Improved hepatocellular carcinoma (HCC) outcomes in a public hospital setting with increased access to procedural-based therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18137-e18137
Author(s):  
Elizabeth S. Ellent ◽  
Tejas V Joshi ◽  
Lee S McDaniel ◽  
Brian C. Boulmay
Keyword(s):  
Public Hospital ◽  
Medical Center ◽  
Image Interpretation ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
P Value ◽  
Hospital Funding

e18137 Background: HCC is the 2nd most common cause of cancer death in the world. We investigate if increased access to various treatment modalities improved outcomes in a public hospital setting. Access to procedural-based treatments improved with development of an in hospital interventional radiology program that resulted from increased public hospital funding starting in 2013 at University Medical Center in New Orleans (UMC). Methods: A retrospective chart review was conducted to analyze 124 patients (pts) diagnosed with HCC from 2013 to 2018 at UMC to determine effect of treatment modality on outcome. Comparative analysis and Fisher’s exact test was performed using a previous study analyzing a similar population (n = 107) from 2007-2013. Results: Pts with HCC treated with transarterial chemoembolization (TACE) had an overall survival (OS) of 82.55% and 54.84% at 1 and 3 years (yr). Pts not treated with TACE had OS of 60.69% and 38.49% at 1 and 3 yr. OS in the 2007-2013 cohort at 1 year was 29%. Progression free survival (PFS) in pts treated with TACE was 52.99% and 22.66% at 1 and 3 yr. PFS in patients not treated with TACE was 58.36% and 50.28% at 1 and 3 yr. Treatment with Sorafenib (S) with or without TACE had OS of 75.84% and 48.43% at 1 and 3 yr. Pts not receiving S had an OS of 69.17% and 48.47% at 1 and 3 yr. PFS was 37.27% and 10.57% in pts treated with S at 1 and 3 yr. PFS for pts not treated with S was 67.00% and 47.02% over 1 and 3 yr. There were 140 total IR procedures which averages to 1.13 IR procedures per pt. Compared to 2007-2013 cohort, more HCC pts had TACE (10% to 56%, p < 0.001) and received S (18% to 39%,p < 0.001). Conclusions: Although PFS was not better for those pts treated with TACE (p value = 0.218), OS was statistically better with TACE (p value = 0.003). Radiologic response rates do not appear to correlate with OS benefit, perhaps due to TACE effect on image interpretation. PFS was decreased in pts treated with S (p value = < 0.0001), possibly due to its use in pts who have progressed despite TACE. The 2013-2018 cohort has superior OS compared to the 2007-2013 cohort at 1 yr. Increased access to procedural- based, locoregional therapy and S positively impacts patient outcomes.

Role of biologic therapy in the treatment of unresectable appendiceal epithelial neoplasms (AEN).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 628-628
Author(s):  
Cathy Eng ◽  
Michael J. Overman ◽  
Keith F. Fournier ◽  
Richard E. Royal ◽  
Aki Ohinata ◽  
...  
Keyword(s):  
Biologic Therapy ◽  
Cost Benefit ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Prognostic Indicator ◽  
Ca 125 ◽  
P Value ◽  
Heated Intraperitoneal Chemotherapy ◽  
Poorly Differentiated ◽  
Cox Proportional Hazard Regression

628 Background: AEN ranges from benign appearing cells to poorly differentiated signet cell adenocarcinoma. Currently, cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is believed to be optimal treatment. Systemic chemotherapy (SC) +/- biologic therapy (BT) is considered when CRS is not feasible. VEGF expression reportedly is a poor prognostic indicator in AEN pts. The purpose of this analysis is to determine the benefit of BT in chemotherapy naïve suboptimal candidates for CRS. Methods: A retrospective chart review of AEN pts registered in our tumor registry between Jan. 2005 to Dec. 2009 was undertaken. Electronic medical records (EMR) were reviewed for CRS, HIPEC, histology, stage, SC + BT, CEA, CA-125, and/or CA 19-9, response (R), and progression-free survival (PFS). All patients were required to be radiographically restaged at MDACC. R was defined as clinical or radiographic benefit. K-M method, Log-Rank, and Cox proportional hazard regression models were used for statistical analysis. Results: Of 625 pts with a diagnosis of AEN, 132 (21%) fulfilled the inclusion criteria and were evaluable for PFS and R. Sixty-five (49%) pts received SC + BT; 67 (51%) pts received SC alone. SC included: 5-FU = 28 (21%), FOLFIRI = 20 (15%), FOLFOX = 71 (54%), and other = 13 (10%). BT included: bevacizumab = 58 (89%), EGFR inhibitor = 6 (9%); 1 pt (2%) received both. Median lines of BT = 1 (range: 1-3). Histologically, 51 (38%) were poorly differentiated and 33 (25%) were signet ring; 26 (20%) had both features. After a median follow-up of 33M, 40 (62%) had stable disease, 12 (19%) partial response, and 12 (19%) progressive disease. Biologic therapy improved median PFS and OS (17M vs. 7M, p-value = 0.007; 68M vs. 50M, p-value = 0.08, respectively). Multivariate analysis indicated improved PFS (HR: 0.49; 95% CI: 0.3-0.8; p-value: <0.001) and OS (HR: 0.52; 95% CI: 0.3-0.8; p value = 0.007) in favor of biologic therapy. Conclusions: Biologic therapy in combination with chemotherapy appears to have a role in surgically unresectable AEN pts with improvement in PFS and OS. Tissue/blood correlatives and quality of life analysis are underway. Prospective analysis including cost-benefit should be considered.

scholarly journals Pharmacist-Driven Management of Chemotherapy Induced Nausea and Vomiting in Hospitalized Adult Oncology Patients. A Retrospective Comparative Study

2011 ◽  
Vol 2 (3) ◽  
Author(s):  
Ramy Elshaboury ◽  
Kathleen Green
Keyword(s):  
Practice Guidelines ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Nausea And Vomiting ◽  
P Value ◽  
Potential Cost

Chemotherapy-induced nausea and vomiting (CINV) is a major adverse event associated with cancer treatments. There are clinical practice guidelines that assist practitioners in managing CINV. Many cancer centers develop protocols for physicians and pharmacists to guide prophylaxis and breakthrough treatments of CINV based on published guidelines. The purpose of this study was to evaluate the outcome differences between pharmacist and physician -driven management of CINV in adult hospitalized cancer patients in a large academic medical center. This is a single center retrospective chart review study. The primary outcome of the study was the number of breakthrough antiemetic doses needed throughout the hospitalization. A total of 106 adult patients receiving inpatient chemotherapy were reviewed for CINV management. Fifty-five patients (52%) were managed according to the pharmacist-driven protocol, and fifty-one patients (48%) were managed by the physician. There was no difference between the two groups in the primary outcome. Patients in the pharmacist-managed group needed 6.4 breakthrough antiemetic doses; whereas, patients in the physician managed group needed 5.9 doses throughout the hospital stay (P-value = 0.7). No difference was seen when results were adjusted for length of hospitalization. There was a difference in adherence to the institution CINV guidelines favoring the pharmacist-driven approach (85% versus 33%, P < 0.0001). In conclusion, pharmacist-run protocol for CINV management was as effective as the standard of care. Protocols that are based on practice guidelines may offer the advantage of care standardization and potential cost savings.   Type: Student Project

scholarly journals Impact of a Multi-disciplinary C. difficile Action Team

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S397
Author(s):  
Emily Heil ◽  
Bharathi Sivasailam ◽  
SoEun Park ◽  
Jose Diaz ◽  
Erik Von Rosenvinge ◽  
...  
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Disciplinary Action ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Post Intervention ◽  
Fecal Microbiota Transplant ◽  
Action Team

Abstract Background Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. Methods A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. Results We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. Conclusion Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. Disclosures All authors: No reported disclosures.

Evaluation of Potential Drug–Drug Interactions With Direct Oral Anticoagulants in a Large Urban Hospital

2018 ◽  
Vol 33 (2) ◽  
pp. 136-141 ◽  
Author(s):  
Yoonsun Mo ◽  
Ayse Karakas-Torgut ◽  
Antony Q. Pham
Keyword(s):  
Drug Interactions ◽  
Medical Center ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Potential Drug ◽  
Urban Hospital ◽  
Combined Use

Objective: The aim of this study is to assess patterns of potential drug–drug interactions (DDIs) with direct oral anticoagulants (DOACs) in an inpatient hospital setting. Methods: A retrospective chart review was conducted at the Brookdale University Hospital and Medical Center (BUHMC) from January 2014 to November 2016. All adult patients admitted to the BUHMC who were treated with a DOAC for at least 3 days were screened. Among them, those who received selected interacting drugs at any time during the course of DOAC therapy were included in this study. Results: This study included 165 patients with an average of 73 years (standard deviation [SD] = 12.3) and 233 cases. The most commonly used concomitant drug with a DOAC was aspirin (58%), followed by amiodarone (16%) and P2Y12 inhibitors (11%). The combined use of dual antiplatelet therapy and a DOAC was identified in 18 (6%) cases. Approximately one-third of the cases encountered were classified as the “avoidance” category. Conclusions: Despite computerized DDI alerts, potentially significant DDIs with DOACs still occur. While the present study provides insight into the current patterns of DDIs, further studies are needed to evaluate clinical outcomes of the potential DDIs with DOACs in practice.

Effect of microscopic residual tumor (MRT) at surgical margin of resection (SMR) in invasive breast cancer (IBC) on survival of non-Hispanic white women in central Pennsylvania (PA)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10569-10569
Author(s):  
A. M. Ingle ◽  
P. Kumar ◽  
B. Baney ◽  
K. Day ◽  
T. Dagen ◽  
...  
Keyword(s):  
White Women ◽  
Medical Center ◽  
Statistical Significance ◽  
Surgical Margin ◽  
Residual Tumor ◽  
Hazard Ratio ◽  
Treatment Modalities ◽  
P Value ◽  
Risk Of Death ◽  
Hispanic White

10569 Background: Few studies that have investigated the long-term effect of MRT in IBC, have demonstrated conflicting results. Mount Nittany Medical Center (MNMC) is located in an agricultural, ethnically-homogenous (Non-Hispanic White) county in PA. To the best of our knowledge, there have been no similar studies conducted on such populations. Our study has investigated the effect of MRT at SMR on overall survival (OS) and event-free survival (EFS) of patients with IBC. Methods: All women diagnosed with IBC from 04/1992 to 06/2005 at MNMC were deemed eligible. Log-rank statistics and Cox proportional hazard models (CPHM) were used for obtaining survival rates. Results: Of the 939 eligible women analysis were performed on 651 women (age range 27–94 years; median 62 years) with complete data on diagnosis, surgical margins and treatment modalities. With a median follow-up time of 4 years (range 0.01–11.3 years), 390 (59.9%), 214 (32.8%), 47 (7.2%) women had stage I, II and III tumor respectively; 540 (83%) patients had no residual tumor at SMR. 484 (74.4%) patients received radiation therapy (RT) ± chemotherapy (CT) and/or hormonal therapy (HT), 383 (58.8%) received HT ± CT and/or RT and 229 (35.2%) received CT ± RT and/or HT. The CPHM demonstrated no statistical significance of MRT on OS (hazard ratio 1.54, p = 0.07), and EFS (hazard ratio = 1.54, p = 0.07) after adjusting for treatment, stage and age. Univariate 10-year OS rate in patients with no MRT was 72.7% (95% confidence interval (CI) 63.1% to 80.1%), versus 61.2% (95% CI 45.3% to 73.8%) in patients with MRT (p-value = 0.07). Ten-year EFS was observed to be 68.9% (95% CI 59.1% to 76.8%) in patients with no MRT, versus 60.8% (95% CI 45.1% to 73.2%) in patients with MRT (p-value = 0.08). Conclusion: In our study, patients with IBC with MRT at SMR have a 1.5 times the risk of death or recurrence as compared to patients with no MRT. However, this difference is statistically not significant over time. No significant financial relationships to disclose.

scholarly journals Developing a Respiratory Depression Scorecard for Capnography Monitoring

2013 ◽  
Vol 4 (3) ◽  
Author(s):  
Katie Felhofer
Keyword(s):  
Risk Factors ◽  
Pulse Oximetry ◽  
Respiratory Depression ◽  
Chart Review ◽  
Medical Center ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Of Minnesota ◽  
Average Patient ◽  
The University

Pulse oximetry is the most common way to measure a patient's respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview), we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of respiratory depression. We conducted a retrospective chart review of all serious opioid-induced over-sedation events that occurred at UMMCFairview between January 1, 2008 and June 30, 2012. Thirteen risk factors were identified which predispose patients to respiratory depression. The average patient demonstrated 3.75 risk factors. The most commonly occurring risk factor was the concomitant use of multiple opioids or an opioid and a CNS-active sedative, followed by an ASA score 䊫 3. Based on this data, we developed a scorecard for choosing patients at the most risk of developing respiratory depression; these patients are the best candidates for capnography. Although further studies are necessary to corroborate this research, at this time giving extra consideration to patients demonstrating the previously stated risk factors is prudent when assessing those patients most in need of capnography.   Type: Student Project

scholarly journals Are Bethesda III Thyroid Nodules More Aggressive than Bethesda IV Thyroid Nodules When Found to Be Malignant?

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2563
Author(s):  
Sena Turkdogan ◽  
Marc Pusztaszeri ◽  
Veronique-Isabelle Forest ◽  
Michael P. Hier ◽  
Richard J. Payne
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Thyroid Nodules ◽  
Molecular Genetic ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
P Value ◽  
Papillary Thyroid ◽  
Genetic Test Results

The Bethesda classification system for thyroid fine needle aspirate (FNA) is used to predict the risk of malignancy and to guide the management of thyroid nodules. We postulated that thyroid malignancies characterized as Bethesda III on FNA have more aggressive features than those classified as Bethesda IV. A retrospective chart review was performed to identify those who underwent thyroid surgery at a single tertiary hospital setting between 2015 and 2020. Associations between Bethesda category, molecular genetic test results, and histopathologic findings were examined. Out of 628 surgeries that were performed, 199 (54.2%) Bethesda III nodules and 216 (82.8%) Bethesda IV nodules were malignant. Of those that were malignant, 37 (18.6%) and 22 (10.2%) Bethesda III and Bethesda IV nodules showed aggressive features, respectively (p value = 0.014). There was a proportionally increased number of aggressive features in extra-thyroidal extension, lymph nodes metastasis, and all aggressive subtypes of papillary thyroid cancer in the Bethesda III category. Although Bethesda IV nodules are much more likely to be malignant (p value = 0.002), our study suggests that Bethesda III nodules that are resected are more likely to have aggressive features than Bethesda IV nodules, with a statistically significant increase in the solid variant of papillary thyroid cancer and lymph node metastasis.

scholarly journals #1: Pediatrics Institutional COVID-19 review

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S4-S5
Author(s):  
Uzma Hasan ◽  
Prakash Karna
Keyword(s):  
Medical Center ◽  
Age Distribution ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
The United States ◽  
Health Concern ◽  
Study Patient ◽  
Comorbid Condition ◽  
Global Public Health ◽  
Presenting Symptoms

Abstract Background Coronavirus disease (COVID-19) caused by SARS-COV2 represents global public health concern, with varied severity of illness in different ages and racial groups. This study aims to describe clinical presentation and outcomes in children aged 0–18 years in a community hospital setting in the United States. Methods This is a retrospective medical record review of pediatric patients (0–18 years) admitted to Saint Barnabas Medical Center between March 2020- August 2020 with confirmed diagnosis of COVID-19 infection. Diagnosis of COVID-19 infection is based on ICD-10 diagnosis code from the coding abstract data of the hospital, and data analysis is based on retrospective chart review using electronic medical records for the patients included in the study. Patient data include demographics (age, sex, race), pre-existing conditions, presenting symptoms, treatments used and outcomes. Findings We identified 27 cases of pediatric COVID-19 patients at Saint Barnabas Medical Center during period of March 2020- August 2020. Fever (74%) was the most frequent symptom identified, followed by cough (44%), nausea/vomiting (30%), abdominal pain (19%), headache (19%), diarrhea (15%), shortness of breath (15%), red eyes (15%), rash (11%), chest pain (4%), and loss of taste/smell (4%). 13 out of 27 patients had imaging with chest X-ray, and 7 (54%) had findings of lung infiltrates or opacities. 6 of 27 patients had echocardiogram, and 4 (67%) had positive echocardiogram findings. 11 of 27 patients had some comorbid condition. 17 of 27 (63%) received no treatment. 3 patients (11%) were treated with IVIG + steroids, 2 (7%) received steroids only, 2 (7%) received Remdesivir, 1 (4%) received HCQ, and 1 (4%) received Tocilizumab along with IVIG+ steroids. Only 3 of 27 patients (11%) required supplemental oxygen treatment. No deaths were reported. Of 27 patients, 11 (41%) received inpatient care in general pediatrics, 10 (37%) received care only in ER, 4 (15%) received ICU level of care, and 2 (7%) received care in newborn nursery. Of 27 patients, 17 (63%) were female, and 10 (37%) were male. Race distribution was 48% black, 22% white, 4 % Asian Indian, and 26% others/unknown. Age distribution was 41% aged &gt;15 yrs, 19% aged 6–10 yrs, 15% aged 1–5 yrs, 11% aged 11–15 yrs, 11% newborn, and 4% 0–1 yr. Interpretation This review supports findings from other studies in children showing overall good prognosis in children diagnosed with COVID-19 infection. This study also shows that there is some racial component involved as black children were infected twice as much as white children. However, it requires more longitudinal studies to confirm these findings, and better understand symptomatology and disease course in children with COVID-19 infection.

scholarly journals IS THERE AN ASSOCIATION BETWEEN OBSTRUCTIVE SLEEP APNEA AND FRAILTY IN OLDER VETERANS WITH DIABETES?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S949-S949
Author(s):  
Jahan E Mahjabin ◽  
Dhanya Baskaran ◽  
Christopher Lewis ◽  
Valeria C Baldivieso ◽  
William Wohlgemuth ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Medical Center ◽  
Frailty Index ◽  
Retrospective Chart Review ◽  
Apnea Hypopnea Index ◽  
P Value ◽  
Frailty Status ◽  
Obstructive Sleep ◽  
The Mean

Abstract Obstructive Sleep Apnea is a highly prevalent disease, where incidence increases with age. Individuals with chronic diseases such as diabetes and obesity are at risk of OSA increasing the risk of frailty. A retrospective chart review was conducted to study the association between OSA and frailty in older diabetic Veterans. Baseline polysomnography data for 91 patients ≥ 65 years was obtained from the electronic health records at the Miami VA Medical Center. Patients were screened for frailty from January 2016 to August 2017, and followed until October 2018. Patients were then dichotomized into frail (Frailty Index (FI) ≥.21) and non-frail (robust FI =&lt;.10 and pre-frail FI ≥.10, &lt;.21) groups. The mean participant age is 70.9 years, with (SD) of 4.8. The mean age for the frail group is 71.1 years, with a SD of 5.2. Mean age for the non-frail group is 70.5 years, with a SD of 4.2. Linear regression demonstrated a significant positive linear relationship between BMI (t=2.096 p-value= .039) and the frailty index. In binomial logistic regression, adjusting for covariates, BMI was associated with increased apnea severity (OR=1.139, 95% CI= 1.044-1.241), p=.003. However, no significant association was found between FI and apnea severity. The severity of OSA based on the Apnea-Hypopnea Index had no significant association with frailty status. However, the study demonstrated a significant association between obesity and frailty, where higher BMI coincided with higher frailty. Increasing BMI coincided with increased severity of OSA, suggesting that BMI acts as a possible confounder between frailty and OSA.

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