A web-based intervention (RESTORE) to support self-management of cancer-related fatigue following primary cancer treatment: a multi-centre proof of concept randomised controlled trial

Purpose: Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treatment. RESTORE is the first web-based resource designed to enhance self-efficacy to manage CRF following curative-intent treatment. The aim of this study is to test the proof of concept and inform the design of an effectiveness trial. Methods: A multi-centre parallel-group two-armed (1:1) exploratory randomised controlled trial (RCT) with qualitative process evaluation was employed in the study. Participants (≥18 years; ≤5 years post treatment with moderate to severe fatigue) were recruited and randomly assigned to RESTORE or a leaflet. Feasibility and acceptability were measured by recruitment, attrition, intervention adherence, completion of outcome measures and process evaluation. Change in self-efficacy to manage CRF was also explored. Outcome measures were completed at baseline (T0), 6 weeks (T1) and 12 weeks (T2). Data were analysed using mixed-effects linear regression and directed content analysis. Results: One hundred and sixty-three people participated in the trial and 19 in the process evaluation. The intervention was feasible (39 % of eligible patients consented) and acceptable (attrition rate 36 %). There was evidence of higher fatigue self-efficacy at T1 in the intervention group vs comparator (mean difference 0.51 [−0.08 to 1.11]), though the difference in groups decreased by 12 weeks. Time since diagnosis influenced perceived usefulness of the intervention. Modifications were suggested. Conclusion: Proof of concept was achieved. The RESTORE intervention should be subject to a definitive trial with some adjustments. Provision of an effective supportive resource would empower cancer survivors to manage CRF after treatment completion

Mechanical intervention after thrombolysis

Revascularisation strategies for acute myocardial infarction have evolved from early admission to coronary care units, bed rest and cardiac rhythm monitoring, to thrombolytic therapy and primary angioplasty. Although mechanical intervention for a failed prior revascularisation attempt is common widespread clinical practice, the outcome of this two-step modality may yet be an issue of debate. The available evidence is selected and reviewed within a clinical reference framework. This enables the presentation of a practical model for all stakeholders participating in cardiovascular care

Outcome in transferred and nontransferred patients after primary percutaneous coronary intervention for ischaemic out-of-hospital cardiac arrest

Objective: To evaluate the impact of transfer from a referral hospital to a center with primary percutaneous coronary intervention (PCI) facilities of ST-segment elevation myocardial infarction (STEMI) patients after successful cardiopulmonary resuscitation (CPR). Methods: We studied all STEMI patients with successful CPR admitted to two centers after out-of-hospital cardiac arrest and CPR from January 2004 to December 2005. Subjects were divided in a transferred (PCI performed after referral from center without PCI facility) and nontransferred (PCI performed in hospital of admission, i.e. center with PCI facility) group. Results: A total of 44 patients were included. Mean age was 61 +/- 13 year and 35 (80%) patients were male. Of all patients 16 (36%) were transferred for treatment. After treatment, the left ventricular function was preserved in 4 (25%) patients of the transferred group are compared with 17 (61%) of the nontransferred group (P = 0.024). In-hospital mortality after follow-up did not differ with 7 (44%) survivors in the transferred group versus 15 (54%) survivors in the nontransferred group (P = 0.76). Patients who did not survive were more often treated with endotracheal intubation (100% versus 71%, P = 0.019), had more often an occlusion of the proximal right coronary artery (37% versus 10%, P = 0.02), and higher glucose levels at admission (15.2 mmol/l +/- 4.4 versus 11.5 mmol/l +/- 4.2, P = 0.009). Conclusion: In conclusion, no difference in outcome was observed between nontransferred and transferred patients. Therefore, we suggest that transfer for primary PCI for STEMI patients after successful CPR should be considered. (C) 2008 Wiley-Liss, Inc

Long Term Effects of Epoetin Alfa in Patients with ST- Elevation Myocardial Infarction

<p>The HEBE III trial showed that epoetin alfa administration in patients with a first ST-elevation myocardial infarction (STEMI) did not improve left ventricular function at 6 weeks after primary percutaneous coronary intervention (PCI). The long term effects of erythropoiesis- stimulating agents on cardiovascular morbidity and mortality are unknown, therefore we evaluated clinical events at 1 year after PCI.</p><p>A total of 529 patients with a first STEMI and successful primary PCI were randomized to standard optimal medical treatment (N = 266) or an additional bolus of 60,000 IU epoetin alfa administered intravenously (N = 263) within 3 h after PCI. Analyses were performed by intention to treat.</p><p>At 1 year after STEMI, 485 patients had complete follow-up. The rate of the composite end point of all-cause mortality, re-infarction, target vessel revascularization, stroke and/or heart failure was 6.4 % (N = 15) in the epoetin alfa group and 9.6 % (N = 24) in the control group (p = 0.18). Thromboembolic events were present in 1.3 % (N = 3) of patients in the epoetin alfa group and 2.4 % (N = 6) in the control group. There was no evidence of benefit from epoetin alfa administration in subgroups of patients.</p><p>Administration of a single bolus of epoetin alfa in patients with STEMI does not result in a reduction of cardiovascular events at 1 year after primary PCI. There was a comparable incidence of thromboembolic complications in both treatment groups, suggesting that epoetin alfa administration is safe at long term.</p>

Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty : The DEBATE study (Doppler Endpoints Balloon Angioplasty Trial Europe)

Background The aim of this prospective, multicenter study was the identification of Doppler flow velocity measurements predictive of clinical outcome of patients undergoing single-vessel balloon angioplasty with no previous Q-wave myocardial infarction. Methods and Results In 297 patients, a Doppler guidewire was used to measure basal and maximal hyperemic flow velocities proximal and distal to the stenosis before and after angioplasty. In 225 patients with an angiographically successful percutaneous transluminal coronary angioplasty (PTCA), post-procedural distal coronary flow reserve (CFR) and percent diameter stenosis (DS%) were correlated with symptoms and/or ischemia at 1 and 6 months, with the need for target lesion revascularization, and with angiographic restenosis (defined as DS greater than or equal to 50% at follow-up). Logistic regression and receiver operator characteristic curve analyses were applied to determine the prognostic cutoff value of CFR and DS separately and in combination. Optimal cutoff criteria for predictors of these clinical events were DS, 35%; CFR, 2.5. A distal CFR after angioplasty >2.5 with a residual DS less than or equal to 35% identified lesions with a low incidence of recurrence of symptoms at 1 month (10% versus 19%, P=.149) and at 6 months (23% versus 47%, P=.005), a low need for reintervention (16% versus 34%, P=.024), and a low restenosis rate (16% versus 41%, P=.002) compared with patients who did nor meet these criteria. Conclusions Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for the short-and long-term outcomes after PTCA, and thus may be used to identify patients who will or will not benefit from additional therapy such as stent implantation