Background
While biologic drugs have demonstrated efficacy across a range of indications, patient access to these drugs is constrained due to their high cost. Biosimilars provide a means to increase ...patient access while reducing the financial burden.
Aims
The primary objective was to determine the current usage of biosimilar and reference trastuzumab and rituximab in four Irish hospitals. A secondary objective involved determining barriers to biosimilar usage.
Methods
This project involved a retrospective chart review to analyse the usage of reference and biosimilar versions of trastuzumab and rituximab. Additionally, a prospective cross-sectional study identified barriers to the usage of biosimilars via the distribution of a novel questionnaire to patients, pharmacists, doctors and students.
Results
The utilisation of biosimilar intravenous trastuzumab and rituximab ranged from 39 to 100%, and 0 to 89%, respectively. A total of
n
= 479 questionnaire responses were included. Biosimilar awareness was significantly lower among ‘Doctors and Medical Students’ (45.3%; 95% CI, 33.8–57.3%) compared to ‘Pharmacists and Pharmacy Students’ (97.1%; 95% CI, 94–98.8%; comparison
p
< 0.001). A significant majority of healthcare professionals agreed biosimilars should have consistent nomenclature (
p
< 0.001). A significant majority of patients (87.3%, 95% CI, 81.3–92%;
p
< 0.001) indicated that they would agree to commence using a biosimilar medicine.
Conclusion
Biosimilar versions of trastuzumab and rituximab were in use to a variable extent. There remains a considerable opportunity to further increase the usage to maximise their potential benefits. A series of challenges were identified including reduced awareness among the medical profession and lack of clear nomenclature.
**Objectives:** Elevated serum troponin values, regardless of cause, are associated with increased short-term and long-term mortality. The objective of this study was to describe and quantify use of ...troponin-related terms in hospital discharge summaries. **Study Design:** Retrospective chart review. **Methods:** We included patients admitted to the medical service of three Rhode Island hospitals in 2018. Patients had to have two or more troponin measurements, including at least one elevated value, as well as a rise-and-fall pattern. We reviewed text from three sections in the discharge summary—the problem list, hospital course, and attending attestation—to identify terms referring to troponin. We double-coded 10% of the sample to assess inter-rater reliability. Troponin terms were grouped by whether they referenced an abnormal level, as well as by the etiology of the elevation. Descriptive statistics were used. **Results:** 257 patients were included; 66% of their discharge summaries had a troponin descriptor. We identified 19 unique troponin terms: three of these terms implied a normal troponin level (e.g., “flat troponin”), seven described an abnormal elevation without specifically referencing myocardial injury as the etiology (e.g., “troponin bump”), and the rest referenced ischemia or infarction (e.g., “NSTEMI”). Over one-third (34%) of the records had no troponin terms in the discharge summary, despite those patients having at least one abnormal troponin level during their hospitalization. **Conclusions:** We found that clinicians used a wide variety of terms to describe troponin elevations in their discharge summaries, including minimizing language and potentially conflicting terms; a third of discharge summaries omitted any mention of the abnormal troponin value. More precise language may facilitate appropriate evaluation and management of these higher risk patients after hospital discharge.
The complete sequence of the mitochondrial genome of the giant tiger prawn, Penaeus monodon (Arthropoda, Crustacea, Malacostraca), is presented. The gene content and gene order are identical to those ...observed in Drosophila yakuba. The overall AT composition is lower than that observed in the known insect mitochondrial genomes, but higher than that observed in the other two crustaceans for which complete mitochondrial sequence is available. Analysis of the effect of nucleotide bias on codon composition across the Arthropoda reveals a trend with the crustaceans represented showing the lowest proportion of AT-rich codons in mitochondrial protein genes. Phylogenetic analysis among arthropods using concatenated protein-coding sequences provides further support for the possibility that Crustacea are paraphyletic. Furthermore, in contrast to data from the nuclear gene EF1alpha, the first complete sequence of a malacostracan mitochondrial genome supports the possibility that Malacostraca are more closely related to Insecta than to Branchiopoda.
Group prenatal care (GC) models are receiving increasing attention as a means of preventing preterm birth; yet, there are limited data on whether group care improves perinatal outcomes in women who ...deliver at term. The purpose of this study was to evaluate our institutional experience with GC over the past decade and test the hypothesis that GC, compared with traditional individual care (TC), improves perinatal outcomes in women who deliver at term.
We performed a retrospective cohort study of women delivering at term who participated in GC compared with TC. A group of 207 GC patients who delivered at term from 2004 to 2014 were matched in a 1:2 ratio to 414 patients with term singleton pregnancies who delivered at our institution during the same period by delivery year, maternal age, race and insurance status. The primary outcome was low birth weight (<2500 g). Secondary outcomes included early term birth (37.0 to 38 6/7 weeks), 5 min APGAR score <7, special care nursery admission, neonatal intensive care unit (NICU) admission, neonatal demise, cesarean section and number of prenatal visits. Outcomes were compared between the two groups using univariable statistics.
Baseline characteristics were similar between the two matched groups. GC was associated with a significant reduction in low birth weight infants compared with TC (11.1% vs 19.6%; relative risk (RR) 0.57; 95% confidence interval (CI) 0.37 to 0.87). Patients in GC were significantly less likely than controls to require cesarean delivery, have low 5 min APGAR scores and need higher-level neonatal care (NICU: 1.5% vs 6.5%; RR 0.22; 95% CI 0.07 to 0.72). There were no significant differences in rates of early term birth and neonatal demise.
Low-risk women participating in GC and delivering at term had a lower risk of low birth weight and other adverse perinatal outcomes compared with women in TC. This suggests GC is a promising alternative to individual prenatal care to improve perinatal outcomes in addition to preterm birth.
Full text
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities.
A pilot randomized controlled trial ...was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle.
Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group (
= 42) or individual (
= 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation SD in group care vs. 3.4 days ± 2.6 SD in individual care;
< 0.01) and gained less weight per week during the study period (0.2 lbs/week interquartile range: 0-0.7 vs. 0.5 lbs/week interquartile range: 0.2-0.9;
= 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4-8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms.
Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes.
· Women with gestational diabetes in group care were 3.5 times more likely to return for postpartum glucose tolerance testing.. · Women with gestational diabetes in group care had less gestational weight gain during the study period.. · Diabetes Group Prenatal Care is a promising intervention to improve outcomes for women with diabetes in pregnancy..
(Abstracted from
Am J Perinatol
2022;39:45–53)
Type 2 diabetes or gestational diabetes mellitus (GDM) occurs in approximately 10% of pregnant women. Having these conditions increases the risk of ...several adverse outcomes, including macrosomia, shoulder dystocia, cesarean delivery, metabolic syndrome, and future cardiovascular diseases.
The relationship between childhood adversity and inflammation is well-established. Examination of positive experiences can provide a more complete understanding of intervention opportunities. We ...investigated associations of adverse and positive experiences, and their intersection, with inflammation in children and adolescents.
Data sources: Longitudinal Study of Australian Children (LSAC; N = 1237) and Avon Longitudinal Study of Parents and Children (ALSPAC; N = 3488). Exposures: Adverse and positive experiences assessed repeatedly (LSAC: 0–11 years; ALSPAC: 0–15 years). Outcomes: Inflammation quantified by high sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls (GlycA) (LSAC: 11–12 years; ALSPAC: 15.5 years). Analyses: Linear regression on the log-transformed outcomes estimated the relative difference in inflammatory markers with adverse/positive experiences, adjusting for socio-demographics and concurrent positive/adverse experiences, respectively.
Most associations were in the expected direction but differed in magnitude by exposure, outcome and cohort. Across both cohorts, adverse experiences were associated with up to 7.3% higher hsCRP (95% CI: −18.6%, 33.2%) and up to 2.0% higher GlycA (95% CI: 0.5%, 3.5%); while positive experiences were associated with up to 22.1% lower hsCRP (95% CI: −49.0%, 4.7%) and 1.3% lower GlycA (95% CI: −2.7%, 0.2%). In LSAC, the beneficial effect of positive experiences on inflammation was more pronounced among those with fewer concurrent adverse experiences.
Across two cohorts, we found small but directionally consistent associations between adverse experiences and higher inflammation, and positive experiences and lower inflammation, particularly for GlycA. Future research should give further consideration to positive experiences to complement the current focus on adversity and inform the design and evaluation of early life interventions.
•Adverse and positive childhood experiences both had small effects on inflammation.•Adverse experiences reduced the beneficial effect of positive experiences on inflammation.•The magnitude of effects varied depending on exposures, outcomes, and contexts.•Increased attention is needed to positive experiences within child health research.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
(Abstracted from
Am J Perinatol
2020; doi: 10.1055/s-0040-1714209)
Approximately 10% of pregnant women have type 2 diabetes or gestational diabetes mellitus (GDM), increasing the risk of poor ...perinatal outcomes such as macrosomia, shoulder dystocia, preeclampsia, or cesarean delivery. One potential strategy to help manage these conditions in this patient population is group prenatal care.
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