Cohort study evaluating the impact of a discharge letter (DL) compared with usual care on adherence to surveillance following treatment for stage II/III colorectal cancer (CRC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 620-620 ◽  
Author(s):  
Janine Marie Davies ◽  
Eugene Batuyong ◽  
Sasha M. Lupichuk ◽  
Robert Hilsden ◽  
Misha Eliasziw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adjuvant Therapy ◽  
Clinical Laboratory ◽  
Ct Imaging ◽  
Care Physician ◽  
Stage Ii ◽  
Disease Stage ◽  
Cancer Centre ◽  
The Impact

620 Background: The 2005 ASCO guidelines recommend surveillance testing and frequencies following surgical +/− adjuvant therapy for stage II/III CRC. In Canada, many patients are discharged from their oncologist to their primary care physician (PCP) for ongoing surveillance. However, adherence to surveillance recommendations is low. This cohort study evaluated adherence to surveillance 1 year after treatment of stage II/III CRC prior to and following implementation of a DL. Methods: Cohort 1 (C1) patients were retrospectively identified from the Alberta Cancer Registry following adjuvant therapy (as applicable) at a tertiary cancer centre (07/2006 - 09/2007). Cohort 2 (C2) patients were prospectively identified from the Registry and clinic records following adjuvant therapy (as applicable), as those discharged from the centre (10/2007 - 4/2009); DL was sent to the patient and PCP recommending surveillance tests and dates. Clinical, laboratory, diagnostic imaging, and endoscopy data was collated. Adherence at 1 year follow-up was compared between cohorts using Kaplan-Meier time-to-event analyses. Results: C1 (n=218) was larger than C2 (n=114) despite the longer accrual time for C2. There were no differences between cohorts by age, sex, primary site of disease, stage, or adjuvant oxaliplatin use. During year 1 of follow-up, 11.8% and 11.4% recurred (local or metastatic) and 6.5% and 2.7% died (p=0.1) in C1 and C2 respectively. Comparing C1 with C2, 14.8% vs. 23.0% of patients had one CEA test within 3 months, 45.2% vs. 72.2% within 6 months, and 71.7% vs. 85.1% within 1 year (p<0.001). Only 44.0% (C1) and 68.6% (C2) had 2 CEA tests within 1 year. Only 3.9% (C1) vs. 6.6% (C2) of patients had 4 CEA tests within the year following treatment as recommended. The rate of CT imaging was 32.3% (C1) and 56.1% (C2); endoscopy was 36.7% (C1) and 42.1% (C2). Conclusions: Implementation of a DL improved compliance with surveillance at 1 year of follow-up following discharge from a tertiary cancer centre, although optimal adherence remains low. However, adherence to CT imaging nearly doubled. Evaluation of compliance at 3 years of follow-up is ongoing.

Retrospective assessment of adherence to ASCO Surveillance Guidelines following treatment for stage II and III colorectal cancer (CRC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17517-e17517
Author(s):  
J. M. Davies ◽  
S. Lupichuk ◽  
E. Batuyong ◽  
R. J. Hilsden ◽  
J. Easaw
Keyword(s):  
Ct Scan ◽  
Adjuvant Treatment ◽  
Laboratory Data ◽  
Primary Care Providers ◽  
Stage Ii ◽  
Stage Iii ◽  
Care Providers ◽  
Cancer Centre ◽  
The Impact

e17517 Background: The 2005 ASCO guidelines for surveillance following adjuvant therapy for CRC outlined recommended surveillance tests and their frequencies including history and physical examination, CEA testing, CT scan and colonoscopy. The purpose of this study was to assess the impact of these guidelines post treatment of stage II and III CRC in the Calgary Health Region (CHR) before and after implementation of a computer generated, personalized discharge letter (DL). Methods: Cohort 1 patients completed adjuvant chemotherapy or radiotherapy for stage II and III CRC between September 1, 2006, and November 30, 2007, prior to implementation of the DL. Cohort 1 was retrospectively identified from the Alberta Cancer Registry. Registry data was collated with laboratory data and diagnostic imaging data is forthcoming. Adherence to the guidelines at 1-year follow-up in cohort 1 was measured. Prospective data collection on patients who completed adjuvant treatment after implementation of the DL (cohort 2) is ongoing. Comparison of adherence rates to surveillance testing between the two cohorts will be reported upon study completion. Results: For cohort 1, 209 of 238 patients referred to the cancer centre were from the CHR and hence included in the analysis. The average age was 65 and 53% were male. Most patients (136/209) had stage III CRC. 1/209 had a local recurrence only. 27/209 progressed to metastatic disease during the 1-year follow-up period, of which 23 of these patients were initially diagnosed with stage III CRC. CEA adherence (≥4 tests taken within 1-year follow-up period) was 38.3% (95% CI 31.7–44.9). CT scan adherence and use of “inappropriate” surveillance testing for cohort 1 will be available at the meeting. Conclusions: This study assesses compliance with the 2005 ASCO CRC surveillance guidelines at 1-year follow-up post adjuvant treatment at a tertiary cancer centre. Analysis of cohort 1 reveals that adherence to CEA testing is suboptimal. The next phase of this study will assess the impact of a DL, sent to patients and primary care providers outlining recommended surveillance tests and dates, on adherence rates. No significant financial relationships to disclose.

Early Stage Diffuse Large B Cell Lymphoma (DLBCL) in the CHOP-R Era: Does Involved Field Radiation Therapy (IFRT) Impact Outcome?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3433-3433
Author(s):  
Manzurul A. Sikder ◽  
Sughosh Dhakal ◽  
Jennifer Kelly ◽  
Steven H. Bernstein ◽  
Faith Young ◽  
...  
Keyword(s):  
Early Stage ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Stage Ii ◽  
Disease Stage ◽  
Event Free Survival ◽  
Bulky Disease ◽  
Free Survival ◽  
The Impact

Abstract Historically, patients (pts) with early stage DLBCL treated without consolidative IFRT more commonly relapsed in sites of initial disease. While event-free survival (EFS) was superior with IFRT after CHOP in the short-term in a large randomized trial (NEJM 339:21), prolonged follow-up demonstrated equivalent overall survival due in part to late relapses (Blood 98:724a). The optimal therapy for pts with early stage DLBCL in the rituximab-CHOP (R-CHOP) era has not been established. To determine the impact of IFRT after R-CHOP treatment on outcome of early stage DLBCL, we reviewed medical records of 67 consecutive pts with stage I and II DLBCL who were primarily treated with R-CHOP with or without IFRT between February 2001 and March 2006. Three to 8 cycles of R-CHOP were administered, and 30–45 Gy IFRT was administered for those irradiated. The Kaplan-Meier method was used for the estimates of outcome. EFS was measured from the date of diagnosis until first documented disease progression or death from any cause. Comparisons were adjusted for IPI by Cox proportional hazards regressions, and all tests were two sided. Median follow-up was 2.6 years (range 0.5–5.5). 45 (67%) of the pts were men. Median age at diagnosis was 60 years (range 20–92); 18 (27%) had ‘B’ symptoms; bulky disease (defined as mass >10cm) was present in 15 (22%); 27 (40%) had stage I and 40 (60%) had stage II disease. Stage-adjusted IPI score distribution was: IPI 0, n=6 (9%); IPI 1, n=17 (25%); IPI 2, n=24 (36%); IPI 3, n=16 (24%); IPI 4, n=4 (6%). 39 (58%) pts had extranodal disease (23% soft tissue, 21% head & neck, 56% others). As expected, since the majority of pts had more than 1 IPI risk factor, the 2-year event-free survival (EFS) was 68% (median EFS not reached). 11 (16%) pts had primary refractory disease including 3 pts who died during treatment, and they were excluded from further analysis. Of the remaining pts, 34 (61%) received IFRT, and 22 were treated with R-CHOP alone. The IPI scores of the 2 groups were balanced, but as expected, stage II disease was more common in pts who received R-CHOP alone. The EFS at 2 years for pts treated with consolidative IFRT was 87%, and with chemotherapy alone was 72%. When controlling for IPI score and the presence of bulky disease, there was a significant benefit in EFS for patients treated with R-CHOP + IFRT compared with R-CHOP alone (p=0.027). Therefore, in pts with early stage DLBCL treated with R-CHOP, we find improved outcomes with a combined modality approach including consolidative IFRT compared with chemotherapy alone as was observed in the CHOP era. Our study has inherent biases due to its retrospective nature, and limited follow-up. However, to our knowledge, this is the first study that compare R-CHOP with and without IFRT in early stage DLBCL, and therefore has important implications on future clinical trial designs.

Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

2020 ◽  
Author(s):  
Erico Castro-Costa ◽  
Jerson Laks ◽  
Cecilia Godoi Campos ◽  
Josélia OA Firmo ◽  
Maria Fernanda Lima-Costa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Old Age ◽  
All Cause Mortality ◽  
The Impact

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

scholarly journals The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Miao Liu ◽  
Jianhua Wang ◽  
Yao He
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Risk Model ◽  
Continuous Variable ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Lower Baseline ◽  
The Impact ◽  
Chinese Male

Aims. This study aimed at assessing the impact of baseline bilirubin (TBiL) on the incidence of diabetic retinopathy (DR) based on a five-year cohort study which consisted of 5323 Chinese male diabetic patients.Methods. A cohort study based on 5323 male diabetic patients was conducted in Beijing, from 2009 to 2013. Both baseline TBiL and follow-up changes were measured. Cox proportional risk model was used to calculate the hazard ratio (HR) of TBiL for DR risk.Results. During the follow-up period, there were 269 new DR cases. The incidence of five-year follow-up was 5.1% (95% CI: 4.5%~5.6%). The TBiL level of those who had diabetic retinopathy was lower than that of those without (12.51+ 1.20 mol/L and 13.11+ 1.32μmol/L,P=0.033). And more interestingly, along with the quintiles of baseline TBiL, there showed a U-shaped curve with DR incidence. And the RRs were 0.928 (95% CI: 0.646–1.331), 0.544 (95% CI: 0.365–0.811), 0.913 (95% CI: 0.629–1.324), and 1.035 (95% CI: 0.725–1.479) for the second, third, fourth, and fifth quintiles of baseline TBiL levels, respectively, compared with the first quintile. For follow-up TBiL changes, after being adjusted for related covariables and baseline TBiL levels (as continuous variable) in the model, the RRs for DR were 1.411 (95% CI: 1.081–1.842) for those who had decreased TBiL level and 0.858 (95% CI: 0.770–0.947) for those who had increased TBiL level during follow-up. And this association was more prominent among those with lower baseline TBiL level.Conclusions. Serum TBiL had a U-shaped relationship with DR incidence, which was independent of control status of diabetes and other related covariates.

scholarly journals Single Pill Indapamide and Perindopril Arginine Combination: Optimal Coupling of Vascular Protection and Hemodynamic Risk Factors Reduction in Patients with Essential Arterial Hypertension

Kardiologiia ◽  
2019 ◽  
Vol 59 (3) ◽  
pp. 18-26 ◽  
Author(s):  
E. V. Borisova ◽  
A. I. Kochetkov ◽  
O. D. Ostroumova
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Arterial Compliance ◽  
Stage Ii ◽  
Stiffness Index ◽  
Single Pill ◽  
Essential Arterial Hypertension ◽  
The Impact

Objective: to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1–2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed.Results. At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24‑hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24‑hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24‑hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by –9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by –11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance – from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %).Conclusion. In AHT naive patients 40–65 years old with stage II grade 1–2 EAH therapy with I / P SPC provided effective 24‑hour BP control, reduced BPV and improved arterial stiffness parameters. 

AB0510 INFLIXIMAB IS AN EFFECTIVE GLUCOCORTICOID-SPARING TREATMENT FOR TAKAYASU ARTERITIS: RESULTS OF A MULTICENTER OPEN-LABEL PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1552.1-1553
Author(s):  
P. Mertz ◽  
J. F. Kleinmann ◽  
M. Lambert ◽  
X. Puéchal ◽  
T. Martin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Takayasu Arteritis ◽  
Conventional Therapy ◽  
Clinical Laboratory ◽  
Immunosuppressive Treatment ◽  
Median Dose ◽  
Open Label ◽  
National Drug ◽  
Sparing Effect

Background:Approximately half of patients with Takayasu Arteritis (TA) have glucocorticoid (GC)-dependency and require the addition of a second-line immunosuppressive treatment.Objectives:Here, we conducted a multicenter open-label prospective cohort study to assess the efficacy and safety of infliximab originator as a GC-sparing agent in TA.Methods:A temporary recommendation for use for infliximab in refractory TA was approved by the French National Drug Authorities (April 2014). Infliximab was administered to patients in case of disease activity with a NIH score ≥2 despite conventional therapy. Data regarding patient’s clinical, laboratory, imaging and treatments were obtained at baseline, and at each following visit until last visit (October 2017). TA activity was evaluated according to NIH criteria and GC requirement throughout the study.Results:Twenty-three patients were enrolled, including 19 female. The median age at inclusion was 33 years (Interquartile range, IQR: 23-44 years). At baseline, 17 (74%) patients were treated with GCs, at a median dose of 10 mg/day (IQR: 0-21) of prednisone-equivalent. After a median follow-up of 36.9 months (IQR: 10-58.7), improvement of ≥1 NIH criterion of TA activity was achieved for 14/22 (64%) patients. The median GC dose was 8 mg/day (IQR: 7-10) at 6 months; 5 mg/day (IQR: 0-8) at 12 months and 0 mg/day (IQR: 0-5) at 36 months of follow-up. Overall, infliximab originator had a significant GC-sparing effect between baseline and last follow-up (p=0.009).Conclusion:This multicenter open-label cohort study suggests that infliximab originator is an effective GC-sparing treatment for TA refractory to conventional therapy.Disclosure of Interests:None declared

scholarly journals The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

2020 ◽  
Vol 48 (4) ◽  
pp. 297-305
Author(s):  
Jolene N Moore ◽  
Wayne W Morriss ◽  
Gebrehiwot Asfaw ◽  
Gosa Tesfaye ◽  
Aaliya R Ahmed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mixed Methods ◽  
Maternal Mortality ◽  
Longitudinal Cohort Study ◽  
Structured Interviews ◽  
Middle Income ◽  
Longitudinal Cohort ◽  
Obstetric Anaesthesia ◽  
The Impact

Summary Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline ( n = 101, 69% response rate). Pre- and post-course MCQs ( n = 121, n = 123 respectively) and pre- and post-course skills tests ( n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up ( n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training ( P < 0.0001) and skills test scores improved from 56.5% to 83.2% ( P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline ( P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

Sign in / Sign up

Export Citation Format

Share Document