Browsing by Author "Department of Medicine, School of Medicine"
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Item 3rd ESO–ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3)(Elsevier, 2017-02) Cardoso, F.; Costa, A.; Senkus, E.; Aapro, M.; André, F.; Barrios, C. H.; Bergh, J.; Bhattacharyya, G.; Biganzoli, L.; Cardoso, M. J.; Carey, L.; Corneliussen-James, D.; Curigliano, G.; Dieras, V.; El Saghir, N.; Eniu, A.; Fallowfield, L.; Fenech, D.; Francis, P.; Gelmon, K.; Gennari, A.; Harbeck, N.; Hudis, C.; Kaufman, B.; Krop, I.; Mayer, M.; Meijer, H.; Mertz, S.; Ohno, S.; Pagani, O.; Papadopoulos, E.; Peccatori, F.; Penault-Llorca, F.; Piccart, M. J.; Pierga, J. Y.; Rugo, H.; Shockney, L.; Sledge, George; Swain, S.; Thomssen, C.; Tutt, A.; Vorobiof, D.; Xu, B.; Norton, L.; Winer, E.; Department of Medicine, School of MedicineItem Adherence to Surveillance Guidelines in Nondysplastic Barrett’s Esophagus(Wolters Kluwer, 2016) Dalal, Kunal S.; Coffing, Jessica; Imperiale, Thomas F.; Department of Medicine, School of MedicineIntroduction: Surveillance patterns in Barrett's esophagus (BE) are not well characterized. Guidelines published between 2002 and 2008 recommended surveillance esophagogastroduodenoscopy (sEGD) at 3-year intervals for nondysplastic BE (NDBE). We assessed guideline adherence in incident NDBE in a Veterans Affairs (VA)-based study. Methods: At a single VA center, we identified incident cases of biopsy-confirmed NDBE between January, 2006 and December, 2008. We excluded patients aged 76 years and above and those who developed BE-associated dysplasia or cancer during follow-up. All sEGDs through October, 2014 were documented. Our primary criteria classified cases as guideline adherent if a sEGD was performed within 6 months of each expected 3-year surveillance interval; in cases with >=2 sEGDs, 1 sEGD >6 months, and <=1 year outside an interval was allowed if the average interval was between 2.5 and 3.5 years. Comorbidity, primary care encounters, presence of long-segment BE (LSBE), endoscopist recommendations, and Charlson comorbidity index (CCI) were assessed. Results: We identified 110 patients (96.4% male, 93.6% white) with mean age 58.9+/-8.5 years at index EGD. Median follow-up was 6.7 years (range, 3.7 to 8.6). Thirty-three (30.0%) cases were guideline adherent; 77 (70.0%) cases were nonadherent, including 52 (47.3%) with irregular surveillance and 25 (22.7%) with no surveillance. Forty cases (14 adherent) had 1 sEGD, 36 (18 adherent) had 2, 8 (1 adherent) had 3, and 1 nonadherent case had 4. Adherent cases were significantly older (61.5 vs. 57.9 y, P=0.04), and tended to have more LSBE (33.3% vs. 20.8%, P=0.16). There were no differences between adherent and nonadherent cases in annual primary care encounters (72.7% vs. 66.2%, P=0.66), CCI>=4 (15.2% vs. 15.6%, P=0.95), biopsy-positive sEGDs (75.8% vs. 76.6%, P=0.92), and any recommendation for subsequent surveillance (81.8% vs. 77.9%, P=0.65). A logistic regression model using age, CCI, and LSBE showed an independent association between adherence and older age (P=0.03). Conclusions: In a single-center VA cohort, sEGD of NDBE was mostly nonadherent to guidelines. Adherent cases were older at baseline with a trend toward more LSBE. A larger study is needed to identify medical and social factors associated with adherence or nonadherence to surveillance.Item Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw(Springer, 2017-01) Yoneda, Toshiyuki; Hagino, Hiroshi; Sugimoto, Toshitsugu; Ohta, Hiroaki; Takahashi, Shunji; Soen, Satoshi; Taguchi, Akira; Nagata, Toshihiko; Urade, Masahiro; Shibahara, Takahiko; Toyosawa, Satoru; Department of Medicine, School of MedicineAntiresorptive agent-related osteonecrosis of the jaw (ARONJ) is an intractable, though rare, complication in cancer patients with bone metastases and patients with osteoporosis who are treated with antiresorptive agents, including bisphosphonates and denosumab. Despite the more than 10 years that have passed since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were reported, our understanding of the epidemiology and pathophysiology of ARONJ remains limited, and data supported by evidence-based medicine are still sparse. However, the diagnosis and staging of ARONJ, identification of risk factors, and development of preventive and therapeutic approaches have advanced significantly over the past decade. The Position Paper 2017 is an updated version of the Position Paper 2010 of the Japanese Allied Committee on Osteonecrosis of the Jaw, which now comprises six Japanese academic societies. The Position Paper 2017 describes a new diagnostic definition for ARONJ, as proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), summarizes our current understanding of the pathophysiology of ARONJ based on a literature search, and suggests methods for physicians and dentists/oral surgeons to manage the disease. In addition, the appropriateness of discontinuing antiresorptive medications (drug holiday) before, during, and after invasive dental treatments is discussed extensively. More importantly, the manuscript also proposes, for the first time, the importance of interactive communication and cooperation between physicians and dentists/oral surgeons for the successful treatment of ARONJ. The Position Paper 2017 is intended to serve as a guide for improving the management of ARONJ patients in Japan.Item Aromatase inhibitor-induced modulation of breast density: clinical and genetic effects(NPG - Nature Publishing Group, 2013-10-29) Henry, N. L.; Chan, H-P; Dantzer, J.; Goswami, C. P.; Li, L.; Skaar, Todd C.; Rae, J. M.; Desta, Z.; Khouri, N.; Pinsky, R.; Oesterreich, S.; Zhou, C.; Hadjiiski, L.; Philips, S.; Robarge, J.; Nguyen, A. T.; Storniolo, A. M.; Flockhart, D. A.; Hayes, D. F.; Helvie, M. A.; Stearns, V.; Department of Medicine, School of MedicineBackground: Change in breast density may predict outcome of women receiving adjuvant hormone therapy for breast cancer. We performed a prospective clinical trial to evaluate the impact of inherited variants in genes involved in oestrogen metabolism and signalling on change in mammographic percent density (MPD) with aromatase inhibitor (AI) therapy. Methods: Postmenopausal women with breast cancer who were initiating adjuvant AI therapy were enrolled onto a multicentre, randomised clinical trial of exemestane vs letrozole, designed to identify associations between AI-induced change in MPD and single-nucleotide polymorphisms in candidate genes. Subjects underwent unilateral craniocaudal mammography before and following 24 months of treatment. Results: Of the 503 enrolled subjects, 259 had both paired mammograms at baseline and following 24 months of treatment and evaluable DNA. We observed a statistically significant decrease in mean MPD from 17.1 to 15.1% (P<0.001), more pronounced in women with baseline MPD ⩾20%. No AI-specific difference in change in MPD was identified. No significant associations between change in MPD and inherited genetic variants were observed. Conclusion: Subjects with higher baseline MPD had a greater average decrease in MPD with AI therapy. There does not appear to be a substantial effect of inherited variants in biologically selected candidate genes.Item Bias in Rating of Rodent Distress during Anesthesia Induction for Anesthesia Compared with Euthanasia(2018-03) Baker, Brittany A.; Hickman, Debra L.; Department of Medicine, School of MedicineSelection of an appropriate method of euthanasia involves balancing the wellbeing of the animal during the procedure with the intended use of the animal after death and the physical and psychologic safety of the observer or operator. The recommended practices for anesthesia as compared with euthanasia are very disparate, despite the fact that all chemical methods of euthanasia are anesthetic overdoses. To explain this disparity, this study sought to determine whether perception bias is inherent in the discussion of euthanasia compared with anesthesia. In this study, participants viewed videorecordings of the anesthesia of either 4 rats or 4 mice, from induction to loss of consciousness. Half of the participants were told that they were observing anesthesia; the other half understood that they were observing euthanasia. Participants were asked to rate the distress of the animals by scoring escape behaviors, fear behaviors, respiratory distress, and other distress markers. For mice, the participants generally rated the distress as high when they were told that the mouse was being euthanized, as compared with the participants who were told that the mouse was being anesthetized. For rats, the effect was not as strong, and the distress was generally rated higher when participants were told they were watching anesthesia. Because the interpretation of distress showed bias in both species—even though the bias differed regarding the procedure that interpreted as distressing—this study demonstrates that laboratory animal professionals must consider the influence of potential perception bias when developing policies for euthanasia and anesthesia.Item Cancer-associated osteoclast differentiation takes a good look in the miR(NA)ror(Elsevier, 2013-10-14) Waning, David L.; Mohammad, Khalid S.; Guise, Theresa A.; Department of Medicine, School of MedicineTumor-bone cell interactions are critical for the development of metastasis-related osteolytic bone destruction. In this issue of Cancer Cell, Ell and colleagues show how a discrete miRNA network regulates osteoclastogenesis during breast cancer bone metastasis. A signature of upregulated miRNAs may have diagnostic and therapeutic implications for bone metastases.Item Care Consistency With Documented Care Preferences: Methodologic Considerations for Implementing the “Measuring What Matters” Quality Indicator(Elsevier, 2016-11) Unroe, Kathleen T.; Hickman, Susan E.; Torke, Alexia M.; Department of Medicine, School of MedicineA basic tenet of palliative care is discerning patient treatment preferences and then honoring these preferences, reflected by the inclusion of “Care Consistency With Documented Care Preferences” as one of 10 “Measuring What Matters quality” indicators. Measuring What Matters indicators are intended to serve as a foundation for quality measurement in health care settings. However, there are a number of logistic and practical issues to be considered in the application of this quality indicator to clinical practice. In this brief methodologic report, we describe how care consistency with documented care preferences has been measured in research on patients near the end of life. Furthermore, we outline methodologic challenges in using this indicator in both research and practice, such as documentation, specificity and relevance, preference stability, and measuring nonevents. Recommendations to strengthen the accuracy of measurement of this important quality marker in health care settings include consistent recording of preferences in the medical record, considerations for selection of treatment preferences for tracking, establishing a protocol for review of preferences, and adoption of a consistent measurement approach.Item Causes of hospital admission in β-thalassemia (CHAT) in Lebanon from 1995 to 2015: A pilot retrospective study from a tertiary care center(Wiley, 2017) Saliba, Antoine N.; Moukhadder, Hassan M.; Harb, Afif; Beydoun, Hassan; Bou-Fakhredin, Rayan; Taher, Ali T.; Department of Medicine, School of MedicineItem Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes(Elsevier, 2017) Hamon, David; Abehsira, Guillaume; Gu, Kai; Liu, Albert; Sadron, Marie Blaye-Felice; Billet, Sophie; Kambur, Thomas; Swid, Mohammed Amer; Boyle, Noel G.; Dandamudi, Gopi; Maury, Philippe; Chen, Minglong; Miller, John M.; Lellouche, Nicolas; Shivkumar, Kalyanam; Bradfield, Jason S.; Department of Medicine, School of MedicineBackground Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.Item Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care(Springer-Verlag, 2017-04) Kroenke, Kurt; Unutzer, Jurgen; Department of Medicine, School of MedicineMental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.