Characteristics of patients with haematological and breast cancer (1996–2009) who died of heart failure-related causes after cancer therapy

Aims: To describe the characteristics and time to death of patients with breast or haematological cancer who died of heart failure (HF) after cancer therapy. Patients with an index admission for HF who died of HF-related causes (IAHF) and those with no index admission for HF who died of HF-related causes (NIAHF) were compared. Methods and results: We performed a linked data analysis of cancer registry, death registry, and hospital administration records (n = 15 987). Index HF admission must have occurred after cancer diagnosis. Of the 4894 patients who were deceased (30.6% of cohort), 734 died of HF-related causes (50.1% female) of which 279 (38.0%) had at least one IAHF (41.9% female) post-cancer diagnosis. Median age was 71 years [interquartile range (IQR) 62–78] for IAHF and 66 years (IQR 56–74) for NIAHF. There were fewer chemotherapy separations for IAHF patients (median = 4, IQR 2–9) compared with NIAHF patients (median = 6, IQR 2–12). Of the IAHF patients, 71% had died within 1 year of the index HF admission. There was no significant difference in HF-related mortality in IAHF patients compared with NIAHF (HR, 1.10, 95% CI, 0.94–1.29, P = 0.225). Conclusions: The profile of IAHF patients who died of HF-related causes after cancer treatment matched the current profile of HF in the general population (over half were aged ≥70 years). However, NIAHF were younger (62% were aged ≤69 years), female patients with breast cancer that died of HF-related causes before hospital admission for HF-related causes—a group that may have been undiagnosed or undertreated until death

Evaluation of the Learnbloodtransfusion education programme: Module 1 Safe Transfusion Practice

This report is an evaluation of theLearnbloodtransfusion (LBT) module 1 Safe Transfusion Practice. It relates findings from a survey and in-depth interviews carried out with module participants. Participants’ knowledge of blood transfusions was tested, views were sought on transfusion practice and perceptions of module 1 were investigated. Those who took module 1 recently were compared with those who were at different time points post module, and comparisons were made between those that had done the eLearning version of module 1 with participants who had taken module 1 face-to-face

Heart failure following blood cancer therapy in pediatric and adult populations

Aim: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalised for heart failure. Methods: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N=23,434); 8,339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7,522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. Results: Of those who were subsequently hospitalised for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. Conclusion: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population

Concert recording 2018-11-29

[Track 1]. French suite. I. Prelude [Track 2]. III. Gavotte / Yvonne Desportes -- [Track 3]. Flower duet from Lakmé / Léo Delibes -- [Track 4]. Hilltribe dance / Yos Vannesorn -- [Track 5]. Toccata and fugue in D minor, BMV 565 / J.S. Bach arranged by A. Brackett -- [Track 6]. Molly on the shore / Percy Grainger arranged by S. Knight -- [Track 7]. Chorale and danza / Vaclac Nelhybel -- [Track 8]. Klezmer suite / Alexis Ciesla

Concert recording 2019-04-17

[Track 1]. Concerto for clarinet and string orchestra / Aaron Copland -- [Track 2]. Dance preludes. I. Allegro molto [Track 3]. II. Andantino [Track 4]. III. Allegro giocoso / Witold Lutoslawski -- [Track 5]. Sonata for clarinet and piano in B♭major. I. Mäβig bewegt [Track 6]. IV. Kleines rondo. Gemächlich / Paul Hindemith -- [Track 7]. Five bagatelles, op. 23. I. Prelude / Gerald Finzi -- [Track 8]. Five bagatelles, op. 23. V. Fughetta / Gerald Finzi -- [Track 9]. Sonata for clarinet in B♭ and piano. I. Allegro tristamente / Francis Poulenc -- [Track 10]. Sonata for clarinet in B♭ and piano. III. Allegro con fuoco / Francis Poulenc -- [Track 11]. Introduction, theme and variations: Theme, var. 1, 2, 3, minor and major / Gioachino Rossini -- [Track 12]. Time pieces. I. Allegro risoluto [Track 13]. II. Andante espressivo / Robert Muczynski -- [Track 14].Sonata for clarinet, op. 120, no. 1. I. Allegro appassionato / Johannes Brahms -- [Track 15]. Wind in the reeds. I. March [Track 16]. II. Humoreske [Track 17]. III. A childhood memory [Track 18]. IV. Ballet russe / Gordon Jacob

Ulcerogenic Helicobacter pylori Strains Isolated from Children: A Contribution to Get Insight into the Virulence of the Bacteria

Infection with Helicobacter pylori is the major cause for the development of peptic ulcer disease (PUD). In children, with no other etiology for the disease, this rare event occurs shortly after infection. In these young patients, habits of smoking, diet, consumption of alcohol and non-steroid anti-inflammatory drugs and stress, in addition to the genetic susceptibility of the patient, represent a minor influence. Accordingly, the virulence of the implicated H. pylori strain should play a crucial role in the development of PUD. Corroborating this, our in vitro infection assays comparing a pool of five H. pylori strains isolated from children with PUD to a pool of five other pediatric clinical isolates associated with non-ulcer dyspepsia (NUD) showed the greater ability of PUD strains to induce a marked decrease in the viability of gastric cells and to cause severe damage in the cells cytoskeleton as well as an impairment in the production/secretion of mucins. To uncover virulence features, we compared the proteome of these two groups of H. pylori strains. Two-dimensional gel electrophoresis followed by mass-spectrometry allowed us to detect 27 differentially expressed proteins between them. In addition to the presence of genes encoding well established virulence factors, namely cagA, vacAs1, oipA “on” status, homB and jhp562 genes, the pediatric ulcerogenic strains shared a proteome profile characterized by changes in the abundance of: motility-associated proteins, accounting for higher motility; antioxidant proteins, which may confer increased resistance to inflammation; and enzymes involved in key steps in the metabolism of glucose, amino acids and urea, which may be advantageous to face fluctuations of nutrients. In conclusion, the enhanced virulence of the pediatric ulcerogenic H. pylori strains may result from a synergy between their natural ability to better adapt to the hostile human stomach and the expression of the established virulence factors

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Does time matter? An investigation of knowledge and attitudes following blood transfusion training

a b s t r a c t The Scottish National Blood Transfusion service have developed an educational programme aimed at ensuring a high standard of care for blood transfusions to minimise risk to patients and healthcare practitioners. This paper investigates whether knowledge and understanding of, and attitudes towards, safe practice declined over time following completion of module 1 of the programme. An online survey was administered to a range of healthcare practitioners who had completed the module. The survey tool tested knowledge and ascertained views on blood transfusion practice and perceptions of the module's importance. Comparisons were made between participants 6e8 weeks, 12e14 months and 22e24 months since module completion. In-depth interviews were conducted with a sub-sample of survey respondents to explore attitudes in more detail. Findings indicate evidence of a slight though statistically significant reduction in the degree of emphasis respondents placed on the importance of understanding aspects of transfusions as time lapsed, but no difference was found in knowledge between those who took the course more recently and those who were up to two years post-module. The study's findings indicate that recognition of the importance of safe practice declines over time and thus also suggests that frequent refresher courses are important to maintain safe practice