Personalized Medicine and Genomics

An emerging model of health care delivery that uses genetic information to customize a patient’s treatment.

Utilization and Outcomes of Sentinel Lymph Node Biopsy in Patients With Early Stage Vulvar Cancer

Nov. 26, 2020

Catherine E. Hermann, Dimitrios Nasioudis, Spyridon A. Mastroyannis, Nawar A. Latif, Ashley F. Haggerty, Robert L. Giuntoli Ii, Lori Cory, Sarah H. Kim, Mark A. Morgan, Emily M. Ko

Abstract [from journal]

Objective: A retrospective cohort study comparing survival and perioperative outcomes of patients with early vulvar cancer who underwent sentinel lymph node biopsy versus standard lymphadenectomy METHODS: Patients diagnosed between January 2012 and December 2015 with vulvar squamous cell carcinoma of less than 4 cm in size, with invasion of at least 1 mm, who underwent sentinel lymph node biopsy, lymphadenectomy, or both were identified from the National Cancer Database. Overall survival was evaluated following

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Alzheimer’s Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis

Jeffrey H. Silber, MD, PhD
Nov. 17, 2020

Jeffrey H. SilberPaul R. Rosenbaum, Joseph G. Reiter, Alexander S. Hill, Siddharth Jain, David A. Wolk, Dylan S. Small, Sean Hashemi, Bijan A. Niknam, Mark D. NeumanLee A. Fleisher, Roderic...

Abstract [from journal]

Objective: To determine if surgery and anesthesia in the elderly may promote Alzheimer's Disease and Related Dementias (ADRD).

Background: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations.

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Racial-Ethnic Disparities In Diabetes Technology Use Among Young Adults With Type 1 Diabetes

Shivani Agarwal, MD, MPH, University of Pennsylvania
Nov. 6, 2020

Shivani Agarwal, Clyde Schechter, Jeffrey Gonzalez, Judith A. Long

Abstract [from journal]

Background: Recent studies highlight racial-ethnic disparities in insulin pump and continuous glucose monitor (CGM) use in people with type 1 diabetes (T1D), but drivers of disparities remain poorly understood beyond socioeconomic status (SES).

Methods: We recruited a diverse sample of young adults (YA) with T1D from six diabetes centers across the U.S., enrolling equal numbers of Non-Hispanic (NH) White, NH Black, and Hispanic YA. We used multivariate logistic regression to examine to what

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Studying Social Media Language Changes Associated With Pregnancy Status, Trimester, And Parity From Medical Records

Sharath Chandra Guntuku, PhD
Oct. 8, 2020

Sharath Chandra GuntukuJessica S. Gaulton, Emily K. Seltzer, David A AschSindhu K. Srinivas, Lyle H. Ungar, Christina Mancheno, Elissa V Klinger, Raina M. Merchant

Abstract [from journal]

We sought to evaluate whether there was variability in language used on social media across different time points of pregnancy (before, during, and after pregnancy, as well as by trimester and parity). Consenting patients shared access to their individual Facebook posts and electronic medical records. Random forest models trained on Facebook posts could differentiate first trimester of pregnancy from 3 months before pregnancy (F1 score = .63) and from a random 3-month time period (F1 score = .64). Posts during pregnancy were more

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Effect Of Passive Choice and Active Choice Interventions in the Electronic Health Record to Cardiologists On Statin Prescribing: A Cluster Randomized Clinical Trial

Oct. 7, 2020

Srinath Adusumalli, Julie E. Westover, Douglas S. Jacoby, Dylan S. Small, Christine VanZandbergen, Jessica Chen, Ann M. Cavella, Rebecca Pepe, Charles A. L. Rareshide, Christopher K. Snider, Kevin G. VolppDavid A. Asch, ...

Abstract [from journal]

Importance: Statin therapy is underused for many patients who could benefit.

Objective: To evaluate the effect of passive choice and active choice interventions in the electronic health record (EHR) to promote guideline-directed statin therapy.

Design, setting, and participants: Three-arm randomized clinical trial with a 6-month preintervention period and 6-month intervention. Randomization conducted at the cardiologist level at 16 cardiology practices in Pennsylvania

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Initial Testing of a Web-based Intervention to Reduce Adolescent Driver Inattention: A Randomized Controlled Trial,

Oct. 3, 2020

Catherine C. McDonald, Jamison D. Fargo, Jennifer Swope, Kristina B. Metzger, Marilyn S. Sommers

Abstract [from journal]

Introduction: Motor vehicle crashes are the leading cause of adolescent death. Inattention to the roadway contributes to crash risk. The objective of this study was to deploy an initial study of a web-based intervention (Let's Choose Ourselves) designed to improve adolescent driver attention to the roadway.

Methods: We used a randomized controlled trial design in a sample of adolescent drivers to test if a web-based intervention decreased cell phone engagement in driving simulation at 3 months

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Heart Transplant Waiting List Implications of Increased Ventricular Assist Device Use as a Bridge Strategy: A National Analysis

Oct. 1, 2020

Jason J. Han, Hadi Elzayn, Matthew M. Duda, Amit Iyengar, Andrew M. Acker, William L. Patrick, Mark Helmers, Edo Y. Birati, Pavan Atluri

Abstract [from journal]

Background: The use of ventricular assist devices (VAD) as a bridge to heart transplant (HT) is increasing, while HT volume remains stagnant. This may portend longer waiting times and an otherwise more competitive environment for all patients on the HT waiting list.

Methods: A retrospective analysis of patients who were listed for HT in the United Network for Organ Sharing (UNOS) database from 2000 to 2015 was conducted. Mean waiting time, proportion of HT reception (%HT), proportion of death

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Validation Of A Machine Learning Algorithm To Predict 180-Day Mortality For Outpatients With Cancer

Sep. 24, 2020

Christopher R. Manz, Jinbo Chen, Manqing Liu, Corey Chivers, Susan Harkness Regli, Jennifer Braun, Michael Draugelis, C. William Hanson, Lawrence N. Shulman, Lynn M. Schuchter, Nina O'Connor, Justin E. BekelmanMitesh S. PatelRavi B....

Abstract [from journal]

Importance: Machine learning (ML) algorithms can identify patients with cancer at risk of short-term mortality to inform treatment and advance care planning. However, no ML mortality risk prediction algorithm has been prospectively validated in oncology or compared with routinely used prognostic indices.

Objective: To validate an electronic health record-embedded ML algorithm that generated real-time predictions of 180-day mortality risk in a general oncology cohort.

Design,

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One Call Makes A Difference: An Evaluation Of The Alzheimer's Association National Helpline On Dementia Caregiver Outcomes

Sep. 23, 2020

Nancy A. Hodgson, Darina V. Petrovsky, Kerry Finegan, Beth A. Kallmyer, Joanne Pike, Sam Fazio

Abstract

Objective: The study evaluated the effects of care consultation delivered through the Alzheimer's Association National Helpline - a free resource in which master's-level clinicians offer confidential support. The study compared the effectiveness of Helpline "Care Consultation" and "Care Consultation Plus" conditions on caller outcomes.

Methods: Four hundred and forty-five non-crisis callers were randomly assigned to the traditional Helpline "Care Consultation" or a "Care Consultation Plus" condition that

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A Randomized Trial of Theory-Informed Appeals for Organ Donor Registration Using Internet Advertisements

Ankur Shah, MD
Sep. 12, 2020

Peter P. ReeseKaren GlanzAnkur Shah, Adam Mussell, Simona Levsky, Lester Shuda, Justine Shults, Judd B. Kessler

Abstract [from journal]

Introduction: Many people do not register as organ donors. We developed 5 different brief appeals for organ donation that were disseminated online. The content was informed by theories of behavior change and studies of the specific cognitive barriers to organ donor registration.

Methods: One message was a persuasive narrative about a transplant recipient. Another message promoted the idea that organ donor registration is a social norm. The knowledge-based message communicated that 1 donor

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A Text Messaging Intervention With Financial Incentive For Adolescents With Type 1 Diabetes

Aug. 30, 2020

Tara Kaushal, Lorraine E. Levitt Katz, Janet Joseph, Michelle Marowitz, Knashawn H. Morales, Daniel Atkins, Dean Ritter, Reid Simon, Lori Laffel, Terri H. Lipman

Abstract [from journal]

Background: Adolescents with type 1 diabetes (T1D) have higher hemoglobin A1C (HbA1c) levels than others. In general, adolescents engage with text messaging (TM) and financial incentives, both associated with improved diabetes outcomes. This study aimed to assess the impact of a TM intervention with financial incentives on self-care behaviors and HbA1c.

Methods: A six-month randomized controlled trial compared MyDiaText™, a TM education and support application, with standard care. The sample

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Characteristics Of Twitter Use By State Medicaid Programs In The United States: Machine Learning Approach

Aug. 17, 2020

Jane M. Zhu, Abeed Sarker, Sarah Gollust, Raina MerchantDavid Grande

Abstract [from journal]

Background: Twitter is a potentially valuable tool for public health officials and state Medicaid programs in the United States, which provide public health insurance to 72 million Americans.

Objective: We aim to characterize how Medicaid agencies and managed care organization (MCO) health plans are using Twitter to communicate with the public.

Methods: Using Twitter's public application programming interface, we collected 158,714 public posts ("tweets") from active

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Effects Of Dual Antiplatelet Therapy On Graft Patency After Lower Extremity Bypass

Grace Wang, MD
Aug. 7, 2020

Nathan Belkin, Jordan B. Stoecker, Benjamin M. Jackson, Scott M. Damrauer, Julia Glaser, Venkat Kalapatapu, Michael A. Golden, Grace J. Wang

Abstract [from journal]

Objective: Current guidelines recommend single agent antiplatelet therapy for patients with symptomatic peripheral arterial disease and for consideration of dual antiplatelet therapy (DAPT) after surgical revascularization. The objective of this study was both to explore prescribing patterns of single versus dual antiplatelet therapy after lower extremity bypass surgery, and to investigate the effects of antiplatelet therapy on bypass graft patency.

Methods: A retrospective analysis of

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Reduction Of Postoperative Opioid Use After Elective Spine And Peripheral Nerve Surgery Using An Enhanced Recovery After Surgery Program

Aug. 6, 2020

Tracy M. Flanders, Joseph Ifrach, Saurabh Sinha, Disha S. Joshi, Ali K. Ozturk, Neil R. Malhotra, Rachel Pessoa, Michael J. Kallan, Lee A. FleisherMichael A. Ashburn, Eileen Maloney, William C. Welch, Zarina S. Ali

Abstract [from journal]

Objective: Enhanced recovery after surgery (ERAS) pathways have previously been shown to be feasible and safe in elective spinal procedures. As publications on ERAS pathways have recently emerged in elective neurosurgery, long-term outcomes are limited. We report on our 18-month experience with an ERAS pathway in elective spinal surgery.

Methods: A historical cohort of 149 consecutive patients was identified as the control group, and 1,141 patients were prospectively enrolled in an ERAS

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The Contemporary Landscape Of Genetic Testing And Breast Cancer: Emerging Issues

Jul. 20, 2020

Payal D. Shah, Susan M. Domchek

Abstract [from journal]

The landscape of genetic testing for breast cancer susceptibility has transformed dramatically over the last decade and a half. Traditionally, the process of genetic testing resided fully within a medical infrastructure, from identification of appropriate testing candidates to gene selection to risk mitigation recommendations. More recently, decreasing costs, advancing technology, and a growing understanding of therapeutic implications of certain genetic test results have led to more widespread uptake of testing that increasingly

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