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Introduction: Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common toxicities associated with immunotherapies, including T cell redirecting bispecific antibodies. Although cooperative group guidelines recommend the use of tocilizumab or other IL-6/IL-6R inhibitors for the management of CRS and ICANS, reports on the use of siltuximab, an IL-6 inhibitor, for the treatment of CRS are limited. Case report: We present the case of a 77-year-old male who received T cell redirecting bispecific antibody therapy with talquetamab for relapsed/refractory multiple myeloma (RRMM) and developed CRS with concurrent ICANS after receiving a second dose of talquetamab. Management and Outcome: The patient received an infusion of siltuximab. The patient recovered from CRS within 1 h of siltuximab administration and ICANS within 7 h of siltuximab administration. Patient tolerated the subsequent dose of talquetamab with no evidence of CRS and continued on study. Discussion: This case describes the successful use of siltuximab for the management of CRS in a patient treated with a T cell redirecting bispecific antibody for RRMM. [ABSTRACT FROM AUTHOR]

Keywords: agonistic behaviors; dominance hierarchy; ethological observations; flower visitor insects; flowers; Paris; urban parks EN agonistic behaviors dominance hierarchy ethological observations flower visitor insects flowers Paris urban parks 1 5 5 03/06/23 20230301 NES 230301 A few minutes of observation of flowers are sufficient to notice that some flower-visiting insects threaten, harass, or attack individuals from other species. We observed that large hoverflies and gray bees tended to attack most of the other individuals, whereas honeybees and yellow-striped bumblebees were much calmer and more peaceful. Thus, large hoverflies, gray bees, "other wild bees" and the "Other" categories are more aggressive than honeybees, yellow-striped bumblebees, and "other bumblebees" (Appendix S1: Figure S3). Honeybees, yellow-striped bumblebees, and the "other bumblebees" and "other wild bees" categories mainly attacked within their own morphospecies. [Extracted from the article]

The standard method for estimating smoking-attributable mortality (SAM) does not account for smoking duration and time since cessation, which prevents analysts from running projections or what-if scenarios on changes in initiation and cessation behaviours. We propose a new method that combines the duration distributions observed in the population with empirical values for the duration effects on mortality from smoking and cessation, which are reported in the epidemiological literature. This new method is more data-demanding than the standard method, and we demonstrate its implementation on French lung cancer cases by creating pseudo-cohorts using pooled cross-sectional surveys (Baromètre Santé, INPES) from 1975 to 2010. We find that lung cancer mortality will increase by 50% until 2035, after which it will plateau. Our simulations show that halving initiation among teenagers would save 20,500 lives over the 50-year period between 2010 and 2060, while doubling the quit rate among adults would save 53,000 lives over the same period. This study statistically substantiates the intuitive belief that interventions and policies that increase cessation save more lives in the medium term than those aimed at decreasing initiation. [ABSTRACT FROM AUTHOR]

Abstract: Much research in France or abroad has highlighted the medical practice variation (MPV) phenomenon. There is no consensus on the origin of MPV between preference-centered approaches versus opportunities and constraints approaches. This study''s main purpose is to assess the relevance of hypotheses which assume that physicians adopt a uniform practice style for their patients for each similar clinical decision in a context of medical decision with low uncertainty and professional practice with weak regulation. Multilevel models are evaluated: first to measure variability of antibiotics prescription by French general practitioners (GPs) for acute rhinopharyngitis regarding clinical guidelines, and to test its significance in order to determine to what extent prescription differences are due to between or within GPs discrepancies; second, to prioritize its determinants, especially those relating to a GP or his/her practice setting environment, while controlling visit or patient confounders. The study was based on 2001 activity data, along with an ad hoc questionnaire, of a sample of 778 GP taken from a panel of 1006 computerized French GPs. We observed that a large part of the total variation was due to intra-physician variability (70%). It is patient characteristics that largely explain the prescription, even if GP or practice setting characteristics (location, level of activity, network participation, continuing medical education) and environmental factors (visit from pharmaceutical sales representatives) also exert considerable influence. This suggests that MPV are partly caused by differences in the type of dissemination of medical information and this may help policy makers to identify and develop facilitators for promoting better use of antibiotics in France and, more generally, for influencing GP practices when it is of interest. [Copyright &y& Elsevier]

Promoting equity in healthcare use requires to respect both principles of horizontal equity, that guarantees everyone the same use of healthcare for a given level of need, and vertical equity, that requires the sickest to receive more care than others, in a proportion deemed appropriate. This study explores the extent to which horizontal and vertical equity in healthcare use among individuals aged 50+ in Europe has been restructured during the COVID-19 pandemic. Using the variance as an inequality measure, we assess horizontal equity in healthcare use based on the fairness gap approach and propose two new measures of vertical equity. The sample includes 24,965 respondents of the SHARE survey from 18 European countries, who participated in wave 8 just before the pandemic and the second SHARE Corona survey in 2021. These data provide information on use of physician and hospital care over the year for each period, as well as on a wide range of health and socio-economic variables. Although pro-rich inequities in healthcare use were observed in some countries before the outbreak, our results do not reveal any significant evolution in horizontal equity during the pandemic. Conversely, vertical equity in healthcare use would have significantly declined in most countries, especially in Central or Eastern Europe. Telemedicine appears to have played a protective role against this decline in vertical equity in countries where it was heavily used during the pandemic. Our results support the case for public policies aimed at restoring access to care for individuals with the highest needs. • "Pro-rich" horizontal inequity in healthcare use before Covid-19 in Europe. • No significant change in horizontal equity in healthcare use with the pandemic. • The normative issue of vertical equity is addressed with simple empirical measures. • Vertical equity in healthcare use has declined with the pandemic in Europe. • Telemedicine has played a protective role against the decline in vertical equity. [ABSTRACT FROM AUTHOR]

Objectives: Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes (' Territoires de Soins Numériques ' or TSN) introduced in France, covering the period 2012–2018. Methods: This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. Results: TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. Conclusions: If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts. [ABSTRACT FROM AUTHOR]

Survival rates for children with acute myeloid leukemia (AML) exceed 60 % when modern, intensified chemotherapeutic regimens and enhanced supportive care measures are employed. Despite well-recognized improvements in outcomes, primary refractory or relapsed pediatric AML yields significant morbidity and mortality, and improved understanding of this obstinate population along with refined treatment protocols are urgently needed. Although a significant number of patients with refractory or relapsed disease will achieve remission, long-term survival rates remain poor, and efforts to identify therapies which will improve OS are under continuous investigation. The current fundamental goal of such investigation is the achievement of as complete a remission as possible without dose-limiting toxicities, and the progression to hematopoietic stem cell transplantation thereafter. In this review the scope of the problem of relapsed and refractory AML as well as current and emerging chemotherapy options will be discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Histiocytic sarcoma (HS) is an exceedingly rare tumor and carries a dismal prognosis when patients present with advanced-stage disease. Because of the poor response rates to conventional chemotherapy and the rarity of the disease, no standard of care exists for patients with HS. The authors report the single-agent use of the anti-CD52 antibody alemtuzumab in 2 patients who had advanced-stage HS. METHODS: Two patients with chemotherapy-refractory, metastatic HS with tumors that expressed the CD52 antigen received a prolonged course of treatment with the anti-CD52 monoclonal antibody alemtuzumab. RESULTS: Resected tumor samples from both patients demonstrated CD52 expression. Both patients had marked responses to single-agent alemtuzumab. One patient had a complete response with no evidence of disease for >5 years. The second patient had a major response to alemtuzumab and also remained alive with no evidence of disease for >4 years. CONCLUSIONS: Further studies need to be performed to examine CD52 expression and function in HS as well as the role of alemtuzumab in a larger cohort of patients. However, the clinical impact of single-agent alemtuzumab in the 2 patients described in this report was very encouraging. Given the toxicity and frequent inefficacy of conventional chemotherapy, patients with incompletely resected HS should be strongly considered for alemtuzumab therapy. Cancer 2012. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]

The presence of Pediatric Palliative Care (PPC) teams and PPC curricula at teaching hospitals are shown to increase resident physician education in pain and symptom management. However, their impact on residents' comfort in caring for children at the end of life (EOL) is not well studied. We sought to examine whether differences exist in reported levels of experience and education with palliative andEOL care among physicians completing residency before versus after the development of a PPC team. We surveyed 329 pediatrics residents and graduates from our medium-sized children's hospital about their experiences and education in providing palliative or EOL care to pediatric patients. We compared responses from residents who completed training prior to the development of a PPC team to those who completed training after its implementation. 149 individuals (45%) responded. Participants who completed residency during or after the implementation of the PPC team were more likely to agree that they received education about EOL symptom management (K2 = 11.58, P < 0.001) and felt comfortable caring for patients at EOL (K2 = 5.62, P = 0.02). Our findings suggest a beneficial impact of PPC team presence on pediatrics resident education. When appropriate, involving of pediatrics residents in the care of children approaching EOL should be supported and encouraged. [ABSTRACT FROM AUTHOR]

Summary: In the phase 3 POLLUX trial, daratumumab in combination with lenalidomide and dexamethasone (D‐Rd) significantly improved progression‐free survival in patients with relapsed/refractory multiple myeloma (RRMM) compared with lenalidomide and dexamethasone (Rd) alone. Here, we present patient‐reported outcomes (PROs) from POLLUX, assessed using the validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30‐item (EORTC QLQ‐C30) and the EuroQol 5‐dimensional descriptive system (EQ‐5D‐5L) questionnaires. Changes from baseline are presented as least‐squares mean changes with 95% confidence intervals (CIs) derived from a mixed‐effects model. PRO assessment compliance rates were high and similar in both D‐Rd and Rd groups through cycle 40 (week 156). In this on‐treatment analysis, mean changes from baseline were significantly greater in EORTC QLQ‐C30 global health status, physical functioning, and pain scores in the D‐Rd group versus the Rd group at multiple time points; however, magnitude of changes was low, suggesting no meaningful impact on health‐related quality of life (HRQoL). Subgroup results were similar to those in the overall population. In the POLLUX study, baseline HRQoL was maintained with prolonged D‐Rd treatment. These findings complement the sustained and significant improvement in progression‐free survival observed with D‐Rd and supports its use in patients with RRMM. Clinical trial registration: NCT02076009. [ABSTRACT FROM AUTHOR]

Summary: In the phase III CASTOR trial, daratumumab, bortezomib and dexamethasone (D‐Vd) significantly extended progression‐free survival compared with bortezomib and dexamethasone (Vd) alone in patients with relapsed/refractory multiple myeloma (RRMM). Here, we present patient‐reported outcomes (PROs) from the CASTOR trial. PROs were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30‐item (EORTC QLQ‐C30) and the EuroQol 5‐dimensional descriptive system questionnaire. Treatment effects through Cycle 8 were measured by a repeated measures mixed‐effects model. After Cycle 8, PROs were only collected for patients in the D‐Vd group who continued on daratumumab monotherapy. Compliance rates for PRO assessments were high and similar between treatment groups. Mean changes from baseline were generally similar between treatment groups for EORTC QLQ‐C30 global health status (GHS), functioning and symptoms, and did not exceed 10 points for either treatment group. Subgroup analyses were consistent with the results observed in the overall population. There was no change in patients' health‐related quality of life for the first eight cycles of therapy; thereafter, patients treated with daratumumab over the long‐term reported improvements in GHS and pain. These results complement the significant clinical benefits observed with D‐Vd in patients with RRMM and support its use in this patient population. [ABSTRACT FROM AUTHOR]

Background: Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation.Methods: EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database.Discussion: EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation.Trial Registration: ClinicalTrials.gov ID: NCT02837406 , 08/18/2016. [ABSTRACT FROM AUTHOR]