Prevalence and factors associated with polypharmacy in older people with cancer

Purpose

Polypharmacy has been associated with drug–drug interactions, adverse drug events, hospitalisation and increased mortality. The purpose of this study was to investigate the prevalence and factors associated with polypharmacy in older people with cancer.

Patients and methods

Patients aged ≥70 years (n?=?385) presenting to the medical oncology outpatient clinic at Royal Adelaide Hospital between January 2009 and July 2010 completed a structured data collection instrument. The instrument included domains related to medications, diagnoses, instrumental activities of daily living (IADLs), Karnofsky Performance Scale (KPS), physical function (SF-36), pain (ten-point visual analogue scale, VAS), weight loss (patient self-reported over previous 6 months), exhaustion (CES-D) and distress (ten-point VAS). Frailty was computed using Fried’s frailty phenotype. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between polypharmacy (defined as five or more self-reported daily medications) and clinical parameters.

Results

Polypharmacy was present in 57 % (n?=?221) of patients. When adjusting for age, gender and Charlson Comorbidity Index (CCI), polypharmacy was associated with being pre-frail (OR?=?2.35, 95%CI?=?1.43–3.86) and frail (OR?=?4.48, 95%CI?=?1.90–10.54) compared to being robust. When adjusting for age, gender, exhaustion, KPS, IADLs, pain and distress, polypharmacy was associated with higher CCI scores (OR?=?1.58, 95%CI?=?1.29–1.94) and poorer physical function (OR?=?1.13, 95%CI?=?1.06–1.20).

Conclusions

Polypharmacy is highly prevalent in older people with cancer and associated with impaired physical function and being pre-frail and frail compared to being robust. Research is needed to identify strategies to minimize patients’ medication regimens.     

Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma

Purpose

As the number of survivors of Hodgkin’s lymphoma (HL) increases, there has been a growing interest in long-term treatment-related side effects and their impact on the quality of life (QoL). The aim of this study was to assess the association of social network and social support with the QoL and fatigue among long-term HL survivors.

Methods

A total of 200 HL survivors were included. The generic Short Form-12 (SF-12) questionnaire, the QoL cancer survivor’s questionnaire (QOL-CS), and the Multidimensional Fatigue Inventory were used to assess QoL and fatigue. Social network and social support were evaluated with the Social Support Survey.

Results

Social network and all social support measures were favorably associated with two or more SF-12 scales, mainly with physical functioning and the mental health scales. Social network and social support dimensions were also associated with better QOL-CS scores. Affective support, informational support, positive interaction, and emotional support were associated with less fatigue.

Conclusions

Both social network and social support are associated with better QoL and lower levels of fatigue in HL survivors. This information may be useful to health professionals and community organizations in implementing effective interventions to improve these patients’ quality of life.     

Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival

Purpose

In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival.

Methods

We investigated a sample of HNSCC patients (n?=?671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p?<?0.05.

Results

Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR)?=?2.660, CI 95%?=?1.661–4.260, p?=?0.000] and large-size malignant disease (T3–T4; OR?=?5.337, CI 95%?=?2.251–12.652, p?=?0.000). Overall survival analysis revealed that ECOG-PS scores (OR?=?1.879, CI 95%?=?1.162–3.038, p?=?0.010), tumor size (OR?=?1.665, CI 95%?=?1.035–2.680, p?=?0.036), and the presence of cervical metastasis (OR?=?3.145, CI 95%?=?2.008–4.926, p?=?0.000) were independent predictors.

Conclusion

Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.     

Motivation,exercise, and stress in breast cancer survivors

Purpose

Reduced stress and reduced risk of cancer recurrence are among the many benefits of physical activity (PA) for cancer survivors. Exercise behaviors are linked to motivational factors. We investigated the associations between motivational profile, self-reported levels of PA and stress, and mental functioning in 94 posttreatment breast cancer survivors who voluntarily enrolled in an exercise program.

Methods

Participants completed the Apter Motivational Style Profile (AMSP), Lifetime of Physical Activity (LTPA) Questionnaire, International Physical Activity Questionnaire (IPAQ), Medical Outcomes Short Form SF-36® (SF-36), and Perceived Stress Scale (PSS) and provided 10 saliva specimens (to measure cortisol levels). PA levels were calculated in metabolic equivalent hours per week (MET-hours/week).

Results

Participants reported high levels of current and historical PA (M?=?39.2 MET-h/week, SD?=?39.7; M?=?14.2 MET-h/week, SD?=?15.4, respectively). They also reported high levels of stress (M?=?33.6, SD?=?4.5) coupled with low mental functionality as measured by SF-36 mental component scale (MCS) (M?=?44.4, SD?=?8.8). PSS was negatively associated with MCS (r?=??0.27, p?=?0.009). Salivary cortisol was not associated with any measure. Participants had a conformist (“follow rules”) and alloic (“about others”) motivational profile. No motivational, exercise history, or stress variables were associated with current PA.

Conclusions

As expected, participants reported higher levels of stress and lower mental functioning. Participants presented a unique motivational profile relative to the general population. Further research into the associations of motivation, exercise behaviors, and stress is warranted.     

In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup

Background

Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.

Objectives

The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).

Methods

Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally.

Results

In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23–1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74–0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02–5.13).

Conclusions

There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals.     

Prevalence, predictors, and prognostic impact of fatigue among Brazilian outpatients with advanced cancers

Purposes

The purposes of this study are to evaluate the impact of cancer-related fatigue (CRF) on quality of life (QoL), and to identify its clinical predictors. In addition, the authors investigated the prognostic impact of CRF and its relationship with the inflammatory marker C-reactive protein.

Method

Data regarding patient characteristics, symptom scores, and QoL indices were collected at the initial evaluation. At the same time, blood samples were collected in order to evaluate some laboratorial markers. Patients were followed by telephone interviews every 15 days until death. CRF was defined as ≥66.67 points on EORTC QLQ-C30 fatigue subscale.

Results

The examined patients had a median age of 61 years (range, 21–86 years) and 50.7 % were male. Median Karnofsky performance score (KPS) was 75.5 (SD, 15.1). The prevalence of CRF was 25 % (55 out of 221). Overall, patients with CRF presented higher symptom burden and also worst QoL scores. The following variables were independently associated with CRF: nausea (OR 1.22, p?=?0.009), dyspnea (OR 1.33, p?=?0.002), KPS (OR 0.96, p?=?0.009), body mass index (OR 0.93, p?=?0.046), and C-reactive protein (OR 1.08, p?=?0.004). The median overall survival (OS) was lower in CRF patients (p?<?0.0001). Only KPS (HR?=?0.96, p?<?0.001) and C-reactive protein (HR?=?1.07, p?<?0.001) were independent prognostic factors for OS.

Conclusions

Advanced cancer patients (ACP) with CRF had a higher burden of symptoms and impaired QoL. Our findings support the hypothesis that chronic inflammatory state (CIS) could play a role in the pathogenesis of fatigue in ACP. Moreover, CIS seems to have greater prognostic impact than the associated fatigue.     

Monitoring changes in quality of life in patients with lung cancer by using specialised questionnaires: implications for clinical practice

Background

Quality of life (QoL) in lung cancer patients is overlooked due to the severity of the disease. Changes in factors comprising QoL need further exploration to determine therapy targets.

Methods and materials

QoL was assessed in 282 patients referred to a specialised centre in Greece for chemotherapy using three reliable scales: Functional Assessment of Cancer Therapy—Lung (FACT-L, Greek version 4), Short Form (SF-36) Health Survey and Hospital Anxiety and Depression Scale (HAD)S.

Results

Comparing QoL scores, it was observed that in comparison to the first chemotherapy, there was a statistically significant deterioration in patients’ physical well-being (p?<?0.0001) at the following chemotherapies. In contrast, there was a statistically significant improvement in patients’ emotional well-being (p?<?0.0001), mental health (p?<?0.0001) and social functioning (p?=?0.006) in the chemotherapies following the first. Observations deriving from survival analyses agree with literature findings: small cell lung cancer (SCLC) patients had significantly shorter survival than non-SLSC (NSCLC) patients, initial performance status was consistent with survival, radiotherapy improved survival, existence of metastases hindered survival, and the number of chemotherapies and QoL scores were positively correlated with survival.

Conclusions

Although patients’ physical functioning deteriorated after chemotherapy, their psychological state, mental health and social functioning improved in comparison with their first chemotherapy. This may be due to the fear of the unknown and the stress patients experience before their treatment. Regarding survival analysis results, it could be stated that the better QoL scores, the longer the survival. The findings underline the importance of psychological support after diagnosis and during the initiation of treatment. This may result in a better QoL, hence leading to prolongation of survival.     

Impact of Intensive Lifestyle Intervention on Depression and Health-Related Quality of Life in Type 2 Diabetes: The Look AHEAD Trial

OBJECTIVE

We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1–4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores.

RESULTS

ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75–0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores.

CONCLUSIONS

ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.     

A descriptive study of persistent oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer

Background

Prolonged neurotoxicity after systemic chemotherapy has the potential to impact on quality of life. We explored the frequency of persistent peripheral neuropathy in patients who received oxaliplatin for colorectal cancer at two local centres.

Patients and methods

Questionnaires were sent to patients who completed treatment with oxaliplatin for colorectal cancer at least 20 months prior to entering the study. Neuropathy questions were adapted from the FACT/GOG-Ntx (V.4) questionnaire.

Results

Of the 56 eligible patients, 27 returned the questionnaire. Twenty-five patients (93 %) experienced neuropathic symptoms during their treatment; 11 had grade-2, and two had grade-3 symptoms. At the time of completing the questionnaire, 17 patients (63.0 %; 95%CI 43.9–79.4 %) were still symptomatic with 12 patients (44.4 %; 95%CI 26.8–63.3) having grade-2 or grade-3 symptoms and three patients (11.1 %; 95%CI 2.9–27.3) having grade-3 neuropathic symptoms. Participants who received more than 900 mg/m² oxaliplatin had a significantly higher risk of persistent grade-2 or grade-3 neuropathy (p?=?0.031, RR?=?8.3 95%CI?=?1.2–57.4). There was a trend toward increased risk of persistent neuropathy of any grade among participants with a history of regular alcohol use (p?=?0.051; RR?=?1.7 95%CI 1.0–2.8).

Conclusion

Persistent oxaliplatin-induced neuropathy is not as uncommon as previously suggested, and the rate of grade-2 and grade-3 symptoms could be considerably higher than previous reports.     

Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity

Objectives

To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer.

Design

A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial.

Setting

Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals.

Participants

One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy.

Interventions

A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©).

Main outcome measures

Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea).

Results

There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio?=?2.29, 95%CI?=?1.04 to 5.05, P?=?0.040) and reports of hand–foot syndrome were on average lower in the control group (odds ratio control/intervention?=?0.39, 95%CI?=?0.17 to 0.92, P?=?0.031).

Conclusion

The study demonstrates that ASyMS^© can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.     

Somatic symptoms in cancer patients trajectory over 12 months and impact on functional status and disability

Purpose

Cross-sectional studies have established the prevalence and functional impairment of somatic symptoms in cancer patients. The purpose of this study was to determine the trajectory and adverse consequences of such symptoms over time.

Methods

Secondary analysis of longitudinal data from 405 cancer patients enrolled in a telecare management trial for pain and/or depression. Somatic symptom burden was measured with a 22-item scale at baseline, 1, 3, 6, and 12 months. Outcomes included the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, the Sheehan Disability Scale (SDS) score, and self-reported total disability days. Mixed methods repeated measures analyses were conducted to determine whether antecedent change in somatic symptom burden predicted functional status and disability.

Results

Symptoms were highly prevalent at baseline, with 15 of the 22 symptoms endorsed by more than half of the patients. A rather constant cross-sectional prevalence over 12 months at the group level belied a quite different trajectory at the patient level where the median persistence, resolution, and incidence rates for 14 of the most common symptoms were 39 %, 37 %, and 24 %, respectively. A clinically significant (i.e., five points) reduction in somatic symptom burden predicted improvement in PCS, MCS, and SDS (all P?<?0.001), as well as a lower likelihood of ≥14 disability days in the past 4 weeks (odds ratio, 0.84; 95 % CI, 0.74 to 0.95).

Conclusions

Somatic symptoms remain burdensome in cancer patients over 12 months and symptom improvement predicts significantly better functional status and less disability.     

Quality of life in long-term survivors following treatment for Hodgkin's disease during childhood and adolescence in the German multicentre studies between 1978 and 2002

Purpose

The purpose of this study was to cross-sectionally assess quality of life (QoL) in survivors of childhood Hodgkin's disease (HD) in a cohort treated for HD in the successive German–Austrian therapy studies HD-78, HD-82, HD-85, HD-87, HD-90, HD-95, respectively, in accordance with the HD-Interval-Treatment recommendation between 1978 and 2002.

Patients and methods

Data from QoL questionnaires were provided by 1,202 (66 %) of 1,819 invited survivors. These included the EORTC QLQ-C30 and socio-demographic variables. Data of a homogenous sub-sample (n?=?725) defined by age (21–41 years) and event- free-survival (no progress, relapse or secondary malignancies) were compared to an age-adjusted German reference sample (n?=?659).

Results

While the global and physical QoL scores were comparable to those of the general population, survivors' mean scores were more than 10 points lower on the EORTC QLQ-C30 scales “Emotional” and “Social Functioning”. On the symptom scales, higher mean scores, exceeding 10 points, were obtained for the scales “Fatigue” and “Sleep”. In general, there was a gender effect showing lower functioning and higher symptom levels in women, most prominently in the group of young women (21–25 years). The results within the group of HD survivors could not be associated with the time since treatment, the age of HD survivors at diagnosis or the extent of therapy burden.

Conclusion

Clinicians engaged in follow-up care should be sensitive to aspects of fatigue and related (emotional) symptoms in HD childhood cancer survivors and encourage their patients to seek further support if needed.     

Metastatic epidural spinal cord compression among elderly patients with advanced prostate cancer

Background

A recent randomized trial demonstrated that for metastatic epidural spinal cord compression (MESCC), a complication of advanced prostate cancer, surgical decompression may be more effective than external beam radiation therapy (RT). We investigated predictors of MESCC, its treatment, and its impact on hospital length of stay for patients with advanced prostate cancer.

Methods

We used the SEER-Medicare database to identify patients >65 years with stage IV (n?=?14,800) prostate cancer. We used polytomous logistic regression to compare those with and without MESCC and those hospitalized for treatment with surgical decompression and/or RT.

Results

MESCC developed in 711 (5 %) of patients, among whom 359 (50 %) received RT and 107 (15 %) underwent surgery?±?RT. Median survival was 10 months. MESCC was more likely among patients who were black (OR 1.75, 95 %CI 1.39–2.19 vs. white) and had high-grade tumors (OR 3.01, 95 %CI 1.14–7.94), and less likely in those younger; with prior hormonal therapy (OR 0.73, 95 %CI 0.62–0.86); or with osteoporosis (OR 0.63, 95 %CI 0.47–0.83). Older patients were less likely to undergo either RT or surgery, as were those with ≥1 comorbidity. Patients with high-grade tumors were more likely to undergo RT (OR 1.92, 95 %CI 1.25–2.96). Those who underwent RT or surgery spent an additional 11 and 29 days, respectively, hospitalized.

Conclusions

We found that black men with metastatic prostate cancer are more likely to develop MESCC than whites. RT was more commonly utilized for treatment than surgery, but the elderly and those with comorbidities were unlikely to receive either treatment.     

Predictors of sexual well-being after endometrial cancer: results of a national self-report survey

Purpose

We examined whether sociodemographic, physical, reproductive, psychological and clinical factors at the time of diagnosis were related to women’s sexual well-being 3–5 years following treatment for endometrial cancer.

Methods

Of the 1,399 women in the Australian National Endometrial Cancer Study, 644 completed a follow-up questionnaire 3–5 years after diagnosis. Of these, 395 women completed the Sexual-Function Vaginal Changes Questionnaire, which was used to assess sexual well-being. Based on two questions assessing worry and satisfaction with their sexuality, women were classified into lower and higher sexual well-being. Multivariable-adjusted logistic regression models were used to examine sexual well-being 3–5 years following cancer treatment and the factors associated with this at diagnosis and at follow-up.

Results

Of the 395 women, 46 % (n?=?181) were categorized into the “higher” sexual well-being group. Women who were older (odds ratio [OR]?=?1.97; 95 % confidence limit [CI], 1.23–3.17), high school educated (OR?=?1.75; 95 % CI, 1.12–2.73), who reported good mental health at the time of diagnosis (OR?=?2.29; 95 % CI, 1.32–3.95) and whose cancer was treated with surgery alone (OR?=?1.93; 95 % CI, 1.22–3.07) were most likely to report positive sexual well-being. At 3–5 years post-diagnosis, women with few symptoms of anxiety (OR?=?2.28; 95 % CI, 1.21–4.29) were also most likely to report positive sexual well-being.

Conclusions

Psychological, sociodemographic and treatment factors are important to positive sexual well-being post-cancer. Care that focuses on maintaining physical and psychosocial aspects of women’s lives will be more effective in promoting positive sexual well-being than care that focuses solely on physical function.     

Outcomes in critically ill chronic lymphocytic leukemia patients

Background

Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality.

Methods

In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included.

Results

Sixty-two patients of 67 years (62–75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6–10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n?=?47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n?=?22), 42 % (n?=?26), and 58 % (n?=?36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23–27.33), need for vasopressors (OR 27.94; 95 % CI 5.37–145.4), and past history of infection (OR 6.62; 95 % CI 1.34–32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included.

Conclusion

Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome.     

The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology

Purpose: Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery.

Methods: Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome.

Results: Being on modified job duty (OR?=?.17, 95%CI: 0.03–0.94), and having a worker’s compensation claim (OR?=?0.08, 95%CI: 0.01–0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR?=?11.96, 95%CI: 2.91–49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR?=?0.95, 95%CI: 0.91–0.98) and the FABQ_work subscale (OR?=?0.92, 95%CI: 0.87–0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR?=?8.9, 95%CI 1.75–45.7) and FABQ_work subscale score?≤25 (OR?=?15.3, 95%CI 2.3–101.9) remained significant.

Discussion: Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability.

• Implications for Rehabilitation

• Impairment-based shoulder measurements were not strong predictors of patient-reported outcome.

• Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability.

• Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels.

     

Efficacy and Safety of Certolizumab Pegol for Crohn’s Disease: A Systematic Review and Meta-Analysis

Introduction

The authors performed a systematic review and meta-analysis of data from randomized controlled trials (RCTs) to evaluate the efficacy and safety of certolizumab pegol.

Methods

The authors searched PubMed, MEDLINE via Medscape, BioMed Central, Google Scholar, China National Knowledge Infrastructure (CNKI), the Cochrane library, and the Directory of Open Access Journals. The outcomes of interest were response and remission rates and the treatment-related toxicity rate.

Results

A total of five RCTs, involving 1,891 participants, were included. The meta-analysis revealed that certolizumab significantly increased the overall (induction + maintenance therapy) response [odds ratio (OR) 1.565, 95% CI 1.056–2.321, P = 0.026] and remission rates (OR 1.626, 95% CI 1.297–2.038, P < 0.001) compared with placebo. Certolizumab significantly increased the response and remission rates when given as maintenance therapy (OR 2.171, 95% CI 1.644–2.866, P < 0.001 and OR 1.888, 95% CI 1.390–2.565, P < 0.001), but not as induction therapy (OR 1.234, 95% CI 0.912–1.671, P = 0.173 and OR 1.361, 95% CI 0.974–1.901, P = 0.071). Certolizumab (induction + maintenance therapy) did not significantly increase the treatment-related toxicity rate compared with placebo (OR 0.985, 95% CI 0.799–1.214, P = 0.887).

Conclusion

Certolizumab may be an efficacious treatment for Crohn’s disease as maintenance therapy and appears to have a favorable safety profile.     

Clinical impact and risk factors for colonization with extended-spectrum β-lactamase-producing bacteria in the intensive care unit

Purpose

The changed epidemiology of extended spectrum beta-lactamases (ESBL), the spread to the community and the need for prudent use of carbapenems require updated knowledge of risk factors for colonization with ESBL-producing enterobacteriaceae (ESBL-PE).

Methods

An 8-month prospective study in the medical ICU of an 850-bed general and university-affiliated hospital.

Results

Of 610 patients admitted, 531 (87?%) had a rectal swab obtained at admission, showing a 15?% (82 patients) ESBL-PE carriage rate, mostly of E. coli (n?=?51, 62?%); ESBL-PE caused 9 (3?%) infections on admission. By multivariable analysis, transfer from another ICU (OR?=?2.56 [1, 22]), hospital admission in another country [OR?=?5.28 (1.56–17.8)], surgery within the past year [OR?=?2.28 (1.34–3.86)], prior neurologic disease [OR?=?2.09 (1.1–4.0)], and prior administration of third generation cephalosporin (within 3–12?months before ICU admission) [OR?=?3.05 (1.21–7.68)] were independent predictive factors of colonization by ESBL-PE upon ICU admission. Twenty-eight patients (13?% of those staying for more than 5?days) acquired ESBL carriage in ICU, mostly with E. cloacae (n?=?13, 46?%) and K. pneumoniae (n?=?10, 36?%). In carriers, ESBL-PE caused 10 and 27?% of first and second episodes of ICU-acquired infections, respectively.

Conclusion

We found a high prevalence of ESBLE-PE colonization on admission to our ICU, even in the subgroup admitted from the community, but few first infections. Identifying risk factors for ESBL-PE colonization may help identifying which patients may warrant empiric ESBL-targeted antimicrobial drug therapy as a means to limit carbapenem use.