bluuebunny/crossref_metadata_2025 huggingface dataset:
Radial vs coccygeal artery Doppler blood pressure measurement in conscious cats
Authors: Zeugswetter Florian K , Tichy Alexander , Weber Katharina
Published: November 2017

Objectives

The aims of the study were to compare the results of systolic blood pressure (SBP) measurements at the radial and coccygeal artery by Doppler ultrasonography and to assess the impact of gender, age, body weight, body condition score (BCS) and stress score on disagreements.

Methods

Eighty cats were included in this prospective, block randomised crossover trial. Blood pressure measurements were performed at home, during hospitalisation or in a local animal shelter by a single trained observer according to the latest ISFM consensus guidelines. Statistical analysis included Spearman’s correlation and ANOVA.

Results

Measurement or site order had no effect on blood pressure measurements ( P = 0.157, P = 0.965). Correlation of radial and coccygeal SBP was moderate (rsp = 0.519, P <0.001) and measurements at the tail were by mean 18.7 ± 37 mmHg higher. The differences between the measuring sites were neither correlated with age (rsp = 0.044, P = 0.710) nor with body weight (rsp = 0.122, P = 0.337). A significant effect of BCS ( P = 0.016), but not gender ( P = 0.246) or stress score ( P = 0.424) was identified. Of the 25 cats with a coccygeal SBP ⩾170 mmHg, 14 (56%) were categorised as mildly hypertensive or normotensive when measurements were performed at the forelimb.

Conclusions and relevance

Choice of the measuring site, coccygeal vs radial artery, has a significant impact on Doppler ultrasonographic SBP results. In many cats, these discrepancies are huge and would certainly affect treatment decisions. Possible explanations include cone-shaped tails, especially in obese cats, leading to distal gapping or slippage of cylindrical cuffs and peripheral pulse pressure amplification. Further studies are urgently needed to clarify whether the discordances are artefacts or have a pathological background.
Navigating unintelligibility: Queer Australian young women’s negotiations of safe sex and risk
Authors: Grant Ruby , Nash Meredith
Published: November 2017

Australian public health promotion positions safe sex as a biomedical, heteronormative concept. Consequently, there is a dearth of scholarly research examining queer young women’s sexual health. To fill this knowledge gap, this article considers how Australian bisexual and queer young women understand ‘safe sex’ and conceptualise ‘good’ sexual citizenship. Drawing on qualitative interviews with 15 participants in Tasmania, findings reveal that although queer women understand heterosexual safe sex, there is little awareness of safer sexual practices with female partners. We argue that gendered sexual scripts shape perceptions of sexual health risk whereby queer women adopt multiple situation-dependent approaches to safer sex.
Contemporary fatherhood: Social, demographic and attitudinal factors associated with involved fathering and long work hours
Authors: Coles Laetitia , Hewitt Belinda , Martin Bill
Published: November 2017

Time pressures around work and care within families have increased over recent decades, exacerbated by an enduring male breadwinner culture in Australia and manifested in increasingly long work hours for fathers. We identified fathers who spent relatively long hours actively caring for children despite long work hours and we compared them with other fathers who did less work, less childcare, or less of both. Using 13 waves of the Household Income and Labour Dynamics in Australia (HILDA) survey, we explored characteristics associated with the time fathers spent in work and care. The age and ethnicity of fathers differentiated those who spent long hours in both work and childcare from all other groups of fathers, yet other factors were also important for the time fathers spent at work or with children. By examining fathers at the margins of the distributions of work and childcare hours, we add valuable insights into associations between work and care for families.
The legacy of Pitirim Sorokin in the transnational alliances of moral conservatives
Authors: Uzlaner Dmitry , Stoeckl Kristina
Published: November 2017

This article examines the legacy of Pitirim A. Sorokin (1889–1968), a Harvard sociologist from the Russian emigration. The authors scrutinise Sorokin as one of the nodal points for today’s moral conservatism. As a scholar, Sorokin has been relegated to the margins of his discipline, but his legacy as a public intellectual has persisted in the United States and has soared in Russia over the last three decades. This article examines Sorokin’s reception in these two nations, some of whose citizens have facilitated the burgeoning transnational phenomenon of twenty-first-century moral conservatism. Four aspects of Sorokin’s legacy are especially relevant in this context: his emphasis on values, his notion of the ‘sensate culture’, his ideas about the family, and his vision for moral revival. The authors conclude that Sorokin functions as a nodal point that binds together individual actors and ideas across national, cultural and linguistic barriers. The article is based on a firsthand analysis of moral conservative discourse and documents, on qualitative interviews and on scholarly literature.
Computational fluid dynamics prediction of hydrodynamic forces on a manoeuvring ship including effects of dynamic sinkage and trim
Authors: Liu Yi , Zou Lu , Zou Zao-Jian
Published: November 2017

Understanding the manoeuvring performance of a ship requires accurate predictions of the hydrodynamic forces and moments on the ship. In the present study, the hydrodynamic forces and moments on a manoeuvring container ship at various rudder and drift angles are numerically predicted by solving the unsteady Reynolds-averaged Navier–Stokes equations. The effects of dynamic sinkage and trim on the hydrodynamic forces are first investigated together with a grid dependency study to estimate the numerical error and uncertainty caused by grid discretization, and with a validation study combining the experimental data. The results show that the effect of dynamic sinkage and trim is non-negligible, since including it improves the hydrodynamic force predictions and reduces the numerical error and uncertainty, and the averaged error and uncertainty are smaller than the other computational fluid dynamics results where sinkage and trim were fixed with given values from model tests. Therefore, it is included in the subsequent systematic simulations regarding the influence of rudder and drift angles. The computed forces, moments and rudder coefficients at different rudder and drift angles on the container ship are compared with the benchmark model test data. From the computations, all the predicted quantities are in satisfactory agreement with the experimental data. The details of the flow filed and hydrodynamic forces, such as pressure distributions, transverse force distributions along the hull, velocity contours, streamlines and wave patterns are presented and discussed, and a deep insight into the physical mechanism in the hydrodynamic forces on a manoeuvring ship is obtained.
Reconceptualizing the presence of students on school governance councils: The a/effects of spatial positioning
Authors: Mayes Eve
Published: November 2017

This article conceptualizes the materialities of school governance council meetings. A concern for the material a/effects of spatial positioning emerged during a participatory action research project concerned with secondary school students’ sense of the benefits and challenges of student representation on school councils. Attending to affective, spatial and material dimensions of power with the conceptual resources of new materialisms, I question representational logics in policy, research and practice related to school councils. In particular, I interrogate whether the presence of human bodies representing interest groups necessarily promotes more democratic relations, and whether questions of power are best explored through discursive analysis alone. School council meetings are understood to be events where the political philosoph(ies) of a school materialize in concrete relations between bodies, and where subjects form, re-form (and de-form) in and through material-discursive practices.
Trigeminal neuralgia caused by a new variant of persistent trigeminal artery associated with agenesis of internal carotid artery
Authors: Medhi Gorky , Pendharkar Hima , terBrugge Karel , Prasad Chandrajit , Gupta Arun Kumar
Published: November 2017

We report a hitherto undescribed persistent carotid vertebral anastomosis associated with ipsilateral internal carotid artery agenesis and bilateral duplication of the intradural vertebral arteries. This rare anomaly was detected on MRI, supplemented by CT angiography while evaluating for cause trigeminal neuralgia in a 37-year-old woman. The aberrant vessel was seen to cause thinning and lateral displacement of the left trigeminal nerve on CISS 3D images. Also noted was a bilateral vertebral artery duplication of the PSA variant with the posterior inferior cerebellar artery arising from the medial limb of the duplication on the left.
Treatment evaluation of acute stroke for using in regenerative cell elements (TREASURE) trial: Rationale and design
Authors: Osanai Toshiya , Houkin Kiyohiro , Uchiyama Shinichiro , Minematsu Kazuo , Taguchi Akihiko , Terasaka Shunsuke
Published: November 2017

Rationale

MultiStem® (HLM051) is one of the promising allogenic cell products for acute ischemic stroke with strong evidence. A previous phase 2 randomized, double-blind, placebo-controlled, multicenter dose-escalation trial showed the safety of MultiStem® for acute ischemic stroke, with a time window beyond that of rt-PA and endovascular thrombectomy. We aim to obtain stronger evidence and to show the efficacy of the MultiStem® for treatment of ischemic stroke.

Sample size

Estimated sample size is 220 (110 patients per group), which has 90% power at 5% significance level.

Methods and design

TREASURE is a randomized, double-blind, placebo-controlled, multicenter phase 2/3 trial. The trial will be done at 31 medical centers in Japan. Patients with acute ischemic stroke including motor or speech deficit defined by a National Institution of Health Stroke Scale (NIHSS) score of 8–20 at baseline will be randomized 1:1 to receive a single intravenous infusion of MultiStem® or placebo within 18–36 h of stroke onset.

Study outcomes

Primary outcome in this study is the proportion of patients with an excellent outcome at day 90 defined by the functional assessment.

Trial registration

ClinicalTrials.gov (NCT02961504).

Conclusion

The TREASURE trial will provide a novel treatment option and expand the therapeutic window for patients with stroke if the results are positive.
Potential link between post-acute ischemic stroke exposure to hypoglycemia and hemorrhagic transformation
Authors: Klingbeil Kyle D , Koch Sebastian , Dave Kunjan R
Published: November 2017

Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.
Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review
Authors: Shunmugam Meenalochani , Phadnis Joideep , Watts Amy , Bain Gregory I.
Published: November 2017

The aim of this study was to analyse lunate fractures and any associated osseo-ligamentous injuries. A systematic review identified 34 cases. We identified carpal instabilities at the radiocarpal and midcarpal joints in volar and dorsal directions. Radiocarpal instabilities (10/34) were usually dorsoradial (8/10), with a transverse lunate fracture, best seen on a coronal image. Midcarpal instabilities (24/34) were usually volar (14/18), with a volar lunate shear fracture, best seen on a sagittal image. Instabilities were sub-classified into non-displaced, subluxated and dislocated. Associated fractures of the scaphoid and the radial and ulnar styloid processes were common. Lunate fractures without subluxation or dislocation had good outcomes with cast immobilization or fixation of associated fractures. Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures. Lunate fracture-dislocations are complex injuries, requiring stabilization of the lunate, associated fractures and ligament injuries; complications are common and acute or delayed salvage procedures may be required.
Prospects for modulating the CD40/CD40L pathway in the therapy of the hyper-IgM syndrome
Authors: Meng Xiangxue , Yang Bin , Suen Wen-Chen
Published: November 2017

The critical role of the CD40/CD40L pathway in B-cell proliferation, immunoglobulin (Ig) isotype switching and germinal center formation has been studied and described extensively in previous literature. Interruption of the CD40/CD40L signal causes hyper-IgM (HIGM) syndrome, which has been classified and recognized as a group of rare inherited immune deficiency disorders. Defects in CD40 and CD40L interactions or in downstream signaling molecules, including activation-induced cytidine deaminase, uracyl-DNA-glycosylase, NF-κB and DNA repair enzymes, result in an increased level of serum IgM and a significantly decreased or absent level of IgA, IgG and IgE that is accompanied by severe recurrent infections and autoimmune diseases. Many genetic defects in HIGM have been identified and, as a result, it is possible for patients to be definitively diagnosed by gene sequencing and to delineate the immunological features of the patients. Modifying the CD40/CD40L signaling pathway may offer the possibility of restoring the normal serum Ab production and curing the immunodeficiency. Hematopoietic stem cell transplantation has achieved a high rate of success using a sibling donor. In addition, successful examples of treating other immunodeficiencies using gene therapy indicated that there was a possibility of eradicating HIGM with this approach. In this review, we summarize the current drugs and a variety of therapeutic approaches for the treatment of the HIGM syndrome by interfering with the defective CD40/CD40L pathway.
Pediatric sleep and autonomic complaints
Authors: Gundrum Kaitlyn , Chelimsky Thomas C , Norins Nan A , Simpson Pippa , Nugent Melodee , Chelimsky Gisela
Published: November 2017

Objectives:

Little is known about the relationship between autonomic dysfunction and sleep disturbances. This study aimed to identify patterns of sleep disturbances and autonomic dysfunction in children.

Methods:

A retrospective chart review of 14 children who underwent sleep and autonomic testing was performed. Subjects were divided into three groups based on sudomotor Composite Autonomic Severity Score Scale score and postural tachycardia syndrome criteria. Sleep quality, sleep architecture, and number of comorbidities were analyzed.

Results:

There were no statistically significant differences between groups in measures of sleep quality, sleep architecture, and number of comorbidities.

Conclusion:

Patients with postural tachycardia syndrome and autonomic dysfunction experience multiple sleep-related complaints. The low power of our study did not allow firm conclusions, but there is no pattern to these abnormalities.
Hypokalemia: A potentially life-threatening complication of tenofovir therapy
Authors: Koratala Abhilash , Ruchi Rupam
Published: November 2017

Tenofovir is a nucleotide analog reverse transcriptase inhibitor approved for the treatment of HIV and hepatitis B infections. It is widely prescribed and an integral part of the recommended regimens for the treatment of HIV infection in antiretroviral-naive patients. Tenofovir is implicated in renal proximal tubular dysfunction, which can be associated with Fanconi syndrome and hypokalemia. When the hypokalemia is severe, it can lead to life-threatening complications. We describe the case of a 59-year-old woman who suffered a cardiac arrest secondary to severe hypokalemia from tenofovir use.
Spontaneous cognitive liberation in the context of rights-defending actions: A case study of the evolution of homeowner activists’ rights consciousness
Authors: Sun Xiaoyi , Huang Ronggui
Published: November 2017

Empirical studies on Chinese homeowners’ activism regarding defending their rights focus mostly on either political opportunities or resource mobilization and often neglect the cognitive process of homeowner activists in developing their rights consciousness. This study attempts to use the perspective of framing and cognitive liberation to gain a nuanced understanding of activists’ subjective cognition in their actions aimed at defending their rights. An analytic framework is proposed which examines two aspects of homeowners’ rights consciousness: the referent of rights (property rights versus rights to self-governance) and the nature of rights (reactive versus proactive). Data were collected from Sina Weibo tweets posted by homeowner activists in the period 2011 to 2015. The results show that activists are universally aware of property rights and are increasingly proactive in seeking self-governance. Subsequent interviews of a group of activists revealed a spontaneous and interactive process of cognitive liberation that derives from both the first-hand experiences and the online discussions with fellow activists. Social media provide platforms upon which activists can exchange information, form networks, and learn from each other about common issues and obstacles and, thus, they promote collective consciousness and facilitate cognitive liberation. This suggests that future studies of activism regarding homeowners’ defence of rights should shift from an event-centered case study approach to an issue-centered analysis of the grass-roots rights movement as a whole.
Juvenile Osteochondritis Dissecans of the Knee: Does Magnetic Resonance Imaging Instability Correlate With the Need for Surgical Intervention?
Authors: Haeri Hendy Simon , de SA Darren , Ainsworth Kelly , Ayeni Olufemi R. , Simunovic Nicole , Peterson Devin
Published: November 2017

Background:

Several magnetic resonance imaging (MRI) classification systems have been developed to determine the degree of instability of juvenile osteochondritis dissecans (JOCD) lesions. Our current practice involves correlating the patients’ symptoms with their MRI findings, but there are many cases in which this correlation is poor and results in incorrect classification of the stability of a JOCD lesion.

Purpose:

To determine whether certain MRI findings of JOCD instability are associated with the necessity for arthroscopic intervention to assess lesion stability. A secondary objective was to determine the interobserver agreement of the Kijowski et al (2008) MRI criteria for osteochondritis dissecans (OCD) instability.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective review was performed of patients who had documented femoral condyle OCD lesions, had open growth plates, and had been evaluated with serial MRI examinations. Each OCD lesion on MRI was classified according to the Kijowski classification as either stable or likely unstable.

Results:

The study included 16 patients (17 knees) with 49 MRI examinations. The initial MRI lesion was graded as stable in 59% (10/17), and 7 of these remained stable throughout the study period, with only 1 requiring operative intervention. Two became unstable on MRI, with 1 requiring surgery and 1 reverting back to stable with nonoperative management. The initial MRI lesion was graded as unstable in 41% (7/17) of the knees, with 2 of these becoming stable on MRI during the follow-up period with nonoperative management. The other 5 lesions remained unstable, with 3 eventually requiring surgery. The most important finding in this study was that MRI instability is a poor predictor of the necessity for surgery for JOCD lesions. The correlation between a nonradiologist and a trained musculoskeletal radiologist in the interpretation of the MRI criteria by Kijowski et al showed only substantial agreement for multiple cysts.

Conclusion:

MRI criteria for OCD instability in the pediatric knee do not always correlate with the necessity for surgery. They are, at times, a helpful adjunct to the management of these patients; however, care must be taken to interpret all available clinical and radiographic information in surgical decision making.
Film Review: I, Daniel Blake I, Daniel Blake
Authors: Gibbons Andrea
Published: November 2017

I, Daniel Blake | Ken Loach, Director | UK/France/Belgium | 2016
Complex conductivity of tight sandstones
Authors: Revil André , Coperey Antoine , Deng Yaping , Cerepi Adrian , Seleznev Nikita
Published: November 2017

Induced polarization well logging can be used to characterize sedimentary formations and their petrophysical properties of interest. That said, nothing is really known regarding the complex conductivity of low-porosity sedimentary rocks. To fill this gap of knowledge, we investigate the complex conductivity of 19 tight sandstones, one bioclastic turbidite, and four sand/smectite mixes. The sandstones and the bioclastic turbidite are characterized by low to very low porosities (in the range of 0.8%–12.3%) and a relatively narrow range of cation exchange capacity (CEC — [Formula: see text]). The sand-clay mixtures are prepared with pure smectite (Na-Montmorillonite, porosity approximately 90%, CEC [Formula: see text]) and a coarse sand (grain size approximately [Formula: see text]). Data quality is assessed by checking that the percentage frequency effect between two frequencies separated by a decade is proportional to the value of the phase lag measured at the geometric frequency. We also checked that the normalized chargeability determined between two frequencies is proportional to the quadrature conductivity at the geometric mean frequency. Our experimental results indicate that the surface conductivity, the normalized chargeability, and the quadrature conductivity are highly correlated to the ratio between the CEC and the bulk tortuosity of the pore space. This tortuosity is obtained as the product of the (intrinsic) formation factor with the (connected) porosity. The quadrature conductivity is proportional to the surface conductivity. All these observations are consistent with the predictions of the dynamic Stern layer model, which can be used to assess the magnitude of the polarization associated with these porous media over the full range of porosity. The next step will be to extend and assess this model to partially saturated sandstones.
Need for nutritional support in advanced cancer patients with cachexia: A survey in palliative care settings.
Authors: Amano Koji , Morita Tatsuya , Miyamoto Jiro , Uno Teruaki , Katayama Hirofumi , Tatara Ryohei
Published: November 2017

100

Background: Few studies have investigated the need for nutritional support in advanced cancer patients in palliative care settings.The aim of this survey is to examine the relationship between the need for nutritional support and cancer cachexia, specific needs, perceptions, and beliefs. Methods: We conducted a questionnaire in outpatient service/palliative care teams/palliative care units. Patients were classified into two groups: 1) Non-cachexia/Pre-cachexia and 2) Cachexia/Refractory cachexia. Results: A total of 117 out of 121 patients responded (96.7%). A significant difference was observed in the need for nutritional support between the groups: Non-cachexia/Pre-cachexia (32.7%) and Cachexia/Refractory cachexia (53.6%) (p = 0.031). The specific needs of patients requiring nutritional support were nutritional counseling (93.8%), ideas to improve food intake (87.5%), oral nutritional supplements (83.0%), parenteral nutrition and hydration (77.1%), and tube feeding (22.9%). The top perceptions regarding the best time to receive nutritional support and the best medical staff to provide nutritional support were “when anorexia, weight loss, and muscle weakness become apparent” (48.6%) and “nutritional support team” (67.3%), respectively. The top three beliefs of nutritional treatments were “I do not wish to receive tube feeding” (78.6%), “parenteral nutrition and hydration are essential” (60.7%), and “parenteral hydration is essential” (59.6%). Conclusions: Patients with cancer cachexia had a greater need for nutritional support. Advanced cancer patients wished to receive nutritional support from medical staff with specific knowledge when they become unable to take sufficient nourishment orally and the negative impact of cachexia becomes apparent. Additionally, most patients wished to receive parenteral nutrition and hydration.
Disparity in use of supportive resources in elderly patients on chemotherapy for gastrointestinal malignancies: A single institution analysis.
Authors: Joshi Prashant J. , Matin Khalid , Sima Adam
Published: November 2017

102

Background: Chemotherapy has clinical benefit for elderly patients with careful selection. Selection is based on ECOG Performance Status determination. Patients with ECOG PS of 0-2 are considered chemotherapy candidates whereas patients with PS > 3 are considered unlikely to benefit from it. Recommended tools such as a Comprehensive Geriatric Assessment (CGA) to help stratify patients further are not widely adopted. This study looks at disparity in use of supportive resources in patients > 65 years of age undergoing chemotherapy at the Virginia Commonwealth University (VCU) Hospital. Methods: We conducted a retrospective analysis for all patients 65 and above with gastrointestinal malignancies (gastroesophageal, colorectal, and pancreatic) treated between January 2005 and July 2016 that received chemotherapy in any setting. ECOG performance status at initiation of therapy was required. Data collected on receipt of supportive resources such as Physical Therapy (PT), Occupational Therapy (OT), Nutrition, Mental Health, Geriatrics and Palliative Care. Exact Pearson’s chi-square tests were used for comparison of services and ECOG PS, race, etc. Results: 226 patients met criteria. Majority of patients were male (56%), white (63%) and had advanced malignancies (80% Stage III/IV disease). Mean age was 72.2 (SD = 5.6). ECOG PS was ≤1 in 88% and ≥2 in the remainder. 61% of patients utilized at least one resource (Palliative care: 46%, Nutrition: 21%, Mental Health: 15%, PT: 13%). Patients with an ECOG PS 0 or 1 tended to use more services; nutrition statistically significant (p = 0.037). Racial disparities observed in receipt of PT (P = 0.002), mental health (P = 0.012), palliative care (P = 0.039) with white patients more likely to receive the service in each case. More white than non-white patients received services (66% vs. 55%, P = 0.067). Conclusions: ECOG PS 0 or 1 correlated with increased utilization as compared to less robust ECOG 2 patients; tools such as CGA for appropriate service allocation are needed. We identified racial disparity in the utilization of certain services and these need further exploration, including patters for referral of these services as a factor.
African American perceptions of early palliative care in oncology.
Authors: Pirl William F. , Saez-Flores Estefany , Arana Neysari , Greer Joseph , El-Jawahri Areej , Temel Jennifer S. , Erin Kobetz
Published: November 2017

104

Background: While ASCO guidelines recommend early palliative care (PC) for patients with metastatic cancer, few African Americans (AA) have participated in PC trials and little data exist on the acceptability and effect of early PC in this population. Using the ADAPT-ITT framework for culturally tailoring evidence-based interventions, we assessed perceptions of PC and its early introduction in oncology in AAs. Methods: We conducted four focus groups with AAs from community centers in Miami. We enrolled adults without a history of cancer to approximate the knowledge and beliefs of someone with newly diagnosed cancer. Focus groups explored knowledge of PC, value of different components of early PC, and perceptions about introducing PC early after cancer diagnosis. We recorded and transcribed the focus groups, performing thematic analysis with NVivo. Results: Thirty-seven AAs participated. Over half were female (24/37), and median age was 54 years old (range 35-71). Participants had little to no knowledge of PC. Lack of familiarity was attributed to AAs receiving sub-standard care and the belief that PC has been kept from AAs. Rather than being concerned that it might result in less cancer treatment, they reported that PC was actually part of doing everything possible for cancer, and it is the “best care.” PC was viewed as a solution to a major theme of doctors not providing adequate information for patients and families to prepare for negative outcomes such as death. However, some objected to discussing specific survival estimates for fear of speaking them into existence. Distinctions were drawn between what doctors manage (treatments) and what God manages (life/death). Participants could not understand why PC would be reserved for later in the course of illness instead of immediately after cancer diagnosis (“Don’t wait until I’m dying; give it to me now!”). PC was described as “supervising your needs and making sure they are addressed.” Conclusions: AAs were enthusiastic about early PC in oncology, but did not support providing specific estimates of survival. End-of-life planning was considered by some to be spiritual and not medical.
Implementation of group visits to improve outpatient oncology advance care planning.
Authors: Lowry Sarah , Lum Hillary , Izumi Seiko , Fromme Erik K
Published: November 2017

11

Background: Oncology patients that participate in advance care planning (ACP) and complete advance directives (AD) are more likely to receive goal-concordant end of life care. The AD documentation rate within our academically-affiliated community outpatient oncology clinic is below national and institutional averages. A group medical visit effectively facilitated ACP in a geriatric primary care setting. This quality improvement project implemented a similar ACP conversation group (ACPCG) in an outpatient oncology setting. Methods: Adult patients in a community oncology clinic were contacted and invited to participate in ACPCG by a nurse practitioner who works in the clinic. Using a facilitation guide, the 2-session intervention included sharing past ACP experiences, identifying surrogate decision makers, starting conversations, and discussing surrogate flexibility. Recruitment, retention, and patient ACP outcomes were measured. Results: Seventy-six patients were successfully contacted and seventeen signed up (22% recruitment rate). Twelve patients participated in the first session, and five attended the second session (42% retention). Recruitment was time intensive, and several patients responded that ACP was not relevant to their situation. Six participants completed an AD prior to attending the first session (50%) but only one had an AD in their medical record. Two had surrogate decision makers documented prior to the intervention (16%). Participants reported the ACPCG as helpful in making the process less overwhelming. There was no increase in AD documentation rates within the medical record four weeks after the intervention, but the rate of surrogate documentation increased to seven (58%). Conclusions: Participants had higher than average rates of AD completion prior to the intervention but had not shared the document with their providers. While the ACPCG was well received by patients, implementation faced multiple challenges. More efficient recruitment methods and strategies to facilitate better patient understanding of ACP are needed.
Preliminary results of a randomized controlled trial of early integration of specialist palliative care within a tertiary cancer center in the Czech Republic.
Authors: Slama Ondrej , Pochop Lukas , Svetlakova Lucie , Bilek Ondrej , Sedo Jiri , Horova Renata , Demlova Regina , Vyzula Rostislav
Published: November 2017

113

Background: Clinical trials in the U.S. and Canada have shown the benefit for patients and the health care system of early integration of palliative care into oncological practice. Nevertheless the practical realisation and the timing of this integration may be controversial. The optimal model of specialist palliative care (SPC) involvement may depend on the quality of standard cancer care in the given country. Methods: We present preliminary results of a randomised controlled trial of early integration of SPC conducted in the largest tertiary cancer center in Czech Republic. The trial compares standard oncology care with integrated SPC to standard oncology care alone in patients with advanced solid tumors treated with palliative antineoplastic therapy. The design of the study is inspired by the study of early PC for patients with advanced NSCLC byTemel et al. (2010). The SPC intervention consists of consultations with palliative care team every 6 weeks. Outcomes assessed at baseline and at 3 and 6 months after enrollment are quality of life (EORTC-QoL-Q30), anxiety and depression (HADS) and structure and cost of end of life care. Results: 100 patients have been randomisd between September 2015 and January 2017 (integrated PC 51 pts, conotrole 49pts). There were differences at 3 and 6 months in QoL (66% vs. 55%, p > 0,05; 63% vs. 49% p > 0,05), prevalence of anxiety (37% vs. 43%, p > 0,05; 32% vs. 54%, p > 0,05) and depression (19% vs. 29% p = 0,02; 20% vs. 27% p > 0,05) in intergated and control arm respectively. The mean time from the last chemotherapy to death was 66 days vs.52 days (p = 0,04) and the enrollment rate to hospice programme was 63% vs. 43% (p = 0,02) at the end of life in favour of integrated palliative care. Conclusions: There seem to be a trend for better results in patient reported outcomes and reasonable resource utilisation in favour of integrated care model in the context of advanced cancer care in Czech Republic. But differences between study arms did not reach statistical significance in patient reported outcomes, probably due to small number of patients. We hope to enrol enough patients within next 6 months to overcome this limitation.
Relevance of rapid geriatric assessment for elderly patients with newly diagnosed malignancy.
Authors: Mehta Hina Niranjan , Farhat Rania , Ravulapati Sravanthi , Tu Yifan
Published: November 2017

115

Background: The elderly population is the fastest growing segment of the US population, and it is widely affected by cancer and its related sequelae. At St. Louis University (SLU), a simple Rapid Geriatric Assessment (RGA) was developed based on the SLU Mental Status Exam (SLUMS). The RGA includes screening for frailty, sarcopenia, nutrition, and cognition. In this pilot study, we used RGA to assess geriatric patients with newly diagnosed malignancy prior to cancer therapy and its ability to improve outcomes in oncology patients. Methods: Elderly patients (aged 65 and above) with newly diagnosed malignancy completed the RGA either inpatient or outpatient at SLU. A retrospective chart review was done to collect patient's demographics, type of malignancy, number of hospitalizations since diagnosis and referral to palliative care over a 6 month period. Relationship between tolerability and RGA subscores were assessed using general linear models, Kaplan-Meier survival analysis and Chi-square testing. Results: Twenty six patients (mean age 76 [65-90]) were included from December 2015 to 2016 of which 9 were male (n = 35) and 17 female (n = 65). 19 patients (73%) were inpatient, 7 (27%) were outpatient and 13 patients (50%) received chemotherapy. Using the Mann-Whitney U test, no significant difference was seen between RGA subscores (FRAIL p = 1; SNAQ p = 0.69; SARC-F p = 0.71; RCS p = 1) in patients receiving versus not receiving chemotherapy. There was no significant difference in overall survival (OS) over a 20 month period based on chemotherapy status (p = 0.39). In our study, 62% of patients (n = 16) were referred to palliative care and noted to have a significant better OS (p = 0.04). Conclusions: The RGA is a self-explanatory tool that can be used in geriatric oncology patients and it can bedone in 10 minutes. In this pilot study, we used this tool in a small number of patients. We plan to perform a prospective study to evaluate the RGA comparing to ECOG-performance status in geriatric patients prior to standard cancer therapies. Improvement of overall survival with incorporation of palliative care in oncology patients is reaffirmed in our study.
Barriers between providers and families regarding palliative care integration in a multidisciplinary pediatric oncology practice.
Authors: Draper Lauren , Pannier Samantha , Mann Karely , Fair Douglas Beaty , Perlman Holly , Moore Dominic , Kirchhoff Anne C.
Published: November 2017

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Background: Pediatric oncology patients are known to have high symptom burden. The pediatric oncology population is a natural fit for early integration of palliative care (PC), yet there are often systemic and communication barriers. We assessed oncologists and supportive care providers’ beliefs about PC and described how well prognosis is currently communicated between clinical team members and families. Methods: Primary Children’s Hospital (PCH) is the only pediatric tertiary care hospital serving the Mountain West region. We conducted surveys and semi-structured interviews with all pediatric oncologists at PCH (N = 12) and supportive care providers such as nurses and social workers (N = 13). Surveys were also administered to caregivers of patients (N = 23). Descriptive statistics were generated. Results: Oncologists and and supportive care providers differ even in their beliefs about who should receive PC and when it should begin. 41.7% (N = 5) of attending pediatric oncologists strongly agreed that their patients could benefit from a comprehensive PC consultation and that this should happen around the time of diagnosis. Of the supportive care providers only 15% (N = 2) strongly agree that their patients could benefit from a PC consultation, but 38% strongly agree it should begin at the time of diagnosis. Of the physicians, 33% (N = 4) believe the system currently in place is “adequate,” while only 8% (N = 1) of supportive care providers agree. Physicians report 100% of the time that they “often or always” discuss prognosis with a family, but only 44% (N = 10) of caregivers strongly agree that prognosis was clearly explained. 57% (N = 4) of patients report additional emotional support would have been helpful. Conclusions: Less than half of providers feel their patients could benefit from a PC consultation, despite the majority feeling the current system is inadequate. Also, providers and caregivers perceive discussions about prognosis, a key part of comprehensive PC, in different ways. Our findings demonstrate that a major barrier to the integration of a comprehensive PC program may be a lack of agreement among providers on the team and ineffective communication with families.
Palliative Care Early and Systematic (PaCES): A survey of colorectal cancer clinicians of barriers and facilitators to early palliative care integration.
Authors: Watanabe Sharon , Sinnarajah Aynharan , Earp Madalene , Tang Patricia A. , Kerba Marc , Simon Jessica
Published: November 2017

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Background: Health systems struggle to systematically provide early and integrated palliative care (PC) to cancer patients. In Alberta, Canada, the PaCES (Palliative Care Early and Systematic) project is addressing this need by building an early PC pathway for advanced colorectal cancer (CRC) patients. As part of this work, we aimed to characterize barriers and facilitators to: a) providing primary palliative care to CRC patients; b) referring CRC patients for PC specialist consults; and c) working with specialist PC and home care services. Methods: This observational, knowledge translation questionnaire study collected both quantitative and open-ended responses from physicians, nurses and other allied health care professionals (HCP) working with advanced CRC patients in Alberta, Canada. Survey questions and format were informed by Michie’s Theoretical Domains Framework. The strength of this framework is that, in addition to identifying specific barriers to delivering early PC, it also maps out suggested solutions to addressing these barriers. Results: The survey response rate was 43% (65/150). 89% of the respondents were physicians or nurses with Medical Oncology as the primary discipline. Time and competing priorities were the biggest barriers to HCPs addressing patients PC needs (65%). Next, role confusion when working with PC teams, and lack of clear process for executing new orders when patients are at home, were identified by over 55% of HCPs as a barrier. Other aspects of working with PC teams, including, lack of standardized communication processes and inadequate documentation processes, were barriers as perceived by over 45% of HCPs. Over 90% of HCPs surveyed believe earlier PC is likely to benefit their patients, and would recommend an earlier PC pathway to their patients. Conclusions: In Alberta, the main barriers to early PC integration are no longer attitudinal, with over 90% believing that early PC is beneficial for their patients. Time needed to address PC needs in a busy oncology clinic is a barrier. A pathway to improve clarity around referral processes and role confusion when working with PC teams will be developed to address these barriers.
Comprehensive distress screening and referral at a tertiary cancer center.
Authors: Loggers Elizabeth Trice , King Stephen Duane Watkins , Fann Jesse R , McMillin Kerry K , David Jodie HN , Harlow Lexi M , Horak Petr , Yi Jean C , Kusnir-Wong Tracy , Jagels Barbara , Shannon-Dudley Moreen
Published: November 2017

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Background: Addressing distress in cancer patients is now broadly recognized as critical to well-being and associated with increased survival. Cancer centers are developing innovative distress screening methods; we describe our novel process and results. Methods: New patients from 9/2015 to 3/2017 received an email requesting completion of a 44-item web-based survey assessing depression (2-item Patient Health Questionnaire), anxiety (2-item Generalized Anxiety Disorder), quality of life (QOL, 28-item Functional Assessment of Cancer Treatment-General), malnutrition (3-item Malnutrition Screening Tool), and 9 items addressing existential crisis, physical function, symptoms, tangible needs and concerns for dependent children. Results were computer scored, with positive screens resulting in direct, automated referrals to supportive care services (SCR). Analysis includes descriptive statistics and logistic regression using SAS 9.4. Results: 71% (n = 2629 of 3724) of those approached provided an email and completed the survey; 73% reporting no survey burden. Non-responders were more likely to be minority, non-English speaking, with non-commercial insurance (all p < 0.001). 59% (n = 1543) of responders screened positive for one or more SCR, including 6% to palliative care for poor QOL or symptoms. Receipt of SCR was more likely with Medicaid insurance (1.36 odds ratio [OR], 95% confidence interval [CI] 1.06-1.76, p = .0061); plan to receive care (1.27 OR, CI 1.07-1.50, p = .0061); and any report of survey burden (2.26 OR, CI 1.83-2.80, p < .0001). Conclusions: Web-based distress screening is feasible, efficient and not burdensome for the majority of cancer patients. Those who find this screening burdensome are two-fold more likely to have distress. Future efforts should address screening of vulnerable populations.
Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists.
Authors: Fareed Muhammad Mohsin , Krishnan Monica Shalini , Spektor Alexander , Huynh Mai Anh , Khouj Yaseer Mohammed , Hertan Lauren Michelle , Nichipor Alexandra , Balboni Tracy A.
Published: November 2017

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Background: Palliative radiation therapy(PRT)is often employed in patients with advanced cancers requiring urgent consultation given the rapidity of presentation.We report on characteristics of urgent palliative oncologic issues encountered by radiation oncologists(RO). Methods: We prospectively evaluated patterns of presentation in162 consecutive consultations for urgent PRT at 3 centers from 5/19/14 to 9/26/14.Survey of palliative care issues was completed by physicians/nurse practitioners including assessment of reasons for urgent radiation oncology consultation,disease presentation characteristics and site of RT delivery.Response rate was 86% with 140 of 162 responses received. Results: Median age of patients was 63 years(29-89)with 39% > 65, 41% from 50-65 and 20% < 50 years;56% were males and 44% females. Most were married(62%)and 30% non-Caucasians.48% had ECOG PS 0-1,whereas it was 2, 3 and 4 in 24%,9% and 3%.Primary cancer diagnoses were lung (28%),breast(13%),prostate(10%),melanoma(10%),sarcoma(7%) and other diagnoses in 32%.Pain was predominant reason for consult(57%)followed by brain metastases(29%),spinal cord/cauda compression (13%),dyspnea (10%),bleeding (8%),bone fracture(4%)and dysphagia(2%).Clinicians managed pain (69%),neurologic symptoms(51%),fatigue (49%),intestinal(21%),respiratory (19%) symptoms,bleeding (14%),insomnia (13%),nausea/vomiting(12%)and dysphagia(6%).Patients presented at all stages 79% at the time of their diagnosis of metastatic cancer,63% with an established ( > 1 month) metastatic cancer diagnosis and continuing to further cancer therapies and 17% proceeding to hospice care without further anti-cancer therapy after PRT. Conclusions: Radiation oncologists care for patients across time course of metastatic cancer diagnosis managing variety of urgent oncologic issues,most commonly metastases causing pain followed by brain metastases and cord compression.They also manage cancer-related symptoms,mostly pain,neurological symptoms and fatigue.These findings point to need for palliative care to be well integrated into radiation oncology practice including education and systems of care.