bluuebunny/crossref_metadata_2025_split huggingface dataset:
P14.105 High incidence of brain metastases in lung cancer patients at the time of primary diagnosis
Authors: Kobyakova E , Nechipay E , Sashin D , Kobiakov N , Kobyakov G L 
Published: September 2019

Abstract

BACKGROUND
Brain metastases (BM) affect 8%-10% of all cancer patients and 40% of patients with metastatic cancer. The majority of BM originate from lung cancer (40%-50%), breast cancer (15%-25%), and melanoma (5%-20%). Total incidence proportions percentage (IP %) of brain metastases was reported as 9.6% for all primary sites combined, and was highest for lung cancer (19.9%). The incidence of BM is believed to be increasing, likely resulting from longer patient survival due to more effective systemic therapies for the primary cancer and the increased use of neuroimaging in neurologically asymptomatic patients.

MATERIAL AND METHODS
Our aim was to determine incidence of brain metastases in lung cancer patients at the time of primary diagnosis on cohort of our regular clinical practice. Since September 2014 till December 2017 189 primarily diagnosed patients with suspected lung cancer were evaluated with brain MRI as obligatory part of diagnostic protocol at N.N. Blokhin Russian Cancer Research Center. MR imaging protocol included T1, T2-weighted images, FLAIR, DWI, VIBE (with contrast enhancement, slice thickness <1.2 mm). According to diagnostic guidelines for lung cancer in Russia, all patients underwent chest CT scan with contrast enhancement, bronchoscopy, abdominal ultrasonography, ultrasonography of cervical lymph nodes (+ CT to evaluate detected abnormalities), bone scintigraphy with X-ray control of detected abnormalities, surgical removal (in case of T1-T2 tumor) or tumor biopsy to determine morphology. Additionally, all patients underwent Whole Body MR DWI, some patients received FDG-PET/CT scan.

RESULTS
Brain metastases were detected in 89 (48%) of 189 patients, while only 9 patients (10.1% of patients with brain metastases) had neurological deficits. Lesion sizes were as follows: 0.1–0.5 cm in 46 (51.7%) patients, 0.5–1.0 cm in 21 (23.6%) patients, 1.0–2.0 cm in 7 (7.9%) patients, 2.0–3.0 cm in 8 (9.0%) patients and >3.0 in 7 (7.9% patients). The majority of patients (45 - 50.56%) had solitary metastases, 10 patients (11.24%) had two lesions and 34 (38.20 %) patients had three and more lesions. Metastatic disease most commonly affected frontal lobes - 45 (50.56%) patients, temporal lobes - 36 (40.45%) patients, parietal lobes - 22 (24.72%) patients, occipital lobes - 22 (24.72%), basal ganglia and brainstem - 18 (20.22%), - 3 (3.37%), cerebellum - 30 (33.71%) patients. Concerning morphology, in 80 of 89 brain metastases NSCLC was identified and in 9 patients SCLC was observed.

CONCLUSION
Very high incidence of brain metastases in lung cancer patients at the time of primary diagnosis in our study cohort may be explained by the use of precision brain MRI as an obligatory part of diagnostic protocol at the time of primary admission. We suggest including precision brain MRI in guidelines for primary diagnosis of lung cancer patients as an obligatory examination
P14.114 Tumor treating fields in glioblastoma clinical practice guidelines: a European and North American landscape analysis
Authors: Lawson McLean A , Kalff R , Walter J 
Published: September 2019

Abstract

BACKGROUND
Tumor treating fields (TTFields) are low-intensity alternating electric fields delivered at intermediate frequencies to disrupt cancer cell division and inhibit tumor growth, with significantly longer mean lifetime survival of 1.8 additional years in glioblastoma (GBM). International, national and local clinical practice guidelines have implications for clinical, personal and policy decision-making. Furthermore, they may impact on patients’ decisions to choose treatment at a given institution or even lead to commencement of legal proceedings for withholding therapies recommended by international guidelines. We performed an in-depth landscape analysis of clinical practice guidelines for GBM in Europe and North America to explore variation in treatment recommendations with a specific focus on TTFields.

MATERIAL AND METHODS
A systematic search was conducted of web sites of international guideline developers, relevant cancer agencies and the MEDLINE and Web of Science literature databases. The following information was extracted from each document meeting the inclusion criteria: whether TTFields is discussed and/or recommended in the guideline, the indications for and role of TTFields in the care protocol, the strength of the recommendation and any constraints placed on the situations where this therapy can or may be offered, including on cost grounds, where applicable. Dates of production and validity periods of the guidelines were also noted. In addition, standard operating procedures (SOPs) from several accredited comprehensive cancer centres in Germany, covering GBM care are compared, with a series of clinical vignettes presented.

RESULTS
The guidelines produced by the National Comprehensive Cancer Network (USA), National Institute for Health and Care Excellence (UK), German Society for Neurology, German Society for Haematology and Medical Oncology, European Association for Neuro-Oncology and European Society for Medical Oncology were critically compared. Wide variation in recommendations relating to the TTFields therapy was observed. Many guidelines had not been updated to reflect the results of the EF-14 study.

CONCLUSION
Discrepancy in the adoption of TTFields across clinical practice guidelines and SOPs has potential implications for care practices. This ultimately affects patient outcomes, safety and quality of care. Ideally, guidelines should be updated dynamically when new evidence indicates a need for a substantive change in the guideline based on a priori criteria. An ongoing revision process for guidelines, perhaps with shorter validity periods or a more flexible approach, may facilitate more expedient adoption of novel therapies in clinical practice guidelines and in practice. Meanwhile, therapies significantly improving OS and PFS should be recommended to patients and this should be documented.
P14.121 Use of corticosteroids in glioblastoma patients A single institution experience
Authors: Smrdel U , Skoblar Vidmar M 
Published: September 2019

Abstract

INTRODUCTION
Corticosteroids are group of drugs widely used in patients with glioblastoma. As they control peritoumoral oedema, virtually all patients are at some time receiving one. Though, they are effective drugs, their use comes with many side effects affecting the QoL, and might even have a detrimental effect on survival.

PATIENTS AND METHODS
We collected the data of patients treated for glioblastoma in Slovenia between 1997 and 2016. In our database of 1051patients, we calculated the survival and progression free survival. Then we checked the corticosteroid use for every individual patient at the time of referral, beginning of radiotherapy (RT), completion of RT, at 3 and 6 months. We stratified patients according to the resection extent, performance status, age groups, and treatment intent. We also looked for any adverse effect which could be connected to corticosteroid usage. Due to historical circumstances, we did not have a peroral dexamethasone in Slovenia until 2012, so patients regularly received methyl prednisolone instead, though they received parenteral dexamethasone. We are reporting all corticosteroid doses calculated and expressed in milligrams of dexamethasone.

RESULTS
At the time of referral, 90 % of patients received corticosteroids. Median dose was 4 mg of dexamethasone 2 times daily (0 to 8 mg 3 times daily). In around half of patients, dexamethasone could be lowered prior to radiotherapy. Factors preventing early tapering were: biopsy only, higher age and performance status. Tapering of dexamethasone than continued after completion of RT. Beside corticosteroid diabetes, proximal myopathy was the most frequent adverse effect, followed by osteoporosis. The group of patients, surviving more than 3 years, had significantly lower dose of corticosteroids at the end of RT than other patients, while there was no difference in dose at the time of referral and afterwards. Tapering of the dose was quicker with the younger patients and also when patients received methyl prednisolone. The patients receiving methyl prednisolone also had more problems with osteoporosis.

DISCUSSION
Our data confirms the benefits and dangers of corticosteroid usage. While all are aware of the corticosteroid diabetes and osteoporosis, the myopathy was most commonly expressed complaint in our patients and might be underreported, especially, when weakness might also be attributed to underlying disease. Not only, is the higher dose of dexamethasone associated with more common and more severe adverse affects, but one could question if there is more direct connection of corticosteroids and survival.

CONCLUSION
While the corticosteroids remain essential medications in glioblastoma patients, they should be used with care. Tapering of the corticosteroids should start as early as possible. Balance between the beneficial effects of corticosteroids and their detrimental effects should be reached.
P14.128 Lack of development of Pneumocystis Jirovecii Pneumonia in a cohort of 103 Italian glioblastoma patients not receiving prophylaxis during post-surgical chemoradiotherapy
Authors: Rifino N , Rigamonti A , Guida F , Bonato C , De Nobili G , Spena G , Salmaggi A 
Published: September 2019

Abstract

BACKGROUND
Patients diagnosed with high grade gliomas (HGG) usually receive surgery, radiation, temozolomide (TMZ) and corticosteroids. A major concern in patients who receive chemoradiotherapy (CRT) is the risk of developing secondary myelosuppression and a related infection during treatment. CRT may also lead to a long-lasting reduction of WBC, associated with early death from tumor progression. Among treatment-related infections, Pneumocystis Jirovecii Pneumonia (PJP) has been reported, since then, PJP prophylaxis has been required by the FDA. However, evidence for PJP during CRT is very limited limited and the rate of PJP still low.

MATERIAL AND METHODS
We did a retrospective, Institutional Review Board-approved cohort study in 103 patients (60 men and 43 women), who were consecutively diagnosed with GBM in “A. Manzoni” Hospital in Lecco during the period May 2007 to December 2013. All of these patients were treated with CRT according to the Stupp protocol without PJP prophylaxis. Haematological toxicities of CRT were assessed according to Common Terminology Criteria for Adverse Events (CTCAE, version 5.0; November 27, 2017). The objective of our study was to investigate the association between CRT and myelosuppression and we evaluated the types of infection contracted on CRT and in particular if the absence of a proper PJP prophylaxis led to an increased rate of PJP.

RESULTS
In our cohort, among 103 patients receiving CRT, 18% developed severe lymphopenia. Among all the subjects enrolled, a total of 9 patients (8.7%) had documented infectious complications during the CRT. Three patients developed community acquired pneumonia. Moreover, we documented three cases of fever without source, two urinary tract infections, one herpes zoster, one herpes simplex 1, one phlegmon and one purulent otitis. However, no one of these patients was diagnosed as PJP despite PJP prophylaxis was not given.

CONCLUSION
In conclusion, our data seem to support a lack of undisputable evidence for a favorable risk/benefit profile in the use of PJP prophylaxis for all newly diagnosed GBM patients undergoing the CRT, also considering the rate of adverse reactions (15.2%) and severe adverse reactions (around 3%, mainly leukopenia) in non-HIV adults receiving trimethoprim/sulphametoxazole for prolonged periods.
Sleep in the completely locked-in state (CLIS) in amyotrophic lateral sclerosis
Authors: Malekshahi Azim , Chaudhary Ujwal , Jaramillo-Gonzalez Andres , Lucas Luna Alberto , Rana Aygul , Tonin Alessandro , Birbaumer Niels , Gais Steffen 
Published: September 2019

AbstractPersons in the completely locked-in state (CLIS) suffering from amyotrophic lateral sclerosis (ALS) are deprived of many zeitgebers of the circadian rhythm: While cognitively intact, they are completely paralyzed, eyes mostly closed, with artificial ventilation and artificial nutrition, and social communication extremely restricted or absent. Polysomnographic recordings in eight patients in CLIS, however, revealed the presence of regular episodes of deep sleep during night time in all patients. It was also possible to distinguish an alpha-like state and a wake-like state. Classification of rapid eye movement (REM) sleep is difficult because of absent eye movements and absent muscular activity. Four out of eight patients did not show any sleep spindles. Those who have spindles also show K-complexes and thus regular phases of sleep stage 2. Thus, despite some irregularities, we found a surprisingly healthy sleep pattern in these patients.
Age Diversity and Age-Based Faultlines in Teams: Understanding a Brezel Phenomenon Requires a Brezel Theory
Authors: Wegge Jürgen , Meyer Bertolt 
Published: September 2019

AbstractDemographic changes in developed countries increase age diversity within organizations and age-based faultlines in work teams. With the current commentary, we briefly take stock of the literature and review the relationships among age diversity, age-based faultlines, and team outcomes. In particular, we argue that current meta-analyses take a much too narrow focus on main effects of objective diversity. We also argue that studies on age-based faultlines, hypothetical dividing lines splitting a team into relatively homogeneous subgroups, focus too narrowly on faultlines based on objective criteria without taking perceptions into account. The conclusions of such studies are of limited value because subjective perceptions of team members (i.e., salience of age and age differences) are ignored, and central contextual influences and moderating variables such as diversity mindsets and team climate are not taken into account. We thus advocate a more complex approach (a “Brezel theory”) for understanding the complex effects of age diversity and age-based faultlines on team functioning (“Brezel” phenomena). Our approach also incorporates the idea that some team members react differently to diversity than others. Two relevant models and associated findings on when and how age diversity and age-based faultlines affect team processes are illustrated. Using these approaches in future research and related training interventions in practice will promote potential benefits and reduce potential disadvantages of age diversity and age-based faultlines in work teams.
Preoperative Behavioral Health, Opioid, and Antidepressant Utilization and 2-year Costs After Spinal Fusion—Revelations From Cluster Analysis
Authors: Lerner Jason , Ruppenkamp Jill , Etter Katherine , Headd Jeffrey J. , Bhattacharyya Samir , Menzie Ann M. , Pracyk John B. , McGuire Kevin J. 
Published: September 2019

Study Design.
Retrospective administrative claims database analysis.

Objective.
Identify distinct presurgery health care resource utilization (HCRU) patterns among posterior lumbar spinal fusion patients and quantify their association with postsurgery costs.

Summary of Background Data.
Presurgical HCRU may be predictive of postsurgical economic outcomes and help health care providers to identify patients who may benefit from innovation in care pathways and/or surgical approach.

Methods.
Privately insured patients who received one- to two-level posterior lumbar spinal fusion between 2007 and 2016 were identified from a claims database. Agglomerative hierarchical clustering (HC), an unsupervised machine learning technique, was used to cluster patients by presurgery HCRU across 90 resource categories. A generalized linear model was used to compare 2-year postoperative costs across clusters controlling for age, levels fused, spinal diagnosis, posterolateral/interbody approach, and Elixhauser Comorbidity Index.

Results.
Among 18,770 patients, 56.1% were female, mean age was 51.3, 79.4% had one-level fusion, and 89.6% had inpatient surgery. Three patient clusters were identified: Clust1 (n = 13,987 [74.5%]), Clust2 (n = 4270 [22.7%]), Clust3 (n = 513 [2.7%]). The largest between-cluster differences were found in mean days supplied for antidepressants (Clust1: 97.1 days, Clust2: 175.2 days, Clust3: 287.1 days), opioids (Clust1: 76.7 days, Clust2: 166.9 days, Clust3: 129.7 days), and anticonvulsants (Clust1: 35.1 days, Clust2: 67.8 days, Clust3: 98.7 days). For mean medical visits, the largest between-cluster differences were for behavioral health (Clust1: 0.14, Clust2: 0.88, Clust3: 16.3) and nonthoracolumbar office visits (Clust1: 7.8, Clust2: 13.4, Clust3: 13.8). Mean (95% confidence interval) adjusted 2-year all-cause postoperative costs were lower for Clust1 ($34,048 [$33,265–$34,84]) versus both Clust2 ($52,505 [$50,306–$54,800]) and Clust3 ($48,452 [$43,007–$54,790]), P < 0.0001.

Conclusion.
Distinct presurgery HCRU clusters were characterized by greater utilization of antidepressants, opioids, and behavioral health services and these clusters were associated with significantly higher 2-year postsurgical costs.

Level of Evidence: 3
Gender Development in Children with Gay, Lesbian, and Heterosexual Parents: Associations with Family Type and Child Gender
Authors: Carone Nicola , Lingiardi Vittorio , Tanzilli Annalisa , Bos Henny M. W. , Baiocco Roberto 
Published: September 2019

ABSTRACT:

Objective:
To examine whether the gender development of 120 Italian children (40 born to gay fathers [GFs] through surrogacy, 40 born to lesbian mothers [LMs] through sperm donation, and 40 born to heterosexual parents [HPs] through sexual intercourse) aged 3 to 9 years differed as a function of family type and/or child gender.

Methods:
Children took part in observed free-play sessions while primary caregivers and nonparent caregivers were administered standardized interviews. Hierarchical linear modeling, analysis of covariance, simple effects analysis, and bootstrapping were conducted.

Results:
Boys and girls of GFs and HPs were reported to show less gender flexibility in their activities and characteristics than boys and girls of LMs. They also received higher scores of gender conforming dress-up play and spent more time playing with gender-conforming toys. In all family types, boys and girls were reported to show low levels of gender-nonconforming dress-up play and observed to spend less time playing with gender-nonconforming toys. Overall, comparisons within genders indicated that boys and girls of GFs and HPs were considered more masculine and feminine, respectively, in their behavior and play, relative to boys and girls in LM families. Age was not a significant covariate in any analysis.

Conclusion:
Our findings do not support the idea that children of gay or lesbian parents show greater gender nonconformity relative to children of HPs. The findings are informative to those concerned with the effects of the absence of a male or female live-in parent on child gender development.
Treatment Outcomes Following Resident Performed Nonvalved (Baerveldt 350) Glaucoma Drainage Device Implantation
Authors: Rothman Adam L. , Rosdahl Jullia A. , Hunter Thomas G. , Challa Pratap , Muir Kelly W. 
Published: September 2019

Precis:
When compared with outcomes by glaucoma specialists in several prospective studies, residents at the Durham Veterans Affairs Medical Center achieved comparable reductions in intraocular pressure (IOP) and failure rates during the year following Baerveldt drainage device implantation.

Purpose:
To review the outcomes of resident performed Baerveldt implantation through 1 year of postoperative management in a resident-run clinic.

Materials and Methods:
The medical records of all veterans at the Durham Veterans Affairs Medical Center were searched to identify those with Baerveldt implantation by resident physicians from July 1, 2007 to June 30, 2017. Exclusion criteria include previous glaucoma tube or concurrent surgical intervention, including cataract extraction. All postoperative visits were reviewed and clinical data were collected. Failure was defined as 2 consecutive visits, starting at postoperative month (POM) 3, with IOP ≤5 mm Hg, or with IOP >21 mm Hg or <20% IOP reduction from baseline, reoperation for glaucoma, or loss of light perception.

Results:
A total of 48 eyes were included with mean (SD) IOP and number of medications: baseline, 23.1 (6.7) mm Hg on 3.7 (1.0) medications; postoperative day 1, 20.5 (11.7) mm Hg on no medications; postoperative week 1, 14.3 (6.9) mm Hg and 1.9 (1.7) medications; POM1, 16.7 (6.4) mm Hg and 2.2 (1.5) medications; POM3, 15.1 (5.2) mm Hg and 2.1 (1.6) medications; POM6 12.8 (4.9) mm Hg and 2.8 (1.3) medications; POM12, 13.0 (4.0) mm Hg and 2.8 (1.4) medications. IOP decreased at all time intervals (P<0.01) but postoperative day 1 (P=0.15) while medication burden was reduced at every visit (P<0.01). Through 12 months, 8 patients (17%) failed with a time to failure of 9.2 (0.3) months. No patients underwent additional glaucoma surgical interventions or lost light perception.

Conclusions:
Residents can safely and efficaciously perform Baerveldt implantation, providing reassurance regarding the autonomy afforded residents in the operating room and clinic.
A Quality Improvement Project to Increase Mother’s Milk Use in an Inner-City NICU
Authors: Kalluri Nikita S. , Burnham Laura A. , Lopera Adriana M. , Stickney Donna M. , Combs Ginny L. , Levesque Bernadette M. , Philipp Barbara L. , Parker Margaret G. 
Published: September 2019

Introduction:
Mother’s milk is recommended for preterm infants due to numerous health benefits. At our inner-city hospital, >80% of mothers of infants younger than 34 weeks’ gestation initiated milk production, but fewer continued until discharge. Among infants younger than 34 weeks’ gestation, we aimed to (1) increase any mother’s milk use in the 24 hours before discharge/transfer to >75%; (2) increase exclusive mother’s milk use in the 24 hours before discharge/transfer to >50%; and (3) reduce racial/ethnic disparities in mother’s milk use.

Methods:
We conducted a quality improvement project from January 2015 to December 2017 focused on prenatal education, first milk expression ≤6 hours after birth, and skin-to-skin care in the first month. We tracked process measures and main outcomes with run and control charts among 202 infants younger than 34 weeks’ gestation eligible to receive mother’s milk born at our hospital; We tracked results according to maternal race/ethnicity subgroups.

Results:
Forty-seven percent of mothers were non-Hispanic black, 28% were Hispanic, and 13% were non-Hispanic white. We improved the rate of first milk expression ≤6 hours after birth and skin-to-skin care in the first month but did not improve rates of any/exclusive mother’s milk use at discharge/transfer. Eight-five percent of infants had mothers that initiated milk production, but only 55% received any mother’s milk at discharge/transfer.

Conclusions:
Our single-center quality improvement effort focused on infants younger than 34 weeks’ gestation whose mothers were predominately Hispanic and non-Hispanic blacks. We successfully increased first milk expression ≤6 hours after birth and skin-to-skin care but did not increase mother’s milk use at discharge/transfer.