Age Demographics of Subjects Enrolled in Global, Interventional Phase 3 Melanoma Clinical Trials

Background Melanoma is a skin cancer with a rising worldwide incidence of just over 280,000 individuals with the greatest burden of illness in European, New Zealander, and Australian populations. Patients are diagnosed with melanoma with the mean and median ages being 65 and 59 years old, respectively. Phase 3 trials not only provide a wide representation of the target population but also study the efficacy for a certain intervention. Objective The objective of this literature review is to analyze patient demographics of phase 3 trials for melanoma and identify if there is a true disparity between the clinical trial age demographics and the natural epidemiological age demographics. Data Sources The authors conducted a search on clinicaltrials.gov, a publicly available resource that lists clinical trials and their data. The reported mean and median ages for each trial were extracted after determining if each trial meets our inclusion criteria. Weighted mean and median ages were calculated using an online calculator. Data Summary Data from 35 trials were evaluated with 30 trials reporting a weighted mean age of 55.85 years and 5 trials reporting a weighted median age of 55.14 years. Conclusion Based on the results, melanoma clinical trials enroll patients who are younger than the epidemiological mean and median ages. Due to this underrepresentation of the elderly patients with melanoma, clinical trials may provide limited application for the use of their results.

Prevalence and pattern of acute and chronic multimorbidity across all body systems and age groups in primary health care

Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems. General practitioners play an important role in looking after multimorbid patients. The aim of this study is to assess the prevalence and pattern of acute and chronic multimorbidity in primary care patients, regardless of body system and age group. A convenience sample of 2099 patients treated by 40 general practitioners was assessed using the Burvill scale. This measure of multimorbidity differentiates according to organ system and covers both acute and chronic illnesses. It also allows severity ratings to be assessed for both acute and chronic conditions, and thus patients’ actual need for general practice care. Patients reported an average of 3.5 (SD = 2.0) acute and/or chronically affected body systems. Overall, 12.7% of patients reported only one health problem, 83.0% at least two, 65.8% at least three, 46.1% at least four, and 29.7% five or more. The most frequent problems were musculoskeletal (62.5%) and psychological (56.6%). Some morbidities were interrelated, while others co-occurred despite being medically independent. In primary care, multimorbidity is the rule rather than the exception. Acute and chronic morbidity both contribute to the burden of illness. Body systems reflect treatment needs. Instead of specialist treatment for individual illnesses, an integrative treatment approach is needed. This is the specialty of general practitioners.

LIFESTYLE DISORDERS IN CHILDREN: AN AYURVEDIC OVERVIEW

Lifestyle Disorders (LSD) are common problems among upper-middle and higher society children. Lifestyle has long been associated with the development of many chronic diseases. It affects both genders. WHO has recognized Noncommunicable diseases (NCDs), especially diabetes, obesity, cardiovascular disease, cancer, and chronic lung disease, have everyday lifestyle linked risk factors like lack of physical activity, unhealthy diet and feeding habits and harmful use of alcohol. Worldwide, the current scenario of NCDs is the primary cause of morbidity and mortality, even in young children. According to WHO Report 2004, these account for nearly 60% of deaths and 47% of the global burden of illness. The rise in NCDs is substantially accelerating in most developing countries like India. In India, 53% of the deaths in 2008 were due to NCDs, and cardiovascular disease (CVDs) alone accounted for 24% of deaths (WHO). In 2005 India experienced the highest loss in potentially productive years of life globally, and the leading cause of death was cardiovascular disease. The cumulative loss of national income for India due to NCDs mortality for 2006-2015 was around USD237 billion. By 2030, this productivity loss is estimated to double to 17.9 million years lost. These major NCDs are preventable through effective Ayurvedic interventions by judiciously treating lifestyle-related modifiable risk factors. This review confers the current scenario of NCDs in children and their Ayurvedic Management.

Burden of illness in carbapenem-resistant Acinetobacter baumannii infections in US hospitals between 2014 and 2019

Background Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. Methods To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014–2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality. Results 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P < 0.01), whereas CS A. baumannii was more frequently associated with bloodstream infections (CS 16.7% and CR 8.6%, P < 0.01). Patients with CR A. baumannii infections had higher in-hospital (CR 16.4% vs CS 10.0%; P < 0.01) and 30-day (CR 32.2% vs CS 21.6%; P < 0.01) mortality compared to those with CS infections. After adjusting for age, sex, admission source, infection site, comorbidities, and treatment with in vitro active antibiotics within 72 h, carbapenem resistance was independently associated with increased mortality (adjusted odds ratio 1.42 [95% confidence interval 1.15; 1.75], P < 0.01). CR infections were also associated with increases in hospital length of stay (CR 11 days vs CS 9 days; P < 0.01), rate of intensive care unit utilization (CR 62.3% vs CS 45.1%; P < 0.01), rate of readmission with A. baumannii infections (CR 17.8% vs CS 4.0%; P < 0.01) and hospital charges. Conclusions These data suggest that the burden of illness is significantly greater for patients with CR A. baumannii infections and are at higher risk of mortality compared with CS infections in US hospitals.

Tragic Triad of Tobacco Dependence, Cancer, and COVID-19 Pandemic: An Urgent Call for Attention by Health Care Systems and Professionals

Tobacco smoke is a well-known carcinogen associated with multiple malignancies. Patients with cancer, as well as survivors, who continue to smoke are at a greater risk for poor cancer treatment outcomes. With the emergence of the COVID-19 pandemic, there is increased frequency and severity of the infection in patients with cancer. Furthermore, smoking and/or vaping increases incidence or likelihood of progression of COVID-19. Cigarette smoking, cancer, and COVID-19 each impose disproportionate burden of illness and death among racial and ethnic minorities. Geographic and population-specific analyses reveal that neighborhoods with lower income and higher minority populations have more tobacco/vape shops and face increased risk associated with tobacco marketing. Referral to tobacco cessation has been reduced during the pandemic. To reduce the adverse health effects of tobacco dependence among patients with cancer during the pandemic, urgent evidence-based solutions are described for health systems and professionals to prioritize tobacco cessation for patients with cancer in the midst of the COVID-19 pandemic, on the basis of cessation implementation at City of Hope Medical Center.

The burden of illness in patients with paroxysmal nocturnal hemoglobinuria receiving treatment with the C5-inhibitors eculizumab or ravulizumab: results from a US patient survey

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare and life-threatening disease with symptoms of hemolysis and thrombosis. Current therapies for this complement-mediated disease rely predominantly on inhibition of the C5 complement protein. However, data on treatment responses and quality of life in C5-inhibitor (C5i)-treated PNH patients are scarce. The objective of this study was to determine C5i treatment effects on clinical parameters, PNH symptoms, quality of life, and resource use for PNH patients. This cross-sectional study surveyed 122 individuals in the USA receiving treatment for PNH with C5-targeted monoclonal antibodies, eculizumab (ECU) or ravulizumab (RAV). Despite most patients receiving C5i therapy for ≥ 3 months (ECU 100%, n = 35; RAV 95.4%, n = 83), many patients remained anemic with hemoglobin levels ≤ 12 g/dL in 87.5% (n = 28/32) and 82.9% (n = 68/82) of ECU and RAV recipients, respectively. A majority of patients on ECU (88.6%; n = 31/35) and RAV (74.7%; n = 65/87) reported fatigue symptoms. Among PNH patients receiving C5i therapy for ≥ 12 months, some still reported thrombotic events (ECU, 10.0%, n = 1/10; RAV, 23.5%, n = 4/17) and required transfusions within the past year (ECU, 52.2%, n = 12/23; RAV, 22.6%, n = 7/31). Other patient-reported PNH symptoms included breakthrough hemolysis, shortness of breath, and headaches. Patients reported scores below the average population norms on the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scales. Overall, this study found that PNH patients receiving ECU or RAV therapy demonstrated a significant burden of illness, highlighting the need for improved PNH therapies.

Guidelines for management of hereditary angioedema: What is new? What is missing?

Background: Hereditary angioedema is an autosomal dominant disease that presents with recurrent episodic swelling of the submucosal and/or subcutaneous tissues of the cutaneous, gastrointestinal, and respiratory systems. Evaluation and treatment guidelines have been published nationally and internationally to aid the treating provider. Methods: A review of the most cited and most recent updated guidelines was undertaken to review key points and to explore real-world feasibility of incorporating them into clinical practice. The International World Allergy Organization/European Academy of Allergy and Clinical Immunology (WAO/EAACI) Guideline for the Management of Angioedema - The 2017 Revision and Update, and the consensus reports from the Hereditary Angioedema International Working Group, the Joint Task Force on Practice Parameters focused practice parameter update, and the most recently updated US HAEA Medical Advisory Board 2020 Guidelines for the Management of Hereditary Angioedema were reviewed and summarized. Results: Key points that have been consistent throughout the guidelines include recommendations for evaluation and classification of hereditary angioedema as well as evidence-based guidelines for treatment. Further attention is required on the evaluation and continuous assessment of the burden of illness and quality of life (QoL). Conclusion: The guidelines for management of hereditary angioedema provide a framework for the clinician. However, the physician-patient dialog with regard to the patient disease experience, which includes attack frequency, severity, and Qol, must be continually assessed.

A Review on Pre and Post Systematic Survey of Corona Virus Disease-19

Coronavirus disease2019(COVID-19)has become a serious ill health causing sever acute respiratory disorder in humans. The most purpose of this work to review various symptoms which occur during this disease of corona. It’s claimed that the coronavirus disease 2019 (COVID -19) Pandemic had a negative impact on psychological state. Since, it's important to spot which factors modulate the strain response to the pandemic. This article gives detailed information of corona virus or disease, that's origin of virus, how these virus affects the body? Which symptoms are produced during this disease? It describes detailed information of not only pre-covid phase but also post-covid phase. Because in some cases, after recovering of covid, some symptoms are remaining in patients and that they can appear as very long time this called post COVID. So, this text Describes that what Symptoms are produced and the way was treated that's it describes over you journey of coronavirus to black fungus i.e., Mucormycosis. The study was informed by emerging clinical understandings of long Covid and theories from the social sciences of the narrative nature of human experience, lived experience of illness and its links to identity, stigma, burden of illness, good professional practice, access to health care, peer support among patient communities and experience-based co-design of services. The main aim of this research study is to assess the impact of theCovid-19 Outbreak on psychological state and to research the flexibility of pre-outbreak SOC levels to predict changes in psychopathological symptoms.

Compassionate Healthcare for Parents of Children with Life-limiting Illnesses: A Qualitative Study

Objectives: Premature death of a child from a serious illness is probably one of the most painful experiences for a parent. This study examined the clinical experiences of bereaved parents of children with a life-limiting illness to provide recommendations for quality care. Materials and Methods: Data were collected using semi-structured in-depth interviews with bereaved parents whose children had died at least 3 months before the interview. Parents were purposively sampled from two institutions offering end-of-life care to children with life-limiting illnesses. Data were analysed using thematic analysis. Results: Data analysis revealed three main themes: (1) Clinical communication, (2) Healthcare infrastructure and (3) Non-physical aspects of healthcare. The seven subthemes uncovered were as follows: (1) Honesty and clarity, (2) empathy, (3) interdisciplinary communication, (4) inconveniences in hospital, (5) home palliative care, (6) financial burden of illness and (7) psychosocial and spiritual support. Conclusion: Strategies to improve healthcare for children and their families are multifold. Underlying the provision of quality care is compassion; a child and family-friendly healthcare system with compassionate providers and compassionate institutional policies are vital components to achieving quality healthcare. Culturally sensitive psychosocial, emotional and spiritual support will need to be integrated as standard care.