DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care ...teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers' level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention.
We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals' clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering.
Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5-6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one's capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5-6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = - 0.39, P = 0.018) and working as a technician (β = - 0.41, P = 0.069) (compared to as a social worker).
Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances.
Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caretaker-report measure of children’s trauma- and abuse-related symptomatology. It contains two reporter validity ...scales and eight clinical scales Post-traumatic Stress-Intrusion (PTS-I), Post-traumatic Stress-Avoidance (PTS-AV), Post-traumatic Stress-Arousal (PTS-AR), Post-traumatic Stress-Total (PTS-TOT), Sexual Concerns (SC), Dissociation (DIS), Anxiety (ANX), Depression (DEP), and Anger/Aggression (ANG), as well as an item assessing hours per week of caretaker contact with the child. This paper introduces the TSCYC and describes its psychometric properties in a multisite validity study.
Method: A total of 219 TSCYCs administered by six clinician/researchers across the United States were analyzed for scale reliability and association with several types of childhood maltreatment.
Results: The TSCYC clinical scales have good reliability and are associated with exposure to childhood sexual abuse, physical abuse, and witnessing domestic violence. The PTS-I, PTS-AV, PTS-AR, and PTS-TOT scales were most predictive, followed by SC in the case of sexual abuse and DIS in the case of physical abuse. There were a small number of age, sex, and race effects on TSCYC scores.
Conclusions: The TSCYC appears to have reasonable psychometric characteristics, and correlates as expected with various types of trauma exposure. Subject to continued validation and the development of general population norms, its use as a clinical measure is supported.
Objectif: Le Trauma Symptom Checklist for Young Children (TSCYC) mesure grâce à une enquête remplie par la personne chargée d’un enfant la symptomatologie liée au traumatisme et aux sévices. Elle comporte deux échelles de validité concernant l’expert et 8 échelles cliniques (stress post-traumatique-intrusion (PTS-I), stress post-traumatique-évitement (PTS-AV), stress-post-traumatique-début (PTS-AR), stress post-traumatique-total (PTS-TOT), intérêts sexuels (SC), dissociation (DIS), anxiété ANX), dépression (DEP) et colère-agressivité (ANG), ainsi qu’une évaluation en heures passées pae semaine par l’adulte concerné avec l’enfant. Cet article présente le TSCYC et décrit ses propriétés psychométriques dans une étude de validité à plusieurs emplacements.
Méthode: Au total, 219 TSCYC ont été administrés par six cliniciens-chercheurs dans l’ensembles des Etats-Unis et analysés selon la fiabilité et l’association avec différents types de mauvais traitements.
Résultats: Les échelles TSCYC ont une bonne fiabilité et sont associées à l’exposition à des sévices physiques et sexuels et au fait d’être témoin de la violence domestique. Les échelles PTS-I, PTS-AV, PTS-AR, et PTS-TOT offrent la meilleure prédiction, suivies par SC dans le cas des sévices sexuels et DIS dans le cas des sévices physiques. Il y a un petit nombre d’effets concernant l’âge, le sexe et la race sur les scores du TSCYC.
Conclusions:Le TSCYC semble posséder des caractéristiques psychométriques raisonnables. Il est en corrélation, comme on s’y attendait, avec l’exposition à des traumatismes variés. Ceci est en faveur de son utilisation en tant que mesure clinique s’il est soumis à une validation continue et au développement de normes pour la population générale.
Objetivo: El Trauma Symptom Checklist for Young Children (TSCYC) es una medida de informe cumplimentada por el cuidador y compuesta por 90 items que evalúa la sintomatologı́a relacionada con el maltrato y el trauma infantil. Contiene dos escalas de validez y ocho escalas clı́nicas (Estrés Postraumático-Intrusión PTS-I, Estrés Postraumático-Evitación PTS-AV, Estrés Postraumático-Activación PTS-AR, Estrés Postraumático-Total PTS-TOT, Preocupación Sexual SC, Disociación DIS, Ansiedad ANX, Depresión DEP, e Ira/Agresión ANG, ası́ como un item que valora el número de horas por semana que el cuidador tiene contacto con el/la niño/a. Este artı́culo presenta el TSCYC y describe sus propiedades psicométricas en un estudio de validez aplicado varios lugares.
Método: Un total de 219 TSCYCs, administrados por seis médicos/investigadores a lo largo de Estados Unidos, fueron analizados para conocer la fiabilidad de la escala y su asociación con diferentes tipos de maltrato infantil.
Resultados: La escalas clı́nicas TSCYC tienen una buena fiabilidad y están asociadas con la exposición del niño al abuso sexual, al maltrato fı́sico, y a ser testigo de violencia doméstica. Las escalas PTS-I, PTS-AV, PTS-AR, y PTS-TOT fueron las más predictivas seguidas por el SC en el caso del abuso sexual y por el DIS en el caso de maltrato fı́sico. Hubo un número pequeño de efectos de edad, sexo y raza en puntuaciones de TSCYC.
Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person's location of care can influence health and wellbeing. Healthcare organizations and ...policy makers are increasingly challenged to better support elders' dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes.
We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively.
The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11).
The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders' health. Additional research targeting housing and care options for the elderly is needed.
Generation of Memory B Cells and Plasma Cells in Vitro Arpin, Christophe; Déchanet, Julie; Van Kooten, Cees ...
Science (American Association for the Advancement of Science),
05/1995, Letnik:
268, Številka:
5211
Journal Article
Recenzirano
After germinal center B cells undergo somatic mutation and antigen selection, they become either memory B cells or plasma cells, but the signal requirements that control entry into either pathway ...have been unclear. When purified human germinal center cells were cultured with interleukin-2, interleukin-10, and cells expressing CD40 ligand, cells with characteristics of memory B cells were generated. Removal of CD40 ligand from the system resulted in terminal differentiation of germinal center B cells into cells with the characteristics of plasma cells. These results indicate that CD40 ligand directs the differentiation of germinal center B cells toward memory B cells rather than toward plasma cells.
Background: Little is known about the costs associated with vitamin K antagonist (VKA) treatment in patients with non-valvular atrial fibrillation (NVAF) in France.
Objectives: To evaluate monthly ...per-patient costs attributable to VKA treatment in NVAF patients from a French societal perspective.
Study design: Retrospective data were obtained from 7 international normalised ratio (INR) monitoring centres in France. Patients older than 18 years of age with NVAF treated with VKA were recruited. Additional patient-level data assessing resource use corresponding with VKA treatment were collected via self-completed questionnaires. Unit costs applicable to 2015 were multiplied by resource use and summed to generate VKA treatment costs.
Results: 363 patients were included; 53% were men. The majority of patients received fluindione (72%). The number of INR tests per patient per month was 1.69 (95% CI, 1.59-1.80). The monthly patient cost was €39.72 (€36.23-43.21) from the French societal perspective. Direct medical costs comprised 76% of overall costs, with drug costs representing 7.4% (€2.4); direct non-medical and indirect costs comprised 10% and 14% respectively.
Conclusions: Costs associated with VKA treatment in NVAF cannot be estimated only with drug costs. When direct and indirect attributable costs associated with VKA treatment are considered, the VKA treatment costs are more substantial.
Legume roots show a remarkable plasticity to adapt their architecture to biotic and abiotic constraints, including symbiotic interactions. However, global analysis of miRNA regulation in roots is ...limited, and a global view of the evolution of miRNA-mediated diversification in different ecotypes is lacking.
In the model legume Medicago truncatula, we analyze the small RNA transcriptome of roots submitted to symbiotic and pathogenic interactions. Genome mapping and a computational pipeline identify 416 miRNA candidates, including known and novel variants of 78 miRNA families present in miRBase. Stringent criteria of pre-miRNA prediction yield 52 new mtr-miRNAs, including 27 miRtrons. Analyzing miRNA precursor polymorphisms in 26 M. truncatula ecotypes identifies higher sequence polymorphism in conserved rather than Medicago-specific miRNA precursors. An average of 19 targets, mainly involved in environmental responses and signalling, is predicted per novel miRNA. We identify miRNAs responsive to bacterial and fungal pathogens or symbionts as well as their related Nod and Myc-LCO symbiotic signals. Network analyses reveal modules of new and conserved co-expressed miRNAs that regulate distinct sets of targets, highlighting potential miRNA-regulated biological pathways relevant to pathogenic and symbiotic interactions.
We identify 52 novel genuine miRNAs and large plasticity of the root miRNAome in response to the environment, and also in response to purified Myc/Nod signaling molecules. The new miRNAs identified and their sequence variation across M. truncatula ecotypes may be crucial to understand the adaptation of root growth to the soil environment, notably in the agriculturally important legume crops.
Encouraging involvement in school-based extracurricular activities (ECA) may be important for preventing high school dropout. However, the potential of these activities remains underexploited, ...perhaps because studies linking ECA involvement and dropout are rare and based on decades-old data. Previous studies also ignore key parameters of student involvement. The present study expands and updates this limited literature by using recent data from a high-risk Canadian sample (N = 545) and by considering a range of involvement parameters. Results showed that consistent involvement in the past year was associated with lower odds of dropout (OR = 0.32; 95% CI = 0.17-0.61). However, adolescents who interrupted their involvement during this period (e.g., because of cancelations or exclusions) were as much at risk of dropout as those who were not involved at all. Findings notably imply that excluding students from ECA (e.g., because of No Pass/No Play policies) may heighten their dropout risk.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Training in shared decision-making (SDM) often focuses solely on dyadic relationships between one healthcare provider and one patient. However, many healthcare decisions often involve two or more ...health professionals. These decisions warrant utilizing an interprofessional shared decision-making (IP-SDM) approach which enables patients and their caregivers to face difficult decisions around care together. Most existing SDM training programs fall short when building interprofessional (IP) competencies and require an approach that integrates IP with SDM. This short report discusses the creation and trial implementation of three enhanced education tools (a video, role-play exercise with decision aid, and an IP observation aid) for an IP-SDM workshop focused on helping homecare teams collaborate with seniors and their caregivers throughout the decision-making process. We developed and implemented these tools in eight study sites of a larger randomized control trial to test the training workshop for homecare teams. The workshop and tools helped participants overcome interprofessional challenges in their work. Participants evaluated the tools and workshop, which offered guidance to better translate teachable IP collaboration competencies within SDM.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Introduction : High total metabolic tumor volume (TMTV) measured on 18F-FDG PET/CT before R-CHOP has been shown to be significantly associated with worse progression-free survival (PFS) and overall ...survival (OS) in patients with diffuse large B-cell lymphoma (DLBCL; Cottereau et al. Clin Cancer Res. 2016;22:3801-9) . The REMARC study (NCT01122472) is an international, multicenter, double-blind, randomized phase III trial that assessed lenalidomide (LEN) maintenance therapy versus placebo (PBO) in 650 patients responding to R-CHOP. With a median follow-up of ~40 months, independent review demonstrated that 2 years of LEN maintenance therapy significantly improved progression-free survival (PFS); median was not reached in the LEN arm vs 58.9 months in the PBO arm (HR=0.71 95% CI, 0.54-0.93; p=0.0135; Thieblemont et al. J Clin Oncol. 2017;35:2473-81).
Methods: For these analyses, patients enrolled in the REMARC trial who had baseline PET/CT before R-CHOP (not mandatory per study protocol) with available fused images and end of treatment PET/CT were included. Total metabolic tumor volume (TMTV, defined as the sum of the regions of the local tumors with FDG uptake) was measured on baseline PET/CT with the 41% SUVmax thresholding method using the free semiautomatic software Beth Israel Fiji20 (http://petctviewer.org). The optimal TMTV cut-off to PFS (per FDA censoring rule) and overall survival (OS) was determined by Receiver Operating Curve (ROC) curves and X-tile analyses. Survival was estimated using Kaplan Meier (KM) curves. Multivariable analysis were performed with descending Cox model including TMTV, IPIaa, treatment arm and PET/CT response evaluated by Deauville criteria. Analyses were performed on the evaluable population and separate arms
Results: 228 of 650 REMARC patients had TMTV data available for analysis, including n=108 in the PBO arm and n=120 in the LEN arm. Clinical characteristics were similar to the overall population. The median baseline TMTV was 295 cm3 (Q1-Q3, 99-702). After a median follow-up of 51.6 mo, 4y-PFS was 73% and 4y-OS was 85%. The optimal TMTV cut-off determined by ROC was 300 cm3 for PFS and OS.
Patients with TMTV >300 vs ≤300 cm3 presented with worse ECOG performance status (ECOG ≥2: 19% vs 9%, p=0.034), higher Ann Arbor stage (stage III-IV: 95% vs 86%, p=0.042), more extra-nodal sites (>1: 65% vs 38%, p<0.001), more frequently elevated LDH (76% vs 43%, p<0.001), higher IPI (IPI 3-5: 87% vs 51%, p<0.001), and higher aaIPI (aaIPI 2-3: 76% vs 34%, p<0.001).
In all evaluated patients, a significant impact of TMTV for cut-offs of >300 vs ≤300 cm3 was observed for PFS (HR=2.09; 95% CI, 1.22-3.69) and OS (HR=2.99; 95% CI, 1.44-6.18). Patients with high TMTV >300 cm3 vs low TMTV ≤300 cm3, respectively, had a 4-year PFS of 57% vs 73% and OS of 70% vs 88%. These results were more disparate when a higher TMTV cut-off of >1000 was applied. In multivariate analysis, only TMTV maintained an independent prognostic value.
The prognostic impact of TMTV >300 vs ≤300 cm3 on PFS (HR=2.4; 95% CI, 1.1-5.22) and OS (HR=5.0; 95% CI, 1.4-17.) was maintained in the PBO arm (Figure 1A). In contrast, when the analysis was focused on patients in LEN arm, TMTV >300 vs ≤300 cm3 lost its prognostic impact on PFS and OS. In the LEN arm, 4-year PFS and OS did not differ significantly between patients with high and low TMTV (Figure 1B).
Conclusion: TMTV measured on baseline PET/CT is a strong prognosticator of outcome in DLBCL, even in patients in response after R-CHOP. High TMTV at baseline was significantly associated with worse PFS and OS in patients receiving PBO following a response to R-CHOP in the REMARC study. Interestingly, LEN maintenance reduces the negative impact of high baseline TMTV on survival in patients with DLBCL
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Casasnovas:takeda: Consultancy; merck: Consultancy; MSD: Consultancy; Roche: Consultancy; Gilead Sciences: Research Funding; Roche: Honoraria; Takeda: Honoraria; Merck: Honoraria; Gilead Sciences: Honoraria; Janssen: Honoraria; Celgene: Honoraria; MSD: Honoraria; Roche: Research Funding; Gilead Sciences: Consultancy; Janssen: Consultancy. Tilly:Celgene: Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Astra-Zeneca: Membership on an entity's Board of Directors or advisory committees. Feugier:Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Ribrag:Infinity: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Amgen: Research Funding; Roche: Honoraria, Other: travel; MSD: Honoraria; BMS: Consultancy, Honoraria, Other: travel; epizyme: Consultancy, Honoraria; NanoString Technologies: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; argenX: Research Funding; pharmamar: Other: travel; Incyte Corporation: Consultancy. Macro:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Financial support for congress; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Financial support for congress; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Financial support for congress; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Financial support for congress. Morschhauser:Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Epizyme: Consultancy; Janssen: Other: Scientific Lectures; Roche: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees. Trotman:Janssen: Other: Unremunerated member of Ad Board, Research Funding; F. Hoffman-La Roche: Other: Travel to meeting, Unremunerated member of Ad Board, Research Funding; Takeda: Other: Unremunerated member of Ad Board; Celgene: Other: Unremunerated member of Ad Board, Research Funding; PCYC: Research Funding; Beigene: Research Funding. Godmer:CELGENE: Other: Invitation to congress. Salles:Servier: Honoraria; Novartis: Consultancy, Honoraria; Morphosys: Honoraria; Servier: Honoraria, Other: Advisory Board; Celgene: Honoraria, Other: Advisory Board, Research Funding; Acerta: Honoraria; Merck: Honoraria; Janssen: Honoraria, Other: Advisory Board; Pfizer: Honoraria; Epizyme: Honoraria; F. Hoffmann-La Roche Ltd: Consultancy, Honoraria, Research Funding; Gilead: Honoraria, Other: Advisory Board; BMS: Honoraria, Other: Advisory Board; Takeda: Honoraria; Amgen: Honoraria; Abbvie: Honoraria. Coiffier:CELGENE: Consultancy, Membership on an entity's Board of Directors or advisory committees; MUNDIPHARMA: Membership on an entity's Board of Directors or advisory committees; CELLTRION: Membership on an entity's Board of Directors or advisory committees; MORPHOSYS: Membership on an entity's Board of Directors or advisory committees; NOVARTIS: Membership on an entity's Board of Directors or advisory committees. Meignan:F. Hoffman-La Roche Ltd: Honoraria.
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