bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of in-hospital cardiopulmonary resuscitation (ICPR) for cardiac arrest in adult patients with metastatic solid cancers: A nationwide inpatient sample (NIS) database analysis from 2012 to 2014.
Authors: Malapati Sindhu Janarthanam , Singh Sunny R K , Kumar Rohit , Ahmed Jibran , Vohra Ishaan , Katiyar Vatsala , Kafri Zyad 
Published: November 2019

44 Background: Cardiopulmonary arrest is known to have a poor prognosis which is further worsened by existing co-morbidities. The prevalence of metastatic malignancy is rapidly increasing with improved cancer treatments and yet the outcomes of ICPR are not well studied in these patients. We aim to study the epidemiology, associations and outcomes in this subpopulation. Methods: Retrospective cohort analysis of the 2012 to 2014 NIS database. We included patients ≥ 18 years with the International Classification of Diseases, 9th Revision, Clinical Modification procedure codes for ICPR and diagnosis codes for solid metastatic cancers. Primary diagnosis of cardiopulmonary arrest was excluded (represents out‐of‐hospital arrest.) Primary outcome was inpatient mortality following ICPR and the factors associated were analyzed using logistic regression. Results: Amongst 1,432,240 admissions of adults with metastatic solid cancers, 0.6% (n = 8840) received ICPR, of which 82% (n = 7245) died in the same admission. Inpatient mortality following ICPR in adults without metastatic solid cancers was 68.7%. For adults with metastatic solid cancers receiving ICPR, mean age was 65.9 years, 57.7% were males and 60.6% Caucasian. Also, 11.5% of them had an inpatient palliative care encounter. On multivariate logistic regression analysis, African Americans had higher mortality than Caucasians (OR 1.5, p 0.01) while elective admission and age < 50 years had lower mortality (OR 0.5, p < 0.05 and OR 0.5, p 0.01 respectively.) There was no difference in mortality based on site of primary tumor, gender, day of admission, Charlson Comorbidity Index, insurance status and hospital teaching status, location or size. Conclusions: Amongst adult patients with metastatic solid cancers receiving ICPR, 82% died within the same admission. Race, age and admission type predicted mortality. Despite known poor prognosis, only 11.5% had a palliative care encounter. [Table: see text]
Performance status, survival, and end-of-life care in adults with non-small cell lung cancer (NSCLC) treated with immunotherapy.
Authors: Petrillo Laura A. , El-Jawahri Areej , Nipp Ryan David , Lichtenstein Morgan , Reynolds Kerry Lynn , Greer Joseph , Temel Jennifer S. , Gainor Justin F. 
Published: November 2019

49 Background: Immune checkpoint inhibitors (ICI) improve survival for adults with metastatic NSCLC. Despite limited data on ICI efficacy in adults with poor performance status (PS), oncologists often elect to treat this population with ICI given their relatively favorable toxicity profile and potential for durable response. We aimed to describe the timing of ICI and patients’ survival based on PS, and explore the effect of late ICI use on end-of-life (EOL) care. Methods: Retrospective study of 235 adults with metastatic NSCLC at a single academic center who initiated ICI from 2015-2017. We compared overall survival (OS) among adults with Eastern Cooperative Oncology Group (ECOG) PS ≥ 2 at ICI start to those with ECOG PS < 2, using the log-rank test and Cox regression, adjusted for age, sex, comorbidity, time from diagnosis and line of therapy. We used logistic regression to analyze the association between ICI in the last 30 days of life and EOL care. Results: The median age at ICI start was 67 (range 37-91), and 83/235 (35%) had ECOG PS ≥ 2. Patients received ICI as first- (19%), second-line (56%) or later (25%) therapy. Median OS was 4.0 months in adults with ECOG PS ≥ 2 and 14.3 months in ECOG PS < 2 (p < 0.0001; HR = 2.5 [95% CI 1.8–3.5]). Among adults who died (n = 165), 17% of those with ECOG PS ≥ 2 started ICI in last 30 days of life and 24% started or continued ICI in their last 30 days, compared to 4% and 7% of ECOG PS < 2 (p = 0.005, p = 0.001, respectively). Receipt of ICI in last 30 days of life was associated with decreased hospice referral (OR 0.29, p = 0.006), decreased odds of hospice stay > 7 days (OR 0.15, p < 0.001), and increased in-hospital death (OR 6.8, p = 0.001). Conclusions: Adults with metastatic NSCLC and ECOG PS ≥ 2 experience significantly shorter survival than those with ECOG PS < 2 and more often receive ICI near the end of life, and late ICI use is associated with decreased hospice use and increased in-hospital death. Clinicians should thus use caution in extrapolating data from clinical trials, which are limited to ECOG PS < 2, to inform the care of adults with ECOG PS ≥ 2. Further, these results highlight potential tradeoffs of ICI and underscore the need for efforts to improve communication about ICI risks and benefits.
Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.
Authors: Kim YuJung , Ahn Grace S. , Kim Hak Ro , Kang Beodeul , Hur Sung Soun , Kim Ji-Won , Kim Se Hyun , Kim Jin Won , Lee Jeong-Ok , Lee Keun-Wook , Kim Jee Hyun , Bang Soo-Mee , Lee Jong Seok 
Published: November 2019

53 Background: Acute Palliative Care Units (ACPUs) are novel inpatient programs in tertiary care centers that provide aggressive symptom management and assist transition to hospice. However, patients often die in the APCU before successfully transferring to hospice. The aim of this study was to evaluate the symptom burden and characteristics of advanced cancer patients who die in the APCU. Methods: We retrospectively reviewed the medical records of all advanced cancer patients admitted to the APCU between April, 2015 and March, 2016 at a tertiary cancer center in Korea. Basic characteristics and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS) were obtained from consultation upon APCU admission. Statistical analyses were conducted to compare patients who died in the APCU with those who were discharged alive. Results: Of the 267 patients analyzed, 87 patients (33%) died in the APCU. The median age of patients was 66 (range, 23-97). Patients who died in the APCU had higher ESAS scores of drowsiness (6 vs 5, P = 0.002), dyspnea (4 vs 2, P = 0.001), anorexia (8 vs 6, P = 0.014) and insomnia (6 vs 4, P = 0.001) compared to patients who discharged alive. Total symptom distress scores (SDS) were also significantly higher (47 vs 40, P = 0.001). Patients who died in the APCU were more likely to be male (odds ratio [OR] for female patients 0.38, 95% confidence interval [CI] 0.22-0.67, P < 0.001) and have higher ESAS scores of drowsiness (OR 2.08, 95% CI, 1.08-3.99, P = 0.029) and dyspnea (OR 2.19, 95% CI 1.26-3.80, P = 0.005). These patients showed significantly shorter survival after APCU admission (7 days vs 31 days, P < 0.001). Conclusions: Advanced cancer patients who die in the APCU are more likely to be male and have significantly higher symptom burden that include drowsiness and dyspnea. These patients show rapid clinical deterioration after APCU admission. More proactive and timely end-of-life care is needed for these patients.
Patterns of palliative care among patients receiving palliative radiotherapy.
Authors: Chen Jie Jane , Rawal Bhupendra , Krishnan Monica Shalini , Hertan Lauren Michelle , Shi Diana D. , Roldan Claudia Sofia , Huynh Mai Anh , Spektor Alexander , Balboni Tracy A. 
Published: November 2019

55 Background: Few studies have examined how palliative care (PC) delivered by a dedicated PC team is integrated at the time of radiotherapy (RT) consultation. We aimed to characterize patterns of PC in relation to RT, predictors of PC, and outcomes based on PC integration. Methods: We retrospectively reviewed 162 patients with metastatic cancer who received palliative RT at a single institution (7/2017-2/2018). PC integration was defined as: no PC, concurrent PC (PC initiated +/- 4 weeks within RT consult), established PC (any PC visit in the 6 months prior to RT consult), and subsequent PC (PC initiated > 4 weeks after RT consult). Logistic regression analyses determined predictors of receiving any PC. Cox proportional hazards regression identified predictors of OS. Results: Median follow-up was 7.8 months (range: 0.3-20.6). Patients (56% female; 84% white; median age: 64 years (range: 22-94)) had a median of 2 metastatic sites (range: 1-6) and 2 prior courses of palliative chemotherapy (range: 0-7). Of the 74 patients (46%) with any PC, 24 (32%) had concurrent PC, 21 (28%) had established PC, and 29 (39%) had subsequent PC. The most common reasons for PC initiation were pain (58%) and goals of care/end-of-life care management (20%). Nearly half (49%) of PC consults occurred in an inpatient setting; a minority (22%) of RT consults were inpatient. On multivariate analysis, receiving any PC significantly differed by race (non-white vs white, OR = 6.40 [95% CI 1.98-20.69], p = 0.002), cancer type (lung vs non-breast other histology, OR = 0.15 [95% CI 0.06-0.35], p < 0.001), and RT consult setting (inpatient vs outpatient, OR = 3.32 [95% CI 1.36-8.13], p = 0.009). On multivariate analysis, male sex (HR = 1.51 [95% CI 1.01-2.27], p = 0.046) and ECOG 2-4 (HR = 2.22 [95% CI 1.47-3.36], p < 0.001) predicted worse OS. Age, marital status, language, insurance type, metastatic burden, prior palliative chemotherapy, and PC integration were not independent predictors of OS. Conclusions: At our institution, dedicated PC occurred in < 50% of patients receiving palliative RT for metastatic cancer. We need initiatives to increase PC for all palliative RT patients, especially in the outpatient setting and for those with lung cancer who were less likely to receive dedicated PC.
OCM community oncology palliative care program: Opioid analgesic utilization.
Authors: Akhtar Adil Jamal , Sheth Karna , Margolis Jeffrey H. , Muskovitz Andrew A. , Zekman Richard Philip , Howard George , Folbe Mitchell , Qamruzzaman Yusuf , Ballouz Samer , Scott-Barney Tammy , Maxwell Karma , Ibrahim Mohammed , Stortz Lexi , Fabbiano Maria 
Published: November 2019

60 Background: Oncology Division of Michigan Health Professionals participates in Oncology Care Model (OCM ). A community oncology program for early and timely involvement of palliative care (PC) was launched in September 2017 to improve cancer pain management. Under-treatment of cancer pain leads to continued patient suffering and impaired quality of life. Appropriate dosing, rotation and frequent assessments are essential for better pain control. This study aims to see the effect of PC on opioid analgesic utilization. Methods: Retrospective claims review was performed with PC patients referred from September 2017 – December 2018 with an opioid class (as defined by CDC) Part D claim (within OCM data). Opioid utilization across agents was measured in morphine-milligram-equivalents (MME). MME per patient per opioid month (PPM) was compared between PC-referred and PC-not referred patients, pre- and post- PC start. Average MME PPM was compared between PC-Engaged and PC declined or unable to reach patients. Within these 2 cohorts, Long-Acting (LA) vs. Short-Acting (SA) opioid utilization was calculated. Results: PC-not referred patients appear to have little monthly variation in opioid dosing. PC-referred patients showed wide variation in opioid dosing before PC. After PC start, opioid dosing stabilized. PC-Engaged patients had more than double MME PPM vs PC declined or unable to reach (2481 MME PPM vs 1198 MME PPM respectively). PC-Engaged patients utilized a higher percentage of LA (43%) whereas PC declined or unable to reach used much less LA (8%). Conclusions: In patients with uncontrolled pain, PC-referral led to decreased variation in opioid dosing and better pain control. Better pain control may be the result of higher utilization of both SA & LA opioids. Patients who do not engage in PC may be at-risk for under-treatment. Study was limited by OCM claims available as of June 2019. Results may be refreshed as more data becomes available.
Radiation oncology program directors’ attitudes towards 27 discrete palliative care skills.
Authors: Chang Eric M. , Raldow Ann C. , Walling Anne M. , Lee Percy P. , Martin Emily J 
Published: November 2019

62 Background: Dedicated conferences in palliative care have been proposed as an ACGME requirement for radiation oncology (RO) residency programs. We assessed RO program directors’ attitudes towards discrete palliative care skills. Methods: In April 2019, we surveyed 93 United States RO residency program directors. The survey assessed program directors’ views of 27 discrete palliative care skills in eight domains adapted from the American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine guidance statement defining high-quality palliative care in oncology. Using a nine-point scale, respondents rated each skill on three constructs: 1) importance to high-quality cancer care, 2) scope within RO practice, and 3) importance in RO residency education. Skills were categorized as “Included” (median score ≥7 for all constructs), “Excluded” (median score ≤3 for all constructs), or “Uncertain” (all other skills) using a composite score of all constructs. Results: Twenty-nine program directors (response rate 31%) completed the survey. Of the 27 skills, respondents rated 100% of the skills as important to care (median score ≥7), 70% of the skills as within the scope of RO practice, and 81% of the skills as important to resident education. No skills were rated as unimportant to care, out of scope, or unimportant to resident education (median score ≤3). Seventy percent of skills were categorized as “Included.” The domains of Caregiver Support (100%), End of Life Care (66%), and Spiritual/Cultural Assessment and Management (33%) had the highest proportions of skills rated as “Uncertain.” Time limitations (28%) and lack of education (28%) were rated as the main barriers to further integration of palliative care into RO. Conclusions: RO program directors value palliative care skills within RO. The majority of the assessed skills were rated as important to care, within scope of practice, and important to resident education.
Epidemiology and factors associated with mortality among inpatients with neoplasm related pain.
Authors: Mariam Roy Arya , Konda Manojna , Mohanakumar Warrier Aravind , Makhoul Issam 
Published: November 2019

72 Background: Intractable pain is one of the invincible entities in cancer and about 75% of cancer patients require inpatient hospital admission at least once in their treatment course. Palliative care service has a significant role in managing cancer pain and thus reducing the recurrent hospital admissions. Methods: We analyzed the association of Mortality Rate (MR) with age, sex, race, emergency admission, hospital regions among patients admitted for Neoplasm Related Pain (NRP). Data from the National Inpatient Sample (NIS) database for the year 2016 was reviewed. Patients admitted with a principal diagnosis of NRP were identified using ICD-10 code. The prevalence of each cancer and characteristics of admissions were also studied. Statistical analysis was performed using STATA and the association was depicted with Chi-Square test. Results: A total of 28609 admissions with a primary diagnosis of NRP was identified. The mean age of admission was found to be 59.38 ± 0.08, with 53.19% patients ≥ 60 years of age. 51.39% were females, 65.58% were Caucasians,16.25% were African Americans. The overall inpatient hospital MR for NRP was 8.16%. There was a significant difference in the MR between inpatients ≥ 60 years of age and <60 years (MR=9% in age ≥ 60, P<0.001). MR was high among Caucasians (8.31%, P=0.021). There exists a small difference in the MR among hospital regions (highest in West at 8.36%, lowest in South 7.68%, p=0.001). There was no statistically significant difference in the MR among sex, emergency vs elective admissions. NRP was most commonly associated with secondary neoplasms, the prevalence in the order: secondary malignant neoplasm of bone (38%), liver and bile duct (26%), followed by lung (11%), peritoneum (10%), brain (9%). The encounter for palliative care was documented only in 8530 admissions (29%). Conclusions: MR is high on people with NRP who are ≥ 60 years, Caucasians. Regional difference also plays a role in this. Further studies are needed to address the causes of the difference. Utilization of palliative care service is found to be less in NRP admissions. Future admissions and mortality rates can be reduced by the effective utilization of palliative care, optimization of outpatient pain management.
The impact of GOLD (Geriatric Oncology Liaison Development) service in oncology patients with significant co-morbidities and/or borderline performance status.
Authors: Kapiris Matthaios , Mansi Janine , Karapanagiotou Eleni 
Published: November 2019

90 Background: ASCO guidelines suggest patients > 65 should have a formal geriatric assessment [1]. We set up a new service in a London Cancer Centre. Cancer patients > 65 were reviewed in a one-stop GOLD clinic. Their focus was to provide a holistic approach to improve the oncology management. Nevertheless, not all cancer patients are fit to receive SACT. The aim of this study was to retrospectively review this group of patients. Methods: From October 2016 to April 2018, 596 patients were reviewed by GOLD. We analysed data for 298 (50%), including GOLD interventions and oncology management. In this cohort, 73% were between70-84 years (median 78). While most patients had SACT, 36 (12.4%) were deemed unfit by the oncology teams and had best supportive care only. These patients had a median age of 78.7 (64-93) and 20 (55.5%) were between 70-84. We also collected data on palliative care referral. Results: The main referrers were GI (10, 28%) and Urology (9, 25%). The rest included haematology (7, 19.4%), lung (5, 13.9%), gynaecology (3, 8.3%), melanoma and H&N (1, 2.8%) each. Referrals came mainly from the oncology teams (22, 61.1%). The remainder were identified from screening due to age (10, 27.8%) or following inpatient admission/Acute Oncology attendance (4, 11.1%). Co-morbidities and borderline performance status for systemic treatment were the two most common reasons for GOLD reviews (47.2% each), 8.3% involved polypharmacy and 2 (5.5%) cases involved social issues. Medication changes were advised for 52.8%. 41.6% did not have any changes to their management. One patient (2.8%) was referred to AHP and one (2.8%) to community palliative care. Fifteen (41.7%) had been referred to the Palliative Care team at the time of their review by GOLD. Conclusions: Despite multi-professional input, there are patients who remain unfit for SACT. It remains unclear whether a one-stop GOLD review added to the management of this group. Further evaluation is required to correctly identify patients who do not require multiple reviews. [1] Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Hurria et al.
Aprendizaje móvil (m-learning) como recurso formativo para empresas
Authors: Rodrigo-Cano Daniel , De-Casas-Moreno Patricia , Aguaded Ignacio 
Published: November 2019

El impacto de las Tecnologías de la Información y la Comunicación (TIC) ha afectado a todos los ámbitos sociales, sobre todo, el educativo. A raíz de este contexto, surgen nuevas metodologías de enseñanza, dónde los dispositivos móviles cobran un rol importante. En este sentido, la presente investigación tiene como objetivo general analizar las competencias digitales adquiridas por los adultos a través de la formación m-learning. Para ello, se parte de la necesidad de empoderar digitalmente al ciudadano con el fin de alcanzar las habilidades pertinentes para su aprendizaje. Sin duda, cada vez son más las empresas que apuestan por cursos de formación en línea y que requieren que sus trabajadores los realicen. Para ello, se ha llevado a cabo una metodología cuantitativa a través de la creación de una encuesta con 28 ítems. La muestra ha estado conformada por un total de 267 alumnos/trabajadores de la Agencia de Medio Ambiente y Agua de la Junta de Andalucía. Los resultados permiten concluir que el m-learning, sobre todo, el uso de los Smartphone, puede alcanzar resultados significativos y favorables en la formación de los trabajadores. Sin embargo, se observa una falta de competencias y alfabetización mediática sobre la correcta utilización de estas herramientas como componentes educativos.
EM DEFESA DO SUS, MAIS GEOGRAFIA: BALANÇO DO IX SIMPÓSIO NACIONAL DE GEOGRAFIA DA SAÚDE
Authors: Ribeiro Eduardo Augusto Werneck 
Published: November 2019

A grande contribuição que nós Geógrafos da Saúde temos com a saúde coletiva é poder comunicar a sociedade o que temos contribuído para melhorar o sistema público de saúde. Este número especial tem este papel.
Além de reunir os trabalhos destacados da IX edição do Simpósio, este número especial é também um balanço científico do evento, uma forma de contribuir para que outros pesquisadores possam ter acesso aos resultados de pesquisas e debates que muitas vezes não foram oportunizados pelos efeitos da crise financeira e seus impactos nos espaços de comunicação entre cientistas e a sociedade.
Mega-Analysis of Gene Expression in Mouse Models of Alzheimer’s Disease
Authors: Zhuang Beryl , Mancarci B. Ogan , Toker Lilah , Pavlidis Paul 
Published: November 2019

AbstractWhile multiple studies have been conducted of gene expression in mouse models of Alzheimer’s disease (AD), their findings have not reached a clear consensus and have not accounted for the potentially confounding effects of changes in cellular composition. To help address this gap, we conducted a re-analysis based meta-analysis (mega-analysis) of ten independent studies of hippocampal gene expression in mouse models of AD. We used estimates of cellular composition as covariates in statistical models aimed to identify genes differentially expressed (DE) at either early or late stages of progression. Our analysis revealed changes in gene expression at early phases shared across studies, including dysregulation of genes involved in cholesterol biosynthesis and the complement system. Expression changes at later stages were dominated by cellular compositional effects. Thus, despite the considerable heterogeneity of the mouse models, we identified common patterns that may contribute to our understanding of AD etiology. Our work also highlights the importance of controlling for cellular composition effects in genomics studies of neurodegeneration.