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The purpose of this study was to describe the acceptability of a stroke telerehabilitation platform from the perspective of both patients and therapists. Two public rehabilitation centers participated in a pilot telerehabilitation trial. A theoretical framework was used to conceptualize acceptability. Semi-structured individual interviews with patients and focus groups of therapists were conducted. Most participants and therapists were satisfied with the intervention. Participants emphasized the advantages of staying at home to get their treatments. Therapists were more skeptical at first about their self-efficacy to deliver therapy remotely. There was a consensus among therapists about the need for a combination of telerehabilitation and in-person visits to optimize treatments. While we found overall good acceptability, effectiveness of this technology could be improved via an accessible user interface, complementary rehabilitation material, and ongoing training and technical just-in-time support with therapists.

In France, colorectal cancer (CRC) remains a public health concern due to its high incidence and mortality, mostly due to incurable metastatic disease. However, the prognosis in this setting has improved in recent years with the advent of therapies targeting the VEGF and EGFR pathways and, more recently, immunotherapy for deficient MisMatch Repair (dMMR) subtypes. The upfront concomitant use of the three cytotoxic molecules 5-FU, irinotecan and oxaliplatin as a FOLFOXIRI or FOLFIRINOX regimen for unresectable disease is also part of the therapeutic progress. It increases response rates and survival compared to bi-chemotherapy alone. In combination with bevacizumab, it improves all efficacy criteria compared to the same combination with bi-chemotherapy and should now be considered a standard 1st-line treatment. Conversely, the combination of tri-chemotherapy and anti-EGFR provides no additional benefit and should not be used at this time. In addition, intensification of chemotherapy is associated with an increase in side effects, particularly hematologic and gastrointestinal. With few exceptions, chemotherapy should not be offered to patients older than 75 years, with WHO≥2 and with severe and/or uncontrolled comorbidities. It must also be accompanied by the best possible supportive care (primary prophylaxis with G-CSF for patients over 65, antiemetic prophylaxis adapted to the individual risk...) and rapidly de-escalated in the event of significant toxicities. The most recent studies published on this topic have attempted to clarify the situations in which tri-chemotherapy plus bevacizumab is most appropriate. Given its high response rate, it should be encouraged as a conversion strategy, especially when the tumor is not a good candidate to bi-chemotherapy plus an anti-EGFR agent. Apart from any plans for secondary resection, tri-chemotherapy plus bevacizumab is also a good option for metastatic colorectal cancer (mCRC) exhibiting poor prognostic factors as a right-sided primary tumor and/or RAS or BRAFV600E mutations. Finally, it is still being studied, particularly in combination with immunotherapies. [ABSTRACT FROM AUTHOR]

Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

Objectives: Older adults (OA; ≥55 years of age) are underrepresented in patients receiving cognitive‐behavioral therapy (CBT). This study evaluates mental health outcomes for OA compared to younger adults (YA; <55 years of age) receiving CBT. Design: This is a pre‐post study comparing the effectiveness of CBT for OA (n = 99) and YA (n = 601) in a CBT service located in a university‐affiliated tertiary care hospital in Canada. Data was collected between 2001 and 2021. Participants received a mean of 18.5 sessions (SD 10) of standard, evidence‐based CBT with treatment integrity checks. The main outcome was clinically significant change, as measured by the Reliable Change Index (RCI). Secondary outcomes were change in the Global Severity Index (GSI‐SCL) of the Symptoms Checklist‐90 (Revised), and Clinical Global Improvement scores (CGI). Results: The RCI allowed a comparison of treatment efficacy across diagnoses. Both groups experienced similar improvement on the RCI (2.92 [±3.64] vs. 3.15 [±4.86], p = 0.65). Furthermore, 39% of OA and 42% of YA no longer met criteria for their diagnoses. Groups did not differ with respect to changes in the GSI‐SCL. The CGI severity comparison suggested that OA had milder illness. In all outcomes (RCI, CGI and GSI‐SCL), participants improved over time. Conclusions: This real‐world study analyzed a large sample of OA and YA undergoing CBT for various mental health conditions. Both groups were found to benefit equally. Key points: This study compared the outcomes of cognitive behavioral therapy (CBT) in older and younger adults for a variety of psychopathologies.There were no significant differences between older adults and younger adults on the observed clinical outcomes.Clinicians should not hesitate to refer their older patients if CBT is available and a reasonable treatment option. [ABSTRACT FROM AUTHOR]