Evaluation of the frailty characteristics and clinical outcomes according to the new frailty-based outcome prediction model (Myeloma Risk Profile-MRP) in a UK real-world cohort of elderly newly diagnosed Myeloma patients

The management of myeloma in the elderly is shifting its focus towards reducing the risk of under-treating fit patients and the risk of over-treating frail patients. Frailty assessment is required in this patient group in order to individualise treatment decisions. In addition to the proven prognostic values of the International Myeloma Working Group (IMWG) frailty score and the revised Myeloma Co-morbidity Index (R-MCI), a new easy-to-use frailty-based risk profile score (high-risk (i.e. frail), medium risk (i.e. intermediate-fitness) and low-risk (i.e. fit)) named Myeloma Risk Profile (MRP) was shown to be predictive of survival in the clinical trial setting. In this retrospective real-world study, we set out to evaluate the frailty characteristics and clinical outcomes according to the different MRP scoring algorithm categories (frail vs. intermediate vs fit), in a high risk cohort of elderly newly diagnosed myeloma patients treated with the fixed-duration triplet therapy VCD (bortezomib with cyclophosphamide and dexamethasone). Clinical outcomes included: reason for treatment discontinuation, overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Out of 100 patients, 62 were frail, 27 were intermediate and 11 were fit, according to MRP scores. To enable meaningful comparisons between comparable numbers, subgroups analyses for ORR, OS, PFS, and AEs focused on frail (n = 62) versus intermediate or fit (n = 38) patients. The proportion of patients in each subgroup who were able to complete the planned course of treatment was (frail: 43.5% vs. intermediate or fit: 55.3%). A higher proportion in the frail subgroup discontinued therapy due to progressive disease (19.4% vs. 2.6%). Discontinuation due to toxicity was comparable across subgroups (14.5% vs. 15.8%), ORR in the total cohort was 75%, and this was comparable between subgroups (frail: 74.2% vs. intermediate or fit: 76.3%). There was a trend for a shorter median OS in the frail subgroup but without a statistical significance: (frail vs. intermediate or fit): (46 months vs. not reached, HR: 1.94, 95% CI 0.89–4.2, p = 0.094). There was no difference in median PFS between subgroups: (frail vs. intermediate or fit): (11.8 vs. 9.9 months, HR: 0.99, 95% CI: 0.61–1.61, P = 0.982). This cohort demonstrated a higher incidence rate of AEs in frail patients compared to those in the intermediate or fit group: patients with at least one any grade toxicity (85.5% vs. 71.1%), patients with at least one ≥G3 AE (37.1% vs. 21.1%). In conclusion, our study is to the first to evaluate clinical outcomes according to MRP in a high risk real-world cohort of patients treated exclusively with the proteasome inhibitor-based VCD therapy. Our study demonstrated a trend for worse OS in addition to worse AE outcomes in the frail group, but no difference in PFS with this fixed-duration therapy. MRP is an easy-to-use tool in clinical practice; its prognostic value was validated in the real-world in a large cohort of patients from the Danish Registry. Further evaluation of MRP in the real-world when continuous therapies are used, can further support the generalisability of its prognostic value in elderly myeloma patients.

The Missing Measure of Loneliness: A Case for Including Neededness in Loneliness Scales

Prominent tools used to measure loneliness such as the UCLA Scale and DJGS include no items related to being needed, i.e., neededness. More recent scales such as the DLS and SELSA do include items on neededness, but only within their romantic loneliness subscales. This paper proposes that new iterations of loneliness scales should include in all subscales two items on neededness: (a) whether a person feels important to someone else and (b) whether that person has good ways to serve others’ well-being. The paper surveys cognate studies that do not rely on loneliness scales but establish a link between neededness and feelings of social connection. It then highlights ways in which neededness items would improve the ability of loneliness scales to specify the risk profile, to delineate variations in the emotional tone and quality of loneliness, and to propose suitable interventions. The paper outlines a theoretical argument—drawing on moral philosophy—that prosociality and being needed are non-contingent, morally urgent human needs, postulating that the protective benefits of neededness vary according to at least four factors: the significance, persistence, non-instrumentality, and non-fungibility of the ways in which a person is needed. Finally, the paper considers implications for the design of appropriate remedies for loneliness.

Sex differences in treatment strategy for coronary artery aneurysms: Insights from the international Coronary Artery Aneurysm Registry

Introduction Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD. Methods Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding. Results Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, p = 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, p = 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, p = 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, p = 0.015). Conclusions These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.

DESAIN ENTERPRISE RISK MANAGEMENT PADA PERGURUAN TINGGI DI STIE MUHAMMADIYAH JAKARTA

Tujuan dari penulisan ini adalah untuk menganalisis penerapan manajemen risiko pada perguruan tinggi di Sekolah Tinggi Ilmu Ekonomi Muhammadiyah Jakarta. Metode penelitian menggunakan desain penelitian eksploratif, karena tujuan penelitian ini adalah untuk memahami permasalahan manajemen risiko pada STIE Muhammadiyah Jakarta. Data diperoleh dengan melakukan wawancara dan barinstorming dengan ketua program studi, kepala bagian, dan kepala Lembaga STIE Muhammadiyah Jakarta, juga dengan menggunakan data sekunder yaitu jumlah mahasiswa, jumlah, dosen, dan data lainnya. Tahapan analisis dilakukan melalui identifikasi risiko, penilaian dan evaluasi risiko, perencanaan mitigasi risiko dan analisis serta interpretasi data. Berdasarkan hasil identifikasi risiko, terdapat 5 risiko inherent yang bisa berdampak signifikan terhadap sustainability STIE MJ. Berdasarkan risk profile dari kelima identifikasi risiko, risiko 1 berdampak kualitatif terhadap penurunan peringkat akreditasi, risiko kedua dan ketiga berdampak terhadap tidak tercapainya sasaran kinerja, risiko keempat dan kelima dapat berdampak terhadap penurunan klasterisasi Nasional Perguruan Tinggi. Dampak kuantitatif risiko 1-3 berdampak terhadap kerugian institusi, risiko no. 4 dan 5 berdampak terhadap rendahnya penyerapan anggaran (cost center). Beberapa risiko memerlukan penangan dalam waktu yang tidak singkat seperti risiko 4 dapat mengakibatkan risiko residual tidak sesuai dengan target risiko yang diharapkan (risk appetite), sehingga diperlukan penanganan risiko secara berkelanjutan. Penelitian ini memiliki keterbatasan yaitu identifikasi risiko tidak dilakukan secara mendalam pada semua unit kerja. Penelitian mendatang diharapkan agar identifikasi risiko dilakukan pada semua unit kerja di Perguruan Tinggi, sehingga risiko yang ada dapat segera dimitigasi dan dilakukan perbaikan segera.

A Scoping Review of Perinatal Palliative Care: Allowing Parents to Be Parents

Objective–Perinatal palliative care (PPC) is an option for patients who discover that their infant has a life-limiting fetal condition, which decreases the burden of the condition using a multidisciplinary approach. Study Design–This review discusses the landmark literature in the past two decades, which have seen significant growth and development in the concept of PPC. Results–The literature describes the background, quality, and benefits of offering PPC, as well as the ethical principles that support its being offered in every discussion of fetal life-limiting diagnoses. Conclusions–PPC shares a similar risk profile to other options after life-limiting diagnosis, including satisfaction with choice of continuation of pregnancy. The present clinical opinion closes by noting common barriers to establishing PPC programs and offers a response to overcome each one. Key Points