There is interest in introducing generic antiretroviral drugs (ARVs) into high-income countries in order to maximise efficiency in health care budgets. Studies examining patients’ and providers’ knowledge and attitudes to generic substitution in HIV are few. This was a cross-sectional, observational study with a convenience sample of adult HIV-infected patients and health care providers (HCPs). Data on demographics, knowledge of generic medicine and facilitators of generic substitution were collected. Descriptive and univariate analysis was performed using SPSS V.23™. Questionnaires were completed by 66 patients. Seventy-one per cent would have no concerns with the introduction of generic ARVs. An increase in frequency of administration (61%) or pill burden (53%) would make patients less likely to accept generic ARVs. There were 30 respondents to the HCP survey. Concerns included the supply chain of generics, loss of fixed dose combinations, adherence and use of older medications. An increase in dosing frequency (76%) or an increase in pill burden (50%) would make HCPs less likely to prescribe a generic ARV. The main perceived advantage was financial. Generic substitution of ARVs would be acceptable to the majority of patients and HCPs. Reinvesting savings back into HIV services would facilitate the success of such a programme.
after the completion of treatment at first month, every 3-6 months thereafter with CT or MRI, liver function tests, and tumor markers. Radiologic responses were evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST) to assess LC. Results: At baseline, SBRT-treated tumors were in more advanced BCLC stage (B-C, 61.4% vs. 15.7%, p<0.001), larger (median, 2.8 cm vs. 1.8 cm; p < 0.001), and had a higher incidence of prior liver-directed treatments (median, 2 times vs. 0 time; p < 0.001) than RFA-treated tumors. The median follow-up period for the entire cohort was 28.0 (IQR, 14.1-46.0) months. The 1-year and 3-year LC rates were 77.7% and 66.0% for tumors treated with SBRT and 82.3% and 66.6% for tumors treated with RFA, respectively (pZ0.232). The 1-and 3-year overall survival rates were 92.1% and 72.2% for patients in RFA group and 86.6% and 58.8% for patients in SBRT group, respectively (p<0.001). In the univariate analysis for LC, tumor size, advanced stage (B or C), and serum AFP levels were attributed to local progression. However, treatment modality was significantly correlated with LC favoring SBRT (HR 0.65, 95% CI 0.50-0.83, p<0.001). Other independent factors included tumor size, advanced stage and serum AFP level in the multivariate analysis. Though there was statistical difference in overall survival according to treatment modality in the univariate analysis favoring RFA, treatment modality (RFA or SBRT) did not contribute to survival outcomes after adjusting all clinical factors in multivariate analysis. Conclusion: Although SBRT-treatment tumors had more negative prognostic factors at baseline, SBRT provided comparable LC rates to RFA. Overall, SBRT was associated with a better LC rate than RFA in the entire cohort after adjusting clinical factors.
Background Inflammation is thought to play an important role in atherosclerotic stroke mechanisms. There is growing interest in the prognostic role of inflammatory biomarkers as risk factors for recurrent vascular events, after ischaemic stroke or transient ischaemic attack (TIA). Elevated fibrinogen levels are independently-associated with the risk of first-ever stroke. However, the prognostic value of fibrinogen, after ischaemic cerebrovascular events is uncertain. Methods We searched EMBASE and Ovid Medline, from 1970-January 2019, for any study that measured Fibrinogen after stroke or TIA, and related it to the risk of recurrent stroke or recurrent vascular events. All records were assessed by 2 independent reviewers. Any disagreements between authors regarding eligibility were resolved by consensus. Results We identified 2,520 publications, of which, 15 articles from 16 individual studies were eligible (11 observational cohorts, 3 cohort studies within randomized control trials, 2 case-control studies). The sample size for recurrent stroke and recurrent vascular events was 9,963 and 7,381 patients, in 11 and 10 studies, respectively. The time from event to phlebotomy was <7 days in 5, 7-90 days in 6, and >90 days in 5 studies, respectively. There was marked heterogeneity in statistical methodologies employed to examine the relationship between fibrinogen and outcomes, which did not allow valid meta-analysis (above/below specified threshold (n=4), differences in means/medians (n=5), risk per unit increase (n=1), per standard deviation (n=3), per quartile (n=1), per decile (n=1) or not specified (n=1)). 4 studies adjusted for all conventional vascular risk factors (age, smoking, diabetes, hypercholesterolaemia/statin use, and hypertension). 2 of 11 studies found a positive association with recurrent stroke. 5 of 10 studies found a positive association with recurrent vascular events. Conclusion The prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.
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