bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ablation of idiopathic ventricular arrhythmias originating from basal cardiac crux region
Authors: Khmao Pichmanil , Hwang Chun , Pak Hui-Nam 
Published: September 2021

Abstract
Background
Ablation of idiopathic ventricular arrhythmias (VAs) in the cardiac crux region is one of the challenging procedures due to the complex anatomical structure where the four chambers of the heart are offset. Although this region is complex, the contiguous cardiac structures allow for the ablation of arrhythmias from adjacent sites.

Case presentation
We present different anatomical approaches in radiofrequency ablation and the ECG characteristics from a case series of VAs originated from the basal inferior ventricular septum, the corresponding endocardial aspect of the basal cardiac crux region.

Conclusions
Ablation of VAs originated from the basal cardiac crux region requires detailed mapping in the proximal coronary venous system and the adjacent structures including the RV, RA, and LV. In addition to the characteristic ECG of basal crux VAs, our three cases present an abrupt precordial transition in V2 with R wave amplitude greater than in V1 and V3.
Lifestyle and oxidative stress status in infertile women in Dar es Salaam, Tanzania: comparative cross-sectional study
Authors: Kasililika Anna Gideon , Odukogbe Akin-Tunde Ademola , Dairo Magbagbeola David , Balandya Belinda Stella , Bunuma Emmanuel Kulwa 
Published: September 2021

AbstractBackgroundFemale infertility is a public health problem, contributing to 65.9% of infertility in Tanzania. Lifestyle and oxidative stress (OS) have been suggested to affect female fertility; however, there are limited and controversial reports. This study aimed to determine the lifestyle and OS status of fertile and infertile women and relate lifestyle and OS to female infertility. The study was conducted among randomly selected 48 fertile and 48 infertile women aged 15–49 years attending a gynaecological clinic at Muhimbili National Hospital. Lifestyle information was collected using a proforma, and a sandwich ELISA method was used to analyse OS biomarkers (malondialdehyde and total antioxidant capacity). Chi-square, independentttest and correlation coefficient were used for data analysis atp< 0.05.ResultsInfertile women were significantly older (33.4 versus 30.3 years,p= 0.03), got married at later ages (25.0 versus 22.8 years,p= 0.02), were in employment (62.5% versus 29.2%,p= 0.001), had attained university degree (56.3% versus 27.1%,p= 0.004) and were more obese, more likely to consume alcoholic drinks (p= 0.02) and less likely to use supplements (p= 0.000) than fertile women. Infertile women had statistically significant higher malondialdehyde (p= 0.000) and lower total antioxidant capacity levels (p= 0.000) than fertile women. The total antioxidant capacity level had a statistically significant negative correlation with alcohol consumption (r= −0.27,p= 0.008) and obesity (r= −0.32,p= 0.002) and a positive correlation with supplement use (r= 0.24,p= 0.02). Also, malondialdehyde level had a statistically significant positive correlation with alcohol consumption (r= 0.31,p= 0.002) and obesity (r= 0.28,p= 0.007).ConclusionsThe differences in socio-demographic characteristics, lifestyle and oxidative stress between fertile and infertile women may account for difficulties in achieving pregnancy among infertile women in Tanzania. Lifestyle factors significantly affect oxidative stress. Health education on appropriate lifestyles that support female fertility and emphasis on supplement use during the preconception period may be beneficial in the management of female infertility.
Status of Palliative Oncology Care for Children and Young People in Sub-Saharan Africa: A Perspective Paper on Priorities for New Frontiers
Authors: Namisango Eve , Bhakta Nickhill , Wolfe Joanne , McNeil Michael J. , Powell Richard A. , Kibudde Solomon , Luyirika Emmanuel B. K. , Mulema Vivienne , Feudtner Chris , Baker Justin N. 
Published: September 2021

PURPOSE The burden of cancer disproportionately affects low- and middle-income countries. Low 5-year survival figures for children with cancer in low-income countries are due to late presentation at diagnosis, treatment abandonment, absence of sophisticated multidisciplinary care, and lack of adequate resources. The reasons for late presentation are partly due to limited awareness of cancer symptoms, high treatment costs, and facility-level barriers to timely access to treatment. Given the systemic challenges, the regional need for palliative oncology care for children care is high. Despite the enormity of the need for palliative oncology for children with cancer in Africa, its level of development remains poor. This paper presents the evidence on the status of palliative oncology care for children in sub-Saharan Africa. METHODS This review provides an overview of the current status of palliative oncology care for children in sub-Saharan Africa, using the WHO building blocks for health systems strengthening as reference points, before proposing a forward-looking prioritized agenda for its development. RESULTS We noted that survival rates for children with cancer remain much poorer in Africa compared with developed countries and palliative oncology care resources are scant. Our results also show low coverage for palliative oncology care services for children, lack of a critical mass of health workers with the skills to deliver the care, a lack of robust documentation of the burden of cancer, widespread lack of access to essential controlled medicines, limited funding from government and limited coverage for palliative oncology care in most cancer control plans. CONCLUSION This review highlights priority areas for action that align to the WHO health system building blocks for strengthening health systems.
Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer.
Authors: Handley Nathan , Wen Kuang-Yi , Gomaa Sameh , Shimada Ayako , Leiby Benjamin , Brassil Kelly Jean , Jackson Lindsey , Calvaresi Anne , Dicker Adam P. 
Published: September 2021

102 Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.
Interinstitutional multidisciplinary virtual tumor board implementation for the management of breast cancer in a public health setting in Mexico.
Authors: Peña-Curiel Omar , Valles-Guerra Orestes , Velazquez-Ayala Karen M , Peña-Iturbide Griselda , Flores Moreno Sonia Maria , Lara-Campos Jackeline Grace , Lara-Esqueda Martín , Herrera-Ríos Nydia Paulina , Montes de Oca Luna Roberto 
Published: September 2021

107 Background: UNEME-DEDICAM (UD) clinics are part of a national public health initiative to provide women prompt access to cervical and breast cancer (BC) screening and diagnosis. Furthermore, UD clinics play a central role in the coordination and prioritization of patient transfer to treatment-specialized institutions. To facilitate this process, we planned and implemented an interinstitutional virtual multidisciplinary tumor board (VMDT). Herein, we present our current experience. Methods: We planned and implemented our VMDT in September 2020. Weekly sessions were established for the multidisciplinary discussion of every newly diagnosed patient at UD with a complete radiology and pathology report. Communication was accomplished through an encrypted and secure internet connection using Microsoft Teams software. VMDT members included breast pathologist, breast imaging, radio oncologist, medical oncologist, and surgical oncologist. Treatment consensus were registered in a Microsoft Word template and integrated into the medical record for each patient. Importantly, the report also included date and time for the consultation at the referral institution. Results: Between September 2020 through May 2021, 74 BC patients were diagnosed at UD. Mean age at diagnosis was 52 years. Sixty-eight patients had invasive BC, of whom early stage (I and II) accounted for 67% of patients; locally advanced (III) for 29%, and advanced (IV) for 4%. Luminal A and B type accounted for 68%; HER2+ve for 25%; and triple negative for 7%. Mean time from biopsy to complete histopathology report (biopsy-report interval) was 2.5 weeks. The mean time from VMDT consensus to patient´s first consultation at referral center (VMDT-referral interval) was 2 weeks. The mean time from biopsy to patient´s first consultation at referral center (total interval) was 5.5 weeks. Conclusions: The VMDT is a plausible strategy to streamline the inter-institutional organization for the timely care of BC patients. UD clinics play a central role in the coordination of transfer of BC patients to tertiary care centers.
Disparities among GU cancer patients referred to palliative care.
Authors: Atiq Saad Omar , Helzberg James , Hirshman Nathan , Atiq Zainab , George Daniel J. , Kamal Arif 
Published: September 2021

114 Background: The role of palliative care in genitourinary (GU) malignancies has been understudied. Despite representing nearly 25% of new cancer diagnoses, with over 350,000 new cases diagnosed each year, few GU patients have been included in palliative care trials under the theory that symptoms are less severe for GU patients than other solid tumors. Early involvement of palliative care services improves the patient care experience, decreases healthcare utilization, is associated with survival benefit, and results in improved quality of life and mood. To further elucidate the role of palliative care in oncology, we must study its utility in subsets of malignancy like GU cancers, as needs for patients may differ by malignancy type. Methods: A retrospective cross-sectional analysis of initial outpatient palliative care visits was performed using data from the Quality Data Collection Tool for Palliative Care (QDACT-PC) database from 2014-2020. QDACT-PC is a web-based, point-of-care registry used by physicians across the United States to track quality metrics associated with patient consultations. Data was collected and analyzed from patients' initial visits including pain scale, dyspnea scale, feeling of well-being (Quality of Life scale), fatigue scale, constipation scale, palliative performance status (PPS), and preference for resuscitation status. Scales for these variables were 0-10, with the exception of a scale of 0-100% for PPS. Patients less than 18 and greater than 90 years old were excluded. Chi-squared and Student’s t-tests were used to compare categorical and continuous variables, respectively. Results: 824 GU oncology patients (358 prostate cancer patients, 251 bladder cancer patients, 215 renal cancer patients) were compared against all patients with non-GU cancers (7807 patients). Notably, non-GU patients reported higher rates of fatigue (4.50 vs. 4.13, p = 0.0013) and dyspnea (1.63 vs. 1.11, p < 0.0001) than GU patients. GU malignancies had non-significant higher reported pain (3.73 vs. 3.60, p = 0.3109) and constipation (1.96 vs. 1.83, p = 0.2319) and lower PPS (4.95 vs. 4.96, p = 0.8555) and QOL (4.55 vs. 4.73, p = 0.0962). Preference for resuscitation at the time of referral was similar between the two groups (p = 0.6339). Only 16.5% of prostate cancer patients referred to palliative care in this database were black, while black patients are often estimated to represent 30% of new prostate cancer diagnoses each year. Conclusions: GU patients represent 9.54% of cancer patients seen by palliative care while the incidence is nearly 25%. Traditionally, GU patients were underrepresented in palliative care trials under the notion of less severe symptoms; however, this study demonstrates that GU patients have as severe symptoms as non-GU patients, highlighting a disparity in referral to palliative care. Furthermore, the lack of representation of black patients suggests potential inequity and warrants further investigation.
Racial disparities in comprehensive biomarker testing and clinical trial enrollment among patients with metastatic colorectal cancer (mCRC).
Authors: Hess Lisa M. , Bruno Debora S. , Li Xiaohong , Su Eric Wen , Patel Monaliben 
Published: September 2021

125 Background: Racial disparities may exist at many levels in the health care system; in oncology, yet little is known about racial disparities in biomarker testing and clinical trial enrollment among patients with mCRC. This study was designed to explore racial differences in comprehensive biomarker testing and clinical trial enrollment in the US using a large real-world database. Methods: This retrospective observational study utilized the Flatiron Health electronic health records database, which includes longitudinal data from patients diagnosed with mCRC. Patients with mCRC were eligible for this study if they had evidence of systemic therapy from 1/1/2017 through 10/30/2020 and were alive for at least 120 days after metastatic diagnosis. Unadjusted analyses summarized differences in biomarker testing and clinical trial enrollment between White and Black race, adjusted regression analyses were conducted using all baseline variables as covariates. These data are de-identified and are not considered human subjects research in accordance with the US Code of Federal Regulations (45 CFR Part 46). Results: A total of 7,879 patients were eligible: 4,803 (61.0%) were White and 838 (10.6%) were Black. Comprehensive testing by next-generation sequencing (NGS) was received by 51.6% and 41.8% of patients who were White and Black, respectively (p < 0.0001). There was no significant difference in clinical trial participation across all lines of therapy (2.9%, White and 2.9% Black). There was a statistically significant relationship between NGS-based testing and clinical trial enrollment (p < 0.0001), however, race was not identified a moderating factor in this relationship in adjusted regression analyses. The receipt of molecularly-targeted therapy was comparable between both races (11.9% and 9.7% for White and Black, respectively; p = 0.06). Patients received FOLFOX+bevacizumab most commonly in the first line (34.3% White; 40.5% Black), all other regimens were within 2 percentage points between racial groups. Targeted agents were each used by less than 7.4% of the study population. Conclusions: The use of NGS-based testing is significantly different by race in this database. The significant relationship between NGS testing and clinical trial enrollment at any time in the database did not appear to be moderated by race; however, descriptive analyses suggest that the ongoing analyses by line of therapy and considering timing of testing may better quantify these relationships. These data may not be generalizable to the entire US population as they are obtained from a single database that is limited to practices using this EHR system.
Perception and barriers to virtual medicine in Hispanics and underrepresented populations.
Authors: Menendez Alvaro G. , Bade Katarina , Hsu Emily , Chhabra Jyoti 
Published: September 2021

169 Background: Perceptions and barriers to virtual medicine (VM) in Hispanics and underrepresented population (H/UP) are unknown. We investigated these parameters in a multicenter oncology trial in hopes of improving quality of care and minimizing potentially negative healthcare outcomes related to this increasingly popular healthcare delivery (HD) technique. Methods: An IRB-approved, 14-item questionnaire was offered in English and Spanish to all pts. receiving care at participating cancer centers over a 6-month period. Examined variables included demographic information, preferences and perceived barriers regarding VM. Multivariable analysis was performed using Chi Square test to determine association between demographic variables and participants preferences and perceived barriers. Results: A total of 180 pts were enrolled. H/UP rely more on social media to receive health information (32.6% vs 23.9%) as opposed to face-to-face. Fewer H/UP have received oncological care through VM (27.9% vs 32.9%) despite comparable preferences regarding incorporation or exclusive use of VM in HD (23.2 % vs 24.6%). Similar levels of satisfaction with current HD methods were reported (83.7% vs 86%). No significant difference by age, level of education, marital status or Hispanic ethnicity was noted although Spanish as primary language was statistically significant (p = 0.001) in patient satisfaction and preferences regarding use of VM. H/UP involve family members more frequently through VM (48.8% vs 29.1). H/UP have more technical barriers to VM as they were up to 2.6 times more likely to not have a phone/ipad/similar or have access to broadband connectivity (23.3% vs 9%; and 16.3% vs 8.2% respectively). Conclusions: H/UP are equally interested and satisfied in receiving oncological care through VM. Given the shift towards outpatient and home-based care, an aging population, and cultural appropriations, VM excitedly allows re-incorporation of family/caregiver in medical engagement. However, fewer H/UP are currently utilizing VM which could be secondary to H/UP’s specific barriers or healthcare bias. Although behavioral interventions may be explored, H/UP barriers are predominantly technical and targetable with appropriate policies that take into consideration institutional and reimbursement programs.
Assessing financial toxicity in patients with metastatic breast cancer: A single institution experience during the COVID-19 pandemic.
Authors: Sinkar Shruti , Too Faith , Carr Kelly , Jelinek Jessica , Saylor Elizabeth , Bacon Jacqueline , Stearns Vered , Smith Karen L. 
Published: September 2021

176 Background: Assessment of financial toxicity (FTox) is recommended as a component of comprehensive supportive care for patients with metastatic cancer. FTox is common in patients with metastatic breast cancer (MBC) and is associated with poor quality of life. Available data suggest many patients with cancer have faced financial hardship during the COVID-19 pandemic. Methods: We evaluated FTox using the COmprehensive Score for Financial Toxicity (COST) measure in patients with MBC at Johns Hopkins clinical sites. Respondents were patients with MBC who completed the COST measure as part of the baseline assessment for one of two IRB-approved quality improvement projects initiated during the COVID-19 pandemic: 1) a pilot project evaluating incorporation of patient-reported outcome (PRO) measures into routine care (RC), and 2) a needs assessment prior to attending a multi-disciplinary clinic (MultiD-C) focusing on supportive care. COST scores range from 0-44 with higher scores indicating better financial well-being. FTox was graded as: Grade 0 (G0): >26, Grade 1 (G1): >14-26, Grade 2 (G2): >0-14 and Grade 3 (G3): 0. Results: 40 patients with MBC completed the COST measure May 2020 through April 2021 as a component of RC and 17 patients with MBC completed the COST measure September 2020 through May 2021 in advance of anticipated attendance at the MultiD-C. Median age (range) for RC and MultiD-C respondents was 64 (36-85) and 55 (37-75) years, respectively. 4 (10%) and 4 (24%) of RC and MultiD-C respondents respectively reported household income < $50,000. The majority of respondents in both groups were White [RC: 28 (70%), MultiD-C: 14 (82%)], non-Hispanic [RC: 36 (90%), MultiD-C: 16 (94%)], had more than high school education [RC: 37 (93%), MultiD-C: 17 (100%)] and all were insured. 27 (68%) of RC respondents and 11 (65%) of MultiD-C respondents were receiving oral cancer therapies. COST scores and grading are shown in the Table. Approximately half of the respondents in each group reported their illness has been at least “a little bit” of a financial hardship [RC: 22 (55%), Multi-D: 8 (47%)]. Conclusions: Patients with MBC receiving care during the COVID-19 pandemic frequently report FTox. Implementation of routine assessment for FTox via PRO measures and identification of strategies to support patients with MBC experiencing FTox are priorities both during the pandemic and beyond.[Table: see text]