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Sinister : once you see him, nothing can save you
Ten years ago, true crime writer Ellison Oswald made his reputation with a best-selling account of a notorious murder. Now, desperate to replicate the success of his first book, he moves his family into a home where the previous occupants were brutally executed and a child disappeared, hoping to find inspiration in the crime scene. In the home, Ellison discovers a cache of terrifying home movies, unwittingly opening the door into a nightmarish mystery.
DVD
The Use of Wearable Devices in Oncology Patients: A Systematic Review
Introduction
The aim of this systematic review was to summarize the current literature on wearable technologies in oncology patients for the purpose of prognostication, treatment monitoring, and rehabilitation planning.
Methods
A search was conducted in Medline ALL, Cochrane Central Register of Controlled Trials, Embase, Emcare, CINAHL, Scopus, and Web of Science, up until February 2022. Articles were included if they reported on consumer grade and/or non-commercial wearable devices in the setting of either prognostication, treatment monitoring or rehabilitation.
Results
We found 199 studies reporting on 18 513 patients suitable for inclusion. One hundred and eleven studies used wearable device data primarily for the purposes of rehabilitation, 68 for treatment monitoring, and 20 for prognostication. The most commonly-reported brands of wearable devices were ActiGraph (71 studies; 36%), Fitbit (37 studies; 19%), Garmin (13 studies; 7%), and ActivPAL (11 studies; 6%). Daily minutes of physical activity were measured in 121 studies (61%), and daily step counts were measured in 93 studies (47%). Adherence was reported in 86 studies, and ranged from 40% to 100%; of these, 63 (74%) reported adherence in excess of 80%.
Conclusion
Wearable devices may provide valuable data for the purposes of treatment monitoring, prognostication, and rehabilitation. Future studies should investigate live-time monitoring of collected data, which may facilitate directed interventions.
This article summarizes the current literature on wearable technologies in oncology patients for the purpose of prognostication, treatment monitoring, and rehabilitation planning.
Journal Article
Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) – A Systematic Review
Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD.
A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the
-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035).
In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV
, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility.
The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
Journal Article
Unmet Healthcare Needs Among People with Inflammatory Bowel Disease: A Canadian Cross-Sectional Population-Representative Study
Purpose
Despite current standards of care, many people with inflammatory bowel disease (IBD) experience significant disease complications and gaps in care. To better understand and address unmet healthcare needs, we need population-level evidence on perceived unmet healthcare needs in people with IBD. Our objective was to compare self-reported unmet healthcare needs among individuals with and without IBD and determine whether accessing medical care attenuates such need.
Methods
We used the 2014 Canadian Community Health Survey, a population-representative cross-sectional survey with a multi-stage cluster randomized design. We compared perceived unmet healthcare needs among individuals with and without IBD using multilevel logistic regression, clustering by respondents’ health regions and accounting for sociodemographic variables and non-IBD chronic conditions. In a second model, we additionally controlled for access to medical care (family physician, specialists, and psychologists).
Results
Eighteen percent of people with IBD (
n
= 114/632) reported an unmet healthcare need within the preceding 12 months, compared with 11% (
n
= 5446/53,333) of those without IBD (SMD: 0.18). Those with IBD were more likely to have an unmet healthcare need (adjusted OR: 1.84, 95% CI 1.19–1.85). Additionally adjusting for respondent-reported recent access to medical care slightly attenuated the association between IBD and unmet healthcare needs (adjusted OR: 1.38, 95% CI 1.10–1.72).
Conclusion
We provide a population-level perspective on unmet healthcare needs, demonstrating the extent and prominence of gaps in the healthcare provided to individuals living with IBD. Our findings underscore the need for improved access to multidisciplinary healthcare teams, and enhanced patient–physician dialog surrounding perceived healthcare needs.
Journal Article
Pivotal studies of pharmacotherapies approved by the US FDA for cancer treatment: a meta-analysis
Abstract
Background
This study aimed to examine the number of FDA-approved cancer pharmacotherapies and analyse pivotal study characteristics over time, including sample sizes.
Methods
We developed a web scraper to collate a cohort of FDA-approved cancer pharmacotherapies from 1953 until 31 December 2024. For each pharmacotherapy, details of pivotal studies leading to approval were recorded, including protocol and final sample size, study design, therapy type, and quality assessment using Cochrane Risk of Bias tools. We used regression analyses and discretization to identify trends in sample size. Type I error was set at 0.05.
(Study protocol pre-registration: https://doi.org/10.17605/OSF.IO/KVA23)
Results
We identified 255 pharmacotherapies, supported by 306 pivotal studies; 125 (49%) were targeted pharmacotherapies, 61 (24%) chemotherapies, 47 (18%) immunotherapies, 21 (8%) hormonal therapies, and 1 (0.4%) other. The median sample size was 290 (IQR = 427); sample sizes increased in the 1990s (median = 407) and remained stable thereafter. Stratified analysis demonstrated smaller sample sizes for phase 1 and 2 studies before 1980, with no change in phase 3 studies. For 165 studies reporting protocol sample sizes, studies from 2020-2024 (median = 147.5) were smaller than those from 2010-2019 (median = 320).
Conclusions
The increase in sample sizes during the 1990s may reflect new policies and legislation. Subsequent stability in sample size could be due to modern trial designs (eg, basket/umbrella studies, surrogate endpoints) that require smaller sample sizes. The recent decrease in protocol sample sizes may herald a similar decline for future studies but requires post-market surveillance to verify credibility.
Journal Article
Representation of Females and Younger Adults in Studies Reporting Predictors of Readmission for Patients with Chronic Obstructive Pulmonary Disease (COPD)
James HB Im,1 Ronald Chow,2 Olivia W So,2 Robert Wu,2 Andrea S Gershon3 1The Hospital for Sick Children, Toronto, ON, Canada; 2University Health Network, University of Toronto, Toronto, ON, Canada; 3Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, CanadaCorrespondence: Ronald Chow, University Health Network, University of Toronto, Toronto, ON, Canada, Email ronald.chow@uhn.ca
Journal Article
Factors associated with loneliness in immigrant and Canadian-born older adults in Ontario, Canada: a population-based study
Background
While loneliness is common in older adults, some immigrant groups are at higher risk. To inform tailored interventions, we identified factors associated with loneliness among immigrant and Canadian-born older adults living in Ontario, Canada.
Methods
We conducted a cross-sectional analysis of 2008/09 data from the Canadian Community Health Survey (Healthy Aging Cycle) and linked health administrative data for respondents 65 years and older residing in Ontario, Canada. Loneliness was measured using the Three-Item Loneliness Scale, with individuals categorized as ‘lonely’ if they had an overall score of 4 or greater. For immigrant and Canadian-born older adults, we developed separate multivariable logistic regression models to assess individual, relationship and community-level factors associated with loneliness.
Results
In a sample of 968 immigrant and 1703 Canadian-born older adults, we found a high prevalence of loneliness (30.8% and 34.0%, respectively). Shared correlates of loneliness included low positive social interaction and wanting to participate more in social, recreational or group activities. In older immigrants, unique correlates included: widowhood, poor health (i.e., physical, mental and social well-being), less time in Canada, and lower neighborhood-level ethnic diversity and income. Among Canadian-born older adults, unique correlates were: female sex, poor mental health, weak sense of community belonging and living alone. Older immigrant females, compared to older immigrant males, had greater prevalence (39.1% vs. 21.9%) of loneliness.
Conclusions
Although both groups had shared correlates of loneliness, community-level factors were more strongly associated with loneliness in immigrants. These findings enhance our understanding of loneliness and can inform policy and practice tailored to immigrants.
Journal Article
Laser-induced phase separation of silicon carbide
Understanding the phase separation mechanism of solid-state binary compounds induced by laser–material interaction is a challenge because of the complexity of the compound materials and short processing times. Here we present xenon chloride excimer laser-induced melt-mediated phase separation and surface reconstruction of single-crystal silicon carbide and study this process by high-resolution transmission electron microscopy and a time-resolved reflectance method. A single-pulse laser irradiation triggers melting of the silicon carbide surface, resulting in a phase separation into a disordered carbon layer with partially graphitic domains (∼2.5 nm) and polycrystalline silicon (∼5 nm). Additional pulse irradiations cause sublimation of only the separated silicon element and subsequent transformation of the disordered carbon layer into multilayer graphene. The results demonstrate viability of synthesizing ultra-thin nanomaterials by the decomposition of a binary system.
Laser beam-induced processing is industrially relevant but often challenging to study in terms of underlying phase transformations. Here authors characterize formation of thin, phase-separated carbon and silicon layers on a silicon carbide substrate by laser-induced melting and solidification.
Journal Article
Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting—a systematic review and meta-analysis
Introduction
Chemotherapy-induced nausea and vomiting (CINV) is a burdensome adverse event frequently associated with chemotherapy treatment of cancer. Evidence suggests that cannabinoid CB2 receptors are present in brainstem neurons, and thus, there may exist a role for cannabinoids to counter CINV. The aim of this paper is to conduct a systematic review and meta-analysis of the efficacy and safety of oral cannabinoids compared with other treatments as documented in randomized controlled trials (RCTs).
Methods
A literature search was conducted using Ovid MEDLINE up until December 31, 2018; Embase Classic and Embase up until 2018 week 53; and Cochrane Central Register of Controlled Trials up until November 2018. Study data were extracted and included in this meta-analysis if they reported on at least one of the following efficacy endpoints: no nausea and no vomiting, no nausea, and no vomiting. The Mantel-Haenszel method and random effects analysis model were used, to generate odds ratio (OR) and accompanying 95% confidence intervals (CI).
Results
In the setting of prophylactic treatment against both nausea and vomiting, oral cannabinoid was more efficacious than placebo or other studied antiemetic treatments. When controlling for vomiting, oral cannabinoid was equally as efficacious as others. Against nausea, oral cannabinoid was equally as effective as other treatments. A greater percentage of patients administered oral cannabinoid for CINV experienced dysphoria, euphoria, and sedation.
Conclusion
Although there exists some evidence suggesting that oral cannabinoids may have a role in controlling for emesis from a neurophysiological perspective, these conclusions are currently not mirrored in the published RCTs to date. However, there exists only a limited number of RCTs, comparisons with older treatment regimens and a lack of standard reporting practice across published literature. Further RCTs should investigate the efficacy and safety of oral cannabinoids, to secure a better picture of the efficacy of oral cannabinoids against CINV.
Journal Article
Association of palliative care and hospital outcomes among solid tumour oncology inpatients
ObjectivesWe aimed to explore the association between receiving an inpatient palliative care consultation and hospital outcomes, including in-hospital death, intensive care unit (ICU) use, discharge to hospice, 30-day readmissions and 30-day emergency department (ED) visits.MethodsWe conducted a retrospective chart review of Yale New Haven Hospital medical oncology admissions from January 2018 through December 2021, with and without inpatient palliative care consultations. Hospital outcome data were extracted from medical records and operationalised as binary. Multivariable logistic regression was used to estimate ORs for the association between number of inpatient palliative care consultations and hospital outcomes.ResultsOur sample included 19 422 patients. Age, Rothman Index, site of malignancy, length of stay, discharge to hospice, ICU admissions, hospital death and readmissions within 30 days differed significantly between patients who received versus did not receive a palliative care consultation. On multivariable analysis, receiving one additional palliative care consultation was significantly associated with higher odds of hospital death (adjusted OR=1.15, 95% CI 1.12 to 1.17) and discharge to hospice (adjusted OR = 1.23, 95% CI 1.20 to 1.26), and lower odds of ICU admission (adjusted OR=0.94, 95% CI 0.92 to 0.97). There was no significant association between palliative care consultations and readmission within 30 days or with ED visits within 30 days.ConclusionInpatients receiving palliative care had increased likelihood of hospital death. However, when controlling for significant differences in patient presentation, patients had nearly 25% greater odds of discharge to hospice and less odds to transition to ICU level of care.
Journal Article