tbuckley/cabot-search huggingface dataset:
Training staff in a virtual unit.
Authors: Traci Rawlinson, Todd Bartholet, Heidi Tonne
Journal: Journal of Clinical Oncology (2018)

119 Background: Nebraska Medicine, a 600 bed academic medical center, had 24 inpatient oncology beds. In order to grow the oncology population, planning for the Fred and Pamela Buffett Cancer Center began. The new center would include 108 inpatient beds on four units: acute, specialty, progressive, and intensive levels of care. A year in advance, plans were initiated to onboard newly hired nurses of various clinical backgrounds with the goal of creating a competent, cohesive health care team. Despite challenges of a nursing shortage in a competitive market and construction of the facility underway, the oncology leadership team developed innovative ways to orient the large number of new staff. Collaboration with existing inpatient units throughout the organization was instrumental in achieving this goal. Methods: The oncology leadership team developed a process to deploy nursing staff into a variety of inpatient units throughout the organization. A partnership was established involving inpatient managers and hospital educators to track progress and learning needs of each individual during the orientation process. Key components were consistent communication between the leadership teams, and ensuring exposure to the relevant oncology patients, procedures and providers. To provide additional support, an existing Oncology Nurse Fellowship program was adapted and utilized to educate on the holistic care of oncology patients. Day in the life scenarios were developed to expose staff to the new space. Lead Nurses for each inpatient unit received additional development training. Team building exercises and staff meetings contributed to creating positive working relationships. Results: A year later 73 nurses and 48 patient care technicians (PCT), along with the inter-professional team, were prepared to competently and holistically care for patients upon opening of the cancer center. Collaboration with 14 units, including the hospital float pool, yielded impressive results. 84 nurses participated in the Oncology Nurse Fellowship program and 62 PCT’s attended Oncology 101, a specific training for PCTs. Conclusions: Through collaboration and innovation, it is possible to orient clinical staff to create a competent, cohesive team before a physical nursing unit exists.
Lower Circulating Folate Induced by a Fidgetin Intronic Variant Is Associated With Reduced Congenital Heart Disease Susceptibility
Authors: Dan Wang, Feng Wang, Kai-Hu Shi, Hui Tao, Yang Li, Rui Zhao, Han Lu, Wenyuan Duan, Bin Qiao, Shi-Min Zhao, Hongyan Wang, Jian-Yuan Zhao
Journal: Circulation (2017)

Folate deficiency is an independent risk factor for congenital heart disease (CHD); however, the maternal plasma folate level is paradoxically not a good diagnostic marker. Genome-wide surveys have identified variants of nonfolate metabolic genes associated with the plasma folate level, suggesting that these genetic polymorphisms are potential risk factors for CHD.To examine the effects of folate concentration-related variations on CHD risk in the Han Chinese population, we performed 3 independent case-control studies including a total of 1489 patients with CHD and 1745 control subjects. The expression of the Fidgetin (FIGN) was detected in human cardiovascular and decidua tissue specimens with quantitative real-time polymerase chain reaction and Western blotting. The molecular mechanisms were investigated by luciferase reporter assays, surface plasmon resonance, and chromatin immunoprecipitation. FIGN-interacting proteins were confirmed by tandem affinity purification and coimmunoprecipitation. Proteasome activity and metabolite concentrations in the folate pathway were quantified with a commercial proteasome activity assay and immunoassays, respectively.The +94762G>C (rs2119289) variant in intron 4 of the FIGN gene was associated with significant reduction in CHD susceptibility (P=5.1×10-14 for the allele, P=8.5×10--13 for the genotype). Analysis of combined samples indicated that CHD risks in individuals carrying heterozygous (GC) or homozygous (CC) genotypes were reduced by 44% (odds ratio [OR]=0.56; 95% confidence interval [CI]=0.47-0.67) and 66% (OR=0.34; 95% CI=0.23-0.50), respectively, compared with those with the major GG genotype. Minor C allele carriers who had decreased plasma folate levels exhibited significantly increased FIGN expression because the transcription suppressor CREB1 did not bind the alternative promoter of FIGN isoform X3. Mechanistically, increased FIGN expression led to the accumulation of both reduced folate carrier 1 and dihydrofolate reductase via inhibition of their proteasomal degradation, which promoted folate absorption and metabolism.We report a previously undocumented finding that decreased circulating folate levels induced by increased folate transmembrane transport and utilization, as determined by the FIGN intronic variant, serves as a protective mechanism against CHD. Our results may explain why circulating folate levels do not have a good diagnostic value.
Abstract 17852: Prognostic Significance of Ventricular Late Potentials in Patients With Pulmonary Sarcoidosis
Authors: Kenji Yodogawa, Yoshihiko Seino, Toshihiko Ohara, Yu-ki Iwasaki, Meiso Hayashi, Yasushi Miyauchi, Wataru Shimizu
Journal: Circulation (2016)

Backgrounds: Early detection of cardiac involvement in sarcoidosis is difficult, but important to achieve optimum treatment results. Signal averaged electrocardiography (SAECG) can detect subtle ca...
Exome sequencing of the TCL1 mouse model for CLL reveals genetic heterogeneity and dynamics during disease development
Authors: Nadja Zaborsky, Franz J. Gassner, Jan P. Höpner, Maria Schubert, Daniel Hebenstreit, Richard Stark, Daniela Asslaber, Markus Steiner, Roland Geisberger, Richard Greil, Alexander Egle
Journal: Leukemia (2018)

The TCL1 mouse model is widely used to study pathophysiology, clonal evolution, and drug sensitivity or resistance of chronic lymphocytic leukemia (CLL). By performing whole exome sequencing, we present the genetic landscape of primary tumors from TCL1 mice and of TCL1 tumors serially transplanted into wild-type recipients to mimic clonal evolution. We show that similar to CLL patients, mutations in mice are frequently subclonal and heterogenous among different primary TCL1 mice. We further describe that this molecular heterogeneity mirrors heterogenous disease characteristics such as organ infiltration or CLL dependent T cell skewing. Similar to human CLL, we further observed the occurrence of novel mutations and structural variations during clonal evolution and found plasticity in the expansion of B cell receptor specific subclones. Thus, our results uncover that the genetic complexity, pathway dependence and clonal dynamics in mouse CLL are in relevant agreement to human CLL, and they are important to consider in future research using the TCL1 mouse for studying CLL.
Abstract 11855: Coronary Computed Tomography Angiography Increases Invasive Procedures Without Improving Clinical Outcomes in Patients With Suspected Acute Coronary Syndrome - A Meta-analysis of Randomized Controlled Trials
Authors: Andrew J Foy, Sanket Dhruva, John M Mandrola, Daniel J Morgan, Rita F Redberg
Journal: Circulation (2016)

Introduction: Coronary computed tomography angiography (CCTA) is considered equal to other forms of noninvasive cardiac testing for low-to-intermediate risk patients with suspected ACS. Clinical trials comparing CCTA to standard care (SC) suggest that CCTA increases invasive coronary angiography (ICA) and revascularization procedures without reducing major adverse cardiac events (MACE), ED revisits, or follow up hospitalizations but were underpowered to detect differences in these endpoints. Given technological advances in CCTA and new trials comparing it to SC, we sought to ascertain the impact of CCTA on clinical outcomes in patients with suspected ACS and a nonischemic workup. Methods: We performed a systematic search of PubMed and EMBASE for randomized controlled trials of CCTA compared to SC from January 2006 through April 2016 with a minimum of 100 patients and 28 days follow up. Studies were restricted to those which included patients with suspected ACS, who were either ED or inpatient status, and whose initial workup was negative for ischemia. Results: Six randomized, controlled trials met our inclusion criteria and involved 2,397 patients undergoing CCTA and 1,834 undergoing SC. Patients who underwent CCTA were significantly more likely to undergo ICA (7.7% vs 5.3%; RR 1.6, p&lt;0.001) and revascularization (4.3% vs 2.1%; RR 2.3, p&lt;0.001). There was no difference in the incidence of death or MI following the index visit, post-discharge ED visits, or rehospitalizations (table). Conclusions: CCTA compared to SC increases rates of ICA and revascularization in patients with suspected ACS and a negative workup but does not improve clinically relevant patient outcomes. CCTA may increase harm compared to SC by exposing patients to unnecessary downstream invasive procedures.
Loss of function NFKB1 variants are the most common monogenic cause of CVID in Europeans.
Authors: Paul Tuijnenburg, Hana Lango Allen, Siobhan O Burns, Daniel Greene, Machiel H Jansen, Emily Staples, Jonathan Stephens, Keren Carss, Daniele Biasci, Helen Baxendale, Moira Thomas, Anita Chandra, Sorena Kiani-Alikhan, Hilary J Longhurst, Suranjith L Seneviratne, Eric Oksenhendler, Ilenia Simeoni, Godelieve J de Bree, Anton Tj Tool, Ester Mm van Leeuwen, Eduard Htm Ebberink, Alexander B Meijer, Salih Tuna, Deborah Whitehorn, Matthew Brown, Ernest Turro, Adrian J Thrasher, Kenneth Gc Smith, James Thaventhiran, Taco W Kuijpers
Journal: Journal of Allergy and Clinical Immunology (2018)
Implementing radiation oncology pathways at Dana-Farber Cancer Institute/Brigham and Women’s Hospital.
Authors: Victoria Hayne, Leah A. Stein, Carole Kathleen Tremonti, Elizabeth H. Baldini, John G. Phillips, Susanna C. Hilfer, David Michael Jackman, Julia Cooper Hall, Teresa L. Greenberg, Joanna M. Hamilton, Joseph O. Jacobson, Neil E. Martin
Journal: Journal of Clinical Oncology (2018)

301 Background: Modern cancer care faces increasing complexity and the challenge of delivering consistent, high-quality care across growing networks. Dana-Farber Pathways address these concerns by translating expert content into treatment algorithms delivered through a web-based platform and implemented across the network. We had previously built 31 Medical Oncology (MO) pathways. Our goal was to build and implement Radiation Oncology (RO) pathways for common cancer conditions in 18 months. Methods: Partnering with lead clinicians from each disease group, we chose the most appropriate framework for each pathway: expand previously established RO pathway; use corresponding MO pathway; or if no framework was available, develop RO pathway in its entirety. We worked with each disease group to gain consensus about the recommended on-pathway selections that reflect the latest research and institutional standard of care. Implementation consisted of pre- and post-launch department communications about metric goals and individual provider training on the system. Because the program was launched without provider incentivization, the usage rate goal was navigations for at least 25% of patients receiving radiation treatment. The on-pathway rate goal range was 70-80%. Results: We exceeded our goal: we built and implemented 25 pathways in 12 months and constructed all 27 pathways in 18 months. We have met both key rate goals across all disease pathways since time of launch: usage rate is 63%; on-pathway rate is 85% (39 providers across 3 sites). Conclusions: A preliminary analysis of RO Pathway data demonstrates collective adoption across all sites. Qualitative surveys show it to be a useful resource in radiation treatment decision-making and in palliative care service. We will continue to analyze the use of RO Pathways and develop strategies to collaborate with MO to further guide multi-disciplinary decision-making.[Table: see text]
Building a cancer registry performance dashboard by leveraging existing workflow documents at a comprehensive cancer center.
Authors: Jing Jing Wang Yakowec, Ingrid Stendhal, Hakim Lakhani, Joseph O. Jacobson
Journal: Journal of Clinical Oncology (2018)

296 Background: Quantifying the performance of a cancer center’s cancer registry is important to plan for resources needed to address shortcomings and projected increases in workload. The objective of this project was to understand the workflow, reporting requirements, and existing documentation of the cancer registry at Dana-Farber Cancer Institute (DFCI) in order to build a dashboard that quantifies monthly performance. Methods: Current state workflow maps were created detailing the three phases of the cancer registry’s operations: case finding, case abstraction, and case follow-up. Individual meetings and a workshop with the cancer registry staff were held to validate workflows, gather operational challenges and improvement ideas, and set performance metrics. Leveraging information already being collected by staff as part of their workflow, a database was designed to collect and auto-visualize monthly performance using Excel and Tableau. Results: The performance dashboard shows monthly trends of ‘on target’ status of the cancer registry’s case finding, case abstraction, and case follow-up efforts. It also quantifies how delayed the cancer registry is in case finding or abstraction and provides new case count trends by care facility, staffing capacity based on case load, and trends in lost to follow-up patients. One hundred percent of the performance dashboard data is from documentation already generated by the cancer registry staff on a routine basis. Data on monthly case load from September 2017 through March 2018 are presented in the table below; given a maximum limit of 86 cases to abstract per abstractor per month, the cancer registry is currently at more than full capacity. Conclusions: A well-designed cancer registry performance dashboard that leverages existing data does not add burden to registry staff and informs how best to manage and utilize resources according to case load. [Table: see text]
Metagenomic analysis of intestinal mucosa revealed a specific eukaryotic gut virome signature in early-diagnosed inflammatory bowel disease
Authors: Federica Ungaro, Luca Massimino, Federica Furfaro, Valeria Rimoldi, Laurent Peyrin-Biroulet, Silvia D’Alessio, Silvio Danese
Journal: Gut Microbes (2018)

Intestinal dysbiosis is one of the causes underlying the pathogenesis of inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD). Besides bacteria, microbiota comprises both prokaryotic and eukaryotic viruses, that together compose the gut virome. Few works have defined the viral composition of stools, while the virome populating intestinal mucosae from early-diagnosed IBD patients has never been studied. Here we show that, by in-depth metagenomic analysis of RNA-Seq data obtained from gut mucosae of young treatment-naïve patients, early-diagnosed for CD and UC, and from healthy subjects (Ctrl), UC patients display significantly higher levels of eukaryotic Hepadnaviridae transcripts by comparison with both Ctrl and CD patients, whereas CD patients show increased abundance of Hepeviridae versus Ctrl. Moreover, we found that UC gut mucosa is characterized by lower levels of Polydnaviridae and Tymoviridae, whereas the mucosa of patients with CD showed a reduced abundance of Virgaviridae. Our findings support the idea that certain eukaryotic viruses might trigger intestinal inflammation and contribute to IBD pathogenesis and pave the way not only for the discovery of novel diagnostic biomarkers but also for the development of anti-viral drugs for the treatment of IBD.
Abstract P267: Geographic Patterns of Cardiovascular Disease Risk Factor Prevalence in the Continental US
Authors: Matthew S Loop, George Howard, Gustavo de los Campos, Mohammad Z Al-Hamdan, Monika M Safford, Emily B Levitan, Leslie A McClure
Journal: Circulation (2016)

Objectives: Our understanding of geographic variation in cardiovascular disease (CVD) risk factors is based upon self-reported variables or geographically limited coverage. Our objective was to explore geographic variation in measured hypertension, measured diabetes, measured dyslipidemia, and self-reported current smoking prevalence. Methods: We used baseline data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, whose community-dwelling participants were recruited nationally between 2003 and 2007. Participants underwent a telephone interview and in-home examination. Hypertension, diabetes, and dyslipidemia were based on physiologic measures or reported medication use. Current cigarette smoking was self-reported. Using participants’ residential latitude and longitude, we tested for clustering of each risk factor using the difference in Ripley’s K functions test and, when we found evidence of clustering, used thin plate regression splines (TPRS) in a logistic regression framework to create age- race-, and sex-adjusted maps of risk factor prevalence. Results: Risk factor status and location data were available for 27,787 of the 30,239 participants (92%). Mean (±SD) age of these participants was 65(±9) years, 41% were black, 55% were women, 59% had hypertension, 22% had diabetes, 54% had dyslipidemia, and 15% were current smokers. We found statistically significant geographic clustering of hypertension, diabetes, and smoking prevalence, but not dyslipidemia. The regions with the highest prevalence varied across risk factors (Figure 1). Conclusions: Louisiana and Mississippi might require the most intense management of CVD risk factors. These maps show variation across and within administrative units, providing an accurate representation of geographic variation in risk factor prevalence. High resolution maps could be put to use by healthcare organizations to justify requests for higher reimbursement rates based upon local population health.
Abstract 16694: Human Cardiac Fibroblasts Speed Up Calcium Transient Decline and Prolong Action Potential Duration in Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes by a Mechanism That Requires Direct Physical Interaction
Authors: Christopher Kane, Nicola Hellen, Tatiana Trantidou, Julia Gorelik, Cesare M Terracciano
Journal: Circulation (2014)

Introduction: Cardiac fibroblasts can influence cardiomyocyte structure and function through direct physical interaction and/or by the secretion of soluble factors. Here we assess the relative importance of these different modalities of interaction with human pathological fibroblasts. Methods: Ventricular fibroblasts were isolated from the explanted hearts of dilated cardiomyopathy (DCM) patients (n=3) and cultured with human induced pluripotent stem cell-derived cardiomyocytes (iPS-CMs) at a ratio of 2:1 for 24 hours in three groups: iPS-CMs with fibroblast conditioned medium (CMed), co-cultured in transwells to allow bi-directional paracrine communication but prevent physical contact (CC), and iPS-CMs in direct contact with fibroblasts (DC). iPS-CMs alone were used as control. iPS-CMs were field stimulated at 1 Hz and calcium transients and action potentials were recorded optically using the fluorescent dyes fluo-4 AM and di-8-ANNEPS respectively. Data is presented as percentage change from control. Res...
Risk-adjusted prediction models using the specialty-specific head and neck reconstructive surgery NSQIP.
Authors: Samantha Tam, Wenli Dong, Ira L Martin, David Matthew Adelman, Randal S. Weber, Carol M. Lewis
Journal: Journal of Clinical Oncology (2018)

240 Background: With increasing health care costs, risk-adjusted quality outcomes are essential. The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) is a robust perioperative risk-adjustment platform, but lacks capture of oncologic- and specialty-specific variables and has limited utility for risk adjustment in head and neck oncologic surgery. This study uses the specialty-specific Head and Neck-Reconstructive Surgery (HNSR) NSQIP to develop risk-adjusted models for patients undergoing head and neck oncologic surgery with reconstruction. Methods: Multiple logistic regression modelling using data from patients in the HNSR NSQIP between 8/2012-10/2016 identified predictors of postoperative morbidity. Final models were validated using a cohort of patients treated between 10/2016-12/2017. The concordance index (c-index) was used to evaluate the model performance. Results: The modelling cohort included 1095 patients and the validation cohort included 407. Models were created to predict probability of postoperative complications (presence of fistula, ventilator dependence &gt; 48 hours, pneumonia, deep/superficial surgical site infection); presence of gastrostomy-jejunostomy (GJ), nasoenteric (NE), or tracheostomy tube at 30 days postoperatively; conversion from NE to GJ tube; unplanned return to the operating room; and length of stay &gt; 7 days. Most discriminant models were those predicting presence of GJ tube (model c-index [M CI ] = 0.91; validation c-index[V CI ] = 0.93), NE tube (M CI = 0.83; V CI = 0.84), and conversion from NE to GJ tube (M CI = 0.86; V CI = 0.80). Prediction models were least discriminant for ventilator dependence (M CI = 0.63; V CI = 0.45), fistula (M CI = 0.58; V CI = 0.54), and unplanned return to the operating room (M CI = 0.59; V CI = 0.51). Conclusions: Reliable and discriminant risk prediction models were able to be created for a variety of perioperative complications incorporating oncologic- and specialty-specific variables in the HNSR NSQIP. These models help inform risk stratification strategies for patients undergoing head and neck reconstructive surgery and the development of a specialty-specific preoperative risk calculators.
Abstract 20130: Incidence of Major Adverse Cardiovascular Events After Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter Registry
Authors: Barbara A Danek, Aris Karatasakis, Anthony Doing, Philip Dattilo, Phuong-Khanh J Nguyen-Trong, Judit Karacsonyi, Aya Alame, Erica Resendes, Pratik Kalsaria, Bavana Rangan, Michele Roesle, Craig Thompson, Subhash Banerjee, Emmanouil Brilakis
Journal: Circulation (2016)

Introduction: High procedural success rates are currently achieved in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), but data on long-term outcomes is limited. Methods: We ...