A pilot survey into the landscape of neuro-oncology care in the community.

BACKGROUND: The complexities of the field of neuro-oncology require multidisciplinary collaboration in order to deliver contemporary comprehensive care. There is increasing awareness that much of neuro-oncology care occurs in the community setting. In 2022, the Society for Neuro-Oncology (SNO) created the Community Neuro-Oncology Committee (CNO) in an inaugural attempt to formally acknowledge community neuro-oncology practitioners. METHODS: A 19 question survey was developed by SNO-CNO to gather initial data on the current landscape of neuro-oncology care in the community. The survey was distributed via the SNO newsletter and email blasts as well as through partnerships with multiple advocacy groups. Results were analyzed and tabulated through R2. RESULTS: There were 112 responses from providers in the United States and Canada. Most providers were physicians and represented multiple disciplines including neurology, neuro-oncology, medical oncology, neurosurgery, and radiation oncology. Sixty-four (57%) described themselves as neuro-oncology-focused. Eighty-eight (79%) reported access to neuro-oncology tumor boards. Sixty-eight (73%) stated they had access to molecular tumor boards. Most respondents felt that they were adequately supported to manage neuro-oncology patients. When dividing responses based on a neuro-oncology-focused practice compared to a less neuro-oncology-focused practice, there were significant differences between access to molecular tumors boards (85% vs 63%, P = .023) and access to clinical trials (98% vs 82%, P = .022). CONCLUSION: This qualitative and quantitative hypothesis-generating data is the start of understanding the challenges faced by community neuro-oncology providers. These results will guide future studies and recommendations aimed toward better supporting them and their patients

Abemaciclib in combination with therapies for patients with metastatic breast cancer: a phase 1b study.

BACKGROUND: The oral, selective, and potent small molecule cyclin-dependent kinases (CDK) 4/6 inhibitor (CDK4/6i) abemaciclib has demonstrated efficacy in advanced breast cancer and high-risk early breast cancer. This Phase 1b study evaluated the safety, tolerability, pharmacokinetics, and antitumor activity of abemaciclib in combination with endocrine therapies (Parts A-D), exemestane + everolimus (Part E), or fulvestrant + LY3023414 (a PI3K/mTOR inhibitor; Part G) in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC), or trastuzumab (Part F), or trastuzumab + pertuzumab (Part H) in patients with HER2-positive (HER2+) MBC. PATIENTS AND METHODS: This study enrolled women aged ≥18 years old with either HR+, HER2- (Parts E and G), or HER2+ (Parts F and H) MBC. Additional requirements included measurable disease or non-measurable but evaluable bone disease (Parts E and F), or measurable disease (Parts G and H), an Eastern Cooperative Oncology Group performance status of 0-1, and no prior treatment with CDK4/6i (Parts E, F, and H). Adverse events were graded, and tumor response was assessed. RESULTS: Nineteen patients in Part E received abemaciclib (150 mg, n=15; 200 mg, n=4) with exemestane + everolimus, 24 patients in Part F received abemaciclib (150 mg, n=18; 200 mg, n=6) with trastuzumab, 12 patients in Part G received 150 mg abemaciclib with fulvestrant + LY3023414 (100 mg, n=7; 150 mg, n=5), and four patients in Part H received abemaciclib (100 mg) with trastuzumab + pertuzumab (with prophylactic loperamide). The most common treatment-emergent adverse events (TEAEs) were diarrhea, fatigue, neutropenia, and nausea. Grade ≥3 TEAEs were reported in 16, 18, 10, and 4 patients in Parts E-H, respectively. Abemaciclib had no effect on the pharmacokinetics of the combination study drugs. The objective response rates for patients with measurable disease were 46.2%, 10.0%, 66.7%, and 25.0% in Parts E-H, respectively. A recommended Phase 2 dose was not established for Parts E, G, and H at the dose levels evaluated, and was determined to be 150 mg Q12H in Part F. CONCLUSIONS: Overall, our results demonstrate safety profiles consistent with those previously established for abemaciclib and provide preliminary data for these combination therapies in the treatment of HR+, HER2- or HER2+ MBC

Enhancing Patient Experience in the Emergency Department Through Nurse Bundling Strategies and Servant Leadership Principles: A Quality Improvement Project.

Background: U.S. federal regulations have shifted health care systems to focus more on providing quality of care than quantity of care. Patient experiences that include nursing communication are important quality measures that have a positive impact on satisfaction ratings. Objective: This quality improvement project aimed to demonstrate that using nurse bundling strategies and employing servant leadership principles to influence nurses\u27 caring behaviors toward patient care may improve patients\u27 ratings on treatment with courtesy and respect. Methods: Registered nurses (RNs) in the emergency department (ED) were observed for 8 weeks in January 2020 using validated measurement tools and completed an electronic, 23-item Servant Leadership Questionnaire (SLQ) survey. Results: Bedside shift reporting observations were the lowest reported strategy. The Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey results did not improve from the previous quarter\u27s data but increased and sustained in the three following quarters. The SLQ survey demonstrated statistically significant increases (p = .0191) from preintervention to postintervention. Conclusion: Though RNs were aware of servant leadership principles, further exploration is warranted to strengthen structures and processes related to nurse bundling strategies and the development of other ED-specific measurement tools and the patients\u27 perception of courtesy and respect, an HCAHPS measure. Implications for Nursing: Expanding RN sample size, including other ED staff members, performing random leadership rounding, and using ED-specific measurement tool are nursing implications

Improving Clinical Care for Cochlear Implant Recipients: The Coupling of Health-Related-Quality-of-Life and Clinical Speech Measures

https://digitalcommons.providence.org/swedish_fish_2025/1004/thumbnail.jp

Virtual Hospital Follow-up: Effects on 30-day Readmission and Patient Satisfaction

https://digitalcommons.providence.org/swedish_fish_2025/1002/thumbnail.jp

Impact of Gum Chewing on Postoperative Ileus Following Open Heart Surgery

https://digitalcommons.providence.org/swedish_fish_2025/1014/thumbnail.jp

Cushing\u27s Disease Clinical Phenotype and Tumor Behavior Vary with Age: Diagnostic and Perioperative Implications.

CONTEXT: Little is known about presenting clinical characteristics, tumor biology, and surgical morbidity of Cushing\u27s disease (CD) with aging. OBJECTIVE: Using a large multi-institutional dataset, we assessed diagnostic and prognostic significance of age in CD through differences in presentation, laboratory results, tumor characteristics, and postoperative outcomes. DESIGN: Data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) were reviewed for patients with CD treated with transsphenoidal tumor resection at 11 centers between 2003 and 2023. Outcomes assessed included comorbidities, presenting features, preoperative endocrine evaluations, perioperative characteristics, postoperative endocrine laboratory values, and complications. RESULTS: Of the 608 patients evaluated, 496 (81.6%) were female; median age at surgery was 44 years (range, 10-78). Increasing age was associated with increasing comorbidities, frailty, rates of postoperative thromboembolic disease, Knosp grade, tumor size, and postoperative cortisol and ACTH nadirs. Conversely, increasing age was associated with decreased hallmark CD features, preoperative 24-hour urinary free cortisol, Ki-67 indices, and arginine vasopressin deficiency. Younger patients presented more frequently with weight gain, facial rounding/plethora, abdominal striae, hirsutism, menstrual irregularities, dorsocervical fat pad, and acne. Obstructive sleep apnea and infections were more common with increasing age. CONCLUSIONS: There are age-dependent differences in clinical presentation, tumor behavior, and postoperative outcomes in patients with CD. Compared to younger patients, older patients present with a less classical phenotype characterized by fewer hallmark features, more medical comorbidities, and larger tumors. Notably, age-related differences suggest a more indolent tumor behavior in older patients, potentially contributing to delayed diagnosis and increased perioperative risk. These findings underscore the need for tailored diagnostic and therapeutic approaches across age groups, with a focus on managing long-term comorbidities and optimizing surgical outcomes