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McGinnis KA, Skanderson M, Justice AC, Tindle HA, Akgün KM, Wrona A, Freiberg MS, Goetz MB, Rodriguez-Barradas MC, Brown ST, Crothers KA. Using the biomarker cotinine and survey self-report to validate smoking data from United States Veterans Health Administration electronic health records. JAMIA Open 2022; 5:ooac040. [DOI: 10.1093/jamiaopen/ooac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Tobacco use/smoking for epidemiologic studies is often derived from electronic health record (EHR) data, which may be inaccurate. We previously compared smoking from the United States Veterans Health Administration (VHA) EHR clinical reminder data with survey data and found excellent agreement. However, the smoking clinical reminder items changed October 1, 2018. We sought to use the biomarker salivary cotinine (cotinine ≥30) to validate current smoking from multiple sources.
Materials and Methods
We included 323 Veterans Aging Cohort Study participants with cotinine, clinical reminder, and self-administered survey smoking data from October 1, 2018 to September 30, 2019. We included International Classification of Disease (ICD)-10 codes F17.21 and Z72.0. Operating characteristics and kappa statistics were calculated.
Results
Participants were mostly male (96%), African American (75%) and mean age was 63 years. Of those identified as currently smoking based on cotinine, 86%, 85%, and 51% were identified as currently smoking based on clinical reminder, survey, and ICD-10 codes, respectively. Of those identified as not currently smoking based on cotinine, 95%, 97%, and 97% were identified as not currently smoking based on clinical reminder, survey, and ICD-10 codes. Agreement with cotinine was substantial for clinical reminder (kappa = .81) and survey (kappa = .83), but only moderate for ICD-10 (kappa = .50).
Discussion
To determine current smoking, clinical reminder, and survey agreed well with cotinine, whereas ICD-10 codes did not. Clinical reminders could be used in other health systems to capture more accurate smoking information.
Conclusions
Clinical reminders are an excellent source for self-reported smoking status and are readily available in the VHA EHR.
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Affiliation(s)
| | | | - Amy C Justice
- VA Connecticut Healthcare System , West Haven, Connecticut, USA
- Department of Medicine, Yale University , New Haven, Connecticut, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC) , Nashville, Tennessee, USA
| | - Kathleen M Akgün
- Department of Medicine, Yale University , New Haven, Connecticut, USA
| | - Aleksandra Wrona
- VA Connecticut Healthcare System , West Haven, Connecticut, USA
- Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC) , Nashville, Tennessee, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC) , Nashville, Tennessee, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
- David Geffen School of Medicine at UCLA , Los Angeles, California, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Department of Medicine, Michael E. DeBakey VAMC, Baylor College of Medicine , Houston, Texas, USA
| | | | - Kristina A Crothers
- Department of Medicine, Harborview Medical Center, University of Washington , Seattle, Washington, USA
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Rhoads DD, Wrona A, Foutz A, Blevins J, Glisic K, Person M, Maddox RA, Belay ED, Schonberger LB, Tatsuoka C, Cohen ML, Appleby BS. Diagnosis of prion diseases by RT-QuIC results in improved surveillance. Neurology 2020; 95:e1017-e1026. [PMID: 32571851 DOI: 10.1212/wnl.0000000000010086] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present the National Prion Disease Pathology Surveillance Center's (NPDPSC's) experience using CSF real-time quaking-induced conversion (RT-QuIC) as a diagnostic test, to examine factors associated with false-negative RT-QuIC results, and to investigate the impact of RT-QuICs on prion disease surveillance. METHODS Between May 2015 and April 2018, the NPDPSC received 10,498 CSF specimens that were included in the study. Sensitivity and specificity analyses were performed on 567 autopsy-verified cases. Prion disease type, demographic characteristics, specimen color, and time variables were examined for association with RT-QuIC results. The effect of including positive RT-QuIC cases in prion disease surveillance was examined. RESULTS The diagnostic sensitivity and specificity of RT-QuIC across all prion diseases were 90.3% and 98.5%, respectively. Diagnostic sensitivity was lower for fatal familial insomnia, Gerstmann-Sträussler-Scheinker disease, sporadic fatal insomnia, variably protease sensitive prionopathy, and the VV1 and MM2 subtypes of sporadic Creutzfeldt-Jakob disease. Individuals with prion disease and negative RT-QuIC results were younger and had lower tau levels and nonelevated 14-3-3 levels compared to RT-QuIC-positive cases. Sensitivity was high throughout the disease course. Some cases that initially tested RT-QuIC negative had a subsequent specimen test positive. Including positive RT-QuIC cases in surveillance statistics increased laboratory-based case ascertainment of prion disease by 90% over autopsy alone. CONCLUSIONS RT-QuIC has high sensitivity and specificity for diagnosing prion diseases. Sensitivity limitations are associated with prion disease type, age, and related CSF diagnostic results. RT-QuIC greatly improves laboratory-based prion disease ascertainment for surveillance purposes. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that second-generation RT-QuIC identifies prion disease with a sensitivity of 90.3% and specificity of 98.5% among patients being screened for these diseases due to concerning symptoms.
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Affiliation(s)
- Daniel D Rhoads
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aleksandra Wrona
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Aaron Foutz
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janis Blevins
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kathleen Glisic
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marissa Person
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan A Maddox
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ermias D Belay
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lawrence B Schonberger
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Curtis Tatsuoka
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mark L Cohen
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian S Appleby
- From the National Prion Disease Pathology Surveillance Center (D.D.R., A.F., J.B., K.G., M.L.C., B.S.A.) and Department of Population and Quantitative Health Sciences (C.T.), Case Western Reserve University; Departments of Pathology (D.D.R., M.L.C., B.S.A.), Neurology (C.T., M.L.C., B.S.A.), and Psychiatry (B.S.A.), Case Western Reserve University/University Hospitals Cleveland Medical Center, OH; School of Public Health (A.W.), Yale University, New Haven, CT; and Division of High-Consequence Pathogens and Pathology (M.P., R.A.M., E.D.B., L.B.S.), National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
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Gadgeel S, Peters S, Mok T, Shaw AT, Kim DW, Ou SI, Pérol M, Wrona A, Novello S, Rosell R, Zeaiter A, Liu T, Nüesch E, Balas B, Camidge DR. Alectinib versus crizotinib in treatment-naive anaplastic lymphoma kinase-positive (ALK+) non-small-cell lung cancer: CNS efficacy results from the ALEX study. Ann Oncol 2019; 29:2214-2222. [PMID: 30215676 PMCID: PMC6290889 DOI: 10.1093/annonc/mdy405] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The phase III ALEX study in patients with treatment-naive advanced anaplastic lymphoma kinase mutation-positive (ALK+) non-small-cell lung cancer (NSCLC) met its primary end point of improved progression-free survival (PFS) with alectinib versus crizotinib. Here, we present detailed central nervous system (CNS) efficacy data from ALEX. Patients and methods Overall, 303 patients aged ≥18 years underwent 1:1 randomization to receive twice-daily doses of alectinib 600 mg or crizotinib 250 mg. Brain imaging was conducted in all patients at baseline and every subsequent 8 weeks. End points (analyzed by subgroup: patients with/without baseline CNS metastases; patients with/without prior radiotherapy) included PFS, CNS objective response rate (ORR), and time to CNS progression. Results In total, 122 patients had Independent Review Committee-assessed baseline CNS metastases (alectinib, n = 64; crizotinib, n = 58), 43 had measurable lesions (alectinib, n = 21; crizotinib, n = 22), and 46 had received prior radiotherapy (alectinib, n = 25; crizotinib, n = 21). Investigator-assessed PFS with alectinib was consistent between patients with baseline CNS metastases [hazard ratio (HR) 0.40, 95% confidence interval (CI): 0.25–0.64] and those without (HR 0.51, 95% CI: 0.33–0.80, P interaction = 0.36). Similar results were seen in patients regardless of prior radiotherapy. Time to CNS progression was significantly longer with alectinib versus crizotinib and comparable between patients with and without baseline CNS metastases (P < 0.0001). CNS ORR was 85.7% with alectinib versus 71.4% with crizotinib in patients who received prior radiotherapy and 78.6% versus 40.0%, respectively, in those who had not. Conclusion Alectinib demonstrated superior CNS activity and significantly delayed CNS progression versus crizotinib in patients with previously untreated, advanced ALK+ NSCLC, irrespective of prior CNS disease or radiotherapy. Clinical trial registration ClinicalTrials.gov NCT02075840
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Affiliation(s)
- S Gadgeel
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
| | - S Peters
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - T Mok
- Department of Clinical Oncology, State Key Laboratory of South China, Chinese University of Hong Kong, Shatin, Hong Kong
| | - A T Shaw
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - D W Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - S I Ou
- Irvine School of Medicine, Chao Family Comprehensive Cancer Center, University of California, Orange, USA
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - A Wrona
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - S Novello
- Department of Oncology, University of Turin, Turin, Italy
| | - R Rosell
- Catalan Institute of Oncology, Barcelona, Spain
| | - A Zeaiter
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - T Liu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - E Nüesch
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - B Balas
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - D R Camidge
- Division of Medical Oncology, University of Colorado, Aurora, USA
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