Less Effective and More Expensive: Is It Time to Move on From Rectal Diazepam?
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ABSTRACT:
SUBMITTER: Nickels KC
PROVIDER: S-EPMC5967593 | biostudies-literature | 2018 Jan-Feb
REPOSITORIES: biostudies-literature
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Less Effective and More Expensive: Is It Time to Move on From Rectal Diazepam?
Epilepsy currents 20180101 1
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Project description: Not available
| S-EPMC10701462 | biostudies-literature
Project description:BackgroundLocally advanced rectal cancer (LARC) poses unique challenges in treatment, with current neoadjuvant chemoradiotherapy (NA-CRT) showing limitations. The CapeOX regimen emerges as a potential less aggressive neoadjuvant chemotherapy (NAC) for LARC.MethodsWe conducted a retrospective study involving treatment-naïve patients with LARC from March 2014 to March 2021 who received 2-4 cycles of CapeOX NAC followed by radical surgery. Treatment response was evaluated using tumor regression grade (TRG), MRI-based TRG (MRI-TRG), and Neoadjuvant Rectal (NAR) score.Results94.7% of patients experienced symptom improvement and 96.4% achieved sphincter-preserving surgery. Post-NAC showed significant tumor regression and MRI confirmed a tumor length reduction (P < 0.001). Clinical and pathological staging discrepancies post-NAC suggest broader therapeutic advantages. 5-year overall and disease-free survival rates were 78.4% and 73.4%. NAR scores provided better prognostic accuracy than MRI-TRG.ConclusionCapeOX NAC presents notable benefits for LARC patients and its clinical significance may be underestimated. The NAR score demonstrates superior prognostic value over MRI-TRG.
| S-EPMC11463052 | biostudies-literature
Project description:Background:Total mesorectal excision (tme) is the current standard of care for the treatment of rectal cancer. However, that surgery is associated with significant morbidity and mortality. Clinicians and patients are seeking alternatives to radical resection. Currently, prevalent organ-sparing strategies under investigation include local excision and nonoperative management (nom). Methods:We reviewed the current evidence in the literature to create an overview of the use of transanal endoscopic surgery and watch-and-wait strategies in the modern management of rectal cancer. Results:Compared with radical resection, transanal endoscopic surgery in patients with early rectal cancer (cT1) having favourable histopathologic features is associated with an increased risk of local recurrence, but no difference in 5-year survival. In patients with T2 or early T3 cancer, strategies that use neoadjuvant or adjuvant therapy as adjuncts to local excision are under evaluation. Nonoperative management is a new option for patients who experience a complete clinical response after neoadjuvant chemoradiotherapy (ncrt). The selection criteria that will appropriately identify patients for whom nom will succeed are not established. Conclusions:Local excision is appropriate for early rectal cancer with favourable histopathologic features. Although organ-preserving strategies are promising, the quality of the evidence to date is insufficient to replace the current standard care in most patients. Patients should be offered nom in the safe setting of a clinical trial or registry. Rigorous follow-up, including endoscopy and imaging at frequent intervals is recommended when radical resection is forgone.
| S-EPMC6878939 | biostudies-literature
Project description:BackgroundThe online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding.MethodsRecruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described.ResultsOf the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program.ConclusionsBeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability.Trial registrationACTRN12617000682347.
| S-EPMC11441226 | biostudies-literature
Project description:BackgroundSedentary behavior is a major concern in multiple sclerosis, as it may accelerate disease progression and physical disability. This is especially concerning in African Americans, who present with greater neurological disability than Caucasians.ObjectiveWe conducted a feasibility trial on an intervention targeting sedentary behavior in African Americans with multiple sclerosis.MethodsWe examined the feasibility of the Sit Less, Move More program, a 12-week behavioral intervention that used text messaging along with theory-driven newsletters and behavioral coaching for managing sedentary behavior. We recruited ambulatory, inactive, African Americans with multiple sclerosis, and assessed feasibility on process, resource, management, and scientific outcomes.ResultsOf the 64 people initially contacted, 45 were assessed for eligibility, 31 were sent the informed consent document, and 30 returned a signed document and were included in the study. Study costs were US$7242.38. Personnel time to complete the study was 130 h. There was a small effect on both device-measured (d = -0.19) and self-reported (d = -0.39) sedentary behavior.ConclusionsThe Sit Less, Move More intervention is safe and feasible for African Americans with multiple sclerosis, and yielded a small reduction in sedentary behavior. The intervention was low cost and well received. Our results suggest the Sit Less, Move More program should progress towards a Phase II trial to determine its efficacy.
| S-EPMC7288826 | biostudies-literature
Project description:BackgroundCall agents spend ~ 90% of their working day seated, which may negatively impact health, productivity, and wellbeing. This study aimed to explore the acceptability and feasibility of a multi-component workplace intervention targeting increased activity and decreased prolonged sitting in the contact centre setting prior to a full-scale effectiveness trial.MethodsAn 8-week non-randomised pre-post feasibility study was conducted. Using a mixed methods approach, focus groups and interviews were thematically analysed to explore the acceptability and feasibility of key study phases, and provide context to agents' process evaluation and survey responses. The multi-component intervention, conducted in a single call centre, included height-adjustable workstations, emails, education and training sessions, and support from team leaders and a workplace champion.ResultsSix (of 20) team leaders were recruited, with 17 of 84 call agents (78% female, 39.3 ± 11.9 years) completing baseline assessments and 13 completing follow-up. High workload influenced recruitment. Call agents perceived assessments as acceptable, though strategies are needed to enhance fidelity. Education sessions, height-adjustable workstations and emails were perceived as the most effective components; however, height-adjustable hot-desks were not perceived as feasible in this setting.ConclusionsThis study has identified unique, pragmatic considerations for conducting a multi-level, multi-component PA and SB intervention and associated evaluation in highly sedentary call agents in the challenging contact centre setting. The intervention was largely perceived positively, with call agents and team leaders describing numerous perceived positive effects on behavioural, health and work-related outcomes. Findings will be of value to researchers attempting to intervene in contact centres and will be used by the current authors to design a subsequent trial.
| S-EPMC6416901 | biostudies-literature
Project description:Unhealthy diets are recognized as a major risk factor for many diseases. The decrease in costs of industrialized products, as well as the possible misinformation about a healthy diet, has led to new behaviors in the dietary patterns of the pediatric population. The costs of dietary patterns have not been estimated in our population, so the objective of this study was to determine the cost associated with dietary patterns in Mexican children and adolescents, hypothesizing that a healthy diet is not necessarily more economically expensive. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents in Mexico City. Data were collected from a food frequency questionnaire and the meal cost of habitual food shopping. Eating patterns were obtained by using principal component analysis. A micro-costing technique was performed to obtain the direct costs of each pattern. When comparing the healthy pattern with the transition and non-healthy patterns, it was observed that there were no statistically significant differences between the dietary patterns (p = 0.8293). The cost of the healthy pattern only takes up 16.6% of the total biweekly income of a salaried Mexican. In this study, no differences were observed between the costs of a healthy and a less healthy diet.
| S-EPMC8624608 | biostudies-literature
Project description:The evolutionary stability of mutualistic interactions involving multiple partners requires "sanctioning"-the ability to influence the fitness of each partner based on its respective contribution. Sanctions must be sensitive to even small differences if even slightly less-beneficial partners could gain a fitness advantage by diverting resources away from the mutualistic service toward their own reproductive fitness. Here, we test whether legume hosts sanction even mediocre N2-fixing rhizobial strains by influencing either nodule growth (which limits rhizobial cell numbers) or carbon accumulation (polyhydroxybutryate or PHB) per rhizobial cell. We also test whether sanctions depend on the availability of less-expensive nitrogen alternatives, either as nitrate or coinoculation with a more-efficient isogenic strain. We found that nitrate eliminated differences in nodule size between the mediocre and more-efficient strains, suggesting that host sanctions were compromised. However, nitrate additions also decreased PHB accumulation by the mediocre strain, which may eliminate any fitness advantages of diverting resources from N2 fixation. Coinoculation with a more-efficient strain could also compromise host sanctions if reduction in fitness from smaller nodules does not offset the potential fitness gain from greater PHB accumulation that we observed in the mediocre strain. Hence, a host's ability to sanction mediocre strains depends not only on alternative sources of nitrogen but also the relative importance of different components of rhizobial fitness.
| S-EPMC7548176 | biostudies-literature
Project description:The validity of biological explanations of patterns of palaeodiversity has been called into question owing to an apparent correlation of diversity with the amount of sedimentary rock preserved. However, this claim has largely been based on comprehensive estimates of global marine Phanerozoic diversity, thus raising the question of whether a similar bias applies to the records of smaller, well-defined taxonomic groups. Here, new data on European Caenozoic marine sedimentary rock outcrop area are presented and compared with European occurrences of three groups of marine mammals (cetaceans, pinnipedimorphs and sirenians). Limited evidence was found for a correlation of outcrop area with marine mammal palaeodiversity. In addition, similar patterns were identified in the cetacean and pinnipedimorph diversity data. This may point to the preservation of a genuine biological signal not overwhelmed by geological biases in the marine mammal diversity data, and opens the door to further analyses of both marine mammal evolution and geological bias in other small and well-defined groups of taxa.
| S-EPMC2664371 | biostudies-literature
Project description:Blacks have higher stroke incidence and experience greater poststroke disability than whites. To optimize care for stroke survivors, it is important to understand the amount of care that they receive and the implications for stroke caregivers. Data from 2 nationally representative, population-based studies, the NHATS (National Health and Aging Trends Study) linked to the NSOC (National Study of Caregiving), were used to identify elderly stroke survivors and their caregivers. We compared hours of care received and unmet activity need among the 581 white and 225 black stroke survivors. We then performed racial comparisons of positive and negative aspects of caregiving reported by caregivers of black and white stroke survivors. Black stroke survivors were more likely than white stroke survivors to have a caregiver (62.5% versus 49.7%; P<0.01) and received on average more hours of help per week (31.7 versus 20.5; P<0.01). There was little racial difference in unmet need for assistance. Caregivers of black stroke survivors reported more positive aspects of caregiving than caregivers of white stroke survivors (6.8 versus 6.0; P<0.01). There was no racial difference in negative aspects of caregiving, depression, or anxiety. Black stroke survivors received an average of ≈11 more hours of care than white stroke survivors without substantial differences in unmet need. Despite providing more hours of care, caregivers of black stroke were more positive about their caregiver role than caregivers of white stroke survivors.
| S-EPMC5325085 | biostudies-literature