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Context Cutpoints can be used as a threshold for screening symptom(s) that warrant intervention(s) and for monitoring patients’ responses to these interventions. Objectives In a sample of oncology patients undergoing chemotherapy, study purposes were to determine the optimal cutpoints for low, moderate, and high symptom burden and determine if these cutpoints distinguished among the symptom groups in any demographic, clinical, and stress characteristics, as well as QOL outcomes. Methods Total of 1329 patients completed a modified version of the Memorial Symptom Assessment Scale (38 symptoms). Using the methodology of Serlin and colleagues, cutpoints were created using symptom occurrence rates and cancer-specific quality of life (QOL) scores. Cutpoints were validated using measures of stress and resilience and a generic measure of QOL (i.e., Medical Outcomes Study Short Form 12 (SF-12)). Results Of the 25 possible cutpoints evaluated, the optimal cutpoint, with the largest between category F statistic, was CP8,15 (Low = 0–8, Moderate = 9–15, High = 16–38 symptoms). Percentage of patients in the Low, Moderate, and High cutpoint groups were 25.3%, 36.3%, and 38.4%, respectively. Significant differences were found among the symptom burden groups in global, cancer-specific, and cumulative life stress (i.e., Low Moderate > High) scores. Conclusion Our findings provide evidence for clinically meaningful cutpoints that can be used to guide symptom assessment and management. These cutpoints may be used to establish alert thresholds for electronic monitoring of symptoms in oncology patients.

Purpose In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms. Methods Patients (n=1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores. Results Based on the findings from the LPA, 47.3% of the patients were classified as “None”; 33.6% as “Subsyndromal”; 13.8% as “Moderate”; and 5.3% as “High”. Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. Conclusions Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.

Cancer-related cognitive impairment (CRCI) is a significant problem for patients receiving chemotherapy. While a growing amount of pre-clinical and clinical evidence suggests that inflammatory mechanisms underlie CRCI, no clinical studies have evaluated for associations between CRCI and changes in gene expression. Therefore, the purpose of this study was to evaluate for differentially expressed genes and perturbed inflammatory pathways across two independent samples of patients with cancer who did and did not report CRCI. The Attentional Function Index (AFI) was the self-report measure used to assess CRCI. AFI scores of5 and of7.5 indicate low versus high levels of cognitive function, respectively. Of the 185 patients in Sample 1, 49.2% had an AFI score of5 and 50.8% had an AFI score of7.5. Of the 158 patients in Sample 2, 50.6% had an AFI score of5 and 49.4% had an AFI score of7.5. Data from 182 patients in Sample 1 were analyzed using RNA-seq. Data from 158 patients in Sample 2 were analyzed using microarray. Twelve KEGG signaling pathways were significantly perturbed between the AFI groups, five of which were signaling pathways related to inflammatory mechanisms (e.g., cytokine-cytokine receptor interaction, tumor necrosis factor signaling). This study is the first to describe perturbations in inflammatory pathways associated with CRCI. Findings highlight the role of cytokines both in terms of cytokine-specific pathways, as well as pathways involved in cytokine production and cytokine activation. These findings have the potential to identify new targets for therapeutics and lead to the development of interventions to improve cognition in patients with cancer.

Highlights • Recognize patients with previous surgeries, especially those involving subcutaneous implants. • Distal shunt catheters must be passed around potential spaces to avoid coiling leading to shunt malfunction. • Note that if a peritoneal catheter does not pass easily a different approach should be considered., Introduction Hydrocephalus is one of the most common disorders of neurosurgery and ventricular shunting, the primary surgical intervention, malfunctions in 85% of patients by 10 years. Presentation of case Here we present a case of a 12-year-old girl with history of a vagal nerve stimulator (VNS) and ventricular shunt, most recently revised from ventriculoatrial (VA) to ventriculoperitoneal (VP) shunt at an outside hospital. The patient presented with a new left chest bulge, nausea, emesis, and seizures. Imaging revealed the patient’s distal shunt catheter to have completely migrated and coiled into the VNS subcutaneous pocket. Subsequently, the patient’s distal shunt catheter was externalized, and later internalized back to a VA shunt. Discussion Potential spaces from previous surgeries such as VNS can lead to coiling of distal shunt catheters. In this case, the coiled distal shunt catheter led to hydrocephalus and the patient’s presenting symptoms. Conclusion It is imperative to recognize patients with previous surgeries, especially those involving subcutaneous implants and to avoid passing of distal shunt catheters through these potential spaces.

Topic Significance & Study Purpose/Background/Rationale An inpatient hematology unit at a NCCN designated cancer center experienced a dramatic increase in patients receiving a chimeric antigen receptor (CAR) T-cell therapy in 2018. Neurologic toxicity at any grade is observed in most patients receiving a CAR T-cell therapy, with more than 58% of patients who received Kymriah™ (1) and 87% of patients who received Yescarta® (2). Although nursing staff was completing a neurologic assessment each shift to identify neurologic toxicity, the assessment and documentation by each nurse varied considerably. Nurses were also having difficulty identifying clear and concrete assessment changes to report to physicians. As the neurologic changes observed in this population can initially be subtle, a tool to accurately and consistently identify changes is vital. A request was made by nursing leadership in May 2018 to create a standardized neurological assessment for patients receiving a CAR T-cell therapy. Methods, Intervention, & Analysis Unit leadership and the unit based practice council collaborated to create a standardized CAR T-cell neurotoxicity assessment tool for nurses. A review of the literature was completed, and the CAR T-cell therapy associated TOXicity (CARTOX) 10-point neurological assessment tool was reviewed. An adapted version of the CARTOX-10 was agreed upon by unit staff, nursing leadership and the CAR T-cell working group. The final version consists of a verbal and writing assessment. The UBPC is presently in the process of educating all nursing staff on how to complete this tool and notify physicians when changes are assessed. Staff are educated during staff huddles, shift handoff, staff meetings, and can view literature on a unit education board. Findings & Interpretation While the implementation of this new tool is currently ongoing, the feedback from nursing staff has been positive and the reception from patients and caregivers has been enthusiastic. Discussion & Implications Implementing a practice change must be interdisciplinary and requires close collaboration amongst frontline nurses, nursing leadership, and physicians. As nursing practice becomes standardized with the development and implementation of this neurotoxicity assessment, we will assess nurse's perception of its feasibility in practice. An accurate neurologic assessment in CAR T-cell recipients is vital and we will validate its effectiveness in identifying neurologic conditions that warrant intervention. 1. Novartis Pharmaceuticals Corporation. (2018). Kymriah™ (tisagenlecleucel) [Package Insert]. East Hanover, NJ: Author. 2. Kite Pharma Inc. (2017). Yescarta® (axicabtagene ciloleucel) [Package Insert]. Santa Monica, CA: Author.

Morphine, a potent narcotic analgesic used for the treatment of acute and chronic pain, was chemically incorporated into a poly(anhydride-ester) backbone. The polymer termed "PolyMorphine", was designed to degrade hydrolytically releasing morphine in a controlled manner to ultimately provide analgesia for an extended time period. PolyMorphine was synthesized via melt-condensation polymerization and its structure was characterized using proton and carbon nuclear magnetic resonance spectroscopies, and infrared spectroscopy. The weight-average molecular weight and the thermal properties were determined. The hydrolytic degradation pathway of the polymer was determined by in vitro studies, showing that free morphine is released. In vitro cytocompatibility studies demonstrated that PolyMorphine is non-cytotoxic towards fibroblasts. In vivo studies using mice showed that PolyMorphine provides analgesia for 3 days, 20 times the analgesic window of free morphine. The animals retained full responsiveness to morphine after being subjected to an acute morphine challenge.

Drainage and diversion of cerebrospinal fluid (CSF) through shunt systems is the most common treatment for hydrocephalus, but complications due to tissue obstruction of the catheter occur in up to 61% of patients. Although shunt systems have undergone limited technological advancements to resist mammalian cell adhesion, there is a need to further reduce adhesion that can exacerbate obstruction. The high intrinsic variability in clinical studies and an inability to predict chronic adhesion of host cells in vitro while maintaining the environmental conditions observed in hydrocephalus have impeded progress. We designed the hydrocephalus shunt catheter bioreactor (HSCB) to measure inflammatory cell adhesion under experimentally manipulated conditions of CSF pressure, pulsation rate, and flow rates. For a 20-h period, astrocytes were perfused through the pulsatile flow system, and adhesion on silicone catheters was recorded. These results were compared with those obtained under static cell culture conditions. Astrocyte adhesion was significantly increased under conditions of increased flow rate (0.25 and 0.30 mL/min), and a trend toward increased adhesion was observed under conditions of elevated pressure and pulsation rate. Because the HSCB represents physiologic conditions more accurately than static cell culture, our results suggest that standard static cell culturing techniques are insufficient to model inflammatory cell adhesion on catheters used in the treatment of hydrocephalus and that changes to the ventricular microenvironment can alter the mechanisms of cellular adhesion. The HSCB represents a relevant test system and is an effective model system for the analysis of cellular adhesion and occlusion of shunt catheters.

Multimedia or new media as many call it, is the use of multiple types of media-text, graphics, sound, animation, and video in any combination -to convey information. The purpose of this paper is to briefly define this technology, describe its components and discuss some of the ways senior management can use and manage multimedia in the workplace