The power of one: Evaluating the impact of a single multi‐disciplinary treatment visit on time to treatment

2020 ◽  
Vol 26 (10) ◽  
pp. 2015-2017
Author(s):  
Sarah M. C. Sittenfeld ◽  
Halle C. F. Moore ◽  
Zachary Greenberg ◽  
Zahraa Al‐Hilli ◽  
Jame Abraham ◽  
...  
Keyword(s):  
Time To Treatment ◽  
Treatment Visit ◽  
The Impact

scholarly journals The Power of One: Evaluating the Impact of a Single Multi-Disciplinary Treatment Visit on Time to Treatment

2020 ◽  
Vol 108 (3) ◽  
pp. e412-e413
Author(s):  
S.M.C. Sittenfeld ◽  
H. Moore ◽  
Z. Greenberg ◽  
Z. Al-Hilli ◽  
J. Abraham ◽  
...  
Keyword(s):  
Time To Treatment ◽  
Treatment Visit ◽  
The Impact

Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia

2015 ◽  
Vol 156 (15) ◽  
pp. 592-597
Author(s):  
László Szerafin ◽  
János Jakó ◽  
Ferenc Riskó
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Prognostic Value ◽  
Lymphocytic Leukaemia ◽  
Treatment Time ◽  
Monocyte Count ◽  
Time To Treatment ◽  
Causes Of Mortality ◽  
The Absolute ◽  
The Impact ◽  
Overal Survival

Introduction: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. Aim: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. Method: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. Results: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25–0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25–0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9–35.3%) and other events (48.1 and11.8%) occurred in patients with medium or high monocyte counts. Conclusions: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too. Orv. Hetil., 2015, 156(15), 592–597.

P1244Survival after septal myectomy in male and female patients with hypertrophic obstructive cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Huurman ◽  
A Schinkel ◽  
M Van Slegtenhorst ◽  
P De Jong ◽  
A Hirsch ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Left Atrial ◽  
Nyha Class ◽  
Composite Endpoint ◽  
P Value ◽  
Time To Treatment ◽  
Left Atrial Diameter ◽  
Septal Myectomy ◽  
Maximal Wall Thickness ◽  
The Impact

Abstract In recent years, studies have debated the impact of gender on the presentation and clinical course of HCM, with research showing that at time of myectomy, women are older, have worse diastolic function and more advanced cardiac remodeling. The clinical impact of these differences is unknown. We included 221 HCM patients (57% men) who underwent septal myectomy and are followed in our center. Time to treatment was calculated in relation to symptom onset. Pre- and post-operative clinical and echocardiographic data were collected. Gender differences were assessed at baseline and in survival analyses for the composite endpoint of all-cause mortality, cardiac transplantation, re-intervention and aborted sudden cardiac death. Women were older at time of myectomy, but time until treatment was similar (table). Pre-operative echocardiographic indices were comparable among groups, but were significantly higher in women when correcting for body surface area. At three months, no differences were found in clinical and echocardiographic results. After 6.1 [2.9–10.1] years, 24% of women and 23% of men had reached the composite endpoint (p=0.30, figure). Gender comparison pre- and post-myectomy Men (n=125) Women (n=96) p value Age 49±14 54±17 0.02 Maximal wall thickness, mm 19.9±4.7 19.8±5.8 0.97 Indexed maximal wall thickness, mm/m2 9.8±2.5 11.5±4.5 0.001 Left atrial diameter, mm 48.1±7.3 45.9±7.3 0.06 Indexed left atrial diameter, mm/m2 23.5±3.5 26.5±7.5 0.002 LV end-diastolic diameter, mm 45.4±7.6 42.8±5.6 0.04 Indexed LV end-diastolic diameter, mm/m2 22.1±3.7 23.6±3.0 0.02 Gradient reduction, %* 75.1±25.0 72.9±28.6 0.63 Improvement in symptoms*† 97 (95%) 64 (89%) 0.34 MWT = maximal wall thickness; LV = left ventricle. *At three months follow-up; †Defined as a reduction of ≥1 NYHA class, measured in 102 men and 72 women. Survival after myectomy Although women present later in life and seem to have more advanced disease at time of myectomy, time to treatment is similar and survival after myectomy is excellent for both men and women.

Percentage of Smudge Cells on Blood Smear Predicts Prognosis in Chronic Lymphocytic Leukemia: A Multicenter Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 745-745
Author(s):  
Grzegorz S. Nowakowski ◽  
James D. Hoyer ◽  
Tait D. Shanafelt ◽  
Diane F. Jelinek ◽  
Laura Z. Rassenti ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Blood Smear ◽  
Independent Predictor ◽  
Continuous Variable ◽  
Lymphocytic Leukemia ◽  
Initial Finding ◽  
Time To Treatment ◽  
Cell Percentage ◽  
Blood Smears ◽  
The Impact

Abstract Background: Smudge cells are ruptured CLL cells seen on blood smears of CLL patients. For over a century, smudge cells were thought to represent an artifact of slide preparation. We recently showed that smudge cell formation was inversely proportional to leukemic B cell vimentin content. Vimentin is a cytoskeletal protein critical for lymphocyte rigidity and migration; high vimentin content is related to poor prognosis in CLL. Concordantly, in an initial small cohort of patients from a single institution, we found that patients with a low (<30%) percentage of smudge cells on a blood smear have a shorter time to treatment (Mayo Clin Proc.2007;82:449–53). In the current study, we evaluated the impact of smudge cell percentage on prognosis of patients with CLL seen at member institutions of the CLL Research Consortium (CRC). Methods: Archived blood smears from untreated patients with CLL were evaluated for smudge levels. All blood smears were prepared manually in a standard fashion from blood obtained by CRC Tissue Core and stained with WrightGiemsa stain. Smudge cells were defined as broken cells with no intact cytoplasm and a disrupted nuclear membrane. A total of 200 lymphocytes and smudge cells were counted on each slide and the results were expressed as the percent smudge cells. The association between the percentage of smudge cells, prognostic factors (IgVH status, CD38, ZAP-70 and FISH) and time to initial therapy (TTT) was examined. Results: We calculated smudge cell percentage on blood smears obtained prior to treatment for 337 CLL patients. The median smudge cell percentage was 32 (range 2–95%). The percentage of smudge cells was lower in CD38 positive patients (mean 33% vs. 38% in CD38 negative patients, p=0.04). No difference in smudge cell percentage was observed based on IgVH gene mutation status or Zap70 expression. Smudge cell percentage as a continuous variable was associated with prolonged TTT, exponential coefficient 0.98, p=0.04. Using our previously published cutoff of 30% to stratify patients in low and high risk categories, the estimated median time to first therapy of patients with smudge cell percentage ≤30% (n=178) was 7.8 years versus not reached in patients in patients with > 30% (n=159) of smudge cells, p=0.0036, (Figure 1). Ten years from diagnosis, 62% of patients with ≤30% of smudge cells versus 39% of patients with >30% of smudge cells required therapy. In multivariate analysis, the low percentage of smudge cells (≤30%) was an independent predictor of the shortened time to treatment (HR 1.86, 95%CI 1.09–3.16, p=0.02). Conclusion: This multicenter study confirms our initial finding that the percentage of smudge cells on a blood smear is an independent predictor of clinical outcome in patients with CLL. The estimation of smudge cell percentage on routine blood smear provides a simple and inexpensive prognostic test available to nearly all patients with a diagnosis of CLL worldwide. It also allows reanalysis and risk stratification of previously completed trials provided that blood smears have been archived. Further studies of the role of the cytoskeleton in CLL biology are warranted and ongoing in our laboratory. Figure Figure

Impact of the Affordable Care Act on early-stage diagnosis and treatment for women with ovarian cancer.

2019 ◽  
Vol 37 (18_suppl) ◽  
pp. LBA5563-LBA5563
Author(s):  
Anna Jo Smith ◽  
Amanda Nickels
Keyword(s):  
Ovarian Cancer ◽  
Affordable Care Act ◽  
Early Stage ◽  
Stage At Diagnosis ◽  
Time To Treatment ◽  
Academic Center ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Affordable Care Act ◽  
The Impact

LBA5563 Background: The 2010 Affordable Care Act (ACA) expanded access to insurance and care for many Americans. Our objective was to evaluate the impact of the ACA on stage at diagnosis and time to treatment for women with ovarian cancer. Methods: We utilized a difference-in-differences (DD) approach to assess stage at diagnosis and time to treatment before and after the 2010 ACA among women with ovarian cancer ages 21-64 years compared to women ages 65 years and older. We used the National Cancer Database with the 2004-2009 surveys as the pre-reform years and the 2011-2014 surveys as the post-reform years. Outcomes were analyzed for women overall and by insurance type, adjusting for patient race, living in a rural area, area-level household income and education level, Charlson co-morbidity score, distance traveled for care, Census region, and care at an academic center. Results: A total of 35,842 ovarian cancer cases pre-reform and 37,145 post-reform were identified for women 21-64 years compared with 28,895 cases pre-reform and 30,604 post-reform for women 65 years and older. The ACA was associated with increased early-stage diagnosis for women 21-64 years compared to women 65 and older with ovarian cancer (DD=1.7%, p-for-trend=0.001). Additionally, the ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (DD=1.6%, p<0.001). Specifically, among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (DD=2.5%, p=0.003 and DD=2.5%, p=0.006). Improvements in stage at diagnosis and time to treatment were seen across race, income, and education groups. Conclusions: Under the Affordable Care Act, women with ovarian cancer were more likely to be diagnosed at an early stage and receive treatment within 30 days of diagnosis. As stage and treatment are major determinants of survival, these gains under the ACA may have long-term impacts on women with ovarian cancer.

Real-world evidence of the impact of prior antibiotic exposure on immune checkpoint inhibitor outcomes in patients with metastatic urothelial cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 452-452
Author(s):  
Jean H. Hoffman-Censits ◽  
Lauren Christine Harshman ◽  
Meredith Metcalf ◽  
Sarah Abou Alaiwi ◽  
Craig S. Meyer ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Real World ◽  
Immune Checkpoint ◽  
Urothelial Cancer ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Treatment Discontinuation ◽  
Time To Treatment ◽  
Metastatic Urothelial Cancer ◽  
The Impact

452 Background: Prior research suggests that systemic antibiotic (ABX) exposure may impact gut microbiome and potentially result in suboptimal immune checkpoint inhibitor (ICI) treatment outcomes. A recent real-world analysis demonstrated that cumulative ABX exposure was associated with poorer outcomes across multiple tumor types independent of known prognostic clinical factors. Given the paucity of real-world data, we set out to evaluate the association of prior ABX exposure with ICI treatment outcomes among patients with metastatic urothelial cancer (mUC). Methods: This was a retrospective analysis using Truven Health MarketScan Commercial, Medicare Supplemental, and Coordination of Benefits (Medicare) databases. Patients with mUC, ≥18 years old, who received first line (1L) ICI therapy between 1/1/2016 and 12/31/2018 were analyzed. Prior ABX exposure was defined as any use in the 90 days prior to 1L ICI therapy initiation. Time to treatment discontinuation was used as a proxy to quantify ICI treatment outcomes. Results: Among the 304 ICI treated patients, 128 (42%) had ABX exposure within 90 days prior to ICI initiation. Statistically significant differences in baseline co-morbidities and urinary tract infections (36% vs. 17%; p<0.001) were observed between patients with vs. without ABX exposure. The median time to treatment discontinuation was shorter for patients with ABX exposure (7.9 months) vs. without (9.3 months). In adjusted regression analysis, there was no statistically significant difference in time to treatment discontinuation between patients with vs. without ABX exposure (p=0.95). These findings were consistent in a sensitivity analysis looking at ABX exposure 30 and 60 days prior to 1L ICI initiation. Conclusions: In this real-world analysis of patients with mUC, those with ABX exposure within 90 days prior to 1L ICI initiation demonstrated similar outcomes to those without ABX exposure. While there was a shorter time to treatment discontinuation in the patients with vs. without ABX exposure, findings were not statistically significant. Further research is warranted to investigate the impact of concomitant ABX use on ICI outcomes.

scholarly journals Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis

Circulation ◽  
2001 ◽  
Vol 104 (22) ◽  
pp. 2653-2659 ◽  
Author(s):  
Yuling Fu ◽  
Shaun Goodman ◽  
Wei-Ching Chang ◽  
Frans Van de Werf ◽  
Christopher B. Granger ◽  
...  
Keyword(s):  
Time To Treatment ◽  
St Segment ◽  
One Year ◽  
The Impact

scholarly journals The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia

PLoS ONE ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. e0152761 ◽  
Author(s):  
Platon Eliseev ◽  
Grigory Balantcev ◽  
Elena Nikishova ◽  
Anastasia Gaida ◽  
Elena Bogdanova ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Initiation ◽  
Diagnostic Algorithm ◽  
Multidrug Resistant ◽  
Line Probe Assay ◽  
Time To Treatment ◽  
Arkhangelsk Region ◽  
Probe Assay ◽  
Time To Treatment Initiation ◽  
The Impact

Abstract TMP77: Baseline Nihss-adjusted Time Window For Iv Tpa In Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marian Muchada ◽  
Marta Rubiera ◽  
Jorge Pagola ◽  
David Rodriguez- Luna ◽  
Alan A. Flores ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Time Window ◽  
Favorable Outcome ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Ischemic Lesion ◽  
Severe Stroke ◽  
Time To Treatment ◽  
The Impact ◽  
Iv Tpa

Background: Updated metaanalysis have shown that beneficial effect of iv tPA on functional outcome decreases progressively overtime until 4.5 h. However, given the differential pattern of arterial occlusion, stroke severity and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aim to identify time windows for different categories of stroke severity and occlusion location. Methods: Were included patients treated according to the criteria of the European Summary of Product Characteristics for alteplase treatment < 4.5h in a Universitary Hospital from 2001- 2011. Patients were grouped according to NIHSS severity in minor NIHSS ≤ 8, moderate stroke NIHSS 9-15, severe stroke NIHSS ≥ 16. We sequentially analyzed time-to-treatment to achieve favorable outcome as mRS ≤ 2 at 3 months. Results: 640 patients were included, of whom 123 patients (19.22%) with minor stroke, 205 (32.5%) with moderate stroke and 312 (48.75%) with severe stroke. The rate of favorable outcome was 79.8%, 62.5%, 24.2% respectively. In patients with minor stroke time-to-treatment did not predict outcome (OR 1.005, 95% CI: 0.997- 1.012; p = 0.264). After adjusting for age and occlusion location only age was a independent variable (OR 1.198; 95% CI: 1.054-1.336; p= 0.001). In patients with moderate stroke time-to-treatment ≤ 240 minutes predict favorable outcome (OR 0.041, 95% CI 0.160- 0.962; p= 0.041), although only age and occlusion location, were independent predictors: (OR 1.061, 95% CI 1.024- 1.098; p= 0.001) and (OR 2.968, 95% CI 1.293- 6.614; p= 0.010), respectively. In patients with severe stroke time-to-treatment ≤ 90 minutes predict favorable outcome (OR 0.428, 95% CI 0.186-0.985; p= 0.046). Adjusting for proximal occlusion, age and time-to-treatment before 90 minutes were independent variables: age (OR 1.045, 95% CI 1.014-1.077, p= 0.004) and time-to-treatment (OR 0.267, 95% CI 0.088- 0.809, p= 0.020) Conclusions: The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity. The window for favorable outcome was <90min for severe strokes and extends to <240min in moderate stokes. However, time-to-treatment appeared unrelated to functional outcome in minor stroke.

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