Key Points Question Is total neoadjuvant therapy (TNT) associated with improved outcomes when compared with standard concurrent chemoradiotherapy followed by surgery and adjuvant chemotherapy (CRT plus A) for locally advanced rectal cancer? Findings In this systematic review and meta-analysis of 7 unique studies including 2416 unique patients, TNT was found to be associated with a significantly higher rate of achieving a pathologic complete response and disease-free survival compared with the standard CRT plus A approach. No significant difference was found in rates of sphincter-preserving surgery or ileostomy requirements between the 2 approaches. Meaning Total neoadjuvant therapy was associated with improved pathologic complete response rates and has a potential disease-free survival advantage compared with the standard CRT plus A strategy in locally advanced rectal cancer.

Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world. Despite significant improvements in the organization of medical care of patients with cancer, numerous surveys of cancer populations demonstrate that significant proportions of patients fail to have their supportive care needs met. One possible solution is the introduction of a care coordinator role using oncology nursing to help ensure that patients' physical, psychological, and social support needs are addressed. Although having face validity, there is little empirical evidence on the effects of nurse-led supportive care coordinator roles on patient reported supportive care outcomes. In this article the authors present the results of a prospective longitudinal cohort study of 113 patients referred to a community-based specialist oncology nursing program. Using validated instruments they found significant improvements in patient-reported outcomes in key supportive care domains: unmet needs, quality of life, and continuity of care, as well as a shift in patterns of health resource utilization from acute care settings to the community over the course of the intervention. The results of this study are important in supporting the design and development of controlled trials to examine provider roles in the coordination of supportive cancer care.

Background Despite advances in treatment, multiple myeloma (MM) remains incurable and results in significant morbidity and mortality. Further research investigating where MM patients die and characterization of end-of-life hospitalizations is needed. Methods We utilized the National Inpatient Sample (NIS) to explore the hospitalization burden of MM patients at the end of their lives. Results The percent of patients dying in the hospital as a percent of overall MM deaths ranged from 54% in 2002 to 41.4% in 2017 (p < 0.01). Blood transfusions were received in 32.7% of these hospitalizations and infections were present in 47.8% of patients. Palliative care and/or hospice consultations ranged from 5.3% in 2002 to 31.4% in 2017 (p < 0.01). Conclusion Our study demonstrates that patients with MM dying in the hospital have a significant requirement for blood transfusions and have a high infection burden. We also show that palliative care and hospice involvement at the end of life has increased over time but remains low, and that ultimately, inpatient mortality has decreased over time, but MM patients die in the hospital at a higher rate than the general population.

Both single-arm and randomized phase II trials appear warranted in certain situations. Investigators should increase consideration of the potential impact on phase III trials to optimally select the proper trial design prior to phase II study implementation.

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BackgroundThe goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB.MethodsARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions.ResultsWe identified 149,190 ARDS patients. The incidence of GIB was the highest among patients > 60 years (P < 0.001). GIB was associated with longer hospitalization days (7.3 days versus 11.9 days, P < 0.001), higher mortality (11% versus 27%, P < 0.001) and greater economic burden ($82,812 versus $45,951, P < 0.001). GIB was common in cirrhosis (OR: 8.3), peptic ulcer disease (OR: 3.7), coagulopathy disorders (OR: 3.003), thrombocytopenia (OR: 2.6), anemia (OR: 2.5) and atrial fibrillation (OR: 1.5). ARDS secondary to aspiration pneumonia (OR: 2.0), pancreatitis (OR: 2.0), sepsis (OR: 1.6) and community acquired pneumonia (OR: 0.8) was more likely to have GIB.ConclusionOur study demonstrates that GIB in ARDS patients is associated with significant increased mortality, hospitalization and health care cost.

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Background: TB is one of the top 10 killer infectious diseases worldwide and Pakistan ranks 6 th. For sputum positive TB cases, incidence is 80/100,000 per year in Pakistan and the disease accounts for 5.1% of the total national disease burden. In Pakistan according to the National Drug resistance (DR) survey (2012-13), the DR-TB incidence is estimated to be at 3.7% among notified new pulmonary cases and 18.1% among retreatment patients. Under DOTS programs, free first line anti-TB medication is provided to the patients. This study was conducted to evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the study population. Methods & Materials: A cross sectional descriptive study was done at medical unit at Federal General Hospital (FGH), Islamabad from Jan-Dec. 2015. Using consecutive sampling technique, 148 confirmed TB patients presenting to medical OPD were enrolled in study and were registered with DOTS program. After taking informed consent, a validated questionnaire was used to gather information including demography, clinical characteristics, details on compliance and outcome status. Data was analyzed using SPSS software. Results: Total 148 TB patients were enrolled. Male to female ratio was 0.94: 1. Mean age was 36 years (±SD 2.8). The most frequent age group was 15-<50 years (106, 72%). Out of total 148 cases, 126 (85%) had pulmonary tuberculosis, 21 (14%) had extra pulmonary TB while one was (1%) was cryptogenic. 130 patients (89%) were newly diagnosed whereas 18 (11%) were relapse cases. Except for 15 cases (9 lost to follow up and 6 deaths), rest 133 completed treatment with 94% cure rate. Patients with pulmonary tuberculosis were 3.4 times more likely to complete the treatment than with extra pulmonary TB (OR: 3.4. CI: 1.2-9.0, P value: 0.01). Among 12-32 years age group, majority of the patients (66, 86%) were of pulmonary TB. Age and gender did not have any statistical association with treatment outcome. Conclusion: DOTS is a very effective strategy to treat tuberculosis patients. Good counseling of the patients by the doctors and TB health care worker can further minimize the risk of treatment default.