tbuckley/cabot-search huggingface dataset:
A systematic approach to improving oral chemotherapy consent compliance in a rural cancer center.
Authors: Paula Benner, Jina Fields, Shylaja Mani, Julie Mathey
Journal: Journal of Clinical Oncology (2021)

206 Background: Ensuring quality and comprehensive cancer care for our patients, families and our communities have been goals for the Cancer Center since its inception. To achieve these goals we must encourage collaborative decision-making, patient autonomy and promote a culture of patient safety with regards to all aspects of care, including treatment planning. Oral chemotherapy consent compliance has been a measured monthly Quality metric by the Cancer Center since 2018. A steady decline in compliance began in June 2019. 38% of all patients prescribed new oral chemotherapy did not sign an Informed Consent prior to beginning therapy. Lack of compliance may compromise patient safety and autonomy. In order to ensure our patients are fully informed regarding recommended treatment options, we evaluated our compliance to ASCO’s Quality Oncology Practice Initiative (QOPI) Core Module, Measure 14 which requires a signed patient consent for chemotherapy. This project was initiated during the 2020 Quality Training Program (QTP) in Alexandria, Virginia and progressed through the COVID-19 pandemic. Methods: Using the systematic approach and quality improvement tools taught during the QTP, we engaged a multidisciplinary Quality Improvement (QI) team to assist in gathering, organizing and interpreting data. The QI team sought input from all providers, their associated teams and Navigators regarding current processes and barriers. Process maps were created for each team; with both variables and percent of consent compliance being compared. The QI team identified common barriers to obtaining consent. A Cause and Effect Diagram, Pareto Chart and Prioritization Matrix were used narrowing the focus for the changes developed for improvement. Two quarterly Plan-Do-Study-Act (PDSA) cycles were conducted from March through September 2020. Results: PDSA cycle one was implemented in March of 2020 immediately prior to the COVID-19 pandemic affecting our area. Despite the competing priority of COVID Pandemic, results improved to 76% compliance over a 4 month period. PDSA cycle 2 was implemented at the end of July 2020. Following PDSA cycle 2, compliance rates improved to 91%. With no additional process changes, compliance continues to maintain through April of 2021 at 92%. Conclusions: The use of the QTP systematic approach improved oral chemotherapy consent compliance to just short of our 92% improvement goal. In spite of the obstacles brought about by COVID-19, compliance rates for August-October 2020 increased to 91%. As a result of the study process, we are now more cognizant of the variability in practices among our providers. This awareness will aid us in development and success of future processes. We continue to monitor compliance and adjust processes related to oral chemotherapy informed consent to accommodate on-going COVID-19 implications, staffing variances and ever-changing approved chemotherapy regimens.
Range, effectiveness, and implementation of decision aids supporting cancer survivors’ decisions over health services participation in the post-treatment phase: A systematic review.
Authors: Yu Ke, Tze Xin Eunice Tan, Ray Chan, Alexandre Chan
Journal: Journal of Clinical Oncology (2021)

203 Background: Cancer patients and survivors encounter a myriad of complex medical decisions starting from their diagnosis of cancer. However, current decision aids (DAs) largely focused on acute treatment and fertility decisions, and not on health service-related decisions such as adoption of supportive care services and programs targeting risk factor modification. This systematic review aims to identify and describe DAs supporting health service-related decisions after the completion of primary treatment until the end of life. Secondary objectives included assessing the effectiveness of these DAs and outlining implementation barriers. Methods: Electronic databases (PubMed and EMBASE) were searched comprehensively for relevant publications in English from inception through April 2020. Additional manual searches were performed on Google Scholar and from reference lists. We included studies that described the purpose and usage of DAs related to health services among cancer survivors 6 months post-diagnosis, after the typical acute treatment phase. Depending on the study design, included studies were assessed for quality using the Cochrane Collaboration’s tool and Critical Appraisal Skills Programme qualitative checklist. Results: Of 896 records screened, 11 studies describing seven DAs met the inclusion criteria. Non-interventional studies were generally of good quality, whereas most (4/6) interventional trials had a high risk of detection bias from failure to blind outcome assessors. DAs described were purposed for the creation of advanced directives, substance use behavior, preference for post-treatment follow-up care schedule, and health insurance were identified. All DAs adopted a multimedia format. DAs were generally acceptable and were associated with higher knowledge and satisfaction among users. No significant effects were observed for decision-making related outcomes, including decisional conflict and self-efficacy. Implementation barriers included time constraints, poor health statuses, limited perceived DA’s usefulness, and inadequate navigational support. Conclusions: The seven DAs identified addressed a diverse range of survivorship issues. Building on preliminary results reporting favorable acceptability, satisfaction, and knowledge, future work should explore the development and utility of DAs as facilitators to quality cancer survivorship care delivery, expanding into areas such as health promotion and choice of survivorship follow-up care models.
Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma
Authors: Tim F. Greten, Ghassan K. Abou-Alfa, Ann Lii Cheng, Austin G. Duffy, Anthony B. El-Khoueiry, Richard S. Finn, Peter R. Galle, Lipika Goyal, Aiwu Ruth He, Ahmed O. Kaseb, Robin Kate Kelley, Riccardo Lencioni, Amaia Lujambio, Donna Mabry Hrones, David J. Pinato, Bruno Sangro, Roberto I. Troisi, Andrea Wilson Woods, Thomas Yau, Andrew X. Zhu, Ignacio Melero
Journal: Journal for ImmunoTherapy of Cancer (2021)

Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.
Medication Reconciliation—Too Much or Not Enough?
Authors: Jeffrey L. Schnipper
Journal: JAMA Network Open (2021)

Alessandro Ceschi, MD, MSc; Roberta Noseda, PhD; Michela Pironi, MSc; Nicole Lazzeri, MSc; Ottavia Eberhardt-Gianella, MSc; Saida Imelli, MSc; Sara Ghidossi, MSc; Stefano Bruni, MSc; Alberto Pagnamenta, MD; Paolo Ferrari, MD
Multicenter study on recent portal venous system thrombosis associated with cytomegalovirus disease
Authors: Chloé De Broucker, Aurélie Plessier, Isabelle Ollivier-Hourmand, Sébastien Dharancy, Christophe Bureau, Jean-Paul Cervoni, Philippe Sogni, Odile Goria, Olivier Corcos, Riccardo Sartoris, Maxime Ronot, Valérie Vilgrain, Emmanuelle de Raucourt, Kamal Zekrini, Hortense Davy, François Durand, Audrey Payancé, Nadira Fidouh-Houhou, Yazdan Yazdanpanah, Dominique Valla, Pierre-Emmanuel Rautou
Journal: Journal of Hepatology (2021)
Cancer treatment and outcomes in patients of color or ethnic minority (PCEM): Oncologist perceptions of racial anxiety and/or implicit bias (RA/IB).
Authors: Ajeet Gajra, Yolaine Jeune-Smith, Alexandrina Balanean
Journal: Journal of Clinical Oncology (2021)

104 Background: Healthcare disparities are prevalent in cancer, with patients of color or ethnic minority (PCEM) at greatest risk for poor outcomes due to limited access to care, low health literacy and socioeconomic status, and potentially, racial anxiety and/or implicit bias (RA/IB) among oncologists. We conducted a descriptive study of medical/hematologic oncologists to assess perceptions of impact of RA/IB on treatment decisions and outcomes in PCEM. Methods: From February to April 2021, U.S.-based medical/hematologic oncologists participated in an online survey of perceptions regarding cancer care and outcomes in PCEM as part of a broader survey of various clinical and practice-related concerns. Questions used a modified 5-point Likert scale with an option of declining to answer, and respondents were aware that data would be anonymized and aggregated. Results: Among the 369 physicians surveyed, median years in practice were 17 (range 2-49). Most (72%) worked in community oncology; 64% were age 40 to 59 years; 21% identified as female, 70% as male, and 9% declined to disclose gender. Racial distribution was 32% White, 33% Asian, 7% Black, 4% Hispanic/Latinx, and 19% declined to disclose. Regarding perception of the degree of racial/ethnic healthcare disparity experienced by PCEM, 33% chose moderate, 29% very high/high, 29% low/none, and 8% declined to answer. Regarding how often RA/IB adversely affected survival among PCEM at their own practice, a majority (58%) chose rarely or never, 33% very often/almost always, often, or sometimes, and 9% declined to answer. Perceived frequency of specific scenarios involving RA/IB as adversely influencing treatment decisions at their practice (referral/recommendation for oncologic standard-of-care [SOC] modalities/services) was also assessed. The combinations of very often/almost always, often, and sometimes responses were: clinical trial referral (35%); palliative/hospice care (31%); novel therapeutic regimen vs. SOC selection (e.g., chemo/targeted/radiation therapy) (28%); surgical treatment recommendation (26%); and genetic/genomic testing referral (24%). Notably, 10% to 12% declined to answer. Conclusions: A majority of the medical/hematologic oncologists surveyed recognized the role of RA/IB in substandard treatment and outcomes among PCEM, but were less likely to perceive it within their own practice, suggesting a need for better identification. Notably, 24% to 35% recognized its adverse influence on SOC treatment decisions for PCEM. Further, 19% declined to identify their own race/ethnicity and 10% consistently declined to answer all treatment decision-making questions related to disparity, suggesting mistrust or apprehension in expressing true views. Findings suggest that oncologists may benefit from improved education regarding RA/IB and healthcare disparities in PCEM.
A Reality Check From the Fields—What’s Next?
Authors: Sergio A. Aguilar-Gaxiola, Sarah M. Ramirez, Edward Kissam
Journal: JAMA Network Open (2021)

Ana M. Mora, MD, PhD; Joseph A. Lewnard, PhD; Katherine Kogut, MPH; Stephen A. Rauch, MPH; Samantha Hernandez, BS; Marcus P. Wong, BS/BA; Karen Huen, PhD; Cynthia Chang, MPH; Nicholas P. Jewell, PhD; Nina Holland, PhD; Eva Harris, PhD; Maximiliano Cuevas, MD; Brenda Eskenazi, PhD; CHAMACOS-Project-19 Study Team; Jose Camacho; Gardenia Casillas; Celeste Castro; Madison J de Vere; Lupe Flores; Lizari Garcia; Maria Reina Garcia; Terry Gomez; Carly Hyland; Daniel Lampert; Aaron McDowell-Sanchez; Dominic Pina Montes; Jacqueline Montoya; Norma Morga; Oguchi Nkwocha; Lilibeth Nunez; Lizbeth Ortiz-Pivaral; Juanita "Liz" Orozco; Marbel Orozco; Kimberly L Parra; Nargis Rezai; Maria T Rodriguez; Monica Romero; Hina Sheth; Jon Yoshiyama; Litzi Zepeda
Prospective, double-blind diagnostic multicentre study of confocal laser endomicroscopy for wheat sensitivity in patients with irritable bowel syndrome
Authors: Christian Bojarski, Paul Tangermann, Christian Barmeyer, Juliane Buchkremer, Ralf Kiesslich, Mark Ellrichmann, Stefan Schreiber, Carsten Schmidt, Andreas Stallmach, Robert Roehle, Christoph Loddenkemper, Severin Daum, Britta Siegmund, Michael Schumann, Reiner Ullrich
Journal: Gut (2021)

Objective A considerable proportion of patients with irritable bowel syndrome (IBS) may be wheat-sensitive and respond to a gluten-free diet (GFD) although they do not have coeliac disease. However, a diagnostic test for wheat sensitivity (WS) is missing. Our study evaluated the diagnostic accuracy (sensitivity and specificity) of confocal laser endomicroscopy (CLE) for the identification of WS as primary outcome. Design In this prospective, double-blind diagnostic study 147 non-coeliac patients fulfilling the Rome III criteria for IBS were tested by CLE for duodenal changes after wheat (index test), soy, yeast or milk exposure. Patients with IBS responding to 2 months of GFD were classified as having WS (reference test) using response criteria recommended by regulatory bodies for pharmaceutical trials of patients with IBS. After 2 months, CLE results were unblinded and patients were advised to exclude those food components that had led to a positive CLE reaction. The clinical response was assessed at follow-up after 6 and 12 months. Results Of 130 patients who completed the study per protocol, 74 (56.9%) responded to GFD and were classified as WS after 2 months, and 38 of these 74 patients were correctly identified by CLE (sensitivity 51.4%; 97.5% CI: 38.7% to 63.9%). A total of 38 of 56 patients without WS were correctly identified by CLE (specificity 67.9%; 97.5% CI: 52.9% to 79.9%). At 6 months follow-up, CLE correctly identified 49 of 59 food-sensitive patients (sensitivity 83.1%; 97.5% CI: 69.9% to 91.3%) but specificity was only 32% (97.5% CI: 15.7% to 54.3%). Conclusion In light of the high proportion of patients with IBS responding to GFD, the diagnostic accuracy of CLE is too low to recommend widespread use of this invasive procedure. Trail registration number This study was registered as clinical trial in the German Registry for Clinical Studies (DRKS00010123).
Publisher Correction: Fully automated closed-loop glucose control compared with standard insulin therapy in adults with type 2 diabetes requiring dialysis: an open-label, randomized crossover trial
Authors: Charlotte K. Boughton, Afroditi Tripyla, Sara Hartnell, Aideen Daly, David Herzig, Malgorzata E. Wilinska, Cecilia Czerlau, Andrew Fry, Lia Bally, Roman Hovorka
Journal: Nature Medicine (2021)
Cooperative tanycytes fuel the neuronal tank
Authors: Roberta Haddad-Tóvolli, Marc Claret
Journal: Journal of Clinical Investigation (2021)

Tanycytes are specialized radial glial cells of the hypothalamus that have emerged as important players that sense and respond to fluctuations in whole-body energy status to maintain energy homeostasis. However, the underlying mechanisms by which tanycytes influence energy balance remain incompletely understood. In this issue of the JCI, Lhomme et al. used transgenic mouse models, pharmacological approaches, and electrophysiology to investigate how tanycytes sense glucose availability and integrate metabolic cues into a lactate tanycytic network that fuels pro-opiomelanocortin (POMC) neuronal activity. Notably, the authors found that the tanycytic network relied on monocarboxylate transporters and connexin-43 gap junctions to transfer lactate to POMC neurons. Collectively, this study places tanycytes at the center of the intercellular communication processes governing energy balance.
Distinct Effects of Heparin and Interleukin‐4 Functionalization on Macrophage Polarization and In Situ Arterial Tissue Regeneration Using Resorbable Supramolecular Vascular Grafts in Rats
Authors: Valentina Bonito, Suzanne E. Koch, Merle M. Krebber, Daniel A. Carvajal‐Berrio, Julia Marzi, Renee Duijvelshoff, Emily B. Lurier, Serena Buscone, Sylvia Dekker, Simone M. J. de Jong, Tristan Mes, Koen R. D. Vaessen, Eva M. Brauchle, Anton W. Bosman, Katja Schenke‐Layland, Marianne C. Verhaar, Patricia Y. W. Dankers, Anthal I. P. M. Smits, Carlijn V. C. Bouten
Journal: Advanced Healthcare Materials (2021)

Two of the greatest challenges for successful application of small-diameter in situ tissue-engineered vascular grafts are 1) preventing thrombus formation and 2) harnessing the inflammatory response to the graft to guide functional tissue regeneration. This study evaluates the in vivo performance of electrospun resorbable elastomeric vascular grafts, dual-functionalized with anti-thrombogenic heparin (hep) and anti-inflammatory interleukin 4 (IL-4) using a supramolecular approach. The regenerative capacity of IL-4/hep, hep-only, and bare grafts is investigated as interposition graft in the rat abdominal aorta, with follow-up at key timepoints in the healing cascade (1, 3, 7 days, and 3 months). Routine analyses are augmented with Raman microspectroscopy, in order to acquire the local molecular fingerprints of the resorbing scaffold and developing tissue. Thrombosis is found not to be a confounding factor in any of the groups. Hep-only-functionalized grafts resulted in adverse tissue remodeling, with cases of local intimal hyperplasia. This is negated with the addition of IL-4, which promoted M2 macrophage polarization and more mature neotissue formation. This study shows that with bioactive functionalization, the early inflammatory response can be modulated and affect the composition of neotissue. Nevertheless, variability between graft outcomes is observed within each group, warranting further evaluation in light of clinical translation.
Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)
Authors: Lasse Ishøi, Mathias Fabricius Nielsen, Kasper Krommes, Rasmus Skov Husted, Per Hölmich, Lisbeth Lund Pedersen, Kristian Thorborg
Journal: British Journal of Sports Medicine (2021)

This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.
Human cytomegalovirus non-primary infection during pregnancy: antibody response, risk factors and newborn outcome
Authors: Paola Zelini, Piera d’Angelo, Marica De Cicco, Cristian Achille, Antonella Sarasini, Loretta Fiorina, Daniela Cirasola, Valentina Marazzi, Stefania Piccini, Milena Furione, Alessia Arossa, Giulia Muscettola, Arsenio Spinillo, Daniele Lilleri
Journal: Clinical Microbiology and Infection (2021)
Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases
Authors: Brad H. Rovin, Sharon G. Adler, Jonathan Barratt, Frank Bridoux, Kelly A. Burdge, Tak Mao Chan, H. Terence Cook, Fernando C. Fervenza, Keisha L. Gibson, Richard J. Glassock, David R.W. Jayne, Vivekanand Jha, Adrian Liew, Zhi-Hong Liu, Juan M. Mejía-Vilet, Carla M. Nester, Jai Radhakrishnan, Elizabeth M. Rave, Heather N. Reich, Pierre Ronco, Jan-Stephan F. Sanders, Sanjeev Sethi, Yusuke Suzuki, Sydney C.W. Tang, Vladimír Tesar, Marina Vivarelli, Jack F.M. Wetzels, Lyubov Lytvyn, Jonathan C. Craig, David J. Tunnicliffe, Martin Howell, Marcello A. Tonelli, Michael Cheung, Amy Earley, Jürgen Floege
Journal: Kidney International (2021)

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Glomerular Diseases is an update to the KDIGO 2012 guideline. The aim is to assist clinicians caring for individuals with glomerulonephritis (GN), both adults and children. The scope includes various glomerular diseases, including IgA nephropathy and IgA vasculitis, membranous nephropathy, nephrotic syndrome, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), infection-related GN, antineutrophil cytoplasmic antibody (ANCA) vasculitis, lupus nephritis, and anti-glomerular basement membrane antibody GN. In addition, this guideline will be the first to address the subtype of complement-mediated diseases. Each chapter follows the same format providing guidance related to diagnosis, prognosis, treatment, and special situations. The goal of the guideline is to generate a useful resource for clinicians and patients by providing actionable recommendations based on evidence syntheses, with useful infographics incorporating views from experts in the field. Another aim is to propose research recommendations for areas where there are gaps in knowledge. The guideline targets a broad global audience of clinicians treating GN while being mindful of implications for policy and cost. Development of this guideline update followed an explicit process whereby treatment approaches and guideline recommendations are based on systematic reviews of relevant studies, and appraisal of the quality of the evidence and the strength of recommendations followed the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. Limitations of the evidence are discussed, with areas of future research also presented.