bluuebunny/crossref_metadata_2025 huggingface dataset:
Electroencephalographic changes in children with attention deficit hyperactivity disorder
Authors: Khalaf Zienab , Salah Aliaa Omar , Zaky Effat Ahmed , Wahab Marowa Abd El
Published: September 2024

Background

Attention deficit hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children who experience delayed language development. This work aimed to study electroencephalographic (EEG) changes in children with ADHD and establish a strategy for prompt identification and suitable management in the future.

Methods

This descriptive cross-sectional study was conducted on 100 children aged between 5 and 12 years old, both sexes, diagnosed with ADHD according to DSM-V Criteria, diagnosed as ADHD children with the Arabic version of Conner’s Parent Rating Scale. Psychometric evaluation by intelligence quotient (IQ) using Stanford Binet Intelligence test. The Receptive Expressive Arabic Language Scale was used to assess language profile.

Results

There was a significant negative correlation between the severity of ADHD and IQ scores. There was an insignificant negative correlation between ADHD and scaled receptive language score and scaled expressive language score. There was an insignificant positive correlation between ADHD and scaled expressive language score. There was a significant difference between EEG changes and combined subtype of ADHD and scaled score of receptive language (P < 0.05). There was an insignificant difference between (EEG changes and language development), the scaled score of expressive, total language, and the scaled score of language.

Conclusions

EEG has clinical utility in the diagnosis of ADHD. The results of EEG analysis in children with ADHD have been quite important, and this novel methodology could offer supplementary factors to strengthen its diagnostic impact.
Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents
Authors: Saldanha Erick F. , Powis Melanie , Sharma Divya , Espin-Garcia Osvaldo , Hack Saidah , Cavalher Felicia , Costa Maria Rita , Simoes Maria , Li Huaqi , Baiad Abed , Chen Kevin , Mohmand Zuhul , Nakhla Peter , Aguiar Samuel , Riechelmann Rachel , Krzyzanowska Monika K.
Published: September 2024

PURPOSE

The early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil).

METHODS

Patients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri–COVID-19 and control cohorts were tested using Cohen's
h
test to assess the standardized differences between the two groups.

RESULTS

Among 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98
v
197) versus a 12.5% reduction at PM (294
v
336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9%
v
29.9%;
P
= .015) and an increase in treatment delay (61.9%
v
9.7%;
P
< .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4%
v
22.3%;
P
< .001) and a higher rate of discontinuation of radiotherapy (9.4%
v
1.1%;
P
< .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9%
v
2.6%;
P
< .001) and PM (10.5%
v
3.6%;
P
< .01).

CONCLUSION

The early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.
Treatment Patterns and Health Care Resource Utilization of Patients With Non–Small Cell Lung Cancer in Puerto Rico: The TREATLINES-ONCOLUNG Study
Authors: Miranda Edgar I. , Gierbolini-Bermúdez Axel , Quintana Rafael , Torres-Cintrón Carlos R. , Ortiz-Ortiz Karen J.
Published: September 2024

PURPOSE

Lung cancer remains one of the leading causes of cancer-related mortality worldwide. It is the third cause of death among patients with cancer in Puerto Rico (PR) and non–small cell lung cancer (NSCLC) is the most prevalent. This study aims to describe the first-line treatment (1LT) and health care resource utilization (HCRU) among patients with NSCLC in PR.

METHODS

A retrospective cohort study was conducted using the PR Central Cancer Registry Health Insurance Linkage Database to describe patients with NSCLC from 2012 to 2016. It describes sociodemographic and clinical characteristics on the basis of stage and histology and includes 1LT patterns and HCRU.

RESULTS

A total of 1,011 patients met the inclusion criteria. Most were male (57.1%), married (54.1%), and had no comorbidities (55.8%). A significant proportion of patients (71.1%) were diagnosed at stages III and IV, with nonsquamous cell carcinoma being the most prevalent histology group (75.9%). About 61.7% received systemic therapy, 36.7% received radiotherapy, and 21.9% underwent surgery. Platinum (Pt)-based combinations were the most common 1LT (82.9%). On average, patients had 4.7 emergency room visits, nearly six hospitalizations, and 22.4 outpatient visits annually. The mean frequencies of positron emission tomography, ultrasounds, computerized tomography scans, and magnetic resonance imaging were 0.95, 0.11, 4.88, and 0.91, respectively.

CONCLUSION

To our knowledge, this study provides the first description of 1LT patterns, HCRU, and sociodemographic information among patients with NSCLC in PR. A significant number of patients were diagnosed at stage III or higher and received Pt-based systemic therapy as their 1LT. More research is required to investigate treatment patterns beyond the 1LT and to gain a comprehensive understanding of optimal care interventions and factors associated with early NSCLC diagnosis.
Registry of Genetic Alterations of Taiwan Non–Small Cell Lung Cancer by Comprehensive Next-Generation Sequencing: A Real-World Cohort Study-Taiwan Cooperative Oncology Group T1521
Authors: Liao Bin-Chi , Chiang Nai-Jung , Chang Gee-Chen , Su Wu-Chou , Luo Yung-Hung , Chong Inn-Wen , Yang Tsung-Ying , Lai Chun-Liang , Hsia Te-Chun , Ho Ching-Liang , Lee Kang-Yun , Hsiao Chin-Fu , Ku Fan-Chen , Fang Wei-Tse , Chih-Hsin Yang James
Published: September 2024

PURPOSE

Tissue-based next-generation sequencing (NGS) analysis is highly recommended for patients with advanced/metastatic non–small cell lung cancer (NSCLC). We investigated a specific patient population with NSCLC that required tissue-based NGS analysis.

MATERIALS AND METHODS

We enrolled 500 patients with advanced/metastatic (1) epidermal growth factor receptor (
EGFR
) mutations or anaplastic large-cell lymphoma kinase (
ALK
) rearrangement–positive NSCLC who had failed at minimum one line of tyrosine kinase inhibitor (TKI) therapy, (2)
EGFR-/ALK
-negative nonsquamous, and (3) non- or light-smoker patients with squamous NSCLC who were treatment-naïve or had failed at maximum two lines of systemic treatment. These patients were divided into five cohorts. Comprehensive tissue-based NGS testing (ACTOnco+) was conducted.

RESULTS

Cohort 1: EGFR TKI-pretreated
EGFR
-mutated population (50.0%, n = 250), cohort 2: ALK inhibitor-pretreated
ALK
-positive population (1.6%, n = 8), cohort 3: treatment-naïve
EGFR-/ALK
-negative population (28.2%, n = 141), cohort 4: pretreated
EGFR-/ALK
-negative population (16.8%, n = 84), and cohort 5: squamous cell carcinoma (3.4%, n = 17). In cohort 1, 11.2% (28/250) of the patients had
MET
amplification, 32.4% (81/250) had been treated with osimertinib, and
EGFR
C797S was detected in 6.2% (5/81) of these patients. In cohort 2, resistance ALK mutation was detected in 37.5% (3/8) of the patients. In cohorts 3 and 4, targetable genetic alterations, including
EGFR
mutation (13.3%),
ERBB2
mutation (9.3%),
MET
exon 14 skipping (5.3%),
KRAS
G12C mutation (4.4%),
ROS1
fusion (2.7%),
RET
fusion (1.8%), and
BRAF
V600E mutation (1.3%), were detected. In cohort 5,
MET
exon 14 skipping was detected in 29.4% (5/17) of the patients.

CONCLUSION

This multicenter registration study investigated tissue-based NGS for a specific patient population with NSCLC in Taiwan.
Expanding Geographical Access to Cancer Care in Botswana: Current Status and Future Prospects
Authors: Swart Norman C. , Lebelonyane Refeletswe , Gutterman Elane M. , Legwaila Morongwa , Friebel-Klingner Tara M. , Antony Reena , Mayer Tina , Sharma Kirthana , Lall Naveena , Kania Brooke , Gaolathe Tendani , Ralefala Tlotlo , Ndaba Vusikhaya , Leselwa Tapologo , Vuylsteke Peter , Marlink Richard
Published: September 2024

PURPOSE

The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers.

METHODS

A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability.

RESULTS

Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH.

CONCLUSION

Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.
Longitudinal assessment of cancer-related distress during cancer treatment using an electronic health record–based tool and impact of social work intervention.
Authors: Couture Lauren , Cropp Brett F. , Taylor Evie , Robbins Tracy , Remick Scot C. , Sanyal Amit
Published: September 2024

207

Background:
Cancer-related distress affects 35-45% of patients. 2020 ASCO-QOPI standards require baseline and ongoing psychosocial assessments, with interventions as needed. We examined the feasibility and outcomes of integrating the NCCN Distress Thermometer (DT) into the oncology electronic health record (EHR) for distress monitoring.
Methods:
A flowsheet containing NCCN DT questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nursing staff administered the electronic DT as part of normal patient ‘rooming’ protocol and alerted providers when distress level was ≥ 4 (DT4). This in turn generated a social work (SW) referral. SW interventions were documented in a SW dashboard.
Results:
Between May 1
st
2023, and April 30
th
2024, our Epic EHR DT was used to screen 6,270 distinct oncology patients, 1,852 scored >=4. 19.7%, 14.2%, 20.4% and 5.4% of the responses were in the emotional, practical, physical, and familial domains respectively. 447 (24.1%) of these patients were referred to SW. When contacted by SW, worry/anxiety in 37.5%, finance in 34.9% and transportation in 29.4% were the top three concerns. Access to grants, free-care, lodging and gas cards was made available to 37.4%, 14.5%, 20.5% and 13.1% of patients respectively. Additionally, in accordance with QOPI certification requirements, 947 patients with active oncology treatment plans were serially screened during successive cycles of chemotherapy generating 6,330 responses. 398 (42%) of these responses indicated DT4. SW referral was placed in 163 (41%) of patients with DT4. Serial distress monitoring revealed a trend towards improved distress in later cycles of chemotherapy, with DT4 percentage decreasing from 27.7% in cycle 1 to 7.9% in cycle 6. Process improvement efforts informed by this data increased DT use from 42.7% to 50% between May-October 2023 and November 2023-April 2024.
Conclusions:
Electronic capture of cancer related distress as part of routine care is feasible in a community-based oncology program and resulted in a variety of meaningful SW interventions. Cumulatively, distress caused by emotional, social, and practical problems are more frequent than distress caused by physical problems, underscoring the need for comprehensive cancer care. Distress tends to diminish during successive cycles of chemotherapy, possibly due to lower cancer related morbidity due to therapy, or increased patient familiarity with chemotherapy and improved use of supportive care.
Communicating a cancer diagnosis using a human centered design approach.
Authors: Borrowman Dexter Janet , Tan Andrew
Published: September 2024

229

Background:
Anticipating and getting "the call" communicating a cancer diagnosis is reportedly one of the most stressful times in a person’s life. If not pre-scheduled patients are often in unfortunate locations, doing distractive activities and are with unsympathetic companions. Additionally, patients ask for a single point of contact, impactful resources, and immediate next steps and appointments scheduling.
Methods:
Pilot/Study: 120 breast cancer patients: Control group: 30 positive, 30 negative DX Test group: 30 positive, 30 negative DX Test approach: co-designed with 10 patients, 5 physicians and 5 staff. Interviews: 7 care team roles. Data collection: customized patient interview assessment tool. Steady State: sustaining work done. Conducted: January 2019 through December 2022. Evaluation Methods -11 tests: t-Tests, One-Way ANOVA, and Capability. Changes Made: call be at a pre-scheduled time delivered by ongoing point of contact offering immediate next steps and appointment scheduling offering meaningful support and resources delivered with deep empathy/compassion.
Results:
The project was highly successful based on the results it achieved. Results: Improved by 64% (original goal of 30%) the composite measure of care satisfaction of patients receiving a breast cancer diagnosis call in Kaiser Permanente Maui, Hawaii. Composite: 1) 61% improvement in “satisfaction with your circumstance”, 2) 63% improvement in “satisfaction with the conversation”, and 3) 70% improvement in “feeling supported” using a local measurement tool.
Conclusions:
The 64% improvement in the patients' experience for cancer diagnosis communication was accomplished by understanding the needs of the patients and care team, establishing new communication protocols and resources, and ensuring the process empowered patients. The study showed that both patients and care teams want a communication process that included the elements in the test approach. This project was deemed a Kaiser Permanente best practice and is in consideration for spread.

Improved by 64% (goal was 30%) the composite measure of care satisfaction of patients receiving a breast cancer diagnosis call in Kaiser Permanente Maui, Hawaii.

Breast Cancer Diagnosis Communication - Key Improvement Metrics:
Control Group
Test Group

Outcome Measure: the composite measure improvement 64% of care satisfaction of patients receiving a DX Results Call

2.39

3.93

Composite Measure 1: 61% improvement in “satisfaction with your circumstance”

2.35

3.78

Composite Measure 2: 63% improvement in “satisfaction with the conversation”

2.50

4.07

Composite Measure 3: 70% improvement in “feeling supported”

2.33

3.95

Process Measure: the error rate over time had a statistically significant difference between the Control and Test groups

30.3

8.90

Balancing Measure: Negative result patients have a similar experience as the Positive result patients

No significant difference

No significant difference
Closing the loop: Utilizing advanced practice providers for a 7-day post hospital discharge follow-up of GI oncology patients at an academic cancer center.
Authors: Shah Deepa , Dalal Nicole , Janchenko Lauren , Neighey Evan , Garrigues Sarah K. , Kafkas Katerina , Maeda Lauren Shizue , Roy Mohana
Published: September 2024

304

Background:
Acute care visits for oncology patients may be preventable, especially for high-risk patients with a recent hospitalization. During our 2023 Fiscal Year, we observed an approximate 22% rate for 30 day readmissions for oncology patients, with our gastrointestinal (GI) oncology patients having the most readmissions, at Stanford Cancer Center. Readmission review through clinician surveys suggested that about 28% of unplanned admissions may have been preventable, with root cause analysis identifying timely access to ambulatory symptom management as a major driver.
Methods:
We established a cancer transitional care (CTC) clinic to provide consistent and timely post-discharge follow-up for oncology patients. We initiated a pilot program for GI oncology patients (chosen due to high acuity and readmission rate) who had an unplanned admission to Stanford Hospital. We aimed to schedule a visit with an advanced practice provider (APPs) within 7 days of discharge. The A3 problem solving process was implemented weekly by a multidisciplinary team. We created a referral in our electronic medical record. Inpatient oncology teams were instructed to place this referral within 3 days before discharge, allowing for adequate patient and family education regarding the goals of CTC visits and ample time for the post-discharge CTC visit to be scheduled prior to patient discharge. Prior to CTC visits, pharmacists performed outreach to reconcile medications to reduce medication errors. Eight oncology APPs were trained regarding the focused nature of a CTC visit, including symptom management, medication reconciliation, and goals of care discussions.
Results:
At baseline, from June 1 and November 30th, 2023, 61% of patients had follow-up within 7 days of discharge and 12% of patients with none. Between December 13, 2023 and April 19, 2024, CTC implementation resulted in a total of 220 referrals for GI oncology discharges, yielding 144 CTC clinic visits. Resulting in 66.1% of patients having follow up within 7 days of discharge and 9% of patients had no follow up scheduled. 79% of visits were within 7 days of discharge, representing a 29% increase in our goal scheduling timeline. The average time between discharge date and CTC visit was 6.2 days. Sixty six patients also received detailed pharmacy reviews with medication reconciliation and addressing medication access issues.
Conclusions:
Through our CTC clinic, we standardized post-discharge follow-up access for GI oncology patients, reducing variability in follow up. We plan to disseminate this model across medical oncology subspecialty clinics. Barriers included standardization of follow up with clinical team and expectations for the visit for both patients and clinicians. Future directions include integrating same day symptom management and urgent care access.
Association between food insecurity, financial toxicity, and healthcare utilization in adolescents and young adults with cancer.
Authors: Algave Marcela , DeStephano David , Khurana Rhea , Sathe Claire M. , Kahn Justine , Accordino Melissa Kate , Hershman Dawn L. , Beauchemin Melissa P.
Published: September 2024

305

Background:
Adolescents and young adults with cancer experience high rates of financial toxicity (FT) and unmet health-related social needs (HRSN: food, housing, transportation insecurity). FT and unmet HRSN, specifically FI, are modifiable factors that impact health outcomes; however, the relationship between FI, FT, and healthcare utilization (emergency department (ED) visits or hospitalizations) remains unclear. Leveraging systematic screening for FT and HRSN using the electronic health record (EHR) patient portal among AYAs with cancer, we examined the association between FI, FT, and healthcare utilization measures among AYAs with cancer.
Methods:
AYAs (ages 15-39) who utilize the EHR patient portal were prompted to complete an 8-item standardized HRSN survey (i.e., food insecurity, housing instability, transportation difficulties) and a 2-item previously established FT survey during e-check in between November 2022 and April 2024. ED visits and hospitalizations were extracted from the EHR directly. Descriptive statistics and associations using chi-square tests were used to describe the patients and examine associations between FI or FT and ED visits or hospitalizations.
Results:
Of 691 AYAs who completed the HRSN survey, 16% (n=109) screened positive for FI. Among AYAs with FI, 42% (n=46) had at least one ED visit compared with 28% (n=163) among AYAs without FI (p<0.01). Among AYAs with FI, 39% (n=43) were hospitalized at least once compared to 31% (n=179) among AYAs without FI (p=0.07). Of 439 AYAs who responded to the FT survey, 66% (n=290) met criteria for high FT. Within this group, 26% (n=74) had at least one ED visit compared with 17% (n=26) who screened negative (p=0.06). Among AYAs with high FT, 22% (n=65) were hospitalized at least once, compared with 19% (n=28) among those with low or moderate FT (p=0.38). Among 384 AYAs who responded to both the HRSN and FT surveys, 19% (n=74) screened positive for FI, 92% (n=68) of whom also had high financial toxicity. The table describes characteristics of screened AYAs by language and race/ethnicity.
Conclusions:
FI may be a risk factor for increased ED visits during cancer treatment among AYAs. Systematic screening to identify FI, FT, and other HRSN is important to facilitate referral for resources, support services, or interventions.

Sociodemographic characteristics of AYA participants in FI and FT screening.

Characteristic
+FI
-FI

+FT
-FT

N=109 (%)

N=582 (5)

p-value

N=290 (%)

N=149 (%)

p-value

Language

<0.01

<0.01

English
82 (75)
496 (85)

241 (83)
134 (90)

Spanish
24 (22)
45 (8)

29 (10)
1(1)

Other
3 (3)
41 (7)

20 (7)
14 (9)

Race/Ethnicity

<0.01

<0.01

Hispanic, any race
67 (61)
175 (30)

125 (43)
16 (11)

Non-Hispanic Black
12 (11)
62 (11)

30 (10)
10 (7)

Non-Hispanic White
16 (15)
219 (38)

78 (27)
84 (56)

Other
14 (13)
126 (22)

57 (20)
39 (26)
Management of immune-checkpoint inhibitor (ICI)-related thyroid dysfunction: An avenue for quality improvement.
Authors: Edupuganti Subhash , Davar Diwakar
Published: September 2024

309

Background:
Hypothyroidism is a common immune-related adverse effect (irAE) with ICI therapy, occurring in 4-9% of patients treated with PD-1 ICI, and 10-15% of patients treated with dual PD-1/CTLA-4 ICI therapy. Prolonged thyroid dysfunction increases risk for cardiovascular and cerebrovascular events. Consensus guidelines recommend weight-based dosing for thyroid repletion in younger patients and/or without cardiovascular comorbidities. We observed that patients on thyroid repletion are often underdosed compared to guideline recommendations. To formally evaluate this, we performed a retrospective study to determine the percentage of ICI-treated cancer patients who are receiving guideline-recommended thyroid repletion at an urban comprehensive cancer center.
Methods:
We identified patients who received PD-1 ICI, either singly or in combination with chemotherapy, TKI, or other ICI to identify patients who met the consensus guideline criteria for weight-based dosing of thyroid repletion. Analysis was restricted to ICI-treated patients who had a thyroid stimulating hormone (TSH) level above 10 mU/L following initiation of therapy. For each patient, we collected the patient’s age, weight, and initial prescribed dose of levothyroxine. We also obtained the date of abnormality and normalization for TSH and free thyroxine (T4).
Results:
402 patients received ICI, either singly or in combination. 55 patients had TSH > 10 mU/L. 15 patients who did not have documentation of hypothyroidism or developed it prior to immunotherapy were excluded. The proportion of patients who were eligible for, and who received weight-based repletion is summarized in the table. The proportion of patients who received guideline-recommended thyroid repletion was: 6/17 (35%) SITC-guideline recommended dose, 18/27 (67%) NCCN-guideline recommended dose and 6/22 (28%) ASCO-guideline recommended dose. The median time to free T4 normalization was 9 weeks (IQR 6-15 weeks) and TSH normalization was 13 weeks (IQR 9-30 weeks).
Conclusions:
At an urban comprehensive cancer center, the incidence of hypothyroidism in ICI-treated cancer patients is 10%. The compliance with guideline recommended weight-based dosing is low, with 33-72% of patients not receiving appropriate therapy, translating into prolonged time to thyroid function normalization. We aim to develop a quality improvement intervention to improve thyroid dosing in this patient population.

Proportion of patients receiving guideline-recommended thyroid repletion.

Criteria
Per SITC Guidelines
Per NCCN Guidelines (if lower end of dosing range)
Per ASCO Guidelines

Patients eligible for weight-based dosing
17
27
22

# of patients who received appropriate initial dosing
6 (35%)
18 (67%)
6 (28%)

Average initial dose prescribed
81 mcg
78 mcg
76 mcg

Average initial dose per guidelines (based on ideal body weight)
107 mcg
71 mcg
109 mcg
Provider and facility factors in relation to receipt of dose-reduced chemotherapy among patients with breast cancer.
Authors: Kantor Elizabeth , O'Connell Kelli , Bhimani Jenna , Blinder Victoria Susana , Doud Rachael P. , Gallagher Grace B. , Griggs Jennifer J. , Kolevska Tatjana , Kroenke Candyce , Laurent Cecile , Liu Raymond , Nakata Kanichi G. , Persaud Sonia , Rivera Donna , Roh Janise M. , Valice Emily , Wang Peng , Bandera Elisa Victoria , Bowles Erin Aiello , Kushi Lawrence H.
Published: September 2024

310

Background:
Little is known about how provider and facility factors relate to patients’ receipt of dose-reduced adjuvant chemotherapy.
Methods:
In a cohort of 8,581 stage I-IIIA women with breast cancer treated with chemotherapy at Kaiser Permanente Northern California between 2006 and 2019, we evaluated the associations between provider- and facility-level factors related to chemotherapy dosing with a primary interest in the first cycle dose reduction (FCDR). Here, FCDR is defined as a first cycle dose proportion <90% of that expected based on the intended regimen, reflecting clinician intent at the outset of chemotherapy. Provider-level factors examined included provider gender, age, race, Hispanic ethnicity, years since completion of medical school, volume of breast cancer patients treated per year, and patient-provider racial concordance; we also examined practice size and rurality. Prevalence ratios (PR) were calculated using generalized linear models of the Poisson family with a log-link function and robust standard errors, accounting for significant patient factors and clustering at the provider level. Results were further mutually-adjusted for significant provider- and facility-level factors to ensure independence of associations.
Results:
Patients treated by providers practicing for longer (30+ years since medical school vs <10 years) were more likely to be dose-reduced at the outset of chemotherapy (PR: 1.94; 95% CI: 1.15-3.25; p-trend: 0.02). Patients treated by providers in a larger practice (10+ vs ≤5 oncologists) were less likely to be dose reduced (PR: 0.53; 95% CI: 0.34-0.84; p-trend: 0.03) as were patients treated by providers treating a higher volume of breast cancer patients (30+ vs ≤15 patients/year: PR 0.64 (95% CI: 0.41-0.99; p-trend: 0.03). Other factors examined were not significantly associated with use of FCDR.
Conclusions:
These results indicate provider years of experience, as well as practice size and the volume of breast cancer patients treated per year are significantly associated with first cycle dose reductions in chemotherapy. This is a complex, multi-factorial issue, and these results indicate that provider- and provider- and facility-level factors should be considered when evaluating sources of heterogeneity in chemotherapy delivery.
Improving vaccination counseling rates in first time patients with cancer: A multi-disciplinary approach.
Authors: Fort Callie , Tepfenhart Tyler , Jha Jyoti , Chavali Ravi , Oliaro Blake , Raina Rohit , Surapaneni Rakesh
Published: September 2024

315

Background:
ASCO guidelines 2024 recommend that “clinicians determine vaccination status and ensure that adults newly diagnosed with cancer about to initiate treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines.” Prior to the study, Baylor Scott and White Hematology Oncology Round Rock (BSWHRR) clinic lacked a formalized process for vaccine education. The primary aim of this study was to increase vaccination counseling for first-time cancer patients with solid tumors or hematologic malignancies. The secondary endpoint was to optimize vaccination status for this group of patients.
Methods:
Inclusion criteria were patients 18 years or older with initial diagnosis of solid tumor or hematologic malignancy, receiving chemotherapy and/or immunotherapy for the first time, and treated within BSWHRR. Exclusion criteria were patients with subsequent malignancy, malignancy requiring second line chemotherapy and/or immunotherapy, or deceased. Patients meeting these criteria n=57 were collected during the pre-intervention period October 15-December 15. Post-intervention data n=52 was collected 6 weeks following the initiation of the intervention from February 18 – April 18. The intervention included a 2-sided handout containing current recommendations for vaccination schedules in immunocompromised adults. These handouts were provided along with counseling at 2 separate encounters (during the initial consult and during chemotherapy education). The handout included instructions for scheduling vaccines with the Baylor Scott and White Pharmacy and/or their PCP. This multi-disciplinary approach included nurse navigators, triage nurses, pharmacists, and physicians. A standardized documentation process was initiated and utilized for both consult and chemotherapy education encounters.
Results:
Following the introduction of vaccine education handouts and standardized documentation, vaccine counseling rates during the consult visit improved from 0% to 49%. Vaccine counseling rates during chemotherapy education visits increased from 0% to 71%. Overall, the number of patients that attended and were counseled during at least one of these visits increased from 0% to 70%. The secondary endpoint of increasing vaccination rates showed that non-seasonal vaccination rates improved. Pneumococcal vaccination rates improved from 33% to 42%, a 27% increase. Shingles coverage improved from 16% to 25%, a 56% increase.
Conclusions:
This study showed that a multidisciplinary approach, utilization of patient/physician education handouts, and standardization of documentation was effective in achieving a substantial increase in vaccination counseling rates for patients with newly diagnosed malignancy. The intervention was also effective in achieving the secondary endpoint of increasing pneumococcal and shingles vaccinations.
Correlation of a single-item measure of financial toxicity with overall score.
Authors: Armache Maria , Gharzai Laila A. , Mady Leila , Sadigh Gelareh , Sun Zequn , Jagsi Reshma , Cella David , Peipert John Devin , Hass Richard
Published: September 2024

351

Background:
Financial toxicity (FT) refers to the financial burden experienced by patients due to direct and indirect costs associated with their medical care. It has been linked to higher symptom burden, poorer clinical outcomes, quality of life, and psychological well-being and has been shown to extend beyond diagnosis and treatment. Despite the availability of validated tools to measure FT, no single-item screening measure has been validated yet. In the context where time constraints are the most cited reason for patients declining FT surveys, it is crucial to develop efficient tools that allow us to routinely screen patients for FT at different stages of their care. We, therefore, sought to establish item 12 (“My illness has been a financial hardship to my family and me”) of the Comprehensive Score for Financial Toxicity (COST) measure as a well-functioning screening item for FT.
Methods:
In this secondary analysis of 579 patients who completed a survey on financial toxicity screening preferences, items 1-11 were scored (including reversing 7 items per the version 2 scoring guidelines), with lower scores indicating worse FT. Analyses focused on establishing a correlation with the total score as well as examining item properties. Item 12 was also reverse scored, so lower scores mean greater hardship.
Results:
Item 12 had an item-total correlation of r = 0.63 (adjusted item-total correlation = .531). Similarly, a linear model with item 12 score as a predictor and total score as the outcome showed that increases of 1 point on item 12 is associated with around 3 total points on the full scale (b = 3.35, p < .001, adjusted R
2
= 0.28. Finally, item analysis with the graded-response item response theory (IRT) model showed very good discrimination (a = 2.10) for item 12, indicating that it can reliably distinguish between low and high FT in patients. IRT results also showed that the item functions as a nearly binary item with responses of “quite a bit” and “very much” corresponding to a high probability of high FT, while responses of “somewhat,” “a little bit,” and “not at all” corresponding to a high probability of low FT.
Conclusions:
This is the first validation of a single-item screening measure for RT. Overall, these results illustrate that item 12 is a good candidate for a single-item screener, with “quite a bit” and “very much” responses indicating a high likelihood of high FT.
Accounting for Socioeconomic Factors and Selection Bias That Affect Survival for Patients With Early-Stage Melanoma
Authors: Seibert Hailey , Kakish Hanna , Bordeaux Jeremy S. , Rothermel Luke D. , Hoehn Richard S.
Published: September 2024

Socioeconomic factors influence the survival of patients with early stage melanoma and thus should be accounted for in prognostication tools.
Black, Queer, and Sick: Amplifying Representation’s Noisiness
Authors: Musser Amber Jamilla
Published: September 2024

The unresolved problematic at the center of Evelynn Hammonds’s “Black (W)holes and the Geometry of Black Female Sexuality” is that of representation. The importance of representation, she argues, lies in its ability to highlight alternative modes of being and thinking. Though Hammonds is ambivalent about queer studies, it is the queerness of black lesbian sexualities that might offer the representational fullness and disruption to norms that she seeks. This essay takes the silence around the black, queer cancer patient to think about how to expand Hammonds’s ideas. It works toward considerations of erotic autonomy in the context of illness by way of thinking with Audre Lorde and masturbation.
Suturing the (W)holes: Erotic Freedom and Reflections on Black Female Sexuality
Authors: Glover Julian Kevon Kamilah
Published: September 2024

This article reflects on the impact of Evelynn Hammonds’s seminal essay “Black (W)holes and the Geometry of Black Female Sexuality” to theorize how suturing might present an apt method for considering the complexities and contradictions of Black female sexuality. This essay takes up Hammonds’s charge to develop a “politics of articulation” to reveal how Black and Latinx transwomen in the Emmy-award-winning series Pose (as represented by Angel Evangelista, Elektra Abundance, and Blanca Evangelista) and Black motherhood in P-Valley (as represented by the relationship between Mercedes and her daughter Terricka) expose the embodied complexities and contradictions of Black female sexuality. The author aims to demonstrate how suturing these two seemingly antagonistic ways of understanding Black female sexuality remains key to a politics of articulation because they conjure idiosyncratic visions of erotic freedom not reliant on negation.
HOLD: SPACE
Authors: Bain Kimberly
Published: September 2024

This article takes up the sonic slippages between black hole, black hold, and Black hold as a threshold for thought. Taking Evelynn Hammonds’s query “what is it like inside a black hole?” as an opening, the author explores the way geometric properties of space shaped not only the material dimensions (volume and capacity) of the hold of the slave ship but also the metaphysical violences that captive Africans underwent in the hold. Through poethical meditations on the hold of the ship, the essay offers Black holds as a practice of Black women’s sexuality. The essay concludes with an analysis of Rivers Solomon’s The Deep and its speculative imaginings of what holding and touch might offer us.
The Cosmos Is a Black Aesthetic
Authors: Prescod-Weinstein Chanda
Published: September 2024

This essay begins with the premise that Evelynn Hammonds’s highly cited “Black (W)holes and the Geometry of Black Female Sexuality” provides a reading strategy that has largely been ignored by subsequent scholarship. This work theorizes science as a Black episteme and addresses space-time as a self-reading strategy and an exemplar for how scientific analogies can illuminate analyses in Black thought. It problematizes the uptake of physical ideas without taking care to understand those physical concepts in conversation with Black scientists. The author shows how Black queer thought can and should inform the creation of intellectual links between Black scientific thinkers and Black thought outside of science.
Black (W)holes: A Problem for Feminist Thought
Authors: Holland Sharon P.
Published: September 2024

Ever since the publication of Evelynn Hammonds’s rejoinder to the evolving discussion of (white) queer studies (differences 1994), we have struggled to think about black female sexuality and how it matters to our understandings of prevailing tropes of feminism. The author of this essay writes across three registers: the first addresses what contemporary discoveries about black holes attempt to tell us about “matter,” or what matters; the second is what Hammonds sought to disrupt or prove impossible in her essay; and the third is a meditation on the place of “elementary particles” in the physics—the possible rupture of time and space—of Hammonds’s work and the work of the late Randall Kenan in his short experimental piece “Chinquapin: Elementary Particles.”
Risk Factors Associated With Seizure After Treatment of Chronic Subdural Hemorrhage: A Systematic Review and Meta-Analysis
Authors: Pacheco-Barrios Niels , Wadhwa Aryan , Lau Tzak S. , Shutran Max , Ogilvy Christopher S.
Published: September 2024

BACKGROUND AND OBJECTIVES:

Chronic subdural hemorrhage (cSDH) is a prevalent neurosurgical pathology, marked by blood collection between the dura mater and the arachnoid membrane. The aim of this systematic review was to provide a comprehensive overview of the risk factors associated with seizures after cSDH treatment.

METHODS:

We systematically searched the following databases for studies conducted until September 28, 2023: PubMed, Embase, SCOPUS, Cochrane Central, WOS, and EBSCO. We selected all studies aiming to assess risk factors associated with seizures after treatment of cSDH. Observation studies written in English, Spanish, and Portuguese were included. The quality of studies was assessed using the Newcastle-Ottawa scale for observational studies.

RESULTS:

A total of 1830 studies were screened after the elimination of duplicates. A total of 18 studies were included, representing 4966 patients. The pooled proportion of seizures after treatment of cSDH is 10% [95% CI 7%, 13%; I2 = 93%]. The risk of seizures was lower in patients undergoing burr hole surgery compared to craniotomy, with an odds ratio of 0.23 (95% CI [0.10, 0.55]; I2 = 0%). Additionally, the risk of seizures in patients receiving prophylactic antiepileptic treatment compared to those without was higher, with an odds ratio of 2.62 (95% CI [0.53, 13.06]; I2 = 66%).

CONCLUSION:

Burr-hole treatment after cSDH presents a lower risk of seizures compared with craniotomy, and the use of prophylactic antiepileptic treatment did not conclusively affect seizure outcomes. Standardization in the reporting of outcomes and more comparative studies are needed to enable better recognition of risk factors of seizures after cSDH treatment.
Allometry in limb regeneration and scale-invariant patterning as the basis of normal morphogenesis from different sizes of blastemas
Authors: Furukawa Saya , Yamamoto Sakiya , Ohashi Ayaka , Morishita Yoshihiro , Satoh Akira
Published: September 2024

Axolotl (Ambystoma mexicanum) limb regeneration begins with blastemas of various sizes, in contrast to the limb developmental process. Despite this size variation, normal limb morphology, consistent with a limb stump size, is regenerated. This outcome suggests the existence of underlying scale-invariant mechanisms. To identify such mechanisms, we examined the allometric relationships between blastema size, and Sonic Hedgehog (Shh) and Fibroblast Growth Factor 8 (Fgf8) expression patterns against limb stump size. We found that all factors showed allometric rather than isometric scaling; specifically, their relative sizes decrease with an increase in limb stump size. However, the ratio of Shh/Fgf8 signaling dominant region was nearly constant, independent of blastema/body size. Furthermore, the relative spatial patterns of cell density and proliferation activity, and the relative position of first digit formation were scale invariant in the summed Shh/Fgf8 crosstalk region. This scale-invariant nature may underlie the morphogenesis of normal limbs from different sizes of blastemas.
International Friends and Enemies
Authors: Kleinman Benny , Liu Ernest , Redding Stephen J.
Published: September 2024

We examine whether, as countries become more economically dependent on a trade partner, they realign politically toward that trade partner. We use network measures of economic exposure to foreign productivity growth derived from the class of trade models with a constant trade elasticity. We establish causality using two different sources of quasi-experimental variation: China’s emergence into the global economy and the reduction in the cost of air travel over time. In both cases, we find that increased economic friendship causes increased political friendship and that our theory-based network measures dominate simpler measures of trading relationships between countries. (JEL D72, E23, F14, F15, F53, O19, P33)
Esthetic preferences of orthodontists, general dentists, and laypersons for Indian facial profiles: A cross-sectional study
Authors: Reddy Harshini , Singla Ritesh , Singla Nishu , Natarajan Madhumitha , Singhal Deepak Kumar
Published: September 2024

Background: Disparity in the esthetic perceptions between a patient and clinician could result in patient dissatisfaction with orthodontic treatment outcomes. The aim of this study was to compare the perceptions of a group of orthodontists, general dentists, and laypersons about the attractiveness of Indian facial profiles. Methods: In this study, a male and a female participants’ photographs and lateral cephalograms were digitally manipulated by inserting them into Dolphin software; we considered four soft tissue parameters at a nasolabial angle, upper lip E-line, lower lip E-line, and pg-pg’, so that 20 profiles were created for each model. A visual analog scale (VAS) along with a question about surgical correction opinion was given to 18 orthodontists, 18 general dentists, and 18 laypersons to score (1-5) from least to most attractive. Spearman’s rank correlation was computed to assess correlation, as well as ANOVA, followed by post hoc Tukey analysis to compare the mean scores, and Chi-square test to determine the opinion about surgical treatment. Results: There was an overall weak and negative correlation between the three groups, indicating that orthodontists attributed lower pleasantness scores to almost all the altered female and male facial profiles. Additionally, statistically significantly lower mean scores were attributed by orthodontists to many females and few male facial profiles. More orthodontists identified the need for surgical correction for a few severely distorted profiles but there was a statistically non-significant difference among the groups for most of the profiles. Conclusions: It was concluded that participants in the three groups had diverse concepts of facial attractiveness in all the parameters considered. Compared to general dentists and laypersons, orthodontists were much more precise, firmer, and meticulous in identifying a favorable or good-looking profile.
Characteristics of ice cream from black soybean sprout juice – red dragon fruit with yolk emulsifier
Authors: Rahayu Wahidah Mahanani , Mustaqim Luthfi , Khairi Amalya Nurul , Permadi Adi , Hidayah Nurul
Published: September 2024

Black soybean germination into sprouts reportedly improved nutrition digestibility and bioactive compound content. Red dragon fruit (RDF) and egg yolk (EY) can be used as natural and halal colorants and emulsifiers. Black soybean sprout (BSS) juice made non-dairy ice cream with red dragon fruit and egg yolk as an emulsifier. This research aimed to measure the effect of various red dragon fruit and egg yolk concentrations on the characteristics of ice cream made from BSS juice. A completely randomized design was applied to six formulations made using the ratio of RDF : EY of FA (20%: 3%), FB (20%: 4%), FC (20%: 5%), FD (40%: 3%), FE (40%: 4%), and FF (40%: 5%). BSS juice was made using 48 hours of room temperature incubated sprout and water at a 1:4 (b/v) ratio. Filtrate was then mixed with sugar, cornstarch, and salt into a dough, which was then mixed with RDF and EY at various concentrations. Nutritional proximate composition, radical scavenging activity, phenolic content, total anthocyanin content, vitamin C, and sensory acceptance were analyzed. Data was then statistically analyzed using one-way ANOVA, followed by Duncan’s Multiple Range Test. Results showed that higher RDF significantly changed overrun, melting rate, increased moisture content, vitamin C (20.4 – 40.23 mg/100 g), antioxidant activity (34.9 – 62.78 % radical scavenging activity), total phenolics (0.341 – 0.536 mg/g GAE), and total anthocyanin (3.905 – 9.726 mg/kg), and hedonic score, but shorter melting time. The shortest melting time was obtained by ice cream made using 20% RDF and 5% EY, the lower concentration of fruit, and the highest concentration of egg yolk, respectively. The results indicated that BSS juice could be used as the main ingredient to make non-dairy ice cream, with red dragon fruit and egg yolk as natural colorants and emulsifiers, respectively.
 
Keywords: Black soybean sprout, Non-dairy ice cream, Red dragon fruit