Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: Hybrid systematic review of systematic reviews protocol

This is the author accepted manuscriptBackground: Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. Methods: We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will form further networks with individual anti-depressants and psychotherapies. We will use frequentist, random effects multivariate network meta-analysis to synthesise the evidence for depression intervention and to achieve a ranking of treatments, using Stata. Rankograms and surface under the cumulative ranking curves will be used for treatment ranking. Local and global methods will evaluate consistency. GRADE will be used to assess evidence quality for primary outcomes. Discussion: The present review will address uncertainties about the evidence in terms of depression management in CAD and may allow for a ranking of treatments, including providing important information for future research efforts

A multi- and mixed-method adaptation study of a patient-centered perioperative mental health intervention bundle

BACKGROUND: Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients\u27 unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery. METHODS: We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded. RESULTS: Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: (1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). (2) Cohort-specific adaptations were recommended based on differing patient needs. (3) Compassion was identified by patients as the most important element. CONCLUSIONS: We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations. CLINICAL TRIALS REGISTRATION: NCT05110690 (11/08/2021)

Dietary inflammatory index (DII) and risk of prostate cancer in a case–control study among Black and White US Veteran men

© 2019, Springer Nature America, Inc. Background: We hypothesized a pro-inflammatory diet would be associated with higher prostate cancer (PC) risk. Methods: We prospectively recruited incident PC cases (n = 254) and controls (n = 328) at the Durham Veteran Affairs, from 2007 to 2018. From a self-completed 61-item Food Frequency Questionnaire, we calculated dietary inflammatory index (DII ® ) scores with and without supplements. We examined the association between DII scores with and without supplements and overall PC risk using logistic regression and risk of low-grade PC (grade group 1) and high-grade PC (grade group 2–5) with multinomial logistic regression. Results: Cases were more likely to be Black (58 vs. 42%), had higher PSA (6.4 vs. 0.8 ng/ml), lower BMI (29.1 vs. 30.6 kg/m 2 ) and were older (64 vs. 62 years) versus controls (all p \u3c 0.01). Both black controls and cases had higher DII scores with and without supplements, though the DII scores with supplements in controls was not significant. On multivariable analysis, there were no associations between DII with or without supplements and overall PC risk (p-trend = 0.14, p-trend = 0.09, respectively) or low-grade PC (p-trend = 0.72, p-trend = 0.47, respectively). Higher DII scores with (p-trend = 0.04) and without supplements (p = 0.08) were associated with high-grade PC, though the association for DII without supplements was not significant. Conclusions: A pro-inflammatory diet was more common among Black men and associated with high-grade PC in our case–control study. The degree to which a pro-inflammatory diet contributes to PC race disparities warrants further study. If confirmed, studies should test whether a low-inflammatory diet can prevent high-grade PC, particularly among Black men

Number of Unfavorable Intermediate‐Risk Factors Predicts Pathologic Upstaging and Prostate Cancer‐Specific Mortality Following Radical Prostatectomy: Results From the SEARCH Database

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135480/1/pros23255.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135480/2/pros23255_am.pd

Modified risk stratification grouping using standard clinical and biopsy information for patients undergoing radical prostatectomy: Results from SEARCH

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139104/1/pros23436_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139104/2/pros23436.pd

What is Donald Trump?:Forms of 'Celebrity' in Celebrity Politics

It is widely assumed that Donald Trump is a ‘celebrity politician’, and that he has cashed in his success on the reality show The Apprentice to secure political credibility and attention. In this respect he fits what Matthew Wood et al (2016) have labelled the ‘superstar celebrity politician’. This characterisation is the latest in a number of refinements to the definition and understanding of the celebrity politician. While this is a helpful move, I want to suggest that it might overlook one key dimension of the phenomenon. Definitions of the celebrity politician tend to focus on the source of their ‘celebrity’ – how they became famous, rather than on how they act out their celebrity role. This latter dimension features in media coverage, where journalists and commentators borrow from showbusiness to describe politics, but is less often analysed in the political science literature. It matters because, I want to suggest, celebrity politicians like Trump act as stars, whether of reality television, rock music or film. They do not just resemble stars; they are them. This is evident in how they are represented, how they perform and how their ‘fans’ respond to them. It is also symptomatic of wider changes in the conduct and form of the contemporary, mediatised political realm

A Clinician\u27s Guide to Next Generation Imaging in Patients With Advanced Prostate Cancer (RADAR III).

PURPOSE: The advanced prostate cancer therapeutic landscape has changed dramatically in the last several years, resulting in improved overall survival of patients with castration naïve and castration resistant disease. The evolution and development of novel next generation imaging techniques will affect diagnostic and therapeutic decision making. Clinicians must navigate when and which next generation imaging techniques to use and how to adjust treatment strategies based on the results, often in the absence of correlative therapeutic data. Therefore, guidance is needed based on best available information and current clinical experience. MATERIALS AND METHODS: The RADAR (Radiographic Assessments for Detection of Advanced Recurrence) III Group convened to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The group also discussed the potential impact of next generation imaging on treatment options based on earlier detection of disease. RESULTS: The group unanimously agreed that progression to metastatic disease is a seminal event for patient treatment. Next generation imaging techniques are able to detect previously undetectable metastases, which could redefine the phases of prostate cancer progression. Thus, earlier systemic or locally directed treatment may positively alter patient outcomes. CONCLUSIONS: The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on laboratory (biomarker) values, comorbidities and symptoms. Currently 18F-fluciclovine and 68Ga prostate specific membrane antigen positron emission tomography/computerized tomography are the next generation imaging agents with a favorable combination of availability, specificity and sensitivity. There is ongoing research of additional next generation imaging technologies, which may offer improved diagnostic accuracy and therapeutic options. As next generation imaging techniques evolve and presumably result in improved global accessibility, clinician ability to detect micrometastases may be enhanced for decision making and patient outcomes

Prostate cancer-derived urine exosomes: a novel approach to biomarkers for prostate cancer

Herein, we describe a novel approach in the search for prostate cancer biomarkers, which relies on the transcriptome within tumour exosomes. As a proof-of-concept, we show the presence of two known prostate cancer biomarkers, PCA-3 and TMPRSS2:ERG the in exosomes isolated from urine of patients, showing the potential for diagnosis and monitoring cancer patients status