Approximately 10% of all pancreatectomies in the US are for IPMNs. In these patients, treated after the revised international consensus guidelines, only 23% of IPMNs contained invasive or high-grade histology. Resections carried similar morbidity regardless of pathology. Improved biomarkers are needed to aid in surgical selection.

Background Historically, women with metastatic breast cancer are excluded from lifestyle interventions under the assumptions that diet and physical activity will have little impact on their disease trajectory. However, recent treatment advances have led to significant increases in survivorship that pose challenges to this assumption. Objective The objectives of this study were: 1) to measure dietary intake, physical functioning and quality of life (QOL) in a subset of women with metastatic breast cancer, and 2) to inform future interventions in this growing population. Design Demographics, clinical characteristics, dietary intake, physical functioning and QOL were examined cross-sectionally using validated methodologies. Participants/setting Twenty-five women with metastatic breast cancer were recruited over a 4 month period (June-September, 2014) from two university hospitals in the Midwest that serve an ethnically diverse patient population. Women completed questionnaires and 24-hour dietary recalls (one weekday, one weekend). Main Outcome Lifestyle habits were analyzed. Statistical analyses Means (± standard deviations) and frequencies were tallied and t-tests were conducted. Results On average, participants were 58.8 (± 12.8) years of age, predominantly minority, had been living with metastatic breast cancer for an average of 36.9 (± 29.3) months, and exhibited significant nutrition impact symptomology (e.g, pain, dry mouth, fatigue.) Bone and lung were the most common sites of metastases. Compared to a larger, normative sample of women with metastatic breast cancer, study participants displayed similar physical (p=0.61) and functional well-being scores (p=0.76), but higher social (p=0.10) and emotional well-being scores (p<0.01). The analyses of lifestyle factors showed that the majority of women were overweight or obese (n=14), not routine exercisers (n=15) and had dietary patterns high in fat and low in fiber. Conclusions This study supports that many women with metastatic breast cancer are in need of carefully tailored, evidence-based lifestyle strategies that address symptom burden, including weight management. The implications of diet and physical activity on QOL in this population remain unexplored.

Background Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). Objective We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). Methods In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire–Depression). Results All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). Conclusions Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. Trial Registration ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213

Time delays, patient confusion regarding professional roles and diagnostic indecision are significant problems for patients referred to hospital orthopaedic clinics from MPTT clinics. This risks sub-optimal patient care and may lead to future medicolegal implications.

BackgroundColorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Although studies have been performed on malignancy behavior in African Americans and Caucasians, scant data are present on other minority racial groups.MethodsA retrospective single center study was performed where 1,860 patient charts with a diagnosis of CRC from January 1, 2004 to December 31, 2014 were reviewed. Data collected on each patient included age, gender, ethnicity, primary site and histological stage at the time of diagnosis. Survival time over the course of 5 years was documented for patients from January 1, 2004 to December 31, 2009. Comparisons were made amongst different racial groups for the above mentioned factors.ResultsStudy population consisted of 27.09% African Americans, 65.61% Caucasians, 3.86% Hispanics, 0.54% South Asians, 1.03% Arabs, 0.54% Asians and 0.22% American Indians. Mean age of CRC presentation was found to be significantly different (P < 0.05) between the three largest racial groups: 71 years for Caucasians, 69 years for African Americans, and 61 years for Hispanics. African Americans (27.09%) and Hispanics (28.79%) presented predominantly at stage IV in comparison to other racial groups. Caucasians presented predominantly at stage III (24.84%). The rectum was the most common site of CRC across all racial groups with the exception of Asians, where sigmoid colon was the predominant site (30%). Adenocarcinoma remained the predominant cancer type in all groups. Hispanics had relatively higher incidence rate of carcinoid tumor (12.68%). Survival time analysis showed that Caucasians tend to have better survival probability over 5 years after initial diagnosis as compared to African Americans and Hispanic (P < 0.05).ConclusionThere is lack of studies performed on minority racial groups in North America. Our study highlighted some important clinical differences of CRC presentation in different racial groups which are not well studied and can be used to formulate future multi-center studies to assess disease behavior.