Towards optimal use of antithrombotic therapy of people with cancer at the end of life: a research protocol for the development and implementation of the SERENITY shared decision support tool Thrombosis Research

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice

Variação sazonal das condições internas de colônias de Melipona marginata obscurior Moure, no Rio Grande do Sul, Brasil Seasonal variations in the internal condictions of colonies the Melipona marginata obscurior Moure, at Rio Grande do Sul, Brazil

O conhecimento das condições internas das colônias de Melipona marginata obscurior Moure, 1971, ao longo do ano, é importante para a compreensão do comportamento das abelhas sem ferrão e seu manejo. Visa-se o estudo da biologia de M. marginata obscurior em ambiente natural, com ênfase na variação sazonal das condições internas das colônias. Quatro colônias foram estudadas no Centro de Pesquisas e Conservação da Natureza Pró-Mata, em São Francisco de Paula, RS. Avaliou-se o volume dos ninhos, a ocorrência e duração da diapausa e o número total de favos e de células de cria nos dois últimos favos. O volume do invólucro inicial das quatro colônias foi semelhante, variando de 2,26 a 2,69 litros. Ao final da avaliação observou-se que o volume do invólucro da colônia A reduziu 5%, enquanto as demais cresceram 61% (colônia B), 84% (C) e 71% (D). A partir do monitoramento mensal dos favos de cria constatou-se a ocorrência de diapausa em três colônias (B, C e D) enquanto a colônia A permaneceu com postura ininterruptamente. As colônias cessaram a construção de células de cria e postura da rainha durante o outono e reiniciaram esta atividade no final do inverno. Sugere-se que a variação do período de diapausa (8 a 23 semanas) seja determinada por fatores internos das colônias. O número máximo de favos registrado durante a primavera e o verão variou de 6 a 8, enquanto que o número estimado de células de cria dos dois últimos favos variou de 116 a 1190. Foi possível reconhecer padrões, bem como variações sazonais, relacionados ao volume do invólucro dos ninhos, à ocorrência de diapausa e ao número de favos e de células de cria nos dois últimos favos. Variações sazonais das condições internas entre as colônias mostraram-se evidentes e podem ser creditadas a características intrínsecas das colônias.<br>The knowledge of the internal conditions of Melipona marginata obscurior Moure, 1971 colonies, through the year, is important for the understanding of the behavior and handling of the stingless bees. This work aims the biological study of the M. marginata obscurior in its natural environment, whith emphasis on the seasonal variation of the internal conditions of colonies. Four colonies were studied at Centro de Pesquisas e Conservação da Natureza Pró-Mata, in São Francisco de Paula, Rio Grande do Sul. It was valuated the nest volume, the diapause occurrence and duration, and the total number of combs and brood cells in the two last combs. For the four colonies the initial involucrum volume was similar, varying from 2.26 to 2.69 liter. In the final of the valuation, it was observed that the colony A volume was reduced to 5%, while the others grow up 61% (colony B), 84% (C) e 71% (D). From the monthly monitoring of the brood combs it was shown that diapause occurred in three colonies (B, C e D), while the colony A remained ininterruptly with posture. The colonies ceased the construction of brood cells and posture of the queen during the autumn and restarted this activity on the final of the winter. It's suggested that diapause period variation (8 to 23 weeks) is determined by internal factors of the colonies. The maximal number of combs, registered during the spring and the summer, varied from 6 to 8, while the number of the brood cells of the two last combs varied from 116 to 1190 cells. It was possible to recognize patterns, as well seasonal variations related to involucrum volume of the nest covering, to diapause occurrence and to number of the combs and brood cells on the two last combs. The seasonal variations of the internal conditions among the colonies were obvious and can be credited to intrinsic characteristics of the colonies

Espécies de Cyperaceae do Centro de Pesquisa e Conservação da Natureza Pró-Mata, município de São Francisco de Paula, RS, Brasil Cyperaceae species of the Centro de Proteção e Conservação da Natureza Pró-Mata, São Francisco de Paula municipality, Rio Grande do Sul State, Brazil

Foi realizado o levantamento florístico das espécies de Cyperaceae do Centro de Pesquisa e Conservação da Natureza PróMata (CPCN Pró-Mata), Rio Grande do Sul. O local de estudo está situado no município de São Francisco de Paula, na região fisiográfica dos Campos de Cima da Serra. Foram efetuadas cinco expedições de coleta e encontradas 42 espécies, distribuídas em oito gêneros. São apresentadas a lista das espécies, chaves de identificação nos níveis genérico e específico e fotomicrografias em Microscopia Eletrônica de Varredura dos aquênios de cada espécie.<br>A floristic survey of Cyperaceae species at the Centro de Proteção e Conservação da Natureza Pró-Mata (CPCN Pró-Mata), Rio Grande do Sul was performed. The study area is located in São Francisco de Paula municipality, in the physiographic region of the Campos de Cima da Serra. In five collecting expeditions, 42 species were found at the study site, distributed on eight genera. A list of the species, analytical keys for genera and species, as well as scanning photomicrographs of the achenes are presented