Validating LENT score in malignant pleural effusion.

Aim: LENT score was developed to predict survival in malignant pleural effusion (MPE), this study aims to validate this score. Objectives: Validate LENT Prognostic Score for MPE and explore survival in these patients. Methods: Retrospective analysis of 202 patients who had MPE and received drainage between January 2013 and June 2015. Results: Median survival was 2.98 months. Patients were classified according to LENT score as low, moderate and high-risk groups: 5 (4.2%), 61 (50.8%), and 54 (45%), respectively. Kaplan-Meier curve showed median survival for each group: 9.41, 5.36 and 0.56 months, respectively, p-values <0.001. AUC for 1, 3 and 6 months: 0.741, 0.781, 0.790, respectively, p-values <0.001. Conclusion: LENT score is valid for predicting survival in patients with MPE.

Place of death for patients treated at a tertiary cancer center in Jordan.

BACKGROUND: Home death is considered to be a marker of good death. Little is known about the place of death and its determinants in patients with cancer in Jordan. METHODS: A retrospective analysis of regularly collected data of cancer patients who had a palliative care consultation at King Hussein Cancer Center and died between 2011 and 2012. Variables analyzed were related to the patient, disease, and palliative care services. Patient-related factors included age at death, gender, place of residence, and code status; disease-related variables were cancer type (solid vs hematological), major primary site, and time from cancer diagnosis to death; palliative care service-related variables included time of consultation for palliative care services to death, location of first palliative encounter (outpatient clinic vs hospital floor), multidisciplinary palliative home care teams involvement, and the number of home care visits before death. We examined the association between each variable and place of death using Pearson's chi-square and the Mann-Whitney tests. Factors with statistical significance of P value < 0.1 were entered into multivariate logistic regression model. RESULTS: Among 630 patients, 80 (12.7%) died at home. Univariate analysis showed the following to be significantly associated with dying at home: male gender, age more than 65 years old, earlier palliative care involvement, and involvement of home care services (P value < 0.05). Independent predictors for dying at home were male gender, age more than 65 years old, and involvement of home care services. CONCLUSIONS: Hospital death is more prevalent than home death in cancer patients in Jordan. Involvement of home care services can help achieve the goal of dying at home.

Prediction of Survival Following Percutaneous Biliary Drainage for Malignant Biliary Obstruction.

BACKGROUND AND OBJECTIVES: Percutaneous transhepatic biliary drain is an intervention used to relieve malignant biliary obstruction. This study aims to explore survival after biliary drain insertion, predictive factors of survival and effectiveness to reduce total bilirubin level. METHODS: We conducted a retrospective analysis of 72 patients who had malignant biliary obstruction and received biliary drain during the time period between March 2005 and February 2015. RESULTS: Median patients' age was 56 years. 38 (52.7%) were males, 34(47.2%) were females. Median survival post biliary drain insertion was 46 days, 95% C/I (37.92-54.02), range (2-453 days). 1, 3, and 6 month survival rates were 64.7%, 26.5%, and 7.4% respectively. Multivariate analysis by Cox proportional hazards regression model showed the presence of ascites to be significant predictors of survival, other factors analyzed were: total bilirubin, serum creatinine, international normalization ratio, serum albumin, pleural effusion and liver metastasis. CONCLUSION: Survival after biliary drain insertion can vary from few days to few months. Presence of ascites is an independent predictor of survival after this intervention.

Symptom Prevalence of Patients with Cancer in a Tertiary Cancer Center in Jordan.

BACKGROUND: Prevalence of symptoms experienced by patients with cancer was studied in different parts of the world. In Jordan, to the best of our knowledge, there is no published data on the prevalence of symptoms among patients with cancer. The aim of this study is to estimate the prevalence of symptoms among patients with cancer in Jordan. METHOD: This was a secondary analysis of crosssectional survey that evaluate the psychometric properties of the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care (EORTC QLQ-C15-PAL) among patients admitted to a tertiary cancer center in Jordan. RESULTS: A total of 175 patients with cancer participated in the study; 51.4% were males, 48.6 % were females, mean age of patients was 50 years. Median number of symptoms per patient was 6, interquartile range was 5-7. The majority of patients (143; 81%) had more than 3 non-pain symptoms each. The most frequently reported symptom was tiredness (82%), whereas the least prevalent symptom was depression (55%). Pain was prevalent in 71% of patients, median severity score was 50%. CONCLUSION: Patients with cancer suffer from a large constellation of symptoms, frequent assessment with a designated tool can help early identification of these symptoms and subsequent management. This highlights the need for integrated palliative services along with other health care provision.

Ileocolic Intussusception in a Leukemic Adult Patient: A Case Report and Review of the Literature.

We present a rare case of intussusception in a 41-year-old man with acute myeloid leukemia without an evidence of leukemic infiltration of the bowel. The patient presented to the emergency room with right lower quadrant pain. Initially he was diagnosed with typhlitis. CT scan was done and showed ileocolic intussusception without a definitive lead point identified. Patient underwent hemicolectomy and histopathological study of the specimen did not show any leukemic infiltrate. High suspicion of intussusception should be kept in mind with leukemic patients presenting with abdominal pain.

Clinical Factors Associated With a Short Survival Time After Percutaneous Nephrostomy for Ureteric Obstruction in Cancer Patients: An Updated Model.

CONTEXT: Patients with advanced cancer can develop ureteric obstruction. Percutaneous nephrostomy (PCN) tube insertion can relieve this obstruction and prevent renal failure. PCN is associated with complications and can worsen quality of life. Prognostic models of survival after PCN in cancer patients can help identify the patients who will most likely benefit from this intervention. This work updates a prognostic model to predict overall survival in cancer patients after receiving PCN. OBJECTIVES: The primary objective was to assess survival of patients with malignant urinary obstruction after PCN tube insertion. The secondary objective was to identify factors associated with poor prognosis in this group of patients and externally validate an existing model. METHODS: We conducted a retrospective analysis of 211 patients who had malignant urinary obstruction and received PCN tube insertion. RESULTS: The median survival was 5.05 months (95% CI = 3.87-7.11; range 2-963 days). On univariate analysis, the factors significantly associated with shorter survival were type of malignancy, bilateral hydronephrosis, serum albumin <3.5 mg/dL, presence of metastasis, ascites, and pleural effusion (P < 0.05). Multivariate analysis using a Cox proportional hazards regression model showed that type of malignancy, serum albumin <3.5 mg/dL, pleural effusion, and bilateral hydronephrosis were significantly associated with shorter survival (P < 0.05). Using the latter three factors, we stratified patients into four prognostic groups: zero risk factors (32 patients), one risk factor (85 patients), two risk factors (78 patients), and three risk factors (16 patients). Median survival for each group was 17.6 months, 7.7 months, 2.2 months, and 1.7 months, respectively (P < 0.0001). CONCLUSION: Survival in patients with malignant ureteric obstruction can range widely from a few days to a few years. The presented prognostic model is an updated model and can be used to identify patients with poor survival after PCN.

Psychometric properties of the Arabic version of EORTC QLQ-C15-PAL among cancer patients in Jordan.

PURPOSE: Health related quality of life (HRQOL) is an important outcome in cancer care and needs assessment by a valid questionnaire. HRQOL questionnaires need to be validated after translations to other languages and cultural settings. The purpose of this study is to evaluate the psychometric properties of the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care (EORTC QLQ-C15-PAL). METHODS: This is a cross-sectional study of a convenient sample of inpatients with cancer. RESULTS: One hundred seventy-five patients completed the EORTC QLQ-C15-PAL questionnaire. Cronbach's alpha coefficient met the 0.7 alpha criterion. Confirmatory factor analysis met the goodness of fit criteria; goodness-of-fit index (GFI), comparative fit index (CFI), normed fit index (NFI) and non-normed fit index (NNFI) >0.90 and root mean square error of approximation (RMSEA) <0.06. All item-scale correlation coefficients exceeded the set value of 0.40, indicating satisfactory convergent validity. In terms of discriminant validity, all items in the questionnaire showed a higher item-scale correlation than item-other scale correlation, except for items 1 and 2 (physical function scale) that showed a higher correlation with fatigue. Construct validity was tested by item inter scale correlation coefficient. All constructs had correlation coefficient <0.70. External validity was tested by comparison of scores of patients who had metastasis and who did not have metastasis. Significant differences (P value <0.05) were found in all scales except for nausea. Age groups were compared and showed significant differences for physical function, fatigue, and global score of HRQOL. CONCLUSION: The Arabic version of the EORTC QLQ-C15-PAL is valid and reliable.

An educational game for teaching clinical practice guidelines to Internal Medicine residents: development, feasibility and acceptability.

BACKGROUND: Adherence to Clinical Practice Guidelines (CPGs) remains suboptimal among internal medicine trainees. Educational games are of growing interest and have the potential to improve adherence to CPGs. The objectives of this study were to develop an educational game to teach CPGs in Internal Medicine residency programs and to evaluate its feasibility and acceptability. METHODS: We developed the Guide-O-Game(c) in the format of a TV game show with questions based on recommendations of CPGs. The development of the Guide-O-Game(c) consisted of the creation of a multimedia interactive tool, the development of recommendation-based questions, and the definition of the game's rules. We evaluated its feasibility through pilot testing and its acceptability through a qualitative process. RESULTS: The multimedia interactive tool uses a Macromedia Flash web application and consists of a manager interface and a user interface. The user interface allows the choice of two game styles. We created so far 16 sets of questions relating to 9 CPGs. The pilot testing proved that the game was feasible. The qualitative evaluation showed that residents considered the game to be acceptable. CONCLUSION: We developed an educational game to teach CPGs to Internal Medicine residents that is both feasible and acceptable. Future work should evaluate its impact on educational outcomes.