- Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy. [Journal Article]Pract Radiat Oncol 2019PR
- CONCLUSIONS: The educational outreach intervention improved knowledge and the likelihood of inter-professional palliative healthcare teams accessing PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.
- Biomarker Immunoprofile and molecular characteristics in salivary duct carcinoma: Clinicopathologic and prognostic implications. [Journal Article]Hum Pathol 2019HP
- Salivary duct carcinoma (SDC) is one of the most aggressive salivary gland tumors and prognosis remains poor for most patients. The aim of this study was to investigate the prognostic implications of biomarker immunoprofile in a cohort of SDC and to identify molecular characteristics through next-generation sequencing (NGS) in a subset of cases. Clinicopathological and follow-up information of 25…
Salivary duct carcinoma (SDC) is one of the most aggressive salivary gland tumors and prognosis remains poor for most patients. The aim of this study was to investigate the prognostic implications of biomarker immunoprofile in a cohort of SDC and to identify molecular characteristics through next-generation sequencing (NGS) in a subset of cases. Clinicopathological and follow-up information of 25 cases diagnosed as SDC were collected. Immunoexpression of AR, HER-2/neu, GATA3, CK5/6 and MIB1 was analyzed, and ERBB2 (HER-2/Neu) gene amplification was investigated by FISH. Cases were classified under the "SDC revised classification system". Eight SDC cases were analyzed by targeted NGS for detection of gene fusions and variants. Overall (OS) and disease-free survival (DFS) were analyzed with Kaplan-Meier curves and Cox regression. Most cases expressed AR (100%), GATA3 (73%), and CK5/6 (76.5%), and 42% expressed HER-2/neu. ERBB2 gene amplification was proven by FISH in 7/15 (46%) cases. Apocrine HER2 (AR+/HER2+) subtype was significantly associated with lower OS (P=.05). NGS analysis revealed nine pathogenic mutations in seven SDC cases, and the most frequently mutated gene was HRAS (4/9), followed by PIK3CA (2/9) and TP53 (2/9). One case (1/9) presented homozygous deletion of locus 9p21 (CDKN2A) and another case (1/9) showed MDM2 amplification. In conclusion, we demonstrated that Apocrine HER2 (AR+/HER2+) is a potential biomarker of poor outcome in SDC. Furthermore, NGS analysis revealed recurrent mutations in SDC.
- Medication safety incidents in paediatric oncology after electronic medication management system implementation. [Journal Article]Eur J Cancer Care (Engl) 2019; :e13152EJ
- CONCLUSIONS: Incidents reflected difficulties with managing therapies rich in interdependencies. EMM, and especially its 'automaticity', contributed to these incidents. As EMM impacts on safety in such high-risk settings, it is essential that users are aware of and attend to EMM automatic behaviours and are equipped to troubleshoot them.
- Binaural Optimization of Cochlear Implants: Discarding Frequency Content Without Sacrificing Head-Shadow Benefit. [Journal Article]Ear Hear 2019EH
- CONCLUSIONS: The "exclusion frequency" ranges that could be removed without diminishing head-shadow benefit are interpreted in terms of low importance in the speech intelligibility index and a small head-shadow magnitude at low frequencies. Although groups and individuals with greater performance asymmetry gained less head-shadow benefit, the magnitudes of these factors did not predict the exclusion frequency range. Overall, these data suggest that for many SSD-CI and BI-CI listeners, the frequency allocation for the poorer-ear CI can be shifted substantially without sacrificing head-shadow benefit, at least for energetic maskers. Considering the two ears together as a single system may allow greater flexibility in discarding redundant frequency content from a CI in one ear when considering bilateral programming solutions aimed at reducing interaural frequency mismatch.
- Preoperative Weight Loss for Morbidly Obese Patients Undergoing Total Knee Arthroplasty: Determining the Necessary Amount. [Journal Article]J Bone Joint Surg Am 2019; 101(16):1440-1450JB
- CONCLUSIONS: Losing at least 20 pounds before total knee arthroplasty was associated with shorter length of stay and lower odds of facility discharge for morbidly obese patients, even while most patients remained morbidly or severely obese. Although there were no differences in operative time or physical function improvement, this has considerable implications for patient burden and cost reduction. Patients and providers may want to focus on larger preoperative weight loss targets.
- Development of a Model to Predict Portal Vein Thrombosis in Liver Transplant Candidates: The Portal Vein Thrombosis Risk Index. [Journal Article]Liver Transpl 2019LT
- Portal vein thrombosis (PVT) is associated with inferior pre- and post-transplantation outcomes. We aimed to create a predictive model to risk stratify transplant candidates for PVT. Data on adult transplants in the United States during the Model for End stage Liver Disease (MELD) era through September 2016 were reviewed. We constructed and validated a scoring system comprised of routine, readily…
Portal vein thrombosis (PVT) is associated with inferior pre- and post-transplantation outcomes. We aimed to create a predictive model to risk stratify transplant candidates for PVT. Data on adult transplants in the United States during the Model for End stage Liver Disease (MELD) era through September 2016 were reviewed. We constructed and validated a scoring system comprised of routine, readily available clinical information to predict the development of incident PVT at 12 months from transplantation listing. 66,568 liver transplant candidates were dichotomized into two groups to construct (n=34,751) and validate (n=31,817) a scoring system. In general, the derivation and validation cohorts were clinically similar. While nonalcoholic steatohepatitis was the strongest independent predictor of incident PVT (HR 1.29, 95% CI 1.08-1.54, p <0.001), age, MELD score, and moderate-severe ascites were associated with increased risk. African American race was associated with decreased risk. A scoring system (PVT Risk Index) of these five variables had area under the curve of 0.71 and 0.70 in both estimation and validation cohorts respectively. By applying the low cutoff score of 2.6, incident PVT could be accurately excluded (94% negative predictive value). Using the high cutoff score of 4.6 (85% positive predictive value), PVT could be diagnosed with high accuracy. The PVT-RI predicts which candidates awaiting lifesaving liver transplantation will and will not develop future PVT. Although this scoring system will require prospective validation, it provides a powerful new tool for the clinician when risk stratifying cirrhosis patients prior to liver transplantation for future PVT development. This article is protected by copyright. All rights reserved.
- Case Report: Early Doxycycline Therapy for Potential Rickettsiosis in Critically Ill Patients in Flea-Borne Typhus-Endemic Areas. [Journal Article]Am J Trop Med Hyg 2019AJ
- Flea-borne typhus (FBT), although usually perceived as a self-resolving febrile illness, actually encompasses a wide spectrum of disease severity, including fulminant sepsis with multi-organ failure. In endemic Texas and California, the incidence of FBT has more than doubled over the last decade. Clinicians remain unfamiliar with severe septic presentations of FBT when considering the etiologies …
Flea-borne typhus (FBT), although usually perceived as a self-resolving febrile illness, actually encompasses a wide spectrum of disease severity, including fulminant sepsis with multi-organ failure. In endemic Texas and California, the incidence of FBT has more than doubled over the last decade. Clinicians remain unfamiliar with severe septic presentations of FBT when considering the etiologies of acute undifferentiated febrile syndromes. The diagnostic challenges of FBT include the nonspecific and variable nature of both history and physical examination and the lack of diagnostic testing that can provide clinically relevant information early in the course of infection. These barriers perpetuate misdiagnoses in critically ill patients and lead to delay in initiating appropriate antibiotics, which may contribute to preventable morbidity and mortality. This case series describes the clinical and diagnostic trajectories of three patients who developed FBT-associated multi-organ dysfunction. These patients achieved resolution of infection after receiving doxycycline in the context of a high clinical suspicion. Patients residing in FBT-endemic areas presenting with a febrile illness of unknown etiology with a suggestive constellation of hyponatremia, elevated transaminase levels, and thrombocytopenia should be suspected of having FBT. Clinicians should proceed to serologic testing with early doxycycline therapy for potential rickettsiosis. Familiarizing clinicians with the presentation of rickettsiosis-associated septic syndromes and its early and appropriate antibiotic treatment can provide lifesaving care and reduce health-care costs through prevention of the morbidity associated with FBT.
- Perspectives of Nurse Managers on Virtual Communication and e-Leadership. [Journal Article]J Nurs Manag 2019JN
- CONCLUSIONS: Effective and safe patient care is dependent on multiple technology applications that require significant knowledge and practice. Nursing leadership may consider the need for more supported mentorship, and engaging programs to educate nurse managers about the dozens of applications required to effectively manage and lead. For technology to be used to its full potential it should be designed with nursing involvement. This article is protected by copyright. All rights reserved.
- Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania. [Journal Article]J Cancer Educ 2019JC
- While more than 90% of breast cancer patients in western countries survive for at least 5 years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam…
While more than 90% of breast cancer patients in western countries survive for at least 5 years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, and included interviews with 196 breast cancer patients diagnosed with early (stage I/II, n = 44) or late (stage III/IV, n = 152) stage who were referred to ORCI from January 2016 to August 2018. The questionnaire elicited information regarding disease history, sociodemographics, barriers to navigating the health system, and patient attitudes towards breast cancer. More early-stage patients (54.5%) stated history of previous breast examinations before their initial diagnosis compared to late-stage patients (19.7%) (p = < 0.001). Financial restraints were cited more often as barriers to diagnosis among late-stage presentation patients (55.7%) compared to early-stage patients (35.5%) (p = 0.047). Patients who were diagnosed at late-stage (47.5%) were also more likely to state time restraints as significant barriers to their diagnosis than early-stage patients (25.8%) (p = 0.041). Although the late diagnosis of breast cancer will take immense efforts of policy workers to resolve, this study offers significant opportunities for making immediate health system changes through patient and physician education that can aid in reducing diagnosis delay in Tanzania other low-income developing countries, and low-income communities within the USA.
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- Evidence-Based Medicine (EBM) is properly perceived but its application is still limited in the orthopedic clinical practice: an online survey among the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members. [Journal Article]Knee Surg Sports Traumatol Arthrosc 2019KS
- CONCLUSIONS: The results of this survey highlight the need for further investigation into the main reasons behind the limited diffusion of the EBM approach, despite the medical community's knowledge and interest in the concept. A wider application of EMB would upgrade clinical practice, linking medical knowledge and scientific evidence to patients' needs which would result of benefit to patients, but also more in general to the health system.