bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Annual Income a Predictor of Completion of Advance Directives (ADs) in Patients With Cancer
Authors: Saeed Fahad , Xing Guibo , Tancredi Daniel J. , Epstein Ronald M. , Fiscella Kevin A. , Norton Sally A. , Duberstein Paul R. 
Published: November 2018

Context: Completion of advance directives (ADs) enhances the likelihood of receiving goal-concordant treatments near the end of life. Previous research on community samples have shown that completion of ADs is less common in lower socioeconomic status demographic group; there is a paucity of such research in patients with cancer. Objectives: To study the effect of income and education on the completion of ADs. Hypothesis: Patients with cancer having lower incomes and education levels would be less likely to report completing ADs. Methods: We conducted cross-sectional analyses of data provided by patients (n = 265) enrolled in the Values and Options in Cancer Care clinical trial. Patients with advanced cancer reported whether they had (1) completed a living will or (2) designated a health-care proxy. Response options for both questions were yes (scored 1), no (scored 0), and unsure (scored 0). We studied the association of lower household income (≤US$20 000) and education level (never attended college) with AD scores. Results: Patients with lower annual incomes had lower AD scores (estimate −0.44; confidence intervals [CI]: −0.71 to −0.16, P = .001); the association between higher educational attainment (some college or more) and completion of ADs was not statistically significant (estimate 0.04, CI: −0.16 to 0.24, P = .70). Conclusion: Interventions to promote completion of ADs among lower income patients with serious illnesses are needed.
Functional optical coherence tomography of retinal photoreceptors
Authors: Yao Xincheng , Son Taeyoon , Kim Tae-Hoon , Lu Yiming 
Published: November 2018

Age-related macular degeneration (AMD) is the leading cause of severe vision loss and legal blindness. It is known that retinal photoreceptors are the primary target of AMD. Therefore, a reliable method for objective assessment of photoreceptor function is needed for early detection and reliable treatment evaluation of AMD and other eye diseases such as retinitis pigmentosa that are known to cause photoreceptor dysfunctions. Stimulus-evoked intrinsic optical signal (IOS) changes promise a unique opportunity for objective assessment of physiological function of retinal photoreceptor and inner neurons. Instead of a comprehensive review, this mini-review is to provide a brief summary of our recent in vitro and in vivo optical coherence tomography (OCT) studies of stimulus-evoked IOS changes in animal retinas. By providing excellent axial resolution to differentiate individual retinal layers, depth-resolved OCT revealed rapid IOS response at the photoreceptor outer segment. The fast photoreceptor-IOS occurred almost right away (∼ 2 ms) after the onset of retinal stimulation, differentiating itself from slow IOS changes correlated with inner neural and hemodynamic changes. Further development of the functional IOS instruments and retinal stimulation protocols may provide a feasible solution to pursue clinical application of functional IOS imaging for objective assessment of human photoreceptors. Impact statement Retinal photoreceptors are the primary target of age-related macular degeneration (AMD) which is the leading cause of severe vision loss and legal blindness. An objective method for functional assessment of photoreceptor physiology can benefit early detection and better treatment evaluation of AMD and other eye diseases that are known to cause photoreceptor dysfunctions. This article summarizes in vitro study of IOS mechanisms and in vivo demonstration of IOS imaging of intact animals. Further development of the functional IOS imaging may provide a revolutionary solution to achieve objective assessment of human photoreceptors.
Improvements in Thigh Strength Symmetry Are Modestly Correlated With Changes in Self-Reported Function After Anterior Cruciate Ligament Reconstruction
Authors: Pottkotter Kristy A. , Di Stasi Stephanie L. , Schmitt Laura C. , Magnussen Robert A. , Paterno Mark V. , Flanigan David C. , Kaeding Christopher C. , Hewett Timothy E. 
Published: November 2018

Background: The association between quadriceps strength and functional outcomes after anterior cruciate ligament reconstruction (ACLR) is a focus of current research, while evaluations of hamstring strength are limited, despite the frequent use of hamstring autografts. Purpose/Hypothesis: The purpose of this study was to determine the relationship between changes in quadriceps and hamstring strength symmetry and self-reported outcomes before ACLR and at 12 and 24 weeks after surgery. We hypothesized that improvements in quadriceps and hamstring strength symmetry would be correlated with improvements in self-reported outcome measures within the first 6 months after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Thirty patients who underwent ACLR with a hamstring autograft were enrolled. Quadriceps and hamstring strength and Knee injury and Osteoarthritis Outcome Score (KOOS) values were assessed before and at 12 and 24 weeks after ACLR; limb symmetry indexes for strength were calculated at each time point. The Friedman and Wilcoxon signed-rank tests were used to analyze changes in KOOS values over time. Spearman rank-order correlations were used to test the relationship between changes in strength and KOOS values between each time point. Results: Hamstring and quadriceps limb symmetry significantly increased with time ( P ≤ .03). Fair correlations were observed between changes in the hamstring index and changes in the KOOS Symptoms subscore from before surgery to 12 weeks postoperatively ( r = 0.48; P ≤ .05). Changes in the quadriceps index (QI) were moderately correlated with changes in the KOOS Sport/Recreation subscore ( r = 0.60; P = .001), and fair correlations were seen between the QI and the KOOS Quality of Life subscore ( r = 0.39; P ≤ .04) from preoperatively to 12 weeks after surgery. Moderate correlations were seen between the QI and the KOOS Sport/Recreation subscore ( r = 0.57; P = .005) from 12 to 24 weeks after surgery. Conclusion: Improvements in quadriceps and hamstring strength symmetry were modestly associated with improvements in athletes’ perceived function in the first 6 months after ACLR. Specifically, improvements in hamstring symmetry were associated with improvements in knee symptoms within the first 12 weeks postoperatively, while improvements in quadriceps symmetry were associated with improvements in self-reported sport function throughout the first 6 months after ACLR. The restoration of strength symmetry within the first 6 months may be a critical component of rehabilitation aimed at maximizing function after ACLR. Further investigation is warranted to comprehensively evaluate whether the timing of strength gains predicts future function, including those who successfully return to their preinjury activity level after ACLR.
Altered functional connectivity in the fear network of firefighters with repeated traumatic stress
Authors: Jeong Hyeonseok , Park Shinwon , Dager Stephen R. , Lim Soo Mee , Lee Suji L. , Hong Haejin , Ma Jiyoung , Ha Eunji , Hong Young Sun , Kang Ilhyang , Lee Eun Hee , Yoon Sujung , Kim Jieun E. , Kim Jungyoon , Lyoo In Kyoon 
Published: November 2018

BackgroundFirefighters are routinely exposed to various traumatic events and often experience a range of trauma-related symptoms. Although these repeated traumatic exposures rarely progress to the development of post-traumatic stress disorder, firefighters are still considered to be a vulnerable population with regard to trauma.AimsTo investigate how the human brain responds to or compensates for the repeated experience of traumatic stress.MethodWe included 98 healthy firefighters with repeated traumatic experiences but without any diagnosis of mental illness and 98 non-firefighter healthy individuals without any history of trauma. Functional connectivity within the fear circuitry, which consists of the dorsal anterior cingulate cortex, insula, amygdala, hippocampus and ventromedial prefrontal cortex (vmPFC), was examined using resting-state functional magnetic resonance imaging. Trauma-related symptoms were evaluated using the Impact of Event Scale – Revised.ResultsThe firefighter group had greater functional connectivity between the insula and several regions of the fear circuitry including the bilateral amygdalae, bilateral hippocampi and vmPFC as compared with healthy individuals. In the firefighter group, stronger insula–amygdala connectivity was associated with greater severity of trauma-related symptoms (β = 0.36, P = 0.005), whereas higher insula–vmPFC connectivity was related to milder symptoms in response to repeated trauma (β = −0.28, P = 0.01).ConclusionsThe current findings suggest an active involvement of insular functional connectivity in response to repeated traumatic stress. Functional connectivity of the insula in relation to the amygdala and vmPFC may be potential pathways that underlie the risk for and resilience to repeated traumatic stress, respectively.Declaration of interestNone.
Efficacy variables in patients with cancer versus patients without cancer treated with methylnaltrexone or placebo: An analysis of two placebo-controlled studies.
Authors: Chamberlain Bruce , Rhiner Michelle , Slatkin Neal E , Stambler Nancy , Israel Robert Joseph 
Published: November 2018

1 Background: A post-hoc analysis of pooled data from two randomized, double-blind studies and their open-label extensions evaluated whether baseline characteristics and efficacy endpoints differ between cancer and noncancer adults with advanced illness and opioid-induced constipation treated with methylnaltrexone (MNTX) or placebo. Methods: Patients received SC MNTX 0.15 mg/kg or placebo (study 302) and SC MNTX 8 mg (38≤62 kg), 12 mg (≥62 kg), or placebo (study 4,000) every other day for two weeks and received the same doses of MNTX as needed during the first 2 weeks of the open-label extensions. Double-blind populations were stratified by those with/without cancer. Efficacy endpoints included rescue-free bowel movements (RFBMs) within 4 hours after each dose for ≥2 of the first 4 doses; time to rescue-free laxation; rescue laxatives use; and ≥3 RFBMs/week and ≥1 RFBM/week in ≥3 of 4 weeks. Results: Median baseline opioid use (mg/day) was greater in cancer (187.9 placebo [n=114]; 180.0 MNTX [n=116]) versus noncancer patients (80.0 placebo [n=71]; 120.0 MNTX [n=62]). MNTX significantly ( P<0.0001) improved the proportion of cancer (56.9%) and noncancer (58.1%) patients with an RFBM within 4 hours after each dose for ≥ two of the first four doses versus placebo (5.3% cancer; 11.3% noncancer). Median time to laxation was significantly ( P≤0.0002) shorter in cancer (0.96 hours) and noncancer (1.25 hours) patients 24 hours after the first dose of MNTX versus placebo (22.53 and >24 hours, respectively). Rescue laxatives were used by 39.7% of cancer and 30.6% of noncancer MNTX patients versus 51.8% of cancer and 39.4% of noncancer placebo patients. Of 108 open-label extension double-blind MNTX patients, 79 (73.1%) achieved ≥3 RFBMs/week with ≥1 RFBM/week increase in ≥ three of four weeks versus 48 (46.6%) of 103 double-blind placebo patients (data from double-blind and first two weeks of open-label). Conclusions: MNTX treatment improved the laxation response, with a faster onset of laxation in patients with and without cancer, and reduced the need for rescue laxatives vs placebo. Improvements over placebo continued into the first two weeks of the open-label extensions for MNTX-treated patients. Clinical trial information: NCT00672477, NCT00402038.
Palliative inpatient radiation therapy: The challenge of treatment non-completion.
Authors: Kuo Jeffrey V. , Daroui Parima , Farol Hanako Y. , Sehgal Varun , Ramsinghani Nilam S. 
Published: November 2018

106 Background: By virtue of their disease acuity and symptom burden, inpatients are good candidates for radiation therapy but may also be at risk of not benefitting from treatment due to premature treatment discontinuation or early demise. The current study describes the inpatient radiation therapy experience at an academic medical center. Methods: Patients receiving palliative radiotherapy in the hospital at any point in their care form the study population. Dose prescriptions were determined on an individual basis by the faculty radiation oncologist. Brachytherapy, IORT, and radiosurgery cases were excluded. Descriptive data was aggregated for analysis. Results: 315 courses given to 275 inpatients between January 2013 and September 2017 form this analysis. Mean age was 56.5 yrs. 96% began as inpatients. The top hospitalization indications were pain (32%), neurological symptoms (9%), and dyspnea (7%). The top treatment indications were spinal metastases (34%), brain metastases (21%), and non-spine bone metastases (12%). The estimated median survival of the entire group was 8.9 wks (range <1 – 189). Ten courses were given during the terminal hospitalization. The overall rate of treatment non-completion was 18%. Non-completion and survival figures for the most common indications provided. Spine treatments in which shorter courses predominated had a non-completion rate (12%) that was lower than for the overall group. The rate of treatment non-completion was particularly high for brain metastases (28%). Conclusions: Hospitalized patients receiving palliative radiation therapy carry a poor prognosis. Their significant symptom burden and limited life expectancies place them at risk for treatment non completion. While short courses developed for spine irradiation are associated with lower non-completion rates, longer courses seen as appropriate for brain irradiation are associated with particularly high non-completion rates.[Table: see text]
Complementary and integrative medicine use for individuals seeking conventional medical oncology care in Chile: Prevalence and patient characteristics.
Authors: Lopez Gabriel , Salas Claudio Alejandro , Cadiz Fernando , Barriga Carolina , Gonzalez Pilar , Acevedo Sandra , Raimilla Patricia , Pincheira Pia , Naing Aung , Quiroga Marta 
Published: November 2018

110 Background: Complementary and integrative medicine (CIM) use during cancer care has increased in western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in South America. Methods: Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile (March-June, 2017) were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included two-tailed t-test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables. Results: Of 432 patients surveyed, 66.7% had a diagnosis of breast cancer, 84.8% were women, the majority between ages 40-60 (32.7%). Of those surveyed, 221 (51.5%) reported CIM use. No association was found between CIM use and sociodemographic variables (sex, age, education, income). Patients with breast cancer (44.6%) reported CIM use, compared to 64.8% of other cancer types (p=0.0001). Most commonly reported CIM types used included herbals (49.1%), vitamins/minerals (40.8%), prayer/meditation (40.4%), and special diets (38.5%). Most frequent reasons for CIM use included “do everything possible” (72%), “improve my immune function” (67.8%), “reduce treatment related side effects” (32.7%), and “recommended by family/friend” (32.7%). Most (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. Majority reported benefits from CIM use (60%). No differences were observed in self-reported quality of life between those using versus not using CIM. Conclusions: The majority of patients receiving conventional oncology care reported engaging in CIM use, with just over half of users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this topic and contribute to improved outcomes.
Discontinuation of poly(adenosine diphosphate-ribose) polymerase inhibitors due to adverse events in patients with recurrent ovarian cancer: A meta-analysis of three phase III trials.
Authors: Thein Kyaw Zin , Sultan Anita , Zaw Myo , Swarup Sriman , Han Myat M. , Myat Yin Mon , Jones Catherine , Hardwicke Fred L. , Awasthi Sanjay 
Published: November 2018

118 Background: Ovarian cancer is the fifth leading cause of cancer-related death among women. Poly adenosine diphosphate ribose polymerase (PARP) inhibitors maintenance has shown to improve survival in patients with recurrent ovarian cancer. Yet, there are notable adverse events which led to treatment discontinuation, interruption, or dose reduction. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of PARP inhibitors discontinuation due to adverse events. Methods: MEDLINE, EMBASE databases and meeting abstracts from inception through June 2018 were queried. Phase III RCTs which employed PARP inhibitors maintenance in ovarian cancer and mentioned treatment interruption, dose reduction and treatment discontinuation due to adverse events were included. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) with 95% confidence interval (CI). Random effects model was applied. Results: Three phase III RCTs with a total of 1,401 patients with recurrent ovarian cancer were eligible. The study arm used olaparib or niraparib or rucaparib while the control arm utilized placebo. The randomization ratio was 2:1 in all studies. The incidence of treatment interruption due to adverse events was 578 (61.8%) in study group versus 46 (9.8%) in control arm. The relative risk for treatment interruption was statistically significant at 5.87 (95% CI: 2.24 – 15.36, P < 0.001). The reduction in dose was reported in 496 (53.1%) in PARP inhibitors arm versus 37 (7.9%) in control group. The pooled RR for dose reduction was 7.49 (95% CI: 3.44 – 16.29, P < 0.001). The treatment discontinuation rate was 11.4% higher with PARP inhibitors than with control arm (RR - 6.84; 95% CI: 3.51 – 13.34, P < 0.001). Conclusions: Our study showed that patients on PARP inhibitors experienced some adverse events which led to significant drop outs although the definitive advantage to PARP inhibitors is still shown in the studies. Preemptive measures with proper supportive care will aide in reducing those toxicities, improve patients’ quality of life and may probably affect patients’ compliance.
Hospice palliative care program management, setup, and operation with a national pilot study in Haidian, Beijing.
Authors: Zhang Zetao , Zhu Yi , He Zhaoping , He Yuling , Wang Naning , Zhao Jianping 
Published: November 2018

121 Background: In 2016, an inpatient hospice palliative care ward was initiated in Beijing Haidian Hospital, which was the first pilot study program in Beijing. Challenges of implementing the program and the process to facilitate change in the hospital’s and society culture in China. Methods: This program has been partnered with Ovation Health International and Hospice Palliative Care Alliance of China Foundation at beginning of the program development in order to streamline the program design and establish standard operating procedures. The program was operated by a multi-disciplinary team which is the first of these kinds of team structure in Chinese health system, including the program manager, physicians, nurses, social workers, psychologic counsellors, chaplains, and volunteers. Results: The program has served over 200 patients and their families in the first year. The inpatient hospice unit has 2 specially decorated rooms with 6 in-patient beds, a meeting room, and a farewell room. The program has expanded its palliative care counselling service to the entire hospital and affiliated community nursing homes and will plan to expand the number of beds to 20 in the inpatient hospice unit. The implementation of the program has been full of obstacles, encompassing the lack of trained professionals, limited financial resources, higher staff turnover, and professional misunderstanding and public rejection. Now upgraded to a National Pilot model of China, the trial program team led by the program manager, has overcome core barriers/challenges in team building, team enablement, resource supporting, public education, and society awareness to keep the program growth. Conclusions: The lessons learned from the experience of developing the first hospital-based hospice palliative care program in the capital of China will be presented. Particularly, barriers and challenges, both modifiable and non-modifiable, will be shared as well as facilitating factors. The authors will share the pathway to partner across disciplines, with policy makers, and in research, education, and practice. This helps the team in the creation of new knowledge and in continuing to establish the evidence-based value of palliative care in China.
Oncology fellows' current practice regarding concurrent outpatient oncology and palliative care.
Authors: Johnson Amy , Fettig Lyle , Newton Erin V. , Comer Amber 
Published: November 2018

122 Background: It is accepted that Palliative Care provides additional support and improves overall care to oncology patients. Literature supports early referral and integration of Palliative Care with standard oncology care and is a guideline from the American Society of Clinical Oncology. In order to make palliative care integration a standard of care, Oncology Fellows should be learning to integrate during their fellowship years. There is little information regarding the Palliative Care experience in the outpatient setting for Oncology Fellows in the United States. This study looked at the current practice model in regards to concurrent Oncology and Palliative Care in the outpatient setting. Methods: An electronic nationwide survey of medical Oncology Fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5% Fellows contacted at 17 institutions responded. 98% of the fellows’ hospital systems offered ambulatory palliative care with 79% having a palliative care specialist available during their ambulatory Oncology clinic. 55% of the Fellows’ patient referrals are occurring when they still have multiple lines of cancer directed treatment planned, and the most common initial referral reason is for symptom management. 97% of fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. Although no participants stated their initial consult request was for psychosocial and/or spiritual support, 95% strongly agreed or agreed that Palliative Care helps ensure these issues are addressed. Conclusions: Early integration of Palliative Care is occurring in the 17 responding institutions around the country as 97% of Fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% of oncology fellows indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics.