tbuckley/cabot-search huggingface dataset:
Understanding the value of clinical survivorship programs.
Authors: Katherine Ramsey Gilmore, Guadalupe R. Palos, Patricia Chapman, Paula A. Lewis-Patterson, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2018)

86 Background: Various models of care exist for the growing number of cancer survivors; yet little is known about the value or the difference in the models’ costs. We sought to assess the professional billing and reimbursements of 2 models of survivorship care; a) oncologist-led and b) advanced practice providers (APPs). Methods: Data were collected from 6 disease specific survivorship clinics, genitourinary, gynecology, head and neck, lymphoma, melanoma, and thyroid. Billing data was obtained to determine the professional billing and reimbursement amounts for these visits over one fiscal year. Comparisons were made between the APP and oncologists average salaries to determine costs per model. Clinic FTE salaries were based on the amount of time an APP devoted to a survivorship activities with 33% fringe benefits added to salaries. Oncologists’ salaries were based on the annual average faculty salary by department including fringe. Results: Billing data of 4,255 outpatient survivorship visits across the six clinics from 09/1/2016 - 8/31/2017 were abstracted. Table 1 summarizes the percentage (%) of professional reimbursement by model of care, oncologist versus APP and survivorship clinic. Conclusions: These data indicate that the advanced practice providers' model of survivorship care was financially more efficient than the oncologist model. Further research is warranted to compare the clinical effectiveness of these models and their impact on patients' outcomes related to their quality of life and satisfaction with care.[Table: see text]
A review of oncologic therapeutic phase III clinical trial literature: Exploring the reporting of clinical trial data of older patients with cancer.
Authors: Karlynn BrintzenhofeSzoc, Armin Shahrokni, Beverly E. Canin, Ira Russell Parker, Jessica L. Krok-Schoen, Thuy Koll, Amy R. MacKenzie, Jennifer Leigh Lund, Christine D Hsu, Kathy Pan, Ritika Vankina
Journal: Journal of Clinical Oncology (2018)

70 Background: With demographic shifts leading to an aging cancer population, the American Society of Clinical Oncology (ASCO) has recommended that journal editors improve the reporting of clinical trial data specific to older adults. This study aimed to assess the current reporting status of clinical trial data regarding older adults with cancer. Methods: This was a review of oncologic therapeutic phase-3 clinical trial data published from 07/01/2016-06/30/2017. Based on a keyword search of EMBASE and PubMed, 929 manuscripts were identified. Removing duplicates (n = 116) and articles that did not meet this study’s cancer inclusion criteria (n = 589), a total of 224 were identified. In the pilot phase there was 85% agreement among the reviewers. Results: Thus far, 197 papers (88%), have been independently reviewed with 118 evaluated by more than one reviewer. Reviewed papers were published in 57 journals including Journal of Clinical Oncology (28, 14.2%), Lancet Oncology (25, 12.7%), and NEJM (20, 10.2%). Much of the literature focused upon the following cancer sites: Breast (33, 16.7%), Lung (27, 13.7%), Colorectal (18, 9.1%), and Prostate (12, 6.1%). 175 articles included inclusion/exclusion criteria, 32 (16.2%) had upper age exclusion criteria. Age was presented in 184 articles and data was stratified by age in 84 (42.6%). Age stratification of effectiveness and toxicity were presented in the results section in 65 (38.2%) and 21 (14.4%). Effectiveness by age was in the discussion section in 37 (18.8%) and toxicity by age in 16 (8.1%). Reviewers could not determine the proportion of study participants who were older adults in 111 articles (56.2%). In the remainder of the articles, the proportion ranged from 0% to 81%, except one in which all participants were older adults. Conclusions: A slim minority of phase-3 oncologic clinical trials included and discussed age-referenced results regarding the effectiveness and toxicity of treatments in older adults. Clinical investigators and journal editors should consider the ASCO recommendation and increase the reporting of oncologic clinical trial data specific to older adults.
Improving the assessment and documentation of constipation at UF Health Cancer Center through mandatory prompts.
Authors: Brian Hemendra Ramnaraign, Bilal Farooqi, Priya Kadambi Gopalan, Merry Jennifer Markham
Journal: Journal of Clinical Oncology (2018)

263 Background: Opioids are commonly prescribed to patients for management of pain and the most common and persistent side effect from opioid use is constipation. Opioid-induced constipation (OIC) affects 52% of patients with advanced cancer and 87% of terminally ill patients. In the Spring 2017 Quality Oncology Practice Initiative (QOPI) chart abstraction round, UF Health Cancer Center’s Medical Oncology clinic notes documented the assessment of constipation in only 45.45% of charts. This is below the academic hospital aggregate documentation rate of 55.61%. Methods: Our objective was to improve the rate of documentation of assessment of constipation in the Thoracic Oncology Clinic at UF Health Cancer Center by 33% to a goal rate of at least 60% by 3 months. We used a Plan-Do-Study-Act model in order to design our project. We worked with the EPIC developers to include a mandatory prompt at the end of the assessment/plan section of the clinic template notes for the Thoracic Oncology practice. Our prompt was “Constipation was addressed and @HE@ {DOES/DOES NOT} have symptoms” where the author chooses from a drop down list to select whether the patient “does” or "does not” have symptoms. We planned to assess a total of 60 random charts in the 3 month post intervention period. Results: At the end of our study, a total of 48 out of 60 charts (80%) documented constipation thus surpassing our goal of 60%. Of the 12 charts assessed that did not address constipation, 11 did not use our revised templates and were notes that were “copied forwarded” from previous encounters. Conclusions: Given that our intervention was a success, we plan to expand these revised templates to the other medical oncology subspecialties in order to better document assessment of constipation for all cancer patients. While our mandatory prompt was shown to lead to increased documentation of constipation, further studies to show whether or not this leads to decreased complaints of abdominal pain, decreased incidences of bowel obstructions, and/or decreased hospital admissions, would be interesting to pursue.
Endoscopic resection of laterally spreading lesions of the ampulla: more answers and more questions
Authors: Dennis Yang, Peter Draganov
Journal: Endoscopy (2018)

See also: Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalentEndoscopy 2018; 50(10): 972-983DOI: 10.1055/a-0587-5228
Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization
Authors: Eran Bellin
Journal: Annals of Internal Medicine (2018)

Letters2 October 2018Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and UtilizationEran Bellin, MDEran Bellin, MDMontefiore Information Technology, Yonkers, New York (E.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0458 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Yoon and colleagues' randomized controlled trial shows that intensive management had an unadjusted difference-in-difference of $2346 instead of $554 as cited in Table 1 of the article. This finding indicates that intensive management was a striking failure when the data are viewed from the perspective of a pure intention-to-treat analysis without postanalysis adjustment.Reference1. Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, et al. Impact of primary care intensive management on high-risk veterans' costs and utilization: a randomized quality improvement trial. Ann Intern Med. 2018;168:846-54. [PMID: 29868706]. doi:10.7326/M17-3039 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Montefiore Information Technology, Yonkers, New York (E.B.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0458. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoImpact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization Jean Yoon , Evelyn Chang , Lisa V. Rubenstein , Angel Park , Donna M. Zulman , Susan Stockdale , Michael K. Ong , David Atkins , Gordon Schectman , and Steven M. Asch Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization John H. Wasson Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization Katherine Rediger and D.R. Bailey Miles Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization Jean Yoon , Evelyn Chang , Lisa V. Rubenstein , Donna M. Zulman , and Steven M. Asch Metrics 2 October 2018Volume 169, Issue 7Page: 514KeywordsConflicts of interestDisclosureIntent to treat analysis ePublished: 2 October 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Differential Sensitivity Analysis for Resistant Malignancies (DISARM) Identifies Common Candidate Therapies across Platinum-Resistant Cancers
Authors: Carl M. Gay, Pan Tong, Robert J. Cardnell, Triparna Sen, Xiao Su, Jun Ma, Rasha O. Bara, Faye M. Johnson, Chris Wakefield, John V. Heymach, Jing Wang, Lauren A. Byers
Journal: Clinical Cancer Research (2018)

Abstract Purpose: Despite a growing arsenal of approved drugs, therapeutic resistance remains a formidable and, often, insurmountable challenge in cancer treatment. The mechanisms underlying therapeutic resistance remain largely unresolved and, thus, examples of effective combinatorial or sequential strategies to combat resistance are rare. Here, we present Differential Sensitivity Analysis for Resistant Malignancies (DISARM), a novel, integrated drug screen analysis tool designed to address this dilemma. Experimental Design: DISARM, a software package and web-based application, analyzes drug response data to prioritize candidate therapies for models with resistance to a reference drug and to assess whether response to a reference drug can be utilized to predict future response to other agents. Using cisplatin as our reference drug, we applied DISARM to models from nine cancers commonly treated with first-line platinum chemotherapy including recalcitrant malignancies such as small cell lung cancer (SCLC) and pancreatic adenocarcinoma (PAAD). Results: In cisplatin-resistant models, DISARM identified novel candidates including multiple inhibitors of PI3K, MEK, and BCL-2, among other classes, across unrelated malignancies. Additionally, DISARM facilitated the selection of predictive biomarkers of response and identification of unique molecular subtypes, such as contrasting ASCL1-low/cMYC-high SCLC targetable by AURKA inhibitors and ASCL1-high/cMYC-low SCLC targetable by BCL-2 inhibitors. Utilizing these predictions, we assessed several of DISARM's top candidates, including inhibitors of AURKA, BCL-2, and HSP90, to confirm their activity in cisplatin-resistant SCLC models. Conclusions: DISARM represents the first validated tool to analyze large-scale in vitro drug response data to statistically optimize candidate drug and biomarker selection aimed at overcoming candidate drug resistance.
Abstract 180: Coronary Artery Aneurysms Identified At School Cardiac Screening
Authors: Hironaga Yoshimoto, Kenji Suda, Shintaro Kishimoto, Yoshiyuki Kudo, Toyojiro Matsuishi, Koichi Yatsunami
Journal: Circulation (2015)

Because most significant complication of Kawasaki disease (KD) is coronary aneurysms, echocardiography is an indispensable part of clinical practice and quality control of echocardiography is mandatory. On the other hand, Japanese government has enforced a law of regular school cardiac screening (SCS) at 1st, 7th, and 10th grader in 1995 and all patients with a history of KD were screened for coronary artery lesion. In this study we report 2 patients with coronary aneurysms picked up by SCS. Case1: A 6-year-old boy was diagnosed with KD at 3 year old and received immunoglobulin (2g/kg/day). His condition improved within 8 days of illness and echocardiographic finding of coronary artery was “normal” in acute phase and at 1and 3 months after the onset of KD. Since then he did not visit clinic for follow-up. At 1st grader SCS, he was diagnosed as having giant coronary artery aneurysms by echocardiography. Indeed coronary angiography revealed sequential coronary aneurysms of 10.8 mm and 12.3 mm in diameter at segment 6 and 5 with a 99% stenosis in between them. Because of signs of coronary ischemia on myocardial perfusion scan, he underwent percutaneous coronary interventions and coronary artery bypass graft surgery later. Case2: A 9-year-old boy was diagnosed with juvenile idiopathic arthritis and his fever continued 10 days. He underwent echocardiography at 9 days of illness but coronary artery lesions were not found. At 7th grader SCS, he was diagnosed as having coronary artery aneurysms by echocardiography. Coronary angiography revealed coronary artery aneurysms of 6.1mm and 6.1 mm in diameter at segment 1 and segment 6. Since then he has been placed on oral aspirin. These 2 cases highlight the issue concerning timing and quality of echocardiography and importance of SCS in detecting patients with coronary undiagnosed aneurysms.
Abstract 12374: Visceral Fat Metabolic Activity is Independently Associated With Coronary Artery Inflammation in Patients With Impaired Glucose Intolerance or Type 2 Diabetes
Authors: Sachiyo Igata, Nobuhiro Tahara, Atsuko Tahara, Yoshikazu Nitta, Akihiro Honda, Norihiro Kodama, Minori Mizoguchi, Sho-ichi Yamagishi, Yoshihiro Fukumoto
Journal: Circulation (2014)

OBJECTIVE: We have very recently demonstrated that pioglitazone could attenuate coronary artery inflammation evaluated by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and computed tomography (CT) in patients with impaired glucose intolerance (IGT) or type 2 diabetes (T2DM) in a glucose-lowering independent manner. However, it remains unclear which clinical factors are associated with reduction of coronary artery inflammation. METHODS: FDG-PET and CT were performed in 47 patients with IGT or T2DM (37 males and 10 females; mean age 68.1±8.3 years). These patients were randomized to treatment with either pioglitazone or glimepiride for 16 weeks. FDG uptakes in the left main trunk and visceral fat were normalized to background blood FDG activity as target-to-background ratio (TBR) to assess coronary artery inflammation (CAI) and visceral fat metabolic activity (VFA). RESULTS: After 16-week treatments, fasting plasma glucose and HbA1c values were comparably reduced in both groups. TBR values...
Dietary destabilisation of the balance between the microbiota and the colonic mucus barrier
Authors: George Birchenough, Bjoern O. Schroeder, Fredrik Bäckhed, Gunnar C. Hansson
Journal: Gut Microbes (2018)

It has long been acknowledged that dietary fibres are important to maintain a healthy gut. Over the past decade, several studies have shown that loss of complex polysaccharides from the Western diet has resulted in alterations to our colonic microbiota. The concurrent increase in the incidence of inflammatory bowel disease in the Western world has driven us to explore the potential mechanistic link between diet, the microbiota and the host defence systems that normally prevent inflammation. Using mice fed a low fibre Western-style diet and robust live tissue analytical methods we have now provided evidence that this diet impairs the colonic inner mucus layer that normally separates bacteria from host cells. Western societies urgently need to develop their understanding of the molecular mechanisms of the diet-microbiota-mucus axis and its implications for inflammatory diseases.
Abstract 14982: Rap1 Mediates Thrombin-Induced Vascular Smooth Muscle Cell Proliferation via an Integrin-Dependent Pathway
Authors: Bo Jiang, Jianhua Huang, George A Stouffer
Journal: Circulation (2016)

Introduction: Neointimal hyperplasia plays an important role in atherosclerosis and restenosis. Vascular smooth muscle cell (SMC) proliferation represents a major contributor to neointimal hyperpla...
Abstract 18650: Activation Mapping of Ventricular Ectopy: Characterization of a Threshold Value Predicting Successful Catheter Ablation
Authors: Will Camnitz, Kenneth Bilchick, John Dimarco, Kevin Driver, John Ferguson, James M Mangrum, Pamela Mason, Rohit Malhotra, Andrew Darby
Journal: Circulation (2015)

Background: Catheter ablation of ventricular ectopy is performed with increasing frequency. Activation mapping to determine the site with the earliest presystolic electrogram (EGM) is the most accurate method to locate the optimal ablation site. Despite this, activation mapping of ventricular ectopy has not been systematically reviewed in a large series, and the optimal activation time predicting successful ablation has not previously been determined. The goal of this study is to determine the local presystolic activation time most predictive of successful ablation. Methods and Results: We retrospectively reviewed 100 consecutive successful endocardial PVC ablations and analyzed the local activation time at each successful and unsuccessful ablation site. A total of 561 ablation lesions were reviewed. Activation time was calculated as the difference between the peak of the local bipolar EGM and the onset of the reference surface QRS complex. Acute success was defined as complete elimination of the target PVC during the procedure with no recurrence at 30 days by ECG and follow-up Holter. A local activation time 27 msec presystolic best predicted success with a sensitivity of 88%, specificity 85%, and an area under the ROC curve of 0.936 (95% CI 0.91 - 0.95; figure 1). The 27 msec presystolic activation time remained most predictive of success after sub-stratifying activation times by location (RVOT v LVOT, outflow v intracavitary). The odds ratio for success with each 1 msec increase in activation time (becomes more negative by 1 msec) is 1.24 (95% CI 1.19 - 1.29). Conclusion: In our experience, a local presystolic activation time of 27 msec is the threshold value most predictive of successful PVC ablation. Our review is the first to systematically characterize an activation time predicting success with PVC ablation in a large cohort. Figure 1
Implementation of a regional structure across an oncology collaborative quality initiative and the impact on physician engagement.
Authors: Samkeliso Beusterien, Louise Bedard, Jennifer J. Griggs
Journal: Journal of Clinical Oncology (2018)

149 Background: The Michigan Oncology Quality Consortium (MOQC) is a statewide collaborative quality initiative (CQI) sponsored by Blue Cross/Blue Shield of Michigan. The consortium uses Quality Oncology Practice Initiative (QOPI) measures to identify gaps in care and opportunities to improve quality. Data are collected on patients regardless of payer. MOQC includes nearly 90% of eligible medical oncologists (n = 364) in Michigan. We describe physician engagement within MOQC and quality improvement efforts after implementation of a regional structure in the CQI. Methods: The MOQC regional structure was introduced in Spring 2017. Forty-eight practices self-selected into 6 regions roughly by geographic location. Beginning in Spring 2017, a physician from each practice was required to attend both the Spring and Fall Regional Meetings and encouraged to bring an additional representative (e.g. administrative leader) from their practice. Regional meetings were facilitated by the MOQC Coordinating Center. Within each region, practices selected to work on one measure from a finite set of QOPI measures. and shared best practices gleaned from their quality improvement work, according to the Plan-Do-Study-Act cycle of quality improvement. We report on our primary outcome, the change in physician engagement, defined as attendance at biannual MOQC meetings (distinct from the Regional Meetings), before and after the introduction of the regional structure. Results: Provider engagement, measured by attendance at the biannual meetings increased from an average of 17.3 physicians in the 3 years before the introduction of the regional structure, to 33 physicians in the first meeting, and 22 physicians in the second meeting after the introduction of the regional structure. Conclusions: Implementation of a regional structure increased provider engagement, and provided a systematic approach to the launching of quality improvement efforts in an oncology CQI. Engaging providers at the regional level, which incorporates cultural aspects of geographically similar practices, may provide opportunities not otherwise recognized in larger consortia.
Unexpected relevant role of gene mosaicism in patients with primary immunodeficiency diseases
Authors: Anna Mensa-Vilaró, María Bravo García-Morato, Oscar de la Calle-Martin, Clara Franco-Jarava, María Teresa Martínez-Saavedra, Luis I. González-Granado, Eva González-Roca, Jose Luis Fuster, Laia Alsina, Osvaldo M. Mutchinick, Angélica Balderrama-Rodríguez, Eduardo Ramos, Consuelo Modesto, Pablo Mesa-del-Castillo, Norberto Ortego-Centeno, Daniel Clemente, Alejandro Souto, Natalia Palmou, Agustín Remesal, Kieron S. Leslie, Enrique Gómez de la Fuente, Luz Yadira Bravo Gallego, Josep María Campistol, Naouel Guirat Dhouib, Mohamed Bejaoui, Lívia Almeida Dutra, Maria Teresa Terreri, Catalina Mosquera, Tatiana González, Jerónima Cañellas, José María García-Ruiz de Morales, Carine H. Wouters, María Teresa Bosque, Weng Tarng Cham, Santiago Jiménez-Treviño, Jaime de Inocencio, Markéta Bloomfield, Rebeca Pérez de Diego, Natalia Martínez-Pomar, Rebeca Rodríguez-Pena, Cecilia González-Santesteban, Pere Soler-Palacín, Ferran Casals, Jordi Yagüe, Luis M. Allende, José Carlos Rodríguez-Gallego, Roger Colobran, Laura Martínez-Martínez, Eduardo López-Granados, Juan I. Aróstegui
Journal: Journal of Allergy and Clinical Immunology (2018)