bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of preoperative malnutrition on postoperative delirium: a systematic review and meta-analysis
Authors: Dong Bo , Wang Jing , Li Pan , Li Jianli , Liu Meinv , Zhang Huanhuan
Published: October 2023

Background

Postoperative delirium (POD) is a common postoperative complication, characterized by disturbance of attention, perception, and consciousness within 1 week after surgery, and linked to cognitive decline, increased mortality, and other serious surgical outcomes. Early identification and treatment of risk factors for POD could reduce the occurrence of delirium and the related poor outcomes. Malnutrition as a possible precipitating factor, defined as the poor anthropometric, functional, and clinical outcomes of nutrient deficiency, has been investigated. However, the evidence is controversial. The goal of this systematic review and meta-analysis was to comprehensively assess the correlation between preoperative malnutrition and POD.

Methods

PubMed, Embase, Cochrane Library, and Web of Science were used to search prospective cohort articles that explored the correlation between preoperative malnutrition and POD from inception until September 30, 2022. Two researchers independently conducted the literature selection and data extraction. The quality of the literature was evaluated according to the Newcastle–Ottawa scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) for POD associated with malnutrition relative to normal nutritional status were calculated.

Results

Seven prospective cohort studies qualified for the meta-analysis, which included 2701 patients. The pooled prevalence of preoperative malnutrition was 15.1% (408/2701), and POD occurred in 428 patients (15.8%). The NOS score was above 7 points in all 7 studies. Our results demonstrated that the pooled OR for malnutrition and POD was 2.32 (95% CI 1.62–3.32) based on a random-effects model. Our subgroup analysis suggested that the relationship between malnutrition and POD was significant in adults following noncardiac surgery (OR = 3.04, 95% CI, 1.99–4.62, P < 0.001), while there was no statistical significance in adults following cardiac surgery (OR = 1.76, 95% CI, 0.96–3.22, P = 0.07). Additionally, in the subgroup analysis based on different malnutrition assessment tools (MNA-SF versus others), a significant association was found in the MNA-SF group (OR = 3.04, 95% CI, 1.99–4.62, P < 0.001), but not in the others group (OR = 1.76, 95% CI, 0.96–3.22, P = 0.07). Other subgroup analyses showed that this association was not significantly affected by evaluation instruments for POD, location of the study, or quality of the article (all P < 0.05).

Conclusions

Based on the currently available evidence, our results suggested that preoperative malnutrition was independently associated with POD in adult surgical patients.
Futures literacy in collaborative foresight networks: advancing sustainable shipbuilding
Authors: Jokinen Leena , Balcom Raleigh Nicolas A. , Heikkilä Katariina
Published: October 2023

Businesses are facing increasing pressure from society and regulators to become more sustainable and do their part to address the climate crisis. These businesses will require continual sustainability innovation formulation and implementation processes to meet these demands. Collaborative foresight (CF) has high potential for helping business sectors produce a continuous stream of sustainability options to select and deploy in finished products. Recent developments in futures studies indicate that a capability called futures literacy (FL)—acts of individuals or groups switching their modes and purposes for imagining futures—is relevant to the production of innovation-related outcomes. FL may be key to driving the effectiveness of such foresight collaborations; however, little is known about its exact functions in such business networks and processes. This article examines this issue in the context of a luxury-cruise shipbuilding network in Finland. It analyzes research data from the foresight workstreams of a multi-partner consortium active across three sequential projects between 2016 and 2022. The foresight team took an interventionist research approach, conducting interviews and workshops as part of all three projects. In this article, we analyze the materials produced from these interventions for the appearances of FL enhancement. Based on this analysis, we found that FL can play key functions in CF, such as supporting actors in perceiving new developmental pathways, identifying new opportunities for innovation, and identifying alternative priorities built from new realizations and insights—a finding in line with existing claims by FL scholars and educators. This article contributes to ongoing discussions about the significance of CF and FL in addressing the most pressing environmental issues of our time. It offers an evidence-based argument for the relevance of taking a capabilities approach (i.e., introducing and developing FL) for business networks seeking to use foresight when engaging in sustainability innovation.
On fear of missing out, social networks use disorder tendencies and meaning in life
Authors: Montag Christian , Müller Marko , Pontes Halley M. , Elhai Jon D.
Published: October 2023

Much research has been conducted on the association between social networks use disorder tendencies (SNUD; i.e. problematic social media use) and well-being. In more detail, a meta-analysis and further research suggest an inverse association between higher SNUD tendencies and lower well-being. In existing studies on social media use and well-being, this association has often been investigated by asking participants about their life satisfaction and/or emotional well-being. A path that has only recently been used to shed further light on SNUD tendencies is the assessment of meaning in life. Against this background, the present study aimed to investigate both the search for and presence of meaning in life in the context of SNUD tendencies in 955 participants. To the best of our knowledge and beyond what has been mentioned, this study is the first to investigate the links between meaning in life variables and state/trait fear of missing out (FoMO), with FoMO being a critical variable known to be linked to the overuse of digital technologies. In a structural equation model, we observed that associations between FoMO and meaning in life variables was mediated by SNUD tendencies. Although the present study is of cross-cultural nature and cannot establish causality, it might be the case that proneness to FoMO might trigger SNUD tendencies and as a consequence, results in more search for meaning in life, while hindering presence of meaning in life.
Functional rolling circle amplification-based sensitive determination and low-speed centrifugation-based isolation of Staphylococcus aureus
Authors: Gao Yan , Li Chaohui , Wang Ying , Yu Xue
Published: October 2023

The ability to quickly and accurately analyze Staphylococcus aureus (S. aureus) and isolate the bacteria in a simplified setting is crucial for the early identification and treatment of infectious illnesses. Here, we describe the development of a new aptamer-based detection and separation technique that combines Mg2+-dependent DNAzyme amplification cascades with catalytic hairpin assembly for enhanced sensitivity. This technique uses a rolling circle amplification procedure to build a detection scaffold with a repetitive functional hairpin structure that, upon identifying S. aureus, can launch a catalytic hairpin assembly-mediated DNAzyme-based cascade signal amplification. This allows S. aureus to be isolated using low-speed centrifugation and simultaneously quantified. The approach has a low limit of detection of 21 cfu/mL and a broad detection range of six orders of magnitude due to the inclusion of the catalytic hairpin assembly for signal amplification. In addition to high sensitivity, the method also demonstrates high selectivity for the identification and isolation of S. aureus, making it a useful instrument for reporting S. aureus infections.
Authentic STEM education through modelling: an international Delphi study
Authors: Hallström Jonas , Norström Per , Schönborn Konrad J.
Published: October 2023

Background

The literature asserts that science, technology, engineering, and mathematics (STEM) education needs to be authentic. Although models and modelling provide a basis from which to increase authenticity by bridging the STEM disciplines, the idea of authentic STEM education remains challenging to define. In response, the aim of this study is to identify consensus on significant elements of authentic STEM education through models and modelling. Views were gathered anonymously over three rounds of questions with an expert panel. Responses were subjected to a multimethod analysis that pursued identification, consensus, and stability in the panel’s revealed propositions and themes around authentic STEM education through modelling.

Results

The panel reached high consensus concerning the potential of STEM education to support learning across traditional subject borders through authentic problem solving. The panel also consented that modelling is indispensable for achieving real-world relevance in STEM education, and that model-based integrated STEM education approaches provide opportunities for authentic problem solving. Furthermore, results showed that integrating individual STEM subjects during teaching, in terms of including disciplinary knowledge and skills, requires specialised competence. Here, technology and engineering subjects tended to implicitly underpin communicated teaching activities aimed at STEM integration.

Conclusions and implications

The panellists stress that STEM disciplines should be taught collaboratively at the same time as they are not in favour of STEM as a subject of its own but rather as a cooperation that maintains the integrity of each individual subject. Many respondents mentioned integrated STEM projects that included modelling and engineering design, although they were not specifically labelled as engineering projects. Thus, real-world STEM education scenarios are often viewed as being primarily technology and engineering based. The panel responses also implicate a need for multiple definitions of authenticity for different educational levels because a great deal of uncertainty surrounding authenticity seems to originate from the concept implying different meanings for different STEM audiences. These international Delphi findings can potentially inform integrated STEM classroom interventions, teacher education development, educational resource and curriculum design.
Pre- and postnatal safe sleep knowledge and planned as compared to actual infant sleep practices
Authors: Ramos Paula Valiño , Hoogerwerf Pamela J. , Smith Penny K. , Finley Carolyn , Okoro Uche E. , Jennissen Charles A.
Published: October 2023

Background

Our objectives were to compare safe sleep knowledge, attitudes and planned vs. actual infant sleep practices among expectant mothers before and after their infant’s birth and to determine whether differences (if present) were associated with any demographic variables.

Methods

Study participants were surveyed at their 28-week prenatal and 6-week postpartum obstetric clinic visits from November 2019–February 2021. Due to COVID-19 pandemic cancellation of in-person postpartum visits, many participants received text messaging encouraging them to take the follow-up survey online. Frequency and comparative analyses were performed.

Results

355 women (44%) completed both pre- and postnatal surveys. Many participants increased their safe sleep knowledge during the study. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat, two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who were unsure or planned sleep practices considered unsafe prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planning to use a crib bumper (17% of the total), almost all (88%) were not using one postnatally. Conversely, some participants who reported they would be following safe sleep practices prenatally were not doing so postpartum. For example, 13% of those stating they would place their child on their back reported using another sleep position on the postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, non-Hispanic Whites (19%) as compared to other races/ethnicities (5%) and those with incomes ≥ $75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, p = 0.0094 and p = 0.0138, respectively.

Conclusions

We observed increases in safe sleep knowledge and that some participants followed safer sleep practices than they had planned. However, there were also participants who planned to use safe sleep practices prenatally who were not doing so after their baby’s birth. Our study identified demographics for which targeted safe sleep education and more effective interventions may be needed.
Effect of remimazolam versus sevoflurane on intraoperative hemodynamics in noncardiac surgery: a retrospective observational study using propensity score matching
Authors: Katsuragawa Takayuki , Mimuro Soichiro , Sato Tsunehisa , Aoki Yoshitaka , Doi Matsuyuki , Katoh Takasumi , Nakajima Yoshiki
Published: October 2023

Background

This study compared the effects of remimazolam and sevoflurane on intraoperative hemodynamics including intraoperative hypotension (IOH).

Results

This study involved adult patients undergoing noncardiac surgery using remimazolam (Group R) or sevoflurane (Group S) for maintenance anesthesia, and invasive arterial pressure measurements, from September 2020 to March 2023 at our hospital. IOH was defined as a mean blood pressure < 65 mmHg occurring for a cumulative duration of at least 10 min. A 1:1 propensity score-matching method was used. The primary endpoint was the occurrence of IOH, and the secondary endpoints were the cumulative hypotensive time, incidence of vasopressor use, and dose of vasopressor used (ephedrine, phenylephrine, dopamine, and noradrenaline). Group R comprised 169 patients, Group S comprised 393 patients, and a matched cohort of 141 patients was created by propensity score matching. There was no significant difference in the incidence of IOH between the two groups (85.1% in Group R vs. 91.5% in Group S, p = 0.138). Patients in Group R had a significantly lower cumulative hypotension duration (55 [18–119] vs. 83 [39–144] min, p = 0.005), vasopressor use (81.6% vs. 91.5%, p = 0.023), and dose of ephedrine (4 [0–8] vs. 12 [4–20] mg, p < 0.001) than those in Group S. There were no significant differences in the doses of other vasopressors between groups.

Conclusions

Compared with sevoflurane, the maintenance of anesthesia with remimazolam was not associated with a decreased incidence of IOH; however, it reduced the cumulative hypotension time, incidence of vasopressor use, and dose of ephedrine.
Introduction to the Thematic Series: Use and consequences of family policies among migrants and their descendants in Europe
Authors: Mussino Eleonora , Kraus Elisabeth , Milewski Nadja
Published: October 2023

This article is the introduction to the Thematic SeriesUse and consequences of family policies among migrants and their descendants in Europe. The study contexts are countries in different Western European regions: Belgium, France, Germany, and Italy. Despite their differences with respect to welfare-state types in general and family policies in particular, these countries also vary when it comes to their immigration histories and current migrant populations. Yet, the fast-growing field of research on the effects of family polices on family and fertility behavior as well as work-family reconciliation has virtually overlooked migrants. To address this void in the existing literature, this Thematic Series raises two research questions: To what degree do family policies include, and are used by, migrants and their descendants? And, to what extent do such polices promote migrants’ integration into European societies? The collection contains six empirical articles investigating either eligibility or use and consequences of two specific family policy measures: parental leave and external childcare. Collectively, the studies show significant disadvantages among migrant groups in eligibility for family policy measures, and consequently in their use and impacts on further life-course patterns, compared to majority populations. They also demonstrate diverging patterns within migrant populations.
Reconstruction of shoulder MRI using deep learning and compressed sensing: a validation study on healthy volunteers
Authors: Dratsch Thomas , Siedek Florian , Zäske Charlotte , Sonnabend Kristina , Rauen Philip , Terzis Robert , Hahnfeldt Robert , Maintz David , Persigehl Thorsten , Bratke Grischa , Iuga Andra
Published: October 2023

Background

To investigate the potential of combining compressed sensing (CS) and deep learning (DL) for accelerated two-dimensional (2D) and three-dimensional (3D) magnetic resonance imaging (MRI) of the shoulder.

Methods

Twenty healthy volunteers were examined using at 3-T scanner with a fat-saturated, coronal, 2D proton density-weighted sequence with four acceleration levels (2.3, 4, 6, and 8) and a 3D sequence with three acceleration levels (8, 10, and 13), all accelerated with CS and reconstructed using the conventional algorithm and a new DL-based algorithm (CS-AI). Subjective image quality was evaluated by two blinded readers using 6 criteria on a 5-point Likert scale (overall impression, artifacts, and delineation of the subscapularis tendon, bone, acromioclavicular joint, and glenoid labrum). Objective image quality was measured by calculating signal-to-noise-ratio, contrast-to-noise-ratio, and a structural similarity index measure. All reconstructions were compared to the clinical standard (CS 2D acceleration factor 2.3; CS 3D acceleration factor 8). Additionally, subjective and objective image quality were compared between CS and CS-AI with the same acceleration levels.

Results

Both 2D and 3D sequences reconstructed with CS-AI achieved on average significantly better subjective and objective image quality compared to sequences reconstructed with CS with the same acceleration factor (p ≤ 0.011). Comparing CS-AI to the reference sequences showed that 4-fold acceleration for 2D sequences and 13-fold acceleration for 3D sequences without significant loss of quality (p ≥ 0.058).

Conclusions

For MRI of the shoulder at 3 T, a DL-based algorithm allowed additional acceleration of acquisition times compared to the conventional approach.

Relevance statement

The combination of deep-learning and compressed sensing hold the potential for further scan time reduction in 2D and 3D imaging of the shoulder while providing overall better objective and subjective image quality compared to the conventional approach.

Trial registration

DRKS00024156.

Key points

• Combination of compressed sensing and deep learning improved image quality and allows for significant acceleration of shoulder MRI.

• Deep learning-based algorithm achieved better subjective and objective image quality than conventional compressed sensing.

• For shoulder MRI at 3 T, 40% faster image acquisition for 2D sequences and 38% faster image acquisition for 3D sequences may be possible.

Graphical Abstract
Perioperative management of a morbidly obese patient with multiple myeloma for spine surgery—when the problem doubles up!
Authors: Garg Shankey , Mahajan Shalvi , Kansal Ankit , Taneja Swati
Published: October 2023

Background

Multiple myeloma (MM) patients are prone to pathological fractures due to osteolytic bone lesions. With improved perioperative care, outcome of patients with vertebral compression fractures presenting for surgical interventions has become better. However, perioperative care of such patients is challenging for the anesthesiologist.

Case presentation

Herein, we report the successful perioperative management of a 55-year-old multiple myeloma patient with the compression fracture of lumbar vertebrae 2nd to 5th, for which balloon kyphoplasty was planned in prone position.

Conclusions

Multiple myeloma patients are at high risk of developing postoperative complications like acute kidney injury (AKI), pneumonia, and infections. In the present case report, we discuss and provide recommendations for better perioperative care to prevent perioperative complications.
Modeling fuel moisture dynamics under climate change in Spain’s forests
Authors: Balaguer-Romano Rodrigo , Díaz-Sierra Rubén , De Cáceres Miquel , Voltas Jordi , Boer Matthias M. , Resco de Dios Víctor
Published: October 2023

Background

Current assessments of the effects of climate change on future wildfire risk are based on either empirical approaches or fire weather indices. No study has yet used process-based models over national scales to understand how and where will increases in climate aridity affect the likelihood of fire activity through changes in the moisture content of live (LFMC) and of dead (DFMC) fuels. Here, we used process-based models to forecast changes in LFMC and DFMC under the 21st century climatic conditions projected from moderate and high greenhouse gas emission scenarios (RCP4.5 and RCP8.5). Predictions were performed across broad productivity gradients in peninsular Spain to understand how productivity mediates the effects of climate change on fuel moisture dynamics.

Results

LFMC and DFMC were predicted to decline under the climatic conditions projected for the coming decades. Increases in the annual frequency of days with fuel moisture content below wildfire occurrence thresholds were predicted to extend fire season lengths by 20 days under RCP4.5 and by 50 days under RCP8.5. The effects of climate change on LFMC and DFMC varied linearly and negatively with productivity (stronger fuel moisture decreases in least productive environments). Although we observed a significant mitigation effect from rising CO2 (via increases in water-use efficiency), it was not enough to offset LFMC declining trends induced by increased temperature and aridity.

Conclusions

We predicted that the warmer and more arid climatic conditions projected for the 21st century will lead to generalized declines in fuel moisture, lengthening fire seasons, and increasing wildfire danger. The use of process-based models to forecast LFMC dynamics allowed the consideration of plant species capabilities to buffer climate change impacts. Significant increases in the fire season length predicted in the most productive environments, currently with large fire return intervals, would pose an increase of fire danger in major Spanish carbon sinks. Finally, the CO2 mitigation effect would not be enough to offset climate change-driven declines in seasonal LFMC levels.
Randomized controlled trial of tailored audit with feedback in VHA long-term care settings
Authors: Kononowech Jennifer , Scott Winifred , Landis-Lewis Zach , Sales Anne E.
Published: October 2023

Background

The Long-Term Care QUERI program supported implementation of the Life-Sustaining Treatment Decisions Initiative in US Veterans Health Administration long-term care settings. The program worked with eleven Community Living Centers (CLCs) and twelve Home-Based Primary Care (HBPC) programs to increase rates of completed templates, using audit with feedback. We distributed monthly feedback reports to site champions showing the number of Veterans with appropriate documentation. Although feedback reports are a common implementation tool, little is known about the most effective ways to design, distribute, and support them. We sought to test tailoring reports with tips using site-specific data, as well as national comparator data.

Methods

We conducted a cluster randomized controlled trial of monthly feedback reports utilizing site-tailored tips and national comparator data compared to our original feedback reports that included only graphical and numerical data. CLC and HBPC team members were invited to participate in brief surveys each quarter to determine if they had received and used the feedback reports. The outcome for CLC residents was the percent with a completed LST template any time prior to the 14th day of their stay. The outcome for HBPC residents was the percent of Veterans with a completed LST template by their second HBPC visit.

Results

The response rate to the survey ranged between 6.8 and 19.3% of staff members across the CLC and HBPC sites with 12.8–25.5% of survey respondents reporting that they had seen the feedback reports. The linear regression models showed no significant association between receiving the enhanced feedback reports and having a higher documentation completion rate.

Conclusions

Receiving feedback reports tailored to sites by including tips based on baseline context assessments and qualitative findings, and reports showing national comparator data, did not have an impact on the number of Veterans with a completed LST template. Having a higher proportion of CLC or HBPC team members view the reports was not associated with an increase in LST template completion. These findings suggest that tailored audit with feedback may not have been effective at the program level, although the proportion of respondents who reported seeing the reports was small.
Influence of board mechanisms on sustainability performance for listed firms in Sub-Saharan Africa
Authors: Kwarteng Peter , Appiah Kingsley Opoku , Addai Bismark
Published: October 2023

This study aims to examine the effects of board mechanisms (board size, board independence, board gender, board educational background, board tenure, foreign directors on board, board leadership–CEO duality, board sub-committees, frequency of board meetings and CEO power) on the sustainability performance (SP) of listed Sub-Saharan Africa (SSA) firms during 2010–2019. The study employed a two-step system generalized method of moments (GMM) estimation technique to test the hypothesised relationships among the variables. The results indicate that a positive and significant relationship exists between board tenure and environmental and economic SP. Board size and frequency of board meetings are positively linked with environmental and social SP. Additionally, the number of board sub-committees is positively correlated with social and economic SP. However, the board of directors’ educational background is negatively associated with both social and economic SP. Diversely, board independence, educational background, and frequency of board meetings displayed a positive connection with the combined SP. These results suggest that board mechanisms have a significant influence on sustainability performance. Our findings offer useful insights for companies, regulatory bodies, and varied stakeholder groups in SSA countries to promote the connection between board mechanisms and SP beyond the present frontiers because it suggests thinking around specific board mechanisms that meet the demand for greater accountability for sustainability performance.
Development of a comprehensive stress assessment tool for Indian public sector employees
Authors: Nanda Pradip Kumar , Nagasubramaniyan G.
Published: October 2023

The study aims to develop a comprehensive stress assessment tool for Indian public sector employees, considering unique stressors, cultural factors, and organizational characteristics. The study employed a deductive approach, cross-sectional design, and mixed-method study based on comprehension of extant stress management theories, to explore the factors contributing to employee stress. The study found that technological disruptions, austerity measures, blame games, multitasking, and work–life balance are significant factors of assessing employee stress. The findings of the study fill the gaps in extant literature and extends support to the job demand control and support model. The findings make practical contributions in assisting practitioners and policymakers to design suitable intervention programs to reduce employee stress and enhance employee productivity. The unique contribution of the study is, first of its kind in the Indian public sector context, that the tool has the potential to assess employee stress effectively at workplace and practitioners can derive benefits of the stress assessment tool.

Graphical abstract
Experimental study on the optimal performance of gas turbine (GT) inlet air filtration system for offshore application
Authors: Effiom Samuel O. , Ajor James A. , Effiom Precious-Chibuzo O. , Edem Isuamfon , Ubi Paschal , Abam Fidelis , Diemuodeke Ogheneruona E.
Published: October 2023

An experimental study on the optimal gas turbine inlet air filtration system performance for offshore applications is presented. The objective is to conduct a comparative real-time data analysis for an offshore selection of optimal filtration system. Different filtration configurations were set up in a wind tunnel under simulated offshore environmental settings. The considered filter grades (A, B, C, D, E and F) align with the ASHRAE filter class (F7, H12, E11, E10, G5 and F9). Offshore contaminants weighing 1000 g, ranging between 0.05 and 20 µm, were used based on ASTM standards. The contaminants were loaded between 20 and 100% mass. The results indicate that the accumulated contaminant across the filter elements at 100% loading for A, B, C, D, and E filters ranged between 205.36 and 318.02 g. Similarly, the pressure differential change across the filters A–B, D–E, B–C, E–F, and filter housing inlet–outlet were estimated at 19.02 kPa, 16.9 kPa, 2.54 kPa, 2.86 kPa, and 2.25 kPa, respectively, while the particle removal efficiency for A, C and D filters were highest calculated at 53%, 58.22% and 51.69%, respectively. The result proved significant, with an overall improvement in the compressor output at 205 kW for a pressure change of 2.25 kPa at the filter housing outlet used to establish the optimal performance. The filter elements recorded decreased efficiency across the compressor stages due to mass accumulation on the media surface area. The study inferred that a 3-stage filtration with filter combination A–B (F7–H12), D–E (E10–G5), and B–C (H12–E11) is suitable for an inlet filtration system for GTs operating within the studied offshore environment.
Inotuzumab Ozogamicin as Induction Therapy for Patients Older Than 55 Years With Philadelphia Chromosome–Negative B-Precursor ALL
Authors: Stelljes Matthias , Raffel Simon , Alakel Nael , Wäsch Ralph , Kondakci Mustafa , Scholl Sebastian , Rank Andreas , Hänel Mathias , Spriewald Bernd , Hanoun Maher , Martin Sonja , Schwab Katjana , Serve Hubert , Reiser Lena , Knaden Julian , Pfeifer Heike , Marx Julia , Sauer Tim , Berdel Wolfgang E. , Lenz Georg , Brüggemann Monika , Gökbuget Nicola , Wethmar Klaus
Published: October 2023

PURPOSE

Despite recent advances in adapting the intensity of treatment for older patients with ALL, current protocols are associated with high rates of early deaths, treatment-related toxicity, and dismal prognosis. We evaluated inotuzumab ozogamicin and dexamethasone (Dex) as induction therapy in older patients with ALL within the German Multicenter Study Group for Adult ALL (GMALL).

PATIENTS AND METHODS

The open-label, multicenter, phase II, INITIAL-1 trial enrolled 45 patients older than 55 years with newly diagnosed, CD22-positive, BCR::ABL-negative B-precursor ALL (B-ALL). Patients received up to three cycles of inotuzumab ozogamicin/Dex and up to six cycles of age-adapted GMALL consolidation and maintenance therapy.

RESULTS

Forty-three evaluable patients with common/pre-B (n = 38) and pro-B ALL (n = 5), with a median age of 64 years (range, 56-80), received at least two cycles of inotuzumab ozogamicin induction therapy. All patients achieved complete remission (CR/CR with incomplete hematologic recovery). Twenty-three (53%) and 30 (71%) patients had no evidence of molecularly assessed measurable residual disease (minimum 10e−4 threshold) after the second and third inductions, respectively. After a median follow-up of 2.7 years, event-free survival at one (primary end point) and 3 years was 88% (95% CI, 79 to 98) and 55% (95% CI, 40 to 71), while overall survival (OS) was 91% (95% CI, 82 to 99) and 73% (95% CI, 59 to 87), respectively. None of the patients died during 6 months after the start of induction. Most common adverse events having common toxicity criteria grade ≥3 during induction were leukocytopenia, neutropenia, thrombocytopenia, anemia, and elevated liver enzymes. One patient developed nonfatal veno-occlusive disease after induction II.

CONCLUSION

Inotuzumab ozogamicin–based induction followed by age-adapted chemotherapy was well tolerated and resulted in high rates of remission and OS. These data provide a rationale for integrating inotuzumab ozogamicin into first-line regimens for older patients with B-ALL.
Improving access to care with implementation of a virtual anemia clinic.
Authors: Koniarczyk Heather , Wilks Mailey L , Boucher Caroline , Aiken Laurie , Akdogan Lori , Allen Mary
Published: October 2023

113

Background: In 2022, our cancer center saw a rapidly rising number of new hematology consult requests, specifically for anemia. This increase created access challenges, especially for our regional hematology oncology practices, who see both malignant and benign consult diagnoses. Our enterprise target metric for assessing access is defined as “median of appointments within 7 days.” This metric was rapidly as far out as 15 days (YTD) in the hematology disease group briefly, therefore calling the leadership team to action. An additional concern was provider dissatisfaction from frequent add-on requests for consults and a pivot from an even split of hematology oncology patients to heavily classical hematology consults. Timely triage and assessment of anemia is necessary for identification of potentially serious underlying cancer diagnoses. Methods: Upon investigation, opportunities to improve patient access were identified as: 1) underutilized APPs; 2) scheduler turnover, communication barriers resulting in up to 30% of new patient slots going unused; 3) anemia consults scheduled at 60 minutes which typically take 30-45 minutes to complete; 4) patients are interested in a virtual appointment for non-oncologic consult diagnoses but scheduling these visit types has been challenging. An APP lead virtual only anemia clinic (VAC) was launched in Sept 2022. The clinic consisted of with five 45-minute consults per day. A decision tree was created to for efficiency and to assist in appropriate diagnoses scheduled. Biweekly huddles for quality assurance of patient care were initiated. No additional FTEs were required to initiate this clinic. Results: In 6 weeks, we were able launch the VAC with utilization strongly in the upper 90%. 5 APPs trained in anemia consults divided Monday-Friday with one virtual day per week. Follow up patients were scheduled in person at regional or main campus locations as indicated. The access metric for hematology consults improved from 15 days (YTD) to 8 (YTD) within the initial 6 months. More specifically, anemia consult diagnoses improved to less than 7 days almost immediately. Anecdotally, patients were satisfied with the appointment availability and care received. Patient experience scores for the participating APPs remained steady throughout the initial first 6 months and are continuing to be followed. Conclusions: A VAC is a potential way to achieve improved patient access to an anemia consult, further providing timely evaluation and treatment. Additional professional revenue that does not utilize physical space, caregivers, building facilities is a positive outcome, in addition to expedited triage, assessment, diagnosis, and treatment for anemia in straightforward and complex patients. There is an added benefit for patients who have an opportunity for virtual care such as quick access to care, decreased financial toxicity, and removal of barriers to care like transportation and taking time off work.
Alternative model to deliver germline genetic testing to patients with advanced prostate cancer (PCa).
Authors: Reizine Natalie Marie , Tawagi Karine , Nuccio Lisa , Hippalgaonkar Neha , Drabek Kirsten , Pan Vivian , Hoskins Kent , Maga Tara , Balay Lara
Published: October 2023

123

Background: Genomic testing is now standard-of-care (SOC) for PCa patients with both therapeutic and hereditable consequences. National guidelines recommend germline testing in all high-risk and advanced PCa patients, regardless of age or family history. Yet, many systemic barriers prevent patients from receiving germline testing promptly, including the burden of appointments, comorbidities, transportation, provider knowledge of genetic testing, and insufficient genetics workforce that limits timely referral to genetic counselors. Methods: We developed a streamlined, alternative genetic care delivery model to improve rates of germline genetic testing for PCa patients. A multidisciplinary team (genitourinary medical oncologists, advanced practice RN, and genetic counselors) developed a tailored pre- and posttest counseling curriculum for PCa patients undergoing germline testing that was delivered by oncology providers. Pretest counseling was incorporated into SOC counseling for somatic tumor genomic testing performed to personalize therapeutics. Systematic posttest counseling was delivered by oncology providers, and men with germline pathogenic/likely pathogenic (P/LP) variants were referred to certified genetic counselors for formal genetic counseling. We retrospectively collected data on PCa patients treated at an academic oncology practice who underwent paired germline/somatic testing through a commercial lab accompanied by tailored pre/posttest counseling, including demographics, clinical characteristics, and germline test results. We performed quarterly audits to monitor quality metrics. Results: From September 2021 to May 2023, seventy-five PCa patients underwent paired germline/somatic tumor testing. The racial/ethnically diverse patient population (self-identified) included 81% Black, 13% Hispanic, and 6% non-Hispanic White men. At the time of analysis, 64 tests had resulted; 9.4% of patients (n=6) had a P/LP germline variant, and 31.2% of patients (n=20) tested negative. The majority of patients (59.4%, n=38) had a variant of unknown significance (VUS). Additional data will be available at the time of presentation. Conclusions: Providing paired germline/somatic tumor testing with tailored pre/posttest education delivered by oncology providers, and formal genetic counseling reserved for patients with P/LP germline variants, is an efficient way to provide guideline-directed genetic services for PCa patients. Given the frequency of VUS, education for pre/posttest counseling is essential, particularly in under-represented minority populations. The frequency of actionable mutations is reduced in underrepresented minority PCa patients compared with reports in the literature, reflecting limitations of current germline testing/bioinformatics platforms and the need for greater inclusion of diverse populations in future studies.
Racial/ethnic disparities in colorectal cancer screening methods: Unveiling patterns and implications.
Authors: Li Joy , Xie Hui , Guo Emily , Wang Qian
Published: October 2023

124

Background: Colorectal cancer screening (CRC) is crucial for reducing morbidity and mortality of CRC. The type of screening method chosen is important for accessibility, compliance, and effectiveness. Colonoscopy and sigmoidoscopy are considered the gold standard while fecal occult blood tests (FOBT) are non-invasive, inexpensive, and more available. Our study examined the racial/ethnic disparities associated with various CRC screening methods. Methods: We utilized the cross-sectional nationally representative data from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS). The sample included individuals between 50-75 years, the recommended age for CRC screening. Logistic regression analysis was performed to investigate up-to-date CRC screening rates and the choice of CRC screening method in related to race/ethnicity, after controlling for confounding factors. Results: Among the weighted population of 119,841,048 individuals aged 50-75 years, 44.6% reported having an up-to-date colonoscopy/sigmoidoscopy only, 5.0% had only FOBT in the past year, and 5.8% had both tests. The logistic regression models revealed that Asians and Pacific Islanders (APIs; adjusted odds ratio [aOR]: 0.59; 95%CI: 0.49-0.69), American Indians and Alaska Natives (AIs/ANs; aOR: 0.73; 95%CI: 0.59-0.90), and Hispanic individuals (aOR: 0.76; 95%CI: 0.69-0.84) were less likely to undergo colonoscopy/sigmoidoscopy only compared to non-Hispanic White (NHW) peers. Conversely, APIs (aOR: 1.46; 95%CI: 0.98-2.17) and Hispanic individuals (aOR: 1.46; 95%CI: 1.20-1.79) were associated with a higher rate of recent FOBT only compared to their NHW individuals. Regarding the combination of up-to-date colonoscopy/sigmoidoscopy and FOBT, non-Hispanic Blacks (NHB; aOR: 1.66; 95%CI: 1.44-1.92) and Hispanic individuals (aOR: 1.61; 95CI: 1.33-1.95) were more likely to have both tests compared to NHW individuals. Conclusions: Our findings highlight the significant variations in CRC screening preferences among different racial/ethnic groups, which are likely influenced by cultural backgrounds, health literacy and access, and language barriers. It is crucial for healthcare providers to acknowledge these differences, as they can significantly impact patient engagement and compliance with CRC screening recommendations. Emphasizing culturally informed approaches to CRC screening is essential for fostering trust, promoting equitable healthcare, and ultimately reducing disparities in CRC outcomes.
Genetic testing in survivorship after diagnosis of breast cancer.
Authors: Katz Steven , Hawley Sarah T. , Hodan Rachel , Kurian Allison W. , Wallner Lauren P.
Published: October 2023

129

Background: Support for universal genetic testing after diagnosis of breast cancer is growing because of concerns that more narrowly targeted guidelines fail to identify all patients who could benefit from genetic risk evaluation (GRE). Little is known about use of genetic testing in survivors of breast cancer over time. Methods: Women who were diagnosed with breast cancer in 2014-15 and reported to the SEER registries of Georgia and Southern California completed a baseline survey about 9 months after diagnosis (N=2502) through the iCanCare study. We performed a follow-up survey (FUPs) about 6 years after diagnosis for 2347 survivors of whom 1430 responded (60% response rate). We asked women about their receipt of clinical germline genetic testing and results, communication with relatives about cancer genetic testing, and use of direct-to-consumer testing (DTCt) after diagnosis. We categorized women into indications (yes/no) for GRE based on clinical guidelines published at time of diagnosis (GRE indication baseline) and at the time of the follow-up survey (GRE indication FUPs only). Results: About half of the respondents (44.6%) had indications for GRE over the study period; 28.0% had an indication at baseline; and an additional 16.6% had an indication by time of the follow-up survey (FUPs only). The Table shows patient-reported testing at FUPs by GRE indication category (baseline, FUPs only, no indication). About two thirds of those with a baseline indication for GRE received genetic testing over the study period: 66.5% vs 43.9% with indication at FUPs only vs 35.0% of those with no indication (p<.001). There were no significant race and ethnic differences in receipt of testing across clinical indications (p=.356). Testers with a pathogenic variant result (n=59) were much more likely to have talked to most or all of their close adult relatives about genetic testing than those with a variant of unknown significance (n=48), or a negative finding (n=384): 64.3% vs 35.0% and 37.1%, respectively (p<.001). Overall, there was very little interest in DTCt for cancer risk: 5.0% researched these tests online somewhat to a lot; and only 3.5% got a DTCt. Conclusions: The proportion of patients with indications for GRE after diagnosis of breast cancer markedly increases in survivorship but many patients do not get genetic testing. Lack of survivor interest in DTCt for cancer risk is reassuring that patients are not substituting these tests for clinical testing. These findings support the growing appeal for universal germline genetic testing for patients with breast cancer.[Table: see text]
Rates of surgery and adjuvant chemotherapy use in patients with stage IB to IIIA non-small cell lung cancer: A provincial population-based study.
Authors: Li Yuchen , Pond Gregory Russell , Shargall Yaron , Begum Housne , Goldshtein Daniel , Juergens Rosalyn A.
Published: October 2023

134

Background: The current standard of treatment for early-stage (IB to IIIA) non-small cell lung cancer (NSCLC) include surgery and adjuvant chemotherapy. The objective of this study is to identify rates of adherence to guideline recommended surgery and adjuvant chemotherapy treatment for early-stage NSCLC for patients living in Ontario, the most populous province of Canada. Methods: A retrospective population-based study using linked administrative data through ICES was completed that included all adult patients with a diagnosis of stage IB to IIIA NSCLC made from 2010 to 2020 in Ontario. Rates of surgery and chemotherapy completion were calculated using available OHIP (Ontario Health Insurance Plan) billing codes. Logistic multivariate regressions were completed to assess for any predictors for completion of surgery and chemotherapy. Results: A total of 24,237 eligible patients were included. By cancer staging, there were 6,495 (26.8%) stage IB, 7,156 (29.5%) stage II, and 10,586 (43.7%) stage IIIA NSCLC patients. Within 180 days of diagnosis, surgery was completed for 9,929 (41.0%) of patients, by cancer staging were 4090/6495 (63.0%), 3719/7156 (52.0%), and 2120/10586 (20.0%) for IB, II, and IIIA respectively. The median time from diagnosis to surgery was 49 days (IQR 23-77 days). Amongst patients who completed surgery, 3344/9929 (33.7%) underwent at least 1 cycle of adjuvant chemotherapy within 180 days. Having advanced age (p<0.001), high Charlson comorbidity score (p<0.001), and low income (p<0.001) are predictors for poor uptake for both chemotherapy and surgery. Being male also reduces the likelihood of undergoing surgery (p<0.001). Conclusions: In our population-based study, less than half of the patients with early-stage (IB-IIIA) NSCLC underwent surgical resection and chemotherapy. These low treatment rates are concerning and may be contributing to suboptimal outcomes. Our findings indicate that elderly individuals with multiple comorbidities and those with low incomes are at the highest risk of not receiving appropriate chemotherapy and surgery. Our data highlight the need for quality improvement strategies aimed at identifying and enhancing treatment uptake within this patient population.