RESUMO
PURPOSE: We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. METHODS: This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. RESULTS: We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician-patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. CONCLUSION: Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes. CLINICAL TRIAL REGISTRATION: Not applicable.
Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Atitude do Pessoal de Saúde , Estudos Transversais , Prescrição Eletrônica/estatística & dados numéricos , Humanos , Relações Médico-Paciente , Qualidade da Assistência à Saúde , Espanha , Inquéritos e Questionários/estatística & dados numéricos , Carga de TrabalhoRESUMO
Discovery and clinical development of monoclonal antibodies with the ability to interfere in the regulation of the immune response have significantly changed the landscape of oncology in recent years. Among the active agents licensed by the regulatory agencies, nivolumab and pembrolizumab are paradigmatic as the most relevant ones according to the magnitude of available data derived from the extensive preclinical and clinical experience. Although in both cases the respective data sheets indicate well-defined dosage regimens, a review of the literature permits to verify the existence of many issues still unresolved about dosing the two agents, so it must be considered an open question of potentially important consequences, in which to work to improve the effectiveness and efficiency of use.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Inibidores de Checkpoint Imunológico/administração & dosagem , Neoplasias/tratamento farmacológico , Nivolumabe/administração & dosagem , Anticorpos Monoclonais Humanizados/farmacocinética , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/farmacocinética , Antineoplásicos Imunológicos/uso terapêutico , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Imunoterapia Adotiva/métodos , Nivolumabe/farmacocinética , Nivolumabe/uso terapêutico , Receptor de Morte Celular Programada 1/antagonistas & inibidoresRESUMO
The objective of the present study was to evaluate the effect of equine chorionic gonadotropin (eCG) administration associated to different proestrus lengths for Fixed-time AI (FTAI) in beef heifers. In Experiment 1, pre-pubertal heifers (n = 46) received a 6-day estradiol/progesterone-based treatment (J-Synch protocol), and were then allocated into four experimental groups in a 2 × 2 factorial design, to receive or not receive eCG (300 IU) at the time of intravaginal progesterone device removal, and to receive GnRH at 48 h or 72 h after device removal (to induce shortened and prolonged proestrus length, respectively). Endometrial samples were obtained 6 d after ovulation from the cranial portion of the uterine horn. The eCG administration induced greater serum estradiol-17ß concentrations before ovulation (P < 0.05) and greater proportion of heifers bearing a competent corpus luteum after ovulation (P = 0.054). Delaying GnRH administration from 48 h to 72 h induced a longer interval from device removal to ovulation (i.e., prolonged proestrus; P < 0.05), larger diameter of the ovulatory follicle, and greater progesterone concentrations on Day 10-11 after ovulation. Heifers in eCG + GnRH72h group had more uterine receptors in luminal epithelium than those in eCG + GnRH48h group (PR and ERα), and than those in No eCG + GnRH72h group (PR) (P < 0.05). No effect of eCG or GnRH treatments was found in endometrial gene expression of progesterone and estrogen receptors. In Experiment 2, a total of 2,598 heifers received the J-Synch protocol associated or not with eCG administration at device removal, followed by FTAI/GnRH at 60 or 72 h after device removal (i.e., prolonged proestrus protocol). Heifers that received eCG had greater P/AI than those not receiving eCG (P < 0.05) and there was an interaction between eCG treatment and time of FTAI. The lowest P/AI was found in those heifers that received FTAI/GnRH at 72 h without eCG treatment at device removal (P < 0.05), and no differences were found between the other experimental groups. In conclusion, prolonging the length of proestrus in J-Synch protocol improves ovulatory follicular diameter and luteal function; and the administration of eCG at device removal improves preovulatory estradiol concentrations and luteal function. Finally, P/AI was enhanced by eCG treatment and the improvement was more evident when FTAI/GnRH was performed at 72 h after device removal.
Assuntos
Bovinos , Gonadotropina Coriônica/farmacologia , Ovulação/efeitos dos fármacos , Útero/efeitos dos fármacos , Animais , Sincronização do Estro/métodos , Feminino , Inseminação Artificial/veterinária , Folículo Ovariano/efeitos dos fármacos , Indução da Ovulação/veterinária , Gravidez , Taxa de Gravidez , Útero/fisiologiaRESUMO
Over the last 2 decades, the standard fluoropyrimidine-based chemotherapy backbone for metastatic colorectal cancer has been complemented by the addition of novel biological agents, achieving impressive increases in 5-year survival rates. Nonetheless, these new combinations have also entailed increases in toxicity, leading to evaluation of de-escalated chemotherapy regimens and "drug holiday" periods in attempts to reduce side effects and optimise quality of life without impairing efficacy. Here, we review the current and emerging evidence for maintenance schedules with chemotherapy and targeted agents, versus continuous treatment after induction treatment, in metastatic colorectal cancer patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Quimioterapia de Manutenção/métodos , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/administração & dosagem , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Capecitabina/administração & dosagem , Cetuximab/administração & dosagem , Ensaios Clínicos como Assunto , Neoplasias Colorretais/patologia , Progressão da Doença , Cloridrato de Erlotinib/administração & dosagem , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Quimioterapia de Indução , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/prevenção & controle , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/efeitos adversos , Oxaliplatina/administração & dosagem , Oxaliplatina/efeitos adversos , Oxaloacetatos/administração & dosagem , Panitumumabe/administração & dosagem , Suspensão de TratamentoRESUMO
The aim of the present study was to investigate the effects of a strategy for extending pro-oestrus (the interval between luteolysis and ovulation) in an oestrus synchronisation protocol (named J-Synch) in beef heifers on follicular growth, sexual steroid concentrations, the oestrogen receptor ERα and progesterone receptors (PR) in the uterus, insulin-like growth factor (IGF) 1 and pregnancy rates. In Experiment 1, heifers treated with the new J-Synch protocol had a longer pro-oestrus period than those treated with the conventional protocol (mean (±s.e.m.) 93.7±12.9 vs 65.0±13.7h respectively; P<0.05). The rate of dominant follicle growth from the time of progesterone device removal to ovulation was greater in heifers in the J-Synch than conventional group (P<0.05). Luteal area and serum progesterone concentrations were greater in the J-Synch Group (P<0.05) for the 12 days after ovulation. Progesterone receptor (PGR) staining on Day 6 after ovulation in the uterine stroma was lower in the J-Synch than conventional group (P<0.05), and the expression of PR gene (PGR) and IGF1 gene tended to be lower in J-Synch-treated heifers (P<0.1). In Experiment 2 (n=2349), the pregnancy rate 30-35 days after fixed-time AI (FTAI) was greater for heifers in the J-Synch than conventional group (56.1% vs 50.7% respectively). In conclusion, our strategy for extending pro-oestrus (i.e. the J-Synch protocol) significantly improves pregnancy establishment in beef heifers. This improvement was related to an increased rate of growth of the dominant ovulatory follicle, greater progesterone concentrations during the ensuing luteal phase and different uterine patterns of PGR and IGF1, which may have favoured embryo development and pregnancy establishment.
Assuntos
Estradiol/análogos & derivados , Sincronização do Estro/fisiologia , Ovário/fisiologia , Proestro/fisiologia , Progesterona/administração & dosagem , Útero/fisiologia , Animais , Bovinos , Estradiol/administração & dosagem , Estradiol/sangue , Sincronização do Estro/efeitos dos fármacos , Feminino , Folículo Ovariano/diagnóstico por imagem , Folículo Ovariano/efeitos dos fármacos , Ovário/diagnóstico por imagem , Ovário/efeitos dos fármacos , Gravidez , Proestro/efeitos dos fármacos , Progesterona/sangue , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Útero/diagnóstico por imagem , Útero/efeitos dos fármacosRESUMO
This Galician consensus statement is a joint oncologists/cardiologists initiative indented to establish basic recommendations on how to prevent and to manage the cardiotoxicity in breast cancer with the aim of ensuring an optimal cardiovascular care of these patients. A clinical screening of the patients before treatment is recommended to stratify them into a determined risk group based on their intrinsic cardiovascular risk factors and those extrinsic arose from breast cancer therapy, thereby providing individualized preventive and monitoring measures. Suitable initial and ongoing assessments for patients with low and moderate/high risk and planned treatment with anthracyclines and trastuzumab are given; also, measures aimed at preventing and correcting any modifiable risk factor are pointed out .
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/prevenção & controle , Cardiotoxicidade/etiologia , Feminino , Humanos , Fatores de RiscoRESUMO
Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.
Assuntos
Antineoplásicos/normas , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Feminino , Humanos , Prognóstico , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismoRESUMO
La tuberculosis es una enfermedad infecciosa, causada por especies del complejo Mycobacterium tuberculosis. Es una enfermedad de fácil transmisión, lo que puede generar un problema en los sitios de cuidado de salud al incrementarse el riesgo de infección entre las personas que se encuentran hospitalizadas, personal médico y visitante. El objetivo de este estudio fue tipificar mediante VNTR-MIRU 35 aislados de M. tuberculosis, obtenidos de pacientes recluidos en el Hospital Universitario de Caracas (HUC) durante 20102011, para establecer si existe estrecha relación genética entre los aislados y detectar si se presentó transmisión intrahospitalaria. En la tipificación por VNTR se observaron 29 patrones genéticos únicos (82,9%) y 3 clústeres, de los cuales sólo uno estuvo conformado por patrones genéticos de aislados provenientes de pacientes con estrecha relación epidemiológica (superposición de períodos de hospitalización). Mediante el análisis comparativo de los patrones genéticos con los depositados en la base de datos de VNTR-plus utilizando el método de Neighbor-joining, se pudo observar que los aislados se agrupaban con patrones LAM (n=25), Haarlem (n=3) y S (n=7). La conformación de un clúster de dos aislados de pacientes con un vínculo epidemiológico sugiere la posible transmisión nosocomial de la TB en el HUC
Tuberculosis (TB) is an infectious disease, caused by species from the Mycobacterium tuberculosis complex (MTBC). It is an easily transmitted disease that it can increase the risk of infection among people who are in hospital, medical staff and visitors The purpose of this study was to molecular typing by VNTR-MIRU 35 isolates of Mycobacterium tuberculosis (M.tb) from hospitalized patients in the "Hospital Universitario de Caracas" during 2010-2011 to establish whether there is a close genetic relationship between isolates and to detect whether the nosocomial transmission was presented. In the analysis of VNTR typing, 29 unique genetic patterns (82,9%) and 3 clusters were observed, of which only one consisted by genetic patterns of isolates from patient with close epidemiologic relation (overlapping of periods of hospitalization). With the comparative analysis of genetic patterns with VNTR-plus database using Neighbor-joining method it was possible to observe the clustering of the isolates with LAM (n=25), Haarlem (n=3), S (n=7). The forming of one cluster with two isolates from patients with epidemiological link suggests a possible nosocomial transmission of TB in HUC
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tuberculose , Transmissão de Doença Infecciosa , Tipagem Molecular , Mycobacterium tuberculosis , Saúde Pública , EpidemiologiaRESUMO
PURPOSE: To evaluate the utility of Ki67 as a prognostic marker in Luminal B node-negative breast cancer patients. METHODS: We identified 888 patients with invasive breast carcinomas who underwent surgery between 1997 and 2004. Several classical factors were collected: age, tumor size, node involvement, tumor grade, estrogen and progesterone receptors, HER2 and Ki-67 expression. We analyzed if these parameters could be considered as a prognostic factor. In early Luminal B group, we investigated which of the following biological features provide information about bad prognosis: lack of progesterone receptor expression, HER2 overexpression/amplification or high Ki-67 value. RESULTS: The majority of patients were alive and without relapse of tumor at the moment of the analysis (70 %). The prognostic factors founded in multivariate analysis were: tumor size, node involvement, grade 3 and Ki-67 expression. When we stratified the sample by immunohistochemistry (IHC) in tumor subtypes, we assessed 680 patients and we observed 191 Luminal B tumors. The biological parameter related to the worst survival in absence of nodal involvement was Ki-67 value. CONCLUSIONS: Ki-67 represents an additional predictor of survival in Luminal B node negative breast cancer. Conversely, neither Progesterone-receptor nor HER2 status proved prognostic significance in this group in our study.
Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/patologia , Antígeno Ki-67/metabolismo , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/metabolismo , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/metabolismo , Carcinoma Lobular/patologia , Carcinoma Medular/metabolismo , Carcinoma Medular/patologia , Feminino , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Taxa de SobrevidaRESUMO
Las Micobacterias de crecimiento rápido (MCR) son patógenos oportunistas capaces de ocasionar infecciones en piel, pulmonares y diseminadas. En Venezuela existe un incremento de estas infecciones derivadas de procedimientos invasivos, entre ellas cirugías estéticas. El tratamiento de esas infecciones requiere la administración de al menos dos antibióticos por varios meses. En la presente revisión se describe los mecanismos de resistencia a los antibióticos que se han reportado en las MCR, principalmente las tres especies que frecuentemente se han asociado a infecciones en piel: M. abscessus, M. chelonae y M. fortuitum. Los factores más importantes relacionados a la resistencia en los esquemas de tratamiento son: cambios relacionados en la permeabilidad de la membrana al antibiótico, la inactivación enzimática y modificaciones del sitio blanco. En MCR se han evidenciado la presencia de betalactamasas con actividad penicilinasas y cefalosporinasas y de acetil-transferasas que pueden modificar los aminoglicósidos. Las modificaciones de las regiones ARNr 23S y ARNr 16S han permitido explicar, en parte, la resistencia a macrólidos y aminoglicósidos. La metilación de los sitios blanco de acción de los macrólidos es otro factor importante, sobre todo en especies como M. abscessus. Éste último mecanismo explica la falla terapéutica que se ha reportado en pacientes tanto en infecciones pulmonares como en infecciones en piel. Es necesario ampliar el estudio sobre los mecanismos de resistencia en estas especies, tomando en consideración las complicaciones que llevan estas infecciones y los tiempos prolongados de tratamientos pudiendo generar efectos secundarios en los pacientes y la frustración cuando ocurre la falla terapéutica.
The rapid growing mycobacteria (RGM) are opportunist pathogens able to cause skin, pulmonary and disseminated infections. In Venezuela there is an increase in the prevalence of these infections especially following esthetic surgery. The treatment of such infections is cumbersome requiring the administration of at least two antibiotics for several months. In the present review we describe the principal antibiotic resistance mechanisms reported for RGM, particular for the species most frequently associated with skin and soft tissue infection: M. abscessus, M. chelonae and M. fortuitum. The most important factors associated with resistance to antibiotics are impermeability of the cell membrane, enzymatic inactivation and changes in the target site. In RGM the presence of the beta-lactamases with penicillinases and cephalosporinase activity has been demonstrated and the presence of acetyl-transferases which can modify aminoglycosides. Changes in the 23S rRNA and 16S rRNA regions has allowed to explain, partly macrolide and aminoglycoside resistance. Mutation in the macrolide target site is another important resistance mechanism, particularly for the species group M. abscessus. This last mechanism can explain treatment failure reported in the patients with pulmonary or skin infection. We conclude that there is a need for more extensive studies about the mechanisms of antibiotic resistance of RGM; taking into account the complications of these infections, the prolonged treatment long time, producing secondary effects and the frustrations of patient and physician caused by therapeutic failures.