Informa Healthcare

Patients with unresectable Gastrointestinal cancers (GI) including advanced colorectal cancer (CRC) and gall bladder cancer (GBC) have limited treatment options. Treatment with chemotherapy is associated with limited success resulting from therapeutic resistance. Immune checkpoint inhibitors are effective for a subset of metastatic CRC (5% with MSI-H status) and up to 30% of patients with GBC. Therefore, there is an urgent unmet need to discover new predictive biomarkers to aid patient selection for ICIs with a demonstrated clinical value in a challenging patient population. We highlight the utility of a liquid biopsy approach to aid selection of GI cancer patients harbouring rare POLE mutations for immunotherapy, leading to complete metabolic response in addition to radiologic responses and extended survival in all three patients. This study advocates for specialised multi-disciplinary teams performing shared clinical decision making to advance personalised care and improve outcomes of a subset of GI cancer patients with a poor prognosis.

Abstract ObjectiveAcute agitation in psychiatric settings presents significant clinical and safety challenges. Pharmacological management is often necessary when de-escalation strategies fail, but optimal medication regimens remain unclear. This study evaluates the safety, efficacy, and adverse event profiles of commonly used intramuscular (IM) pharmacologic regimens for acute agitation in a multicenter cohort.MethodsWe conducted a retrospective cohort study using de-identified data extracted from the HCA Healthcare corporate database. Adult psychiatric patients who received PRN intramuscular medications for acute agitation were included. Patients were stratified into four treatment groups based on administered medication: (1) haloperidol monotherapy, (2) haloperidol + lorazepam, (3) haloperidol + diphenhydramine, and (4) haloperidol + lorazepam + diphenhydramine. Outcomes assessed included frequency of PRN use, benztropine administration, and incidence of hypotensive and hypoxic episodes. Generalized linear modeling was used for statistical analysis.ResultsThe combination regimen of haloperidol + lorazepam + diphenhydramine (Group 4) was associated with significantly higher odds of receiving multiple PRN administrations compared to haloperidol alone (Group 1). However, this regimen, along with the diphenhydramine-inclusive group (Group 3), was linked to a significantly lower likelihood of requiring benztropine, suggesting a reduction in extrapyramidal symptom burden. No statistically significant group differences were observed in hypotensive or hypoxic episodes.ConclusionTriple-agent regimens may be associated with increased treatment intensity but offer benefits in reducing extrapyramidal symptoms without increasing cardiovascular or respiratory risk. These findings support the thoughtful use of combination IM regimens, particularly those including diphenhydramine, in the management of acute agitation in psychiatric settings.

Sudden cardiac death is the leading medical cause of death among football players. Determining the optimal cardiac screening, the use of carefully selected medical assessments to detect underlying cardiovascular conditions associated with sudden cardiac arrest/death, is a desired objective of the Fédération Internationale de Football Association (FIFA) for football players of all ages. To date, cardiac screening recommendations in football have primarily focused on adult competitive players. Acknowledging its responsibility for player health worldwide, FIFA convened an international working group of cardiology and sports medicine experts to develop cardiac screening recommendations for youth football players. This group performed structured literature reviews and ultimately congregated in January of 2024, when recommendations were presented, scrutinised and judged using a systematic process. The final FIFA recommendations for youth cardiac screening include personal medical history, family medical history, focused physical examination and resting 12-lead electrocardiography. This document provides detailed rationale and clinical recommendations for youth cardiac screening and emphasises the importance of emergency action planning.

Advancements in technology have revolutionised models of healthcare delivery, including the use of telehealth. The coronavirus disease 2019 pandemic prompted a rapid increase in the uptake of telehealth in cancer and other healthcare services through, for example, the use of teleconsultations, and this method of healthcare delivery continues to be used. Skilled communication by healthcare professionals working in cancer care is vital to support patients and their families through their cancer journey, and such communication must extend to teleconsultations. This article explores patients’ perceptions and experiences of teleconsultations when undergoing cancer treatments and follow-up care and discusses the importance of evaluating patient satisfaction with this method of healthcare service delivery.

Abstract BackgroundDepression and anxiety are two frequent neuropsychiatric symptoms in Alzheimer’s disease (AD). Moreover, depressive symptoms and anxiety are frequently associated with greater amyloid deposition and risk of Alzheimer’s dementia. The aim of the present study is to assess the association between anxiety and depression and amyloid burden.MethodIn the AMPYAD study, participants with subjective cognitive decline (SCD+, n = 244), mild cognitive impairment (MCI, n = 341) and dementia (n = 255) were enrolled in eight European memory clinics between 2018 and 2020. They underwent three study visits (baseline, six months, thirteen months) with collection of cognitive data and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale, HADS) as well as measures of quality of life and coping strategies. Amyloid burden was obtained as the standardized centiloid values (CL). Correlation analyses were carried out for HADS‐Scores and CL. We analyzed the progression of depressive and anxiety symptoms over time between patients with and without presence of amyloid (CL≥21) using mixed‐model‐ANOVA. All analyses were corrected for time of PET result disclosure.ResultA total of 840 patients (46.2% female; mean age of 70.9 (SD = 7.8)) were included. Among SCD+ patients, CL values were positively correlated with baseline anxiety scores (r(216) = .14, p = .038). In contrast, MCI and dementia patients showed a negative correlation between CL and depressive symptoms (r(296) = ‐.16, p = .005; r(209) = ‐.23, p<.001). In SCD+, there was no significant interaction between time and CL status for anxiety (p = .512), but a significant main effect of time (F(2,302) = 3.4, p = .036, η² = .02), indicating a decline in anxiety symptoms over time. A trend indicated higher anxiety for amyloid positive participants, but the effect missed statistical significance (p = .068). For depressive symptoms, we found no main effects and no significant interaction of time and CL status.ConclusionThe AMYPAD study contains a large amyloid‐PET data set of patients from eight European memory clinics. We observed an association of increased anxiety scores with amyloid load in SCD+, but reduced symptoms of depression with higher amyloid load in the MCI and dementia group. These findings and their longitudinal development over time will be put into a broader context of patient characteristics.

The primary objective of this study was to identify the relationship between rates of falls among hospitalized patients and the use of inpatient medications associated with falls. This is a retrospective study on patients older than 60 years, hospitalized between January 1, 2021, and December 31, 2021. Ventilated patients and patients with a length of stay or fall less than 48 hours after admission were excluded. Falls were determined by assessing documented post fall assessments in the medical record. Patients who fell were matched 3:1 with control patients based on demographic data (age, sex, length of stay up to the fall time, and Elixhauser Comorbidity score). For controls, a pseudo time to fall was assigned based on matching. Medication information was gathered from barcode administration data. Statistical analysis was conducted using R and RStudio. A total of 6363 fall patients and 19,089 controls met the inclusion and exclusion criteria. Seven drug classes were identified as statistically significant ( P < 0.001) in increasing an inpatient's rate of falling: angiotensin-converting enzyme inhibitors (unadjusted odds ratio [OR], 1.22), antipsychotics (OR, 1.93), benzodiazepines (OR, 1.57), serotonin modulators (OR, 1.2), selective serotonin-reuptake inhibitors (OR, 1.26), tricyclics and norepinephrine reuptake inhibitors (OR, 1.45), and miscellaneous antidepressants (OR, 1.54). Hospitalized patients older than 60 years are more likely to fall while taking angiotensin-converting enzyme inhibitors, antipsychotics, benzodiazepines, serotonin modulators, selective serotonin-reuptake inhibitors, tricyclics, norepinephrine reuptake inhibitors, or miscellaneous antidepressants. Patients on opiates and diuretics had a significant decrease in rate of falls.

How do we measure quality of life and utility of interventions? In this episode of the Value Insider podcast, host Mike Chambers speaks with Prof. Nancy Devlin about incorporating quality of life in value assessment. Prof. Devlin is professor of health economics at the University of Melbourne. Her past roles include Director of Research at the Office of Health Economics (OHE) London, Professor of Health Economics at City University of London, and she has been director of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). She is the Chair of the Board of the EuroQol Research Foundation, the international research organization which has developed and maintains the EQ-5D patient-reported outcome (PRO) instrument. Prof Devlin explains the value of the patient voice and how it can be measured and taken into account when considering the value of healthcare interventions.