Career Impact of Palliative Care Fellowship Training for Nurse Practitioners.

Background: Postgraduate fellowship training for nurse practitioners (NP) in palliative care can ameliorate workforce shortages; however, currently there are few NP fellowships and little evidence about outcomes, such as retention in hospice and palliative nursing, job satisfaction, or professional contributions. Objective: To describe the impact of palliative care fellowship training on the careers of NP alumni. Methods: A survey was electronically distributed to all NP alumni of an interprofessional palliative care fellowship since adult and pediatric nursing cohorts were added (2009-2022). Results: Most respondents still worked in hospice and/or palliative care; a majority of them engaged in professional activities beyond clinical work and reported high career satisfaction. Alumni endorsed multiple benefits of postgraduate fellowship except for post-fellowship compensation. Conclusions: NP palliative care fellowship alumni reported multiple career benefits including job satisfaction, professional accomplishment, and ongoing employment at their training institutions.

A Three-Step Taxane Titration Protocol Decreases Hypersensitivity Reactions During First and Second Exposures.

INTRODUCTION: Patients receiving taxanes are at risk for developing hypersensitivity reactions (HSRs) primarily during first and second lifetime exposures. Immediate HSRs require emergency care and can interfere with the continuation of preferred treatment. Although different approaches to slow titration have been used successfully for desensitization after HSR occurrence, there are no standardized recommendations for taxane titration to prevent HSRs. PURPOSE: To determine if a gradual, three-step infusion rate titration decreases the rate and severity of immediate HSRs during first and second lifetime exposures to paclitaxel and docetaxel. METHODS: We used a prospective, interventional design with historical comparisons to evaluate a sample of 222 first and second lifetime exposure paclitaxel and docetaxel infusions. The intervention was a three-step infusion rate titration provided at the initiation of first and second lifetime exposures. Ninety-nine titrated infusions were compared with 123 historical records of nontitrated infusions. RESULTS: Compared with the nontitrated group (n = 123), the titrated group (n = 99) had significantly less HSRs (19% v 7%; P = .017). No significant difference in HSR severity was found between groups (P = 1.00). However, four nontitrated patients received epinephrine, and one required transfer to the emergency department (ED) because of reaction severity. In contrast, no titrated patients received epinephrine or required transfer to the ED. In the nontitrated group, seven patients did not complete their infusions versus one patient in the titrated group. CONCLUSION: A standardized, three-step infusion rate titration prevented HSR occurrence. Significant issues affecting practice feasibility and sustainability were addressed.

Mammogram Order Completion Rates Among Women with Diabetes.

INTRODUCTION: Breast cancer is one of the leading causes of death among women residing in the United States. Early detection through mammogram screening can decrease the morbidity and mortality associated with the disease. For women with diabetes, however, incidence and mortality rates of breast cancer are increased. METHODS: This was a retrospective examination, identifying orders and completion of mammogram among patients with and without diabetes, 2015 to 2019, through the electronic health record. Diabetes and other factors were identified as possible predictors of completion. RESULTS: Of the 16,688 patients who were included in this study, only 54.5% successfully completed mammography orders prescribed by their primary care physician. The 40 to 49 age group had the highest order completion rate at 57.6%. The prevalence of diabetes in this sample was 21.3%. Overall, 51.6% of patients with diabetes completed mammogram orders compared with 55.3% of patients without diabetes. DISCUSSION: Patients with diabetes were significantly less likely to complete mammogram screenings (51.6%) compared with patients without diabetes (55.3%), despite there being an increased incidence of breast cancer among patients with diabetes. Factors such as the lack of access to treatment centers, affordability, patient education, among others may have contributed to low completion rates.

Aggressive Central Nervous System Relapse after Autologous Stem Cell Transplant in Multiple Myeloma: Case Reports and Literature Review.

Extramedullary disease is an aggressive presentation at diagnosis and relapse for multiple myeloma (MM) patients. Central nervous system (CNS) is a very rare manifestation of the extramedullary disease, accounting for less than 1% of MM on diagnosis and relapse. Neurological symptoms are unspecific and usually attributed to other causes. We present two patients with CNS-MM at relapse after autologous stem cell transplant highlighting the importance of clinical suspicion and interdisciplinarity at diagnostic workup as well as the need for intensive therapeutic options on such rare and aggressive cases. The presence of neurological abnormalities in anamnesis and physical examination on a patient with MM should always prompt to suspect of a CNS involvement, and active investigation must be undertaken. MRI is the standard radiological method to detect CNS-MM, with histopathological corroboration by stereotactic biopsy and CSF evaluation alongside. Treatment of CNS-MM should include two essential approaches-be able to cross the BBB and treat the systemic disease. There is no standard therapy for this extramedullary relapse, and a tailored and multiple therapy should be promptly started-intrathecal therapy, radiotherapy, and systemic therapy, including an immunomodulator.

Hyperpolarization by activation of halorhodopsin results in enhanced synaptic transmission: Neuromuscular junction and CNS circuit.

Optogenetics offers a unique method to regulate the activity of select neural circuits. However, the electrophysiological consequences of targeted optogenetic manipulation upon the entire circuit remain poorly understood. Analysis of the sensory-CNS-motor circuit in Drosophila larvae expressing eHpHR and ChR2-XXL revealed unexpected patterns of excitability. Optical stimulation of motor neurons targeted to express eNpHR resulted in inhibition followed by excitation of body wall contraction with repetitive stimulation in intact larvae. In situ preparations with direct electrophysiological measures showed an increased responsiveness to excitatory synaptic activity induced by sensory stimulation within a functional neural circuit. To ensure proper function of eNpHR and ChR2-XXL they were expressed in body wall muscle and direct electrophysiological measurements were obtained. Under eNpHR induced hyperpolarization the muscle remained excitable with increased amplitude of excitatory postsynaptic synaptic potentials. Theoretical models to explain the observations are presented. This study aids in increasing the understanding of the varied possible influences with light activated proteins within intact neural circuits.

Malignant melanoma with synchronous thyroid metastases: case report and literature review

SUMMARY Thyroid metastases are rare in clinical practice. We describe the case of an 85-year-old woman who was referred to our department due to a multinodular goiter with compressive symptoms and subclinical hyperthyroidism. The patient was also undergoing evaluation for a polyp in her left nasal cavity, which was then diagnosed as a malignant melanoma of the nasal mucosa. A thoracoabdominal magnetic resonance imaging obtained for cancer staging revealed a > 50% tracheal obstruction caused by the goiter. The patient underwent simultaneous total thyroidectomy and melanoma excision. Histological analysis of the thyroid showed the presence of multiple metastatic foci from the melanoma. Due to the patient’s age, a decision was made to maintain her under surveillance and administer palliative treatment if necessary. Although metastases to the thyroid are rare, they should be considered in the differential diagnosis of thyroid lesions in patients with a known primary tumor. The thyroidectomy, performed in this patient’s case, allowed the diagnosis of the metastases and relief of compressive symptoms caused by the goiter.

Malignant melanoma with synchronous thyroid metastases: case report and literature review.

Thyroid metastases are rare in clinical practice. We describe the case of an 85-year-old woman who was referred to our department due to a multinodular goiter with compressive symptoms and subclinical hyperthyroidism. The patient was also undergoing evaluation for a polyp in her left nasal cavity, which was then diagnosed as a malignant melanoma of the nasal mucosa. A thoracoabdominal magnetic resonance imaging obtained for cancer staging revealed a > 50% tracheal obstruction caused by the goiter. The patient underwent simultaneous total thyroidectomy and melanoma excision. Histological analysis of the thyroid showed the presence of multiple metastatic foci from the melanoma. Due to the patient's age, a decision was made to maintain her under surveillance and administer palliative treatment if necessary. Although metastases to the thyroid are rare, they should be considered in the differential diagnosis of thyroid lesions in patients with a known primary tumor. The thyroidectomy, performed in this patient's case, allowed the diagnosis of the metastases and relief of compressive symptoms caused by the goiter.

Fine needle aspiration in intraocular metastasis from pleuropulmonary blastoma. A case report and a review of the literature.

Pleuropulmonary blastoma (PPB) is a rare primitive intrathoracic malignant neoplasm that occurs almost exclusively in children and adolescents. PPB is classified into three types according to the presence of cystic and solid areas. We report a case of PPB with an intraocular metastasis diagnosed by fine needle aspiration (FNA): 3-year-old female was treated for type II PPB by neoadjuvant chemotherapy and surgery. Four years later, she presented with an intraocular lesion. To differentiate between metastasis or other malignancy, a transcleral FNA was performed and showed two cellular populations represented by roundish malignant cells and spindle-shaped cells. The patient was treated with chemotherapy and diode laser ablation. A year later, the patient had enucleation and rare residual cells were found on the histological specimen. Patient remains disease-free 66 months after the last surgical treatment. Diagn. Cytopathol. 2017;45:156-160. © 2016 Wiley Periodicals, Inc.

Gastric inflammatory fibroid polyp mimicking a gastrointestinal stromal tumour.

Inflammatory fibroid polyp of the gastrointestinal tract is a rare, benign neoplasm, most frequently located in the gastric antrum. Symptoms depend on the location and the size of the lesion. Biopsies are limited for the diagnosis of inflammatory fibroid polyps and diagnosis may not be possible until resection. The authors present a case of a 55-year-old woman, presenting with an upper gastrointestinal bleeding due to a large gastric inflammatory fibroid polyp imitating a gastrointestinal stromal tumor.

Gastric inflammatory fibroid polyp mimicking a gastrointestinal stromal tumor

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Pulmonary aspergillosis diagnosed by endoscopic ultrasound fine-needle aspiration.

Pulmonary aspergillosis generally occurs in patients with prolonged neutropenia or immunosupression. Definitive diagnosis depends on the demonstration of the organism in tissue, as positive culture result from sputum, needle biopsy, or bronchoalveolar lavage fluid. Even though endoscopic ultrasound (EUS) fine needle aspiration (FNA) of paraesophageal/mediastinal lesions has been used numerous times, this is the first case that reports an aspergilloma diagnosed by EUS-FNA, allowing us to reach a definitive diagnosis. We present a patient with a nodular lesion located in the right upper lobe lung, with ground-glass opacity. Upper EUS revealed an ill-defined hypoechoic paraesophageal lesion with a central annular image. Culture results from EUS-FNA were positive for Aspergillus fumigatus. There are no previous reports of EUS imaging features of pulmonary aspergillosis. We believe that this central annular image in an ill-defined hypoechoic paraesophageal lesion may be a characteristic feature.

Neurocognitive effects of childhood cancer treatment.

With changes in the approach to treatment of childhood leukemia and brain tumors, more children are surviving into adulthood. With this increase in long-term survivorship, long-term neurocognitive side effects have emerged. Research has shown that these survivors suffer a variety of neurocognitive effects including changes in attention span, concentration, school performance and executive functioning. Researchers continue to study changes in therapy with the hopes of decreasing these long-term side effects without compromising overall survival rates. Others have focused on developing adaptations to how these children learn, equipping them with tools to better cope with learning deficits. Still, others have looked into pharmacological interventions. This chapter will discuss the historical course of therapy for both leukemia and brain tumors. In addition, it will highlight how late effect studies guided changes in therapeutic approach for both childhood leukemias and brain tumors. This chapter will also discuss specific neurocognitive effects from childhood cancer treatment, challenges in research methodologies as well as current pharmacological and nonpharmacological interventions for affected childhood cancer survivors.