tbuckley/cabot-search huggingface dataset:
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Authors: Virginia Hernández‐Gea, Juan Carlos Garcia‐Pagan
Journal: Hepatology (2018)

Potential conflict of interest: Nothing to report. The prognostic value of the Model for End‐Stage Liver Disease (MELD) in the setting of acute variceal bleeding is largely known.1 Indeed, a MELD‐based model (calibrated MELD) accurately assigns a probability of 6‐week mortality for each value of MELD.3 However, when selecting patients for preemptive transjugular intrahepatic portosystemic shunt (p‐TIPS), selection based on Child and active bleeding is the only proven strategy that improves outcome and increases survival. Satsangi reinforces the value of MELD in predicting bad outcome and survival after TIPS placement but in the clinical scenario of emergent TIPS in variceal bleeding after pharmacological and/or endoscopic treatment failure4 and in refractory ascites.4 We want to clarify that these two situations significantly differ from our population of study and should not be mixed up. Indeed, p‐TIPS, placed ideally within 24 hours or at least during the first 3 days after admission, precisely aims to avoid treatment failure in patients with a high risk of bad outcome treated with the standard of care combination of drugs plus endoscopic treatment. Therefore, factors predicting TIPS futility may completely differ in these three distinct TIPS indications (refractory ascites, emergent TIPS for treatment failure, and p‐TIPS). We acknowledge that, although p‐TIPS was clearly associated with a survival improvement in Child C cirrhosis (<14), mortality was not completely prevented (22% at 1 year versus 47% in the drug + endoscopy–treated). Whether different parameters, including a given MELD cutoff, better refine the high‐risk population requires further study. Special attention should be paid to Fig. 2 of the present study, showing that mortality in the p‐TIPS group was lower than expected according to MELD. Therefore, until more robust predictors are identified, p‐TIPS candidates should be selected based on Child C (<14 points) and Child B plus active bleeding criteria; and no additional criteria can be recommended.
Insights from the 2018 Biology of Genomes meeting
Authors: Ninad Oak, Sharon E. Plon
Journal: Genome biology (2018)

A report on the Cold Spring Harbor Laboratory 31st annual meeting on the Biology of Genomes, held at Cold Spring Harbor, New York, USA, 8–12 May, 2018. The 2018 Biology of Genomes meeting at Cold Spring Harbor Laboratories covered a wide range of topics with research relevant to many aspects of genomics. Here we highlight two areas of research where multiple talks provided new insights.
Survivorship: The UHealth patient experience.
Authors: Adrienne Marie Vazquez, Chinny Trivedi, Annette Amoros
Journal: Journal of Clinical Oncology (2018)

183 Background: The University of Miami has a formal Survivorship Program based on the Commission on Cancer (CoC) requirements. CoC requires accredited institutions to deliver survivorship care plans (SCP) to patients who fit analytic criteria. There is a lack of research on the patient experience as it pertains to survivorship care. Methods: Using a Likert-type scale, dual language survey (English and Spanish), patients were asked 6 questions about the Survivorship Clinic visit ranging from scheduling feasibility to information received during the visit and any opinions to improve the visit for future patients. Patients were given two weeks to complete the survey through a secure, HIPAA compliant online source (REDCap). Those who did not reply were called on the phone by a registered nurse to obtain a statistically significant sample size. Results: Of the 236 patients that were contacted, 45 responded (Breast 38.3%, Gastrointestinal 12.8%, Prostate 10.6%, Gynecologic 8.5%, Lymphoma 6.4%, Lung 6.4%, Sarcoma 4.3%, Other 12.8%). Our results found that 95.7% of patients would recommend this visit to anyone who has completed cancer treatment. Also, 59.6% of patients found the SCP to be most helpful, followed by Survivorship Provider input (38.3%) and then American Cancer Society Healthy living tips (36.2%). As a note, it was mentioned in free text that 11.1% would have preferred a similar visit at the beginning of treatment, at the completion of treatment and/or incremental follow up. Of those surveyed, 88.9% were referred to nutrition, 44.4% to exercise physiology and 27.8% to psychology/psychiatry. Conclusions: Of the patients surveyed 95.7% were satisfied with the survivorship visit. Our conclusion based on survey results shows that institutions should continue to provide formal survivorship care as per CoC requirements. Future directions should look at expanding services to patients at diagnosis and throughout the continuum of treatment and follow up. As survivorship programs grow, practices should consider increasing resources to accommodate the identified needs of patients at the beginning and end of cancer treatment.
Harnessing AI for health equity in oncology research and practice.
Authors: Alexandra Urman, Ching-Kun Wang, Irene Dankwa-Mullan, Ethan Scheinberg, Michael J. Young
Journal: Journal of Clinical Oncology (2018)

67 Background: Recent advances in artificial intelligence (AI) carry underexplored practical and ethical implications for the practice of clinical oncology. As oncologic applications of AI proliferate, a framework for guiding their ethical implementations and equitable distribution will be crucial. Methods: We reviewed the current landscape of AI applications in oncology research and clinical practice by reviewing the current body of evidence in PubMed and Medline. Key ethical challenges and opportunities to address health equity are critically evaluated and highlighted. Ethical implications for patients, clinicians and society at large are delineated, with particular focus on the impact and ramifications of AI with respect to healthcare disparities and equity of oncology care delivery. Results: Growing concerns that AI may widen disparities in oncologic care by virtue of lack of affordability, inconsistent accessibility and biased machine-learning models are addressed. Although there is potential for AI to widen disparities in oncology care, using foresight in application, AI has the potential to (1) democratize access to specialized clinical knowledge, (2) improve the accuracy of predicting cancer susceptibility, recurrence and mortality, (3) prevent diagnostic errors in under-resourced settings, (4) minimize unintended bias and (5) enable access to tailored therapeutic options including clinical trials if appropriately deployed. Separately, AI can be harnessed to identify areas of underserved needs and optimize systems of health-information sharing and reimbursements as blockchain technology converges with AI. As AI advances it will have a larger presence in oncology research and clinical practice. Conclusions: A strategic framework integrating ethical standards and emphasizing equitable implementation can help ensure that the potential of AI to address disparities in oncology are maximally captured and its perils averted. Further work is being done on exploring these challenges and will be submitted as a manuscript.
Association Between Antibiotic Prescribing for Respiratory Tract Infections and Patient Satisfaction in Direct-to-Consumer Telemedicine
Authors: Kathryn A. Martinez, Mark Rood, Nikhyl Jhangiani, Lei Kou, Adrienne Boissy, Michael B. Rothberg
Journal: JAMA Internal Medicine (2018)

knee.The knee arthroplasty rate increased, but most of the increase preceded the decline in arthroscopy rates.Between 1999 and 2014, the prevalence of osteoarthritis in the US adult population more than doubled from 6.6% to 14.3%. 6Trends in per capita knee surgical procedures, which are not adjusted for the increase in the prevalence of osteoarthritis, likely understate the degree to which use of arthroscopic surgery as a treatment for knee pain has declined.Some private insurers have started to require physicians to obtain authorization before an arthroscopic knee procedure.The fee-for-service Medicare program does not require prior authorization.Private insurers covered 72% of knee arthroscopies in patients younger than 65 years, and Medicare covered 83% of these procedures in patients aged 65 years or older.I could not observe the impact of prior authorization requirements directly, but trends in arthroscopy rates in these age groups were similar, indicating that the requirements may not be a major factor behind the decline in rates.The results suggest that the accumulating evidence on the lack of benefit associated with knee arthroscopy, compared with medical management, has altered treatment decisions.Despite the lower use rates, knee arthroscopy is still a common procedure.There may be additional opportunities to reduce the use of knee arthroscopy without adversely affecting patient outcomes.
Abstract 14570: Oxygen Uptake (VO2)/Work Rate (WR) Flattening in Heart Failure Patients With Reduced EF: Insights From Exercise-Echocardiography
Authors: Francesco Bandera, Marta Pellegrino, Greta Generati, Valeria Donghi, Eleonora Alfornzetti, Andrea Garatti, Marco Guazzi
Journal: Circulation (2013)

Background: Cardiopulmonary exercise test (CPET) allows functional assessment by assessing VO2 and its kinetic. The flattening of VO2/WR slope during incremental maximal exercise has been described...
A Case of Liver Injury Mimicking Metastasis After Gamma Knife Therapy for Lung Cancer
Authors: Kun Tang, Xiangwu Zheng, Jie Lin, Weiwei Yin
Journal: Clinical Nuclear Medicine (2018)

A 52-year-old man presented a mixed low-density lesion with high FDG uptake in hepatic segment VIII after gamma knife therapy for lung cancer, which was easily misdiagnosed as hepatic metastasis. Follow-up PET/CT assessment demonstrated that the hepatic lesion was barely observed and without FDG accumulation 5 months after radiotherapy. This case suggests that a new FDG-avid lesion at PET/CT after radiotherapy for lung cancer can be caused by radiation-induced liver injury. Knowledge of its imaging characteristics and nature course evaluated by follow-up PET/CT is critical to avoid misinterpretation of this lesion as metastases.
Bile Collection Detected With BrIDA Scintigraphy in a Patient With Hepatocellular Carcinoma
Authors: Daria Maccora, Daniela Di Giuda, Francesca Romana Ponziani, Maurizio Pompili, Venanzio Valenza
Journal: Clinical Nuclear Medicine (2018)

A 47-year-old man, with a history of anabolic steroid abuse, developed hepatic adenomatosis and multifocal hepatocellular carcinoma. He underwent ultrasound and CT follow-up, showing multiple solid and fluid hepatic lesions. Consequently, hospitalization was required because of high fever (up to 39°C), weakness, and anorexia. An abdominal CT scan revealed an enlargement of one of the intrahepatic fluid collections. Biochemical and microbiological analyses of a fluid sample showed bilirubin and bile acids as well as Streptococcus cristatus and Enterobacter cloacae. Thus, the patient underwent Tc-trimethylbromo-iminodiacetic acid scintigraphy, demonstrating bile collection in the lesion with a flow from a bile duct.
Development of a financial navigation program to ease the burden of financial toxicity.
Authors: Melissa Monak, Georgina T. Rodgers, Kimberly Bell, Antoinette Whitt, Shontia Gamble, Laron Jones, Tamara Mason, Ni'Ema Lewis
Journal: Journal of Clinical Oncology (2018)

124 Background: Due to the rising cost of cancer care, even well-insured patients are at risk for financial toxicity. Cancer treatment costs can be challenging for patients and families because of increasing deductibles, increasing premiums and frequent co-payments. At Cleveland Clinic Cancer Centers, our goal is to identify patients at risk for financial distress and help ease the financial stress and hardship associated with cancer care. Methods: The Financial Navigator (FN) role was created in 2016 to complete benefits investigations to determine covered services and minimize the patient’s out of pocket expenses. We are participants in the Oncology Care Model and are expected to provide and document the estimated out-of-pocket costs in the patient’s medical record. Navigators conduct telephone outreach calls with treatment patients to educate them on their benefits. The FN also assists with applications on copay assistance and free drug options. Finally, the FN will connect patients with resources for premium assistance and household expenses when copay assistance isn’t an option. The FN team has grown to 7 FTE’s since 2016. Results: Since 2016 the dollar amount approved through copay assistance applications has increased by 65%, the free drug value received increased by 62%, and YTD 2018 data shows that we have surpassed all of 2017 in what we collected towards patient out of pockets from copay assistance programs. We have also been able to comply with the out of pocket expense metric for OCM, not only for our Medicare patients, but for all of our treatment patients and compliance has risen from 44% in December 2017 to 98% in April 2018. Conclusions: In conclusion our Navigators have built relationships with Social Workers, Care Coordinators, and community services that are available to patients. This added benefit helps patients with non-medical financial stressors. The team can connect patients to organizations that can assist with household utilities, childcare concerns, food concerns, and mortgages. Utilization of the FN role has helped the healthcare team and patients to identify ways to mitigate the costs of care and distress related to financial concerns.
Timing of adjuvant chemotherapy administration for early breast cancer.
Authors: Andrew L. Salner, Shelby Smith, Peter Paul Yu
Journal: Journal of Clinical Oncology (2018)

62 Background: Adjuvant chemotherapy treatment has contributed to the reduction in cause-specific mortality from early stage breast cancer by reducing the risk of recurrence and metastasis. The initiation of adjuvant chemotherapy is typically started within 4-8 weeks following surgery. Although earlier treatment does not necessarily render a better prognosis, treatment delayed beyond 12 weeks may result in an unfavorable decrease in disease-free survival. In order to explore quality data for each of our 5 cancer centers and their breast surgeons, we conducted a quality outcomes project to examine our data and factors which could result in delay. Methods: We conducted a retrospective review evaluating all cases of patients diagnosed with stage 1 and 2 breast cancer at all of our cancer centers during the 2015 and 2016 calendar years, utilizing patient lists obtained from our cancer registries. Patients who received neoadjuvant chemotherapy or who had inadequate data were excluded. Variables included stage at diagnosis, percent of nodal positivity, age at diagnosis, race and ethnicity, attending surgeon, type of surgery (breast conservation vs. mastectomy +/- reconstruction), and number of days from final breast surgery to initiation of adjuvant chemotherapy treatment. Results: 757 and 319 patients with Stage I and II breast cancer respectively were identified in our 5 cancer centers. 16% had nodal positivity, and 25.6% received adjuvant chemotherapy. Average age at diagnosis was 62.5, and average age for node positive and adjuvant chemotherapy were 58.5 and 56.8. Days to chemotherapy ranged from 3-208, with 94% of patients treated in less than 12 weeks and ranges of mean days to begin chemotherapy 35.6 to 55.4 in our cancer centers. No significant differences were noted by age, race, ethnicity, stage, surgery type, surgeon, or hospital. Conclusions: This study reveals outcomes suggesting that our breast cancer teams at our cancer centers are meeting the current standard of care for initiation of adjuvant chemotherapy, and points to the value of quality studies in assuring standards of care.
Economic burden of brain metastases in patients with anaplastic lymphoma kinase positive (ALK+) non–small cell lung cancer (NSCLC) receiving second-line ALK inhibitors.
Authors: Huamao Mark Lin, Lucy Pan, Peijie Hou, Hui Huang, Avinash Desai, Mohammad Jahanzeb
Journal: Journal of Clinical Oncology (2018)

13 Background: De-novo brain metastases (BM) occur in 15-35% of patients with ALK+ NSCLC, and the prevalence increases to as high as 60% over the course of first-line crizotinib therapy. Reports on the economic burden of brain metastases in patients who progress on first-line therapy are scarce. The objective of this study was to evaluate the economic impact of BM among patients with ALK+ NSCLC treated with second-line ALK inhibitors. Methods: This retrospective study used the Optum Research database to identify adult patients with a lung cancer diagnosis code (≥1 inpatient claim or ≥2 outpatient claims ≥30 days but ≤1 year apart) and use of a second-line ALK inhibitor (e.g. alectinib or ceritinib) after crizotinib, between January 2011 and March 2017. Index date was defined as the date of the first claim with a second-line ALK inhibitor. BM were identified if the patient had BM diagnosis prior to index date. Healthcare costs and resource utilization were calculated on a per-patient-per-month (PPPM) basis up to 12 months of follow up after index date. Multivariate regression was used to assess the impact of BM on PPPM cost, while controlling for patient demographics, comorbidities and type of second-line ALK inhibitor. Results: 523 patients with NSCLC received at least one ALK inhibitor during the study period. Use of a second-line ALK inhibitor (alectinib or ceritinib post-crizotinib) was observed in 112 patients (43 alectinib, 69 ceritinib). Among second-line ALK inhibitor users, 52.7% (n = 59) had BM. In those with BM, the PPPM total healthcare costs were $26,415 compared with $21,278 in those without BM. Regression results showed that the adjusted mean total PPPM cost for those receiving second-line ALK inhibitor with BM was 1.39 times as high as those without BM (p-value = 0.0287). Conclusions: Economic burden of brain metastases is high for ALK+ NSCLC patients receiving second-line ALK inhibitors. The study highlights the economic value of novel therapies to delay brain metastases during early lines of therapy in these patients.
Abstract P177: Potential Value of Intensive Blood-Pressure Treatment Based on Predicted Lifetime Cardiovascular Disease at Age 40: Computer Simulation Study
Authors: Anusorn Thanataveerat, Sonia Singh, Ciaran Kohli-Lynch, Yiyi Zhang, Eric Vittinghoff, Mark Pletcher, Andrew E Moran
Journal: Circulation (2018)

Introduction: In the SPRINT trial, intensive blood pressure (BP) treatment saved lives and was cost-effective in high-risk older adults. It is unclear if intensive BP treatment should be extended to high-risk adults aged 40-49 years. Objectives: We used individual patient computer simulation to assess the incremental value of extending intensive BP treatment to adults as young as age 40 with high cardiovascular disease (CVD) risk. We selected patients aged &lt;60 years with high lifetime risk because few have high ten-year risk. Methods: Male and female cohorts of 100,000 individuals were assembled from NHANES surveys 1999-2010 using sampling weights. BP and other risk factor trajectories were projected for ages 40 to 69 years based on Framingham Offspring Cohort analyses. The “standard of care” treatment scenario simulated treating BP &lt;140/90 mmHg in all patients ≥140/90 mmHg. Two alternative scenarios were simulated: add intensive treatment (goal &lt;130/90 mmHg) from age 40-69 or from age 50-59 in patients with high lifetime risk. The lifetime risk thresholds (Table 1) were chosen in order to capture patients with forecasted ten-year CVD risk ≥ 10% at age 60. Costs included added treatment and side-effect costs and avoided CVD costs; indexed to 2016. Incremental cost-effectiveness ratios (ICERs) assessed changes in costs and quality-adjusted life years due to adding intensive BP goals. Results: Over a 30-year time horizon, adding intensive treatment in high lifetime risk patients at age 40 would prevent 2,880 additional CVD events in males and 2,958 in females compared to treating only BP &lt;140/90 mmHg. Intensive treatment in high lifetime risk patients before age 60 appeared generally cost-effective except in females aged 40 years (ICER $59,000). Conclusion: Our results suggest that over the long term, intensive BP treatment may be cost-effective in high-risk men as young as 40 and high-risk women as young as 50. Lifetime cardiovascular disease risk might be used to select high risk middle-aged adults for intensive BP treatment.
Abstract 19759: Improvement of Diastolic Function by Exosome Injection in a Rat Model of Heart Failure With Preserved Ejection Fraction
Authors: Jae Hyung Cho, Romain Gallet, Geoffrey de Couto, Lizbeth Sanchez, Eduardo Marbán, Eugenio Cingolani
Journal: Circulation (2016)

Introduction: Cardiosphere-derived cells (CDCs) improve diastolic function when injected in rats with heart failure with preserved ejection fraction (HFpEF) by decreasing inflammation and fibrosis....
Navigating Speed Bumps on the Innovation Highway in Hemophilia Therapeutics
Authors: Donna M. DiMichele
Journal: HemaSphere (2018)

The unprecedented emergence of novel therapeutics for both hemophilia A and B during the last half decade has been accompanied by the promise of even more extraordinary progress in ameliorative and curative strategies for both disorders. Paradoxically, the speed of innovation has created new dilemmas for persons with hemophilia and their physicians with respect to optimizing individual choices from the expanding menu of standard and novel therapies and approaches to symptom or risk reduction, and ultimately, to normalizing the hemophilia phenotype. Among the most disruptive new approaches, challenges remain in the form of the adverse reactions that have been observed with nonfactor therapies, as well as in the uncertain long-term safety profile of potentially curative gene therapy. Together, these challenges have generated uncertainty as to how to adopt novel therapies and treatment strategies across a diverse patient population, creating speed bumps on the hemophilia innovation highway. It is from this perspective that this article discusses the current state of gene therapy and bleeding prophylaxis for hemophilia A and B, as well as prevention and treatment of the factor VIII inhibitor phenotype in hemophilia A. It further posits that these speed bumps may provide important clues to the mechanistic understanding of both symptom manifestation and resilience within the hemophilia phenotype, as well as opportunities to reconsider and reconfigure the current paradigms for symptom prediction and individualized therapeutic decision making.