Abstract: The present study analyzed outcomes of surgery followed by concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM) at a single institution. Outcomes were retrospectively reviewed in 252 consecutive patients with newly diagnosed GBM who underwent surgery followed by CCRT with TMZ at the authors' institution between 2005 and 2013. At initial operation, 126 (50.0%), 55 (21.8%), 45 (17.9%), and 26 (10.3%) patients underwent gross total resection (GTR), subtotal resection, partial resection (PR), and biopsy, respectively. Their median overall survival (OS) was 20.8 months (95% confidence interval [CI] 17.7-23.9 months) and their median progression-free survival was 12.7 months (95% CI 11.2-14.2 months). The O-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 78 (34.1%) of the 229 patients assayed, and an isocitrate dehydrogenase 1 mutation was detected in 7 (6.6%) of the 106 patients analyzed. Univariate analyses showed that patient age, involvement of eloquent areas, involvement of the subventricular zone, presence of leptomeningeal seeding, Karnofsky Performance Status, extent of resection (EOR), MGMT promoter methylation, and presence of an oligodendroglioma component were prognostic of OS. Multivariate analysis showed that age, involvement of eloquent areas, presence of leptomeningeal seeding, EOR, and MGMT promoter methylation were significantly predictive of survival. OS in patients with GBM who undergo surgery followed by CCRT with TMZ is enhanced by complete resection. Other factors significantly prognostic of OS include that age, involvement of eloquent areas, presence of leptomeningeal seeding, and MGMT promoter methylation.

Abstract: BACKGROUND: Children with intestinal failure (IF) on parenteral nutrition (PN) are at high risk for bacteremia, and delays in antibiotic administration have been associated with increased morbidity and mortality. We designed an emergency department (ED) quality improvement (QI) initiative to reduce time to administration of intravenous antibiotics in febrile children with IF on PN. METHODS: Our aim was to decrease the mean time for febrile children with IF on PN to receive intravenous antibiotics by 50% to <60 minutes over a 12-month period. Secondary outcome measures were ED, hospital, and ICU length of stay (LOS). Our process measure was the rate of ordering recommended antibiotics, and our balancing measure was the rate of hypoglycemia. Interventions included increasing provider knowledge of IF, streamlining order entry, providing individualized feedback, and standardizing the triage process. Results were analyzed by using statistical process control methodology and time series analysis. RESULTS: We identified 149 eligible ED patients, of which 62 (41.6%) had bacteremia. The mean time to antibiotics decreased after the onset of the QI initiative from 112 to 39 minutes, and the ED LOS decreased from 286 to 247 minutes, but the total length of hospital and ICU stays were unchanged. The rate of hypoglycemia was also unchanged. CONCLUSIONS: Our QI intervention for febrile children with IF on PN shortened the time to receive antibiotics. Larger studies are needed to demonstrate the impact on overall LOS and mortality.

Abstract: OBJECTIVE: Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization. METHODS: A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bage, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (>/= 2 and >/= 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables. RESULTS: The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8-19.6) and 10.6% (95%CI 9.1-12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition' form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09-2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan. CONCLUSIONS: The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases. OBJETIVO: Avaliar a associacao da multimorbidade, modelo de atencao basica e posse de plano de saude com hospitalizacao. METODOS: Estudo transversal de base populacional com 1.593 idosos (60 anos ou mais) residentes na zona urbana do municipio de Bage, Rio Grande do Sul. O desfecho foi a hospitalizacao no ano anterior a entrevista. A multimorbidade foi avaliada por meio de dois pontos de corte (>/= 2 e >/= 3). O modelo de atencao basica foi definido pela residencia em areas cobertas pela atencao tradicional ou da Estrategia Saude da Familia. A posse de plano de saude foi referida pelos idosos. Realizou-se analise bruta e ajustada por regressao de Poisson utilizando modelo hierarquizado. O ajuste incluiu variaveis demograficas, socioeconomicas, capacidades funcionais e de servicos de saude. RESULTADOS: A ocorrencia de hospitalizacao geral e nao cirurgica foi de 17,7% (IC95% 15,8-19,6) e 10,6% (IC95% 9,1-12,1), respectivamente. Idosos com multimorbidade hospitalizaram mais em comparacao com os idosos sem multimorbidade, independentemente da forma de operacionalizacao da exposicao. O plano de saude aumentou em 1,71 (IC95% 1,09-2,69) vezes a internacao hospitalar entre residentes nas areas da Estrategia Saude da Familia em comparacao aos idosos residentes nas areas tradicionais sem plano de saude. CONCLUSOES: A multimorbidade aumentou a ocorrencia de hospitalizacoes, principalmente aquelas nao cirurgicas. Idosos com plano de saude e residentes em areas de Estrategia Saude da Familia internaram mais, independentemente da presenca de multiplas doencas.