183 Background: The Georgia Cancer Center for Excellence (GCCE) at Grady received a 5-year MERCK Patient Centered Grant in 2017 that focuses on improving care to vulnerable cancer patients (pts) through the introduction of nurse (RN) navigators, a dietician and a part time exercise coach. A review of the literature shows improved patient outcomes and satisfaction with decreased time to treatment for breast and lung cancer pts. [1-2] RN navigation has been shown to expedite care and one of our goals for the MERCK grant was to study the effect of introducing RN navigation in a safety net hospital for three cancer sites. Methods: Three RN navigators were hired for the Breast, GYN and Aerodigestive cancer programs since 2017. RN navigators meet all newly diagnosed cancer pts during clinic and track their progression of care, often intervening for timeliness of work up and treatment. Each RN navigator keeps a record of pts navigated. An audit of this prospectively collected data measuring time from diagnosis to treatment for breast, GYN and aerodigestive cancer pts took place for 2018 and 2019. Inclusion criteria: diagnosed and treated at Grady, navigated by RN, and not Stage IV disease. Results: The total numbers of cancer pts navigated over the past two years were 244 breast, 131 GYN, and 265 aerodigestive pts. Using the inclusion criteria described in the methods section, the time from diagnosis to treatment decreased for these three cancer sites (see Table). Conclusions: Implementation of RN navigators within the cancer program trended towards decreases in time from diagnosis to treatment for our breast, GYN, and aerodigestive cancer patients. These measurable improvements over three cancer sites are largely attributed to RN navigation and suggest that cancer outcomes will improve over time for our patients treated in our safety net hospital. We plan to study patients who were retained in the system or were adherent to care to better understand the importance of RN navigation in our system. References: (1)Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to Surgery and Breast Cancer Survival in the US. JAMA Oncol 2016;2(3):330–339. (2) Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer. Thorax 2009;64:749-756. [Table: see text]
Mental health disorders such as anxiety and/or depression are the most common mental health disorders seen among reproductive aged women and can increase during pregnancy. Many sociodemographic risk factors have been associated with anxiety and/or depression in pregnancy, which can lead to adverse maternal and infant outcomes including the risk of a hypertensive pregnancy. The current study prospectively examined self-reported anxiety, depression and stress in pregnant women without a history of fetal loss or mood disorders beginning at 20–26 weeks. At each study visit, circulating immune factors associated with perinatal mood disorders were measured in blood samples that were collected. A total of 65 women were eligible for data analysis, 26 of which had hypertensive pregnancies. There was not a significant difference in self-reported depression, anxiety or stress between hypertensive disorders of pregnancy and normotensive women. Black women were more likely to have a hypertensive pregnancy and develop a perinatal mood disorder compared to non-black women. Both the inflammatory cytokines interleukin-17 and tumor necrosis factor-alpha were increased in patients with perinatal mood disorders. However, additional research is needed in a larger sample to truly understand the relationship between these factors along with the underlying etiologies and the associated outcomes.
INTRODUCTION:Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes.METHODS:IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used.RESULTS:Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates.CONCLUSION:For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.
administration in cancer diagnosis was assigned as "cancer group"(n¼3), and a fertile donor group was assigned as "control group"(n¼3). Written informed consent was obtained from all patients and this study design was approved by institutional review board of Yokohama City University Medical Center.MATERIALS AND METHODS: The original diseases of cancer group were non-Hodgkin malignant lymphoma(n¼2) and malignant soft tissue tumor(n¼1). Measuring the total sperm count by CASA, they were adjusted to 6 million in all specimens, and protein concentration was adjusted by BCA assay. After trypsin digestion and desalting, the expressed proteins in spermatozoa were analyzed by LQ-MS/MS and database searching was performed in two groups. Validation was performed for the proteins with different expression levels by Western-blotting.RESULTS: A total of 1,152 proteins and 5,268 peptides were identified by global proteomics in both groups. Sorted by max fold change of expressions (>5 folds) and ANOVA (p<0.01), 29 proteins were identified. Of these identified proteins, we focused on a few proteins, one is cancer-associated protein highly expressed in digestive tract and urinary tract. In sperm of patients with cancer, this protein was overexpressed 54.8-folds more than that of fertile donor. This protein co-works with other protein of T-cell proliferation factor. Regimens of cancer chemotherapy patients in cancer group received were ABVD and IFM, ADM, and VCM therapy, respectively. It was speculated that T cell proliferation was induced by protein interaction after induction of cancer chemotherapy. By the Western-blotting, expression of this protein was validated. Moreover, oxidative stress-associated proteins with different expression levels compared to control were identified, which supported our previous study.CONCLUSIONS: It was speculated that T cell proliferation was induced by interaction between these proteins after induction of cancer chemotherapy. Moreover, cancer chemotherapy could induce oxidative stress apoptosis in spermatozoa. Functional analysis of these proteins would provide clue to the mechanisms of impaired spermatogenesis after cancer chemotherapy.SUPPORT: This study was supported by JSPS KAKENHI Grant Number 18K16739.
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