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Developing working knowledge of integrated care models can guide pharmacists in operationalizing comprehensive medication management (CMM) alongside behavioral health services for holistic primary care integration. Over the last decade forces from both within and outside the pharmacy profession have culminated in trends toward an oversupply of pharmacists in the United States. In response, advocates of the profession have called for the materialization of long-awaited advancements in innovative, team-based, medication management roles. Although pharmacists are uniquely qualified to provide CMM services, the widespread integration to primary care teams has lagged behind that of other professions, such as behavioral health. Through the application of evidence-based integrated care models, behavioral health clinicians have become regular and routine contributors to primary care teams. To thrive in primary care roles, pharmacists must be able to navigate established teams practicing within existing integrated care models. Understanding how primary care physicians interact with other specialties, such as behavioral health, and the implications this has for pharmacy will play a role in meaningful adaptation of CMM services.The National Association of Boards of Pharmacy recently established a task force to explore the feasibility of developing regulations based on "standards of care" rather than "prescriptive rule-based regulation." The Board sought to update its professional practice standards by transitioning from prescriptive regulations to a "standard of care" model that harmonizes pharmacists education and training with their legal scope of practice. In doing so, the Board expanded practice authority to include prescription adaptation services and independent prescribing of certain drug classes. As the Board approached how to update its facility standards, it pursued 2 primary goals (1) Make the regulations practice- and technology-agnostic; and (2) Enable decentralization of pharmacy functions to offsite locations. The Board achieved its goal of reducing overall word count and restrictions in its laws. The Board also created a more permissive professional practice standard rooted in a "standard of care" approach that is more closely aligned with the regulatory model employed by the medical and nursing professions.

The definition of "early recurrence (ER)" after rectal cancer surgery is currently unclear.

To determine an evidence-based cut-off to distinguish early and late recurrence (LR) for patients with rectal cancer and compare the clinicopathological factors between the two groups.

Patients who underwent neoadjuvant chemoradiotherapy (nCRT) and radical resection for locally advanced rectal cancer were included. A minimum p-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into ER and LR groups based on overall survival. A logistic regression model was used to assess risk factors for ER.

A total of 763 patients were included, of which 167 (21.9%) experienced recurrence. The optimal cut-off value of recurrence-free survival to differentiate between ER (n=125, 74.9%) and LR (n=42, 25.1%) was 24months (P=0.000001). The median postrecurrence survival of ER and LR was 12months and 22months, respectively (p=0.028). The most common recurrent sites in patients with ER and LR were lung metastases, the incidence of liver metastases, however, differed considerably in ER and LR (27.2% vs 9.5%, P=0.019). Risk factors including elevated preoperative carcinoembryonic antigen (CEA), higher ypTNM stage, positive circumferential resection margin (CRM), and perineural invasion were significantly associated with ER.

A recurrence-free interval of 24months is the optimal cut-off value for defining ER versus LR. Elevated preoperative CEA, higher ypTNM staging, positive CRM, and perineural invasion were associated with ER of locally advanced rectal cancer.

A recurrence-free interval of 24 months is the optimal cut-off value for defining ER versus LR. Elevated preoperative CEA, higher ypTNM staging, positive CRM, and perineural invasion were associated with ER of locally advanced rectal cancer.

The aim of this study was to evaluate the safety of natural orifice specimen extraction surgery (NOSES) and to compare the short- and long-term outcomes of three techniques of NOSES for rectal cancer (RC).

A consecutive series of RC patients in stage I-III who underwent laparoscopic NOSES were enrolled. Three main techniques of NOSES included specimen eversion and extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER) and intra-abdominal resection and specimen extraction (IREX). selleck chemicals llc The postoperative complications, 5-year disease free survival (DFS), 5-year local recurrence rate (LRR) and 5-year distant metastasis rate (DMR) were compared in three techniques.

268 RC patients met inclusion criteria, including 83 patients treated with EVER, 75 patients treated with EXER and 110 patients treated with IREX. Tumor location was the most critical factor associated with technique selection, with P<0.001. Postoperative complication rate was 12.3% for all patients, and it was 18.1% for EVER, 13.3% for EXER and 7.3% for IREX. There were no significant differences for anastomotic leakage, anastomotic bleeding and intraabdominal abscess among three technique groups, with P>0.05. For long-term outcomes, the 5-year DFS, 5-year LRR and 5-year DMR were 85.03%, 4.22% and 11.00% for all patients. Patients in advanced tumor stage have worse long-term survival compared with patients in early stage, but no significant survival differences were observed among three technique groups.

Three techniques of NOSES for RC had acceptable short- and long-term outcomes, and tumor location was a determinant of technique selection.

Three techniques of NOSES for RC had acceptable short- and long-term outcomes, and tumor location was a determinant of technique selection.

This study was conducted to identify patients who may benefit from adjuvant chemoradiotherapy (CRT) for positive or close resection margin (RM) after curative resection of pancreatic adenocarcinoma.

From 2004 to 2015, total of 472 patients with pancreatic adenocarcinoma underwent curative resection. After excluding patients with RM>2mm or unknown, remaining 217 patients were retrospectively analyzed. Forty-six (21.2%) patients were treated with adjuvant chemotherapy alone (CTx; mainly gemcitabine-based), 142 (65.4%) with adjuvant CRT (mainly upfront), and 29 (13.4%) patients didn't receive any adjuvant therapy (noTx group).

Locoregional recurrence rate was significantly lower in the CRT group (43.7%) than in the CTx group (71.7%) or noTx group (65.5%) (p=0.001). Significant survival benefits of CRT over CTx (HR 0.602, p=0.020 for overall survival (OS); HR 0.599, p=0.016 for time to any recurrence (TTR)) were demonstrated in multivariate analysis. CRT group had more 5-year survivors than other groups.