Patients report improvements in continuity of care when quality of life assessments are used routinely in oncology practice: Secondary outcomes of a randomised controlled trial.

INTRODUCTION AND AIM: In a randomised trial investigating the effects of regular use of health-related quality of life (HRQOL) in oncology practice, we previously reported an improvement in communication (objective analysis of recorded encounters) and patient well-being. The secondary aims of the trial were to measure any impact on patient satisfaction and patients' perspectives on continuity and coordination of their care. METHODS: In a prospective trial involving 28 oncologists, 286 cancer patients were randomised to: (1) intervention arm: regular touch-screen completion of HRQOL with feedback to physicians; (2) attention-control arm: completion of HRQOL without feedback; and (3) control arm: no HRQOL assessment. Secondary outcomes were patients' experience of continuity of care (Medical Care Questionnaire, MCQ) including 'Communication', 'Coordination' and 'Preferences to see usual doctor' subscales, patients' satisfaction, and patients' and physicians' evaluation of the intervention. Analysis employed mixed-effects modelling, multiple regression and descriptive statistics. RESULTS: Patients in the intervention arm rated their continuity of care as better than the control group for 'Communication' subscale (p=0.03). No significant effects were found for 'Coordination' or 'Preferences to see usual doctor'. Patients' evaluation of the intervention was positive. More patients in the intervention group rated the HRQOL assessment as useful compared to the attention-control group (86% versus 29%), and reported their doctors considered daily activities, emotions and quality of life. CONCLUSION: Regular use of HRQOL measures in oncology practice brought changes to doctor-patient communication of sufficient magnitude and importance to be reported by patients. HRQOL data may improve care through facilitating rapport and building inter-personal relationships

PROGNOSTIC FACTORS IN PATIENTS WITH METASTATIC BREAST CANCER ON СHEMOHORMONOTHERAPY

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CHARACTERISTICS OF DIVERSIONS OF IMMUNOLOGIC INDEXES IN LUNG CANCER PATIENTS UNDERGOING COMPLEX TREATMENT

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The impact of winter flooding with saline water on foliar carbon uptake and the volatile fraction of leaves and fruits of lemon (Citrus limon) trees

We investigated the consequences of recurrent winter flooding with saline water on a lemon (Citrus limon (L.) Burm.f.) orchard, focussing on photosynthesis limitations and emission of secondary metabolites (isoprenoids) from leaves and fruits. Measurements were carried out immediately after flooding (December), at the end of winter (April) and after a dry summer in which plants were irrigated with optimal quality water (September). Photosynthesis was negatively affected by flooding. The effect was still visible at the end of winter, whereas the photosynthetic rate was fully recovered after summer, indicating an unexpected resilience capacity of flooded plants. Photosynthesis inhibition by flooding was not due to diffusive limitations to CO2 entry into the leaf, as indicated by measurements of stomatal conductance and intercellular CO2 concentration. Biochemical and photochemical limitations seemed to play a more important role in limiting the photosynthesis of flooded plants. In young leaves, characterised by high rates of mitochondrial respiration, respiratory rates were enhanced by flooding. Flooding transiently caused large and rapid emission of several volatile isoprenoids. Emission of limonene, the most abundant compound, was stimulated in the leaves, and in young and mature fruits. Flooding changed the blend of emitted isoprenoids, but only few changes were observed in the stored isoprenoids pool.

APPROXIMATION OF LIMIT STATE SURFACES IN MONOTONIC MONTE CARLO SETTINGS

International audienceThis article investigates the theoretical convergence properties of the estimators produced by a numerical exploration of a monotonic function with multivariate random inputs in a structural reliability framework.The quantity to be estimated is a probability typically associated to an undesirable (unsafe) event and the function is usually implemented as a computer model. The estimators produced by a Monte Carlo numerical design are two subsets of inputs leading to safe and unsafe situations, the measures of which can be traduced as deterministic bounds for the probability. Several situations are considered, when the design is independent, identically distributed or not, or sequential. As a major consequence, a consistent estimator of the (limit state) surface separating the subsets under isotonicity and regularity arguments can be built, and its convergence speed can be exhibited. This estimator is built by aggregating semi-supervized binary classifiers chosen as constrained Support Vector Machines. Numerical experiments conducted on toy examples highlight that they work faster than recently developed monotonic neural networks with comparable predictable power. They are therefore more adapted when the computational time is a key issue

An integrated overview of physiological and biochemical responses of Celtis australis to drought stress

Trees in Mediterranean areas frequently face severe drought stress events, due to sudden decreases in soil water availability associated to intense heat waves. The knowledge of strategies adopted by plants to cope with the environmental pressures associated to Mediterranean climate is crucial for reforestation strategies and planning future urban greening. Here we investigated the physiological and biochemical adjustments activated by Celtis australis in response to drought stress during summer. Despite widely used for reforestation in Southern Mediterranean, how C. australis responds to the severe challenges imposed by Mediterranean climate has not investigated yet. In our study, we performed analyses of water relations, gas exchange and PSII performance, the concentration of photosynthetic pigments, the activity and the concentration of primary antioxidants in plants exposed to drought stress of increasing severity. Data of our study reveal that C. australis displays both conservative water use and isohydric behavior in response to drought, and diffusive resistance mostly limits photosynthesis even at severe drought. Our study also reveals an effective down-regulation rather than permanent impairment of PSII photochemistry in response to drought stress of increasing severity, since excess electron transport due to declines in photosynthesis (-61% at severe stress, compared to control) was matched by an increase in nonphotochemical quenching (+71% at severe stress, compared to control). However, our study highlights that under severe drought, zeaxanthin (and neoxanthin) increased by 75% (and 25%), likely served an important function as chloroplast antioxidant, other than sustaining nonphotochemical quenching. Antioxidant enzymes and ascorbate also increased (+132% on average for superoxide dismutase, ascorbate peroxidase, and catalase) and contributed in countering oxidative stress in severely droughted plants. Large adjustments in the suite of physiological and biochemical traits may effectively enable C. australis to gain carbon at appreciable rates while avoiding irreversible damage to the photosynthetic apparatus even when challenged by severe drought stress, thereby making this species an excellent candidate for forest and urban plantings in sites experiencing extended periods of drought stress

INFLUENCE OF PIRACETAM ON ERYTHROPOIESIS IN RATS

The effects of piracetam (2 x 200 mg/kg b. w.) injected intraperitoneally for three days on erythropoiesis and some functional characteristics of erythrocytes were studied in Wistar rats. A significant increase of reticulocytes in relative (by 122,03 %, p < 0,01) and in absolute counts (by 109,29 %, p < 0,01), an increase of 59Fе incorporation in newly-formed erythrocytes (by 13,80 %) and a significant rise of erythroblasts as followed: total counts (by 59,39 %, p < 0,01), proerythroblasts (by 52,87 %, p < 0,05), and orthochromatic erythroblasts (by 54,25 %, p< 0,01) were observed in the piracetamtreated rats. It was accepted that piracetam stimulated erythroid proliferation and differentiation. Erythroid deformability enhanced by 14,69 % (p < 0,01) but spontaneous haemolysis of erythrocytes reduced by 16,95 % (p < 0,025). Thus it could be suggested that piracetam, along with its stimulatory effect on erythropoiesis, improves some of the most important functional characteristics of erythrocytes such as deformability and oxidative resistance

Deriving a preference-based measure for cancer using the EORTC QLQ-C30 : a confirmatory versus exploratory approach

Background: To derive preference-based measures from various condition-specific descriptive health-related quality of life (HRQOL) measures. A general 2-stage method is evolved: 1) an item from each domain of the HRQOL measure is selected to form a health state classification system (HSCS); 2) a sample of health states is valued and an algorithm derived for estimating the utility of all possible health states. The aim of this analysis was to determine whether confirmatory or exploratory factor analysis (CFA, EFA) should be used to derive a cancer-specific utility measure from the EORTC QLQ-C30. Methods: Data were collected with the QLQ-C30v3 from 356 patients receiving palliative radiotherapy for recurrent or metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter based on a conceptual model (the established domain structure of the QLQ-C30: physical, role, emotional, social and cognitive functioning, plus several symptoms) and clinical considerations (views of both patients and clinicians about issues relevant to HRQOL in cancer). The dimensions determined by each method were then subjected to item response theory, including Rasch analysis. Results: CFA results generally supported the proposed conceptual model, with residual correlations requiring only minor adjustments (namely, introduction of two cross-loadings) to improve model fit (increment χ2(2) = 77.78, p 75% observation at lowest score), 6 exhibited misfit to the Rasch model (fit residual > 2.5), none exhibited disordered item response thresholds, 4 exhibited DIF by gender or cancer site. Upon inspection of the remaining items, three were considered relatively less clinically important than the remaining nine. Conclusions: CFA appears more appropriate than EFA, given the well-established structure of the QLQ-C30 and its clinical relevance. Further, the confirmatory approach produced more interpretable results than the exploratory approach. Other aspects of the general method remain largely the same. The revised method will be applied to a large number of data sets as part of the international and interdisciplinary project to develop a multi-attribute utility instrument for cancer (MAUCa)