tbuckley/cabot-search huggingface dataset:
Application of a Natural Language Processing Algorithm to Asthma Ascertainment. An Automated Chart Review
Authors: Chung-Il Wi, Sunghwan Sohn, Mary C. Rolfes, Alicia Seabright, Euijung Ryu, Gretchen Voge, Kay A. Bachman, Miguel A. Park, Hirohito Kita, Ivana T. Croghan, Hongfang Liu, Young J. Juhn
Journal: American Journal of Respiratory and Critical Care Medicine (2017)

Difficulty of asthma ascertainment and its associated methodologic heterogeneity have created significant barriers to asthma care and research.We evaluated the validity of an existing natural language processing (NLP) algorithm for asthma criteria to enable an automated chart review using electronic medical records (EMRs).The study was designed as a retrospective birth cohort study using a random sample of 500 subjects from the 1997-2007 Mayo Birth Cohort who were born at Mayo Clinic and enrolled in primary pediatric care at Mayo Clinic Rochester. Performance of NLP-based asthma ascertainment using predetermined asthma criteria was assessed by determining both criterion validity (chart review of EMRs by abstractor as a gold standard) and construct validity (association with known risk factors for asthma, such as allergic rhinitis).After excluding three subjects whose respiratory symptoms could be attributed to other conditions (e.g., tracheomalacia), among the remaining eligible 497 subjects, 51% were male, 77% white persons, and the median age at last follow-up date was 11.5 years. The asthma prevalence was 31% in the study cohort. Sensitivity, specificity, positive predictive value, and negative predictive value for NLP algorithm in predicting asthma status were 97%, 95%, 90%, and 98%, respectively. The risk factors for asthma (e.g., allergic rhinitis) that were identified either by NLP or the abstractor were the same.Asthma ascertainment through NLP should be considered in the era of EMRs because it can enable large-scale clinical studies in a more time-efficient manner and improve the recognition and care of childhood asthma in practice.
Comparison of initial and recertification QOPI scores: Maintaining compliance through direct surveyor and practice interaction.
Authors: Anne C. Chiang, Constance Barysauskas, Tara Conti-Kalchik, Terry Gilmore, Carolyn Bennett Hendricks, Michael N. Neuss, Joseph O. Jacobson
Journal: Journal of Clinical Oncology (2017)

246 Background: Since 2006, the ASCO QOPI certification program has certified 322 practices, of which 197 practices have recertified. This retrospective study compares the number and type of standards passed at the time of initial and subsequent re-certification, and examines if on-site audits at the original certification influenced re-certification scores. Methods: 87 unique US practices that obtained QOPI certification with on-site audits at the original and re-certification between 2006 and 2014 were included. 17 QOPI certification standards were included in the analysis. Standards are metric based, except 3 standards that are observable. We defined total score per certification round as the total number of standards passed and used a Wilcoxon Rank Sum Test to test the concordance of standards passed between rounds. Linear regression models were used to identify factors related to higher recertification scores. A two-sided p&lt;0.05 defined statistical significance. Results: 31 practices (36%) showed concordance of the 3 observable standards in the initial and re-certification rounds. For standards that assess policies, procedure and credentials of the practice, and do not require direct observation, 52 practices demonstrated improvement whereas 14 did not (p&lt;0.0001). In contrast, for the standards that require direct observation, only 22 practices showed improvement versus 34 that did not (p=0.07). Three standards were most commonly missed in both rounds: initial chart documentation and at each clinical visit, and double verification of chemotherapy administration. There were no significant predictors of higher recertification scores. Conclusions: Many diverse oncology practices are voluntarily achieving and maintaining QOPI certification. Sustainable improvement is easier to identify in policy-based measures compared to directly observed ones. Three standards not usually passed at recertification highlight the need for assessment of psychosocial and performance status, comprehension of treatment goals, and chemotherapy double-verification. On-site evaluation of practices is key for targeting and sustaining quality efforts.
Maternal Body Mass Index in Early Pregnancy and Risk of Epilepsy in Offspring
Authors: Neda Razaz, Kristina Tedroff, Eduardo Villamor, Sven Cnattingius
Journal: JAMA Neurology (2017)

There is growing concern about the long-term neurologic effects of prenatal exposure to maternal overweight and obesity. The causes of epilepsy are poorly understood and, in more than 60% of the patients, no definitive cause can be determined.To investigate the association between early pregnancy body mass index (BMI) and the risk of childhood epilepsy and examine associations between obesity-related pregnancy and neonatal complications and risks of childhood epilepsy.A population-based cohort study of 1 441 623 live single births at 22 or more completed gestational weeks in Sweden from January 1, 1997, to December 31, 2011, was conducted. The diagnosis of epilepsy as well as obesity-related pregnancy and neonatal complications were based on information from the Sweden Medical Birth Register and National Patient Register. Multivariate Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% CIs after adjusting for maternal age, country of origin, educational level, cohabitation with partner, height, smoking, maternal epilepsy, and year of delivery. Data analysis was conducted from June 1 to December 15, 2016.Risk of childhood epilepsy.Of the 1 421 551 children born between January 1, 1997, and December 31, 2011, with covariate information available, 7592 (0.5%) were diagnosed with epilepsy through December 31, 2012. Of these 3530 (46.5%) were female. The overall incidence of epilepsy in children aged 28 days to 16 years was 6.79 per 10 000 child-years. Compared with offspring of normal-weight mothers (BMI 18.5 to <25.0), adjusted HRs of epilepsy by maternal BMI categories were as follows: overweight (BMI 25.0 to <30.0), 1.11 (95% CI, 1.04-1.17); obesity grade I (BMI 30.0 to <35.0), 1.20 (95% CI, 1.10-1.31); obesity grade II (BMI 35.0 to <40.0), 1.30 (95% CI, 1.12-1.50); and obesity grade III (BMI≥40.0), 1.82 (95% CI, 1.46-2.26). The rates of epilepsy were considerably increased for children with malformations of the nervous system (adjusted HR, 46.4; 95% CI, 42.2-51.0), hypoxic ischemic encephalopathy (adjusted HR, 23.6; 95% CI, 20.6-27.1), and neonatal convulsions (adjusted HR, 33.5; 95% CI, 30.1-37.4). The rates of epilepsy were doubled among children with neonatal hypoglycemia (adjusted HR, 2.10; 95% CI, 1.90-2.33) and respiratory distress syndrome (adjusted HR, 2.43; 2.21-2.66), and neonatal jaundice was associated with more than a 50% increased risk of epilepsy (adjusted HR, 1.47; 95% CI, 1.33-1.63). The elevated risk of epilepsy in children of overweight or obese mothers was not explained by obesity-related pregnancy or neonatal complications.The rates of childhood epilepsy increased with maternal overweight or obesity in a dose-response manner. Given that overweight and obesity are modifiable, prevention of obesity may be an important public health strategy to reduce the incidence of childhood epilepsy.
Development and pilot of brief surveys to evaluate the quality of patient-centered cancer care.
Authors: Marcy Winget, Farnoosh Haji-Sheikhi, Steve Asch
Journal: Journal of Clinical Oncology (2017)

202 Background: Oncology practices have increasingly engaged in patient-centered systematic quality improvement efforts. One test of their effectiveness is patient feedback, yet many existing instruments are unwieldy or insensitive to change. Here we describe the development and pilot testing of short patient surveys used to assess change in patient experience of the key domains of access, communication, and coordination. Methods: Domains and corresponding questions of patient-centered care were informed by existing literature and tools available online, with a focus on domains relevant to cancer patients. Questions were modified from validated or semi-validated instruments to have a consistent 4 or 5-category Likert response scale, put into four unique short instruments that included at most ten questions each and piloted in cancer clinic waiting rooms. Input from patients was sought to assess: 1) relevance and clarity of questions; 2) whether important concepts were missing; 3) acceptability to patients regarding place and timing of surveys and; 4) estimate top box scores. Internal consistency of the final question sets for each domain was examined using Cronbach’s alpha. Results: Patient feedback from the pilot was positive with respect to all above categories. The following modifications were made based on top box score analysis: 1) created a common 5-point Likert scale for all questions and 2) excluded questions with a top box score higher than 80%. An open comment field was also added to complement the quantitative responses. Cronbach’s alpha for all domains was ≥ 0.80 expect for the access domain which was 0.51. The final 4 complementary instruments have 7-8 questions each and take only a few minutes for patients to complete. Each return patient receives one of the instruments randomly at clinic visits so information on all domains is continuously collected and a given patient has the opportunity to provide feedback on all domains over time; response rates are approximately 60%. Conclusions: The short surveys are being used to assess the effectiveness of interventions. Other cancer centers and their patients may find similar short surveys an improvement over general patient satisfaction surveys e.g., Press-Ganey.
Improving the quality of oncology fellows' clinical documentation.
Authors: Debasmita Saha, Susan Tannenbaum
Journal: Journal of Clinical Oncology (2017)

124 Background: Proper documentation in oncology is a vital skill for fellows to learn. It not only allows for delivery of safe patient care by providing a mean for communication within providers, but it is also essential for coding and reimbursements, audits, research, quality/healthgrade scores and provides the the main body of medico-legal defense. From an educational perspective, it takes into account all 6 competences of medical education and hence is an integral part of fellowship training. The objective of this quality improvement project is to improve our fellows' documentation by ensuring they communicate timely and effectively a comprehensive care plan. Methods: We identified 10 random charts of patients who are actively being treated with systemic therapy by 4 of our senior fellows. The initial and a random follow up notes were reviewed and 34 areas thought to be of importance, specifically in oncology, were identified and logged. Verbal and written feedbacks were provided regarding their performances and areas of improvement, after which charts were re-evaluated in 6 months. Results: See table below. Conclusions: We successfully improved the fellows' documentation skills through this project, creating a better practice module. [Table: see text]
Phase I/II study of a docetaxel (DOC) and gemcitabine (GEM) combination for early recurrent (≤12 months)(ER) or refractory (R) epithelial ovarian cancer (EOC): Kansai Clinical Oncology Group, Japan
Authors: Y. Itani, S. Adachi, K. Ito, S. Takeuchi, M. Akiyama, K. Hosokawa, T. Tabata, H. Tsubamoto, H. Fujita, H. Nakamura
Journal: Journal of Clinical Oncology (2004)

5046 Background:There is no standard chemotherapy regimen for EOC that does not respond to platinum-based chemotherapy (R-EOC), or responds but progresses within 12 months after completing chemotherapy (ER-EOC). Purpose: To determine the efficacy of a DOC and GEM combination for R-EOC or ER-EOC, we conducted phase 1/2 study. Methods:Between October 2000 and November 2003, R-EOC or ER-EOC patients (pts) entered this multi-institutional study. Eligible criteria: histologically verified EOC, age 16 -75 years, ECOG-PS ≤2, adequate bone marrow, hepatic, and renal function, and written informed consent. GEM was administered on days 1 and 8, and DOC on day 8. This treatment was repeated every 3 weeks. The doses were escalated as follows: dose level 1 (DL1); DOC 70 mg/m2, GEM 800 mg/m2, DL2: DOC 70 mg/m2, GEM 1000 mg/m2. Toxicities were assessed according to NCI-CTC ver2.0J and responses were assessed according to both RECIST for measurable disease and Rustin's criteria for CA125. Results:Thirty-four pts were enrolled and administered 95 cycles. The median cycle was 3 (1–7 cycles), median age was 56 years (21 to 74 years), and median interval from prior chemotherapy was 2 months (1 to 12 months). Seventeen pts received more than 3 chemotherapy regimens before the enrollment. Three pts experienced no dose-limiting toxicities (DLTs) in DL1. Two of the three pts in DL2 were experienced DLTs: febrile neutropenia grade 3 (1), and thrombocytopenia grade 4 (1). Then, 28 patients were subjected to the phase 2 study with DL1 as a recommended dose. Thirty-two patients were assessable for response. Response rate was 19.1% (6/32) with 1CR (3.1%), 5PR (16%), and 9SD(28%). One-year and 2-year survival were 51.2% and 23.4%, respectively. The median survival time was 13 months. Toxicities were mainly hematological (G3/G4): neutropenia (16%/50%), thrombocytopenia (19%/0%), anemia (13%/0%), and febrile neutropenia (3%/0%). There were no grade 3 or 4 non-hematological toxicities. Conclusions:A DOC and GEM combination for R-EOC and ER-EOC with DL1 is active and well tolerable. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Eli Lilly Japan K.K.
BRCA1/2 mutations as prognostic factors in bilateral breast cancer (BC) patients
Authors: J. Rogozinska, B. Utracka-Hutka, E. Grzybowska, E. Nowicka, B. Maka, J. Steffen
Journal: Journal of Clinical Oncology (2004)

9647 Background: Incidence of primary bilateral BC is rare and not extending 5%. BRCA1/2 mutation carriers diagnosed with BC have a strong life time risk of developing a contralateral BC (53% vs 2%). Methods: We analyzed the group of 108 patients with bilateral BC who attended our Cancer Center between 2000 and 2002 and who gave their consent for genetic test. Patients with synchronous BC were defined as having contralateral BC within 1 year. Similarities and differences between BRCA1/2 carriers and non carriers were analyzed in terms of family history, pathology of tumor, age of diagnosis and development of contralateral BC and second cancer. Results: The median age of the group at the time of diagnosis of BC was 47 years (28–76). Before age of 50, BC developed 73% of patients, including 22% before age of 40. Synchronous BC was diagnosed in 30 (28%) patients, metachronous in 78 (72%). Family history of BC was present in 32/108 patients, and of ovarian cancer in 5/108 patients. BRCA1/2 mutation was detected in 32/108 patients. Family history of BC was identified in 46,9% of these patients, comparing to 22,4% of non carriers (p<0.05). Synchronous BC was diagnosed significantly rarer 4/32 (12.5%) in BRCA1/2 carriers than in non carriers group 26/76 (34.2%). Also patients with BRCA mutations when diagnosed were younger than non carriers (41.3 vs 47.9) and time to diagnosis of contralateral BC was shorter. BRCA1/2 carriers had significantly higher incidence of medullary BC (13.6% vs 1.7%). There was no difference in the incidence of other tumor pathology. BRCA1/2 carriers developed significantly more frequent ovarian cancer than non carriers 12/32 and 1/72 respectively. Conclusions: Patients with bilateral BC having BRCA mutations are significantly younger, than non carriers and time of developing of contralateral BC is shorter.They have significantly more frequent family history of BC and higher risk of developing of ovarian cancer. The differences in clinical aspects of BRCA carriers with bilateral BC, should be considered in clinical management. No significant financial relationships to disclose.
Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial
Authors: Julia K Prague, Rachel E Roberts, Alexander N Comninos, Sophie Clarke, Channa N Jayasena, Zachary Nash, Chedie Doyle, Deborah A Papadopoulou, Stephen R Bloom, Pharis Mohideen, Nicholas Panay, Myra S Hunter, Johannes D Veldhuis, Lorraine C Webber, Les Huson, Waljit S Dhillo
Journal: The Lancet (2017)

Hot flushes affect 70% of menopausal women and often severely impact physical, psychosocial, sexual, and overall wellbeing. Hormone replacement therapy is effective but is not without risk. Neurokinin B signalling is increased in menopausal women, and has been implicated as an important mediator of hot flushes.This phase 2, randomised, double-blind, placebo-controlled, single-centre, crossover trial assessed the effectiveness of an oral neurokinin 3 receptor antagonist (MLE4901) on menopausal hot flushes. Eligible participants were healthy women aged 40-62 years, having seven or more hot flushes in every 24 h of which some were reported as being severe or bothersome, who had not had a menstrual period for at least 12 months, and who had not been taking any medication shown to improve menopausal flushes in the preceding 8 weeks. Participants received 4 weeks of MLE4901 (40 mg, orally, twice daily) and placebo (orally, twice daily) in random order separated by a 2 week washout period. Randomisation was completed by a central computer, and participants were allocated to treatment number in numerical order. The primary outcome was the total number of hot flushes during the final week of both treatment periods. Analyses were by intention to treat and per protocol using generalised linear mixed models and standard crossover analysis. All analyses were prespecified in the study protocol. The trial is registered at ClinicalTrials.gov, number NCT02668185.68 women were screened between Feb 3 and Oct 10, 2016, of which 37 were randomly assigned and included in an intention-to-treat analysis. 28 participants completed the trial and were included in a per-protocol analysis. MLE4901 significantly reduced the total weekly number of hot flushes by 45 percentage points (95% CI 22-67) compared with the placebo (intention-to-treat adjusted means: placebo 49·01 [95% CI 40·81-58·56] vs MLE4901 19·35 [15·99-23·42]; adjusted estimate of difference 29·66 [17·39-42·87], p<0·0001). Treatment was well tolerated. Three participants developed a transaminase rise (alanine aminotransferase 4·5-5·9 times the upper limit of normal) with a normal bilirubin 28 days after starting MLE4901, which normalised within 90 days.Treatment with a neurokinin 3 receptor antagonist (MLE4901) could be practice changing as it safely and effectively relieves hot flush symptoms without the need for oestrogen exposure. Larger scale studies of longer duration are now indicated.UK Medical Research Council and National Institute for Health Research.
The role of image-guided intensity modulated proton therapy in glioma
Authors: David R. Grosshans, Radhe Mohan, Vinai Gondi, Helen A. Shih, Anita Mahajan, Paul D. Brown
Journal: Neuro-Oncology (2017)

Gliomas represent a broad spectrum of disease with life-expectancy outcomes ranging from months to decades. As our understanding of the molecular profiles of gliomas expands rapidly, practitioners are now better able to identify patients with favorable versus nonfavorable prognoses. Radiation therapy plays a key role in glioma treatment, improving disease control and oftentimes survival. However, for survivors, either long-term or short-term, radiation-induced cognitive impairments may negatively impact their quality of life. For patients with both favorable and unfavorable prognoses, intensity modulated proton therapy (IMPT) may offer significant, yet unproven benefits. IMPT is the newest and most advanced proton delivery technique, one with substantial benefits compared with historical proton techniques. IMPT allows practitioners to maximize the physical benefits of protons, increasing normal tissue sparing and reducing the potential for adverse effects. For more aggressive tumors, the dose conformality and normal tissue sparing afforded by IMPT may also allow for dose escalation to target volumes. However, in order to truly maximize the clinical potential of IMPT, the field of radiation oncology must not only implement the most advanced technologies, but also understand and capitalize on the unique biologic aspects of proton therapy.
Health economic impact of breast cancer index (BCI) in patients with hormone responsive breast cancer (HRBC) considering extended adjuvant endocrine therapy (EET).
Authors: Tara Beth Sanft, Alyssa Berkowitz, Brock Schroeder, Christos Hatzis, Catherine A. Schnabel, Bilge Aktas, Adam M. Brufsky, Lajos Pusztai, Gary Gustavsen, G J. Van Londen
Journal: Journal of Clinical Oncology (2017)

25 Background: Previous research has demonstrated the benefit of EET for HRBC, however, the absolute benefit is modest and commits women to an extra 5 yrs of treatment. The Breast Cancer Index (BCI) is a gene expression-based test that has been validated to quantify the risk of late recurrence (BCI subscore) and to predict likelihood of benefit from EET (H/I subscore). We have previously shown that the use of BCI increases patient and physician confidence in decision-making and leads to fewer recommendations for EET. The current analysis extends our results to a larger sample size and presents a health economic analysis to assess the cost effectiveness of the use of BCI for EET decision-making. Methods: We developed a fact-based economic model to project the cost effectiveness of BCI using a cohort of 140 patients with stage I-III HRBC from Yale Cancer Center and University of Pittsburgh Medical Center who had completed ≥3.5 yrs of endocrine therapy and had undergone BCI testing in the context of this study. Physicians completed questionnaires to indicate their recommendations for EET before and after BCI results. Costs associated with EET, toxicity, follow-up, and metastatic recurrence were modeled over 5 yrs of extended therapy. Model inputs were based on published literature. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Changes in EET recommendations after BCI were observed in 29% of patients, with 21% changing from recommended to not recommended, and 8% from not recommended to recommended. The projected net cost savings of BCI testing in this population of patients who are disease free at 5 yrs post-diagnosis is $5,190 per patient tested. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving EET based on BCI results and decreased adverse events and comorbidities for patients with low BCI scores who did not receive EET. Conclusions: Based on the decision impact of BCI in a real-world cohort, the test is projected to be cost saving for women with early stage hormone receptor positive breast cancer who are recurrence free at 5 yrs post-diagnosis on adjuvant endocrine therapy.