To see the other types of publications on this topic, follow the link: Deaconess Medical Center – Spokane.
Journal articles on the topic 'Deaconess Medical Center – Spokane'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Deaconess Medical Center – Spokane.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Cullen, Diane. "Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA." Medicine & Science in Sports & Exercise 38, Supplement (May 2006): 39. http://dx.doi.org/10.1249/00005768-200605001-00009.
Full text
2
Awtrey, Christopher S., David V. Fobert, and Daniel B. Jones. "The Simulation and Skills Center at Beth Israel Deaconess Medical Center." Journal of Surgical Education 67, no. 4 (July 2010): 255–57. http://dx.doi.org/10.1016/j.jsurg.2010.05.023.
Full text
3
Nakamori, Shiro. "Study abroad at Beth Israel Deaconess Medical Center, Harvard Medical School." Japanese Journal of Thrombosis and Hemostasis 29, no. 4 (2018): 446–47. http://dx.doi.org/10.2491/jjsth.29.446.
Full text
4
Apovian, Caroline. "Report from CORE New England, Beth Israel Deaconess Medical Center and Boston Medical Center." Obesity Management 4, no. 4 (August 2008): 189–92. http://dx.doi.org/10.1089/obe.2008.0208.
Full text
5
N/A. "Beth Israel Deaconess Medical Center Receives $500,000 Bristol-Myers Squibb Unrestricted Metabolic Research Grant." Journal Of Investigative Medicine 52, no. 01-S1 (2004): 016. http://dx.doi.org/10.2310/6650.2004.12342.
Full text
6
Pavlakis, Martha, and Douglas W. Hanto. "Clinical pathways in transplantation: a review and examples from Beth Israel Deaconess Medical Center." Clinical Transplantation 26, no. 3 (December 5, 2011): 382–86. http://dx.doi.org/10.1111/j.1399-0012.2011.01564.x.
Full text
7
Gewin, Virginia. "Pier Paolo Pandolfi, Director, Cancer Genetics Programme, Beth Israel Deaconess Medical Center, Harvard University." Nature 447, no. 7141 (May 2007): 228. http://dx.doi.org/10.1038/nj7141-228a.
Full text
8
Sands, D. Z., D. M. Rind, and C. Safran. "Online Medical Records: A Decade of Experience." Methods of Information in Medicine 38, no. 04/05 (1999): 308–12. http://dx.doi.org/10.1055/s-0038-1634406.
Full textAbstract:
AbstractThe electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.
9
Ronan, Matthew V., Aravind Menon, Lakshman Swamy, and David Thornton. "Experiential Learning Through Local Implementation of a National Chief Resident in Quality and Patient Safety Curriculum." American Journal of Medical Quality 35, no. 2 (June 27, 2019): 171–76. http://dx.doi.org/10.1177/1062860619859076.
Full textAbstract:
The Clinical Learning Environment Review was created to evaluate quality improvement and patient safety (QIPS) beginning in 2013. Little guidance has been offered on implementing QIPS curricula for residency education. The aim was to provide a model QIPS residency curriculum from VA Boston Healthcare System (VABHS), wherein a chief resident in quality and patient safety (CRQS) participates in a national curriculum implementing skills and concepts locally. The CRQS mentors a patient safety resident with faculty oversight. The program involves case investigations, educational conferences, and experiential learning. Participants are residents from Beth Israel Deaconess Medical Center, Boston Medical Center, and Brigham and Women’s Hospital and medical students from Boston University Medical School and Harvard Medical School. Local and national CRQS programs are evaluated. The patient safety rotation is evaluated locally. The local curriculum at VABHS augments the national curriculum and deploys a patient safety education that develops experiential learning skills.
10
Siewert, Bettina, Jonathan B. Kruskal, Ronald Eisenberg, Ferris Hall, and Jacob Sosna. "Quality Improvement Grand Rounds at Beth Israel Deaconess Medical Center: CT Colonography Performance Review after an Adverse Event." RadioGraphics 30, no. 1 (January 2010): 23–31. http://dx.doi.org/10.1148/rg.301095125.
Full text
11
Hasoon, Jamal. "COVID-19 Numbers in Massachusetts and Changes Implemented at Beth Israel Deaconess Medical Center Department of Pain Medicine." Pain Physician 4S;23, no. 8;4S (August 14, 2020): S467—S468. http://dx.doi.org/10.36076/ppj.2020/23/s467.
Full text
12
Nguyen, K. H., M. Huberman, M. Goldstein, S. Kobayashi, and D. B. Costa. "Patterns of care for non-small cell lung cancer at an academic institution affiliated with a National Cancer Institute–designated cancer center: Beth Israel Deaconess Medical Center." Journal of Clinical Oncology 29, no. 15_suppl (May 20, 2011): e18034-e18034. http://dx.doi.org/10.1200/jco.2011.29.15_suppl.e18034.
Full text
13
Galligan, M., and T. Lee. "Development Of The New Nurse Orientation Program For The Hematology/Oncology/Bone Marrow Transplant Inpatient Unit At Beth Israel Deaconess Medical Center." Biology of Blood and Marrow Transplantation 16, no. 2 (February 2010): S325. http://dx.doi.org/10.1016/j.bbmt.2009.12.509.
Full text
14
Kopelman, David B., Sharon B. Wright, Howard Gold, Preeti Mehrotra, and Preeti Mehrotra. "800. Oral Vancomycin Prophylaxis Against Clostridioides difficile in Patients Admitted to a Tertiary Academic Medical Center." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S443—S444. http://dx.doi.org/10.1093/ofid/ofaa439.990.
Full textAbstract:
Abstract Background In an effort to more accurately diagnose Clostridioides difficile infection (CDI), many hospitals have switched to two-step testing algorithms that rely on nucleic acid amplification testing with reflex enzyme immunoassay for toxin. Additionally, oral vancomycin prophylaxis (OVP) against CDI is increasingly being used; initial studies focused on preventing recurrence in patients with a prior history of CDI, but OVP is also being studied in primary prevention. We hypothesized that following the implementation of two-step testing, clinicians may use OVP for prevention of a patient’s first episode of CDI based on knowledge of prior PCR+/Toxin- testing. Methods We performed a single-center, retrospective cohort study of patients admitted to Beth Israel Deaconess Medical Center. We identified patients who received oral vancomycin once daily or BID for the prevention of CDI following implementation of two-step testing. Patients who received oral vancomycin as part of a taper following acute infection were excluded. We categorized rationale for prophylaxis based on clinical documentation and collected details of patients’ CDI history, antibiotic exposure, and subsequent CDI testing during hospitalization. Results In the 12 months following implementation of two-step testing, there were 80 patients who received OVP during hospitalization (2 daily and 78 BID). The vast majority (73, 91.3%) had a history of CDI and received OVP for secondary prevention while receiving systemic antibiotics. There were only 3 patients (3.8%) without known clinical history of CDI whose clinicians documented prophylaxis based on previous PCR+/Toxin- testing. Patients on OVP received a mean of 4.1 systemic antibiotics during hospitalization. When continuing OVP for a finite period after discontinuation of systemic antibiotics, this was most commonly done for 2-7 days (16 of 26, 61.5%). 22 patients underwent stool testing for CDI while receiving OVP in the hospital and all resulted PCR-negative. OVP Indication OVP Duration Conclusion Following implementation of two-step testing for CDI, use of OVP for primary prevention based solely on knowledge of PCR+/Toxin- testing in patients without a history of CDI was rare. Acute CDI appears unlikely in patients actively receiving OVP. Disclosures All Authors: No reported disclosures
15
Chopra, S., S. Luthra, L. Dalal, M. Blattner, J. August, R. Thomas, and E. Heckaman. "0592 Prevalence of Sleep Apnea in Patients with Tracheobronchomalacia." Sleep 43, Supplement_1 (April 2020): A226—A227. http://dx.doi.org/10.1093/sleep/zsaa056.589.
Full textAbstract:
Abstract Introduction Tracheobronchomalacia (TBM) is a pathologic weakness in the trachea and bronchi leading to excessive dynamic narrowing of the airway. A relationship between sleep disordered breathing (SDB) and TBM has been observed before. SBD may be an important contributor to development or progression of TBM. The objective was to determine the Prevalence and characteristics of sleep disordered breathing in patients with tracheobronchomalacia. Methods We performed a retrospective chart review of patients who have been diagnosed with tracheobronchomalacia and who also underwent a polysomnogram (PSG) at the AASM - accredited Sleep Center of Beth Israel Deaconess Medical Center. Results In our 24 patient cohort of TBM, 71% were females, mean age 55 years (SD ± 12.3 years) and mean BMI 31.7 kg/m2 (SD ± 9.4 kg/m2). In patients with TBM we found a sleep apnea prevalence of 62.5% (n= 15), defined as an apnea-hypopnea index>5/hour (hour) with a desaturation greater than 4%. Of the 15 patients, 73.3% (n = 11) had mild sleep apnea, 20% (n = 3) had moderate sleep apnea, 6.6% (n = 1) had severe sleep apnea, defined per the AASM criteria with oxygen desaturation greater than 4%. The TBM cohort had a mean sleep efficiency of 72.7% (SD ± 22.2%) with a mean REM of 16.3% (SD ± 9.8 %). Other characteristics included a median AHI 3% of 19.9/hour (95% CI 3.9 - 25.0), median AHI 4% of 5.5/hour (95% CI 3.9 - 9.3), Respiratory disturbance index of 22/hour (95% CI 15.1 to 28.4). No unique challenges for treatment with positive airway pressure were noted. Conclusion Sleep apnea may be more common in patients with tracheobronchomalacia and could be regularly screened. Support none
16
Newman, Nancy J. "Does this patient have temporal arteritis?Smetana GW,∗∗Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Shmerling RH. JAMA 2002;287:92–101." American Journal of Ophthalmology 133, no. 6 (June 2002): 865. http://dx.doi.org/10.1016/s0002-9394(02)01486-1.
Full text
17
Ye, Huihui, and Thomas M. Ulbright. "Difficult Differential Diagnoses in Testicular Pathology." Archives of Pathology & Laboratory Medicine 136, no. 4 (April 1, 2012): 435–46. http://dx.doi.org/10.5858/arpa.2011-0475-ra.
Full textAbstract:
Context.—Although relatively rare, testicular cancer is the most common solid organ malignancy in young men and remains a leading cause of cancer death in this population. Different types of testicular tumors are treated differently, with an overall very high cure rate with proper management. Pathologists must, therefore, be familiar with important diagnostic pitfalls in testicular pathology, particularly those that result in different treatments or prognoses. Objective.—To summarize key diagnostic features and useful ancillary tools for the most frequently encountered problems in testicular tumor pathology. Data Sources.—Current texts, PubMed (National Library of Medicine) articles, and archives at Indiana University School of Medicine and Beth Israel Deaconess Medical Center were all reviewed. Conclusions.—Problematic differential diagnoses include seminoma versus nonseminomatous germ cell tumors, germ cell tumors versus non–germ cell tumors, intratubular germ cell neoplasia versus atypical germ cells with maturation arrest, pseudolymphovascular invasion versus real lymphovascular invasion in germ cell tumors, and macroscopic Sertoli cell nodules versus Sertoli cell tumors. In almost all cases, awareness of the differential diagnostic possibilities based on routine light microscopic features permits application of either additional, directed observations or immunohistochemical studies that lead to an accurate diagnosis.
18
Dixon, Michael D., and Scott Engum. "Pediatric Trauma System Evaluation before and after Level II Verification." American Surgeon 85, no. 11 (November 2019): 1281–87. http://dx.doi.org/10.1177/000313481908501137.
Full textAbstract:
ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.
19
Bloch, B. Nicolas, Robert E. Lenkinski, and Neil M. Rofsky. "The role of magnetic resonance imaging (MRI) in prostate cancer imaging and staging at 1.5 and 3 Tesla: The Beth Israel Deaconess Medical Center (BIDMC) approach." Cancer Biomarkers 4, no. 4-5 (November 4, 2008): 251–62. http://dx.doi.org/10.3233/cbm-2008-44-507.
Full text
20
Han, Yan-Qiu, Lei Zhang, Zhi-De Hu, Giuseppe Lippi, Peng Li, Pei-Heng Ouyang, and Li Yan. "Performance of D-dimer for predicting sepsis mortality in the intensive care unit." Biochemia medica 31, no. 2 (June 15, 2021): 309–17. http://dx.doi.org/10.11613/bm.2021.020709.
Full textAbstract:
The prognostic value of D-dimer (DD) in sepsis remains controversial. This study aimed to investigate the performance of DD for predicting sepsis mortality in the hospital and for identifying its potential correlates. The clinical and laboratory data of adult sepsis patients were extracted from the Medical Information Mart for Intensive Care III (MIMIC III, v1.4) database using the structured query language (SQL). The database contains critical illness admitted to the intensive care unit at Beth Israel Deaconess Medical Center between June 2001 and October 2012. The association between DD and mortality was investigated with receiver operating characteristic (ROC) curve, restricted cubic spline and logistic regression analysis. Subgroup analysis was also used for identifying DD correlates. The study population consisted of 358 sepsis patients. Those who died during hospital stay (N = 160) had significantly higher DD values than those who survived (N = 198). The area under the ROC curve (AUC) of DD was 0.59 (P < 0.010). In subgroup analysis, white blood cell (WBC) count > 18 x109/L and vasopressor therapy significantly decreased DD diagnostic performance. Categorical DD value was independently associated with hospital mortality after sequential organ failure score (SOFA) and blood lactate adjustment. Restricted cubic spline analysis revealed a U-shape relationship between DD and in-hospital mortality. We conclude that the accuracy of DD for predicting in-hospital sepsis mortality depends on WBC count and vasopressor therapy. Both low and extremely elevated DD values are associated with higher risk of death.
21
Lee, Joon, and David M. Maslove. "Customization of a Severity of Illness Score Using Local Electronic Medical Record Data." Journal of Intensive Care Medicine 32, no. 1 (May 12, 2015): 38–47. http://dx.doi.org/10.1177/0885066615585951.
Full textAbstract:
Purpose: Severity of illness (SOI) scores are traditionally based on archival data collected from a wide range of clinical settings. Mortality prediction using SOI scores tends to underperform when applied to contemporary cases or those that differ from the case-mix of the original derivation cohorts. We investigated the use of local clinical data captured from hospital electronic medical records (EMRs) to improve the predictive performance of traditional severity of illness scoring. Methods: We conducted a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, which contains clinical data from the Beth Israel Deaconess Medical Center in Boston, Massachusetts. A total of 17 490 intensive care unit (ICU) admissions with complete data were included, from 4 different service types: medical ICU, surgical ICU, coronary care unit, and cardiac surgery recovery unit. We developed customized SOI scores trained on data from each service type, using the clinical variables employed in the Simplified Acute Physiology Score (SAPS). In-hospital, 30-day, and 2-year mortality predictions were compared with those obtained from using the original SAPS using the area under the receiver–operating characteristics curve (AUROC) as well as the area under the precision-recall curve (AUPRC). Test performance in different cohorts stratified by severity of organ injury was also evaluated. Results: Most customized scores (30 of 39) significantly outperformed SAPS with respect to both AUROC and AUPRC. Enhancements over SAPS were greatest for patients undergoing cardiovascular surgery and for prediction of 2-year mortality. Conclusions: Custom models based on ICU-specific data provided better mortality prediction than traditional SAPS scoring using the same predictor variables. Our local data approach demonstrates the value of electronic data capture in the ICU, of secondary uses of EMR data, and of local customization of SOI scoring.
22
Galan, Mark, Young Bae Kim, and Jonathan L. Hecht. "Does Physiologic Breakdown Mask Significant Pathology in Endometrial Biopsies? A Retrospective Case-Control Study." Archives of Pathology & Laboratory Medicine 130, no. 12 (December 1, 2006): 1847–49. http://dx.doi.org/10.5858/2006-130-1847-dpbmsp.
Full textAbstract:
Abstract Context.—Adequacy criteria for endometrial biopsy samples do not exist. Objective.—To assess the sensitivity of endometrial sampling for detecting neoplasia in the setting of extensive glandular and stromal breakdown. Design.—Retrospective case-control study. Surgical pathology records between 1996 and 2005 at Beth Israel Deaconess Medical Center (Boston, Mass) were searched for endometrial samples with diagnoses containing the key words “menstrual” or “extensive breakdown.” Hospital records for these women were parsed for demographics, clinical indications, and follow-up with rebiopsy within 6 months. Age cutoffs enriched the population for women at higher risk for carcinoma. A control group, consisting of 2 age-matched control patients for each test patient, was also studied; each control patient had an endometrial sample taken within a 6-month period and was not diagnosed with extensive breakdown, menstrual endometrium, or neoplasia on initial sampling. Results.—Fifty-four cases were identified. The primary biopsy reports had benign descriptive diagnoses (ie, proliferative, secretory, polyp). Follow-up biopsies showed benign pathology in all cases and specific causes of bleeding—including polyp, leiomyoma, or endometritis—in 28 (52%) of 54. In the control group, neoplasia was found in 2 of the 108 follow-up biopsies. Only 5 other controls had specific diagnoses; all were polyps. Conclusions.—Extensive breakdown or menstrual-pattern endometrium may mask other specific benign pathologies but does not commonly mask cancer.
23
Wang, Ludi, and Xiaoguang Zhou. "Detection of Congestive Heart Failure Based on LSTM-Based Deep Network via Short-Term RR Intervals." Sensors 19, no. 7 (March 28, 2019): 1502. http://dx.doi.org/10.3390/s19071502.
Full textAbstract:
Congestive heart failure (CHF) refers to the inadequate blood filling function of the ventricular pump and it may cause an insufficient heart discharge volume that fails to meet the needs of body metabolism. Heart rate variability (HRV) based on the RR interval is a proven effective predictor of CHF. Short-term HRV has been used widely in many healthcare applications to monitor patients’ health, especially in combination with mobile phones and smart watches. Inspired by the inception module from GoogLeNet, we combined long short-term memory (LSTM) and an Inception module for CHF detection. Five open-source databases were used for training and testing, and three RR segment length types (N = 500, 1000 and 2000) were used for the comparison with other studies. With blindfold validation, the proposed method achieved 99.22%, 98.85% and 98.92% accuracy using the Beth Israel Deaconess Medical Center (BIDMC) CHF, normal sinus rhythm (NSR) and the Fantasia database (FD) databases and 82.51%, 86.68% and 87.55% accuracy using the NSR-RR and CHF-RR databases, with N = 500, 1000 and 2000 length RR interval segments, respectively. Our end-to-end system can help clinicians to detect CHF using short-term assessment of the heartbeat. It can be installed in healthcare applications to monitor the status of human heart.
24
Morrow, Phuong K., Gerburg M. Wulf, Joe Ensor, Daniel J. Booser, Julia A. Moore, Peter R. Flores, Yan Xiong, et al. "Phase I/II Study of Trastuzumab in Combination With Everolimus (RAD001) in Patients With HER2-Overexpressing Metastatic Breast Cancer Who Progressed on Trastuzumab-Based Therapy." Journal of Clinical Oncology 29, no. 23 (August 10, 2011): 3126–32. http://dx.doi.org/10.1200/jco.2010.32.2321.
Full textAbstract:
Purpose Trastuzumab resistance has been linked to activation of the phosphoinositol 3-kinase (PI3K) pathway. Phosphatase and tensin homolog (PTEN) is a dual phosphatase that counteracts the PI3K function; PTEN loss leads to activation of the Akt cascade and the downstream mammalian target of rapamycin (mTOR). Preclinical studies demonstrated that mTOR inhibition sensitized the response to trastuzumab in mice with HER2 overexpressing and PTEN-deficient breast xenografts. Our trial evaluated the safety and efficacy of the combination of everolimus and trastuzumab in women with HER2-overexpressing metastatic breast cancer (MBC) that progressed on trastuzumab-based therapy. Patients and Methods This represents a pooled analysis (n = 47), stemming from two trials that occurred concurrently in The University of Texas MD Anderson Cancer Center, Beth Israel Deaconess Medical Center, and Dana-Farber Cancer Institute. Patients with HER2-overexpressing MBC who had progressed on trastuzumab-based therapy received trastuzumab every 3 weeks in combination with daily everolimus. Results Among 47 patients, the combination of everolimus and trastuzumab provided partial responses in seven patients (15%) and persistent stable disease (lasting 6 months or longer) in nine patients (19%), resulting in a clinical benefit rate of 34%. The median progression-free survival (PFS) was 4.1 month. Fatigue, infection, and mucositis were the predominant nonhematologic toxicities. Trastuzumab did not have significant influence on the pharmacokinetic profile of everolimus. Patients with PTEN loss demonstrated decreased overall survival (P = .048). However, PFS was not affected by PTEN loss. Conclusion Inhibition of mTOR results in clinical benefit and disease response in patients with trastuzumab-resistant HER2-overexpressing MBC.
25
Jacobs, Marjorie Lee. "Musical Odyssey: From Pain to Recovery." Music and Medicine 11, no. 3 (July 26, 2019): 206. http://dx.doi.org/10.47513/mmd.v11i3.673.
Full textAbstract:
Psychiatric rehabilitation aims to promote health recovery from significant losses, both physical and psychological, that have derailed the lives of adults and young adults diagnosed with a serious mental illness (SMI) so that they can actively participate in rebuilding and recreating themselves. The population faces premature morbidity and experiences higher than average rates of chronic and life-threatening disorders. When participants join the BU Center for Psychiatric Rehabilitation services’ programs, they take on the role of student, increasing their knowledge, skills, and supports to further their personal goals and recovery journeys. The submission, Musical Odyssey: From Pain to Recovery, is an original poem informed by the values and practices of my work in the field of psychiatric rehabilitation as well as my recent medical experience as a patient. The poem was inspired primarily by my four-month experience of having to navigate through the primary care system and advocate for myself to get services for two herniated discs while working. During this period I was teaching three courses: Empowering Ourselves through Song, Buddhist Psychology’s Path of Recovery, and Mindfulness: The Practice of Buddhist Psychology.In the 2018 fall semester, I was role modeling recovery-oriented rehabilitation for my students, a Certified Peer Support Specialist, and three interns (two from BU School of Social Work and one from Tufts University). Despite excruciating pain from two herniated discs, I taught almost all the classes before and after a micro-discectomy and hemi-laminectomy surgery at the Beth Israel Deaconess Medical Center and prepared detailed lesson plans for my interns who had the opportunity to develop their clinical and teachings skills while receiving my support. My suffering and sharing of daily meditation, music listening, and singing helped grow everyone’s awareness, compassion, and commitment to mindfulness practice.
26
Rahimian, Maryam, Jeremy L. Warner, Sandeep K. Jain, Roger B. Davis, Jessica A. Zerillo, and Robin M. Joyce. "Significant and Distinctive n-Grams in Oncology Notes: A Text-Mining Method to Analyze the Effect of OpenNotes on Clinical Documentation." JCO Clinical Cancer Informatics, no. 3 (December 2019): 1–9. http://dx.doi.org/10.1200/cci.19.00012.
Full textAbstract:
PURPOSE OpenNotes is a national movement established in 2010 that gives patients access to their visit notes through online patient portals, and its goal is to improve transparency and communication. To determine whether granting patients access to their medical notes will have a measurable effect on provider behavior, we developed novel methods to quantify changes in the length and frequency of use of n-grams (sets of words used in exact sequence) in the notes. METHODS We analyzed 102,135 notes of 36 hematology/oncology clinicians before and after the OpenNotes debut at Beth Israel Deaconess Medical Center. We applied methods to quantify changes in the length and frequency of use of sequential co-occurrence of words ( n-grams) in the unstructured content of the notes by unsupervised hierarchical clustering and proportional analysis of n-grams. RESULTS The number of significant n-grams averaged over all providers did not change, but for individual providers, there were significant changes. That is, all significant observed changes were provider specific. We identified eight providers who were late note signers. This group significantly reduced its late signing behavior after OpenNotes implementation. CONCLUSION Although the number of significant n-grams averaged over all providers did not change, our text-mining method detected major content changes in specific providers’ documentation at the n-gram level. The method successfully identified a group of providers who decreased their late note signing behavior.
27
Thomas, R. J. "0704 Treatment-emergent Central Sleep Apnea Predicts Residual Respiratory Instability During Cpap Use At 6 Months." Sleep 43, Supplement_1 (April 2020): A268. http://dx.doi.org/10.1093/sleep/zsaa056.700.
Full textAbstract:
Abstract Introduction The prevalence, severity, significance, and predictors of residual sleep apnea during use of continuous positive airway pressure (CPAP) remain uncertain. High loop gain is associated with or induces periodic breathing and central sleep apnea (CSA). Treatment-emergent CSA (TE-CSA) is often considered a transient phenomenon of no long-term clinical significance. Standard polysomnographic features were assessed as risk factors for high residual apnea during compliant CPAP use. Methods Patients with sleep apnea (mean AHI 53.6, SD:33/hour of sleep) who underwent split night studies were prospectively entered in a database. They were all treated with positive airway pressure at the Beth Israel Deaconess Medical Center (Boston) and tracked by the EncoreAnywhere system. Machine detected AHI (AHIm) was extracted for a week average at month 6. The manual scored AHI(AHIs) was calculated from the last waveform graph during every month. Logistic regression assessed predictors of elevated automated (5 or greater) or manual (10 or greater) residual events//hour of use. Results A total of 69 CPAP compliant (average of at least 4 hours) subjects were analyzed. Age: 59.5 (range 17-81), gender: 47/69 male. 44/69 had an elevated manual AHI, while 20/69 had an elevated autodetected AHI. The only predictors of high residual apnea were TE-CSA (5 or more central apneas and hypopneas/hour of sleep): Odds Ratio 3.6 (CI: 1.07-12-3), p: 0.39. and the treatment component arousal index: Odds Ratio 1.06 (CI: 1.01-1.11), p: 0.018. Machine estimated AHI, which under-detected events by a factor of 3 or more, was not associated with any measure. Conclusion Residual apnea is common after 6 months of compliant CPAP use, and the only predictors identified were TE-CSA and treatment component arousal index. Support This study is supported by American Academy of Sleep Medicine Foundation, Category-I award to RJT
28
Dalal, L., N. Yuenan, M. Pogach, and R. J. Thomas. "0786 Non-24 Hour Sleep Wake Syndrome: A Cohort Analysis." Sleep 43, Supplement_1 (April 2020): A299—A300. http://dx.doi.org/10.1093/sleep/zsaa056.782.
Full textAbstract:
Abstract Introduction Although commonly described in the blind population, diagnosis in sighted individuals can be difficult due to perceived rarity and underlying co-morbid conditions. Our objective was to identify the characteristics of N24 rhythm individuals, and responses to varied treatments. Methods Patients were identified to have non-24-hour sleep wake syndrome (N24) via history, sleep diaries or digital logs, paired melatonin profiling as well as actigraphy through retrospective chart review at the Beth Israel Deaconess Medical Center, Sleep Disorders Clinic. Results 37 patients were identified from 2007 to 2019 with N24 syndrome, BMI of 28, and 67% male. The mean age of onset was within the teenage years (16), and age at diagnosis of 35 years. Paired melatonin profiles (24-hour salivary melatonin, 3-hourly, separated by 7 days, in the subject’s own home) showed “movement”. Depression and anxiety were seen in 54% and 29% of the cohort respectively. 75% (28) of the patients had a treatment strategy involving light, and 54% (20) included melatonin. The combination of melatonin and light led to a clinical improvement in 41% of individuals under that regimen (17). Low dose lithium (8 subjects) enhanced melatonin/light responses. A strategy of combining the orexin antagonist suvorexant with melatonin or ramelteon (3 subjects) helped stabilize the circadian rhythm. Tasimelteon treatment has been initiated in 4 subjects. Conclusion These data suggest that while comorbid psychiatric conditions are prevalent, a significant proportion of the cohort did not have associated psychiatric disease. Patients reported onset of symptoms in the teenage years, however there was significant delay to diagnosis. Besides light/melatonin, orexin antagonism and low dose lithium may have benefits, but require more systematic assessments. Paired melatonin estimations could be considered as a definitive testing strategy. Support
29
Hammond, Michael M., Changyu Shen, Stephanie Li, Dhruv S. Kazi, Marwa A. Sabe, A. Reshad Garan, Lawrence J. Markson, et al. "Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience." PLOS ONE 15, no. 12 (December 22, 2020): e0244379. http://dx.doi.org/10.1371/journal.pone.0244379.
Full textAbstract:
Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
30
Platzbecker, Katharina, Fanny P. Timm, Sait Ashina, Timothy T. Houle, and Matthias Eikermann. "Migraine treatment and the risk of postoperative, pain-related hospital readmissions in migraine patients." Cephalalgia 40, no. 14 (August 24, 2020): 1622–32. http://dx.doi.org/10.1177/0333102420949857.
Full textAbstract:
Background Migraine treatment may mitigate migraine and associated pain in the perioperative period. Objective The aim of the study was to estimate the effect of perioperative acute and prophylactic migraine treatment on the risk of postoperative 30-day hospital readmission with an admitting diagnosis specifying any pain complaints among migraine patients. Design Electronic health records were analysed for 21,932 adult migraine patients undergoing surgery between 2005 and 2017 at Beth Israel Deaconess Medical Center and Massachusetts General Hospital in Boston, Massachusetts, USA. Methods Perioperative abortive migraine treatment was defined as guideline-recommended medication (triptan, ergotamine, acetaminophen, nonsteroidal anti-inflammatory drug) prescription after surgery, within 30 days after discharge and prior readmission. Perioperatively continued prophylactic migraine treatment was defined as prescription both prior to surgery and perioperatively for recommended medications (beta-blockers, antidepressants, antiepileptics, onabotulinumtoxin A). Results Overall, 10,921 (49.8%) patients received a prescription for abortive migraine drugs. Of these, 1.2% and 1.5% of patients with and without such prescription were readmitted for pain, respectively. Patients with abortive treatment had lower odds of pain-related readmission (adjusted odds ratio 0.63 [95% confidence interval 0.49–0.81]). Prophylactic migraine treatment showed no effect on pain-related readmission independently of acute treatment (adjusted odds ratio 0.97 [95% confidence interval 0.72–1.32]). Conclusions Migraine patients undergoing surgery with a perioperative prescription for abortive migraine drugs were at decreased risk of pain-related hospital readmission.
31
Azimaraghi, Omid, Maximilian Hammer, Peter Santer, Katharina Platzbecker, Friederike C. Althoff, Maria Patrocinio, Stephanie D. Grabitz, et al. "Study protocol for a randomised controlled trial evaluating the effects of the orexin receptor antagonist suvorexant on sleep architecture and delirium in the intensive care unit." BMJ Open 10, no. 7 (July 2020): e038474. http://dx.doi.org/10.1136/bmjopen-2020-038474.
Full textAbstract:
IntroductionInsomnia frequently occurs in patients admitted to an intensive care unit (ICU). Sleep-promoting agents may reduce rapid eye movement sleep and have deliriogenic effects. Suvorexant (Belsomra) is an orexin receptor antagonist with Food and Drug Administration (FDA) approval for the treatment of adult insomnia, which improves sleep onset and maintenance as well as subjective measures of quality of sleep. This trial will evaluate the efficacy of postoperative oral suvorexant treatment on night-time wakefulness after persistent sleep onset as well as the incidence and duration of delirium among adult cardiac surgical patients.Methods and analysisIn this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 120 patients, aged 60 years or older, undergoing elective cardiac surgery with planned postoperative admission to the ICU. Participants will be randomised to receive oral suvorexant (20 mg) or placebo one time a day starting the night after extubation. The primary outcome will be wakefulness after persistent sleep onset. The secondary outcome will be total sleep time. Exploratory outcomes will include time to sleep onset, incidence of postoperative in-hospital delirium, number of delirium-free days and subjective sleep quality.Ethics and disseminationEthics approval was obtained through the ‘Committee on Clinical Investigations’ at Beth Israel Deaconess Medical Center (protocol number 2019P000759). The findings will be published in peer-reviewed journals.Trial registration numberThis trial has been registered at clinicaltrials.gov on 17 September 2019 (NCT04092894).
32
Rosen, Matthew, Andrew Chalupka, Kathryn Butler, Alok Gupta, and Stephen R. Odom. "Pathologic Findings Suggest Long-term Abnormality after Conservative Management of Complex Acute Appendicitis." American Surgeon 81, no. 3 (March 2015): 297–99. http://dx.doi.org/10.1177/000313481508100333.
Full textAbstract:
Perforated or phlegmonous appendicitis is often treated with antibiotics and drainage as needed. The rationale, risk of recurrence, timing, or even the necessity of subsequent elective interval appendectomy (IA) is debated. We retrospectively reviewed all appendectomies performed at Beth Israel Deaconess Medical Center between 1997 and 2011. We determined if the appendix was removed emergently or as IA. Demographic characteristics, hospital length of stay, computed tomography (CT) results, and operation type (open or laparoscopic) were determined. In IA specimens, narrative pathology reports were assessed for evidence of anatomic, acute, or chronic abnormality. A total of 3562 patients had their appendix removed during this time period. Thirty-four patients were identified as having IA. Of these, only three (8.8%) had a pathologically normal appendix. All three patients were female and all had initially abnormal CTscans. Eight specimens (23.5%) had evidence of chronic and 10 (29.4%) had evidence of acute appendicitis. An additional 10 (29.4%) specimens contained a combination of acute and chronic inflammation. Mean time to operation in the IA group was 57.1 days (range, nine to 234 days) after index diagnosis by CTscan. Given the high percentage of IA specimens with acute or chronic appendicitis and the extremely high proportion (91%) of patients with pathologically abnormal specimens, it appears that IA may be justified in most cases.
33
Myers, Timothy, and Helen H. Wang. "Fibroadenoma Mimicking Papillary Carcinoma on ThinPrep of Fine-Needle Aspiration of the Breast." Archives of Pathology & Laboratory Medicine 124, no. 11 (November 1, 2000): 1667–69. http://dx.doi.org/10.5858/2000-124-1667-fmpcot.
Full textAbstract:
Abstract Objective.—To compare and contrast benign and malignant lesions of the breast that have similar appearances on fine-needle aspiration cytology and that constitute diagnostic pitfalls. Design.—The cytology files (dated November 1995 through May 1998) of the Beth Israel Deaconess Medical Center were searched to identify cases of breast fine-needle aspiration biopsies that were highly cellular and composed of bland-appearing spindle/columnar cells and that could represent either epithelial or stromal cells; these cases were reported as indeterminate (atypical/suspicious) and had subsequent excisional biopsies taken. Results.—Four such cases were found. Two were fibroadenomas and 2 were papillary carcinomas. Their appearances were strikingly similar on aspiration cytology. All cases were prepared with the ThinPrep method. On microscopic examination, all 4 cases were hypercellular and had many single cells and clusters of columnar/elongate cells. Immunocytochemistry proved these cells to be of epithelial origin. At least occasional bipolar stromal cells were seen in the background. The only appreciable difference between the benign and malignant cases was more significant nuclear atypia, which was barely discernible, in the malignant cases. Immunocytochemistry for smooth muscle actin was helpful in 2 cases that had sufficient material. Conclusions.—Some cases of fibroadenomas and papillary carcinomas can be very difficult, if not impossible, to distinguish on fine-needle aspiration cytology. Immunocytochemistry may be helpful if sufficient material is available. To avoid false-negative or false-positive diagnosis on cytology, it is best to report such cases as atypical or suspicious with final diagnosis pending excisional biopsy.
34
Ni, Y., K. Dunhsm, L. Cunningham, and R. Thomas. "0661 Comparison Between Ventilator Detected Apnea Hypopnea Index and Manual Scored Results." Sleep 43, Supplement_1 (April 2020): A252. http://dx.doi.org/10.1093/sleep/zsaa056.657.
Full textAbstract:
Abstract Introduction The apnea hypopnea index and percentage of periodic breathing detected by the ventilator machine are often used by sleep doctors to evaluate whether sleep apnea has been adequately treated or need further interventions. There are concerns about the accuracy of this autodetection. Methods Patients with sleep apnea who were treated with positive airway pressure at the Beth Israel Deaconess Medical Center (Boston) and tracked by the EncoreAnywhere system were included. The machine detected AHI(AHIm) and PB(PBm) were extracted from the first week data in every month from the start of use. The manual scored AHI(AHIs) and PB(PBs) were calculated from the last waveform graph during every month. The apnea hypopnea index as well as periodic breathing in 1st, 2nd, 3rd,6th month AHIm, AHIs, PBm and PBs were compared respectively. Results A total of 128 patients were included. The mean age was 56.5 and 66% of them were male. In the first month, the mean AHIs was significantly higher than AHIm, 16.27 vs. 5.36, p<0.001. There was also a large difference between percentage of PBs and PBm, 15.55% vs. 1.96, p<0.001. 78% patients whose AHIm <5 were actually has AHIs >5. The Kappa value for the AHIm and AHIs were 0.074, p=0.069; the value of PBm and PBs was 0.216, p=0.015. In the 2nd, 3rd and 6th months, the mean difference between AHIs and AHIm was 10.58, 10.68, 10.12, respectively. The mean difference between PBs and PBm was 12.32%,11.53%,and 9.18%. Conclusion Autodetection of respiratory events consistently under-estimates the severity of residual events. Mean differences remained stable over 6 months. Caution is recommended when attributing non-apnea reasons for residual symptoms in patients with apparently low machine estimated AHI and PB. Support This study is supported by American Academy of Sleep Medicine Foundation, category-I award to RJT
35
Roustit, Matthieu, Jordan Loader, Carly Deusenbery, Dimitrios Baltzis, and Aristidis Veves. "Endothelial Dysfunction as a Link Between Cardiovascular Risk Factors and Peripheral Neuropathy in Diabetes." Journal of Clinical Endocrinology & Metabolism 101, no. 9 (July 11, 2016): 3401–8. http://dx.doi.org/10.1210/jc.2016-2030.
Full textAbstract:
Abstract Context: Cardiovascular risk factors are well-known predictors of the development of diabetic peripheral neuropathy (DPN), which has traditionally been considered as a manifestation of diabetes-associated microangiopathy. Because endothelial dysfunction is strongly associated with all cardiovascular risk factors, we hypothesized that it may be a link between cardiovascular risk factors and DPN. Objective: The primary objective of this study was to test whether endothelial dysfunction is a predictor of DPN. Design and Setting: This is a cross-sectional analysis of a cohort composed of patients followed at the Microcirculatory Laboratory, Beth Israel Deaconess Medical Center. Patients: Participants with diabetes without DPN (n = 192) and with DPN (n = 166), subjects with prediabetes (n = 75), and nondiabetic controls (n = 59) were included. Interventions: Endothelial function was assessed with flow-mediated dilation (FMD) of the brachial artery. Inflammatory cytokines and biomarkers of endothelial function (soluble intercellular and vascular cell adhesion molecules) were quantified using a multiplex bead-based immunoassay. Neurological assessment included the neuropathy disability score (NDS). Main Outcome Measure: The relationship between FMD and NDS assessed using multiple linear regression. Results: In addition to already known risk factors of DPN, FMD was strongly associated with NDS (β = −0.24; P < .001). Sensitivity analysis that removed FMD from the model provided similar results for soluble intercellular cell adhesion molecule-1, another biomarker of endothelial function. Confirmatory factor analysis further showed that endothelial dysfunction is a significant mediator between glycosylated hemoglobin and diabetes duration and diabetic complications. Conclusions: This study shows that endothelial dysfunction occurs early in the pathophysiology of diabetes and is a link between cardiovascular risk factors and DPN.
36
Allen-Dicker, Joshua, Shoshana J. Herzig, Kenneth J. Mukamal, and Anjala Tess. "ACGME Duty Hour Revisions and Self-Reported Intern ICU Sleep Schedules." Journal of Graduate Medical Education 6, no. 3 (September 1, 2014): 561–66. http://dx.doi.org/10.4300/jgme-d-13-00263.1.
Full textAbstract:
Abstract Background The Accreditation Council for Graduate Medical Education duty hour standards restrict continuous duty for postgraduate year (PGY)–1 residents to 16 hours. Objective We aimed to assess the relationship between a duty hour–compliant schedule and resident sleep. Methods To comply with 2011 duty hour limits, Beth Israel Deaconess Medical Center restructured its intensive care unit call model for internal medicine PGY-1 residents from a traditional shift model to an overlapping shorter-duration shift model with preserved educational periods. Before and after schedule changes, we used daily surveys of PGY-1 residents to collect self-reported data on quantity and quality of sleep and quality of education. Results A total of 1162 surveys were sent to 43 interns before scheduling changes, and 1305 were sent to 41 interns after the changes. Response rate was 31.2% (362 of 1161) before and 22.2% (290 of 1305) after. Before changes, 57.7% (209 of 362) reported receiving 6 hours or more of sleep in a 24-hour period compared to 72.4% (210 of 290) after the changes (adjusted relative risk, 1.33; 95% CI, 1.15–1.53), with an adjusted difference of 0.83 hours of sleep per 24 hours (95% CI, 0.28–1.38). After the intervention, on a 5-point Likert scale, residents reported higher quality of sleep (odds ratio [OR], 1.62; 95% CI, 1.01–2.60) and greater satisfaction with their education (OR, 2.59; 95% CI, 1.40–4.81). Conclusions Following conversion to a duty hour–compliant model with preserved didactic time, PGY-1 residents reported minor increases in quantity and quality of sleep per 24-hour period, and increased satisfaction with the educational experience.
37
Jacobs, Timothy W., Allen M. Gown, Hadi Yaziji, Melissa J. Barnes, and Stuart J. Schnitt. "Comparison of Fluorescence In Situ Hybridization and Immunohistochemistry for the Evaluation of HER-2/neu in Breast Cancer." Journal of Clinical Oncology 17, no. 7 (July 1999): 1974. http://dx.doi.org/10.1200/jco.1999.17.7.1974.
Full textAbstract:
PURPOSE: To compare fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) in the determination of HER-2/neu status of breast cancers. MATERIALS AND METHODS: FISH and IHC for HER-2/neu were performed on formalin-fixed paraffin sections of 100 consecutive invasive breast cancers. FISH was performed at Beth Israel Deaconess Medical Center, Boston, MA, using the Oncor/Ventana INFORM kit (Ventana Medical Systems, Tucson, AZ; formerly sold by Oncor, Inc, Gaithersburg, MD) in a laboratory certified as proficient in this procedure. IHC was performed at PhenoPath Laboratories, Seattle, WA, using a polyclonal antibody to the HER-2/neu protein. FISH and IHC were analyzed in a blinded fashion, and the results were then compared. Procedure and interpretation times and reagent costs for FISH and IHC were also compared. RESULTS: HER-2/neu was amplified by FISH in 26% of cases, and 23% were HER-2/neu–positive by IHC. FISHand IHC were both assessable in 90 cases. Concordance between FISH and IHC results was seen in 82 of these cases (91%, P < .001). The FISH procedure required more technologist time and more interpretation time per case for the pathologist than IHC. Reagent costs were substantially higher for FISH than for IHC. CONCLUSION: There is a high level of correlation between FISH and IHC in the evaluation of HER-2/neu status of breast cancers using formalin-fixed paraffin-embedded specimens. Although the choice of which assay to use should be left for individual laboratories to make based on technical and economic considerations, our results may make it difficult to justify the routine use of FISH for determination of HER-2/neu status in breast cancer.
38
Fish, Madeleine, Jeannette Parkes, Nazima Dharsee, Scott Dryden-Peterson, Jason Efstathiou, Lowell Schnipper, Bruce Chabner, and Aparna R. Parikh. "The Program for Enhanced Training in Cancer: An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa." JCO Global Oncology 6, Supplement_1 (July 2020): 13. http://dx.doi.org/10.1200/go.20.70000.
Full textAbstract:
PURPOSE Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals as a result of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS In its initial 2 years (2018 and 2019), the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of 14 fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants before arrival and upon departure, and 8 participated in semistructured interviews. RESULTS Five themes emerged from the qualitative data: expectations of POETIC, differences in oncology between the United States and sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care, research development, and collaboration among medical, radiation, and surgical oncologists. The time in Boston modeled a research infrastructure that participants expressed interest in emulating at their home hospitals. In addition, the fellowship inspired some participants to address prevention and survivorship efforts in their home countries. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION POETIC was found to be feasible and valuable. The results from the first years justify the program’s continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future work will involve long-term follow up with participants and the development of an alumni network.
39
Rojan, Adam A., Nadia Q. Rehman, Renee E. Funches, Federico Campigotto, Jonathan Webster, Gregory C. Connolly, Anita Aggarwal, et al. "Pharmacologic Thromboprophylaxis Is Frequently Prescribed In Hospitalized Cancer Patients At Academic Medical Centers: A Prospective, Cross-Sectional, Multi-Center Study." Blood 122, no. 21 (November 15, 2013): 2374. http://dx.doi.org/10.1182/blood.v122.21.2374.2374.
Full textAbstract:
Abstract Background Venous thromboembolism (VTE) is a frequent complication in hospitalized cancer patients and is associated with increased morbidity and mortality. Guidelines from major organizations recommend that all hospitalized patients with active malignancy receive pharmacologic thromboprophylaxis in the absence of bleeding or another contraindication. Nevertheless, reported rates of thromboprophylaxis use in hospitalized cancer patients have been low in several retrospective studies. We conducted a prospective cross-sectional study of hospitalized cancer patients at five academic hospitals to determine rates of thromboprophylaxis use and factors influencing the decision to administer thromboprophylaxis during hospitalization. Methods Administration of thromboprophylaxis to hospitalized cancer patients was assessed prospectively over consecutive days at five medical centers: University of Rochester, Johns Hopkins University, Beth Israel Deaconess Medical Center, University of California at Davis, and the DC Veterans Administration Medical Center/George Washington University. Data collected included reason for admission, cancer type and stage, and treatment as well as established risk factors for VTE including elements of the Padua Scoring System (PSS). The American College of Chest Physicians recommends the utilization of the PSS to guide thromboprophylaxis of hospitalized patients and a score of ≥4 is considered high risk for VTE. Univariate analysis for association of risk factors with the use of pharmacologic thromboprophylaxis was performed with two-sided Fisher exact tests and univariate logistic regression. Multivariable stepwise logistic regression model was performed to assess the influence of risk factors on the probability of receiving pharmacologic thromboprophylaxis. Results Seven-hundred and seventy-five patients were included in the study with a mean age of 56.3 years. Four hundred and thirty-five patients were male (56%) and 423 had hematologic malignancies (55%). The primary reason for admission was for cancer therapy in 254 cases (33%). Five hundred and eighty patients were considered high risk for VTE (≥4) using the PSS. Pharmacologic thromboprophylaxis was prescribed in 392 patients (51%, range 29%-71%). Accounting for contraindications to anticoagulation, 74% (N=528) of all cancer patients received appropriate hospital thromboprophylaxis. Among the cancer patients without contraindications for anticoagulation, individuals hospitalized with solid tumors were significantly more likely to receive thromboprophylaxis than those with hematologic malignancies (OR 2.34, 95% CI 1.43-3.82, P=0.0007). Cancer patients admitted for cancer-directed therapy (i.e. chemotherapy or radiation) were significantly less likely to receive thromboprophylaxis than those admitted for other medical conditions (OR 0.37 95% CI 0.22-0.61, P<0.0001). Sixty-three percent of low risk cancer patients as determined by PSS received anticoagulant thromboprophylaxis. Contraindications for anticoagulation were evident for the majority of the 383 patients (N=247, 64%) who did not receive pharmacologic thromboprophylaxis such as 161 with severe thrombocytopenia (42%), 43 with active hemorrhage (11%), 15 with a history of hemorrhage (4%), 2 with heparin induced thrombocytopenia (0.5%), and 11 on comfort-measure-only care (3%). Among the 136 patients who did not receive anticoagulation, 58.8% were considered high risk by the PSS. Conclusions This prospective, cross-sectional, multi-center study demonstrated that appropriate pharmacologic thromboprophylaxis is administered to the majority of hospitalized cancer patients. Despite absence of established benefit, the majority of lower risk cancer patients receive thromboprophylaxis during hospitalization. Disclosures: Wun: Daiichi-Sankyo: Research Funding. Rickles:Leo: Research Funding. Streiff:Bristol Myers Squibb: Research Funding; Sanofi: Consultancy, Honoraria; Eisai, Daiichi-Sankyo, Boehringer-Ingelheim, Janssen HealthCare: Consultancy. Khorana:Leo, Sanofi: Research Funding. Zwicker:Sanofi: Research Funding.
40
McDonnell, Brian, Shannon Stillwell, Shelby Hart, and Roger B. Davis. "Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study." Physical Therapy 98, no. 6 (February 19, 2018): 528–38. http://dx.doi.org/10.1093/ptj/pzy032.
Full textAbstract:
AbstractBackgroundStandardized tests and outcome measures (STOM) have not been consistently implemented as part of most physical therapists’ practice. Incidence of STOM use among physical therapists at Beth Israel Deaconess Medical Center was similar to low levels cited nationally among acute care physical therapists. Targeted knowledge translation (KT) strategies have been suggested to promote the application of research evidence into clinical decision making.PurposeThe purpose of this quality improvement (QI) effort was to implement a series of interventions aimed at increasing both use and interpretation of STOM by physical therapists practicing in acute care.DesignThis study used an observational longitudinal design.MethodsA literature review identified current barriers and facilitators to the use of STOM by physical therapists. KT strategies were tailored to the practice setting in order to target barriers and promote facilitators to the use of STOM. Data were collected through retrospective chart review at baseline and then subsequently at 4 periods following the implementation of the QI project.ResultsA statistically significant increase in both the use (primary outcome) and interpretation (secondary outcome) of STOM was observed following the implementation of KT strategies. The increase was sustained at all subsequent measurement periods.LimitationsLimitations include the lack of a control group and the small number of setting- and diagnosis-specific STOM available for use by physical therapists practicing in acute care.ConclusionsImplementation of KT strategies was associated with an increase in the frequency of use and interpretation of STOM. Similar QI efforts are feasible in any acute care physical therapy department and potentially other settings.
41
Olanrewaju, Rashidah Funke, S. Noorjannah Ibrahim, Ani Liza Asnawi, and Hunain Altaf. "Classification of ECG signals for detection of arrhythmia and congestive heart failure based on continuous wavelet transform and deep neural networks." Indonesian Journal of Electrical Engineering and Computer Science 22, no. 3 (June 1, 2021): 1520. http://dx.doi.org/10.11591/ijeecs.v22.i3.pp1520-1528.
Full textAbstract:
According to World Health Organization (WHO) report an estimated 17.9 million lives are being lost each year due to cardiovascular diseases (CVDs) and is the top contributor to the death causes. 80% of the cardiovascular cases include heart attacks and strokes. This work is an effort to accurately predict the common heart diseases such as arrhythmia (ARR) and congestive heart failure (CHF) along with the normal sinus rhythm (NSR) based on the integrated model developed using continuous wavelet transform (CWT) and deep neural networks. The proposed method used in this research analyses the time-frequency features of an electrocardiogram (ECG) signal by first converting the 1D ECG signals to the 2D Scalogram images and subsequently the 2D images are being used as an input to the 2D deep neural network model-AlexNet. The reason behind converting the ECG signals to 2D images is that it is easier to extract deep features from images rather than from the raw data for training purposes in AlexNet. The dataset used for this research was obtained from Massachusetts Institute of Technology-Boston's Beth Israel Hospital (MIT-BIH) arrhythmia database, MIT-BIH normal sinus rhythm database and Beth Israel Deaconess Medical Center (BIDMC) congestive heart failure database. In this work, we have identified the best fit parameters for the AlexNet model that could successfully predict the common heart diseases with an accuracy of 98.7%. This work is also being compared with the recent research done in the field of ECG Classification for detection of heart conditions and proves to be an effective technique for the classification.
42
Huang, Kexin, Tamryn F. Gray, Santiago Romero-Brufau, James A. Tulsky, and Charlotta Lindvall. "Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study." Journal of the American Medical Informatics Association 28, no. 8 (April 21, 2021): 1660–66. http://dx.doi.org/10.1093/jamia/ocab051.
Full textAbstract:
Abstract Objective Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods. Materials and Methods This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes. Results For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839). Discussion Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction. Conclusions Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians’ and nurses’ notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.
43
Nahas, Myrna Rita, Jessica A. Zerillo, Stephen A. Cannistra, and Cheryle Totte. "Raising the safety bar: The hematology/oncology patient safety committee." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 144. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.144.
Full textAbstract:
144 Background: Enhancing patient safety can prevent unintended outcomes arising from defects in healthcare delivery systems. The Hematology/Oncology Patient Safety Committee (HOPSC) at Beth Israel Deaconess Medical Center (BIDMC) is a multidisciplinary team of healthcare providers that meets monthly to review inpatient and outpatient adverse events, near misses, and medical errors that impact patient safety. Methods: Our aim was to quantify and qualify the cases that the HOPSC has reviewed from 2012-2013. In order to identify trends in event reporting, we reviewed the number of events reported to the HOPSC in both the inpatient and outpatient settings. We further subdivided events into two categories: medication-related and non-medication related. Additionally, we delineated which healthcare provider initiated the reporting of each event. Results: Over the two-year period, a total number of 1,061 events were reported to the HOPSC. Of these, 259 were medication-related events. Of the events reported, 40 were by a physician/NP and 1,021 were by a nurse. There was a discrepancy in the type of event reported (24.4% medication vs. 75.6% non-medication related) as well as in the type of reporter (3.8% physician/NP vs. 96.2% nurse). Of all the events reported, 8 were escalated to the Department of Medicine Peer Review Committee. Conclusions: Through review of healthcare provider event reports, the HOPSC has identified several types of adverse events and near misses in the Hematology/Oncology division at BIDMC. The events are mostly reported by inpatient nurses and are primarily medication-related. Given this skewed reporting pattern, we will investigate the reasons why reporting by physicians, especially in the outpatient setting, is limited. Our reported outline of the HOPSC operations may also guide oncology practices elsewhere in their own development of patient safety peer review committees. [Table: see text]
44
Mafi, John N., Roanne Mejilla, Henry Feldman, Long Ngo, Tom Delbanco, Jonathan Darer, Christina Wee, and Jan Walker. "Patients learning to read their doctors’ notes: the importance of reminders." Journal of the American Medical Informatics Association 23, no. 5 (February 11, 2016): 951–55. http://dx.doi.org/10.1093/jamia/ocv167.
Full textAbstract:
Abstract Objective To examine whether patients invited to review their clinicians’ notes continue to access them and to assess the impact of reminders on whether patients continued to view notes. Materials and methods We followed OpenNotes trial participants for 2 years at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS). Electronic invitations alerting patients to signed notes stopped at GHS after year 1, creating a natural experiment to assess the impact of reminders. We used generalized linear models to measure whether notes were viewed within 30 days of availability. Results We identified 14 360 patients (49 271 visits); mean age 52.2; 57.8% female. In year 1, patients viewed 57.5% of their notes, and their interest in viewing notes persisted over time. In year 2, BIDMC patients viewed notes with similar frequency. In contrast, GHS patients viewed notes far less frequently, a change starting when invitations ceased (RR 0.29 [0.26–0.32]) and persisting to the end of the study (RR 0.20 [0.17–0.23]). A subanalysis of BIDMC patients revealed that black and other/multiracial patients also continued to view notes, although they were overall less likely to view notes compared with whites (RR 0.75 [0.67–0.83] and 0.93 [0.89–0.98], respectively). Discussion As millions of patients nationwide increasingly gain access to clinicians’ notes, explicit email invitations to review notes may be important for fostering patient engagement and patient-doctor communication. Conclusion Note viewing persists when accompanied by email alerts, but may decline substantially in their absence. Non-white patients at BIDMC viewed notes less frequently than whites, although their interest also persisted.
45
Zhou, Ying, Ming-Hua Zheng, Chao-Sheng Chen, Dan-Qin Sun, Xin-Xin Chen, Mei Sun, Yan-Hui Wang, Yi Liu, Jing-Ye Pan, and Chen-Fei Zheng. "Prognostic value of hematocrit levels among critically ill patients with acute kidney injury." European Journal of Inflammation 17 (January 2019): 205873921984682. http://dx.doi.org/10.1177/2058739219846820.
Full textAbstract:
The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.
46
Sengupta, Debarka, Vaibhav Singh, Seema Singh, Dinesh Tewari, Mudit Kapoor, Debabrata Ghosh, and Shivam Sharma. "Patient-Specific Predictive Antibiogram in Decision Support for Empiric Antibiotic Treatment." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s521—s522. http://dx.doi.org/10.1017/ice.2020.1205.
Full textAbstract:
Background: The rising trend of antibiotic resistance imposes a heavy burden on healthcare both clinically and economically (US$55 billion), with 23,000 estimated annual deaths in the United States as well as increased length of stay and morbidity. Machine-learning–based methods have, of late, been used for leveraging patient’s clinical history and demographic information to predict antimicrobial resistance. We developed a machine-learning model ensemble that maximizes the accuracy of such a drug-sensitivity versus resistivity classification system compared to the existing best-practice methods. Methods: We first performed a comprehensive analysis of the association between infecting bacterial species and patient factors, including patient demographics, comorbidities, and certain healthcare-specific features. We leveraged the predictable nature of these complex associations to infer patient-specific antibiotic sensitivities. Various base-learners, including k-NN (k-nearest neighbors) and gradient boosting machine (GBM), were used to train an ensemble model for confident prediction of antimicrobial susceptibilities. Base learner selection and model performance evaluation was performed carefully using a variety of standard metrics, namely accuracy, precision, recall, F1 score, and Cohen κ. Results: For validating the performance on MIMIC-III database harboring deidentified clinical data of 53,423 distinct patient admissions between 2001 and 2012, in the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center in Boston, Massachusetts. From ~11,000 positive cultures, we used 4 major specimen types namely urine, sputum, blood, and pus swab for evaluation of the model performance. Figure 1 shows the receiver operating characteristic (ROC) curves obtained for bloodstream infection cases upon model building and prediction on 70:30 split of the data. We received area under the curve (AUC) values of 0.88, 0.92, 0.92, and 0.94 for urine, sputum, blood, and pus swab samples, respectively. Figure 2 shows the comparative performance of our proposed method as well as some off-the-shelf classification algorithms. Conclusions: Highly accurate, patient-specific predictive antibiogram (PSPA) data can aid clinicians significantly in antibiotic recommendation in ICU, thereby accelerating patient recovery and curbing antimicrobial resistance.Funding: This study was supported by Circle of Life Healthcare Pvt. Ltd.Disclosures: None
47
Gaughan, Elizabeth Mary, Sarah K. Cryer, Beow Yong Yeap, David Michael Jackman, and Daniel Botelho Costa. "Family history of lung cancer in never smokers with non-small cell lung cancer (NSCLC) and its association with tumors harboring epidermal growth factor receptor (EGFR) mutations." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 7579. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.7579.
Full textAbstract:
7579 Background: Inherited susceptibility to lung cancer is an understudied subject, however it has been described among never smokers (<100 cigarettes/lifetime). Never smokers with NSCLC comprise an important subgroup of patients enriched for tumors harboring oncogene aberrations in the EGFR and ALK genes. We aimed to better characterize the incidence of family history of lung cancer in the setting of routine tumor genotyping among never smokers with NSCLC. Methods: Clinicopathologic data plus tumor genotype (EGFR, KRAS, ALK) from 230 consecutive never smokers seen at Beth Israel Deaconess Medical Center and Dana-Farber Cancer Institute was compiled. We retrospectively analyzed the incidence of a family history of any cancer and lung cancer in these patients. Results: In our cohort, the average age was 56 years, 67% of the patients were women, 75% were white, 41% had advanced NSCLC and 87% had adenocarcinoma histology. In these tumors, 98/230 (43%) had an EGFR mutation, 16/155 (10%) had KRAS mutations and 27/127 (17%) had an ALK translocation. Family history of any cancer was common (57%) and specific family history of lung cancer was present in 42/230 cases (18%). Out of thecases with a family history of any cancer, 22/53 (41.5%) EGFR-mutated, 1/6 (17%) KRAS-mutated and 3/20 (15%) ALK-translocated cohorts had a family history of lung cancer. The rate of family history of lung cancer to family history of cancer was significantly higher in the EGFR-mutated cohort when compared to the ALK translocated plus KRAS-mutated cohorts (p=0.023). Conclusions: Family history of lung cancer is common in never smokers with NSCLC, and there seems to be a particular link in families in which the proband has an EGFR-mutated tumor. Further study of families with EGFR-mutated NSCLC may yield insights into the pathogenesis of this tumor type.
48
Althoff, Friederike C., Xinling Xu, Luca J. Wachtendorf, Denys Shay, Maria Patrocinio, Maximilian S. Schaefer, Timothy T. Houle, Philipp Fassbender, Matthias Eikermann, and Karuna Wongtangman. "Provider variability in the intraoperative use of neuromuscular blocking agents: a retrospective multicentre cohort study." BMJ Open 11, no. 4 (April 2021): e048509. http://dx.doi.org/10.1136/bmjopen-2020-048509.
Full textAbstract:
ObjectiveTo assess variability in the intraoperative use of non-depolarising neuromuscular blocking agents (NMBAs) across individual anaesthesia providers, surgeons and hospitals.DesignRetrospective observational cohort study.SettingTwo major tertiary referral centres, Boston, Massachusetts, USA.Participants265 537 adult participants undergoing non-cardiac surgery between October 2005 and September 2017.Main outcome measuresWe analysed the variances in NMBA use across 958 anaesthesia and 623 surgical providers, across anaesthesia provider types (anaesthesia residents, certified registered nurse anaesthetists, attendings) and across hospitals using multivariable-adjusted mixed effects logistic regression. Intraclass correlations (ICC) were calculated to further quantify the variability in NMBA use that was unexplained by other covariates. Procedure-specific subgroup analyses were performed.ResultsNMBAs were used in 183 242 (69%) surgical cases. Variances in NMBA use were significantly higher among individual surgeons than among anaesthesia providers (variance 1.32 (95% CI 1.06 to 1.60) vs 0.24 (95% CI 0.19 to 0.28), p<0.001). Procedure-specific subgroup analysis of hernia repairs, spine surgeries and mastectomies confirmed our findings: the total variance in NMBA use that was unexplained by the covariate model was higher for surgeons versus anaesthesia providers (ICC 37.0% vs 13.0%, 69.7% vs 25.5%, 69.8% vs 19.5%, respectively; p<0.001). Variances in NMBA use were also partially explained by the anaesthesia provider’s hospital network (Massachusetts General Hospital: variance 0.35 (95% CI 0.27 to 0.43) vs Beth Israel Deaconess Medical Center: 0.15 (95% CI 0.12 to 0.19); p<0.001). Across provider types, surgeons showed the highest variance, and anaesthesia residents showed the lowest variance in NMBA use.ConclusionsThere is wide variability across individual surgeons and anaesthesia providers and institutions in the use of NMBAs, which could not sufficiently be explained by a large number of patient-related and procedure-related characteristics, but may instead be driven by preference. Surgeons may have a stronger influence on a key aspect of anaesthesia management than anticipated.
49
Khera, Tanvi, Pooja A. Mathur, Valerie M. Banner-Goodspeed, Shilpa Narayanan, Marie Mcgourty, Lauren Kelly, Kerry Palihnich, et al. "Scheduled Prophylactic 6-Hourly IV AcetaminopheN to Prevent Postoperative Delirium in Older CaRdiac SurgicAl Patients (PANDORA): protocol for a multicentre randomised controlled trial." BMJ Open 11, no. 3 (March 2021): e044346. http://dx.doi.org/10.1136/bmjopen-2020-044346.
Full textAbstract:
IntroductionPostoperative delirium is common among older cardiac surgery patients. Often difficult to predict and address prophylactically, delirium complicates the postoperative course by increasing morbidity and mortality as well as prolonging both hospital and intensive care unit (ICU) lengths of stay. Based on our pilot trial, we intend to study the effect of scheduled 6-hourly acetaminophen administration for 48 hours post-cardiac surgery with cardiopulmonary bypass (CPB) on the incidence of in-hospital delirium and long-term neurocognitive outcomes. Additionally, effect on duration and severity of delirium, rescue analgesic consumption, acute and chronic pain scores and lengths of hospital and ICU stay will also be explored.Methods and analysisThis multicentre, randomised, placebo-controlled, quadruple-blinded trial will include 900 older (>60 years) cardiac surgical patients requiring CPB. Patients meeting the inclusion criteria and not meeting any exclusion criteria will be enrolled at seven centres across the USA with Beth Israel Deaconess Medical Center (BIDMC), Boston, as the central coordinating centre. Additional sites may be included to broaden or speed accrual. The primary outcome measure is the incidence of in-hospital delirium till day 30. Secondary outcomes include the duration and severity of in-hospital delirium, hospital and ICU lengths of stay, postoperative pain scores, postoperative rescue analgesic consumption, postoperative cognitive function and chronic sternal pain. Creation of a biorepository and the use of intraoperative-blinded electroencephalogram (EEG) and cerebral oximetry data will support exploratory endpoints to determine mechanistic predictors of postoperative delirium.Ethics and disseminationThis trial is approved and centrally facilitated by the Institutional Review Board at BIDMC. An independent Data Safety and Monitoring Board is responsible for maintaining safety oversight. Protocol # 2019 P00075, V.1.4 (dated 20 October 2020).Trial registration numberNCT04093219.
50
Carlson, Kristen, Jack Tuszynski, and Ze’ev Bomzon. "CSIG-26. IS INTRINSIC APOPTOSIS THE SIGNALING PATHWAY ACTIVATED BY TUMOR-TREATING FIELDS FOR GLIOBLASTOMA?" Neuro-Oncology 21, Supplement_6 (November 2019): vi49. http://dx.doi.org/10.1093/neuonc/noz175.196.
Full textAbstract:
Abstract Increasingly, tumor-treating fields (TTFields, 2 V/cm, 200 kHz) are accepted as the fourth treatment modality for glioblastoma. Evidence shows that substituting non-steroidal inflammation control (celecoxib) for dexamethasone increases overall survival from 4.8 to 11.0 months, and more recently, up to 60 months. Toward explaining TTFields mechanism of action (MoA), our numerical simulations indicate that TTFields disrupt functionality of microtubules, which in turn trigger the intrinsic apoptotic pathway independent of cell cycle checkpoints. We present the theory and empirical evidence. 1) TTFields act similarly to chemotherapeutic ‘spindle poisons’ by interfering with microtubule (MT) polymerization, increasing free tubulin by 20% in relative terms; 2) Finite element modeling shows TTFields amplify electric field strength, in accord with empirical results, a) along the MT when aligned with the cell axis, where field strength exceeds 10–16 N required to disrupt motor protein transit, and b) 15x at MT ends when orthogonal to cell axis; 3) Either through producing excess free tubulin, which may block voltage-dependent anion channels, or direct effects on the mitochondrial inner and outer membranes, TTFields inhibit expression of pro-survival protein Bcl-2; 4) Decreased Bcl-2 expression activates the intrinsic apoptotic pathway in a novel cell-cycle-checkpoint and caspase-independent manner; 5) Patients using low (< 4.1 mg/day) vs. high (>4.1 mg/day) dexamethasone doses experienced an average 8.7 vs. 3.2 months OS and up to 60 months; 6) Numerous studies in both brain and other tissues show that dexamethasone a) promotes extrinsic, immune-system apoptosis and b) inhibits intrinsic, Bcl-2/Bax mediated apoptosis; 7) Downstream effects of intrinsic apoptosis are remarkably similar to empirically-observed effects of TTFields on tumor cells. Research supported by Novocure Ltd. Dept of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA USA. carlsokw@bidmc.harvard.edu. Dept of Physics, University of Alberta, Edmonton, Canada, Novocure Ltd., Haifa, Israel.