfer from the Indian Ocean to the Atlantic Ocean (Agulhas leakage) has an important effect on the global thermohaline circulation and climate. The lack of long transfer record prevents elucidation of its role on climate changes throughout the Quaternary. Here, we present a 1,350-ka accumulation rate record of the planktic foraminiferal species Globorotalia menardii. We demonstrate that, according to previous assumptions, the presence and reseeding of this fauna in the subtropical southeast Atlantic was driven by interocean exchange south of Africa. The Agulhas transfer strengthened at glacial ice-volume maxima for every glacial-interglacial transition, with maximum reinforcements organized according to a 400-ka periodicity. The long-term dynamics of Agulhas leakage may have played a crucial role in regulating meridional overturning circulation and global climate changes during the Mid-Brunhes event and the Mid-Pleistocene transition, and could also play an important role in the near future.
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Mudança Climática/história , Oceano Atlântico , Foraminíferos/isolamento & purificação , História Antiga , Temperatura Alta , Oceano Índico , Cloreto de SódioRESUMO
OBJECTIVE: To investigate the hemodynamic and outcome effects of implementing prophylactic positive end-expiratory pressure (PEEP) versus zero end-expiratory pressure (ZEEP) in patients during the postintubation period in the emergency setting. METHODS: The present study was a prospective, single-centre, interventional, single-blinded randomized trial performed in a 16-bed medical intensive care unit. The study cohort consisted of consecutive patients who urgently required intubation. During the postintubation period, patients received either 5 cmH2O PEEP or ZEEP. The primary aim was to assess the variation in mean arterial pressure (MAP) from baseline up to 90 min postintubation. The secondary aim was to determine the mean duration of intubation, level of MAP support after intubation and 28-day mortality. RESULTS: Seventy-five consecutive patients with similar mean (+/- SD) baseline characteristics and preintubation MAP (76+/-18 mmHg in the ZEEP group and 78.5+/-23 mmHg in the PEEP group, P=Not significant [NS]) were studied. The final analysis was performed in 33 patients in the ZEEP group and 30 patients in the PEEP group. Regarding outcome measures following intubation, delta MAP (ie, the difference between the lowest MAP values from baseline) was not differentially affected in either group (P=NS); the mean durations of intubation were similar (ZEEP 9.2+/-8.5 days versus PEEP 9.2+/-8.8 days, P=NS); 28-day mortality was not discriminative (ZEEP 14 of 33, PEEP nine of 30; P=NS); and levels of MAP support after intubation were comparable between the two groups. CONCLUSION: In the present trial, there was no evidence that implementing a prophylactic PEEP of 5 cmH2O adversely affects short-term hemodynamics or outcome in medical intensive care patients during the postintubation period.
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Pressão Sanguínea , Intubação Intratraqueal , Respiração com Pressão Positiva/métodos , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Serviços Médicos de Emergência , Feminino , Humanos , Intubação Intratraqueal/mortalidade , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/mortalidade , Estudos ProspectivosAssuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Exantema/induzido quimicamente , Dermatopatias Vesiculobolhosas/induzido quimicamente , Doença Aguda , Animais , Antibacterianos/administração & dosagem , Biópsia , Cefalosporinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Picada de Aranha/tratamento farmacológico , Volume Sistólico , Síndrome de Resposta Inflamatória Sistêmica/induzido quimicamente , Taquicardia Sinusal/induzido quimicamente , CefprozilRESUMO
Two sediment cores were collected in an inactive area of the deep-sea hydrothermal vent field Rainbow (36 degrees N on the Mid-Atlantic Ridge). Metals and carbonates were abundant throughout the cores; calcite (CaCO3) was found throughout the cores while dolomite [CaMg(CO3)2] and siderite (FeCO3) were only found in deeper layers. Using polymerase chain reaction (PCR)-amplified 16S rRNA gene sequence analysis, we examined the bacterial and archaeal diversity in a sediment layer that contained the three carbonates. The retrieved bacterial and archaeal sequences were new and less than 4% of the sequences exhibited 94% or more identity with that of cultured organisms. The analysis of the composition of the bacterial library revealed a high diversity of sequences. Half of the bacterial clones was affiliated to the gamma-Proteobacteria. Most of them had environmental sequences retrieved from deep-sea sediments as closest relatives, some of which being distantly related to free-living and symbiotic sulfur-oxidizers. Other sequences clustered in the alpha-, delta- and epsilon-Proteobacteria, the 'Bacteroidetes', the 'Planctomycetes', the 'Nitrospirae', the 'Actinobacteria', the 'Chlorobi ' and the 'Verrumicrobia'. Based on clonal abundance and sequence comparisons, phylotype groups putatively involved in the oxydation of sulfur compounds appeared to dominate in the studied sample. The majority of the archaeal sequences clustered in an euryarchaeotic lineage recently identified in the walls of black smokers suggesting a possible thermophilic way of life of these uncultured microorganisms. Oxygen isotopic composition of siderite and dolomite indicated that they were formed at 67 degrees C and 94 degrees C respectively. Together with chemical and microbiological data, this suggested that hydrothermal fluids may have circulated through this sediment.