Predicting Acorn-Grass Weight Gain Index using non-destructive Near Infrared Spectroscopy in order to classify Iberian pig carcasses according to feeding regime

The classification of Iberian pig carcasses into different commercial categories according to feeding regime was evaluated by means of a non-destructive analysis of the subcutaneous adipose tissue using Near Infrared Spectroscopy (NIRS). A quantitative approach was used to predict the Acorn-Grass Weight Gain Index (AGWGI), and a set of criteria was established for commercial classification purposes. A total of 719 animals belonging to various batches, reflecting a wide range of feeding regimes, production systems and years, were analyzed with a view to developing and evaluating quantitative NIRS models. Results for the external validation of these models indicate that NIRS made clear differentiation of batches as a function of three feeding regimes possible with high accuracy (<i>Acorn, Recebo</i> and <i>Feed</i>), on the basis of the mean representative spectra of each batch. Moreover, individual analysis of the animals showed a broad consensus between field inspection information and the classification based on the AGWGI NIRS prediction, especially for extreme categories (<i>Acorn</i> and <i>Feed</i>).<br><br>La clasificación en distintas categorías comerciales según régimen alimenticio de canales de cerdo Ibérico fue evaluada mediante el análisis no destructivo de muestras de tejido adiposo subcutáneo por Espectroscopía del Infrarrojo Cercano (NIRS). Partiendo de una aproximación cuantitativa para predecir el Índice de Reposición en Montanera (IRM) se establecieron una serie de criterios para proceder a su clasificación comercial. Se analizaron un total de 719 animales pertenecientes a diversas partidas, que recogen una amplia variabilidad de muestras de distintos regímenes alimenticios, campañas y sistemas productivos, para el desarrollo y evaluación de los modelos NIRS cuantitativos. Los resultados de validación externa de los modelos indicaron que es posible discriminar con una gran exactitud entre partidas de distintos categorías (<i>Bellota, Recebo</i> y <i>Cebo</i>), en base al espectro medio representativo de cada partida. Además, el análisis individualizado de los animales mostró un amplio consenso entre la información recibida de campo y la clasificación en base a la predicción del parámetro IRM por NIRS, sobre todo para categorías con características extremas (<i>Bellota</i> y <i>Cebo</i>)

Gratitude among advanced cancer patients and their caregivers: The role of early palliative care

Objective: A cancer diagnosis represents a unique trauma, given its life-threatening, multidimensional, and uncertain nature. Gratitude is a construct representing the emotional state that arises when individuals recognize that a benefit has been received as a result of someone else’s action or a spiritual entity’s intervention. Based on the positive psychological wellbeing, gratitude has been associated with improved health outcomes even in the disease setting. Thus, the models of care that foster gratitude should be adopted in the clinical context. This study aims to explore whether and how gratitude may originate in patients with advanced cancer and their caregivers undergoing early palliative care (EPC). Methods: We analyzed 251 reports from 133 patients and 118 caregivers describing their clinical experience in two EPC units. The sources of gratitude were identified and ranked based on their frequencies. Words expressing gratitude and words referring to communication and spirituality were collected by means of the Linguistic Inquiry and Word Count software and correlated. Results: In total, 123 (92.5%) of 133 patients’ and 97 (82.2%) of 118 caregivers’ reports, respectively, included explicit or implicit expressions of gratitude. Gratitude was associated specifically with successful physical symptom management, emotional support, improved attitude toward death, better information, humanity, and the familiar environment. The use of words of gratitude in patients’ reports was positively correlated with the use of words referring to communication (r =.215, p =.026) and spirituality (r =.612, p &lt;.001). Conclusion: Our results suggest that interventions within the EPC model based on doctor–patient–caregiver communication may allow patients and caregivers to experience a feeling of gratitude, and this may represent a resource to be exploited to improve their physical and psychosocial wellbeing

Sensitive detection of circulating breast cancer cells by reverse-transcriptase polymerase chain reaction of maspin gene

Background: Maspin, a recently identified protein related to the family of serpins, is believed to play a role in human breast cancer. In an effort to improve the present methods of detection, we have developed a reverse-transcriptase polymerase chain reaction (RT-PCR) assay for maspin transcript to identify small numbers of mammary carcinoma cells in the peripheral blood and bone marrow of patients with breast cancer. Patients and methods: Five non-neoplastic mammary tissue samples, 13 breast cancer specimens as well as 17 peripheral blood and 4 bone marrow samples from normal subjects were screened for the presence of maspin mRNA by RT-PCR. The same assay was applied to peripheral blood or bone marrow samples obtained from 29 patients with stages I to IV breast cancer. Results: By RT-PCR it was possible to amplify maspin mRNA in all of the primary and metastatic breast cancer specimens, but in none of the normal hemopoietic samples from healthy donors. Thus, detection of maspin transcript in the peripheral blood or marrow of a patient known to have breast cancer is indicative of the presence of mammary carcinoma cells. In reconstitution experiments, maspin RT-PCR reliably detected 10 mammary carcinoma cells in 1 million normal peripheral-blood mononuclear cells (PBMCs). None of the 9 patients with stages I, II, or III breast cancer had maspin transcript in peripheral blood. Of note, 3 of 9 patients with stage TV breast cancer receiving systemic therapy at the time of sample collection, but only I of 11 patients with stage IV not receiving therapy, had detectable maspin transcript in peripheral blood. Moreover, 3 marrow specimens from stage TV patients tested positive by this assay. Conclusions: This pilot study suggests that maspin RT-PCR assay is a sensitive, specific and sufficiently rapid method for detection of small numbers of circulating cells and marrow micrometastases in breast cancer patients. The possibility of applying this assay in the detection of tumor cell contamination of both marrow and stem-cell apheresis harvests of breast cancer patients merits further investigation

Early Palliative Care in Acute Myeloid Leukemia

Background: Several novel targeted therapies seem to improve the outcome of acute myeloid leukemia (AML) patients. Nonetheless, the 5-year survival rate remains below 40%, and the trajectory of the disease remains physically and emotionally challenging, with little time to make relevant decisions. For patients with advanced solid tumors, the integration of early palliative care (EPC) with standard oncologic care a few weeks after diagnosis has demonstrated several benefits. However, this model is underutilized in patients with hematologic malignancies. Methods: In this article, we analyze the palliative care (PC) needs of AML patients, examine the operational aspects of an integrated model, and review the evidence in favor of EPC integration in the AML course. Results: AML patients have a high burden of physical and psychological symptoms and high use of avoidant coping strategies. Emerging studies, including a phase III randomized controlled trial, have reported that EPC is feasible for inpatients and outpatients, improves quality of life (QoL), promotes adaptive coping, reduces psychological symptoms, and enhances the quality of end-of-life care. Conclusions: EPC should become the new standard of care for AML patients. However, this raises issues about the urgent development of adequate programs of education to increase timely access to PC

Perceptions of Death Among Patients with Advanced Cancer Receiving Early Palliative Care and Their Caregivers: Results from a Mixed-Method Analysis

BACKGROUND: Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. MATERIAL AND METHODS: Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. RESULTS: Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P &lt; .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, Ps &lt; .0001; adjectives, Ps &lt; .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. CONCLUSIONS: EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers

Early palliative care versus usual haematological care in multiple myeloma: retrospective cohort study

Objectives Although early palliative care (EPC) is beneficial in acute myeloid leukaemia, little is known about EPC value in multiple myeloma (MM). We compared quality indicators for palliative and end of life (EOL) care in patients with MM receiving EPC with those of patients who received usual haematological care (UHC).Methods This observational, retrospective study was based on 290 consecutive patients with MM. The following indicators were abstracted: providing psychological support, assessing/managing pain, discussing goals of care, promoting advance care plan, accessing home care services; no anti MM treatment within 14 and 30 days and hospice length of stay &gt;7 days before death; no cardiopulmonary resuscitation, no intubation, &lt;2 hospitalisations and emergency department visits within 30 days before death. Comparisons were performed using unadjusted and confounder adjusted regression models.Results 55 patients received EPC and 231 UHC. Compared with UHC patients, EPC patients had a significantly higher number of quality indicators of care (mean 2.62 +/- 1.25 vs 1.12 +/- 0.95; p&lt;0.0001)); a significant reduction of pain intensity over time (p&lt;0.01) and a trend towards reduced aggressiveness at EOL, with the same survival (5.3 vs 5.46 years; p=0.74)).Conclusions Our data support the value of integrating EPC into MM routine practice and lay the groundwork for future prospective comparative studies

La produzione di raccomandazioni cliniche con il metodo GRADE: l&apos;esperienza sui farmaci oncologici

Questo Dossier \ue8 dedicato alla presentazione del background scientifico e dei risultati del Progetto AFO (Appropriatezza farmaci oncologici) sviluppato dall\u2019Agenzia sanitaria e sociale della Regione Emilia-Romagna nell\u2019ambito del Programma Ricerca e innovazione (PRI E-R). Dal punto di vista del background scientifico l\u2019elemento di originalit\ue0 del progetto \ue8 stato la sperimentazione dell\u2019uso del metodo GRADE (Grading of Recommendations Assessment, Development and Evaluation) per la produzione e graduazione di raccomandazioni cliniche relative all\u2019effetto degli interventi sanitari. Il metodo GRADE \ue8 nato dall\u2019attivit\ue0 avviata nel 2000 di un gruppo di lavoro internazionale che ha ritenuto necessario mettere a punto un approccio unificato alla produzione di raccomandazioni cliniche in presenza di una molteplicit\ue0 di sistemi di grading tra loro non sempre coerenti e la cui variabilit\ue0 mette in serio pericolo la fruibilit\ue0 dello strumento linee guida/raccomandazioni. Dal punto di vista dei contenuti e delle modalit\ue0 operative, il Progetto AFO - che ha anche ottenuto un finanziamento da parte del Ministero del Lavoro, della salute e delle politiche sociali nell\u2019ambito del Programma Ricerca finalizzata (Fondo ex art. 12 DLgs 502/1992) - \ue8 nato con l\u2019obiettivo di sperimentare la possibilit\ue0 di coinvolgere gruppi multidisciplinari di clinici nella produzione di raccomandazioni sull\u2019uso appropriato di farmaci oncologici, sia nuovi sia gi\ue0 registrati ma in evoluzione per quanto riguarda le indicazioni cliniche. Nella prima parte del Dossier, dopo una breve introduzione relativa alla filosofia del programma PRI E-R e agli scopi del progetto AFO, viene presentato il metodo GRADE, le sue assunzioni e le tappe operative di applicazione. Nella seconda parte vengono presentati i risultati del lavoro dei tre panel multisciplinari che hanno prodotto complessivamente 32 raccomandazioni per la terapia adiuvante e la fase avanzata del trattamento dei tumori della mammella, del colon retto e del polmone. Conclude la seconda parte del Dossier una discussione circa le criticit\ue0 di applicazione del metodo e le potenzialit\ue0 e i limiti del suo utilizzo per la produzione di strumenti utili al miglioramento dell\u2019appropriatezza d\u2019uso dei farmaci. Nell\u2019Appendice viene infine riportato, a scopo esemplificativo, il testo di due raccomandazioni relative all\u2019uso del trastuzumab nella terapia adiuvante del tumore della mammella e delle fluoropirimidine nella terapia adiuvante del tumore del colon.This report is devoted to the presentation of the scientific background and results of the AFO (an acronym standing for Appropriateness of Oncologic Drugs) project developed by the Health Care and Social Agency of Emilia-Romagna region in the framework of the Research and Innovation program (PRI E-R). From the methodological standpoint the novelty of the project stems from the utilisation of the GRADE method (Grading of Recommendation, Assessment, Development and Evaluation) for the production and grading of clinical recommendations on the effects of health care interventions. The GRADE method originated from the work of an international working group that, starting 2001, was convened to go beyond the variations in the existing methods for producing and grading clinical recommendations. These variations were mostly due to conceptual inconsistencies that, if not properly recognised and addressed, would jeopardise the credibility of the entire guidelines movement. From the subject matter standpoint the AFO project - which was also partially supported by a research grant from the Italian Ministry of Welfare, Health and Social Affairs - was conceived to test the feasibility of a working methodology where multidisciplinary panels of clinicians would be convened to produce clinical recommendations on newly registered drugs as well as those already in widespread use but whose indications change over time. In the first part of the report, after a brief introduction on the working hypotheses and objectives of the PRI ER program and the AFO project, the GRADE method is presented and discussed. In the second part the results of the activities of the three panels that produced a total of 32 recommendations for the adjuvant and advanced treatment of breast, colorectal and lung cancer are reported. The final session of the report addresses some open issues relative to the application of the GRADE method to the production of clinical recommendations construed with the explicit aim of improving quality and appropriateness of care in oncology. In the Appendix, two examples of the recommendations produced though this project are presented: they refer to Trastuzumab in the treatment of early breast cancer and Fluoropirimide in the adjuvant therapy of colon cancer

Morphinofobia: the situation among the general population and health care professionals in North-Eastern Portugal

<p>Abstract</p> <p>Background</p> <p>Morphinofobia among the general population (GP) and among health care professionals (HP) is not without danger for the patients: it may lead to the inappropriate management of debilitating pain. The aim of our study was to explore among GP and HP the representation and attitudes concerning the use of morphine in health care.</p> <p>Methods</p> <p>A cross-sectional study was done among 412 HP (physicians and nurses) of the 4 hospitals and 10 community health centers of Beira Interior (Portugal)and among 193 persons of the GP randomly selected in public places. Opinions were collected through a translated self-administered questionnaire.</p> <p>Results</p> <p>A significant difference of opinion exists among GP and HP about the use of morphine. The word morphine first suggests drug to GP (36,2%) and analgesia to HP (32,9%.). The reasons for not using morphine most frequently cited are: for GP morphine use means advanced disease (56%), risk of addiction (50%), legal requirements (49,7%); for HP it means legal risks (56,3%) and adverse side effects of morphine such as somnolence - sedation (30,5%) The socio-demographic situation was correlated with the opinions about the use of morphine.</p> <p>Conclusions</p> <p>False beliefs about the use of morphine exist among the studied groups. There seems to be a need for developing information campaigns on pain management and the use of morphine targeting. Better training and more information of HP might also be needed.</p