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Santin AD, Vergote I, González-Martín A, Moore K, Oaknin A, Romero I, Diab S, Copeland LJ, Monk BJ, Coleman RL, Herzog TJ, Siegel J, Kasten L, Schlicker A, Schulz A, Köchert K, Walter AO, Childs BH, Elbi C, Bulat I. Safety and activity of anti-mesothelin antibody-drug conjugate anetumab ravtansine in combination with pegylated-liposomal doxorubicin in platinum-resistant ovarian cancer: multicenter, phase Ib dose escalation and expansion study. Int J Gynecol Cancer 2023; 33:562-570. [PMID: 36564099 PMCID: PMC10086500 DOI: 10.1136/ijgc-2022-003927] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Anetumab ravtansine is an antibody-drug conjugate consisting of a fully human anti-mesothelin monoclonal antibody conjugated to cytotoxic maytansinoid tubulin inhibitor DM4. Mesothelin is highly expressed in ovarian cancer. This phase Ib study determines the safety, pharmacokinetics, and anti-tumor activity of anetumab ravtansine and pegylated liposomal doxorubicin in mesothelin-expressing platinum-resistant ovarian cancer. METHODS Anetumab ravtansine (5.5 or 6.5 mg/kg) and pegylated liposomal doxorubicin (30 mg/m2) were administered intravenously every 3 weeks to 65 patients with platinum-resistant epithelial ovarian cancer. Mesothelin expression was assessed by central immunohistochemistry. Adverse events, tumor response (RECIST 1.1), and progression-free survival were determined. Biomarker samples were assessed by ELISA and next-generation sequencing. RESULTS In dose escalation, nine patients received anetumab ravtansine across two doses (5.5 or 6.5 mg/kg). The maximum tolerated dose of anetumab ravtansine was 6.5 mg/kg every 3 weeks and no dose-limiting toxicities were observed. In dose expansion, 56 patients were treated at the maximum tolerated dose. The most common treatment-emergent adverse events of any grade were nausea (47.7%), decreased appetite (43.1%), fatigue (38.5%), diarrhea (32.3%), and corneal disorder (29.2%). In all treated patients the objective response rate was 27.7% (95% CI 17.3% to 40.2%), including one complete (1.5%) and 17 partial responses (26.2%), with median duration of response of 7.6 (95% CI 3.3 to 10.2) months and median progression-free survival of 5.0 (95% CI 3.2 to 6.0) months. In an exploratory analysis of a sub-set of patients (n=19) with high mesothelin expression who received ≤3 prior lines of systemic therapy, the objective response rate was 42.1% (95% CI 20.3% to 66.5%) with a median duration of response of 8.3 (95% CI 4.1 to 12.0) months and median progression-free survival of 8.5 (95% CI 4.0 to 11.4) months. CONCLUSIONS Anetumab ravtansine and pegylated liposomal doxorubicin showed tolerability and promising clinical activity. These results established the dose schedule and the mesothelin-positive target population of this combination for a phase III study in platinum-resistant ovarian cancer. TRIAL REGISTRATION NUMBER NCT02751918.
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Affiliation(s)
| | - Ignace Vergote
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Kathleen Moore
- University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Ana Oaknin
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Sami Diab
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona, Phoenix, AZ, USA
| | | | | | | | | | | | | | | | | | | | - Cem Elbi
- Bayer HealthCare Pharmaceuticals Inc, Whippany, NJ, USA
| | - Iurie Bulat
- ARENSIA Exploratory Medicine, Institute of Oncology Unit, Chisinau, Moldova
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Kindler HL, Novello S, Bearz A, Ceresoli GL, Aerts JGJV, Spicer J, Taylor P, Nackaerts K, Greystoke A, Jennens R, Calabrò L, Burgers JA, Santoro A, Cedrés S, Serwatowski P, Ponce S, Van Meerbeeck JP, Nowak AK, Blumenschein G, Siegel JM, Kasten L, Köchert K, Walter AO, Childs BH, Elbi C, Hassan R, Fennell DA. Anetumab ravtansine versus vinorelbine in patients with relapsed, mesothelin-positive malignant pleural mesothelioma (ARCS-M): a randomised, open-label phase 2 trial. Lancet Oncol 2022; 23:540-552. [PMID: 35358455 PMCID: PMC10512125 DOI: 10.1016/s1470-2045(22)00061-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few treatment options exist for second-line treatment of malignant pleural mesothelioma. We aimed to assess the antibody-drug conjugate anetumab ravtansine versus vinorelbine in patients with unresectable locally advanced or metastatic disease overexpressing mesothelin who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. METHODS In this phase 2, randomised, open-label study, done at 76 hospitals in 14 countries, we enrolled adults (aged ≥18 years) with unresectable locally advanced or metastatic malignant pleural mesothelioma, an Eastern Cooperative Oncology Group performance status of 0-1, and who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. Participants were prospectively screened for mesothelin overexpression (defined as 2+ or 3+ mesothelin membrane staining intensity on at least 30% of viable tumour cells by immunohistochemistry) and were randomly assigned (2:1), using an interactive voice and web response system provided by the sponsor, to receive intravenous anetumab ravtansine (6·5 mg/kg on day 1 of each 21-day cycle) or intravenous vinorelbine (30 mg/m2 once every week) until progression, toxicity, or death. The primary endpoint was progression-free survival according to blinded central radiology review, assessed in the intention-to-treat population, with safety assessed in all participants who received any study treatment. This study is registered with ClinicalTrials.gov, NCT02610140, and is now completed. FINDINGS Between Dec 3, 2015, and May 31, 2017, 589 patients were enrolled and 248 mesothelin-overexpressing patients were randomly allocated to the two treatment groups (166 patients were randomly assigned to receive anetumab ravtansine and 82 patients were randomly assigned to receive vinorelbine). 105 (63%) of 166 patients treated with anetumab ravtansine (median follow-up 4·0 months [IQR 1·4-5·5]) versus 43 (52%) of 82 patients treated with vinorelbine (3·9 months [1·4-5·4]) had disease progression or died (median progression-free survival 4·3 months [95% CI 4·1-5·2] vs 4·5 months [4·1-5·8]; hazard ratio 1·22 [0·85-1·74]; log-rank p=0·86). The most common grade 3 or worse adverse events were neutropenia (one [1%] of 163 patients for anetumab ravtansine vs 28 [39%] of 72 patients for vinorelbine), pneumonia (seven [4%] vs five [7%]), neutrophil count decrease (two [1%] vs 12 [17%]), and dyspnoea (nine [6%] vs three [4%]). Serious drug-related treatment-emergent adverse events occurred in 12 (7%) patients treated with anetumab ravtansine and 11 (15%) patients treated with vinorelbine. Ten (6%) treatment-emergent deaths occurred with anetumab ravtansine: pneumonia (three [2%]), dyspnoea (two [1%]), sepsis (two [1%]), atrial fibrillation (one [1%]), physical deterioration (one [1%]), hepatic failure (one [1%]), mesothelioma (one [1%]), and renal failure (one [1%]; one patient had 3 events). One (1%) treatment-emergent death occurred in the vinorelbine group (pneumonia). INTERPRETATION Anetumab ravtansine showed a manageable safety profile and was not superior to vinorelbine. Further studies are needed to define active treatments in relapsed mesothelin-expressing malignant pleural mesothelioma. FUNDING Bayer Healthcare Pharmaceuticals.
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Affiliation(s)
- Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Alessandra Bearz
- Department of Medical Oncology and Immune-Related Cancers, CRO-IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giovanni L Ceresoli
- Department of Medical Oncology, Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Centre, Rotterdam, Netherlands
| | - James Spicer
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Paul Taylor
- Department of Medical Oncology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kristiaan Nackaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, Universitair Ziekenhuis Leuven, KU Leuven, Leuven, Belgium
| | - Alastair Greystoke
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Ross Jennens
- Epworth Cancer Services Clinical Institute, Epworth Healthcare, Richmond, VIC, Australia
| | - Luana Calabrò
- Department of Oncology, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Jacobus A Burgers
- Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Armando Santoro
- Humanitas University, Milan, Italy; Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Susana Cedrés
- Department of Medical Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Piotr Serwatowski
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jan P Van Meerbeeck
- Department of Thoracic Oncology, Antwerp University and University Hospital and European Reference Network for Rare or Low Prevalence Complex Disease (ERN-LUNG), Antwerp, Belgium
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia; National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - George Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan M Siegel
- Clinical Statistics Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Linda Kasten
- Statistics, Syneos Health Clinical Solutions, Morrisville, NC, USA
| | - Karl Köchert
- Biomarker and Data Insights, Bayer AG Pharma, Berlin, Germany
| | - Annette O Walter
- Translational Medicine Oncology, Bayer AG Pharma, Berlin, Germany
| | - Barrett H Childs
- Oncology Development, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Cem Elbi
- Global Clinical Development, Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Raffit Hassan
- Department of Thoracic and GI Malignancies, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
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Rog D, Oh J, Chambers C, Fox EJ, McCombe P, Otero S, Margolin DH, Kasten L, Compston DAS. 1127 Pregnancy outcomes in alemtuzumab trials and registry design. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Coles A, Giovannoni G, Moreau T, Havrdova E, Margolin D, Kasten L, Singer B. ALEMTUZUMAB IMPROVES 3-YEAR QUALITY OF LIFE IN CARE-MS II. J Neurol Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In the 2-year, phase 3 CARE–MS II study (NCT00548405) of relapsing-remitting multiple sclerosis (RRMS) patients with inadequate efficacy response to prior therapy, alemtuzumab demonstrated superior efficacy and quality-of-life (QoL) improvements versus subcutaneous interferon beta-1a, with manageable safety. Here, QoL outcomes are examined in alemtuzumab-treated patients at Year 3 in an ongoing extension study (NCT00930553). 393 of 435 alemtuzumab 12 mg-treated patients entered the extension study; 80 received as-needed alemtuzumab retreatment during Year 3. Mean Functional Assessment of multiple sclerosis total score (scale 0–176) improved from baseline to year 3 (119.1 vs 124.8; P<0.0001), with 5 of 6 subscales significantly improved. Mean Short-Form 36–Item survey physical and mental component summary scores (scale 1–100) rose from baseline to Year 3 (42.7 vs 44.7; P<0.0001, and 44.9 vs 46.5; P=0.042, respectively), with 6 of 8 subscales improved, and 82% and 73% of patients, respectively, having a stable or improved score at Year 3. EuroQol 5–dimensional visual analogue scale score improved from baseline to Year 3 (70.1 vs 73.0; P=0.0045). Overall sustained improvement in physical, mental, and emotional aspects of QoL were observed through 3 years in this population of alemtuzumab-treated RRMS patients, even though most patients received only 2 alemtuzumab treatment courses.
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Marsiske M, Dzierzewski JM, Thomas KR, Kasten L, Jones R, Johnson K, Willis S, Whitfield K, Ball K, Rebok G. Race-related disparities in 5-year cognitive level and change in untrained ACTIVE participants. J Aging Health 2013; 25:103S-27S. [PMID: 24385632 PMCID: PMC3882334 DOI: 10.1177/0898264313497794] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The current study examined a 5-year cognitive change in untrained African American and White participants from the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study. METHOD Five-year trajectories of memory, reasoning, visual processing speed/useful field of view, digit-symbol substitution, and vocabulary were investigated. Education, health, gender, age, and retest/practice effects were controlled for, and a missing data pattern mixture approach was used to adjust for dropout effects. RESULTS After considering age, education, health, and gender, being African American uniquely explained 2% to 7% of the variance in cognitive performance. There were virtually no significant race differences in the rates of change. DISCUSSION Race-related results in the current study are consistent with previous research suggesting that social advantage factors such as education have a stronger influence on the level of performance than the rate of change. The small remaining effects of being African American on performance levels likely reflect uncontrolled variation in factors like literacy and financial advantage.
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Affiliation(s)
- Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida
| | | | - Kelsey R. Thomas
- Department of Clinical and Health Psychology, University of Florida
| | | | - Rich Jones
- Social and Health Policy Research, Hebrew Senior Life
| | - Kathy Johnson
- Department of Psychology, Indiana University Purdue University at Indianapolis
| | - Sherry Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Karlene Ball
- Department of Psychology, University of Alabama-Birmingham
| | - George Rebok
- Department of Mental Health, Johns Hopkins University
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Harrow BS, Tompkins CP, Mitchell PD, Smith KW, Soldz S, Kasten L, Fleming K. The impact of publicly funded managed care on adolescent substance abuse treatment outcomes. Am J Drug Alcohol Abuse 2006; 32:379-98. [PMID: 16864469 DOI: 10.1080/00952990600753677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.
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Affiliation(s)
- Brooke S Harrow
- New England Research Institutes (NERI), Watertown, Massachusetts 02472, USA.
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7
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Larson MJ, Zhang A, Smith K, Kasten L. Access To Services: Multiple Perspectives From Adults With Substance Abuse Disorders In Massachusetts. Adm Policy Ment Health 2005; 32:357-71. [PMID: 15844854 DOI: 10.1007/s10488-004-1664-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper describes how 267 Massachusetts adult substance abuse consumers rated the substance abuse counseling they have received, their access to behavioral health care, and their overall experiences with their health plan or free care. This perspective is supplemented with information from administrative data on type of care received immediately after the baseline interview, including use of wraparound services while in treatment. We hypothesized that consumers in a carve-out behavioral health plan would view their care more favorably because they had a payment source for both substance abuse and mental health care. This hypothesis was confirmed. However, it is access to Medicaid insurance, not involvement of managed care, that is associated with greater access and higher consumer ratings of care.
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Affiliation(s)
- Mary Jo Larson
- Institute for Health Services Research & Policy, New England Research Institutes, Watertown, MA 02472, USA.
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8
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Morrill AC, Kasten L, Urato M, Larson MJ. Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse. J Subst Abuse 2002; 13:169-84. [PMID: 11547617 DOI: 10.1016/s0899-3289(01)00065-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. METHODS Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. RESULTS Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. CONCLUSION Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.
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Affiliation(s)
- A C Morrill
- New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA.
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Mahoney DM, Tarlow B, Jones RN, Tennstedt S, Kasten L. Factors affecting the use of a telephone-based intervention for caregivers of people with Alzheimer's disease. J Telemed Telecare 2002; 7:139-48. [PMID: 11346473 DOI: 10.1258/1357633011936291] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the usefulness of a computer-mediated interactive voice response (IVR) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer's disease. The randomization procedure resulted in 49 caregivers being assigned to the intervention group and 51 to the control group. Using their ordinary telephone, the caregivers were linked to the four components of the IVR system: monitoring and counselling, an in-home support group, 'ask the expert', and a respite conversation. During an 18-month study, total system usage amounted to 55 min per user (SD 78, range 1-318). Half the participants used the system for at least 22 min, and 25% for at least 70 min. Participants made between one and 45 calls over the study period, averaging 11 calls (SD 12). Approximately half of the intervention group used the system regularly for two or more months. These 'adopters' were significantly older, more highly educated and reported a greater sense of management of the situation than 'non-adopters'. Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session. The IVR approach appealed to a subset of users. However, the overall preference was for human interaction.
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Affiliation(s)
- D M Mahoney
- Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, Massachusetts 02131, USA.
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Geron SM, Smith K, Tennstedt S, Jette A, Chassler D, Kasten L. The home care satisfaction measure: a client-centered approach to assessing the satisfaction of frail older adults with home care services. J Gerontol B Psychol Sci Soc Sci 2000; 55:S259-70. [PMID: 10985297 DOI: 10.1093/geronb/55.5.s259] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The Home Care Satisfaction Measure (HCSM) is an easy to administer, psychometrically sound instrument based on consumer-defined notions of satisfaction, including perspectives of ethnic minorities. The HCSM provides an overall home care satisfaction score and subscale scores for 5 common services, all on a 0-100 scale. METHODS Focus groups with African American, Hispanic, and non-Hispanic White older adults were audiotaped. Tapes were transcribed and analyzed with grounded theory methods. Correlational and common factor analyses were conducted to select items, and the instrument was field tested with 228 frail, low-income, older home care recipients. RESULTS Test-retest reliabilities ranged from .68 to .88, with high internal consistency reliabilities. Substantial concurrent validity was achieved for subscale and overall HCSM scores. Home care satisfaction was not related to gender, age or race but was negatively associated with physical disability. Significant social desirability effects were found. DISCUSSION In the increasingly important area of home care, the HCSM is the first measure developed on the basis of the views of older consumers that also meets standard psychometric criteria. The HCSM provides a consumer-based indicator of quality and can be used to examine changes in satisfaction over time and differences among providers or within a single agency.
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Affiliation(s)
- S M Geron
- Boston University School of Social Work, Watertown, Massachusetts, USA.
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Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci 1998; 53:P384-92. [PMID: 9826971 DOI: 10.1093/geronb/53b.6.p384] [Citation(s) in RCA: 298] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.
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Affiliation(s)
- S Tennstedt
- New England Research Institutes, Watertown, Massachusetts, USA.
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Abstract
With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.
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Affiliation(s)
- J Howland
- Boston University School of Public Health, MA 02118, USA.
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Rubenstein JL, Halton A, Kasten L, Rubin C, Stechler G. Suicidal behavior in adolescents: stress and protection in different family contexts. Am J Orthopsychiatry 1998; 68:274-284. [PMID: 9589765 DOI: 10.1037/h0080336] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Recent suicidal behavior was reported on a questionnaire by 14% of 272 high school students. Two-thirds of the suicidal teenagers neither received help nor disclosed their self-harm to anyone. Depression and stress--especially family suicidality, feelings of violation, and sexuality--increased the risk, as did parental separation, divorce, and most dramatically, remarriage. Family cohesiveness helped alleviate the risk in the nonintact families.
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Affiliation(s)
- J L Rubenstein
- Department of Psychiatry, Boston University School of Medicine, Mass., USA
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Abstract
BACKGROUND To determine if physician specialty, length of time in practice, and fear of malpractice influence the diagnosis and management of breast cancer in older women. METHODS We used a fractional factorial design that controlled for patient age (65 or 80 years), race, socioeconomic status, mobility, comorbidity, and assertive behavior through 2 videotaped scenarios (a potential breast cancer [no. 1] and a known stage IIA breast cancer [no. 2]). One hundred twenty-eight white male physicians equally divided by specialty (surgeon versus nonsurgeon) and time in practice (< or = 15 or >15 years) viewed the videotapes and made recommendations. RESULTS The physician subjects saw 46 patients per week, 59% female, and 47% age > or = 65. Their concern over malpractice was 4.7 (on a 10-point Likert scale with a higher score indicating more concern) and did not differ by specialty or time in practice (P values > 0.7). After viewing scenario no. 1, surgeons were less likely than nonsurgeons to consider breast cancer as the principal diagnosis (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2 to 0.9) and to obtain a tissue diagnosis (OR = 0.3, 95% CI = 0.1 to 0.9). However, in scenario no. 2, surgeons were more likely to offer reconstruction (OR = 3.8, 95% CI = 1.4 to 10.4). Physicians in practice < or = 15 years were more likely than those in practice <15 years to obtain a tissue diagnosis in scenario no. 1 (OR = 6.1, 95% CI = 1.9 to 19.2) and to perform full primary therapy in scenario no. 2 (OR = 2.8, 95% CI = 1.2 to 6.9). Physicians who performed an extensive metastatic evaluation (bone or computer tomography [CT] scan) had greater concern over malpractice than those who did not, as did physicians who performed an axillary node dissection (OR = 2.1, 95% CI 1.3 to 3.4 and OR = 1.8, 95% CI = 1.1 to 3.0). CONCLUSIONS With the uncertainty of how to diagnose and treat older women with breast cancer, physician specialty, length of time in practice, and concern over malpractice do influence clinical decisions.
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Affiliation(s)
- R B Burns
- Evans Department of Medicine, Boston Medical Center Hospital, Massachusetts 02118, USA
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15
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Abstract
The study focused on the influences of both patient characteristics and physician experience on the recall of two breast cancer cases. Two general research questions were addressed: 1) whether patient characteristics such as age, race, and assertiveness affect a physician's initial problem representation, and 2) whether the recall advantage for physicians of intermediate levels of experience extends to physicians who have been out of medical school for at least six years, 128 physicians with a minimum of six years' experience were presented with two videotapes of a doctor-patient encounter. In the first videotape (the pre-workup scenario), the patient had just discovered a lump; in the second (the post-workup scenario), she had recently had a biopsy. Following the presentation of each videotape, the physicians were instructed to record a synopsis of the case prior to making diagnoses, ordering tests, and providing treatment recommendations. The synopses were coded to capture information from the cases that the physicians were able to recall and inferences that they generated based on this information. Two critical findings were obtained. First, none of the patient characteristics investigated consistently produced differences in recall or inference generation across the two scenarios. Second, physician recall was a monotonically decreasing function of years of experience. The latter result is interpreted using a theoretical framework from Schmidt and Boshuizen.
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Affiliation(s)
- R Durante
- New England Research Institutes, Watertown, Massachusetts 02172, USA
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16
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Schwartz JL, Brinkman WJ, Kasten L, Miller DW, Moan EI, Murphy YT, Stella D, Sedita BA. Altered metaphase chromosome structure in xrs-5 cells is not related to its radiation sensitivity or defective DNA break rejoining. Mutat Res 1995; 328:119-26. [PMID: 7537859 DOI: 10.1016/0027-5107(94)00201-f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The chinese hamster ovary (CHO) cell line xrs-5 is a radiation-sensitive derivative of CHO-K1 cells. The xrs-5 cells have a defect in DNA double-strand break rejoining and show alterations in chromosome structure and nuclear morphology. The relationship between radiation sensitivity and metaphase chromosome morphology was examined in 12 'revertant' xrs-5 clones isolated following treatment with 5-azacytidine. nine of the clones were radioresistant while the other three retained xrs-5-like radiation sensitivity. Chromosome morphology reverted to CHO-K1-like characteristics in three of the radioresistant clones and one of the radiosensitive clones suggesting that the over-condensed metaphase chromosome morphology of xrs-5 cells does not underlie its radiation sensitivity. Radiation sensitivity did correlate with DNA double-strand break rejoining ability. The radioresistant clones showing the over-condensed xrs-5-like chromosome morphology were also slightly more sensitive to the topoisomerase II inhibitor etoposide (VP-16) than CHO-K1, suggesting that the over-condensed morphology might be due to alterations in the phosphorylation of chromatin proteins.
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Affiliation(s)
- J L Schwartz
- Center for Mechanistic Biology and Biotechnology, Argonne National Laboratory, IL 60439-4833, USA
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17
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Abstract
To more completely understand unmet need as an indicator of demand for long-term care, longitudinal data on a representative sample of disabled elders were used to track the extent, type, and predictors of unmet need(s) over a 4-year period. Unmet IADL needs were more common than unmet PADL needs with only 1-2% reporting both types. Unmet needs appear to be temporary rather than persistent and are predicted by lack of an engaged (not necessarily unavailable) caregiving system. The data suggest that the rate of unmet personal care need rather than the rate of any unmet need represents a more accurate estimate of the number of elders for whom community long-term care services are critical to decrease risk of institutionalization.
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Affiliation(s)
- S Tennstedt
- New England Research Institute, Watertown, MA 02172
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