scholarly journals Future care for long-term cancer survivors: towards a new model

2021 ◽  
Author(s):  
M. Provencio ◽  
N. Romero ◽  
J. Tabernero ◽  
R. Vera ◽  
D. V. Baz ◽  
...  
Keyword(s):  
Health Professionals ◽  
Health Management ◽  
Current Model ◽  
New Drugs ◽  
Final Report ◽  
Funding Model ◽  
Future Care ◽  
The Cost

Abstract Purpose The increase in the prevalence "long-term cancer survivor” (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. Methods This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. Results 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. Conclusion The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.

Exploring the value of social network ‘care maps’ in the provision of long-term conditions care

2019 ◽  
pp. 174239531983646
Author(s):  
Jessica Young ◽  
Ursula Poole ◽  
Fardowsa Mohamed ◽  
Shona Jian ◽  
Martyn Williamson ◽  
...  
Keyword(s):  
Social Network ◽  
Health Professionals ◽  
Long Term Conditions ◽  
Care Community ◽  
Therapeutic Value ◽  
Care Maps ◽  
Hospital Wards ◽  
Reflection On Practice

Objectives There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of ‘care maps’ – a patient-identified social network map of their care community – for health professionals in providing person-centred care. Methods We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes. Results Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients’ support networks, synthesising what is known and unknown. Health professionals understood patients’ perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice. Discussion Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had ‘social function’ for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients’ lifeworlds.

Can Information on Cost Improve Clinicians' Behavior?: Lessons from Health Care Trials and Management

1997 ◽  
Vol 13 (4) ◽  
pp. 553-561 ◽  
Author(s):  
Peter F. Lowet ◽  
John M. Eisenberg
Keyword(s):  
Health Care ◽  
Price Competition ◽  
Educational Interventions ◽  
Cost Information ◽  
Improved Outcomes ◽  
Practice Variations ◽  
The Cost ◽  
The Impact

AbstractFacing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

scholarly journals Nonmyeloablative allografting for newly diagnosed multiple myeloma: the experience of the Gruppo Italiano Trapianti di Midollo

Blood ◽  
2009 ◽  
Vol 113 (14) ◽  
pp. 3375-3382 ◽  
Author(s):  
Benedetto Bruno ◽  
Marcello Rotta ◽  
Francesca Patriarca ◽  
Daniele Mattei ◽  
Bernardino Allione ◽  
...  
Keyword(s):  
Chronic Gvhd ◽  
Human Leukocyte ◽  
Response Duration ◽  
Tumor Burden ◽  
New Drugs ◽  
Newly Diagnosed ◽  
Leukocyte Antigen ◽  
Total Body

Abstract Despite recent advances, allografting remains the only potential cure for myeloma. From July 1999 to June 2005, 100 newly diagnosed patients younger than 65 years were enrolled in a prospective multicenter study. First-line treatment included vincristin, adriamycin, and dexamethasone (VAD)–based induction chemotherapy, a cytoreductive autograft (melphalan 200 mg/m2) followed by a single dose of nonmyeloablative total body irradiation and allografting from an human leukocyte antigen (HLA)–identical sibling. Primary end points were the overall survival (OS) and event-free survival (EFS) from diagnosis. After a median follow-up of 5 years, OS was not reached, and EFS was 37 months. Incidences of acute and chronic graft-versus-host disease (GVHD) were 38% and 50%, respectively. Complete remission (CR) was achieved in 53% of patients. Profound cytoreduction (CR or very good partial remission) before allografting was associated with achievement of posttransplantation CR (hazard ratio [HR] 2.20, P = .03) and longer EFS (HR 0.33, P < .01). Conversely, development of chronic GVHD was not correlated with CR or response duration. This tandem transplantation approach allows prolonged survival and long-term disease control in patients with reduced tumor burden at the time of allografting. We are currently investigating the role of “new drugs” in intensifying pretransplantation cytoreduction and posttransplantation graft-versus-myeloma effects to further improve clinical outcomes. (http://ClinicalTrials.gov; NCT-00702247.)

scholarly journals CYSTIC FIBROSIS: A BREAKTHROUGH IN 21ST-CENTURY THERAPY

2020 ◽  
Vol 23 (1) ◽  
pp. 35-41
Author(s):  
Olga I. Simonova ◽  
Yulia V. Gorinova ◽  
Vera P. Chernevich
Keyword(s):  
Cystic Fibrosis ◽  
Web Of Science ◽  
New Drugs ◽  
Cystic Fibrosis Gene ◽  
Multicenter Studies ◽  
Antibacterial Compounds ◽  
The Russian Federation ◽  
Mucolytic Agents

The review presents new data on the latest advances in the treatment of cystic fibrosis, a rare genetic disease. The methods used were literature search in the Scopus, Web of Science, and EMBASE databases. The importance of a number of drugs prescribed for anti-inflammatory purposes (ibuprofen, azithromycin) is discussed, data from multicenter studies of new drugs are presented. The role of mucolytic agents and the need to develop new antibacterial compounds are shown. Particular attention in the review is given to the development of new targeted therapies for cystic fibrosis. The data of studies of ivacaftor, lumacactor, tezacactor in this category of patients are presented, as well as a spectrum of mutations of the cystic fibrosis gene in which these molecules can be prescribed. The experience of the use of correctors in adult patients with cystic fibrosis in the Russian Federation is described, the effectiveness and safety of the long-term use of these drugs are described.

scholarly journals Sexually opposite effects of testosterone on mating success in wild rock hyrax

2019 ◽  
Vol 30 (6) ◽  
pp. 1611-1617
Author(s):  
Lee Koren ◽  
Yishai Weissman ◽  
Inbar Schnitzer ◽  
Rosanne Beukeboom ◽  
Einat Bar Ziv ◽  
...  
Keyword(s):  
Mate Guarding ◽  
Female Reproductive Success ◽  
Rock Hyrax ◽  
Proximate Mechanisms ◽  
Physiological Processes ◽  
Procavia Capensis ◽  
Males And Females ◽  
The Cost

Abstract Although males and females share traits, their motivations and needs may be different, due to life-history disparities that lead to divergent selection pressures. Proximate mechanisms underlying differences between the sexes include hormones that mediate the development and activation of suites of traits. Testosterone is associated with morphological features, physiological processes, and social behaviors in both sexes. However, even if present in similar concentrations in the circulation, testosterone often affects males and females differently. We combined behavioral mating observations of the wild polygynandrous rock hyrax (Procavia capensis) with hair testosterone that represents long-term integrated levels. We found that whereas copulation success increases with the rise in testosterone in males it decreases in females. We did not find an association between testosterone and choosiness in either sex. However, we found that males with higher testosterone mate-guarded females with lower testosterone. Our findings show disassortative mating and mate-guarding in respect to testosterone and provide clues to the cost of testosterone for females, in terms of copulation success. These results open up intriguing questions relating to the role of testosterone in mediating a similar trade-off in male and female reproductive success.

Introduction to this special section: The role of advanced modeling in enhanced carbon storage

2021 ◽  
Vol 40 (6) ◽  
pp. 408-412
Author(s):  
Josef Paffenholz
Keyword(s):  
Carbon Capture ◽  
Fossil Fuels ◽  
Special Section ◽  
Intergovernmental Panel ◽  
Carbon Capture And Sequestration ◽  
Net Zero ◽  
The Cost ◽  
Term Monitoring

To limit the warming of the planet to no more than a 2°C increase, models show that net-zero release of anthropomorphic CO2 must be achieved by the middle of the century. For the foreseeable future, the majority of the world's energy will still be provided by fossil fuels, so other methods, besides expanding the contribution of renewable energy, are needed in order to achieve this goal. According to the Intergovernmental Panel on Climate Change (IPCC), carbon capture and sequestration (CCS) is one such method, without which the cost to achieve the 2°C target would more than double. To achieve this climate goal, CCS efforts must increase by approximately 100-fold from current levels within the next 20 years. Geophysical simulations on suitable geologic models will provide an important tool to streamline and accelerate the vast expansion of geophysical site characterization and long-term monitoring tasks required for industrial-scale CCS to succeed.

The Role of Cardiac Rehabilitation in Achieving Optimal Treatment

2011 ◽  
Vol 7 (1) ◽  
pp. 62
Author(s):  
Miguel Mendes ◽  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Medical Treatment ◽  
Lifestyle Changes ◽  
Coronary Syndrome ◽  
Secondary Prevention Programme ◽  
Lifestyle Measures ◽  
The Cost

The clinical practice of European cardiologists is directed by the European Society of Cardiology’s guidelines for several clinical entities, in which ‘optimal medical treatment’ (a specific drug regime and lifestyle measures) for each syndrome is defined. The described pharmacotherapy is composed of several drugs, since the clinical research behind the recommendations is conducted using an ‘on top of’ strategy. For example, an asymptomatic patient after an acute coronary syndrome with normal ventricular function and without residual ischaemia has an indication to take at least four types of tablets per day, which is difficult to understand and to follow long term. The cost of the drugs is sometimes beyond the patient’s means, which also contributes to lower compliance. A clinician’s practice is usually very busy, which means it is almost impossible to perform patient education and promote adherence to drug therapy and lifestyle changes. Cardiac rehabilitation, as proved by the Global Secondary Prevention Strategies to Limit Event Recurrence after Myocardial Infarction (GOSPEL) study, may be considered the best available secondary prevention programme, as it educates patients and promotes adherence to the optimal medical treatment to a greater degree than usual care.

An update on the management of gout

2018 ◽  
Vol 56 (1) ◽  
pp. 9-12 ◽  
Keyword(s):  
Treatment Options ◽  
New Drugs ◽  
British Society ◽  
European League Against Rheumatism ◽  
Urate Lowering Treatment ◽  
The Uk ◽  
New Evidence ◽  
Urate Crystals

Gout is the most common form of inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012.1,2 It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission.3 It has been suggested that the management of gout in the UK remains suboptimal.1 In 2004, we concluded that there was a woeful lack of evidence to guide treatment or prophylaxis for gout, particularly with regard to choice of drug or doses.4 The introduction of new drugs and new evidence on the efficacy and safety of treatment options has led the European League Against Rheumatism (EULAR) and the British Society of Rheumatology (BSR) to update their guidelines on the management of gout.2,5 Nevertheless, there are differing views on target serum uric acid (SUA) levels and the role of urate lowering treatment (ULT).2,5–7 Here, we review the latest guidance on the management of gout and consider the role of long-term ULT.

scholarly journals Mental health and politics since the eurozone crisis: The role of mental health professionals

2019 ◽  
Vol 62 ◽  
pp. 28-29 ◽  
Author(s):  
Isabel M. Perera
Keyword(s):  
Mental Health ◽  
Economic Crisis ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
The Body ◽  
Generalized Anxiety ◽  
Eurozone Crisis ◽  
The Mind

Abstract Some of the most immediate health effects of the 2008 economic crisis concerned the mind, not the body. Rates of generalized anxiety, chronic depression, and even suicide spiked in many European societies. This viewpoint highlights the role of mental health professionals in responding to this emergency, and argues that their sustained mobilization is necessary to its long-term resolution.

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