Avoiding the needle: A quality improvement program introducing apixaban for extended thromboprophylaxis after major gynecologic cancer surgery.

OBJECTIVE: Patients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP. METHODS: In this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures. RESULTS: From August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0.0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than $125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events. CONCLUSIONS: Introduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.

Concurrent Lapatinib With Brain Radiation Therapy in Patients With HER2+ Breast Cancer With Brain Metastases: NRG Oncology-KROG/RTOG 1119 Phase 2 Randomized Trial.

PURPOSE: Lapatinib plus whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) was hypothesized to improve the 12-week intracranial complete response (CR) rate compared with either option of radiation therapy (RT) alone for patients with brain metastases (BM) from human epidermal growth factor receptor 2-positive (HER2+) breast cancer. METHODS AND MATERIALS: This study included patients with HER2+ breast cancer with ≥1 measurable, unirradiated BM. Patients were randomized to WBRT (37.5 Gy/3 wk)/SRS (size-based dosing) ± concurrent lapatinib (1000 mg daily for 6 weeks). Secondary endpoints included objective response rate (ORR), lesion-specific response, central nervous system progression-free survival, and overall survival. RESULTS: From July 2012 to September 2019, 143 patients were randomized, with 116 analyzable for the primary endpoint. RT + lapatinib did not improve 12-week CR (0% vs 6% for RT alone, 1-sided P = .97), or ORR at 12 weeks. At 4 weeks, RT + lapatinib showed higher ORR (55% vs 42%). Higher graded prognostic assessment and ≤10 lesions were associated with higher 12-week ORR. Grade 3 and 4 adverse event rates were 8% and 0% for RT and 28% and 6% for RT + lapatinib. CONCLUSIONS: The addition of 6 weeks of concomitant lapatinib to WBRT/SRS did not improve the primary endpoint of 12-week CR rate or 12-week ORR. Adding lapatinib to WBRT/SRS showed improvement of 4-week ORR, suggesting a short-term benefit from concomitant therapy.

Risk for Hereditary Neoplastic Syndromes in Women with Mismatch Repair-Proficient Endometrial Cancer.

Endometrial cancer (EC) is a prevalent malignancy in women, and those who are proficient in the DNA mismatch repair (pMMR) pathway may have a family history (FH) that meets the criteria for a hereditary neoplastic condition (HNS). This study aimed to estimate the risk of HNS in women with pMMR endometrial tumors by analyzing their FH. To achieve this, we collaborated with a primary study and collected FH information by telephone. The final sample comprised 42 women who responded to the Primary Screening Questionnaire. Their family pedigrees were drawn and categorized according to internationally standardized criteria for the risk of HNS. Results showed that 26 women (61%) were found to be at risk for HNS, with Bethesda criteria being met by 23%, Amsterdam criteria by 15%, and 4% met the attenuated familial adenomatous polyposis criteria. Our results emphasize the importance of FH and the need to encourage healthcare professionals to collect and document FH more frequently, even if it is self-reported. By identifying individuals with HNS, we can improve their outcomes and reduce the burden of cancer in families with a predisposition to cancer.

Novel Prognostic Staging System for Patients With De Novo Metastatic Breast Cancer.

PURPOSE: Given the heterogeneity and improvement in outcomes for metastatic breast cancer (MBC), we developed a staging system that refines prognostic estimates for patients with metastatic cancer at the time of initial diagnosis, de novo MBC (dnMBC), on the basis of survival outcomes and disease-related variables. METHODS: Patients with dnMBC (2010-2016) were selected from the National Cancer Database (NCDB). Recursive partitioning analysis (RPA) was used to group patients with similar overall survival (OS) on the basis of clinical T category, grade, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. Three-year OS rates were used to assign a final stage: IVA: >70%, IVB: 50%-70%, IVC: 25 to <50%, and IVD: <25%. Bootstrapping was applied with 1,000 iterations, and final stage assignments were made based on the most commonly occurring assignment. Unadjusted OS was estimated. Validation analyses were conducted using SEER and NCDB. RESULTS: At a median follow-up of 52.9 months, the median OS of the original cohort (N = 42,467) was 35.4 months (95% CI, 34.8 to 35.9). RPA stratified patients into 53 groups with 3-year OS rates ranging from 73.5% to 5.7%; these groups were amalgamated into four stage groups: 3-year OS, A = 73.2%, B = 61.9%, C = 40.1%, and D = 17% (log-rank P < .001). After bootstrapping, the survival outcomes for the four stages remained significantly different (log-rank P < .001). This staging system was then validated using SEER data (N = 20,469) and a separate cohort from the NCDB (N = 7,645) (both log-rank P < .001). CONCLUSION: Our findings regarding the heterogeneity in outcomes for patients with dnMBC could guide future revisions of the current American Joint Committee on Cancer staging guidelines for patients with newly diagnosed stage IV disease. Our findings should be independently confirmed.

Vivências subjetivas de profissionais que realizam Vigilância em Saúde do Trabalhador / Subjective experiences of professionals who carry out Occupational Health Surveillance

Este artigo objetiva compreender a mobilização subjetiva que surge na atividade de trabalho de profissionais que realizam Vigilância em Saúde do Trabalhador (Visat). Participaram deste estudo cinco trabalhadores, de ambos os sexos, de um Centro de Referência em Saúde do Trabalhador (Cerest) da capital de um estado do Nordeste do Brasil, os quais foram entrevistados nos meses de janeiro e fevereiro de 2020. Os materiais produzidos foram analisados à luz da Psicodinâmica do Trabalho. Os resultados mostram que sua fonte de sofrimento está ligada ao que é vivido pelos trabalhadores das empresas que passam por Visat, cujos problemas relacionados à precarização muitas vezes ficam sem solução. Ao lado disso, aqueles que fazem Visat também se percebem muitas vezes precarizados em seus salários, vínculos e condições de trabalho. Finalmente, a falta de estrutura e investimento em saúde do trabalhador, assim como a legislação

This study aims to understand the subjective mobilization that arises in the work activity of professionals who perform Worker Health Surveillance (WHS). In total, five workers of all genders from a Worker Health Reference Center (WHRC) in a capital city of a Northeastern state in Brazil participated in this study. They were interviewed in January and February 2020. The materials produced were analyzed in light of Work Psychodynamics. Results show that their source of suffering is linked to what they experience in companies undergoing WHS, whose precarization-related problems often remain unresolved. In addition to this, those who perform WHS also often perceive themselves as in precarious situations regarding their salaries, job security, and working conditions. Finally, the lack of structure and investment in workers' health and legislation (particularly at the municipal level) pose significant challenges for them to carry out their work

Pseudo Bartter Syndrome in anorexia nervosa.

INTRODUCTION: Anorexia nervosa is a psychiatric disorder with various non-psychiatric manifestations that arise from the self-imposed malnourishment and possible purging behaviors. These medical manifestations or complications may mimic non psychiatric disorders and difficult the diagnosis of an eating disorder. CASE REPORT: We report the case of a patient with a binge-eating/purging subtype of anorexia nervosa, whose purges consisted in diuretic abuse. She kept her purges secret and during more than 1 year she was admitted several times in the emergency room for, sometimes life-threatening, hypokalemia. Furthermore, she consulted practitioners from different specialties and was hospitalized in a nephrology service to investigate chronic hypokalemia and other metabolic and hydroelectrolytic disturbances. A Bartter Syndrome was suspected, and she underwent genetic testing. Eventually she started psychiatric follow up and was admitted as an inpatient under the care of a specialized eating disorders unit. CONCLUSION: This patient presented a series of metabolic disturbances secondary to the diuretic abuse, that mimicked the manifestations of hereditary tubulopathies like Bartter Syndrome. Coincidentally it was found that the patient had a mutation in a gene linked to Bartter Syndrome, that wasn't enough to justify this diagnosis. So, a Pseudo Bartter Syndrome secondary to the diuretic abuse was evident. The focus on medical manifestations delayed the recognition of the anorexia nervosa and the associated diuretic abuse as the main cause of the electrolyte and metabolic disturbances. This case emphasizes the importance of being familiarized with the non-psychiatric manifestations of eating disorders, so they may be rapidly recognized and managed. LEVEL OF EVIDENCE: Level V, Case Report.

Ancestral library identifies conserved reprogrammable liver motif on AAV capsid.

Gene therapy is emerging as a modality in 21st-century medicine. Adeno-associated viral (AAV) gene transfer is a leading technology to achieve efficient and durable expression of a therapeutic transgene. However, the structural complexity of the capsid has constrained efforts to engineer the particle toward improved clinical safety and efficacy. Here, we generate a curated library of barcoded AAVs with mutations across a variety of functionally relevant motifs. We then screen this library in vitro and in vivo in mice and nonhuman primates, enabling a broad, multiparametric assessment of every vector within the library. Among the results, we note a single residue that modulates liver transduction across all interrogated models while preserving transduction in heart and skeletal muscles. Moreover, we find that this mutation can be grafted into AAV9 and leads to profound liver detargeting while retaining muscle transduction-a finding potentially relevant to preventing hepatoxicities seen in clinical studies.

Germline Testing and Somatic Tumor Testing for BRCA1/2 Pathogenic Variants in Ovarian Cancer: What Is the Optimal Sequence of Testing?

PURPOSE: In 2020, ASCO recommended that all women with epithelial ovarian cancer have germline testing for BRCA1/2 mutations, and those without a germline pathogenic variant (PV) should have somatic tumor testing to determine eligibility for a poly (ADP-ribose) polymerase inhibitor. Consequently, the majority of patients with ovarian cancer will have both germline testing and somatic testing. An alternate strategy is tumor testing first and then germline testing if there is a PV in the tumor and/or significant family history. The objective was to conduct a cost-effectiveness analysis comparing the two testing strategies. METHODS: The Markov model compared the costs (US dollars) and benefits of two testing strategies for newly diagnosed ovarian cancer: (1) ASCO strategy and (2) tumor testing triage for germline testing. Data were applied from SOLO-1, and costs were from wholesale acquisition prices, Medicare, and published sources. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number tested and identified with germline and somatic BRCA PV for olaparib maintenance treatment annually in the US population. RESULTS: The ASCO strategy was more effective but more costly than tumor testing triage in identifying patients for olaparib, with an incremental cost-effectiveness ratio of $281,296 US dollars per progression-free life year gained. Assuming 10,000 eligible patients with ovarian cancer annually, Monte Carlo simulation yielded comparable numbers of patients with BRCA PV in the germline and tumor with the ASCO and tumor testing triage strategies (2,080 v 2,062, respectively), but substantially higher number of patients tested using the ASCO strategy (8,052 v 3,076). CONCLUSION: The ASCO strategy may identify more BRCA PVs but is not cost-effective. Tumor testing in epithelial ovarian cancer as triage for germline testing is the favored strategy in this health care system.

Narcisismo, pró-sociabilidade e agressão: o papel mediador da empatia / Narcisismo, prosociabilidad y agresión: el papel mediador de la empatía / Narcissism as Predictor of Pro-Socialness and Aggression: The Mediating Role of Empathy

O presente estudo objetivou investigar o papel mediador da empatia, tomando em conta o narcisismo como variável preditora em dois diferentes modelos, tendo a pró-sociabilidade como variável dependente no primeiro e as dimensões de agressão no segundo. Para isso, contouse com uma amostra de 205 participan-tes da cidade de João Pessoa (m = 27.43; dp= 9.13). Utilizouse a Single-Item Narcissism Scale, aEscala Multidimensional de Reatividade Interpessoal, a Es-cala de Pró-sociabilidade, o Questionário de Agressão e um questionário sociodemográfico. Os dados foram processados com o auxílio do ibmspss e amos através das análises descritivas e inferenciais (correlações e me-diação). Os resultados apontaram para efeitos diretos negativos do narcisismo na empatia e no comportamento pró-social; e efeitos diretos positivos na agressão. Além disso, verificouse o papel mediador da empatia na relação entre o narcisismo e a pró-sociabilidade, não encontrado na relação narcisismo e agressão. Esses achados corroboram estudos prévios, bem como contribuem para o entendimento das interrelações dos construtos estudados.

El presente estudio tuvo como objetivo investigar el papel mediador de la empatía, teniendo en cuenta el narcisismo como variable predictora en dos modelos diferentes, con la prosociabilidad como variable dependiente en el primero y las dimensiones de agresión en el segundo. Para ello, se contó una muestra de 205 encuestados de la ciudad de João Pessoa (m= 27.43; sd= 9.13). Se utilizó la Escala de Narcisismo de Ítem Único, la Escala de Reactividad Interpersonal Multidimensional, la Es-cala de Prosociabilidad, el Cuestionario de Agresión yun cuestionario sociodemográfico. Los datos fueron procesados con la ayuda de ibmspss y amos, a través de análisis descriptivos e inferenciales (correlaciones y mediación). Los resultados apuntaron a efectos negativos directos del narcisismo sobre la empatía y el comportamiento prosocial, y a efectos directos positivos sobre la agresión. Además, se verificó el papel mediador de la empatía en la relación entre narcisismo y prosociabilidad, lo que no se encontró en la relación entre narcisismo y agresión. Estos hallazgos corroboran estudios previos, además de contribuir a la comprensión de las interrelaciones de los constructos estudiados.

This study aimed to investigate the mediating role of empathy, considering narcissism as a predictor variable in two different models, with pro-sociality as the dependent variable in the first and dimensions of agression in the second. The sample was composed of 205 respondents from João Pessoa (m= 27.43, sd = 9.13). We used the Single-Item Narcissism Scale, the Multidimensional Interpersonal Reactivity Scale, the Pro-Sociability Scale, the Aggression Questionnaire, and a sociodemographic questionnaire. The data were processed using ibmspssand amos through descriptive and inferential analyses (correlations and mediation). The main results pointed to negative direct effects of narcissism on empathy and pro-social behavior and to direct positive effects on ag-gression. Furthermore, it was confirmed that empathy has a mediating role in the relation between narcissism and pro-sociability, which was not found for the relation between narcissism and aggression. These findings corro-borate previous studies and contribute to the comprehension of the interrelationships of the studied constructs.

Conhecimento sobre Direitos das Crianças e dos Adolescentes de Mães do Rio Grande do Sul / Mothers' Awareness of Children and Adolescents' Rights in Rio Grande do Sul / Conocimiento de las Madres sobre los Derechos de los Niños y Adolescentes en Rio Grande do Sul

Ainda que o Estatuto da Criança e do Adolescente tenha 30 anos, observam-se impasses em relação ao seu conhecimento por parte dos brasileiros, bem como à sua implementação. Esse estudo objetivou analisar o conhecimento de mães de crianças de dois a oito anos sobre os direitos das crianças e dos adolescentes e sua percepção sobre situações de violação. Para tanto, 56 mães responderam a uma entrevista, que foi analisada quanti e qualitativamente. A análise demonstrou que muitas participantes não souberam nomear a lei brasileira específica responsável pela proteção dos direitos. Ainda, 89,3% não consideravam a palmada como violência física e somente sete mães apresentaram convicção de que a palmada seja uma agressão. Em relação ao abuso sexual, 94,64% das participantes consideraram violência sexual os atos de mostrar fotos/vídeos, tocar e olhar com malícia para uma criança. Contudo, frente à apresentação de uma situação hipotética de relação sexual entre uma jovem de 14 anos e um adulto de mais de 35 anos, 30,35% das mães apontaram a adolescente como total ou parcialmente responsável pelo ato. Os resultados evidenciaram a necessidade de debates sobre a legislação, como também da promoção de atividades que ofereçam para os pais alternativas não violentas de educação.

Even though the Statute for Children and Adolescents is 30 years old, there are still impasses in relation to its awareness on the part of Brazilians, as well as its implementation. This study aimed to analyze the mothers of 2 to 8-year-olds' awareness about the rights of children and adolescents and perception of violations. For this purpose, 56 mothers responded to an interview which was quantitative and qualitatively analyzed. The analysis showed many participants were unable to name the specific Brazilian law responsible for the protection of rights. In addition, 89.3% did not consider spanking as physical violence and only seven mothers recognized spanking as physical aggression. Regarding sexual abuse, 94.64% of the participants considered acts of showing photos or videos and inappropriate touching and looking at a child as sexual violence. However, considering a hypothetical situation of sexual intercourse between a 14-year-old young girl and an adult over 35 years old, 30.35% of the mothers indicated the adolescent was total or partially responsible for the act. Results highlight the need for debates about legislation, besides the promotion of activities that offer parents non-violent education alternatives.

Aunque el Estatuto de la Niñez y la Adolescencia tenga 30 años, aún existen embarazos con respecto al conocimiento por parte de los brasileños, así como la implementación. Este estudio tuvo como objetivo analizar el conocimiento de las madres de niños de 2 a 8 años sobre los derechos de los niños y adolescentes y su percepción de las situaciones de violación. Para ello, 56 madres respondieron a una entrevista, la cual fue analizada cuantitativa y cualitativamente. El análisis mostró que muchas participantes no supieron nombrar la ley brasileña específica responsable de la protección de derechos. Además, el 89,3% no consideró las palmadas como violencia física y solo siete madres las reconocieron como agresión física. En relación al abuso sexual, el 94,64% de las participantes consideró como actos sexuales mostrar fotos o videos, tocar y mirar a un niño con malicia. Sin embargo, frente la presentación de una situación hipotética de relación sexual entre una niña de 14 años y un adulto mayor de 35 años, el 30,35% de las madres señalaron a la adolescente como total o parcialmente responsable del hecho. Los resultados mostraron la necesidad de debates sobre legislación, así como la promoción de actividades que ofrezcan a los padres alternativas no violentas a la educación.

Markers of mitochondrial energy metabolism and their potential relationships with fatigue in human adults: a scoping review

This scoping review aimed to synthesize the best available evidence of the associations between molecular and genetic markers of mitochondrial metabolism and fatigue in human adults. The research question guiding this review was, "Are there potential relationships between mitochondrial metabolism markers and fatigue?" The literature search used three terms (mitochondria; fatigue; energy metabolism), which yielded 263 manuscripts and 22 theses/dissertations. The studies included in the review had to meet three criteria: (1) Include adult participants (≥18 years of age); (2) Show a relationship between mitochondrial energy metabolism and fatigue; (3) Be published in English, Spanish, or Portuguese. Of the 17 articles included for a full-text review, some had a cross-sectional design (6/17, 35%), and more than half (12/17, 70%) were published between 2015 and 2020. The predominant population studied were patients diagnosed with chronic fatigue syndrome (9/17, 53%). Most studies (15/17, 88%) assessed fatigue with validated instruments. Mitochondrial markers associated with fatigue are a) mitochondrial transport pathways and respiratory chain, b) mutations in mitochondrial DNA, and c) energy disorders in cells of the immune system, such as natural killer cells. Mitochondrial metabolic activities, such as the production and transport of ATP, are significant components that may help understand the etiology of fatigue. Future directions should include longitudinal study designs, characterization of fatigue phenotypes, and the identification of markers involved in production and transport pathways. The clinical relevance in this field can lead to interventions targeting mitochondrial markers to reduce or prevent fatigue.

Binge Drinking Among Public Sector Food Service Workers in Brazil: Physical and Psychosocial Demands on Focus.

OBJECTIVE: To investigate occupational risk factors associated with binge drinking (BD) among public sector food service workers in a Brazilian capital. METHODS: All workers from the Government-backed Economy Restaurant Program (GbERP) in Belo Horizonte city were evaluated. BD was defined as consumption of five or more doses (male) or four or more doses (female) of alcoholic beverages on a single occasion within 30 days. Occupational psychosocial and physical stressors were the main exposure variables; sociodemographic, health, and lifestyle variables were inserted as potential confounding factors. We performed logistic regression. RESULTS: A total of 214 people participated in the study and 30.7% reported BD. Psychosocial (violence and high demands) and ergonomic aspects were associated with the outcome. CONCLUSION: There was a high prevalence of BD among GbERP workers. Actions are necessary to reduce violence and high strain and consequently BD.

Use of Treatment-Focused Tumor Sequencing to Screen for Germline Cancer Predisposition.

Next-generation sequencing assays are capable of identifying cancer patients eligible for targeted therapies and can also detect germline variants associated with increased cancer susceptibility. However, these capabilities have yet to be routinely harmonized in a single assay because of challenges with accurately identifying germline variants from tumor-only data. We have developed the Oncology and Hereditary Cancer Program targeted capture panel, which uses tumor tissue to simultaneously screen for both clinically actionable solid tumor variants and germline variants across 45 genes. Validation using 14 tumor specimens, composed of patient samples and cell lines analyzed in triplicate, demonstrated high coverage with sensitive and specific identification of single-nucleotide variants and small insertions and deletions. Average coverage across all targets remained >2000× in 198 additional patient tumor samples. Analysis of 55 formalin-fixed, paraffin-embedded tumor samples for the detection of known germline variants within a subset of cancer-predisposition genes, including one multiexon deletion, yielded a 100% detection rate, demonstrating that germline variants can be reliably detected in tumor samples using a single panel. Combining targetable somatic and actionable germline variants into a single tumor tissue assay represents a streamlined approach that can inform treatment for patients with advanced cancers as well as identify those with potential germline variants who are eligible for confirmatory testing, but would not otherwise have been identified.

A qualitative study to evaluate physician attitudes regarding omission of surgery among exceptional responders to neoadjuvant systemic therapy for breast cancer (NRG-CC006).

PURPOSE: Accrual to clinical trials that challenge well-established treatment paradigms represents a unique challenge. Physician opinions on investigation of a novel approach to breast cancer treatment, in which patients with complete response to neoadjuvant chemotherapy are offered omission of lumpectomy, are unknown. NRG-CC006 sought to describe physician attitudes toward a novel approach to breast cancer treatment. METHODS: We recruited 18 participants in the fields of surgery, medical oncology, and radiation oncology to participate in the semi-structured telephone interviews. Main outcomes are qualitative themes associated with omission of surgery. RESULTS: Of 18 interview participants, specialty and gender were evenly represented across surgery, medical oncology, and radiation oncology. Qualitative themes included general attitudes toward treatment de-escalation, stakeholder considerations, and trial/protocol considerations. The vast majority of participants expressed interest in investigation of omission of surgery, with all participants endorsing need for further investigation into treatment de-escalation. Stakeholder considerations in opening such a trial emphasized need for multidisciplinary involvement and, particularly, the unique role of surgeons as gatekeepers in breast cancer treatment. Finally, participants endorsed a need for further foundational studies to develop ways to predict complete pathologic response to chemotherapy without surgical intervention. CONCLUSIONS: Physicians expressed interest in investigating a novel approach to breast cancer treatment that would omit surgery in complete responders to neoadjuvant chemotherapy. Multidisciplinary input, and specifically surgeon engagement, will be key to the success of future investigations. Ongoing work to develop approaches to predict pathologic complete response accurately is needed to achieve the promise of this idea. ClinTrials #: BR005: NCT03188393 June 13, 2017.

Too Much Too Late? Chemotherapy Administration at the End of Life: A Retrospective Observational Study.

PURPOSE: Cancer treatment for those nearing death has become increasingly aggressive over time despite evidence that less aggressive approaches are associated with better quality of life and sometimes longer survival. Chemotherapy administration in the last 14 days of life is one of the proposed benchmarks for quality of cancer care. The purpose of our study is to evaluate factors associated with aggressive cancer treatment in patients who died within 2 weeks of receiving chemotherapy. METHODS: This retrospective cohort study evaluated adult patients who died between 1 February 2018 and 1 March 2019 after receiving cancer treatment in the preceding 14 days at the Prisma Health Cancer Institute. This project was approved by our institutional review board. Data was obtained by review of electronic medical records and analyzed using commercial software. RESULTS: We identified 92 patients who met inclusion criteria for the study. Of those who were staged, 57% had metastatic disease. A majority received treatments with only palliative intent (54%). These patients overwhelmingly died in the hospital (62%). Few had documented advanced directives (28%) or dedicated palliative care for longer than 1 week (28%). Overall, this cohort reflects a rate of 11.7% of patients who received cancer treatment during the study time period. SIGNIFICANCE OF RESULTS: Patients receiving aggressive cancer treatment at the end of life elucidate significant gaps in quality cancer care, particularly the early involvement of dedicated palliative care. Systematic review helped identify multiple gaps and assisted in implementing interventions to improve this outcome.

"Programa universitário por um dia": ação de responsabilidade social e inclusão / "Programa universitario por un día": acción de responsabilidad social e inclusión / "University for a day program": action of social responsibility and inclusion

RESUMO Introdução: ações de aproximação de alunos de ensino médio público para universidades públicas são essenciais para facilitar a transição acadêmica e incentivar o ingresso e a permanência estudantil. Tais ações ainda apresentam aos alunos visitantes as possibilidades inerentes ao ambiente acadêmico qualificado e propiciam oportunidades e novo pensar sobre seu futuro pessoal e profissional. Objetivo: relatar as atividades do Programa Universitário por um Dia (EERP-USP), que se caracterizam como ações de responsabilidade social e de inclusão universitária. Método: estudo descritivo, tipo relato de experiência, de ações de extensão universitária para os alunos do ensino médio público, obtido a partir da análise de um banco de dados preexistente. Resultados: no período de março a novembro de 2019, o Programa Universitário por um Dia recebeu 426 alunos do ensino médio de escolas públicas de Ribeirão Preto-SP e região, sendo a maioria do sexo feminino (64%) e com idade média de 17 anos. Do total de participantes do projeto, seis obtiveram aprovação no processo seletivo da Fundação Universitária para o Vestibular (FUVEST) para ingresso na Universidade de São Paulo. Conclusão: os resultados revelam o caráter social de inclusão com impacto positivo como ação de extensão universitária.

RESUMEN Introducción: las acciones para acercar a los estudiantes de secundaria pública a las universidades públicas son fundamentales para facilitar la transición académica y fomentar la matrícula y permanencia de los estudiantes. Tales acciones aún presentan a los estudiantes visitantes las posibilidades inherentes al entorno académico calificado y brindan oportunidades y nuevas formas de pensar sobre su futuro personal y profesional. Objetivo: dar a conocer las actividades del Programa Universitario por un Día (EERP-USP), las cuales se caracterizan como acciones de responsabilidad social e inclusión universitaria. Método: estudio descriptivo, tipo de relato de experiencia, de acciones de extensión universitaria para estudiantes de secundaria pública, obtenido a partir del análisis de una base de datos preexistente. Resultados: en el período de marzo a noviembre de 2019, el Programa Universitario por un Día recibió a 426 estudiantes de secundaria de escuelas públicas de Ribeirão Preto-SP y región, la mayoría mujeres (64%) y con una edad promedio de 17 años. Del total de participantes en el proyecto, seis obtuvieron la aprobación en el proceso de selección de la Fundación Universitaria del Vestibular (FUVEST) para el ingreso a la Universidad de São Paulo. Conclusión: los resultados revelan el carácter social de la inclusión con impacto positivo como acción de extensión universitaria.

ABSTRACT Introduction: actions to bring public high school students closer to public universities are essential to facilitate the academic transition and encourage student enrollment and permanence. Such actions still present visiting students with the possibilities inherent in the qualified academic environment and provide opportunities and new thinking about their personal and professional future. Objective: to report the activities of the University for a Day Program (EERP-USP), which are characterized as actions of social responsibility and university inclusion. Method: descriptive study, type of experience report, of university extension actions for public high school students, obtained from the analysis of a pre-existing database. Results: in the period from March to November 2019, the University for a Day Program received 426 high school students from public schools in Ribeirão Preto-SP and region, the majority being female (64%) and with an average age of 17 years old. Of the total number of project participants, six obtained approvals in the selection process of the Fundação Universitária para o Vestibular (FUVEST) for admission to the University of São Paulo. Conclusion: the results reveal the social character of inclusion with a positive impact as a university extension action.

Less Toxic Chemotherapy in Locally Advanced Breast Cancer.

OBJECTIVES: Preoperative chemotherapy produces tumor shrinkage in most patients with locally advanced breast cancer, including some pathological complete responses (pCRs). We attempted this using a much less toxic sequential regimen, given with concurrent bevacizumab. METHODS: Patients with locally advanced breast cancer received 3 intravenous doses each of preoperative sequential liposome encapsulated doxorubicin 25 mg/m2, paclitaxel 175 mg/m2, and cyclophosphamide 600 mg/m2, with concurrent bevacizumab every 2 weeks without growth factor support. RESULTS: Between March 2008 and December 2009, 32 patients received treatment. There was no cardiotoxicity, and other toxicity was mild (no grade 4 or 5 toxicity). No long-term toxicity, including cardiotoxicity, has been observed. Every patient had ≥30% reduction in tumor size; 9 of 31 patients who completed chemotherapy had pCR at operation. Seven years later, 22 of 32 patients remain free of recurrence and 27 of 32 are alive. CONCLUSIONS: The preoperative chemotherapy used appears to be comparably effective, but much less toxic than that used in most conventional regimens and should be studied further. Concurrent treatment with bevacizumab (reported separately) did not provide any additional benefit.