tbuckley/cabot-search huggingface dataset:
Implementation of a fellow-initiated financial toxicity screening tool in medical oncology clinics.
Authors: Samuel Craig Brondfield, Hala Borno, Claire Mulvey, Li-Wen Huang, Pelin Cinar
Journal: Journal of Clinical Oncology (2018)

64 Background: Financial toxicity is an increasingly recognized problem for patients receiving cancer treatment, particularly in the high-cost precision medicine era. Financial toxicity is linked to asset depletion, debt, and bankruptcy. To address this imminent concern, we designed, implemented, and evaluated a fellow-initiated financial toxicity screening tool for use in medical oncology clinics. Methods: An interprofessional team of University of California San Francisco (UCSF) social workers and physicians selected three highly rated items from the COST measure, a published financial toxicity tool with validity evidence. We oriented all UCSF hematology/oncology fellows to the tool and the concept of financial toxicity. We instructed fellows to screen all patients other than second-opinion visits and to offer a social work referral to high-scoring patients. Implementation was from August 2017 to March 2018. While screening was initially documented in the progress note, in October 2017 we built a navigator into the electronic medical record to facilitate screening. We randomly selected one half-day per week for each fellow and reviewed charts for screening scores. The cumulative goal was to screen 30% of eligible patients during implementation. Results: Fellows (n = 8) rotated in five disease-specific medical oncology clinics. Prior to implementation, fellows did not document financial toxicity (0%). At the mid-point of implementation, fellows had screened 32% of patients. By the end, the cumulative screening rate decreased to 18%. The screening tool will be presented. Qualitative fellow feedback identified lack of provider familiarity with financial toxicity, packed clinic visits, and difficulty remembering to screen as barriers. Fellows suggested that screening performed by clinic staff prior to the encounter might better inform the visit. Conclusions: Fellow-initiated financial toxicity screening was initially successful but decreased over time. Future iterations could include screening prior to the encounter, augmenting provider financial toxicity training, and continual reminders. Future work is needed to improve screening and mitigate the impact of financial toxicity.
Primary Prevention of Ischemic Stroke
Authors: Larry B. Goldstein, Robert Adams, Kyra Becker, Curt D. Furberg, Philip B. Gorelick, George Hademenos, Martha Hill, George Howard, Virginia J. Howard, Bradley Jacobs, Steven R. Levine, Lori Mosca, Ralph L. Sacco, David G. Sherman, Philip A. Wolf, Gregory J. del Zoppo, None Members
Journal: Circulation (2001)
Public health and health systems: implications for the prevention and management of type 2 diabetes in south Asia
Authors: Andrew P Hills, Anoop Misra, Jason M R Gill, Nuala M Byrne, Mario J Soares, Ambady Ramachandran, Latha Palaniappan, Steven J Street, Ranil Jayawardena, Kamlesh Khunti, Ross Arena
Journal: The Lancet Diabetes & Endocrinology (2018)
Lessons learned from the investigation of a sustained increase in paclitaxel hypersensitivity reactions (P-HSR) at a large community oncology practice: A mystery not fully solved.
Authors: Katherine Enright, Heather Bussey, Maritza Carvalho, Mary Yousef, Allan Mills, Jeffrey A. Myers
Journal: Journal of Clinical Oncology (2018)

233 Background: Trillium Health Partners (THP) is a large community oncology practice that has a culture of quality and safety. An investigation was triggered by a perceived increase in the rate of P-HSR during a weekly quality huddle in the chemotherapy suite. At the time THP had no formal hypersensitivity reaction tracking process. A retrospective review of P-HSR over the preceding 18 months identified an increase in reaction rates from a baseline of 1% to 4.5% that started 3 months prior to the raised concern. Methods: A systematic quality review was undertaken to identify triggers for the change and to identify steps to decrease P-HSR to baseline. There was no identified change in premedication, administration or compounding practice and no association with drug or lot number was identified. The increase in P-HSR was coincident with a change in the intravenous (IV) pumps and tubing system across the hospital. The change in IV pumps introduced several potential triggers including: a change in the options for priming the IV tubing which introduced a potential for variable concentrations of drug reaching the patient at the outset of the infusion, an interaction between drug and IV tubing, and a doubling of the IV tubing length which could result in incomplete delivery of the premedication. Results: Sequential practice changes were introduced to address each potential driver including i) a slow infusion protocol for first 2 cycles, ii) alternative tubing sets, iii) practice alert regarding potential for under-delivery of premedication. Over time P-HSR trended down towards the historic baseline, no single intervention had a sustained impact, although the practice alert regarding the administration of premedication seemed to induce the most change. A step wise withdrawal of interventions that were felt to be non impactful is underway. Conclusions: Although no clear cause for the increase in P-HSR was identified the systematic quality review resulted in improved standardization of nursing practice for chemotherapy delivery and the methodical approach also lead to the establishment of a more comprehensive hypersensitivity reporting system at THP.
Epidemiology and determinants of type 2 diabetes in south Asia
Authors: Andrew P Hills, Ross Arena, Kamlesh Khunti, Chittaranjan Sakerlal Yajnik, Ranil Jayawardena, Christiani Jeyakumar Henry, Steven J Street, Mario J Soares, Anoop Misra
Journal: The Lancet Diabetes & Endocrinology (2018)
Juvenile Spring Eruption Associated With Parvovirus B19 Infection
Authors: Alexander Kreuter, Bijan Koushk Jalali, Christian Tigges, Steffi Silling, Percy Lehmann, Ulrike Wieland
Journal: JAMA Dermatology (2018)

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Subacute cutaneous lupus erythematosus and dermatomyositis associated with anti‐programmed cell death 1 therapy
Authors: A.L. Marano, J.M. Clarke, M.A. Morse, A. Shah, W. Barrow, M.A. Selim, R.P. Hall, A.R. Cardones
Journal: British Journal of Dermatology (2018)

Programmed cell death 1 (PD-1) blockade has rapidly emerged as an effective therapy for a wide variety of metastatic malignancies. It has been associated with multiple immune-related adverse effects, including cutaneous eruptions. We describe two patients with clinical and histological findings that were consistent with subacute cutaneous lupus erythematosus (SCLE) after receiving PD-1 inhibitor therapy for metastatic lung cancer. We successfully treated our first patient with systemic and topical steroids, photoprotection and hydroxychloroquine. However, he subsequently developed dermatomyositis after continuing PD-1 inhibitor therapy. Our second patient presented with a protracted course of a cutaneous eruption in spite of discontinuation of anti-PD-1 therapy and treatment with systemic corticosteroids and infliximab. This patient's SCLE resolved after the addition of topical steroids and photoprotection and discontinuation of anti-tumour necrosis factor therapy. She and her oncology team decided to pursue non-PD-1 inhibitor treatment for lung cancer owing to a lack of tumour response. We add SCLE and dermatomyositis to the growing list of autoimmune complications of PD-1 blockade. Our cases raise a number of questions, particularly in relation to the viability of continuing anti-PD-1 therapy after developing SCLE and the role of immunosuppressive therapy in patients with PD-1 inhibitor-associated connective tissue disease. What's already known about this topic? Programmed cell death 1 (PD-1) blockade, which is rapidly emerging as a therapy for a wide variety of metastatic malignancies, has been associated with multiple immune-related adverse effects. These include systemic autoimmune diseases such as colitis and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side-effects of PD-1 inhibitors most commonly reported in clinical trials include lichenoid reactions, eczematous dermatitis and vitiligo. What does this study add? We report two cases of PD-1 inhibitor-associated subacute cutaneous lupus erythematosus (SCLE), with one patient progressing to dermatomyositis with continued PD-1 inhibitor treatment. In addition to being a novel cutaneous adverse event, we also demonstrate the possibility of development of multiple autoimmune diseases in one patient, which is different from classic drug-related SCLE. We discuss the treatment challenges for patients with autoimmune skin disease receiving PD-1 inhibitor therapy.
Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial
Authors: Nerys M Astbury, Paul Aveyard, Alecia Nickless, Kathryn Hood, Kate Corfield, Rebecca Lowe, Susan A Jebb
Journal: BMJ (2018)

To test the effectiveness and safety of a total diet replacement (TDR) programme for routine treatment of obesity in a primary care setting.
Abstract 16185: Medicare Budget Implications of Left Atrial Appendage Closure for Stroke Risk Reduction in Non-Valvular Atrial Fibrillation
Authors: Shannon O Armstrong, Stacey L Amorosi, Susan S Garfield, Ken Stein
Journal: Circulation (2014)

Introduction: Strokes associated with atrial fibrillation (AF) are estimated to cost Medicare $8 billion annually. Advancements in stroke prevention are aimed at improving clinical outcomes and reducing healthcare costs. This analysis quantifies the budget impact to Medicare and Medicare beneficiaries of left atrial appendage closure (LAAC) with the Watchman Device compared to warfarin, the standard of care, and rivaroxaban, the most commonly prescribed new oral anticoagulant in the US, for stroke risk reduction in non-valvular AF. Methods: A budget impact model was developed from a Medicare perspective using 2.3-year data from PROTECT AF and relative risks from ROCKET AF. The model captured all costs of treatment and associated complications. Costs for stroke included acute, direct costs as well as long-term disability costs. Cost data were from 2014 US DRGs. Medicare deductibles and co-insurance rates were used in the patient analysis. Results: In addition to better net clinical outcomes (table), LAAC is cost neutral to Medicare relative to warfarin and rivaroxaban by year 5, and one third less costly than both by year 10. Treatment-related complications comprised 33% of LAAC total costs compared to 65% for rivaroxaban and 87% for warfarin at year 5. Patient out-of-pocket costs for LAAC were lower than warfarin and rivaroxaban at 2 and 3 years, respectively. Conclusions: Upfront LAAC procedural costs are offset by ongoing therapy and complication costs associated with warfarin and rivaroxaban. LAAC with Watchman represents an opportunity for improved clinical outcomes and substantial savings to both Medicare and Medicare beneficiaries.
Inclusion of health-related quality-of-life data in oncology drug reimbursement submissions in Canada: A review of submissions to the pan-Canadian Oncology Drug Review.
Authors: Adam JN Raymakers, Dean Regier, Stuart Peacock
Journal: Journal of Clinical Oncology (2018)

94 Background: For health technologies, and cancer treatments specifically, economic evaluation is often used to assess the value of new treatments. The preferred approach to economic evaluation is often cost-utility analysis (CUA). In CUA, incremental costs and benefits of a new treatment and a standard of care are calculated with benefits quantified using the quality-adjusted life-year (QALY); the QALY attempts to account for the quantity and quality of life (using a utility weight). The utility weight often comes from a generic, preference-based measure of health-related quality of life (HRQoL), such as the 5-dimension EuroQol measure (EQ-5D). Many submissions for reimbursement by manufacturers, and indeed many clinical trials, still do not include HRQoL data which may result in lower quality submissions and thus, sub-optimal decisions. Methods: We reviewed submissions to the pan-Canadian Oncology Drug Review (pCODR), the body charged with making reimbursement recommendations in Canada. We reviewed submissions from those first recorded (August 2012) to the present (June 2018). Only submissions that were completed (status listed as 'Notification to Implement Issued') were included. Upon completion, three documents are produced by pCODR: the final recommendation from the pCODR Expert Review Committee, the final clinical guidance report, and the final economic guidance report. All three documents were searched for how HRQoL was incorporated into the economic evaluation. Results: In total, 135 submissions were made to pCODR over the period. Of these, 107 (79.3%) had been completed and met the criteria for inclusion. In most studies, the incremental gain in QALYs from the new technology was small (in 2017 submissions the mean QALY gain was 1.1 QALYs). In addition, few studies reported an original measure of HRQoL, with most citing previously completed studies of variable relevance and quality. Conclusions: Our results indicate that manufacturers should improve the collection of HRQoL data of patients alongside clinical trials. This would enhance the focus on patients and improve decision-making around reimbursement of treatments.
Abstract 15625: Targeting Mitochondrial Hsp90: A New Promising Avenue for Reversing Pulmonary Arterial Hypertension
Authors: Olivier Boucherat, Sandra Breuils-Bonnet, Jolyane Meloche, Sophie Chabot, Caroline Lambert, Eve Tremblay, Gopinath Sutendra, Evangelos Michelakis, Young Chan Chae, Dario Altieri, Roxane Paulin, Steeve Provencher, Sébastien Bonnet
Journal: Circulation (2016)

Introduction: Pulmonary arterial hypertension (PAH) is a vascular remodeling disease with a poor prognosis and no therapeutic option. Although the causal pathomechanisms contributing to remodeling ...
The effect of facility volume on treatment guideline compliance and overall survival in oral tongue squamous cell carcinoma.
Authors: Samantha Tam, Xianglin L. Du, Carol M. Lewis, Jose-Miguel Yamal, Randal S. Weber
Journal: Journal of Clinical Oncology (2018)

17 Background: National treatment guidelines guide cancer care using the best available evidence and understanding the drivers of guideline compliance is essential to identifying modifiable factors to improve quality of care. This study aims to explore the impact of facility volume on the rate of guideline compliance in patients with oral tongue cancer and its effect on overall survival. Methods: Using National Cancer Database from 2004 to 2013, this retrospective cohort study investigated patients undergoing curative surgical treatment for oral tongue squamous cell carcinoma. Patients were divided into three tertiles according to mean annual case volume at their treatment facility. Guideline compliance was based on the National Comprehensive Cancer Network oral cavity cancer guidelines. Predictors of guideline compliance and overall survival were determined using multiple logistic regression and Cox Proportional Hazards models. Results: Guideline compliant care was delivered in 54.5% of the 35,810 eligible patients. Those treated at intermediate volume facilities had 1.75 times greater odds of receipt of guideline compliant care (95% CI = 1.57-1.96) and 2.14 times greater in high volume facilities (95% CI = 1.91-2.40) compared to low volume facilities. Guideline compliance (adjusted hazard ratio [HR adj ] = 0.78, 95% CI = 0.72-0.84) and treatment at a high volume facility (HR adj = 0.88, 95% CI = 0.80-0.98) were independent predictors of overall survival. Conclusions: Facility volume independently predicted guideline compliance in oral tongue cancer. Guideline compliance and treatment at a high case volume facility were predictors of overall survival. Clinicians should apply guideline compliant care regardless of practice setting and treatment at higher volume centers should be considered.
Milk and egg intervention during pregnancy and allergic disease in offspring up to 30 years of age
Authors: Charlotta Flodström, Anna Bergström, Anna Nopp, Gunnar Lilja, Inger Kull
Journal: Allergy (2018)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation
Authors: Sachin J. Shah, Mark H. Eckman, Sara Aspberg, Alan S. Go, Daniel E. Singer
Journal: Annals of Internal Medicine (2018)

Background: Stroke rates in patients with nonvalvular atrial fibrillation (AF) who are not receiving anticoagulant therapy vary widely across published studies; the resulting effect on the net clinical benefit of anticoagulation in AF is unknown. Objective: To determine the effect of variation in published AF stroke rates on the net clinical benefit of anticoagulation. Design: Markov model decision analysis. Warfarin was the base case, and non–vitamin K antagonist oral anticoagulants (NOACs) were modeled in a secondary analysis. Setting: Community-dwelling adults. Patients: 33 434 adults with incident AF. Measurements: Quality-adjusted life-years (QALYs). Results: Of the 33 434 patients, 27 179 had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or more. The population benefit of warfarin anticoagulation for these patients was least using stroke rates from the ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) study and greatest using those from the Danish National Patient Registry (6290 QALYs [95% CI, ±2.3%] vs. 24 110 QALYs [CI, ±1.9%]; P < 0.001). The optimal CHA2DS2-VASc score threshold for anticoagulation was 3 or more using stroke rates from ATRIA, 2 or more using those from the Swedish AF cohort study, 1 or more using those from the SPORTIF (Stroke Prevention using ORal Thrombin Inhibitor in atrial Fibrillation) study, and 0 or more using those from the Danish National Patient Registry. Accounting for lower rates of NOAC-associated intracranial hemorrhage decreased optimal CHA2DS2-VASc score thresholds, but these thresholds still varied widely. Limitation: Measured benefit may not generalize to other populations. Conclusion: Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation. Primary Funding Source: None.
Integrating mental health professionals into the care team to better recognize and manage delirium in hospitalized oncology patients.
Authors: Joseph Hooley, Laurel Ralston, Joel Daniel Marcus, Carolyn Best, Diana Karius, Heather Koniarczyk, Corrine Shepherd, Cheryl M Carrino, Christa Poole
Journal: Journal of Clinical Oncology (2018)

83 Background: Delirium is a common neuropsychiatric condition associated with increased morbidity and mortality, length of hospitalization, and distress. The prevalence of delirium in cancer ranges from 10% to 30% in hospitalized patients and up to 85% in terminally ill cancer patients. Rates of delirium on Cleveland Clinic’s inpatient oncology units were lower than expected. Our goal was to integrate mental health professionals into the care team to assist with better recognition and management of delirium. Methods: Education was developed for a range of caregivers, including physicians, nurses, and advanced practice providers. It was facilitated by a psychiatrist, psychologist, and clinical social workers, and included proper identification of both hyper- and hypoactive delirium through use of the Brief Confusion Assessment Method (bCAM) and use of a delirium order set to treat and manage patients identified as positive for delirium. An important component of this education included a proper assessment and comparison of patients’ current mental status compared to their true baseline prior to hospitalization. Additional integration directly into the care team included participation of the psychiatrist, psychologist, and clinical social workers into each team’s multidisciplinary rounds to facilitate discussions around delirium and its appropriate management, and separate targeted rounding which included one-to-one education with front-line caregivers. Results: During the first year of integration, substantial improvements were noted. The percentage of patients identified as positive for delirium through bCAM screening increased from 3.4% to 15.8% after 12 months, and utilization of the delirium order set increased from 11.1% to 58.3%. Additionally, the average nursing unit length of stay (LOS) for delirium-positive patients decreased by more than 2 days compared to baseline. Conclusions: Integration of mental health providers into the care team to assist with recognizing and managing patients with delirium and to provide direct education to front-line caregivers has helped to rapidly improve delirium identification and management for oncology inpatients.