Spine Stereotactic Body Radiation Therapy in Geriatric Patients: Implications of Age and Dose on Iatrogenic Vertebral Compression Fracture Risk.

Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for spinal metastases; however, outcomes specific to a geriatric population have not been described. This study aims to investigate the efficacy and safety of spine SBRT, in particular the rate of iatrogenic vertebral compression fracture (VCF), in patients aged 70 and older.

Patients And Methods: From a prospectively maintained single-institutional database of 976 patients and 2407 spinal segments treated with SBRT for vertebral metastases between 2008 and 2021, all patients aged 70 or above were retrospectively reviewed.

Differentiating Separate Primary Lung Adenocarcinomas From Intrapulmonary Metastases With Emphasis on Pathological and Molecular Considerations: Recommendations From the International Association for the Study of Lung Cancer Pathology Committee.

Introduction: With the implementation of low-dose computed tomography screening, multiple pulmonary tumor nodules are diagnosed with increasing frequency and the selection of surgical treatments versus systemic therapies has become challenging on a daily basis in clinical practice. In the presence of multiple carcinomas, especially adenocarcinomas, pathologically determined to be of pulmonary origin, the distinction between separate primary lung carcinomas (SPLCs) and intrapulmonary metastases (IPMs) is important for staging, management, and prognostication.

Methods: We systemically reviewed various means that aid in the differentiation between SPLCs and IPMs explored by histopathologic evaluation and molecular profiling, the latter includes DNA microsatellite analysis, array comparative genomic hybridization, TP53 and oncogenic driver mutation testing and, more recently, with promising effectiveness, next-generation sequencing comprising small- or large-scale multi-gene panels.

Delayed diagnosis to treatment interval (DTI) in head & neck cancers - A systematic review and meta-analysis.

Introduction: Delayed diagnosis to treatment interval (DTI) in head and neck cancers (HNC) can significantly impact patient outcomes. The need for multimodal treatment in HNC may cause delays in initiation of treatment. This systematic review aims to provide a comprehensive understanding of the consequences of delayed DTI on both oncologic and QoL outcomes, proposing a new quality benchmark along the treatment continuum of HNC patients.

An International Factorial Vignette-Based Survey of Intubation Decisions in Acute Hypoxemic Respiratory Failure.

Objectives: Intubation is a common procedure in acute hypoxemic respiratory failure (AHRF), with minimal evidence to guide decision-making. We conducted a survey of when to intubate patients with AHRF to measure the influence of clinical variables on intubation decision-making and quantify variability.

Design: Factorial vignette-based survey asking "Would you recommend intubation?" Respondents selected an ordinal recommendation from a 5-point scale ranging from "Definite no" to "Definite yes" for up to ten randomly allocated vignettes.

The Family Snapshot-Innovation to integrate family context into daily interactions in the NICU.

Aim: Current literature favours individualised decision making, an approach that requires understanding patients within their context and tailoring treatment and recommendations to their unique needs. In neonatology, family context becomes synonymous with patient context. In the neonatal intensive care unit (NICU), the team may be challenged to understand the intricacies of the family context, paramount for both families and clinicians.

Depression, Obstructive Sleep Apnea and Cognitive Impairment (DOC) Screen Completion Time Reflects Executive Function, Speed of Processing and Fluency.

Background: The depression, obstructive sleep apnea and cognitive impairment (DOC) screen assesses three post-stroke comorbidities, but additional information may be gained from the time to complete the screen. Cognitive screening completion time is rarely used as an outcome measure.

Objective: To assess DOC screen completion time as a predictor of cognitive impairment in stroke/transient ischemic attack clinics.

Accuracy of the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among vaccinated and unvaccinated patients infected with Omicron: a cohort study.

Objective: The objective is to externally validate and assess the opportunity to update the Canadian COVID-19 Mortality Score (CCMS) to predict in-hospital mortality among consecutive non-palliative COVID-19 patients infected with Omicron subvariants at a time when vaccinations were widespread.

Design: This observational study validated the CCMS in an external cohort at a time when Omicron variants were dominant. We assessed the potential to update the rule and improve its performance by recalibrating and adding vaccination status in a subset of patients from provinces with access to vaccination data and created the adjusted CCMS (CCMS).

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.

Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.

Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.

Failure of Ventricular Fibrillation Sensing During Subcutaneous Implantable Defibrillator Testing: A Twitchy Situation.

Oversensing of extra-cardiac noise may inhibit delivery of subcutaneous cardiac implantable defibrillator (S-ICD) therapy. We report a case of diaphragmatic tetany resulting in the inhibition of S-ICD therapy at the time of defibrillator testing without the use of muscle relaxants. Clinicians should be aware of this phenomenon.

Supportive care strategies in myelodysplastic syndromes and acute myeloid leukemia in older adults: a national survey of Canadian hematologists.

Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are severe myeloid disorders associated with significant morbidity and mortality. Because of patient and disease factors, many older adults are treated as outpatients with less-intensive therapy. Optimal supportive care strategies to minimize bleeding and infectious complications in this patient population have not been systematically evaluated.

International Comparison of Quality Indicators for Adults Hospitalized for Heart Failure: A Systematic Review.

Background: There is limited international agreement on defining care quality for the millions of people hospitalized with heart failure worldwide. Our objective was to compare and measure agreement across existing internationally published quality indicators (QIs) for the care of adults hospitalized for heart failure.

Methods: Systematic review and evidence gap map of internationally published articles reporting on QIs for adults hospitalized for heart failure, using PubMed, MEDLINE, EMBASE, and TRIP from inception to July 18, 2022.

Homocysteine, neurodegenerative biomarkers, and APOE ε4 in neurodegenerative diseases.

Introduction: Elevated plasma homocysteine (Hcy) is associated with an increased risk of developing neurodegenerative diseases; however, its relationship with the apolipoprotein E (APOE) ε4 allele has not been well characterized.

Methods: Participants clinically diagnosed with Alzheimer's disease or mild cognitive impairment (AD/MCI), frontotemporal dementia, Parkinson's disease, or cerebrovascular disease were stratified by the presence of the APOE ε4 allele. Volumetric magnetic resonance imaging, plasma amyloid/tau/neurodegeneration biomarkers, and cognitive performance were quantified.

Association Between Sociodemographic Factors and Self-Reported Diabetic Retinopathy: A Cross-sectional, Population-Based Analysis.

Purpose: This study aimed to investigate the relationship between sociodemographic and healthcare access factors with self-reported diabetic retinopathy (DR) prevalence in a nationally representative sample of the United States.

Design: This is a population based, cross-sectional analysis.

Methods: Data from those who answered the question, "Have you ever been told by a doctor or other health professional that you had diabetic retinopathy?" from the 2017 National Health Interview Survey (NHIS) was analyzed through logistic regression to examine the association between DR prevalence and social determinants of health (SDH).

Correlation of CTCAE and patient-reported breast radiation dermatitis symptom scores.

Background And Purpose: Clinicians use the CTCAE scale to grade radiation dermatitis (RD) based on edema, erythema, and desquamation. The purpose of this study was to correlate the CTCAE scores with the severity of patient-reported symptoms using a skin symptom assessment (SSA) and the Radiation-Induced Skin Reaction Assessment Scale (RISRAS).

Materials And Methods: This is a secondary analysis of a randomized controlled trial involving 376 patients receiving Mepitel Film or standard-of-care for RD prophylaxis.

Changes in functional status during and after pregnancy in people with cerebral palsy: An international observational study.

Background: There is limited information surrounding physical changes people with cerebral palsy (CP) experience during pregnancy.

Methodology: This is a subgroup analysis of an international online questionnaire, developed with input from individuals with CP. Data collection included demographics, baseline functional status, and functional status changes during pregnancy.

Development and validation of a clinical prediction tool to estimate survival in community-dwelling adults living with dementia: a protocol.

Introduction: A clinical prediction tool to estimate life expectancy in community-dwelling individuals living with dementia could inform healthcare decision-making and prompt future planning. An existing Ontario-based tool for community-dwelling elderly individuals does not perform well in people living with dementia specifically. This study seeks to develop and validate a clinical prediction tool to estimate survival in community-dwelling individuals living with dementia receiving home care in Ontario, Canada.

Sex-Related Differences in Speaker Introductions at Ophthalmology Grand Rounds.

Purpose: Sex bias remains a pervasive reality in academic medicine, often reflected in subtle linguistic choices, which can skew perceptions of competence and perpetuate workplace inequity. This study aims to investigate the relationship between host sex, speaker sex, and speaker introduction practices in ophthalmology grand rounds events.

Design: Cross-sectional study.

The effect of surgical management in mitigating fragility fracture risk among individuals with primary hyperparathyroidism.

Background: Primary hyperparathyroidism predominately affects women who are postmenopausal and causes complications, including fragility fractures. Its treatment is parathyroidectomy, which is associated with low complication and >95% cure rates. Considering fractures are associated with premature death, we aimed to determine whether the surgical management of individuals with biochemical diagnosis of primary hyperparathyroidism was associated with a reduction in fracture risk.

Sequential Grafting of the Left Internal Thoracic Artery to the Left Anterior Descending Artery and Graft Failure.

Background: There is concern that left internal thoracic artery (LITA)-to diagonal (D)-to left anterior descending artery (LAD) grafts may be more susceptible to failure compared with single LITA-LAD grafts.

Methods: Pooled individual patient data from 8 clinical trials with systematic graft imaging were analyzed to assess the incidence of sequential LITA-D-LAD vs single LITA-LAD grafts. Mixed-effects multivariable logistic regression, adjusting for patient characteristics and clustering within trials, was used.

Proportion of Gleason Score ≥8 Prostate Cancer on Biopsy and Tumor Aggressiveness in Matched Cohorts of East Asian and Non-East Asian Men.

Background: Historically, Asia had a lower prostate cancer (PCa) incidence and mortality compared with Western countries, but the gap is narrowing. Paradoxically, Asians have been reported to present with more advanced disease though more favorable outcomes. Despite PCa becoming an emerging health priority in East Asia, our knowledge remains limited.

The In-Hospital Code Stroke: A Look Back and the Road Ahead.

With increased patient volumes and complexity, stroke occurrence in hospitalized patients has become relatively more common. The process of activating a code stroke in-hospital differs in many institutions. An emergency team-based response to inpatient acute code stroke is warranted, with many protocols modeled similarly to the cardiac arrest response.

Impact of the COVID-19 pandemic on breast cancer surgeries in a Canadian population.

Purpose: The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level.

Ultrasound-Based Radiation Enhancement: Concepts, Mechanisms and Therapeutic Applications.

Microbubbles have emerged as versatile carriers used both for cancer diagnosis and therapy. Microbubbles in the presence of ultrasound waves undergo cavitation, generating bioeffects near the cell's vicinity. Studies have shown ultrasound-stimulated microbubbles (USMB) to cause mechanical perturbation of endothelial cells, resulting in acid sphingomyelinase (ASMase)-induced ceramide production.