tbuckley/cabot-search huggingface dataset:
QIM19-138: Care Coordination Between Prescribers and the Specialty Pharmacy—Qualitative Insights Into Designing a Quality Improvement Program for Multisite Community Oncology Practices
Authors: Stacey W. MucCullough, David Blaisdell, Jonathan K. Kish, Pat Farmer, JaLyna Laney, Tom Valuck, Natalie Dickson, Johnetta Blakely, Dianna Shipley, Jesus Berdeja, Gregg Shepard, Bertrand M. Anz, Carolyn Kelsey, Jack Taylor, Chadi Nabhan, Jeffrey F. Patton, Annette Powers
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: There is 1 multiple myeloma (MM) quality metric available (treatment with bisphosphonates, developed by the American Society of Hematology) to evaluate the quality of cancer care delivered to improve patient experience and outcomes. As many community practices integrate specialty pharmacy (SP) services into their practice, patient education, treatment adherence, and visit scheduling coordination are becoming increasingly complex, particularly for treatments with Risk Evaluation and Mitigation Strategies (REMS) programs. We sought to understand the fundamental challenges facing a multisite community oncology practice undergoing SP centralization to identify potential quality gaps for patients with MM. Methods: Structured, in-depth interviews were conducted with physicians treating the highest volume of MM patients across 5 different urban and rural sites of a single multisite community practice. The interviews covered 6 domains: access to care or clinical advice/communication (ACC/AC); care coordination (CC); disease management for MM (DMMM); patient education (PE); medication management (MedMgmt); and data and quality improvement (DQI). Results: Five providers treating 304 MM patients from January 2016 through April 2018 identified several key issues related to the interaction between the SP and clinical sites: ACC/AC, coordination of efforts to ensure patient affordability of both oral/intravenous components; CC, centralize pharmacy workflow processes (specifically REMS enrollment) to ensure timely receipt of medication (high priority); DMMM/PE, inconsistent patient education regarding the role of the centralized pharmacy in the REMS programs, side-effect management, and intent of therapy; MedMgmt, limited concern/understanding of the impact of oral therapy adherence; DQI, no set standards for MM-specific quality measures for benchmarking performance between SP and practices. Conclusions: This qualitative survey identified several areas for improving MM-related quality of care in terms of the relationship between a centralized SP and satellite offices. To address these themes, the practice further integrated licensed practical nurses into the SP. Additionally, 2 quality improvement measurement opportunities were proposed: (1) measuring adherence using pharmacy refill data and (2) overall treatment delay (number of days from prescribing to pick-up/ship to patient).
Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g
Authors: Jane E. Brumbaugh, Nellie I. Hansen, Edward F. Bell, Amaanti Sridhar, Waldemar A. Carlo, Susan R. Hintz, Betty R. Vohr, Tarah T. Colaizy, Andrea F. Duncan, Myra H. Wyckoff, Michelle L. Baack, Matthew A. Rysavy, Sara B. DeMauro, Barbara J. Stoll, Abhik Das, Rosemary D. Higgins
Journal: JAMA Pediatrics (2019)

Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation. To characterize outcomes of liveborn infants with a BW less than 400 g. This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018. Birth weight less than 400 g. The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit. Of the 205 included infants, 121 (59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101 of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%). Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.
Develop a 3D neurological disease model of human cortical glutamatergic neurons using micropillar-based scaffolds
Authors: Cheng Chen, Xin Dong, Kai-Heng Fang, Fang Yuan, Yao Hu, Min Xu, Yu Huang, Xixiang Zhang, Danjun Fang, Yan Liu
Journal: Acta Pharmaceutica Sinica B (2019)

Establishing an effective three-dimensional (3D) in vitro culture system to better model human neurological diseases is desirable, since the human brain is a 3D structure. Here, we demonstrated the development of a polydimethylsiloxane (PDMS) pillar-based 3D scaffold that mimicked the 3D microenvironment of the brain. We utilized this scaffold for the growth of human cortical glutamatergic neurons that were differentiated from human pluripotent stem cells. In comparison with the 2D culture, we demonstrated that the developed 3D culture promoted the maturation of human cortical glutamatergic neurons by showing significantly more MAP2 and less Ki67 expression. Based on this 3D culture system, we further developed an in vitro disease-like model of traumatic brain injury (TBI), which showed a robust increase of glutamate-release from the neurons, in response to mechanical impacts, recapitulating the critical pathology of TBI. The increased glutamate-release from our 3D culture model was attenuated by the treatment of neural protective drugs, memantine or nimodipine. The established 3D in vitro human neural culture system and TBI-like model may be used to facilitate mechanistic studies and drug screening for neurotrauma or other neurological diseases.
Miroir: A National, Multicenter, Non-Interventional Study of Patients with Relapsed and/or Refractory Multiple Myeloma (RRMM) Treated with Pomalidomide (POM) in France
Authors: Cyrille Hulin, Margaret Macro, Sophie Gourgou, Bertrand Arnulf, Florence Lachenal, Caroline Lenoir, Anne-Marie Stoppa, Marie Lorraine Chretien, Laure Vincent, Aurore Perrot, Philippe Moreau, Lionel Karlin, Cécile Fohrer, Jean-Richard Eveilard, Jean Fontan, Olivier Decaux
Journal: Blood (2017)
Building on the ACA to Achieve Universal Coverage
Authors: Matthew Fiedler, Henry J. Aaron, Loren Adler, Paul B. Ginsburg, Christen L. Young
Journal: New England Journal of Medicine (2019)

Interview with Dr. Matthew Fiedler on policies for extending coverage to the remaining uninsured populations in the United States. (08:38)Download U.S. universal coverage can be achieved by expanding Medicaid in all states, increasing assistance for buying coverage in the marketplace, ensuring that people enroll in affordable coverage for which they're eligible, and addressing coverage for undocumented immigrants.
HSR19-113: Valued Outcomes in the Cancer Experience (VOICE™): Scale Development and Initial Validation
Authors: Alexandra K. Zaleta, Shauna McManus, Joanne S. Buzaglo, Eva Y. N. Yuen, Julie S. Olson, Melissa F. Miller, Karen Hurley, Lillie D. Shockney, Sara Goldberger, Mitch Golant, Kevin Stein
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: Despite growing recognition that patient preferences and values should inform cancer care, patients’ views continue to be under-represented. We developed a quantitative tool, Valued Outcomes in the Cancer Experience (VOICE), to measure patient priorities and to understand discrepancies between what matters most to patients and what patients believe they can control. This study presents VOICE development and initial validation. Methods: 459 cancer patients completed an online survey and rated level of importance and perceived control for 54 value items (0=not at all; 4=very much). Items were derived from patient and caregiver focus groups and included themes such as independence, functional abilities, planning for the future, symptom management, health knowledge, and social support. Participants also completed validated measures of hope, optimism, quality of life, financial toxicity, spiritual well-being, illness perceptions, social support, self-efficacy, intolerance of uncertainty, and cancer-related distress. Iterative exploratory factor analysis (EFA) with direct oblique rotation, magnitude of importance and control ratings, and Pearson correlations between items and validation measures were used to inform scale refinement. Results: Participants were 86% non-Hispanic white; mean age=60 years, SD=10; 38% breast cancer, 18% blood, 9% lung, 9% prostate; mean time since diagnosis=6.5 years, SD=6; 22% metastatic. Items that did not load in the EFA, or were not associated with conceptually relevant validation measures, were removed or reworded. The final EFA explained over half of the variance in the data and demonstrated good fit, with absolute and relative fit indices in established acceptable ranges (P&lt;.001). The refined VOICE measure addresses diverse themes including access to care, maintaining independence, longevity, shared decision making, illness understanding, symptom management, emotional support, connection to illness community, spirituality, and end of life preparation. Conclusions: The study results demonstrate a framework for developing a quantitative, multidimensional measure of patient values. By understanding what matters most to patients, VOICE is positioned to bring patient preferences to the foreground of cancer care, contribute to shared decision making, and enhance care. Next steps include further validation of this tool in diverse settings, including oncology practices and community-based organizations.
HSR19-112: Qualitative Development of a Patient-Reported Outcome Measure of Symptom Burden in Breast Cancer
Authors: Meagan S. Whisenant, Faith A. Strunk, Debasish Tripathy, Loretta A. Williams
Journal: Journal of the National Comprehensive Cancer Network (2019)

Background: The use of disease-specific patient-reported outcomes (PROs) is critical for facilitating individualized symptom monitoring and improving cancer patient outcomes. The MD Anderson Symptom Inventory (MDASI) is a PRO measure of symptom burden. The purpose of this study was to describe the patient experience and define the content domain for the MDASI module specific to breast cancer (MDASI-Br). Methods: 36 patients with breast cancer across the disease and treatment continuum described their experience in single qualitative interviews. Content analysis was used to define the symptom burden content domain. An expert panel scored the relevance on a 0–4 scale (4 = relevant) of the symptoms identified from the qualitative interviews. Symptoms were selected for inclusion in the MDASI-Br if they met at least 1 of the following criteria: (1) mean relevance rating of ≥3 by the expert panel, (2) described by ≥20% of patients in qualitative interviews, or (3) core MDASI items. Results: Participants had a mean age of 57.9 years, 86.1% had stage I–III, and 52.8% were on active treatment. 36 symptoms were identified, with 14 reported by ≥20% of participants. Symptoms varied among participants based on disease stage and treatment modality. Fatigue and distress were described by most women regardless of treatment, whereas arm swelling was reported only by women who had undergone surgery, and skin changes were reported primarily by women who received radiation therapy. Patients volunteered ways in which symptoms affected daily functioning. 21 symptoms were included in the MDASI-Br for psychometric testing, including 6 breast cancer-specific symptoms: breast changes, hot flashes, constipation, arm swelling, fingernail or toenail changes, and skin changes. Two additional symptoms, vaginal dryness and decrease in sexual interest or activity, were included because they are common to endocrine therapy. Conclusions: Patients with breast cancer experience numerous but distinct symptoms related to disease and treatment that may result in interference with daily activities, relationships, life plans, treatment adherence, and mood. Various treatments result in unique symptom burden. The content domain for a PRO symptom-burden measure of breast cancer encompasses the diversity, severity, and activity interference of common symptoms of breast cancer and its treatment.
A cytochrome P450 allele confers pyrethroid resistance on a major African malaria vector, reducing insecticide-treated bednet efficacy
Authors: Gareth D. Weedall, Leon M. J. Mugenzi, Benjamin D. Menze, Magellan Tchouakui, Sulaiman S. Ibrahim, Nathalie Amvongo-Adjia, Helen Irving, Murielle J. Wondji, Micareme Tchoupo, Rousseau Djouaka, Jacob M. Riveron, Charles S. Wondji
Journal: Science Translational Medicine (2019)

A cytochrome P450 DNA marker in a major mosquito vector of malaria indicates that pyrethroid resistance reduces bednet efficacy.
Burden of illness in adults with atopic dermatitis: Analysis of National Health and Wellness Survey data from France, Germany, Italy, Spain, and the United Kingdom
Authors: Laurent Eckert, Shaloo Gupta, Abhijit Gadkari, Puneet Mahajan, Joel M. Gelfand
Journal: Journal of the American Academy of Dermatology (2019)

BackgroundThe disease burden of atopic dermatitis (AD) in European populations is not well known.ObjectiveTo establish the disease burden in European adult patients with AD.MethodsData were from the 2016 National Health and Wellness Survey conducted in France, Germany, Italy, Spain, and the United Kingdom. Bivariate analyses were conducted on outcomes between controls without AD matched to patients with self-reported AD (both n = 1860).ResultsPatients with AD and a subset of patients with inadequately controlled AD (IC-AD) versus controls without AD, respectively, reported significantly higher (P < .001) 36-Item Short Form Health Survey Physical and Mental Component Summaries (PCS, MCS), and anxiety (31.9% and 51.7% vs 14.4%), depression (25.8% and 36.2% vs 12.9%), and sleep disorder (22.7% and 39.7% vs 12.6%) prevalences. Patients with IC-AD versus controls without AD reported significantly greater (P < .001) overall work (57.1% vs 23.7%) and activity impairment (51.7% vs 26.5%). In addition, 21.6% of patients with AD and 37.9% of patients with IC-AD reported ≥1 emergency department visit in the previous 6 months versus 16.5% of controls without AD, and 93.1% of patients with AD versus 84.2% of those without AD had ≥1 clinician visit (both P < .001). Of these, patients with IC-AD showed greater burden on most outcomes than patients with controlled AD.LimitationsLow response rate, possible selection bias due to survey technology availability, and patient-reported data susceptible to recall bias.ConclusionPatients with AD reported significant burden on health, health-related quality of life, productivity, activities, and health care.
Adherence to supportive periodontal treatment
Authors: José J. Echeverría, Ana Echeverría, Raúl G. Caffesse
Journal: Periodontology 2000 (2019)

Abstract Like any other chronic disease, periodontal disease can be treated, but not eradicated. Personal maintenance of periodontal health requires the continuous elimination of bacterial accumulation at the gingival level, which demands periodical professional assistance. Of upmost importance is the patient being able to actively follow the counsel of the care providers. Thus, patient compliance, adherence, and persistence are paramount for the long‐term success of periodontal therapy. Unfortunately, in medicine as well as in dentistry, most studies show that, sooner rather than later, an unacceptable percentage of patients quit maintenance care. However, different studies have shown that there are behavioral techniques which may significantly improve the degree of motivation, compliance and persistence of patients with oral hygiene and supportive periodontal treatment. The right interval between maintenance visits has not been determined yet, but should be implemented according to patient needs, which do not necessarily coincide with the standard three‐month interval historically accepted as adequate. Adherence to periodontal maintenance results in reduction of plaque and bleeding on probing, and potentially slowing down or halting the disease progression. Finally, based on numerous retrospective studies, patient compliance could be considered a disease‐modifying factor positively affecting tooth survival. However, a lack of randomized clinical trials means this last statement is still open to question.
In utero and postnatal VX-770 administration rescues multiorgan disease in a ferret model of cystic fibrosis
Authors: Xingshen Sun, Yaling Yi, Ziying Yan, Bradley H. Rosen, Bo Liang, Michael C. Winter, T. Idil Apak Evans, Pavana G. Rotti, Yu Yang, Jaimie S. Gray, Soo Yeun Park, Weihong Zhou, Yulong Zhang, Shashanna R. Moll, Lisa Woody, Dao M. Tran, Licong Jiang, Annelotte M. Vonk, Jeffrey M. Beekman, Paul Negulescu, Fred Van Goor, Dennis F. Fiorino, Katherine N. Gibson-Corley, John F. Engelhardt
Journal: Science Translational Medicine (2019)

Cystic fibrosis (CF) is a multiorgan disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). In patients with CF, abnormalities initiate in several organs before birth. However, the long-term impact of these in utero pathologies on disease pathophysiology is unclear. To address this issue, we generated ferrets harboring a VX-770 (ivacaftor)-responsive CFTR G551D mutation. In utero VX-770 administration provided partial protection from developmental pathologies in the pancreas, intestine, and male reproductive tract. Homozygous CFTR G551D/G551D animals showed the greatest VX-770-mediated protection from these pathologies. Sustained postnatal VX-770 administration led to improved pancreatic exocrine function, glucose tolerance, growth and survival, and to reduced mucus accumulation and bacterial infections in the lung. VX-770 withdrawal at any age reestablished disease, with the most rapid onset of morbidity occurring when withdrawal was initiated during the first 2 weeks after birth. The results suggest that CFTR is important for establishing organ function early in life. Moreover, this ferret model provides proof of concept for in utero pharmacologic correction of genetic disease and offers opportunities for understanding CF pathogenesis and improving treatment.
<i>Candida</i> Bloodstream Infections Among Persons Who Inject Drugs — Denver Metropolitan Area, Colorado, 2017–2018
Authors: Devra M. Barter, Helen L. Johnston, Sabrina R. Williams, Sharon V. Tsay, Snigdha Vallabhaneni, Wendy M. Bamberg
Journal: MMWR Morbidity and Mortality Weekly Report (2019)

Candidemia, a bloodstream infection caused by Candida species, is typically considered a health care-associated infection, with known risk factors including the presence of a central venous catheter, receipt of total parenteral nutrition or broad-spectrum antibiotics, recent abdominal surgery, admission to an intensive care unit, and prolonged hospitalization (1,2). Injection drug use (IDU) is not a common risk factor for candidemia; however, in the context of the ongoing opioid epidemic and corresponding IDU increases, IDU has been reported as an increasingly common condition associated with candidemia (3) and methicillin-resistant Staphylococcus aureus bacteremia (4). Little is known about the epidemiology of candidemia among persons who inject drugs. The Colorado Department of Public Health and Environment (CDPHE) conducts population-based surveillance for candidemia in the five-county Denver metropolitan area, encompassing 2.7 million persons, through CDC's Emerging Infections Program (EIP). As part of candidemia surveillance, CDPHE collected demographic, clinical, and IDU behavior information for persons with Candida-positive blood cultures during May 2017-August 2018. Among 203 candidemia cases reported, 23 (11%) occurred in 22 patients with a history of IDU in the year preceding their candidemia episode. Ten (43%) of the 23 cases were considered community-onset infections, and four (17%) cases were considered community-onset infections with recent health care exposures. Seven (32%) of the 22 patients had disseminated candidiasis with end-organ dysfunctions; four (18%) died during their hospitalization. In-hospital IDU was reported among six (27%) patients, revealing that IDU can be a risk factor in the hospital setting as well as in the community. In addition to community interventions, opportunities to intervene during health care encounters to decrease IDU and unsafe injection practices might prevent infections, including candidemia, among persons who inject drugs.