bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative evaluation of older cancer patients: Why some patients did not proceed with planned surgery.
Authors: Williams Taylor Raines , Alexander Koshy , Korc-Grodzicki Beatriz , Sarraf Saman , Shahrokni Armin
Published: November 2017

38

Background: Older cancer patients may need to make challenging treatment decisions at the time of preoperative evaluation. This study assesses the reasons and outcomes of older cancer patients who did not proceed with planned surgery. Methods: This is a retrospective analysis of a cohort of 1767 older cancer patients who presented to the Geriatrics clinic for preoperative evaluation between 1/2015 and 12/2016. Differences in Geriatric Assessment between those who proceeded and did not proceed with surgery were assessed within a month after preoperative evaluation. Charts of those who did not proceed with surgery were reviewed to identify the reasons, and outcomes of those patients. Results: In total, 114 out of 1767 (6.5%) did not proceed with surgery. Functional status played an important role in this decision. Among patients with Karnofsky Performance Scale (KPS) of 80+, 20% had their procedure in another institution; this was 0% for patients with KPS 70-. 61% of patients with KPS 50 opted for surveillance or supportive care, compared to 37% and 32% of those with KPS 60-70 and 80+, respectively. Reasons cited for not medically clearing the patients also differed. 60% and 69% of those with KPS 80+ and 60-70 were not cleared based on comorbid conditions, compared to 44% of those with KPS 50-. On the other hand, 44% of patients with KPS 50- had documented frailty as a reason for not getting clearance, compared to 15% and 23% of those with KPS 80+ and KPS 60-70. Conclusions: Geriatricians play an important role in helping patients reach proper medical decisions at the time of surgery. Future studies should look at various interventions that may assist older cancer patients/caregivers in their decision making at the time of surgery.
Shared understanding: Predicting home hospice nurse-cancer family caregiver communication similarity.
Authors: Reblin Maija , Kane Lauren , Baucom Brian R , Clayton Margaret F. , Ellington Lee
Published: November 2017

40

Background: In cancer home hospice, families provide 24/7 care with support from a nurse-led hospice team. Effective patient-caregiver-nurse communication can facilitate a “shared understanding,” resulting in better patient caregiver outcomes. Shared understanding may be evidenced by high similarity in language usage/meaning. Objective: Describe communication caregiver-nurse similarity (relatedness in word usage/meaning) in cancer home hospice using latent semantic analysis (LSA) and to identify nurse communication processes, confidence, and preferences that predict communication similarity. Methods: As part of a larger study, nurse home hospice visits to spouse cancer caregivers were audio recorded. Interaction analysis was used to quantify caregiver and nurse emotion talk, nurse partnering, and nurse dominance (ratio of total nurse/caregiver talk). Nurses completed questionnaires to capture preference for patient oriented care and confidence in their communication. Verbatim transcripts were analyzed using LSA, a tool that assesses the similarity of communication (range 0-1 where higher scores indicate greater similarity). Descriptive statistics and bivariate correlations were calculated. Results: 31 nurse-caregiver home hospice interactions were analyzed. Nurses were female, average age 44.03 (SD = 9.8), with an average 14.6 years experience. Spouse caregivers were 77% female, average age 64.7 (SD = 10.9). The average LSA score was .83 (range = .66-.89). Higher LSA values were significantly associated with more nurse partnering (r = .36, p = .05) and lower nurse dominance (r = -.39, p = .03), but not caregiver or nurse emotion talk (ps > .05). Higher LSA values also predicted more nurse-reported preference for patient-oriented care (r = -.75, p < .01) and lower nurse communication confidence (r = -.46, p = .01). Conclusions: Our findings suggest that hospice nurses who are more patient-oriented, listen to and encourage caregivers’ concerns are more likely to use concordant meaning and language usage in their home hospice visits. Further research should examine if a nurse’s use of language similarity strategies improve caregiver understanding, competency and satisfaction with care.
Perceptions of prognosis and treatment risk in older patients with acute myeloid leukemia (AML).
Authors: Nicholson Showly , Abel Gregory A. , Fathi Amir Tahmasb , Steensma David P. , LeBlanc Thomas William , DeAngelo Daniel J. , Wadleigh Martha , Hobbs Gabriela , Foster Julia , Brunner Andrew Mark , Amrein Philip C. , Stone Richard M. , Temel Jennifer S. , El-Jawahri Areej
Published: November 2017

43

Background: Older patients ( > 60 years) with AML face difficult treatment decisions as they can be treated either with risky multi-drug intensive chemotherapy for a small chance of a cure, or non-intensive and non-curative palliative chemotherapy. However, studies have not described patients understanding of their prognosis and treatment risk. Methods: We conducted a longitudinal study of older patients newly diagnosed with AML at two tertiary care hospitals. At enrollment, we assessed patients and oncologists perception of treatment-related mortality. At one month, we assessed patients and oncologists perception of prognosis using the Prognosis and Treatment Perception Questionnaire. Results: We enrolled consecutive patients within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. The majority of patients reported that it is somewhat (58/92, 63.0%) or extremely (26/92, 28.3%) likely to die due to treatment while their oncologists reported that it is very unlikely (80.0%; 74/92) for the patient to die due to their treatment (P < 0.001). Most patients (90.0%, 73/81) reported that they were somewhat or very likely to be cured of their leukemia while most oncologists reported that it is unlikely or very unlikely for the patient to be cured (74% (60/81)) (P < 0.001). Patients receiving both intensive and non-intensive chemotherapy had significant misperceptions about their prognosis (Table 1). Conclusions: Older patients with AML have substantial misperceptions regarding the risks of their treatment and they overestimate the likelihood of cure, compared to their oncologists estimates. Prognostic misperceptions are especially striking in patients receiving non-intensive chemotherapy. Interventions to facilitate communication are needed to ensure patients with AML have an accurate understanding of their treatment risks and prognosis and are therefore enabled to make informed decisions about treatment. [Table: see text]
The PULSES project: Teaching the vital elements of code status discussions to oncology residents.
Authors: Levine Oren Hannun , Menjak Ines B. , Brule Stephanie Yasmin , McConnell Meghan , Dhesy-Thind Sukhbinder K. , Mukherjee Som , Brouwers Melissa C.
Published: November 2017

46

Background: Discussions with cancer patients around cardiopulmonary resuscitation, or ‘code status,’ are often led by trainees in oncology, but formal education for this competency is lacking. In this study, we developed and tested a novel communication tool, the PULSES framework, for informed code status decision-making (a six-step approach summarized by the PULSES acronym [see Table]), through an educational workshop. Methods: A multicentre randomized controlled trial was carried out at 3 academic cancer centres in Ontario, Canada. Residents in medical oncology (MO) and radiation oncology (RO) programs completed a workshop and an observed structured clinical exam (OSCE). Participants were randomized to complete the training before the OSCE (experimental arm) or after the OSCE (control arm). Randomization was stratified for centre and oncology discipline. Expert raters evaluated communication with two rating tools: the novel PULSES scale and the communication skills assessment form (CSAF), a validated benchmark tool that is not specific to oncology content. The primary outcome was improvement in PULSES scores. Results: Forty-six residents consented to participate (28 RO and 18 MO). Groups were well balanced for program and year of training. Participants in the experimental group had higher mean PULSES score than those in the control group (80.4±13.5 vs 63.4±9.7; p<.001; maximum score = 108). There was no significant effect for oncology program and no significant interaction between program and training condition. Scores from the PULSES and CSAF scales were highly correlated (R = 0.864). Conclusions: The PULSES training improved performance among oncology residents for code status discussions. Improved communication scores were not scale-specific. The PULSES framework offers a standardized approach and can be incorporated into competency-based curricula for postgraduate oncology programs. Future work will explore whether communication training in this area impacts patient-level outcomes. [Table: see text]
Do differences in patient-provider relationships explain racial differences in side effect burden among women with breast cancer in the pathways study?
Authors: Check Devon , Chawla Neetu , Ergas Isaac J. , Roh Janise M. , Kolevska Tatjana , Kushi Lawrence , Kwan Marilyn L.
Published: November 2017

48

Background: Prior research suggests that black patients with cancer report a greater burden of symptoms compared to white patients. Differences in patient-provider relationships may be an underlying and modifiable factor in these observed disparities. We examined differences in side effect burden by race/ethnicity and tested the hypothesis that patient-provider communication and trust may partly explain differences in symptom burden among women with breast cancer (BC). Methods: We conducted a cross-sectional analysis of data collected from 4,505 women diagnosed with BC from 2005-2013 at Kaiser Permanente Northern California. Women were asked two months post-diagnosis how much they were bothered by treatment side effects (FACT-B). Using modified Poisson regression, we assessed the association of race/ethnicity with side effect bother, adjusting for clinical characteristics, socioeconomic status (SES), and patient-provider communication and patients’ trust in providers in a step-wise fashion. Provider communication and trust were measured using the Interpersonal Processes of Care survey and a one-item assessment of patients’ trust in providers, respectively. Results: Before adjustment, Black, Hispanic, and Asian patients were at least 75% more likely than white patients to report high (vs. low) side effect bother (p < 0.0001). Bivariate associations of communication and trust with side effect bother and race/ethnicity were statistically significant. For example, patients with high (vs. low) scores for shared decision-making were more likely to be white than black (46% vs. 39%) and less likely to experience high vs. low side effect bother (10% vs. 14%, p < 0.0001 for both comparisons). However, after adjusting for clinical and SES characteristics in a multivariable analysis, the addition of patient-provider communication and trust to the model did not substantially alter disparity estimates. Conclusions: In our sample, patient-provider communication did not modify racial disparities in side effect bother. Further research is needed to explore additional modifiable factors underlying potential disparities in side effect management.
Hereditary cancer prevalence and communication about family history risks in palliative care.
Authors: Razzak A. Rab , Bailey Lauren , Yu Brandon , Abusamaan Mohammed , Kang In Guk , Ma Brittany , Emidio Bunmi , Owodunni Oluwafemi , Smith Thomas J. , Bodurtha Joann
Published: November 2017

56

Background: Hereditary cancer (CA) assessment & communication about family history (FH) risks in palliative care are underexplored & could be critical for surviving relatives. FH may not be adequately reviewed & appropriate information conveyed in the palliative care (PC) setting, even though family health is a legacy concern of patients. Cancer patients seeking PC never wish for their relatives to have CA & may be an important resource for communication about their relative’s CA risk & appropriate referrals. Methods: This prospective observational study among cancer patients receiving PC consultations was conducted at a 977-bed academic urban hospital between June 2016 & March 2017. Data were collected through structured interviews and chart review during hospitalizations. Results: 75 adult cancer patients were enrolled. Patients’ average age at diagnosis was 55.3 ± 15.7 years. 41(55%) self-identified as male; 34(45%) as female; 20(27%) as black, 49 (65%) white, and 6(8%) other. 24 patients (32%) were considered to have pedigrees that merited referral as high-risk. 32 patients (43%) thought that their CA had a likely genetic or inherited component. 48(64%) thought the palliative care setting was an appropriate place to discuss the implications. The mean comfort level in addressing these questions was 8.7 on a 10 point scale with 10 indicating extremely comfortable. Conclusions: Review of FH may be an intervention that PC providers & families can discuss & incorporate in legacy activities. This could enhance CA prevention, especially among high-risk families. There is room for enhancement in how FH & patient and family concern are integrated in the palliative & cancer care continuum.
Education program for cancer patients and families.
Authors: Messinger Marina , Yadav Udit , Thekkekara Romy Jose , McDunn Susan H.
Published: November 2017

57

Background: Studies of patient education and communication have been shown to affect patient health outcomes, including emotional and physical health. Effective patient education is challenged by limitations in patient literacy. As much as 20% of the American population was found to have a low literacy level at or below a 5th grade reading level. Our program was based in a public hospital treating underserved patients from lower socioeconomic backgrounds who often have low baseline health literacy and varying educational backgrounds. Methods: A cancer patient education program was organized for recently diagnosed cancer patients and their families. A lecture and interactive learning session was implemented to teach the basics of what cancer is, what chemotherapy is, social services available to patients, and counseling services available. A pre- and post-survey was administered to assess patients’ confidence in their understanding of cancer, chemotherapy, navigation of social and counseling services. Patients self rated their level of understanding as “poor”, “a little”, “average”, “good”, or “very good”. Results: Comparison of pre- and post-survey results showed self-assessed improvement of understanding of cancer, chemotherapy, social services, and counseling services by more than one level of understanding (1.29, 1.37, 1.18, 1.14 level of understanding improvement respectively). Conclusions: A patient education program for cancer patients teaching the basics of cancer and chemotherapy as well as giving patients and families resources for social services and counseling services is a very necessary resource. Better patient understanding of health issues may improve compliance with treatments, help alleviate anxiety, and enable patients and their families to participate actively in their care. This need is especially felt in a hospital treating an underserved population. Survey results show an improvement in patient self-assessed understanding of cancer, chemotherapy, and social services.
Goals of care documentation in advanced cancer.
Authors: Harle Ingrid , Karim Safiya , Booth Christopher M.
Published: November 2017

58

Background: Documenting goals of care (GOC) is integral to patient centered care, decision making and quality performance. Studies show patients value conversations about GOC after receiving a terminal diagnosis. Positive effects have been demonstrated for survival, quality of life, disease management and healthcare savings. The ASCO QOPI recommends documentation within 3 visits from diagnosis of metastatic cancer. For hospital inpatients, GOC are more often integrated into care planning, as admissions frequently reflect changes in illness trajectory, yet documentation remains poor. This Quality Improvement (QI) initiative aims to increase GOC documentation for ambulatory patients and referral rates to Palliative Medicine. Methods: A retrospective cohort receiving palliative chemotherapy for metastatic lung, pancreas, colorectal and breast cancers during 2010-2015 were identified from pharmacy records at a Canadian Regional Cancer Centre. Inclusion criteria required a minimum of 4 clinic visits post treatment. Clinical notes of Oncologists and Palliative Medicine Physicians were reviewed for GOC documentation and referrals to Palliative Medicine. Baseline data determined improvement target rates. A clinical practice QI initiative applied passive and active phases, beginning May 2016. Passive phase included the development of a guideline, documentation template and referral process. The active phase is the implementation process (ongoing). Results: A cohort included 456 patients with metastatic cancer, 63% lung cancer. Oncologists documented GOC in 6% (26/456) and referred 47% to Palliative Medicine. GOC rate was 48% post-referral. Improvement target rates were set at 40% and for referrals 70% by March 2017. Analysis during the passive phase showed Oncologists’ GOC documentations increased to 15%. Analysis of the active phase is ongoing and preliminary results will be presented. Conclusions: Low rates of GOC documentation and referrals to Palliative Medicine persist. The passive phase of engaging physicians in the QI development positively influenced GOC documentation. This QI initiative will inform the sustainability of GOC documentation, Palliative Medicine referrals and standardization of institutional guidelines.
Do hospitalized cancer patients requiring palliative care consultation discharged to subacute rehabilitation ever get anticancer therapy again?
Authors: Khan Muhammad Azeem , Pettit Clint S. , Groninger Hunter
Published: November 2017

62

Background: Patients with advanced cancer inevitably experience a functional decline that is often associated with notable symptom burden and/or indications for clarification of goals. Palliative care (PC) services frequently engage such patients during hospital stays. For many of these patients, discharge plans to sub-acute rehabilitation facilities (SAR) in order to ‘gain strength’ for future cancer treatment is a common practice. We wished to examine if inpatients with advanced cancer receiving PC consultation who are discharged to SAR are ever able to follow up with their oncology team and receive anti-cancer therapy. Methods: A search was conducted in our institution’s electronic medical system for hospitalized patients with cancer who received inpatient PC consultation and were subsequently discharged to SAR. Patients were excluded if they did not follow with an oncologist at MWHC as an out patient prior to the admission being reviewed or if they had never received anti cancer therapy before. Results: From 2015-2017, 16 patients meeting our criteria were identified. For 14 (82.4%) patients Palliative Care was consulted to either discuss goals of care and/or assist with pain management.13 (76%) patients were discharged to SAR to ‘improve strength’. However only 7 (44%) patients saw their oncologist after discharge from SAR. Of those 7 only 3 (19%) received further anti cancer therapy. 4 of the 7 (57%) patients that saw their oncologist after SAR had an ECOG of 1 on admission, the other 3 had an ECOG of 2. No patient with an ECOG of 2 or greater ever received cancer treatment again. Exactly half of the 16 patients were eventually readmitted to our hospital. Conclusions: SAR may not be an appropriate discharge disposition for patients with cancer who have a decline in functional status. Less than half the patients with cancer discharged to SAR from our institute with the intention to gain strength for future chemotherapy saw their oncologist again and the overwhelming majority (particularly those with an ECOG performance score of 2 and greater) never received anti cancer therapy again. This data can be considered to make informed decisions when discussing goals of care.
Prognostic factors, symptoms, and consequences of electrolyte imbalances in patients who suffered from cancer.
Authors: Bryniarski Pawel
Published: November 2017

74

Background: Dyselectrolytemia is a common problem in patients with terminal cancer. It worsens the quality of life and increases the amount of complications. The aim of our study was to determine factors connected with dyselectrolytemia in patients with terminal cancer. Methods: 310 terminal cancer patients admitted to Palliative Care Unit were retrospectively analyzed. Detailed physical examination, medical history and laboratory parameters were taken upon admission. Univariate and multivariate logistic regression analysis were used to determine possible predictors, symptoms and consequences of dyselectrolytemia. Results: On admission 67,74% of patients had dyselectrolytemia. They were more frequently admitted to hospital from Emergency Department (OR=Odds Ratio=2,879, p=probability value=0,00004), had higher PS scale note (OR=1,627, p=0,0001), were more often cachectic (OR=1,915, p=0,0083), had more often constipation (OR=1,728,p=0,0275), were more often dehydrated (OR=2,609 ,p=0,0007), had lower albumin level (OR=0,909, p=0,00001). They had 275% higher risk of death (OR=2,758, p=0,0001). Multivariate logistic regression analysis after adjustment for possible confounders reviled that admission to hospital from Emergency Department (OR=2,652, p=0,01), higher PS scale note (OR=1,445, p=0,001), opioids administration (OR=2,747, p=0,003), dehydration (OR=1,966 , p=0,038) and higher risk of death (OR=2,432, p=0,002) remained independently associated with dyselectrolytemia. Conclusions: Higher PS scale note, occurrence of dehydration, admission to hospital from Emergency Department and opioids administration are factors associated with dyselectrolytemia. Patients with electrolytes imbalances had 275% higher risk of death. Project "Extension of life and improvement of its quality and reduction of cancer patients' mortality due to proper control of water and electrolyte management and elimination of risk factors for dehydration and dyselectrolytemia." Co-financed by the European Social Fund under the project of the Ministry of Science and Higher Education of Poland entitled "Best of the best! 2.0 ".
Pharmacokinetics/pharmacodynamics (PK/PD), safety, and tolerability of fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV) in pediatric subjects.
Authors: Mora Jaume , Valero Miguel , DiCristina Cara , Jin Mandy , Chain Anne , Bickham Kara
Published: November 2017

93

Background: Fosaprepitant is approved to prevent CINV in adults. The aim of this study was to determine appropriate fosaprepitant dosing in children. Methods: This was a phase 2b, multicenter, randomized, dose-ranging study to evaluate PK/PD, safety, and tolerability of a single dose of fosaprepitant administered concomitantly with ondansetron, with or without dexamethasone. Eligible subjects were newborn to 17 years of age who were scheduled to receive emetogenic chemotherapy for a documented malignancy. PK/PD data were collected in cycle 1 only. The study was designed to compare 3 doses of fosaprepitant versus placebo in 2 to 17 year olds, with an open-label amendment evaluating a fourth dose in <12 year olds. Pediatric exposures were compared with historical adult PK data. Results: 234 subjects were enrolled and received study medication (Table). All but one completed cycle 1. One subject (5 mg/kg regimen) discontinued because of anaphylactic reaction. In 167 subjects with evaluable PK data, aprepitant exposures were dose proportional. Adolescents (12-17 years) receiving fosaprepitant 150 mg had exposures similar to adults at the same dose. Owing to a higher clearance in children <12 years old, a higher weight-normalized dose (5 mg/kg) was necessary to achieve comparable exposures. The AE profile was typical of subjects with cancer receiving emetogenic chemotherapy. The most common drug-related AE was hiccups. Conclusions: In pediatric subjects receiving fosaprepitant to prevent CINV, aprepitant exposures were dose proportional. Subjects <12 years old required higher doses to achieve exposures comparable with adults. Fosaprepitant was well tolerated in this population. Clinical trial information: NCT01697579. [Table: see text]
Using electronic patient reported outcomes to identify gaps in quality of care in radiation oncology.
Authors: Marquez Celine Denise , Braunstein Steve E. , Morin Olivier , Fogh Shannon E.
Published: November 2017

94

Background: Improving quality of care involves identifying patient health needs and designing systems to meet those needs reliably. Within Radiation Oncology, patient health needs encompass measurable, physical quantities such as a reduction in tumor size, as well as subjective needs, as in freedom from pain. Patient reported outcomes (PRO) have the potential to identify subjective health needs and to guide treatment towards symptoms patients find most bothersome, thereby improving quality of care. Here we report the unmet health needs revealed by systematic electronic PRO data collection in a Radiation Oncology department. Methods: 50 consecutively treated patients for a variety of malignant and nonmalignant, primary and metastatic disease were surveyed within the CNS subdivision of a single Radiation Oncology department using electronic EORTC QLQ C30 or PRO-CTCAE CNS forms displayed on a touch screen tablet. Patients were then followed with PRO surveys at two additional time points, 1-2 weeks post radiotherapy treatment and again at one month. Results: Of 27 planned PRO CTCAE surveys of 9 patients, 22 (81%) were completed and available for evaluation. 6/9 (67%) of patients taking the PRO CTCAE reported “severe” or “very severe” side effects. The most commonly reported “severe” or “very severe” symptoms were fatigue (6/9, 67%), insomnia (3/9, 33%), anxiety (2/9, 22%), and sad/unhappy feelings (2/9, 22%). Of 123 planned EORTC QLQ C30 surveys of 41 patients, 109 (89%) were completed and accessible for evaluation. 38/41 (93%) of patients taking EORTC QLQ C30 reported side effects impacting their lives “quite a bit” or “very much”. The most common symptoms impacting patients “quite a bit” and/or “very much” were fatigue (25/41, 61%), pain (17/41, 41%), insomnia (15/41, 37%), and worry (14/41, 34%). Conclusions: Gaps that may exist between the quality of care we wish to provide and the care patients experience may be recognized and addressed by incorporating PROs into our standard clinical practice. Integrating electronic PROs into our clinical systems will help us to more reliably identify unmet patient health needs, personalize care, and respond to side effects and symptoms that are of the greatest concern to patients.
Impact of a clinical pathway tool on appropriate palliative radiation therapy for bone metastases.
Authors: Rotenstein Lisa , Kerman Alexander O. , Martin Neil E. , Balboni Tracy A. , Krishnan Monica Shalini , Killoran Joseph , Taylor Allison
Published: November 2017

97

Background: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Methods: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Results: The final pathway was used in 38% of 723 bone metastases radiation prescription made since March 2016, with appropriate SFRT rates rising from 18% prior to implementation to 48% post-launch in cases where the pathway was used (p < 0.01). There was no increase in the appropriate SFRT rate for cases treated after March 2016 but not entered into the pathway tool as compared to cases prior to pathway tool implementation. Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians’ confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. Conclusions: Our experience demonstrates the utility of clinical pathway decision support for bone metastases in complex academic settings. Pathway use significantly increased appropriate care, more than doubling appropriate treatment rates relative to a synchronous group. Next steps include increasing the pathway’s ease of use, refining its prognostic abilities, and measuring related value effects.
Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study.
Authors: Mohammed Shan Darrel , Savage Pamela , Zimmermann Camilla
Published: November 2017

98

Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.
Increased Hyperalgesia and Proinflammatory Cytokines in the Spinal Cord and Dorsal Root Ganglion After Surgery and/or Fentanyl Administration in Rats
Authors: Chang Lu , Ye Fang , Luo Quehua , Tao Yuanxiang , Shu Haihua
Published: November 2017

BACKGROUND:

Perioperative fentanyl has been reported to induce hyperalgesia and increase postoperative pain. In this study, we tried to investigate behavioral hyperalgesia, the expression of proinflammatory cytokines, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the activation of microglia in the spinal cord and dorsal root ganglion (DRG) in a rat model of surgical plantar incision with or without perioperative fentanyl.

METHODS:

Four groups of rats (n = 32 for each group) were subcutaneously injected with fentanyl at 60 μg/kg or normal saline for 4 times with 15-minute intervals. Plantar incisions were made to rats in 2 groups after the second drug injection. Mechanical and thermal nociceptive thresholds were assessed by the tail pressure test and paw withdrawal test on the day before, at 1, 2, 3, 4 hours, and on the days 1–7 after drug injection. The lumbar spinal cord, bilateral DRG, and cerebrospinal fluid of 4 rats in each group were collected to measure IL-1β, IL-6, and TNF-α on the day before, at the fourth hour, and on the days 1, 3, 5, and 7 after drug injection. The lumbar spinal cord and bilateral DRG were removed to detect the ionized calcium-binding adapter molecule 1 on the day before and on the days 1 and 7 after drug injection.

RESULTS:

Rats injected with normal saline only demonstrated no significant mechanical or thermal hyperalgesia or any increases of IL-1β, IL-6, and TNF-α in the spinal cord or DRG. However, injection of fentanyl induced analgesia within as early as 4 hours and a significant delayed tail mechanical and bilateral plantar thermal hyperalgesia after injections lasting for 2 days, while surgical plantar incision induced a significant mechanical and thermal hyperalgesia lasting for 1–4 days. The combination of fentanyl and incision further aggravated the hyperalgesia and prolonged the duration of hyperalgesia. The fentanyl or surgical incision upregulated the expression of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG for more than 7 days and increase of ionized calcium-binding adapter molecule 1 in the spinal cord. The combination of fentanyl and incision resulted in higher increase of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG.

CONCLUSIONS:

The surgical plantar incision with or without perioperative fentanyl induced significant mechanical and thermal hyperalgesia, an increased expression of IL-1β, IL-6, TNF-α in the spinal cord and DRG, and activation of microglia in the spinal cord.
The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial
Authors: Krohg Anders , Ullensvang Kyrre , Rosseland Leiv Arne , Langesæter Eldrid , Sauter Axel R.
Published: November 2017

BACKGROUND:

Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery.

METHODS:

A randomized, double-blind, controlled trial was performed. Forty parturients undergoing cesarean delivery received bilateral ultrasound-guided QL blocks with either 2 mg/mL ropivacaine or saline postoperatively. All patients received spinal anesthesia with bupivacaine and sufentanil and a postoperative analgesic regimen of paracetamol, ibuprofen, and ketobemidone administered by a patient-controlled analgesic pump. The ketobemidone consumption and time of each dose administered were recorded. The primary outcome was ketobemidone consumption during the first 24 hours postoperatively. Secondary and exploratory analyses compared repeated measures of pain scores, nausea, and fatigue, and total differences in time until patients were able to stand and able to walk 5 m, and the interaction between the effective analgesic score and time.

RESULTS:

All 40 patients completed the trial, 20 in each group. The cumulative ketobemidone consumption in 24 hours was reduced in the active group compared with the control group (P = .04; ratio of means = 0.60; 95% confidence interval, 0.37–0.97). The effective analgesic scores were significantly better in the treatment group compared with the placebo group both at rest (P < .01) and during coughing (P < .01).

CONCLUSIONS:

QL block with ropivacaine reduces the postoperative ketobemidone consumption and pain intensity as a part of a multimodal analgesic regimen that excludes neuraxial morphine.
Stage 1 Registered Report: Effect of deficient phagocytosis on neuronal survival and neurological outcome after temporary middle cerebral artery occlusion (tMCAo)
Authors: Emmrich Julius V. , Neher Jonas J. , Boehm-Sturm Philipp , Endres Matthias , Dirnagl Ulrich , Harms Christoph
Published: November 2017

Stroke is a major cause of death and disability worldwide. In addition to neuronal death resulting directly from energy depletion due to lack of blood supply, inflammation and microglial activation following ischemic brain injury has been increasingly recognized to be a key contributor to the pathophysiology of cerebrovascular disease. However, our understanding of the cross talk between the ischemic brain and the immune system is limited. Recently, we demonstrated that following focal ischemia, death of mature viable neurons can be executed through phagocytosis by microglial cells or recruited macrophages, i.e. through phagoptosis. It was shown that inhibition of phagocytic signaling pathways following endothelin-1 induced focal cerebral ischemia leads to increased neuronal survival and neurological recovery. This suggests that inhibition of specific phagocytic pathways may prevent neuronal death during cerebral ischemia. To further explore this potential therapeutic target, we propose to assess the role of phagocytosis in an established model of temporary (45min) middle cerebral artery occlusion (tMCAo), and to evaluate neuronal survival and neurological recovery in mice with deficient phagocytosis. The primary outcome of this study will be forelimb function assessed with the staircase test. Secondary outcomes constitute Rotarod performance, stroke volume (quantified on MR imaging or brain sections, respectively), diffusion tensor imaging (DTI) connectome mapping, and histological analyses to measure neuronal and microglial densities, and phagocytic activity. Male mice aged 10-12 weeks will be used for experiments.
Easy and efficient ensemble gene set testing with EGSEA
Authors: Alhamdoosh Monther , Law Charity W. , Tian Luyi , Sheridan Julie M. , Ng Milica , Ritchie Matthew E.
Published: November 2017

Gene set enrichment analysis is a popular approach for prioritising the biological processes perturbed in genomic datasets. The Bioconductor project hosts over 80 software packages capable of gene set analysis. Most of these packages search for enriched signatures amongst differentially regulated genes to reveal higher level biological themes that may be missed when focusing only on evidence from individual genes. With so many different methods on offer, choosing the best algorithm and visualization approach can be challenging. The EGSEA package solves this problem by combining results from up to 12 prominent gene set testing algorithms to obtain a consensus ranking of biologically relevant results.This workflow demonstrates how EGSEA can extend limma-based differential expression analyses for RNA-seq and microarray data using experiments that profile 3 distinct cell populations important for studying the origins of breast cancer. Following data normalization and set-up of an appropriate linear model for differential expression analysis, EGSEA builds gene signature specific indexes that link a wide range of mouse or human gene set collections obtained from MSigDB, GeneSetDB and KEGG to the gene expression data being investigated. EGSEA is then configured and the ensemble enrichment analysis run, returning an object that can be queried using several S4 methods for ranking gene sets and visualizing results via heatmaps, KEGG pathway views, GO graphs, scatter plots and bar plots. Finally, an HTML report that combines these displays can fast-track the sharing of results with collaborators, and thus expedite downstream biological validation. EGSEA is simple to use and can be easily integrated with existing gene expression analysis pipelines for both human and mouse data.
Parallel Miocene‐dominated diversification of the lichen‐forming fungal genus Oropogon (Ascomycota: Parmeliaceae) in different continents
Authors: Wei Xin-Li , Leavitt Steven D. , Huang Jen-Pan , Esslinger Theodore L. , Wang Li-Song , Moncada Bibiana , Lücking Robert , Divakar Pradeep K. , Lumbsch H. Thorsten
Published: November 2017

Lineages with broad, intercontinental distributions can provide insight into factors that influence diversity across both temporal and geographic scales. Lichens are well known for distinct biogeographic distribution patterns, including a high number of lineages with intercontinental distributions. The lichen‐forming fungal genus Oropogon, from one of the largest families of lichen‐forming ascomycetes, Parmeliaceae, occurs in both Asia and the Neotropics. How this genus obtained this disjunct distribution is not currently known. To better understand factors shaping diversity in Oropogon, we (i) estimated the timing of diversification of major clades within this genus; (ii) inferred the historical biogeography of Oropogon; and (iii) identified factors that potentially affected the distribution and evolution of this genus. Our results suggest that the genus originally radiated during the early Miocene, with subsequent diversification events occurring during the middle Miocene. Ancestral area reconstructions for Oropogon suggest that the genus was either widespread with subsequent separate diversification in Asia and America or originated in the New World (America), with subsequent migration to Asia. We hypothesize that the Mi‐1 glaciation impacted diversification of Oropogon species in Asia, and that the rise of major mountain ranges, such as the Himalayas, helped promote diversification in Oropogon in the Old World.
Experience of surgical treatment of thyroid and parathyroid diseases
Authors: Ilyicheva Elena , Ilyicheva Elena , Zharkaya Anastasia , Zharkaya Anastasia , Bulgatov Dmitriy , Bulgatov Dmitriy , Makhutov Valeriy , Makhutov Valeriy , Borichevskiy Vitaliy , Borichevskiy Vitaliy , Karasev Valeriy , Karasev Valeriy , Aldaranov Gennadiy , Aldaranov Gennadiy , Ovakimyan Gor , Ovakimyan Gor
Published: November 2017

Background. In our country some aspects of thyroid and parathyroid surgery are still discussed.

Aim. To present our experience in surgical treatment of benign diseases of the thyroid and parathyroid glands.

Materials and methods. A retrospective analysis of the results of surgical treatment of 1511 patients with thyroid and

parathyroid disease was performed.

Results. Thyroidectomy was performed in 73.6 % of cases with thyroid diseases. The frequency of postoperative

complications: laryngeal paresis – 1.37 %, hypoparathyroidism – 0.84 %, hemorrhagic complications – 1.2 %. Selective

parathyroidectomy was performed in 99 % of cases with primary hyperparathyroidism. Persistent hypoparathyroidism

and laryngeal paresis have not been identified. Total parathyroidectomy with central neck dissection, upper mediastinum

and upper horn of the thymus gland was performed in 66.3 % of cases with secondary hyperparathyroidism. Persistent

laryngeal paresis was established in 3.3 % of cases, hemorrhagic complications – in 3.3 %.

Conclusions. Constant analysis of our own results gives us reasons for our own attitude to the controversial issues

of thyroid and parathyroid surgery. Presently, we prefer thyroidectomy in the treatment of diffuse toxic goiter and

multinodular goiter, hemithyroidectomy – for the single-node goiter. In the surgical treatment of primary and uremic

hyperparathyroidism, we consider mandatory the use of intraoperative monitoring of intact parathyroid hormone. When

performing total parathyroidectomy, we perform the autotransplantation of the fragment of the parathyroid gland.
Psychology in medicine
Authors: Abramova Galina , Yudchic Yuliya
Published: November 2017

The textbook addresses the problems of psychological research arising at the intersection of professional interests of doctors and psychologists. It can be used by representatives of these professions in the process of choosing the content and forms of influence on the experiences of a person associated with his health and diseases.
The manual is intended for students of medical and psychological specialties, studying courses in deontology, valeology, psychosomatic medicine, General psychology, clinical and medical psychology. Specialists in the field of practical medicine and psychology can use the information provided to organize professional interaction.
Robust Dynamic Pricing with Two Substitutable Products
Authors: Chen Ming , Chen Zhi-Long
Published: November 2017

We consider a practical dynamic pricing problem with two substitutable products involving a number of business rules commonly seen in practice. Demand substitution exists between the two products (interproduct substitution) and may also exist across different time periods (intertemporal substitution). However, there is limited demand information such that the underlying probability distributions of the demand cannot be characterized precisely. We use an interval to represent, respectively, the demand for each individual product in each period, the aggregate demand for the two products in each period, and the total aggregate demand for the two products across multiple time periods. We propose a robust optimization model for this problem to maximize the worst-case total revenue. For the problem with interproduct demand substitution only, we develop a dynamic programming algorithm and show that the search spaces in the DP can be reduced greatly, which enables the algorithm to generate optimal solutions in a reasonable amount of time. For the problem with both interproduct and intertemporal demand substitutions, we develop a more complex dynamic programming algorithm and design a fully polynomial time approximation scheme that guarantees a proven, near optimal solution in a manageable computation time for practically sized problems. Our computational results show that, compared to a risk-neutral approach, our robust optimization approach can decrease the variance of the revenue at a small expense of the average revenue. We also generate a number of managerial insights: (i) none of the key structural properties commonly studied in the pricing literature hold for our problem; (ii) the revenue impact of ignoring intertemporal demand substitution when such substitution exists can be quite significant; and (iii) under- or overestimating the bounds of the demand intervals or imposing moderate business rules leads to relatively small revenue loss, typically less than 3%.

The online appendix is available at https://doi.org/10.1287/msom.2017.0639 .