bluuebunny/crossref_metadata_2025 huggingface dataset:
Willingness to bear adversity and beliefs about the curability of advanced cancer.
Authors: Loh Kah Poh , Mohile Supriya Gupta , Epstein Ronald M. , McHugh Colin , Flannery Marie Anne , Culakova Eva , Lei Lianlian , Wells Megan , Gilmore Nikesha , Babu Dilip Sankar , Conlin Alison Katherine , Thomas Melanie B. , Berenberg Jeffrey L. , Duberstein Paul
Published: November 2018

20

Background: Older patients with advanced cancer who are certain that they could be cured pose unique challenges for physicians who wish to help them prepare for death. By estimating the prevalence of absolute certainty about curability (ACC) and examining its correlates we aim to inform the development of interventions to improve end of life care. We hypothesized that patients who report greater willingness to bear adversity in exchange for longevity will be more likely to demonstrate ACC. Methods: This is a cross-sectional analysis of a nationwide geriatric assessment trial. Patients were asked: “What are the chances the cancer will go away and never come back with treatment [100% (ACC), > 50%, 50/50, < 50%, 0%, or unclear].” We assessed willingness to bear adversity using two types of trade-off questions. For trade-offs between treatment-related adverse reactions and survival, five statements on specific adverse reactions (nausea/vomiting, assistance with activities, bedbound state, confusion, worsening memory) were administered. For trade-off preferences between quality of life (QoL) and survival, patients answered the following statement: “Maintaining my QoL is more important to me than living longer”. Logistic regression was used to assess the independent associations of patient trade-off preferences with ACC, after controlling for covariates. Results: 349 older patients were included; 8.0% had ACC. 7.4% of respondents disagreed/strongly disagreed with the statement “Maintaining my QoL is more important than living longer.” Patients who were willing to trade QoL for survival were more likely to demonstrate ACC (AOR 4.43, 95% CI 1.13-17.42). Trade-off preferences between adverse reactions and survival were not associated with ACC. Non-white race, < high school education, lower household income, lack of social support, intact functional status, and no polypharmacy were associated with ACC (p < 0.05). Conclusions: Patients with advanced cancer who are more willing to accept a decreased QoL for survival are more likely to be certain that they will be cured. Beyond sharing prognosis, clinicians might help patients improve prognostic understanding by helping them identify and articulate their values and beliefs.
Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.
Authors: Haider Ali , Qian Yu , Lu Zhanni , Naqvi Syed Mussadiq Ali Akbar , Zhuang Amy , Reddy Akhila Sunkepally , Dalal Shalini , Arthur Joseph Anthony , Tanco Kimberson Cochien , Dev Rony , Williams Janet L. , Wu Jimin , Liu Diane D. , Bruera Eduardo
Published: November 2018

201

Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]
Evaluation of the effectiveness of a new medical device containing verbascoside, polyvinylpyrrolidone, and hyaluronic acid in prevention and treatment of mucositis in patients with cancer.
Authors: Nigro Olga
Published: November 2018

206

Background: Mucosal injury is the consequence of biologic events coupled with the influence of the oral environment and microbiome. Oral mucositis is one of the most common toxicities of chemoradiation therapies. Incidence and severity varies by chemoradiation regimens, radiation fıelds, and tumor site. The influence of mucositis on quality of life is greater among patients than the medical literature would suggest. Lack of experience in evaluating treatment toxicities is a daily problem in cancer patients. The aim of this study was to assess the efficacy of verbascoside’s (mucosyte) oral solution on mucositis in cancer patients. Methods: Fourty-five patients with different grade mucositis treated with mucosyte (ranging from 1-2 to 6-7 rinses/day, according to the guidelines) were evaluated from October 2017 to June 2018. Patients were monitored every week until complete remission. Results: Of 45 patients enrolled, 5 had G1 oral mucositis at baseline, 21 had G2, 13 had G3 and 3 had G4. Three patients had G0 oral mucositis at baseline. Median age was 66.8 years. Six patients were treated with carboplatin/paclitaxel, and six with cisplatin/pemetrexed for non-small cell lung cancer; nine patients were treated with paclitaxel, six with adriamycin/cyclophosphamide, and two with eribulin for breast cancer; four patients were treated with FOLFOX for intestinal adenocarcinoma; three patients were treated with nab-paclitaxel/gemcitabine for pancreatic cancer; five patients were treated with cisplatin/cetuximab, and four with cisplatin/cetuximab plus radiotherapy for squamous-cell head and neck cancer. All patients reached complete remission in a median time of 14.9 days (10-24 days). Conclusions: Mucosyte treatment was able to rapidly shorten G3/4 oral mucositis to G1/2, and to never happen mucositis in G0 at baseline. Thus, we suggest that mucosyte can be effective both in prevention and treatment of mucositis.
More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer.
Authors: Ma Joseph , Sera Chris , Roeland Eric
Published: November 2018

211

Background: Constipation is a distressing physical symptom inadequately assessed in patients with cancer. Total opioid consumption may impact opioid-induced constipation (OIC) prevalence. This study examined total daily opioid consumption on self-reported constipation in patients with cancer. Methods: We performed a retrospective analysis in patients who had a histologically-confirmed cancer diagnosis and completed at least 2 outpatient PC visits at an academic palliative care (PC) clinic. At each PC visit, we collected self-reported constipation scores (11-point scale, 0 [no symptom] to 10 [worst symptom]) and 24-hour oral morphine equivalents (OME) for up to 5 visits. Spearman correlation examined the association between OME and presence of constipation rated ≥3 and Wilcoxan-Mann-Whitney examined OME between patients with or without constipation. Univariable logistic regression examined associations of independent variables on constipation. Results: We identified 404 patients with cancer (mean age 55.5±14.3 years, 61.9% women, 89% metastatic disease). The most common cancer types were gastrointestinal (n = 115; 31%) and gynecologic (n = 47; 13%). Stimulant laxative use was observed in 172 (44.9%) patients. Across all visits, we observed a weak association between OME and patient-reported constipation score (r = 0.16-0.24, p < 0.05 for 4 of 5 visits). Mean OME increased, while mean constipation score decreased across visits. At the first visit, higher mean OME was seen in patients who self-reported constipation (128.8 vs 92.3; p < 0.05). In contrast, for each subsequent clinic visit there was no difference in mean OME in patients with or without constipation. Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation. Conclusions: A weak association was observed between OME and self-reported constipation in cancer patients across multiple palliative care visits. Except for the first clinic visit, there was no difference in OME and self-reported constipation scores. These results suggest a lack of a clear association between total opioid consumption and patient-reported constipation.
Random versus targeted urine drug testing among cancer patients receiving opioid therapy at a supportive care clinic.
Authors: Arthur Joseph Anthony , Lu Zhanni , Hui David , Nguyen Kristy , Prado Bernard Lobato , Edwards Tonya , Yennu Sriram J. , Reddy Suresh , Liu Diane D. , Bruera Eduardo
Published: November 2018

221

Background: Although urine drug testing (UDT) is an effective risk monitoring tool for patients on chronic opioid therapy, there is currently no evidence to guide physicians in identifying who should have UDT, or when and how often it should be ordered. The main objective of our study was to describe the characteristics of patients who underwent random UDT and a similar cohort who underwent targeted UDT. Methods: Demographic and clinical information of 212 patients who underwent random UDT was retrospectively reviewed and compared with 88 patients who underwent targeted UDT. Targeted UDT was ordered based on the physician’s estimation of patient risk for nonmedical opioid use. All patients were eligible for random UDT regardless of their risk potential for nonmedical opioid use. Results: 212/231 (92%) eligible patients underwent random UDT. Of these 59 (28%) had abnormal results. Among 64 abnormalities detected, 14 (20%) were prescribed opioids that were absent from the urine, 19 (30%) were unprescribed opioids that were present, and 32 (50%) were illicit drugs (91% marijuana). 38/88(43%) of targeted patients had abnormal results. Among 49 abnormalities detected, 13 (27%) were prescribed opioids that were absent from the urine, 15 (31%) were unprescribed opioids that were absent, and 21 (43%) were illicit drugs (71% marijuana). UDT abnormalities were significantly higher in the targeted group than the random group (43.2% vs. 27.8%, p=0.01). There were no significant differences in demographic and clinical characteristics between random and targeted patients with abnormal UDT findings. UDT abnormality was independently associated with age (OR= 0.97 per year, 95% CI: 0.95-0.99, p=0.012), female gender (OR=0.47, 95% CI: 0.28-0.81, p=0.006), anxiety (OR=1.11per point, 95% CI: 1.01-1.22, p=0.039), and appetite (OR= 1.14 per point, 95% CI: 1.04-1.26, p=0.006). Conclusions: More than 1 in 4 cancer patients who underwent random UDT had abnormal results. UDT abnormality in randomly selected patients were no different from targeted patients. Further studies are needed to guide clinical practice regarding standardization of UDT ordering among patients with cancer.
Let’s chat: Piloting an approach to patient-caregiver goal discussions in a neuro-oncology clinic.
Authors: Reblin Maija , Ketcher Dana , Taber Jennifer M. , Cloyes Kristin G , Baucom Brian R , Clayton Margaret F. , Ellington Lee
Published: November 2018

28

Background: Communication is important to fostering joint coping in patients with advanced cancer and their family caregivers. Joint goal setting has been shown to enhance relationship quality for dyads and increase interpersonal ease and connection. Often patients and caregivers indicate they wish to discuss issues together but have difficulty doing so, which can inhibit dyadic coping and achievement of treatment goals and interpersonal plans. The aim of this study was to determine the feasibility and describe the methods of a short, one-time goal communication intervention for neuro-oncology patients and their primary family caregivers. Methods: Participants were recruited from a neuro-oncology clinic at an NCI-Designated Comprehensive Cancer Center. After informed consent from both patient and caregiver, the dyad was taken to a private room to complete a demographic questionnaire, eight-minute self-directed dyadic discussion of goals, and post-discussion questionnaire. For the discussion, dyads were asked to create and discuss three goals they had for themselves, and three goals they thought their partner would list, with at least one non-cancer related goal. Results: 10 dyads (n=20) were recruited for this study. Participants were mostly white, non-Hispanic, and married spouses. Only one patient participant was unable to list three goals. Dyads reported that the discussion was not stressful and they found high levels of benefit. Analysis of questionnaire and open-ended feedback overwhelmingly indicated the discussion task was useful to participants and that the study environment encouraged open, non-confrontational communication. Conclusions: Our brief prompted dyadic discussion intervention was feasible to implement and participants reported it was useful. Communication between advanced cancer patients and caregivers is vitally important to facilitate dyadic coping and ensure dyads are better able to achieve their goals. This pilot could be easily adapted to facilitate dyadic communication longitudinally to help facilitate communication between patients and caregivers along the cancer care continuum.
Gender and preferences for palliative care: Perceptions of efficacy.
Authors: Korotkin Brittany D. , Perry Laura M , Kazan Adina S , Atiya Wasef , Duberstein Paul , Saeed Fahad , Hoerger Michael
Published: November 2018

34

Background: Palliative care is underutilized by patients with cancer. Understanding differences in preferences is critical for promoting access. This study tested the hypothesis that women would be more favorably disposed toward palliative care than men. Methods: Two samples of individuals with cancer ( N = 633 and N = 413) provided data on demographics and self-reported health and completed the Palliative Care Preferences Scale, a multifaceted assessment that measures emotional, cognitive, and behavioral aspects of preferences. We conducted t-tests to examine gender differences in palliative preferences in each sample, and analysis of covariance to examine the difference while controlling for age, race/ethnicity, education, cancer type, time since diagnosis, and presence of metastases. Results: As hypothesized, t-tests revealed a significant difference of palliative care preferences across gender for both samples ( p < .001 and p = .020) with women preferring palliative care more so than men. Findings were comparable when controlling for age, race/ethnicity, education, cancer type, time since diagnosis, and presence of metastases ( p = .018 and p = .015). Analysis of the cognitive subscale revealed that relative to men, women viewed palliative care as more efficacious ( p < .001 and p < .001). Conclusions: Findings across the two samples demonstrate greater preferences for palliative care among women than men. Future research should examine whether psychoeducational interventions can be tailored based on gender to increase preferences for palliative care.
Clinician versus patient: Who gets it right when assessing function in palliative care?
Authors: Mann Sara Lauren , Collier Willem Hardie , Ose Dominik , Brogan Shane , Beck Anna Catherine , Sindt Jill E.
Published: November 2018

40

Background: The Karnofsky Performance Score (KPS) is an important prognostic indicator in cancer care. Additionally, patient-reported outcomes are increasingly incorporated into clinical care and are validated in cancer patients with the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS). However, little is known about the concordance of the provider-rated KPS and patient-rated PROMIS measures. Methods: Retrospective review of patients with advanced cancer who underwent implantation of an intrathecal pump for refractory pain. We compared KPS and PROMIS scores recorded within 1 week of each other. PROMIS scores included an average score and 3 domains: physical function, fatigue, and pain interference. We divided each measure into 3 previously-described categories (Functionally Independent, Needs Limited Assistance, and Functionally Dependent) and assessed categorical concordance within each measure. The association of patient-related demographic and clinical characteristics were analyzed with KPS–PROMIS concordance using chi-square and Mann-Whitney U tests. Results: 47 patients were included. The provider-rated KPS score consistently indicated a higher functional status compared to the patient-rated PROMIS average score and across all PROMIS domain scores. 40% of patients were rated “Functionally Dependent” using the average PROMIS score, compared to just 19.1% using the KPS, a statistically significant difference (p=0.042). We noted categorical concordance of 55.3% for PROMIS average score, 57.5% for physical function, 44.7% for fatigue and 42.7% for pain interference compared to KPS. We found no statistically significant associations between concordance and patient demographics or characteristics. Conclusions: Our results revealed a notably low concordance in functional status in advanced cancer patients between provider-rated KPS and patient-rated PROMIS measures. Provider-rated scores consistently indicated a higher overall performance status, in particular with measures of the lowest functional status. Additional work is needed to better understand the reasons for this lack of concordance and its implications for ongoing clinical decision-making.
Lung cancer: Significance of place of diagnosis.
Authors: Bishnoi Rohit , Shah Chintan , Hincapie Echeverri Jacobo , Robinson Katherine , Wang Yu , Lee Ji-Hyun , Schmit Jessica Marie
Published: November 2018

60

Background: Patients who are diagnosed with lung cancer through emergency department tend to do poorly. We conducted a retrospective study to examine the effect of place of diagnosis on various cancer outcomes including survival, health care cost, and end-of-life (EOL) care. Methods: Patients who died from lung cancer between January 2015 and July 2017 were reviewed. Initial place of diagnosis was determined (Emergency Department/Urgent clinic (ED/UC) or Outpatient). Descriptive statistics, exact Pearson chi-square test, Kaplan-Meier method, and multivariable Cox regression model were used to compare the two groups. Results: 227 patients were included in the analysis. Median age at diagnosis was 65 years. 52% were male; 85% were white. 57% of patients were diagnosed through ED/UC, whereas 43% were diagnosed as part of an outpatient workup. Age, gender, race, and histology (small cell vs. non-small cell) did not vary significantly between the two groups. Rates of palliative care intervention and advance directives were similar. Patients diagnosed through ED/UC were more likely to be metastatic, have symptoms, and not receive any cancer directed therapy. Cost of care was similar between the two groups. Median survival in those who presented to ED/UC was significantly shorter (2.5 vs. 6.5 mo; p<0.001) with a hazard ratio of 1.7 (95% CI:1.3-2.3), even after adjusting for potential confounding factors (age, metastasis, insurance, smoking, treatment). Conclusions: Patients diagnosed with lung cancer through the ED/UC have worse outcomes than those diagnosed as an outpatient. Despite similar cost of care, survival outcomes are worse. This variable remains significant despite controlling for confounders in multivariate analysis.[Table: see text]
Survival outcomes and end of life use of immunotherapy (IO) supplied free of charge for cancer patients.
Authors: Agarwal Rajiv , Epstein Andrew S. , Saltz Leonard B.
Published: November 2018

62

Background: IO has increased both hope and uncertainty for patients (pts) with cancer. Many pts who do not qualify for trials have received IO from manufacturers free of charge (“compassionate use” or “expanded access”). We report the survival outcomes of such pts using free IO at Memorial Sloan Kettering Cancer Center (MSK). Methods: Pharmacy dispensing logs from 1/1/2015 to 12/31/2017 were reviewed to identify cancer pts who received free ipilimumab (I), nivolumab (N), or pembrolizumab (P) at MSK’s clinics and inpatient hospital. Outcomes and IO use relative to the end of life were analyzed. Results: Outpatient use: n = 484 pts, with 10 pts using free IO in more than one case: median age 61 (range 18 - 93); 222 women, 262 men. 99% had metastatic or locally advanced disease; 6 pts received adjuvant IO. IO case distribution: 303 P, 3 I, 134 N, and 55 with variable combinations of I/N. Median number of doses per pt: 4. Table shows progression free survival (PFS) rates by cancer type. Of 317 known pt deaths, 90 pts received IO in the last 30 days of life. 17 pts initiated IO as an inpatient: median age 57 (range 25-79); 10 women, 7 men. IO case distribution: 12 P, 3 N, and 2 I/N. Median number of doses per pt: 1. The median overall survival from first dose was 24 days. No pts achieved 3-month PFS and 12 pts received IO in the last 30 days of life. Conclusions: To date, this is the largest published cohort of pts who received IO free of charge. IO started in patients too sick to be outpatient was ineffective. Ongoing analyses are examining response relative to mutational burden, healthcare-associated costs, and key end-of-life outcomes for this patient population. [Table: see text]
A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.
Authors: Koh Su-Jin , An Ho Jung , Jun Hyun Jung , Chun Sang Hoon , Lee Kyung Hee , Ahn Hee Kyung , Jung Hyun Ae , Ju Hee Kim , Kim Min-Ho
Published: November 2018

8

Background: Terminally ill patients can decide end-of-life preferences with physicians in Physician Orders for Life-Sustaining Treatment (POLST) form. We did multi-center, prospective study to assess the feasibility of completing the POLST form in real oncologic practice. Methods: The inclusion criteria were patients with terminal cancer, age ≥20, and sufficient to communicate. The primary end point was the completion rate of the POLST. The questionnaire about the barriers from physicians or patients was asked to whom refused the POLST discussion. Results: From June to December 2017, 336 patients were enrolled from seven hospitals. The median age was 66 (20–94) years, 52.7% were male, 60.4% showed ECOG 3/4, and hepato-pancreato-biliary (26.2%) was the most common origin, followed by lung (23.2%) and gastro-intestinal (19.9%). Patients were in various situations: hospice care (41.2%), after progression (37.9%), under active treatment (15.8%), or just diagnosed as cancer (5.1%). The expected survival duration was 10.6 ±7.3 months. The POLST forms were introduced in 60.1%, and 31.3% signed the form. The barriers from physicians were reluctance of family members (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%); lack of time (22.7%), guilty feeling (21.5%), prognostic (21.0%) or time (16.6%) uncertainty. The barriers from patients were lack of knowledge/understanding in 41.3% for each, denial of prognosis (14.3%), emotional discomfort (63.5%), and difficulty in making decision by themselves (66.7%). Conclusions: One-third of patients completed the POLST forms, and various barriers were found. To overcome those barriers, social engagement, education, and systemic support might be necessary.
ASCO Guideline report: Palliative Care in the Global Setting—ASCO Resource-Stratified Practice Guideline.
Authors: Cleary James F. , Osman Hibah , Gafer Nahla , Shrestha Sudip , Ali Zipporah , Temin Sarah B. ,   ASCO Guideline Expert Panel
Published: November 2018

85

Background: The purpose of the new ASCO resource-stratified guideline on global palliative care (Osman H, Shrestha S, Temin S, et al, Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline, JGO, 2018) is to provide expert guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings and was intended to complement the 2016 “Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update”. Methods: ASCO convened a multidisciplinary, multinational panel of experts. Guideline development involved a systematic review, a modified ADAPTE process of existing high-quality guidelines and a formal consensus-based process with the expert panel and additional experts (consensus ratings group), as well as open comment. Results: The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including expert panel). Conclusions: The recommendations help define: the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings.
The effect of palliative care consults on deprescribing in palliative cancer patients.
Authors: Marin Helen , Mayo Patrick , Dersch-Mills Deonne , Ling Spencer , Thai Vincent , Cusano Frances , Chambers Carole
Published: November 2018

92

Background: The transition from active cancer treatment to palliative care often results in a shift in drug risk-benefit assessment which requires the deprescribing of various medications. In addition, a change in patients’ goals of care (GOC) necessitates the alteration of drug therapy which includes both deprescribing and the addition of medications intended to improve quality of life. Depending on a patient’s GOC, a medication can be considered as inappropriate. Methods: The study was a one year retrospective database review and included cancer patients seen by the PCC team at the University of Alberta Hospital. Primary Objective: Comparison between potentially inappropriate medications (PIMs) prior to the palliative care consult (PCC) versus after the PCC. Secondary objective: Association between PIMs and GOC. The OncPal guidelines were used to identify and determine the number of PIMs prior to the PCC and after the PCC. Results: The reduction in PIMs prior to PCC versus after the PCC was 49% and was statistically significant (p < 0.001), demonstrating the PCC has a positive significant impact on deprescribing PIMs. For our secondary outcome, an overall decrease in PIMs was observed with the changes of GOC. This decrease in PIMs associated with GOC although not statistically significant, demonstrates that one of the benefits of a PCC is the GOC conversation. Conclusions: Deprescribing in palliative cancer patients can benefit patients by reducing their pill burden, decrease potentially side effects, and potentially decrease healthcare costs. This study shows the positive impact a PCC has on deprescribing and reassessing GOC. Furthermore, this study reveals the importance of using guidelines for deprescribing in palliative oncology and brings to light other medications that may be considered PIMs.
Attitudes and beliefs of a mandatory palliative care rotation by hematology and medical oncology fellows at a major comprehensive cancer center.
Authors: Reddy Suresh , Tanco Kimberson Cochien , Liu Diane D. , Williams Janet L. , Yennu Sriram J. , Wolff Robert A. , Bruera Eduardo
Published: November 2018

98

Background: The ACGME requires incorporating palliative care (PC) competencies into Hematology and Medical Oncology (HMO) fellowship curriculum. The primary aim of this study was to determine the attitudes and beliefs regarding PC of HMO fellows who completed a 4 week mandatory PC rotation. Methods: The rotation included a 4 week standardized curriculum covering all PC domains and all HMO fellows rotated in acute palliative care unit (APCU), consult service and outpatient clinic. HMO fellows were provided educational materials and attended all didactic sessions. All HMO fellows from 2004 to 2017 were sent a 39 item survey adapted from published studies on oncology trainee perception of PC. Results: 77/105 (73%) HMO fellows completed the survey (median age of 40 years, 57% males and 82% practicing in an academic setting). The following were reported to improve after the PC rotation: (a) assessment and management of symptoms (98%); (b) opioid prescription (89%), opioid rotation (78%) and identification of opioid side effects (87%); (c) communication with patients and families (91%), advance care planning discussion (88%), DNR discussion (88%); (d) comfort discussing ethical issues (74%); (e) ability to cope with stress of terminal illness (58%). Strongly agree to agree was expressed by 76 (98%) for improved knowledge of symptom assessment & management vs 57 (74%) for ethics (p = 0.0001) and 45 (58%) for coping with stress of terminal illness (p = 0.0001). HMO fellows were more likely to refer patients to PC (83%) for uncontrolled symptoms (97%), psychological distress (88%) or with advanced disease regardless of symptoms (56%) after the rotation. The APCU rotation was felt to be most beneficial (93%). The PC rotation educational experience was felt to be either far better or better (53%) or same (45%) as other oncology rotations. 98% would recommend PC rotations to other HMO fellows and 95% felt rotation should be mandatory. Conclusions: HMO fellows reported PC rotation improved their knowledge in all PC domains, felt PC rotation was far better to better than other oncology rotations, and were more likely to refer patients to PC.
Development of an integrated palliative and supportive care service within an academic cancer center.
Authors: Loschiavo Sarah , Stoute Trena , Hook Karen
Published: November 2018

99

Background: Timely incorporation of palliative services with chemotherapy treatment has become a new standard of care for oncology patients based on evidence-driven national clinical practice guidelines. However, best practices for service integration are not known, particularly for small academic centers. In our 224 bed university hospital, we hypothesized that advertisement, responsiveness to needs and service integration would result in increased utilization of palliative and supportive care. We report the process of developing our Integrated Model of Care. Methods: The program began with a 1.0 FTE APRN boarded as a FNP and certified as an advanced hospice and palliative nurse. The goal was to identify opportunities for her integration within the outpatient cancer center. A needs-assessment survey was sent to medical oncology faculty with the following items: proposed change in service name, care areas of greatest need, limitations to providing palliative care, additional growth opportunities. The Interdisciplinary Supportive Care Team was created utilizing existing staff. One year of billed consults were reviewed. The APRN attended tumor boards, team meetings, biweekly Interdisciplinary Team Meetings, communicated directly with the Inpatient Hem/Onc Team and provided educational sessions. Results: Needs assessment survey and service name change proposal sent to 14 oncology providers: 50% completed survey; seven responded YES to name change; zero providers responded NO. Of the 489 consults billed within the 1st year of service, 249 were inpatient and 240 outpatients. 168 individual patients were referred; > 72 patients were referred to palliative/hospice services; > 82 patients died. One year satisfaction survey; 17 respondents; 88.23% were satisficed and 100% would consult again. Conclusions: Medical oncology faculty at our institution responded favorably to the development of a designated “Oncology Supportive Care Service” evidenced by increased consultation and utilization of services. Optimizing clinical infrastructure, processes, education and research has led to the success of this integrated care model, lending to recruitment of additional allied health professionals and ongoing program growth.
False positives in trans-eQTL and co-expression analyses arising from RNA-sequencing alignment errors
Authors: Saha Ashis , Battle Alexis
Published: November 2018

Sequence similarity among distinct genomic regions can lead to errors in alignment of short reads from next-generation sequencing. While this is well known, the downstream consequences of misalignment have not been fully characterized.  We assessed the potential for incorrect alignment of RNA-sequencing reads to cause false positives in both gene expression quantitative trait locus (eQTL) and co-expression analyses. Trans-eQTLs identified from human RNA-sequencing studies appeared to be particularly affected by this phenomenon, even when only uniquely aligned reads are considered. Over 75\% of trans-eQTLs using a standard pipeline occurred between regions of sequence similarity and therefore could be due to alignment errors. Further, associations due to mapping errors are likely to misleadingly replicate between studies. To help address this problem, we quantified the potential for "cross-mapping'' to occur between every pair of annotated genes in the human genome. Such cross-mapping data can be used to filter or flag potential false positives in both trans-eQTL and co-expression analyses. Such filtering substantially alters the detection of significant associations and can have an impact on the assessment of false discovery rate, functional enrichment, and replication for RNA-sequencing association studies.
ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ВЕГЕТАТИВНОЙ НЕРВНОЙ СИСТЕМЫ У КРЫС, ПОСЛЕ ВДЫХАНИЯ ВЫСОКОДИСПЕРСНОГО АЭРОЗОЛЯ ИЗ ЭЛЕКТРОННОЙ СИСТЕМЫ ДОСТАВКИ НИКОТИНА
Authors: Korolev Igor Borisovich , Podkaura Oksana Vladimirovna
Published: November 2018

Целью исследования послужило изучение функционального состояния вегетативной нервной системы у крыс, после вдыхания высокодисперсного аэрозоля из электронной системы доставки никотина. Исследование проведено на 20 половозрелых особях. Выявлена инверсия чувствительности вегетативной нервной системы у крыс при действии высокодисперсного аэрозоля, поступающего из прибора, имитирующего электронную сигарету, при однократном воздействии регистрировался функциональный дисбаланс вегетативной регуляции ритма сердца с преобладанием парасимпатикотонии и недостаточностью нейрогуморальной авторегуляции миокарда на фоне централизации управления работой сердца при выраженной флуктуации адренергического компонента. С увеличением экспозиции при многократных ингаляциях наблюдалась выраженная дезадаптация животных, что ассоциируется с дисфункцией вегетативной нервной системы в виде снижениения активности парасимпатического отдела и повышения тонуса симпатического отдела.
АФФЕКТИВНЫЕ И ТРЕВОЖНЫЕ НАРУШЕНИЯ В КОЛОПРОКТОЛОГИЧЕСКОЙ ПРАКТИКЕ (НАУЧНЫЙ ОБЗОР)
Authors: Bekker Roman Aleksandrovich , Bykov Yuriy Vitalevich
Published: November 2018

Цель исследования: Представить читателю подробный обзор распространённости аффективных и тревожных нарушений в колопроктологической практике, а также коморбидных с депрессивными и тревожными нарушениями колопроктологических заболеваний (в частности, таких типичных для депрессии, как хронические запоры), гипотезы о механизмах двусторонней патофизиологической связи депрессивных и тревожных нарушений с колопроктологическими заболеваниями, а также обзор того, как психотропные лекарства могут влиять на функцию толстой кишки в положительную (терапевтически полезную) или отрицательную (способствующую колопроктологическим заболеваниям) сторону, и как традиционно применяемые в колопроктологии лекарства и методы лечения могут, в свою очередь, влиять на состояние психики в обе стороны, и представить вытекающие из этого стратегии одновременного лечения как психических, так и колопроктологических заболеваний.Методология проведения работы: Авторами был проведён поиск литературы о связи колопроктологических заболеваний, таких, как болезнь Крона, неспецифический язвенный колит, запоры, анальные трещины и др., с депрессивными и тревожными состояниями, с использованием соответствующих ключевых слов, в поисковых системах PubMed и Google Scholar. Затем авторами был проведён поиск литературы о психиатрических осложнениях применяемых в колопроктологии лекарств и методов лечения и о применении их с терапевтическими целями в психиатрии, а также о применении антидепрессантов, анксиолитиков и других психотропных лекарств в колопроктологии.Результаты: Полученные в результате этого обзора данные свидетельствуют о тесной двусторонней связи депрессивных и тревожных состояний с функцией толстого кишечника и с целым рядом колопроктологических заболеваний, а также о перспективности использования некоторых колопроктологических лекарств и методов лечения (например, антицитокиновых препаратов, пробиотиков, аминосалицилатов, трансплантации фекальной микробиоты) в психиатрии, а психотропных лекарств – при ряде колопроктологических заболеваний, и о необходимости уделять большее внимание выявлению и лечению коморбидных депрессивных и тревожных состояний у колопроктологических больных, и колопроктологических проблем, таких, как хронические запоры или дисбактериоз кишечника, у депрессивных и тревожных больных.Область применения результатов: Полученные нами данные заслуживают самого широкого применения как в колопроктологической, так и в психиатрической практике.
ИСПОЛЬЗОВАНИЕ ДЕРЕВЬЕВ КЛАССИФИКАЦИИ ДЛЯ РАСПОЗНАВАНИЯ ОБЪЕКТОВ НА ЦИФРОВЫХ ИЗОБРАЖЕНИЯХ МИКРОСКОПИЧЕСКИХ ПРЕПАРАТОВ
Authors: Narkevich Artem Nikolaevich
Published: November 2018

Цель. Построение математических моделей деревьев классификации для распознавания объектов на цифровых микроскопических изображениях мокроты, окрашенной по методу Циля-Нильсена.Материалы и методы. Использовались данные о 177 393 объектах, выделенных на цифровых изображениях микроскопических препаратов: 6 708 объектов – кислотоустойчивые микобактерии, 170 685 – иные объекты. Анализ объектов производился по 240 цветовым и морфометрическим признакам. Для классификации объектов использовались деревья классификации, построенные различными методами.Результаты. Наибольшим показателем точности обладает дерево классификации, построенное методом Исчерпывающий CHAID, но данное дерево имеет более низкий показатель чувствительности по сравнению с деревом классификации, построенным методом CHAID. При этом последнее упомянутое дерево классификации включает в себя меньшее количество параметров объектов, необходимых для классификации. Чувствительность дерева классификации построенного методом CHAID составила 94,0 [93,4; 94,6]%, специфичность – 92,1 [92,0; 92,1]%, точность – 92,2 [92,1; 92,3]%.Заключение. Построенные с использованием различных методов деревья классификации позволяют осуществлять автоматическое распознавание объектов, выделяемых на цифровых микроскопических изображениях мокроты, окрашенной по методу Циля-Нильсена. При этом наилучшими показателями, характеризующими диагностическую способность данных моделей, для решения данной задачи обладает дерево классификации, построенное методом CHAID.
АНАЛИЗ ФОРМИРОВАНИЯ ПОНЯТИЯ ЗДОРОВОГО ОБРАЗА ЖИЗНИ СРЕДИ УЧАЩЕЙСЯ МОЛОДЕЖИ И МОТИВАЦИИ К НЕМУ В КОНТЕКСТЕ ПРЕДСТОЯЩЕЙ ПРОФЕССИОНАЛЬНОЙ ДЕЯТЕЛЬНОСТИ
Authors: Fedotkinа Svetlana Aleksandrovna , Gridin Mikhail Yuryevich , Khugaevа Elsa Valerevna
Published: November 2018

В последние годы, наравне с актуальной проблемой неблагоприятного демографического прогноза, а также с перспективой увеличения пенсионного возраста, тема здорового образа жизни становится все более актуальной.Благодаря политике государства, в настоящее время, осуществляется реализация межсекторального взаимодействиям по контролю и профилактике неинфекционных заболеваний с целью создания необходимых условий для ведения здорового образа жизни (ЗОЖ) населения.Но, несмотря на активную политику государства, многие россияне, и в том числе и учащаяся молодежь, не имеют достаточной мотивации к ведению здорового образа жизни.В рамках реализации популяционной стратегии профилактики неинфекционных заболеваний, формирование мотивации к ЗОЖ у учащейся молодежи проходит во время их обучения в ВУЗах. Медицинские ВУЗы характерны тем, что они готовят специалистов, которые будут осуществлять популяционную стратегию, в том числе собственным примером.Предметом изучения нашего исследования является уровень знаний по понятию здорового образа жизни. В нашей работе, на примере студентов, курсантов и клинических ординаторов военно-медицинской академии имени С.М. Кирова, была изучена самооценка образа жизни учащейся молодежи и мотивации к нему.С этой целью был проведен выборочный социологический опрос обучающихся по специально разработанной анкете.В результате обработки данных проведенного опроса, нам удалось выяснить, что большая часть респондентов имеет низкий уровень самосохранительной культуры и считает свой образ жизни недостаточно здоровым, а также желала бы его изменить. Учитывая данное желание наших респондентов, мы предполагаем, что активизировать мотивацию к здоровому образу жизни можно в рамках некоторых дисциплин.
КОЛОРЕКТАЛЬНЫЙ РАК: ЭПИДЕМИОЛОГИЯ И ФЕНОТИП ПАЦИЕНТОВ В РЕСПУБЛИКЕ ХАКАСИЯ
Authors: Shtygasheva Olga Vladimirovna , Ageeva Elizaveta Sergeevna , Balobina Natalya Sergeevna , Manasheva Diliya Ismagilovna
Published: November 2018

Состояние вопроса. Риск развития колоректального рака (КРР) повышается при длительности течения ВЗК, а риск малигнизации полипа возрастает с величиной полипа. Выявление и мониторинг гиперпластических и аденоматозных полипов играет важную роль в превенциии и ранней диагностике КРР. Цель – изучить эпидемиологические особенности КРР в Хакасии и частоту стратифицированных факторов риска заболевания по данным витального анамнеза для формирования когорты пациентов, которые должны быть исследованы в первую очередь.Методы. Анализ заболеваемости; локализации, морфологии опухоли, пятилетней выживаемости за период 2006–2015 годы. Ретроспективный анализ историй болезней. Анкетирование по данным витального анамнеза. Достоверность различий между двумя группами пациентов оценивалась с применением критерия соответствия (χ2) при р˂0,05. Корреляционный анализ проводили с применением критерии Спирмена при р˂0,05.Результаты. В период 2011 по 2015 год – увеличилось число пациентов с КРР состоящих на диспансерном учете, по сравнению с периодом 2006–2010 год. Преобладающим типом является аденокарцинома разной степени дифференцировки, локализация в прямой кишке была более частой, чем в ободочной кишке. В период 2011–2015 г. увеличилась доля пациентов с 1–2 стадией заболевания и увеличение пятилетней выживаемости пациентов после установления диагноза. Средний возраст больных КРР – 69 (61–77) лет. Средняя продолжительность жизни у женщин превышала у мужчин на десять и более лет.Риск развития КРР у пациентов с ожирением был в 1,5 раза выше, чем у людей с нормальной массой тела. Гиподинамия у мужчин встречалась в 5 раз чаще, курение в 2 раза больше, чем у женщин. Среди женщин с КРР имели сахарный диабет 2 типа в 4 раза, холецистэктомию в 2,5 раза, сочетанную патологию в 3 раза и длительный анамнез по ВЗК 5 раз больше, чем мужчин.Заключение. Увеличение показателей заболеваемости КРР в Республике Хакасия обусловлено увеличением первичной заболеваемости, в том числе за счет активно выявленных пациентов; увеличением доли пациентов с впервые установленным диагнозом КРР на 1–2 стадиях заболевания, повышением пятилетней выживаемости пациентов.
Body image in women participants of strength training: association with sociodemographic factors and practice time
Authors: Sousa Manoela Vieira , Martins Cilene Rebolho , Lunardi Morgana , Biduski Grazieli Maria , Ferrari Elisa Pinheiro , Freitas Cíntia de la Rocha
Published: November 2018

In Brazil, the evidence indicates a high prevalence of dissatisfaction with body image (BI) among adult women. Studies show that gym goers have characteristics that differ from other populations. Specifically, women who practice strength training (ST) exhibit intense concern about well-being, which presents as strong self-criticism of the body. This group of women are typically in search for an ideal body pattern stipulated by society. e purpose of the present study was to identify in the women the perception with BI, classify then as satisfied or dissatisfied, and association this information whit age group, anthropometric indicators (body mass index and perimeter of waist), and variables related to the practice of ST (purpose and time of the practice). The sample group consisted of 77 women aged 20 to 54 years (29.83 ± 9.75) who practiced ST. For the assessment of BI, the Body Shape Questionnaire (BSQ) was used in addition to a questionnaire around the other variables. A descriptive analysis was used, chi-squared test and Fisher’s Exact test were adopted at a significance level of 5%. The results demonstrated that among all participants, 87.0% were satisfaction with BI. It was found association direct with the dissatisfaction of BI with the purpose of the practice of ST (p = 0.031) and with the practice time (p = 0.030). Were found, in which the women less satisfied with their BI were those who trained for body mass control and practiced ST for more than 6 months. The other variables did not show significant associations with BI. It is concluded that the women who practice ST have shown a positive perception regarding their body image, associated to the objective and the time of the practice.
Be bold, be brave!
Authors: Rawstrone Annette
Published: November 2018

Children who are adventurous and enjoy a challenge are often those who are the most confident and independent. This process of encouraging risk-taking begins at home, says Annette Rawstrone.
The role of core needle biopsies in the management of neck lumps
Authors: Kalra A , Prucher G-M , Hodges S
Published: November 2018

Introduction

King’s College Hospital has proudly provided a one-stop neck lump clinic since 2012. These multidisciplinary clinics allow for rapid diagnoses due to in-clinic investigations. In April 2013, ultrasound-guided core needle biopsies were introduced as an alternative/adjunct to fine-needle aspiration cytology and open biopsies for obtaining histological diagnoses. The aim of the study was to assess the impact of core needle biopsies on the diagnosis of neck lumps compared with fine-needle aspiration cytology and open biopsies between April 2015 and May 2016.

Materials and methods

Data were collected prospectively between April 2015 and May 2016 and analysed for numbers of fine-needle aspiration cytology, core needle biopsies and open biopsies performed and diagnoses made.

Results

A total of 190 patients were seen on the clinic; 51 had fine-needle aspiration cytology and 19 procedures gave a diagnosis. Of the remainder of these patients, 21 went on to have a core needle biopsy and 12 biopsies gave a diagnosis. An additional eight patients only had a core needle biopsy, of which five biopsies gave a diagnosis. Of the ten patients who had an open biopsy, four had a previous fine-needle aspiration cytology and core needle biopsy, three only a core needle biopsy, two had neither and one had fine-needle aspiration cytology.

Conclusion

The introduction of core needle biopsies has reduced the number of open biopsies performed. With increasing acceptance of this minimally invasive technique, core needle biopsies appear to be forming the key diagnostic investigation in patients with neck lumps.