A comparison of response in the presence or absence of a delay in induction therapy with bortezomib, lenalidomide, and dexamethasone

2018 ◽  
Vol 25 (7) ◽  
pp. 1692-1698 ◽  
Author(s):  
Allison J Schepers ◽  
Alexis R Jones ◽  
Brandi N Reeves ◽  
Sascha A Tuchman ◽  
Jill S Bates
Keyword(s):  
Induction Therapy ◽  
Response Rate ◽  
Medical Center ◽  
Reproductive Potential ◽  
The United States ◽  
Delay Group ◽  
Primary Objective ◽  
Third Party ◽  
Mean Delay ◽  
Risk Patients

Purpose Lenalidomide, bortezomib, and dexamethasone (RVd) has emerged as a preferred induction therapy in multiple myeloma (MM) in the United States. Due to lenalidomide's teratogenic risk, patients and prescribers must comply with a risk evaluation and mitigation strategy (REMS) program. The REMS program limits dispensing to certain third-party specialty pharmacies, whose average prescription fill times are longer than in-house specialty pharmacies. In practice, a delay in procurement of lenalidomide may mean that patients start therapy with only bortezomib and dexamethasone, delaying the start of more effective triplet therapy. The primary objective of this study is to determine if a delay from start of bortezomib and dexamethasone to start of triplet therapy with lenalidomide impacts rate of achievement of very good partial response (VGPR) after four cycles of RVd. Methods This was a single-center retrospective review of adults with newly diagnosed MM who received RVd induction therapy at University of North Carolina Medical Center between April 2014 and June 2017. Patients who started lenalidomide ≥10 days after bortezomib comprised the “Delay” group, while those who started lenalidomide concurrently with bortezomib or within 1–9 days after bortezomib comprised the “No Delay” group. The primary outcome was VGPR or better response rate after four cycles of RVd. Results Thirty-eight patients met inclusion criteria. Nine patients (23.7%) experienced any delay in initiation of lenalidomide, with a mean delay of 7.8 days (range 1–18). Four patients (10.5%) experienced a delay ≥10 days. No patients in the Delay group were of reproductive potential, compared to 8.8% in the No Delay group ( p = 0.54). VGPR or better response rate did not differ between the Delay and No Delay groups (66.7% vs. 58.8%, p = 0.79). The mean number of lenalidomide prescriptions generated per RVd cycle was 1.35 (range 1–5, SD 0.74). Conclusions This study did not demonstrate an effect on clinical response after delays ≥10 days between bortezomib and lenalidomide initiation. No patients in the delay group were females of reproductive potential, which is the primary target for increased safety behind the REMS program.

scholarly journals Evaluation of Thrombotic Risk in Thyroid Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A861-A861
Author(s):  
Chukwuka Akamnonu ◽  
David A Cohen
Keyword(s):  
Pulmonary Embolism ◽  
Thyroid Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
The United States ◽  
Primary Objective ◽  
Cancer History ◽  
Thrombotic Risk ◽  
History Of

Abstract Introduction: Current guidelines from the International Society of Thrombosis and Hemostasis recommend limited screenings for deep vein thrombosis (DVT) or pulmonary embolism (PE) with no identifiable precipitating factor (termed unprovoked). There is paucity of data with regards to thyroid cancer screening in the setting of an unprovoked VTE. Studies from Europe have shown an association between VTE and thyroid cancer; however, these studies do not account for differences in iodine availability, thus the need for studies in the United States. Understanding the risk of thyroid cancer as a provocative factor in developing a deep venous thrombosis (DVT) or pulmonary embolism (PE) may be able to facilitate case detection of disease and prevent future morbidity and mortality from thyroid cancer and/or VTE. Objectives: The primary objective of this study is to understand the risk of developing VTE in the setting of thyroid cancer. Methods: In this retrospective chart review study, we reviewed electronic medical records of patients with a history of DVT or PE between ages 18-99, presenting to all outpatient clinics at a single academic medical center in New Jersey between October 1, 2015, and Dec 31, 2018. We screened for coexistent cancer history among this group, and from this sample we further isolated cases of thyroid cancer. Results: 345 patients were found to have a history of VTE. 187 were female (54%) and 113 (29%) had a history of malignancy. The most common cancers were breast (19%), colorectal (9%), leukemia (9%), prostate (8%), and lymphoma (8%). Thyroid cancer accounted for 2% of all discovered cases. Conclusion: In this retrospective analysis, 2% of all patients with VTE and cancer carried a diagnosis of thyroid cancer. Although this suggests a relatively low risk, given the medical burden of a venous thromboembolism and the comparable proportion of thyroid cancer in all new cancer cases, thyroid cancer should be considered a provoking factor in unprovoked VTE.

Phase I trial of safety of combining BCG with pembrolizumab in patients with high grade superficial bladder cancer unresponsive to previous intravesical therapy.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. TPS111-TPS111 ◽  
Author(s):  
Shaheen Riadh Alanee ◽  
Kathy Robinson ◽  
Sherjeel Sana
Keyword(s):  
Bladder Cancer ◽  
Induction Therapy ◽  
Superficial Bladder Cancer ◽  
The United States ◽  
Primary Objective ◽  
Immune Checkpoints ◽  
Intravesical Therapy ◽  
Fixed Dose ◽  
High Grade ◽  
Bcg Therapy

TPS111 Background: Bacille Calmette-Guerin (BCG) is the most effective agent in the treatment of high grade superficial bladder cancer (HGSBC); however, not all patients respond to BCG, and recurrent disease is associated with a poor prognosis. The blockade of immune checkpoints of the pathway involving programmed death 1 (PD1) has been shown recently to be effective in cancer therapy. We started the first trial in the United States to combine an anti-PD1 drug (pembrolizumab) with BCG therapy in patients with HGSBC. Methods: The primary objective of the study was to determine the safety of administering a 200 mg fixed dose of pembrolizumab in conjunction with intravesical BCG treatment in HGSBC patients who have failed two courses of induction therapy or one course of BCG induction therapy followed by maintenance therapy. Patients included had to have pathologically documented HGSBC (Ta, T1) at time of restaging, or have pathologically documented high grade CIS of the bladder at time of initial resection for recurrent/persistent bladder cancer. Subjects were treated with six cycles (21 day cycle) of pembrolizumab treatment combined with six consecutive weeks of concurrent BCG installation beginning with cycle 3 of pembrolizumab. The first three subjects were to be treated at a dose of 100 mg pembrolizumab to ensure safety for the combination. If no safety issues were to happen, dosing was to be escalated to 200 mg every three weeks. Our secondary objective was to determine the 19 week and the three, twelve, and twenty-four month post-treatment completion complete response rate. The first patient received cycle 1 of pembrolizumab treatment in July of 2015. As of the date of writing this letter, five patients have completed treatment on this trial. The trial is soon to open a second site at Henry Ford Health System in addition to Southern Illinois University with the goal of full enrollment to be achieved in the next 6 months. Clinical trial information: NCT02324582.

Emergency Physician Involvement in Hospital Preparedness: A National Survey of Academic Medical Centers

2020 ◽  
pp. 1-4
Author(s):  
Kevin M. Ryan ◽  
Sina Mostaghimi ◽  
Julianne Dugas ◽  
Eric Goralnick
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Emergency Preparedness ◽  
Response Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Academic Medical Centers ◽  
Medical Centers ◽  
Academic Medical

ABSTRACT Objectives: The aim of this study was to determine the involvement of emergency medicine physicians at academic medical centers across the United States as well as their background training, roles in the hospital, and compensation if applicable for time dedicated to preparedness. Methods: A structured survey was delivered by means of email to 109 Chairs of Emergency Medicine across the United States at academic medical centers. Unique email links were provided to track response rate and entered into REDCap database. Descriptive statistics were obtained, including roles in emergency preparedness, training, and compensation. Results: Forty-four of the 109 participants responded, resulting in a response rate of 40.4%. The majority held an administrative role in emergency preparedness. Formal training for the position (participants could select more than 1) included various avenues of education such as emergency medical services fellowship or in-person or online courses. Of the participants, most (93.18%) strongly agreed that it was important to have a physician with expertise in disaster medicine assisting with preparedness. Conclusions: The majority of responding academic medical center participants have taken an active role in hospital emergency preparedness. Education for the roles varied though, often consisted of courses from emergency management agencies. Volunteering their time for compensation was noted by 27.5%.

scholarly journals Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study (Preprint)

2021 ◽  
Author(s):  
Benjamin A Y Cher ◽  
Eric A Wilson ◽  
Alexa M Pinsky ◽  
Ryan F Townshend ◽  
Ann V Wolski ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Patient Portal ◽  
Telephone Triage ◽  
Telephone Hotline ◽  
Risk Patients ◽  
Triage Algorithm

BACKGROUND During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. OBJECTIVE The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. METHODS Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). RESULTS A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. CONCLUSIONS The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases.

scholarly journals Dilemmatic tensions around parenthood: the ambiguous third-party role in Assisted Reproductive Technologies and Surrogacy in France and Portugal

2019 ◽  
Vol 56 (2) ◽  
pp. 381-404 ◽  
Author(s):  
Catarina Delaunay
Keyword(s):  
Assisted Reproductive Technologies ◽  
Reproductive Potential ◽  
The United States ◽  
Reproductive Technologies ◽  
Third Party ◽  
Special Focus ◽  
Human Beings ◽  
Reproductive Process ◽  
Gay Couples ◽  
Pregnancy And Childbirth

This article analyzes couples’ attitudes towards the third-party role in Assisted Reproductive Technologies with gamete donation, and problematizes parenthood and kinship. I base my analysis on 66 in-depth interviews with different ART actors (from beneficiaries to professionals) in France and Portugal, conducted as part of a research project already completed. Special focus is given to 19 interviews with heterosexual and homosexual couples who used third-party reproduction in Europe and the United States. I found a physical and moral detachment operation among heterosexual and lesbian couples vis-a-vis the donor of reproductive potential, who is depersonalized and reduced to a functionality. The objective is to preserve the intimacy of the couple and the autonomy of the parental project. This contrasts with innovative and enlarged family dynamics developed by gay couples, who integrate both female figures (surrogate and oocyte donor) in their children’s family history, through bonding efforts in a logic of reciprocity (gift and counter-gift). The purpose is to reject the negative image of a woman’s body being commodified while preserving the natural appearance of procreation. I conclude that a naturalist conception of kinship persists —one based on shared biogenetic substances that bind together one parent and the donor-conceived child— along with the centrality of biological processes such as pregnancy and childbirth. There are different ways of easing tensions inherent to the contractual intervention of third parties in the reproductive process. ART re-elaborates the line of demarcation between commodities and gifts and between living things and human beings, while reconfiguring family concepts.

scholarly journals The Burden of Neurocysticercosis at a Single New York Hospital

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Amy Spallone ◽  
Luboslav Woroch ◽  
Keith Sweeney ◽  
Roberta Seidman ◽  
Luis A. Marcos
Keyword(s):  
United States ◽  
New York ◽  
Medical Center ◽  
Long Island ◽  
Taenia Solium ◽  
The United States ◽  
University Hospital ◽  
Predominantly Hispanic ◽  
Icd 10 ◽  
Risk Patients

Neurocysticercosis (NCC), a disease caused by the larval pork tapeworm Taenia solium, has emerged as an important infection in the United States. In this study, we describe the spectrum of NCC infection in eastern Long Island, where there is a growing population of immigrants from endemic countries. A retrospective study was designed to identify patients diagnosed with NCC using ICD-9 and ICD-10 codes in the electronic medical records at Stony Brook University Hospital between 2005 and 2016. We identified 52 patients (56% male, median age: 35 years) diagnosed with NCC in the only tertiary medical center in Suffolk County. Twenty-five cases were reported in the last three years of the study. Forty-eight (94%) patients self-identified as Hispanic or Latino in the electronic medical record. Twenty-two (44%) and 28 (56%) patients had parenchymal and extraparenchymal lesions, respectively. Nineteen (41.3%) patients presented with seizures to the emergency department. Six patients (11.7%) had hydrocephalus, and five of them required frequent hospitalizations and neurosurgical interventions, including permanent ventriculoperitoneal shunts or temporary external ventricular drains. No deaths were reported. The minimum accumulated estimated cost of NCC hospitalizations during the study period for all patients was approximately 1.4 million United States dollars (USD). In conclusion, NCC predominantly affects young, Hispanic immigrants in Eastern Long Island, particularly in zip codes correlating to predominantly Hispanic communities. The number of cases diagnosed increased at an alarming rate during the study period. Our study suggests a growing need for screening high-risk patients and connecting patients to care in hopes of providing early intervention and treatment to avoid potentially detrimental neurological sequelae.

Community Outreach Partnership Center (COPC)

2003 ◽  
Vol 1 (2) ◽  
pp. 44-51
Author(s):  
Kristine Brown ◽  
James Sturges
Keyword(s):  
Health Promotion ◽  
Los Angeles ◽  
Mexican Immigrants ◽  
Community Outreach ◽  
Well Being ◽  
Integrated Services ◽  
The United States ◽  
Primary Objective ◽  
Health Promotion Program ◽  
Federal Grant

With the continued influx of Mexican immigrants to the United States, especially to Southern California, health concerns and needs have increased among this population over the last several years. California State Polytechnic University, Pomona (Cal Poly Pomona) obtained a federal grant that provided resources to establish the Community Outreach Partnership Center (COPC). COPC consists of comprehensive efforts to improve the overall well-being of the Angela Chanslor area within the City of Pomona in East Los Angeles. Focus areas of the project include 1) Education and Integrated Services, 2) Community Planning and Capacity Building for Neighborhood Revitalization and Safety, and 3) Job Development and Training. The focus of this paper is health promotion activities within Education and Integrated Services. The primary objective of this portion of the program was to provide residents with physical examinations and health screenings, health education, and medical and social service referrals. Topics discussed are the target community, general overview of COPC, Family Services Information and Referral Program (i.e. health promotion program within Education and Integrated Services), program impact and results, and suggestions for continued implementation and future efforts. / Con la influencia continua de inmigrantes Mexicanos a los Estados Unidos, especialmente al sur de California, ciertas necesidades con respecto a la salud han incrementado en esta poblacion en los ultimos anos. California State Polytechnic University, Pomona (Cal Poly Pomona). Obtuvo ayuda Federal para establecer El Community Outreach Partnership Center (COPC). El centro COPC consiste de esfuerzos conprensivos para mejorar el bienestar del area Angela Chanslor que esta ubicado en la Ciudad de Pomona en la parte Este de Los Angeles. Las partes enfocadas del proyecto incluyen, 1) Educacion y servicios Integrados, 2) Plan para la Comunidad y un Edificio de Capacitacion para la comunidad que dara revitalizacion y seguridad, 3) Y habrira trabajos y entrenamientos. El enfoque de este proyecto es de actividades en Promocion de Salud aliadas con educacion y Servicios Integrados. El objetivo principal de esta porcion del programa era de proveer a los residentes con examinaciones fisicas, educacion para la salud, y eran referidas a servicios medicos y sociales. Los topicos que son tratados son: La comunidad que sera ayudada, El enfoque general de COPC, informacion del programa para referir a servicios familiares, el impacto del programa y resultados, y sugerencias para implementar futuros esfuerzos.

Systematic Government Access to Private-Sector Data in the United States I

2017 ◽  
Author(s):  
Stephanie K. Pell
Keyword(s):  
Private Sector ◽  
Public Information ◽  
The United States ◽  
Third Party ◽  
Threat Detection ◽  
Detection And Identification ◽  
Potential Applications ◽  
September 11 Attacks ◽  
Access To Data ◽  
Sector Data

After the September 11 attacks, law enforcement's mission expanded to include, at times even prioritize, the general “prevention, deterrence and disruption” of terrorist attacks, which presumed a new emphasis upon threat detection and identification by analyzing patterns in larger, less specific bodies of information. Indeed, the unprecedented level of “third-party” possession of information inevitably makes the private sector the most reliable and comprehensive source of information available to law enforcement and intelligence agencies alike. This chapter explores the potential applications of systematic government access to data held by third-party private-sector intermediaries that would not be considered public information sources but, rather, data generated based on the role these intermediaries play in facilitating economic and business transactions (including personal business, such as buying groceries or staying at a hotel on vacation).

scholarly journals Medical Student Attitudes Toward Blood Donation in Times of Increased Need

2021 ◽  
pp. 000313482110110
Author(s):  
Rahima Khatun ◽  
Banan W. Otaibi ◽  
Anna Ssentongo ◽  
Joshua P. Hazelton ◽  
AmandaB. Cooper
Keyword(s):  
Medical Students ◽  
Student Attitudes ◽  
Response Rate ◽  
Blood Donation ◽  
Multivariable Analysis ◽  
The United States ◽  
Mass Casualty ◽  
Academic Institution ◽  
Donor Pool ◽  
Willingness To Donate

Background In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Methods Three anonymous REDCap surveys were administered to all medical students at a rural academic institution. Surveys 1 and 2 were administered preceding and after an institution-wide MCI drill, in September and November 2019, respectively. Survey 3 was administered following a student-organized COVID-19 blood drive in June 2020. Multivariable analysis was performed to determine if factors, ie, experience with MCI drills and emergency medical services (EMS) training, were associated with willingness to donate blood. Furthermore, barriers to donation among those not willing to donate were assessed. Results Overall response rate for MCI surveys (surveys 1 and 2) was 38% (mean age 25.2 years and 50% women). 91% (n = 210) of respondents were willing to donate blood. Previous participation in MCI drills and EMS training was not associated with higher willingness to donate blood. Response rate for survey 3 was 15.6% (59.4% women), and 30 (31.3%) respondents indicated they did not volunteer to donate blood during the COVID-19 drive. Most common reasons for not donating were “other,” medical concerns, and being out-of-town. Conclusions Majority of medical students are willing to donate blood during times of increased need and offer a possible solution to increase blood donor pool.

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