Abstract Objective Physical activity (PA) and screen time (ST) are associated with self-rated health (SRH) in adults; however, SRH has been less studied among youth, and information about self-rated ...mental health (SRMH) is lacking. This study examined the associations of PA and ST with SRH and SRMH among adolescents. Methods Cross-sectional data from the 2011–2012 Canadian Community Health Survey included 7725 participants aged 12–17 years, representing 1,820,560 Canadian adolescents. Associations of self-reported PA and ST to SRH and SRMH were assessed, controlling for age, race/ethnicity, smoking, highest household education and weight status. Results Excellent/very good SRH was reported by 78% of active vs. 62% of inactive adolescents, and 77% of those meeting vs. 70% of those exceeding ST guidelines (both p < 0.001). Excellent/very good SRMH was reported by 81% of active vs. 76% of inactive adolescents, and 84% of those meeting vs. 78% of those exceeding ST guidelines (both p < 0.001). Inactive adolescents had twice higher odds of sub-optimal SRH, and inactive girls had 30% greater odds of sub-optimal SRMH. Adolescents exceeding 2 h/day ST had 30% greater odds of sub-optimal SRH, and 30–50% greater odds of sub-optimal SRMH. Conclusion PA and ST are independently associated with health perceptions among Canadian adolescents. Interventions should consider health perceptions in addition to biomedical outcomes.
Summary Background The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) have developed frameworks that quantify survival gains in light of toxicity ...and quality of life to assess the benefits of cancer therapies. We applied these frameworks to a cohort of contemporary randomised controlled trials to explore agreement between the two approaches and to assess the relation between treatment benefit and cost. Methods We identified all randomised controlled trials of systemic therapies in non-small-cell lung cancer, breast cancer, colorectal cancer, and pancreatic cancer published between Jan 1, 2011, and Dec 31, 2015, and assessed their abstracts and methods. Trials were eligible for inclusion in our cohort if significant differences favouring the experimental group in a prespecified primary or secondary outcome were reported (secondary outcomes were assessed only if primary outcomes were not significant). We assessed trial endpoints with the ASCO and ESMO frameworks at two timepoints 3 months apart to confirm intra-rater reliability. Cohen's κ statistic was calculated to establish agreement between the two frameworks on the basis of the median ASCO score, which was used as an arbitrary threshold of benefit, and the framework-recommended ESMO threshold. Differences in monthly drug cost between the experimental and control groups of each randomised controlled trial (ie, incremental drug cost) were derived from 2016 average wholesale prices. Findings 109 randomised controlled trials were eligible for inclusion, 42 (39%) in non-small-cell lung cancer, 36 (33%) in breast cancer, 25 (23%) in colorectal cancer, and six (6%) in pancreatic cancer. ASCO scores ranged from 2 to 77; median score was 25 (IQR 16–35). 41 (38%) trials met the benefit thresholds in the ESMO framework. Agreement between the two frameworks was fair (κ=0·326). Among the 100 randomised controlled trials for which drug costing data were available, ASCO benefit score and monthly incremental drug costs were negatively correlated (ρ=–0·207; p=0·039). Treatments that met ESMO benefit thresholds had a lower median incremental drug cost than did those that did not meet benefit thresholds (US$2981 IQR 320–9059 vs $8621 1174–13 930; p=0·018). Interpretation There is only fair correlation between these two major value care frameworks, and negative correlations between framework outputs and drug costs. Delivery of optimal cancer care in a sustainable health system will necessitate future oncologists, investigators, and policy makers to reconcile the disconnect between drug cost and clinical benefit. Funding None.
The authors concluded that positive results for anti-Borrelia IgG antibodies were a strong independent predictor for AF (odds ratio 8.21; 95% confidence interval 3.08 to 21.88; p <0.0001). In terms ...of baseline characteristics, besides a difference in proportion of patients with Borrelia IgG antibodies, AF was also significantly associated with higher body mass index, obesity, hypertension, chronic kidney disease, and heart failure. ...in addition to AF, the presence of Borrelia IgG antibodies was also significantly associated with obesity and chronic kidney disease while age, male gender, and hypertension were associated at p <0.10.
Objective
To assess the impact of coronavirus disease 2019 (COVID‐19) on burnout rates in Canadian Urology trainees.
Subjects and Methods
A total of 37 chief residents representing all 12 Canadian ...Urology residency programmes attended a preparatory examination in December 2019 pre‐pandemic and 39 chief residents attended virtually in November 2020 during the pandemic. The Maslach Burnout Inventory (MBI) for medical professionals’ questionnaire was administered anonymously to both groups. The MBI covers emotional exhaustion, depersonalisation, and personal accomplishment. Descriptive statistics were used to analyse the data.
Results
There was a 100% response rate in the convenience sample (n = 37) in 2019 and 64.1% response rate (n = 25) in 2020. Overall, 70% of chief residents in Canadian Urology programmes showed evidence of burnout in 2019 compared to 88% in 2020 (P = 0.101). There was a statistically significant difference between the two cohorts in emotional exhaustion (mean sd 16.2 5.6 in 2019 and 20.2 6.2 in 2020, P = 0.011) and personal accomplishment scores (mean sd 32.2 4.5 in 2019 and 30.6 3.6 in 2020, P = 0.039).
Conclusions
This study is the first to examine the impact of the pandemic on burnout rates in Urology trainees. Burnout rates are high in trainees at baseline, and the pandemic appears to have exacerbated emotional exhaustion, and personal accomplishment, but not overall burnout rates. Vigilance and proactive steps need to be implemented to alleviate this crisis.
To determine the incidence of thromboembolic events (TEEs) in ovarian cancer patients and to identify risk factors that are significantly associated with the development of venous thromboembolism ...(VTE), arterial thromboembolism (ATE), or overall TEEs in this population.
This is a retrospective cohort study of 4491 patients with epithelial ovarian cancer identified in the British Columbia cancer registry between 1996 and 2017. The presence of TEEs and risk factors were identified in administrative health records from fee-for-service provider visits and hospital data using ICD-9-CM and ICD-10-CM billing codes. Statistical analysis was performed using Chi-squared test and Fischer's exact test.
Of 4491 patients with epithelial ovarian cancer included in this study, 1.74% experienced ATE and (9.44%) experienced VTE. There was a significant association found between the occurrence of TEEs and all-cause mortality. Sepsis was significantly associated with both venous and arterial thromboembolism. The top three risk factors for arterial thromboembolism included peripheral vascular disease (PVD), open wound, and aneurysm.
Risk factors predictive of thrombosis in ovarian cancer patients are not consistent between ATE and VTE, thus thrombotic events should not be combined for analysis. Differential thrombosis risk assessment is needed to improve prevention strategies and guide thromboprophylaxis for these patients.
•In a large cohort of patients with epithelial ovarian cancer, thrombosis rate was 9.44% (VTE) and 1.74% (ATE).•Significant association was found between thrombosis occurrence and all-cause mortality.•Thrombosis risk factors are not consistent between ATE and VTE and sepsis is significantly associated with both.•Differential thrombosis risk assessment is needed to guide thromboprophylaxis for these patients.
The randomized clinical trial (RCT) in oncology has evolved since its widespread adoption in the 1970s. In recent years, concerns have emerged regarding the use of putative surrogate end points, such ...as progression-free survival (PFS), and marginal effect sizes.
To describe contemporary trends in oncology RCTs and compare these findings with earlier eras of RCT design and output.
Retrospective cohort study of systemic therapy RCTs in breast, colorectal, and non-small cell lung cancer published in 7 major journals between 2010 and 2020. This strategy replicates prior work and allows for comparison of trends with RCTs published between 1995 to 2004 and 2005 to 2009.
Data on RCT design, funding, results, and reporting were extracted from the published RCT report. Findings from the current period (2010-2020) were compared with data from RCTs published from 1995 to 2004 and 2005 to 2009. Descriptive and bivariate statistics were used to analyze temporal trends.
The cohort included 298 RCTs (132 44% breast, 111 37% non-small cell lung cancer, 55 19% colorectal cancer). Experimental treatment included molecular inhibitor (171 of 298 57%), cytotoxic (83 of 298 28%), hormone (15 of 298 5%), and immune (24 of 298 8%) therapies. Sixty-nine percent (206 of 298) of RCTs were of palliative intent. The most common primary end point is now PFS; this has increased substantially over time (from 0% 0 of 167 to 18% 25 of 137 to 42% 125 of 298; P < .001). Of 298 RCTs, 265 (89%) are now funded by industry (previously 95 of 167 57% and 107 of 137 78%; P < .001). Fifty-eight percent (173 of 298) of trials met their primary end point. Among positive trials, median improvement in overall survival and PFS was 3.4 and 2.9 months, respectively. More than one-third (117 of 298 39%) of reports used a professional medical writer; this increased substantially during the study period (from 3 of 27 11% in 2010 to 12 of 18 67% in 2020; P < .001).
This cohort study suggests that contemporary oncology RCTs now largely measure putative surrogate end points and are almost exclusively funded by the pharmaceutical industry. The increasing role of medical writers warrants attention. To demonstrate that new cancer treatments are high value, the oncology community needs to consider the extent to which study end points and target effect size provide meaningful benefit to patients.
The cancellation of elective surgeries is a major problem that increases wait times, exacerbates costs and can negatively affect patients, both psychologically and physically. Our objectives were to ...investigate the reasons for cancellations across specialties at a single centre, to compare these reasons with previous data from the same centre between 2005 and 2009 and to examine how cancellations affected patients' lives and views of the medical system in cases when the cancellations were potentially preventable.
Cancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic centre were retrospectively reviewed. We evaluated the rates and reasons for cancellation and interviewed a subset of patients whose surgery was cancelled for a potentially preventable reason (i.e., operating room running late, bed shortage, emergency case took place of scheduled surgery).
Across 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons. Compared with the data collected previously for general, gynecological and urological procedures, cancellation rates increased from 8.1% to 11.8%. Although patients reported inconvenience, they were generally satisfied with the availability and the quality of the health care they received.
Consistent with the previous study, our data suggest that most cancellations occur because of administrative or structural processes that are potentially preventable. Targeting these processes may help to reduce cancellations for elective surgeries and thereby improve economic efficiency and patient outcomes.
Immunotherapy has emerged as an effective treatment option for the management of advanced cancers. The effects of these immune checkpoint inhibitors in the older patient population has not been ...adequately assessed.
To understand the impact of aging on CTLA-4 and PDL-1 inhibitors efficacy and immune-related adverse events (irAE) in the context of real-world management of advanced solid cancers.
This retrospective study involved all non-study patients with histologically-confirmed metastatic or inoperable solid cancers receiving immunotherapy at Kingston Health Sciences Centre. We defined ‘older patient’ as age ≥ 75. All statistical analyses were conducted under SPSS IBM for Windows version 24.0.
Study outcomes included immunotherapy treatment response, survival, as well as number, type, and severity of irAEs.
Our study (N = 78) had 29 (37%) patients age <65, 26 (33%) patients age 65–74, and 23 (30%) patients age ≥75. Melanoma, non-small cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the study population, respectively. Distributions of ipilimumab (32%), nivolumab (33%), and pembrolizumab (35%) were similar in the study. The response rates were 28%, 27%, and 39% in the age <65, age 64–74, age ≥75 groups, respectively (P = 0.585). Kaplan-Meier curve showed a median survival of 28 months (12.28–43.9, 95% CI) and 17 months (0–36.9, 95% CI) in the age <65 and age 64–74 groups, respectively; the estimated survival probability did not reach 50% in the age ≥75 group (P = 0.319). There were no statistically significant differences found in terms of irAEs, multiple irAEs, severity of grade 3 or higher, types of irAEs, and irAEs resolution status when comparing between different age groups.
Our results suggest that patients age ≥75 are able to gain as much benefit from immunotherapy as younger patients, without excess toxicity. Our findings suggest that single agent immunotherapy is generally well-tolerated across different age groups with no significant difference in the type, frequency or severity of irAEs. Future studies evaluating aging and combination immunotherapy are warranted.
Purpose Obesity is associated with impaired health-related quality of life (HRQL). As perceived constructs, self-rated health (SRH) and general life satisfaction (LS) might be more strongly related ...to perceived weight status than actual weight status. The aim was to assess agreement between perceived weight status and self-reported body mass index (BMI), and to investigate their associations with SRH and LS as indicators of HRQL. Methods Cross-sectional data included 87,545 adults aged 18–65 years from the 2005 Canadian Community Health Survey. Agreement between perceived weight status and self-reported BMI was assessed. Prevalence of suboptima SRH and LS was estimated by perceived weight status and BMI, and adjusted logistic regression used to assess the odds of suboptimal outcomes. Results Overall agreement between perceived weight status and self-reported BMI was only moderate (females: k = 0.58; males: k = 0.42). The lowest prevalences of suboptimal SRH and LS were in those who reported both a healthy weight BMI and “about right” weight perception. Discordance between perceived weight status and BMI status, and congruence (i.e. perceived weight status = BMI) aroung underweight or over-weight/obese were associated with poorer SRH and LS. For weight perceptions of “about right”, BMI status had minimal influence on suboptimal SRH or LS, while perceptions of underweight or overweight were associated with higher odds of suboptimal SRH and LS, independent of BMI. Conclusions Adults’ weight status perceptions often do not agree with their actual weight status, even when self-reported. While both perceived and actual weight status influence self-rated health and life satisfaction, perceptions are more strongly associated with these HRQL indicators and should be considered when informing obesity-targeted policies and programmes.
Work-hour restrictions as set forth by the Accreditation Council for Graduate Medical Education (ACGME) and other governing bodies have forced training programs to seek out new learning tools to ...accelerate acquisition of both medical skills and knowledge. As a result, competency-based training has become an important part of residency training. The purpose of this study was to directly compare arthroscopic skill acquisition in both high-fidelity and low-fidelity simulator models and to assess skill transfer from either modality to a cadaveric specimen, simulating intraoperative conditions.
Forty surgical novices (pre-clerkship-level medical students) voluntarily participated in this trial. Baseline demographic data, as well as data on arthroscopic knowledge and skill, were collected prior to training. Subjects were randomized to 5-week independent training sessions on a high-fidelity virtual reality arthroscopic simulator or on a bench-top arthroscopic setup, or to an untrained control group. Post-training, subjects were asked to perform a diagnostic arthroscopy on both simulators and in a simulated intraoperative environment on a cadaveric knee. A more difficult surprise task was also incorporated to evaluate skill transfer. Subjects were evaluated using the Global Rating Scale (GRS), the 14-point arthroscopic checklist, and a timer to determine procedural efficiency (time per task). Secondary outcomes focused on objective measures of virtual reality simulator motion analysis.
Trainees on both simulators demonstrated a significant improvement (p < 0.05) in arthroscopic skills compared with baseline scores and untrained controls, both in and ex vivo. The virtual reality simulation group consistently outperformed the bench-top model group in the diagnostic arthroscopy crossover tests and in the simulated cadaveric setup. Furthermore, the virtual reality group demonstrated superior skill transfer in the surprise skill transfer task.
Both high-fidelity and low-fidelity simulation trainings were effective in arthroscopic skill acquisition. High-fidelity virtual reality simulation was superior to bench-top simulation in the acquisition of arthroscopic skills, both in the laboratory and in vivo. Further clinical investigation is needed to interpret the importance of these results.
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