bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of an embedded clinical oncology pharmacy model across the State of Michigan.
Authors: Mackler Emily R. , Wietzke Julie , Schwartz Ashley , Young Katie , Reyes-Gastelum David , Griggs Jennifer J. , Choe Hae Mi , Farris Karen B. 
Published: September 2022

58 Background: The oncology pharmacist role has evolved to address implications of newer cancer therapies by increased integration in direct patient care and management of cancer therapy side effects and adherence. Despite the ability of oncology pharmacists to provide high-value, high-quality care to patients with cancer, it remains difficult for community oncology practices to justify the cost of the pharmacist. The purpose of this study is to characterize a model, Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM), that supports the integration of clinical oncology pharmacists into community practices via financial support to the practices, clinical support to the pharmacist team, and outcomes assessment. The results will provide insight into how pharmacists support patient care and how to substantiate a pharmacist in practices. Methods: This multicenter, retrospective analysis was conducted between October 2020 – March 2022. POEM pharmacists received support in the development of collaborative practice agreements, billing guidance, and ongoing oncology continuing education. Practices received support via a percentage of salary support for the pharmacist the first 3 years and value-based reimbursement for participation. A standardized method for collecting patient demographics, pharmacist encounter characteristics, and intervention information was created via RedCap. Patients receiving care by the pharmacist were provided a 4-item survey to rate their experience. Results: As of March 2022, POEM has 6 clinical oncology pharmacists representing 8 physician organizations, 24 oncology clinics, and 72 physicians. 1944 patients have been seen via 4296 encounters and 4380 interventions. 49% of patients were female, 93% white, and 74% > 60 years. The primary reasons for pharmacist care were treatment with oral anticancer agents (OAA) (52%), non-immunotherapy IV (22%), and immunotherapy (20%). Pharmacists recorded an average of 77 patient encounters/week over the last year and 108/week over the past quarter. 47% of these encounters were billed using care management codes. Additionally, pharmacists recorded an average of 82 interventions/week over the past year and 101/week over the last quarter. Interventions were Education and Referrals (49%), Medication Modification (24%), and Comprehensive Medication Review or Medication Reconciliation (20%). Patients were satisfied with the pharmacists’ care and felt it was important to meet with a pharmacist before beginning their cancer treatment. Conclusions: Early results indicate positive patient experiences from education sessions and medication interventions to improve patient symptoms. Future outcome analyses will quantify the return on investment of clinical pharmacist integration into oncology community practices by measuring pre- and post-intervention healthcare utilization and patient clinical outcomes.
Racial and ethnic disparities in the cervical cancer screening cascade in three U.S. health care settings.
Authors: Spencer Jennifer C. , Kim Jane , Wang Lei , Tiro Jasmin A. , Feldman Sarah , Kamimeni Aruna , Skinner Celette Sugg , McCarthy Anne Marie , Haas Jennifer 
Published: September 2022

109 Background: There are wide disparities in cervical cancer incidence and mortality in the US by race and ethnicity. Our objective was to characterize racial and ethnic differences in routine cervical cancer screening and follow-up of abnormal findings across three US healthcare settings. Methods: We used 2016 to 2019 data from three sites participating in the METRICS research center, part of the PROSPR II consortium. We evaluated screening among average risk, screen-eligible patients receiving care at participating sites, by race and ethnicity as captured in the EHR. Among patients with a high-risk abnormal finding, we evaluated the proportion receiving colposcopy or biopsy within six months. We conducted multivariate regression to assess the extent to which clinical, socioeconomic, and structural characteristics mediate observed differences in screening. Results: We identified 188,415 eligible patients; 74.6% received cervical cancer screening during the 3-year study window. Screening use was lower among non-Hispanic Black (66.8%) patients and higher among Hispanic (82.5%), Asian/Pacific Islander (75.8%) patients, and those who identified as multi-racial or “other” race (75.8%) compared to non-Hispanic White (71.4%) patients. In multivariate regression, most differences were explained by the distribution of patients across sites, with the lowest screening rate observed at the site caring for the majority of both Black and Hispanic patients. However, Hispanic patients remained more likely to be screened even after controlling for a variety of clinical and sociodemographic factors (Risk Ratio: 1.14 [1.12, 1.16]). Among those receiving a screening test, Black and Hispanic patients were more likely to receive Pap-only testing (vs. HPV DNA co-testing) compared to non-Hispanic White patients and were more likely to have abnormal findings. Follow-up from abnormal results within six months was low for all groups (68.7%) but highest among Hispanic participants (77.7%). Conclusions: In a large cohort of patients receiving care in three community settings, cervical cancer screening and follow-up were lower than national targets. Lower screening for Black women is strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity. More research is needed to characterize the relatively higher screening for Hispanic women, which is not explained by observed individual or systemic factors. Additionally, it is crucial to focus on follow-up after abnormalities are identified, which is low for all populations.
Palliative care utilization in metastatic prostate cancer: An analysis of the National Cancer Database.
Authors: Wu Xinxin , Swedek Michelle , Malouff Timothy Dean , Silberstein Peter T. 
Published: September 2022

202 Background: Prostate cancer is one of the most prevalent cancers among males with an increasing incidence rate since 2007. Bone metastases are commonly associated with prostate cancer. Prostate cancer patients with painful bone metastases can be treated palliatively with external radiation being the standard of care. The role of palliative care can be beneficial in metastatic prostate cancer given its largely incurable course even after intensive multimodal therapy. There has yet to be a study that explores the impact of race, insurance status, education level, facility type, rural/urban geography, and income level on the overall utilization of palliative care for the cancer, the palliative treatment the patients were more likely to receive based on the different demographic variables, and the palliative care disparity between socioeconomic groups. Methods: This is a retrospective study of adults diagnosed with all subtypes of AJCC staged metastatic prostate cancer between 2004 and 2017 in the National Cancer Database (NCDB) to determine palliative care usage (n = 64,268). Demographic factors were studied in relation to the receipt of palliative care. Cross tabulation analysis was performed and evaluated using Pearson Chi-Square and ANOVA tests. Kaplan-Meier curves were utilized to calculate survival probabilities with log-rank analysis. Exclusion criteria included concurrent tumors and missing data. Results: Approximately 15.8% of the patients diagnosed with metastatic prostate cancer received palliative care (10180/64268). The number of cases diagnosed has grown every year between 2004 (n = 2140) and 2017 (n = 6,961). The same pattern was seen for palliative care usage in these patients (n = 352 in 2004 and n = 1325 in 2017). The patients that did not receive palliative care were older (71.3 vs 70.7, range 40-90+, p < 0.001). The patients who did receive PC were more likely to be non-Hispanic (94.6%, p < 0.001), white (78.6%, p < 0.001) patients at a comprehensive community cancer program (40.9%, p < 0.001). Palliative care was more likely utilized in rural settings (2% vs 1.6%, p < 0.001), higher Charlson-Deyo score (0.41 vs 0.38, p < 0.001), all facility locations excluding Mountain or Pacific, lower levels of high school degree attainment, lower overall survival, and those in age groups ranged 40-49, 50-59, and 60-69. There was no statistical significant difference in great circle distance between those that utilized palliative care and those that did not. Conclusions: We identified trends among patients receiving palliative or not. Factors that were correlated with palliative care usage included race, Charlson-Deyo score, treatment facility type, region, education level, rural setting, and specific age groups. As palliative care continues to be utilized more frequently, we hope that this study can serve as a useful baseline for preventing disparities in care.
Improving comprehensive genotyping in patients with newly diagnosed non-squamous NSCLC: Results from a prospective trial of a behavioral nudge intervention.
Authors: Aggarwal Charu , Carpenter Erica L. , Scholes Dylan G. , Hwang Wei-Ting , McWilliams Tara , Singh Aditi Puri , Sun Lova , Kosteva John A. , Costello Michael Robert , Doucette Abigail , Gabriel Peter Edward , Roy Megan , Martella Anthony O. , Thompson Jeffrey C. , Cohen Roger B. , Langer Corey J. , Shulman Lawrence N. , Marmarelis Melina Elpi 
Published: September 2022

362 Background: Despite current guidelines, less than 50% of patients with metastatic (m) non-squamous (NSq) NSCLC undergo comprehensive molecular genotyping. At our institution, based on improved comprehensiveness of genotyping with use of concurrent tissue (T) and plasma (P) next generation sequencing (NGS), we designed an electronic medical record (EMR)-based nudge intervention to auto-generate an order for P NGS at the time of initial consultation, while T NGS was carried out reflexively based on institutional pathways. Methods: A prospective study was conducted at the Abramson Cancer Center and 2 community sites within the University of Pennsylvania Health System after IRB approval. A provider team-focused EMR-based nudge intervention was designed to order P NGS at the time of new patient consultation. Eligible patients for the nudge were identified using an EMR based checklist, that included 3 criteria i. newly diagnosed, ii. treatment naïve, iii. mNSq NSCLC. Results from the intervention period (4/2021-12/2021) were compared to baseline data from similar patients treated at our institution between 01/2019 and 03/2021. Categories of NCCN guideline recommended molecular genotyping were defined as: i) comprehensive: EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, and ii) incomplete or no testing performed. The proportion of patients with comprehensive molecular genotyping prior to 1st-line therapy were compared in the pre- and post-intervention groups using the chi-square test. Results: 526 patients with mNSq NSCLC were included in this analysis: 381 in the pre-intervention cohort, 145 in the post-intervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent concurrent T+P testing resulting in improved comprehensive molecular genotyping. In addition, a greater proportion of patients had comprehensive genotyping available prior to 1st-line therapy in the post-intervention vs pre-intervention cohort (Table). Conclusions: Across 3 practice sites, a provider team-focused EMR-based nudge intervention was associated with a significantly higher proportion of patients with mNSq NSCLC undergoing comprehensive molecular genotyping, both overall and prior to 1st-line therapy. These findings demonstrate that behavioral, EMR-based nudges can promote guideline concordant diagnostic testing at both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC.[Table: see text]
Variation in patient demographics across different modalities of tele-oncology.
Authors: Rodgers Thomas David , Burningham Zachary , Halwani Ahmad Sami , Kelley Michael J. , Passero Vida Almario 
Published: September 2022

394 Background: TeleOncology encompasses the delivery of care virtually though modalities such as electronic consultation (e-consult), telephone and video visits. The National TeleOncology (NTO) program was created by Veterans Affairs (VA) to address growing disparities in care across the VA network. Through NTO, subspecialty hematologists/oncologists can provide recommendations and care for patients located at VA centers across the county. We aimed to investigate differences in patient utilization of available forms of TeleOncology. Methods: NTO was started in 2020 and offers virtual care to over 20 VA sites. Patient visits were catalogued across different forms of TeleOncology including telephone, e-consult (chart review only), VA Video Connect (VVC, synchronous video visit with patient at home), and Clinical Video Telehealth (CVT, synchronous video visit with patient at local VA). Total and unique patient encounters were analyzed based on patient age, gender, race, care assessment need (CAN) score (predictor for identifying patients at high-risk for poor outcomes), and patient rurality. Modalities of telehealth were then compared. Results: 3008 unique patients and 5921 encounters were recorded (October 2019-May 2022). The majority of patients accessed care by CVT visit (n = 1915). Patient characteristics were statistically different between the modes of TeleOncology. Patients participating in CVT were older (Mean 70.5 (95% CI 69.97-70.97) vs 65.5 years old (95% CI 64.62-66.68) and had higher CAN scores (mean score 82 (95% CI 80.96-82.74) vs 69 (95% CI 66.76-70.74)), compared to patients assessed through e-consult. Conversely black and female patients were overrepresented in the e-consult group compared to the CVT group (Table). Patients receiving care by telephone were more often located in a rural or highly rural region compared to those seen through VVC (71.5% vs 52%). Conclusions: The NTO program offers unique insights into utilization patterns of different forms of virtual care. Patient characteristics were not similar across the e-consult, telephone, and video visit groups. Importantly racial and gender disparities were noted, with African American and female patients, being disproportionately cared for through chart review only compared to a video visit. These results represent a first step in understanding how patients’ interface with virtual care modalities. Future studies could investigate how patient and system factors might influence observed patterns.[Table: see text]
Real-world versus clinical trial CAR T outcomes among patients diagnosed with diffuse large B-cell lymphoma.
Authors: McBride Kaitlyn , Snyder Sophie 
Published: September 2022

413 Background: Chimeric antigen receptor (CAR) T cell therapy is a high-value innovative therapy for patients diagnosed with diffuse large B cell lymphoma (LBCL). The Federal Drug Administration (FDA) has approved three CAR T-cell therapies for these patients: axicabtagene ciloleucel, tisagenlecleucel and liso-cel. Data on real-world survival and adverse events (AEs) among Medicare beneficiaries receiving CAR T is limited. This study aims to compare real-world CAR T outcomes to clinical trial results. Methods: Retrospective cohort analysis using CMS 100% Medicare Fee-for-Service (FFS) Inpatient (Part A) and Outpatient (Part B) claim files. The database contains information on inpatient and outpatient diagnoses based on the International Classification of Diseases 10th Revision-Clinical Modification (ICD-10-CM). Inpatient files were used to identify Medicare FFS beneficiaries with LBCL diagnosis (ICD-10-CM code C83.3) who received inpatient CAR T procedure between January 2020 and March 2021. Demographic characteristics (age & sex), 12-month survival, and AEs were identified and compared to outcomes from three CAR T clinical trials (tisagenlecleucel: JULIET; axicabtagene ciloleucel (axi-cel): ZUMA-1; and lisocabtagene maraleucel (liso-cel): TRANSCEND NHL 001). Results: The real-world cohort (RW pts) consisted of 463 Medicare FFS beneficiaries with LBCL who were administered CAR T cell therapy inpatient between January 2020 and March 2021. A higher proportion of RW pts were aged 65 or older compared to clinical trial patients, and a lower proportion of RW pts were male (57% vs 65%). Overall, fewer RW pts experienced cytokine release syndrome (CRS) and anaemia compared to patients across the clinical trials (Table). Other common AEs, including neutropenia, fatigue, and thrombocytopenia, occurred at lower rates among RW pts compared to rates in the axicabtagene ciloleucel and liso-cel clinical trials. Survival at 12-months was comparable between RW pts and clinical trial patients. Conclusions: Study findings suggest that real-world occurrence of common AEs following inpatient CAR T administration, including CRS and anaemia, are lower compared to clinical trial outcomes. Real-world evidence of CAR T is critical for understanding real-world benefit, safety, and value of novel therapies.[Table: see text]
Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).
Authors: Azizoddin Desiree Rachel , Anderson Kris-Ann S. , Baltazar Ashton Riley , Beck Meghan R , Tulsky James A. , Edwards Robert R. , Businelle Michael , Enzinger Andrea Catherine 
Published: September 2022

418 Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were >21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.
Aldosterone, Renin, and Aldosterone-to-Renin Ratio Variability in Screening for Primary Aldosteronism
Authors: Ng Elisabeth , Gwini Stella May , Libianto Renata , Choy Kay Weng , Lu Zhong X , Shen Jimmy , Doery James C G , Fuller Peter J , Yang Jun 
Published: September 2022

Abstract

Context
The plasma aldosterone concentration (PAC), renin, and aldosterone-to-renin ratio (ARR) are used to screen for primary aldosteronism (PA). Substantial intra-individual variability of PAC and ARR using plasma renin activity in the context of usual antihypertensive therapy has been described, but there is no data on ARR variability calculated using direct renin concentration (DRC).

Objective
To describe the intra-individual variability of PAC, DRC, and ARR in the absence of interfering medications in patients with and without PA.

Design
Retrospective cohort study.

Patients
Hypertensive patients referred for investigation of PA, with at least 2 ARR measurements while off interfering medications.

Setting
Endocrine hypertension service of a tertiary center, from May 2017 to July 2021.

Main outcome measures
PAC, DRC, and ARR variability was calculated as coefficient of variation (CV) and percent difference (PD).

Results
Analysis of 223 patients (55% female, median age 52 years), including 162 with confirmed PA, demonstrated high variability with a sample CV of 22-25% in the PAC and sample CV of 41% to 42% in the DRC and ARR in both the PA and non-PA groups. The degree of variability was substantially higher than the assays’ analytical CV. Sixty-two patients (38%) with PA had at least one ARR below 70 pmol/L:mU/L (2.4 ng/dL:mU/L), a cut-off for first-line screening of PA.

Conclusions
Significant intra-individual variability in PAC, DRC, and hence ARR occurs in a large proportion of patients being investigated for PA. These findings support the need for at least 2 ARR before PA is excluded or further investigated.
Modern Translations
Authors: Balboni Philip , Clements Henry 
Published: September 2022

AbstractThis article seeks to clarify how scholarship in postcolonial studies and new ontology (the “ontological turn”) has construed the problem of modernity as a problem of translation. Drawing on resources from the field of secular studies, it suggests that projects to provincialize or repudiate the universalism of modern thought, as well as the translations this universalism enables, tend to reinscribe the very translational problematic these projects aim to mitigate or overturn.
Single-motor and multi-motor motility properties of kinesin-6 family members
Authors: Poulos Andrew , Budaitis Breane G. , Verhey Kristen J. 
Published: September 2022

ABSTRACT
Kinesin motor proteins are responsible for orchestrating a variety of microtubule-based processes including intracellular transport, cell division, cytoskeletal organization, and cilium function. Members of the kinesin-6 family play critical roles in anaphase and cytokinesis during cell division as well as in cargo transport and microtubule organization during interphase, however little is known about their motility properties. We find that truncated versions of MKLP1 (HsKIF23), MKLP2 (HsKIF20A), and HsKIF20B largely interact statically with microtubules as single molecules but can also undergo slow, processive motility, most prominently for MKLP2. In multi-motor assays, all kinesin-6 proteins were able to drive microtubule gliding and MKLP1 and KIF20B were also able to drive robust transport of both peroxisomes, a low-load cargo, and Golgi, a high-load cargo, in cells. In contrast, MKLP2 showed minimal transport of peroxisomes and was unable to drive Golgi dispersion. These results indicate that the three mammalian kinesin-6 motor proteins can undergo processive motility but differ in their ability to generate forces needed to drive cargo transport and microtubule organization in cells.