Early palliative care for improving quality of life and survival in patients with advanced cancer: a systematic review and meta-analysis

Objective: The main goal was to evaluate the effectiveness of early palliative care in patients with advanced cancer. Methods: The search in the MEDLINE/PubMed, CRD, Cochrane Library, CINAHL, EMBASE, Google Scholar, ICTRP and ClinicalTrials.gov databases was conducted in June 2017. Two reviewers independently screened titles and abstracts with consensus agreement. We undertook quality assessment according to GRADE criteria. Randomized Controlled Trials (RCT) that assessed the effectiveness of EPC in adult patients with a diagnosis- advanced cancer were included. The quantitative evidence was summarized in a meta-analysis using random effect models. Results: The selection phase retrieved 14,026 records, 7 papers were included in the meta-analysis. The standardized mean difference the outcomes assessed were: improvement quality of life (0.17 higher; 95% CI; 0.05, 0.29) after 3 months, (0.42 higher; 95% CI; 0.21, 0.63) after 6 months, and (0.16 higher; 95% CI; -0.20, 0.53) after 12 months; improvement of symptom intensity (-0.13 lower; 95% CI; -0.26, 0.00) after 3 months, (-0.27 lower; 95% CI; -0.53, -0.01) after 6 months, and (-0.39 lower; 95% CI; -0.76, -0.03) after 12 months; improve depressive mood (-0.19 lower; 95% CI; - 0.36, -0.01) after 3 months, (-0.21 lower; 95% CI; -0.45, 0.04) after 6 months, and (-0.09 lower; 95% CI; -0.81, 0.63) after 12 months; and survival (OR = 0.71 higher; 95% CI; 0.51, 0.99). Conclusion: Our findings suggest that EPC effectively improves quality of life and consequently increases the likelihood of survival of patients with advanced or metastatic cancer. However, due to worsening of the disease stage over time, a limited effect was observed after 12 months of follow-up

Early economic evaluation of the digital gait analysis system for fall prevention–Preliminary analysis of the GaitSmart system

Objective: To develop an early economics evaluation (EEE) to assess the cost-effectiveness of the GS in reducing the RoF and FoF. Methods: A cost-effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost-effectiveness ratio per quality-adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results: The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = -£4479.57 and cost of RoF = -£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion: The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving

The Influence of Fasting and Energy Restricting Diets on Blood Pressure in Humans: A Systematic Review and Meta‑Analysis

Introduction: To the best of our knowledge, no comprehensive meta-analysis has been carried out to investigate the effect of different approaches of fasting and calorie restriction on blood pressure. Aim: Thus, the present systematic review and meta-analysis was designed to examine the effect of fasting and energy restricting diets on blood pressure in adult subjects. Methods: We searched PubMed/Medline, Scopus, the Cochrane Library, and Google Scholar up to June 2019. The clinical trials that examined the effects of fasting and energy restricting diets on Blood Pressure was identified using MESH and non-MESH terms. Results: 23 studies, including a total of 1397 participants, reported SBP and DBP as an outcome measure. Overall results from the random-effects model indicated that fasting and energy restricting administration elicited significant changes in SBP (weight mean difference (WMD): � 1.88 mmHg, 95 CI � 2.50, � 1.25) and DBP (WMD � 1.32 mmHg, 95 CI � 1.81, � 0.84, p = 0.000). Subgroup analyses displayed that intervention duration � 12 weeks more effectively reduced SBP (WMD: -3.26 mmHg) and DBP (WMD � 1.32 mmHg). In addition, these analyses showed that fasting regimens (WMD � 3.26 mmHg) more effectively reduced SBP than energy restricting diets (WMD � 1.09 mmHg). Conclusion: The principal finding of this study was that fasting and energy restricting diets elicited, overall, significant reductions in SBP and DBP. Subsequent subgroup analyses revealed that intervention duration � 12 weeks and fasting regimens more effectively reduced SBP and DBP. © 2020, Italian Society of Hypertension

Marker-assisted pyramiding of resistance loci to grape downy mildew

O objetivo deste trabalho foi o emprego da seleção assistida por marcadores moleculares para piramidação dos locos de resistência Rpv1 e Rpv3.1, em videira (Vitis vinifera), e avaliar o nível de resistência conferido por eles contra isolados brasileiros de míldio (Plasmopara viticola). Uma progênie de 23 plantas, com segregação para os dois locos de resistência, foi obtida do cruzamento entre os genótipos Gf2000-305-122 e Gf.Ga-52-42. A progênie foi genotipada com quatro marcadores microssatélites e fenotipada, quanto à resistência a P. viticola, em discos foliares. A análise molecular identificou seis plantas com os locos Rpv1 e Rpv3.1 piramidados. Plantas com os locos Rpv1 + Rpv3.1, Rpv3.1 e Rpv1 apresentaram 12,8, 30,0 e 33,1 esporangióforos por disco foliar, respectivamente. As plantas sem locos de resistência tiveram esporulação densa. A análise fenotípica da expressão dos dois locos piramidados foi confirmada somente para quatro plantas que mostraram o maior nível de resistência, isto é, média de 1.8 esporangióforos. Desenvolveu-se uma metodologia de alto rendimento para a piramidação dos locos Rpv1 e Rpv3.1, que confirmou o aumento da resistência a P. viticola. O material genético superior selecionado apresenta alta resistência ao míldio e elevado potencial enológico para o melhoramento da videira no Brasil.The objective of this work was to use a marker-assisted selection for pyramiding the resistance loci Rpv1 and Rpv3.1 in grapevine (Vitis vinifera), and to evaluate their conferred resistance against Brazilian downy mildew (Plasmopara viticola) isolates. A progeny of 23 plants, segregating for the two resistance loci, was obtained by the cross between the Gf 2000-305-122 and Gf.Ga-52-42 genotypes. The progeny was genotyped with four microsatellite markers and phenotyped for resistance to P. viticola using a bioassay with leaf discs. Six plants containing the Rpv1 and Rpv3.1 pyramided loci were identified by the molecular analysis. Plants harboring the Rpv1 + Rpv3.1, Rpv3.1, and Rpv1 loci showed 12.8, 30.0, and 33.1 sporangiophores per leaf disc, respectively. Plants with no resistance loci showed a dense sporulation. The phenotypic analysis of the expression of the two pyramided loci was only confirmed for four plants that showed the highest resistance level, i.e., mean value of 1.8 sporangiophores. A high-throughput method for pyramiding the Rpv1 and Rpv3.1 loci was developed, which confirmed the increased resistance to P. viticola. The selected elite genetic material shows a high resistance to downy mildew and elevated enological potential for grapevine breeding in Brazil

Effectiveness evaluation of public policy incentive R&D in technological innovation in Brazil: a focus on law of the well

<p>The present paper will address pharmaceutical industries that carry out research, development and innovation (RD&amp;I) Brazil and their consequent adherence to tax incentives based on ‘Law of the Well’ (Brazilian, Law No. 11,196 / 2005). Our hypothesis evaluates if public policies of incentives for transformation of technological knowledge could encourage firms to invest in RD&amp;I. Our research was based on Government Annual Reports that reported the use of tax incentives during a period between 2006 and 2012; and legal framework destined for supporting research, both provided by Ministry of Science, Technology and Innovation of Brazil. During the studied period, an increase of 800% of the participating companies of the ‘Law of the Well’ was observed, demonstrating a need to invest in R&amp;D. The sum of the expenditure of defrayal for the computation of the incentives the companies that operated in real income regime and have chosen to take advantage of tax incentives ‘Law of the Well’ amounted to R $40.52 billion. Well although one of the purposes of the ‘Law of the Well’ is to subsidize the establishment of researchers in companies, the total value of capital expenditure does not exceed 4$ 40,52 bilhões. Embora um dos propósitos da Lei do Bem seja subsidiar a fixação de pesquisadores nas empresas, os valores totais das despesas capitais não ultrapassam a 4% do valor total investido em atividades de P&amp;D. Semelhantemente observa-se que os percentuais de incentivo ao desenvolvimento e registro de patentes também não ultrapassam a 1%. Embora a Lei do Bem se apresente como um aparato institucional que contribui para as empresas se tornarem eficientes e competitivas para enfrentar o acirrado mercado globalizado, indicadores recentes sobre os gastos com P&amp;D no Brasil demonstram certa estagnação nos investimentos nos diversos setores.</p><p><br />Palavras-chave: Lei do Bem. Políticas públicas. Complexo farmacêutico. Inovação tecnológica.</p

Impacto da atenção farmacêutica na função pulmonar de pacientes com asma grave

O estudo avaliou a influência do serviço de Atenção Farmacêutica na otimização dos resultados terapêuticos de pacientes com asma grave não controlada, em uso de formoterol associado à budesonida. Utilizou-se o Método Dáder de Seguimento Farmacoterapêutico e o Teste do Controle de Asma (ACT™) para avaliação de resultados, assim como a espirometria. Foram acompanhados 26 pacientes por um período não inferior a seis meses, cuja média de idade foi 55 ± 11 anos, destes, 22 (84%) foram do gênero feminino. Na pesquisa verificou-se que 22 (84,6%) pacientes apresentaram mais de uma enfermidade associada à asma grave e 24 (92%) faziam uso de dois ou mais fármacos. Foram detectados 58 resultados negativos associados aos medicamentos (RNM), com incidência de 2,2 ± 0,99 RNM por usuário. O RNM mais frequente foi insegurança não quantitativa identificada em 11 usuários (43%), sendo 31% desses devido às reações adversas ao medicamento. Foram realizadas 65 intervenções farmacêuticas para resolver os RNM, com média de 2,5 ± 1,2 por paciente, das quais 85% ocorreram na farmácia sem a necessidade de voltar ao médico. Dos resultados clínicos, após as intervenções farmacêuticas, todos os usuários tiveram melhora significativa da asma (p<0,05), porém 2 deles (7,6%) ainda apresentaram asma não controlada. Assim, o estudo sinalizou a necessidade do acompanhamento farmacoterapêutico aos usuários com asma grave não controlada para otimização dos resultados clínicos