Wolters Kluwer Health Research Articles

Treatment reality of patients with BRAF-mutant advanced/metastatic melanoma in Switzerland in the era of choice.

Cutaneous melanoma represents a major cause of cancer death in Europe. Without adequate therapy, the 5-year survival rate is 15-20% in distant metastatic disease. Evaluating the status quo of treatment standards in advanced melanoma and rationale for therapy decisions in Switzerland between January 2016 and September 2018. In this retrospective, anonymized registry, data of male and female patients with unresectable advanced/metastatic BRAF-positive cutaneous melanoma treated in first-, second- and third-line with registered substances were analyzed using descriptive statistics. Forty-one patients (56.1% male) were included providing a total of 70 treatment lines (first-line: n = 41; second-line: n = 18; and third-line: n = 11). Within the patients presenting with stage III or IV melanoma, immunotherapy with checkpoint inhibitors was more frequently administered as first-line treatment than targeted therapy (TT) (70.7% vs. 29.3%). Across all lines, patients received TT in 47.1% (predominantly combined BRAF-MEK-inhibition) and immunotherapy in 52.9% of the cases (anti-PD-1 monotherapy in 62.2% and anti-PD-1/anti-CTLA-4 combinations in 37.8%). Most commonly, the treatment type was switched from TT to immunotherapy or vice versa upon disease progression. The most frequent rationales for prescribing either TT or immunotherapy were physician's preference (40.0%) or remission pressure (28.6%), respectively. Disease progression led to treatment discontinuation more frequently than undesired events. Patients in Switzerland with unresectable advanced or metastatic BRAF-mutant melanoma predominantly receive guideline-recommended treatments. IO was used as predominant front-line therapy, with TT/immunotherapy switch being the predominant treatment principle. Sequencing studies are underway to identify the optimal treatment regimen for those patients. 32: 366-372 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Private equity acquisitions: physician considerations at different stages of career.

To assess the impact of private equity acquisitions on physician career considerations, with particular attention to stage of career. Recent studies have demonstrated a clear increase in private equity acquisitions in ophthalmology, particularly in retina-oriented practices. Survey-related publications of recent fellow graduates may provide insights regarding considerations of early career ophthalmologists, whereas commentaries from senior ophthalmologists offer insights to considerations of late career physicians. To date, no published evidence exists regarding the differential financial and/or professional effects of private equity acquisitions on ophthalmologists with regards to career stage. Such effects may differ on the specific structure, nature, and terms of the private equity acquisition. Private equity acquisitions in ophthalmology may have several short-term, mid-term, and long-term effects on physicians over a variety of financial and career considerations. As such, there may be a differential effect of private equity acquisitions on early, mid, and late career physicians. Future outcome-related data will be necessary to fully understand the impact of private equity acquisitions on physicians both professionally and with regards to clinical care.

Hypoxia-inducible factor prolyl hydroxylase enzyme inhibitors: ready for primetime?

Hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors have recently been developed as a new treatment for anemia associated with chronic kidney disease (CKD). Several of these have been approved in Europe (roxadustat), China, and Japan, but none approved in the United States to date, although daprodustat has been submitted as a new drug application to the Food and Drug Administration. The aim of this review is to critically appraise the available data, particularly the most recent publications, and offer a personal viewpoint on whether or not these drugs are ready for primetime. The efficacy of HIF prolyl hydroxylase inhibitors in improving CKD anemia and maintaining a higher hemoglobin is undisputed, but there remain some concerns about safety, particularly in the long term. Some of the safety concerns may result from an exaggerated pharmacological response, while other potential adverse effects could be due to transcriptional effects of these agents beyond genes involved in erythropoiesis. HIF prolyl hydroxylase inhibitors are already being used in clinical practice in several countries of the world, and ongoing research is being conducted to define the role of these drugs not only in the management of anemia but also beyond into other clinical settings.

Selected Abstracts for October 2022 Issue.

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Neoantigen-Specific T Cells in Adoptive Cell Therapy.

The holy grail of cancer therapeutics is the destruction of cancer cells while avoiding harm to normal cells. Cancer is unique from normal tissues because of the presence of somatic mutations that accumulate during tumorigenesis. Some nonsynonymous mutations can give rise to mutated peptide antigens (hereafter referred to as neoantigens) that can be specifically recognized by T cells. Thus, the immunological targeting of neoantigens represents a safe and promising strategy to treat patients with cancer. This article reviews the clinical application of adoptive cell therapy targeting neoantigens in patients with epithelial cancers.

HPV-Associated Cancer Trends Since Vaccine Initiation.

Decreasing cervical cancer rates may be associated with human papillomavirus (HPV) vaccine use.It may be too early to evaluate the association between HPV vaccine use and trends in oropharyngeal cancer in men.

Abstracts of Scientific Papers and Posters Presented at Physiatry '22: May 24-28, 2022.

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Commentary: Futility in Psychiatry.

While other medical professions have grappled with end-of-life care, the areas of palliative psychiatry, and more particularly, futility in psychiatry, have not been thoroughly addressed. The 3 cases presented in this issue illustrate how patients can succumb to a medical condition while presenting with primary psychosis (a patient with treatment-resistant schizophrenia who starves himself), secondary psychosis (a patient with small cell cancer of the lung who develops psychotic symptoms in the context of a paraneoplastic neurological syndrome), or a factitious disorder (a patient with self-induced aplastic anemia from ingesting an oral chemotherapy agent). The descriptions of these challenging cases show how collaborative teamwork among psychiatric and medical treatment teams, including the provision of palliative care, can help patients and families, even if a fatal outcome appears certain.

Introducing a Resiliency Bundle for Home Care Nurses.

Home healthcare (HHC) nurses are experiencing stress and burnout related to high workloads, isolation on the job, and COVID-19 restrictions. A literature review found numerous interventions effective in reducing nurse burnout through building resiliency and decreasing moral distress. The purpose of this evidence-based project was to improve resiliency and decrease the risk of burnout in HHC nurses through the introduction of a resiliency bundle. The following resiliency bundle interventions were implemented: a) gratitude strategies, b) connecting with co-workers, c) storytelling, and d) resiliency training. Duffy's Quality-Caring Model and Neal's Theory of Home Health Nursing Practice framed the project. The interventions were implemented in an HHC department at a large Midwestern pediatric hospital. Outcomes were measured using a pre- and postimplementation resiliency and burnout survey, which used a Likert scale to allow for quantitative analysis. Fourteen nurses completed the presurvey, 11 completed the postsurvey, and 10 completed both pre- and postsurveys. Results showed no statistically significant change in resiliency or burnout after implementation; however, nurses expressed desire to continue using the bundle pieces, especially the gratitude strategies, connecting with co-workers, and sharing stories. Leadership should take burnout risk in HHC nurses seriously and look for innovative ways to promote resiliency.

2022 ISPAN Meeting Abstracts.

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Interventions Led by General Practice RNs Can Significantly Reduce Blood Pressure.

Interventions led by general practice RNs can reduce systolic and diastolic blood pressure in adults with hypertension.

Comparison of Endoscopic Facet Joint Denervation to the Percutaneous Technique Regarding Efficacy in Patients With Low Back Pain: A Randomized Controlled Trial

This was a single-center prospective randomized controlled study. The aim was to compare the efficacy of endoscopic facet joint denervation (FJD) with that of the percutaneous technique in terms of pain, functional disability, and quality of life in patients with low back pain (LBP). Different controlled studies in patients with LBP have shown short-term benefits from percutaneous FJD. Observational studies have demonstrated that endoscopic FJD may be more effective. As the superiority of the endoscopic technique has not been clearly demonstrated in previous studies, a prospective randomized controlled study was conducted. For this study, 40 patients with LBP lasting more than 6 months duration and at least 50% pain reduction on the visual analog scale after medial branch block under fluoroscopy, were assigned randomly to receive percutaneous or endoscopic FJD. The primary outcome was pain, as indicated by visual analog scale. Secondary outcomes were functional disability, as assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and quality of life, as assessed by the Short Form Health Survey (SF-36). After the intervention, the pain level decreased significantly in both groups ( P <0.001); however, the effect was still significant in the endoscopic group (EG) and diminished to lower than the statistical significance in the percutaneous group (PG) after 12 months. The ODI and RDQ scores also improved significantly in both groups ( P <0.001). However, the ODI and RDQ were significantly better ( P <0.001) in the EG after 12 months. In the SF-36, we observed significant improvement in both groups three months after the intervention. The effect decreased after six months in the PG and was predominantly not demonstrable after 12 months, whereas in the EG there was still a strong significant improvement on all scales ( P <0.001) after 12 months. Percutaneous and endoscopic FJD reduced pain and improved functionality and quality of life. However, the effects decreased or disappeared in the PG after 12 months, whereas there was still a strong significant improvement in the EG.

Expanded Conceptual Framework for Ethical Action by Nurses on the "Further Upstream and Farther Downstream" Determinants of Health Equity.

Determinants of health (DOH) are key predictors of health, wellness, morbidity, and mortality. The more familiar social DOH are not the only DOH. By themselves, the social DOH do not adequately explain how individuals and populations achieve and maintain health equity or inequity. Other DOH also exert political, economic, and institutional forces at all levels of the socioecological systems in which humans interact with their environment.According to the American Nurses Association, the Nursing Code of Ethics is a "non-negotiable moral standard for the profession" (Fowler, 2015a, p. viii). Provision 9 of the Code of Ethics states that social justice is of primary concern for social ethics (p. 159) and that professional nurses are obligated to advocate for and integrate principles of social justice into nursing practice and health policy (p. 151).In search of conceptual explanations for these phenomena, and to locate health equity/inequity within a wide array of upstream DOH, a comprehensive review of the interdisciplinary professional literature and conceptual analysis were conducted. A new conceptual framework that acknowledges nursing's collective responsibility for ethical action for transformative change was developed. The framework addresses both "further upstream" antioppression efforts and "farther downstream" efforts to remediate the impacts of health inequity.The purpose of this Policy Watch column was to introduce a new "Expanded Conceptual Framework for Ethical Action by Nurses on the 'Further Upstream and Farther Downstream' Determinants of Health Equity" (Fornili, 2022).

Reliability and validity of the Neck Disability Index among patients undergoing cervical surgery.

To explore the internal consistency and factor structure of the Neck Disability Index (NDI) among patients undergoing surgery on the cervical spine. This was an observational retrospective cohort study among 392 patients undergoing cervical surgery of any kind in a university hospital between 2018 and 2021. The patients responded to repeated surveys preoperatively, and 3, 12 and 24 months postoperatively. The reliability and validity of the NDI were investigated using Cronbach's alpha and factor analysis. The internal consistency of the NDI was found to be good at 0.86. The exploratory factor analysis demonstrated unidimensionality. The correlations between the main factor 'disability' and all the individual items of the NDI were at least moderate. The highest correlations were observed for pain intensity, reading, driving and recreation. The NDI is an internally consistent and unidimensional scale when applied to a population of patients undergoing cervical surgery. 45: 273-278 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Pandemic Adaptations to an Honors Program Inaugural Capstone Projects

The COVID-19 pandemic and public health response of the US health care system and government provided unique opportunities for nursing education as it disrupted the usual mode of operation. An honors program at a private university at the epicenter of the pandemic pivoted multiple times to avoid failing to support the capstone projects of its inaugural cohort. Collaborative outreach with mentors and instructional technologists created opportunities for virtual delivery of patient and nursing student education and program evaluation. The lessons learned became part of the roster of resources for future cohorts to sustainably design and deliver their capstone projects.

Abstract Book for the 27th Congress of the European Hematology Association

Log in or Register Get new issue alertsGet alerts Submit your manuscript Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Register Login Articles & Issues Latest ArticlesCurrent IssuePrevious Issues Subject Areas Cell and Gene TherapiesHematopoiesisLymphoid MalignanciesMyeloid MalignanciesRed Cell and Iron MetabolismThrombosis and HemostasisView All Featured Content Latest ArticlesReviews & ControversiesGuidelinesHemaTopicsHemaBitesEHA Research RoadmapCAR T-CellGene TherapyCOVID-19Biosimilars For Authors Instructions for Authors Submit Your PaperBenefits for AuthorsOpen Access Editorial, Legal, and Ethical PoliciesLanguage Editing Services About Us About the JournalEditorial BoardAffiliated SocietyReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Creating Video Abstracts for Scholarly Dissemination.

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious IssuesPublished Ahead-of-Print Collections Editorials of Laura Weiss Roberts, MD, MAAM Last PageAddressing Race and Racism in Medical EducationThe Role of Academic Medicine in Firearm Injury PreventioneBooksView All For Authors Submit a ManuscriptInformation for AuthorsLanguage Editing ServicesAuthor Permissions Journal Info About the JournalAbout the AAMCJournal MastheadSubmit a ManuscriptAdvertising InformationSubscription ServicesReprints and Back IssuesClassified AdsRights and PermissionsFor ReviewersFor MediaFor Trainees All Articles Images Videos Podcasts Blogs Advanced Search

Antibiotics Not Needed in Many Children with Community-Acquired Pneumonia.

According to this study: Many previously healthy children younger than age three who have uncomplicated community-acquired pneumonia will do well without antibiotics.

1011-P: School-Day Routines Positively Impact Time in Range for Children with Type 1 Diabetes

The impact of school day routines on glycemic control in children is unclear. We compared continuous glucose monitor (CGM) metrics for youth with type 1 diabetes during weekday school hours (8AM-3PM) between two 4-week periods before and during the COVID-pandemic, when children had transitioned to virtual school. Youth with &amp;gt;70% CGM wear (n=209) were included; 46% male, mean±SD age 10.6±1.5 years, hemoglobin A1c 7.5±0.8%, 64% on insulin pumps. Time in range (TIR, 80-180 mg/dL) was similar during the pandemic (51.6±24.1%) compared to pre-pandemic (50.8±23.3%) . Using random coefficient multilevel linear mixed models, younger age (p=0.025) and pump use (p=0.043) predicted TIR, but not race (p=0.76) , diabetes duration (p=0.07) , body mass index (p=0.54) , or insurance status (p=0.45) . TIR pre- vs. during the pandemic varied significantly by time of day (p&amp;lt;0.001) . With in-person school pre-pandemic, TIR increased over school hours; with virtual school during the pandemic, TIR decreased in the morning and then remained steady (Figure) . Time above range (TAR, &amp;gt;180 mg/dL) had the opposite pattern. These findings suggest that in-person school can contribute to better TIR and lower TAR. Possible explanations include classroom and physical activity routines, plus school nurse support. During virtual school, continued routines are important and interventions to optimize diabetes care in school may benefit glycemic control. Disclosure C.March: None. J.K.Lutz: None. K.Jeong: None. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi. S.D.Rothenberger: None. E.Miller: Other Relationship; Wolters Kluwer Health. I.Libman: Consultant; Novo Nordisk. Funding ISPAD-JDRF Fellowship Award UPMC Children's Hospital of Pittsburgh Cochrane Weber Endowment

The true incidence of recurrent implantation failure.

To review the merits and limitations of current definitions of recurrent implantation failure (RIF), how they translate into estimates of incidence and to summarize how emerging concepts of individualizing the recognition of this condition can assist in changing the way RIF is identified, studied and managed. The notion of a one size fits all definition of RIF is seen to be of limited clinical value, as the individual risk of repeated IVF failure has many determinants and causes. Novel approaches provide a means of identifying 'actionable' RIF in individual patients. Uncertainties as to what constitutes, causes and defines RIF have served to limit progress in its management. A new approach promises to permit progress from the current impasse.