Correction to: Impact of smoking habit on adult-onset Still’s disease prognosis,findings from a multicentre observational study

Clinical Rheumatology -     

The impact of advanced patient age in liver transplantation: a European Liver Transplant Registry propensity-score matching study

BackgroundThe futility of liver transplantation in elderly recipients remains under debate in the HCV eradication era.MethodsThe aim was to assess the effect of older age on outcome after liver transplantation. We used the ELTR to study the relationship between recipient age and post-transplant outcome. Young and elderly recipients were compared using a PSM method.ResultsA total of 10,172 cases were analysed. Recipient age >65 years was identified as an independent risk factor associated with reduced patient survival (HR:1.42 95%CI:1.23–1.65,p < 0.001). After PSM, 2124 patients were matched, and the same association was found between elderly recipients and patient survival and graft survival (p < 0.001). As hepatocellular carcinoma and alcoholic cirrhosis were independent prognostic factors for patient and graft survival a propensity score-matching was performed for each. Patient and graft survival were significantly worse (p < 0.05) in the alcoholic cirrhosis elderly group. However, patient and graft survival in the hepatocellular carcinoma cohort were similar (p > 0.05) between groups.ConclusionLiver transplantation is an acceptable and safe curative option for elderly transplant candidates, with worse long-term outcomes compare to young candidates. The underlying liver disease for liver transplantation has a significant impact on the selection of elderly patients.     

Improving the use of patient-reported outcomes among patients receiving radiation therapy during the COVID-19 pandemic

IntroductionThe use of Patient-Reported Outcomes (PROs) is an important part of care for patients receiving radiation therapy. Established processes for patients to complete symptom screening using PROs were disrupted by the COVID-19 pandemic. This study reports the implementation of a Radiation Therapist led “champion” model to support the use of PROs during the COVID-19 pandemic.MethodsPatient charts were audited May 3 to May 22, 2020 to measure the initial impact of the pandemic on weekly completion rates of PROs for patients receiving active radiation treatment. Beginning May 25, 2020, two Radiation Therapists acted as champions to promote the use of PROs among patients and staff. Weekly completion rates of PROs were monitored from May 25, 2020 to May 28, 2021. The type of Patient Reported Outcome Measure (PROM) utilized and treatment intent was also recorded.ResultsAfter implementing the champion model, the weekly completion of PROs increased to an average of 47.0 ± 11.7 (47.5 ± 12.6%) from the initial baseline average of 8.7 ± 1.5 (9.4 ± 2.1%). For PROs completed, the distribution of PROMs was an average of 37.2 ± 9.6 (47.7 ± 12.7%) and 9.8 ± 3.5 (47.0 ± 16.9%) for the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the Expanded Prostate Cancer Index Composite (EPIC) respectively. An average of 5.1 ± 2.9 (26.3 ± 12.7%) and 41.9 ± 10.1 (52.4 ± 14.1%) was recorded for palliative and curative intent respectively.DiscussionAn increased number of PROs were completed after implementing the Radiation Therapist led champion model. Patients receiving a radical course of treatment more frequently completed PROs, which in part reflects the longer treatment courses with increased opportunity for PROs to be completed.ConclusionThe Radiation Therapist led champion model supported ongoing monitoring and completion of PROs during the COVID-19 pandemic and has now been integrated into the department's standard clinical practice.     

Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence,risk factors and outcome

PurposeThe purpose of this study was to retrospectively determine the incidence of early enlarging cavitation after percutaneous radiofrequency ablation (RFA) of lung tumor and identify risk factors associated with their occurrence.Patients and methodsA total of 245 patients (140 men, 105 women; mean age, 62.7 ± 11.8 [SD] years; age range: 31–87 years) with 605 lung tumors who were treated using 401 RFA sessions from April 2010 to March 2020 were included. Of which, 31 patients with 38 early enlarging cavitation and control group (151 patients with 228 tumors) were analyzed. Early enlarging cavitation was defined as cavities with an enlarged size (>3 cm) occurring on ablated lesions within seven days after RFA. Incidence of cavitation, risk and post-procedural factors of occurrence, major adverse events (AEs) that occurred in RFA sessions with cavitation, and course of cavitation were evaluated. AEs were classified using the CIRSE classification system for complications.ResultsThirty-eight cavities (6.3%, 38/605 tumors) in 31 patients occurred in an average of 3.1 ± 1.7 days (range, 1–7 days) after 32 RFA sessions. Distance from pleura ≥ 20 mm, contact with vessel ≥ 3 mm, multitined expandable electrode ≥ 3 cm, and bronchus ≥ 2 mm encompassed in the ablation zone were independent risk factors of occurrence. Fever ≥ 38.5 °C, white blood cell count ≥ 10,000/μl one day after RFA, and steroid therapy were independent post-procedural factors of occurrence. Twenty-four Grade 3 and two Grade 6 AEs occurred. Twenty-nine cavities disappeared within a mean duration of 111.9 ± 64.9 (SD) days (range: 44–274 days) and four remained with a mean follow-up of 279.2 ± 174 (SD) days; five patients were lost to follow-up.ConclusionsEarly enlarging cavitation occurs in 6.3% of lung tumors treated with RFA and are associated with 26 major AEs in 32 sessions. Aforementioned procedural factors and post-procedural inflammation were significant risk factors of occurrence.