Adherence to adjuvant endocrine therapy among breast cancer survivors: a systematic review and meta-synthesis of the qualitative literature using grounded theory

Purpose: Numerous studies have examined non-adherence to adjuvant endocrine therapy in women recovering from breast cancer, but none provide a comprehensive theory to explain the challenges of long-term medication-taking and resilience needed to continue. The aim of this study was to source, appraise, and synthesise data from existing qualitative studies to develop an in-depth explanatory model of non-adherence and discontinuation of hormonal medication among breast cancer survivors. Methods: A comprehensive search of databases and the literature identified 24 eligible qualitative studies published 2010-2019. Quotations (n= 801) listed within these papers and the original author interpretations were synthesised using NVivo, and grounded theory methodology. Results: At the beginning, knowledge about adjuvant endocrine therapy, trust in doctors, and worries and expectations, mean agreeing to medication is the only viable option, akin to a Hobson’s choice. Thereafter, women’s ability to deal with medication side-effects, knowledge, and support received affect their decision to continue, akin to a horned dilemma where giving up the medication risks cancer recurrence, and continuing means reduced contentment. Women stopping medication altogether question treatment necessity, search for normalcy, and prioritise quality of life. Conclusion: Shared experiences and understandings were uncovered by examining commonalities in existing publications. The core category explained the difficulties women face with the initial decision to accept long-term endocrine therapy and then the everyday challenges of continuing or deciding to stop treatment early. An educational tool to inform survivors and health professionals about these challenges could potentially improve women’s experience on treatment and in turn their adherence

Methods for the synthesis of qualitative research: a critical review

<p>Abstract</p> <p>Background</p> <p>In recent years, a growing number of methods for synthesising qualitative research have emerged, particularly in relation to health-related research. There is a need for both researchers and commissioners to be able to distinguish between these methods and to select which method is the most appropriate to their situation.</p> <p>Discussion</p> <p>A number of methodological and conceptual links between these methods were identified and explored, while contrasting epistemological positions explained differences in approaches to issues such as quality assessment and extent of iteration. Methods broadly fall into 'realist' or 'idealist' epistemologies, which partly accounts for these differences.</p> <p>Summary</p> <p>Methods for qualitative synthesis vary across a range of dimensions. Commissioners of qualitative syntheses might wish to consider the kind of product they want and select their method – or type of method – accordingly.</p

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ

<p>Abstract</p> <p>Background</p> <p>The syntheses of multiple qualitative studies can pull together data across different contexts, generate new theoretical or conceptual models, identify research gaps, and provide evidence for the development, implementation and evaluation of health interventions. This study aims to develop a framework for reporting the synthesis of qualitative health research.</p> <p>Methods</p> <p>We conducted a comprehensive search for guidance and reviews relevant to the synthesis of qualitative research, methodology papers, and published syntheses of qualitative health research in MEDLINE, Embase, CINAHL and relevant organisational websites to May 2011. Initial items were generated inductively from guides to synthesizing qualitative health research. The preliminary checklist was piloted against forty published syntheses of qualitative research, purposively selected to capture a range of year of publication, methods and methodologies, and health topics. We removed items that were duplicated, impractical to assess, and rephrased items for clarity.</p> <p>Results</p> <p>The Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement consists of 21 items grouped into five main domains: introduction, methods and methodology, literature search and selection, appraisal, and synthesis of findings.</p> <p>Conclusions</p> <p>The ENTREQ statement can help researchers to report the stages most commonly associated with the synthesis of qualitative health research: searching and selecting qualitative research, quality appraisal, and methods for synthesising qualitative findings. The synthesis of qualitative research is an expanding and evolving methodological area and we would value feedback from all stakeholders for the continued development and extension of the ENTREQ statement.</p

Diviseurs sur les courbes réelles

Dans un article sur les sommes de carrés, Scheiderer a prouvé que pour toute courbe algébrique, réelle, projective, irréductible, lisse, ayant des points réels, il existait un entier N tel que tout diviseur de degré plus grand que N soit linéairement équivalent à un diviseur dont le support est totalement réel. Ensuite Huisman et Monnier ont montré que dans le cas des courbes avec beaucoup de composantes connexes, ie. celle en ayant au moins autant que le genre g, ici supposé strictement positif, de la courbe, on pouvait prendre N égal à 2g 1. Monnier a également abordé la question pour les cas des courbes singulières : il en a exhibé pour lesquelles un tel entier n'existait pas et d'autres pour lesquelles il existait. Dans cette thèse on étend la classe des courbes singulières pour lesquelles un tel entier existe, essentiellement des courbes avec des noeuds ou des cusps, et on arrive dans certains cas a contrôlé explicitement cet entier en fonction du genre de la courbe et du nombre de ces singularités. Pour y parvenir on utilise d'une part une " singularisation successive " et d'autre part une variante de l'invariant où l'on demande qu'en plus les points du support soient deux-à-deux distincts. Pour ce nouvel invariant, on étend tel quel les résultats sur les courbes ayant beaucoup de composantes et on traite celui des courbes de genre 2 ayant une seule composante, le " premier " cas jusqu'alors inconnu : dans ce cas la borne 3 est impossible en général, mais par contre 5 convient.In an article about sums of squares, Scheiderer proved that for every real, algebraic, projective, irreducible, smooth curve with some real points, their exists an integer N such that every divisor of degre not lower than N is linearly equivalent to a divisor whose support is totally real. Then Huisman and Monnier proved that for real curves with many components, ie. those with at least as many components as the genus g, assumed here to be positive, of the curve, one can choose N equal to 2g 1. Monnier also dealed with singular curves: he showed that for some of them such an integer does not exist and gave some others where it does exist. In this thesis we extend the classe of singular curves for wich such an integer exists, essentially those with nodes and cusps, and we sometimes manage to bound such an integer in terms of the genus. To do so, an "iterative singularisation" is used and also a slightly different invariant where we ask the real points of the support to be distinct from each-other. We extend the results about curves with many components to that new invariant and deal with curves of genus 2 having only one component, which is the "very first" unknown case so far: in that case, 3 cannot bound the invariant, but 5 does.ANGERS-BU Lettres et Sciences (490072106) / SudocSudocFranceF