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Objective The efficacy of Rhodococcus equi-specific hyperimmune plasma (HIP) is usually evaluated in vitro. Anticoagulants (AC) used for plasma collection can negatively impact bacterial replication but their effect on R. equi growth has not been evaluated. The aim of this study was to establish the effect that AC routinely used in veterinary medicine (ACD, K2EDTA, Li Heparin, and Na Citrate) have on in vitro R. equi growth. To assess this, in vitro assays commonly used to test HIP efficacy (direct effect on microorganism and macrophage infection), were performed using each AC and non-treated bacteria. Results There was no direct effect of ACD, Li Heparin or Na Citrate on R. equi growth. These AC significantly (p R. equi colonies after macrophage infection was significantly (p 2EDTA inhibited the formation of R. equi colonies by 12 h in all the assays. In conclusion, AC should be taken into consideration when interpreting in vitro results as their negative effect on bacterial growth may be mistakenly interpreted as HIP efficacy. ACD and Li Heparin appear more appropriate for the selected assays.

Objectives: To determine whether patients with neurogenic claudication associated with lumbar spinal stenosis would prefer a treatment that makes it possible for them to walk farther or walk with less pain; to examine associations between this treatment preference and patient-reported and in-clinic treadmill testing measures of walking ability and walking-associated pain. Methods: In this cross-sectional study, 269 patients with neurogenic claudication were asked to report their pain intensity when walking, complete the Swiss Spinal Stenosis Questionnaire, rank their outcome preferences for treatment, and undergo standardized treadmill testing, including measures of final pain rating and time to first pain of moderate intensity (T first ). Descriptive statistics were used to characterize patient preferences for treatment outcome. Associations between self-report questionnaires and standardized treadmill testing outcomes were evaluated using Spearman correlations. Results: Seventy-nine percent of patients expressed a preference for treatment that allowed them to walk with less pain. Preference for reduced pain was associated with higher pain during daily walking, along with a shorter T first and higher final pain severity on treadmill testing. In contrast, patient preference for treatment outcome was not associated with self-reported measures of daily walking capacity or walking distance on the treadmill. Conclusions: A majority of patients with neurogenic claudication prioritized walking with reduced pain over walking farther. Reduction in pain while walking may therefore constitute a sufficient patient-focused treatment outcome for the majority of these patients. These results have implications for clinical trial design and assessment of treatment efficacy in neurogenic claudication.

Background American Society for Clinical Oncology (ASCO) quality measures for terminal cancers recommend early advance care planning and hospice at the end of life. We sought to evaluate adherence to 5 palliative care quality measures and explore associations with patient outcomes in glioblastoma. Methods This is a retrospective analysis of 117 deceased glioblastoma patients over 5 years. Records were reviewed to describe adherence to palliative care quality measures and patient outcomes. Data regarding emotional assessments, advance directives, palliative care consultation, chemotherapy administration, hospice, location of death, and overall survival were collected. Results Median overall survival was 12.9 months. By the second oncology visit, 22.2% (26/117) had an emotional assessment completed. Advance directives were documented for 52.1% (61/117) by the third neuro-oncology visit (30/61 health care proxy), yet 26.5% (31/117) did not have any advance directive before the last month of life. With regard to other ASCO quality measures, 36.8% (43/117) had a palliative care consult; 94.0% (110/117) did not receive chemotherapy in the last 14 days of life; 59.8% (70/117) enrolled in hospice >7 days before death; and 56.4% (66/117) died in a home setting. Patients who enrolled in hospice >7 days before death were 3.56 times more likely to die in a home setting than patients enrolled Conclusions Late advance directive documentation, minimal early palliative care involvement, and the association of early hospice enrollment with death in a home setting underscore the need to improve care and better define palliative care quality measures in glioblastoma.

In a population health-driven health care system, data collection through the use of clinical registries is becoming imperative to continue to drive effective and efficient patient care. Clinical registries rely on a department’s ability to collect high-quality and accurate data. Currently, however, data are collected manually with a high risk for error. The University of Rochester’s Department of Neurosurgery in conjunction with the university’s Clinical and Translational Science Institute has implemented the integrated use of the Informatics for Integrating Biology and the Bedside (i2b2) informatics framework with the Research Electronic Data Capture (REDCap) databases.

BACKGROUND: Clinical trials favor aggressive therapy for glioblastoma. Maximally safe surgical resection, radiotherapy, and temozolomide chemotherapy are considered standards of care. However, it is unclear if these treatments improve population-based overall survival, as the selection criteria used in clinical trials are often relatively narrow. METHODS: We prospectively collected patients registered in a population-based database for primary HGGs (n = 363) treated in Rochester, NY from 2000 to 2014. We sought to track survival trends and evaluate treatment efficacies. RESULTS: The median age at diagnosis was 61 years. The majority of patients were white (94.5%) with glioblastoma (77.7%). Most (84.3%) had died (all causes) during the follow-up interval. Overall, patients who received combination treatment of surgery, radiation and chemotherapy have better survival (median 490.0 days) than those who received combination of surgery and radiation therapy (median 239.0 days, p < 0.001) or surgery alone (median 95.0 days, p < 0.001). We further grouped patients into three time periods for comparison: 2000 to 2004, 2005 to 2009, and 2010 to 2014. We found no appreciable differences in the median, 6-month, and 2-year survivals between each time interval (median survival time: 368.0 vs. 360.0 vs. 358.0 days, respectively). Notably, the rate of combination of surgery, radiation and chemotherapy significantly increased over the time (32.5% vs. 64.0% vs. 67.6%, respectively). We also observed that patients who received surgery and radiation therapy had a better survival time during 2000 to 2004 (median 275.5 days) compared to those in 2005 to 2009 (median 89.0 days, p < 0.05). CONCLUSIONS: Our data indicate that while temozolomide chemotherapy clearly improves survival with HGG, its benefit is limited to a subset of patients. Expanding its use to all HGG as is now common practice does not improve overall patient population survival. A more personalized usage strategy for temozolomide is needed.

242 Background: Caregiver (CG) burden is particularly high in glioblastoma (GBM) because neurologic deficits lead to cognitive dysfunction and physical dependence. The amount of time that CGs devote to GBM pts is not well described. The extent to which time burden impacts CG quality of life and perceived burden is unknown. Methods: We performed an IRB-approved prospective analysis of 38 CGs of pts with newly diagnosed GBM enrolled over 8 mo. at a single academic institution. CGs were defined as individuals responsible for any aspect of pt support, and multiple CGs were allowed for each pt. CGs completed the Caregiver Quality of Life in Cancer (CQOLC) survey plus questions about CG role and time dedicated to pt care within 2 mo. of initial neuro-oncology visit. We described time burden and correlated this with 3 CQOLC questions addressing CG stress, emotional well-being, and perceived burden. Results: 30/38 CGs completed the surveys. The 30 CGs (21 female) included 16 spouses, 8 children, 3 parents, 2 siblings and 1 friend. 21 were primary CGs (13 female). 21 CG spent > 40 hrs/wk with pt, 10 spent > 40 hrs/wk on direct pt care, and 7 spent > 40 work hrs/wk caring for the pt. Table 1 illustrates CG time burden stratified by primary vs non-primary CG. CG time spent on direct pt care positively correlated with CGs feeling overwhelmed by their responsibilities as assessed by the CQOLC (p < 0.0001, spearman coefficient 0.66). Amount of work hrs spent on pt care also correlated with the CG feeling overwhelmed. (p = 0.0003, spearman coefficient 0.61). Conclusions: CG time burden in GBM is substantial even at the time of diagnosis, and is most notable in primary CGs. CG time burden correlates with signs of emotional distress as measured by the CQOLC. Assessing time burden for individual CGs may help identify early risk for distress and develop interventions to improve CG quality of life. [Table: see text]