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Introduction: Clinically complex patients often require multiple medications. Polypharmacy is associated with inappropriate prescriptions, which may lead to negative outcomes. Few effective tools are available to help physicians optimise patient medication. This study assesses whether an electronic medication management support system (eMMa) reduces hospitalisation and mortality and improves prescription quality/safety in patients with polypharmacy. Methods and analysis: Planned design: pragmatic, parallel cluster-randomised controlled trial; general practices as randomisation unit; patients as analysis unit. As practice recruitment was poor, we included additional data to our primary endpoint analysis for practices and quarters from October 2017 to March 2021. Since randomisation was performed in waves, final study design corresponds to a stepped-wedge design with open cohort and step-length of one quarter. Scope: general practices, Westphalia-Lippe (Germany), caring for BARMER health fund-covered patients. Population: patients (≥18 years) with polypharmacy (≥5 prescriptions). Sample size: initially, 32 patients from each of 539 practices were required for each study arm (17 200 patients/arm), but only 688 practices were randomised after 2 years of recruitment. Design change ensures that 80% power is nonetheless achieved. Intervention: complex intervention eMMa. Follow-up: at least five quarters/cluster (practice). recruitment: practices recruited/randomised at different times; after follow-up, control group practices may access eMMa. Outcomes: primary endpoint is all-cause mortality and hospitalisation; secondary endpoints are number of potentially inappropriate medications, cause-specific hospitalisation preceded by high-risk prescribing and medication underuse. Statistical analysis: primary and secondary outcomes are measured quarterly at patient level. A generalised linear mixed-effect model and repeated patient measurements are used to consider patient clusters within practices. Time and intervention group are considered fixed factors; variation between practices and patients is fitted as random effects. Intention-to-treat principle is used to analyse primary and key secondary endpoints.
Unermüdliche Pflanzer sind die meisten Mosi, die - gemeinsam mit den Bisa - in Tenkodogo, Verwaltungshauptstadt der Provinz Boulgou im Südosten Burkina Fasos, die Bevölkerungsmehrheit stellen. Im Zentrum ihrer agrarisch geprägten Vorstellungswelt stehen die Kulturpflanzen, vor allem die Hirsearten Sorghum bicolor und Pennisetum americanum, von deren gutem Gedeihen das Überleben in jenem Gebiet weitgehend abhängt. Diese in der täglichen Ernährung unentbehrlichen Pflanzen spielen allerdings in unseren Ausführungen keine Rolle. Wir wollen vielmehr zeigen, wonach selten oder nicht genutze Wildpflanzen, vor allem Kräuter und Gräser, ihren Namen erhielten. Ihre Taxonomie stützt sich wesentlich auf Ordnungssysteme des Alltags, basierend auf der "natürlich-sozialen" Organisation und Opposition von Drinnen und Draußen, welche durch die Gegensätze Kulturland und Busch, Nutzpflanze und Unkraut, Haustier und Wildtier, Gruppenoberhäupter und gesellschaftliche Außenseiter, Menschen und Geister repräsentiert werden.
Le système de la parenté, qui est en général la base de l’ordre social, peut être remplacé par un ordre alternatif, c'est-à-dire par un ordre du voisinage (ou bien par l’ordre spatial). Dans le cas du lignage Dambure, c’est la proximité et la distance entre les concessions qui déterminent les obligations mutuelles: On construit de nouveaux concessions toujours très proches les unes des autres et on a aussi construit une place centrale appartenant aux quatre concessions les plus anciennes. En plus, les deux formes peuvent se renforcer mutuellement et de cette manière supporter les prétentions sur le rôle dominant du lignage principal. Le contrôle social pratiqué par le chef d’un lignage maximal peut être exercé de façon plus effective dans un groupe de voisins directs. A la base de ces connaissances, l’analyse de l’ordre de l’espace peut aider à décrire la réalité sociale.
Tenkodogo, a township situated in the south-eastern part of Burkina Faso on the road leading from the capital Ouagadougou to the Togo border, has approximately 29,000 inhabitants. It is Burkina's seventh largest town and is the location of the regional government of the Boulgou-Province. This regional government is represented by a high-commissioner and a "préfet" as it is the residence of a traditional ruler, otherwise known as Tenkodogo-naaba. His sphere of influence covers many villages and hamlets in the region: in total he is the sovereign of nearly 120,000 people. The power of the traditional rulers was curtailed first by the arrival and following overrule of the French colonialists and then after independence by Sankara and his revolutionary government. The kings ceased to be the ultimate judges who were able to determine life and death of their subjects. Henceforth they were no longer allowed to recruit subjects for certain work on their fields, and they no longer could claim control over the allocation of resources. Their position was strengthened anew by Sankara's successor in office, Blaise Campaore, who quickly recognized that collaborating with the traditional rulers could only be of advantage: in fact they later proved to be his best supporters in the election campaign.
Einmal im Jahr, einundzwanzig Tage nach dem für Ahnen und Jenseitsmächte zelebrierten Erntedank, würdigen König und Hofstaat mit einem gesonderten Fest, Bugum Yaoge~, den Vorfahren, von dem sich die Tenkodogo-Dynastie in direkter Linie herleitet: Naaba Bugum. Naaba Bugum selbst hat seinen Fuß wahrscheinlich nie nach Ye~le~yan gesetzt, wie Tenkodogo - in Anlehnung an einen nahen Regenzeitfluß - damals noch hieß. Naaba Sigri leitete den Beginn einer Expansion ein, die etwa hundert Jahre später, unter einem seiner Nachfolger, Naaba Bãogo, zur Unterwerfung der südlichen Bisa von Loanga und Bane und damit zur größten territorialen Ausdehnung vor Einzug der französischen Kolonialmacht führen sollte.
Nos travaux dans les villages mosi de la région de Tenkodogo, au centreest du Burkina Faso, portent directement sur le thème central du Projet de Recherche de l'Université de Francfort: Les relations mutuelles entre la culture d'une population et son milieu naturel. Sur la base d'une étude approfondie de l'environnement naturel, on devrait répondre à la question suivante: comment les Hommes conçoivent et estimentils ce milieu, quelles valeurs lui attribueton; en outre, sur la base de quels principes et d'après quels critères de préférence utilisentils leurs sols en tant que cultivateurs; quelles raisons déterminent-elles l'expansion des Mosi méridionaux dans cette aire géographique, la fondation des villages ainsi que leur dévéloppement démographique. Enfin quel est l'impact de tout cela sur l'environnement naturel, c'est-à-dire quelles sont les conséquences écologiques des conceptions et comportements susmentionnés. Nos recherches sur le terrain débutèrent en 1991 sous la forme d'une collaboration interdisciplinaire étroite entre l'ethnologie, la géographie physique et la botanique. L'objectif à long terme est une comparaison entre les Mosi méridionaux, leurs voisins bisa, les Gulmance et enfin un groupe mosi du nord.
OBJECTIVE: To compare efficacy, safety, and tolerability of an oral enzyme combination (OEC) containing proteolytic enzymes and bioflavonoid vs diclofenac (DIC), a nonselective nonsteroidal anti-inflammatory drug in the treatment of osteoarthritis of the knee.
MATERIALS AND METHODS: This was an individual patient-level pooled reanalysis of patient-reported data from prospective, randomized, double-blind, parallel-group studies in adult patients with moderate-to-severe osteoarthritis of the knee treated for at least 3 weeks with OEC or DIC. Appropriate trials were identified with a systemic literature and database search. Data were extracted from the original case-report forms and reanalyzed by a blinded evaluation committee. The primary end point was the improvement of the Lequesne algofunctional index (LAFI) score at study end vs baseline. Secondary end points addressed LAFI response rates, treatment-related pain-intensity changes, adverse events, and laboratory parameters.
RESULTS: Six trials were identified that enrolled in total 774 patients, of whom 759 had post-baseline data for safety analysis, 697 (n=348/349 with OEC/DIC) for intent to treat, 524 for per protocol efficacy analysis, and 500 for laboratory evaluation. LAFI scores - the primary efficacy end point - decreased comparably with both treatments and improved with both treatments significantly vs baseline (OEC 12.6±2.4 to 9.1±3.9, DIC 12.7±2.4 to 9.1±4.2, effect size 0.9/0.88; P<0.001 for each). In parallel, movement-related 11-point numeric rating-scale pain intensity improved significantly (P<0.001) and comparably with both treatments from baseline (6.4±1.9/6.6±1.8) to study end (3.8±2.7/3.9±2.5). Overall, 55/81 OEC/DIC patients of the safety-analysis population (14.7%/21.1%, P=0.022) reported 90/133 treatment-emergent adverse events, followed by premature treatment discontinuations in 22/39 patients (5.9%/10.2%, P=0.030). Changes in laboratory parameters were significantly less with OEC vs DIC: on average 18.8% vs 86.3% of patients presented a decrease with respect to hemoglobin, hematocrit, or erythrocyte count (P<0.001), and 28.2% vs 72.6% showed an increase in AST, ALT, or GGT (P<0.001).
CONCLUSION: When compared with DIC, OEC showed comparable efficacy and a superior tolerability/safety profile associated with a significantly lower risk of treatment-emergent adverse events, related study discontinuations, and changes in laboratory parameters.
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by impaired antimicrobial activity in phagocytic cells. As a monogenic disease affecting the hematopoietic system, CGD is amenable to gene therapy. Indeed in a phase I/II clinical trial, we demonstrated a transient resolution of bacterial and fungal infections. However, the therapeutic benefit was compromised by the occurrence of clonal dominance and malignant transformation demanding alternative vectors with equal efficacy but safety-improved features. In this work we have developed and tested a self-inactivating (SIN) gammaretroviral vector (SINfes.gp91s) containing a codon-optimized transgene (gp91(phox)) under the transcriptional control of a myeloid promoter for the gene therapy of the X-linked form of CGD (X-CGD). Gene-corrected cells protected X-CGD mice from Aspergillus fumigatus challenge at low vector copy numbers. Moreover, the SINfes.gp91s vector generates substantial amounts of superoxide in human cells transplanted into immunodeficient mice. In vitro genotoxicity assays and longitudinal high-throughput integration site analysis in transplanted mice comprising primary and secondary animals for 11 months revealed a safe integration site profile with no signs of clonal dominance.
Comprehensive analysis of tumour sub-volumes for radiomic risk modelling in locally advanced HNSCC
(2020)
Simple Summary: Radiomic risk models are usually based on imaging features, which are extracted from the entire gross tumour volume (GTV entire ). This approach does not explicitly consider the complex biological structure of the tumours. Therefore, in this retrospective study, we investigated the prognostic value of radiomic analyses based on different tumour sub-volumes using computed tomography imaging of patients with locally advanced head and neck squamous cell carcinoma who were treated with primary radio-chemotherapy. The GTV entire was cropped by different margins to define the rim and corresponding core sub-volumes of the tumour. Furthermore, the best performing tumour rim sub-volume was extended into surrounding tissue with different margins. As a result, the models based on the 5 mm tumour rim and on the 3 mm extended rim sub-volume showed an improved performance compared to models based on the corresponding tumour core. This indicates that the consideration of tumour sub-volumes may help to improve radiomic risk models.
Abstract: Imaging features for radiomic analyses are commonly calculated from the entire gross tumour volume (GTVentire). However, tumours are biologically complex and the consideration of different tumour regions in radiomic models may lead to an improved outcome prediction. Therefore, we investigated the prognostic value of radiomic analyses based on different tumour sub-volumes using computed tomography imaging of patients with locally advanced head and neck squamous cell carcinoma. The GTVentire was cropped by different margins to define the rim and the corresponding core sub-volumes of the tumour. Subsequently, the best performing tumour rim sub-volume was extended into surrounding tissue with different margins. Radiomic risk models were developed and validated using a retrospective cohort consisting of 291 patients in one of the six Partner Sites of the German Cancer Consortium Radiation Oncology Group treated between 2005 and 2013. The validation concordance index (C-index) averaged over all applied learning algorithms and feature selection methods using the GTVentire achieved a moderate prognostic performance for loco-regional tumour control (C-index: 0.61 ± 0.04 (mean ± std)). The models based on the 5 mm tumour rim and on the 3 mm extended rim sub-volume showed higher median performances (C-index: 0.65 ± 0.02 and 0.64 ± 0.05, respectively), while models based on the corresponding tumour core volumes performed less (C-index: 0.59 ± 0.01). The difference in C-index between the 5 mm tumour rim and the corresponding core volume showed a statistical trend (p = 0.10). After additional prospective validation, the consideration of tumour sub-volumes may be a promising way to improve prognostic radiomic risk models.
Purpose: To develop and validate a CT-based radiomics signature for the prognosis of loco-regional tumour control (LRC) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated by primary radiochemotherapy (RCTx) based on retrospective data from 6 partner sites of the German Cancer Consortium - Radiation Oncology Group (DKTK-ROG).
Material and methods: Pre-treatment CT images of 318 patients with locally advanced HNSCC were collected. Four-hundred forty-six features were extracted from each primary tumour volume and then filtered through stability analysis and clustering. First, a baseline signature was developed from demographic and tumour-associated clinical parameters. This signature was then supplemented by CT imaging features. A final signature was derived using repeated 3-fold cross-validation on the discovery cohort. Performance in external validation was assessed by the concordance index (C-Index). Furthermore, calibration and patient stratification in groups with low and high risk for loco-regional recurrence were analysed.
Results: For the clinical baseline signature, only the primary tumour volume was selected. The final signature combined the tumour volume with two independent radiomics features. It achieved moderately good discriminatory performance (C-Index [95% confidence interval]: 0.66 [0.55–0.75]) on the validation cohort along with significant patient stratification (p = 0.005) and good calibration.
Conclusion: We identified and validated a clinical-radiomics signature for LRC of locally advanced HNSCC using a multi-centric retrospective dataset. Prospective validation will be performed on the primary cohort of the HNprädBio trial of the DKTK-ROG once follow-up is completed.
Background: To investigate patients’ perspectives on polypharmacy and the use of a digital decision support system to assist general practitioners (GPs) in performing medication reviews. Methods: Qualitative interviews with patients or informal caregivers recruited from participants in a cluster-randomized controlled clinical trial (cRCT). The interviews were transcribed verbatim and analyzed using thematic analysis. Results: We conducted 13 interviews and identified the following seven themes: the patients successfully integrated medication use in their everyday lives, used medication plans, had both good and bad personal experiences with their drugs, regarded their healthcare providers as the main source of medication-related information, discussed medication changes with their GPs, had trusting relationships with them, and viewed the use of digital decision support tools for medication reviews positively. No unwanted adverse effects were reported. Conclusions: Despite drug-related problems, patients appeared to cope well with their medications. They also trusted their GPs, despite acknowledging polypharmacy to be a complex field for them. The use of a digital support system was appreciated and linked to the hope that reasons for selecting specific medication regimens would become more comprehensible. Further research with a more diverse sampling might add more patient perspectives.