Family physician involvement in cancer care follow-up: the experience of a cohort of patients with lung cancer.

PURPOSE There has been little research describing the involvement of family physicians in the follow up of patients with cancer especially during the primary treatment phase We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician s involvement in their follow up at the different phases of cancer METHODS In 5 hospitals in the province of Quebec Canada patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months whether they had metastasis or not, for a maximum of 18 months to assess aspects of their family physician s involvement in cancer care RESULTS Of the 395 participating patients 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey except at the advanced phase where a majority attributed this role to their family physician At baseline only 16% of patients perceived a shared care pattern between their family physician and oncologists but this pro portion increased with cancer progression Most patients would have liked their family physician to be more involved in all aspects of cancer care CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow up of their lung cancer they also wish their family physicians to be involved Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow u

Cosmology at Low Redshifts

It is argued that it is far more cost effective to carry out some projects with medium-sized dedicated zenith telescopes rather than large steerable telescopes, freeing the later to carry out projects that truly need them. I show that the large number of objects observed with a surveying 4-m zenith telescope allows one to carry out cosmological projects at low redshifts. Examining two case studies, I show first that a variability survey would obtain light curves for several thousands of type Ia supernovae per year up to z=1 and easily discriminate among competing cosmological models. Finally, I discuss a second case study, consisting of a spectrophotometric survey carried out with interference filters, showing its power to discriminate among cosmological models and to study the large-scale distribution of galaxies in the Universe.Comment: PDF file 294KB Astronomy & Astrophysics 2003, In Pres

Marine and Hydrokinetic Renewable Energy Technologies: Potential Navigational Impacts and Mitigation Measures

On April 15, 2008, the Department of Energy (DOE) issued a Funding Opportunity Announcement for Advanced Water Power Projects which included a Topic Area for Marine and Hydrokinetic Renewable Energy Market Acceleration Projects. Within this Topic Area, DOE identified potential navigational impacts of marine and hydrokinetic renewable energy technologies and measures to prevent adverse impacts on navigation as a sub-topic area. DOE defines marine and hydrokinetic technologies as those capable of utilizing one or more of the following resource categories for energy generation: ocean waves; tides or ocean currents; free flowing water in rivers or streams; and energy generation from the differentials in ocean temperature. PCCI was awarded Cooperative Agreement DE-FC36-08GO18177 from the DOE to identify the potential navigational impacts and mitigation measures for marine hydrokinetic technologies, as summarized herein. The contract also required cooperation with the U.S. Coast Guard (USCG) and two recipients of awards (Pacific Energy Ventures and reVision) in a sub-topic area to develop a protocol to identify streamlined, best-siting practices. Over the period of this contract, PCCI and our sub-consultants, David Basco, Ph.D., and Neil Rondorf of Science Applications International Corporation, met with USCG headquarters personnel, with U.S. Army Corps of Engineers headquarters and regional personnel, with U.S. Navy regional personnel and other ocean users in order to develop an understanding of existing practices for the identification of navigational impacts that might occur during construction, operation, maintenance, and decommissioning. At these same meetings, “standard” and potential mitigation measures were discussed so that guidance could be prepared for project developers. Concurrently, PCCI reviewed navigation guidance published by the USCG and international community. This report summarizes the results of this effort, provides guidance in the form of a checklist for assessing the navigational impacts of potential marine and hydrokinetic projects, and provides guidance for improving the existing navigational guidance promulgated by the USCG in Navigation Vessel Inspection Circular 02 07. At the request of the USCG, our checklist and mitigation guidance was written in a generic nature so that it could be equally applied to offshore wind projects. PCCI teleconferenced on a monthly basis with DOE, Pacific Energy Ventures and reVision in order to share information and review work products. Although the focus of our effort was on marine and hydrokinetic technologies, as defined above, this effort drew upon earlier work by the USCG on offshore wind renewable energy installations. The guidance provided herein can be applied equally to marine and hydrokinetic technologies and to offshore wind, which are collectively referred to by the USCG as Renewable Energy Installations

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector

Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study

Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context

Place des nouveaux traitements médicaux dans l’endométriose douloureuse, RPC Endométriose CNGOF-HAS

OBJECTIVE: The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS: A review of the literature was conducted by consulting Medline data until July 2017. RESULTS: Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3). CONCLUSION: Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C)

Impact of ageing and a synbiotic on the immune response to seasonal influenza vaccination; a randomised controlled trial

Background & Aims Ageing increases risk of respiratory infections and impairs the response to influenza vaccination. Pre- and probiotics offer an opportunity to modulate anti-viral defenses and the response to vaccination via alteration of the gut microbiota. This study investigated the effect of a novel probiotic, Bifidobacterium longum bv. infantis CCUG 52486, combined with a prebiotic, gluco-oligosaccharide, on the B and T cell response to seasonal influenza vaccination in young and older subjects. Methods In a double-blind, randomized controlled trial, 58 young (18-35y) and 54 older (60-85y) subjects were supplemented with the synbiotic for 8 weeks. At 4 weeks they were administered with a seasonal influenza vaccine. B and T cell phenotype and responsiveness to in vitro re-stimulation with the vaccine were assessed at baseline, 4, 6 and 8 weeks. Results B and T cell profiles differed markedly between young and older subjects. Vaccination increased numbers of memory, IgA+ memory, IgG+ memory and total IgG+ B cells in young subjects, but failed to do so in older subjects and did not significantly alter T cell subsets. Seroconversion to the H1N1 subunit in the older subjects was associated with higher post-vaccination numbers of plasma B cells, but seroconversion was less consistently associated with T cell phenotype. B and T cell subsets from both young and older subjects demonstrated a strong antigen-specific recall challenge, and although not influenced by age, responsiveness to the recall challenge was associated with seroconversion. In older subjects, CMV seropositivity was associated with a significantly lower recall response to the vaccine, but the synbiotic did not affect the responsiveness of B or T cells to re-stimulation with influenza vaccine. Conclusions Antigen-specific B and T cell activation following an in vitro recall challenge with the influenza vaccine was influenced by CMV seropositivity, but not by a synbiotic

Links Between Metabolic and Structural Changes in the Brain of Cognitively Normal Older Adults: A 4-Year Longitudinal Follow-Up

We aimed to longitudinally assess the relationship between changing brain energy metabolism (glucose and acetoacetate) and cognition during healthy aging. Participants aged 71 ± 5 year underwent cognitive evaluation and quantitative positron emission tomography (PET) and magnetic resonance imaging (MRI) scans at baseline (N = 25) and two (N = 25) and four (N = 16) years later. During the follow-up, the rate constant for brain extraction of glucose (Kglc) declined by 6%–12% mainly in the temporo-parietal lobes and cingulate gyri (p ≤ 0.05), whereas brain acetoacetate extraction (Kacac) and utilization remained unchanged in all brain regions (p ≥ 0.06). Over the 4 years, cognitive results remained within the normal age range but an age-related decline was observed in processing speed. Kglc in the caudate was directly related to performance on several cognitive tests (r = +0.41 to +0.43, allp ≤ 0.04). Peripheral insulin resistance assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) was significantly inversely related to Kglc in the thalamus (r = −0.44, p = 0.04) and in the caudate (r = −0.43, p = 0.05), and also inversely related to executive function, attention and processing speed (r = −0.45 to −0.53, all p ≤ 0.03). We confirm in a longitudinal setting that the age-related decline in Kglc is directly associated with declining performance on some tests of cognition but does not significantly affect Kacac