scholarly journals Improvement Diagnosis and Treatment of Mantle Cell Lymphoma in a Middle-Income Country: A Time-Dependent Analysis in Mexico

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3051-3051
Author(s):  
Juan Rangel-Patiño ◽  
Perla R. R. Colunga-Pedraza ◽  
Gladys P Agreda ◽  
Oyuky Gissell Aguirre-Reyes ◽  
David Gomez-Almaguer ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Middle Income Country ◽  
Diagnosis And Treatment ◽  
Middle Income ◽  
Factors Associated ◽  
Mantle Cell ◽  
Group A ◽  
Group B ◽  
Over Time ◽  
Time Dependent Analysis

Abstract Introduction: Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma representing 4-9% of all lymphomas. The disease prognosis remains adverse. However, diagnosis and treatment of MCL have undergone a significant improvement in the last years. The World Bank considers Mexico as a Middle-Income Country (MIC). Therefore, MICs experience a delay in accomplishing diagnosis and prognosis strategies and low access to treatment innovation for hematologic malignancies. In Mexico, there is scarce information on the clinical features and treatment patterns of MCL over time. Mainly, the prognosis impact of these strategies is unknown. Methods: We retrospectively evaluated all consecutive patients with a pathological diagnosis of MCL in three referral centers for the uninsured population in Mexico from 2008 to 2020. We followed patients to June 2021 until lost follow-up or death. We made a Time-Dependent-Analysis (TDA) to evaluate the effect of the diagnosis and treatment improvements over time. We divided the population into two groups, from 2008 to 2014 (Group A) and from 2015 to 2020 (Group B). Hematopathologists reviewed all cases at their respective centers. We excluded patients that do not receive treatment and patients without pathological confirmation. Clinical, pathological, and treatment data were collected. Responses were assessed per the Lugano criteria. Event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method, differences between the groups were evaluated with a log-rank test. Multivariate analysis of factors associated with mortality was assessed with a Cox regression model with a Confidence Interval(CI) of 95%. Results: A total of 139 patients were included in the analysis; 67 patients from Group A; and 72 patients from Group B. The median age was 64 years, 42% were younger than 65 years, 76% were male, 22% had ECOG 2-4, 81% had extra nodal involvement, 28.1% had bulky disease, 94% had stage III/IV disease, 58% had bone marrow involvement, 40.7% had high risk simplified MIPI. Regarding diagnosis approaches between the two groups, only 23% in Group A had an immunohistochemical evaluation of Ki67 compared with an 84% of Group B (p<0.001). The rest of the differences between the groups are in Table 1. In terms of treatment, 84% received an anthracycline-based treatment, 3% bendamustine-based treatment, and 12% a low-intensity treatment, with no difference between the groups. In addition to base treatment, 30% received High-dose Cytarabine (HiDAC), been more frequent in Group B (p<0.001), 59% received rituximab during induction, 37% in Group A, and 80% in Group B, (p<0.001). The main reason to avoid the use of rituximab was the cost and only 20.3% used rituximab maintenance, being more frequent in Group B (p=0.018). The 13.7% received an autologous stem cell transplant, been more frequent in Group B (p= 0.002). Only two patients (1.4%) received treatment in a Clinical Trial setting. In terms of response, in Group A, 58% achieved Complete Response (CR) against 34% of Group B (p=0.006). Median OS on Group A was 38 months (95% CI 25.6 -50.3) against Not Reached in Group B (Log Rank p = 0.037). On the other hand, the median EFS on Group A was 17 months (95% CI 11.6-22.39) against 29 months (95% CI17.6-40.3) in Group B (Log Rank p = 0.005) Figure 2. A multivariate analysis of factors associated with higher mortality found a high-risk MIPI score with an HR of 2.54 (CI 95% 1.5-4.0, p <0.001). Factors associated with lower mortality were the addition of HiDAC in induction HR 0.39 (CI 95% 0.20- 0.75, p= 0.005) and rituximab maintenance HR 0.48 (CI 95% 0.24-0.94, p=0.035) Conclusion: This is the first real-world report of MCL in Mexico. Characteristics of the disease resemble the ones reported by other countries. Despite the limitations of a retrospective analysis, the TDA makes evident the prognosis improvement over time. With progress in EFS of 12 months and an OS impact. Even though the prognosis improvement, to the date, there is a 20% of patients with no rituximab access. Transplant access is low beside that 42% of patients were younger than 65 years, and Clinical Trial access is almost null. Novel therapies for MIC are under development with encouraging results in the first-line and relapsed/refractory setting. However, the high costs of these therapies will limit the access in MIC and would expand the gap of MCL prognosis if a health care strategy that allow access to them is not implemented. Figure 1 Figure 1. Disclosures Rangel-Patiño: Abbvie: Speakers Bureau; Bristol: Consultancy. Agreda: Roche: Speakers Bureau; Astrofarma: Speakers Bureau; Janssen: Speakers Bureau. Gomez-Almaguer: Bristol-Myers-Squibb: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau. Ramirez-Ibarguen: Takeda: Consultancy, Speakers Bureau; Roche: Speakers Bureau; Janssen: Speakers Bureau; Astra Zeneca: Speakers Bureau; Abbvie: Speakers Bureau; MSD: Consultancy; Asofarma: Consultancy.

scholarly journals Temsirolimus Has Activity in Non–Mantle Cell Non-Hodgkin's Lymphoma Subtypes: The University of Chicago Phase II Consortium

2010 ◽  
Vol 28 (31) ◽  
pp. 4740-4746 ◽  
Author(s):  
Sonali M. Smith ◽  
Koen van Besien ◽  
Theodore Karrison ◽  
Janet Dancey ◽  
Peter McLaughlin ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Response Rate ◽  
Cell Lymphoma ◽  
Single Agent ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Mantle Cell ◽  
Group A ◽  
Group B ◽  
Indolent Lymphomas

PurposeDespite high initial remission rates, most lymphomas relapse and require further therapy. The mammalian target of rapamycin (mTOR) pathway is a validated target in mantle cell lymphoma, but has not been extensively evaluated in other lymphomas.Patients and MethodsWe performed a phase II trial of single-agent temsirolimus 25-mg weekly in patients with relapsed aggressive and indolent lymphomas. The primary objective was overall and complete response rate. Patients were stratified by histology: group A (diffuse large B-cell lymphoma, transformed follicular lymphoma), group B (follicular lymphoma), and group C (chronic lymphocytic leukemia/small lymphocytic lymphoma, and other indolent lymphomas).ResultsEighty-nine patients were treated, with outcome strongly dependent on histology. Group A had an overall and complete response rate of 28.1% and 12.5%, respectively, and median progression-free survival (PFS) of 2.6 months and median overall survival (OS) of 7.2 months. Group B had overall and complete response rates of 53.8% and 25.6%, respectively, and median PFS of 12.7 months; median OS has not yet been reached. Group C had a partial response rate of 11% with no complete responders. Toxicity was mainly mild and/or reversible myelosuppression and mucositis; however, four patients developed pneumonitis.ConclusionsSingle-agent temsirolimus has significant activity in both diffuse large B-cell lymphoma and follicular lymphoma, although the durability of responses and PFS are longer for patients with follicular lymphoma. This is the first report of substantial activity of temsirolimus in lymphomas other than mantle cell lymphoma, and supports further evaluation of mTOR as a target in these diseases.

12-Year Experience with High-Dose Rituximab-Containing Autologous Stem Cell Transplantation for SOX11-Positive Mantle Cell Lymphoma Patients in First Remission: Emerging Lymphoma-Free Survival Plateau After 3 Years,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4138-4138
Author(s):  
Zaher I Chakhachiro ◽  
Rima M Saliba ◽  
Grace-Julia Okoroji ◽  
Martin Korbling ◽  
Amin M Alousi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Lymph Node ◽  
Cell Lymphoma ◽  
High Dose ◽  
Ki 67 ◽  
Free Survival ◽  
Mantle Cell ◽  
Group A ◽  
Group B

Abstract Abstract 4138 Background: The addition of high-dose rituximab to conditioning regimens has been shown to improve outcomes of autologous stem cell transplantation (ASCT) for mantle cell lymphoma (MCL) patients (pts) in first partial (PR) or complete remission (CR)(Tam C et al. Blood 2009,113:4144). It has been suggested that absence of SOX11 expression can identify a subtype of indolent MCL with excellent outcomes that might be managed more conservatively than conventional MCL. We now report updated results of ASCT for 40 MCL pts treated at our center between 05/99 and 10/10. We also report on SOX-11 expression in a subset of these pts. Methods and Patients: Pts had a median age of 54 years (range, 38–72), and 30% were older than 60 years. At diagnosis, 60% had IPI>1, 30% had intermediate/high MIPI, 88% had stage IV disease, and 78% had bone marrow involvement. 28% had blastic features and Ki-67 was ≥30% in 11/23 (52%) pts who were tested. Pts were treated with R-CHOP or R-hyper-CVAD × 4 cycles induction in 30% and 45% respectively (Group A). Since 2001, pts were referred to ASCT only if they failed to achieve CR with >4 cycles of R-hyper-CVAD induction (n= 10, 25%) (Group B). Prior to transplant, CR (or CR unconfirmed-CRu) was present in 62% pts; 38% were in PR, and 18% were PET+. Conditioning was R-BEAM and R-Cy-TBI conditioning in 77% and 23% respectively. Pts received R during stem cell collection with R administered at 375 mg/m2 on the day before initiating chemotherapy for stem cell mobilization, and again at 1000 mg/m2, 7 days later. Pts then received additional R at 1000 mg/m2 on days +1 and +8 after ASCT, as previously described. Pts were staged with CT, PET (whenever indicated) scans, bone marrow biopsy, and colonoscopy (if history of GI involvement) every 3 months for the first year, every 6 months for 5 years, then yearly thereafter. Results: a. SOX11: Formalin-fixed, paraffin-embedded tissue biopsy sections were assessed by immunohistochemistry (IHC) using anti-Sox-11 rabbit polyclonal antibody (Abcam, Cambridge, MA; 1:1500). For IHC controls we used a tissue microarray including 13 cases of MCL in addition to one complete section of MCL serving as positive controls, and sections from two cases of small lymphocytic lymphoma involving lymph node serving as negative controls. The 11 cases consisted of five GI biopsies, three lymph node biopsies, two bone marrows and one testis. 10/11 showed positive staining for SOX11. The case with negative staining, a GI biopsy, had scattered positive cells. b. Clinical outcome : Following transplantation, CR/CRu was achieved in 100% pts. With a median follow-up of 37 months (range, 6–145), 10 pts experienced recurrent disease. All progressions occurred within 3 years, with a clear plateau emerging subsequently (Figure). The projected lymphoma-free-survival at 10-year, was 65% (95%CI, 44–80). A tendency for a higher risk of relapse was observed in R-hyper-CVAD resistant pts (Group B) pts [4/10 pts (40%) vs 6/30 (20%) in Group A; HR 2.5 (95%CI, 0.7–9.2), p=0.2)], and in pts with ki-67 ≥30% [HR 2.2 (95%CI, 0.4–11), p=0.3). MIPI, blastic histology, age (> 60 years), disease status at transplant (CR/PR) and conditioning were not found to be of prognostic value in our study. 2 pts (5%) developed myelodysplasia, one of which was concurrent with progression. Conclusions: ASCT with high-dose rituximab has the potential to cure a proportion of pts with MCL after response to induction chemotherapy. Our results are favorable despite the inclusion of pts who were resistant to R-hyper-CVAD. Randomized studies comparing this strategy to conventional chemo-immunotherapy are warranted. The prognostic significance of Ki-67 level needs to be assessed in a larger cohort of patients. Disclosures: No relevant conflicts of interest to declare.

Radioimmunotherapy In Relapsed/Refractory Mantle Cell Lymphoma Patients: Final Results Of a European MCL Network Phase II Trial

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4384-4384 ◽  
Author(s):  
Simone Ferrero ◽  
Alessandro Pastore ◽  
Roswitha Forstpointner ◽  
Christian W. Scholz ◽  
Antonio Pezzutto ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Board Of Directors ◽  
Response Rate ◽  
Cell Lymphoma ◽  
Advisory Committees ◽  
Bulky Disease ◽  
Mantle Cell ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Background Great efforts have been made in the last years to improve the therapeutical options of patients with mantle cell lymphoma (MCL), a distinct lymphoma subtype characterized by dismal long term prognosis. Although radioimmunotherapy (RIT) has been shown to be effective in follicular lymphoma, only one single-center experience of 31 evaluable patients has been published so far in relapsed MCL [Wang et al., JCO 2009]. The European MCL Network conducted a phase II, prospective, multicenter trial evaluating a single dose of yttrium-90-ibritumomab tiuxetan (90Y-IT) as reinduction or consolidation in patients with relapsed or refractory MCL. Patients and Methods Relapsed or refractory MCL patients after or not eligible for autologous stem cell transplantation (ASCT) with<25% bone marrow involvement received a single infusion of rituximab (250 mg/m2, day 1) followed by a sequential infusion of rituximab and 90Y-IT 0.4 mCi/kg on day 8 (0.3 mCi/kg if thrombocytes<150000/μl or prior ASCT: group A). In patients with high tumor load a short prior immuno-chemotherapy (e.g. 3 cycles of rituximab-bendamustin) was allowed (group B). The primary study objective was response rate (complete/partial responses, CR/PR), secondary objectives were progression-free survival (PFS), overall survival (OS), as well as safety of 90Y-IT. Results Between June 2004 and September 2008, 48 eligible patients were enrolled (16 group A, 32 group B) and 45 are evaluable for response. Median age was 68 years, 75% were males. Seventy-three % presented with high or intermediate risk MCL international prognostic index (MIPI), 42% with elevated lactate dehydrogenase, and 29% had bulky disease. Median number of previous therapies was 2 (range 1-5) in group A and 4 (range 1-6) in group B; 98% of patients received prior rituximab, 29% prior radiotherapy, 13% prior ASCT, 0% prior new agents and 15% had chemorefractory disease. The major toxicities consisted of myelosuppression, with thrombocytopenia in 21 patients (53%), neutropenia in 13 (33%) and anemia in 9 (23%; all grade 3/4, respectively), and one lethal bleeding. Non-hematologic grade 3/4 toxicities were gastrointestinal (n=3), infectious (n=1), and neurological (n=1), with a single patient (2%) developing a secondary myelodysplasia. Overall response rate (ORR) was 40% (20% CR) in group A and 72% (38% CR) in group B, with 5 patients converting from PR to CR. After a median follow-up of 38 months (range: 24-53 months), median PFS was 3.7 months in group A and 8.9 months in group B, translating in a median OS of 13.8 months and 31.2 months, respectively (Figure 1). In the 25 90Y-IT responders, PFS and OS were 23 months and 33.7 months, respectively, and patients responding to immunochemotherapy (group B) also showed a more favorable time to progression (16.9 months). No difference in survival rates was noticed according to MIPI, bulky disease, number and type of previous therapies, chemorefractoriness, and median time from initial diagnosis. Conclusions To the best of our knowledge, this is the largest trial assessing 90Y-IT therapy in relapsed/refractory MCL patients. Response rates in heavily pre-treated patients were comparable to those of other targeted approaches, though 90Y-IT showed a more favorable toxicity profile. Our experience suggests, that RIT applied as consolidation therapy might be the preferred approach, seeming to improve the quality and duration of response. Finally, responses appear to be independent from established risk factors and previous therapies. Further evaluation of the role of 90Y-IT in first-line therapy of MCL patients is ongoing. Disclosures: Off Label Use: Zevalin for treatment of relapsed mantle cell lymphoma. Scholz:Bayer: Speakers Bureau; Spectrum: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau. Keller:Sepropharm: Consultancy. Dreyling:Jannsen: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau, support of ITS, support of ITS Other; Celgene: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau, support of ITS Other; Pfizer: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau, support of ITS , support of ITS Other; Roche: Speakers Bureau, support of ITS , support of ITS Other; Mundipharma: support of ITS Other.

Anterior approach levator plication for congenital ptosis, absorpable versus non absorpable sutures

2021 ◽  
pp. 112067212110053
Author(s):  
Moustafa Salamah ◽  
Ashraf Mahrous Eid ◽  
Hani Albialy ◽  
Sherif Sharaf EL Deen
Keyword(s):  
Randomized Study ◽  
Early Postoperative Period ◽  
Polyglactin 910 ◽  
Exclusion Criteria ◽  
Congenital Ptosis ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Over Time

Purpose: To compare the efficacy of two different suture types in levator plication for correction of congenital ptosis. Subjects and methods: Prospective comparative interventional randomized study involving 42 eyes of 42 patients aged more than 6 years with congenital ptosis and good levator action. The exclusion criteria were as follows: bilateral ptosis, history of previous surgery, fair or poor levator action, and associated other ocular diseases. Patients were randomized into group A, in which double-armed 5/0 polyester Ethibond were used, and group B, in which double-armed 5/0 Coated Vicryl® (polyglactin 910) suture material we used. Outcomes including eyelid height and stability of eyelid height over time were compared with follow-up data. The MRD was 4.05 ± 0.36 mm and 3.95 ± 0.34 after 1 week for both groups A and B, respectively. At the end of study follow up period (24 weeks), the MRD was 3.60 ± 0.42 mm in group A, and 2.52 ± 0.85 mm in group B. Conclusion: No difference in eyelid height between two groups in early postoperative period, but the postoperative eyelid height was more stable over time in the 5/0 polyester Ethibond group (group A) than in the 5/0 Coated Vicryl® (polyglactin 910) group (group B).

Prevalence, diagnostic criteria, and factors associated with sarcopenic obesity in older adults from a low middle income country: A systematic review

2020 ◽  
Author(s):  
Maria Sortênia Alves Guimarães ◽  
Carolina Araújo dos Santos ◽  
Joice da Silva Castro ◽  
Leidjaira Lopes Juvanhol ◽  
Fabiane Aparecida Canaan Rezende ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Diagnostic Criteria ◽  
Middle Income Country ◽  
Income Country ◽  
Sarcopenic Obesity ◽  
Middle Income ◽  
Factors Associated

scholarly journals Association between Sarcopenia and Depression in Patients with Chronic Liver Diseases

2019 ◽  
Vol 8 (5) ◽  
pp. 634 ◽  
Author(s):  
Hiroki Nishikawa ◽  
Hirayuki Enomoto ◽  
Kazunori Yoh ◽  
Yoshinori Iwata ◽  
Yoshiyuki Sakai ◽  
...  
Keyword(s):  
Liver Diseases ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Chronic Liver ◽  
Chronic Liver Diseases ◽  
Average Standard Deviation ◽  
Factors Associated ◽  
Group A ◽  
Group B ◽  
Group D

Association between sarcopenia, as evaluated by grip strength (GS) and skeletal muscle mass (SMM), and depression, as evaluated by Beck Depression Inventory-2nd edition (BDI-II) in chronic liver diseases (CLDs, n = 414, average age = 61.5 years), was investigated. Study subjects were classified into four groups: Group A (n = 60), lower GS and lower SMM (sarcopenia); group B (n = 44), lower GS and higher SMM; group C (n = 100), higher GS and lower SMM; group D (n = 210), higher GS and higher SMM. Factors associated with BDI-II score ≥11 were examined. BDI-II score 0–10 (normal) was found in 284 (68.6%), 11–16 (minimal) in 76 (18.4%), 17–20 (mild) in 24 (5.8%), 21–30 (moderate) in 15 (3.6%), and ≥31 (severe) in 15 (3.6%). The average ± standard deviation BDI-II score in liver cirrhosis (LC) patients (10.2 ± 9.6, n = 152) was significantly higher than that in non-LC patients (7.4 ± 7.2, n = 262) (p = 0.0058). Univariate analysis identified three factors to be significantly associated with BDI-I score ≥11: Our classification (groups of A, B, C, and D) (p = 0.0259), serum albumin (p = 0.0445), and the presence of LC (p = 0.0157). Multivariate analysis revealed that only group A (p = 0.0074, group D as a reference) was significant. In conclusion, sarcopenia can be an independent predictor for depression in CLDs.

Surgical Resection and Rituximab Show No Benefit in the Treatment of Primary Gastric Diffuse Large B-Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5110-5110
Author(s):  
Haiwen Huang ◽  
Tianwen Fu ◽  
Qiangli Wang ◽  
Ting Xu ◽  
Xiaochen Chen ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
B Cell ◽  
Surgical Resection ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Chemotherapy Group ◽  
Large B Cell Lymphoma ◽  
Group A ◽  
Group B ◽  
Large B Cell

Abstract Objectives Clinically, primary gastric diffuse large B cell lymphoma (PG-DLBCL) is not encountered commonly. The optimal treatment of PG-DLBCL remains controversial. Whether patients should receive surgical resection, Rituximab or not was most concerned about. Here we analized 83 patients with PG-DLBCL retrospectivly and evaluated the effect of surgical option and Rituximab in the treatment of PG-DLBCL. Methods From January 2009 to December 2014, 83 cases of PG-DLBCL patients in the First Affiliated Hospital of Soochow University were retrospectively studied. Forty cases received surgical resection plus chemotherapy (group A) and 43 patients underwent chemotherapy alone (group B). The operation mode is decided by the surgeon according to the patients¡¯ current condition and the chemotherapy regimens of two groups were CHOP or R-CHOP. Patients¡¯ characteristics were listed in Table 1. The main outcomes of overall survival (OS) and the progression free survival (PFS) were analized by using the Kaplan-Meier (K-M) method. Results The K-M analysis showed that the 3-year PFS and OS in group A were 66.7% and 68.4%, respectively. On the other hand, the 3-year PFS and OS of group B were 82.6%and 85.7%, respectively. There is no significant difference between the two groups. For patients received CHOP or R-CHOP, the 5-year OS were 77.7% and 78.2% (p=0.178). And the 3-year PFS were 74.9% and 75.5% (p=0.347). The difference between the two groups was not statistically significant. In group A, the 5-year PFS of R-CHOP group and CHOP group is 62.5% and 71.2% £¨p=0.747£©, the 5-year OS of R-CHOP group and CHOP group is 64.2% and 73.6% (p=0.853). In group B, the 5-year PFS of R-CHOP group and CHOP group is 83.4% and 81.8% £¨p=0.706£©, the 5-year OS of R-CHOP group and CHOP group is 85.7% and 83.5% (p=0.753). The univariate analyses indicated that age and lactate dehydrogenase (LDH) level were related to prognosis. Multivariate analysis of prognostic factors with a Cox model showed that IPI was the only independent prognostic factor. Conclusions This study shows that PG-DLBCL patients have a similar long-term survival rate when adopted surgery plus chemotherapy. Therefore, resection of the primary tumor before systemic chemotherapy does not improve the survival of the patients with PG-DLBCL. At the same time, the addition of Rituximab to chemotherapy doesn¡¯t make difference for the survival of PG-DLBCL. More prospective clinical trials about the effect of surgical operation and rituximab are needed to confirm the results of our study. Table 1. Patients¡¯ baseline characteristics Patients £¨%£© P value With surgical resection(Group A, n£½40£© Without chemotherapy (Group B, n £½ 43 £© Gender Male 19£¨47.5%£© 24£¨55.8%£© 0.449 Female 21£¨52.5%£© 19£¨44.2%£© Age ¡Ü60 15£¨37.5%£© 22£¨51.2%£© 0.211 £¾60 25£¨62.5%£© 21£¨48.8%£© Ann Arbor Stage I/II 13£¨32.5%£© 7£¨16.3%£© 0.084 Stage III/IV 27£¨67.5%£© 36£¨83.7%£© ECOG £¼2 19£¨47.5%£© 22£¨51.2%£© 0.739 ¡Ý2 21£¨52.5%£© 21£¨48.8%£© Treatment plan R-CHOP 23£¨57.5%£© 24£¨55.8%£© 0.887 CHOP 17£¨42.5%£© 19£¨44.2%£© LDH ¡Ü245 24£¨60.0%£© 27£¨62.8%£© 0.794 £¾245 16£¨40.0%£© 16£¨37.2%£© IPI ¡Ü2 13£¨32.5%£© 15£¨34.9%£© 0.818 £¾2 27£¨67.5%£© 28£¨65.1%£© ECOG: Eastern Cooperative Oncology Group; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; LDH: lactate dehydrogenase Disclosures No relevant conflicts of interest to declare.

Efeccc

2017 ◽  
Vol 18 (5) ◽  
pp. 808
Author(s):  
Carlos Enrique Cabrera-Pivaral ◽  
Sergio Alberto Ramírez-García ◽  
Marco Antonio Zavala-González
Keyword(s):  
Rheumatic Diseases ◽  
Primary Healthcare ◽  
Clinical Competence ◽  
Educational Interventions ◽  
Wilcoxon Test ◽  
Diagnosis And Treatment ◽  
Average Score ◽  
Quasi Experimental ◽  
Group A ◽  
Group B

Objetive To measure the effect of an educational intervention on clinical competences for diagnosis and treatment of rheumatic diseases in primary healthcare physicians working in the Guadalajara Metropolitan Area, Jalisco, Mexico.Methodology Quasi-experimental study conducted in physicians from two primary health care units. The study was carried out in a 40 physicians sample, 21 in Group “A” (intervention) and 19 in Group “B” (control). The clinical competence for diagnosis and treatment of rheumatic diseases was measured in both groups by means of an instrument previously designed and validated (Kuder-Richardson reliability index =0,94).Results Clinical competence average score prior to intervention was 47 for Group “A” and 42 for Group “B”, while after the intervention it was 72 and 47 respectively, which shows statistically significant differences (Wilcoxon test, p<0,05).Conclusions Clinical competence for diagnosis and treatment of rheumatic diseases in primary healthcare physicians is low; however, it can be improved by implementing educational interventions based on a constructivist approach.

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