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Oluwole OO, Dholaria B, Knight TE, Jain T, Locke FL, Ramsdell L, Nikiforow S, Hashmi H, Mooney K, Bhaskar ST, Morris K, Gatwood K, Baer B, Anderson LD, Hamadani M. Chimeric Antigen Receptor T-Cell Therapy in the Outpatient Setting: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Transplant Cell Ther 2024; 30:131-142. [PMID: 37951502 DOI: 10.1016/j.jtct.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
The first series of chimeric antigen receptor T (CAR-T) cell therapy products were approved in 2017 to 2019 and have shown remarkable efficacy in both clinical trials and the real-world setting, but at the cost of prolonged patient hospitalization. As the toxicity management protocols were refined, the concept of cellular therapy administered in the outpatient setting gained steam, and single institutions began to perform certain aspects of CAR-T monitoring in the outpatient setting for select patients. However, there are many considerations for a successful outpatient program. In anticipation of increasing use of CAR-T-cell therapy in the outpatient setting as a mechanism to overcome frequent hospital bed shortages and high cost of inpatient care, the American Society for Transplantation and Cellular Therapy convened a group of experts in hematology, oncology, and cellular therapy to provide a comprehensive review of the existing publications on outpatient CAR-T cell therapy, discuss selected ongoing clinical trials of outpatient CAR-T, and describe strategies to optimize safety without compromising efficacy for patients treated and monitored in the outpatient setting.
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Affiliation(s)
- Olalekan O Oluwole
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Bhagirathbhai Dholaria
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tristan E Knight
- Cancer and Blood Disorders Center, Seattle Children's Hospital - Seattle, Washington; Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Washington School of Medicine - Seattle, Washington
| | - Tania Jain
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Linda Ramsdell
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sarah Nikiforow
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, South Carolina
| | - Kathy Mooney
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shakthi T Bhaskar
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katrina Morris
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katie Gatwood
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brittney Baer
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapies Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ly A, Sanber K, Tsai HL, Ondo A, Mooney K, Shedeck A, Baker J, Imus PH, Wagner-Johnston N, Jain T. Outpatient CD19-directed CAR T-cell therapy is feasible in patients of all ages. Br J Haematol 2023; 203:688-692. [PMID: 37642134 DOI: 10.1111/bjh.19090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Andrew Ly
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khaled Sanber
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hua-Ling Tsai
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela Ondo
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathy Mooney
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Audra Shedeck
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie Baker
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Philip Hollingsworth Imus
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nina Wagner-Johnston
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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Sanber K, Ly A, Ondo A, Mooney K, Baker J, Shedeck A, Wagner-Johnston N, Jain T. Outpatient CD28-costimulated CAR T-cells for B-cell malignancies with CNS involvement. Am J Hematol 2023; 98:E301-E304. [PMID: 37539824 DOI: 10.1002/ajh.27051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Khaled Sanber
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Ly
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela Ondo
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathy Mooney
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie Baker
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Audra Shedeck
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nina Wagner-Johnston
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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Choi W, Nourzadeh H, Chen Y, Ainsley C, Desai V, Kubli A, Vinogradskiy Y, Mooney K, Werner-Wasik M, Mueller A. Novel Deep Learning Segmentation Models for Accurate GTV and OAR Segmentation in MR-Guided Adaptive Radiotherapy for Pancreatic Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e462. [PMID: 37785478 DOI: 10.1016/j.ijrobp.2023.06.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) MR-guided adaptive radiotherapy (MRgART) improves target coverage and organ-at-risk (OAR) sparing in pancreatic cancer radiation therapy (RT). Inter-fractional changes in patients undergoing RT require time intensive re-delineation of gross tumor volume (GTV) and OARs prior to adaptive optimization. Accurate automatic segmentation has the potential to significantly improve efficiency of the adaptive workflow. We hypothesized that state-of-the-art deep learning (DL) segmentation models could adequately segment GTV and OARs in both planning and daily fractional MR scans. MATERIALS/METHODS The study included 21 patients with pancreatic cancer treated with MRgART (10 Gy x 5 fractions). The planning MR as well as all daily MR images and registrations were collected (6 image sets per patient and a total of 126 image sets). The planning MR and fraction 1-4 image sets were used as the training set (N = 105), while the test set (N = 21) comprised images for fraction 5, to simulate the last step of incremental learning from planning to final fraction. Evaluated contours included the GTV, Small Bowel, Large Bowel, Duodenum, Left and Right Kidney, Liver, Spinal Cord, and Stomach. To mimic clinical conditions, contour accuracy was evaluated within the ring structure surrounding the PTV, inside of which daily adaptive re-contouring is applied (2 cm expansion in the cradio-caudal direction, 3 cm expansion otherwise). We evaluated three DL model architectures: SegResNet, SegResNet 2D, and SwinUNETR to autosegment GTV and OARs. The segmentation models were trained on the training set using 5-fold cross-validation (CV) and quantitatively analyzed by comparing against clinically used contours with DICE scores. Qualitative analysis was performed by a radiation oncologist using a scoring scale: 1 = perfect, 2 = minor discrepancy, 3 = moderate discrepancy, and 4 = rejected. RESULTS Overall, the DL segmentations were in acceptable agreement with clinical contours. The best performing model was the SwinUNETR model with overall training DICE = 0.88±0.06, test DICE = 0.78±0.11, and qualitative score of 1.6±0.8. The agreement between the DL model and clinical segmentation for the GTV was 0.79±0.08, with a qualitative score of 2.2±0.9. The highest and lowest OAR DICE scores were for the Left Kidney (DICE = 0.93) and Small Bowel (DICE = 0.68), respectively. The highest qualitative OAR scores were for the Kidney, Liver, and Spinal Cord (score = 1.0) and the lowest qualitative score was for the Duodenum (score = 2.3) CONCLUSION: We report here the most comprehensive work on DL segmentation for pancreatic cancer MRgART, including quantitative and clinically-pertinent qualitative evaluations of 126 image sets and 3 DL architectures. Our data show good quantitative agreement between DL and clinical contours, and acceptable clinician evaluations for the majority of GTVs and OARs. The current work has great potential to significantly reduce a major bottleneck in the MRgART workflow for pancreatic cancer patients.
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Affiliation(s)
- W Choi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - H Nourzadeh
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - C Ainsley
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - V Desai
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - A Kubli
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Y Vinogradskiy
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - K Mooney
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - M Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Poiset SJ, Laufer T, Anne PR, Mooney K, Werner-Wasik M, Posey JA, Bashir B, Lin D, Basu-Mallick A, Lavu H, Yeo CJ, Mueller A. Early Outcomes of MR-Guided SBRT for Patients with Recurrent Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e333-e334. [PMID: 37785174 DOI: 10.1016/j.ijrobp.2023.06.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Local treatment options for patients with locally recurrent pancreatic adenocarcinoma (L-PAC) are limited, with expected median survival time (MST) of 8-11 months (mo) following recurrence. MRI-guided radiation therapy (MRgRT) provides the ability to dose escalate while sparing normal tissue. The literature for MR-guided Stereotactic Body Radiotherapy (MRgSBRT) for L-PAC is sparse. Here we report on the early outcomes of MRgSBRT in patients with L-PAC. MATERIALS/METHODS Patients with prior resection of pancreatic adenocarcinoma with post-operative chemotherapy as indicated followed by local recurrence of disease at prior surgical site and treated with MRgSBRT at a single tertiary referral center from 5-2021 to 8-2022 for L-PAC were identified from our prospective database. MRgSBRT was delivered to 40-50 Gy in 4-5 fractions with target and OAR delineation per institutional standards. Descriptive analysis of the patient, disease, and treatment characteristics were performed. Endpoints included local control, defined as absence of tumor progression per RECIST criteria, distant failure, overall survival (OS), and acute and chronic toxicities per Common Terminology Criteria for Adverse Events (CTCAE), version 5. RESULTS Eleven patients with L-PAC were identified with median follow-up of 10.7 mo (3.2 - 22.3). Ten of those underwent surgical resection at the treating radiation facility and one patient underwent preoperative radiation for 50.4 Gy in 28 fractions followed by surgical resection at an outside hospital. MRgRT was delivered a median of 18.8 mo (3.5 - 48.0) following resection. There were 5 females and 6 males, with a median age of 72 years (52-83) and median KPS of 80 (60-100). OS rates following initial diagnosis at 12, 18 and 24 mo were 100%, 82%, and 61%, respectively, with an MST of 25.3 mo (12.4-53.1). OS rates following recurrence at 6 and 12 mo were 82% and 52%, respectively, with an MST of 10.7 mo (3.2 - 21.9). One patient experienced local failure at 7.8 mo, and 9 patients experienced distant failure at a median of 3.4 mo (0.3 - 21.9) following MRgSBRT. Five patients experienced distant failure less than 3 mo following radiation. Grade 1 or 2 acute GI toxicity was noted in 45% of patients and chronic GI toxicity, in 18% of patients. No Grade≥3 AEs were noted. CONCLUSION MRgSBRT for recurrent pancreatic adenocarcinoma demonstrates good local control with acceptable acute and chronic toxicity as well as reasonable overall survival. Distant failure remains a substantial problem with a significant number of patients demonstrating metastases immediately following radiation, suggesting the presence of micro-metastatic disease prior to local therapy. Adequate patient selection for MRgSBRT, and proper integration of systemic therapy in this patient population remains a topic of discussion that requires further exploration.
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Affiliation(s)
- S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - T Laufer
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - P R Anne
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - K Mooney
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - M Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - J A Posey
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - B Bashir
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - D Lin
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - A Basu-Mallick
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - H Lavu
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - C J Yeo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - A Mueller
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Bybee S, Cloyes K, Mooney K, Supiano K, Baucom B, Ellington L. Posttraumatic growth and life course stress predict dyadic wellbeing among sexual and gender minority (SGM) and non-SGM couples facing cancer. Psychooncology 2022; 31:1860-1868. [PMID: 36151881 PMCID: PMC10550009 DOI: 10.1002/pon.6036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined: (1) Differences among sexual and gender minority (SGM) and non-SGM couples' life course stress, posttraumatic growth (PTG), individual, and dyadic wellbeing while facing cancer, (2) The predictive ability of PTG and life course stress on wellbeing for each dyad member, and (3) The predictive ability of dyad-level PTG and dyad-level life course stress on dyadic wellbeing. METHODS Thirty SGM and 30 non-SGM dyads (N = 60) completed measures assessing demographics, life course stress, PTG, individual, and dyadic wellbeing. Regression and multilevel models tested predictive hypotheses. RESULTS Participants were 56.3 years old on average (SD = 13.6) and were together for 24.2 (SD = 14.9) years. SGM participants reported greater life course stress and higher scores on the Depression, Anxiety, and Stress Scales (DASS-21) than non-SGM participants. A dyad members' higher PTG predicted their partners' higher DASS-21 score, dyad members' higher life course stress predicted their own higher DASS-21 score, and patients' higher life course stress predicted their partners' higher DASS-21 score. Greater dyadic PTG predicted greater dyadic wellbeing. CONCLUSIONS SGM and non-SGM couples experience PTG equally despite SGM couples' greater life course stress and higher DASS-21 scores. Future research is needed to explore how PTG may affect individuals and couples differently.
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Affiliation(s)
- S. Bybee
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K.G. Cloyes
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K. Mooney
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - K.P. Supiano
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
| | - B.R.W. Baucom
- The University of Utah Department of Psychology, 380 S 1530 E, Salt Lake City, UT 84112
| | - L. Ellington
- The University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT 84112
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Mooney K, Iacob E, Donaldson G. 1565P Predictive elements of cancer treatment symptom burden and the effectiveness of symptom treatment approaches. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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8
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Gladstone DE, Kim BS, Mooney K, Karaba AH, D'Alessio FR. Regulatory T Cells for Treating Patients With COVID-19 and Acute Respiratory Distress Syndrome: Two Case Reports. Ann Intern Med 2020; 173:852-853. [PMID: 32628535 PMCID: PMC7370819 DOI: 10.7326/l20-0681] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland (D.E.G., K.M.)
| | - Bo Soo Kim
- Johns Hopkins University School of Medicine, Baltimore, Maryland (B.S.K., A.H.K., F.R.D.)
| | - Kathy Mooney
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland (D.E.G., K.M.)
| | - Andrew H Karaba
- Johns Hopkins University School of Medicine, Baltimore, Maryland (B.S.K., A.H.K., F.R.D.)
| | - Franco R D'Alessio
- Johns Hopkins University School of Medicine, Baltimore, Maryland (B.S.K., A.H.K., F.R.D.)
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Padilla L, Burmeister J, Burnett O, Covington E, Den R, Dominello M, Du K, Galavis P, Junell S, Kahn J, Kishore M, Mooney K, Studenski M, Yechieli R, Fields E. Interprofessional Image Verification Workshop for Physician and Physics Residents: A Multi-Institutional Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Jackowich R, Hecht E, Mooney K, Pukall C. 106 Online Pelvic Floor Physical Therapy Group Program for Women with Persistent Genital Arousal Disorder: A Descriptive Feasibility Study. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yang R, Mooney K. INCIDENCE OF AND RISK FACTORS FOR FALLS IN CANCER PATIENTS RECEIVING CHEMOTHERAPY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R. Yang
- University of Utah, Salt Lake City, Utah
| | - K. Mooney
- University of Utah, Salt Lake City, Utah
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Addy C, Mooney K, Moore J, Crossan A, Hanna S, Ryan C, Brown V, Downey D. IPD2.06 Development of a regional monitoring system for Inhaled Antibiotic collection as a measure of adherence. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Addy C, Mooney K, Moore J, Crossan A, Hanna S, Ryan C, Brown V, Downey D. IPD2.04 Assessing the clinical impact of motivational interviewing on inhaled antibiotic (IA) adherence in CF. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Cohen AL, Factor RE, Mooney K, Wade M, Serpico V, Salama M, Nelson E, Porretta J, Matsen C, Ostrander E, Bernard P, Boucher K, Neumayer L. Abstract P2-10-05: PowerPIINC trial: Changes in tumor proliferation index and quality of life with 7 days of preoperative tamoxifen. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-10-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: A decrease in Ki67 has been shown to be a predictor of response to tamoxifen. Previous trials have shown a decreased Ki67 proliferation index in breast tumors with as little as 2 weeks of preoperative tamoxifen. However, shortening the preoperative treatment time in window of opportunity studies increases patient acceptance for trial participation. The POWERPIINC trial examined the effect of 7 days of preoperative tamoxifen on breast tumor proliferation and patient symptoms.
METHODS: Adult women with untreated stage I or II invasive breast cancer that was ER positive (>1%) planning on breast surgery with no contraindications to tamoxifen were enrolled. Women received 20mg of tamoxifen for 7 days up to the day of surgery and for 14 days afterwards. Proliferation was assessed by Ki67 immunohistochemistry before and after 7 days of tamoxifen. The proliferation genes from the PAM50 were also assessed by RT-PCR. Symptoms and QOL were assessed by the FACT-ES, MENQoL, and BMQ.
RESULTS: 52 women were enrolled, and 44 were evaluable for Ki67. The median age was 58.5 years, and the median tumor diameter was 1.2cm. Most women (73%) were post-menopausal. Most tumors were PR positive (88%). Only 8% of tumors were HER2-positive. The Ki67 decreased by a geometric mean of 40% (95% CI 29%-63%), and 73% (95% CI 57%-85%) of women had tumors with decreased proliferation after 7 days of tamoxifen (p=0.0001 by paired t-test). No correlation was seen between the change in Ki-67 and change in FACT-ES or MENQoL scores. Women reported minimal to no bother from psychosocial or physical symptoms at baseline or on the day of surgery. Expression level of individual proliferation genes did not change after 7 days of tamoxifen.
CONCLUSION: Seven days of tamoxifen showed a similar relative decrease in the Ki67 proliferation index as that reported for longer courses. Therefore, short window of opportunity trials can be informative.
Citation Format: Cohen AL, Factor RE, Mooney K, Wade M, Serpico V, Salama M, Nelson E, Porretta J, Matsen C, Ostrander E, Bernard P, Boucher K, Neumayer L. PowerPIINC trial: Changes in tumor proliferation index and quality of life with 7 days of preoperative tamoxifen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-10-05.
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Affiliation(s)
- AL Cohen
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - RE Factor
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - K Mooney
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - M Wade
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - V Serpico
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - M Salama
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - E Nelson
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - J Porretta
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - C Matsen
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - E Ostrander
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - P Bernard
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - K Boucher
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
| | - L Neumayer
- University of Utah, Salt Lake City, UT; University of Arizona, Tucson, AZ
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Mooney K, Beck S, Echeverria C, Donaldson G. The impact of an automated, telephone-based coaching module on the adoption of an exercise program for cancer chemotherapy patients experiencing symptoms. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Early warning scoring systems are tools for nurses to help monitor their patients and improve how quickly a patient experiencing a sudden decline receives clinical care. Nurse leaders and frontline staff at a major academic medical center implemented a new early warning system that gives clear guidelines to nurses, nursing assistants, and other clinicians about vital-sign parameters and changes in patients' mental status.
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Andreozzi J, Mooney K, Bruza P, Curcuru A, Saunders S, Gladstone D, Pogue B, Green O. TU-AB-BRA-12: Quality Assurance of An Integrated Magnetic Resonance Image Guided Adaptive Radiotherapy Machine Using Cherenkov Imaging. Med Phys 2016. [DOI: 10.1118/1.4957422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mooney K, Zhao T, Duan Y, Zhang M, Green O, Mutic S, Yang D. TU-AB-202-06: Quantitative Evaluation of Deformable Image Registration in MRI-Guided Adaptive Radiation Therapy. Med Phys 2016. [DOI: 10.1118/1.4957428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Mooney K, Ryan C, Downey D. ePS03.5 Adherence monitoring in cystic fibrosis centres: Current practice and pharmacists’ perspectives. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mooney K, Yaddanapudi S, Mutic S, Goddu S. SU-E-T-249: Determining the Sensitivity of Beam Profile Parameters for Detecting Energy Changes in Flattening Filter-Free Beams. Med Phys 2015. [DOI: 10.1118/1.4924611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Mooney K, Altman M, Garcia-Ramirez J, Thomas M, Zoberi I, Mullen D, DeWees T, Esthappan J. SU-F-BRA-14: Optimization of Dosimetric Guidelines for Accelerated Partial Breast Irradiation (APBI) Using the Strut-Adjusted Volume Implant (SAVI). Med Phys 2015. [DOI: 10.1118/1.4925225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mooney K, Chen S, Feigenberg S, Sharma N, D'Souza W. Determining the Internal Margin (IM) for Lung and Gastrointestinal Tumors Based on Real-Time Measurements. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zhang H, Malinowski K, Mooney K, DSouza W. The Accuracy of Intrafraction Tumor Motion Modeling With Respiratory Surrogates Using Supervised Learning. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shi X, Lin J, Diwanji T, Mooney K, D' Souza W, Mistry N. SU-E-J-108: Template Matching Based On Multiple Templates Can Improve the Tumor Tracking Performance When There Is Large Tumor Deformation. Med Phys 2014. [DOI: 10.1118/1.4888160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Mooney K, Mistry N, Diwanji T, Lin J, Shi X, Regine W, D' Souza W. WE-G-17A-02: MRI-Based Lung Tumor Tracking with Navigator Echo Pulses. Med Phys 2014. [DOI: 10.1118/1.4889504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Neumayer L, Mooney K, Factor R, Salama M, Cohen A, Serpico V, Fletcher D, Bernard P, Nelson E, McGreevy J. Abstract OT3-2-02: PreOperative window of endocrine therapy provides information to increase compliance: POWER PIINC: A feasibility study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot3-2-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The addition of systemic therapy to the surgical treatment of breast cancer has improved survival of patients. A mainstay of systemic therapy in the setting of hormone receptor positive breast cancer is endocrine therapy. Despite the known advantages, the compliance with short and long term systemic endocrine therapy is less than ideal. Several studies report significant rates of non-compliance with endocrine therapy, either in patients never starting the medication or not completing the recommended multi-year course. It is estimated that as many as 10% of patients per year discontinue their therapy. We wondered why women would forgo such an important part of their treatment and how we might intervene to improve compliance. Using information gleaned from POWER PIINC, we hope to design a behavioral intervention study to see if the patient knowing her tumor's preoperative response to endocrine therapy will improve long term compliance. In order to do such a study we would need to define the minimal length of preoperative endocrine therapy needed to detect measurable changes in the tumor.
After 14 days of endocrine therapy, significant decreases in Ki67 can be seen in most hormone sensitive breast cancers. In fact two current studies are using this information (POETIC and ADAPT trials). Both of these trials are being conducted outside of the U.S. where operative therapy does not typically occur within a week or two of seeing the surgeon. POWER PIINC is a feasibility study to determine if we can detect changes in Ki67 with only 7 days of therapy. The results of POWER PIINC will inform the behavioral intervention trial.
Trial Design: This is a prospective, single-arm feasibility study. Participants take tamoxifen for 7 days prior to surgery. Ki67 is measured pre (core biopsy) and post (surgical specimen) tamoxifen.
Eligibility critieria: Non-pregnant women age 18 or older with a hormone positive (>1% ER or PR) clinical Stage 1 or 2 breast cancer who are candidates for surgical therapy of their breast cancer. No concurrent CYP2D6 inhibitors or other contraindications to tamoxifen.
Specific Aims:
Primary Objective:
Demonstrate a significant reduction in Ki67 expression in tumors with 7 days of pre-surgical tamoxifen.
Secondary Objectives:
- Evaluate symptom patterns from baseline through 18 months of follow-up (presence, severity, and bother)
-Evaluate 18-month endocrine therapy adherence
-Evaluate change in attitude regarding endocrine therapy
-Evaluate correlation between changes in Ki67 expression and symptom scores
-Evaluate additional changes in proliferative markers (subset of PAM 50)
Statistical Methods: A one-sample t-test will be applied to the log-ratio of Ki67 at resection to pre therapy. If this ratio is not normally distributed we will use a non-parametric Wilcoxon test. Secondary objectives will be analyzed using a variety of appropriate statistical tests.
Accrual: Target accrual is 52 patients over 18 months. We opened this study in August of 2012. To date (9 months) we have accrued 23 patients.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT3-2-02.
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Affiliation(s)
- L Neumayer
- Huntsman Cancer Institute, Salt Lake City, UT
| | - K Mooney
- Huntsman Cancer Institute, Salt Lake City, UT
| | - R Factor
- Huntsman Cancer Institute, Salt Lake City, UT
| | - M Salama
- Huntsman Cancer Institute, Salt Lake City, UT
| | - A Cohen
- Huntsman Cancer Institute, Salt Lake City, UT
| | - V Serpico
- Huntsman Cancer Institute, Salt Lake City, UT
| | - D Fletcher
- Huntsman Cancer Institute, Salt Lake City, UT
| | - P Bernard
- Huntsman Cancer Institute, Salt Lake City, UT
| | - E Nelson
- Huntsman Cancer Institute, Salt Lake City, UT
| | - J McGreevy
- Huntsman Cancer Institute, Salt Lake City, UT
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Mooney K, Lasio G, Lu W, Feigenberg S, Regine W, D'Souza W. An Approximate Entropy-Based Method for Prediction of 4D-CT Quality From Respiratory Signals. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mooney K, Chen S, Feigenberg S, Sharma N, D'Souza W. A Population-Based Treatment Margin for Respiratory Motion of Lung Tumors. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mooney K, Chen S, Feigenberg S, D' Souza W. SU-C-141-03: Assessing ITV and PTV Coverage for Mobile Tumors with Real-Time Fluoroscopy Imaging. Med Phys 2013. [DOI: 10.1118/1.4813963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shi X, Diwanji T, Mooney K, D' Souza W, Mistry N. TH-C-141-10: Error of Template Matching for Tracking Tumor Motion Is No Larger Than Inter-Operator Variability. Med Phys 2013. [DOI: 10.1118/1.4815778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Olsen MM, Wilt M, Van de castle B, Mooney K, Cohen M, Taffe E, Swisher M, McCready J, Daniel D, Krumm S, Chen ARS. An electronic chemotherapy administration safety checklist: The safe transition from paper to computer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
303 Background: This abstract describes the successful implementation of an electronic chemotherapy administration safety checklist and the outcomes that led to further enhancement of safe chemotherapy administration. The purpose of this abstract is to give an overview of the processes in transitioning from a paper checklist to an electronic version. Following the implementation of a paper chemotherapy administration safety checklist in 2002, this cancer center realized a significant reduction in chemotherapy errors reaching patients. The checklist became a model for many practitioners across the U.S. Our implementation of the Sunrise computerized provider order entry (CPOE) system in oncology inpatient units in 10/2009 included support for all of the 2009 ASCO/ONS chemotherapy ordering standards, and featured a two-way interface with the pharmacy system, and an electronic medication administration record. In the 12 months following its deployment, the rate of chemotherapy errors that reached the patient fell from 2.71 per 100 chemotherapy admissions using our paper system to 1.11 per 100 chemotherapy admissions using CPOE. With the advent of electronic documentation it became apparent that the paper checklist was outdated. Methods: An electronic chemotherapy checklist was implemented, replacing a paper version that had been in use for almost a decade. The proper design and implementation of the electronic version were essential to ensure that the safety achieved with the paper checklist was not compromised. After pilot testing, the checklist was implemented. Results: The electronic chemotherapy checklist was accepted by staff and resulted in a decrease in errors reaching the patient. Conclusions: The safe administration of chemotherapy is the number one priority at our cancer center. To our surprise the electronic checklist has been a welcomed addition to our armamentarium against chemotherapy errors. The checklist has enhanced independent safety checks due to required independent sign-on of the electronic system. The checklist also heightened awareness of chemotherapy safety checks, which were unchanged, leading us to believe that the paper version had become somewhat ineffective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Allen Ray Sing Chen
- The Armstrong Institute for Patient Safety and Quality and The Sidney Kimmel Comprehensive Cancer Center at The Johns Hopkins University, Baltimore, MD
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Shultz R, Mooney K, Anderson S, Marcello B, Garza D, Matheson GO, Besier T. Functional movement screen: inter-rater and subject reliability. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brown C, Mooney K. P102 The symptom experience of a patient treated for cancer. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Perinatal transmission of HIV accounts for almost all new HIV infections in children. There is an increased risk of perinatal transmission of HIV with maternal illicit substance abuse. Little is known about neonatal immune system alteration and subsequent susceptibility to HIV infection after morphine exposure. We investigated the effects of morphine on HIV infection of neonatal monocyte-derived macrophages (MDM). Morphine significantly enhanced HIV infection of neonatal MDM. Morphine-induced HIV replication in neonatal MDM was completely suppressed by naltrexone, the opioid receptor antagonist. Morphine significantly up-regulated CCR5 receptor expression and inhibited the endogenous production of macrophage inflammatory protein-1beta in neonatal MDM. Thus, morphine, most likely through alteration of beta-chemokines and CCR5 receptor expression, enhances the susceptibility of neonatal MDM to HIV infection, and may have a cofactor role in perinatal HIV transmission and infection.
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Affiliation(s)
- Yuan Li
- Division of Immunologic and Infectious Diseases, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, U.S.A
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Zylla D, Li Y, Bergenstal E, Merrill JD, Douglas SD, Mooney K, Guo CJ, Song L, Ho WZ. CCR5 expression and beta-chemokine production during placental neonatal monocyte differentiation. Pediatr Res 2003; 53:853-8. [PMID: 12621126 PMCID: PMC4009693 DOI: 10.1203/01.pdr.0000059749.82140.4a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The stage of maturation of monocytes affects their susceptibility to HIV infection. The beta-chemokines and their receptor CCR5 play a crucial role in inflammatory reactions and HIV infection. We therefore examined the correlation between the expression of CCR5 and beta-chemokine production and the susceptibility to HIV infection during cord monocyte (CM) differentiation into macrophages. CM and CM-derived macrophages (CMDM) were examined for beta-chemokine and CCR5 expression. The susceptibility of the CM cultured in vitro at different time points to HIV infection was also determined. Although the levels of CCR5 mRNA expression in freshly isolated CM are comparable to those in CMDM, CM had significantly lower levels of CCR5 protein on the cell surface than CMDM did. Steady increase of CCR5 protein expression on the cell surface was observed during CM differentiation into macrophages. The CCR5 expression correlated with the increased susceptibility to HIV infection by CMDM. Although there was no significant difference in endogenous beta-chemokine production between CM and CMDM, HIV infection of CMDM significantly enhanced production of macrophage inflammatory protein-1alpha and -1beta. CCR5 receptor plays a critical role in HIV infection of neonatal blood monocyte/macrophages.
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Affiliation(s)
- Dylan Zylla
- Division of Immunologic and Infectious Diseases, The Children's Hospital of Philadelphia, PA 19104, USA
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Cangialose CB, Blair AE, Borchardt JS, Ades TB, Bennett CL, Dickersin K, Gesme DH, Henderson IC, McGinnis LS, Mooney K, Mortenson LE, Sperduto P, Winkenwerder W, Ballard DJ. Purchasing oncology services. Kerr L. White Institute/American Cancer Society Task Force on Purchasing Oncology Services. Cancer 2000; 88:2876-86. [PMID: 10870075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. METHODS A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. RESULTS The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. CONCLUSIONS The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.
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Affiliation(s)
- C B Cangialose
- Kerr L. White Institute for Health Services Research, Decatur, GA, USA
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Johnson DI, Mooney K, DiStefano M, Sullivan M, Haber D, Kalriess G. Using hospital information systems to manage outcomes. J Nurs Care Qual 1998; 12:37-47. [PMID: 9682570 DOI: 10.1097/00001786-199808000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses techniques used at Staten Island University Hospital to help automate manual data collection for performance improvement reports and outcomes analysis. If data must be collected manually, it is time to take a look at information available in your hospital's information system.
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Affiliation(s)
- D I Johnson
- Patient Care Services, Staten Island University Hospital, New York, USA
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Abstract
As the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) has shifted the focus of its survey process to the organization as a whole, new techniques are needed to prepare for surveys. Staten Island University Hospital used teams based on the eleven important functions to achieve a successful survey.
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Affiliation(s)
- D Weller
- Patient Care Services, Staten Island University Hospital, NY, USA
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Mooney K. Valuing human diversity can enrich and strengthen our personal and work lives. ONS News 1997; 12:2. [PMID: 9070020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Rutledge DN, Greene P, Mooney K, Nail LM, Ropka M. Use of research-based practices by oncology staff nurses. Oncol Nurs Forum 1996; 23:1235-44. [PMID: 8883071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE/OBJECTIVES To determine the extent to which oncology staff nurses adopted eight specific research-based practices and the impact of demographic and resource factors on adoption of these practices. DESIGN Cross-sectional mail survey. SETTING National. SAMPLE 1,100. METHODS Network sampling techniques: 2,000 Oncology Nursing Society (ONS) staff nurses were randomly and proportionally selected from seven practice setting categories; each ONS nurse was asked to recruit a non-ONS staff nurse colleague. Both groups completed the Oncology Nursing Practice Questionnaire, which measures adoption of eight research-based practices. MAIN RESEARCH VARIABLES Extent of adoption, including awareness, persuasion, and implementation of eight specific practices; nurse demographics; and work-related resources. FINDINGS Awareness was high, with 53%-96% of nurses reporting awareness of the eight practices. Overall, 28% were aware of all practices while 10% were aware of half or fewer. Less-aware nurses differed from other nurses in demographics and resources. Computed "extent of adoption" scores showed that almost 90% of aware nurses used seven of the practices at least sometimes. CONCLUSIONS Oncology staff nurses with awareness of a practice were implementing the practice in their organization. IMPLICATIONS FOR NURSING PRACTICE The findings establish a need for developing educational programs to enhance awareness of specific practices and to creatively reach nurses who are unlikely to seek programs outside their employing agencies.
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Affiliation(s)
- D N Rutledge
- Patient Services, American Cancer Society, Atlanta, GA, USA
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Mooney K. Ask yourself, "Why do I stay in oncology nursing?" and think about your response. ONS News 1996; 11:2. [PMID: 8716485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Medvec BR, Pelusi JL, Camp-Sorrell D, Kleinschmidt P, Krebs L, Mooney K. Assistive personnel: their use in cancer care--an Oncology Nursing Society position paper. Oncol Nurs Forum 1996; 23:647-51. [PMID: 8735323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- B R Medvec
- Oncology Service, Flower Hospital, Sylvania, OH, USA
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Ferrell BR, Nail LM, Mooney K, Cotanch P. Applying for Oncology Nursing Society and Oncology Nursing Foundation grants. Oncol Nurs Forum 1989; 16:728-30. [PMID: 2780410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Mooney K. [The heart of nursing]. Int Nurs Rev 1965; 12:43-9. [PMID: 5175027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mooney K. An educated heart. Int Nurs Rev 1965; 12:17-23. [PMID: 5174382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mooney K. [The heart of nursing]. Rev Enferm (Lisboa) 1965; 4:159-65. [PMID: 5174164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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