BACKGROUND: Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records. OBJECTIVE:To assess the rate of documentation of code status in the electronic longitudinal medical records (LMR) of patients with metastatic cancer. DESIGN:Retrospective review of 2,498 patients with metastatic solid tumors at an academic cancer center. An electronic patient database and the LMR were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status. PARTICIPANTS:The sample consisted of adult patients with metastatic prostate, breast, ovarian, bladder kidney, colorectal, non-colorectal gastrointestinal (GI), and lung cancers. MEASUREMENTS:Primary outcome was the percentage of documented code status in the LMR.MAIN RESULTS: Among the 2,498 patients, 20.3% had a documented code status. Code status was designated most frequently in patients with non-colorectal GI (193/ 609, 31.7%) and lung (179/583, 30.7%) cancers and least frequently in patients with genitourinary malignancies [bladder/kidney (4/89, 4.5%), ovarian (4/93, 4.3%), and prostate (7/365, 1.9%) cancers]. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. CONCLUSIONS:Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.KEY WORDS: resuscitation preferences; DNR/DNI; metastatic cancer. J Gen Intern Med 25(2):150-3

We describe the preparation, characterization, and potential-dependent optical absorption spectroscopy of transparent nanocrystalline TiO 2 films possessing well-defined morphologies. Regarding preparation, Langmuir-Blodgett techniques are used to deposit between one and four monolayers of TiO 2 nanocrystallites on conducting glass. As the average spacing between the nanocrystallites constituting a deposited monolayer may be controlled, the degree of nanoporosity of the resulting nanocrystalline film can be determined. Subsequent firing fuses the constituent crystallites of the deposited monolayers and ensures an ohmic contact with the conducting substrate. Characterization by electron microscopy and optical absorption spectroscopy has been undertaken. The former reveals the above films to be nanoporous or close-packed arrays of anatase nanocrystallites. The latter has allowed determination of an absorption coefficient for anatase at 326 nm. Measurement of potential-dependent optical absorption spectra has also proved possible. Results obtained suggest that the degree of charge accumulation possible at a given applied potential is dependent on the morphology of the nanocrystalline film.

In this study we investigated the effects of materials prepared with electrical poling on neurite outgrowth in vitro and nerve regeneration in vivo. Neuro-2a cells were seeded on poled and unpoled poly(lactic-co-glycolic) (PLGA) films and observed at time periods 24, 48 and 72 h post-seeding. The percentage of cells with neurites and the neurites per cell were quantified using light microscopy. At 48 and 72 h post-seeding, both the number of cells with neurites and the neurites per cell were significantly increased on the poled films compared to those on unpoled films. An established rat sciatic nerve model was used for in vivo studies to assess the effects of PLGA guides, poled for two different periods, on peripheral nerve regeneration. Guides were inserted in rats to bridge a 1.0 cm gap created in the right sciatic nerve. After four weeks, nerves regenerated through poled guides displayed a significant increase in conduction velocity and significantly increased numbers of axons across the guides, as compared to nerves regenerating through an unpoled guidance channel. Electrical poling was shown to promote neurite growth, axon regeneration and the conduction rate of the repaired nerve. We concluded that guides prepared with electrical poling enhance peripheral nerve regeneration.

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