A RETROSPECTIVE ANALYSIS OF CLAIMS DATA TO DETERMINE SYMPTOMS ASSOCIATED WITH OVARIAN CANCER

According to the American Cancer Society, approximately twenty percent (20% of women with ovarian cancer are diagnosed at an early stage (e.g. stage I or II), which subsequently means eighty percent (80%) of women diagnosed with this disease are at the late stage (e.g. stage III or IV) and are likely not to survive. No cure exists and, concurrently, studies show mixed results in utilizing blood tests and transvaginal ultrasounds to screen for ovarian cancer. While symptoms are not easily discernable, some oncologists have validated there are common symptoms women experience prior to diagnosis. As these symptoms are not routinely recognized by general practitioners as an indicator to detect ovarian cancer, we conducted a retrospective study to determine whether certain types of symptoms are evident prior to the diagnosis. Our two specific aims included: (1) conduct an exploratory study to determine if certain symptoms were prevalent in women that are diagnosed with ovarian cancer; and (2) assess and compare symptoms experienced by women diagnosed with ovarian cancer to women that have not been diagnosed with any type of cancer. The symptoms were identified by forty-seven (47) International Classification of Disease, 9th revision (ICD-9), diagnosis codes and categorized into four primary groups: (i) abdominal-pelvis; (ii) bladder; (iii) digestive; and (iv) pain. In conjunction with identifying the type of symptoms experienced, reoccurrence and combination of symptoms were also analyzed. The data to support this study was derived from health insurance claims between 2008 through 2013 from a commercial payer. All subjects for both studies were residents in the state of Texas and were a minimum of 24 years old. The analysis of the first aim of the study was primarily descriptive to assess symptoms and frequencies experienced prior to diagnosis. Of the 3,601 women diagnosed with ovarian cancer, 2,292 (64%) experienced a related symptom prior to or at diagnosis. Over 60% (n=1544) of women experienced a first symptom associated with abdomen and pelvis and 85% of overall complaints were associated with this group of symptoms. Pain was the second most frequent complaint at 45%, followed by digestive at 24% and bladder at 18%. This was also confirmed in women who experienced a combination of symptoms where abdomen and pelvis along with pain was shown to be the highest complaint at 41%. The results of the first study consequently led to pursue the second aim which included a nested case control study comparing a subset of 789 women diagnosed with ovarian cancer to women who did not have any history of cancer. The results supported statistical significance in symptoms experienced specific to abdomen and pelvis in conjunction with pain as well as digestive. While these symptoms are ordinary and are difficult to distinguish as having an association with ovarian cancer, the findings of this research appear to affirm that a symptom index may prove to be a useful method when recurring complaints are presented in women

Studies of FLT3 mutations in paired presentation and relapse samples from patients with acute myeloid leukemia: implications for the role of FLT3 mutations in leukemogenesis, minimal residual disease detection, and possible therapy with FLT3 inhibitors

FLT3 mutations, either internal tandem duplications (ITDs) or aspartate residue 835 (D835) point mutations, are present in approximately one third of patients with acute myeloid leukemia (AML) and have been associated with an increased relapse rate. We have studied FLT3 mutations in paired presentation and relapse samples to ascertain the biology of these mutations and to evaluate whether they can be used as markers of minimal residual disease. At diagnosis, 24 patients were wild-type FLT3, and 4 acquired a FLT3 mutation at relapse (2 D835+, 2 ITD+), with a further patient acquiring an ITD at second relapse. Of 20 patients positive at diagnosis (18 ITD+, 2 D835+), 5 who were all originally ITD+ had no detectable mutation at relapse, as determined by a sensitive radioactive polymerase chain reaction. One of these patients had acquired an N-Ras mutation not detectable at presentation. Furthermore, another patient had a completely different ITD at relapse, which could not be detected in the presentation sample. These results indicate that FLT3 mutations are secondary events in leukemogenesis, are unstable, and thus should be used cautiously for the detection of minimal residual disease

Effects of a Community Population Health Initiative on Blood Pressure Control in Latinos.

Background Hypertension remains one of the most important, modifiable cardiovascular risk factors. Yet, the largest minority ethnic group (Hispanics/Latinos) often have different health outcomes and behavior, making hypertension management more difficult. We explored the effects of an American Heart Association-sponsored population health intervention aimed at modifying behavior of Latinos living in Texas. Methods and Results We enrolled 8071 patients, and 5714 (65.7%) completed the 90-day program (58.5 years ±11.7; 59% female) from July 2016 to June 2018. Navigators identified patients with risk factors; initial and final blood pressure ( BP ) readings were performed in the physician\u27s office; and interim home measurements were recorded telephonically. The intervention incorporated home BP monitoring, fitness and nutritional counseling, and regular follow-up. Primary outcomes were change in systolic BP and health-related quality of life. Using a univariate paired-samples pre-post design, we found an average 5.5% (7.6-mm Hg) improvement in systolic BP (139.1 versus 131.5, t=10.32,

Quality Improvement Practices in Academic Emergency Medicine: Perspectives from the Chairs

Objective: To assess academic emergency medicine (EM) chairs’ perceptions of quality improvement (QI) training programs.Methods: A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department.Results: The response rate to the survey was 69% (N = 59). 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260), but there was a statistically significant (χ2 = 14.383; p = 0.006) relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care.Conclusion: Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation.[West J Emerg Med. 2010; 11(5):479-485.

Screening for Latent Polycythemia Vera in Renal Cell Carcinoma–Associated Erythrocytosis

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Characterization of a novel variant BCR–ABL1 fusion transcript in a patient with chronic myeloid leukemia: Implications for molecular monitoring

AbstractMolecular monitoring of BCR–ABL1 transcript levels using quantitative polymerase chain reaction is an essential part of the modern management of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors. Establishing the diagnostic BCR–ABL1 fusion transcript is necessary in order to select appropriate primers and probes for such monitoring. A case is described in which quantitative polymerase chain reaction failed to detect the presence of BCR–ABL1 fusion transcript in a Philadelphia chromosome-positive chronic myeloid leukemia patient. Further investigation demonstrated a novel in-frame BCR–ABL1 fusion transcript with a breakpoint in BCR exon 13 and insertion of a sequence of ABL1 intron 1, therefore enabling subsequent molecular monitoring. This case highlights the requirement for characterization of the BCR–ABL1 transcript type at chronic myeloid leukemia diagnosis. Issues concerning standardized methodological approaches and interpretation of transcript levels in such rare cases are discussed