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  • 1
    Online Resource
    Online Resource
    Icosapent Ethyl Reduces Ischemic Events in Patients With a History of Previous Coronary Artery Bypass Grafting: REDUCE-IT CABG
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. 23 ( 2021-12-07), p. 1845-1855
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. 23 ( 2021-12-07), p. 1845-1855
    Abstract: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92] ; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.121.056290
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients : 5-Year Outcomes of the SURTAVI Randomized Clinical Trial
    American Medical Association (AMA) ; 2022
    In:  JAMA Cardiology Vol. 7, No. 10 ( 2022-10-01), p. 1000-
    Details
    In: JAMA Cardiology, American Medical Association (AMA), Vol. 7, No. 10 ( 2022-10-01), p. 1000-
    Abstract: In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited. Objective To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial. Design, Setting, and Participants SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021. Intervention Patients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis. Main Outcomes and Measures The prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years. Results A total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P  =   .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P   & amp;lt; .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm 2 vs 1.8 [0.6] cm 2 ; P   & amp;lt; .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%] ; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P  = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%] ; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P   & amp;lt; .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%] ; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P  = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention. Conclusions and Relevance Among intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.
    Type of Medium: Online Resource
    ISSN: 2380-6583
    URL: Article
    DOI: 10.1001/jamacardio.2022.2695
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Biochemical Pathways and Modeling
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Clinical Obstetrics & Gynecology Vol. 64, No. 1 ( 2021-03), p. 12-19
    Details
    In: Clinical Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 64, No. 1 ( 2021-03), p. 12-19
    Abstract: The precise etiology of the biochemical changes and the resulting constellation of symptoms seen in polycystic ovary syndrome (PCOS) has remained a mystery. Despite advances in our knowledge, the pathogenesis and alterations in the biochemical pathways underlying this disease are still not fully understood. PCOS is a multifactorial syndrome where a combination of genetics, lifestyle, and hormone abnormalities all play an intertwining role. This article will provide an in-depth look at the multitude of biochemical pathways that are dysregulated in PCOS and their relation to alterations in female physiology.
    Type of Medium: Online Resource
    ISSN: 0009-9201
    URL: Article
    DOI: 10.1097/GRF.0000000000000583
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2047473-8
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  • 4
    Online Resource
    Online Resource
    Patients’ education about a new service available at Memorial Sloan Kettering Multidisciplinary Clinic for frail patients with central nervous system cancers.
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 34_suppl ( 2018-12-01), p. 146-146
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 34_suppl ( 2018-12-01), p. 146-146
    Abstract: 146 Background: A multidisciplinary clinic (MDC) is a pilot project in the MSK Department of Neurology designed to improve quality of care and patient satisfaction. The MDC enables the patient to receive coordinated care from multiple providers (eg a physical therapist, physiatrist, nutritionist, social worker, case manager, spiritual advisor, and neurologist) in one location in one longer visit. This approach is new, and few patients (pts) have had the opportunity to experience the MDC. We hypothesized that giving the patient information about the MDC will increase the MDC volume. Methods: This is a prospective quality improvement study from June 14, 2018 to July 20, 2018 conducted in four Neuro-Oncology clinics. Pts with primary or metastatic central nervous system (CNS) cancers were identified prior to the visits in their regular oncology clinic. Pts were asked if they were interested in receiving verbal or written information (brochure) about the MDC. For each patient, we recorded if they agreed to receive information, what information they received, and whether they scheduled an appointment at the MDC. We also recorded patient demographics, CNS cancer type, and whether they were accompanied by caregivers. Results: We approached 41 pts. Of the 41 pts, 31(74%) were accompanied by caregivers. Median patient age was 58 (range, 24-79) years. 26 (62%) were female. CNS cancers were primary brain tumors in 31 (76%) and brain metastases in 10 (24%). 27 (64%) of 41 pts agreed to receive both verbal information and a brochure. The remaining 14 (36%) pts did not want to receive more information about the MDC; of these, one patient didn’t take a brochure, 2 pts resided out of the country, and one patient said all needs had been addressed. Within 4 weeks of this pilot study four (15%) of 27 pts scheduled an appointment in the MDC clinic for upcoming dates. Conclusions: Among our pts with CNS tumors visiting their oncologists, 64% were willing to receive information about the MDC, four (15%) made an appointment with the MDC. More study is needed to facilitate education about and access to the MDC; to identify potential barriers; and to obtain longer follow-up.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2018.36.34_suppl.146
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 5
    Online Resource
    Online Resource
    A new model of care for patients with central nervous system cancers.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 15_suppl ( 2019-05-20), p. e18029-e18029
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 15_suppl ( 2019-05-20), p. e18029-e18029
    Abstract: e18029 Background: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Neurological impairments can transform relationship dynamics as loved ones become caregivers. These issues are difficult to address within a single outpatient oncology clinic. Methods: The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 08/2017 to 01/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. The MdCC team, comprised of a neurologist, nurse, physiatrist, physical therapist, social worker(SW), case manager(CM), dietitian(RD), and chaplain. During a 3-hour visit, MdCC providers saw each pt/caregiver. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Results: Seventy-six pts were seen: 37 were female, median age 60. Of these 76 pts, 63 had primary CNS cancers; glioblastoma (51%) and high-grade glioma (HGG) (29%). Fifty-five were receiving cancer-directed therapy at the time of MdCC. Over 70% had never seen a SW, CM, RD, or physiatrist prior to MdCC. Pts’ most commonly reported need was “not being able to do the things I used to do”; for caregivers it was “I need my partner to have an ongoing CM.” Seventy-four pts (97%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 70 (92%) which increased signed health care proxy forms by 11% and DNR orders by 3%. New/updated physical therapy was ordered for 48 pts (61%), orthotics for 8 (10%), and new equipment for 12 (15%). Five pts were referred to a food assistance program. Forty-five pts completed a satisfaction survey; of these, 96% were highly satisfied, and would recommend MdCC to others. Conclusions: Pts’/caregivers’ unmet needs were effectively identified and addressed in this new model, and an emphasis on supportive and coordinated care contributed to high pt/caregiver satisfaction. We therefore propose to offer this clinic for all pts with HGG to improve pts’ well-being, quality of care, and increase pt/caregiver satisfaction.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.15_suppl.e18029
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 6
    Online Resource
    Online Resource
    QOLP-12. A NOVEL MULTIDISCIPLINARY CARE CLINIC MODEL FOR FRAIL PATIENTS WITH CENTRAL NERVOUS SYSTEM MALIGNANCIES
    Oxford University Press (OUP) ; 2018
    In:  Neuro-Oncology Vol. 20, No. suppl_6 ( 2018-11-05), p. vi216-vi217
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 20, No. suppl_6 ( 2018-11-05), p. vi216-vi217
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noy148.898
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2094060-9
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  • 7
    Online Resource
    Online Resource
    QOLP-19. A NEW MODEL OF CARE FOR PATIENTS WITH CENTRAL NERVOUS SYSTEM CANCERS
    Oxford University Press (OUP) ; 2019
    In:  Neuro-Oncology Vol. 21, No. Supplement_6 ( 2019-11-11), p. vi201-vi201
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 21, No. Supplement_6 ( 2019-11-11), p. vi201-vi201
    Abstract: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Neurological impairments can transform relationship dynamics with caregivers. These issues are difficult to address within a single outpatient oncology clinic. The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 08/2017 to 04/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. The MdCC team: a neurologist, nurse, physiatrist (RM), physical therapist, social worker (SW), case manager (CM), dietitian (RD), and chaplain saw each pt/caregiver during a 3-hour visit. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Seventy-eight pts were seen: 39 were female, median age 59. Of these 78 pts, 65 had primary CNS cancers; predominantly glioblastoma (52%) and high-grade glioma (29%). Over 60% had never seen a SW, CM, RD, or physiatrist prior to MdCC. Seventy-six pts (97%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 72 (92%) which increased signed health care proxy forms by 17% and DNR orders by 6% at time or within a month post MdCC. New/updated physical therapy was ordered for 48 pts (61%), orthotics for 8 (10%), and new equipment for 12 (15%). 25 pts (32%) continued following with physiatrists. Forty-eight pts completed a satisfaction survey; of these, 96% were highly satisfied, and would recommend MdCC to others. Pts’/caregivers’ unmet needs were effectively identified and addressed in this new model, The presence of these providers at time of MdCC allows for real time assessment of pts’/caregivers’, their support system, multidisciplinary team collaboration, planning, coordination of community services and implementation of a safe patient centered plan of care.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noz175.839
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2094060-9
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  • 8
    Online Resource
    Online Resource
    New model of care for patients with central nervous system cancers.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 31_suppl ( 2019-11-01), p. 87-87
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 31_suppl ( 2019-11-01), p. 87-87
    Abstract: 87 Background: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Likewise, neurological impairments can transform pts’ relationship dynamics with caregivers. These issues, along with prognosis and end of care planning, are difficult to address within a single outpatient oncology clinic. Methods: The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 8/2017 to 6/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. Twice a month between 8/2017- 6/2019, a team comprised of a neurologist, nurse, physiatrist (RM), physical therapist, social worker (SW), case manager (CM), dietitian (RD), and chaplain (C) saw patients with neurological deficits and KPS ≤80. Within a 3 hour-visit, providers rotated in to see patients and their caregivers. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit, and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Results: Eighty-two pts with advanced cancer were seen: 40 were female, median age 59. Of these 82 pts, 66 had primary CNS cancers, predominantly high-grade glioma/glioblastoma (79%). Over 60% had never seen a CM, RM, RD or C prior to MdCC. Seventy-eight pts (95%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 75 pts (91%) which increased signed health care proxy forms by 16% and DNR orders by 6% at time or within a month post-MdCC. New/updated physical therapy was ordered for 50 pts (61%), orthotics for 10 (12%), and new equipment for 14 (17%). Forty-nine pts completed a satisfaction survey: of these, 96% were highly satisfied, and would recommend MdCC to others. Conclusions: Pts’/caregivers’ unmet needs were effectively identified and addressed within a single MdCC visit. The presence of several providers through MdCC allows for the assessment of pts’/caregivers’ needs and coping skills in real time. The MdCC also facilitates discussing pts’ goals of care, assessing their support system, and implementing a safe patient-centered plan of care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.31_suppl.87
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 9
    Online Resource
    Online Resource
    Marked Response of a Hypermutated ACTH-Secreting Pituitary Carcinoma to Ipilimumab and Nivolumab
    The Endocrine Society ; 2018
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 103, No. 10 ( 2018-10-01), p. 3925-3930
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 103, No. 10 ( 2018-10-01), p. 3925-3930
    Abstract: Pituitary carcinoma is a rare and aggressive malignancy with a poor prognosis and few effective treatment options. Case A 35-year-old woman presented with an aggressive ACTH-secreting pituitary adenoma that initially responded to concurrent temozolomide and capecitabine prior to metastasizing to the liver. Following treatment with ipilimumab and nivolumab, the tumor volume of the dominant liver metastasis reduced by 92%, and the recurrent intracranial disease regressed by 59%. Simultaneously, her plasma ACTH level decreased from 45,550 pg/mL to 66 pg/mL. Molecular Evaluation Both prospective clinical sequencing with Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets and retrospective whole-exome sequencing were performed to characterize the molecular alterations in the chemotherapy-naive pituitary adenoma and the temozolomide-resistant liver metastasis. The liver metastasis harbored a somatic mutational burden consistent with alkylator-induced hypermutation that was absent from the treatment-naive tumor. Resistance to temozolomide treatment, acquisition of new oncogenic drivers, and subsequent sensitivity to immunotherapy may be attributed to hypermutation. Conclusion Combination treatment with ipilimumab and nivolumab may be an effective treatment in pituitary carcinoma. Clinical sequencing of pituitary tumors that have relapsed following treatment with conventional chemotherapy may identify the development of therapy-induced somatic hypermutation, which may be associated with treatment response to immunotherapy.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/jc.2018-01347
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2018
    detail.hit.zdb_id: 2026217-6
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  • 10
    Online Resource
    Online Resource
    Neuroimaging Abnormalities with Hypoqlossal Nerve Palsies
    Wiley ; 1996
    In:  Journal of Neuroimaging Vol. 6, No. 4 ( 1996-10), p. 240-242
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 6, No. 4 ( 1996-10), p. 240-242
    Type of Medium: Online Resource
    ISSN: 1051-2284
    URL: Article
    DOI: 10.1111/jon199664240
    Language: English
    Publisher: Wiley
    Publication Date: 1996
    detail.hit.zdb_id: 2035400-9
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