Subgroup And Quality Of Life Analyses Of The Phase Iii Clinical Trial Of Novottf-100a Versus Best Standard Chemotherapy For Recurrent Glioblastoma

BACKGROUND: NovoTTF is a portable device delivering low-intensity, intermediate-frequency, electric fields using noninvasive, disposable scalp electrodes. These fields physically interfere with cell division. Preliminary studies in recurrent and newly diagnosed glioblastoma (GBM) have shown promising results. A phase III study in recurrent GBM has recently been concluded. METHODS: Adults (KPS ≥ 70%) with recurrent GBM (any recurrence) were randomized (stratified by surgery and center) to either NovoTTF administered continuously (20-24 hours/day, 7 days/week) or the best available chemotherapy (best physician choice [BPC]). Primary endpoint was overall survival (OS); 6-month progression-free survival (PFS6), 1-year survival, and QOL were secondary endpoints. RESULTS: Two hundred thirty-seven patients were randomized (28 centers in the United States and Europe) to either NovoTTF alone (120 patients) or BPC (117 patients). Patient characteristics were balanced, median age was 54 years (range, 23-80 years), median KPS was 80% (range, 50-100). One quarter had surgery for recurrence, and over half were at their second or more recurrence. A survival advantage for the device group was seen in patients treated according to protocol (median OS, 7.8 months vs. 6.1 months; n = 185; p = 0.01). Moreover, subgroup analysis in patients with better prognostic baseline characteristics (KPS ≥ 80%; age ≤ 60; 1st-3rd recurrence) demonstrated a robust survival benefit for NovoTTF patients compared to matched BPC patients (median OS, 8.8 months vs. 6.6 months; n = 110; p < 0.01). In this group, 1-year survival was 35% vs. 20% and PFS6 was 25.6% vs. 7.7%. Interestingly, in patients who failed bevacizumab prior to the trial, OS was also significantly extended by NovoTTF (4.4 months vs. 3.1 months; n = 23 vs. n = 21; p < 0.02). Quality of life was equivalent or superior in NovoTTF patients. CONCLUSIONS: NovoTTF, a noninvasive, novel cancer treatment modality shows significant therapeutic efficacy with improved quality of life. The impact of NovoTTF was more pronounced when patients with better baseline prognostic factors were treated. A large scale phase III clinical trial in newly diagnosed GBM is currently being conducted.

Brachial or wrist blood pressure in obese patients : which is the best ?

RESUME L'obésité et l'hypertension atteignent des niveaux épidémiques aussi bien dans les pays industrialisés que dans ceux en voie de développement. La coexistence de ces deux pathologies est associée à un risque cardiovasculaire augmenté. Traditionnellement on mesure la pression artérielle (PA) au bras au moyen d'un brassard qui détermine la pression systolique et diastolique en utilisant soit la méthode auscultatoire ou oscillométrique. L'utilisation d'un brassard de taille standard chez le patient avec un tour de bras augmenté peut surestimer la pression artérielle. Il semble même qu'il existe un rapport idéal entre le tour de bras, et la taille du brassard La mesure à domicile de la pression artérielle avec des appareils validés donne des valeurs de la PA valables. Plusieurs appareils existent sur le marché et depuis quelques années les appareils de mesure de la PA au poignet font leur apparition sur le marché. Cette étude vise à comparer chez des sujets sains et obèses les valeurs de PA obtenues au poignet avec celles obtenues au bras en utilisant deux appareils validés l'OMRON HEM 705-CP et l'OMRON R6. L'OMRON HEM 705-CP permet l'utilisation soit d'un brassard standard (13x30 cm) ou d'un brassard large (16x38 cm), et l'OMRON R6 mesure la PA au poignet. Nous avons comparé un groupe de sujets obèses [Body Mass Index (BMI) >35kg/m2] avec un groupe de sujets sains (BMI <25kg/m2). Ont été exclues de l'étudé les personnes prenant un traitement antihypertenseur ainsi que celles souffrant d'arythmies. La PA a été mesurée en position assise avec le bras gauche sur une table à hauteur du coeur. Un brassard large a été employé pour les sujets obèses et un brassard standard pour les sujets sains. Trois mesures ont été effectuées, la première après une pause de 5 min et chacune des suivantes avec un intervalle de 2 min. La pression d'inflation maximale a été fixée à 170 mmHg. Nous avons utilisé la formule proposée par Marks LA et al pour déterminer si le rapport entre la taille des brassards fournis avec l'OMRON .HEM 705-CP et le tour de bras de nos sujets était optimal (taille du brassard = 9.34 x log10 taille du bras). Nos résultats ne montrent pas de différence statistiquement significative de la PA diastolique entre les deux groupes, qu'elle soit mesurée au bras ou au poignet. La PA systolique mesurée au bras s'est par contre avérée significativement plus basse chez les sujets obèses que chez les sujets sains. Aucune différence n'a été trouvée lorsque la mesure est effectuée au poignet. En utilisant la formule fournie par Marks le rapport entre taille du brassard (large chez les obèses) et tour de bras a été de 10.30±30 chez les sujets obèses et 9.630.45 chez les sujets sains (p<0.001). Le rapport entre tour de bras et brassard chez les sujets obèses est nettement au-dessus de la valeur optimale, ce qui suggère une possible sous-estimation de la PA systolique chez ces sujets. Ces résultats suggèrent qu'il existe un risque de sous-estimer la PA chez le patient obèse lors de l'utilisation d'un brassard large. Cette erreur pourrait être réduite par l'utilisation d'appareils de mesure au poignet. validés chez le sujet obèse.

Bonnes pratiques de promotion de la santé des personnes âgées : développement des théories d'action des interventions = Best Practice Gesundheitsförderung im Alter (BPGF) : Entwicklung von Wirkungsmodellen.

Le projet "Bonnes pratiques de promotion de la santé des personnes âgées" vise à définir des recommandations pour promouvoir la santé des personnes âgées dans les différents cantons suisses adhérents au projet. Cinq instituts suisses ont ainsi été mandatés à produire un rapport faisant état de la situation relative à cinq domaines :- mesures visant à stimuler l'activité physique;- prévention des chutes;- participation du corps médical (médecins de famille);- conseils en matière de santé, manifestations, cours;- accès aux groupes-cibles et outils de recrutement.Dans le but de définir les bases pour une évaluation future des interventions recommandées, le présent rapport, sollicité par Promotion Santé Suisse, détaille le travail effectué avec les équipes responsables de chaque domaine pour élaborer une série de trois synthèses de leur travail, à savoir :- une analyse de la situation en question (problèmes constatés);- une théorie d'action définissant les objectifs intermédiaires et finaux à atteindre à partir des recommandations faites dans leur domaine;- une liste des indicateurs associés aux objectifs prioritaires.Ces synthèses ont été réalisées à l'aide du modèle de catégorisation des résultats de promotion de la santé et de la prévention (SMOC) un outil développé conjointement par les Instituts universitaires de médecine sociale et préventive de Berne et de Lausanne, en collaboration avec Promotion Santé Suisse. Les théories d'action ainsi élaborées ont ensuite été intégrées dans une théorie d'action globale correspondant à l'ensemble du projet " Bonnes pratiques de promotion de la santé des personnes âgées ". [P. 5]

Conduite automobile et troubles cognitifs: comment anticiper [Driving and cognitive impairment: how best to anticipate?].

Driving requires integrating multiple motor, sensory, and cognitive skills. As people age, cognition becomes increasingly vulnerable due to impairment and dementia. Older drivers suffering from dementia, even at an early stage, have been shown to be significantly more likely to develop unsafe driving. Primary care physicians have the difficult task to assess these persons' driving capacity. This paper briefly describes the consequences of altered cognition on driving capacity and proposes an algorithm to address this challenge.

Présentation de la méthode de revue systématique BEST

Séance de travail de la Direction des Soins, CHUV, Lausanne

Endovascular Versus Open Abdominal Aortic Aneurysm: Best Decision.

Since the first implantation of an endograft in 1991, endovascular aneurysm repair (EVAR) rapidly gained recognition. Historical trials showed lower early mortality rates but these results were not maintained beyond 4 years. Despite newer-generation devices, higher rates of reintervention are associated with EVAR during follow-up. Therefore, the best therapeutic decision relies on many parameters that the physician has to take in consideration. Patient's preferences and characteristics are important, especially age and life expectancy besides health status. Aneurysmal anatomical conditions remain probably the most predictive factor that should be carefully evaluated to offer the best treatment. Unfavorable anatomy has been observed to be associated with more complications especially endoleak, leading to more re-interventions and higher risk of late mortality. Nevertheless, technological advances have made surgeons move forward beyond the set barriers. Thus, more endografts are implanted outside the instructions for use despite excellent results after open repair especially in low-risk patients. When debating about AAA repair, some other crucial points should be analysed. It has been shown that strict surveillance is mandatory after EVAR to offer durable results and prevent late rupture. Such program is associated with additional costs and with increased risk of radiation. Moreover, a risk of loss of renal function exists when repetitive imaging and secondary procedures are required. The aim of this article is to review the data associated with abdominal aortic aneurysm and its treatment in order to establish selection criteria to decide between open or endovascular repair.

'And the best essay is...' : Extended contact and cross-group friendships at school

We conducted one experimental intervention based on extended contact principles aimed at fostering the formation of cross-group friendships within educational settings. Italian school children took part in a school competition for the best essay on personal experiences of cross-group friendships with immigrants, to be written in small groups. This manipulation was intended to favour the exchange of personal positive cross-group experiences, thus capitalizing on the benefits of extended contact. In the control condition, participants wrote an essay on friendship, without reference to cross-group relations. Results revealed that children who took part in the intervention reported a higher number of outgroup friends 3 months later. This indirect effect was sequentially mediated by pro-contact ingroup and outgroup norms and by outgroup contact behavioural intentions. This study provides experimental evidence that interventions based on extended contact can foster cross-group friendship formation. Theoretical and practical implications of the findings are discussed.

Best practice report on policy learning infrastructures in innovative labour market policies

This report synthesizes the findings of 11 country reports on policy learning in labour market and social policies that were conducted as part of WP5 of the INSPIRES project, which is funded by the 7th Framework Program of the EU-Commission. Notably, this report puts forward objectives of policy learning, discusses tools, processes and institutions of policy learning and presents the impacts of various tools and structures of the policy learning infrastructure for the actual policy learning process. The report defines three objectives of policy learning: evaluation and assessment of policy effectiveness, vision building and planning, and consensus building. In the 11 countries under consideration, the tools and processes of the policy learning, infrastructure can be classified into three broad groups: public bodies, expert councils, and parties, interest groups and the private sector. Finally, we develop four recommendations for policy learning: Firstly, learning processes should keep the balance between centralisation and plurality. Secondly, learning processes should be kept stable beyond the usual political business cycles. Thirdly, policy learning tools and infrastructures should be sufficiently independent from political influence or bias. Fourth, Policy learning tools and infrastructures should balance out mere effectiveness, evaluation and vision building.

Body donations today and tomorrow: What is best practice and why?

There is considerable agreement that the use of human bodies for teaching and research remains important, yet not all universities use dissection to teach human gross anatomy. The concept of body donation has evolved over centuries and there are still considerable discrepancies among countries regarding the means by which human bodies are acquired and used for education and research. Many countries have well-established donation programs and use body dissection to teach most if not all human gross anatomy. In contrast, there are countries without donation programs that use unclaimed bodies or perhaps a few donated bodies instead. In several countries, use of cadavers for dissection is unthinkable for cultural or religious reasons. Against this background, successful donation programs are highlighted in the present review, emphasizing those aspects of the programs that make them successful. Looking to the future, we consider what best practice could look like and how the use of unclaimed bodies for anatomy teaching could be replaced. From an ethical point of view, countries that depend upon unclaimed bodies of dubious provenance are encouraged to use these reports and adopt strategies for developing successful donation programs. In many countries, the act of body donation has been guided by laws and ethical frameworks and has evolved alongside the needs for medical knowledge and for improved teaching of human anatomy. There will also be a future need for human bodies to ensure optimal pre- and post-graduate training and for use in biomedical research. Good body donation practice should be adopted wherever possible, moving away from the use of unclaimed bodies of dubious provenance and adopting strategies to favor the establishment of successful donation programs. Clin. Anat. 29:11-18, 2016. © 2015 Wiley Periodicals, Inc.