tbuckley/cabot-search huggingface dataset:
Education, engagement, and MIPS: The new era of accountability.
Authors: Diane Denny, DBA, Danielle Gross, Maurie Markman
Journal: Journal of Clinical Oncology (2018)

111 Background: As 2017 marked the start of CMS’ new Quality Payment Program (QPP), a national network of hospitals worked together with its physician practices to ensure maximum participation and benefit. Each practice consisted of multi-specialists collaborating in the treatment of oncology patients and reporting through the American Society of Clinical Oncology qualified data registry. Methods: A team was created with the primary tasks of 1) transitioning and ensuring readiness; 2) selecting and reporting on measures of interest associated with two QPP categories, Quality and Improvement Activities (IAs) and 3) educating its practices on the merits of participation. This included the creation of infographics titled MACRA 101, 201, 301 and a detailed Q&amp;A tool for maintaining information exchange. The former was a progressive approach to educating on the law, that success is a team sport, and that public reporting of performance data is here to stay, concluding with a call to action. Results: Oncology measures were reported for the full CY17 as follows. The same quality improvement activity of data capture, metric review and process re-design became the narrative for the practices’ selection of its two required IAs. Conclusions: Although year one allowed for lesser requirements to enable transition, positioning the practices to report at the maximum level resulted in strong physician-hospital collaboration as well as the potential for financial and reputational gain. An unintended benefit was the realization that mandatory discrete fields in the practices’ EHR would benefit the practitioners in the long term as resource requirements needed to abstract from free-text is not sustainable.[Table: see text]
Utilization of care at the end of life in Medicare decedents with advanced cancer.
Authors: Audrey S. Wallace, Courtney Williams, Maria Pisu, Debra Parker Oliver, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2018)

22 Background: Despite increasing evidence supporting minimization of aggressive care at the end of life, little literature exists reporting timing of chemotherapy and radiation in relation to hospice referral. Methods: Deceased Medicare beneficiaries age ≥65 years with stage IV cancer at 12 sites in 5 southeast US states were identified from 2012-2015. All utilization of radiation, chemotherapy, hospice, hospitalizations, and emergency department [ED] visits were abstracted and tabulated from Medicare claims during the last 6 months of life. Results: Among 3516 deceased patients, median age at time of metastatic disease was 73 years (IQR 68-79). Most patients were white (81%), male (55%), with two or more comorbidities (54%). The most common primary cancer sites were lung (38%), gastrointestinal (27%), and genitourinary (10%). In the last 6 months of life, 65% and 66% of patients visited the ED or were hospitalized; 11% received radiation and 28% received chemotherapy. Median days from last course of treatment to death for patients with chemotherapy (n = 978) was 45 days (IQR 23-83) and with radiation (n = 380) was 52 days (IQR 19-100). After completion of radiation, 54% of patients continued to receive systemic therapy. In subset analysis of patients with a hospice referral after final delivery of radiation and/or chemotherapy (n = 768), there was persistent late referral to hospice. Patients referred to hospice within 0-7 days of completing radiation or chemotherapy had similar median length of time on hospice when compared to those referred to hospice between 91-180 days after treatment (median 14 [IQR 4-35] vs. median 18 [IQR 8-43] days). Conclusions: In decedents with poor performing cancer histologies, low utilization of hospice and high rates of ED visits and hospitalization remain. Late referral to hospice persisted irrespective of last course of radiation or chemotherapy timing. High utilization of hospitalization and emergency visits at EOL may be ameliorated by earlier hospice referral.
Abstract 12735: Potential of the Single Beat Estimation for End Systolic Pressure-Volume Relation in Patients With Single Ventricular Heart
Authors: Hirofumi Saiki, Seiko Kuwata, Clara Kurishima, Satoshi Masutani, Hideaki Senzaki
Journal: Circulation (2015)

Background: Estimation of ventricular elastance at the aortic valve opening is fundamental for assessment of non-invasive end-systolic elastance (Ees). Despite conditional variability of time varying elastance (Et) property, the Et during isovolumic contraction (IVC) is less variable and highly adjustable, thus Et has been used to estimate Ees in a number of clinical studies. However, uncertain characteristics of Et due to morphological diversity hindered its application in single ventricular hearts (SV). We tested our hypothesis that Et in early systole is independent of ventricular morphology in SV patients. Methods: During cardiac catheterization, a total of 78 pressure volume relationships were constructed from 26 children including 18 Fontan patients (right dominant: SRV n=8, left dominant: SLV n=10) and controls (n=8). Et curve, normalized both for Ees and time to Ees, was compared among groups at baseline, dobutamine infusion (DOB, 5 mcg/kg/min) and rapid supraventricular pacing. Results: Shapes of Et in SRV and SLV at both baseline and DOB were similar, particularly during IVC and ejection phase (Figure). While Et was stable during pacing with additional 20-30 bpm to the baseline heart rate (HR), relaxation delay caused disturbance of Et in some patients at HR greater than 170 bpm. The slope ratio (α) of Et during ejection phase to that during IVC, which determines subtle variations of Et, was significantly correlated with ejection fraction (EF, R=.65, p&lt;.01) and independent of ventricular type, preload and afterload. Conclusion: Et properties in Fontan patients, both with SRV and SLV, highly resemble those in controls at baseline, with DOB, and physiological pacing during systole. Similar to structurally normal hearts, α can be predicted by EF. While impact of diastolic property on early systole should be accounted for in high HR patients, our results rationalized the utility of normalized Et that provides a fulcrum point to estimate Ees in Fontan circulation.
Supportive measures to enhance clinical trial data management in oncology community network practices.
Authors: Elizabeth Anne Johnson, Jay C. Andersen, Sandy Smith, Bharat Patel, Susan S. Night, Lauren Steckel
Journal: Journal of Clinical Oncology (2018)

38 Background: As an innovative industry leader of Research Site Management Organizations, US Oncology Research (USOR) sought to develop a best practice to support over 65 community practice network sites to comply with Sponsor data entry expectations. Efforts led by the Clinical Trial Manager (CTM) focused on bringing research site awareness to priority data, Sponsor deadlines, and weekly performance feedback via the ‘Healthy Data Habits Pathway’. Methods: The Healthy Data Habits Pathway was created to define the role of CTM involvement in data management operations on behalf of USOR. In collaboration with Sponsor, the USOR CTM reviewed data management reports weekly for data entry trends. Results: Two separate oncology clinical trials (different Sponsors) implemented the Pathway with renal and breast oncology indications. The renal trial demonstrated an almost 90% reduction in total query count for 8 sites in 7 months while the breast trial reported 7 of 14 sites (50%) meeting Sponsor goal of 20 or fewer total queries in 13 weeks. Interventions included emailed notifications, site manager calls, and weekly CTM-Sponsor collaboration teleconferences. Conclusions: Clinical research Sponsors and sites both strive towards maintaining data integrity in an ever-evolving atmosphere of complex oncology trials and increasingly-detailed data capture requirements. Implementation of Pathway interventions increases site and Sponsor engagement in daily data management operations. [Table: see text]
A Not-So-New Treatment for Old Bones
Authors: Clifford J. Rosen
Journal: New England Journal of Medicine (2018)

Low bone mineral density (i.e., a T score below −2.5) is the current operational definition of osteoporosis. However, low bone mineral density is actually a risk factor for fracture, not a disease marker. Notwithstanding, nearly all osteoporosis treatment algorithms are based on bone mineral density, frequently combined with the clinical risk factors of age and prevalent fractures. Given the high prevalence of low bone mineral density with advanced age, a review of the history underlying determination of risk and the concept of osteopenia is worthwhile. When measurement of bone density was first introduced 25 years ago, absolute bone mineral density . . .
Abstract 15077: SuPAR Predicts Cardiovascular Outcomes in Heart Failure Independently of High Sensitivity Troponin I
Authors: Salim S Hayek, Yi-An Ko, Mosaab Awad, Andreas Kalogeropoulos, Kareem Hosny, Keyur Patel, Shuai Zheng, Ravila Bhimani, Joy Hartsfield, Jonathan Kim, Peter Wilson, Leslee Shaw, Melissa Tracy, Changli Wei, Jochen Reiser, Arshed Quyyumi
Journal: Circulation (2016)

Introduction: Soluble urokinase-type plasminogen activator receptor (suPAR) is a novel biomarker that reflects immune activation, and predicts adverse outcomes including incident heart failure (HF)...
Abstract 18124: An Irx4+ Ventricular Progenitor Isolated by Spherical Nucleic Acid Nanoparticles
Authors: Mitch Biermann, Annie Shao, Tianxiao Han, Gary Lyons, Timothy Kamp
Journal: Circulation (2015)

While human pluripotent stem cell-derived cardiomyocytes have shown promise in engrafting and maturing in animals following myocardial infarction, transplanted cells largely exist as histologically self-contained blocks of cells with moderate or undetectable functional benefit. We therefore sought to develop methods to isolate a proliferative progenitor capable of differentiating both to functional ventricular cardiomyocytes and supportive cardiac mesenchymal cells, as these cells may hold promise for regenerative medicine. To isolate a ventricular progenitor, fluorescent spherical DNA nanoparticles (nanoflares) were synthesized to target RNA of the ventricular transcription factor Irx4 at an intermediate stage in cardiac differentiation of human pluripotent stem cells using small molecule, defined conditions without genetic modification or transfection. The synthesized nanoflare was nontoxic by Annexin V/7AAD flow cytometry and did not affect differentiation or expression of cardiac genes in RT-qPCR, including Irx4. Upon differentiation, nanoflare-FACS-separated Irx4+ cells were found to give rise to 50% cTnT+ cardiomyocytes and 46% Thy1+ mesenchymal cells. In sorted cells, we used sensitive droplet digital RT-PCR to detect early upregulation of lineage-specific genes. Relative to Irx4 -/Low cells, Irx4+ cells had significant upregulation of ventricular-specific mlc2v but not atrial genes (Hey1, CoupTF2, SLN). In characterizing their mesenchymal potency, Irx4+ cells had significant enrichment in smooth muscle actin and N-cadherin. Intriguingly, during monolayer differentiation of Irx4+ cells, a marked aggregation occurs in which Thy1+ mesenchymal cells surround and embed large assemblies of beating cTnT+ cardiomyocytes. Consistent with a matrix remodeling phenotype, both protease inbitior expression (TIMP1) and protease activity by zymography were increased in sorted Irx4+ compared to negative cells. Conclusions: We have here isolated early ventricular progenitor cells using novel, non-invasive methods. Their remodeling activity may allow more seamless myocardial integration than differentiated cardiomyocytes and provide insights into the role of cell-cell interactions during human cardiac development.
68Ga–Prostate-Specific Membrane Antigen PET/CT and 18F-FDG PET/CT of Primary Signet Ring Cell Breast Adenocarcinoma
Authors: Ashwin Singh Parihar, Bhagwant Rai Mittal, Apurva Sood, Rajender Kumar Basher, Gurpreet Singh
Journal: Clinical Nuclear Medicine (2018)

Primary signet ring cell adenocarcinoma of the breast is a rare neoplasm. Similar to other mucinous neoplasms, it has low FDG avidity and poor prognosis compared with the traditional ductal/lobular carcinomas. We present a case of a 40-year-old woman with signet ring cell adenocarcinoma and skeletal fluorosis showing higher uptake of Ga-prostate-specific membrane antigen in the primary lesion and the metastatic sites compared with F-FDG on PET/CT imaging. Additionally, diffuse increased prostate-specific membrane antigen uptake was noticed in the entire skeleton, likely due to skeletal fluorosis.
Abstract P212: The Association Between Serum Vitamin D and Valvular Calcification in the Multi-Ethnic Study of Altherosclerosis
Authors: Martin Tibuakuu, Di Zhao, Ian H de Boer, Eliseo Guallar, Anna E Bortnick, Pamela L Lutsey, Matthew J Budoff, Jorge R Kizer, Bryan R Kestenbaum, Erin D Michos
Journal: Circulation (2017)

Background: Serum 25-hydroxyvitamin D [25(OH)D] levels have been identified as a possible modifiable risk factor for cardiovascular disease (CVD) but the association may not be linear. Whether 25(OH)D is associated with valvular calcification is unknown. We examined the association of 25(OH)D with Aortic Valve Calcification (AVC) and Mitral Annular Calcification (MAC) in a multi-ethnic cohort. We hypothesized that both deficient and excess 25(OH)D levels are associated with increased calcification (i.e. U-shaped distribution of risk). Methods: We studied 5,392 MESA participants who had 25(OH)D levels and a cardiac CT performed at baseline (2000-2002) and a follow-up CT scan at the 2 nd or 3rd Exam. AVC and MAC were quantified by the Agatston score. Using relative risk regression, we evaluated the multivariable adjusted risk of prevalent and incident AVC and MAC by 25(OH)D quintiles with median quintile as reference. Results: The mean age of participants was 62 ±10 yrs; 53% were women and 26% black. Prevalent AVC and MAC were observed in 12% and 9%, respectively. There was no statistically significant association between 25(OH)D and prevalent AVC or MAC in cross-sectional analyses. Over a mean follow-up of 2.5 yrs, 4.1% developed incident AVC and 4.5% developed incident MAC. After adjusting for demographic variables, the 5 th quintile of 25(OH)D was associated with a 33% [RR 0.67 (95% CI 0.45, 0.99)] lower risk of incident MAC compared to the 3 rd quintile. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors [ TABLE ]. There was no association of 25(OH)D with incident AVC [0.89 (0.59, 1.36) for 5 th vs. 3 rd quintile, Model 1]. Conclusion: Low 25(OH)D levels were not associated with increased likelihood of prevalent valvular calcification. Higher 25(OH)D were associated with reduced risk of incident MAC independent of demographics, but not with incident AVC. In sum, 25(OH)D may be associated with progression of mitral calcification, but future studies with longer follow-up are needed.
Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial
Authors: Rebecca J Guy, James Ward, Louise M Causer, Lisa Natoli, Steven G Badman, Annie Tangey, Belinda Hengel, Handan Wand, David Whiley, Sepehr N Tabrizi, Mark Shephard, Christopher K Fairley, Basil Donovan, David A Anderson, David G Regan, Lisa Maher, John M Kaldor
Journal: The Lancet Infectious Diseases (2018)
Abstract 15869: Egg Consumption and Risk of Coronary Heart Disease in the Million Veteran Program
Authors: Lisa M Abramovitz, Xuan-Mai T Nguyen, Yuk-Lam Ho, David R Gagnon, Jason Vassy, Kelly Cho, Christopher O'Donnell, Peter F Wilson, J. Michael Gaziano, Luc Djousse
Journal: Circulation (2017)

Introduction: Coronary heart disease (CHD) is the leading cause of death in the US. It remains unclear whether dietary cholesterol affects blood cholesterol, and the latter is associated with CHD. ...
E3 ligase FBXW7 aggravates TMPD-induced systemic lupus erythematosus by promoting cell apoptosis
Authors: Zhenlu Chong, Chunjing Bao, Jia He, Tianxiao Chen, Lijia Zhong, Gaopeng Li, Huanle Li, Lutong Fang, Yinjing Song, Guoxiang Fu, Xuyan Yang, Lihua Lai, Yang Liu, Qingqing Wang
Journal: Cellular and Molecular Immunology (2018)
Assessment of scheduled pharmacy follow-up for patients receiving oral chemotherapy.
Authors: Emily R. Mackler, Kathleen W. Beekman, Carol Yarrington, Anne Gentz, Laura Bushey, Kathleen Davis, Jennifer J. Griggs, Karen B Farris
Journal: Journal of Clinical Oncology (2018)

151 Background: Management of oral chemotherapy presents many challenges to oncology practitioners. The purpose of this study is to describe how incorporation of pharmacy scheduled calls to oncology patients receiving oral chemotherapy can identify patients who are experiencing moderate-to-severe symptom burden and/or medication non-adherence and require a therapeutic intervention. Methods: We utilized multiple resources from a statewide quality collaborative aimed at the management of patients receiving oral chemotherapy including patient education, a patient reported outcome (PRO) assessment, and templated documentation. As part of our planned workflow enhancements, our pharmacist provided patient education before chemotherapy started and regularly called patients within 2 weeks of starting their oral therapy. The pharmacist asked the patient about symptoms and adherence using the PRO assessment. A chart audit was performed to summarize the patient reports and recorded interventions. Results: 203 patients taking oral chemotherapy were called by the pharmacist in an 18-month time period between 10/1/16 - 3/28/18. In this study, we will summarize patient demographic information including age, gender, diagnosis, oral chemotherapy medication; PRO assessment results including symptom burden based on the Edmonton Symptom Assessment Scale (ESAS), most bothersome symptom, confidence to self-manage, medication adherence, and reasons for non-adherence, and pharmacist interventions and consequential treatment modifications. Conclusions: Patients taking oral chemotherapy for the treatment of cancer are at risk of side effects from their treatment and suboptimal therapeutic benefits in the setting of non-adherence. Our analysis will summarize the degree of symptom burden patients experience in the first couple weeks of treatment and areas were a pharmacist may optimize their medication regimen prior to their scheduled follow-up with their oncologist. We plan to use this data to improve patient self-management support.
Undertreated pain: Trends over time for older adults with and without cancer.
Authors: Carolyn J Presley, Jennifer Kapo, Shi-Yi Wang, Maureen Canavan, Ella Sheinfeld, Shelli Feder, Erin Kent, Amy J. Davidoff
Journal: Journal of Clinical Oncology (2018)

15 Background: Concerns about the adequacy of pain management among older adults are increasing. We examined calendar year (CY) trends in prescription medication (Rx) use by older adults with and without cancer who reported pain interference with normal activities. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims data, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis or without cancer history. We used Rx claims to characterize use of opioids, non-opioid analgesics, local anesthetics and anti-epileptics during the 90 days post survey. Participant reported pain-related activity limitations within the past 30 days (pain interference) were summarized as severe, moderate, or none. We applied multivariable logistic regression to determine associations of Rx use with CY, cancer status, and pain interference, controlling for socio-demographics, chronic conditions, plan type and Part D Low Income Subsidy. Adjusted outcome levels were predicted based on the regression coefficients. Results: In the total sample (N = 15,624), pain Rx was used by 30%, with 20% receiving opioids. Severe or moderate pain interference with activities was reported by 23% and 46%, respectively. Among respondents with cancer (N = 9,105), 49% reporting severe (28% moderate) pain interference received any pain Rx; 37% &amp; 18% used opioids, respectively. For those without cancer, adjusted pain Rx use rates were significantly lower in all categories. Pain Rx increased over CY for cancer respondents with moderate pain (25% in 2008 to 31% in 2012; p = .017), but not for those reporting severe pain interference. In addition, pain Rx increased over CY for the cohort without cancer with no pain interference (11% in 2008 to 14% in 2012; p = .027). Conclusions: Despite increased focus on symptom management, the majority of older adults who experienced moderate or severe pain interference did not have Rx for pain management. Efforts to identify and target unmet supportive care needs for Medicare beneficiaries, with and without cancer, are necessary to further improve quality of life.
Abstract 11930: Sex Differences in Cardiac Troponin and the Risk of Death or Major Cardiovascular events in Men and Women With Diabetes and Coronary Artery Disease
Authors: Brendan M Everett, Maria Brooks, Helen Vlachos, Bernard R Chaitman, Robert L Frye, Deepak L Bhatt
Journal: Circulation (2015)

Background: Circulating cardiac troponin T concentrations are higher in men than in women, but the biological causes and clinical implications of this observation are poorly understood. Methods and Results: We measured cardiac troponin T with a high-sensitivity assay (hsTnT) in 684 women and 1601 men with type 2 diabetes (T2D) and stable ischemic heart disease (SIHD) who were enrolled in the BARI 2D trial. Median (IQR) hsTnT was higher in men [12.4 ng/L (8.7-20.8)] than in women [9.1 ng/L (6.4-15.6); P&lt;0.0001] and a higher proportion of men (43.6%) than women (29.1%) were above the current established upper reference limit of 14 ng/L (P&lt;0.0001). Sex remained a significant predictor of natural log normalized hsTnT after adjusting for a wide array of covariables, including age, race, insulin use, renal function, ejection fraction, and HbA1c. Within quintiles of hsTnT measured at baseline, the 5-year incidence of the composite cardiovascular outcome of myocardial infarction, stroke, heart failure, or death was consistently higher in women than in men (Figure 1). In sex-stratified Cox models adjusting for possible confounders, the increase in the relative risk of the composite endpoint across quintiles of hsTnT appeared similar in men and women (Figure 2). Conclusions: In the BARI 2D trial, women have lower baseline hsTnT concentrations, but higher absolute risk of myocardial infarction, stroke, heart failure, or death for a given concentration of hsTnT. These data raise the question of whether sex-specific cutoffs for cardiac troponin T should be considered.