Search

Sensitive to wounded histories, how do Christians and Jews befriend one another? Many will answer this question quite differently. One person feels an invitation to visit a synagogue, perhaps staying [...]

Background: Ursodeoxycholic acid (UDCA) treatment is associated with a reduced incidence of colonic neoplasia in preclinical models and in patients with conditions associated with an increased risk for colon cancer. We conducted a phase III, double-blind placebo-controlled trial of UDCA to evaluate its ability to prevent colorectal adenoma recurrence. Methods: We randomly assigned 1285 individuals who had undergone removal of a colorectal adenoma within the past 6 months to daily treatment with UDCA (8-10 mg/kg of body weight; 661 participants) or with placebo (624 participants) for 3 years or until follow-up colonoscopy. Recurrence rates (number of recurrent adenomas per unit time) were compared by use of a Huber-White variance estimator. Proportions of participants with one or more recurrent adenomas were compared with a Pearson chi-square statistic; adjusted odds ratios (ORs) were obtained by logistic regression. All statistical tests were two-sided. Results: We observed a non-statistically significant 12% reduction in the adenoma recurrence rate associated with UDCA treatment, compared with placebo treatment. However, UDCA treatment was associated with a statistically significant reduction (P = .03) in the recurrence of adenomas with high-grade dysplasia (adjusted OR = 0.61, 95% confidence interval = 0.39 to 0.96). We observed no statistically significant differences between UDCA and placebo groups in recurrence with regard to adenoma size, villous histology, or location. Conclusions: UDCA treatment was associated with a non-statistically significant reduction in total colorectal adenoma recurrence but with a statistically significant 39% reduction in recurrence of adenomas with high-grade dysplasia. Because severely dysplastic lesions have a high risk of progression to invasive colorectal carcinoma, this finding indicates that future chemoprevention trials of UDCA in individuals with such lesions should be considered.

Biomarker testing in oncology is fundamental for targeted therapy use and clinical trial participation. Factors contributing to previously identified racial disparities in biomarker testing remain unclear. This study investigated biomarker testing, clinical trial participation, and targeted therapy by race among patients with metastatic lung cancer with Medicaid coverage in the United States.

AbstractAimsThis study was designed to describe health care resource utilization (HCRU) of patients with metastatic colorectal cancer (CRC) or gastric cancer to test the hypothesis that greater treatment variability would be associated with increased HCRU.MethodsA retrospective observational study using Marketscan claims data was conducted. Eligible patients had a first diagnosis of metastatic CRC or gastric cancer between 2004 and 2015 and must have received systemic anti-cancer therapy after diagnosis. Treatment variability was measured using the Herfindahl-Hirschman Index (HHI). HHI scores were stratified by quartile. HCRU variables were evaluated throughout the follow-up period and described by 6-month periods. Chi-square test was used for categorical variables and ANOVA for continuous variables.ResultsA total of 55,403 CRC and 9,073 gastric cancer patients were eligible. First-line HHI scores ranged from 0.1304–0.2778 for CRC and 0.0383–0.1778 for gastric cancer by state of residence. Statistically significant differences by HHI quartiles for HCRU in CRC included hospitalizations (p = 0.0003), ER visits (p < 0.0001), ER visits leading to hospitalization (p < 0.0001), and supportive care (all agents studied, p < 0.01). For gastric cancer, significant differences by HHI quartile were observed for ER visits (p = 0.002) and selected supportive care (G-CSF, erythropoiesis-stimulating agents, bisphosphonates, nutritional support, and antiemetics, each p < 0.05). No consistent increasing or decreasing trends were observed across the quartiles for either cohort.LimitationsLarge sample sizes could lead to statistical significance without being clinically meaningful. High treatment heterogeneity in the gastric cancer cohort and lack of a homogeneous quartile for comparisons limited the ability to evaluate HCRU by different levels of treatment variability.ConclusionsStatistically significant relationships were observed between treatment variability as measured by HHI and increased HCRU, but no consistent directional trends in HCRU variables were observed. Therefore, this study failed to reject the null hypothesis of equivalent HCRU by level of treatment variability.

AbstractAims:The objective of this feasibility study was to determine the extent to which data from randomized controlled trials (RCTs) may serve as a useful source for collecting health care resource use (HCRU) for the purposes of estimating costs of managing adverse events (AEs), specifically, grade 3–4 nausea and thrombocytopenia, which may be experienced during chemotherapy treatment.Materials and Methods:The feasibility study was conducted in four steps: (1) HCRU data were extracted from patient narratives in four phase 3 RCTs in non–small cell lung cancer; (2) missing HCRU data were imputed; (3) unit costs were applied to the resulting HCRU data set and costs of managing AEs were estimated; and (4) the overall utility of using RCT data as a source for estimating costs of AEs was evaluated.Results:33 nausea and 68 thrombocytopenia AEs met eligibility criteria and were evaluated in this study. Medication usage was recorded as a treatment in 76% of nausea AEs, although only 14% of the instances of medication usage included the minimum data elements required for costing. Platelet transfusions were provided in 24% of thrombocytopenia AEs; however, in only one instance were the minimum data elements recorded. Of nausea and thrombocytopenia AEs, 18% and 72%, respectively, required no missing data assumptions or imputation.Limitations:Only two AEs were considered, and they may not be representative of all AEs in terms of suitability for use in estimating HCRU and costs of managing AEs. Not all grade 3–4 AEs met the criteria for requiring a patient narrative. HCRU data in the narratives were incomplete.Conclusions:The usefulness of RCTs for estimating the costs of AEs may be improved by using a standardized form to collect HCRU data for key AEs, including an appropriate level of detail required to estimate costs of managing the AEs.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2008.01.047 Byline: Lisa M. Hess (a), Joanne M. Jeter (a), Marge Benham-Hutchins (a)(b), David S. Alberts (a) Keywords: Bisphosphonates; Osteonecrosis of the jaw; Osteoporosis; Paget's disease Abstract: Bisphosphonates are medications that impact bone reformation by inhibiting osteoclast function. Osteonecrosis of the jaw has been reported among patients receiving these medications. It is unclear if the risk factors associated with osteonecrosis of the jaw among cancer patients taking bisphosphonates also are possible risk factors among patients receiving these medications for other indications. Author Affiliation: (a) College of Medicine, Arizona Cancer Center, University of Arizona, Tucson (b) College of Nursing, University of Arizona, Tucson. Article Note: (footnote) This work was supported in part by NCI grants P30-CA023074 and R25T-CA078447.

Background

Aim:A comparison of conventional pairwise propensity score matching (PSM) and generalized PSM method was applied to the comparative effectiveness of multiple treatment options for lung cancer. Materials & methods:Deidentified data were analyzed. Covariate balances between compared treatments were assessed before and after PSM. Cox proportional hazards regression compared overall survival after PSM. Results & conclusion:The generalized PSM analyses were able to retain 61.2 of patients, while the conventional PSM analyses were able to match from 24.1 to 77.1 of patients from each treatment comparison. The generalized PSM achieved statistical significance (p < 0.05) in 8/10 comparisons, whereas conventional pairwise PSM achieved 1/10. The noted differences arose from different matched patient samples and the size of the samples.

AbstractBackground:Lung cancer is one of the most prevalent cancers in the US. This study was designed to evaluate the actual drug wastage and cost to the healthcare system using patient-level retrospective observational electronic medical record (EMR) data from a cohort of lung cancer patients in the US.Methods:Data from the Flatiron Health advanced non-small cell lung cancer (NSCLC) cohort was used for this study. Drug administered amount (in mg) was used to determine an optimal set of available vial sizes to minimize waste. Drug wastage was defined as the difference between the drug amount in the optimal set of vials and the administered amount. Wholesale acquisition costs were used to value the cost of drugs, with and without vial sharing assumptions. The amount and cost of waste were quantified over the 2-year study period (January 2015–December 2016).Results:There were 8,467 eligible patients included in this study, providing data from 103,826 unique drug administrations across multiple lines of therapy. Overall wastage was 4.37% of the total medication used to care for patients. While costs per administration were low, the total cost of wastage for the study population represented $16,630,112 across the 2-year study period. Assuming that vial sharing occurred at the site level slightly reduced waste to 3.74% (reducing costs to $15,953,212 over 2 years).Conclusions:Drug wastage is an important concern and has implications on healthcare costs in NSCLC. Evaluation of these real-world data suggest that pharmacists and physicians are able to reduce drug wastage by optimizing vial combinations and sharing vials among patients. Even small amounts of reduction in wastage could be useful in reducing healthcare costs in the US; however, caution is needed with drug rounding efforts to ensure patients do not receive a sub-optimal dose of medication.

Aim:To develop a claims-based prediction model of poor performance status (PS) in commercially insured and Medicare supplemental beneficiaries with cancer. Patients & methods:Retrospective analysis was conducted of electronic medical records (EMR) from community oncology practices linked to MarketScan claims. Multivariable logistic regression predicted PS scores from the EMR using claims-based diagnostic and procedure codes. Results:The study included 8442 patients diagnosed with cancer from 2007 to 2015. Overall, 8.1 of patients had poor EMR-based PS. Bootstrapping results from the final model showed sensitivity and specificity of approximately 75 with a predicted probability cutpoint  0.078, c-statistic  0.821 and pseudo-R2 0.25. Conclusion:Patients with poor PS can be identified in claims data. This prediction model enables future studies evaluating cancer treatments and outcomes to account for PS.

This article explores the toxic dynamics of our public sphere today through a lens of the inner, soul-psychological work necessary to alter human reactivity to the sensations of fear. It employs a playful term, shadowdancing, (i) to invite curiosity into what we do not know that we do not know, (ii) to deepen our perceptions of self and other through the natural and avoidant use of projection, and (iii) to examine the ancient-new wisdom of the circle way as a “container” in which to lean into the collective dance of shadow and projection. Rooted in Jungian and object-relations psychological perspectives, each term is defined and examined in the hope of inviting fear to become a pathway to transformation within, and in circle-way gatherings of those willing. Guiding principles of invitation, not obligation; every voice is equal; catching courage from one another; and presume goodwillattempt to pique interest in finding ancient and new ways of becoming more and more conscious, and less and less reactive to the overwhelming flows of fear in our world today.

AbstractAims:The objective of this study was to quantify the current and to project future patient and insurer costs for the care of patients with non-small cell lung cancer in the US.Materials and methods:An analysis of administrative claims data among patients diagnosed with non-small cell lung cancer from 2007–2015 was conducted. Future costs were projected through 2040 based on these data using autoregressive models.Results:Analysis of claims data found the average total cost of care during first- and second-line therapy was $1,161.70 and $561.80 for patients, and $45,175.70 and $26,201.40 for insurers, respectively. By 2040, the average total patient out-of-pocket costs are projected to reach $3,047.67 for first-line and $2,211.33 for second-line therapy, and insurance will pay an average of $131,262.39 for first-line and $75,062.23 for second-line therapy.Limitations:Claims data are not collected for research purposes; therefore, there may be errors in entry and coding. Additionally, claims data do not contain important clinical factors, such as stage of disease at diagnosis, tumor histology, or data on disease progression, which may have important implications on the cost of care.Conclusions:The trajectory of the cost of lung cancer care is growing. This study estimates that the cost of care may double by 2040, with the greatest proportion of increase in patient out-of-pocket costs. Despite the average cost projections, these results suggest that a small sub-set of patients with very high costs could be at even greater risk in the future.

Re: 'Navy Woman Dies in Motorcycle Crash' (Summer 2004) I am deeply bothered by your recent article in the Sea&Shore magazine due to the inaccurate reporting of the accident. First, [...]

NSCLC is a solid tumor with a growing number of actionable biomarkers that may inform treatment. Current guidelines recommend a broad, panel-based approach be taken to identify actionable markers. This retrospective study used a deidentified electronic health records database in the United States to evaluate utilization of various testing modalities.

The study evaluated the diagnostic value and cost-effectiveness of next generation sequencing (NGS)-based testing versus various combinations of single-gene tests (SGT) for the selection of first-line treatment for patients with advanced/metastatic non-squamous non-small cell lung cancer (NSCLC) in the US.

Background: A variety of measures have been developed to calculate refill adherence from administrative data such as pharmacy claims databases. These measures have focused on improving the accuracy of adherence measures or clarifying the evaluation time frame. As a result, there are many measures used to assess adherence that may or may not be comparable or accurate.Objective: To compare available refill adherence measures.Methods: A systematic literature review was conducted to identify current or recently used measures of calculating adherence from administrative data. A MEDLINE search (January 1990–March 2006) was undertaken using the search terms adherence or compliance in the title combined with administrative, pharmacy, or records in any field, including subheadings medical, nursing, and hospital records. Non-English articles were excluded. Seven hundred fifteen articles were available for review. Review articles and letters were excluded from measure selection, but were included in the search terms and used to identify additional research articles. Adherence measures were excluded if they were incompletely described, produced non-numeric values, or were duplicates. Eleven refill adherence measures were identified and compared using data from the LOSE Weight (Long-term Outcomes of Sibutramine Effectiveness on Weight) study. Measures compared include Continuous Measure of Medication Acquisition (CMA); Continuous Multiple Interval Measure of Oversupply (CMOS); Medication Possession Ratio (MPR); Medication Refill Adherence (MRA); Continuous Measure of Medication Gaps (CMG); Continuous, Single Interval Measure of Medication Aquisition (CSA); Proportion of Days Covered (PDC); Refill Compliance Rate (RCR); Medication Possession Ratio, modified (MPRm); Dates Between Fills Adherence Rate (DBR); and Compliance Rate (CR).Results: The results suggest that the CMA, CMOS, MPR, and MRA are identical in terms of measuring adherence to prescription refills throughout the study period, each with a value of 63.5%; CMG and PDC are slightly lower (63.0%) and are equivalent to MRA when oversupply is truncated. CR, MPRm, RCR, and CSA result in higher adherence values of 84.4%, 86.6%, 104.8%, and 109.7%, respectively.Conclusions: Five measures produce equivalent results for measuring prescription refill adherence over the evaluation period. Of these, MRA has the fewest calculations, is easily truncated if one desires to exclude surplus medication issues, and requires the least amount of data. MRA is therefore recommended as the preferred measure of adherence using administrative data.

Background:Patients with mantle cell lymphoma (MCL) have limited treatment options following covalent BTK inhibitor (cBTKi) therapy, with no standard regimens defined. The aim of this study was to investigate real-world treatment patterns and the outcomes for patients with MCL following cBTKi treatment utilizing two separate datasets - one from the US and one from Japan.

This retrospective observational study was designed to evaluate overall survival in a real-world patient population and to identify predictive factors associated with receipt of second-line therapy. A retrospective analysis of electronic medical records (Flatiron Health, New York) was conducted among patients initiating first-line therapy from January 1, 2013, through April 30, 2018. Eligible patients were diagnosed with advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma and ≥18 years of age at the time of treatment initiation. Patients alive 45 days after discontinuation of first-line therapy were considered potentially eligible for continued therapy and were categorized into those who received and those who did not receive second-line therapy. Survival analyses were conducted using Kaplan-Meier method and log-rank test without adjusting for any baseline covariates. Factors associated with further treatment were evaluated using logistic regression. A total of 3850 patients met eligibility criteria. Among the 2516 patients available to receive second-line therapy, 1515 (60.2%) received second-line therapy and 1001 (39.8%) did not receive further therapy. Among those potentially eligible to receive second-line therapy, median survival was 15.4 months (95% confidence interval [CI]: 14.6-16.0) from initiation of first-line therapy for those who received second-line therapy and 10.0 months (95% CI: 9.3-10.7) for those who did not. Longer duration of first-line therapy (≥169 vs ≤84 days), HER2-positive tumors, initially diagnosed with stage IV disease, less weight loss during first-line therapy, and younger age were associated with receipt of second-line therapy (all P< .001). Longer survival was associated with multiple lines of therapy; however, these results should be interpreted with caution, and no causal relationship can be inferred.

The author reflects on the concept of "The Story" in the Bible which is a living word. She suggests that "The Story" works best in times of trouble bringing people closer to one another. According to her, it is a path, a way of life, and not just Christian education which reciprocates good for evil and shows grace and hope in the face of hopeless situations. However, she opines that one must continuously struggle to learn more about God.

The article offers insights into the use of technology at the time of Jesus Christ's great commission to his followers. There was a suspicion about the familiarity of Jesus with techne in regard to carpentry and the useful beauty of woodworking. Today, argument goes within congregation about the potential of technology in threatening the authenticity of human relationships.

The author reflects on ethics of caritas and the public church in the U.S. She commented on the purpose of communal listening to the Spirit's intent and teaching for lives of confessional Christian discipleship. The author also discusses the relation of the church and theology in the context of religious domain.

The article relates the author's experience and insights on the motivation of the Christian denomination to participate in peace activism. She ponders on the subject and on the her weariness of words in services of Christian worship. She felt an intense feeling of anger after becoming aware of the inherent dehumanization of Christians. Yet the author has learned and understood the disciplines of peaceful resistance to one's environment.

The article discusses a creative approach towards fruitful renewal in spirituality and congregational life. The author has tried to suggest and apply fly-fishing as one of the practices in continuing education events. It was observed that such event has led participants to exert effort towards supportive spiritual renewal.

This article presents information on the importance of rituals for Catholics. The author recounts her participation in an ordination of Roman Catholic women to the priesthood. In contrast to many contemporary associations with worship, the pillars of import, for the author's consideration, now emerge as lives of integrity and the power of ritual. The author observes that the catholic community refuses to sacrifice the depth of ritual in the face of strictures about proper worship. The author found herself engaged in the question of ritual observance and symbolic action. She tries to find answers about ritual that empowers, challenges, nurtures and sustains.

Considers the question about the monetary aspect of stewardship. Binds of stewardship within congregational life; Issues of esteem that relate to stewardship; Characteristics of an authentic understanding of stewardship.

Reflects on the role of religious leaders in working with their faith community. Planning for ministry in the church; Theologian Rusty Reno's advice on planning; Howard Thurman's poem "The Work of Christmas" which offers a description of a vision for church.

The article focuses on practices of faith and the logic of Spirit. Pastoral educators face the challenges of the "too big" and "too small" in the life of the Spirit. Craig Dykstra names this educational challenge in his book "Growing in the Life of Faith: Education and Christian Practices," published in 1999. He reminds us all that the prospect of reaching/learning a whole way of life, the means by which we come to know and trust God, is rightfully too big for any educator in a community of faith.

Looks into the use of technology in your ministry and worship service. Access to a global perspective; Development of literacy and patriarchal cultures; Ability of technology to lure the attention of participants away from shared relationships with God.