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While early epidemiologic studies ascribed increases in the incidence of human papillomavirus-associated oropharyngeal cancers to middle-aged patients, recent analyses have demonstrated an increasing median age of diagnosis. click here Treatment of patients older than 70 years is controversial as their inclusion in the practice-defining clinical trials has been limited and the survival benefit conferred by chemotherapy may be outweighed by treatment toxic effects.

To assess the oncologic outcomes of older adults with human papillomavirus-associated oropharyngeal cancer who underwent upfront transoral robotic surgery and pathologic characteristics-guided adjuvant therapy in a large cohort of patients with close follow-up.

A retrospective cohort analysis was conducted in a tertiary care academic medical center between January 1, 2010, and December 30, 2017. Patients aged 70 years or older at time of diagnosis with biopsy-proven and surgically resectable p16-positive oropharyngeal cancers were included. Data analysisings of this cohort study suggest that transoral robotic surgery and pathologic characteristic-guided adjuvant therapy can provide beneficial survival outcomes, infrequent perioperative mortality, and, for most carefully selected older adults, obviate the need for chemotherapy.
The findings of this cohort study suggest that transoral robotic surgery and pathologic characteristic-guided adjuvant therapy can provide beneficial survival outcomes, infrequent perioperative mortality, and, for most carefully selected older adults, obviate the need for chemotherapy.
Although the beneficial effect of sacubitril/valsartan (SAC/VAL) compared to enalapril was consistent across ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM) groups, the PARADIGM-HF study did not analyze the effect of ventricular remodelling on patients with different etiologies, which may affect clinical treatment outcomes. This study aimed to compare left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes.

A total of 1,576 patients were analyzed. Patients were grouped by LVEF changes following SAC/VAL treatment for 8-month period. LVEF improvement ≥15% was defined as "significant improvement", and <5% or worse was classified as "lack of improvement". The primary outcome was a composite of cardiovascular death and unplanned hospitalization for heart failure.Patients with NICM had lower baseline LVEF but improvement was significantly greater comparing to those with ICM (baseline 28.0 ± 7.7% vs. 30.1 ± 7.1%, p < 0.001, LVEF increase of 11.1 ± 12.6% vs. 6.7 ± 10.2%, p < 0.001). The effect of functional improvement of SAC/VAL on NICM patients showed bimodal distribution. Primary endpoints were inversely associated with LVEF changes in NICM patients adjusted hazard ratio was 0.42 (95% confidence interval [CI] 0.31-0.58, p < 0.001) for NICM patients with significant improvement, and was 1.73 (95% CI 1.38-2.16, p < 0.001) for NICM patients but lack of improvement. Primary endpoints of ICM patients did not demonstrate an association with LVEF changes.

Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients indicates favorable outcome.
Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients indicates favorable outcome.
Benevolent and hostile ageism are subtypes of ageism that characterize older adults as incompetent. With benevolent ageism, older adults are also viewed as warm. The coronavirus disease 2019 (COVID-19) pandemic has strained resources and prompted debates about priority for older adults versus other groups.

College students completed an online survey of how much priority should be given to older adults in 3 relevant health care-related scenarios and 3 relevant employment scenarios.

Benevolent ageism significantly predicted higher priority for older adults to receive health care (triage, COVID-19 vaccine, and COVID-19 testing) and employment resources (retention of job and working from home) while greater endorsement of hostile ageism significantly predicted lower priority ratings.

These findings replicate and extend past work. As the COVID-19 pandemic continues to wreak havoc on health care and employment resources, this study sheds light on one factor-benevolent and hostile ageism-that contributes to a greater understanding of prioritization views toward a vulnerable segment of the population.
These findings replicate and extend past work. As the COVID-19 pandemic continues to wreak havoc on health care and employment resources, this study sheds light on one factor-benevolent and hostile ageism-that contributes to a greater understanding of prioritization views toward a vulnerable segment of the population.
To describe how health systems may respond to sudden changes in operations by leveraging existing resources and to share one organization's experience responding to the coronavirus disease (COVID-19) pandemic.

In a health system based in Illinois and Wisconsin, pharmacy services are provided by a single, integrated department responsible for all aspects of pharmaceutical care within the organization. Hospital, retail, ambulatory care, and population health services are all managed under one leadership team. All pertinent ancillary services are also managed within the department, including informatics, supply chain, and drug policy. During the COVID-19 pandemic, the pharmacy services leadership has successfully managed volume and capacity challenges by redirecting resources to where they are needed. A disaster response framework based on Federal Emergency Management Agency guidance was put in place, and change management principles were used to rapidly operationalize change. Components of the nimble response have included quickly increasing capacity, thoughtful and timely communication to all team members, strategic decision making with available data, creating an agile pool of labor, and maintaining an efficient system supply chain. Well-being and resilience are emphasized alongside reflection on lessons learned. Some changes made in the urgent response to the pandemic are being considered for long-term implementation.

Organizations have the potential to respond to almost any situation if they are integrated and teams work together to build flexibility. The keys to success are thoughtful maximization of existing resources and strong communication.
Organizations have the potential to respond to almost any situation if they are integrated and teams work together to build flexibility. The keys to success are thoughtful maximization of existing resources and strong communication.
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