Risultati per: Terapia antibiotica: breve durata vs. lunga durata

Stroke, Volume 54, Issue Suppl_1, Page AWMP104-AWMP104, February 1, 2023. Background:Approximately 14% of the US population resides in rural areas, which have higher rates of chronic disease and are often medically underserved. We compared 1-year outcomes after ischemic stroke for Medicare beneficiaries living in urban vs rural areas.Methods:We identified all Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US acute-care hospitals with ischemic stroke in 2015 to 2017. Patients were followed up to 1 year through 2018 for death or ischemic stroke recurrence and categorized according to geographic remoteness of their residence using the Rural-Urban Community Area codes. We balanced patient characteristics between the rural/urban categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical characteristics. We created adjusted Kaplan-Meier curves based on the IPW and fit Cox models to assess differences in 1-year all-cause mortality and recurrent stroke weighted by the IPW and accounting for competing risks.Results:There were 536,930 stroke patients (32,635 isolated rural, 40,240 small rural, 66,320 large rural, 397,735 urban; mean age 79.0 years, 54.7% women, 82.5% White). For isolated rural, small rural, large rural, and urban residents, 1-year adjusted mortality rates were 24.1%, 24.6%, 24.7%, and 22.9%, and 1-year stroke recurrence rates were 8.0%, 7.8%, 7.9%, and 8.1%, respectively. Compared with urban residents, isolated rural (HR 1.07, 95% CI 1.04-1.09), small rural (1.09, 1.07-1.12), and large rural (1.10, 1.08-1.12) residents had greater risk of death within 1 year after stroke, but there was little difference in recurrence (Fig. A). Urban residents had the lowest mortality across regions, but there was variation among the rural subcategories and for recurrence in region-stratified analyses (Fig. B).Conclusions:Ischemic stroke patients living in urban areas had a lower risk of mortality within 1 year compared with those living in more rural areas.

Stroke, Volume 54, Issue Suppl_1, Page ATP44-ATP44, February 1, 2023. Introduction:Telestroke is the use of videoconferencing technology by a stroke specialist to assess and treat acute ischemic stroke patients who present elsewhere. It has been well-studied previously in a “Hub-and-Spoke” model. In 2021, Telestroke was used to assess and treat acute ischemic stroke patients who presented primarily after-hours to our comprehensive stroke center because we were concerned the COVID-19 pandemic could affect the timeliness of in-person code stroke assessments. After implementation, we determined the efficacy and safety outcomes for patients treated with Telestroke versus in-person assessments.Hypothesis:We hypothesized that there will be no difference in the efficacy or safety outcomes between patients treated using Telestroke vs. in-person assessments.Methods:A retrospective chart review identified acute ischemic stroke patients who presented to our center in 2021, who were assessed and treated using either Telestroke or an in-person assessment. The primary outcomes for efficacy were door-to-needle (DTN) time for alteplase administration and door to puncture (DTP) time for endovascular thrombectomy. The primary safety outcomes were 3-month mortality and symptomatic intracranial hemorrhage rates (sICH).Results:We treated 302 acute stroke patients in 2021, with 18.2% (n=55/302) of patients treated using Telestroke. There were no differences in clinical outcomes between patients treated using Telestroke vs. in-person assessments: median DTN (35.5min (n=42) vs. 33min (n=182), p

To the Editor We read with interest the recent A021501 phase 2 randomized clinical trial and the accompanying Editorial. The trial investigates the individual contributions of neoadjuvant chemotherapy and chemoradiotherapy in patients with borderline resectable pancreatic ductal adenocarcinoma (PDAC). Patients received either stereotactic body radiotherapy (SBRT; 33-40 Gy in 5 fractions) or hypofractionated image-guided radiotherapy (25 Gy in 5 fractions). The median overall survival (OS) for the chemoradiotherapy and chemotherapy arms was 17.1 and 29.8 months, respectively. In the Discussion, the authors claimed that chemotherapy could be a new standard of neoadjuvant treatment. We believe that this study has the following limitations in reaching such a conclusion.

To the Editor We read with interest the editorial interpretation by Ahn et al of the A021501 trial but disagree with the authors’ conclusions. Radiation therapy has been a central component of neoadjuvant trials for pancreatic cancer (PC) for more than a decade; however, the duration of neoadjuvant chemotherapy and optimal radiation dose remain unanswered. Randomized clinical trials must be adequately powered to compare treatment interventions. Unfortunately, about 75% of participants in the A021501 trial did not complete the assigned intervention, limiting the interpretation about the role of radiation therapy. Despite that important detail, the Editorial’s interpretation that neoadjuvant radiation therapy (in any form) is questionable for patients with operable PC is not a conclusion supported by A021501. To make that conclusion would require typically more than 500 patients randomized (eg, RTOG 0848 and CONKO-007). In addition, A021501 did not address more established neoadjuvant hypofractionated or conventionally fractionated radiation therapy standards.

In Reply We appreciate—and are not surprised by—the robust response to the A021501 phase 2 randomized clinical trial and its accompanying Editorial, particularly from the radiation oncology community. As Hall and colleagues observe, radiation therapy (RT) has been a central component of neoadjuvant trials for pancreatic cancer (PC) for years. But should it remain so? Our study was a further attempt to help answer this question. It was designed specifically to determine whether either systemic chemotherapy with mFOLFIRINOX or mFOLFIRINOX followed by hypofractionated RT would improve the 18-month overall survival rate of patients with borderline resectable PC relative to a historic control rate of 50%. However, it was not designed nor powered to definitively address the value of RT in the neoadjuvant setting.

To the Editor We congratulate Katz et al on their ambitious phase 2 randomized clinical trial designed to prospectively compare modified FOLFIRINOX (mFOLFIRINOX) alone vs sequential mFOLFIRINOX and hypofractionated radiotherapy for patients with borderline resectable pancreatic cancer (BRPC). Much commentary, including the accompanying Editorial, has characterized the A021501 trial as a failure of radiotherapy to improve outcomes in BRPC, in contrast with prior randomized clinical trials demonstrating improved rates of R0 resection and overall survival for patients treated with neoadjuvant chemoradiotherapy. We contend that this characterization is unfounded due to intrinsic methodological limitations of the study, including (1) timing of randomization, (2) potential cohort imbalances, and (3) power limitations resulting from the early closure of the radiotherapy arm. These limitations, in our view, render the A021501 trial unable to generate definitive conclusions regarding the utility of radiotherapy in BRPC, and we caution against overgeneralization of this trial’s results.

This subgroup analysis of a randomized clinical trial investigates whether tucatinib in combination with trastuzumab and capecitabine provides survival and intracranial benefits for patients with ERBB2-positive metastatic breast cancer and brain metastases.

This randomized clinical trial examines quality of life in patients with resected melanoma at high risk for relapse who were treated with adjuvant pembrolizumab vs standard of care with either ipilimumab or high-dose interferon α 2b.

To the Editor The Alliance Group is to be commended for inserting Central Review at multiple critical steps in a patient’s passage through the A021501 protocol. The authors state that the “reasons why an insufficient number of patients in arm 2 [with radiotherapy (RT)] met the prespecified threshold for R0 resection is not immediately evident.” Beyond the small sample size and the heterogeneity of even radiographically similar borderline resectable cases, there may be some clues if one can explain the distribution differences displayed in eTable 2 in the Supplement. Specifically, arm 2 had more “advanced disease at surgery” and “metastases discovered at surgery”—and consequentially was noted to have a lower percentage undergoing pancreatectomy (35% vs 49% [arm 1, preoperative chemotherapy only]) as well as completing the entire protocol (18% vs 30%, respectively).

Results of a large clinical trial counter previous findings of benefit with torsemide.

Messa a punto all’IRCCS IRE, in laboratorio fa regredire malattia

This randomized, placebo-controlled platform trial compares the use of low-dose fluvoxamine (50 mg twice daily) for 10 days compared with placebo in outpatients with mild to moderate COVID-19.

In Reply We thank the authors for their comments about our recent article exploring racial differences in the accuracy of temporal thermometers. We agree with Dr Newman that self-reported race is an imperfect proxy for skin color. If differences in skin color are the basis of the temperature differences observed between oral and temporal thermometers, the magnitude of the difference would be better measured using an objective measure of skin color in a prospective study rather than self-reported race in a retrospective data analysis.

To the Editor A recent Research Letter examined temperatures generated with temporal artery thermometers with the goal of identifying systemic bias in medical devices. As one of us (F.P.) is the inventor of the temporal artery thermometer, and as we are scientists working for its manufacturer, we wish to highlight that this study showed that Black and White patients had essentially the same fever rates and temporal temperatures (eg, 38 °C: 10.1% vs 10.8% [P = .49]; mean, 36.98 °C vs 36.97 °C [P = .67]).

To the Editor A recent Research Letter reported that temperatures measured by temporal thermometers are lower than those measured orally in Black patients but not in White patients. However, I am concerned that this study used race as a proxy for skin color. Because people can have a range of skin colors despite their so-called race, the results of this study would have been more meaningful if it had used a biological parameter with one of the more objective measurements of skin color, such as a spectrophotometer or one of the visual scales.