The management of hot flushes for men treated with androgen deprivation therapy for prostate cancer: a survey of UK practice

Androgen deprivation therapy (ADT) is one of the main treatments for prostate cancer. Short-term ADT of between 6 months and 3 years is often used in combination with radiotherapy to treat localised and locally advanced prostate cancer. Permanent or intermittent ADT is used to treat metastatic disease. Hot flushes affect 44-80% of men undergoing ADT for prostate cancer, with around 27% saying they are the most distressing side effect.1 A recent UK survey found 30.7% of men treated with ADT reported moderate or major problems with hot flushes.2 Low testosterone levels are thought to cause dysfunction in thermoregulation in the hypothalamus, resulting in peripheral vasodilatation.3 Symptoms include a feeling of warmth, flushing of the skin, perspiration, chills, anxiety and palpitations. A variety of treatments have been evaluated and there is evidence of efficacy for several of them, however they all have additional side effect profiles. The National Institute for Health and Care Excellence (NICE) and European Association of Urology recommend offering medroxyprogesterone or cyproterone acetate.4-5 NICE has said there is currently a lack of evidence to support the use of complementary therapies. Addressing the side-effects of cancer treatment is one of the top ten Living with and Beyond Cancer research priorities established by the National Cancer Research Institute. However, there is little evidence on the standard of care that UK clinicians offer to men suffering with hot flushes

Patients’ and partners’ views of care and treatment provided for metastatic castrate resistant prostate cancer in the UK

Objective Documentations of the experiences of patients with advanced prostate cancer and their partners are sparse. Views of care and treatment received for metastatic castrate resistant prostate cancer (mCRPC) are presented here. Methods Structured interviews conducted within 14 days of a systemic therapy for mCRPC starting and 3 months later explored: treatment decisions, information provision, perceived benefits and harms of treatment, and effects of these on patients’ and partners’ lives. Results Thirty-seven patients and 33 partners recruited from UK cancer centres participated. The majority of patients (46%) reported pain was their worst symptom and many wanted to discuss its management (baseline-50%; 3 months-33%). Patients and partners believed treatment would: delay progression (>75%), improve wellbeing (33%), alleviate pain (≈12%) and extend life (15% -patients, 36% -partners). At 3 months most men (42%) said fatigue was the worst treatment-related side effect (SE), 27% experienced unexpected SEs, and 54% needed help with SEs. Most patients received SE information (85% written; 75% verbally); many additionally searched the internet (33%-patients; 55%-partners). Only 54% of patients said nurse support was accessible. Conclusion Pain and other symptom management is not optimal. Increased specialist nurse provision and earlier palliative care links are needed. Dedicated clinics may be justified

Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review

From Springer Nature via Jisc Publications RouterHistory: received 2021-04-04, accepted 2021-08-29, registration 2021-10-14, pub-electronic 2021-10-28, online 2021-10-28, collection 2021-12Publication status: PublishedAbstract: Background: Workplace transmission is a significant contributor to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. Previous studies have found that infectious illness presenteeism could contribute to outbreaks in occupational settings and identified multiple occupational and organisational risk factors. Amid the COVID-19 pandemic, it is imperative to investigate presenteeism particularly in relation to respiratory infectious disease (RID). Hence, this rapid review aims to determine the prevalence of RID-related presenteeism, including COVID-19, and examines the reported reasons and associated risk factors. Methods: The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in English and Chinese. Database searches included MEDLINE, EMBASE, Web of Science, China Knowledge Resource Integrated Database (CNKI) and preprint databases MedRxiv and BioRxiv. Results: The search yielded 54 studies, of which four investigated COVID-19-related presenteeism. Prevalence of work presenteeism ranged from 14.1 to 55% for confirmed RID, and 6.6 to 100% for those working with suspected or subclinical RID. The included studies demonstrated that RID-related presenteeism is associated with occupation, sick pay policy, age, gender, health behaviour and perception, vaccination, peer pressure and organisational factors such as presenteeism culture. Conclusions: This review demonstrates that presenteeism or non-adherence to isolation guidance is a real concern and can contribute to workplace transmissions and outbreaks. Policies which would support workers financially and improve productivity, should include a range of effective non-pharmaceutical inventions such as workplace testing, promoting occupational health services, reviewing pay and bonus schemes and clear messaging to encourage workers to stay at home when ill. Future research should focus on the more vulnerable and precarious occupational groups, and their inter-relationships, to develop comprehensive intervention programs to reduce RID-related presenteeism

Systematic Review: Outcomes and Adverse Events From Randomised Trials in Crohn's Disease

APPEAL FROM DISTRICT COURT\u27S SUPPLEMENTAL FINDINGS OF FACT AND CONCLUSIONS OF LAW AND SUPPLEMENTAL DECREE OF DIVORCE, IN THE FOURTH JUDICIAL DISTRICT COURT IN AND FOR UTAH COUNTY, STATE OF UTAH, THE HONORABLE FRED D. HOWARD, PRESIDING