Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center.

This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.

Immune checkpoint inhibitor-induced myocarditis, myositis, myasthenia gravis and transaminitis: a case series and review.

Immune checkpoint inhibitors have been incorporated into the treatment of various malignancies. An increasing body of literature is reporting rare but potentially fatal adverse events associated with these agents. In this case series, the authors report the clinical features and outcomes of seven patients who received immune checkpoint inhibitors for different solid organ malignancies and developed a tetrad of immune-related myocarditis, myositis, myasthenia gravis and transaminitis. Herein the authors review the literature and describe the current diagnostic and management approach for this overlapping syndrome. The authors' series highlights the importance of a high index of clinical suspicion, prompt comprehensive investigations, early multidisciplinary team involvement and initiation of immunosuppressive therapy when immune-related adverse events are suspected.

Cancer immunotherapy is used in the treatment of different cancer types. Immunotherapy activates the immune system to detect and attack cancer cells, but side effects may arise from the immune system inadvertently attacking normal tissues and organs. The increased use of immunotherapy has led to an increase in the reporting of rare but potentially life-threatening treatment-related side effects. In this case series, the authors report the clinical features and outcomes of seven patients who developed inflammation of the heart, muscles, nerve and muscle junctions and liver following treatment with immunotherapy. The authors review the scientific literature and discuss the current understanding of and management approach to this rare syndrome. The authors' report highlights the importance of a high degree of clinical suspicion, prompt comprehensive testing to confirm diagnosis, early involvement of experts from different specialties and early initiation of treatment in the management of this unique syndrome.

Overlapping central and peripheral nervous system syndromes in MOG antibody-associated disorders.

OBJECTIVE: Antibodies to myelin oligodendrocyte glycoprotein (MOG) are associated with CNS demyelination inclusive of optic neuritis (ON) and transverse myelitis (TM). To examine whether peripheral nervous system (PNS) involvement is associated with MOG antibody-associated disorders (MOGAD), we performed detailed characterization of an Australasian MOGAD cohort. METHODS: Using a live cell-based assay, we diagnosed 271 adults with MOGAD (2013-2018) and performed detailed clinical and immunologic characterization on those with likely PNS involvement. RESULTS: We identified 19 adults with MOGAD and PNS involvement without prior TM. All patients had CNS involvement including ON (bilateral [n = 3], unilateral [n = 3], and recurrent [n = 7]), a cortical lesion (n = 1), meningoencephalitis (n = 1), and subsequent TM (n = 4). Clinical phenotyping and neurophysiology were consistent with acute inflammatory demyelinating polyneuropathy (n = 1), myeloradiculitis (n = 3), multifocal motor neuropathy (n = 1), brachial neuritis (n = 2), migrant sensory neuritis (n = 3), and paresthesia and/or radicular limb pain (n = 10). Onset MRI spine was consistent with myeloradiculitis with nerve root enhancement in 3/19 and normal in 16/19. Immunotherapy resulted in partial/complete PNS symptom resolution in 12/15 (80%) (steroids and/or IV immunoglobulin n = 9, rituximab n = 2, and plasmapheresis n = 1). We identified serum antibodies targeting neurofascin 155, contactin-associated protein 2, or GM1 in 4/16 patients with MOGAD PNS compared with 0/30 controls (p = 0.01). There was no binding to novel cell surface antigens using an in vitro myelinating sensory neuronal coculture model. CONCLUSIONS: Myeloradiculitis, combined central and peripheral demyelination syndromes, and inflammatory neuropathies may be associated with MOGAD and may be immunotherapy responsive. We identified a subgroup who may have pathology mediated by coexistent autoantibodies.

Examining the effect of 5-HTTLPR on depressive symptoms in postmenopausal women 1 year after initial breast cancer treatment.

BACKGROUND: Depression following the diagnosis of breast cancer has been well documented, and occurs in as many as 40% of women. The serotonin transporter gene SLC6A4 and its functional polymorphism 5-HTTLPR have been extensively studied as factors in the development of depression. Many research studies have demonstrated conflicting results, and the contribution of 5-HTTLPR to depression is unclear. PURPOSE: The purpose of this study was to compare the relationship between depressive symptoms and serotonin transporter gene polymorphisms between women with early-stage breast cancer 1 year following initial diagnosis and surgery and matched controls. METHODS: Participants (N = 125), included postmenopausal women following breast cancer surgery (n = 80) and age-and education-matched healthy controls (n = 45). The genetic elements of interest were the long (LA) and short (S) alleles of 5-HTTLPR, as well as the single nucleotide polymorphism rs25531 A > G within the L-allele (LG). DNA was extracted from either blood or saliva and analyzed for the SLC6A4 polymorphisms. The outcome measures for this longitudinal study included Beck Depression Inventory scores and physical function domain scores from the Medical Outcome Study Short Form 36. RESULTS: Women with breast cancer demonstrated greater depressive symptomatology and decreased physical function compared to healthy controls. The LA/LA genotype was associated with increased depressive symptomatology in the overall sample and within the controls. The LA/LA genotype appeared with greater frequency in the experimental group, but the relationship with increased depressive symptoms was not observed. Physical function was a significant (p < 0.00) predictor of depressive symptoms in both groups at 12 months. CONCLUSION: The relationship between 5-HTTLPR and depressive symptomatology in breast cancer patients remains unclear. A potential clinical application includes monitoring physical function and addressing increased depressive symptoms as physical function declines.

A Call to Action to Address Barriers to Breastfeeding and Lactation Faced by Student-Mothers.

Many new mothers returning to school after childbirth face barriers within their academic settings to meeting their goals for exclusive breastfeeding. Potential barriers to breastfeeding faced by student-mothers include lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among mothers, health care providers, and university administrators and faculty. Here we advocate for six action steps to help remove barriers to breastfeeding faced by student-mothers.