bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinician versus patient: Who gets it right when assessing function in palliative care?
Authors: Mann Sara Lauren , Collier Willem Hardie , Ose Dominik , Brogan Shane , Beck Anna Catherine , Sindt Jill E. 
Published: November 2018

40 Background: The Karnofsky Performance Score (KPS) is an important prognostic indicator in cancer care. Additionally, patient-reported outcomes are increasingly incorporated into clinical care and are validated in cancer patients with the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS). However, little is known about the concordance of the provider-rated KPS and patient-rated PROMIS measures. Methods: Retrospective review of patients with advanced cancer who underwent implantation of an intrathecal pump for refractory pain. We compared KPS and PROMIS scores recorded within 1 week of each other. PROMIS scores included an average score and 3 domains: physical function, fatigue, and pain interference. We divided each measure into 3 previously-described categories (Functionally Independent, Needs Limited Assistance, and Functionally Dependent) and assessed categorical concordance within each measure. The association of patient-related demographic and clinical characteristics were analyzed with KPS–PROMIS concordance using chi-square and Mann-Whitney U tests. Results: 47 patients were included. The provider-rated KPS score consistently indicated a higher functional status compared to the patient-rated PROMIS average score and across all PROMIS domain scores. 40% of patients were rated “Functionally Dependent” using the average PROMIS score, compared to just 19.1% using the KPS, a statistically significant difference (p=0.042). We noted categorical concordance of 55.3% for PROMIS average score, 57.5% for physical function, 44.7% for fatigue and 42.7% for pain interference compared to KPS. We found no statistically significant associations between concordance and patient demographics or characteristics. Conclusions: Our results revealed a notably low concordance in functional status in advanced cancer patients between provider-rated KPS and patient-rated PROMIS measures. Provider-rated scores consistently indicated a higher overall performance status, in particular with measures of the lowest functional status. Additional work is needed to better understand the reasons for this lack of concordance and its implications for ongoing clinical decision-making.
Lung cancer: Significance of place of diagnosis.
Authors: Bishnoi Rohit , Shah Chintan , Hincapie Echeverri Jacobo , Robinson Katherine , Wang Yu , Lee Ji-Hyun , Schmit Jessica Marie 
Published: November 2018

60 Background: Patients who are diagnosed with lung cancer through emergency department tend to do poorly. We conducted a retrospective study to examine the effect of place of diagnosis on various cancer outcomes including survival, health care cost, and end-of-life (EOL) care. Methods: Patients who died from lung cancer between January 2015 and July 2017 were reviewed. Initial place of diagnosis was determined (Emergency Department/Urgent clinic (ED/UC) or Outpatient). Descriptive statistics, exact Pearson chi-square test, Kaplan-Meier method, and multivariable Cox regression model were used to compare the two groups. Results: 227 patients were included in the analysis. Median age at diagnosis was 65 years. 52% were male; 85% were white. 57% of patients were diagnosed through ED/UC, whereas 43% were diagnosed as part of an outpatient workup. Age, gender, race, and histology (small cell vs. non-small cell) did not vary significantly between the two groups. Rates of palliative care intervention and advance directives were similar. Patients diagnosed through ED/UC were more likely to be metastatic, have symptoms, and not receive any cancer directed therapy. Cost of care was similar between the two groups. Median survival in those who presented to ED/UC was significantly shorter (2.5 vs. 6.5 mo; p<0.001) with a hazard ratio of 1.7 (95% CI:1.3-2.3), even after adjusting for potential confounding factors (age, metastasis, insurance, smoking, treatment). Conclusions: Patients diagnosed with lung cancer through the ED/UC have worse outcomes than those diagnosed as an outpatient. Despite similar cost of care, survival outcomes are worse. This variable remains significant despite controlling for confounders in multivariate analysis.[Table: see text]
Survival outcomes and end of life use of immunotherapy (IO) supplied free of charge for cancer patients.
Authors: Agarwal Rajiv , Epstein Andrew S. , Saltz Leonard B. 
Published: November 2018

62 Background: IO has increased both hope and uncertainty for patients (pts) with cancer. Many pts who do not qualify for trials have received IO from manufacturers free of charge (“compassionate use” or “expanded access”). We report the survival outcomes of such pts using free IO at Memorial Sloan Kettering Cancer Center (MSK). Methods: Pharmacy dispensing logs from 1/1/2015 to 12/31/2017 were reviewed to identify cancer pts who received free ipilimumab (I), nivolumab (N), or pembrolizumab (P) at MSK’s clinics and inpatient hospital. Outcomes and IO use relative to the end of life were analyzed. Results: Outpatient use: n = 484 pts, with 10 pts using free IO in more than one case: median age 61 (range 18 - 93); 222 women, 262 men. 99% had metastatic or locally advanced disease; 6 pts received adjuvant IO. IO case distribution: 303 P, 3 I, 134 N, and 55 with variable combinations of I/N. Median number of doses per pt: 4. Table shows progression free survival (PFS) rates by cancer type. Of 317 known pt deaths, 90 pts received IO in the last 30 days of life. 17 pts initiated IO as an inpatient: median age 57 (range 25-79); 10 women, 7 men. IO case distribution: 12 P, 3 N, and 2 I/N. Median number of doses per pt: 1. The median overall survival from first dose was 24 days. No pts achieved 3-month PFS and 12 pts received IO in the last 30 days of life. Conclusions: To date, this is the largest published cohort of pts who received IO free of charge. IO started in patients too sick to be outpatient was ineffective. Ongoing analyses are examining response relative to mutational burden, healthcare-associated costs, and key end-of-life outcomes for this patient population. [Table: see text]
A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer.
Authors: Koh Su-Jin , An Ho Jung , Jun Hyun Jung , Chun Sang Hoon , Lee Kyung Hee , Ahn Hee Kyung , Jung Hyun Ae , Ju Hee Kim , Kim Min-Ho 
Published: November 2018

8 Background: Terminally ill patients can decide end-of-life preferences with physicians in Physician Orders for Life-Sustaining Treatment (POLST) form. We did multi-center, prospective study to assess the feasibility of completing the POLST form in real oncologic practice. Methods: The inclusion criteria were patients with terminal cancer, age ≥20, and sufficient to communicate. The primary end point was the completion rate of the POLST. The questionnaire about the barriers from physicians or patients was asked to whom refused the POLST discussion. Results: From June to December 2017, 336 patients were enrolled from seven hospitals. The median age was 66 (20–94) years, 52.7% were male, 60.4% showed ECOG 3/4, and hepato-pancreato-biliary (26.2%) was the most common origin, followed by lung (23.2%) and gastro-intestinal (19.9%). Patients were in various situations: hospice care (41.2%), after progression (37.9%), under active treatment (15.8%), or just diagnosed as cancer (5.1%). The expected survival duration was 10.6 ±7.3 months. The POLST forms were introduced in 60.1%, and 31.3% signed the form. The barriers from physicians were reluctance of family members (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%); lack of time (22.7%), guilty feeling (21.5%), prognostic (21.0%) or time (16.6%) uncertainty. The barriers from patients were lack of knowledge/understanding in 41.3% for each, denial of prognosis (14.3%), emotional discomfort (63.5%), and difficulty in making decision by themselves (66.7%). Conclusions: One-third of patients completed the POLST forms, and various barriers were found. To overcome those barriers, social engagement, education, and systemic support might be necessary.
ASCO Guideline report: Palliative Care in the Global Setting—ASCO Resource-Stratified Practice Guideline.
Authors: Cleary James F. , Osman Hibah , Gafer Nahla , Shrestha Sudip , Ali Zipporah , Temin Sarah B. ,   ASCO Guideline Expert Panel
Published: November 2018

85 Background: The purpose of the new ASCO resource-stratified guideline on global palliative care (Osman H, Shrestha S, Temin S, et al, Palliative Care in the Global Setting: ASCO Resource-Stratified Practice Guideline, JGO, 2018) is to provide expert guidance to clinicians and policymakers on implementing palliative care in resource-constrained settings and was intended to complement the 2016 “Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update”. Methods: ASCO convened a multidisciplinary, multinational panel of experts. Guideline development involved a systematic review, a modified ADAPTE process of existing high-quality guidelines and a formal consensus-based process with the expert panel and additional experts (consensus ratings group), as well as open comment. Results: The systematic review included 48 full-text publications regarding palliative care in resource-constrained settings, along with cost-effectiveness analyses; the evidence for many clinical questions was limited. These provided indirect evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% (by consensus ratings group including expert panel). Conclusions: The recommendations help define: the models of care, staffing requirements, and roles and training needs of team members in a variety of resource settings for palliative care. Recommendations also outline the standards for provision of psychosocial support, spiritual care, and opioid analgesics, which can be particularly challenging and often overlooked in resource-constrained settings.
The effect of palliative care consults on deprescribing in palliative cancer patients.
Authors: Marin Helen , Mayo Patrick , Dersch-Mills Deonne , Ling Spencer , Thai Vincent , Cusano Frances , Chambers Carole 
Published: November 2018

92 Background: The transition from active cancer treatment to palliative care often results in a shift in drug risk-benefit assessment which requires the deprescribing of various medications. In addition, a change in patients’ goals of care (GOC) necessitates the alteration of drug therapy which includes both deprescribing and the addition of medications intended to improve quality of life. Depending on a patient’s GOC, a medication can be considered as inappropriate. Methods: The study was a one year retrospective database review and included cancer patients seen by the PCC team at the University of Alberta Hospital. Primary Objective: Comparison between potentially inappropriate medications (PIMs) prior to the palliative care consult (PCC) versus after the PCC. Secondary objective: Association between PIMs and GOC. The OncPal guidelines were used to identify and determine the number of PIMs prior to the PCC and after the PCC. Results: The reduction in PIMs prior to PCC versus after the PCC was 49% and was statistically significant (p < 0.001), demonstrating the PCC has a positive significant impact on deprescribing PIMs. For our secondary outcome, an overall decrease in PIMs was observed with the changes of GOC. This decrease in PIMs associated with GOC although not statistically significant, demonstrates that one of the benefits of a PCC is the GOC conversation. Conclusions: Deprescribing in palliative cancer patients can benefit patients by reducing their pill burden, decrease potentially side effects, and potentially decrease healthcare costs. This study shows the positive impact a PCC has on deprescribing and reassessing GOC. Furthermore, this study reveals the importance of using guidelines for deprescribing in palliative oncology and brings to light other medications that may be considered PIMs.
Attitudes and beliefs of a mandatory palliative care rotation by hematology and medical oncology fellows at a major comprehensive cancer center.
Authors: Reddy Suresh , Tanco Kimberson Cochien , Liu Diane D. , Williams Janet L. , Yennu Sriram J. , Wolff Robert A. , Bruera Eduardo 
Published: November 2018

98 Background: The ACGME requires incorporating palliative care (PC) competencies into Hematology and Medical Oncology (HMO) fellowship curriculum. The primary aim of this study was to determine the attitudes and beliefs regarding PC of HMO fellows who completed a 4 week mandatory PC rotation. Methods: The rotation included a 4 week standardized curriculum covering all PC domains and all HMO fellows rotated in acute palliative care unit (APCU), consult service and outpatient clinic. HMO fellows were provided educational materials and attended all didactic sessions. All HMO fellows from 2004 to 2017 were sent a 39 item survey adapted from published studies on oncology trainee perception of PC. Results: 77/105 (73%) HMO fellows completed the survey (median age of 40 years, 57% males and 82% practicing in an academic setting). The following were reported to improve after the PC rotation: (a) assessment and management of symptoms (98%); (b) opioid prescription (89%), opioid rotation (78%) and identification of opioid side effects (87%); (c) communication with patients and families (91%), advance care planning discussion (88%), DNR discussion (88%); (d) comfort discussing ethical issues (74%); (e) ability to cope with stress of terminal illness (58%). Strongly agree to agree was expressed by 76 (98%) for improved knowledge of symptom assessment & management vs 57 (74%) for ethics (p = 0.0001) and 45 (58%) for coping with stress of terminal illness (p = 0.0001). HMO fellows were more likely to refer patients to PC (83%) for uncontrolled symptoms (97%), psychological distress (88%) or with advanced disease regardless of symptoms (56%) after the rotation. The APCU rotation was felt to be most beneficial (93%). The PC rotation educational experience was felt to be either far better or better (53%) or same (45%) as other oncology rotations. 98% would recommend PC rotations to other HMO fellows and 95% felt rotation should be mandatory. Conclusions: HMO fellows reported PC rotation improved their knowledge in all PC domains, felt PC rotation was far better to better than other oncology rotations, and were more likely to refer patients to PC.
Development of an integrated palliative and supportive care service within an academic cancer center.
Authors: Loschiavo Sarah , Stoute Trena , Hook Karen 
Published: November 2018

99 Background: Timely incorporation of palliative services with chemotherapy treatment has become a new standard of care for oncology patients based on evidence-driven national clinical practice guidelines. However, best practices for service integration are not known, particularly for small academic centers. In our 224 bed university hospital, we hypothesized that advertisement, responsiveness to needs and service integration would result in increased utilization of palliative and supportive care. We report the process of developing our Integrated Model of Care. Methods: The program began with a 1.0 FTE APRN boarded as a FNP and certified as an advanced hospice and palliative nurse. The goal was to identify opportunities for her integration within the outpatient cancer center. A needs-assessment survey was sent to medical oncology faculty with the following items: proposed change in service name, care areas of greatest need, limitations to providing palliative care, additional growth opportunities. The Interdisciplinary Supportive Care Team was created utilizing existing staff. One year of billed consults were reviewed. The APRN attended tumor boards, team meetings, biweekly Interdisciplinary Team Meetings, communicated directly with the Inpatient Hem/Onc Team and provided educational sessions. Results: Needs assessment survey and service name change proposal sent to 14 oncology providers: 50% completed survey; seven responded YES to name change; zero providers responded NO. Of the 489 consults billed within the 1st year of service, 249 were inpatient and 240 outpatients. 168 individual patients were referred; > 72 patients were referred to palliative/hospice services; > 82 patients died. One year satisfaction survey; 17 respondents; 88.23% were satisficed and 100% would consult again. Conclusions: Medical oncology faculty at our institution responded favorably to the development of a designated “Oncology Supportive Care Service” evidenced by increased consultation and utilization of services. Optimizing clinical infrastructure, processes, education and research has led to the success of this integrated care model, lending to recruitment of additional allied health professionals and ongoing program growth.
False positives in trans-eQTL and co-expression analyses arising from RNA-sequencing alignment errors
Authors: Saha Ashis , Battle Alexis 
Published: November 2018

Sequence similarity among distinct genomic regions can lead to errors in alignment of short reads from next-generation sequencing. While this is well known, the downstream consequences of misalignment have not been fully characterized. We assessed the potential for incorrect alignment of RNA-sequencing reads to cause false positives in both gene expression quantitative trait locus (eQTL) and co-expression analyses. Trans-eQTLs identified from human RNA-sequencing studies appeared to be particularly affected by this phenomenon, even when only uniquely aligned reads are considered. Over 75\% of trans-eQTLs using a standard pipeline occurred between regions of sequence similarity and therefore could be due to alignment errors. Further, associations due to mapping errors are likely to misleadingly replicate between studies. To help address this problem, we quantified the potential for "cross-mapping'' to occur between every pair of annotated genes in the human genome. Such cross-mapping data can be used to filter or flag potential false positives in both trans-eQTL and co-expression analyses. Such filtering substantially alters the detection of significant associations and can have an impact on the assessment of false discovery rate, functional enrichment, and replication for RNA-sequencing association studies.
The role of core needle biopsies in the management of neck lumps
Authors: Kalra A , Prucher G-M , Hodges S 
Published: November 2018

Introduction King’s College Hospital has proudly provided a one-stop neck lump clinic since 2012. These multidisciplinary clinics allow for rapid diagnoses due to in-clinic investigations. In April 2013, ultrasound-guided core needle biopsies were introduced as an alternative/adjunct to fine-needle aspiration cytology and open biopsies for obtaining histological diagnoses. The aim of the study was to assess the impact of core needle biopsies on the diagnosis of neck lumps compared with fine-needle aspiration cytology and open biopsies between April 2015 and May 2016. Materials and methods Data were collected prospectively between April 2015 and May 2016 and analysed for numbers of fine-needle aspiration cytology, core needle biopsies and open biopsies performed and diagnoses made. Results A total of 190 patients were seen on the clinic; 51 had fine-needle aspiration cytology and 19 procedures gave a diagnosis. Of the remainder of these patients, 21 went on to have a core needle biopsy and 12 biopsies gave a diagnosis. An additional eight patients only had a core needle biopsy, of which five biopsies gave a diagnosis. Of the ten patients who had an open biopsy, four had a previous fine-needle aspiration cytology and core needle biopsy, three only a core needle biopsy, two had neither and one had fine-needle aspiration cytology. Conclusion The introduction of core needle biopsies has reduced the number of open biopsies performed. With increasing acceptance of this minimally invasive technique, core needle biopsies appear to be forming the key diagnostic investigation in patients with neck lumps.
Laparoscopic hemi-splenectomy: a valid option in selected cases such as epidermoid cyst
Authors: Tejero-Pintor FJ , Cuesta-De la Llave C , Rodriguez-Lopez M , Bailon-Cuadrado M , Pacheco-Sánchez D 
Published: November 2018

Splenic cysts are a rare pathology, which can be classified as true (25%) or pseudocysts (75%). Total splenectomy has been the treatment of choice, particularly in recent times with the advent of the laparoscopic approach. However, as the spleen is an organ with multiple immunological functions, the laparoscopic partial splenectomy is an alternative, which is technically difficult but effective. We present a case of a 26-year-old woman with incidental evidence of a splenic cyst in an abdominal ultrasound scan. We performed a laparoscopic partial splenectomy to preserve the function of the spleen because of the patient’s youth. Laparoscopic partial splenectomy allows the effective removal of lesions and preservation of splenic function. Although more research is needed to clarify the most effective approach, this case is further evidence that this surgical approach may be beneficial for selected patients.
DESENVOLVIMENTO DE UMA ESTAÇÃO METEOROLÓGICA AUTOMÁTICA PARA MANEJO DE IRRIGAÇÃO
Authors: Finholdt Gustavo , Mantovani Everardo Chartuni , Sediyama Gilberto Chohaku , Ramos Marcio Mota , Vieira Gustavo Haddad Souza 
Published: November 2018

Neste trabalho teve-se como objetivo o desenvolvimento de uma estação meteorológica automática com tecnologia nacional para manejo de irrigação. Ela foi constituída pelos cinco sensores utilizados na metodologia de cálculo do balanço hídrico, em que dois parâmetros importantes são a precipitação pluviométrica e a ETo. Desenvolveu-se o equipamento com display para visualização dos dados de dias anteriores, memória para armazenar dados de até um ano em base horária, porta de comunicação de dados com microcomputador via protocolo RS-232, programa de microcomputador para efetuar a aquisição e visualização dos dados e painel solar para carregar a bateria da estação. Após o desenvolvimento do equipamento, realizou-se a calibração dos sensores, com base em metodologias recomendadas pela WMO, atingindo um índice de correlação (r) de 1,000, 0,998, 0,999, 0,997 e 1,000, para os sensores de vento, chuva, umidade relativa, irradiância solar e temperatura, respectivamente. O desenvolvimento do equipamento atendeu aos objetivos da autossuficiência energética; manipulação dos dados com e sem o uso de um microcomputador; simplicidade no uso; facilidade na manutenção; e boa correlação na resposta de seus sensores.
Dessa forma, conclui-se que o equipamento desenvolvido atende aos requisitos técnicos e operacionais para sua utilização na agricultura. Porém, sendo um protótipo, ele ainda não constitui uma substituição imediata para os equipamentos similares existentes no mercado, faltando, para isso, testes em laboratórios de metrologia acreditados nacional e internacionalmente que certifiquem seu funcionamento.