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There is debate surrounding the appropriate threshold for lymph node harvest during esophagectomy in patients with esophageal cancer, specifically for those receiving preoperative radiation. The purpose of this study was to determine the impact of lymph node yield on survival in patients receiving preoperative chemoradiation for esophageal cancer. The National Cancer Database (NCDB) was utilized to identify patients with esophageal cancer that received preoperative radiation. The cohort was divided into patients undergoing minimal (<9) or extensive (≥9) lymph node yield. Demographic, operative, and postoperative outcomes were compared between the groups. Kaplan–Meier analysis with the log rank test was used to compare survival between the yield groups. Cox proportional hazards model was used to determine the association between lymph node yield and survival. In total, 886 cases were included: 349 (39%) belonging to the minimal node group and 537 (61%) to the extensive group. Unadjusted 5-year survival was similar between the minimal and extensive groups, respectively (37.3% vs. 38.8%; P  > 0.05). After adjustment using Cox regression, extensive lymph node yield was associated with survival (hazard ratio 0.80, confidence interval 0.66–0.98, P  = 0.03). This study suggests that extensive lymph node yield is advantageous for patients with esophageal cancer undergoing esophagectomy following induction therapy. This most likely reflects improved diagnosis and staging with extensive yield. [ABSTRACT FROM AUTHOR]

Abstract: Recrudescence of latent and dormant viruses may lead to overwhelming viremia in immunosuppressed hosts. In immunocompromised hosts, Simian virus 40 (SV40) reactivation is known to cause nephritis and demyelinating central nervous system disease. Here, we report SV40 viremia leading to fatal interstitial pneumonia in an immunosuppressed host following renal allotransplantation. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: Exercise has the potential to improve the ability of a patient with cystic fibrosis (CF) to cope with the physical demands of everyday life, and may improve prognosis. The purpose of this study was to compare the effects of a home-based, semi-supervised, upper-body strength-training regimen with a similarly structured aerobic training regimen. DESIGN: Data were collected during a 1-year randomized clinical trial. SETTING: Counselors conducted in-home visits with the participants once per week for the first 8 weeks followed by monthly visits for the remainder of the study. PATIENTS: Sixty-seven patients with CF, aged 8 to 18 years, participated in the trial. INTERVENTION: Participants in both exercise conditions were encouraged to exercise at least three times per week for 1 year. Each child in the aerobic group was given a stair-stepping machine, and each child in the upper-body strength training group was given an upper-body-only weight-resistance machine. MEASURES AND RESULTS: Aerobic fitness, pulmonary function, quality of life, and strength were measured at baseline, at 6 months, and at 12 months. Strength training increased the maximum weight lifted for biceps curls significantly more than aerobic training (p < 0.02). However, this differential did not remain significant after control for increase in height. Both training procedures were associated with increased strength (p < 0.002) and physical work capacity (PWC) [p < 0.033]. CONCLUSIONS: We concluded that strength and aerobic training may increase upper-body strength, and that both types of training may increase PWC for children with CF. Future trials should be conducted with no-training control subjects and larger samples to increase statistical power. [ABSTRACT FROM AUTHOR]

We sought to describe the knowledge of, understanding of, and follow-up after atypical cervical cytology among low-income, urban women. Of 554 women who had an ASCUS or atypical Pap result in 1996,215 (39%) completed a telephone survey. Many (19%) had poor follow-up. Thirty percent of women denied ever being told of abnormal cytology; Spanish-speakers were more likely to be unaware (43.2% vs. 22.7%, p < .01) of abnormal cytology. Cancer fear was quite high, as were misconceptions regarding cause. Many women were unsatisfied with the information they received regarding their cytology. [ABSTRACT FROM AUTHOR]

Uses case vignettes from 44 residents of a nursing home to assess their preference for care. Questions about resuscitation, hospital transfer, feeding tubes, and restraint use; Ethics; Advanced directives; Dementia.

Substituted judgment has been proposed as a method of promoting the autonomy of the mentally incapacitated patient, but little is known about the accuracy of surrogate decision makers in reflecting the true wishes of patients. In this study, surrogate decision makers' views (those of primary care providers and close family members) were compared with the decisions of currently competent chronically ill elderly patients, using a hypothetic cardiopulmonary resuscitation scenario under circumstances of current health and progressive dementia. Concordance between patients and their surrogates was evaluated by assessing percent agreement, kappa coefficient (for concordance beyond chance), and directionality of discrepant responses. Most patient respondents chose to be resuscitated in both scenarios. Although patients predicted that both their physicians (90%) and family members (87%) would accurately represent their wishes, neither family members nor physicians, in fact, were able to adequately predict patients' wishes in both scenarios (kappa less than or equal to 0.3 in all scenarios; percent agreement range, 59% to 88%). Few patients had ever discussed their resuscitation preferences with either their family member (16%) or their physician (7%). These results cast doubt on the usefulness of a strict substituted judgment standard as an approach to medical decision making for patients with diminished mental capacity. [ABSTRACT FROM AUTHOR]

This paper compares the grief responses of widows and widowers of different age groups over the 1st year of bereavement. The results strongly suggest that older widows and widowers perceive themselves as adjusting better to their loss and suffering from less depression and fewer anxiety symptoms than their younger counterparts. Furthermore, the oldest widows/widowers demonstrate the most consistent improvement in their levels of distress over time. Thus, when it comes to coping, older persons are not at the disadvantage that certain stereotypes and “clinical wisdoms” have previously suggested. Seniors are every bit as adaptive and able to cope with the severest forms of stress as anyone else, and they are, if anything, less prone to depression than are younger individuals. [ABSTRACT FROM PUBLISHER]

Purpose Sensitized candidates with unacceptable antigens are a group that demands special attention in lung transplantation. While calculated panel reactive antigen (cPRA) is used to assign allocation priorities in some solid organ transplants, this is not the case in lung transplantation. The association between cPRA and lung transplant outcomes is unknown, as well as the impact of cPRA on waiting list time and mortality. Methods We performed a retrospective cohort review from May, 2005 to 2018 of the SRTR registry with additional unacceptable antigen (UA) data provided by UNOS, that was used to calculate the pre-transplant cPRA (for candidates that provided UA data), for candidates ≥ 12 years of age waitlisted for first-time isolated lung transplantation. Candidates were stratified based upon lack of unacceptable antigen or cPRA for patients with any unacceptable antigens reported. Unadjusted competing risks and adjusted sub-distribution hazard models were fit. Results 29,008 candidates met inclusion criteria including 23,490 with no cPRA, 3,470 with cPRA < 50, and 2,048 with cPRA ≥ 50. On adjusted analysis, increasing cPRA was independently associated with increased waitlist mortality at 1-year (HR 3.43, 95% CI 2.73-4.31, p < 0.001) and decreased rate of transplantation (71.9% Vs 69.5% Vs 44.4%; respectively, P < 0.001). Furthermore, patients with cPRA ≥ 50 had a longer waitlist time compared with cPRA < 50 and no cPRA patients (mean 400.8 days vs 218.7 and 189.4 days, respectively, p < 0.001). Once transplanted, however, post-transplant survival between cohorts was similar. Conclusion Sensitized lung transplant candidates experience longer waitlist times, lower rates of transplantation, and higher rates of waitlist mortality. Further evaluation of allocating organs with consideration of candidate cPRA may be warranted in order to optimize equity in access to transplants. [ABSTRACT FROM AUTHOR]

Reports that Eolas, the Irish science and technology agency, has a very low budget to spend on research compared to other countries.

Decisions about care at the end of life are not only influenced by doctor-patient-family relationships and physician practice, but also by institutional "culture." An institutional assessment of the quality of care provided to dying hospitalized patients was undertaken to characterize and identify factors influencing it and to find opportunities for improvement. An analysis of hospital data, three physician and nursing focus group discussions, structured review of records of targeted patients (61) who had an "expected death," and interviews with 31 surviving family members of the targeted patients served as the basis for an institutional needs assessment intended to precede the development of a quality improvement program to improve hospital care of patients at the end of life. Data were primarily gathered regarding older adults, including a significant number of nursing home residents. The assessment led to a methodology for developing a quality improvement program based upon feedback to physicians and nurses regarding the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Purpose It has been suggested that the length of time between donor brain death and cross clamp impacts post-transplant graft function and recipient survival in lung transplantation. Methods The 2007-2018 United Network for Organ Sharing (UNOS) Registry was queried for all adult recipients undergoing isolated lung transplantation (single or bilateral) for the first time. Donation after circulatory death (DCD) donors or those with an unknown time from brain death until cross clamp were excluded. Recipients were stratified by those who received an allograft from donors with times from brain death until cross clamp less than (SHORT) or greater than (LONG) the median. The primary outcome of interest was post-transplant survival, which was evaluated with Kaplan-Meier and Cox Proportional Hazards analyses. Results 15,914 lung transplant recipients met inclusion criteria. Median time from donor brain death until cross clamp was 36 hours (IQR 17). Recipients of SHORT donors were more likely treated with IV antibiotics pre-transplant (12.3% vs 10.6%, p = 0.001) and spent a longer time on the waiting list (median 64 vs 58 days, p = 0.016). Both cohorts had similar lung allocation scores (median 40.8 vs 41.0, p = 0.292). Overall survival between the two cohorts was equivalent on Kaplan-Meier analysis (Figure 1, log-rank p = 0.776). On evaluation of other thresholds, time from donor brain death until cross clamp greater than the 75th percentile or less than the 25th percentile similarly did not impact recipient survival. After adjustment for donor and recipient characteristics, graft ischemic time, and year of transplant on Cox Proportional Hazards assessment, donor time from brain death until cross clamp was not associated with decreased survival (AHR 1.00, p = 0.981). Conclusion Time from donor brain death until cross clamp is not associated with decreased post-transplant survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably. [ABSTRACT FROM AUTHOR]