bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linking reimbursement to patient-reported quality of life: Provider perspectives.
Authors: Feinberg Bruce A. , Jeune-Smith Yolaine , Fortier Stephanie , Yeh Ting-Chun , Kish Jonathan , Gajra Ajeet 
Published: October 2020

75 Background: In the value-based era, policymakers have begun incorporating quality of life (QoL) components into payment models, such as the Merit-based Incentive Payment System (MIPs), Oncology Care Model (OCM), and Accountable Care Organization (ACO), to increase accountability. This qualitative research study sought to understand how providers address their patients’ QoL issues in a value-based environment. Methods: A live meeting in September 2019 brought together community oncology healthcare providers (HCPs) from across the United States. Participants submitted their demographic information via a web-based pre-meeting survey and their responses pertaining to patient QoL via an audience response system during the live meeting. Participant responses and their practice demographics were analyzed using descriptive statistics. Results: 71 HCPs participated in this live market research program: 51 medical oncologists/hematologists (herein referred to as physicians) and 20 nurse practitioners or physician assistants (herein referred to as APPs). 50% of physicians and 25% of APPs were from privately owned community practices. Half of HCPs indicated that their practices are collecting and reporting QoL data through value-based programs: 28% of physicians and 60% of APPs were in OCM-participating practices. Regarding accountability, over 80% of HCPs strongly agreed that they have a role in improving patients’ QoL. However, 32% of physicians and 25% of APPs agreed that their payment should be tied to patients’ QoL improvement. According to HCPs, the top factor impacting patients’ QoL was symptom and symptom burden (83%). To address QoL in their patients, HCPs reported addressing patients’ psychosocial needs (78%), implementing survivorship care planning (76%), and using nurse navigators (69%). 70% of physicians and 95% of APPs were confident that their patients have reliable resources for managing their QoL issues. Conclusions: HCPs recognize their role in improving patients’ QoL, and their practices have made several transformations to improve patients’ QoL; they are confident that their patients have resources for managing QoL issues. However, many HCPs disagree with linking QoL improvements to their payment. Further studies are needed to understand QoL from patients’ perspectives in the value-based environment.
Pharmacoeconomic savings associated with alternate dosing strategy of nivolumab and ipilimumab combination therapy.
Authors: Kupsh Allison , Alwan Laura , Segal Eve M. , Hammer Kathryn J. , Hall Evan Thomas 
Published: October 2020

79 Background: Nivolumab (NIVO) plus ipilimumab (IPI) is a commonly used therapy for advanced melanoma. Original weight-based dosing of NIVO 1 mg/kg plus IPI 3 mg/kg (NIVO1+IPI3) was approved in 2017. Recently, the CHECKMATE 511 trial demonstrated improved tolerability of NIVO 3 mg/kg plus IPI 1 mg/kg (NIVO3 + IPI1) compared to the original dosing regimen without observed differences in efficacy.Objective: To determine the pharmacoeconomic implications of NIVO1+IPI3 and NIVO3+IPI1 with a dose banding strategy applied. Methods: Patients with advanced melanoma (N = 21) who received IPI and NIVO in combination between 4/2019 – 7/2019 were evaluated via a single-center retrospective chart review. A total of 118 checkpoint inhibitor doses (59 NIVO, 59 IPI) were analyzed.Weapplied a dose banding strategy to both NIVO1+IPI3 and NIVO3+IPI1 regimens to examine pharmaceutical expenditures using the two dosing regimens, whichincluded our organization 10% dose-vial rounding policy. Pharmaceutical expenditure using average wholesale price (AWP), which was $32.42 per mg of NIVO and $180.03 per mg of IPI, was calculated for each dosing strategy (NIVO1+IPI3 and NIVO3+IPI1). Results: The anticipated cost savings of patients receiving NIVO3+IPI1 combination therapy compared to NIVO1+IPI3, (both with dose rounding strategy applied), was $1,459,473 or >$70,000 per patient, representing a 47.2% savings from the original NIVO1 +IPI3 regimen (Table). Conclusions: In addition to improved tolerability and comparable efficacy for NIVO3+IPI1 vs NIVO1+IPI3, our study shows that adoption of the NIVO3+IPI1 regimen results in significant savings in drug costs. Considerations should be made in future combination trials to compare NIVO3+IPI1 as a treatment arm to NIVO1+IPI3 to see if comparable clinical results can be obtained with less toxicity and decreased pharmaceutical spending. [Table: see text]
The COVID-19 pandemic impact on breast cancer care delivery at an academic center in New York City.
Authors: Satish Tejus , Raghunathan Rohit , Prigoff Jake , Wright Jason Dennis , Hillyer Grace , Trivedi Meghna S. , Kalinsky Kevin , Crew Katherine D. , Hershman Dawn L. , Accordino Melissa Kate 
Published: October 2020

88 Background: The coronavirus disease 2019 (COVID-19) pandemic has altered healthcare delivery. To save resources and reduce patient exposure, non-urgent care has been postponed. Previous work has focused on cancer patients with COVID-19, but little has been reported on the impact on patients without COVID-19. We aimed to characterize breast cancer (BC) patients without COVID-19 whose care was impacted by the COVID-19 pandemic at an academic center in New York City. Methods: We performed a retrospective cohort study of BC patients treated at a medical oncology practice between 2/1/2020-4/30/2020. Patients were included if they were scheduled to receive intravenous or injectable therapy or were scheduled as a new patient. Patients were excluded if they tested positive for COVID-19 or transferred care during the study period. Demographic and treatment information were obtained by chart review. Delays/changes in systemic therapy, imaging, interventional radiology procedures, radiation, and surgery were tracked. Delays were defined as postponements of scheduled care. Changes were defined as care alterations without postponements. Care impact was defined as any change/delay in any of the above oncologic care a patient was scheduled for. We conducted a univariate analysis to compare demographics and care impact using χ2 analyses. Results: Of 351 eligible patients, the majority had stage 0-III BC (71.9%) and hormone receptor-positive HER2-negative BC (69.5%). Less than half were Caucasian (43.9%). Care was impacted due to the pandemic in 149 (42.5%) of patients. Surgery changes/delays were most frequent (37 of 84 patients, 44.0%), followed by changes/delays in systemic therapy (90 of 351 patients, 25.6%) and imaging (58 of 282 patients, 20.6%). Patients of Asian, Black, and other non-reported races were more likely to experience a care impact vs. Caucasian patients (47.1% vs. 44.4% vs. 55.6% vs. 31.2%, p = 0.001). Hispanic patients were more frequently impacted vs. non-Hispanic patients (47.6% vs. 35.9%, p = 0.06). Medicaid and Medicare patients were also more frequently impacted vs. commercially insured patients (54.7% vs. 41.4% vs. 36.2%, p = 0.02). BC stage and hormone receptor status were not significantly associated with care impacts. Conclusions: We found that nearly half of our BC patients experienced a change/delay in workup or treatment during the COVID-19 pandemic. We also found significant racial and socioeconomic disparities in the likelihood of care impact. Ongoing studies will determine the impact of alterations in care on cancer outcomes.
The association between Medicaid insurance, biomarker testing, and outcomes in patients with advanced non-small cell lung cancer (aNSCLC).
Authors: Gross Cary Philip , Meyer Craig S. , Ogale Sarika , Kent Matthew , Wong William Bruce 
Published: October 2020

89 Background: Prior work suggests that patients (pts) with Medicaid experience lower quality cancer care and worse outcomes than pts with private insurance. It is unclear whether these disparities persist in the era of personalized medicine. We therefore examined the relation between Medicaid (vs private) insurance and receipt of biomarker testing, targeted therapy, and overall survival in a contemporary cohort of pts with aNSCLC. Methods: We conducted a retrospective study of pts with aNSCLC, diagnosed Jan 2011 through Sep 2019 using the nationwide US Flatiron Health EHR-derived de-identified databases comprising data from over 280 (largely community based) cancer clinics (~800 sites of care) and representing more than 2.4 million US cancer patients available for analysis. Eligible pts were 18-64 years old, had either Medicaid or Commercial insurance at the time of advanced diagnosis, and had a visit ≤120 days after advanced diagnosis. We assessed evidence of receipt of biomarker testing (ALK, EGFR, BRAF, ROS1, PDL1) according to year of diagnosis. The likelihood of testing, biomarker-driven therapy (immunotherapy (CIT) or tyrosine kinase inhibitor (TKI) treatment and mortality were compared by insurance type using Cox regression adjusted for baseline characteristics. Results: The sample included 6,145 commercially insured and 865 Medicaid pts. Compared with commercially insured pts, Medicaid beneficiaries were more likely to be Black (20% vs. 9.3%); P < 0.01) and less likely to have evidence of testing with any biomarkers (57% vs. 71%; P < 0.01). In the adjusted analysis, Medicaid pts were less likely to have evidence of testing (HR [95%CI]: 0.81 [0.74, 0.89], p < 0.01), any 1L treatment (HR [95%CI]: 0.72 [0.66, 0.79], p < 0.01) and 1L biomarker-driven therapy (HR [95%CI]: 0.70 [0.58, 0.84], p < 0.01). A higher risk of death was observed in Medicaid vs. commercially insured pts (HR [95%CI]: 1.23 [1.13, 1.34], p < 0.01) which was partially ameliorated after adjusting for testing and treatment (HR [95% CI: 1.15 [1.05, 1.25], p < 0.01). Among Medicaid pts, those who had no biomarker tests had a 27% higher risk of mortality compared to those who had at least one test (HR [95% CI: 1.27 [1.06, 1.53], p < 0.01). Conclusions: Medicaid pts with aNSCLC had a 23% higher risk of mortality than commercially insured pts. The increased risk of mortality was partially mediated by disparities in testing and treatment, and improved access to these resources may improve outcomes for Medicaid beneficiaries.
Eligibility of real-world patients with metastatic lung cancer for clinical trial participation: A population-based analysis.
Authors: Batra Atul , Kong Shiying , Rigo Rodrigo , Cheung Winson Y. 
Published: October 2020

93 Background: Due to highly selective enrollment in clinical trials, the generalizability of results may be limited. This study aimed to identify the proportion of real-world patients with metastatic lung cancer (MLC) eligible to participate in a clinical trial. Methods: We identified patients diagnosed with MLC in a large Canadian province from 2004 to 2017. Ineligibility to participate in a clinical trial was defined by common exclusion criteria: age > 75 years, anemia, comorbid conditions (heart disease, uncontrolled diabetes, kidney disease, or liver disease) and history of a prior malignancy or immunosuppression. Logistic regression models were used to describe the likelihood of receiving systemic therapy and Cox regression models were constructed to determine the association of trial ineligibility with overall survival (OS). Results: A total of 13,996 patients were included; the median age was 70 years and 46.9% were women. Of these, 8,615 (61.6%) were trial-ineligible. The common reasons for ineligibility were age > 75 years (11.5%), abnormal renal function (8.3%) and prior immunosuppression (3.2%). Further, 32.3% of patients were ineligible by multiple exclusion criteria. In the real-world, 40.6% and 21.8% of trial-eligible and ineligible patients received systemic therapy (P < .001), respectively. After adjusting for age and sex, trial-ineligible patients had lower odds of receiving systemic therapy (odds ratio, .84; 95% confidence interval [CI], .76-.92; P < .001). At a median follow-up of 66.2 months, the median OS of trial-eligible patients was 5.1 months as compared to 2.9 months in those deemed ineligible (P < .001). Receipt of systemic therapy was associated with longer OS in both trial-eligible (10.5 vs 2.7 months, P < .001) and ineligible (9.3 vs 2.1 months, P < .001) patients. In a Cox regression model that adjusted for age, sex and systemic therapy, ineligibility was predictive of worse OS. Conclusions: More than half of patients with MLC are ineligible to participate in clinical trials. Real-world use of systemic therapy was generally low, but its use was associated with improvement in OS even among individuals considered trial-ineligible. Clinical trials should broaden their eligibility criteria to better represent the phenotype of real-world patients so that findings are more generalizable. [Table: see text]
Adrenal Venous Sampling–Guided Adrenalectomy Rates in Primary Aldosteronism: Results of an International Cohort (AVSTAT)
Authors: Ohno Youichi , Naruse Mitsuhide , Beuschlein Felix , Schreiner Florentine , Parasiliti-Caprino Mirko , Deinum Jaap , Drake William M , Fallo Francesco , Fuss Carmina T , Grytaas Marianne A , Ichijo Takamasa , Inagaki Nobuya , Kakutani Miki , Kastelan Darko , Kraljevic Ivana , Katabami Takuyuki , Kocjan Tomaz , Monticone Silvia , Mulatero Paolo , O’Toole Sam , Kobayashi Hiroki , Sone Masakatsu , Tsuiki Mika , Wada Norio , Williams Tracy Ann , Reincke Martin , Tanabe Akiyo 
Published: October 2020

Abstract

Context
Adrenal venous sampling (AVS) is the current criterion standard lateralization technique in primary aldosteronism (PA). Japanese registry data found that 30% of patients with unilateral PA did not undergo adrenalectomy, but the reasons for this and whether the same pattern is seen internationally are unknown.

Objective
To assess the rate of AVS-guided adrenalectomy across an international cohort and identify factors that resulted in adrenalectomy not being performed in otherwise eligible patients.

Design, Setting, and Participants
Retrospective, multinational, multicenter questionnaire-based survey of management of PA patients from 16 centers between 2006 and 2018.

Main Outcome Measures
Rates of AVS implementation, AVS success rate, diagnosis of unilateral PA, adrenalectomy rate, and reasons why adrenalectomy was not undertaken in patients with unilateral PA.

Results
Rates of AVS implementation, successful AVS, and unilateral disease were 66.3%, 89.3% and 36.9% respectively in 4818 patients with PA. Unilateral PA and adrenalectomy rate in unilateral PA were lower in Japanese than in European centers (24.0% vs 47.6% and 78.2% vs 91.4% respectively). The clinical reasoning for not performing adrenalectomy in unilateral PA were more likely to be physician-derived in Japan and patient-derived in Europe. Physician-derived factors included non-AVS factors, such as good blood pressure control, normokalemia, and the absence of adrenal lesions on imaging, which were present before AVS.

Conclusion
Considering the various unfavorable aspects of AVS, stricter implementation and consideration of surgical candidacy prior to AVS will increase its diagnostic efficiency and utility.
Phenotypic Variability of Patients With PAX8 Variants Presenting With Congenital Hypothyroidism and Eutopic Thyroid
Authors: Camats Núria , Baz-Redón Noelia , Fernández-Cancio Mónica , Clemente María , Campos-Martorell Ariadna , Jaimes Nadya , Antolín María , Garcia-Arumí Elena , Blasco-Pérez Laura , Paramonov Ida , Mogas Eduard , Soler-Colomer Laura , Yeste Diego 
Published: October 2020

Abstract

Purpose
Thyroid dyshormonogenesis is a heterogeneous group of hereditary diseases produced by a total/partial blockage of the biochemical processes of thyroid-hormone synthesis and secretion. Paired box 8 (PAX8) is essential for thyroid morphogenesis and thyroid hormone synthesis. We aimed to identify PAX8 variants in patients with thyroid dyshormonogenesis and to analyze them with in vitro functional studies.

Patients and Methods
Nine pediatric patients with a eutopic thyroid gland were analyzed by the Catalan screening program for congenital hypothyroidism. Scintigraphies showed absent, low, or normal uptake. Only one patient had a hypoplastic gland. On reevaluation, perchlorate discharge test was negative or compatible with partial iodine-organization deficit. After evaluation, 8 patients showed permanent mild or severe hypothyroidism. Massive-sequencing techniques were used to detect variants in congenital hypothyroidism-related genes. In vitro functional studies were based on transactivating activity of mutant PAX8 on a TG-gene promoter and analyzed by a dual-luciferase assays.

Results
We identified 7 heterozygous PAX8 exonic variants and 1 homozygous PAX8 splicing variant in 9 patients with variable phenotypes of thyroid dyshormonogenesis. Five were novel and 5 variants showed a statistically significant impaired transcriptional activity of TG promoter: 51% to 78% vs the wild type.

Conclusions
Nine patients presented with PAX8 candidate variants. All presented with a eutopic thyroid gland and 7 had deleterious variants. The phenotype of affected patients varies considerably, even within the same family; but, all except the homozygous patient presented with a normal eutopic thyroid gland and thyroid dyshormonogenesis. PAX8 functional studies have shown that 6 PAX8 variants are deleterious. Our studies have proven effective in evaluating these variants.
Pickleball: Review and Clinical Recommendations for this Fast-growing Sport
Authors: Vitale Kenneth , Liu Steven 
Published: October 2020

Abstract
Pickleball is a single or doubles volley sport played with paddles and ball on a hardcourt. Growing in popularity in recent years, injuries can occur similar to racquet sports; however, there is a scarcity of references in the literature for sports medicine providers encountering these athletes and injuries. This review provides clinicians treating pickleball athletes with an overview of the sport, a case study demonstrating the significant injuries that can occur in pickleball, and a review of the available literature. We provide a discussion on common pickleball injuries, injury prevention strategies, and event coverage recommendations to better equip sports medicine providers with a base of knowledge and a clinical approach to treat these athletes, or “picklers,” who enjoy this fast-growing sport.
Common Injuries in Whitewater Rafting, Kayaking, Canoeing, and Stand-Up Paddle Boarding
Authors: Spittler Jack , Gillum Ryan , DeSanto Kristen 
Published: October 2020

Abstract
Paddle sports continue to be popular forms of outdoor recreation in the United States and around the world. This includes not only the more traditional sports of rafting, kayaking, and canoeing but also the newer and growing sport of stand-up paddle boarding. Because these sports are based in an aquatic environment, and frequently whitewater, there are unique, significant risks of injury. Overall, injuries in paddling sports are mostly musculoskeletal and are both acute and chronic in nature. Some injuries, such as environmental and head injuries, are especially problematic because they can lead to serious morbidity and mortality, most importantly drowning. This review describes the epidemiology, type, and location of injuries across paddle sports. It not only focuses on whitewater injuries but also includes information on injuries sustained in other aquatic paddling environments.
QUARTIC: QUick pArallel algoRithms for high-Throughput sequencIng data proCessing
Authors: Jarlier Frédéric , Joly Nicolas , Fedy Nicolas , Magalhaes Thomas , Sirotti Leonor , Paganiban Paul , Martin Firmin , McManus Michael , Hupé Philippe 
Published: October 2020

Life science has entered the so-called 'big data era' where biologists, clinicians and bioinformaticians are overwhelmed with high-throughput sequencing data. While they offer new insights to decipher the genome structure they also raise major challenges to use them for daily clinical practice care and diagnosis purposes as they are bigger and bigger. Therefore, we implemented a software to reduce the time to delivery for the alignment and the sorting of high-throughput sequencing data. Our solution is implemented using Message Passing Interface and is intended for high-performance computing architecture. The software scales linearly with respect to the size of the data and ensures a total reproducibility with the traditional tools. For example, a 300X whole genome can be aligned and sorted within less than 9 hours with 128 cores. The software offers significant speed-up using multi-cores and multi-nodes parallelization.
The Relation Between Physical Activities and the Occurrence of Dysmenorrhea
Authors: Fatimah Adinda Dwi Beauty , Rohmah Fayakun Nur 
Published: October 2020

Background: According to a research conducted in Palestine, there are 85.1% university students reportedly having pain during menstruation. The occurrence of dysmenorrhea in Indonesia is 86%. The high occurrence of dysmenorrhea has less attention from the public and even from the adolescents themselves. One of the factors that influence the occurrence of dysmenorrhea is physical activities. Women who do not do exercise regularly have 3.48 times of risk to experience dysmenorrhea. This study aims to reveal the correlation between physical activities and dysmenorrhea. Method: This was quantitative research with cross sectional design. The population in this study was 136 female students of D4 Medical Laboratory Technology study program. Sixty eight respondents were contributed in this study with exclusion and inclusion criteria. The sampling technique used was total sampling. Bivariate analysis used was the Fisher’s Exact correlation test. The research hypothesis was there was a correlation between physical activities and the occurrence of dysmenorrhea. Results: There were 51 respondents who experienced dysmenorrhea (75%) and there were 53 respondents who were categorized at moderate physical activities obtained p < 0.05). Conclusion: It can be concluded that there is a relation between physical activities and dysmenorrhea
Birth trauma: the mediating effects of perceived support
Authors: Baptie Grace , Andrade Jackie , Bacon Alison M. , Norman Alyson 
Published: October 2020

Background Many women experience their childbirth as traumatic, and 4-6% of mothers present with postnatal post-traumatic stress disorder. Aims To measure the relationship between obstetric intervention, perceived support in childbirth and mothers' experiences of postnatal trauma, and to identify salient aspects of the birth experience that are considered traumatic. Methods A total of 222 women in their first year postpartum were recruited between October and December 2018 via local mother and baby groups in southwest England (UK) and online social media pages. They completed an online survey regarding their birth experience. Further insight into mother's birth experiences was garnered through free-text responses in the survey. Results Overall, 29% of mothers experienced a traumatic birth and 15% met full or partial criteria for post-traumatic stress disorder. Feeling supported mediated the relationship between obstetric intervention and postnatal trauma symptoms. Conclusions This study reinforces the value of supportive healthcare professionals and the power of a nurturing environment, which can buffer the potentially negative effects of an obstetrically complicated birth on postnatal trauma symptoms.