Changes in health-related quality of life following percutaneous coronary intervention – a nationwide prospective cohort study

Background

In addition to mortality and morbidity, improved health-related quality of life (HRQOL) is a goal of treatment in patients suffering of cardiovascular heart disease. There is a limited knowledge of changes in HRQOL following percutaneous coronary intervention (PCI).

Aims

The aims of this study were to determine total and gender specific changes in HRQOL at baseline and four-years following PCI.

Methods

This study use data from the Norwegian Coronary Stent Trial which included 9013 patients undergoing first time percutaneous coronary intervention in Norway during September 2008–February 2011. HRQOL was assessed using the Short-Form-12 (SF-12) at baseline and at four years of follow up in a representative subgroup (n=775).

Results

The mean age was 64 years (SD 9.2) and 75% were male. Eighty percent were living with a partner and 67% had a higher level of education. The majority of the patients had stable angina as indication for PCI (40%). There was a significant improvement in all domains of SF-12 from baseline to four years of follow up (p<0.001). The highest changes were in Role Physical (43.6 vs. 48.2), Bodily Pain (44.8 vs. 50.1) and Vitality (44.1 vs. 49.3). Analysing gender differences at four years follow-up, men had a higher improvement in the physical component summary score than women (4.8 vs 2.8, p=0.04), but not in the mental component summary score (2.8 vs 4.4, p=0.11).

Conclusion

In patients undergoing first time PCI, HRQOL improved significant from baseline to four years of follow up. Both at baseline and at five years of follow up males report a higher HRQOL compared to females.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Northern Norway Regional Health Authority

Electronic reporting of diagnostic laboratory test results from all healthcare sectors is a cornerstone of national preparedness and control of COVID-19 in Denmark

The COVID‐19 pandemic has led to an unprecedented demand for real‐time surveillance data in order to inform critical decision makers regarding the management of the pandemic. The aim of this review was to describe how the Danish national microbiology database, MiBa, served as a cornerstone for providing data to the real‐time surveillance system by linkage to other nationwide health registries. The surveillance system was established on an existing IT health infrastructure and a close network between clinical microbiologists, information technology experts, and public health officials. In 2020, testing capacity for SARS‐CoV‐2 was ramped up from none to over 10,000 weekly PCR tests per 100,000 population. The crude incidence data mirrored this increase in testing. Real‐time access to denominator data and patient registries enabled adjustments for fluctuations testing activity, providing robust data on crude SARS‐CoV‐2 incidence during the changing diagnostic and management strategies. The use of the same data for different purposes, for example, final laboratory reports, information to the public, contact tracing, public health, and science, has been a critical asset for the pandemic response. It has also raised issues concerning data protection and critical capacity of the underlying technical systems and key resources. However, even with these limitations, the setup has enabled decision makers to adopt timely interventions. The experiences from COVID‐19 may motivate a transformation from traditional indicator‐based public health surveillance to an all‐encompassing information system based on access to a comprehensive set of data sources, including diagnostic and reference microbiology.

De novo assembly and annotation of the North American bison (Bison bison) reference genome and subsequent variant identification

Genomic tools have improved the ability to manage bison populations and enhanced efforts to conserve this iconic species. These tools have been particularly useful for detecting introgression of cattle genome within bison herds but are limited by the need to use the cattle genome as a surrogate for mapping reads. This complicates efforts to distinguish the species of origin of chromosomal segments in individual bison at the genomic level. An assembly (Bison_UMD1.0) based on 75X genome coverage by Illumina and 454 reads was generated using the MaSuRCA assembler, generating a 2.81 Gigbases de novo reference genome from American bison. Comparison of bison and domestic cattle references identified 28 443 364 single nucleotide variants and 2 627 645 insertions/deletions distinguishing the species. Sequence alignment of an additional 12 modern bison samples and two historic bison samples to domestic cattle and bison references provides a dataset of genomic variants defining the different species and within-species variation. This first annotated draft assembly represents a resource for the management and conservation of bison, as well as a means to study the effects on the genome of interspecies hybridization. The comparisons of historical bison sequences with the new bison reference identified genomic differences between modern and pre-population bottleneck bison. The results support the application of genomics to enhance future research on disease, the establishment of satellite conservation herds and insight into bison and cattle speciation. The first genome assembly for bison and dataset provides a foundation that can be built upon as genetic technologies improve over the years.

Mind-Craft: Exploring the Effect of Digital Visual Experience on Changes to Orientation Sensitivity in Visual Contour Perception

Visual perception depends fundamentally on statistical regularities in the environment to make sense of the world. One such regularity is the orientation anisotropy typical of natural scenes; most natural scenes contain slightly more canonical (horizontal and vertical) information than oblique information. This property is likely a primary cause of the oblique effect in which subjects experience greater perceptual fluency with horizontally and vertically oriented content than oblique. Recent changes in the visual environment, including the "carpentered" content in urban scenes and the framed, caricatured content in digital screen media presentations, may have altered the typical (natural) level of orientation anisotropy. The current work evaluated whether digital visual experience, or visual experience with framed digital content, has the potential to alter the magnitude of the oblique effect in visual perception. Experiment 1 successfully established a novel eye-tracking method capable of indexing the visual oblique effect quickly and reliably and demonstrated the oblique effect. Experiment 2 used this method and found that one session of exposure to a specific video game altered visual orientation perception. Taken together, these results indicate that exposure to the realistic, but caricatured scene statistics of digital screen media, can alter visual contour perception in one session.

0944 Shhh! Initiative: Sleep Health Practices In Pediatric Hospitals

Introduction

Hospitalizations often result in significant sleep disruption, despite the importance of sleep in healing (Cmiel, et al., 2004). Research-to-date has focused primarily on adult intensive care (ICU) with minimal focus on pediatric patients. The aim of this study was to assess pediatric inpatient healthcare providers’ understanding of and attitudes towards sleep in the hospital environment with the goal of developing a sleep health educational intervention as well as modifications to standards of care that unnecessarily interrupt sleep of pediatric inpatients.

Methods

An online survey was administered to pediatric inpatient staff (nurses, physicians, residents) at a Mid-Atlantic children’s hospital focused on assessing their understanding of sleep in the context of inpatient care (N = 316). Respondents were 30-50 years old (54%), primarily identified as female (88%), and most (60%) reported being in a nursing position.

Results

Quantitative findings (N = 316) revealed that 65% reported patients were sometimes, rarely, or never allowed to sleep without being awakened from administration of non-critical medications. A majority (63.8%) reported that sometimes, rarely, or never do they consider interruption of sleep in decisions on when to give medications, while 54.9% reported the quantity and quality of sleep is rarely/never considered in a patient’s treatment. Qualitative responses (N = 248) confirmed these findings with 34.3% reporting that they considered re-scheduling medications to minimize sleep interruptions. Despite this finding, only 15.7% reported they would assess or give attention to sleep in the context of patient recovery and treatment.

Conclusion

Pediatric healthcare providers are aware of the importance of sleep for their patients; however, they are not prioritizing sleep as a part of treatment in their behaviors and decisions. Next steps include developing and implementing an intervention for pediatric healthcare providers to follow through on limiting sleep interruptions as well as focusing on sleep in the treatment process.

Support

N/A

Determining the IgG concentrations in bovine colostrum and calf sera with a novel enzymatic assay

Background

Immune protection in newborn calves relies on a combination of the timing, volume and quality of colostrum consumed by the calf after birth. Poor quality colostrum with inadequate immunoglobulin concentration contributes to failed transfer of passive immunity in calves, leading to higher calf morbidity and mortality. Therefore, estimating colostrum quality and ensuring the transfer of passive immunity on farm is of critical importance. Currently, there are no on-farm tools that directly measure immunoglobulin content in colostrum or serum. The aim of this study was to apply a novel molecular assay, split trehalase immunoglobulin G assay (STIGA), to directly estimate immunoglobulin content in dairy and beef colostrum and calf sera, and to examine its potential to be developed as on-farm test. The STIGA is based on a split version of trehalase TreA, an enzyme that converts trehalose into glucose, enabling the use of a common glucometer for signal detection. In a first study, 60 dairy and 64 beef colostrum and 83 dairy and 84 beef calf sera samples were tested with STIGA, and the resulting glucose production was measured and compared with radial immunodiffusion, the standard method for measuring immunoglobulin concentrations.

Results

Pearson correlation coefficients between the methods were determined and the sensitivity, specificity, and accuracy of the test were calculated for different colostrum quality and failed transfer of passive immunity cut-off points. The correlations of the STIGA measured by colorimetric enzymatic reaction compared to radial immunodiffusion for dairy and beef colostrum were 0.72 and 0.73, respectively, whereas the correlations for dairy and beef sera were 0.9 and 0.85, respectively. Next, STIGA was tested in a blinded study with fresh colostrum and serum samples where the correlation coefficient was 0.93 and 0.94, respectively. Furthermore, the performance of STIGA followed by glucometer readings resulted in correlations with radial immunodiffusion of 0.7 and 0.85 for dairy and beef colostrum and 0.94 and 0.83 for dairy and beef calf serum.

Conclusions

A split TreA assay was validated for measurement of the immunoglobulin content of colostrum and calf sera using both a lab-based format and in a more user-friendly format compatible with on-farm testing.

Salt-Induced Control of the Grafting Density in Poly(ethylene glycol) Brush Layers by a Grafting-to Approach

In this work, a method to obtain control of the grafting density during the formation of polymer brush layers by the grafting-to method of thiolated poly(ethylene glycol) onto gold is presented. The grafting density of the polymer chains was adjusted by adding Na₂SO₄ in concentrations between 0.2 and 0.9 M to the aqueous polymer solution during the grafting process. The obtained grafting densities ranged from 0.26 to 1.60 chains nm^-2, as determined by surface plasmon resonance. The kinetics of the grafting process were studied in situ by a quartz crystal microbalance with dissipation, and a mushroom to brush conformational transition was observed when the polymer was grafted in the presence of Na₂SO₄. The transition from mushroom to brush was only observed for long periods of grafting, highlighting the importance of time to obtain high grafting densities. Finally, the prepared brush layer with the highest grafting density showed high resistance to the adsorption of bovine serum albumin, while layers with a lower grafting density showed only limited resistance.

Identification of Brucella spp. in feral swine (Sus scrofa) at abattoirs in Texas, USA

Various tissues, nasal swabs, urine and blood samples were collected from 376 feral swine at two federally inspected abattoirs in Texas during six separate sampling periods in 2015. Samples were tested for Brucella spp. by culture and serology. Brucella spp. were cultured from 13.0% of feral swine, and antibodies were detected in 9.8%. Only 32.7% of culture-positive feral swine were also antibody positive, and 43.2% of antibody-positive feral swine were culture positive. Approximately, the same number of males (14.0%) and females (12.1%) were culture positive, and slightly more males (10.5%) than females (8.7%) were antibody positive. Our results indicate that serology likely underestimates the prevalence of feral swine infected, and that those who come in contact with feral swine should be aware of the symptoms of infection with Brucella spp. to ensure prompt treatment.

Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus

BACKGROUND/OBJECTIVE

Diet represents a key strategy for the prevention of obesity and type 2 diabetes among women with a history of gestational diabetes mellitus (GDM), although effective dietary patterns to prevent weight gain in the long term are largely unknown. We sought to evaluate whether improvement in overall diet quality is associated with less long-term weight gain among high-risk women with prior GDM.

SUBJECTS/METHODS

Women with a history of GDM (N=3397) were followed from 1991 to 2011, or until diagnosis of type 2 diabetes or other chronic disease. Usual diet was assessed via food frequency questionnaire every 4 years from which we calculated the Alternative Healthy Eating Index (aHEI-2010), Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary pattern scores. Weight, lifestyle and health-related outcomes were self-reported every 2 years. We estimated the change in dietary score with change in body weight using linear regression models adjusting for age, baseline body mass index (BMI), baseline and simultaneous change in physical activity and smoking status and other risk factors.

RESULTS

Women were followed up to 20 years, gaining an average 1.9 kg (s.d.=7.0) per 4-year period. Women in the highest quintile (Q5) of diet change (most improvement in quality) gained significantly less weight per 4-year period than the lowest quintile (Q1; decrease in quality), independent of other risk factors (4-year weight change, aHEI-2010: Q5=1.30 kg vs Q1=3.27 kg; AMED: Q5=0.94 kg vs Q1=2.56 kg, DASH: Q5=0.64 kg vs Q1=2.75 kg). Significant effect modification by BMI (p-interactions <0.001) indicated a greater magnitude of weight change among women with a higher baseline BMI for all three patterns.

CONCLUSIONS

Increased diet quality was associated with less weight gain, independent of other lifestyle factors. Post-partum recommendations on diet quality may provide one strategy to prevent long-term weight gain in this high-risk group.

Youth with disabilities' perspectives of the environment and participation: a qualitative meta-synthesis

Meta-syntheses can enhance our knowledge regarding the impact of the environment on the participation of youth with disabilities and generate theoretical frameworks to inform policy and best practices. The purpose of this study was to describe school-aged youth with disabilities' perspectives regarding the impact of the environment and modifications on their participation. A meta-synthesis systematically integrates qualitative evidence from multiple studies. Six databases were searched and 1287 citations reviewed for inclusion by two independent raters; 15 qualitative articles were selected for inclusion. Two independent reviewers evaluated the quality of each study and coded the results section. Patterns between codes within and across articles were examined using a constant comparative approach. Environments may be more or less inclusive for youth with disabilities depending upon others' understanding of individual abilities and needs, youth involvement in decisions about accommodations, and quality of services and policies. Youth implemented strategies to negotiate environmental barriers and appraised the quality of their participation based on the extent to which they engaged alongside peers. This meta-synthesis generated a framework illustrating the relationship between the environment, modifications and participation, and provided a conceptualization of participation grounded in the lived experiences of youth with disabilities. Findings reveal gaps in current knowledge and highlight the importance of involving youth with disabilities in decision making.

Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital

OBJECTIVE

To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies.

DESIGN

Retrospective medical record review of hospital admissions during 2005 in eight countries.

SETTING

Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety.

PARTICIPANTS

Convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled.

MAIN OUTCOME MEASURES

Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed by a senior physician for determination of adverse event, its preventability, and the resulting disability.

RESULTS

Of the 15,548 records reviewed, 8.2% showed at least one adverse event, with a range of 2.5% to 18.4% per country. Of these events, 83% were judged to be preventable, while about 30% were associated with death of the patient. About 34% adverse events were from therapeutic errors in relatively non-complex clinical situations. Inadequate training and supervision of clinical staff or the failure to follow policies or protocols contributed to most events.

CONCLUSIONS

Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied, and hence should be a high priority public health problem. Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors. The convenience sampling of hospitals might limit the interpretation of results, but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research. Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more resources.

A Relativistic Four- and Two-component Generalized-active-space Coupled Cluster Method

We present an overview of our recent developments of relativistic generalized-active-space coupled cluster and its initial applications to heavy-element systems. The new genuinely string-based method may treat coupled cluster expansions of general order and simulate multi-reference expansions by including higher excitations in properly constructed active spinor spaces. The four-component Dirac-Coulomb Hamiltonian or any approximation to it may be employed, and the underlying spinors are assumed and required to be time-reversal partners. The capability of the new approach is demonstrated and discussed in sample applications to HBr and BiH.

Brain metastases in breast cancer: Different survival by biological subtype and Ki67 expression

1069

Background: Ten to 15% of patients (pts) with breast cancer will be diagnosed with central nervous system (CNS) metastases, and autopsy series suggest that up to 30% of pts have evidence of CNS disease at the time of death. The idenfication of factors that may predispose to CNS metastasis may help lead to earlier detection and possibly to improvement in disease management. Methods: Breast cancer pts with CNS metastases were identified within a database of 1300 breast cancer diganoses from 1995 to 2007 at the Department of Oncology, Azienda ULSS 13 VE. Pathologic features of tumor samples were examined using standard immunohistochemical assays. Results: Fifty-one pts with CNS metastases were identified. Median age at primary breast cancer diagnosis was 49 years (range, 28–78); median time to CNS metastases was 45 months (range, 3–244). HER2 overexpression was found in tumors from 25 pts (49.0%); 23 pts had tumors lacking overexpression of HER2, estrogen receptors (ER), and progesterone receptors (PgR) (ie, “triple negative” disease). Overexpression of p53 (at least 20% tumor cells positive), Ki67 (at least 20%), and BCL2 (at least 30%) were detected in tumors from 16 pts (31.4%), 32 pts (62.7%), and 14 pts (27.5%), respectively. Median survival from CNS involvement was 3.67 months (95% CI 2.05–5.28), with 24.4% and 15.3% of patients estimated to be alive at 12 and 24 months, respectively (Kaplan-Meier product limit method). A Cox proportional hazards analysis found that Ki67 overexpression was the only factor independently associated with a significantly increased risk of death (2.7-fold increase, p=0.028), while triple negative status was associated with a 1.8-fold increase in the risk of death (P=0.08) (Table). Conclusions: In our series of breast cancer pts with CNS metastases, nearly all had either HER2 overexpression or triple-negative disease. Pts whose tumors had higher proliferative indices, assessed by Ki67, had the poorest prognosis.

[Table: see text]

[Table: see text]

Interstitial nephritis with acute renal failure following cardiac surgery and treatment with methicillin

Six patients developed acute renal failure 13-19 days after cardiac surgery with extracorporeal circulation. None of the patients had suffered from postoperative hypotension; slight hemolysis was present for only 1-2 days post-operatively. Acute renal failure lasted for 11-80 days in four patients. In two patients creatinine clearance stabilized at reduced values. Seven renal biopsies from the six patients showed severe acute interstitial nephritis with mononuclear cellular infiltration and distal tubular damage. No immune deposits were detected in glomeruli or tubular basement membrane. All six patients had been treated prophylactically with methicillin and the acute renal disease was probably elicited by this drug.

Detection of adverse events in a Scottish hospital using a consensus-based methodology

OBJECTIVE

To determine, using a consensus based methodology, the rate and nature of adverse events (AEs) among patients admitted to acute medicine, acute surgery and obstetrics in a large teaching hospital in Scotland.

METHODS

Retrospective case-note review of 450 medical, nursing and medication records to identify and classify adverse events. For 354 patients whose length of stay was greater than 24 hours, the overall adverse event rate was 7.9% which ranged from 0% in obstetrics, 7.2% in acute medicine to 13% in acute surgery. Among all AEs, 43% were deemed preventable by a consensus group and 59% of the AEs contributed to a proportion of the patients' hospital stay or led to hospital readmission. Whilst nurse identification of adverse events was highly specific (94%), its sensitivity was poor (43%). Only 10% of the identified AEs were identified by the hospital's voluntary reporting system for adverse events. The estimated additional cost of adverse events in terms of bed days was ł69,189 which if extrapolated Scotland-wide could cost ł297 million per annum.

CONCLUSIONS

This study supports the need to continue the traditional retrospective record review to identify adverse events. The current hospital-based reporting of adverse events does not provide a complete measure of adverse events and needs to be complemented by other measures.

K+ as a vasodilator in resting human muscle: implications for exercise hyperaemia

AIM

Potassium (K(+)) released from contracting skeletal muscle is considered a vasodilatory agent. This concept is mainly based on experiments infusing non-physiological doses of K(+). The aim of the present study was to investigate the role of K(+) in blood flow regulation.

METHODS

We measured leg blood flow (LBF) and arterio-venous (A-V) O(2) difference in 13 subjects while infusing K(+) into the femoral artery at a rate of 0.2, 0.4, 0.6 and 0.8 mmol min(-1).

RESULTS

The lowest dose increased the calculated femoral artery plasma K(+) concentration by approx.1 mmol L(-1). Graded K(+) infusions increased LBF from 0.39 +/- 0.06 to 0.56 +/- 0.13, 0.58 +/- 0.17, 0.61 +/- 0.11 and 0.71 +/- 0.17 L min(-1), respectively, whereas the leg A-V O(2) difference decreased from 74 +/- 9 to 60 +/- 12, 52 +/- 11, 53 +/- 9 and 45 +/- 7 mL L(-1), respectively (P < 0.05). Mean arterial pressure was unchanged, indicating that the increase in LBF was associated with vasodilatation. The effect of K(+) was totally inhibited by infusion (27 micromol min(-1)) of Ba(2+), an inhibitor of Kir2.1 channels. Simultaneous infusion of ATP and K(+) evoked an increase in LBF equalled to the sum of their effects.

CONCLUSIONS

Physiological infusions of K(+) induce significant increases in resting LBF, which are completely blunted by inhibition of the Kir2.1 channels. The present findings in resting skeletal muscle suggest that K(+) released from contracting muscle might be involved in exercise hyperaemia. However, the magnitude of increase in LBF observed with K(+) infusion suggests that K(+) only accounts for a limited fraction of the hyperaemic response to exercise.

Vaccination in conservation medicine

Unprecedented human population growth and anthropogenic environmental changes have resulted in increased numbers of people living in closer contact with more animals (wild, domestic, and peridomestic) than at any other time in history. Intimate linkage of human and animal health is not a new phenomenon. However, the global scope of contemporary zoonoses has no historical precedent. Indeed, most human infectious diseases classed as emerging are zoonotic, and many of these have spilled over from natural wildlife reservoirs into humans either directly or via domestic or peridomestic animals. Conservation medicine has recently emerged as a meaningful discipline to address the intersection of animal, human, and ecosystem health. Interest in the development of novel vaccines for wildlife encounters important challenges that may prevent progress beyond the conceptual phase. Although notable examples of successful wildlife immunisation programmes exist, depending upon key considerations, vaccination may or may not prove to be effective in the field. When implemented, wildlife vaccination requires a combination of novel zoonosis pathogen management strategies and public education to balance conservation, economic, and public health issues.

A surgically induced hypoxic environment causes changes in the metastatic behaviour of tumours in vitro

The use of laparoscopic techniques for curative resections of malignant tumours has been under scrutiny. The potential benefits to the patient in the form of earlier recovery and less immune paresis are countered by the reports of increased tumour recurrence. The biological sequelae of the hypoxic laparoscopic environment on tumour cells is unknown. Components of the metastatic cascade were evaluated under in vitro laparoscopic conditions using a human colonic adenocarcinoma cell line (SW1222). Exposure to the laparoscopic gases carbon dioxide and helium for 4 h, comparable to the duration of a laparoscopic colorectal resection, had no effect on cell viability. A cellular hypoxic insult was demonstrated by the induction of hypoxia inducible factor 1alpha (HIF-1alpha). Exposure also resulted in significant reduction in homotypic adhesion as well as to a variety of extracellular matrix components. These effects were recoverable under re-oxygenation. The changes were reflected at the molecular level by significant down regulation of adhesion molecules known to be involved in tumour progression (E-cadherin, CD44 and beta1 sub-unit). Modulation of adherence has significant implications for laparoscopic oncological surgery, demonstrating that tumours become potentially more friable and easier to disseminate in surgeons who are less experienced or where instrumentation is sub-optimal.

Randomized Phase III Study of Docetaxel Compared With Paclitaxel in Metastatic Breast Cancer

Purpose

This randomized, controlled, multicenter, open-label, phase III study compared docetaxel versus paclitaxel in patients with advanced breast cancer that had progressed after an anthracycline-containing chemotherapy regimen.

Patients and Methods

Patients (n = 449) were randomly assigned to receive either docetaxel 100 mg/m2(n = 225) or paclitaxel 175 mg/m2(n = 224) on day 1, every 21 days until tumor progression, unacceptable toxicity, or withdrawal of consent.

Results

In the intent-to-treat population, both the median overall survival (OS, 15.4 v 12.7 months; hazard ratio [HR], 1.41; 95% CI, 1.15 to 1.73; P = .03) and the median time to progression (TTP, 5.7 months v 3.6 months; HR, 1.64; 95% CI, 1.33 to 2.02; P < .0001) for docetaxel were significantly longer than for paclitaxel, and the overall response rate (ORR, 32% v 25%; P = .10) was higher for docetaxel. These results were confirmed by multivariate analyses. The incidence of treatment-related hematologic and nonhematologic toxicities was greater for docetaxel than for paclitaxel; however, quality-of-life scores were not statistically different between treatment groups over time.

Conclusion

Docetaxel was superior to paclitaxel in terms of OS and TTP. ORR was higher for docetaxel. Hematologic and nonhematologic toxicities occurred more frequently in the docetaxel group. The global quality-of-life scores were similar for both agents over time.