Description: Background: The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. However, this is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Relational coordination (RC) provides a framework to explore this. The aim of this study was to explore RC between specialist physicians, specialist diabetes nurses (DNEs), generalist physicians in primary care (GPs) and generalist nurses (practice nurses (PNs)) and to explore the association between RC and the initiation of insulin in general practice, and the belief that it is appropriate for this task to be carried out in general practice. Methods: A survey was distributed to a convenience sample of specialist physicians, DNEs, GPs and practice nurses. We collected data on demographics, models of care and RC in relation to insulin initiation. We expected that RC would be higher between specialists than between specialists and generalists. We expected higher RC between specialists and generalists to be associated with insulin initiation in general practice and with the belief that it is appropriate for insulin initiation to be carried out in general practice. We used descriptive statistics and non-parametric tests to explore these hypotheses. Results: 179 health professionals returned completed surveys. Specialists reported higher RC with each other and lower RC with PNs. All groups except PNs reported their highest RC with DNEs, suggesting the potential for DNEs to serve as boundary spanners. Lower RC with specialists was reported by those working within a general practice model of care. Health professionals who felt that a general practice model was appropriate reported lower communication with specialist physicians and higher shared knowledge with GPs. Conclusion: Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study?s results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE?s to play a boundary spanner role in this process.

Description: The clinical significance of mucinous prostatic adenocarcinoma remains uncertain. From 6440 cases of prostatic adenocarcinoma treated by radical prostatectomy and reported by Aquesta Uropathology from 2009 to 2014, mucinous components of 5-100% were found in 143 (2.2%). The mean age was 61.4 years, mean preoperative serum was PSA 7.8 ng/mL and clinical stage category was cT1 in 81% and cT2 in 19% of cases. Cases were graded using the 2014 International Society of Urological Pathology recommendation of grading the underlying architecture and Gleason scores were 3+4 in 13.3%, 4+3 in 54.5%, 4+4 in 2.1%, 3+4 or 4+3 both with tertiary 5 in 11.9% and 9-10 in 18.2%. The mucinous component invariably had a high-grade component. Extraprostatic extension was found in 46.8% of cases. In 21.6%, the tumour volume was ≥3 cm³ and 9.7% had surgical margin positivity. Seminal vesicle involvement was found in 6.9%. In 73 cases the mucinous component of the tumour was 〉 25% and when cases were divided on the basis of the area of mucin present (≤ 25% v 〉 25%) there was no significant difference between clinical or pathologic features. Similar findings were achieved when cases were compared with a control group of grade-matched non-mucinous carcinoma cases. The 5 year biochemical recurrence (BCR) rates for mucinous vs non-mucinous cancer were 12.5% vs 17% (p=0.15). It was concluded that prostatic adenocarcinoma with mucinous components is often high grade; however, the prognosis appears to be similar to non-mucinous cancers of similar GS. This article is protected by copyright. All rights reserved.

Description: Background: Hospitalized patients are at increased risk for candidemia and invasive candidiasis (C/IC). Improved therapeutic regimens with enhanced clinical and pharmacoeconomic outcomes utilizing existing antifungal agents are still needed. Methods: An open-label, non-comparative study evaluated an intravenous (IV) to oral step-down strategy. Patients with C/IC were treated with IV anidulafungin and after 5 days of IV therapy had the option to step-down to oral azole therapy (fluconazole or voriconazole) if they met prespecified criteria. The primary endpoint was the global response rate (clinical + microbiological) at end of treatment (EOT) in the modified intent-to-treat (MITT) population (at least one dose of anidulafungin plus positive Candida within 96 hours of study entry). Secondary endpoints included efficacy at other time points and in predefined patient subpopulations. Patients who stepped down early (

Description: Lifestyle factors have been well-studied in relation to breast cancer prognosis overall, however, associations of lifestyle and late outcomes (〉5 after diagnosis) have been much less studied, and no studies have focused on ER+ breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all-cause mortality among 6,295 5-year ER+ stage I-III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre-to-post-diagnosis weight change, BMI (kg/m 2 ), recreational physical activity (PA), alcohol intake, and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥10% weight gain and obesity (BMI 30-34.99 and ≥35) were associated with increased risk of late recurrence (HRs (95% CIs): 1.24 (1.00-1.53), 1.40 (1.05-1.86) and 1.41 (1.02-1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01-1.62). PA was inversely associated with late all-cause mortality (0.81 (0.71-0.93) and 0.71 (0.61-0.82) for 4.9-〈17.4 and ≥17.4 MET-h/wk). A U-shaped association was observed for late all-cause mortality and BMI using updated weight (1.42 (1.15-1.74) and 1.40 (1.09-1.81), 〈21.5 and ≥ 35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long-term ER+ breast cancer survivors. This article is protected by copyright. All rights reserved.

Description: Purpose To achieve artifact-suppressed whole-brain pass-band-balanced steady-state free precession functional MRI from a single functional magnetic resonance imaging (fMRI) scan. Methods A complete and practical data acquisition sequence for alt-SSFP fMRI was developed. First, multishot flyback-echo-planar imaging (EPI) and echo-time shifting were used to achieve data acquisition that was robust against eddy currents, gradient delays, and ghosting artifacts. Second, a steady-state catalyzation scheme was implemented to reduce oscillations in the transient signal when catalyzing in and out of alternate steady states. Next, a short spatial-spectral radiofrequency (RF) pulse was designed to achieve excellent fat-suppression while maintaining a repetition time 〈15 ms to sensitize functional activation toward smaller vessels and capillaries. Lastly, parallel imaging was used to achieve whole-brain coverage and sufficiently high temporal resolution. Results Breath-hold experiments showed excellent fat-suppression and alt-SSFP's capability to recover functional sensitivity from signal dropout regions of conventional gradient-echo and banding artifacts from conventional pass-band-balanced steady-state free precession. Applying fat-suppression resulted in improved activation maps and increased temporal SNR. Visual stimulus functional studies verify the proposed method's excellent functional sensitivity to neuronal activation. Conclusion Artifact-suppressed images are demonstrated, showing a practical pass-band-balanced steady-state free precession fMRI method that permits whole-brain imaging with excellent blood oxygen level-dependent sensitivity and fat suppression. Magn Reson Med, 2015. © 2015 Wiley Periodicals, Inc.