Indiana University Health University Hospital is a teaching hospital in Indianapolis, Indiana, United States, affiliated with the Indiana University School of Medicine and Indiana University Health.With nearly 1,100 physician faculty members at Indiana University Health University Hospital, physicians, surgeons, nurses and staff care for more than 57,000 patients a year.[citation needed] Approximately 52 percent of physicians in Indiana were trained at Indiana University Health University Hospital.[citation needed] In addition, Indiana University Health University Hospital physicians and staff continuously seek advances in medicine. The staff actively participate in approximately 150 clinical and prevention trials to provide optimal patient treatments.[citation needed] As part of Indiana University Health, the hospital works closely with nearby Indiana University Health Methodist Hospital and Riley Hospital for Children at Indiana University Health.The Indiana University Health University Hospital Emergency Department closed on June 30, 2014, with its adult emergency room care services moving to the Indiana University Health Methodist Hospital Emergency Medicine and Trauma Center.
The phase II GeparNuevo trial investigated whether adding durvalumab to neoadjuvant chemotherapy (NACT) only in patients with early triple-negative breast cancer cT1b-cT4a-d would improve pathologic complete response (pCR) rate and patient survival. Hundred and seventy-four patients were randomly assigned to receive durvalumab or placebo concurrently with nab-paclitaxel once per week and followed by dose-dense epirubicin and cyclophosphamide. With 86.4 months of median follow-up compared with the previously reported 43.7 months, durvalumab showed sustained significant improvements in long-term outcomes as defined by STEEP compared with placebo regarding not only invasive disease-free survival (iDFS; hazard ratio [HR], 0.56 [95% CI, 0.32 to 0.99]; stratified log-rank P = .0431), but also distant disease-free survival (DDFS; HR, 0.41 [95% CI, 0.21 to 0.80]; P = .0069) and overall survival (OS; HR, 0.33 [95% CI, 0.14 to 0.79]; P = .0085). All analyses were stratified by stromal tumor-infiltrating lymphocytes (sTILs) at baseline (low [≤10%], intermediate [11%-59%], high [≥60%]). In exploratory subgroup analysis, patients with nodal involvement at baseline demonstrated a greater iDFS benefit (HR, 0.33 [95% CI, 0.144 to 0.771]; P = .01; Pinteraction = 0.045). sTILs in residual disease (RD) could be assessed in 39/71 patients without pCR. Post hoc analyses by sTILs high (>10%) versus low (≤10%) in RD showed estimated 7-year iDFS rates of 92.3% (95% CI, 56.6 to 98.9) and 51.4% (95% CI, 29.2 to 69.7), respectively. Hence, adding durvalumab to dose-dense NACT without adjuvant continuation of checkpoint inhibition improved long-term survival outcomes, irrespective of the extent of pathologic response. This underscores the necessity to re-evaluate the adjuvant continuation of checkpoint inhibition.
Malignant brain tumors inevitably recur, leading to progressive neurological decline. Palliative care is essential for optimizing patient outcomes, yet its integration into neuro-oncology remains inconsistent. We conducted a nationwide survey to evaluate palliative care practices among German neuro-oncologists and assessed the impact of physicians’ comfort on end-of-life discussions in patient care. A nationwide, anonymous survey was distributed to 481 neuro-oncologists who are members of the Neuro-oncology Working Group of the German Cancer Society. The questionnaire, developed in collaboration with board-certified palliative care specialists, evaluated physicians’ demographic characteristics, palliative care knowledge, and access to palliative care resources. Of 92 respondents, 81 (88%) reported comfort in discussing end-of-life issues, while 11 (12%) expressed discomfort. Physicians comfortable with these discussions more frequently addressed withholding of life-sustaining interventions (88% versus 55%, p=0.011), arranged home care (81% versus 64%, p=0.019), and facilitated hospice placement (68% versus 36%, p=0.021). They also initiated these conversations earlier and observed greater patient receptivity to palliative care (p=0.049). These associations remained significant in multivariable logistic regression. While most neuro-oncologists report comfort with end-of-life discussions, this comfort strongly influences timing and extent of palliative care integration. Our findings highlight the need for structured palliative care training to ensure timely and effective discussions, ultimately improving care for neuro-oncological patients.
Abstract Patient‐reported outcome measures (PROMs) are vital tools to evaluate patient health status. Although a plethora of validated tools are available to evaluate common pathologies in knee arthroscopy, agreement on the most appropriate metrics for different populations and procedures has not been reached. Selection of an appropriate PROM requires consideration of its validity, clinically significant outcomes, and ceiling effects. The validation of an outcome measure encompasses three distinct psychometric properties: validity, reliability, and responsiveness, and the demonstration of appropriate psychometric validity lends credibility of the results derived from its use in clinical and research settings. Notably, statistical significance does not always translate to clinical significance. Minimal clinically important difference, patient‐acceptable symptomatic state, and substantial clinical benefit are clinically significant outcomes that represent the spectrum of meaningful clinical impact for a patient. However, these metrics are population‐ and study‐specific and should be interpreted at the individual level. Ceiling effects prevent differentiation between patients scoring at the upper extreme of the PROM and are an important limitation of several instruments used to evaluate patients undergoing orthopaedic sports medicine knee procedures. The purpose of this narrative review is to provide a comprehensive overview of popular PROMs used in the evaluation of orthopaedic sports medicine knee procedures and review their applicability to commonly encountered pathologies. The scoring, interpretation, and psychometric properties of each PROM are presented along with examples of minimal clinically important difference, substantial clinical benefit, and patient‐acceptable symptomatic state values found for the specific cohorts in previous studies. Level of Evidence Level V, expert opinion.
Background The present study reports a multicenter experience of using hydrophilic polymer-coated (HPC) flow diverters (FDs) with prasugrel single antiplatelet therapy (SAPT) to treat posterior circulation aneurysms (PCAs).Methods A prospectively maintained database was retrospectively reviewed to identify all cases of intracranial PCA treated with HPC-coated FDs under SAPT (prasugrel). The clinical presentation and outcomes, periprocedural and postprocedural complications, and degree of occlusion at follow-up (FU) were evaluated.Results A total of 74 patients were treated (45.9% female). Ischemic complications were experienced by two patients (2.7%) and were dependent on the use of FDs. No cases of aneurysm rupture or hemorrhagic complications related to antiplatelet therapy or the FD treatment were recorded. The rate of complete occlusion was 77.9% in the early FU period (3-6 months) and 90.3% in the initial 12-month period.Conclusion In this single-arm retrospective study, HPC-coated FDs with prasugrel SAPT were associated with high safety in the treatment of ruptured and unruptured PCA and high occlusion rates at early- and mid-term FU.
