Risultati per: Cardio-oncology: rivista open access

Stroke, Volume 54, Issue Suppl_1, Page AHUP4-AHUP4, February 1, 2023. Introduction:Mechanical thrombectomy (MT) is a highly safe and effective standard of care for acute ischemic strokes with large vessel occlusion. However, timely access to MT is extremely limited on a global scale, with vast disparities in access between countries. MT2020+, a global non-profit initiative of SVIN, aimed to create a semi-quantitative global MT access barrier score (MTABS) to objectively measure the barriers impeding the implementation of treatment worldwide.Methods:Four independent investigators performed an in-depth systematic literature review using the peer review of electronic search strategies. Barriers to access were identified and categorized into 3 groups: information and diagnostic, physical, and financial. An international expert panel was created and scored each attribute using a modified Delphi process with the assistance of consultants from the University of Calgary W21C. A 1-9-point scale was used, with 1 being not at all important and 9 being extremely important. A meeting was held for the attributes that require deliberation. After an agreement, a list of attributes for access was elaborated. Next, a ranking of importance and individual weighting was done. We assigned a presence of or lack of an attribute a numerical value (1 for yes, 0 for no) and multiply by its weight to determine a final score.Results:After an initial screening of 2864 abstracts, 121 studies were included in the final systematic review. A total of 34 possible attributes that are barriers to access were identified. After the modified Delphi process, 26 individual attributes were selected. The MTABS was made with possible results from 0-62 points, with higher scores meaning higher barriers to access to MT.Conclusions:The global MTABS represents the first tool to quantify barriers to MT access worldwide. Its implementation will objectively measure the magnitude and identify key barriers to guide regional public health interventions to improve MT workflow and access.

Stroke, Volume 54, Issue Suppl_1, Page AWMP75-AWMP75, February 1, 2023. Background:Social determinants of health are emerging as a key group of risk factors for cerebrovascular disease. Carotid artery stenosis (CAS) is an important risk factor for ischemic stroke. We hypothesize that community deprivation, an exposure that captures several social determinants for health, leads to significant disparities in healthcare access in patients with known CAS.Methods:We conducted a cross-sectional study within the All of Us Research Program, a prospective population study that aims to enroll 1 million Americans. We included study participants with CAS, as defined by validated ICD-9/10 codes. We evaluated access to healthcare using 5 metrics included in the Health Care Access and Utilization Survey (Table 1). We evaluated community deprivation using the Deprivation Index, a novel compound metric developed by the American Community Survey. We tested for association between tertiles of the Deprivation Index (labeled low, intermediate and high community deprivation) and health care access using multivariable models adjusting for potential confounders.Results:Of 333,845 participants enrolled in All of Us, we identified 2,465 (0.74%) participants with CAS (mean age 69, 53% female). Of these, 259 (10.5%) could not afford prescription medication, 132 (5.4%) could not afford specialist care, 144 (5.8) skipped medications, 109 (4.4%) could not afford follow up care and 97 (3.9%) could not afford mental health care. In unadjusted analysis, higher community deprivation was associated with a higher prevalence of all 5 evaluated indicators of poor access to health. In multivariable analysis adjusted for potential confounder variables, difficulty affording prescription medication, specialist care and follow up care remained statistically significant (Table 1).Conclusion:Among persons with CAS enrolled in All of Us, community deprivation was associated with a lower likelihood of accessing and utilizing important healthcare services.

Stroke, Volume 54, Issue Suppl_1, Page AHUP6-AHUP6, February 1, 2023. Background:Social determinants of health are emerging as a key group of risk factors for cerebrovascular disease. Carotid artery stenosis (CAS) is an important risk factor for ischemic stroke. We hypothesize that community deprivation, an exposure that captures several social determinants for health, leads to significant disparities in healthcare access in patients with known CAS.Methods:We conducted a cross-sectional study within the All of Us Research Program, a prospective population study that aims to enroll 1 million Americans. We included study participants with CAS, as defined by validated ICD-9/10 codes. We evaluated access to healthcare using 5 metrics included in the Health Care Access and Utilization Survey (Table 1). We evaluated community deprivation using the Deprivation Index, a novel compound metric developed by the American Community Survey. We tested for association between tertiles of the Deprivation Index (labeled low, intermediate and high community deprivation) and health care access using multivariable models adjusting for potential confounders.Results:Of 333,845 participants enrolled in All of Us, we identified 2,465 (0.74%) participants with CAS (mean age 69, 53% female). Of these, 259 (10.5%) could not afford prescription medication, 132 (5.4%) could not afford specialist care, 144 (5.8) skipped medications, 109 (4.4%) could not afford to follow up care and 97 (3.9%) could not afford mental health care. In unadjusted analysis, higher community deprivation was associated with a higher prevalence of all 5 evaluated indicators of poor access to health. In multivariable analysis adjusted for potential confounder variables, difficulty affording prescription medication, specialist care and follow up care remained statistically significant (Table 1).Conclusion:Among persons with CAS enrolled in All of Us, community deprivation was associated with a lower likelihood of accessing and utilizing important healthcare services.

This cohort study analyzes suicide rates among reproductive-aged women from 1974 to 2016 to determine their association with state-level legislative policies surrounding abortion and restricted access to reproductive care.

Timely access to scientific research findings for the broadest possible audience is a principle on which sound science is based. Access to new findings helps other scientists adjust their hypotheses and open new lines of inquiry, thereby supporting and accelerating further discovery and innovation. For those who rely on newly generated evidence to develop policies and define practices that improve medicine and public health, rapid and equitable access is critical. The principle of broad access is a cornerstone of transparency, reinforces rigor and reproducibility, and ultimately, is critical to all stakeholders’ trust in science.

The Brief Report titled “Contrasting Case-Control and Normative Reference Approaches to Capture Clinically Relevant Structural Brain Abnormalities in Patients With First-Episode Psychosis Who Are Antipsychotic Naive,” published online September 28, 2022, was changed to open access status under the CC-BY license. This article was corrected online.

Timely access to scientific research findings for the broadest possible audience is a principle on which sound science is based. Access to new findings helps other scientists adjust their hypotheses and open new lines of inquiry, thereby supporting and accelerating further discovery and innovation. For those who rely on newly generated evidence to develop policies and define practices that improve medicine and public health, rapid and equitable access is critical. The principle of broad access is a cornerstone of transparency, reinforces rigor and reproducibility, and ultimately, is critical to all stakeholders’ trust in science.

This study examines the use of single-arm trials for US Food and Drug Administration drug approvals.

Timely access to scientific research findings for the broadest possible audience is a principle on which sound science is based. Access to new findings helps other scientists adjust their hypotheses and open new lines of inquiry, thereby supporting and accelerating further discovery and innovation. For those who rely on newly generated evidence to develop policies and define practices that improve medicine and public health, rapid and equitable access is critical. The principle of broad access is a cornerstone of transparency, reinforces rigor and reproducibility, and ultimately, is critical to all stakeholders’ trust in science.

JAMA Oncology is committed to publishing influential original research, opinions, and reviews that advance the science of oncology and improve the clinical care of patients with cancer.

Timely access to scientific research findings for the broadest possible audience is a principle on which sound science is based. Access to new findings helps other scientists adjust their hypotheses and open new lines of inquiry, thereby supporting and accelerating further discovery and innovation. For those who rely on newly generated evidence to develop policies and define practices that improve medicine and public health, rapid and equitable access is critical. The principle of broad access is a cornerstone of transparency, reinforces rigor and reproducibility, and ultimately, is critical to all stakeholders’ trust in science.

Introduction
Neoadjuvant chemotherapy (NAC) has been demonstrated effective in several tumours, but its benefit has not yet been elucidated in colorectal cancer, especially locally advanced colorectal cancer (LACRC).

Methods and analysis
This is a single-arm, open-label, prospective phase II exploratory clinical trial. Patients with LACRC will receive four cycles of NAC with 5-fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI), followed by operation and then adjuvant chemotherapy with capecitabine and oxaliplatin for two to five cycles or single-agent capecitabine for five cycles, or observation. The primary endpoint is the rate of tumour regression grade (TRG) 0–2 in the resected tumour tissue, which is evaluated by experienced pathologists according to the Ryan R TRG grading system. Secondary endpoints include objective response rate, pathologic complete response, microscopically complete resection rate, progression-free survival, distant metastasis-free survival, overall survival, toxicity and compliance to study treatment, molecular markers, quality of life to study treatment and the number of patients with 30-day postoperative mortality. The objective of this study is to analyse the efficacy and safety of FOLFOXIRI as the NAC regimen in patients with LACRC and to identify a promising treatment strategy in this setting.

Ethics and dissemination
Written informed consent will be required from and provided by all patients enrolled. The study protocol has been approved by the independent ethics committee of West China Hospital, Sichuan University (approval number: 2021403). This study will demonstrate the potential benefit of NAC with the FOLFOXIRI regimen. Results will be shared with policymakers and the academic community to promote the clinical management of colon cancer.

Trial registration number
NCT05018182.

Introduction
Chronic cytomegalovirus (CMV) infection is very frequent in people living with HIV (PLWH). High anti-CMV IgG titres, which may be linked to transient CMV replication, have been associated with earlier mortality, CD8 T-cell expansion, lower CD4/CD8 ratio and increased T-cell senescence. We previously showed that anti-CMV IgG titres correlated with gut permeability in PLWH on antiretroviral therapy (ART), which was associated with microbial translocation, systemic inflammation and non-infectious/non-AIDS comorbidities. Letermovir, a novel anti-CMV drug with a good safety profile, was recently approved for anti-CMV prophylaxis in allogeneic haematopoietic stem cell transplant recipients. A drastic and selective reduction of both low-grade replication and clinically significant CMV infections, combined with an improved immune reconstitution have been reported. In vitro, letermovir prevented CMV-induced epithelial disruption in intestinal tissues. Based on these findings, we aim to assess whether letermovir could inhibit CMV subclinical replication in CMV-seropositive PLWH receiving ART and, in turn, decrease CMV-associated gut damage and inflammation.

Method and analysis
We will conduct a multi-centre, open-label, randomised, controlled clinical trial, including a total of 60 CMV-seropositive ART-treated PLWH for at least 3 years, with a viral load 400 cells/µL. Forty participants will be randomised to receive letermovir for 14 weeks and 20 participants will receive standard of care (ART) alone. Plasma, pheripheral blood mononuclear cells (PBMCs), and stool samples will be collected. Colon biopsies will be collected in an optional substudy. We will assess the effect of letermovir on gut damage, microbial translocation, inflammation and HIV reservoir size.

Ethics and dissemination
The study was approved by Health Canada and the Research Ethics Boards of the McGill University Health Centre (MUHC-REB, protocol number: MP37-2022-8295). Results will be made available through publications in open access peer-reviewed journals and through the CIHR/CTN website.

Trial registration number
NCT05362916.

New England Journal of Medicine, Volume 388, Issue 3, Page 281-283, January 2023.

About one third of these patients reported using cannabis, often with a decrease in use of other analgesics as a result.

Objective
This study explores sources of stress, conditions that help reduce stress levels and coping strategies among parents of children with cancer receiving chemotherapy at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.

Design
A qualitative phenomenological approach was used.

Setting
Parents of children receiving chemotherapy at the TASH paediatric oncology unit.

Participants
Fifteen semistructured in-depth interviews were conducted with nine mothers and six fathers of children with cancer from November 2020 to January 2021.

Results
Sources of stress related to child’s health condition as the severity of the child’s illness, fear of treatment side effects and loss of body parts were identified. Parents mentioned experiencing stress arising from limited access to health facilities, long waiting times, prolonged hospital stays, lack of chemotherapy drugs, and limited or inadequate information about their child’s disease condition and treatment. Other sources of stress were insufficient social support, stigmatisation of cancer and financial problems. Conditions decreasing parents’ stress included positive changes in the child’s health, receiving cancer treatment and access to drugs. Receiving counselling from healthcare providers, getting social support and knowing someone who had a positive treatment outcome also helped reduce stress. Coping strategies used by parents were religious practices including prayer, crying, accepting the child’s condition, denial and communication with health providers.

Conclusion
The main causes of stress identified by parents of children with cancer in Ethiopia were the severity of their child’s illness, expectations of poor treatment outcomes, unavailability of cancer treatment services and lack of social/financial support. Measures that should be considered to reduce parents’ stress include providing psycho-oncological care for parents and improving the counselling available to parents concerning the nature of the child’s illness, its treatment, diagnostic procedures and treatment side effects. It may also be helpful to establish and strengthen family support groups and parent-to-parent communication, improve the availability of chemotherapy drugs and offer more education on coping strategies.