2021
Leerapan, Borwornsom; Kaewkamjornchai, Phanuwich; Atun, Rifat; Jalali, Mohammad S.
How systems respond to policies: intended and unintended consequences of COVID-19 lockdown policies in Thailand. Journal Article
In: Health policy and planning, 2021, ISSN: 1460-2237, ().
@article{Leerapan2021,
title = {How systems respond to policies: intended and unintended consequences of COVID-19 lockdown policies in Thailand.},
author = {Borwornsom Leerapan and Phanuwich Kaewkamjornchai and Rifat Atun and Mohammad S. Jalali},
url = {https://pubmed.ncbi.nlm.nih.gov/34435199/},
doi = {10.1093/heapol/czab103},
issn = {1460-2237},
year = {2021},
date = {2021-08-01},
journal = {Health policy and planning},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kim, Judith; Lee, Minyi; Baldwin-Hunter, Brittany; Solfisburg, Quinn S.; Lightdale, Charles J.; Korem, Tal; Hur, Chin; Abrams, Julian A.
Minimal Associations between Short-Term Dietary Intake and Salivary Microbiome Composition. Journal Article
In: Microorganisms, vol. 9, 2021, ISSN: 2076-2607, ().
@article{Kim2021,
title = {Minimal Associations between Short-Term Dietary Intake and Salivary Microbiome Composition.},
author = {Judith Kim and Minyi Lee and Brittany Baldwin-Hunter and Quinn S. Solfisburg and Charles J. Lightdale and Tal Korem and Chin Hur and Julian A. Abrams},
url = {https://pubmed.ncbi.nlm.nih.gov/34442819/},
doi = {10.3390/microorganisms9081739},
issn = {2076-2607},
year = {2021},
date = {2021-08-01},
journal = {Microorganisms},
volume = {9},
abstract = {Increasing evidence points to the esophageal microbiome as an important co-factor in esophageal neoplasia. Esophageal microbiome composition is strongly influenced by the oral microbiome. Salivary microbiome assessment has emerged as a potential non-invasive tool to identify patients at risk for esophageal cancer, but key host and environmental factors that may affect the salivary microbiome have not been well-defined. This study aimed to evaluate the impact of short-term dietary intake on salivary microbiome composition. Saliva samples were collected from 69 subjects prior to upper endoscopy who completed the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment. Salivary microbiome composition was determined using 16S rRNA amplicon sequencing. There was no significant correlation between alpha diversity and primary measures of short-term dietary intake (total daily calories, fat, fiber, fruit/vegetables, red meat intake, and fasting time). There was no evidence of clustering on beta diversity analyses. Very few taxonomic alterations were found for short-term dietary intake; an increased relative abundance of and was associated with high fruit and vegetable intake, and an increased relative abundance of a taxon in the family was associated with increased red meat intake. Short-term dietary intake was associated with only minimal salivary microbiome alterations and does not appear to have a major impact on the potential use of the salivary microbiome as a biomarker for esophageal neoplasia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Increasing evidence points to the esophageal microbiome as an important co-factor in esophageal neoplasia. Esophageal microbiome composition is strongly influenced by the oral microbiome. Salivary microbiome assessment has emerged as a potential non-invasive tool to identify patients at risk for esophageal cancer, but key host and environmental factors that may affect the salivary microbiome have not been well-defined. This study aimed to evaluate the impact of short-term dietary intake on salivary microbiome composition. Saliva samples were collected from 69 subjects prior to upper endoscopy who completed the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment. Salivary microbiome composition was determined using 16S rRNA amplicon sequencing. There was no significant correlation between alpha diversity and primary measures of short-term dietary intake (total daily calories, fat, fiber, fruit/vegetables, red meat intake, and fasting time). There was no evidence of clustering on beta diversity analyses. Very few taxonomic alterations were found for short-term dietary intake; an increased relative abundance of and was associated with high fruit and vegetable intake, and an increased relative abundance of a taxon in the family was associated with increased red meat intake. Short-term dietary intake was associated with only minimal salivary microbiome alterations and does not appear to have a major impact on the potential use of the salivary microbiome as a biomarker for esophageal neoplasia.
Rustgi, Sheila D.; Oh, Aaron; Hur, Chin
Testing and Treating Helicobacter Pylori Infection in Individuals with Family History of Gastric Cancer is Cost-effective. Journal Article
In: Gastroenterology, 2021, ISSN: 1528-0012, ().
@article{Rustgi2021a,
title = {Testing and Treating Helicobacter Pylori Infection in Individuals with Family History of Gastric Cancer is Cost-effective.},
author = {Sheila D. Rustgi and Aaron Oh and Chin Hur},
url = {https://pubmed.ncbi.nlm.nih.gov/34461053/},
doi = {10.1053/j.gastro.2021.08.042},
issn = {1528-0012},
year = {2021},
date = {2021-08-01},
journal = {Gastroenterology},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Forster, Martin; Brealey, Stephen; Chick, Stephen; Keding, Ada; Corbacho, Belen; Alban, Andres; Pertile, Paolo; Rangan, Amar
Cost-effective clinical trial design: Application of a Bayesian sequential model to the ProFHER pragmatic trial. Journal Article
In: Clinical trials (London, England), pp. 17407745211032909, 2021, ISSN: 1740-7753, ().
@article{Forster2021,
title = {Cost-effective clinical trial design: Application of a Bayesian sequential model to the ProFHER pragmatic trial.},
author = {Martin Forster and Stephen Brealey and Stephen Chick and Ada Keding and Belen Corbacho and Andres Alban and Paolo Pertile and Amar Rangan},
url = {https://pubmed.ncbi.nlm.nih.gov/34407641/},
doi = {10.1177/17407745211032909},
issn = {1740-7753},
year = {2021},
date = {2021-08-01},
journal = {Clinical trials (London, England)},
pages = {17407745211032909},
abstract = {There is growing interest in the use of adaptive designs to improve the efficiency of clinical trials. We apply a Bayesian decision-theoretic model of a sequential experiment using cost and outcome data from the ProFHER pragmatic trial. We assess the model's potential for delivering value-based research. Using parameter values estimated from the ProFHER pragmatic trial, including the costs of carrying out the trial, we establish when the trial could have stopped, had the model's value-based stopping rule been used. We use a bootstrap analysis and simulation study to assess a range of operating characteristics, which we compare with a fixed sample size design which does not allow for early stopping. We estimate that application of the model could have stopped the ProFHER trial early, reducing the sample size by about 14%, saving about 5% of the research budget and resulting in a technology recommendation which was the same as that of the trial. The bootstrap analysis suggests that the expected sample size would have been 38% lower, saving around 13% of the research budget, with a probability of 0.92 of making the same technology recommendation decision. It also shows a large degree of variability in the trial's sample size. Benefits to trial cost stewardship may be achieved by monitoring trial data as they accumulate and using a stopping rule which balances the benefit of obtaining more information through continued recruitment with the cost of obtaining that information. We present recommendations for further research investigating the application of value-based sequential designs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
There is growing interest in the use of adaptive designs to improve the efficiency of clinical trials. We apply a Bayesian decision-theoretic model of a sequential experiment using cost and outcome data from the ProFHER pragmatic trial. We assess the model's potential for delivering value-based research. Using parameter values estimated from the ProFHER pragmatic trial, including the costs of carrying out the trial, we establish when the trial could have stopped, had the model's value-based stopping rule been used. We use a bootstrap analysis and simulation study to assess a range of operating characteristics, which we compare with a fixed sample size design which does not allow for early stopping. We estimate that application of the model could have stopped the ProFHER trial early, reducing the sample size by about 14%, saving about 5% of the research budget and resulting in a technology recommendation which was the same as that of the trial. The bootstrap analysis suggests that the expected sample size would have been 38% lower, saving around 13% of the research budget, with a probability of 0.92 of making the same technology recommendation decision. It also shows a large degree of variability in the trial's sample size. Benefits to trial cost stewardship may be achieved by monitoring trial data as they accumulate and using a stopping rule which balances the benefit of obtaining more information through continued recruitment with the cost of obtaining that information. We present recommendations for further research investigating the application of value-based sequential designs.
Dalgic, Ozden Onur; Wu, Haoran; Erenay, F. Safa; Sir, Mustafa Y.; Özaltın, Osman Y.; Crum, Brian A.; Pasupathy, Kalyan S.; Consortiu, Pooled Resource Open-Access A. L. S. Clinical Trials
Mapping of Critical Events in Disease Progression through Binary Classification: Application to Amyotrophic Lateral Sclerosis. Journal Article
In: Journal of biomedical informatics, vol. 123, pp. 103895, 2021, ISSN: 1532-0480, ().
@article{Dalgic2021,
title = {Mapping of Critical Events in Disease Progression through Binary Classification: Application to Amyotrophic Lateral Sclerosis.},
author = {Ozden Onur Dalgic and Haoran Wu and F. Safa Erenay and Mustafa Y. Sir and Osman Y. \"{O}zaltın and Brian A. Crum and Kalyan S. Pasupathy and Pooled Resource Open-Access A. L. S. Clinical Trials Consortiu},
url = {https://pubmed.ncbi.nlm.nih.gov/34450286/},
doi = {10.1016/j.jbi.2021.103895},
issn = {1532-0480},
year = {2021},
date = {2021-08-01},
journal = {Journal of biomedical informatics},
volume = {123},
pages = {103895},
abstract = {The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analysis of disease progression poses data challenges, such as censoring and misclassification errors, which need to be addressed to provide meaningful research findings and inform patients. We developed a novel binary classification approach to map scale scores into disease tollgates to describe disease progression leveraging standard/modified Kaplan-Meier analyses. The approach is demonstrated by estimating progression pathways in amyotrophic lateral sclerosis (ALS). Tollgate-based ALS Staging System (TASS) specifies the critical events (i.e., tollgates) in ALS progression. We first developed a binary classification predicting whether each TASS tollgate was passed given the itemized ALSFRS-R scores using 514 ALS patients' data from Mayo Clinic-Rochester. Then, we utilized the binary classification to translate/map the ALSFRS-R data of 3,264 patients from the PRO-ACT database into TASS. We derived the time trajectories of ALS progression through tollgates from the augmented PRO-ACT data using Kaplan-Meier analyses. The effects of misclassification errors, condition-dependent dropouts, and censored data in trajectory estimations were evaluated with Interval Censored Kaplan Meier Analysis and Multistate Model for Panel Data. The approach using Mayo Clinic data accurately estimated tollgate-passed states of patients given their itemized ALSFRS-R scores (AUCs\>0.90). The tollgate time trajectories derived from the augmented PRO-ACT dataset provide valuable insights; we predicted that the majority of the ALS patients would have modified arm function (67%) and require assistive devices for walking (53%) by the second year after ALS onset. By the third year, most (74%) ALS patients would occasionally use a wheelchair, while 48% of the ALS patients would be wheelchair-dependent by the fourth year. Assistive speech devices and feeding tubes were needed in 49% and 30% of the patients by the third year after ALS onset, respectively. The onset body region alters some tollgate passage time estimations by 1-2 years. The estimated tollgate-based time trajectories inform patients and clinicians about prospective assistive device needs and life changes. More research is needed to personalize these estimations according to prognostic factors. Further, the approach can be leveraged in the progression of other diseases.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analysis of disease progression poses data challenges, such as censoring and misclassification errors, which need to be addressed to provide meaningful research findings and inform patients. We developed a novel binary classification approach to map scale scores into disease tollgates to describe disease progression leveraging standard/modified Kaplan-Meier analyses. The approach is demonstrated by estimating progression pathways in amyotrophic lateral sclerosis (ALS). Tollgate-based ALS Staging System (TASS) specifies the critical events (i.e., tollgates) in ALS progression. We first developed a binary classification predicting whether each TASS tollgate was passed given the itemized ALSFRS-R scores using 514 ALS patients' data from Mayo Clinic-Rochester. Then, we utilized the binary classification to translate/map the ALSFRS-R data of 3,264 patients from the PRO-ACT database into TASS. We derived the time trajectories of ALS progression through tollgates from the augmented PRO-ACT data using Kaplan-Meier analyses. The effects of misclassification errors, condition-dependent dropouts, and censored data in trajectory estimations were evaluated with Interval Censored Kaplan Meier Analysis and Multistate Model for Panel Data. The approach using Mayo Clinic data accurately estimated tollgate-passed states of patients given their itemized ALSFRS-R scores (AUCs>0.90). The tollgate time trajectories derived from the augmented PRO-ACT dataset provide valuable insights; we predicted that the majority of the ALS patients would have modified arm function (67%) and require assistive devices for walking (53%) by the second year after ALS onset. By the third year, most (74%) ALS patients would occasionally use a wheelchair, while 48% of the ALS patients would be wheelchair-dependent by the fourth year. Assistive speech devices and feeding tubes were needed in 49% and 30% of the patients by the third year after ALS onset, respectively. The onset body region alters some tollgate passage time estimations by 1-2 years. The estimated tollgate-based time trajectories inform patients and clinicians about prospective assistive device needs and life changes. More research is needed to personalize these estimations according to prognostic factors. Further, the approach can be leveraged in the progression of other diseases.
Fligor, Scott C; Lubitz, Carrie C.; James, Benjamin C
ASO Author Reflections: Does Timely Surgery Matter in Papillary Thyroid Cancer? Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3567, 2021, ISSN: 1534-4681, ().
@article{Fligor2021,
title = {ASO Author Reflections: Does Timely Surgery Matter in Papillary Thyroid Cancer?},
author = {Scott C Fligor and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33755830/},
doi = {10.1245/s10434-021-09799-x},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3567},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fligor, Scott C; Lopez, Betzamel; Uppal, Nishant; Lubitz, Carrie C.; James, Benjamin C
Time to Surgery and Thyroid Cancer Survival in the United States. Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3556-3565, 2021, ISSN: 1534-4681, ().
@article{Fligor2021b,
title = {Time to Surgery and Thyroid Cancer Survival in the United States.},
author = {Scott C Fligor and Betzamel Lopez and Nishant Uppal and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33768394/},
doi = {10.1245/s10434-021-09797-z},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3556-3565},
abstract = {Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer. In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and \> 180 days. Subgroup analyses were conducted by T stage. Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors. Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer. In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and > 180 days. Subgroup analyses were conducted by T stage. Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors. Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.
Fligor, Scott C; Lopez, Betzamel; Uppal, Nishant; Lubitz, Carrie C.; James, Benjamin C
ASO Visual Abstract: Time to Surgery and Thyroid Cancer Survival in the United States. Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3566, 2021, ISSN: 1534-4681, ().
@article{Fligor2021a,
title = {ASO Visual Abstract: Time to Surgery and Thyroid Cancer Survival in the United States.},
author = {Scott C Fligor and Betzamel Lopez and Nishant Uppal and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33768401/},
doi = {10.1245/s10434-021-09834-x},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3566},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Garber, Jeffrey R.; Papini, Enrico; Frasoldati, Andrea; Lupo, Mark A.; Harrell, R. Mack; Parangi, Sareh; Patkar, Vivek; Baloch, Zubair W.; Pessah-Pollack, Rachel; Hegedus, Laszlo; Crescenzi, Anna; Lubitz, Carrie C.; Paschke, Ralf; Randolph, Gregory W.; Guglielmi, Rinaldo; Lombardi, Celestino P.; Gharib, Hossein
American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool. Journal Article
In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 27, no. 7, pp. 649-660, 2021, ().
@article{Garber2021,
title = {American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool.},
author = {Jeffrey R. Garber and Enrico Papini and Andrea Frasoldati and Mark A. Lupo and R. Mack Harrell and Sareh Parangi and Vivek Patkar and Zubair W. Baloch and Rachel Pessah-Pollack and Laszlo Hegedus and Anna Crescenzi and Carrie C. Lubitz and Ralf Paschke and Gregory W. Randolph and Rinaldo Guglielmi and Celestino P. Lombardi and Hossein Gharib},
url = {https://pubmed.ncbi.nlm.nih.gov/34090820/},
year = {2021},
date = {2021-07-01},
urldate = {2021-07-01},
journal = {Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists},
volume = {27},
number = {7},
pages = {649-660},
address = {United States},
abstract = {OBJECTIVE: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. METHODS: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. RESULTS: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. CONCLUSION: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. METHODS: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. RESULTS: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. CONCLUSION: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.
Hur, Chin
Gastric Cancer:: An Update on the Rapidly Changing Characteristics and Evolving Opportunities for Interventions. Journal Article
In: Gastrointestinal endoscopy clinics of North America, vol. 31, pp. xv–xviii, 2021, ISSN: 1558-1950, ().
@article{Hur2021,
title = {Gastric Cancer:: An Update on the Rapidly Changing Characteristics and Evolving Opportunities for Interventions.},
author = {Chin Hur},
url = {https://pubmed.ncbi.nlm.nih.gov/34053643/},
doi = {10.1016/j.giec.2021.04.002},
issn = {1558-1950},
year = {2021},
date = {2021-07-01},
journal = {Gastrointestinal endoscopy clinics of North America},
volume = {31},
pages = {xv--xviii},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Munden, Reginald F; Black, William C; Hartman, Thomas E; MacMahon, Heber; Ko, Jane P; Dyer, Debra S; Naidich, David; Rossi, Santiago E; McAdams, H Page; Goodman, Eric M; Brown, Kathleen; Kent, Michael; Carter, Brett W; Chiles, Caroline; Leung, Ann N; Boiselle, Phillip M; Kazerooni, Ella A; Berland, Lincoln L; Pandharipande, Pari
Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. Journal Article
In: Journal of the American College of Radiology : JACR, 2021, ISSN: 1558-349X, ().
@article{Munden2021,
title = {Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee.},
author = {Reginald F Munden and William C Black and Thomas E Hartman and Heber MacMahon and Jane P Ko and Debra S Dyer and David Naidich and Santiago E Rossi and H Page McAdams and Eric M Goodman and Kathleen Brown and Michael Kent and Brett W Carter and Caroline Chiles and Ann N Leung and Phillip M Boiselle and Ella A Kazerooni and Lincoln L Berland and Pari Pandharipande},
url = {https://pubmed.ncbi.nlm.nih.gov/34246574/},
doi = {10.1016/j.jacr.2021.04.014},
issn = {1558-349X},
year = {2021},
date = {2021-07-01},
journal = {Journal of the American College of Radiology : JACR},
abstract = {The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
Chu, Jacqueline; Ghenand, Omkar; Collins, Joy; Byrne, James; Wentworth, Adam; Chai, Peter R; Dadabhoy, Farah; Hur, Chin; Traverso, Giovanni
Thinking green: modelling respirator reuse strategies to reduce cost and waste. Journal Article
In: BMJ open, vol. 11, pp. e048687, 2021, ISSN: 2044-6055, ().
@article{Chu2021,
title = {Thinking green: modelling respirator reuse strategies to reduce cost and waste.},
author = {Jacqueline Chu and Omkar Ghenand and Joy Collins and James Byrne and Adam Wentworth and Peter R Chai and Farah Dadabhoy and Chin Hur and Giovanni Traverso},
url = {https://pubmed.ncbi.nlm.nih.gov/34275864/},
doi = {10.1136/bmjopen-2021-048687},
issn = {2044-6055},
year = {2021},
date = {2021-07-01},
journal = {BMJ open},
volume = {11},
pages = {e048687},
abstract = {To compare the impact of respirator extended use and reuse strategies with regard to cost and sustainability during the COVID-19 pandemic. Cost analysis. USA. All healthcare workers within the USA. Not applicable. A model was developed to estimate usage, costs and waste incurred by several respirator usage strategies over the first 6 months of the pandemic in the USA. This model assumed universal masking of all healthcare workers. Estimates were taken from the literature, government databases and commercially available data from approved vendors. A new N95 respirator per patient encounter would require 7.41 billion respirators, cost $6.38 billion and generate 84.0 million kg of waste in the USA over 6 months. One respirator per day per healthcare worker would require 3.29 billion respirators, cost $2.83 billion and generate 37.22 million kg of waste. Decontamination by ultraviolet germicidal irradiation would require 1.64 billion respirators, cost $1.41 billion and accumulate 18.61 million kg of waste. H O vapour decontamination would require 1.15 billion respirators, cost $1.65 billion and produce 13.03 million kg of waste. One reusable respirator with daily disposable filters would require 18 million respirators, cost $1.24 billion and generate 15.73 million kg of waste. Pairing a reusable respirator with H O vapour-decontaminated filters would reduce cost to $831 million and generate 1.58 million kg of waste. The use of one surgical mask per healthcare worker per day would require 3.29 billion masks, cost $460 million and generate 27.92 million kg of waste. Decontamination and reusable respirator-based strategies decreased the number of respirators used, costs and waste generated compared with single-use or daily extended-use of disposable respirators. Future development of low-cost,simple technologies to enable respirator and/or filter decontamination is needed to further minimise the economic and environmental costs of masks.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To compare the impact of respirator extended use and reuse strategies with regard to cost and sustainability during the COVID-19 pandemic. Cost analysis. USA. All healthcare workers within the USA. Not applicable. A model was developed to estimate usage, costs and waste incurred by several respirator usage strategies over the first 6 months of the pandemic in the USA. This model assumed universal masking of all healthcare workers. Estimates were taken from the literature, government databases and commercially available data from approved vendors. A new N95 respirator per patient encounter would require 7.41 billion respirators, cost $6.38 billion and generate 84.0 million kg of waste in the USA over 6 months. One respirator per day per healthcare worker would require 3.29 billion respirators, cost $2.83 billion and generate 37.22 million kg of waste. Decontamination by ultraviolet germicidal irradiation would require 1.64 billion respirators, cost $1.41 billion and accumulate 18.61 million kg of waste. H O vapour decontamination would require 1.15 billion respirators, cost $1.65 billion and produce 13.03 million kg of waste. One reusable respirator with daily disposable filters would require 18 million respirators, cost $1.24 billion and generate 15.73 million kg of waste. Pairing a reusable respirator with H O vapour-decontaminated filters would reduce cost to $831 million and generate 1.58 million kg of waste. The use of one surgical mask per healthcare worker per day would require 3.29 billion masks, cost $460 million and generate 27.92 million kg of waste. Decontamination and reusable respirator-based strategies decreased the number of respirators used, costs and waste generated compared with single-use or daily extended-use of disposable respirators. Future development of low-cost,simple technologies to enable respirator and/or filter decontamination is needed to further minimise the economic and environmental costs of masks.
Knudsen, Amy; Rutter, Carolyn M; Meester, Reinier G S; Lansdorp-Vogelaar, Iris; Zauber, Ann G; Kuntz, Karen M
Colorectal Cancer Screening in Young Adults. Journal Article
In: Annals of internal medicine, vol. 174, no. 7, pp. 1039–1040, 2021, ISSN: 1539-3704, ().
@article{Knudsen2021a,
title = {Colorectal Cancer Screening in Young Adults.},
author = {Amy Knudsen and Carolyn M Rutter and Reinier G S Meester and Iris Lansdorp-Vogelaar and Ann G Zauber and Karen M Kuntz},
url = {https://pubmed.ncbi.nlm.nih.gov/34280341/},
doi = {10.7326/L21-0245},
issn = {1539-3704},
year = {2021},
date = {2021-07-01},
journal = {Annals of internal medicine},
volume = {174},
number = {7},
pages = {1039--1040},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Beninato, Toni; Laird, Amanda M.; Graves, Claire E.; Drake, F. Thurston; Alhefdhi, Amal; Lee, Janie; Kuo, Jennifer H.; Grubbs, Elizabeth G.; Wang, Tracy S.; Pasieka, Janice L.; Lubitz, Carrie C.
Impact of the COVID-19 pandemic on the practice of endocrine surgery. Journal Article
In: American journal of surgery, vol. 223, iss. 4, pp. 670-675, 2021, ISSN: 1879-1883.
@article{Beninato2021,
title = {Impact of the COVID-19 pandemic on the practice of endocrine surgery.},
author = {Toni Beninato and Amanda M. Laird and Claire E. Graves and F. Thurston Drake and Amal Alhefdhi and Janie Lee and Jennifer H. Kuo and Elizabeth G. Grubbs and Tracy S. Wang and Janice L. Pasieka and Carrie C. Lubitz},
url = {https://pubmed.ncbi.nlm.nih.gov/34315576/},
doi = {10.1016/j.amjsurg.2021.07.009},
issn = {1879-1883},
year = {2021},
date = {2021-07-01},
urldate = {2021-07-01},
journal = {American journal of surgery},
volume = {223},
issue = {4},
pages = {670-675},
abstract = {This study investigates the impact of the COVID-19 pandemic on endocrine surgeons. A survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. 77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15-50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p \< 0.001). Use of in-office procedures (p \< 0.001) and length of observation prior to discharge for thyroid surgery (p \< 0.05) decreased. The COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study investigates the impact of the COVID-19 pandemic on endocrine surgeons. A survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. 77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15-50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p < 0.001). Use of in-office procedures (p < 0.001) and length of observation prior to discharge for thyroid surgery (p < 0.05) decreased. The COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.
Barreto, Esteban A.; Guzikowski, Sophia; Michael, Carie; Carter, Jocelyn; Betancourt, Joseph R.; Tull, Andrea; Tan-McGrory, Aswita; Donelan, Karen
The role of race, ethnicity, and language in care transitions. Journal Article
In: The American journal of managed care, vol. 27, no. 7, pp. e221–e225, 2021, ISSN: 1936-2692, ().
@article{Barreto2021,
title = {The role of race, ethnicity, and language in care transitions.},
author = {Esteban A. Barreto and Sophia Guzikowski and Carie Michael and Jocelyn Carter and Joseph R. Betancourt and Andrea Tull and Aswita Tan-McGrory and Karen Donelan},
url = {https://pubmed.ncbi.nlm.nih.gov/34314122/},
doi = {10.37765/ajmc.2021.88705},
issn = {1936-2692},
year = {2021},
date = {2021-07-01},
journal = {The American journal of managed care},
volume = {27},
number = {7},
pages = {e221--e225},
abstract = {To identify areas where transition from hospital to community could be improved, with a special focus on racial, ethnic, and language differences. A cross-sectional survey administered by postal mail and bilingual telephone interviewers. Patients were randomly selected within strata by race, ethnicity, and language proficiency. A total of 224 patients (response rate: 63.5%) who had recently experienced a hospital stay completed the survey. Overall, 1 in 4 patients were alone at discharge. More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials. We noted significant differences by race, ethnicity, and language in technology access and in patient-reported worries in the posthospital period. Hispanic or Latino patients and patients with limited English proficiency were less likely to report access to a computer and less likely to access the Patient Gateway portal. Black or African American patients were also less likely to use the Patient Gateway portal. Asian patients were more likely to be worried about getting home health services. Our findings highlight the enhanced difficulties that diverse patients may experience when transitioning from hospital to community-based settings. When considering how to best address the complex needs of diverse populations, interventions must be sensitive to the presence or absence of others, potential digital divides, and medical interpretation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To identify areas where transition from hospital to community could be improved, with a special focus on racial, ethnic, and language differences. A cross-sectional survey administered by postal mail and bilingual telephone interviewers. Patients were randomly selected within strata by race, ethnicity, and language proficiency. A total of 224 patients (response rate: 63.5%) who had recently experienced a hospital stay completed the survey. Overall, 1 in 4 patients were alone at discharge. More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials. We noted significant differences by race, ethnicity, and language in technology access and in patient-reported worries in the posthospital period. Hispanic or Latino patients and patients with limited English proficiency were less likely to report access to a computer and less likely to access the Patient Gateway portal. Black or African American patients were also less likely to use the Patient Gateway portal. Asian patients were more likely to be worried about getting home health services. Our findings highlight the enhanced difficulties that diverse patients may experience when transitioning from hospital to community-based settings. When considering how to best address the complex needs of diverse populations, interventions must be sensitive to the presence or absence of others, potential digital divides, and medical interpretation.
Lawson, Marissa B.; Lee, Christoph I.; Hippe, Daniel S.; Chennupati, Shasank; Fedorenko, Catherine R.; Malone, Kathleen E.; Ramsey, Scott D.; Lee, Janie
Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes. Journal Article
In: Journal of the National Comprehensive Cancer Network : JNCCN, 2021, ISSN: 1540-1413, ().
@article{Lawson2021,
title = {Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes.},
author = {Marissa B. Lawson and Christoph I. Lee and Daniel S. Hippe and Shasank Chennupati and Catherine R. Fedorenko and Kathleen E. Malone and Scott D. Ramsey and Janie Lee},
url = {https://pubmed.ncbi.nlm.nih.gov/34330103/},
doi = {10.6004/jnccn.2020.7801},
issn = {1540-1413},
year = {2021},
date = {2021-07-01},
journal = {Journal of the National Comprehensive Cancer Network : JNCCN},
abstract = {The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80-4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64-2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10-6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26-3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67-2.61). Nonreceipt of mammography was associated with younger age (40-49 vs 50-59 years; OR, 1.69; 95% CI, 1.45-1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03-1.07). In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80-4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64-2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10-6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26-3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67-2.61). Nonreceipt of mammography was associated with younger age (40-49 vs 50-59 years; OR, 1.69; 95% CI, 1.45-1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03-1.07). In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.
DiGennaro, Catherine; Garcia, Gian-Gabriel; Stringfellow, Erin; Wakeman, Sarah; Jalali, Mohammad S.
Changes in characteristics of drug overdose death trends during the COVID-19 pandemic. Journal Article
In: The International journal on drug policy, vol. 98, pp. 103392, 2021, ISSN: 1873-4758, ().
@article{DiGennaro2021,
title = {Changes in characteristics of drug overdose death trends during the COVID-19 pandemic.},
author = {Catherine DiGennaro and Gian-Gabriel Garcia and Erin Stringfellow and Sarah Wakeman and Mohammad S. Jalali},
url = {https://pubmed.ncbi.nlm.nih.gov/34325184/},
doi = {10.1016/j.drugpo.2021.103392},
issn = {1873-4758},
year = {2021},
date = {2021-07-01},
journal = {The International journal on drug policy},
volume = {98},
pages = {103392},
abstract = {Reports analyzing drug overdose (OD) mortality data during the COVID-19 pandemic are limited. Outcomes across states are heterogenous, necessitating assessments of associations between COVID-19 and OD deaths on a state-by-state level. This report aims to analyze trends in OD deaths in Massachusetts during COVID-19. Analyzing 3,924 death records, we characterize opioid-, cocaine-, and amphetamine-involved OD mortality and substance co-presence trends from March 24-November 8 in 2020 as compared to 2018 and 2019. OD deaths involving amphetamines increased by 85% from 2019 to 2020 (61 vs. 113; P\<0.001) but were steady from 2018 to 2019. Heroin's presence continued to decrease (341 in 2018, 247 in 2019, 157 in 2020; P\<0.001); however, fentanyl was present in more than 85% of all OD deaths across all periods. Among OD deaths, alcohol involvement consistently increased, present in 250 deaths in 2018, 299 in 2019 (P=0.02), and 350 in 2020 (P=0.04). In 2019, 78% of OD decedents were White and 7% were Black, versus 73% and 10% in 2020 (P=0.02). Increased deaths involving stimulants, alcohol, and fentanyl reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary.},
keywords = {},
pubstate = {ppublish},
tppubtype = {article}
}
Reports analyzing drug overdose (OD) mortality data during the COVID-19 pandemic are limited. Outcomes across states are heterogenous, necessitating assessments of associations between COVID-19 and OD deaths on a state-by-state level. This report aims to analyze trends in OD deaths in Massachusetts during COVID-19. Analyzing 3,924 death records, we characterize opioid-, cocaine-, and amphetamine-involved OD mortality and substance co-presence trends from March 24-November 8 in 2020 as compared to 2018 and 2019. OD deaths involving amphetamines increased by 85% from 2019 to 2020 (61 vs. 113; P<0.001) but were steady from 2018 to 2019. Heroin's presence continued to decrease (341 in 2018, 247 in 2019, 157 in 2020; P<0.001); however, fentanyl was present in more than 85% of all OD deaths across all periods. Among OD deaths, alcohol involvement consistently increased, present in 250 deaths in 2018, 299 in 2019 (P=0.02), and 350 in 2020 (P=0.04). In 2019, 78% of OD decedents were White and 7% were Black, versus 73% and 10% in 2020 (P=0.02). Increased deaths involving stimulants, alcohol, and fentanyl reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary.
Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S.; Gazelle, G. Scott; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C.
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 31, no. 6, pp. 941-949, 2021, ISSN: 1557-9077, ().
@article{Toumi2020,
title = {Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018.},
author = {Asmae Toumi and Catherine DiGennaro and Vahab Vahdat and Mohammad S. Jalali and G. Scott Gazelle and Jagpreet Chhatwal and Rachel R Kelz and Carrie C. Lubitz},
url = {https://pubmed.ncbi.nlm.nih.gov/33280499/},
doi = {10.1089/thy.2020.0643},
issn = {1557-9077},
year = {2021},
date = {2021-06-18},
urldate = {2021-06-18},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {31},
number = {6},
pages = {941-949},
abstract = {\textbf{Background:} The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. \textbf{Methods:} Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. \textbf{Results:} A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. \textbf{Conclusions:} There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
Hammer, Mark M; Eckel, Andrew; Palazzo, Lauren; Kong, Chung Yin
Cost-Effectiveness of Treatment Thresholds for Subsolid Pulmonary Nodules in CT Lung Cancer Screening. Journal Article
In: Radiology, pp. 204418, 2021, ISSN: 1527-1315, ().
@article{Hammer2021,
title = {Cost-Effectiveness of Treatment Thresholds for Subsolid Pulmonary Nodules in CT Lung Cancer Screening.},
author = {Mark M Hammer and Andrew Eckel and Lauren Palazzo and Chung Yin Kong},
url = {https://pubmed.ncbi.nlm.nih.gov/34128723/},
doi = {10.1148/radiol.2021204418},
issn = {1527-1315},
year = {2021},
date = {2021-06-01},
journal = {Radiology},
pages = {204418},
abstract = {Background Guidelines such as the Lung CT Screening Reporting and Data System (Lung-RADS) are available for determining when subsolid nodules should be treated within lung cancer screening programs, but they are based on expert opinion. Purpose To evaluate the cost-effectiveness of varying treatment thresholds for subsolid nodules within a lung cancer screening setting by using a simulation model. Materials and Methods A previously developed model simulated 10 million current and former smokers undergoing CT lung cancer screening who were assumed to have a ground-glass nodule (GGN) at baseline. Nodules were allowed to grow and to develop solid components over time according to a monthly cycle and lifetime horizon. Management strategies generated by varying treatment thresholds, including the solid component size and use of the Brock risk calculator, were tested. For each strategy, average U.S. costs and quality-adjusted life years (QALYs) gained per patient were computed, and the incremental cost-effectiveness ratios (ICERs) of those on the efficient frontier were calculated. One-way and probabilistic sensitivity analyses of results were performed by varying several relevant parameters, such as treatment costs or malignancy growth rates. Results Variants of the Lung-RADS guidelines that did not treat pure GGNs were cost-effective. Strategies based on the Brock risk calculator did not reach the efficient frontier. The strategy with the highest QALYs under a willingness-to-pay threshold of $100 000 per QALY included no treatment of GGNs and a threshold of 4-mm solid component size for treatment of subsolid nodules. This strategy yielded an ICER of $52 993 per QALY (95% CI: 44 407, 64 372). Probabilistic sensitivity analysis showed this was the optimal strategy under a range of parameter variations. Conclusion Treatment of pure ground-glass nodules was not cost-effective. Strategies that use modifications of the Lung CT Screening Reporting and Data System guidelines were cost-effective for treating part-solid nodules; an optimal threshold of 4 mm for the solid component yielded the most quality-adjusted life years. © RSNA, 2021},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background Guidelines such as the Lung CT Screening Reporting and Data System (Lung-RADS) are available for determining when subsolid nodules should be treated within lung cancer screening programs, but they are based on expert opinion. Purpose To evaluate the cost-effectiveness of varying treatment thresholds for subsolid nodules within a lung cancer screening setting by using a simulation model. Materials and Methods A previously developed model simulated 10 million current and former smokers undergoing CT lung cancer screening who were assumed to have a ground-glass nodule (GGN) at baseline. Nodules were allowed to grow and to develop solid components over time according to a monthly cycle and lifetime horizon. Management strategies generated by varying treatment thresholds, including the solid component size and use of the Brock risk calculator, were tested. For each strategy, average U.S. costs and quality-adjusted life years (QALYs) gained per patient were computed, and the incremental cost-effectiveness ratios (ICERs) of those on the efficient frontier were calculated. One-way and probabilistic sensitivity analyses of results were performed by varying several relevant parameters, such as treatment costs or malignancy growth rates. Results Variants of the Lung-RADS guidelines that did not treat pure GGNs were cost-effective. Strategies based on the Brock risk calculator did not reach the efficient frontier. The strategy with the highest QALYs under a willingness-to-pay threshold of $100 000 per QALY included no treatment of GGNs and a threshold of 4-mm solid component size for treatment of subsolid nodules. This strategy yielded an ICER of $52 993 per QALY (95% CI: 44 407, 64 372). Probabilistic sensitivity analysis showed this was the optimal strategy under a range of parameter variations. Conclusion Treatment of pure ground-glass nodules was not cost-effective. Strategies that use modifications of the Lung CT Screening Reporting and Data System guidelines were cost-effective for treating part-solid nodules; an optimal threshold of 4 mm for the solid component yielded the most quality-adjusted life years. © RSNA, 2021
Palamara, Kerri; Chu, Jacqueline T; Chang, Yuchiao; Yu, Liyang; Cosco, Dominique; Higgins, Stacy; Tulsky, Asher; Mourad, Ronda; Singh, Simran; Steinhauser, Karen; Donelan, Karen
Who Benefits Most? A Multisite Study of Coaching and Resident Well-being. Journal Article
In: Journal of general internal medicine, 2021, ISSN: 1525-1497, ().
@article{Palamara2021,
title = {Who Benefits Most? A Multisite Study of Coaching and Resident Well-being.},
author = {Kerri Palamara and Jacqueline T Chu and Yuchiao Chang and Liyang Yu and Dominique Cosco and Stacy Higgins and Asher Tulsky and Ronda Mourad and Simran Singh and Karen Steinhauser and Karen Donelan},
url = {https://pubmed.ncbi.nlm.nih.gov/34100238/},
doi = {10.1007/s11606-021-06903-5},
issn = {1525-1497},
year = {2021},
date = {2021-06-01},
journal = {Journal of general internal medicine},
abstract = {Coaching has been shown to improve resident well-being; however, not all benefit equally. Assess predictors of changes in resident physician well-being and burnout in a multisite implementation of a Professional Development Coaching Program. Pre- and post-implementation surveys administered to participant cohorts at implementation sites in their intern year. Effect size was calculated comparing pre- and post-intervention paired data. In total, 272 residents in their intern year at five internal medicine residency programs (Boston Medical Center, University Hospitals Cleveland Medical Center, Duke University, Emory University, Massachusetts General Hospital). Analyses included 129 residents with paired data. Interns were paired with a faculty coach trained in positive psychology and coaching skills and asked to meet quarterly with coaches. Primary outcomes included Maslach Burnout Inventory depersonalization (DP) and emotional exhaustion (EE) subscales, and the PERMA well-being scale. Key predictors included site, demographics, intolerance of uncertainty, hardiness-resilience, gratitude, and coping. Program moderators included were reflection, goal setting, and feedback. Well-being (PERMA) changed from baseline to follow-up in all participants; females showed a decline and males an increase (-1.41 vs. .8},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Coaching has been shown to improve resident well-being; however, not all benefit equally. Assess predictors of changes in resident physician well-being and burnout in a multisite implementation of a Professional Development Coaching Program. Pre- and post-implementation surveys administered to participant cohorts at implementation sites in their intern year. Effect size was calculated comparing pre- and post-intervention paired data. In total, 272 residents in their intern year at five internal medicine residency programs (Boston Medical Center, University Hospitals Cleveland Medical Center, Duke University, Emory University, Massachusetts General Hospital). Analyses included 129 residents with paired data. Interns were paired with a faculty coach trained in positive psychology and coaching skills and asked to meet quarterly with coaches. Primary outcomes included Maslach Burnout Inventory depersonalization (DP) and emotional exhaustion (EE) subscales, and the PERMA well-being scale. Key predictors included site, demographics, intolerance of uncertainty, hardiness-resilience, gratitude, and coping. Program moderators included were reflection, goal setting, and feedback. Well-being (PERMA) changed from baseline to follow-up in all participants; females showed a decline and males an increase (-1.41 vs. .8
Kumar, Shria; Saumoy, Monica; Oh, Aaron; Schneider, Yecheskel; Brand, Randall E; Chak, Amitabh; Ginsberg, Gregory G; Kochman, Michael L; Canto, Marcia Irene; Goggins, Michael Gilbert; Hur, Chin; Kastrinos, Fay; Katona, Bryson W; Rustgi, Anil K
Threshold Analysis of the Cost-effectiveness of Endoscopic Ultrasound in Patients at High Risk for Pancreatic Ductal Adenocarcinoma. Journal Article
In: Pancreas, 2021, ISSN: 1536-4828, ().
@article{Kumar2021,
title = {Threshold Analysis of the Cost-effectiveness of Endoscopic Ultrasound in Patients at High Risk for Pancreatic Ductal Adenocarcinoma.},
author = {Shria Kumar and Monica Saumoy and Aaron Oh and Yecheskel Schneider and Randall E Brand and Amitabh Chak and Gregory G Ginsberg and Michael L Kochman and Marcia Irene Canto and Michael Gilbert Goggins and Chin Hur and Fay Kastrinos and Bryson W Katona and Anil K Rustgi},
url = {https://pubmed.ncbi.nlm.nih.gov/34149034/},
doi = {10.1097/MPA.0000000000001835},
issn = {1536-4828},
year = {2021},
date = {2021-06-01},
journal = {Pancreas},
abstract = {Data from the International Cancer of the Pancreas Screening Consortium studies have demonstrated that screening for pancreatic ductal adenocarcinoma can be effective and that surveillance improves survival in high-risk individuals. Endoscopic ultrasound (EUS) and cross-sectional imaging are both used, although there is some suggestion that EUS is superior. Demonstration of the cost-effectiveness of screening is important to implement screening in high-risk groups. Results from centers with EUS-predominant screening were pooled to evaluate efficacy of index EUS in screening. A decision analysis model simulated the outcome of high-risk patients who undergo screening and evaluated the parameters that would make screening cost-effective at a US $100,000 per quality-adjusted life-year willingness to pay. One-time index EUS has a sensitivity of 71.25% and specificity of 99.82% to detection to detect high-risk lesions. Screening with index EUS was cost-effective, particularly at lifetime pancreatic cancer probabilities of greater than 10.8%, or at lower probabilities if life expectancy after resection of a lesion that was at least 16 years, and if missed, lesion rates on index EUS are 5% or less. Pancreatic cancer screening can be cost-effective through index EUS, particularly for those individuals at high-lifetime risk of cancer.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Data from the International Cancer of the Pancreas Screening Consortium studies have demonstrated that screening for pancreatic ductal adenocarcinoma can be effective and that surveillance improves survival in high-risk individuals. Endoscopic ultrasound (EUS) and cross-sectional imaging are both used, although there is some suggestion that EUS is superior. Demonstration of the cost-effectiveness of screening is important to implement screening in high-risk groups. Results from centers with EUS-predominant screening were pooled to evaluate efficacy of index EUS in screening. A decision analysis model simulated the outcome of high-risk patients who undergo screening and evaluated the parameters that would make screening cost-effective at a US $100,000 per quality-adjusted life-year willingness to pay. One-time index EUS has a sensitivity of 71.25% and specificity of 99.82% to detection to detect high-risk lesions. Screening with index EUS was cost-effective, particularly at lifetime pancreatic cancer probabilities of greater than 10.8%, or at lower probabilities if life expectancy after resection of a lesion that was at least 16 years, and if missed, lesion rates on index EUS are 5% or less. Pancreatic cancer screening can be cost-effective through index EUS, particularly for those individuals at high-lifetime risk of cancer.
Panda, Nikhil; Solsky, Ian; Neal, Brandon J; Hawrusik, Becky; Lipsitz, Stuart; Lubitz, Carrie C.; Gibbons, Chris; Brindle, Mary; Sinyard, Robert D; Onnela, Jukka-Pekka; Cauley, Christy; Haynes, Alex B
Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study. Journal Article
In: Annals of surgery open : perspectives of surgical history, education, and clinical approaches, vol. 2, pp. e060, 2021, ISSN: 2691-3593.
@article{Panda2021,
title = {Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study.},
author = {Nikhil Panda and Ian Solsky and Brandon J Neal and Becky Hawrusik and Stuart Lipsitz and Carrie C. Lubitz and Chris Gibbons and Mary Brindle and Robert D Sinyard and Jukka-Pekka Onnela and Christy Cauley and Alex B Haynes},
url = {https://pubmed.ncbi.nlm.nih.gov/34179891/},
doi = {10.1097/AS9.0000000000000060},
issn = {2691-3593},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Annals of surgery open : perspectives of surgical history, education, and clinical approaches},
volume = {2},
pages = {e060},
abstract = {Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], \< 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], = 0.024). Patients expected better HRQL than they experienced. Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], = 0.024). Patients expected better HRQL than they experienced. Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.
Marrero, Wesley J.; Lavieri, Mariel S; Guikema, Seth D; Hutton, David W; Parikh, Neehar D
A machine learning approach for the prediction of overall deceased donor organ yield. Journal Article
In: Surgery, 2021, ISSN: 1532-7361, ().
@article{Marrero2021a,
title = {A machine learning approach for the prediction of overall deceased donor organ yield.},
author = {Wesley J. Marrero and Mariel S Lavieri and Seth D Guikema and David W Hutton and Neehar D Parikh},
doi = {10.1016/j.surg.2021.06.004},
issn = {1532-7361},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Surgery},
abstract = {Optimizing organ yield (number of organs transplanted per donor) is a potentially modifiable way to increase the number of organs available for transplant. Models to predict the expected deceased donor organ yield have been developed based on ordinary least squares regression and logistic regression. However, alternative modeling methodologies incorporating machine learning may have superior performance compared with conventional approaches. We evaluated the predictive accuracy of 14 machine learning models for predicting overall organ yield in a cross-validation procedure. The models were parameterized using data from the Organ Procurement and Transplantation Network database from 2000 to 2018. The inclusion criteria for the study were adult deceased donors between 18 and 84 years of age that had at least 1 organ procured for transplantation. A total of 89,520 donors met the inclusion criteria. Their mean (standard deviation) age was 44 (15) years, and approximately 58% were male. Our cross-validation analysis showed that a tree-based gradient boosting model outperformed the remaining 13 models. Compared with the currently used prediction models, the gradient boosting model improves prediction accuracy by reducing the mean absolute error between 3 and 11 organs per 100 donors. Our analysis demonstrated that the gradient boosting methodology had the best performance in predicting overall deceased donor organ yield and can potentially serve as an aid to assess organ procurement organization performance.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Optimizing organ yield (number of organs transplanted per donor) is a potentially modifiable way to increase the number of organs available for transplant. Models to predict the expected deceased donor organ yield have been developed based on ordinary least squares regression and logistic regression. However, alternative modeling methodologies incorporating machine learning may have superior performance compared with conventional approaches. We evaluated the predictive accuracy of 14 machine learning models for predicting overall organ yield in a cross-validation procedure. The models were parameterized using data from the Organ Procurement and Transplantation Network database from 2000 to 2018. The inclusion criteria for the study were adult deceased donors between 18 and 84 years of age that had at least 1 organ procured for transplantation. A total of 89,520 donors met the inclusion criteria. Their mean (standard deviation) age was 44 (15) years, and approximately 58% were male. Our cross-validation analysis showed that a tree-based gradient boosting model outperformed the remaining 13 models. Compared with the currently used prediction models, the gradient boosting model improves prediction accuracy by reducing the mean absolute error between 3 and 11 organs per 100 donors. Our analysis demonstrated that the gradient boosting methodology had the best performance in predicting overall deceased donor organ yield and can potentially serve as an aid to assess organ procurement organization performance.
Byrne, James D; Young, Cameron C; Chu, Jacqueline N; Pursley, Jennifer; Chen, Mu Xian; Wentworth, Adam J; Feng, Annie; Kirtane, Ameya R; Remillard, Kyla A; Hancox, Cindy I; Bhagwat, Mandar S; Machado, Nicole; Hua, Tiffany; Tamang, Siddartha M; Collins, Joy E; Ishida, Keiko; Hayward, Alison; Becker, Sarah L; Edgington, Samantha K; Schoenfeld, Jonathan D; Jeck, William R; Hur, Chin; Traverso, Giovanni
Personalized Radiation Attenuating Materials for Gastrointestinal Mucosal Protection. Journal Article
In: Advanced science (Weinheim, Baden-Wurttemberg, Germany), vol. 8, pp. 2100510, 2021, ISSN: 2198-3844, ().
@article{Byrne2021,
title = {Personalized Radiation Attenuating Materials for Gastrointestinal Mucosal Protection.},
author = {James D Byrne and Cameron C Young and Jacqueline N Chu and Jennifer Pursley and Mu Xian Chen and Adam J Wentworth and Annie Feng and Ameya R Kirtane and Kyla A Remillard and Cindy I Hancox and Mandar S Bhagwat and Nicole Machado and Tiffany Hua and Siddartha M Tamang and Joy E Collins and Keiko Ishida and Alison Hayward and Sarah L Becker and Samantha K Edgington and Jonathan D Schoenfeld and William R Jeck and Chin Hur and Giovanni Traverso},
url = {https://pubmed.ncbi.nlm.nih.gov/34194950/},
doi = {10.1002/advs.202100510},
issn = {2198-3844},
year = {2021},
date = {2021-06-01},
journal = {Advanced science (Weinheim, Baden-Wurttemberg, Germany)},
volume = {8},
pages = {2100510},
abstract = {Cancer patients undergoing therapeutic radiation routinely develop injury of the adjacent gastrointestinal (GI) tract mucosa due to treatment. To reduce radiation dose to critical GI structures including the rectum and oral mucosa, 3D-printed GI radioprotective devices composed of high-Z materials are generated from patient CT scans. In a radiation proctitis rat model, a significant reduction in crypt injury is demonstrated with the device compared to without ( \< 0.0087). Optimal device placement for radiation attenuation is further confirmed in a swine model. Dosimetric modeling in oral cavity cancer patients demonstrates a 30% radiation dose reduction to the normal buccal mucosa and a 15.2% dose reduction in the rectum for prostate cancer patients with the radioprotectant material in place compared to without. Finally, it is found that the rectal radioprotectant device is more cost-effective compared to a hydrogel rectal spacer. Taken together, these data suggest that personalized radioprotectant devices may be used to reduce GI tissue injury in cancer patients undergoing therapeutic radiation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Cancer patients undergoing therapeutic radiation routinely develop injury of the adjacent gastrointestinal (GI) tract mucosa due to treatment. To reduce radiation dose to critical GI structures including the rectum and oral mucosa, 3D-printed GI radioprotective devices composed of high-Z materials are generated from patient CT scans. In a radiation proctitis rat model, a significant reduction in crypt injury is demonstrated with the device compared to without ( < 0.0087). Optimal device placement for radiation attenuation is further confirmed in a swine model. Dosimetric modeling in oral cavity cancer patients demonstrates a 30% radiation dose reduction to the normal buccal mucosa and a 15.2% dose reduction in the rectum for prostate cancer patients with the radioprotectant material in place compared to without. Finally, it is found that the rectal radioprotectant device is more cost-effective compared to a hydrogel rectal spacer. Taken together, these data suggest that personalized radioprotectant devices may be used to reduce GI tissue injury in cancer patients undergoing therapeutic radiation.
Siebert, Uwe; Milev, Sandra; Zou, Denise; Litkiewicz, Michal; Gaggin, Hannah K; Tirapelle, Linda; Masson, Serge; Januzzi, James L
In: The American journal of cardiology, vol. 15, no. 147, pp. 61-69, 2021, ISSN: 1879-1913.
@article{Siebert2021,
title = {Dconomic Evaluation of an N-terminal pro B-type Natriuretic Peptide-supported Diagnostic Strategy among Dyspneic Patients Suspected of Acute Heart Failure in the Emergency Department.},
author = {Uwe Siebert and Sandra Milev and Denise Zou and Michal Litkiewicz and Hannah K Gaggin and Linda Tirapelle and Serge Masson and James L Januzzi},
url = {https://pubmed.ncbi.nlm.nih.gov/33617809/},
doi = {10.1016/j.amjcard.2021.01.036},
issn = {1879-1913},
year = {2021},
date = {2021-05-01},
urldate = {2021-05-01},
journal = {The American journal of cardiology},
volume = {15},
number = {147},
pages = {61-69},
abstract = {Our objective was to perform an economic evaluation of an N-terminal pro B-type natriuretic peptide (NT-proBNP)-supported diagnostic strategy among dyspneic patients suspected of acute heart failure (AHF) in the emergency department (ED). A decision-tree model was developed to evaluate clinical outcomes and costs for NT-proBNP-supported assessment compared with clinical assessment alone over 6 months from the United States (US) Medicare perspective. The model considered rule-in/rule-out cutoffs identified in the ICON and ICON-RELOADED studies. AHF prevalence, diagnostic accuracies, and medical resource use conditional on disease status and test results were derived from ICON-RELOADED. Several assumptions based on prior studies of NT-proBNP acute dyspnea and verified with clinicians were applied to medical resource use and assessed in sensitivity analyses. Compared with clinical assessment alone, NT-proBNP-supported assessment improved overall probability of correct diagnosis by a relative 7% (18% for true-positive and 5% for true-negative). This led to relative reductions in medical resource use in ED and hospital, including fewer initial hospitalizations (-14%), required echocardiograms (-31%), cardiology admissions (-16%), intensive care unit admissions (-12%), ED readmissions (-3%), and hospital readmissions (-22%). NT-proBNP use decreased average inpatient management costs by a relative 10%, yielding cost savings of US$2,337 per patient ED visit. These findings were robust in sensitivity analyses. In conclusion, based on a contemporary trial of patients with acute dyspnea, this analysis reaffirmed that using NT-proBNP as a diagnostic tool may improve the management of patients with dyspnea presenting to EDs and is likely to be cost-saving from the US Medicare perspective.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Our objective was to perform an economic evaluation of an N-terminal pro B-type natriuretic peptide (NT-proBNP)-supported diagnostic strategy among dyspneic patients suspected of acute heart failure (AHF) in the emergency department (ED). A decision-tree model was developed to evaluate clinical outcomes and costs for NT-proBNP-supported assessment compared with clinical assessment alone over 6 months from the United States (US) Medicare perspective. The model considered rule-in/rule-out cutoffs identified in the ICON and ICON-RELOADED studies. AHF prevalence, diagnostic accuracies, and medical resource use conditional on disease status and test results were derived from ICON-RELOADED. Several assumptions based on prior studies of NT-proBNP acute dyspnea and verified with clinicians were applied to medical resource use and assessed in sensitivity analyses. Compared with clinical assessment alone, NT-proBNP-supported assessment improved overall probability of correct diagnosis by a relative 7% (18% for true-positive and 5% for true-negative). This led to relative reductions in medical resource use in ED and hospital, including fewer initial hospitalizations (-14%), required echocardiograms (-31%), cardiology admissions (-16%), intensive care unit admissions (-12%), ED readmissions (-3%), and hospital readmissions (-22%). NT-proBNP use decreased average inpatient management costs by a relative 10%, yielding cost savings of US$2,337 per patient ED visit. These findings were robust in sensitivity analyses. In conclusion, based on a contemporary trial of patients with acute dyspnea, this analysis reaffirmed that using NT-proBNP as a diagnostic tool may improve the management of patients with dyspnea presenting to EDs and is likely to be cost-saving from the US Medicare perspective.
Laszkowska, Monika; Rodriguez, Steven; Kim, Judith; Hur, Chin
Heavy Alcohol Use Is Associated With Gastric Cancer: Analysis of the National Health and Nutrition Examination Survey From 1999 to 2010. Journal Article
In: The American journal of gastroenterology, vol. 116, no. 5, pp. 1083-1086, 2021, ISSN: 1572-0241, ().
@article{Laszkowska2021a,
title = {Heavy Alcohol Use Is Associated With Gastric Cancer: Analysis of the National Health and Nutrition Examination Survey From 1999 to 2010.},
author = {Monika Laszkowska and Steven Rodriguez and Judith Kim and Chin Hur},
url = {https://pubmed.ncbi.nlm.nih.gov/33625123/},
doi = {10.14309/ajg.0000000000001166},
issn = {1572-0241},
year = {2021},
date = {2021-05-01},
journal = {The American journal of gastroenterology},
volume = {116},
number = {5},
pages = {1083-1086},
abstract = {Evidence regarding the association between alcohol use and gastric cancer (GC) has been inconsistent. Adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010 were included. Multivariable regression was used to assess the association between GC and heavy alcohol use (≥5 alcoholic drinks daily). Of 470,168 individuals surveyed, 342 had a history of GC. Heavy alcohol use was associated with GC (odds ratio 3.13, 95% confidence interval 1.15-8.64) on multivariable analysis. This is the largest study to our knowledge to demonstrate an association between heavy alcohol use and GC in the United States.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Evidence regarding the association between alcohol use and gastric cancer (GC) has been inconsistent. Adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010 were included. Multivariable regression was used to assess the association between GC and heavy alcohol use (≥5 alcoholic drinks daily). Of 470,168 individuals surveyed, 342 had a history of GC. Heavy alcohol use was associated with GC (odds ratio 3.13, 95% confidence interval 1.15-8.64) on multivariable analysis. This is the largest study to our knowledge to demonstrate an association between heavy alcohol use and GC in the United States.
Larsen, Dana; Chu, Jacqueline T; Yu, Liyang; Chang, Yuchiao; Donelan, Karen; Palamara, Kerri
Correlating Burnout and Well-being in a Multisite Study of Internal Medicine Residents and Faculty. Journal Article
In: Journal of general internal medicine, vol. 36, no. 5, pp. 1422-1426, 2021, ISSN: 1525-1497, ().
@article{Larsen2021,
title = {Correlating Burnout and Well-being in a Multisite Study of Internal Medicine Residents and Faculty.},
author = {Dana Larsen and Jacqueline T Chu and Liyang Yu and Yuchiao Chang and Karen Donelan and Kerri Palamara},
url = {https://pubmed.ncbi.nlm.nih.gov/33674923/},
doi = {10.1007/s11606-021-06653-4},
issn = {1525-1497},
year = {2021},
date = {2021-05-01},
journal = {Journal of general internal medicine},
volume = {36},
number = {5},
pages = {1422-1426},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dioun, Shayan; Chen, Ling; Melamed, Alexander; Gockley, Allison; Clair, Caryn M St; Hou, June Y; Tergas, Ana I; Khoury-Collado, Fady; Hur, Chin; Hershman, Dawn L; Wright, Jason D
Üptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia." Journal Article
In: Obstetrics and gynecology, vol. 137, no. 5, pp. 924-934, 2021, ISSN: 1873-233X, ().
@article{Dioun2021,
title = {\"{U}ptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia."},
author = {Shayan Dioun and Ling Chen and Alexander Melamed and Allison Gockley and Caryn M St Clair and June Y Hou and Ana I Tergas and Fady Khoury-Collado and Chin Hur and Dawn L Hershman and Jason D Wright},
url = {https://pubmed.ncbi.nlm.nih.gov/33831939/},
doi = {10.1097/AOG.0000000000004352},
issn = {1873-233X},
year = {2021},
date = {2021-05-01},
journal = {Obstetrics and gynecology},
volume = {137},
number = {5},
pages = {924-934},
abstract = {To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia. Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation. Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P.001). Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia. Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation. Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P.001). Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.
Lubitz, Carrie C.; Kiernan, Colleen M; Toumi, Asmae; Zhan, Tiannan; Roth, Mara Y; Sosa, Julie A; Tuttle, R Michael; Grubbs, Elizabeth G
Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer. Journal Article
In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 27, no. 5, pp. 383-389, 2021, ISSN: 1530-891X, ().
@article{Lubitz2021,
title = {Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer.},
author = {Carrie C. Lubitz and Colleen M Kiernan and Asmae Toumi and Tiannan Zhan and Mara Y Roth and Julie A Sosa and R Michael Tuttle and Elizabeth G Grubbs},
url = {https://pubmed.ncbi.nlm.nih.gov/33840638/},
doi = {10.1016/j.eprac.2021.01.005},
issn = {1530-891X},
year = {2021},
date = {2021-05-01},
journal = {Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists},
volume = {27},
number = {5},
pages = {383-389},
abstract = {To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.
Chhatwal, Jagpreet; Postma, Maarten J
Health Economics of Interventions to Tackle the Coronavirus 2019 Pandemic. Journal Article
In: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, vol. 24, pp. 605–606, 2021, ISSN: 1524-4733, ().
@article{Chhatwal2021,
title = {Health Economics of Interventions to Tackle the Coronavirus 2019 Pandemic.},
author = {Jagpreet Chhatwal and Maarten J Postma},
url = {https://pubmed.ncbi.nlm.nih.gov/33933227/},
doi = {10.1016/j.jval.2021.03.002},
issn = {1524-4733},
year = {2021},
date = {2021-05-01},
journal = {Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research},
volume = {24},
pages = {605--606},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chou, Shinn-Huey S; Baikpour, Masoud; Zhang, Wei; Mercaldo, Sarah Fletcher; Lehman, Constance D; Samir, Anthony E
Shear-Wave Elastography of the Breast: Impact of Technical Image Quality Parameters on Diagnostic Accuracy. Journal Article
In: AJR. American journal of roentgenology, vol. 216, pp. 1205–1215, 2021, ISSN: 1546-3141, ().
@article{Chou2021,
title = {Shear-Wave Elastography of the Breast: Impact of Technical Image Quality Parameters on Diagnostic Accuracy.},
author = {Shinn-Huey S Chou and Masoud Baikpour and Wei Zhang and Sarah Fletcher Mercaldo and Constance D Lehman and Anthony E Samir},
url = {https://pubmed.ncbi.nlm.nih.gov/33729888/},
doi = {10.2214/AJR.19.22728},
issn = {1546-3141},
year = {2021},
date = {2021-05-01},
journal = {AJR. American journal of roentgenology},
volume = {216},
pages = {1205--1215},
abstract = {The purpose of this study is to determine the impact of shear-wave elastography (SWE) image quality parameters on the diagnostic performance of elasticity measurements in classifying breast lesions. This retrospective study included 281 breast lesions that underwent SWE and ultrasound-guided biopsy performed between October 1, 2017, and August 31, 2018. Three readers who were blinded to pathologic outcomes independently scored the image quality of each SWE image (with low quality denoted by a score of 0 and high quality indicated by a score of 1) on the basis of five parameters: B-mode visualization of the lesion on a dual-panel display, SWE red pattern (denoting high stiffness) in the near field of the FOV, appearance of the surrounding tissue, FOV placement, and ROI placement for the maximum (E ), minimum (E ), mean (E ), and SD (E ) of Young modulus elasticity measurements. Using ROC analysis, we compared the performance of E , E , and E in diagnosing malignancy on low- and high-quality images on the basis of consensus (i.e., majority) scores for each individual quality parameter as well as two models combining a few of the quality parameters. Three quality parameters (B-mode visualization of the lesion, presence of a near-field red pattern, and the appearance of the surrounding tissue) showed moderate-to-substantial interobserver agreement. SWE images were considered high quality ( = 167) if both B-mode visualization and near-field red pattern received a consensus score of 1, and they were considered low quality ( = 114) if either parameter received a consensus score of 0. High-quality images had a statistically higher AUC value than low-quality images when E ( \< .001), E ( = .002), and E ( \< .001) were used as classifiers of malignancy. Quality parameters can support radiologists who are performing and interpreting breast SWE images. These quality parameters have the potential to improve the accuracy of SWE in differentiating malignant from benign breast lesions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The purpose of this study is to determine the impact of shear-wave elastography (SWE) image quality parameters on the diagnostic performance of elasticity measurements in classifying breast lesions. This retrospective study included 281 breast lesions that underwent SWE and ultrasound-guided biopsy performed between October 1, 2017, and August 31, 2018. Three readers who were blinded to pathologic outcomes independently scored the image quality of each SWE image (with low quality denoted by a score of 0 and high quality indicated by a score of 1) on the basis of five parameters: B-mode visualization of the lesion on a dual-panel display, SWE red pattern (denoting high stiffness) in the near field of the FOV, appearance of the surrounding tissue, FOV placement, and ROI placement for the maximum (E ), minimum (E ), mean (E ), and SD (E ) of Young modulus elasticity measurements. Using ROC analysis, we compared the performance of E , E , and E in diagnosing malignancy on low- and high-quality images on the basis of consensus (i.e., majority) scores for each individual quality parameter as well as two models combining a few of the quality parameters. Three quality parameters (B-mode visualization of the lesion, presence of a near-field red pattern, and the appearance of the surrounding tissue) showed moderate-to-substantial interobserver agreement. SWE images were considered high quality ( = 167) if both B-mode visualization and near-field red pattern received a consensus score of 1, and they were considered low quality ( = 114) if either parameter received a consensus score of 0. High-quality images had a statistically higher AUC value than low-quality images when E ( < .001), E ( = .002), and E ( < .001) were used as classifiers of malignancy. Quality parameters can support radiologists who are performing and interpreting breast SWE images. These quality parameters have the potential to improve the accuracy of SWE in differentiating malignant from benign breast lesions.
Omidvari, Amir-Houshang; Hazelton, William D; Lauren, Brianna N; Naber, Steffie K; Lee, Minyi; Ali, Ayman; Seguin, Claudia; Kong, Chung Yin; Richmond, Ellen; Rubenstein, Joel H; Luebeck, Georg E; Inadomi, John M; Hur, Chin; Lansdorp-Vogelaar, Iris
In: Gastroenterology, vol. 161, no. 2, pp. 487-494, 2021, ISSN: 1528-0012, ().
@article{Omidvari2021,
title = {The optimal age to stop endoscopic surveillance of Barrett's esophagus patients based on sex and comorbidity: a comparative cost-effectiveness analysis.},
author = {Amir-Houshang Omidvari and William D Hazelton and Brianna N Lauren and Steffie K Naber and Minyi Lee and Ayman Ali and Claudia Seguin and Chung Yin Kong and Ellen Richmond and Joel H Rubenstein and Georg E Luebeck and John M Inadomi and Chin Hur and Iris Lansdorp-Vogelaar},
url = {https://pubmed.ncbi.nlm.nih.gov/33974935/},
doi = {10.1053/j.gastro.2021.05.003},
issn = {1528-0012},
year = {2021},
date = {2021-05-01},
urldate = {2021-05-01},
journal = {Gastroenterology},
volume = {161},
number = {2},
pages = {487-494},
abstract = {Current guidelines recommend surveillance for non-dysplastic Barrett's esophagus (NDBE) patients but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. We used three independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from one additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental cost-effectiveness ratio (ICER) of one more surveillance was just below the willingness-to-pay threshold of $100,000/QALY. The benefit of having one more surveillance endoscopy strongly depended on age, sex and comorbidity. For men with NDBE and severe comorbidity, one additional surveillance at age 80 years provided 4 more QALYs per 1,000 BE patients at an additional cost of $1,2 million, while for women with severe comorbidity the benefit at that age was 7 QALYs at a cost of $1.3 million. For men with no, mild, moderate and severe comorbidity, the optimal ages of last surveillance were 81, 80, 77 and 73 years, respectively. For women, these ages were lower: 75, 73, 73 and 69 years, respectively. Our comparative modeling analysis illustrates the importance of considering comorbidity status and sex when deciding upon the age to discontinue surveillance in patients with NDBE.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Current guidelines recommend surveillance for non-dysplastic Barrett's esophagus (NDBE) patients but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. We used three independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from one additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental cost-effectiveness ratio (ICER) of one more surveillance was just below the willingness-to-pay threshold of $100,000/QALY. The benefit of having one more surveillance endoscopy strongly depended on age, sex and comorbidity. For men with NDBE and severe comorbidity, one additional surveillance at age 80 years provided 4 more QALYs per 1,000 BE patients at an additional cost of $1,2 million, while for women with severe comorbidity the benefit at that age was 7 QALYs at a cost of $1.3 million. For men with no, mild, moderate and severe comorbidity, the optimal ages of last surveillance were 81, 80, 77 and 73 years, respectively. For women, these ages were lower: 75, 73, 73 and 69 years, respectively. Our comparative modeling analysis illustrates the importance of considering comorbidity status and sex when deciding upon the age to discontinue surveillance in patients with NDBE.
Knudsen, Amy; Rutter, Carolyn M.; Peterse, Elisabeth F. P.; Lietz, Anna; Seguin, Claudia; Meester, Reinier G. S.; Perdue, Leslie A.; Lin, Jennifer S.; Siegel, Rebecca L.; Doria-Rose, V. Paul; Feuer, Eric J.; Zauber, Ann G.; Kuntz, Karen M.; Lansdorp-Vogelaar, Iris
Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force Journal Article
In: JAMA, vol. 325, no. 19, pp. 1998-2011, 2021, ISSN: 0098-7484, ().
@article{knudsen2021,
title = {Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force},
author = {Amy Knudsen and Carolyn M. Rutter and Elisabeth F. P. Peterse and Anna Lietz and Claudia Seguin and Reinier G. S. Meester and Leslie A. Perdue and Jennifer S. Lin and Rebecca L. Siegel and V. Paul Doria-Rose and Eric J. Feuer and Ann G. Zauber and Karen M. Kuntz and Iris Lansdorp-Vogelaar},
url = {https://doi.org/10.1001/jama.2021.5746},
doi = {10.1001/jama.2021.5746},
issn = {0098-7484},
year = {2021},
date = {2021-05-01},
journal = {JAMA},
volume = {325},
number = {19},
pages = {1998-2011},
abstract = {The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF.Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed.Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer.This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF.Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed.Estimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer.This microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.
Reitsma, Marissa B; Claypool, Anneke L.; Vargo, Jason; Shete, Priya B; McCorvie, Ryan; Wheeler, William H; Rocha, David A; Myers, Jennifer F; Murray, Erin L; Bregman, Brooke; Dominguez, Deniz M; Nguyen, Alyssa D; Porse, Charsey; Fritz, Curtis L; Jain, Seema; Watt, James P; Salomon, Joshua A; Goldhaber-Fiebert, Jeremy D
Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California. Journal Article
In: Health affairs (Project Hope), pp. 101377hlthaff2021000, 2021, ISSN: 1544-5208, ().
@article{Reitsma2021,
title = {Racial/Ethnic Disparities In COVID-19 Exposure Risk, Testing, And Cases At The Subcounty Level In California.},
author = {Marissa B Reitsma and Anneke L. Claypool and Jason Vargo and Priya B Shete and Ryan McCorvie and William H Wheeler and David A Rocha and Jennifer F Myers and Erin L Murray and Brooke Bregman and Deniz M Dominguez and Alyssa D Nguyen and Charsey Porse and Curtis L Fritz and Seema Jain and James P Watt and Joshua A Salomon and Jeremy D Goldhaber-Fiebert},
doi = {10.1377/hlthaff.2021.00098},
issn = {1544-5208},
year = {2021},
date = {2021-05-01},
journal = {Health affairs (Project Hope)},
pages = {101377hlthaff2021000},
abstract = {With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined "high-exposure-risk" households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
With a population of forty million and substantial geographic variation in sociodemographics and health services, California is an important setting in which to study disparities. Its population (37.5 percent White, 39.1 percent Latino, 5.3 percent Black, and 14.4 percent Asian) experienced 59,258 COVID-19 deaths through April 14, 2021-the most of any state. We analyzed California's racial/ethnic disparities in COVID-19 exposure risks, testing rates, test positivity, and case rates through October 2020, combining data from 15.4 million SARS-CoV-2 tests with subcounty exposure risk estimates from the American Community Survey. We defined "high-exposure-risk" households as those with one or more essential workers and fewer rooms than inhabitants. Latino people in California are 8.1 times more likely to live in high-exposure-risk households than White people (23.6 percent versus 2.9 percent), are overrepresented in cumulative cases (3,784 versus 1,112 per 100,000 people), and are underrepresented in cumulative testing (35,635 versus 48,930 per 100,000 people). These risks and outcomes were worse for Latino people than for members of other racial/ethnic minority groups. Subcounty disparity analyses can inform targeting of interventions and resources, including community-based testing and vaccine access measures. Tracking COVID-19 disparities and developing equity-focused public health programming that mitigates the effects of systemic racism can help improve health outcomes among California's populations of color.
Carter, Jocelyn; Hassan, Susan; Walton, Anne; Yu, Liyang; Donelan, Karen; Thorndike, Anne N
Ëffect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial." Journal Article
In: JAMA network open, vol. 4, pp. e2110936, 2021, ISSN: 2574-3805, ().
@article{Carter2021,
title = {\"{E}ffect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial."},
author = {Jocelyn Carter and Susan Hassan and Anne Walton and Liyang Yu and Karen Donelan and Anne N Thorndike},
url = {https://pubmed.ncbi.nlm.nih.gov/34014324/},
doi = {10.1001/jamanetworkopen.2021.10936},
issn = {2574-3805},
year = {2021},
date = {2021-05-01},
journal = {JAMA network open},
volume = {4},
pages = {e2110936},
abstract = {Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. ClinicalTrials.gov Identifier: NCT03085264.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. ClinicalTrials.gov Identifier: NCT03085264.
Rustgi, Sheila D; Oh, Aaron; Yang, Jeong Yun; Kang, Dasol; Wolin, Edward; Kong, Chung Yin; Hur, Chin; Kim, Michelle K
Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis. Journal Article
In: BMC cancer, vol. 21, no. 1, pp. 597, 2021, ISSN: 1471-2407, ().
@article{Rustgi2021,
title = {Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis.},
author = {Sheila D Rustgi and Aaron Oh and Jeong Yun Yang and Dasol Kang and Edward Wolin and Chung Yin Kong and Chin Hur and Michelle K Kim},
url = {https://pubmed.ncbi.nlm.nih.gov/34030646/},
doi = {10.1186/s12885-021-08306-5},
issn = {1471-2407},
year = {2021},
date = {2021-05-01},
journal = {BMC cancer},
volume = {21},
number = {1},
pages = {597},
abstract = {Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous neoplasms. Although some have a relatively benign and indolent natural history, others can be aggressive and ultimately fatal. Somatostatin analogues (SSAs) improve both quality of life and survival for these patients once they develop metastatic disease. However, these drugs are costly and their cost-effectiveness is not known. A decision-analytic model was developed and analyzed to compare two treatment strategies for patients with Stage IV GEP-NETs. The first strategy had all patients start SSA immediately while the second strategy waited, reserving SSA initiation until the patient showed signs of progression. Sensitivity analysis was performed to explore model parameter uncertainty. Our model of patients age 60 with metastatic GEP-NETs suggests empiric initiation of SSA led to an increase 0.62 unadjusted life-years and incremental increase in quality-adjusted life years (QALYs) of 0.44. The incremental costs were $388,966 per QALY and not cost-effective at a willingness-to-pay threshold of $100,000. Death was attributed to GEP-NETs for 94.1% of patients in the SSA arm vs. 94.9% of patients in the DELAY SSA arm. Sensitivity analysis found that the model was most sensitive to costs of SSAs. Using probabilistic sensitivity analysis, the SSA strategy was only cost-effective 1.4% of the time at a WTP threshold of $100,000 per QALY. Our modeling study finds it is not cost-effective to initiate SSAs at time of presentation for patients with metastatic GEP-NETs. Further clinical studies are needed to identify the optimal timing to initiate these drugs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous neoplasms. Although some have a relatively benign and indolent natural history, others can be aggressive and ultimately fatal. Somatostatin analogues (SSAs) improve both quality of life and survival for these patients once they develop metastatic disease. However, these drugs are costly and their cost-effectiveness is not known. A decision-analytic model was developed and analyzed to compare two treatment strategies for patients with Stage IV GEP-NETs. The first strategy had all patients start SSA immediately while the second strategy waited, reserving SSA initiation until the patient showed signs of progression. Sensitivity analysis was performed to explore model parameter uncertainty. Our model of patients age 60 with metastatic GEP-NETs suggests empiric initiation of SSA led to an increase 0.62 unadjusted life-years and incremental increase in quality-adjusted life years (QALYs) of 0.44. The incremental costs were $388,966 per QALY and not cost-effective at a willingness-to-pay threshold of $100,000. Death was attributed to GEP-NETs for 94.1% of patients in the SSA arm vs. 94.9% of patients in the DELAY SSA arm. Sensitivity analysis found that the model was most sensitive to costs of SSAs. Using probabilistic sensitivity analysis, the SSA strategy was only cost-effective 1.4% of the time at a WTP threshold of $100,000 per QALY. Our modeling study finds it is not cost-effective to initiate SSAs at time of presentation for patients with metastatic GEP-NETs. Further clinical studies are needed to identify the optimal timing to initiate these drugs.
Rapalino, O; Pourvaziri, A; Maher, M; Jaramillo-Cardoso, A; Edlow, B L; Conklin, J; Huang, S; Westover, B; Romero, J M; Halpern, Elkan F.; Gupta, R; Pomerantz, S; Schaefer, P; Gonzalez, R G; Mukerji, S S; Lev, M H
Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy. Journal Article
In: AJNR. American journal of neuroradiology, vol. 42, no. 4, pp. 632-638, 2021, ISSN: 1936-959X, ().
@article{Rapalino2021,
title = {Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy.},
author = {O Rapalino and A Pourvaziri and M Maher and A Jaramillo-Cardoso and B L Edlow and J Conklin and S Huang and B Westover and J M Romero and Elkan F. Halpern and R Gupta and S Pomerantz and P Schaefer and R G Gonzalez and S S Mukerji and M H Lev},
url = {https://pubmed.ncbi.nlm.nih.gov/33414226/},
doi = {10.3174/ajnr.A6966},
issn = {1936-959X},
year = {2021},
date = {2021-04-01},
journal = {AJNR. American journal of neuroradiology},
volume = {42},
number = {4},
pages = {632-638},
abstract = {Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m , .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, .05) and higher serum sodium levels (147 versus 139 mmol/L, = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions ( .001). Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m , .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, .05) and higher serum sodium levels (147 versus 139 mmol/L, = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions ( .001). Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.
Jalali, Mohammad S.; DiGennaro, Catherine; Sridhar, Devi
The need for a prediction model assessment framework - Authors' reply. Journal Article
In: The Lancet. Global health, vol. 9, no. 4, pp. e405, 2021, ISSN: 2214-109X, ().
@article{Jalali2021e,
title = {The need for a prediction model assessment framework - Authors' reply.},
author = {Mohammad S. Jalali and Catherine DiGennaro and Devi Sridhar},
url = {https://pubmed.ncbi.nlm.nih.gov/33581048/},
doi = {10.1016/S2214-109X(21)00021-8},
issn = {2214-109X},
year = {2021},
date = {2021-04-01},
journal = {The Lancet. Global health},
volume = {9},
number = {4},
pages = {e405},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kastrinos, Fay; Ingram, Myles A; Silver, Elisabeth R; Oh, Aaron; Laszkowska, Monika; Rustgi, Anil K; Hur, Chin
Gene-Specific Variation in Colorectal Cancer Surveillance Strategies for Lynch Syndrome. Journal Article
In: Gastroenterology, 2021, ISSN: 1528-0012 (Electronic), ().
@article{Kastrinos2021,
title = {Gene-Specific Variation in Colorectal Cancer Surveillance Strategies for Lynch Syndrome.},
author = {Fay Kastrinos and Myles A Ingram and Elisabeth R Silver and Aaron Oh and Monika Laszkowska and Anil K Rustgi and Chin Hur},
url = {https://pubmed.ncbi.nlm.nih.gov/33839100/},
doi = {10.1053/j.gastro.2021.04.010},
issn = {1528-0012 (Electronic)},
year = {2021},
date = {2021-04-01},
journal = {Gastroenterology},
abstract = {BACKGROUND \& AIMS: Lynch syndrome is associated with pathogenic variants in 4 mismatch repair (MMR) genes that increase lifetime risk of colorectal cancer (CRC). Guidelines recommend intensive CRC surveillance with colonoscopy every 1-2 years starting at 25 years for all carriers of Lynch syndrome-associated variants, regardless of gene product. We constructed a simulation model to analyze the effects of different ages of colonoscopy initiation and surveillance intervals for each MMR gene (MLH1, MSH2, MSH6, and PMS2) on CRC incidence and mortality, quality-adjusted life-years (QALYs), and cost. METHODS: Using published literature, we developed a Markov simulation model of Lynch syndrome progression for patients with each MMR variant. The model simulated clinical trials of Lynch syndrome carriers, varying age of colonoscopy initiation (5-year increments from 25-40 years) and surveillance intervals (1-5 years). We assessed the optimal strategy for each gene, defined as the strategy with the highest QALYs and incremental cost-effectiveness ratio below a $100,000 willingness-to-pay threshold (WTP). RESULTS: Optimal surveillance for patients with pathogenic variants in the MLH1 and MSH2 genes was colonoscopy starting at 25 years of age, with 1-2 year surveillance intervals. Initiating colonoscopy at age 35 and 40 years, with 3-year intervals, was cost effective for patients with pathogenic variants in MSH6 or PMS2, respectively. CONCLUSIONS: We developed a simulation model to select optimal surveillance starting ages and intervals for patients with Lynch syndrome based on MMR variant. The model supports recommendations for intensive surveillance of patients with Lynch syndrome-associated variants in MLH1 or MSH2. However, for patients with Lynch syndrome-associated variants of MSH6 or PMS2, later initiation of surveillance at 35 and 40 years, respectively, and at 3-year intervals, can be considered.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND & AIMS: Lynch syndrome is associated with pathogenic variants in 4 mismatch repair (MMR) genes that increase lifetime risk of colorectal cancer (CRC). Guidelines recommend intensive CRC surveillance with colonoscopy every 1-2 years starting at 25 years for all carriers of Lynch syndrome-associated variants, regardless of gene product. We constructed a simulation model to analyze the effects of different ages of colonoscopy initiation and surveillance intervals for each MMR gene (MLH1, MSH2, MSH6, and PMS2) on CRC incidence and mortality, quality-adjusted life-years (QALYs), and cost. METHODS: Using published literature, we developed a Markov simulation model of Lynch syndrome progression for patients with each MMR variant. The model simulated clinical trials of Lynch syndrome carriers, varying age of colonoscopy initiation (5-year increments from 25-40 years) and surveillance intervals (1-5 years). We assessed the optimal strategy for each gene, defined as the strategy with the highest QALYs and incremental cost-effectiveness ratio below a $100,000 willingness-to-pay threshold (WTP). RESULTS: Optimal surveillance for patients with pathogenic variants in the MLH1 and MSH2 genes was colonoscopy starting at 25 years of age, with 1-2 year surveillance intervals. Initiating colonoscopy at age 35 and 40 years, with 3-year intervals, was cost effective for patients with pathogenic variants in MSH6 or PMS2, respectively. CONCLUSIONS: We developed a simulation model to select optimal surveillance starting ages and intervals for patients with Lynch syndrome based on MMR variant. The model supports recommendations for intensive surveillance of patients with Lynch syndrome-associated variants in MLH1 or MSH2. However, for patients with Lynch syndrome-associated variants of MSH6 or PMS2, later initiation of surveillance at 35 and 40 years, respectively, and at 3-year intervals, can be considered.
Harvey, H. Benjamin; Gowda, Vrushab
Clinical applications of AI in MSK imaging: a liability perspective. Journal Article
In: Skeletal radiology, 2021, ISSN: 1432-2161, ().
@article{Harvey2021,
title = {Clinical applications of AI in MSK imaging: a liability perspective.},
author = {H. Benjamin Harvey and Vrushab Gowda},
url = {https://pubmed.ncbi.nlm.nih.gov/33835241/},
doi = {10.1007/s00256-021-03782-z},
issn = {1432-2161},
year = {2021},
date = {2021-04-01},
journal = {Skeletal radiology},
abstract = {Artificial intelligence (AI) applications have been gaining traction across the radiology space, promising to redefine its workflow and delivery. However, they enter into an uncertain legal environment. This piece examines the nature, exposure, and theories of liability relevant to musculoskeletal radiologist practice. More specifically, it explores the negligence, vicarious liability, and product liability frameworks by way of illustrative vignettes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Artificial intelligence (AI) applications have been gaining traction across the radiology space, promising to redefine its workflow and delivery. However, they enter into an uncertain legal environment. This piece examines the nature, exposure, and theories of liability relevant to musculoskeletal radiologist practice. More specifically, it explores the negligence, vicarious liability, and product liability frameworks by way of illustrative vignettes.