ABSTRACT Objectives To investigate variation across 78 New South Wales public hospitals, in mortality in the 30 days following admission and in returns to acute care (readmissions) in the 30 days ...following discharge for acute myocardial infarction, ischaemic stroke, heart failure, pneumonia, hip fracture surgery. Approach Linked data were used to (1) construct an analytic unit – an index period of care that comprised concatenated acute, contiguous hospitalisations with the principal diagnosis of interest; (2) to capture outcomes both within the index hospital and following discharge, wherever they occurred; (3) to enhance risk adjustment with one year look back for relevant comorbidities; (4) to assess fair attribution of outcomes. A risk-standardised mortality ratio (RSMR) and a risk standardised readmission ratio (RSRR) were calculated as the ratio of the observed to the expected number events at a given hospital, by developing and validating condition specific system-level prediction models. Funnel plots identified outliers. For the RSRR, the competing risk of death was considered. Results For both outcome indicators, sensitivity was enhanced by the use of linked data (33%-100% more deaths; 23%–32% more returns to acute care or readmissions). For mortality, RSMRs that only capture deaths in hospital, as opposed to deaths within 30 days of admission, were shown to be biased and change the outlier status of about 20% of hospitals. Including socioeconomic status in risk adjustment models altered the outlier status of about 10% of hospitals on the cusp of statistical significance but did not significantly alter the RSMRs. For returns to acute care, sensitivity analyses that included socioeconomic status in the models found there was no significant improvement in discriminatory power. For example, in the case of ischaemic stroke, the c-statistic for the model without inclusion of SES was 0.593 (0.578-0.610); inclusion of SES resulted in a c-statistic of 0.600 (0.583-0.616). There were some changes in hospital-level results but there was no clear evidence of a systematic effect on results. Conclusion The risk-standardised ratio method, based on linked data, compares a hospital’s results given its case mix with an average New South Wales hospital with the same case mix. Ratio-based indicators have been reported publicly and have proven to be a valuable screening tool to identify hospitals where further investigation may be required locally.
Making and breaking the rules Lévesque, Andrée; Klein, Yvonne M
Making and breaking the rules,
2010, 20100209, 1994, 2014, 1994-01-01, 1994-12-15
eBook
By examining the underside of a staid and repressive society, Andrée Lévesque reveals an alternate and more accurate history of women and sexual politics in early twentieth-century Quebec.
Abstract
Background
Rivoceranib is an oral, selective tyrosine kinase inhibitor of VEGFR-2 with demonstrated efficacy for gastric cancer in China. ANGEL was a global phase III study to evaluate the ...efficacy and safety of rivoceranib in gastric cancer.
Methods
Main eligibility criteria included advanced/metastatic adenocarcinoma of the stomach or gastroesophageal junction after failure of ≥ 2 prior lines of chemotherapy; ECOG PS ≤ 1. Patients were stratified by geographic region (Asia vs North America/Europe), disease measurability, prior ramucirumab use, and treatment therapy line (3rd or ≥ 4th), and randomized (2:1 ratio) to rivoceranib 700 mg qd po or matched placebo with BSC until disease progression, intolerable toxicity or withdrawal of consent. Primary endpoint: overall survival (OS, ITT population). Secondary endpoints: progression-free survival (PFS); objective response rate (ORR); disease control rate (DCR); quality of life (QoL); safety. Clinical trial registration: NCT03042611.
Results
Overall, 460 patients (rivoceranib n = 308, placebo n = 152) were enrolled from Feb 2017 – Oct 2018. Baseline demographics were balanced. While mOS in ≥ 3rd-line patients did not show statistical difference for rivoceranib vs placebo (5.78 vs 5.13 mo; HR = 0.93; 95% CI 0.74–1.15; p = 0.4850), mPFS was significantly improved with rivoceranib (2.83 vs 1.77 mo; HR = 0.57; 95% CI 0.46–0.79; p < 0.0001), as was ORR (6.87% vs 0%; p = 0.0020) and DCR (42.37% vs 13.08%; p < 0.0001) in patients with measurable lesions. Furthermore, in ≥ 4th-line patients (rivoceranib n = 122, placebo n = 63) mOS (6.43 vs 4.73 mo; HR = 0.65; 95% CI 0.46–0.92; p = 0.0195) and mPFS (3.52 vs 1.71 mo; HR = 0.38; 95% CI 0.27–0.53; p < 0.0001) were significantly improved with rivoceranib vs placebo. Treatment was generally well tolerated; the most common treatment-related AEs were hypertension (34%) and hand-foot syndrome (26%).
Conclusions
While OS was not significantly improved in the overall population, most other efficacy endpoints including OS in ≥ 4th-line suggest that rivoceranib has a benefit and is well tolerated in patients with gastric cancer.
Clinical trial identification
NCT03042611.
Editorial acknowledgement
Lee Miller, Miller Medical Communications Ltd.
Legal entity responsible for the study
LSK BioPharma.
Funding
LSK BioPharma.
Disclosure
Y. Kang: Advisory / Consultancy: ONO; Advisory / Consultancy: BMS; Advisory / Consultancy: Daehwa; Advisory / Consultancy: LSK Biopharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Macrogenics; Advisory / Consultancy: Zymeworks; Advisory / Consultancy: Blueprint; Advisory / Consultancy: Merck Serono; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Advisory / Consultancy: Astellas; Research grant / Funding (institution): Roche. M. Di Bartolomeo: Honoraria (self), Speaker Bureau / Expert testimony: Lilly spa; Honoraria (self), Speaker Bureau / Expert testimony: Servier; Honoraria (self), Speaker Bureau / Expert testimony: Merck-Serono; Honoraria (self), Speaker Bureau / Expert testimony: MSD; Travel / Accommodation / Expenses: Roche spa; Travel / Accommodation / Expenses: Sanofi. I. Chau: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Eli-Lilly; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: MSD; Advisory / Consultancy: Bayer; Advisory / Consultancy: Roche; Advisory / Consultancy, Research grant / Funding (institution): Merck-Serono; Advisory / Consultancy: Five Prime Therapeutics; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Oncologie International; Advisory / Consultancy: Pierre Fabre; Research grant / Funding (institution): Janssen-Cilag; Research grant / Funding (institution): Sanofi Oncology. H.H. Yoon: Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): Merck; Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): LSK; Honoraria (institution), Advisory / Consultancy: BeiGene; Advisory / Consultancy: FivePrime Therapeutics; Research grant / Funding (institution): Eli Lilly; Research grant / Funding (institution): Merrimack; Research grant / Funding (institution): Genetech/Roche; Research grant / Funding (institution): Boston Biomedical. S. Cascinu: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Bayer; Honoraria (self), Speaker Bureau / Expert testimony: Amgen; Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: Lilly. M. Ryu: Honoraria (self), Advisory / Consultancy: ONO; Honoraria (self), Advisory / Consultancy: BMS; Honoraria (self), Advisory / Consultancy: MSD; Honoraria (self), Advisory / Consultancy: Lilly; Honoraria (self), Advisory / Consultancy: Taiho; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy: Daehwa. K. Lee: Honoraria (self), Travel / Accommodation / Expenses: BMS; Honoraria (self): Eli Lilly; Research grant / Funding (institution): ALX Oncology; Research grant / Funding (institution): Array BioPharma; Research grant / Funding (institution): ASLAN Pharmaceuticals; Research grant / Funding (institution): AstraZeneca/MedImmune; Research grant / Funding (institution): Five Prime Therapeutics; Research grant / Funding (institution): Green Cross Corp.; Research grant / Funding (institution): LSK BioPharma; Research grant / Funding (institution): Macrogenics; Research grant / Funding (institution): Merck KGaA; Research grant / Funding (institution): MSD; Research grant / Funding (institution): Ono Pharmaceutical; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Pharmacyclics. A. McGinn: Shareholder / Stockholder / Stock options, Full / Part-time employment: LSK BioPharma. N. Sankar: Shareholder / Stockholder / Stock options, Full / Part-time employment: LSK BioPharma. N. Boku: Honoraria (self), Research grant / Funding (institution): Ono Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Taiho Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Bristol-Myers Squibb; Honoraria (self): Eli Lilly; Honoraria (self): Chugai. All other authors have declared no conflicts of interest.
Red travellers Lévesque, Andrée; Klein, Yvonne M
Red travellers,
2006, 20061103, 2000, 2006-11-03, 20060101, Volume:
6
eBook
Corbin's "red itinerary" began when she joined the Young Communist League in Edmonton. She later held party posts across the country through her involvement with The Worker in Toronto, a French ...communist paper in Montreal, the Workers' Cooperative in Timmins, and a lumbermen's strike in Abitibi - where she was jailed for taking part in a protest. She died of tuberculosis in London, Ontario, in 1944.
Le Fibroscan
® ne mesure pas uniquement la fibrose hépatique. En effet, l’élasticité hépatique est modifiée au cours des hépatites aiguës virales ou chez des malades ayant une stéatose. L’influence ...de la consommation alcoolique et du sevrage sur l’élasticité hépatique mesurée par Fibroscan
® n’a pas encore été étudiée.
Vingt-trois patients alcoolodépendants (20 hommes, 3 femmes, âge médian 47 ans 42-53), ayant une consommation supérieure à 21 verres par semaine chez les hommes et 14 verres chez les femmes ont été inclus dans cette étude. Ces malades étaient hospitalisés une semaine pour sevrage alcoolique. Les patients porteurs d’hépatites virales (A, B ou C) ou séropositifs pour le VIH étaient exclus. L’existence d’une ascite ou d’un IMC
>
30 kg/m
2 étaient des critères d’exclusion. Un bilan biologique (transaminases, GGT, VGM, alcoolémie et CDT Transferrine Carboxy-Deficiente) ainsi qu’un fibroscan
® étaient systématiquement effectués à J0, J8, J30 et J60. Un malade était considéré comme abstinent si l’interrogatoire du patient concordait avec le bilan biologique. La variation de l’élasticité hépatique > 20 % était considérée comme significative.
A ce jour, 23 malades ont eu un bilan complet à J8, 22 à J30 et 19 à J60. A J8, après une semaine de sevrage, 13 patients (56,5 %) avaient une diminution significative de l’élasticité hépatique. A J60, 12 patients (63 %) étaient abstinents et 8 d’entre eux avaient une diminution significative de l’élasticité. Chez les abstinents, la médiane de baisse d’élasticité par rapport à J0 était de −12,5 % à J8, −17,3 % à J30 et −27,8 % à J60.
En comparant au groupe rechuteur entre J8 et J60, 6 patients abstinents (50 %) avaient une diminution significative de l’élasticité
versus 0 dans le groupe des rechuteurs (P
=
0,04). La médiane de variation d’élasticité hépatique était de −20 % chez les abstinents et de +32 % chez les rechuteurs (P
=
0,007).
L’élasticité hépatique mesurée par Fibroscan
® chez les patients ayant une forte consommation d’alcool diminue avec le sevrage. La variation de l’élasticité hépatique pourrait être un marqueur de sevrage. Enfin, chez ces patients alcooliques, l’évaluation de la fibrose hépatique par Fibroscan
® n’est pas fiable en raison des fortes amplitudes de variation de l’élasticité au cours du sevrage d’alcool.
The authors detail how the Bush and Clinton administrations relied on catering to allies and building large coalitions to deal with major international security challenges, while other principal ...powers were either pre-occupied with their domestic problems or deferred to the United States. As a consequence, on the eve of 11 September 2001 the United Nations Security Council remained an older, outmoded power configuration incapable of responding efficiently to the with novel challenges besetting it. Its relevance has been further questioned by the unilateral occupation of Iraq by the United States.
The future of NATO David, Charles-Philippe; Lévesque, Jacques
The future of NATO,
c1999, 19990520, 1999, 1999-05-20, Volume:
6
eBook
The Future of NATO looks at the conceptual and theoretical approaches that underlie the question of enlarging NATO's membership and the consequences of enlargement on international relations. It ...examines the policies of some of NATO's leading member states - including Canada, which has recently begun a two-year term on the security council - and deals with the issue of enlargement from the point of view of the East European candidates, focusing on Russia and its opposition to the current process.
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