scholarly journals Clinical evaluation of fitness to drive in patients with brain metastases

2019 ◽  
Vol 6 (6) ◽  
pp. 484-489
Author(s):  
Cristina Valencia-Sanchez ◽  
Vanessa C Gorelkin ◽  
Maciej M Mrugala ◽  
Akanksha Sharma ◽  
Sujay A Vora ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Motor Skills ◽  
Cognitive Assessment ◽  
Neurologic Examination ◽  
Fitness To Drive ◽  
Trail Making ◽  
Group Members ◽  
The Mean ◽  
Driving Fitness ◽  
Ability To Drive

Abstract Background Guidelines to provide recommendations about driving restrictions for patients with brain metastases are lacking. We aim to determine whether clinical neurologic examination is sufficient to predict suitability to drive in these patients by comparison with an occupational therapy driving assessment (OTDA). Methods We prospectively evaluated the concordance between neurology assessment of suitability to drive (pass/fail) and OTDA in 41 individuals with brain metastases. Neuro-oncology evaluation included an interview and neurological examination. Participants subsequently underwent OTDA during which a battery of objective measures of visual, cognitive, and motor skills related to driving was administered. Results The mean age of patients who failed OTDA was age 68.9 years vs 59.3 years in the group members who passed (P = .0046). The sensitivity of the neurology assessment to predict driving fitness compared with OTDA was 16.1% and the specificity 90%. The 31 patients who failed OTDA were more likely to fail Vision Coach, Montreal Cognitive Assessment, and Trail Making B tests. Conclusions There was poor association between the assessment of suitability to drive by neurologists and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The positive predictive value was high to predict OTDA failure. Age could be a factor affecting OTDA performance. The results raise questions about the choice of assessments in making recommendations about driving fitness in people with brain metastases. OTDA should be strongly considered in patients with brain metastases who wish to continue driving.

C-28 Raven’s Progressive Matrices: Validation of a Short Form

2019 ◽  
Vol 34 (6) ◽  
pp. 1057-1057
Author(s):  
M Irrgang ◽  
M Dorenkamp ◽  
P Reohr ◽  
P Vik
Keyword(s):  
Cognitive Assessment ◽  
Short Form ◽  
Global Memory ◽  
Cognitive Measures ◽  
Average Correlation ◽  
Global Estimate ◽  
Trail Making ◽  
The Mean ◽  
Raven's Standard Progressive Matrices ◽  
Raven's Progressive Matrices

Abstract Objective The Raven’s Standard Progressive Matrices (RSPM) is a 60-item measure of non-verbal abstract reasoning. The length of the RSPM presents a potential barrier to its use. Consequently, Bilker et al. (2012) identified a 9-item short form (RSPM-SF). The purpose of this study is to (a) provide descriptive statistics for the RSPM-SF from a non-patient sample, and (b) validate the RSPM-SF by exploring correlations with congruent and divergent cognitive measures. Method Twenty men and 23 women, aged 55 to 83 (M = 67.79), completed a test battery that included the SPM-SF and global, memory, verbal, and executive measures. Results The mean score for the RSPM-SF was 4.40 (median = 4, mode = 4, SD = 1.92). RSPM-SF correlated best with the Montreal Cognitive Assessment (r = .548, CI: .297 to .729) and poorest with letter fluency (r = .065, CI: -.456 to .127). Correlations with executive measures ranged from a low of .308 (Tower Test; CI: .019 to .549) to a high of .470 (Trail Making Test Part-B; CI: .197 to .675). The average correlation with executive scores was .412. Average correlation with learning (both verbal and non-verbal) was .435, and with recall was .296. Conclusions RSPM historically was viewed as a non-verbal global estimate of cognitive ability. Present findings support using the RSPM-SF as a global measure, as it correlated well with both verbal and nonverbal, and executive and memory tests. Descriptive data suggested that the RSPM-SF items ranged from easy to difficult.

Dosimetric comparison of fractionated radiosurgery plans using frameless Gamma Knife ICON and CyberKnife systems with linear accelerator–based radiosurgery plans for multiple large brain metastases

2020 ◽  
Vol 132 (5) ◽  
pp. 1473-1479 ◽  
Author(s):  
Eun Young Han ◽  
He Wang ◽  
Dershan Luo ◽  
Jing Li ◽  
Xin Wang
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Treatment Time ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Normal Brain ◽  
Large Brain ◽  
The Mean

OBJECTIVEFor patients with multiple large brain metastases with at least 1 target volume larger than 10 cm3, multifractionated stereotactic radiosurgery (MF-SRS) has commonly been delivered with a linear accelerator (LINAC). Recent advances of Gamma Knife (GK) units with kilovolt cone-beam CT and CyberKnife (CK) units with multileaf collimators also make them attractive choices. The purpose of this study was to compare the dosimetry of MF-SRS plans deliverable on GK, CK, and LINAC and to discuss related clinical issues.METHODSTen patients with 2 or more large brain metastases who had been treated with MF-SRS on LINAC were identified. The median planning target volume was 18.31 cm3 (mean 21.31 cm3, range 3.42–49.97 cm3), and the median prescribed dose was 27.0 Gy (mean 26.7 Gy, range 21–30 Gy), administered in 3 to 5 fractions. Clinical LINAC treatment plans were generated using inverse planning with intensity modulation on a Pinnacle treatment planning system (version 9.10) for the Varian TrueBeam STx system. GK and CK planning were retrospectively performed using Leksell GammaPlan version 10.1 and Accuray Precision version 1.1.0.0 for the CK M6 system. Tumor coverage, Paddick conformity index (CI), gradient index (GI), and normal brain tissue receiving 4, 12, and 20 Gy were used to compare plan quality. Net beam-on time and approximate planning time were also collected for all cases.RESULTSPlans from all 3 modalities satisfied clinical requirements in target coverage and normal tissue sparing. The mean CI was comparable (0.79, 0.78, and 0.76) for the GK, CK, and LINAC plans. The mean GI was 3.1 for both the GK and the CK plans, whereas the mean GI of the LINAC plans was 4.1. The lower GI of the GK and CK plans would have resulted in significantly lower normal brain volumes receiving a medium or high dose. On average, GK and CK plans spared the normal brain volume receiving at least 12 Gy and 20 Gy by approximately 20% in comparison with the LINAC plans. However, the mean beam-on time of GK (∼ 64 minutes assuming a dose rate of 2.5 Gy/minute) plans was significantly longer than that of CK (∼ 31 minutes) or LINAC (∼ 4 minutes) plans.CONCLUSIONSAll 3 modalities are capable of treating multiple large brain lesions with MF-SRS. GK has the most flexible workflow and excellent dosimetry, but could be limited by the treatment time. CK has dosimetry comparable to that of GK with a consistent treatment time of approximately 30 minutes. LINAC has a much shorter treatment time, but residual rotational error could be a concern.

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

Prolonged survival in a subgroup of patients with brain metastases treated by gamma knife surgery

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 262-265
Author(s):  
C. P. Yu ◽  
Joel Y. C. Cheung ◽  
Josie F. K. Chan ◽  
Samuel C. L. Leung ◽  
Robert T. K. Ho
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Patient Survival ◽  
Gamma Knife Surgery ◽  
Prolonged Survival ◽  
Organ Involvement ◽  
Lesion Volume ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The authors analyzed the factors involved in determining prolonged survival (≥ 24 months) in patients with brain metastases treated by gamma knife surgery (GKS). Methods. Between 1995 and 2003, a total of 116 patients underwent 167 GKS procedures for brain metastases. There was no special case selection. Smaller and larger lesions were treated with different protocols. The mean patient age was 56.9 years, the mean number of initial lesions was 3.15, and the mean lesion volume was 10.45 cm.3 The mean follow-up time was 9.2 months. The median patient survival was 8.68 months. One-, 2-, 3-, 4-, and 5-year actuarial survival rates were 31.8%, 19.8%, 14.6%, 7.7%, and 6.9%, respectively. Patient age, number of lesions at presentation, and lesion volume had no influence on patient survival. Twenty-three (19.8%) patients survived for 24 months or more. Certain factors were associated with increased survival time. These were stable primary disease (21 of 23 patients), a long latency between diagnosis of the primary tumor and the occurrence of brain metastases (mean 28.4 months, median 16 months), absence of third-organ involvement, and repeated local procedures. Ten patients underwent repeated GKS (mean 3.4 per patient). Seven patients required open surgery for local treatment failures (recurrence or radiation necrosis). Two patients had both. Fifteen patients underwent repeated procedures. Conclusions. Aggressive local therapy with GKS, repeated GKS, and GKS plus surgery can achieve increased survival in a subgroup of patients with stable primary disease, no third-organ involvement, and long primary-brain secondary intervals.

Tele-ophthalmology for screening for eye diseases in older patients with cognitive complaints

2020 ◽  
pp. 1357633X1989388
Author(s):  
Anne-Sophie Boureau ◽  
Helene Masse ◽  
Guillaume Chapelet ◽  
Laure de Decker ◽  
Pascal Chevalet ◽  
...  
Keyword(s):  
Cognitive Assessment ◽  
Older Patients ◽  
Screening Method ◽  
Poor Quality ◽  
Eye Diseases ◽  
Ophthalmological Examination ◽  
Cognitive Complaints ◽  
The Mean ◽  
To Come ◽  
Retinal Photographs

Introduction Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. Methods This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. Results The mean age of the 298 patients included was 83.5 years  ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. Discussion The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.

Ten Years of Extracorporeal Membrane Oxygenation: Neurodevelopmental Outcome

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 549-555
Author(s):  
Dena Hofkosh ◽  
Heidi M. Feldman ◽  
Ann E. Thompson ◽  
Robert J. Nozza ◽  
Susan S. Kemp ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
High Frequency ◽  
Neurodevelopmental Outcome ◽  
Cognitive Testing ◽  
Neurologic Examination ◽  
Cognitive Score ◽  
School Aged Children ◽  
Membrane Oxygenation ◽  
The Mean

Of the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores ≥85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores &lt;70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 ± 12 [SD], IQ controls = 107 ± 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 ± 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 ± 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Diagnostic value of apparent diffusion coefficient in differentiating between high-grade gliomas and brain metastases

2017 ◽  
Vol 59 (5) ◽  
pp. 599-605 ◽  
Author(s):  
Ionut Caravan ◽  
Cristiana Augusta Ciortea ◽  
Alexandra Contis ◽  
Andrei Lebovici
Keyword(s):  
Diffusion Coefficient ◽  
Brain Metastases ◽  
Apparent Diffusion Coefficient ◽  
Curve Analysis ◽  
High Grade ◽  
Peritumoral Edema ◽  
Roc Curve Analysis ◽  
Apparent Diffusion ◽  
Adc Values ◽  
The Mean

Background High-grade gliomas (HGGs) and brain metastases (BMs) can display similar imaging characteristics on conventional MRI. In HGGs, the peritumoral edema may be infiltrated by the malignant cells, which was not observed in BMs. Purpose To determine whether the apparent diffusion coefficient values could differentiate HGGs from BMs. Material and Methods Fifty-seven patients underwent conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) before treatment. The minimum and mean ADC in the enhancing tumor (ADCmin, ADCmean) and the minimum ADC in the peritumoral region (ADCedema) were measured from ADC maps. To determine whether there was a statistical difference between groups, ADC values were compared. A receiver operating characteristic (ROC) curve analysis was used to determine the cutoff ADC value for distinguishing between HGGs and BMs. Results The mean ADCmin values in the intratumoral regions of HGGs were significantly higher than those in BMs. No differences were observed between groups regarding ADCmean values. The mean ADCmin values in the peritumoral edema of HGGs were significantly lower than those in BMs. According to ROC curve analysis, a cutoff value of 1.332 × 10−3 mm2/s for the ADCedema generated the best combination of sensitivity (95%) and specificity (84%) for distinguishing between HGGs and BMs. The same value showed a sensitivity of 95.6% and a specificity of 100% for distinguishing between GBMs and BMs. Conclusion ADC values from DWI were found to distinguish between HGGs and solitary BMs. The peritumoral ADC values are better than the intratumoral ADC values in predicting the tumor type.

scholarly journals Elaborating on Team-Member Disagreement: Examining Patterned Dispersion in Team-Level Constructs

2018 ◽  
Vol 44 (1) ◽  
pp. 165-210 ◽  
Author(s):  
Andrew C. Loignon ◽  
David J. Woehr ◽  
Misty L. Loughry ◽  
Matthew W. Ohland
Keyword(s):  
Team Member ◽  
Theoretical Frameworks ◽  
Individual Group ◽  
Team Members ◽  
Team Outcomes ◽  
Emergent States ◽  
Multilevel Theory ◽  
Group Members ◽  
The Mean ◽  
Mean Differences

Emergent states are team-level attributes that reflect team members’ collective attitudes, values, cognitions, and motivations and influence team effectiveness. When measuring emergent states (e.g., cohesion, conflict, satisfaction), researchers frequently collect ratings from individual group members and aggregate them to the team level. After aggregating to the team level, researchers typically focus on mean differences across teams and ignore variability within teams. Rather than focusing on the mean level of emergent states, this study draws on recent advances in multilevel theory and describes an approach for examining the specific patterns of dispersion (i.e., disagreement) across five emergent states. Our findings suggest that teams reliably demonstrate different patterns of rating dispersion that are consistent with existing theoretical frameworks and typologies of dispersion, yet have not previously been empirically demonstrated. We also present evidence that the different patterns of dispersion in emergent states are significantly related to key team outcomes, even after controlling for the mean levels of those emergent states. These findings underscore the importance of exploring additional forms of team-level constructs and highlight ways of extending our understanding of group-level phenomena.

Phase 1, 2 trial of concurrent anti-PD1 and stereotactic radiosurgery for melanoma and non-small cell lung cancer brain metastases (NCT02858869).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2022-2022
Author(s):  
Mohammad Khurram Khan ◽  
Tahseen Nasti ◽  
Troy Kleber ◽  
David H. Lawson ◽  
Melinda Lynne Yushak ◽  
...  
Keyword(s):  
T Cells ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Benefit ◽  
Progression Free Survival ◽  
Free Survival ◽  
Early Activation ◽  
Previously Treated ◽  
The Mean ◽  
Grade 3

2022 Background: The safety and efficacy of concurrent pembrolizumab (anti-PD1) and stereotactic radiosurgery (SRS) for brain metastases (BM) is unknown. Methods: Patients with melanoma or NSCLC, 1-10 brain metastases, ≥ 1 extra-cranial lesion, age ≥ 18, and ECOG 0-1 were treated with anti-PD1 every 3 weeks. SRS was administered 1-2 days after starting anti-PD1. SRS used three different radiation arms: Arm A used 6 Gray (Gy) in 5 fractions (fx), Arm B used 9 Gy in 3 fx, and Arm C used 18-21 Gy in single fx. Primary endpoint was grade 3 CNS toxicity at 3 months (CTCAE v 4.0). Secondary endpoints were overall survival (OS), local control (LC) within the SRS field, intra-cranial progression free survival (IC-PFS), extra-cranial progression free survival (EC-PFS), rate of extra-cranial clinical benefit, and immunological changes. OS, LC, IC-PFS, and EC-PFS were estimated using the Kaplan-Meier method, and covariates were compared using log-rank tests. 95% confidence intervals for 6-month and 12-month were estimated using Greenwood’s formula. Results: 25 patients were treated from 2016 until 2020. The mean age was 61. The mean number of CNS lesions was 2.7. The mean number of extra-cranial lesions was 2.5. Six were enrolled on Arm A, 12 on Arm B, and 7 on Arm C. 21 had melanoma. 4 had NSCLC. Of the melanoma, 8 were BRAF-, 10 were BRAF+, and 3 had unknown mutation status. 12 patients (48%) had progressed on prior immunotherapy and/or other oncological therapies. The trial met its primary endpoint, with no grade 3 CNS toxicity at 3 months. Two patients (8%) experienced ≥ Grade 3 anti-PD1 related toxicity, and no grade 5 toxicity was noted. The median OS was 32.8 months. The 6 and 12 month OS were 79.1% (56.5-90.8%) and 67.8% (43.3-83.5%), respectively. The 1 year OS was similar between previously treated and treatment naïve patients (71.8% vs. 65.6%), suggesting some role for SRS in overcoming therapy resistance. However, with longer follow-up, the OS trended worse (p=0.07) for previously treated patients. LC was 95.7% (72.9-99.4%) at 6 and 12 months. IC-PFS at 6 months was 69.1% (45.8-83.9%), and at 12 months was 57.5% (33.7-75.5%). The EC-PFS at 6 and 12 month was 54.5% (32.1-72.4%) and 43.6% (22.3-63.2%), respectively. Clinical benefit, which was defined as a best overall response of stable disease or better according to RECIST 1.1, occurred in 12 patients (48%). No outcome differences were noted amongst the three different SRS arms. 70% of the patients demonstrating early activation (within 3 weeks of starting SRS/anti-PD1) of CD8+PD1+Ki67+ T cells demonstrated a clinical benefit. 100% of patients that failed to show early activation of CD8+PD1+Ki67+ T cells progressed. Conclusions: Concurrent pembrolizumab (Anti-PD-1) and SRS is safe and effective. Early activation of CD8+PD1+Ki67+ T cells correlates with improved outcome. Further trials testing pembrolizumab and SRS are justified. Clinical trial information: NCT02858869.

Assessing driving fitness in dementia: a challenge for old age psychiatrists

2019 ◽  
Vol 27 (5) ◽  
pp. 501-505
Author(s):  
Duncan Neilson ◽  
Emme Chacko ◽  
Gary Cheung
Keyword(s):  
Therapeutic Alliance ◽  
Old Age ◽  
Thematic Analysis ◽  
Negative Impact ◽  
Formal Training ◽  
Fitness To Drive ◽  
Dementia Patients ◽  
Driving Fitness ◽  
Structured Approach ◽  
Previous Training

Objective: To investigate how old age psychiatrists consider the fitness of dementia patients to drive safely and the challenges they face. Method: Participants were interviewed using a semi-structured approach that explored topics including their approach to driving fitness and cessation, challenges experienced and previous training. Thematic analysis was used to generate main themes. Results: Thirteen participants were recruited. Most felt they were not experts in driving fitness. Many found these assessments challenging for both themselves and their patients, with a negative impact on therapeutic alliance. There was a lack of formal training and variability both in the approach when considering fitness to drive as well as raising the issue of driving with patients. Conclusions: These results highlight the need to increase the availability of training for driving fitness, and to develop a standardised approach to help improve consistency amongst clinicians.

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