Evaluation Of Clinical Impact Research Articles

Transportation assistance in gynecologic oncology: A pilot study.

206 Background: Patients who experience transportation barriers to cancer care are less likely to receive optimal treatment and more likely to have delays in care. Our objective was to assess the prevalence of transportation barriers and the impact of a transportation intervention in gynecologic cancer care. Methods: We prospectively screen patients seen at new visits and at clinical trial enrollment in the 5 University of Pennsylvania gynecologic oncology practices for transportation barriers to cancer care. Patients who screen positive are referred to the intervention program, a ride-sharing service through RideHealth. Rides are available to and from clinic visits, to and from chemotherapy or radiation sessions, or to surgical procedures. There are no income or insurance restrictions on transportation assistance; per federal regulation, patients had to live within 40 miles of their oncology practice to receive transportation. Results: From June 2022 to April 2023, 1200 patients were screened. Of these, 34 screened positive for transportation barriers. All of those who screened positive accepted ride-sharing services. Two patients who screened positive were not eligible for ridesharing as they lived greater than 40 miles from our practices. Two patients who screened positive had transportation benefits available through their health insurance and were redirected to those services. We have provided 193 rides for 30 identified patients. The average length of ride was 9.2 miles (range 2.4-14), and the average cost per month was $1,200. Evaluation of clinical impact is ongoing. Conclusions: Transportation assistance is highly acceptable to patients and can facilitate access to cancer care.

Abstract 98: The somatic mutational landscape of the mitochondrial genome in prostate cancer: evaluation of clinical impact

Abstract Prostate cancer remains the most prevalent and second most lethal non-skin cancer in men. Whole genome studies have provided important insights into specific driver genes, however most of these studies have not assessed one key portion of the genome: the mitochondrial genome. To gain a complete understanding of the most commonly-diagnosed sub-groups of prostate cancer: low- and intermediate-risk localized disease, we surveyed the mitochondrial genomes from next-generation sequencing (NGS) data of over 300 tumour samples from prostate cancer patients. These samples were mainly from prostate cancer patients with clinical Gleason Scores of 3+3, 3+4 and 4+3. All had at least 5 years of follow-up data (median > 8 years), allowing identification of clinical associations with identified somatic mutations via Cox Proportional Hazards modeling and machine-learning. Recurrent somatic mutations in mtDNA were identified, and these were associated with clinical outcomes. One third of patients were found to have a somatic mtDNA mutation. These mutations appear to be associated with age of patient. The mtDNA region with the majority of mutations was the regulatory D-loop region, although certain proteins had high numbers of mutations. Those somatic mutations occurring within the coding regions in general were nonsynonymous. Specific identified candidate somatic mutations were validated via Sanger sequencing. Clinical associations between somatic were also integrated with existing copy-number alteration (CNA) biomarkers using machine learning methods to evaluate performance. mtDNA mutations were also compared to identified aberrations (CNA, PGA, SNVs) within the nuclear genome to determine correlations between the two genomes, in addition to other somatic mutations or altered-expression in nuclear-encoded mitochondrial proteins. Taken together, these data demonstrate a key role for mitochondrial mutations in driving prostate cancer. Citation Format: Julia F. Hopkins, Veronica Y. Sabelnykova, John Watson, Lawrence E. Heisler, Junyan Zhang, Michael Fraser, Theodorus van der Kwast, Robert G. Bristow, Paul C. Boutros. The somatic mutational landscape of the mitochondrial genome in prostate cancer: evaluation of clinical impact. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 98.

Evaluating Research for Clinical Significance: Using Critically Appraised Topics to Enhance Evidence-based Neuropsychology

Meehl’s (1973, Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press) distinction between statistical and clinical significance holds special relevance for evidence-based neuropsychological practice. Meehl argued that despite attaining statistical significance, many published findings have limited practical value since they do not inform clinical care. In the context of an ever expanding clinical research literature, accessible methods to evaluate clinical impact are needed. The method of Critically Appraised Topics (Straus, Richardson, Glasziou, & Haynes, 2011, Evidence-based medicine: How to practice and teach EBM (4th ed.). Edinburgh: Elsevier Churchill-Livingstone) was developed to provide clinicians with a “toolkit” to facilitate implementation of evidence-based practice. We illustrate the Critically Appraised Topics method using a dementia screening example. We argue that the skills practiced through critical appraisal provide clinicians with methods to: (1) evaluate the clinical relevance of new or unfamiliar research findings with a focus on patient benefit, (2) help focus of research quality, and (3) incorporate evaluation of clinical impact into educational and professional development activities.

Assessing new strategies for TB diagnosis in low- and middle-income countries

In this manuscript, we report the current situation of tuberculosis globally and in Brazil, the need for new strategies toward tuberculosis control, focusing on new diagnostic technologies. Critical comments are given on the state of the art regarding the evaluation of new health technologies, degree of scientific evidence needed, evaluation of clinical impact, cost-effectiveness of incorporation into the health system and the social impact.

Identification of Potential Biomarkers for Giant Cell Tumor of Bone Using Comparative Proteomics Analysis

Giant cell tumor of bone can be locally aggressive and occasionally can metastasize in the lungs. To identify new markers predictive of aggressive behavior, we analyzed five patients who developed lung metastasis and five who remained disease free for a minimum of 5 years. Using two-dimensional electrophoresis, we detected 28 differentially expressed spots. Fourteen spots were identified using mass spectrometry, including seven up-regulated and seven down-regulated in metastatic samples and classified according to functional categories. We then selected five proteins involved in cell cycle or apoptosis. Thioredoxin peroxidase, allograft inflammatory factor 1, and ubiquitin E2N had more than threefold up-regulation; glutathione peroxidase 1 had 1.9-fold up-regulation; and heat shock protein 27 showed down-regulation in metastatic samples with a very low P value. After validation and analysis of protein levels, evaluation of clinical impact was assessed in a much wider cohort of primary archival specimens. Immunodetection showed a higher frequency of thioredoxin peroxidase, allograft inflammatory factor 1, ubiquitin E2N, and glutathione peroxidase 1 overexpression in primary tumors that developed into lung metastases or that locally relapsed than in the disease-free group, with variable stain intensity and distribution. Kaplan-Meier analysis showed that high expression of glutathione peroxidase 1 was strongly related to local recurrence and metastasis, suggesting that its up-regulation may identify a subset of high-risk patients with giant cell tumor prone to receive diverse clinical management.

初発大腸癌手術症例２７例のＦＤＧ‐ＰＥＴに関する検討

FDG-PET検査を術前に施行した27例の初発大腸癌手術症例を対象に臨床病理学的因子(肉眼分類深達度,組織型,大きさ)についてPETの有用性を検討した.それぞれについて,統計学的な有意差は認められなかったものの,PET陽性率は肉眼分類では2型(90%),4型(100%)が高く,深達度ではsmでも66%と比較的高い結果となった.また,大きさでは40mm以上の症例で陰性例が存在した.さらに,病理組織学的にリンパ節転移を認めた標本のリンパ節と癌部の大きさを計測したところ,リンパ節の大きさはPET検査において:重要である可能性が示唆された.

Computer-assisted clinical decision support systems

This review deals with the historical evolution and methodological basis of computerized medical decision support tools. It also reviews the verification, validation and impact evaluation methods of these systems. The acceptability of them from the health professionals depends on the pro-activity and usefulness of the systems, between other factors. The clinical impact evaluation methods are described in deep detail and the Hunt et al review of 1998 is updated.