Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Empowerment of whom? The gap between what the system provides and patient needs in hip fracture management: A healthcare professionals’ lifeworld perspective

Aims and objectives: To use a Habermasian lifeworld theoretical perspective to illuminate a treatment gap for hip fracture patients in a Danish university hospital to guide future healthcare services. Background: Most healthcare systems focus on systematised guidelines to help reduce hospital length of stay in response to increasing demand because of the ageing of the global population. For patients with hip fractures, a previous study demonstrated that there is a lack of patient empowerment and a gap between patients’ needs and wishes and what was provided by the healthcare system. Design: In this follow-up study, the previous findings were introduced to a mixed group of health professionals (HPs) who participated in focus group discussions (n = 3, with a total of 18 HPs). Methods: Data were analysed using qualitative content analysis. By analysing the discourse of the discussions using Habermas’ perspective, the lack of patient-empowerment was illuminated and facilitated, describing it in terms of the gap it creates in communicative actions between HPs and patients. Results: Information and education of patients in systematised pathways, such as those for patients with hip fractures, are dominated by a biomedical discourse. Patients are overwhelmed by the psycho-social implications of the hip fracture, leaving them in a shock-like state of mind. Conclusion: Empowerment of patients should involve empowerment of HPs by providing them with skills to support patients in a shock-like state of mind. There is also a need to provide HPs with a more individually targeted means of informing and educating patients

BALTEX Radar Data Centre Products and their Methodologies

The Baltic Sea Experiment (BALTEX) is the European regional project within the Global Energy and Water Cycle Experiment (GEWEX). The BALTEX Working Group on Radar (WGR) is responsible for coordinating weather radar activities within the framework of BALTEX, including the establishment and operation of a Radar Data Centre (BRDC) which can provide BALTEX with wind and precipitation datasets. This report presents the state of the WGR and the BALTEX Radar Network (BALTRAD). Those products being generated at the BRDC are presented and discussed, as are the methods used to create them. The BALTRAD network consists of 29, mostly C-band, radars in six countries. Communications to/from the BRDC are conducted both through operational lines and through provisional lnternetbased solutions. The BRDC operates in near-real time. Individual radar images containing radar reflectivity factor (dBZ) are produced with a temporal resolution of 15 min. These are combined to create composite images, also every 15 minutes. A systematic gauge correction method is introduced for application to point observations from the synoptical network. These corrected gauge observations are used together with radar sums to create spatially continuous, gauge-adjusted threeand twelve-hour accumulations. The gauge adjustment technique is shown to minimize the bias between radar and gauge observations, while also reducing the range dependency on the radar data. All image products have horizontal resolutions of 2 km. A wind profile product is also created using VAD and VVP techniques