tbuckley/cabot-search huggingface dataset:
Long-term impact of patient navigation (PN) for breast cancer (BCA) screening in an urban academic medical center.
Authors: Lisa Phuong, Jesus Del Santo Anampa Mesias, Melanie Lozada, Della F. Makower
Journal: Journal of Clinical Oncology (2020)

130 Background: PN improves BCA screening rates in underserved women, and decreases health care disparities. However, there is limited data regarding the ability of PN effect sustained change. We evaluated the long-term impact of PN for BCA screening at our institution, by assessing the rate at which women who underwent screening mammogram (SM) in 2017, with the aid of PN, completed subsequent (f/u) SM within guideline-concordant time frames. Methods: Patients (pts) consisted of women seen by our institution’s primary care providers, with referral for SM in the electronic medical record (EMR), but without scheduled appointment, who received PN between June 1 and September 30, 2017, and successfully completed SM in 2017. Pts were identified from the screening navigation database. EMR was reviewed to obtain demographic data, rate of f/u SM, and time from 2017 SM to prior and f/u SM. Wilcoxon signed-rank test was used for analysis. Results: 179 pts completed SM with the aid of PN in 2017. Median age was 58 (range 37-77), 52.5% were Hispanic, 26.8% Black; and 2.8% Asian. Preferred languages were English (70.4%) and Spanish (25.7%). 6 pts had never had prior SM; 30 had no prior SM at our institution. Median time between 2017 SM and prior SM was 29 months (mo) (range 12-104); only 20 pts (11.2%) had a prior SM within 24 mo. 177 pts were eligible for f/u SM in 2018 and 2019 (1 diagnosed with BCA on 2017 SM; 1 died in 2017). 85 pts (48%) completed f/u SM; 68 (39%) completed within 24 mo. Only 2 pts required PN to complete f/u SM. In pts with time to screening data available for both 2017 SM and f/u SM (n = 80), median time to SM improved from 24 to 16 mo (p &lt; 0.01). Decreases were seen in Black (22 to 14 mo, p &lt; 0.01), White (31 to 16 mo, p = 0.03), and Hispanic pts (28 to 18.5 mo, p &lt; 0.01), and in English (22 to 15 mo, p &lt; 0.01) and Spanish speakers (26 to 20 mo, p &lt; 0.01). Conclusions: A single episode of PN for BCA screening had a sustained impact on pts at our institution, leading to improved compliance with future SM. Improvement was seen in pts of diverse races, ethnicities, and language preferences. Focused PN for pts who did not complete f/u SM is planned.
Precision 3D‐Printed Cell Scaffolds Mimicking Native Tissue Composition and Mechanics
Authors: Amelie Erben, Marcel Hörning, Bastian Hartmann, Tanja Becke, Stephan A. Eisler, Alexander Southan, Séverine Cranz, Oliver Hayden, Nikolaus Kneidinger, Melanie Königshoff, Michael Lindner, Günter E. M. Tovar, Gerald Burgstaller, Hauke Clausen‐Schaumann, Stefanie Sudhop, Michael Heymann
Journal: Advanced Healthcare Materials (2020)

Cellular dynamics are modeled by the 3D architecture and mechanics of the extracellular matrix (ECM) and vice versa. These bidirectional cell-ECM interactions are the basis for all vital tissues, many of which have been investigated in 2D environments over the last decades. Experimental approaches to mimic in vivo cell niches in 3D with the highest biological conformity and resolution can enable new insights into these cell-ECM interactions including proliferation, differentiation, migration, and invasion assays. Here, two-photon stereolithography is adopted to print up to mm-sized high-precision 3D cell scaffolds at micrometer resolution with defined mechanical properties from protein-based resins, such as bovine serum albumin or gelatin methacryloyl. By modifying the manufacturing process including two-pass printing or post-print crosslinking, high precision scaffolds with varying Young's moduli ranging from 7-300 kPa are printed and quantified through atomic force microscopy. The impact of varying scaffold topographies on the dynamics of colonizing cells is observed using mouse myoblast cells and a 3D-lung microtissue replica colonized with primary human lung fibroblast. This approach will allow for a systematic investigation of single-cell and tissue dynamics in response to defined mechanical and bio-molecular cues and is ultimately scalable to full organs.
Results of a pilot study to increase adherence to ASCO G-CSF recommendations at community clinics.
Authors: Karma L. Kreizenbeck, Kathryn Egan, Tracy Wong, Barbara Jagels, Barbara Jensen, Julie C. Smith, Blair Billings Irwin, Heather Noble, Scott David Ramsey
Journal: Journal of Clinical Oncology (2020)

19 Background: An ASCO 2012 Choosing Wisely recommendation cautions against the use of primary prophylactic colony stimulating factors (PP-CSF) for chemotherapy regimens with &lt;20% risk of febrile neutropenia (FN). Our pilot aimed to test the feasibility and impact of using academic detailing and an automated CSF ordering system on CSF prescribing at 6 regional community oncology clinics in Washington State. Methods: The intervention was 1) academic detailing for oncologists during a regular staff meeting and 2) reconfiguring ordering systems to show FN risk and PP-CSF recommendation in a passive alert and include or exclude PP-CSF standing orders with &gt;20% or ≤20% FN risk regimens, respectively. Clinic tumor registries were queried for patients with stage II-IV breast, non-small cell lung, or colorectal cancer starting first-line chemotherapy pre- or post-intervention. PP-CSF use, FN risk factors, and chemotherapy regimens matching the study protocol were manually abstracted. A regimen order was coded as adherent if it is low (&lt;10%) FN risk without PP-CSF use; intermediate (10-20%) FN risk without PP-CSF use or FN risk factors are present; or high (&gt;20%) FN risk with PP-CSF use. Results: The intervention was successfully implemented at 4 out of 6 participating clinics. The remaining 2 clinics were transitioning from paper to electronic orders in 1-2 years or using a system managed by a non-participating hospital. Adherence across the four implementing clinics increased after the intervention. *=p&lt;0.05 Implementation of the CSF order-entry intervention was successful across a variety of ordering systems, including paper-based systems. Overall, while adherence prior to the intervention was high for these clinics, the order entry systems significantly improved adherence. Population characteristics and data availability may account for variation in adherence. Conclusions: An intervention with both academic detailing and ordering system presets may help increase adherence to Choosing Wisely recommendations. [Table: see text]
Knowledge and evaluation of geriatric assessment (GA) domains among U.S. community oncologists/hematologists (cOH).
Authors: Ajeet Gajra, Stephanie Fortier, Yolaine Jeune-Smith, Bruce A. Feinberg
Journal: Journal of Clinical Oncology (2020)

206 Background: GA is a multidisciplinary assessment consisting of the following domains: physical function, comorbidity, cognition, mood, social support, nutrition and medication review. Conducting a GA with validated instruments to assess these domains has been shown to improve outcomes in older adults with cancer [Soo, et al ASCO 2020]. The utilization of validated GA tools and its domains versus use of other surrogates from history and physical exam (HPE) for risk-stratification in older adults in the community practice setting is unclear. In this survey-based study, we assessed the knowledge of GA and the methods used to evaluate GA domains among cOH. Methods: Questions pertaining to GA and the care of older adults with cancer were developed by two medical oncologists (AG and BAF) and presented to cOH with diverse US geographic representation at live meetings and via web-based questionnaire between September 2019 and March 2020. Results were analyzed using descriptive statistics. Results: Of the 173 participants surveyed, 59% reported performing no GA, while 13% and 28% reported performing GA on all and selected older adults, respectively. When presented with a list of daily living activities, over half of cOH were unable to correctly identify all activities of daily living (ADLs) and instrumental ADLs (56% and 70%, respectively). The top 2 methods used by cOH to assess physical functional were the ECOG performance status (82%) and HPE (42%). For assessment of cognition, most cOH used HPE (78%) or the Mini Mental State Exam (MMSE; 12%). Social support was assessed via HPE (44%) or GA (27%). cOH reported that medication review is performed by an office staff (medical assistant 31%, nurse 12%, pharmacist 5%), with the physician signing off on the information reported in the chart irrespective of who entered the medication information (50%). Regarding chemotherapy dosing in older adults with cancer, only 7% utilized GA to inform chemotherapy dose; 48% reported starting at a lower chemotherapy dose with intent to escalate, while 33% reported starting at the standard dose with intent to de-escalate if toxicity is encountered. Lastly, 27% stated that oncologists are not adequately equipped to care for older adults with cancer given the complexity involved. Conclusions: Many cOH do not utilize validated instruments to assess the domains of GA. There also appear to be knowledge gaps regarding individual domains of GA. There is a need to further the education of cOH regarding the components and value of GA in older adults with cancer.
Economic Costs of Diabetes in the U.S. in 2017
Journal: Diabetes Care (2018)

This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017.We use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S.The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.
Adverse event clusters present at dose-reduction in CLL patients on ibrutinib in the U.S. Veterans Health Administration.
Authors: Christopher R Frei, Kellie Ryan, Hannah Le, Daniel McHugh, Obiageri O Obodozie-Ofoegbu, Chengwen Teng, Xavier Jones, Samantha Galley, Kathleen Franklin, Juan Tavera, Michelle Janania Martinez, David Gregorio, Snegha Ananth, Ricardo Uribe, Prathibha Surapaneni, Manuel Ricardo Espinoza-Gutarra, Michael Song, Zohra Nooruddin
Journal: Journal of Clinical Oncology (2020)

252 Background: Previously, we reported that adverse events (AEs) were the top reason for dose reductions in VHA patients on novel agents. Some AEs might be problematic but might not directly lead to dose reduction; however, these concomitant AEs should not be overlooked. This study describes AE clusters that occurred with the primary AE that led to dose reduction in VHA CLL patients receiving ibrutinib. Methods: This is a retrospective chart review study of CLL patients treated with ibrutinib in the VHA from October 2013 to March 2018. Variables included the presence of dose reduction, the reasons for dose reduction, primary AEs leading to dose reduction, and concomitant AEs present at the time of dose reduction. Descriptive statistics were used to summarize AE clusters. Results: Out of 1069 CLL patients on ibrutinib, 285 patients experienced dose reduction due to AEs and were included in this analysis. The most common AEs leading to dose reduction were: musculoskeletal (11%), bleeding (11%), fatigue (10%), infection (9%), atrial fibrillation (8%), diarrhea (8%), and rash (8%). Fatigue was the leading concomitant AE present at dose reduction among patients who were dose reduced due to musculoskeletal (18%), infection (12%), diarrhea (18%), and rash (25%). Fatigue was also the second-leading or third leading concomitant AE among those who were dose reduced due to atrial fibrillation (13%) or bleeding (10%). Musculoskeletal was the leading or second-leading concomitant AE present at dose reduction among those who were dose reduced due to fatigue (17%), infection (12%), or diarrhea (14%). Bleeding was the leading concomitant AE among those who were dose reduced due to atrial fibrillation (17%) and vice versa. Conclusions: This study provides evidence that fatigue and musculoskeletal AEs are problematic in CLL patients on ibrutinib in the VHA. These were not only among the most common primary AEs but also the leading concomitant AEs present at dose reduction. Although not directly leading to dose reduction, these ‘nuisance’ AEs can greatly affect quality of life among CLL patients and warrant more attention from clinicians. A better understanding of all AEs present at dose reduction may help clinicians better manage patients on novel agents. These data also highlight the unmet need for novel agents with a ‘cleaner’ safety profile.
Melphalan and Exportin 1 Inhibitors Exert Synergistic Antitumor Effects in Preclinical Models of Human Multiple Myeloma
Authors: Joel G. Turner, Yan Cui, Alexis A. Bauer, Jana L. Dawson, Juan A. Gomez, Jongphil Kim, Christopher L. Cubitt, Taiga Nishihori, William S. Dalton, Daniel M. Sullivan
Journal: Cancer Research (2020)

High-dose chemotherapy with melphalan followed by autologous transplantation is a first-line treatment for multiple myeloma. Here, we present preclinical evidence that this treatment may be significantly improved by the addition of exportin 1 inhibitors (XPO1i). The XPO1i selinexor, eltanexor, and KOS-2464 sensitized human multiple myeloma cells to melphalan. Human 8226 and U266 multiple myeloma cell lines and melphalan-resistant cell lines (8226-LR5 and U266-LR6) were highly sensitized to melphalan by XPO1i. Multiple myeloma cells from newly diagnosed and relapsed/refractory multiple myeloma patients were also sensitized by XPO1i to melphalan. In NOD/SCIDγ mice challenged with either parental 8226 or U266 multiple myeloma and melphalan-resistant multiple myeloma tumors, XPO1i/melphalan combination treatments demonstrated stronger synergistic antitumor effects than single-agent melphalan with minimal toxicity. Synergistic cell death resulted from increased XPO1i/melphalan-induced DNA damage in a dose-dependent manner and decreased DNA repair. In addition, repair of melphalan-induced DNA damage was inhibited by selinexor, which decreased melphalan-induced monoubiquitination of FANCD2 in multiple myeloma cells. Knockdown of FANCD2 was found to replicate the effect of selinexor when used with melphalan, increasing DNA damage (γH2AX) by inhibiting DNA repair. Thus, combination therapies that include selinexor or eltanexor with melphalan may have the potential to improve treatment outcomes of multiple myeloma in melphalan-resistant and newly diagnosed patients. The combination of selinexor and melphalan is currently being investigated in the context of high-dose chemotherapy and autologous transplant (NCT02780609). SIGNIFICANCE: Inhibition of exportin 1 with selinexor synergistically sensitizes human multiple myeloma to melphalan by inhibiting Fanconi anemia pathway-mediated DNA repair.
Quetiapine augmentation of prolonged exposure therapy in veterans with PTSD and a history of mild traumatic brain injury: design and methodology of a pilot study
Authors: Muhammad R. Baig, Robert D. Beck, Jennifer L. Wilson, Jennifer A. Lemmer, Adeel Meraj, Eric C. Meyer, Jim Mintz, Alan L. Peterson, John D. Roache
Journal: Military Medical Research (2020)

Selective serotonergic reuptake inhibitors (SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder (PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury (mTBI) is problematic since SSRIs could exacerbate post-concussion syndrome (PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy. We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of mTBI. We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full- scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans. NCT04280965 .
Covid-19: Only half of 16 000 patients missed from England’s official figures have been contacted
Authors: Elisabeth Mahase
Journal: BMJ (2020)

Details of nearly 16 000 cases of covid-19 were not transferred to England's NHS Test and Trace service and were missed from official figures because of an error in the process for updating the data.England's health and social care secretary, Matt Hancock, told the House of Commons on Monday 5 October that after the error was discovered on Friday 2 October "6500 hours of extra contact tracing" had been carried out over the weekend.But as at Monday morning only half (51%) of the people had been reached by contact tracers.
State-wide quality improvement addressing overutilization of neurokinin-1 receptor antagonists.
Authors: Emily R. Mackler, Kelly Marie Procailo, Louise Bedard, Jennifer J. Griggs
Journal: Journal of Clinical Oncology (2020)

8 Background: The overuse of neurokinin-1 receptor antagonists (NK1-RAs) is a focus of quality measurement within the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO-QOPI) and the American Board of Internal Medicine (ABIM) as a Choosing Wisely measure. The Michigan Oncology Quality Collaborative (MOQC) is a statewide collaborative with participation of nearly 100% of oncologists. The purpose of this project was to provide quality improvement practice support for deimplementation of NK1-RAs in the upfront prevention of chemotherapy- induced nausea and vomiting (CINV) for low and moderate emetic chemotherapy regimens (QOPI measure SMT28a) to less than 30% in practices across the State, with lower scores indicating better performance. Methods: In 2018, MOQC added the QOPI SMT28a measure as part of its standard quality measure module for collection by all MOQC practices. A quality improvement intervention was initiated that consisted of 1) baseline assessments of measure performance, prescriber knowledge and beliefs, and pre-populated antiemetic order sets, 2) reporting practice and state-level performance to MOQC practices, 3) state-wide CINV education, and 4) a value-based reimbursement (VBR) related to measure performance. Post-intervention performance was assessed with the Fall 2019 and Spring 2020 QOPI-measurement. Results: Responses from a survey assessing pre-populated antiemetic order sets (32/43, 74% response rate), 23% of practices had a pre-populated order set for NK1-RA and/or olanzapine in moderate emetic regimens. The post-education order set survey found that 48% of respondents (25/43, 54% response rate) either modified or were in the process of modifying their order sets. Conclusions: Deimplementation of unnecessary and low value antiemetics in patients receiving low- or moderate emetic chemotherapy was possible via a state-wide quality improvement program that involved performance reporting to practices, collaborative-wide education, modification of standing order sets, and VBR based on performance. [Table: see text]