Objective Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. Methods A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission <3 days. Inpatient direct hospital costs were calculated for the last 30 days of life from accounting records. Data were analyzed using Fisher's Exact, Mann–Whitney U, Kaplan–Meier, and Student's T testing. Results 49% of patients had a palliative medicine consultation and 18% had timely consultation. Median ACE score for patients with timely palliative medicine consultation was 0 (range 0–3) versus 2 (range 0–6) p = 0.025 for patients with untimely/no consultation. Median inpatient direct costs for the last 30 days of life were lower for patients with timely consultation, $0 (range 0–28,019) versus untimely, $7729 (0–52,720), p = 0.01. Conclusions Timely palliative medicine consultation was associated with lower ACE scores and direct hospital costs. Prospective evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs.

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Objective There is limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in last six months of life. Patient demographics, patterns of care and utilization of palliative medicine consultation services were evaluated. Methods 100 patients who died from gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within one year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record and analyses were made using Students T, and Mann-Whitney testing with SPSS software. Results The mean age of patients was 60 years (range 30–94 years). Racial/ethnic distribution was 38% Caucasian, 34% Black, and 15% Hispanic. 75% of patients received chemotherapy within the last six months of life, 30% received chemotherapy within the last six weeks of life. The median number of days hospitalized during the last six months of life was 24 (range 0–183 days). During the last six months of life, 19% were admitted to the Intensive Care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardio-pulmonary resuscitative efforts. 64% had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had ≥ 14 days from consultation until death versus patients who had ≤ 14 days or no consultation, 21 (72%) versus 29 (41%), p =0.004. Patients who were single were less likely to have a palliative medicine consultation, p=0.005. Conclusions End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality-of-life. These pilot data suggest that factors for implementation of timely hospice referral, family support and legacy building should include specialists trained in palliative medicine.

BACKGROUND AND PURPOSE: Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. MATERIALS AND METHODS:This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample t tests and x 2 tests of independence were performed to evaluate the significance of the difference between the groups.RESULTS: Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (P , .001). The presence of an intact anterior meningovertebral ligament had 83.3% sensitivity and 100% specificity for tuberculous spondylodiscitis, a 100% positive predictive value, and a 97.2% negative predictive value. CONCLUSIONS:The presence of an intact anterior meningovertebral ligament has high sensitivity and specificity for tuberculous spondylodiscitis-associated epidural abscess, though these results should be validated in a larger sample.

The normal range for the BUN:creatinine ratio (BCR) has not been determined for infants and children. The objectives of this study were to: (1) test the hypothesis that the BCR is higher in young children; and (2) establish normal BCR ranges for children of various ages. In this retrospective single-center review, 482 patients evaluated in an ambulatory setting were studied. The mean BCR declined significantly with age (P<0.0001). There was an inverse relationship between BCR and age, BMI, and serum creatinine and a direct relationship with BUN and GFRe. Based on our findings, we conclude that BCR values in adult patients are inapplicable to children below 10 years of age. We suggest that BCR greater than 60 in children ≤10 years and greater than 30 in children >10 years be considered abnormal. Application of age-specific pediatric criteria will ensure the proper application of the BCR in evaluating acutely ill children (word count: 150)

The aim of this retrospective study was to investigate the association of palliative medicine consultation with inpatient hospital costs and ACE (aggressiveness of care at the end of life) scores in patients with gynecologic malignancies. Data were obtained from inpatient and outpatient medical records of 100 consecutive patients who died of primary gynecologic malignancies at a single institution. Timely consultation for palliative care was defined as exposure to inpatient consultation for 30 days or more before death. Metrics used to tabulate ACE scores included the following: admission ABSTRACT Standard therapy for platinum-resistant ovarian cancer (OC) is single-agent chemotherapy. The most active single agents are pegylated liposomal doxorubicin, paclitaxel, and topotecan. Use of these single agents has limited benefit, and their use in combination increases toxicity without improving efficacy. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor, inhibiting development of new blood vessels and cancer growth. This agent has shown activity in OC both as monotherapy and when combined with chemotherapy.AURELIA (Avastin Use in Platinum-Resistant Epithelial OC) is an open-label randomized phase III trial designed to evaluate the efficacy and safety of the combination of bevacizumab and chemotherapy in patients with platinumresistant OC. Eligible participants had measurable/assessable OC that had progressed within 6 months after completing platinum-based therapy. Patients were excluded who had refractory disease or had received more than 2 prior anticancer

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