Updated version of Prognostication presentation. Not be used as sole basis for any medical decisions. Please talk with your doctor if you have questions about this information.
Effective pain management in terminally ill requires
Understanding of pain control strategies
Ongoing assessment
Diagnosis of pain
Breakthrough pain relief
Fine adjustment of medications
Opioid rotation
Unresolved psychosocial or spiritual issue can be great impact to pain management
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Effective pain management in terminally ill requires
Understanding of pain control strategies
Ongoing assessment
Diagnosis of pain
Breakthrough pain relief
Fine adjustment of medications
Opioid rotation
Unresolved psychosocial or spiritual issue can be great impact to pain management
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
History taking and examination in Palliative careruparnakhurana
Palliative medicine is a specialized branch of medicine dealing with the the care of patients and their families who are suffering with serious life limiting illnesses, impeccable assessment of pain and other distressing symptoms, management of social, psychological and spiritual domains
Ethical Issues Regarding Nutrition and Hydration in Advanced IllnessMike Aref
Be able to discuss and clarify “pleasure feeding” with patients and their families
Identify ethical issues with continuing or stopping artificial nutrition and hydration
Understand complications of artificial nutrition and hydration that are not ethically justifiable
Be able to discuss issues of self-dehydration and self-starvation
Community-based Palliative Care: Trends, Challenges, Examples and Collaborati...wwuextendeded
Community-based Palliative Care: Trends, Challenges, Examples and Collaboration with Payers - Eric Wall, MD, MPH
Presented at the 2015 Palliative Care Summer Institute conference at Bellingham Technical College
Palliative Care Interdisciplinary Team model for Clinical Ethics Consultation...Andi Chatburn, DO, MA
Interactive workshop presentation exploring the Palliative Care model for Interdisciplinary Team consultation in an application for Clinical Ethics Consultation. Presented at the American Society for Bioethics and Humanities national conference in San Diego, October 17, 2014.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Presented as part of the Capacity Building in Policy Briefs Development Workshop conducted by Research Chair for Evidence-Based Health Care and Knowledge Translation
In collaboration with World Health Organization, Regional Office for the Eastern Mediterranean in King Saud University 2019.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
This slide presented in Suandok Palliative care day 17th May 2012: The aim is to introduce clinician working in palliative care to recognize importance of data collaboration and dissemination.
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
History taking and examination in Palliative careruparnakhurana
Palliative medicine is a specialized branch of medicine dealing with the the care of patients and their families who are suffering with serious life limiting illnesses, impeccable assessment of pain and other distressing symptoms, management of social, psychological and spiritual domains
Ethical Issues Regarding Nutrition and Hydration in Advanced IllnessMike Aref
Be able to discuss and clarify “pleasure feeding” with patients and their families
Identify ethical issues with continuing or stopping artificial nutrition and hydration
Understand complications of artificial nutrition and hydration that are not ethically justifiable
Be able to discuss issues of self-dehydration and self-starvation
Community-based Palliative Care: Trends, Challenges, Examples and Collaborati...wwuextendeded
Community-based Palliative Care: Trends, Challenges, Examples and Collaboration with Payers - Eric Wall, MD, MPH
Presented at the 2015 Palliative Care Summer Institute conference at Bellingham Technical College
Palliative Care Interdisciplinary Team model for Clinical Ethics Consultation...Andi Chatburn, DO, MA
Interactive workshop presentation exploring the Palliative Care model for Interdisciplinary Team consultation in an application for Clinical Ethics Consultation. Presented at the American Society for Bioethics and Humanities national conference in San Diego, October 17, 2014.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Presented as part of the Capacity Building in Policy Briefs Development Workshop conducted by Research Chair for Evidence-Based Health Care and Knowledge Translation
In collaboration with World Health Organization, Regional Office for the Eastern Mediterranean in King Saud University 2019.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
This slide presented in Suandok Palliative care day 17th May 2012: The aim is to introduce clinician working in palliative care to recognize importance of data collaboration and dissemination.
This IT Brand Pulse mini-report includes only market leader data from the independent, non-sponsored survey conducted in January 2017 covering six categories of brand leadership–Market, Price, Performance, Reliability, Service & Support and Innovation–for twelve Networked Storage products.
Complete survey data for each product category is available. Please contact us at info@itbrandpulse.com for information and pricing.
QR codes explanation for our CEO Staff meeting Term4 2012, includes link to a great use of QR codes by Sukiennice Museum and ideas used by our schools for learning
Understanding Uterine Cancer Treatment Optionsbkling
Join Dr. Bhavana Pothuri, gynecologic oncologist at NYU Langone Medical Center, as she breaks down the different types of uterine cancer treatments available to patients based on their particular diagnosis. Learn about new research and treatment updates, options for when cancer recurs, side effects, and more.
Presentazione a cura del Dottor Gabriele Capurso - "HOT TOPICS IN GASTROENTEROLOGIA - I TUMORI DELL'APPARATO DIGERENTE: cosa è cambiato e cosa bisogna sapere" - Roma 10/11/2018
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
EAU - Guidelines on Prostate Cancer Organ Confined by Dr. Ali Mujtaba, Sindh Institute of Urology and Transplantation (SIUT)
https://www.youtube.com/watch?v=kXX9ItF4as4
https://www.youtube.com/watch?v=0m4YUI6Rr5w
Presentatie Prof. dr. Deckers en Prof. dr. BotsCVON
Combining Atherosclerosis Imaging and New and Novel Markers in Asymptomatic Subjects at Intermediate CVD Risk: Implications for Pathophysiology, Prediction and Prevention.
Communication of prognosis has multiple barriers to achieve shared understanding between patient and clinician. In this slide deck designed for Hospice and Palliative Medicine fellows, I look at some key studies and applied techniques to best address talking about 'How long do I have, doc?'
This slide deck does not cover how to formulate a prognosis.
Hospice and Palliative Care Online: From clutter to curationChristian Sinclair
My slidedeck from the 13th Australian Palliative Care Conference. Features the tools I use and my workflow for finding good information online to curate, create and share.
Updated slidedeck for 2014 University of Kansas Medical Center Hospice and Palliative Care Fellowship Lecture series.
Presentation skills two hour workshop. Please also see updated handout and presentation preparation worksheet
Pallimed/GeriPal Blogs to Boards - Hospice/Palliative Medicine Board Review 2...Christian Sinclair
Blogs to Boards
Created by Pallimed and GeriPal contributors in 2012 as a free study tool for the 2012 Hospice and Palliative Medicine board certification test. Creative Commons license - you must include attribution and links to Pallimed and GeriPal, and cannot reproduce for any commercial use.
We have posted the questions and answers separately if you are looking for those.
Pallimed/GeriPal Blogs to Boards - Hospice/Palliative Medicine Board Review 2...Christian Sinclair
Blogs to Boards
Created by Pallimed and GeriPal contributors in 2012 as a free study tool for the 2012 Hospice and Palliative Medicine board certification test. Creative Commons license - you must include attribution and links to Pallimed and GeriPal, and cannot reproduce for any commercial use.
We have posted the questions without the answers separately if you are looking for those.
Plenary presentation at the American Academy of Hospice and Palliative Medicine 2012.
This presentation is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. Please give attribution to Christian T Sinclair, MD, FAAHPM for use of this slide deck in parts or in whole.
Please see the Creative Commons License on the second slide. This slide deck is for medical education uses only and does not constitute medical advice. Please consult with your own health care provider.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
6. A prognosis is an estimation of possible future outcomes of a treatment or a disease process…
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8. … founded upon a combination of personal experience, statistics, and validated models
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11. Theory for Prognostic Model Clinical Findings Individual Prognosis General Prognosis Diagnosis Pathological Findings Psychosocial Factors Co-morbidities Therapy Adapted from Vigano 2000
74. Dementia - MDS-12 AUROC for >6 (0.64) was better than FAST 7c (0.51) Mitchell 2004 Total Risk Score Mortality Estimate @ 6m 0 9% 1-2 10% 3-5 23% 6-8 40% 9-11 57% >12 70%
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Editor's Notes
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield 11. Prognosis (Evidence-based) A. Disease specific i. Cancer ii. COPD iii. CHF iv. ALS v. Stroke (Acute vs chronic) vi. Dementia B. Debility i. Wt loss ii. Decubiti Als Trauma Debility End stage heart
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Common responses to what is the prognosis?, obliged to perform many other unpleasant tasks, prognosis can seem mysterious powerful, final like death, routine versus serious prognosis (prognosis with moral overtones) PubMed results Jan 2007 Diagnosis 5.5mil Therapy 4.8 mil Prognosis 600k Ellipses of prognosis The Principles and Practices of Medicine 1892-1988
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Estimation of possible future outcomes of a treatment or a disease process Founded upon a combination of personal experience, statistics, and validated models
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Estimation of possible future outcomes of a treatment or a disease process Founded upon a combination of personal experience, statistics, and validated models
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Failure to prognosticate may lead to harm (unwanted therapies, flogging, etc.) threat versus reassurance
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Concept of natural course – problematic – impact of therapy interventions and the doctors role in responsibility in clinical course Prognostication as reassuring/comforting Prognosis as managing death – avoiding responsibility Predicting controls death but also associates you with death
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Clinical prediction vs. statistical modeling Accuracy Applicability to clinical situation Description of outcomes clinically irrelevant Inconsistent application
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield During the phase II intervention, patients experienced no improvement in patient-physician communication (eg, 37% of control patients and 40% of intervention patients discussed CPR preferences) or in the five targeted outcomes, i.e., incidence of timing of written DNR orders (adjusted ratio, 1.02; 95% confidence interval [CI], 0.90 to 1.15) physicians' knowledge of their patients' preferences not to be resuscitated (adjusted ratio, 1.22; 95% CI, 0.99 to 1.49), number of days spent in an ICU, receiving mechanical ventilation, or comatose before death (adjusted ratio, 0.97; 95% CI, 0.87 to 1.07), or level of reported pain (adjusted ratio, 1.15; 95% CI, 1.00 to 1.33). The intervention also did not reduce use of hospital resources (adjusted ratio, 1.05; 95% CI, 0.99 to 1.12).
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Black is cancer, gray in non-cancer
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Validated by Morita Complex, 6 week breakpoint Palliative performance scale (modified Karnofsky) 10–20 4 30–50 2.5 ‡ 60 0 Oral intake Severely reduced 2.5 Moderately reduced 1.0 Normal 0 Oedema Present 1.0 Absent 0.0 Dyspnoea at rest Present 3.5 Absent 0.0 Delirium Present 4.0 Absent 0.0 Interpretation of the PPI score Total score PPV for 6-week survival NPV for 6-week survival >4 0.83 0.71
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Adjuvant Online Breast Colon Lung
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Pubmed research Prognosis 660k Therapy 5.1m Diagnosis 5.9m
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield We must know the art and the science, be willing to make decisions in the face of error
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Mortality thoroughly studied Organ allocation for liver transplant Great effort to allocate organs according to “sickest first” instead of location and waiting times
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Reliably predicts death within 1 week, 3 months, and 1 year Kamath et al. Hepatology, 2001 Do we want to standardize the citations in the lower left corner?
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Hepatology/Liver Transplantation Serum sodium, direct measure of severity of portal hypertension. Portal htn -> splanchnic arterial dilation -> decreased svr -> increased sympathetic, adh, renin-ang-ald system
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Involuntary weight loss of 5% or more
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Found in NCCN guidelines
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Taken from National Comprehensive Cancer Network guidelines 2006
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Limited stage = disease confined to ipsilateral hemithorax and one radiation field Only 33% of diagnoses are limited stage As reported on a mesothelioma website, I couldn’t find references on that website so maybe I shouldn’t use this data…it was the only place I found thorough numbers… I also found a website with article entitled “small cell lung cancer” by Jahan, T et al. www.cancersupportivecare.com that quoted the following numbers Limited stage 2 year survival 20% Extensive stage 2 year survival 5% Recurrence after remission 2-3 months
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Sahn in Seminars in Respiratory and Critical Care 2001
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield New 2008
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield New 2008
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield New for 2008
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield New for 2008
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield First comprehensive multivariate approach Good vs poor outcome Poor includes severe disability, vegetative state, and death Good is moderate disability, independent but unable to resume prior activity and good recovery 20 seconds no O2, 5 min no ATP no glucose Old text - “Predicting Outcome From Hypoxic-Ischemic Coma” Levy et al. JAMA 1985 Study developed newly constructed, empirically derived guidelines to predict outcome within the first few days after a cardiac arrest or similar global hypoxic-ischemic insult
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Signs related to recovery/lack of recovery 0/52 patients initially lacking pupillary reflex ever became independent, only 3 regained consciousness At three days absent or posturing motor responses were incompatible with future independence At initial exam, most favorable sign was incomprehensible speech
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Proposed that patients with absent pupil and motor response no better than flexion at 72 hr undergo ssep, if no response no chance of recovery and further care regarded as futile, palliative care given.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield O2 and consciousness lost within 20 seconds, glucose and atp depleted by 5 minutes Citatations? Booth JAMA 2004
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Item 1 & 3 sound the same
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Severe = requiring mechanical ventilation
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Also lower body temp
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Citation Also Holloway
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Citation Also holloway
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Citation Holloway
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield 325 patients with dementia
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Activities of Daily Living Scale = 28∗ 1.9 ––––– Male Sex 1.9 ––––– Cancer 1.7 ––––– Oxygen Therapy Needed in Prior 14 Days 1.6 ––––– Congestive Heart Failure 1.6 ––––– Shortness of Breath 1.5 ––––– <25% of Food Eaten at Most Meals 1.5 ––––– Unstable Medical Condition 1.5 ––––– Bowel Incontinence 1.5 ––––– Bedfast 1.5 ––––– Age >83 y 1.4 ––––– Not Awake Most of the Day 1.4 –––––
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield If Total Risk Score is… 0 1 or 2 3, 4, or 5 6, 7, or 8 9, 10, or 11 Risk Estimate of Death Within 6 Months, % 8.9 10.8 23.2 40.4 57.0 ≥ 12 70.0
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Caraceni A , Nanni O , Maltoni M , Piva L , Indelli M , Arnoldi E , Monti M , Montanari L , Amadori D , De Conno F . Unita' di Riabilitazione e Terapie Palliative, Department of Anesthesia and Critical Care, National Cancer Institute of Milan, Italy. BACKGROUND: The objective of this study was to evaluate the impact of delirium on the survival of advanced cancer patients also assessed with a validated prognostic score (the palliative prognostic [PaP] score). METHODS: The study population was a prospective multicenter consecutive case series of advanced cancer patients for whom chemotherapy was no longer considered viable and who were referred to palliative care programs. Clinical and biologic prognostic factors included in the PaP score were assessed at study entry. The Confusion Assessment Method criteria were applied to screen patients presenting with delirium. Survival times were measured from time of enrollment and death taken as an outcome. Survival curves were traced with the Kaplan-Meier method and comparison were based on log rank tests. RESULTS: Delirium was found in 109 cases among 393 consecutive patients (27.7%). The diagnosis of delirium was independently associated with male gender, central nervous system metastases, lower performance status, worse clinical prediction of survival, and progestational treatment. The survival curve of patients with delirium was significantly different from the nondelirious patients curve (log rank, 31.6, P < 0.0001). The median survival time was 21 days (95% confidence interval [CI], 16-27) for the delirious patients and 39 days (95% CI 33-49) for the others. Multivariate analysis showed that the diagnosis of delirium and PaP score were independently associated with prognosis. CONCLUSIONS: The diagnosis of delirium significantly worsens life expectancy prognosticated with the PaP score. By using the PaP score together with the assessment of cognitive status, physicians can correctly predict patients 30-day survival in greater than 70% of cases.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Afessa B , Morales IJ , Scanlon PD , Peters SG . Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA. afessa.bekele@mayo.edu OBJECTIVE: To describe prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. DESIGN: Analysis of prospectively collected data. SETTING: A multidisciplinary intensive care unit of an inner-city university hospital. PATIENTS: Patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure from August 1995 through July 1998. MEASUREMENTS AND MAIN RESULTS: Data were obtained concerning demographics, arterial blood gas, Acute Physiology and Chronic Health Evaluation (APACHE) II score, sepsis, mechanical ventilation, organ failure, complications, and hospital mortality rate. Fifty-nine percent of patients were male, 63% white, and 36% African-American; the mean age was 63.1 +/- 8.9 yrs. Noninvasive mechanical ventilation was tried in 40% of patients and was successful in 54% of them. Invasive mechanical ventilation was required in 61% of the 250 admissions. Sepsis developed in 31% of patients, nonpulmonary organ failure in 20%, pneumothorax in 3%, and acute respiratory distress syndrome in 2%. Multiple organ failure developed in 31% of patients with sepsis compared with 3% without sepsis (p <.0001). Predicted and observed hospital mortality rates were 30% and 15%, respectively. Differences in age and arterial carbon dioxide and oxygen tensions between survivors and nonsurvivors were not significant. Arterial pH was lower in nonsurvivors than in survivors (7.21 vs. 7.25, p =.0408). The APACHE II-predicted mortality rate (p =.0001; odds ratio, 1.046; 95% confidence interval, 1.022-1.070) and number of organ failures (p <.0001; odds ratio, 5.524; 95% confidence interval, 3.041-10.031) were independent predictors of hospital outcome; invasive mechanical ventilation was not an independent predictor. CONCLUSIONS: Physiologic abnormalities at admission to an intensive care unit and development of nonrespiratory organ failure are important predictors of hospital outcome for critically ill patients with chronic obstructive pulmonary disease who have acute respiratory failure. Improved outcome would require prevention and appropriate treatment of sepsis and multiple organ failure.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Caraceni A , Nanni O , Maltoni M , Piva L , Indelli M , Arnoldi E , Monti M , Montanari L , Amadori D , De Conno F . Unita' di Riabilitazione e Terapie Palliative, Department of Anesthesia and Critical Care, National Cancer Institute of Milan, Italy. BACKGROUND: The objective of this study was to evaluate the impact of delirium on the survival of advanced cancer patients also assessed with a validated prognostic score (the palliative prognostic [PaP] score). METHODS: The study population was a prospective multicenter consecutive case series of advanced cancer patients for whom chemotherapy was no longer considered viable and who were referred to palliative care programs. Clinical and biologic prognostic factors included in the PaP score were assessed at study entry. The Confusion Assessment Method criteria were applied to screen patients presenting with delirium. Survival times were measured from time of enrollment and death taken as an outcome. Survival curves were traced with the Kaplan-Meier method and comparison were based on log rank tests. RESULTS: Delirium was found in 109 cases among 393 consecutive patients (27.7%). The diagnosis of delirium was independently associated with male gender, central nervous system metastases, lower performance status, worse clinical prediction of survival, and progestational treatment. The survival curve of patients with delirium was significantly different from the nondelirious patients curve (log rank, 31.6, P < 0.0001). The median survival time was 21 days (95% confidence interval [CI], 16-27) for the delirious patients and 39 days (95% CI 33-49) for the others. Multivariate analysis showed that the diagnosis of delirium and PaP score were independently associated with prognosis. CONCLUSIONS: The diagnosis of delirium significantly worsens life expectancy prognosticated with the PaP score. By using the PaP score together with the assessment of cognitive status, physicians can correctly predict patients 30-day survival in greater than 70% of cases.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Narcotic and benzodiazepine use after withdrawal of life support: association with time to death? Chan JD , Treece PD , Engelberg RA , Crowley L , Rubenfeld GD , Steinberg KP , Curtis JR . Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA. jdchan@u.washington.edu OBJECTIVE: To determine whether the dose of narcotics and benzodiazepines is associated with length of time from mechanical ventilation withdrawal to death in the setting of withdrawal of life-sustaining treatment in the ICU. DESIGN: Retrospective chart review. SETTING: University-affiliated, level I trauma center. PATIENTS: Consecutive critically ill patients who had mechanical ventilation withdrawn and subsequently died in the ICU during two study time periods. RESULTS: There were 75 eligible patients with a mean age of 59 years. The primary ICU admission diagnoses included intracranial hemorrhage (37%), trauma (27%), acute respiratory failure (27%), and acute renal failure (20%). Patients died during a median of 35 min (range, 1 to 890 min) after ventilator withdrawal. On average, 16.2 mg/h opiates in morphine equivalents and 7.5 mg/h benzodiazepine in lorazepam equivalents were administered during the time period starting 1 h before ventilator withdrawal and ending at death. There was no statistically significant relationship between the average hourly narcotic and benzodiazepine use during the 1-h period prior to ventilator withdrawal until death, and the time from ventilator withdrawal to death. The restriction of medication assessment in the last 2 h of life showed an inverse association between the use of benzodiazepines and time to death. For every 1 mg/h increase in benzodiazepine use, time to death was increased by 13 min (p = 0.015). There was no relationship between narcotic dose and time to death during the last 2 h of life (p = 0.11). CONCLUSIONS: We found no evidence that the use of narcotics or benzodiazepines to treat discomfort after the withdrawal of life support hastens death in critically ill patients at our center. Clinicians should strive to control patient symptoms in this setting and should document the rationale for escalating drug doses. PMID: 15249473 [PubMed - indexed for MEDLINE]
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Kollef MH , Ahrens TS , Shannon W . Department of Medicine, Washington University School of Medicine, St.Louis, MO, USA. OBJECTIVE: To identify clinical predictors for tracheostomy among patients requiring mechanical ventilation in the intensive care unit (ICU) setting and to describe the outcomes of patients receiving a tracheostomy. DESIGN: Prospective cohort study. SETTING: Intensive care units of Barnes-Jewish Hospital, an urban teaching hospital. PATIENTS: 521 patients requiring mechanical ventilation in an ICU for >12 hours. INTERVENTIONS: Prospective patient surveillance and data collection. MEASUREMENTS AND MAIN RESULTS: The main variables studied were hospital mortality, duration of mechanical ventilation, length of stay in the ICU and the hospital, and acquired organ-system derangements. Fifty-one (9.8%) patients received a tracheostomy. The hospital mortality of patients with a tracheostomy was statistically less than the hospital mortality of patients not receiving a tracheostomy (13.7% vs. 26.4%; p = .048), despite having a similar severity of illness at the time of admission to the ICU (Acute Physiology and Chronic Health Evaluation [APACHE] II scores, 19.2 +/- 6.1 vs. 17.8 +/- 7.2; p = .173). Patients receiving a tracheostomy had significantly longer durations of mechanical ventilation (19.5 +/- 15.7 days vs. 4.1 +/- 5.3 days; p < .001) and hospitalization (30.9 +/- 18.1 days vs. 12.8 +/- 10.1 days; p < .001) compared with patients not receiving a tracheostomy. Similarly, the average duration of intensive care was significantly longer among the hospital nonsurvivors receiving a tracheostomy (n = 7) compared with the hospital nonsurvivors without a tracheostomy (n = 124; 30.9 +/- 16.3 days vs. 7.9 +/- 7.3 days; p < .001). Multiple logistic regression analysis demonstrated that the development of nosocomial pneumonia (adjusted odds ratio [AOR], 4.72; 95% confidence interval [CI], 3.24-6.87; p < .001), the administration of aerosol treatments (AOR, 3.00; 95% CI, 2.184.13; p < .001), having a witnessed aspiration event (AOR, 3.79; 95% CI, 2.30-6.24; p = .008), and requiring reintubation (AOR, 2.21; 95% CI, 1.54-3.18; p = .028) were variables independently associated with patients undergoing tracheostomy and receiving prolonged ventilatory support. Among the 44 survivors receiving a tracheostomy in the ICU, 38 (86.4%) were alive 30 days after hospital discharge and 31 (70.5%) were living at home. CONCLUSIONS: Despite having longer lengths of stay in the ICU and hospital, patients with respiratory failure who received a tracheostomy had favorable outcomes compared with patients who did not receive a tracheostomy. These data suggest that physicians are capable of selecting critically ill patients who most likely will benefit from placement of a tracheostomy. Additionally, specific clinical variables were identified as risk factors for prolonged ventilatory assistance and the need for tracheostomy.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield 5 year 65% with cancer For example, a serum albumin of less than 3.0 g/dL versus greater than 4.0 g/dL confers a 4.4 times greater risk of death; a serum albumin level of less than 3.5 g/dL is associated with a 1–year mortality of approximately 50%. For stage 5 CKD patients, poor functional status is also highly predictive of early death. Fifteen studies examining the relationship between functional status and mortality found a significant association with early death. Measures used to assess functional status have included the Karnofsky or Modified Karnofsky Scale, the Gutman functional status, activities of daily living, and Medical Outcomes Study 36-item Short Form (SF-36).2 In 2000, Beddhu
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield JPMrenal pall care article
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Added for 2008 Zoccolella, S et al. for the SLAP Registry. Analysis of survival and prognostic factors in amyotrophic lateral sclerosis: a population based study. J Neurol Neurosurg Psychiatry . Volume 79(1), January 2008, pp 33-7. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ . 2008 February 23; 336(7641): 425–429. Kinzbrunner BM, Weinreb NJ, Merriman MP. Debility, unspecified: a terminal diagnosis. Am J Hosp Palliat Care. 1996 Nov-Dec;13(6):38-44.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield Added for 2008 Zoccolella, S et al. for the SLAP Registry. Analysis of survival and prognostic factors in amyotrophic lateral sclerosis: a population based study. J Neurol Neurosurg Psychiatry . Volume 79(1), January 2008, pp 33-7. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ . 2008 February 23; 336(7641): 425–429. Kinzbrunner BM, Weinreb NJ, Merriman MP. Debility, unspecified: a terminal diagnosis. Am J Hosp Palliat Care. 1996 Nov-Dec;13(6):38-44.
Evidence Based Prognostication - AAHPM Annual Assembly 2007 February 14, 2007 Sinclair, Salacz, Affield 1: Mirimanoff RO, Gorlia T, Mason W, Van den Bent MJ, Kortmann RD, Fisher B, Reni M, Brandes AA, Curschmann J, Villa S, Cairncross G, Allgeier A, Lacombe D, Stupp R.Related Articles, Links Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol. 2006 Jun 1;24(16):2563-9. PMID: 16735709 [PubMed - indexed for MEDLINE] 2: Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group.Related Articles, Links Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10;352(10):987-96. PMID: 15758009 [PubMed - indexed for MEDLINE] 3: Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R.Related Articles, Links Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51. PMID: 9128946 [PubMed - indexed for MEDLINE] 4: Athanassiou H, Synodinou M, Maragoudakis E, Paraskevaidis M, Verigos C, Misailidou D, Antonadou D, Saris G, Beroukas K, Karageorgis P.Related Articles, Links Randomized phase II study of temozolomide and radiotherapy compared with radiotherapy alone in newly diagnosed glioblastoma multiforme. J Clin Oncol. 2005 Apr 1;23(10):2372-7. PMID: 15800329 [PubMed - indexed for MEDLINE]