tbuckley/cabot-search huggingface dataset:
Thirty-Year Incidence and Mortality Trends in Upper and Lower Gastrointestinal Bleeding in Finland
Authors: Pareen Vora, Arto Pietila, Markku Peltonen, Gunnar Brobert, Veikko Salomaa
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Epidemiological data on lower gastrointestinal bleeding (GIB) in the general population are sparse. <h3>Objective</h3> To describe the incidence, recurrence, mortality, and case fatality rates of major upper GIB and lower GIB in the general population of Finland between 1987 and 2016. <h3>Design, Setting, and Participants</h3> This prospective cohort study used data from the 1987 to the 2012 cycles of the National FINRISK Study, a health examination survey that was conducted every 5 years in Finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for GIB were excluded. Participants were followed up from survey enrollment to onset of GIB that led to hospitalization, death from any cause, or study end (December 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from February 1, 2019, to January 31, 2020. <h3>Main Outcomes and Measures</h3> Incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified GIB. Outcome measures were stratified by sex and age group. <h3>Results</h3> Among the 39 054 participants included in the study, 494 (1.3%) experienced upper GIB (321 men [65.0%]; mean [SD] age, 52.8 [12.1] years) and 645 (1.7%) had lower GIB (371 men [57.5%]; mean [SD] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 person-years (95% CI, 0.85-1.04) for upper GIB and 1.26 per 1000 person-years (95% CI, 1.15-1.38) for lower GIB; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper GIB remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower GIB until the rate stabilized. The proportion of recurrent GIB events showed an increasing trend from 1987 to 2016. The upper GIB–specific mortality was higher (0.07 per 1000 person-years; 95% CI, 0.04-0.09) than the lower GIB–specific mortality (0.01 per 1000 person-years; 95% CI, 0.001-0.03). Case fatality was high for those with upper GIB (7.0%; 95% CI, 4.7-10.1) compared with those with lower GIB (0.4%; 95% CI, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (&lt;2%) with GIB. <h3>Conclusions and Relevance</h3> This study found that the overall incidence rate of upper GIB was lower than the incidence of lower GIB, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper GIB. These data can serve as a reference when putting into context the rates of drug-associated GIB and can inform efforts to improve GIB care and outcome and to prevent rebleeding or death for patients with major GIB.
Linking reimbursement to patient-reported quality of life: Provider perspectives.
Authors: Bruce A. Feinberg, Yolaine Jeune-Smith, Stephanie Fortier, Ting-Chun Yeh, Jonathan Kish, Ajeet Gajra
Journal: Journal of Clinical Oncology (2020)

75 Background: In the value-based era, policymakers have begun incorporating quality of life (QoL) components into payment models, such as the Merit-based Incentive Payment System (MIPs), Oncology Care Model (OCM), and Accountable Care Organization (ACO), to increase accountability. This qualitative research study sought to understand how providers address their patients’ QoL issues in a value-based environment. Methods: A live meeting in September 2019 brought together community oncology healthcare providers (HCPs) from across the United States. Participants submitted their demographic information via a web-based pre-meeting survey and their responses pertaining to patient QoL via an audience response system during the live meeting. Participant responses and their practice demographics were analyzed using descriptive statistics. Results: 71 HCPs participated in this live market research program: 51 medical oncologists/hematologists (herein referred to as physicians) and 20 nurse practitioners or physician assistants (herein referred to as APPs). 50% of physicians and 25% of APPs were from privately owned community practices. Half of HCPs indicated that their practices are collecting and reporting QoL data through value-based programs: 28% of physicians and 60% of APPs were in OCM-participating practices. Regarding accountability, over 80% of HCPs strongly agreed that they have a role in improving patients’ QoL. However, 32% of physicians and 25% of APPs agreed that their payment should be tied to patients’ QoL improvement. According to HCPs, the top factor impacting patients’ QoL was symptom and symptom burden (83%). To address QoL in their patients, HCPs reported addressing patients’ psychosocial needs (78%), implementing survivorship care planning (76%), and using nurse navigators (69%). 70% of physicians and 95% of APPs were confident that their patients have reliable resources for managing their QoL issues. Conclusions: HCPs recognize their role in improving patients’ QoL, and their practices have made several transformations to improve patients’ QoL; they are confident that their patients have resources for managing QoL issues. However, many HCPs disagree with linking QoL improvements to their payment. Further studies are needed to understand QoL from patients’ perspectives in the value-based environment.
Status of digitization of medical records in oncology centers in India: A survey of current status.
Authors: Karthika Nageswararaj, Sripriya Raman, Anis Basha
Journal: Journal of Clinical Oncology (2020)

306 Background: Electronic medical or health record (EMR/EHR) system is yet to be universally adopted in India. In 2012 and 2016 Indian Ministry of Health published a detailed roadmap for EHR adoption. We wanted to assess the status of EMR/EHR adoption in oncology centers in India. Methods: Authors developed a short online survey to capture the use of paper charts vs. generic EMR vs. oncology specific EMR by practicing oncologists in India. The survey was shared to oncologists on June 6, 2020 through closed social media groups. Responses to the survey were collected anonymously and data aggregated for analysis. Survey will remain open till July 4, 2020. Results: At the time of abstract submission on June 16, there were 48 unique survey responses. Of those who responded to the survey, 69% were 25-45 years of age, 73% male, 71% were practicing in the state of Tamil Nadu, and 21% were practicing in a rural area or close to a small city. Oncologists from all subspecialties were represented in the survey including radiation oncology (65%), surgical oncology (25%), medical oncology (6%), and pediatric oncology/nuclear medicine (4%). About 46% had completed their training within the last 10 years, and 30% of respondents have done part of their training in foreign countries. Summary of responses to our survey is provided in the table below. Conclusions: Paper chart is still the predominant mode of clinical data capture within oncology. Administrative barriers and cost are perceived as major obstacles despite most oncologists reporting that they would very likely adapt to an onco specific EMR. [Table: see text]
Response to: ‘Correspondence on ‘Safety and tolerability of nintedanib in patients with systemic sclerosis-associated interstitial lung disease: data from the SENSCIS trial’’ by Bredemeier
Authors: James R Seibold, Veronika Kohlbrenner, Margarida Alves, Oliver Distler
Journal: Annals of the Rheumatic Diseases (2020)

Following the publication of data on the safety and tolerability of nintedanib in the SENSCIS trial,1 2 and INBUILD trial,3 Dr Bredemeier has raised the question of the risk of serious respiratory infections with nintedanib treatment in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) and other interstitial lung diseases (ILDs).4 We have made a thorough investigation into this question and concluded that the evidence from clinical trials does not suggest an increased risk of infections in patients treated with nintedanib. Further, the mechanistic effects of nintedanib, an inhibitor of tyrosine kinases, do not suggest a plausible mechanism by which nintedanib would affect the risk of infection.5

We acknowledge that in the SENSCIS trial, there were numerical imbalances between the nintedanib and placebo groups in the percentages of patients with overall serious infections (6.6% vs 3.5%) or serious lower respiratory tract infections (3.5% vs 1.7%). This difference was driven largely by serious adverse events of pneumonia (2.8% (n=8) vs 0.3% (n=1)), when pneumonia was defined using …
Recombinant MG53 Protein Protects Mice from Lethal Influenza Virus Infection
Authors: Adam D. Kenney, Zhongguang Li, Zehua Bian, Xinyu Zhou, Haichang Li, Bryan A. Whitson, Tao Tan, Chuanxi Cai, Jianjie Ma, Jacob S. Yount
Journal: American Journal of Respiratory and Critical Care Medicine (2020)
Association Between Clinical Value and Financial Cost of Cancer Treatments: A Cross-Sectional Analysis
Authors: Aaron P. Mitchell, Sara M. Tabatabai, Pranammya Dey, Jennifer A. Ohn, Michael A. Curry, Peter B. Bach
Journal: Journal of the National Comprehensive Cancer Network (2020)

The cost of cancer treatment has increased significantly in recent decades, but it is unclear whether these costs have been associated with commensurate improvement in clinical value. This study aimed to assess the association between the cost of cancer treatment and 4 of the 5 NCCN Evidence Blocks (EB) measures of clinical value: efficacy of regimen/agent, safety of regimen/agent, quality of evidence, and consistency of evidence.
Abstract B26: Combinational effect of sulforaphane (SFN) and epigenetic demethylation agent 5-aza-2’-deoxycytidine (DAC) on metastatic melanoma
Authors: Tung-chin Chiang, L. Joseph Su, Brian S. Koss, Charity Washam, Stephanie Byrum, Aaron Storey, Alan J. Koss
Journal: Cancer Research (2020)

Abstract UV exposure-induced oxidative stress is implicated as the driving mechanism of melanoma development. Increased oxidative stress results in imbalanced reactive oxygen species (ROS) that damage DNA and dysregulated epigenetic modifications and leads to melanoma progression. Sulforaphane (SFN) is the natural bioactivated product of the cruciferous vegetable family (e.g., broccoli and Brussels sprouts) and is known to play a dual role in cytoprotection and to induce apoptosis in the tumor via antioxidant regulation and histone modification of epigenetic enzymes. We investigated the combinational effect of 5-aza-2’-deoxycytidine (DAC), an FDA-approved DNA-modification epigenetic drug and SFN in melanoma cells. We found further cell growth inhibition and an increased number of altered gene expression profiles, increased survival-related cytokine expression, as well as unique histones post-translational modifications (PTMs) upon combinational treatments compared to single treatment in vitro. These results set the stage for animal studies. The long-term goal of the current study is to find an optimal dietary dose of antioxidants from SFN to reduce the burden of oxidative stress, which may contribute to melanoma recurrence, a constant problem with current treatments. In addition to recurrence, a reduced dose of epigenetic drugs applied may minimize the side effects of single-high-dose treatment. Citation Format: Tung-chin Chiang, L. Joseph Su, Brian S. Koss, Charity Washam, Stephanie Byrum, Aaron Storey, Alan J. Koss. Combinational effect of sulforaphane (SFN) and epigenetic demethylation agent 5-aza-2’-deoxycytidine (DAC) on metastatic melanoma [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr B26.
Reprogramming of miR-181a/DNA methylation patterns contribute to the maternal nicotine exposure-induced fetal programming of cardiac ischemia-sensitive phenotype in postnatal life
Authors: Jie Jian, Peng Zhang, Yong Li, Bailin Liu, Yanyan Zhang, Lubo Zhang, Xuesi M Shao, Jian Zhuang, Daliao Xiao
Journal: Theranostics (2020)

Background: E-cigarette and other novel electronic nicotine delivery systems (ENDS) have recently entered the market at a rapid pace. The community desperately needs answers about the health effects of ENDS. The present study tested the hypothesis that perinatal nicotine exposure (PNE) causes a gender-dependent increase in vulnerability of the heart to ischemia-reperfusion (I/R) injury and cardiac dysfunction in male rat offspring via reprogramming of the miRNA-181a (miR-181a)-mediated signaling pathway and that miR-181a antisense could rescue this phenotype. Methods: Nicotine or saline was administered to pregnant rats via subcutaneous osmotic minipumps from gestational day 4 until postnatal day 10. Cardiac function and molecular biological experiments were conducted in ~3- month-old offspring. Results: PNE enhanced I/R-induced cardiac dysfunction and infarction in adult male but not in female offspring, which was associated with miR-181a over-expression in left ventricle tissues. In addition, PNE enhanced offspring cardiac angiotensin receptor (ATR) expressions via specific CpG hypomethylation of AT1R/AT2R promoter. Furthermore, PNE attenuated cardiac lncRNA H19 levels, but up-regulated cardiac TGF-β/Smads family proteins and consequently up-regulated autophagy-related protein (Atg-5, beclin-1, LC3 II, p62) expression in the male offspring. Of importance, treatment with miR-181a antisense eliminated the PNE's effect on miR-181a expression/H19 levels and reversed PNE-mediated I/R-induced cardiac infarction and dysfunction in male offspring. Furthermore, miR-181a antisense also attenuated the effect of PNE on AT1R/AT2R/TGF-β/Smads/autophagy-related biomarkers in the male offspring. Conclusion: Our data suggest that PNE could induce a reprogramming of cardiac miR-181a expression/DNA methylation pattern, which epigenetically modulates ATR/TGF-β/autophagy signaling pathways, leading to gender-dependent development of ischemia-sensitive phenotype in postnatal life. Furthermore, miR-181a could severe as a potential therapeutic target for rescuing this phenotype.
Acute kidney injury in severely injured patients admitted to the intensive care unit
Authors: Alberto F. García, Ramiro Manzano-Nunez, Juan G. Bayona, Maria P. Naranjo, Dary Neicce Villa, Manuel Moreno, Sebastian Ossa, Juan M. Martinez, Nathalia Martinez, Juan C. Puyana
Journal: Military Medical Research (2020)

Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the intensive care unit (ICU) for whom creatine kinase (CK) levels were available.For this retrospective observational study, we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome.A total of 315 patients were included. The trauma mechanisms were blunt (n = 130), penetrating (n = 66) and blast (n = 44) trauma. The median (interquartile range, IQR) of injury severity score (ISS) was 21 (16-29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0-4)), Acute Physiology and Chronic Health Evaluation (APACHE II) score (median (IQR) in the AKI group: 18 (10-27)), CK greater than 5000 U/L, lactic acid concentration at admission, and dobutamine administration were independently associated with AKI.We found that age, APACHE II score, thoracic trauma, lactic acidosis, and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.
Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation.
Authors: Andrea Harzstark, Lisa J. Herrinton, Lauren C. Walker, Liyan Liu, Tatjana Kolevska, Mark St. Lezin, Craig R. Nichols, Siamak Daneshmand, Joseph Presti
Journal: Journal of Clinical Oncology (2020)

39 Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were &lt; 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.
Defining high-quality NSCLC care at U.S. cancer centers.
Authors: Mark A. Socinski, Leigh Boehmer
Journal: Journal of Clinical Oncology (2020)

229 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on individual components of care and advocate multidisciplinary collaboration, guidance spanning the complete patient journey is lacking. We aimed to compile quality-focused recommendations for the multidisciplinary team and selected clinical criteria for ideal NSCLC care, and propose a new set of metrics encompassing the entire care continuum. These metrics would be used as a new benchmark for ideal NSCLC care via the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy to compile evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Quality recommendations were organized within key care areas of the patient journey: care coordination and patient education, diagnosis and biomarker testing, staging and treatment planning, and survivorship. Results: A total of 32 recommendations were included across the 4 key NSCLC care areas. Key quality recommendations are listed (Table). Conclusions: The full set of recommendations define ideal NSCLC care and serve as a valuable guide for multidisciplinary practice and quality improvement initiatives. [Table: see text]
Reduced-intensity therapy for pediatric lymphoblastic leukemia: impact of residual disease early in remission induction
Authors: Iman Sidhom, Khaled Shaaban, Sarah H. Youssef, Nesreen Ali, Seham Gohar, Wafaa M. Rashed, Mai Mehanna, Sherine Salem, Sonya Soliman, Dina Yassin, Emad Mansour, Elaine Coustan-Smith, Raul C. Ribeiro, Gaston K. Rivera
Journal: Blood (2020)
Similarities in Risk for COVID-19 and Cancer Disparities
Authors: Lisa A. Newman, Robert A. Winn, John M. Carethers
Journal: Clinical Cancer Research (2020)

Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. In the United States, COVID-19 disproportionately affects racial and ethnic minorities, particularly African Americans, with an observed 2-fold higher rate for hospitalization and greater than 2-fold higher rate for death as compared with White Americans. The disparity seen with COVID-19 is consistent with patterns of disparities observed for cancer; it is well documented that 5-year survival rates for multiple cancers are lower in African Americans compared with White Americans. Root cause contributions for the disparity overlap between COVID-19 and cancer. While cancer is a genetic disease that is influenced by tissue microenvironment, COVID-19 is an infectious disease that is enabled by cellular expression of angiotensin-converting enzyme 2 receptors. However, socioeconomic disadvantages, level of education, lifestyle factors, health comorbidities, and limited access to medical care appear to fuel underlying risk for both cancer and COVID-19 disparities. In addition to African Americans demonstrating higher risk of acquiring and dying from either disease, they are underrepresented in clinical trials involving cancer or COVID-19. Long-term disparities are present with survivorship from cancer and may be likely with survivorship from COVID-19; both have revealed untoward effects on postdiagnosis economic viability for African Americans. Collaborative strategies that include community engagement, diverse participation in cancer and COVID-19 clinical trials, providing insurance for affected persons who lost employment due to either disease, and supporting safety-net and public hospitals for health care access will be critical to stem these disparities.