Real-life Management Research Articles

Real-Life Management of Pancreatic Cysts: Simplified Review of Current Guidelines.

Pancreatic cysts are becoming a popular diagnostic tool due to the increased availability of high-quality cross-sectional imaging. Pancreatic cystic lesions constitute closed, liquid-containing cavities, which are either neoplastic or non-neoplastic. While serous lesions often follow a benign course, mucinous lesions can hide carcinoma and, therefore, require different management. Moreover, all cysts should be considered mucinous until proven otherwise, thus limiting the errors in managing these entities. Due to the need for high contrast soft tissue imaging, magnetic resonance imaging represents an elective, non-invasive diagnostic tool. Endoscopic ultrasound (EUS) has started gaining more prominence with regard to the proper diagnosis and management of pancreatic cysts, offering quality information with minimal risks. Enabling both the acquisition of endoscopic images of the papilla and the endosonographic high-quality evaluation of septae, mural nodules along with the vascular patterns of the lesion contribute to a definitive diagnosis. Moreover, the possibility of obtaining cytological or histological samples could become mandatory in the foreseeable future, allowing for more precise molecular testing. Future research should focus on detecting methods to quickly diagnose high-grade dysplasia or early cancer for patients with pancreatic cysts, thus allowing time for appropriate treatment and avoiding surgical overtreatment or over surveillance in selected cases.

Medically unexplained somatic complaints: management in real life

Medically unexplained somatic complaints (MUSC) are a common phenomenon in primary care settings, and they pose a challenge to clinicians in terms of diagnosis and management. MUSC refers to the presence of physical symptoms that are not attributed to any known medical or organic cause. These symptoms can significantly affect patients’ quality of life and impose a substantial burden on healthcare systems. In real-life clinical practice, managing MUSC requires a multifaceted approach that includes a thorough clinical evaluation, psychoeducation, and collaborative care. The management of MUSC should start with establishing a good rapport with the patient and understanding their concerns and beliefs about their symptoms. Clinicians should also rule out any underlying medical conditions that may contribute to the symptoms. Once medical causes are excluded, the focus should shift to addressing the psychosocial factors that may be contributing to the symptoms. This can include educating patients about the nature of MUSC and the role of stress and anxiety in exacerbating their symptoms. Collaborative care involving primary care clinicians, mental health professionals, and other specialists is an effective approach for managing MUSC. It is essential to tailor the treatment to the individual needs of the patient and to ensure that they are engaged and motivated to participate in their care. In conclusion, managing MUSC in real-life clinical practice requires a collaborative, patient-centered approach that addresses the physical, psychological, and social factors contributing to the symptoms. Clinicians should adopt a biopsychosocial model of care and that maximizes patient engagement and improves their quality of life. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 184

(304) Relevance of Self-masturbation-related vs. Coital Erectile Function in the Real-life Management of Patients with Erectile Dysfunction

Abstract Introduction The Masturbation Erection Index (MEI) has been recently validated in the setting of the investigation of men presenting with erectile dysfunction (ED). Objective We sought to analyze the correlation between MEI and the findings of the widely used International Index for Erectile Function (IIEF) in a cross-sectional study in men seeking medical help for ED. Methods Data from the last 87 consecutive men presenting for ED at a tertiary referral centre were analyzed. All patients were asked to complete both IIEF and MEI at the same time. Complete sociodemographic and clinical data were collected. ED severity was defined according to Cappelleri’s criteria. Linear regression model tested the association between MEI, IIEF total and IIEF domains scores. Violin plot was used to display distribution of MEI scores into IIEF-EF categories. Loess curve was applied to investigate the probability of MEI to predict ED as a function of age. Results Median (interquartile range [IQR]) age at presentation was 44 (3.5-53.5) years. According to IIEF-EF scores, ED severity was: no ED in 9 (10%), mild ED in 14 (16%), mild-to-moderate ED in 19 (22%), moderate ED 12 (14%) and severe ED in 33 (38%) patients, respectively. The more severe the ED, the higher the MEI scores (Figure 1); indeed, median MEI scored 7 (3-8) in men with no ED and 19 (10-26) in men with severe ED (p<0.05). Of note, 16 patients (18%) depicted low MEI scores (i.e., under the median), but moderate or severe ED as for their IIEF scores. Finally, a univariable negative association between MEI scores and IIEF-overall satisfaction and IIEF-intercourse satisfaction scores was found [i.e. the higher the MEI scores, the lower the intercourse and overall sexual satisfaction (p<0.001)]. Although MEI decreased throughout aging, it was not significantly different in younger vs. older men with ED. Conclusions As expected, there is a strong association between IIEF and MEI scores, which does not lower with aging. Of all, one out of 5 patients presented with lower overall and intercourse satisfaction notwithstanding high MEI scores, thus outlining the clinical relevance of both investigations in the real-life setting. Disclosure No

Real-Life Anemia Management Among Patients with Non-Dialysis-Dependent Chronic Kidney Disease in Three European Countries.

Anemia is prevalent among patients with chronic kidney disease (CKD), yet current evidence indicates that treatment may not adhere to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We aimed to document the management of patients with non-dialysis-dependent (NDD)-CKD receiving erythropoiesis-stimulating agent (ESA) therapy in Europe. This retrospective, observational study extracted information from medical records in Germany, Spain, and the UK. Eligible patients were adults with NDD-CKD stages 3b-5 who initiated ESA therapy for anemia between January and December 2015. Anemia was defined as hemoglobin (Hb) <13.0 g/dL (males) or <12.0 g/dL (females). Data regarding ESA treatment, treatment response, concomitant iron therapy and blood transfusions were extracted up to 24 months post-ESA initiation, and data on CKD progression until abstraction date. Eight hundred and forty-eight medical records were abstracted. Approximately 40% received no iron therapy prior to ESA initiation. At ESA initiation, mean ± standard deviation Hb level was 9.8 ± 1.0 g/dL. Most patients received darbepoetin alfa, and switching between ESAs was rare (8.5% of patients). Concomitant intravenous and oral iron therapy was prescribed for 36% and 42% of patients, respectively, during initial ESA therapy. Mean Hb levels reached the target level (10-12g/dL) within 3-6 months of ESA initiation. Hb, transferrin saturation, and ferritin levels were infrequently monitored from 3 months post-ESA initiation. Rates of blood transfusion, dialysis, and diagnosis of end-stage renal disease were 16.4%, 19.3%, and 24.6%, respectively. Rates of kidney transplant and death were 4.8% and 8.8%, respectively. Among ESA-treated patients, ESA initiation was in accordance with KDIGO guidelines, but subsequent monitoring of Hb and iron deficiency were suboptimal.

Real-Life Data on the Management of Incompletely Excised Basal Cell Carcinoma

Background: The histopathologic presence of basal cell carcinoma (BCC) cells at one or more margins of the specimen after surgical excision is considered suggestive of incomplete tumor clearance. The management of incompletely excised BCC might vary in different clinical scenarios from re-excision to application of other treatments or even watchful waiting. Objective: The aims of the study were to report the real-life management of incompletely excised BCC in a tertiary referral center and compare the recurrence rates according to the selected management modality. Methods: A retrospective study was conducted at a tertiary Dermatology Center in Northern Greece. Our electronic database was scanned over a 5-year period to retrieve all BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep). The included patients were divided into 3 groups according to the selected management after incomplete excision: group 1 included those who underwent immediate re-excision (n = 26), group 2 those who were followed up without any additional therapy (n = 40), and group 3 those who were treated with adjuvant/complementary non-surgical treatment (n = 18). Finally, we recorded the presence or absence of residual tumor in the new histopathologic report of those tumors that were selected to be re-excised (group 1). The primary outcome was the appearance of clinical tumor recurrence. Results: Of 1,689 BCCs recorded in our database, 84 met the inclusion criteria and were included in the analysis. Re-excision had been selected in 26 of 84 patients (group 1), watchful waiting in 40 (group 2), and non-surgical treatments in 18 (group 3). The histopathologic reports of the 26 tumors of group 1 that were re-excised revealed residual tumor in 14 (53.8%) cases. Overall, a clinical recurrence occurred in 14 of 84 patients (16.7%) after a mean follow-up of 17 months. The median time to recurrence was 14 months. Of 40 patients without any treatment, recurrence developed in 10 (25%), while only 2 of 18 patients treated with non-surgical treatments recurred (11.1%). Conclusions: Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients. This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy.

Full-deployed energy management system tested in a microgrid cluster

Under a hierarchical structure perspective, the integration of tools like the internet of things, cloud computing, and machine learning into a microgrid real-time energy management system involves superior capabilities like an autonomous and scalable design, massive storage capabilities, real-time information analysis and processing, and security issues control, to mention a few. This paper evaluates most of them using a cloud-based real-time energy management system integrated into a real-life hardware-in-the-loop testbed. The proposed cloud-based system is tested by solving an economic power dispatch problem including the equalization of the multiple battery-based energy storage systems interacting within a multi-microgrid environment. The test assessment combined reviewing and running microgrid models, incorporating these models into a real-life power-hardware-in-the-loop unit, linking the testbed to a cloud server, and merging the energy management system with on-demand computing tools, primarily machine learning and the internet of things. As established by the experimental evidence, this paper cites the benefits of combining machine learning techniques and internet of things tools with a scalable and autonomous real-life cloud-based energy management system architecture to improve the framework's functionality, enhance the energy forecasting for generation and usage, and cut down the price paid to the service provider.

Indicating if water is safe for human consumption using an enhanced machine learning approach

Predicting water quality accurately is critically important in real-life water resource management. This work proposes an approach based on supervised machine learning to predict water quality. Motivated, by the success of the non-smooth loss function for supervised learning problems [22], we reformulate the learning problem as a regularized optimization problem whose fidelity term is the hinge loss function and the hypothesis space is a polynomial approximation. To deal with the non-differentiability of the loss function, a special smoothing function is proposed. Then, the obtained optimization problem is solved by an improved conjugate gradient algorithm. Finally,some experiments results are presented.

Using Part of Business Analytics for Learning and Working

The purpose of this study was to demonstrate some parts of business analysis, more specifically, to show the application of knowledge in business management and real-life situation. The research explores some aspects of business analysis, including enterprise management, foundations of business analysts, planning and monitoring, and data science statistics. Business analysis is a crucial discipline in the growth and development of business through implementing change. This paper covers the overview of business analysis and the application of knowledge in real life and business management. This brief demonstrates a summary of the business analysis programme, including the business analysis foundations and statistics for data science. The primary concepts outlined in business analysis foundations include business competencies, enterprise analysis, requirements, and solutions. Similarly, the paper covers statistics for data science, where vital concepts such as regression analysis, numerical and categorical variables, fundamentals, distribution, and hypothesis testing are presented. In addition, the analysis presents the most exciting discovery during the course elaborating on the birth and development of business analysis from the 1940s until today. Additionally, the paper covers the most crucial information presented in the course: business analysis application and its benefits in organizations. Also, it presents the application of business knowledge in daily life to define needs and solve problems. Furthermore, business analytics knowledge is applied during doctoral research and personal healthcare management. The brief covers the practical application of business analysis skills in large corporations such as Apple Inc., including big data analysis, HR management, communication, and manufacturing. Besides large corporations, business analytics skills apply in small companies in mitigating risks, operation analysis, and market analysis. Lastly, the paper demonstrates the practical application of knowledge in individual entrepreneurship, such as innovation analysis, revenue generation, system analysis, and mind mapping.

A Study of Career Maturity, Information-Seeking Behavior, Entrepreneurial Efficacy, Problem-Solving Skills, and Managerial Skills of Undergraduate Students in Thailand

Nowadays, in addition to the hard skills like academic knowledge of new graduates, other soft skills of management such as Career Maturity (CM), Information-Seeking Behavior (ISB), Entrepreneurial Efficacy (EE), Problem-Solving Skills (PSS), and Managerial Skills (MS) are also required by the company owner as they will be useful in real-life work management. The objectives of this study are: 1) to investigate the current competencies of CM, ISB, EE, PSS, and MS of undergraduate students in Thailand, 2) to investigate the different competencies of CM, ISB, EE, PSS, and MS across different gender, faculties, and grade levels. This study uses an online questionnaire to collect data from 569 undergraduate students from Thailand. The result shows that the reliability of the data collecting tool is acceptable (Cronbach’s alpha was at 0.87) and the current findings further reveal that the total competencies of CM, ISB, and MS are different by gender but on the other way, total competencies of all 5 which means to CM, ISB, EE, PSS, and MS are different by faculties and grade levels. The information from this study can make instructors or teachers develop a modern classroom that can increase competitiveness for undergraduate students and prepare them to be qualified to apply for future employment.

The role of e-government in disaster management: A review of the literature

Aim/purpose – Disasters or catastrophic events create unforeseen circumstances and require new approaches from local and national administrations in addressing the nega- tive impacts on society and the economy. Determining the role of e-government in providing the kind of services that are especially needed has become particularly rele- vant during COVID-19. This paper aims to assess the progress and current state of research on the role of e-government during or in the aftermath of catastrophic events. The purpose of this research is twofold: one, to benefit scholars by providing directions and a basis for further research, and two, to offer guidance to decision-makers involved with disaster management. Design/methodology/approach – The methodology used in this study is a systematic literature review. Multiple databases, including EBSCO, Elsevier, Emerald, JSTOR, Google Scholar, SAGE, ScienceDirect, Scopus, Springer, Taylor and Francis, and Wiley Online Library were searched for appropriate papers. In total, 36 papers published between 2004 and 2022 met our inclusion criteria and were analyzed. Findings – The study produced three types of findings. First, an analysis of the themes and trends in the existing literature. Second, a synopsis of the published research find- ings in the reviewed papers. And third, a description of the needs and opportunities for further research. Research implications/limitations – This study should help other researchers in direct- ing their efforts in further exploration, and it should help people involved with real-life disaster management to navigate through the effective role and application of e-government. The main limitation is that we found only 36 research papers that met our inclusion criteria. Originality/value/contribution – Despite the potentially critical role that e-government may have in mitigating the negative effects of catastrophic events, research on e-government in disaster management seems to be still underdeveloped, and to our knowledge, there is no published systematic review of such research. Keywords: disaster management, e-government, literature review. JEL Classification: H11, H12, I31, O21, O35.

Real world data on the demographic and clinicopathological profile and management of patients with early-stage HER2-positive breast cancer and residual disease treated with adjuvant trastuzumab emtansine (KARMA study)

IntroductionTrastuzumab emtansine (T-DM1) significantly improves invasive disease-free survival and reduces the risk of recurrence in patients with HER2-positive early breast cancer (EBC) with residual disease (RD). The KARMA study aimed to describe the characteristics and management of these patients in clinical practice in Spain. Material and methodsWe conducted a multicentre retrospective study in patients with HER2-positive EBC with RD following neoadjuvant treatment (NeoT) and who had received ≥1 dose of T-DM1 as adjuvant treatment. The primary endpoint was the evaluation of sociodemographic and clinicopathological characteristics of these patients. ResultsA total of 114 patients were included (March–July 2020). At diagnosis, most tumours were infiltrating ductal carcinoma (IDC) (93.9 %), grade 2 (56.1 %), and hormone receptor (HR)-positive (79.8 %). Over 75 % of patients had disease in operable clinical stages (T1–3 N0–1). In the neoadjuvant setting, 86.8 % of patients received trastuzumab plus pertuzumab, and 23.6 % achieved radiological complete response. Breast-conserving surgery was performed in 55.8 % of patients. Surgical specimens showed that 89.5 % of patients had IDC, 49.1 % grade 2, 84.1 % HR-positive, and 8.3 % HER2-negative disease. Most patients had RD classified as RCB-II and Miller/Payne grade 3/4. Grade 3 treatment-related adverse events (trAEs) occurred in 5.3 % of patients. No grade 4/5 AEs occurred. Over 95 % of patients were free of invasive-disease during T-DM1 adjuvant treatment. ConclusionThe KARMA study describes the characteristics of patients with HER2-positive EBC with RD after NeoT and the real-life management of a T-DM1 adjuvant regimen, which showed a manageable safety profile in line with the KATHERINE trial data.

Systemic sclerosis associated interstitial lung disease: a survey of current practices in France.

Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). We performed an overview of the diagnostic approaches, follow-up and treatment strategies used in France for the management of SSc-associated ILD (SSc-ILD). A structured nationwide online survey was submitted to participants via the French Medical Societies for Internal Medicine and Pneumology, and research groups on SSc-ILD from May 2018 to June 2020. The 79 multiple-choice and 9 open-ended questions covered the screening of ILD at baseline, monitoring of patients with established SSc-ILD and its management. Fourteen optional vignettes exploring different clinical phenotypes of SSc-ILD were submitted to evaluate therapeutic decisions. All of the 93 participants screened SSc patients for ILD at baseline with 83 (89%) participants relying on a systematic chest computed tomography (CT) scan. Pulmonary function tests (PFT) were prescribed by 87 (94%) participants at baseline and during follow-up. Treatment was started based on abnormal PFT (95%), chest CT scan characteristics (89%), worsening dyspnoea (72%) and drop in SpO2 during 6-min walk tests (66%). First-line therapy was cyclophosphamide (CYC) (89%), mycophenolate mofetil (MMF) (83%) and prednisone (73%). Rituximab as second-line immunosuppressive therapy (41%) was preferred to antifibrotic agents (18%), and a median daily prednisone dose of 10 mg (interquartile range, 10-15) was prescribed by 73% participants. Extensive SSc-ILD with worsening PFT (95%), regardless of diffusing capacity for carbon monoxide values and skin extension, were more likely to be treated, and CYC was favoured over MMF (p < 0.01). Extensive SSc-ILD with disease duration of less than 5 years was also a criterium for treatment initiation. This overview of practices in diagnosis, follow-up and treatment of SSc-ILD in France describes real-life management of patients. It highlights heterogeneity in this management and gaps in current strategies that should be addressed to improve and harmonize clinical practices in SSc-ILD.

Вклад ингибиторов дипептидилпептидазы 4-го типа в реальную практику управления сахарным диабетом 2 типа

Type 2 diabetes (T2D) has been recognized as a non-infectious pandemic for decades. However, because of many causes of diabetes, we are still far from even a significant slow-down of its spread. Every year, experts predict a greater increase in the number of patients with this disabling condition. Currently, medical practitioners face difficult choices when prescribing medications. On the one hand, the doctor should consider the health status of patients (who often have many comorbidities and receive complex treatment) to maintain the main commandment: "do no harm". Effective drugs that achieve the primary goal (an effective and safe reduction in glycemia), add pleiotropic effects (if possible), and are well tolerated to adhere to the recommended treatment should be selected. In recent years, novel drugs for T2DM with good efficacy, safety profile, and minimal side effects and adverse reactions have emerged to solve this issue. These medications recuperate impaired organ functions and regenerate cells. This paper reviews the properties of glucose-lowering medications belonging to dipeptidyl peptidase 4 (DPP-4) inhibitors. KEYWORDS: diabetes mellitus, hypoglycemia, gosogliptin, molecular weight, clinical recommendations, pleiotropic effect, comorbid patient. FOR CITATION: Chernikova N.A., Knyshenko O.A. Impact of dipeptidyl peptidase 4 inhibitors on real-life management of type 2 diabetes. Russian Medical Inquiry. 2023;7(9):580–585 (in Russ.). DOI: 10.32364/2587-6821-2023-7-9-5.

Trends in treatment and outcomes of atrial fibrillation during 2007-17 in Finland.

Guidelines on the management of atrial fibrillation (AF) have evolved significantly during the past two decades, but the concurrent developments in real-life management and prognosis of AF are unknown. We assessed trends in the treatment and outcomes of patients with incident AF between 2007 and 2017. The registry-based nationwide FinACAF (Finnish AntiCoagulation in Atrial Fibrillation) cohort covers all patients with AF in Finland from all levels of care. We determined the proportion of patients who were treated with oral anticoagulants (OACs) or rhythm control therapies, experienced an ischaemic stroke or bleeding event requiring hospitalization, or died within 1-year follow-up after AF diagnosis. We identified 206 909 patients (mean age 72.6 years) with incident AF. During the study period, use of OACs increased from 43.6 to 76.3%, and the increase was most evident in patients with at least moderate stroke risk. One-year mortality decreased from 13.3 to 10.6%, and the ischaemic stroke rate from 5.3 to 2.2%. The prognosis especially improved in patients over 75 years of age. Concurrently, a small increase in major bleeding events was observed. Use of catheter ablation increased continuously over the study period, but use of other rhythm-control therapies decreased after 2013. Stroke prevention with OACs in patients with incident AF improved considerably from 2007 to 2017 in Finland. This development was accompanied by decreasing 1-year mortality and the reduction of the ischaemic stroke rate by more than half, particularly among elderly patients, whereas there was only slight increase in severe bleeding events.

209 A COMMON CASE OF AORTIC STENOSIS IN A UNIQUE QUADRICUSPID ANATOMY: MANAGEMENT IN REAL LIFE

Abstract A 85-year-old lady with severe dyspnea presented in emergency dept. of our institution in Reggio Emilia last July. Typical signs and symptoms of heart failure were associated with high voltage at ECG and echocardiographic findings show a reduced EF (40%) with trans-aortic mean gradient of 42 mmHg, aortic valvular area of 0.8 cm2 and moderate aortic regurgitation. At CT scan analysis, a dismorphic quadricuspid aortic valve (QAV) was detected. This is a rare congenital heart disease generally unrelated to other cardiac abnormalities and usually diagnosed incidentally. Due to QAV stenosis rarity, many considerations in Trans Aortic Valve Implantation (TAVI) in QAV are unclear. Some individuals with QAV develop aortic regurgitation and rarely other cardiovascular complications such as aortic aneurysm. Because of its infrequency, it is difficult to characterize these patients and standardize their management. Tailored therapy is more than ever necessary. Our patient also had bicameral pacemaker for grade II Mobitz 2 atrioventricular blockage. At coronarography angiography mild atheromasia was detected; AngioCT reconstructions in figure 1 panel A and B show the presence of QAV. Severe wall atheromasia along the entire course of the aorta was also detected. A few days later the patient underwent the TAVI procedure. A coronary guidewire was positioned in right coronary artery in order to protect its ostium that was slightly lower and, as known from literature, QAV has a longer leaflet height and a shallower cusp depth. After implantation of a Balloon Expandable Valve, a chimney stenting was also performed. An excellent final result was achieved with a safe deployment and a 90/10 final position (last aortography frame in Figure 2, where both coronary arteries are well visible). Post-procedural echo follow-up showed a well functioning aortic prosthesis (with mean gradient of 9 mmHg). The case presented is particularly interesting mainly for three reasons: Extreme rarity of this condition that can be challenging especially in the elderly people with calcific valve affected by stenosis and regurgitation;Paucity of procedural data in literature on QAV;It is a real life management example with subsequent successful implantation of the BEV and chimney stenting in QAV;

Real-world evidence analysis of the follicle-stimulating hormone use in male idiopathic infertility.

Male idiopathic infertility remains a therapeutic challenge in the couple infertility management. In this setting, an empirical treatment with follicle-stimulating hormone (FSH) is allowed, although not recommended. Twenty-one clinical trials and four meta-analyses highlighted an overall increased pregnancy rate in case of FSH administration, but the indiscriminate FSH prescription is still unsupported by clinical evidence in idiopathic infertility. This context could represent an example in which real-world data (RWD) could add useful information. From a nationwide clinical practice survey performed in Italy, emerged the clinicians' attitude to prescribe FSH in the case of impaired semen with a significant improvement of semen parameters, identifying FSH treatment as a therapeutic card in the real-life management. Although more robust data are still needed to optimize FSH treatment in male idiopathic infertility, RWD should be included in the body of evidence considered in healthcare decision-making.

What Is the Benefit of Autologous Stem Cell Transplantation in Multiple Myeloma Beyond the Age of 65? Inputs from Real-World Data in the Emmy Cohort

Background The management of newly diagnosed multiple myeloma (NDMM) patients under 70 years of age, in good health condition and without comorbidities, is based on an induction therapy followed by high-dose therapy with autologous stem cell transplantation (ASCT) and maintenance (1). Several studies have demonstrated this regimen to be effective up to 65 years of age (2). Beyond this age, patients are often excluded from clinical trials and few real-world evidence studies are available. The EMMY study, a large-scale real-world study designed to assess the epidemiology and real-life management of MM, describes the use of ASCT in patients aged of 65 and over and its efficacy compared to other treatments. Methods EMMY is a non-interventional, prospective study conducted in 72 IFM (Intergroupe Francophone du Myélome, sponsor) centers in France. Any patient initiating treatment for MM over a 3-month observation period, from October to December, is included, since 2017. It is a dynamic cohort with the inclusion of 800 to 1000 additional patients each year (3616 patients included at the end of 2020). Data are updated annually from hospital records up to 2021. NDMM patients aged 65 years and over, who received a front-line therapy with ASCT (ASCT+), were identified and described. Progression-free survival (PFS) (median and rates at 36 and 48 months (m)), time to next treatment (TTNT) (median and rates at 36m and 48m) and overall survival (OS) rates at 36m and 48m were described for ASCT+ patients ≥65 years and compared to ASCT+ patients <65 years identified in EMMY (Wilcoxon test). ASCT+ patients ≥65 years were also compared with non-autologous transplant patients (ASCT-) of the same age ([65-75[ years). Same analyses were conducted for the subgroup of ASCT+ / ASCT- patients aged of 66-70 years. Results Among the 1597 NDMM patients enrolled in EMMY, 156 NDMM patients ≥65 years of age received a first-line therapy with ASCT; 129 (82.7%) had less than 70 years and 27 beyond (17.3%). Patients were male (55.1%), without comorbidities (72.4%) with an ECOG of 0 or 1 (89.4%) and an ISS score of 1, 2, 3 for 30.3%, 39.4% and 30.3% of them. For those patients, mPFS was estimated at 47.7m (95 CI% [34.4 to not reached]) with 36m and 48m PFS rates estimated at 56.1% (95 CI% [46.2; 66.0]) and 48.6% (95 CI% [37.0; 60.3]). mTTNT was not reached while 36m and 48m TTNT rates were 67.6% (95 CI% [57.7; 77.4]) and 57.4% (95 CI% [45.3; 69.4]). Regarding OS, 36m and 48m rates were 96.2% (95 CI% [92.8; 99.5]) and 89.3% (95 CI% [81.0; 97.6]). Survival outcomes for ASCT+ patients aged ≥65 years did not differ from those for ASCT+ patients aged <65 years (n=397 in EMMY) for PFS (p=0.32), TTNT (p=0.54), and OS (p=0.54). ASCT+ patients aged ≥ 65 years had similar characteristics (M/F ratio, ECOG, ISS, comorbidities) than ASCT+ patients aged <65 years. Compared with ASCT- patients of same age (n=397), ASCT+ patients aged ≥65 years had higher survival outcomes with a significant improvement in PFS (mPFS of 47.7m vs. 19.4m and 36m rates of 56.1% vs. 32.8%, p<0.0001, Figure 1), in TTNT (mTTNT not achieved vs 23.4m in ASCT- patients and 36m rates of 67.6% vs. 34.7%, p<0.0001); and in OS (36m rates of 96.5% vs. 74.0%, p=0.0013). ASCT+ patients aged ≥ 65 years had a median age of 67.5 years (vs. 70.8 years), ECOG 0-1 for 89.4% (vs. 69.0%), comorbidities for 27.6% (vs. 44.3%) and ISS II or III for 69.7% (vs. 76.4%) compared to ACST- patients aged ≥65 years. Same comparisons performed with the 66-70 years subgroup of ASCT+ (n=105) and ASCT- (n=192) patients confirmed previous survival outcomes results in terms of PFS (mPFS of 47.5m vs 20.6m, p=0.0004), TTNT (p<0.0001) and OS (p=0.0002). Conclusion These results are among the first estimates of the higher efficacy of ASCT in selected patients aged 65 years and over. Almost half patients (46.2%) up to 70 years of age received ASCT as first-line therapy, less frequently (about 10%) beyond. Although the use of ASCT is usually reserved to healthy patients, its clinical benefit over 65 years is significant in terms of survival and equivalent to that observed in younger patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Relevance of self-masturbation-related vs. coital erectile function in the real-life management of patients with erectile dysfunction

Relevance of self-masturbation-related vs. coital erectile function in the real-life management of patients with erectile dysfunction

Relevance of self-masturbation-related vs. coital erectile function in the real-life management of patients with erectile dysfunction

Relevance of self-masturbation-related vs. coital erectile function in the real-life management of patients with erectile dysfunction

Scheduling mobile dental clinics: A heuristic approach considering fairness among school districts.

Mobile dental clinics (MDCs) are suitable solutions for servicing people living in rural and urban areas that require dental healthcare. MDCs can provide dental care to the most vulnerable high-school students. However, scheduling MDCs to visit patients is critical to developing efficient dental programs. Here, we study a mobile dental clinic scheduling problem that arises from the real-life logistics management challenge faced by a school-based mobile dental care program in Southern Chile. This problem involves scheduling MDCs to treat high-school students at public schools while considering a fairness constraint among districts. Schools are circumscribed into districts, and by program regulations, at least 50% of the students in each district must receive dental care during the first semester. Fairness prevents some districts from waiting more time to receive dental care than others. We model the problem as a parallel machine scheduling problem with sequence-dependent setup costs and batch due dates and propose a mathematical model and a genetic algorithm-based solution to solve the problem. Our computational results demonstrate the effectiveness of our approaches in obtaining near-optimal solutions. Finally, dental program managers can use the methodologies presented in this work to schedule mobile dental clinics and improve their operations.