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Aminoglycoside (AG) antibiotics, such as tobramycin, are known to be ototoxic but important clinically due to their bactericidal efficacy. Persons with cystic fibrosis (CF) are at risk for AG-induced ototoxicity due to the repeated use of intravenous (IV) tobramycin for the treatment of pulmonary exacerbations. While it is well-established that ototoxic hearing loss is highly prevalent in this clinical population, the progression of hearing loss over time remains unclear. Cumulative IV-AG dosing has been associated with a higher risk of ototoxic hearing loss, yet some individuals lose substantial hearing after a single IV-AG treatment, while others never seem to lose hearing.

31 persons with CF (18 on IV tobramycin, 13 controls) were enrolled in an observational study. Pure-tone hearing thresholds (0.25-16kHz) were measured at baseline (pre-treatment) and at follow-up for each subject. A hearing shift was determined using various metrics, and outcomes were compared to characterize changes in hearing bilaterally for both study groups.

Comparison of pure-tone threshold shifts between baseline and follow-up audiograms following either a course of IV tobramycin (n=18) or no intervening therapy (n=13) demonstrated significant (p<0.05) threshold shifts in all continuous metrics tested.

A single course of IV tobramycin causes ototoxic hearing loss in some people with CF, which supports the need for routine ototoxicity monitoring and management in this clinical population. These findings also suggest that people with CF are a suitable population for clinical trials examining ototherapeutics in single IV-tobramycin treatment episodes.
A single course of IV tobramycin causes ototoxic hearing loss in some people with CF, which supports the need for routine ototoxicity monitoring and management in this clinical population. These findings also suggest that people with CF are a suitable population for clinical trials examining ototherapeutics in single IV-tobramycin treatment episodes.
The incidence of acute myeloid leukemia (AML) in older patients is increasing, but practice guidelines balancing quality-of-life, time outside of hospital and overall survival (OS) are not established.

We conducted a retrospective analysis comparing time outside hospital, OS and end-of-life care in AML patients ≥60years treated with intensive chemotherapy (IC), hypomethylating agents (HMA) and best supportive care (BSC) in a tertiary hospital.

Of 201 patients diagnosed between 2005 and 2015, 54% received IC while 14% and 32% were treated with HMA and BSC respectively. Median OS was significantly higher in patients treated with IC and HMA compared with BSC (11.5 versus 16.2 versus 1.3months; p<.0001). Median number of hospital admissions for the entire cohort was 3 (1-17) and patients spent <50% of their life after the diagnosis in the hospital setting. Compared to BSC, IC (HR 0.27, p<.0001) and HMA therapy (HR 0.16, p<.0001) were associated with the lower likelihood of spending at least 25% of survival time in hospital. Although 66% patients were referred to palliative care, the interval between referral to death was 24 (1-971) days and 46% patients died in the hospital.

Older patients with AML, irrespective of treatment, require intensive health care resources, are more likely to die in hospital and less likely to use hospice services. Older AML patients treated with disease modifying therapy survive longer than those receiving BSC, and spend >50% of survival time outside the hospital. These data are informative for counselling older patients with AML.
50% of survival time outside the hospital. These data are informative for counselling older patients with AML.
The aim of this study is to describe determinants of quality of life (QOL) quoted by vulnerable older patients with cancer and compare them with domains included in cancer-specific QOL questionnaires.

This prospective, monocenter, observational study was performed in a French university hospital. Cancer patients Patients with cancer aged over 74years were recruited when referred for an out-patient geriatric evaluation (n=102). After geriatric assessment, they were invited to respond to open-ended questions, Q1 "For you, what is most important to have a good QOL?" Q2 "What could improve your QOL?" Q3 "What could worsen your QOL?" A Delphi process was conducted to categorize patient responses according to content analysis.

The most frequently patient-reported determinants for high quality of life were maintaining close ties with family/friends or social relations, autonomy for decision and mobility without depending on others, being in good health, not suffering from pain and the absence of problems concerning relatives. selleck chemical Global health status, physical functioning/mobility, social functioning and worries about others were the more frequently mentioned QOL domains related to the EORTC QLQ-C30 and ELD14 questionnaires. Some determinants of QOL were not linked to pre-defined domains, some others without a 100% consensus after the Delphi process, illustrating the subjectivity of QOL analysis by a single practitioner.

Patient interview with open-ended questions provides valuable supplementary information to QOL questionnaires, in order to personalize health related (cancer treatment, pain management…) and global (maintenance of autonomy and family/social relations…) assessment and intervention.
Patient interview with open-ended questions provides valuable supplementary information to QOL questionnaires, in order to personalize health related (cancer treatment, pain management…) and global (maintenance of autonomy and family/social relations…) assessment and intervention.The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000-2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.
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