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1.
Future Oncol ; 17(35): 4959-4969, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34783255

RESUMO

Aim: A retrospective chart review of ibrutinib-treated patients with chronic lymphocytic leukemia (CLL) was conducted. Patients & methods: Adults with CLL who initiated ibrutinib were followed for ≥6 months (n = 180). Results: Twenty-five percent of first-line ibrutinib patients experienced ≥1 dose reduction, mainly due to adverse events (AEs; 79%). Treatment discontinuations and dose holds occurred in 20 and 34% of patients, respectively, most commonly due to AEs (73 and 74%). Approximately one-quarter of relapsed/refractory ibrutinib patients experienced ≥1 dose reduction, mainly due to AEs (88%). Treatment discontinuation and dose holds occurred in 40% of patients (58 and 76% due to AEs, respectively). Conclusion: Dose reductions, holds and discontinuations were frequent in patients with CLL receiving ibrutinib in routine clinical practice.

3.
Ann Surg Oncol ; 28(5): 2438-2446, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33523364

RESUMO

AIMS: National studies have demonstrated disparities in the treatment and survival of pancreatic cancer patients based on socioeconomic status (SES). This study aimed to identify specific differences in perioperative management and outcomes based on patient SES and to study the role of a multidisciplinary clinic (MDC) in mitigating any variations. METHODS: The study analyzed patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma in a large hospital system. The patients were categorized into groups of high and low SES and whether they were managed by the authors' pancreatic cancer MDC or not. The study compared differences in disease characteristics, receipt of multimodality therapy, perioperative outcomes, and recurrence-free and overall survival. RESULTS: Of the 162 low-SES patients and 119 high-SES patients, 54% were managed in the MDC. Outside the MDC, low-SES patients were less likely to receive neoadjuvant chemotherapy and had less minimally invasive surgery, a longer OR time, less enhanced recovery participation, and more major complications (p < 0.05). No SES disparities were observed among the MDC patients. Despite similar tumor characteristics, the low-SES patients had inferior median overall survival (21 vs 32 months; p = 0.005), but the MDC appeared to eliminate this disparity. Low SES correlated with inferior survival for the non-MDC patients (17 vs 32 months; p < 0.001), but not for the MDC patients (24 vs 25 months; p = 0.33). These findings persisted in the multivariable analysis. CONCLUSION: A pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival for low-SES patients.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Carcinoma Ductal Pancreático/cirurgia , Disparidades em Assistência à Saúde , Humanos , Recidiva Local de Neoplasia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Classe Social
4.
J Gastrointest Surg ; 25(4): 983-990, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32314230

RESUMO

BACKGROUND: Robotic pancreatic surgery is expanding throughout centers across the country. We investigated national trends in the use and outcomes for robotic-assisted pancreaticoduodenectomy (RPD) and distal pancreatectomy (RDP) for primary pancreatic tumors. METHODS: The National Cancer Database was queried for RPD and RDP performed during three time periods: 2010-2012, 2013-2014, and 2015-2016. These time periods were compared for patient and center factors as well as surgical outcomes. RESULTS: The use of robotic surgery increased during the study period. Most centers performed a low volume of robotic surgery (RPD, 82% of centers averaged < 1 case/year; RDP, 87% averaged < 1 case/year). From the first to last time period, the proportion of cases performed at academic centers decreased (RPD, 83% to 56%; RDP, 77% to 58%, p < 0.001) while patient characteristics remained largely unchanged. For RPD, improvements in mortality (6.7 to 1.8%, p = 0.013) and lymphadenectomy (18 to 21 nodes, p = 0.035) were observed, with no changes in conversion to open surgery, negative margin resections, or readmissions. For RDP, length of stay decreased (7 to 6 days, p = 0.048), but there were no changes in other outcomes. Compared with academic centers, non-academic centers had equivalent rates of conversion to open surgery, negative margins, and 90-day mortality. On multivariate analysis, there was no difference in survival between academic and non-academic centers. DISCUSSION: Robotic pancreas surgery is expanding to a greater variety of centers nationwide with preservation of key surgical outcomes. These findings support the continued rigorous training and proliferation of qualified robotic pancreas surgeons going forward.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Procedimentos Cirúrgicos Robóticos , Humanos , Pâncreas , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia
5.
J Surg Oncol ; 122(2): 234-242, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32350882

RESUMO

BACKGROUND: Robotic pancreatectomy is gaining momentum; however, limited data exist on the long-term survival of this approach for pancreatic ductal adenocarcinoma (PDAC). The objective of this study is to compare the long-term oncologic outcomes of robotic pancreaticoduodenectomy (RPD) and robotic distal pancreatectomy (RDP) to open surgery in patients with PDAC. STUDY DESIGN: Robotic and open pancreatectomy for stages I-III PDAC were obtained from the 2010 to 2016 National Cancer Database. RESULTS: We identified 17 831 pancreaticoduodenectomies and 2718 distal pancreatectomies of which 626 (4%) and 332 (12%) were robotic, respectively. There was no difference in median overall survival between RPD (22.0 months) and open pancreatoduodenectomy (21.8 months; logrank P = .755). The adjusted hazard ratio [HR] was 1.014 (95% confidence interval [CI]: 0.903-1.139). The median overall survival for RDP (35.3 months) was higher than open distal pancreatectomy (ODP) (24.9 months; logrank P = .001). The adjusted HR suggests a benefit to RDP compared to ODP (HR, 0.744; 95% CI: 0.632-0.868) CONCLUSION: In a national cohort of resected pancreatic adenocarcinoma, the robotic platform was associated with similar long-term survival for pancreaticoduodenectomy, but improved survival for distal pancreatectomy.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia , Idoso , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Pancreatectomia/métodos , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
J Emerg Nurs ; 44(6): 570-575, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29685676

RESUMO

PROBLEM: False-positive blood-culture results due to skin contamination of samples remain a persistent problem for health care providers. Our health system recognized that our rates of contamination across the 4 emergency department campuses were above the national average. METHODS: A unique specimen collection system was implemented throughout the 4 emergency departments and became the mandatory way to collect adult blood cultures. The microbiology laboratory reported contamination rates weekly to manage potential problems; 7 months of data are presented here. RESULTS: There was an 82.8% reduction in false positives with the unique specimen collection system compared with the standard method (chi-squared test with Yates correction, 2-tailed, P = 0.0001). Based on the historical 3.52% rate of blood-culture contamination for our health facilities, 2.92 false positives were prevented for every 100 blood cultures drawn, resulting from adoption of the unique specimen collection system as the standard of care. CONCLUSION: This unique collection system can reduce the risk of blood culture contamination significantly and is designed to augment, rather than replace, the standard phlebotomy protocol already in use in most health care settings.


Assuntos
Coleta de Amostras Sanguíneas/métodos , Serviço Hospitalar de Emergência , Contaminação de Equipamentos/prevenção & controle , Flebotomia/métodos , Melhoria de Qualidade , Adulto , Sangue/microbiologia , Hemocultura/métodos , Reações Falso-Positivas , Humanos
7.
J Pathol Inform ; 9: 47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30662793

RESUMO

Introduction/Background: Cancer registries in the US collect timely and systematic data on new cancer cases, extent of disease, staging, biomarker status, treatment, survival, and mortality of cancer cases. Existing methodologies for accessing local cancer registry data for research are time-consuming and often rely on the manual merging of data by staff registrars. In addition, existing registries do not provide direct access to these data nor do they routinely provide linkage to discrete electronic health record (EHR) data, reports, or imaging data. Automation of such linkage can provide an impressive data resource and make valuable data available for translational cancer research. Methods: The UPMC Network Cancer Registry collects highly structured, longitudinal data on all reportable cancer patients, from the point of the diagnosis throughout treatment and follow-up/outcomes. Using commercial registry software, we collect data in compliance with standards governed by the North American Association of Central Cancer Registries. This standardization ensures that the data are highly structured with standard coding and collection methods, which support data exchange among central cancer registries and the Centers for Disease Control and Prevention. Results: At the UPMC Hillman Cancer Center and University of Pittsburgh, we explored the feasibility of linking this well-curated, structured cancer registry data with unstructured text (i.e., pathology and radiology reports), using the Text Information Extraction System (TIES). We used the TIES platform to integrate breast cancer cases from the UPMC Network Cancer Registry system and then combine these data with other EHR data as a pilot use case that can be replicated for other cancers. Conclusions: As a result of this integration, we now have a single searchable repository of information for breast cancer patients from the UPMC registry, combined with their pathology and radiology reports. The system that we developed is easily scalable to other health systems and cancer centers.

8.
Ann Surg Oncol ; 24(8): 2387-2396, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28534079

RESUMO

BACKGROUND: National Cancer Database analysis showed 70% of patients with stage I pancreatic adenocarcinoma (PDA) did not have surgery. We sought to analyze adherence to expected treatment (ET) by stage for PDA and identify factors that led to no treatment (NT) or unexpected treatment (UT) in a recent cohort. METHODS: Using our Institutional Cancer Registry (ICR), we identified patients with PDA from 2004 to 2013. ET was defined as surgery ± chemotherapy ± radiation for stages I and II, chemotherapy ± radiation for stage III, and chemotherapy for stage IV, while UT was defined as no surgery for stages I and II, surgery for stage III, or ± surgery ± XRT for stage IV. RESULTS: Overall, 2340 patients were identified (stages I and II = 51%, stage III = 11%, stage IV = 38%; ET = 58%, UT = 18%, NT = 24%). A total of 1183 patients had resectable PDA (stages I and II; ET = 57%, UT = 27%, NT = 16%), with ET demonstrating the best overall survival, but UT showing better survival than NT (p < 0.0001). In addition, 261 patients had unresectable PDA (stage III; ET = 69%, UT = 12%, NT = 18%), and survival was best in UT, but ET had a survival advantage over NT (p < 0.0001). Finally, 896 patients had metastatic PDA (stage IV; ET = 55%; UT = 9%; NT = 36%), with the NT group showing worse survival than the ET and UT groups (p < 0.0001). CONCLUSIONS: Unlike previous reports, most patients with early-stage disease had ET. ET and UT were associated with better survival than NT in all stages, and surgical cohorts have improved survival regardless of stage. Younger age, male sex, white race, and less comorbidity were predictors of receiving treatment.


Assuntos
Adenocarcinoma/terapia , Bases de Dados Factuais , Neoplasias Pancreáticas/terapia , Padrões de Prática Médica , Sistema de Registros/estatística & dados numéricos , Adenocarcinoma/patologia , Idoso , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Pancreáticas/patologia , Taxa de Sobrevida , Fatores de Tempo , Falha de Tratamento
9.
Ann Surg Oncol ; 24(5): 1406-1413, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27896518

RESUMO

BACKGROUND: Locally advanced unresectable pancreatic cancer (LAPC) historically portends a poor prognosis. FOLFIRINOX and gemcitabine/nab-paclitaxel have proven effective in the metastatic setting. We sought to evaluate the outcomes of these regimens compared with older regimens in LAPC. METHODS: A retrospective, single institutional review of all consecutive LAPC treated with "new" (FOLFIRINOX and/or gemcitabine/nab-paclitaxel) and "old" (gemcitabine or 5-FU) chemotherapy from 2010 to 2014 was performed. Univariate and multivariate predictors of resection and survival were determined. RESULTS: A total of 92 patients (new chemotherapy = 61, old chemotherapy = 31) were analyzed, of which 19 (21%) underwent eventual resection (median overall survival [OS] = 32 vs. 14.3 months for unresected patients, P = 0.0002). For the overall cohort, resection (hazard ratio [HR] 0.261, P = 0.014), radiation therapy (HR 0.458, P = 0.004), number of lines of chemotherapy (HR 0.486, P = 0.012), and new chemotherapy (HR 0.593 vs. old regimens, P = 0.065) were independent predictors of OS on multivariate analyses (MVA). On MVA, predictors of eventual resection were head and neck tumors (OR 0.307, P = 0.033) or SMA involvement (OR 0.285, P = 0.023). In nonresected patients (73), MVA showed treatment with new chemotherapy (HR 0.452, P = 0.006), radiation (HR 0.459, P = 0.006), and number of lines of CT (HR 0.705, P = 0.013) to be predictors of survival. CONCLUSIONS: In LAPC, use of FOLFIRNOX and/or gemcitabine/nab-paclitaxel is associated with improved survival compared with older chemotherapy regimens, regardless of eventual resection. Tumor location and relationship to certain vasculature are important determinants of resection in this cohort.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminas/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Fluoruracila/administração & dosagem , Humanos , Metástase Linfática , Masculino , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Paclitaxel/administração & dosagem , Pâncreas/patologia , Pancreatectomia , Radioterapia , Estudos Retrospectivos , Taxa de Sobrevida
10.
Ann Surg Oncol ; 23(13): 4149-4155, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27459986

RESUMO

BACKGROUND: Morbidity and mortality of pancreatectomy has improved and chemotherapeutic options for pancreatic cancer (PC) are growing, yet there is reluctance to treat octogenarians. This study examined the reasons for failure to treat and analyzes outcomes in octogenarians with PC. METHODS: Retrospective chart review 2005-2013. Demographics, tumor characteristics, treatment, reason for lack of treatment, Charlson comorbidity index (CCI), and survival were analyzed. Expected treatment for early-stage patients (I/II) included surgery ± chemotherapy ± radiation. Expected treatment for advanced stage patients (III/IV) was chemotherapy. RESULTS: A total of 431 octogenarians were analyzed. Mean age was 84.0 ± 3.4, 59.6 % female, and 44.1 % received no treatment. Patients with operable tumors (I = 31 [7.2 %]/II = 214 [49.7 %]) had surgery 39.2 % of the time. Age was a predictor of not receiving surgery (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.70-0.86; p = 0.0001), whereas CCI was not. The most common reason for no surgery was contraindication despite similar CCI. Median overall survival for early-stage patients was better in the surgical group (15.8 vs. 5.5 months) than nonsurgical group (p < 0.0001). Advanced patients (III = 54 [12.5 %]/IV = 132 [30.6 %]) had similarly low treatment rates (n = 65 [34.9 %]). Survival for advanced disease was best for treated patients (6.9 vs. 1.8 months; p < 0.0001). CCI did not differ between those receiving chemotherapy and not, although age was significantly different (p < 0.0001). CONCLUSIONS: There is significant deviation from expected treatment for octogenarians with PC. While no correlation existed between CCI and treatment, age correlated with therapy for nearly all stages. Chronological age, not comorbidity, may drive recommendation for treatment in elderly patients.


Assuntos
Antineoplásicos/uso terapêutico , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/terapia , Fatores Etários , Idoso de 80 Anos ou mais , Comorbidade , Contraindicações de Medicamentos , Contraindicações de Procedimentos , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Estadiamento de Neoplasias , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Recusa do Paciente ao Tratamento
11.
J Surg Res ; 202(2): 246-52, 2016 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-27229097

RESUMO

BACKGROUND: The purpose of this study was to evaluate the impact of a multidisciplinary clinic (MDC) on the treatment of pancreatic ductal adenocarcinoma. We hypothesized that an MDC would improve trial participation, multimodality therapy, neoadjuvant therapy, time to treatment, and survival. MATERIALS AND METHODS: Pancreatic ductal adenocarcinoma cancer registry patients from 2008-2012 were analyzed. Outcomes of patients evaluated at the MDC were compared with patients not evaluated at the MDC (non-MDC). RESULTS: A total of 1408 patients were identified, 557 (40%) MDC and 851 (60%) non-MDC. MDC were more likely to be an earlier stage than non-MDC (P = 0.0005): I - 4% versus 4%, II - 54% versus 43%, III - 11% versus 9%, and IV - 32% versus 44%. MDC were younger than non-MDC (68 versus 70; P = 0.005); however, younger (<75) and older (≥75) patients were more likely to receive treatment in MDC than non-MDC. MDC were more likely to participate in trials than non-MDC (28% versus 14%; P < 0.0001). MDC were more likely to receive treatment than non-MDC (90% versus 71%; P < 0.0001). MDC were more likely to receive two (38% versus 24%; P < 0.0001) or three (12% versus 9%; P = 0.02) therapies than non-MDC. No difference in time to first treatment in MDC than non-MDC (0.95 versus 0.92 mo; P = 0.69). After adjusting for age, stage, and therapy, there was a trend; however, no statistical difference in disease-free survival (hazard ratio [HR] of non-MDC versus MDC 0.80; 95% confidence interval [95% CI] 0.61-1.05; P = 0.11), time to recurrence (HR of non-MDC versus MDC 0.69; 95% CI 0.45-1.04; P = 0.07), or overall survival (HR of non-MDC versus MDC 0.81; 95% CI, 0.62-1.07; P = 0.13). CONCLUSIONS: Patients evaluated in an MDC were more likely to receive any treatment, receive multimodality therapy, neoadjuvant therapy, and participate in a clinical trial.


Assuntos
Institutos de Câncer/organização & administração , Carcinoma Ductal Pancreático/terapia , Comunicação Interdisciplinar , Neoplasias Pancreáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/mortalidade , Ensaios Clínicos como Assunto , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Processos e Resultados em Cuidados de Saúde , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Pennsylvania , Prognóstico , Melhoria de Qualidade , Sistema de Registros , Estudos Retrospectivos , Análise de Sobrevida
12.
J Pathol Inform ; 12010 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-20922029

RESUMO

CONTEXT: Tissue banking informatics deals with standardized annotation, collection and storage of biospecimens that can further be shared by researchers. Over the last decade, the Department of Biomedical Informatics (DBMI) at the University of Pittsburgh has developed various tissue banking informatics tools to expedite translational medicine research. In this review, we describe the technical approach and capabilities of these models. DESIGN: Clinical annotation of biospecimens requires data retrieval from various clinical information systems and the de-identification of the data by an honest broker. Based upon these requirements, DBMI, with its collaborators, has developed both Oracle-based organ-specific data marts and a more generic, model-driven architecture for biorepositories. The organ-specific models are developed utilizing Oracle 9.2.0.1 server tools and software applications and the model-driven architecture is implemented in a J2EE framework. RESULT: The organ-specific biorepositories implemented by DBMI include the Cooperative Prostate Cancer Tissue Resource (http://www.cpctr.info/), Pennsylvania Cancer Alliance Bioinformatics Consortium (http://pcabc.upmc.edu/main.cfm), EDRN Colorectal and Pancreatic Neoplasm Database (http://edrn.nci.nih.gov/) and Specialized Programs of Research Excellence (SPORE) Head and Neck Neoplasm Database (http://spores.nci.nih.gov/current/hn/index.htm). The model-based architecture is represented by the National Mesothelioma Virtual Bank (http://mesotissue.org/). These biorepositories provide thousands of well annotated biospecimens for the researchers that are searchable through query interfaces available via the Internet. CONCLUSION: These systems, developed and supported by our institute, serve to form a common platform for cancer research to accelerate progress in clinical and translational research. In addition, they provide a tangible infrastructure and resource for exposing research resources and biospecimen services in collaboration with the clinical anatomic pathology laboratory information system (APLIS) and the cancer registry information systems.

13.
J Registry Manag ; 36(4): 117-24; quiz 163-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20795553

RESUMO

Pathology reports represent a rich data source for cancer registries. The College of American Pathologists (CAP) Cancer Checklists present pathology reports in synoptic form and allow registries to be updated electronically. To assess the challenge of employing the CAP Cancer Checklists in pathology laboratories and transmitting that information to cancer registries, we conducted a pilot project: the Reporting Pathology Protocols project (RPP2). The RPP2 project was a multi-year, "proof of concept" demonstration that assessed pathology report-generated data for 3 CAP Cancer Checklists (breast, prostate, and melanoma) in several different cancer registry-pathology laboratory combinations in 3 states. Collaborating pathology laboratories and state cancer registries in California, Maine, and Pennsylvania identified key questions (queries) to address in the course of the project, developed and tested standardized HL7 messaging specifications to link senders and recipients, and then assessed the actual process results using either parallel reporting or retrospective-prospective cases for each tumor type. Successful electronic transfer and capture of pertinent data elements for numerous examples of each tumor type was accomplished in each participating cancer registry/reporting laboratory/information system combination. We noted shortcomings in the electronically encoded CAP Checklists as opposed to text-based reports, particularly for breast cancers. We uncovered opportunities to improve Checklists and the information systems that incorporate them. Workflow, productivity, and timeliness of reporting are areas where electronically encoded reports may enhance cancer registry processes. The accuracy and completeness of electronically encoded data appears largely comparable to text-based data, but subject to the degree of synchrony between the formats of text-based and electronic reports.


Assuntos
Registros Eletrônicos de Saúde , Controle de Formulários e Registros/métodos , Neoplasias/patologia , Patologia Clínica/métodos , Sistema de Registros , Sistemas de Informação em Laboratório Clínico , Humanos , Neoplasias/epidemiologia , Systematized Nomenclature of Medicine
14.
J Clin Oncol ; 26(31): 5074-7, 2008 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-18809610

RESUMO

PURPOSE: The National Cancer Institute (NCI) has historically evaluated the participation of underserved minorities within University of Pittsburgh Cancer Institute (UPCI) clinical trials in relation to the proportion of African Americans in the general population of the UPCI primary service area of Allegheny County (12%). This standard seemed to be unrealistically high as a result of a younger age distribution of African Americans within the county. METHODS: The proportions of African Americans within the following four separate county populations were compared using data from 2000 to 2004: general population; invasive cancer patients; invasive cancer patients diagnosed or treated at UPCI-affiliated facilities; and patients enrolled onto UPCI's clinical therapeutic trials. RESULTS: Although the proportion of African Americans within the general population was approximately 13%, only 9.8% of patients diagnosed with invasive cancers were African American. Approximately 9.5% of all cancer patients diagnosed or treated at UPCI facilities were African American, which is comparable to the county-wide percentage of African American cancer patients. Recruitment rate of African Americans to oncology clinical trials from within the UPCI patient population was 7.6%. The NCI benchmark did not reflect the actual invasive cancer incidence rate in African American patients. By comparing the percentage of African Americans contributing to cancer incidence with the percentage of African American cancer patients treated at research-affiliated institutions, a more appropriate benchmark was derived. CONCLUSION: The method developed by UPCI is recommended as a useful mechanism for benchmarking recruitment of African American cancer patients to clinical therapeutic trials at other cancer centers.


Assuntos
Afro-Americanos , Benchmarking , Ensaios Clínicos como Assunto/normas , Neoplasias/etnologia , Seleção de Pacientes , Afro-Americanos/estatística & dados numéricos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Humanos , National Cancer Institute (U.S.) , Invasividade Neoplásica , Neoplasias/patologia , Neoplasias/terapia , Pennsylvania/epidemiologia , Desenvolvimento de Programas , Estados Unidos/epidemiologia
15.
BMC Cancer ; 8: 236, 2008 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-18700971

RESUMO

BACKGROUND: Advances in translational research have led to the need for well characterized biospecimens for research. The National Mesothelioma Virtual Bank is an initiative which collects annotated datasets relevant to human mesothelioma to develop an enterprising biospecimen resource to fulfill researchers' need. METHODS: The National Mesothelioma Virtual Bank architecture is based on three major components: (a) common data elements (based on College of American Pathologists protocol and National North American Association of Central Cancer Registries standards), (b) clinical and epidemiologic data annotation, and (c) data query tools. These tools work interoperably to standardize the entire process of annotation. The National Mesothelioma Virtual Bank tool is based upon the caTISSUE Clinical Annotation Engine, developed by the University of Pittsburgh in cooperation with the Cancer Biomedical Informatics Grid (caBIG, see http://cabig.nci.nih.gov). This application provides a web-based system for annotating, importing and searching mesothelioma cases. The underlying information model is constructed utilizing Unified Modeling Language class diagrams, hierarchical relationships and Enterprise Architect software. RESULT: The database provides researchers real-time access to richly annotated specimens and integral information related to mesothelioma. The data disclosed is tightly regulated depending upon users' authorization and depending on the participating institute that is amenable to the local Institutional Review Board and regulation committee reviews. CONCLUSION: The National Mesothelioma Virtual Bank currently has over 600 annotated cases available for researchers that include paraffin embedded tissues, tissue microarrays, serum and genomic DNA. The National Mesothelioma Virtual Bank is a virtual biospecimen registry with robust translational biomedical informatics support to facilitate basic science, clinical, and translational research. Furthermore, it protects patient privacy by disclosing only de-identified datasets to assure that biospecimens can be made accessible to researchers.


Assuntos
Mesotelioma/diagnóstico , Mesotelioma/patologia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/patologia , Bancos de Tecidos , Biologia Computacional/métodos , DNA/metabolismo , Bases de Dados como Assunto , Humanos , National Institutes of Health (U.S.) , Análise de Sequência com Séries de Oligonucleotídeos , Parafina , Estudos Prospectivos , Estudos Retrospectivos , Software , Estados Unidos , Interface Usuário-Computador
16.
Cancer ; 113(7): 1705-15, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18683217

RESUMO

BACKGROUND: Honest broker services are essential for tissue- and data-based research. The honest broker provides a firewall between clinical and research activities. Clinical information is stripped of Health Insurance Portability and Accountability Act-denoted personal health identifiers. Research material may have linkage codes, precluding the identification of patients to researchers. The honest broker provides data derived from clinical and research sources. These data are for research use only, and there are rules in place that prohibit reidentification. Very rarely, the institutional review board (IRB) may allow recontact and develop a recontact plan with the honest broker. Certain databases are structured to serve a clinical and research function and incorporate 'real-time' updating of information. This complex process needs resolution of a variety of issues regarding the precise role of the HB and their interaction with data. There also is an obvious need for software solutions to make the task of deidentification easier. METHODS: The University of Pittsburgh has implemented a novel, IRB-approved mechanism to address honest broker functions to meet the specimen and data needs of researchers. The Tissue Bank stores biologic specimens. The Cancer Registry culls data and annotating information as part of state- and federal-mandated functions and collects data on the clinical progression, treatment, and outcomes of cancer patients. The Cancer Registry also has additional IRB approval to collect data elements only for research purposes. The Clinical Outcomes Group is involved in patient safety and health services research. Radiation Oncology and Medical Oncology provide critical treatment related information. Pathology and Oncology Informatics have designed software tools for querying availability of specimens, extracting data, and deidentifying specimens and annotating data for clinical and translational research. These entities partnered and submitted a joint IRB proposal to create an institutional honest broker facility. The employees of this conglomerate have honest broker agreements with the University of Pittsburgh and the Medical Center. This provides a large group of honest brokers, ensuring availability for projects without any conflict of interest. RESULTS: The honest broker system has been an IRB-approved institutional entity at the University of Pittsburgh since 2003. The honest broker system currently includes 33 certified honest brokers encompassing the multiple partners of this system. The honest broker system has handled >1600 requests over the past 4 years with a 25% increase in volume each year. CONCLUSIONS: The current results indicate that the collaborative honest broker model described herein is robust and provides a highly functional solution to the specimen and data needs for critical clinical and translational research activities.


Assuntos
Pesquisa Biomédica , Modelos Biológicos , Bancos de Tecidos , Confidencialidade , Comitês de Ética em Pesquisa , Health Insurance Portability and Accountability Act , Humanos , Aplicações da Informática Médica , Sistema de Registros , Bancos de Tecidos/ética , Estados Unidos
17.
BMC Cancer ; 8: 91, 2008 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-18397527

RESUMO

BACKGROUND: Recent advances in genomics, proteomics, and the increasing demands for biomarker validation studies have catalyzed changes in the landscape of cancer research, fueling the development of tissue banks for translational research. A result of this transformation is the need for sufficient quantities of clinically annotated and well-characterized biospecimens to support the growing needs of the cancer research community. Clinical annotation allows samples to be better matched to the research question at hand and ensures that experimental results are better understood and can be verified. To facilitate and standardize such annotation in bio-repositories, we have combined three accepted and complementary sets of data standards: the College of American Pathologists (CAP) Cancer Checklists, the protocols recommended by the Association of Directors of Anatomic and Surgical Pathology (ADASP) for pathology data, and the North American Association of Central Cancer Registry (NAACCR) elements for epidemiology, therapy and follow-up data. Combining these approaches creates a set of International Standards Organization (ISO) - compliant Common Data Elements (CDEs) for the mesothelioma tissue banking initiative supported by the National Institute for Occupational Safety and Health (NIOSH) of the Center for Disease Control and Prevention (CDC). METHODS: The purpose of the project is to develop a core set of data elements for annotating mesothelioma specimens, following standards established by the CAP checklist, ADASP cancer protocols, and the NAACCR elements. We have associated these elements with modeling architecture to enhance both syntactic and semantic interoperability. The system has a Java-based multi-tiered architecture based on Unified Modeling Language (UML). RESULTS: Common Data Elements were developed using controlled vocabulary, ontology and semantic modeling methodology. The CDEs for each case are of different types: demographic, epidemiologic data, clinical history, pathology data including block level annotation, and follow-up data including treatment, recurrence and vital status. The end result of such an effort would eventually provide an increased sample set to the researchers, and makes the system interoperable between institutions. CONCLUSION: The CAP, ADASP and the NAACCR elements represent widely established data elements that are utilized in many cancer centers. Herein, we have shown these representations can be combined and formalized to create a core set of annotations for banked mesothelioma specimens. Because these data elements are collected as part of the normal workflow of a medical center, data sets developed on the basis of these elements can be easily implemented and maintained.


Assuntos
Aplicações da Informática Médica , Mesotelioma , Neoplasias Pleurais , Bancos de Tecidos , Biologia Computacional , Bases de Dados como Assunto , Humanos , Software , Integração de Sistemas
18.
BMC Cancer ; 7: 144, 2007 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-17672904

RESUMO

BACKGROUND: Synoptic reporting, either as part of the pathology report or replacing some free text component incorporates standardized data elements in the form of checklists for pathology reporting. This ensures the pathologists make note of these findings in their reports, thereby improving the quality and uniformity of information in the pathology reports. METHODS: The purpose of this project is to develop the entire set of elements in the synoptic templates or "worksheets" for hematologic and lymphoid neoplasms using the World Health Organization (WHO) Classification and the College of American Pathologists (CAP) Cancer Checklists. The CAP checklists' content was supplemented with the most updated classification scheme (WHO classification), specimen details, staging as well as information on various ancillary techniques such as cytochemical studies, immunophenotyping, cytogenetics including Fluorescent In-situ Hybridization (FISH) studies and genotyping. We have used a digital synoptic reporting system as part of an existing laboratory information system (LIS), CoPathPlus, from Cerner DHT, Inc. The synoptic elements are presented as discrete data points, so that a data element such as tumor type is assigned from the synoptic value dictionary under the value of tumor type, allowing the user to search for just those cases that have that value point populated. RESULTS: These synoptic worksheets are implemented for use in our LIS. The data is stored as discrete data elements appear as an accession summary within the final pathology report. In addition, the synoptic data can be exported to research databases for linking pathological details on banked tissues. CONCLUSION: Synoptic reporting provides a structured method for entering the diagnostic as well as prognostic information for a particular pathology specimen or sample, thereby reducing transcription services and reducing specimen turnaround time. Furthermore, it provides accurate and consistent diagnostic information dictated by pathologists as a basis for appropriate therapeutic modalities. Using synoptic reports, consistent data elements with minimized typographical and transcription errors can be generated and placed in the LIS relational database, enabling quicker access to desired information and improved communication for appropriate cancer management. The templates will also eventually serve as a conduit for capturing and storing data in the virtual biorepository for translational research. Such uniformity of data lends itself to subsequent ease of data viewing and extraction, as demonstrated by rapid production of standardized, high-quality data from the hemopoietic and lymphoid neoplasm specimens.


Assuntos
Neoplasias Hematológicas/classificação , Linfoma/classificação , Patologia Clínica/normas , Organização Mundial da Saúde , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/epidemiologia , Humanos , Linfoma/diagnóstico , Linfoma/epidemiologia , Estados Unidos
19.
Adv Anat Pathol ; 14(5): 320-2, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17717431

RESUMO

Pathology informatics involves management and analysis of large complex data sets derived from various tests performed in clinical and anatomic pathology laboratories, annotated biorepositories, image analysis, telepathology, and large scale experiments, including gene expression analysis, proteomics, and tissue array studies. It facilitates intelligent use of computing technologies to improve patient care and understand the natural history of disease. Herein, we describe the various bioinformatics tools used to support translational research at the University of Pittsburgh Medical Center.


Assuntos
Pesquisa Biomédica , Aplicações da Informática Médica , Patologia Clínica/métodos , Patologia Cirúrgica/métodos , Humanos , Patologia Clínica/educação , Patologia Clínica/tendências , Patologia Cirúrgica/educação , Patologia Cirúrgica/tendências
20.
Ultrasound Q ; 21(1): 19-25, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15716755

RESUMO

Ultrasound guided intervention has become the preferred method to diagnose primary neoplasms and suspected metastatic disease. With developments in technology and changes in practice patterns, the types of referrals for ultrasound guided intervention will evolve. The purpose of this review is to highlight a variety of new or relatively new aspects of image guided biopsy and to focus on areas of growth.


Assuntos
Biópsia por Agulha/métodos , Hepatite C/patologia , Neoplasias/patologia , Ultrassonografia de Intervenção , Humanos
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