Citations

Metastatic meningioma exhibits diverse dissemination patterns across organ systems (lungs, bone, liver, soft tissue, etc), with molecular imaging—particularly gallium 68 DOTA Tyr3-octreotide PET/CT—playing a pivotal role in detection, characterization, and guiding management.

Abstract Psychological distress, moral injury, and burnout are prevalent among intensive care unit (ICU) professionals, impacting individual well-being, team dynamics, and patient safety. Structured peer support programmes, delivered by trained colleagues rather than mental health professionals, could be implemented as low-threshold, scalable interventions to promote psychological safety and resilience. This review outlines five foundational pillars for implementing peer support in the ICU, including formal programme design, training, inclusivity, confidentiality, and continuous evaluation. It also addresses practical strategies to overcome cultural and institutional barriers, such as stigma, time constraints, and hierarchical norms. Drawing on current evidence and recent unpublished survey data from North American critical care cardiologists, the article provides a practical framework for integrating peer support into ICU culture. Peer support represents a complementary approach to formal mental health services and offers tangible benefits for clinician well-being, retention, and quality of care.

Abstract Aims The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients. Methods Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification. Results From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65). Conclusions In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage.

345 Background: Pediatric febrile neutropenia (PFN) requires emergent evaluation due to risk of invasive bacterial infection. In the management of PFN, there are varying, accepted definitions for fever requiring emergency evaluation and neutropenia requiring admission. Problem statement: From September 1, 2022 - May 31, 2023, 15.1% (n = 11/73) of emergency department (ED) visits and 17.1% (n = 6/35) of admissions for PFN at Mayo Clinic Rochester may be considered unnecessary due to patients not meeting updated clinical criteria. Aim: Decrease unnecessary ED visits and hospitalizations for PFN by 50% from 15.1% to 7.5% (for ED visits) and from 17.1% to 8.6% (for hospitalizations) by 02/29/2024 without adversely impacting mortality from invasive bacterial infection. Methods: We used the DMAIC framework for process improvement. Interventions included (1) adoption of a higher fever definition for PFN, (2) adoption of a risk-stratified neutropenia definition for hospital admission, (3) provided electronic fever plans with definitions to all families, (4) re-iterated that parents call on-call provider with any concern for fever, (5) educated pediatric oncology staff on definition and management of fevers in pediatric oncology patients, and (6) educated pediatric emergency department staff on definition and management of fevers in pediatric oncology patients. Interventions were tested with rapid tests of change. Relevant clinical characteristics, variables, and outcomes for all patients from pediatric oncology were tracked for all encounters of pediatric oncology patients presenting to the ED for acute illnesses. Results: At baseline,15.1% (n = 11/73) of ED visits for PFN were considered unnecessary due to patients not meeting clinical criteria for emergency evaluation. Post-interventions, unnecessary ED visits for PFN had decreased to 3.4% (n = 1/32). At baseline, 17.1% (n = 6/35) of hospitalizations were considered unnecessary due to patients not meeting clinical criteria for admission. Post-interventions, 7.7% (n = 2/26) of hospitalizations were considered unnecessary. There were no patient deaths from invasive bacterial infection among this cohort at baseline or after interventions. Conclusions: Multiple interventions including adoption of a higher, accepted fever threshold and risk stratified neutropenia definition for PFN was associated with a reduction of unnecessary ED visits and hospitalizations for PFN without an increase in mortality from invasive bacterial infection. The projected medical expense savings of approximately $144,000-$210,000 per year.

431 Background: The National Adult and Influenza Immunization Summit (NAIIS) promoted clinical subspecialist efforts toward vaccination assessment and recommendation as one strategy to increase adult vaccination rates. Problem Statement: Between August 1, 2022, and May 31, 2023, 0% (n=0/100) of patients seen in medical oncology at Mayo Clinic (Rochester, MN) and receiving chemotherapy for breast cancer had a documented comprehensive vaccination status assessment by breast medical oncology staff. Aim Statements: (1) To increase the rate of comprehensive vaccination status assessment performed by breast medical oncology staff from 0% to 75% of patients receiving chemotherapy for breast cancer by September 2024. (2) To increase the rate of documented vaccination recommendation for patients who were not up to date with recommended vaccinations from 0% to 50% by September 2024. Methods: We deployed multiple interventions including physician and nurse education; development of patient education materials; and a standard operating procedure (SOP) for vaccination status assessment, vaccination recommendation, and vaccine-related documentation. Our SOP utilized an Epic SmartPhrase with following elements: (1) SmartLink that autopopulated overdue vaccinations, (2) hidden tip text permitting the use to hyperlink to Health Maintenance, (3) SmartLists that captured nurse actions (e.g., provided education) and encounter outcomes (e.g., patient endorsed plans to receive vaccinations), and (4) scripting for immunization education. Results: Multi-faceted interventions were associated with an improvement in the documented rate of comprehensive vaccination status assessment from 0% (n=0/100) to 82.8% (n=101/122). Most patients (77.2%, n=78/101) were not up to date with recommended vaccinations. Recommendations for appropriate vaccinations were made for 80.8% (n=63/78) of patients who were not up to date. Only 19.2% (n=15/78) of patients who were not up to date endorsed intention to receive missing/recommended vaccines. Counterbalance: Nurses were able to assess vaccination status and make appropriate recommendations in less than 5 minutes per patient. There was no difference in nurse-reported workflow burden related to vaccination status assessment, recommendation, or documentation after intervention. Conclusions: This quality project aligned our breast medical oncology practice with vaccination-related care promoted by NAIIS. We increased rates of vaccination status assessment and vaccination recommendations without impacting nurse-reported workflow burden. Medical subspecialty clinic engagement in vaccination efforts is feasible.

Abstract BACKGROUND Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome characterized by development of multiple neoplasms, including central nervous system (CNS) hemangioblastomas, renal cell carcinoma (RCC), pancreatic neuroendocrine tumors (pNETs), and retinal hemangioblastomas. Belzutifan, a hypoxia-inducible factor 2-alpha (HIF-2α) inhibitor, has demonstrated efficacy in treating VHL-associated tumors. This study evaluates our institutional experience with belzutifan in patients with VHL-related tumors. MATERIAL AND METHODS We conducted a retrospective cohort study across three Mayo Clinic sites, including patients aged ≥18 years with genetically confirmed VHL disease who received belzutifan between October 2021 and March 2025. Clinical/radiological data, and adverse events (AEs) were extracted from electronic health records. Tumor responses were assessed using RECIST v1.1 criteria for RCC, pNET, CNS hemangioblastoma. Retinal hemangioblastoma responses were evaluated through ophthalmologic assessments. RESULTS Forty-five patients were included (median age 44 58% female). Sixty-seven percent had RCC, 91% had CNS hemangioblastomas, 53% had pNETs, and 62% had retinal hemangioblastomas. The median duration of belzutifan therapy was 22.6 months (range 1.0-41.4 months). Among patients with RCC (n=26), overall response rate (ORR) was 19% and median time to best response (MTBR) was 7.4 months. Five patients had partial response (PR), 15 had stable disease (SD), and 1 had progressive disease (PD). For CNS hemangioblastomas (n=41), ORR was 12%, MTBR was 6.2 months. 5 patients had PR, 30 had SD, and none had PD. For pNET (n=17), ORR was 41%, MTBR was 8.2 months. One patient had CR, 6 patients had PR, 6 had SD, none had PD. For retinal hemangioblastomas (n=28), 6 (21%) showed improvement, 9 (32%) remained stable, and 3 (11%) showed progression. MTBR was 6.7 months. Treatment-related AEs occurred in 98% of patients. Common AEs included anemia (89%), fatigue (80%), hypoxia (18%), and headache (13%). Grade 3 AEs were observed in 20% of patients, including anemia (7%), hypoxia (9%), fatigue (4%), pneumonitis (2%), loss of consciousness (2%). One patient experienced a grade 4 event (status epilepticus). Anemia management involved iron supplementation (n=11), RBC transfusion (n=3), dose reduction (n=2), treatment holiday (n=8), permanent discontinuation (n=1). Hypoxia management included dose reduction (n=1), treatment holiday (n=3), discontinuation (n=1). CONCLUSION Belzutifan shows clinical activity across various VHL-associated neoplasms in real-world practice, with a manageable safety profile. The lower ORR compared to the phase III trial may reflect differences in baseline disease, including lower tumor burden in our cohort. These findings support its continued use in VHL disease, with attention to monitoring and managing treatment-related AEs.

Abstract BACKGROUND Ovarian cancer rarely metastasises to the brain, thus studies reporting the outcomes of affected patients are lacking. Stereotactic radiosurgery (SRS) is now the mainstay of management for patients with brain metastases (BM) from most primary sites, but little evidence of its efficacy in ovarian cancer is available. The current study was undertaken to provide guidance for SRS management using pooled data from multiple institutions. MATERIAL AND METHODS Centers participating in the IRRF (International Radiosurgery Research Foundation) were asked to provide outcome data for patients who had SRS for ovarian cancer brain metastases between 2020 and 2024 and at least one clinical and imaging follow-up after the procedure. Primary endpoints included survival from SRS, local tumor response according to RANO-BM criteria and occurrence of adverse radiation effects (ARE). Cox regression analyses were performed to identify variables impact each endpoint. RESULTS 128 patients had SRS for a total of 532 BM treated. Epithelial histology was the most common (91%). Median age at SRS was 62 years (IQR 56-70). Median KPS was 80% (IQR 80-90%) and 71.9% of patients had neurological symptoms at presentation. Other active systemic metastases were present in 41.4%. The median number of treated BM was 2 (IQR1-3) and the median cumulative treatment volume was 6 cc (IQR 2-12.9). The median margin dose was 18 Gy (IQR 16-20). At last follow-up, 19.5% of patients were still alive. The median overall survival (OS) after SRS was 27 months, and 6-, 12- and 24-month OS was 83.8%, 74.2% and 52.2%, respectively. Multivariate analyses revealed that increasing age at SRS (HR 1.02, p=0.05), active systemic metastases (HR 2, p=0.005) and increasing number of brain metastases (HR 1.05, p=0.04) were associated with worse survival, while repeating SRS (HR 0.4, p=0.002) led to improved survival. Local failure occurred in 12.8% of treated BM. Actuarial progression-free survival (PFS) at 6, 12 and 24 months was 92.3%, 86.6% and 70.3%, respectively. Only prior WBRT (HR 4.36, p=0.03) led to worse local control on multivariate analyses. New remote BM appeared in 49.5% of patients and 14.5% suffered from leptomeningeal dissemination. ARE were seen in 12.1% of BM but were symptomatic in only 3.2%. On multivariate analyses, prior SRS (HR 3.13, p=0.002) was associated with increased risk of ARE. CONCLUSION Ovarian cancer brain metastases can be safely and effectively managed with SRS as the primary treatment modality in most patients.

Objectives The purpose of the current study was to evaluate differences in total sleep time and heart rate variability (HRV) in active-duty firefighters between on-shift and off-shift days. Methods 59 structural firefighters (age: 37.3±7.3 years; height: 1.80±0.08 m; weight: 88.9±14.1 kg and body mass index (BMI): 27.5±4.1 kg/m2) participated in this longitudinal observation study. Each morning for 15 weeks, firefighters were asked to sync a smart ring with a smartphone application to download night-time data, which were then extracted to a cloud-based software application for later analysis. The software also computed a readiness score each morning. All day types were coded as on-shift or off-shift. Results The average nightly sleep time for all firefighters was 6.95±1.24 hours. When off-shift, firefighters recorded more sleep compared with on-shift nights (off-shift: 6.97±0.50 hours vs on-shift: 6.68±0.52 hours; p<0.0001). HRV (p<0.0001) and readiness scores (p=0.02) were lower off-shift compared with on-shift. For the lagged correlation analysis, total sleep time was moderately positively correlated with the following day’s readiness score. Conclusions Firefighters recorded more total sleep time when off-shift compared with on-shift; however, HRV and readiness scores were higher on-shift. The lag-time correlations indicate an association between sleep time and HRV or readiness scores, with approximately half of the variability in readiness being attributable to changes in total sleep time, which highlights the complexity of the readiness and HRV signals/systems.