Search

PurposeA disconnect often exists between those with the expertise to manage and analyze complex, multi-source data sets, and the clinical, social services, advocacy, and public health professionals who can pose the most relevant questions and best apply the answers. We describe development and implementation of a cancer informatics infrastructure aimed at broadening the usability of community cancer data to inform cancer control research and practice; and we share lessons learned. MethodsWe built a multi-level database known as The Ohio Cancer Assessment and Surveillance Engine (OH-CASE) to link data from Ohio’s cancer registry with community data from the U.S. Census and other sources. Space- and place-based characteristics were assigned to individuals according to residential address. Stakeholder input informed development of an interface for generating queries based on geographic, demographic, and disease inputs and for outputting results aggregated at the state, county, municipality, or zip code levels. ResultsOH-CASE contains 723,410 patient records for Ohioans diagnosed with cancer from 1/1/2006 – 12/31/2017 across 88 counties containing 1215 municipalities and 1197 zip codes. Stakeholder feedback from cancer center community outreach teams, advocacy organizations, public health, and researchers suggests a broad range of uses of such multi-level data resources accessible via a user interface. ConclusionOH-CASE represents a prototype of a transportable model for curating and synthesizing data to understand cancer burden across communities. Beyond supporting collaborative research, this infrastructure can serve the clinical, social services, public health, and advocacy communities by enabling targeting of outreach, funding, and interventions to narrow cancer disparities.

Objectives Identify the incidence, rate of physician recognition, diagnostic practices and cancer outcomes for unintentional weight loss (UWL). Methods We completed a secondary analysis of structured and unstructured EHR data collected from adult patients between January 1, 2020 and December 31, 2021. We used four common definitions to define UWL, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy. Unstructured physicians’ notes were used to identify both intentional weight loss (e.g. dieting) as well as physician recognition of UWL. Cancer outcomes were identified within 12 months of UWL using diagnostic codes. Physician actions (lab tests, etc.) in response to UWL were identified through manual chart review. Results Among 29,494 established primary care patients with a minimum of two weight measurements in 2020 and in 2021, we identified 290 patients who met one or more criteria for UWL (1 %). UWL was recognized by physicians in only 60 (21 %). UWL was more common and more likely to be recognized among older patients. Diagnostic practices were quite variable. A complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the three most common tests ordered in response to UWL. Five patients were diagnosed with cancer within 12 months of UWL (3 in whom UWL was recognized; two in whom it was not.) Conclusions Unintentional weight loss is poorly recognized across a diverse range of patients. A lack of research-informed guidance may explain both low rates of recognition and variability in diagnostic practices.

Background Prophylactic antibiotics are used prior to TRUS PNB to reduce risk for infectious complications such as UTI, prostatitis, epididymitis, orchitis, bacteremia and sepsis. Fluoroquinolones have been commonly used for prophylaxis, however, the incidence of post TRUS PNB infections caused by fluoroquinolone resistant Escherichia coli has increased. The purpose of this study was to characterize the prophylaxis agents used nationwide in the Veterans Health Administration (VHA) prior to TRUS PNB. Methods We conducted a review of records of all patients undergoing TRUS PNB in the VHA database from January 1st, 2013 to December 31st, 2018. We collected data about outpatient oral prophylaxis antibiotics, inpatient injectable antibiotics and microbiology results from rectal swabs and urine cultures performed within 90 days prior to the procedure. Results Of 153,055 patients undergoing prostate biopsy between January 1st, 2013 and December 31st, 2018, 27.6% (n=42,319) had urine cultures and 3.9% (n=5,294) had rectal swab cultures done within the 90-day window prior to the procedure. Among these who had urine and rectal swabs culture, 3.0% (n=1,292) and 20.1% (n=1,062) were positive for E. coli, respectively; 40.2% of E. coli isolates recovered from urine and 89.6% recovered from rectal swabs were resistant to fluoroquinolones. Table 1 shows the frequencies and percentages of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure. Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Conclusion Despite the high rate of recovery of fluoroquinolone-resistant E. coli in pre-procedure urine and rectal swabs, oral fluoroquinolones remained the most frequently used prophylactic agents prior to TRUS PNB. This inadequate prophylactic coverage may increase the risk of infectious complications following prostate biopsy. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen: Advisor/Consultant.