Background. Pain is an important problem for patients with cancer and is particularly important for elderly patients with cancer and their family care givers. Increasingly, cancer is managed on an outpatient basis with pain management responsibility assumed by the family at home. This study evaluated a structured pain education program that included three components: basic pain management principles and assessment, pharmaco‐logic interventions, and nondrug treatments. Methods. The pain education intervention was implemented across three home visits with two paints of follow‐up evaluation. Outcomes of the 66 elderly patients with cancer completing the educational program included measures of quality of life, patient knowledge and attitudes regarding pain, and use of a self‐care log to document drug and nondrug interventions and their effectiveness. Results. Repeated measurement analysis was used to evaluate the outcomes of the three‐part education intervention. Results indicate an improvement in knowledge and attitudes regarding pain as well as the use of drug and nondrug interventions. Outcomes of the quality of life instrument suggest significant effect of pain on all aspects of quality of life, including physical well being, psychological well being, social concerns, and spiritual well being. Conclusions. The investigators concluded that the pain education intervention provided important support to elderly patients with cancer and family members at home. Structured pain education based on an evolving science of pain relief should become a part of the standard health care for pain management. Improved pain management includes quality of life for the elderly patient with cancer as well as for family care givers.

Epidemiological studies of statin use and liver cancer risk have produced conflicting results. We examined the association between statin use and risk of primary liver cancer in two large independent study populations taking account of important covariates and main indications of statins such as high cholesterol and chronic liver disease. We performed a nested case–control study within the Scottish Primary Care Clinical Informatics Unit (PCCIU) database. Five controls were matched to cases with primary liver cancer and we used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with statin use. We also conducted a prospective cohort study within the UK Biobank using self‐reported statin use and cancer‐registry recorded primary liver cancer outcomes. Cox regression was used to calculate hazard ratios (HRs) and 95% CIs. In the PCCIU case–control analysis, 434 liver cancer cases were matched to 2,103 controls. In the UK Biobank cohort, 182 out of 475,768 participants developed incident liver cancer. Statin use was associated with 39% lower risk of liver cancer in the PCCIU (adjusted OR 0.61, 95% CI 0.43–0.87). When we examined specific subtypes of liver cancer in the UK Biobank, statin use was associated with lower risk of hepatocellular carcinoma (HCC; adjusted HR, 0.48; 95% CI, 0.24–0.94) but not intrahepatic bile duct carcinoma (IBDC; adjusted HR, 1.09; 95% CI, 0.45–2.64). In conclusion, we found a consistent inverse relationship between statin use and risk of primary liver cancer which was only seen for HCC but not IBDC.

The rate of appropriate drug prescribing in kidney impairment is low and remains a patient safety concern. Our results suggest that CDS improves drug prescribing, particularly when providing guidance on new prescriptions.

We found some evidence that PPI use was associated with liver cancer. Whether this association is causal or reflects residual confounding or reverse causation requires additional research.

Serum biomarkers of iron status and risk of primary liver cancer: A systematic review and meta-analysis.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Gentamicin pharmacokinetics show wide inter‐individual variability across all age groups and impaired gentamicin clearance is associated with impaired creatinine clearance in older people. • Changes in body composition and renal function with old age and frailty are likely to affect the pharmacokinetics of gentamicin. • There is current debate on whether the Modification of Diet in Renal Disease (MDRD) equation estimate of glomerular filtration rate (GFR) should replace the Cockcroft Gault equation estimate of creatinine clearance for calculation of doses of renally excreted drugs. WHAT THIS STUDY ADDS • The volume of distribution of gentamicin is not significantly lower in frail than in non frail older people. • The correlation between volume of distribution of gentamicin and actual bodyweight is poor in frail and moderate in non frail older people. • Gentamicin clearance is significantly lower in frail than in non frail older people. • The Cockcroft Gault calculation of creatinine clearance, calculated using ideal bodyweight, gave the best estimate of gentamicin clearance in this population of frail and non frail older people. • The MDRD estimate of GFR and Cockcroft Gault estimate of creatinine clearance, calculated using actual bodyweight, overestimate gentamicin clearance in frail and non frail older people. AIMS Frailty, a syndrome of decreased physiological reserve that is prevalent in old age, impacts on clinical pharmacology. The aims of the study were to (1) determine whether frailty affects the pharmacokinetics of gentamicin and (2) assess the accuracy of different estimates of body size and renal clearance as estimates of gentamicin pharmacokinetics in older inpatients. METHODS This was an observational study of gentamicin pharmacokinetics in a cohort of Australian hospital inpatients aged ≥65 years, who were administered prophylactic intravenous gentamicin. RESULTS Of the 31 participants, 14 were frail and 17 non frail on the Reported Edmonton Frail Scale. The mean volume of distribution of gentamicin was 14.8 ± 1.4 l in frail participants and 15.3 ± 2.2 l in non frail (NS). Volume of distribution correlated best with lean bodyweight. Gentamicin clearance was significantly lower in frail participants (46.6 ± 10.7 ml min−1) than in non frail (58.2 ± 12.4 ml min−1, P= 0.01). The Cockcroft Gault estimate of creatinine clearance calculated using ideal bodyweight gave the best estimate of gentamicin clearance (mean error – 0.15 ml min−1, 95% CI −2.67, 2.39). The Cockcroft Gault creatinine clearance calculated using actual bodyweight and the estimated glomerular filtration rate from the modified diet in renal disease equation overestimated gentamicin clearance, with mean errors of −10.15 ml min−1 (95%CI −13.60, −6.71) and −18.86 ml min−1 (95% CI −22.45, −15.27), respectively. The Cockcroft Gault creatinine clearance calculated using lean bodyweight underestimated gentamicin clearance (mean error 6.54 ml min−1, 95% CI 4.18, 8.90). CONCLUSIONS Frail older people...

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Background Evidence of a protective effect of coffee consumption for liver cancer has been found but inconclusive for other digestive cancers. Few previous studies have investigated coffee type (specifically instant or ground coffee) and few investigated a range of digestive cancer types within the one cohort. We therefore investigated the association between coffee consumption by type with digestive cancers in a large UK population-based cohort. Methods We analysed data from the UK Biobank cohort study using self-reported coffee consumption and cancer-registry recorded incident digestive cancers. Hazard ratios (HRs) and 95% CIs were calculated using Cox regression. Risk of every type of digestive cancer was investigated in association with coffee consumption by dose-response and by coffee type (decaffeinated, instant, ground). Results Over 7.5 years of follow-up, 3,567 developed digestive cancer among 471,851 participants. A marked association was observed for hepatocellular carcinoma by any dose of coffee (HR 0.50, 95% CI 0.29, 0.87) and by instant coffee (HR 0.51, 95% CI 0.28, 0.93). We did not observe significant consistently reduced risks of other individual digestive cancer types amongst coffee drinkers. Conclusion We found some evidence that coffee consumption was inversely associated with hepatocellular carcinoma which was apparent for instant coffee consumption.