tbuckley/cabot-search huggingface dataset:
Standardization of the inpatient oncology signout process.
Authors: Anish B Parikh, Elizabeth Aronson, Amir S. Steinberg, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2019)

253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]
Time driven activity-based costing methods used in radiation oncology clinics.
Authors: Shalini Moningi, Shane Mesko, Amy Catherine Moreno, Matthew S. Ning, Thomas A. Aloia, Seungtaek Choi, Melenda Jeter, Wendi Martinez, Iris Recinos, Thai Nguyen, John C. Frenzel, Katy E. French, Quynh Nguyen, Joseph M. Herman
Journal: Journal of Clinical Oncology (2019)

79 Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results. [Table: see text]
Ofatumumab (HuMax-CD20), a Novel CD20 Monoclonal Antibody, Is An Active Treatment for Patients with CLL Refractory to Both Fludarabine and Alemtuzumab or Bulky Fludarabine-Refractory Disease: Results from the Planned Interim Analysis of An International Pivotal Trial
Authors: Anders Osterborg, Thomas J. Kipps, Jiri Mayer, Stephan Stilgenbauer, Catherine D Williams, Andrzej Hellmen, Tadeusz Robak, Richard R Furman, Peter Hillmen, Marek Trneny, Martin J.S. Dyer, Swaminathan Padmanabhan, Tomas Kozak, Geoffrey Chan, Randy L Davis, Nedjad Losic, Charlotte A. Russell, Magdalena Piotrowska, Joris Wilms, William G. Wierda
Journal: Blood (2008)
Abstract 275: Modulation of Energy Metabolism by Metformin Prevents Diet Induced Cardiac Dysfunction in a Mouse Model of Adult Congenital Heart Disease
Authors: Raghav Pandey, Julia C Wilmanns, Olivia Hon, Nadia A Rosenthal, Milena B Furtado, Mauro W Costa
Journal: Circulation Research (2019)

Objective: Congenital heart disease (CHD) is the most frequent birth defect worldwide. Improved surgical and treatment interventions have led to a significant increase in the number of adult patients with CHD, now referred to as ACHD. However the mechanisms whereby ACHD predisposes patients to heart dysfunction are still unclear. ACHD is strongly associated with metabolic syndrome, but how ACHD interacts with poor modern lifestyle choices and other comorbidities, such as hypertension, obesity, and diabetes, is mostly unknown. Methods: We used a newly characterized mouse genetic model of ACHD to investigate the consequences and the mechanisms associated with combined obesity and ACHD predisposition and metabolic intervention studies by metformin. Results: ACHD mice placed under metabolic stress (high fat diet) displayed decreased left ventricular ejection fraction. Comprehensive physiological, biochemical, and molecular analysis showed that ACHD hearts exhibited early changes in energy metabolism with increased glucose dependence. These changes preceded cardiac dysfunction mediated by exposure to high fat diet and were associated with increased disease severity. Restoration of metabolic balance by metformin lead to improved liver function in both control and ACHD mice and prevented the development of heart dysfunction in ACHD predisposed mice. Metabolomic analysis of these animals revealed that metformin leads to an ACHD specific increase in metabolites associated with fat acid oxidation, likely reflecting upregulation of FAO. Conclusions: This study reveals that early metabolic impairment reinforces heart dysfunction in ACHD predisposed individuals and diet or pharmacological interventions can be used to modulate heart function and attenuate heart failure. Our current hypothesis is that metformin treatment leads to normalization of energy use by ACHD heart by enhancing FAO and we are currently performing CRISPR/Cas9 mediated deletion of key metabolic genes to characterize their role in ACHD. This data indicates that early manipulation of energy metabolism may be an important avenue for intervention in ACHD patients to prevent or delay onset of heart failure and secondary comorbidities.
Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes
Authors: Sue A. Brown, Boris P. Kovatchev, Dan Raghinaru, John W. Lum, Bruce A. Buckingham, Yogish C. Kudva, Lori M. Laffel, Carol J. Levy, Jordan E. Pinsker, R. Paul Wadwa, Eyal Dassau, Francis J. Doyle, Stacey M. Anderson, Mei Mei Church, Vikash Dadlani, Laya Ekhlaspour, Gregory P. Forlenza, Elvira Isganaitis, David W. Lam, Craig Kollman, Roy W. Beck
Journal: New England Journal of Medicine (2019)

Closed-loop systems that automate insulin delivery may improve glycemic outcomes in patients with type 1 diabetes.
Adoptive Therapy with Cord Blood Regulatory T Cells Does Not Impair Anti-Leukemia Activity of Infused Donor Cells
Authors: Hongbing Ma, Mitsutaka Nishimoto, Ke Zeng, Tuongvan D Nguyen, William Schuler, Joshua Kellner, Jaimol Peedikayil, Mi-Ae Lyu, Santhana Thangavelu-Devaraj, Simrit Parmar
Journal: Blood (2018)
Building a population management informatics infrastructure for oncology care.
Authors: Jennifer Elston Lafata, Stephen Harris, Megan Fasold, Audrey Holdren, Hanna Kelly Sanoff
Journal: Journal of Clinical Oncology (2019)

315 Background: While most primary care practices have informatics infrastructures to support population management, such infrastructures are not commonplace in oncology. Yet, value-based care requires that oncology practices be able to identify patients in real time, use risk stratification to target care efficiently, and monitor care quality to identify improvement opportunities. We describe an oncology informatics infrastructure development initiative in a large academic medical center. Methods: We convened a quality improvement team of administrators, analysts, clinicians, health services researchers and performance improvement staff. The team was sponsored by a senior leadership committee convened for a strategic planning initiative. We used PDSA cycles to develop and test ways to leverage data from an electronic health record (EHR) and billing system for oncology patient identification, risk stratification, and routine quality monitoring. We used clinician engagement, medical record review, and tumor registry comparisons to validate query strategies. Results: After considering different query strategies, we opted to identify patients via a new cancer treatment episode (as defined by a cancer diagnosis combined with evidence of pharmaceutical, radiation, and/or surgical treatment for cancer with no evidence of such treatment in the prior six months). This was done using diagnostic and procedural codes for chemo/immunotherapy and radiation treatment, and pathology reports and procedural codes for surgery. Using this approach, we identified over 7800 cancer treatment episodes within the health system in 2018. These episodes corresponded to 4178 chemo/immunotherapy, 1437 radiation, and 3440 surgical treatments. Quality monitoring has identified opportunities to enhance data capture, harmonize documentation processes across practitioners and practices, and initiate quality improvement efforts. Conclusions: Using data from the EHR and billing systems we are able to identify oncology patients as they initiate a cancer treatment episode. In so doing, we are able to track the quality of care delivered to oncology patients as they move across the care continuum from treatment to survivorship.
Abstract 180: Blood Outgrowth Endothelial Cell-derived Exosomes Mediate Therapeutic Neovascularization
Authors: Stefan P Janssens, Arief Wibowo, Hilde Gillijns, Ellen Caluwe, Denise Veltman, Leen Delrue, Jozef Bartunek
Journal: Circulation Research (2019)

Background: Blood outgrowth endothelial cells (BOECs) mediate therapeutic neovascularization in experimental models. We hypothesized that BOECs promote angiogenesis via secretion of exosomes, extracellular vesicles with an important role in cell-to-cell communication. Methods: We derived exosomes from BOECs of patients with ischemic heart failure (HF with LVEF &lt;35%) and age-matched controls (CON) in normoxia and 1% O 2 hypoxia by differential ultracentrifugation and used nano tracking (NTA) and immunoblot analysis to identify size, number, and surface markers. We characterized protein and miRNA content by proteomic LC-MS-Orbitrap analysis of trypsin-digested exosomes and validated selected peptides using ELISA. We measured expression of pro-angiogenic miRNAs and tested in vitro angiogenic potential of HUVECs in the presence or absence of exosomes using matrigel 2D-tube formation and 3D-spheroid sprouting assays. We compared in vivo angiogenesis using a wound healing model in nude mice. Results: NTA showed higher exosome concentrations in hypoxia compared to normoxia (14.38±0.23x10E8 vs 12.05±0.23x10E8 particles/ml, n=7, P&lt;0.001) with robust expression of exosome markers TSG101 and Flotilin-1. Compared to serum stimulation (positive control), BOEC-derived exosomes similarly enhanced 2D vascular network growth and 3D spheroid sprouting angiogenesis whereas absence of serum or exosomes did not (P&lt;0.001). Bioinformatic proteome analysis identified 249 shared proteins in HF and CON, and 72 proteins exclusively present in HF with abundant expression of matricellular proteins and angiogenic growth factors. Exosomes derived in hypoxia contained significantly higher levels of pro-angiogenic miR-210-3p, miR-210-5p and miR-21-3p (P&lt;0.05 vs normoxia, n=6). Closure of the skin wound after 4 and 5 days was significantly better in animals treated with BOEC-derived exosomes and accompanied with greater density of CD31-positive neovessels. Conclusion: BOEC-derived exosomes effectively induce vascular network formation and sprouting angiogenesis and stimulate wound healing in vivo. The identified protein and miRNA content in BOEC-derived exosomes may constitute a promising allogenic approach for therapeutic neovascularization.
Monitoring Asparaginase Activity in 21 Patients with Extranodal NK/T-Cell Lymphoma Shows a Very High Proportion of Asparaginase Inactivation
Authors: Arnaud Jaccard, Sammara Chaubard, Jean-François Benoist, Lucile Couronne, Laure Philippe, Emmanuel Gyan, Ronan Le Calloch, Aline Moignet Autrel, Rémy Gressin, Jacques Vargaftig, Aline Clavert, Emmanuel Bachy, Olivier Hermine
Journal: Blood (2018)
Patient and provider perceptions of emergency room visits during chemotherapy.
Authors: Laura Elizabeth Panattoni, Salene M.W. Jones, Kaylin J. Bolt, Karma L. Kreizenbeck, Annika Ittes, Scott David Ramsey
Journal: Journal of Clinical Oncology (2019)

183 Background: Emergency room (ER) visits during chemotherapy are costly. To identify potential causes of ER visits, we interviewed oncology patients and providers about symptoms and other factors related to ER visits. Methods: People with cancer (n = 19) and oncology physicians and nurses (n = 11) were interviewed using a semi-structured protocol. Interviews were transcribed. The study team developed a codebook and interviews were coded deductively. Four of the interviews were double coded. Results: Patients reported communicating with their physicians mostly by telephone. Patients reported a variety of distressing symptoms from chemotherapy including infection, mouth sores, distress, fatigue, neuropathy, gastrointestinal (GI) effects. Pain, fever, neuropathy, and dizziness were symptoms that motivated ER visits. Patients reported that contact with their care team and having a specific plan for symptoms helped prevent ER visits. Patients also reported that going through chemotherapy the first time was harder because they did not know what to expect and the patient education can be overwhelming. Providers did not always have formal protocols for proactively contacting patients but those that did contacted patients early in treatment. Providers reported GI symptoms, pain, shortness of breath, dizziness, and infection as causes of ER visits. They reported difficulties assessing symptoms due to reporting inaccuracies and reticence to share details. Providers cited financial insecurity, remote living, and lack of social support as factors increasing risk of ER visits. Providers reported some patients would not call frequently enough while a smaller subset called more frequently than providers perceived as needed. Conclusions: Results suggest contact with the care team is crucial for preventing ER visits during chemotherapy. Symptoms causing ER visits were consistent with previous literature
Adjuvant chemotherapy in patients with malignant fibrous histiocytoma: Single center experience.
Authors: Olga Sekhina, Anatoly Bulanov, Mikhail Fedyanin, Beniamin Bokhyan, Oleg Bliznukov, Mamed Aliev
Journal: Journal of Clinical Oncology (2013)

e21510 Background: There is controversy information about efficacy of adjuvant chemotherapy (ACT) for treatment of Soft Tissue Sarcomas (STS) due to histological heterogeneity of these tumors. Whereas STS are heterogeneous group with different sensitivity to chemotherapy (CT), we conducted retrospective study to assess efficacy of adjuvant chemotherapy in patient with high-grade malignant fibrous histiocytoma (MFH). Methods: From 2000 to 2010, 56 patients with localized malignant fibrous histiocytoma were treated in Russian Cancer Research Center named after N.N. Blokhin. Main features: median age 61 years (range: 16–83 years); III stage 37/56, 66%; II stage 19/56, 34%, median tumor size 10cm (range: 2-25 cm); ACT received 18/56, 32%; ACT not received 36/56, 64%; doxorubicin-based CT 16/18, 88%; ifosfamid-based CT 2/18, 12%. Median follow-up was 59 month. Results: Median disease free survival (DFS) was 30 month. Median overall survival (OS) not reached. Median DFS in patients receiving CT was 30 month versus 10 month in patients without CT (p=0.02, HR=2.5; 95% CI 1.09-5.3). In patients with ACT disease progression was observed statistically significantly less often, then without it (39% versus 69%, p=0.04). Three-year OS in patients with ACT was 95% versus 65% in patients control group (p=0.05). We conducted univariate analysis of features, which influence the risk of disease progression disease. Features of favorable prognosis were T1 (p=0.05) and ACT (p=0.04). In multivariate analysis these features remained statistically significant: T (p=0.01, OR 6.7; 95% CI 1.3-34.1), ACT (p=0.02, OR 0.2; 95% CI 0.05-0.7). Conclusions: ACT improved DFS and OS in patients with high-grade localized resectable MFH. These benefits require confirmation in larger studies.
Abstract 431: The Capillaries in Ischemic Border Zone: Origin And Role in Myocardial Infarction and Heart Failure
Authors: Jiqiu Chen, Lifan Liang, Roger J Hajjar
Journal: Circulation Research (2019)

It is a general believe that a blocked artery and its capillary are the main factor to determine myocardial infarction (MI) size and cardiac dysfunction. We have be plagued by the problem in repairing and regeneration of MI for many decades. How to improve the infarcted myocardium? By relieving the obstruction in coronary artery or promoting the angiogenesis of capillaries in the ischemic border zone? How to regrow the deteriorated capillary? From where? It is incredible to image the role of nearby non-ligated vessels in myocardial death and cardiac depression. In the present study, we show evidences that ischemic MI are not determined solely by the occluded artery, but also involved the nearby non-occluded artery, especially its capillaries that contributed nearly one-third effort to the MI. The mechanism is unclear yet, but this phenomenon is very interesting, offers a novel perspective to study heart failure. Arterial resistance to ischemia is a new object in heart failure research. It is unclear why some arterial vessel could survive in transmural MI, more interestingly it is unknown if capillaries could be regenerated from the residue arterial vessel in MI. The role of capillary both in ischemic artery and nearby non-ischemic branch in MI development is an amazing challenge. It is unknown why occlusion of left branch of LCA could degenerate capillaries on right branch of LCA. Inflammation probably plays a role in this phenomenon, but the knowledge of its mechanism is totally lacking even it indicates a potential path to new treatment strategy of ischemic heart disease.
Improved Risk Stratification With Addition Of Male Sex (S) To The Elderly International Prognostic Index (S-EIPI) For DLBCL Patients &gt; 60 Years Treated With R-CHOP: An International Collaboration Of The US Intergroup, German High-Grade Non-Hodgkin Lymphoma Study Group and Groupe d’Etude De Lymphome d’Adultes
Authors: Ranjana H. Advani, Fangxin Hong, Thomas M. Habermann, Hailun Li, Brad S. Kahl, Vicki A. Morrison, Edie A. Weller, Gaurav Varma, Richard I Fisher, Bruce A. Peterson, Bruce D. Cheson, Randy D. Gascoyne, Sandra J. Horning, Sami Bousetta, Bertrand Coiffier, Marita Ziepert, Michael Pfreundschuh
Journal: Blood (2013)
Decreased Survival and Increased Rate of Fibrotic Progression in Essential Thrombocythemia Chronicled after the FDA Approval Date of Anagrelide
Authors: Ayalew Tefferi, Natasha Szuber, Kebede H. Begna, Mrinal M. Patnaik, Michelle A. Elliott, C. Christopher Hook, Alexandra Wolanskyj, Curtis A. Hanson, Rhett P. Ketterling, Animesh Pardanani, Naseema Gangat
Journal: Blood (2018)
Pharmacological activation of IKr in models of long QT Type 2 risks overcorrection of repolarization
Authors: Matthew D Perry, Chai-Ann Ng, Melissa M Mangala, Timothy Y M Ng, Adam D Hines, Whitney Liang, Michelle J O Xu, Adam P Hill, Jamie I Vandenberg
Journal: Cardiovascular Research (2019)

Current treatment for congenital long QT syndrome Type 2 (cLQTS2), an electrical disorder that increases the risk of life-threatening cardiac arrhythmias, is aimed at reducing the incidence of arrhythmia triggers (beta-blockers) or terminating the arrhythmia after onset (implantable cardioverter-defibrillator). An alternative strategy is to target the underlying disease mechanism, which is reduced rapid delayed rectifier current (IKr) passed by Kv11.1 channels. Small molecule activators of Kv11.1 have been identified but the extent to which these can restore normal cardiac signalling in cLQTS2 backgrounds remains unclear. Here, we examined the ability of ICA-105574, an activator of Kv11.1 that impairs transition to the inactivated state, to restore function to heterozygous Kv11.1 channels containing either inactivation enhanced (T618S, N633S) or expression deficient (A422T) mutations.ICA-105574 effectively restored Kv11.1 current from heterozygous inactivation enhanced or expression defective mutant channels in heterologous expression systems. In a human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) model of cLQTS2 containing the expression defective Kv11.1 mutant A422T, cardiac repolarization, estimated from the duration of calcium transients in isolated cells and the rate corrected field potential duration (FPDc) in culture monolayers of cells, was significantly prolonged. The Kv11.1 activator ICA-105574 was able to reverse the prolonged repolarization in a concentration-dependent manner. However, at higher doses, ICA-105574 produced a shortening of the FPDc compared to controls. In vitro and in silico analysis suggests that this overcorrection occurs as a result of a temporal redistribution of the peak IKr to much earlier in the plateau phase of the action potential, which results in early repolarization.Kv11.1 activators, which target the primary disease mechanism, provide a possible treatment option for cLQTS2, with the caveat that there may be a risk of overcorrection that could itself be pro-arrhythmic.