Moving beyond transition outcomes: Meta-analysis of remission rates in individuals at high clinical risk for psychosis

Background and Aims: Elderly patient might experience an increased risk of complications after laparoscopic Roux-en-Y gastric bypass. We aimed to perform a meta-analysis of comparative studies on this issue in patients aged 60 years or older. Material and Methods: A systematic literature search was performed. Medline, Cochrane Library, Embase, Scopus, and Google Scholar were searched until July 2016 for studies on outcomes of laparoscopic Roux-en-Y gastric bypass in elderly versus younger patients. Primary outcomes were mortality and overall complications. Secondary outcomes were length of hospital stay, excess weight loss percentage, effect on diabetes, hypertension, hyperlipidemia and obstructive sleep apnea. Heterogeneity across the studies was evaluated by the I2 test, and a random effects model was used. Results were expressed as mean difference and risk ratio (RR). Results: Seven studies involving 3128 patients were retrieved and included in this study. A significantly increased risk of mortality and overall complications was observed among patients older than 60 years compared with younger ones (RR, 6.12; 95% confidence interval 1.08–34.83; p = 0.04; RR, 1.51; 95% confidence interval 1.07–2.11; p = 0.02). Particularly, elderly patients experienced 1% increased risk of mortality and 3% increased risk of overall complications. Length of stay, diabetes, and obstructive sleep apnea remission rates were similar among the groups. Excess weight loss percentage was significantly greater among younger patients (mean difference, −3.44; 95% confidence interval −5.20, −1.68; p < 0.001), as were hypertension (RR, 0.57; 95% confidence interval 0.42–0.76; p < 0.001) and hyperlipidemia (RR, 0.61; 95% confidence interval 0.45–0.83; p = 0.002) remission rates. Conclusion: Laparoscopic Roux-en-Y gastric bypass in patients older than 60 years may be a risky bariatric surgery operation due to higher complications and mortality and may not be as effective as in patients younger than 60 years. Thus, older patients should be carefully counseled before this procedure for individual risk–benefit assessment.

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Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update

Journal of Clinical Oncology ◽

10.1200/jco.2017.74.0472 ◽

2017 ◽

Vol 35 (24) ◽

pp. 2838-2847 ◽

Cited By ~ 137

Author(s):

Ian Krop ◽

Nofisat Ismaila ◽

Fabrice Andre ◽

Robert C. Bast ◽

William Barlow ◽

...

Keyword(s):

Breast Cancer ◽

Systemic Therapy ◽

Hormone Receptor ◽

Early Stage ◽

Adjuvant Systemic Therapy ◽

Node Negative ◽

Clinical Risk ◽

Hormone Receptor Positive ◽

High Clinical Risk ◽

Positive Breast Cancer

Purpose This focused update addresses the use of MammaPrint (Agendia, Irvine, CA) to guide decisions on the use of adjuvant systemic therapy. Methods ASCO uses a signals approach to facilitate guideline updates. For this focused update, the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study to evaluate the MammaPrint assay in 6,693 women with early-stage breast cancer provided a signal. An expert panel reviewed the results of the MINDACT study along with other published literature on the MammaPrint assay to assess for evidence of clinical utility. Recommendations If a patient has hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, node-negative breast cancer, the MammaPrint assay may be used in those with high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy due to its ability to identify a good-prognosis population with potentially limited chemotherapy benefit. Women in the low clinical risk category did not benefit from chemotherapy regardless of genomic MammaPrint risk group. Therefore, the MammaPrint assay does not have clinical utility in such patients. If a patient has hormone receptor–positive, HER2-negative, node-positive breast cancer, the MammaPrint assay may be used in patients with one to three positive nodes and a high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy. However, such patients should be informed that a benefit from chemotherapy cannot be excluded, particularly in patients with greater than one involved lymph node. The clinician should not use the MammaPrint assay to guide decisions on adjuvant systemic therapy in patients with hormone receptor–positive, HER2-negative, node-positive breast cancer at low clinical risk, nor any patient with HER2-positive or triple-negative breast cancer, because of the lack of definitive data in these populations. Additional information can be found at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .

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Models Predicting Psychosis in Patients With High Clinical Risk: A Systematic Review

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.00223 ◽

2020 ◽

Vol 11 ◽

Author(s):

Cristiana Montemagni ◽

Silvio Bellino ◽

Nadja Bracale ◽

Paola Bozzatello ◽

Paola Rocca

Keyword(s):

Systematic Review ◽

Clinical Risk ◽

High Clinical Risk

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Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2019.00749 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Gerhard Andersson ◽

Per Carlbring ◽

Alexander Rozental

Keyword(s):

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Cognitive Behavior ◽

Remission Rates

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Abstract OT1-05-02: OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer

10.1158/1538-7445.sabcs18-ot1-05-02 ◽

2019 ◽

Author(s):

RC Stein ◽

L Hughes-Davies ◽

A Makris ◽

IR Macpherson ◽

C Conefrey ◽

...

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Cost Effectiveness ◽

Randomized Trial ◽

Early Breast Cancer ◽

Clinical Utility ◽

Prospective Randomized Trial ◽

Clinical Risk ◽

High Clinical Risk

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Organizational forms and methods of early diagnosis of hereditary tumors

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0014.0779 ◽

2020 ◽

Vol 13 (4) ◽

pp. 1-9

Author(s):

Aleh Kuzniatsou ◽

Andrei Shpakou

Keyword(s):

Ovarian Cancer ◽

Colon Cancer ◽

High Risk ◽

Early Diagnosis ◽

Hereditary Cancer ◽

Border Region ◽

Organizational Forms ◽

Hereditary Ovarian Cancer ◽

Clinical Risk ◽

High Clinical Risk

Background: With the development of genetic research in oncology, it has become possible to track and identify early and preclinical forms of hereditary oncological diseases, which allows timely and effective preventive and therapeutic measures in relation to relatives at risk. Aim of the study: Assessment of genetically determined neoplasms in the region and the development of organizational forms and methods for early diagnosis. Material and methods: 10,727 residents of the Belarus-Poland border region were examined. Clinical and medical history data of 2,054 patients with tumors of the breast (1406), ovaries (239), and colon (409) were analyzed. As a result of the questionnaire, three main observation groups were formed: “high risk of hereditary cancer”, “hereditary cancer suspected”, and “no risk of hereditary cancer”. Results: Register and hospital screenings were the most informative types of screening. Of the 149 HBC patients who underwent molecular genetic testing, BRCA1 gene mutations were found in 5.37%, 5382insC in all cases. Seven mutations were detected in 77 individuals with a diagnosis of HOC and in 6 cases 5382insC and in 2 - 4145delA. Signs of hereditary ovarian cancer and suspicion of it were found in 1.12%, including people who were found to have a high risk of hereditary ovarian cancer. By their effectiveness, register and hospital screenings significantly exceeded the population, p<0.01. 1.67% of women suffering from this disease met the high clinical risk criteria for hereditary ovarian cancer. A high clinical risk of hereditary tumor genesis was established in 0.73% of cases among patients with a diagnosis of colon cancer. Conclusions: The results of assessing the clinical risk of hereditary cancer according to population screening indicates that approximately 1.2% of the population has an increased clinical risk of developing hereditary breast, ovarian, and colon cancer.

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