The disease-specific total costing method (Sum_Diagnosis Specific) was most commonly used and its use increased over the time period covered by this review. The investigation of subgroup heterogeneity in COI estimates represents an area for future research.
Background: Hypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes between SF-SRS versus HF-SRS across our multi-center academic network. Methods: Patients treated with SF-SRS or HF-SRS for brain metastasis from 2013 to 2018 across 5 radiation oncology centers were retrospectively reviewed. SF-SRS dosing was standardized, whereas HF-SRS dosing regimens were variable. The co-primary endpoints of local control and radiation necrosis were estimated using the Kaplan Meier method. Multivariate analysis using Cox proportional hazards modeling was performed to evaluate the impact of select independent variables on the outcomes of interest. Propensity score adjustments were used to reduce the effects confounding variables. To assess dose response for HF-SRS, Biologic Effective Dose (BED) assuming an α/β of 10 (BED 10) was used as a surrogate for total dose.
Objectives To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self‐management (DSM) in a primary care setting. Methods The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site‐related information of the physicians were also collected. Key findings Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent <20 min on face‐to‐face visits. Approximately, 95% of physicians considered self‐care activities such as regular moderate exercise, following a recommended diet, regular blood glucose testing, proper insulin administration and adherence to oral medication as extremely important. Practice‐related aspects such as patient–physician communication, patient health literacy and patient follow‐up were unanimously considered extremely important, and performance on these measures was rated positively. Interestingly, 66% of physicians felt responsible to some extent for their patient's failure to reach type 2 DSM goals. Physician perceived barriers that contributed to clinical inertia included cost of medications, lack of patient motivation and knowledge, non‐compliance with diet and medications, polypharmacy and lack of time and social support. Conclusions The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self‐management and improved clinical outcomes in type 2 diabetes population.
Background and purpose Meningiomas express the somatostatin receptor (SSTR), which normal bone and brain lack. PET imaging with SSTR ligands such as 68 Ga-DOTATATE have been recently shown to aid in the imaging and identification of menginiomas. We hypothesize that 68 Ga-DOTATATE PET/CT in conjunction with MRI aids in radiation (RT) target volume delineation and evaluating treatment response. Materials and methods Nineteen patients with meningiomas underwent 68 Ga-DOTATATE PET/CT and MRI for RT planning and/or post-treatment follow-up. Meningiomas were grade I (n = 9) or not biopsied (n = 8) and frequently involved base of skull (n = 10). Ten (53%) patients received post-operative RT and 9 (47%) received fractaionted RT. In the subgroup that underwent both pre- and post-RT 68 Ga-DOTATATE PET as well as MRI (n = 10), ROVER (ABX GmbH, Radeberg, Germany) adaptive thresholding software was utilized to measure total lesion activity (mean and max) before and after treatment. Tumor volume based on MRI was calculated before and after treatment. Total lesion activity and tumor volume changes were compared using Wilcoxon signed rank test. Results 68 Ga-DOTATATE PET/CT identified intraosseous (n = 4, 22%), falcine (n = 5, 26%) and satellite lesions (n = 3, 19%) and clarified the diagnosis of meningioma, resulting in a change in management in three patients. Mean total lesion activity decreased 14.7% (median), from pre to post-RT 68 Ga-DOTATATE PET [range 97–8.5% (25–75%),S = − 26.5, p = 0.0039]. Max total lesion activity decreased 36% (median) over the same period [range 105–15% (25–75%), S = − 26.5 p = 0.0039]. In contrast, meningioma volumes based on MRI measurements did not significantly change per RECIST criteria and Wilcoxon signed rank test (S = − 3, p = 0.7422). Conclusion 68 Ga-DOTATATE PET/CT helped confirm suspected diagnoses and delineate target volumes particularly when lesions involved osseous structures and the falx. Mean and max total tumor 68 Ga-DOTATATE activity on PET/CT decreased at three months following RT despite stable tumor volumes on MRI. Future studies are warranted to (1) assess the sensitivity and specificity of 68 Ga-DOTATATE PET/CT, (2) evaluate the impact of 68 Ga-DOTATATE PET/CT-based planning on treatment outcomes, and (3) assess the prognostic significance of these post-treatment imaging changes.
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