Purpose Although oral chemotherapy offers advantages over intravenous chemotherapy, it creates a unique set of challenges. Potential barriers include treatment complexity, patient responsibility for medication adherence and monitoring, reduced healthcare contact, and increased financial burden. The purpose of this study is to estimate the prevalence of drug-related problems among a sample of patients treated with oral chemotherapy agents. Methods A single-center, retrospective chart review was conducted on patients prescribed oral chemotherapy at our institution between 1 January 2017 and 31 August 2017. The primary endpoint was the incidence of drug-related toxicities within 90 days of starting treatment. Secondary endpoints included incidence of drug–drug interactions, proportion of patients receiving medication education by a clinical pharmacist, and quantification of issues related to medication access. Results Charts of 100 patients were reviewed. Median time to oral chemotherapy receipt by the patient from the day the order was written was eight days. Prior to initiating therapy, 27% of patients received education by a clinical pharmacist. Toxicity checks were conducted by the provider at 30, 60, and 90 days for 80%, 65%, and 48% of patients, respectively. Treatment-related toxicities secondary to oral chemotherapy were reported by 79% of patients, with 55% classified as severe. Potential drug interactions were in 55% of the patients. Conclusion Data from this study have highlighted avenues for pharmacists to make an impact on patients newly started on oral chemotherapy. Opportunities exist to increase patient education, ensure appropriate follow-up, and assess adherence while preventing and managing treatment-related toxicities.
Abstract Background Polypharmacy (PP) and potentially inappropriate medications (PIM) are highly prevalent in older adults with cancer. This study systematically reviews the associations of PP and/or PIM with outcomes and, through a meta-analysis, obtains estimates of postoperative outcomes associated with PP in this population. Materials and Methods We searched PubMed, Embase, Web of Science, and Cochrane Register of Clinical Trials using standardized terms for concepts of PP, PIM, and cancer. Eligible studies included cohort studies, cross-sectional studies, meta-analyses, and clinical trials which examined outcomes associated with PP and/or PIM and included older adults with cancer. A random effects model included studies in which definitions of PP were consistent to examine the association of PP with postoperative complications. Results Forty-seven articles met the inclusion criteria. PP was defined as five or more medications in 57% of the studies. Commonly examined outcomes included chemotherapy toxicities, postoperative complications, functional decline, hospitalization, and overall survival. PP was associated with chemotherapy toxicities (4/9 studies), falls (3/3 studies), functional decline (3/3 studies), and overall survival (2/11 studies). A meta-analysis of four studies indicated an association between PP (≥5 medications) and postoperative complications (overall odds ratio, 1.3; 95% confidence interval [1.3–2.8]). PIM was associated with adverse outcomes in 3 of 11 studies. Conclusion PP is associated with postoperative complications, chemotherapy toxicities, and physical and functional decline. Only three studies showed an association between PIM and outcomes. However, because of inconsistent definitions, heterogeneous populations, and variable study designs, these associations should be further investigated in prospective studies.
Abstract Through storylines dealing with catastrophic changes, visual media has much been celebrated and appreciated for its efforts to evoke the perils of the Anthropocene in South Asia. But as the crises escalate, other cultural artefacts, especially popular songs, are being explored and harnessed by musicians, bands, and singers across the region to promote environmental awareness. Over the past decade, as popular music culture has mushroomed in the Indian Sub-continent, its extraordinary potential to grasp the attention of consumers towards environmental concerns is being utilized by renowned Indian musicians. These artists have yoked the potential of popular music to reflect issues of environment and sustainability. Exploring the trajectory and topoi of ecomusicology and drawing theoretical insights from it, this chapter examines singer and music composer Papon’s song ‘Waise hi Rehna, Waise hi Behna’—a plea for river conservation. The work brings together music and environment to address the anthropogenic environmental crisis that has gripped the Indian sub-continent. Through a detailed examination of individual sections of the song, the chapter emphasizes that the pollution of rivers in India, that Papon alludes to, fits well into Rob Nixon’s understanding of “slow violence” and Dipesh Chakravarty’s perceptions of the “planetary crisis.” The chapter further scrutinizes the elements—ecologically-charged lyrics and cinematography—that the song employs to provoke public awareness of the human-induced ecological catastrophe. The chapter also explores the various aspects of listening to songs and music within the framework of ecology and environment, strengthening the argument that eco-songs illustrate music as a reliable medium to promote environmental sustainability.
The risk of disease spread is contingent on not only the biological properties of causal agents, such as viruses and bacteria, but also the socio-ecological context of the outbreak. Therefore, researchers need to incorporate the variation in animal-animal interactions in models of disease spread. Much research has focused on how ecological factors (seasonality, mating systems) can influence the variation in animal interactions, but heterogeneity in interactions may arise due to human action, and this has received little attention. We hypothesised that social-mediated differences in the landscape can have consequences for interactions for free-roaming dogs and consequently for disease spread. We used GPS collared data from 31 free-ranging dogs present along a farm-village gradient to build social contact networks to examine differences in interactions. Additionally, we simulated scenarios of rabies infection of two types, dumb and furious, on the contact network structure of village and farm dogs. We found significant differences in the node degree between village and farm contact networks, but the node betweenness was similar. Our simulations showed that infections arising in village dogs are likely to spread to that network, but infections arising in farm dogs get are less likely to spread. Interestingly, this was independent of the type of rabies infection. We discuss our results in light of control strategies for managing rabies in the tropics.
10518 Background: Type-2 diabetes mellitus (T2DM) increases the risk of breast cancer among postmenopausal women. Metformin has demonstrated a chemoprotective effect in breast cancer, however its role in HR+/HER2- breast cancer (HR+/HER2- BC), the most common subtype, has not been studied among older women with T2DM in the United States. This study evaluated if increased exposure to metformin is associated with a reduced risk of HR+/HER2- BC among postmenopausal women with T2DM. Methods: A case-control study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2015). Those diagnosed with HR+/HER2- BC as their first/only cancer after incident T2DM diagnosis were cases. The event date was the date of HR+/HER2- BC diagnosis in cases, and randomly assigned to non-cancer T2DM controls based on the distribution in cases. Cases were matched to up to 4 controls each using incidence density sampling with replacement. Metformin exposures were defined as cumulative dose, average intensity and adherence, measured during the 1-year lookback period prior to the event date. Dose (mg) was categorized as: 0, 0-30,000, 30,001-136,000, 136,001-293,000, and > 293,000. Average intensity per day (mg/day) was categorized as: 0, 1-500, and > 500. To evaluate adherence, those without metformin claims during the lookback period were excluded. Adherence measures were: binary proportion of days covered (PDC) (≥0.80, < 0.80) and adherence trajectories. Group based trajectory modeling was used to identify trajectories (adherent, slow decline, rapid decline, and early discontinuation). The Anderson Behavioral Model was used to guide selection of covariables: demographic and clinical variables (diabetes severity, metabolic syndrome, comedications, and health status). Conditional logistic regression was used to evaluate the association between exposure to metformin and the risk of HR+/HER2- BC. Results: The main cohort included 690 cases and 2747 controls. A decremental reduction in odds of HR+/HER2- BC in the highest cumulative dose (OR = 0.72, 95% CI: 0.55-0.95; OR = 0.60, 95% CI: 0.42-0.85) and intensity (OR = 0.61, 95% CI:0.46-0.82) categories of metformin was observed compared to the no-metformin group. Those non-adherent to metformin had 45% (OR = 1.45, 95% CI: 1.08-1.94) increased odds of HR+/HER2- BC compared to those adherent. The risk of HR+/HER2- BC in the adherent (OR = 0.67, 95% CI: 0.39-1.14), slow decline (OR = 0.75, 95% CI: 0.43-1.32) and rapid decline (OR = 0.73, 95% CI: 0.41-1.31) trajectories was not statistically significant compared to the early discontinuation trajectory. Conclusions: This retrospective study based on SEER-Medicare found an association between high dose and intensity of metformin use with reduced odds of incidence of HR+/HER2- BC among postmenopausal women with T2DM. Adherence to metformin also showed protective effect against HR+/HER2- BC.
Federally qualified health centers provide care to medically underserved populations, the same individuals often underrepresented in the electoral process. These centers are unique venues to access patients for voter registration services.
METHODS
We undertook a clinician-led, nonpartisan voter registration drive within 2 university-affiliated federally qualified health centers in the Bronx, New York. Patients were approached by voter registration volunteers in clinic waiting areas during a 12-week period.
RESULTS
Volunteers directly engaged with 304 patients. Of the 128 patients who were eligible and not currently registered, 114 (89%) registered to vote through this project. This number corresponded to 38% of all patients engaged. Sixty-five percent of new registrants were aged younger than 40 years.
CONCLUSIONS
This project was successful in registering clinic patients to vote. Clinics are not only health centers, but also powerful vehicles for bringing a voice to civically disenfranchised communities.
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