Tag: nevin manimala

JCO Clin Cancer Inform. 2025 Apr;9:e2400253. doi: 10.1200/CCI-24-00253. Epub 2025 Apr 22.

ABSTRACT

PURPOSE: Incorporating patient-reported outcomes (PROs) into health care processes can improve engagement with patients; however, adopting PROs at scale is challenging. The aim of this study was to describe the design, development, and adoption at scale of a comprehensive PRO program for standard of care and research at a cancer center.

METHODS: Requirements for a PRO program were obtained from multiple stakeholders. Components of the program included a governance process to assure a consistent and satisfactory experience for patients completing PRO questionnaires, tools to create and manage questionnaires and related content, methods to send questionnaires to relevant patients at the appropriate time, interactive tools for patients to complete the questionnaires as part of their portal experience, and integration of PRO data into workflows for clinicians. We used descriptive statistics to assess the use of the program from 2016 to 2023.

RESULTS: From program launch (on February 1, 2016) until December 31, 2023, 189 unique questionnaires were developed (101 for standard-of-care, 70 for research, and 18 for quality improvement). Of the 432,497 unique patients who were assigned at least one questionnaire, 314,685 (73%) completed at least one. Of 5,948,464 questionnaires sent, 3,098,574 (52%) were completed. The median completion time was 2 minutes.

CONCLUSION: Large-scale adoption of PROs at a cancer center is feasible. Key considerations for success include governance processes, attention to patient experience and clinician workflow, and the ability to manage complex inclusion criteria and timing of delivery of questionnaires. These principles should be disseminated so the full potential of PROs in health care can be realized.

PMID:40262062 | DOI:10.1200/CCI-24-00253

Health Rep. 2025 Apr 16;36(4):3-13. doi: 10.25318/82-003-x202500400001-eng.

ABSTRACT

BACKGROUND: It is not clear whether the increased mortality pattern observed in a prior analysis of the Canadian Census Health and Environment Cohorts for HIV/AIDS, diabetes, prostate cancer, and uterine cancer among Black adults is reflected in incident hospitalization (a marker of severity) or the diagnosis of these diseases, nor is it clear whether disparities exist regarding early screening and survivability.

METHODS: To understand the paths that contribute to differential mortality patterns, standard Cox proportional hazard models were used to assess the incidence risk of diagnosis (uterine and prostate cancer) and incident hospitalization (HIV and diabetes) among 161,520 Black adults, compared with 6,866,070 White adults. Competing risk regression was used to evaluate the cumulative risk of death for the four disease outcomes since diagnosis or hospitalization. For the observed differential cancer mortality, mediation analysis was conducted to investigate the role of cancer diagnosis at follow-up (a proxy for delayed diagnosis that is not entirely indicative of late-stage cancer).

RESULTS: Across all examined outcomes, except for uterine cancer, Black adults had elevated incident diagnoses or hospitalizations compared with White adults. Notably, Black males demonstrated a risk of incident prostate cancer and hospitalizations from HIV and diabetes twice as high relative to White males. For Black females, the risk of incident HIV hospitalization was 12 times as high. However, Black females were 15% less likely to be diagnosed with uterine cancer, compared with White females. Cumulative mortality risk analysis showed significantly lower survivability (two times lower) among Black females diagnosed with uterine cancer, relative to White females. Delayed diagnosis mediated a marginally higher proportion of the total differential uterine cancer mortality among Black females (14.9%; 95% confidence interval [CI]: 10.5% to 23.1%), compared with White females (8.9%; 95% CI: 6.3% to 13.9%).

INTERPRETATION: This study unveils substantial parallels between heightened incidence risk and relative mortality for most of the four explored outcomes between Black and White adults in Canada. Notably, the study highlights a lower incident diagnosis of uterine cancer among Black females, despite a relatively higher uterine cancer mortality. Three in every 20 uterine cancer deaths were mediated through the time of uterine cancer diagnosis (relatively delayed in Black females), underscoring the need for targeted interventions and early detection strategies to address health disparities in this population.

PMID:40262030 | DOI:10.25318/82-003-x202500400001-eng

Cardiol Rev. 2025 Apr 22. doi: 10.1097/CRD.0000000000000930. Online ahead of print.

ABSTRACT

Patients undergoing cardiac catheterization are advised not to take anything by mouth after midnight. However, limited scientific data exist on whether fasting before catheterization procedures improves clinical outcomes compared with nonfasting. A comprehensive literature search was performed by investigators using major bibliographic databases to identify studies that compared clinical outcomes for fasting versus nonfasting patient groups following cardiac catheterization procedures. The risk ratios (RR) and mean difference (MD) were pooled along with 95% confidence intervals (CIs) for dichotomous and continuous outcomes using R studios. A total of 9 trials were included in the review reporting data for 3432 patients (fasting: 1710 and nonfasting: 1702). There was no statistically significant difference between the 2 groups for incidence of procedural complications (RR: 1.05, 95% CI: 0.78-1.40; P = 0.757), 30-day mortality (RR: 0.83, 95% CI: 0.32-2.18; P = 0.71), 30-day readmissions (RR: 1.05, 95% CI: 0.74-1.49; P = 0.77), aspiration (RR: 0.45, 95% CI: 0.06-3.50; P = 0.45), contrast-associated acute kidney injury (RR: 0.90, 95% CI: 0.52-1.58; p 0.72), hypoglycemia (RR: 1.27, 95% CI: 0.74-2.17; P = 0.39), and nausea/vomiting (RR: 0.83, 95% CI: 0.46-1.51; P = 0.55). The nonfasting group was associated with significantly better satisfaction scores compared to the fasting group (standardized MD: 0.70, 95% CI: 0.13-1.27; P = 0.02). Before cardiac catheterization, a nonfasting approach is associated with higher satisfaction and similar procedural outcomes and adverse events compared to a fasting approach. The practice of routine fasting before cardiac catheterization should be reconsidered.

PMID:40262020 | DOI:10.1097/CRD.0000000000000930

WMJ. 2025;124(1):74-77.

NO ABSTRACT

PMID:40262014

WMJ. 2025;124(1):42-46.

ABSTRACT

INTRODUCTION: Implicit bias in patient care and outcomes is well documented. However, the presence of bias in hospital security interactions is a relatively new area of research. Flags placed on the electronic medical record identify patients considered high risk for negative outcomes, including those with security interactions.

OBJECTIVE: We sought to explore the types of flags and their frequency, differences among patients with flags, and their pattern over time.

METHODS: We conducted a retrospective chart review of flags placed on electronic medical records over 13 years of adults 18 years or older who were patients at a Midwest, tertiary, academic medical center. Descriptive statistics were used to explore patient demographic data. Chi-square tests were executed to compare patients with different flag types.

RESULTS: Three flag types were investigated: “communication alert,” “vulnerable/unsafe, behavior” and “risk management.” The communication alert flag was most common, although Black male patients were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). Patients who were prescribed anti-anxiety medications, antidepressants, antipsychotics, and psychotherapeutics also were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). The highest number of flags was placed during quarter 3 – the months of July, August, and September.

CONCLUSIONS: Records of patients with certain demographics and on certain medications were more likely to be labeled with vulnerable/unsafe behavior flags. There is no clear protocol to determine what behaviors elicit which flag. Standardized procedures could help provide transparency to this issue.

PMID:40262006

WMJ. 2025;124(1):17-21.

ABSTRACT

INTRODUCTION: People experiencing homelessness are more likely than the general population to have chronic health conditions and often encounter significant barriers to health care access. Many of these barriers can be affected by community-based factors, such as availability of reliable transportation, past experiences with health care systems, and community attitudes toward the unhoused population. This project aims to assess the needs and barriers to health care identified by people experiencing homelessness in a rural Midwestern city.

METHODS: The survey used was adapted from a survey previously conducted to assess the needs of the homeless population in Milwaukee, Wisconsin. Surveys were distributed during outreach around the city of Wausau, Wisconsin. Data were transcribed and reviewed, and descriptive statistics were calculated.

RESULTS: A total of 45 surveys were completed. Most participants identified as White, non-Hispanic males (n = 24, 53%) and were 46 to 55 years old (n = 14, 31%). Barriers to health care included lack of housing, cost, transportation, lack of a mailing address, inadequate hours, and disrespectful care. Eighty-six percent of participants (n = 38) reported having a mental health diagnosis, yet only 26% (n = 12) stated that they see a mental health professional.

CONCLUSIONS: Individuals experiencing homelessness in a rural community have broad and complex barriers to accessing health care. Given limited resources in smaller communities, innovative and holistic solutions should be considered when aiming to make care more equitable.

PMID:40262002

Sci Signal. 2025 Apr 22;18(883):eado3473. doi: 10.1126/scisignal.ado3473. Epub 2025 Apr 22.

ABSTRACT

Cellular plasticity mediates tissue development as well as cancer growth and progression. In breast cancer, a shift to a more epithelial phenotype (epithelialization) underlies a state of reversible cell growth arrest called tumor dormancy, which enables drug resistance, tumor recurrence, and metastasis. Here, we explored the mechanisms driving epithelialization and dormancy in aggressive mesenchymal-like breast cancer cells in three-dimensional cultures. Overexpressing either of the epithelial lineage-associated transcription factors OVOL1 or OVOL2 suppressed cell proliferation and migration and promoted transition to an epithelial morphology. The expression of OVOL1 (and of OVOL2 to a lesser extent) was regulated by steroid hormones and growth factors and was more abundant in tumors than in normal mammary cells. An uncharacterized and indirect target of OVOL1/2, C1ORF116, exhibited genetic and epigenetic aberrations in breast tumors, and its expression correlated with poor prognosis in patients. We further found that C1ORF116 was an autophagy receptor that directed the degradation of antioxidant proteins, including thioredoxin. Through C1ORF116 and unidentified mediators, OVOL1 expression dysregulated both redox homeostasis (in association with increased ROS, decreased glutathione, and redistribution of the transcription factor NRF2) and DNA damage and repair (in association with increased DNA oxidation and double-strand breaks and an altered interplay among the kinases p38-MAPK, ATM, and others). Because these effects, as they accumulate in cells, can promote metastasis and dormancy escape, the findings suggest that OVOLs not only promote dormancy entry and maintenance in breast cancer but also may ultimately drive dormancy exit and tumor recurrence.

PMID:40261955 | DOI:10.1126/scisignal.ado3473

Proc Natl Acad Sci U S A. 2025 Apr 29;122(17):e2417813122. doi: 10.1073/pnas.2417813122. Epub 2025 Apr 22.

ABSTRACT

Generic equilibria are derived for turbulent relaxing plasmas via an entropy-maximization procedure that accounts for the short-time conservation of certain collisionless invariants. The conservation of these collisionless invariants endows the system with a partial “memory” of its prior conditions but is imperfect on long time scales due to the development of a turbulent cascade to small scales, which breaks the precise conservation of phase volume, making this memory imprecise. The equilibria are still determined by the short-time collisionless invariants, but the invariants themselves are driven to a universal form by the nature of the turbulence. This is numerically confirmed for the case of beam instabilities in one-dimensional electrostatic plasmas, where sufficiently strong turbulence appears to cause the distribution function of particle energies to develop a universal power-law tail, with exponent -2.

PMID:40261929 | DOI:10.1073/pnas.2417813122

J Neuropathol Exp Neurol. 2025 Apr 22:nlaf034. doi: 10.1093/jnen/nlaf034. Online ahead of print.

ABSTRACT

Pituitary neuroendocrine tumors (PitNETs) are among the most common tumors encountered in neurooncology. While the majority of PitNETs demonstrate indolent behavior, a subset of tumors demonstrates aggressive behavior, including invasion into surrounding structures. As traditional imaging has limited capacity to distinguish tumor from post-operative changes, better methods of tumor delineation are needed to guide management. Somatotroph adenomas are known to express high levels of SSTR2, and SSTR2-targeting PET imaging has shown clinical utility in the management of neuroendocrine tumors and meningiomas. In this retrospective study of archival PitNETs (n = 271) and autopsy controls (AC) (n = 20), we show that although significant differences in SSTR2 immunostaining are appreciable between adenoma subtypes and ACs, high-staining cases are encountered in all subtypes. In ACs, females demonstrated significantly stronger SSTR2 staining than males. Weak age-related trends towards increasing labelling in females and decreasing labelling in males were noted but these did not reach statistical significance. Decreasing age-related trends were seen in gonadotrophs in both sexes; this was statistically significant in females. Our findings suggest that SSTR2-targeting imaging modalities may assist clinical management of a subset of PitNETs and that these results may need to be interpreted with consideration of patient age and sex.

PMID:40261909 | DOI:10.1093/jnen/nlaf034

PLOS Glob Public Health. 2025 Apr 22;5(4):e0004446. doi: 10.1371/journal.pgph.0004446. eCollection 2025.

ABSTRACT

Developing active ingredients for the global market requires substantial investment, often exceeding 300 million euros. This process takes an average of 12 years from initiation to commercialization. Despite this lengthy timeline, the industry frequently encounters significant restrictions and bans on active ingredients due to stringent international regulations and evolving environmental safety requirements. In this context, the analysis of regulatory lists using advanced machine learning and statistical modeling techniques becomes crucial for identifying the key parameters that influence the restriction and banning of active ingredients. This study aims to provide insights that enhance decision-making processes, thereby contributing to sustainability by reducing unnecessary environmental research and development efforts. The findings indicate that Governmental and Non-Governmental Organizations, as well as Blacklists, are key influencers in the restriction and ban of active ingredients for agricultural use, with Codex Alimentarius acting as a regional influencer depending on the specific country. Ultimately, the insights derived from this research can assist industries and policymakers in developing more effective regulatory strategies, promoting sustainable practices, and ensuring that new active ingredients are selected based on comprehensive and informed criteria that consider both safety and environmental impact.

PMID:40261900 | DOI:10.1371/journal.pgph.0004446