Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.     

Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk

Prevalence of osteoporosis is more than 50% in older adults, yet current clinical methods for diagnosis that rely on areal bone mineral density (aBMD) fail to detect most individuals who have a fragility fracture. Bone fragility can manifest in different forms, and a “one-size-fits-all” approach to diagnosis and management of osteoporosis may not be suitable. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides additive information by capturing information about volumetric density and microarchitecture, but interpretation is challenging because of the complex interactions between the numerous properties measured. In this study, we propose that there are common combinations of bone properties, referred to as phenotypes, that are predisposed to different levels of fracture risk. Using HR-pQCT data from a multinational cohort (n = 5873, 71% female) between 40 and 96 years of age, we employed fuzzy c-means clustering, an unsupervised machine-learning method, to identify phenotypes of bone microarchitecture. Three clusters were identified, and using partial correlation analysis of HR-pQCT parameters, we characterized the clusters as low density, low volume, and healthy bone phenotypes. Most males were associated with the healthy bone phenotype, whereas females were more often associated with the low volume or low density bone phenotypes. Each phenotype had a significantly different cumulative hazard of major osteoporotic fracture (MOF) and of any incident osteoporotic fracture (p < 0.05). After adjustment for covariates (cohort, sex, and age), the low density followed by the low volume phenotype had the highest association with MOF (hazard ratio = 2.96 and 2.35, respectively), and significant associations were maintained when additionally adjusted for femoral neck aBMD (hazard ratio = 1.69 and 1.90, respectively). Further, within each phenotype, different imaging biomarkers of fracture were identified. These findings suggest that osteoporotic fracture risk is associated with bone phenotypes that capture key features of bone deterioration that are not distinguishable by aBMD. © 2021 American Society for Bone and Mineral Research (ASBMR).     

Uncertainty evaluation at three spatial scales for the NDVI-based VWC estimation method used in the SMAP algorithm

Vegetation water content (VWC) is the key input parameter for a soil moisture retrieval algorithm based on microwave remote sensing, and VWC uncertainty can limit the estimated accuracy of soil moisture. There has been little research on VWC algorithm development and validation in China, and the uncertainty of the VWC estimation method has not been well evaluated. Therefore, the aim of this study is to evaluate the uncertainty of the VWC estimation method used in the SMAP (Soil Moisture Active Passive) algorithm on three spatial scales (the point-scale, 30 m scale, and 1 km scale) for maize in northeast China. Results from three ground experimental datasets showed that the SMAP VWC estimation method was strongly biased with an average overestimation of 1.16 kg m^?2,1.04 kg m^?2, and 1.13 kg m^?2 for the point-scale, 30 m scale, and 1 km scale respectively, and maximum bias occurred in the mid-stage of maize. Also, a new power relationship between NDVI (Normalized Difference Vegetation Index) and VWC was proposed for the 30 m scale based on Sentinel 2 NDVI and field VWC values from 2017 experiment, with respective R² (coefficient of determination) and Root Mean Squared Error (RMSE) values of 0.80 and 0.67 kg m^?2. The results confirmed that this power relationship was still suitable for VWC estimation at the 1 km scale, and it has smaller bias than the original SMAP VWC method. Future work will be carried out to evaluate the applicability of this VWC estimation method over a lager region. It is expected that it can improve the accuracy of soil moisture by providing high precision VWC input parameters.     

Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment

Abstract

Objective

Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients’ preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies.     

免疫检查点抑制剂应用于晚期胃癌治疗的研究进展

我国属胃癌高发国家,且以进展期胃癌为主。以手术和化疗为主的多学科治疗无法有效改善晚期胃癌患者的预后。近年来,免疫检查点抑制剂类药物的疗效在诸多癌症中得到了证实,因此,该类药物在胃癌中的治疗效果也受到了广泛的关注。本文对近年来的相关研究成果进行综述,全面介绍了免疫检查点抑制剂类药物在胃癌治疗中的临床应用情况、联合用药情况以及不良反应。对于其他治疗均失败的晚期胃癌患者,PD-1抑制剂是一个可行的治疗选项,其代表药物派姆单抗是目前唯一被美国食品药品监督管理局批准应用于胃癌治疗的免疫抑制剂类药物,而我国国家食品药品监督管理总局尚未批准任何此类药物应用于胃癌的临床治疗。如何进一步提高治疗的客观缓解率,将会是后续临床和基础研究的一大焦点。     

关于医用B超基本工作原理及故障维修措施的研究

经济社会的快速发展,提升了人们的生活水平人们对医疗事业的发展提出了更高的要求,我国也加大了对医疗事业的建设与发展。尤其是所使用的相关设备与仪器。其中,医用B超就是最主要的医疗设备,能够通过设备的检查,对人体的身体情况以数据的形式展现,直接能够了解到人体的健康情况,提升医疗事业的技术水平,同时,也为医疗工作这提供了方便快捷的工作方式。但是,医用B超设备在使用的过程中,会受到一些因素的影响,使其发生故障,会对各项工作造成不同程度的影响。因此,需要对其加强管理,能够及时地发现故障问题,采取科学的措施解决,确保医疗事业的稳定发展。