OBJECTIVES: This study developed a model that predicted 30-day mortality for acute myocardial infarction (AMI) and compared the SMR among 41 Malaysian public hospitals using statistical process control charts.
METHODS & RESULTS: Data from referral centres and specialist hospitals with cardiology services were analysed. Both referral centres and specialist hospitals had comparable mortality, except for Hospitals A and B, which the study considered outliers. Two-thirds of the remaining hospitals had an SMR of above one (SMR 1.05-1.51), but the indices were still within the expected variations.
CONCLUSION: The SMR coupled with a funnel plot and variable life adjusted display (VLAD) can identify hospitals with potentially higher than expected mortality rates.
METHODS: Samples of bone marrow from patients with MM who were sensitive or resistant to lenalidomide were collected. The expression levels of PARP1 at the messenger RNA and protein levels were detected through polymerase chain reaction and western blot. MM cell lines were cultivated in vitro, cell lines resistant to lenalidomide were screened out, and the expression levels of PARP1 in the resistant cell lines were detected. The apoptosis level was also detected in the lenalidomide-resistant MM cell lines treated with a PARP1 inhibitor. The proliferation rates of the two groups of cells at different time points were evaluated by mono-methyl terephthalate (MMT) experiments. Finally, the effect of PARP1 on the proliferation of lenalidomide-resistant MM through the microRNA-192-5p-AKT signaling pathway was analyzed.
RESULTS: In the lenalidomide-resistant cell lines, the expression level of PARP1 was higher, the proliferation more rapid, and the apoptosis rate was lower than lenalidomide-sensitive cell lines. Additionally, the activated AKT pathway was suppressed by downregulating the expression of microRNA-192-5p. MM resistance can be inhibited to some extent by impacting PARP1.
CONCLUSIONS: PARP1 is involved in the production of lenalidomide resistance in MM, and could serve as a potential target for the treatment of MM in the future.
METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.
RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.
CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.