Palliative Workforce Development and a Regional Training Program.

Aims: Our primary aims were to assess growth in the local hospital based workforce, changes in the composition of the workforce and use of an interdisciplinary team, and sources of support for palliative medicine teams in hospitals participating in a regional palliative training program in Chicago.

Methods: PC program directors and administrators at 16 sites were sent an electronic survey on institutional and PC program characteristics such as: hospital type, number of beds, PC staffing composition, PC programs offered, start-up years, PC service utilization and sources of financial support for fiscal years 2012 and 2014.

Results: The median number of consultations reported for existing programs in 2012 was 345 (IQR 109 - 2168) compared with 840 (IQR 320 - 4268) in 2014.

The Use of Structural Distal Femoral Allograft for Acetabular Reconstruction of Paprosky Type IIIA Defects at a Mean 21 Years of Follow-Up.

Background: Revision total hip arthroplasty in patients with a nonsupportive superior acetabulum often requires secondary augmentation beyond a hemispherical cup to achieve reliable fixation. Treatment options include using a higher hip center, jumbo cup, custom triflange implant, cages, or filling the superior defect with a bilobed implant, structural allograft, or metal augments. We previously reported a cohort of 31 patients treated with porous-coated hemispherical cups and distal femoral allograft for Paprosky type IIIA acetabular defects.

Predictive model for survival in patients having repeat radiation treatment for painful bone metastases.

Purpose: To establish a survival prediction model in the setting of a randomized trial of re-irradiation for painful bone metastases.

Methods: Data were randomly divided into training and testing sets with an approximately 3:2 ratio. Baseline factors of gender, primary cancer site, KPS, worst-pain score and age were included with backward variable selection to derive a model using the training set.

Revisiting classification of pain from bone metastases as mild, moderate, or severe based on correlation with function and quality of life.

Purpose: The objective of our study was to determine the optimal cut points for classification of pain scores as mild, moderate, and severe based on interference with function and quality of life (QOL).

Methods: We evaluated 822 patients who completed the Brief Pain Inventory (BPI) and/or the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 30 (QLQ-C30) prior to receiving repeat radiation therapy for previously irradiated painful bone metastases. Optimal cut points for mild, moderate, and severe pain were determined by the MANOVA that yielded the largest F ratio for the between category effect on the seven interference items of BPI and the six functional domains of QOL (physical, role, emotional, cognitive, social functioning, and global QOL) as indicated by Pillai's Trace, Wilk's λ, and Hostelling's Trace F statistics.

High rate of microbleed formation following primary intracerebral hemorrhage.

Background: We sought to investigate the frequency of microbleed development following intracerebral hemorrhage in a predominantly African-American population and to identify predictors of new microbleed formation.

Aims And/or Hypothesis: To investigate the frequency and predictors of new microbleeds following intracerebral hemorrhage.

Methods: The DECIPHER study was a prospective, longitudinal, magnetic resonance-based cohort study designed to evaluate racial/ethnic differences in risk factors for microbleeds and to evaluate the prognostic impact of microbleeds in this intracerebral hemorrhage population.

Stroke volume optimization: the new hemodynamic algorithm.

Critical care practices have evolved to rely more on physical assessments for monitoring cardiac output and evaluating fluid volume status because these assessments are less invasive and more convenient to use than is a pulmonary artery catheter. Despite this trend, level of consciousness, central venous pressure, urine output, heart rate, and blood pressure remain assessments that are slow to be changed, potentially misleading, and often manifested as late indications of decreased cardiac output. The hemodynamic optimization strategy called stroke volume optimization might provide a proactive guide for clinicians to optimize a patient's status before late indications of a worsening condition occur.

Phase II study of panobinostat in combination with bevacizumab for recurrent glioblastoma and anaplastic glioma.

Background: Panobinostat is a histone deacetylase inhibitor with antineoplastic and antiangiogenic effects in glioma that may work synergistically with bevacizumab. We conducted a multicenter phase II trial of panobinostat combined with bevacizumab in patients with recurrent high-grade glioma (HGG).

Methods: Patients with recurrent HGG were treated with oral panobinostat 30 mg 3 times per week, every other week, in combination with bevacizumab 10 mg/kg every other week.

Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomized trial.

Purpose: We previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. It is unknown whether alleviating pain also improves patient perception of quality of life (QOL).

Patients And Methods: We used the database of a randomized trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPI-PS), is associated with patient perception of benefit, as measured using the European Organisation for Resesarch and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI).

Exploring hemodynamics: a review of current and emerging noninvasive monitoring techniques.

The lack of randomized controlled trials suggesting improved outcomes with pulmonary artery catheter use and pressure-based hemodynamic monitoring has led to a decrease in pulmonary artery catheter use. However, an increasing amount of literature supporting stroke volume optimization (SVO) has caused a paradigm shift from pressure-based to flow-based techniques. This article discusses emerging flow-based techniques, supporting evidence, and considerations for use in critical care for methods such as Doppler, pulse contour, bioimpedance, bioreactance, and exhaled carbon dioxide.

Comparison of transperineal mapping biopsy results with whole-mount radical prostatectomy pathology in patients with localized prostate cancer.

Objective. We sought to evaluate the accuracy of transperineal mapping biopsy (TMB) by comparing it to the pathology specimen of patients who underwent radical prostatectomy (RP) for localized prostate cancer. Methods.

Serum free light chains, interferon-alpha, and interleukins in systemic lupus erythematosus.

Objective: Interleukin-6 (IL-6), interleukin-10 (IL-10), interferon-alpha (IFN-α), and free light chains (FLCs: lambda, kappa) have all been noted to be of importance in systemic lupus erythematosus (SLE). Herein, we quantified and explored the relationship between these inflammatory mediators and disease activity in SLE; and stratified by their current anti-dsDNA antibody status.

Methods: Seventy-seven SLE patients underwent assessment of disease activity using the SLE disease activity index (SLEDAI).

Enhancement of the subtemporal approach by partial posterosuperior petrosectomy with hearing preservation.

Background: The microsurgical management of aneurysms in the interpeduncular and ambient cisterns remains challenging. The classic subtemporal approach has several limitations.

Objective: To present a modification of this approach that allows for broader exposure with hearing preservation.

Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial.

Background: Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy.

Methods: We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide.

Cognitive and motor function in long-duration PARKIN-associated Parkinson disease.

Importance: Data on the long-term cognitive outcomes of patients with PARKIN-associated Parkinson disease (PD) are unknown but may be useful when counseling these patients.

Objective: Among patients with early-onset PD of long duration, we assessed cognitive and motor performances, comparing homozygotes and compound heterozygotes who carry 2 PARKIN mutations with noncarriers.

Design, Setting, And Participants: Cross-sectional study of 44 participants at 17 different movement disorder centers who were in the Consortium on Risk for Early-Onset PD study with a duration of PD greater than the median duration (>14 years): 4 homozygotes and 17 compound heterozygotes (hereafter referred to as carriers) and 23 noncarriers.

Results of the 2012-2013 Association of Residents in Radiation Oncology (ARRO) job search and career planning survey of graduating residents in the United States.

Purpose/objective(s): To determine the timeline used by postgraduate year (PGY)-5 radiation oncology residents during the job application process and the factors most important to them when deciding on a first job.

Methods And Materials: In 2012 and 2013, the Association of Residents in Radiation Oncology conducted a nationwide electronic survey of PGY-5 radiation oncology residents in the United States during the final 2 months of their training. Descriptive statistics are reported.

Amiodarone-induced thyrotoxicosis in adults with congenital heart disease--clinical presentation and response to therapy.

Objective: The development of amiodarone-induced thyrotoxicosis (AIT) can threaten the hemodynamic stability of adult patients with congenital heart disease (CHD). Here, we describe the natural history and treatment response of AIT in this at-risk population.

Methods: We studied retrospectively all cases of AIT that occurred in CHD patients at our institution after a minimum of 3 months on amiodarone.

The effect of payer type on clinical outcomes in total knee arthroplasty.

This was a retrospective cohort analysis of 112 patients undergoing primary total knee arthroplasty, wherein baseline demographics, resource utilization, and outcomes were compared by insurance type: Medicaid, Medicare, or private. At the time of surgery, Medicaid patients were younger (P<.0001) and had lower preoperative Knee Society Scores than Medicare and private patients (P=.

Decline in tested and self-reported cognitive functioning after prophylactic cranial irradiation for lung cancer: pooled secondary analysis of Radiation Therapy Oncology Group randomized trials 0212 and 0214.

Purpose: To assess the impact of prophylactic cranial irradiation (PCI) on self-reported cognitive functioning (SRCF), a functional scale on the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30).

Methods And Materials: Radiation Therapy Oncology Group (RTOG) protocol 0214 randomized patients with locally advanced non-small cell lung cancer to PCI or observation; RTOG 0212 randomized patients with limited-disease small cell lung cancer to high- or standard-dose PCI. In both trials, Hopkins Verbal Learning Test (HVLT)-Recall and -Delayed Recall and SRCF were assessed at baseline (after locoregional therapy but before PCI or observation) and at 6 and 12 months.

ALK+ Anaplastic Large Cell Lymphoma With Bladder Involvement Presenting as Fever of Unknown Origin: A Case Report and Literature Review.

Anaplastic large cell lymphoma (ALCL) is a rare malignant tumor normally originating in lymph nodes, though it can occur in extranodal sites. We report a 59-year-old man with anaplastic lymphoma kinase (ALK) positive ALCL involving the bladder diagnosed post-mortem who presented with fever of unknown origin. This is the seventh reported case of ALCL presenting as a bladder neoplasm.

Persistent sciatic artery presenting with limb ischemia.

The persistent sciatic artery (PSA) is a rare but clinically significant congenital vascular anomaly. Clinical presentation varies and PSA can cause a number of complications, including limb loss. We describe the presenting features and treatments in two patients.

Evaluating the effectiveness of pediatric pain management guidelines.

In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain.