tbuckley/cabot-search huggingface dataset:
Health system stakeholder perceptions of financial assistance programs at a comprehensive cancer center.
Authors: Jennifer Spencer, Michelle L. Manning, Donald L. Rosenstein, Cleo A. Samuel, Katherine Elizabeth Reeder-Hayes, Jean Sellers, Stephanie B. Wheeler
Journal: Journal of Clinical Oncology (2018)

114 Background: Cancer-related financial burden is a growing problem that has been linked to psychosocial distress, treatment delays and non-adherence, and excess mortality risk. Comprehensive cancer centers often provide financial support resources to mitigate financial burden, but the scope of these services and the processes involved are poorly understood. We conducted an in-depth qualitative analysis of key health system stakeholders to understand these processes and identify areas for improvement. Methods: Semi-structured interviews were conducted with 12 stakeholders involved in the financial assistance process at a public comprehensive cancer center. Interviews elicited descriptions of programs, perceived strengths and weakness, and the stakeholders' roles in helping patients obtain financial assistance. A codebook was developed inductively and interviews were coded in duplicate, with codes added as new themes emerged. Coded data were used to develop and revise a system-wide process map of financial support resources. Results: Stakeholders described numerous resources for financial assistance, both internal (e.g., Charity Care) and external (e.g., manufacturer assistance). Although participants described feeling pride at helping patients obtain assistance, numerous barriers were identified, including delays in processing applications, duplicative processes, insufficient time to address patients' concerns, lack of dedicated staff to address the complexity of navigating resources, and perception that existing resources are inadequate to meet patient needs. Conclusions: Processes required to obtain financial support for cancer patients often place a high administrative burden on patients who must proactively seek resources, understand complex eligibility criteria and complete multiple, often overlapping applications, even within comprehensive cancer center environments. Dedicated financial navigators may assist patients in accessing existing available resources, and health systems should consider moving beyond patient-activated pathways of access to financial support to avoid exacerbating disparities for the most vulnerable patients.
Management of Helicobacter pylori infection
Authors: R. Foy, J. Parry, C. Woodman, E. A J Rauws, R. W M van der Hulst
Journal: BMJ (1998)

Editor—Benefits from treating Helicobacter pylori infection may depend less on the choice of eradication regimen than on the selection of patients to be treated. Rauws and van der Hulst make sound recommendations for the former at the expense of misleading on the latter.1 Their advice to general practitioners to test and prescribe eradication treatment in dyspeptic patients aged under 45 reflects that of the European Helicobacter Study Group2; neither set of recommendations is evidence based. 

Both sets of recommendations advocate the safety net of specialist referral when eradication has failed in primary care. This ignores the reality that fewer than one quarter of dyspeptic patients with H pylori infection have peptic ulcer disease and that only this group of patients can be confidently expected to benefit from eradication treatment.3 Treating all dyspeptic patients infected with H pylori would therefore result in most of those with non-ulcer dyspepsia or gastro-oesophageal reflux disease receiving an unproved treatment. Even if a sizeable placebo effect is assumed, symptoms may recur or persist in many of these patients. They may also recur or persist in a minority of those with peptic ulcer disease who have not initially responded to eradication treatment either because of antibiotic resistance or because of poor concordance with treatment. The combination of a high prevalence of dyspeptic patients who also happen to be positive for H pylori, a high frequency of failure of treatment, and a blanket recommendation that all patients in whom treatment has failed should be referred for specialist opinion could result in gastroenterology services being overwhelmed. 

Furthermore, knowledge of the potential causal association between H pylori infection and gastric cancer may have an impact on both doctors’ and patients’ behaviour.4 Widespread testing for H pylori and subsequent labelling of patients with positive results could result in a high proportion of the population requiring or demanding medical follow up. Until evidence is forthcoming from trials, general practitioners may wish to avoid such dilemmas by limiting eradication treatment to patients with proved peptic ulceration.
Abstract 18089: Shared Single Nucleotide Polymorphisms May Explain the Relationship Between Clusters of Comorbid Risk Factors and Incident Heart Failure in the Framingham Heart Study
Authors: Laura Stevens, Michael A Hinterberg, Carsten Goerg, David P Kao
Journal: Circulation (2016)

Introduction: Multiple single nucleotide polymorphisms (SNPs) directly related to myocardial function have been implicated in congestive heart failure (CHF). Polymorphisms related to non-cardiac risk factors for CHF remain incompletely described. Hypothesis: CHF risk factors reflect shared genetic determinants with CHF. Methods: Participants from the Framingham Heart Study Original and Offspring cohorts underwent genotyping using the Affymetrix GeneChip Human Mapping 100k set. In total 1345 subjects were included in this analysis. Incident heart failure was defined as any hospitalization or history of clinical CHF during routine exam visits that was not present at baseline. Family-based association testing (FBAT) was performed to identify SNPs associated with incident CHF. SNPs with an FBAT p-value <0.0025 were analyzed using an SNP-specific extension of RenoDOI, a Cytoscape-based knowledge-based visual analysis platform. Results: Incident CHF occurred in a total of 73 (5.4%) subjects. A total of 277 SNPs...
Successes with and barriers to patient-reported outcome deployment at a comprehensive cancer center.
Authors: Nadine Jackson McCleary, Deborah Schrag, Neil E. Martin, Sadiqa Mahmood, Elizabeth Beyer, Linda Joyce, Shawn Martin, James A. Tulsky, Brian M. Wolpin, Joseph O. Jacobson, Jason Johnson, Michael J. Hassett
Journal: Journal of Clinical Oncology (2018)

292 Background: Routine collection of patient reported outcomes (PROs) reduces hospitalizations and improves quality of life. In the absence of clear implementation guidelines and research guiding deployment, PROs may not have the desired impact on outcomes in routine oncology practice. We share lessons learned from PRO deployment at Dana-Farber Cancer Institute. Methods: We developed a symptom/toxicity assessment tool based on the PRO-CTCAE to capture 15 symptomatic adverse events with a 1-week recall: fatigue/ decreased appetite/insomnia/ shortness of breath/numbness and tingling/concentration, general pain/anxiety/sadness, rash, nausea/vomiting/fever, constipation, and diarrhea. Responses from eligible English-literate patients scheduled for a gastrointestinal cancer center or adult palliative care visit between January 18 to March 22, 2018 were transmitted directly from clinic tablet to the EMR. To evaluate the deployment, we sought qualitative feedback from clinic staff and three multidisciplinary working groups comprised of patients, nurses, pharmacists, operations leaders, quality/safety experts, and health services researchers to identify technical and workflow gaps in PRO Content, Implementation, and Analytics. Results: We noted a 38% response rate of the N = 4440 PROs assigned to N = 4440 scheduled visits for N = 2055 unique patients (36% were completed, 2% started but not completed); 62% were not started. Workflow enhancement requests include an updated summary view, a clinical documentation tool, a scoring algorithm to highlight severe responses, and a quality metric dashboard to evaluate the deployment. Ongoing analyses are studying the proportion of moderate-severe symptomatic adverse events reported and their association with provider action (i.e., supportive care referral, chemotherapy treatment plan modification, or unplanned ED/hospitalization in the subsequent 30 days). Conclusions: Refinement of the PRO deployment strategy is needed to guide implementation efforts and demonstrate meaningful impact in routine oncology practice.
Disability burden in patients with tenosynovial giant cell tumors in the United States from employer perspective.
Authors: Feng Lin, Raluca Ionescu-Ittu, Irina Pivneva, Willy Wynant, Sherry Shi, Azadeh Shohudi Mojdehi, Eric Wu, Jackie Kwong, John A. Abraham
Journal: Journal of Clinical Oncology (2018)

92 Background: Tenosynovial giant cell tumor (TGCT) is a rare locally aggressive tumor causing pain, swelling, joint destruction, and limited mobility. This study assessed the disability burden and the associated costs in TGCT patients from an employer’s perspective. Methods: A retrospective analysis was performed using medical and disability claims from the OptumHealth database. Incident patients 18-64 years old with a diagnosis of TGCT (as identified by ICD-9: 727.02, 719.2x; ICD-10: D48.1, D21.x, M12.2) were matched 1:10 to controls without TGCT based on age, gender, index year, and follow-up duration. Patients without earning and disability data were excluded. Days of work loss due to disability claims and absenteeism associated with medical visits were compared using Poisson regression models. Costs were compared using generalized linear models. Results: A total of 1,395 eligible TGCT patients were matched with 13,950 controls without TGCT. Despite similar demographics (36% female, mean age 45-47) and only slightly higher comorbidity burden (mean Charlson Comorbidity Index (CCI): 0.3 versus 0.2), TGCT patients had increased usage of analgesic drugs (44% versus 20%) and MRI tests (37% versus 3%), prior to their diagnosis, compared with controls. During follow-up, TGCT patients were more likely to have disability claims (15.1% vs. 5.6%; p &lt; 0.001), had more disability claim days (9.5 versus 2.0; p &lt; 0.001), medically related absenteeism days (9.9 versus 4.3; p &lt; 0.001), and total days of work loss (19.4 versus 6.3; p &lt; 0.001) per person-year compared with their matched controls. After adjusting for age, gender, index year and CCI score, the average annual indirect cost per person was greater for patients with TGCT than controls ($4,653 versus $1,902; p &lt; 0.001). Conclusions: In addition to the known problems of pain, limitation of mobility, and eventual joint destruction, TGCT patients had substantial indirect costs associated with increased work absenteeism and disability. These findings highlight the unmet need for more effective treatments to reduce not only the medical, but also the economic burden of TGCT.
A false-positive Trichomonas vaginalis result due to Trichomonas tenax presence in clinical specimens may reveal a possible T. tenax urogenital infection
Authors: T. Brosh-Nissimov, M. Hindiyeh, R. Azar, G. Smollan, N. Belausov, M. Mandelboim, G. Rahav, N. Keller, S. Gefen-Halevi
Journal: Clinical Microbiology and Infection (2018)
Evaluation and identification of protocols for safe and efficacious institutional administration of intravenous immune globulin in hypogammaglobulinemia associated with chronic lymphocytic leukemia, non-Hodgkin lymphoma, and multiple myeloma.
Authors: Doron Feinsilber, Cole McCoy, Parameswaran Hari, Patrick C. Foy, Ravi Narra, Timothy S Fenske, Nirav Niranjan Shah, Laura Christian Michaelis, Vidya Kollu, Katrina Angela Mears, Kristin Osinski, Nancy Froggatt, Ehab L. Atallah, Binod Dhakal
Journal: Journal of Clinical Oncology (2018)

250 Background: Hematologic malignancies effect both humoral and cell-mediated immunity. We hypothesize that for patients with Chronic Lymphocytic Leukemia (CLL), Non-Hodgkins Lymphoma (NHL), and Multiple Myeloma (MM) outcomes improve with adherence to National Comprehensive Cancer Network (NCCN) guidelines for intravenous immunoglobulin (IVIG).Our objective is to understand resource allocation and implementation of IVIG in outpatient and inpatient settings. We identified a cohort of patients with hypogammaglobulinemia for assessing incidence of sepsis, outcomes, and resource use. We initiated this project by undertaking a large descriptive study of current IVIG use. Methods: A retrospective Institutional Review Board (IRB) approved data capture was conducted covering 2016-2018. Inclusion criteria involved those on an active chemotherapy plan, age &gt; 18 years and diagnosis of CLL, NHL, or MM. IgA deficiency, anaphylaxis to IVIG, planned chemotherapy, inherited immunodeficiency, and thymic deficiency were excluded. We considered patients to be suitable for IVIG if IgG was &lt; 500 mg/dL for CLL and MM and &lt; 400 mg/dL in NHL. Outcomes, number of admissions, sepsis, ICU care, infectious etiology, and monthly IgG levels were examined. Results: A preliminary i2b2 data capture identified a cohort of 563 patients that yielded 12% with bacteremia, 21% with sepsis, and 23% with pneumonia of which 87% were admitted. 28% received IVIG during the 2-year period. Of the 563, 77% were hospitalized and 21% required ICU care. 54% of ICU patients received inpatient IVIG. All influenza and parainfluenza cases were inpatient. Final data analysis will yield greater detail in comparing inpatient to outpatient IVIG use. Conclusions: Large academic institutions appear to have significant variability in use of IVIG in patients with lymphopenia and hematologic malignancies. With this data, we plan to assess for patient-level outcomes based on adherence to NCCN guidelines as a way to enhance Physician Quality Reporting System (PQRS) standards by prioritizing outpatient use of IVIG.
Abstract P283: Resistance Exercise Reduces the Risk of Developing Excess Body Fat and Abdominal Obesity
Authors: Angelique G Brellenthin, Duck-chul Lee, Xuemei Sui, Steven Blair
Journal: Circulation (2018)

Introduction: Excess body fat and abdominal obesity have been associated with cardiovascular diseases. While aerobic exercise is often recommended to prevent fat accumulation, less evidence exists detailing the specific effects of resistance exercise, independent of or combined with aerobic exercise, on the development of excess body fat and abdominal obesity. Hypothesis: We hypothesized that resistance exercise would be associated with a lower incidence of developing excess body fat and abdominal obesity. Methods: Participants were 7,685 men and women aged 18 to 89 years (mean age, 46) who received a preventive medical examination during 1987-2005 in the Aerobics Center Longitudinal Study. Participants with a history of myocardial infarction, stroke, cancer, excess body fat, or abdominal obesity at baseline were excluded. Resistance exercise (RE) and meeting the 2008 US Physical Activity Guidelines (RE ≥2 days/week) for RE were determined by self-reported leisure-time exercise. Excess body fat was defined as % body fat (≥25 in men, ≥30 in women) based on underwater weighing or skinfold measurements and abdominal obesity as waist girth (&gt;102 cm in men, &gt;88 cm in women). Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident excess body fat and abdominal obesity by RE levels after adjusting for baseline age, sex, examination year, body weight, current smoking, heavy alcohol drinking, and meeting aerobic exercise (AE) guidelines (≥500 MET-minutes per week). Results: During an average follow-up of 5 years, 1517 (20%) developed excess body fat and 552 (14%) developed abdominal obesity. Individuals meeting the RE guidelines (30%; 2323 of 7685) had a 26% and 25% lower risk of developing excess body fat (HR: 0.74; 95% CI: 0.65 to 0.84) and abdominal obesity (HR: 0.75; 95% CI: 0.61 to 0.92), respectively, after adjusting for potential confounders including AE. The HRs (95% CIs) of incident abdominal obesity were 0.70 (0.48-1.01), 0.62 (0.44-0.87), 0.98 (0.67-1.42), and 0.62 (0.42-0.91), while the HRs (95% CIs) of incident excess body fat were 0.84 (0.69-1.03), 0.71 (0.59-0.86), 0.75 (0.59-0.96), and 0.56 (0.43-0.72), in weekly RE time of 1-59, 60-119, 120-179, and ≥180 minutes/week, respectively, compared with no RE. In the combined analysis of RE and AE, HRs (95% CIs) of incident excess body fat and abdominal obesity were 0.71 (0.53-0.95) and 0.62 (0.37-1.04) in meeting RE guidelines only, 0.86 (0.77-0.97) and 0.80 (0.66-0.97) in meeting AE guidelines only, and 0.65 (0.56-0.75) and 0.62 (0.49-0.79) in meeting both RE and AE guidelines, respectively, compared with meeting none of the guidelines. Conclusions: We found that RE, independent of and combined with AE, is associated with a reduced risk of developing excess body fat and abdominal obesity.
Abstract 11694: 6-minute Walk Test Distance After Bosentan to Macitentan Switch in Adult Outpatients With Group 1 Pulmonary Hypertension: A Multicenter Retrospective Cohort
Authors: Nicolas A Caruso, María T Politi, Javier A Lescano, Juan M Farina, Damian N Spagnuolo, Ferreyra Raul, Sergio V Perrone, Adrian Lescano, Guillermo R Bortman
Journal: Circulation (2017)

Introduction: Endothelin receptor antagonists (ERA) have shown to be beneficial in improving clinical, haemodynamic and echocardiographic variables in patients with group 1 pulmonary hypertension. ...
Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population
Authors: Mee Kyoung Kim, Kyungdo Han, Yong-Moon Park, Hyuk-Sang Kwon, Gunseog Kang, Kun-Ho Yoon, Seung-Hwan Lee
Journal: Circulation (2018)

Background: Variability in metabolic parameters, such as fasting blood glucose and cholesterol concentrations, blood pressure, and body weight can affect health outcomes. We investigated whether variability in these metabolic parameters has additive effects on the risk of mortality and cardiovascular outcomes in the general population. Methods: Using nationally representative data from the Korean National Health Insurance System, 6 748 773 people who were free of diabetes mellitus, hypertension, and dyslipidemia and who underwent ≥3 health examinations from 2005 to 2012 were followed to the end of 2015. Variability in fasting blood glucose and total cholesterol concentrations, systolic blood pressure, and body mass index was measured using the coefficient of variation, SD, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability. Participants were classified numerically according to the number of high-variability parameters (eg, a score of 4 indicated high variability in all 4 metabolic parameters). Cox proportional hazards models adjusting for age, sex, smoking, alcohol, regular exercise, income, and baseline levels of fasting blood glucose, systolic blood pressure, total cholesterol, and body mass index were used. Results: There were 54 785 deaths (0.8%), 22 498 cases of stroke (0.3%), and 21 452 myocardial infarctions (0.3%) during a median follow-up of 5.5 years. High variability in each metabolic parameter was associated with a higher risk for all-cause mortality, myocardial infarction, and stroke. Furthermore, the risk of outcomes increased significantly with the number of high-variability metabolic parameters. In the multivariable-adjusted model comparing a score of 0 versus 4, the hazard ratios (95% CIs) were 2.27 (2.13–2.42) for all-cause mortality, 1.43 (1.25–1.64) for myocardial infarction, and 1.41 (1.25–1.60) for stroke. Similar results were obtained when modeling the variability using the SD, variability independent of the mean, and average real variability, and in various sensitivity analyses. Conclusions: High variability of fasting blood glucose and total cholesterol levels, systolic blood pressure, and body mass index was an independent predictor of mortality and cardiovascular events. There was a graded association between the number of high-variability parameters and cardiovascular outcomes.
Development of PLGA micro- and nanorods with high capacity of surface ligand conjugation for enhanced targeted delivery
Authors: Jiafu Cao, Jin-Seok Choi, Murtada A. Oshi, Juho Lee, Nurhasni Hasan, Jihyun Kim, Jin-Wook Yoo
Journal: Asian Journal of Pharmaceutical Sciences (2018)

Particle shape has been recognized as one of the key properties of nanoparticles in biomedical applications including targeted drug delivery. Targeting ability of shape-engineered particles depends largely on targeting ligands conjugated on the particle surface. However, poor capacity for surface ligand conjugation remains a problem in anisotropic nanoparticles made with biodegradable polymers such as PLGA. In this study, we prepared anisotropic PLGA nanoparticles with abundant conjugatable surface functional groups by a film stretching-based fabrication method with poly (ethylene-alt-maleic acid) (PEMA). Scanning electron microscopy images showed that microrods and nanorods were successfully fabricated by the PEMA-based film stretching method. The presence of surface carboxylic acid groups was confirmed by confocal microscopy and zeta potential measurements. Using the improved film-stretching method, the amount of protein conjugated to the surface of nanorods was increased three-fold. Transferrin-conjugated, nanorods fabricated by the improved method exhibited higher binding and internalization than unmodified counterparts. Therefore, the PEMA-based film-stretching system presented in this study would be a promising fabrication method for non-spherical biodegradable polymeric micro- and nanoparticles with high capacity of surface modifications for enhanced targeted delivery.