Context.-Recurrent epidermal growth factor receptor (EGFR) mutations are seen in a subset of pulmonary adenocarcinomas. These mutations are targeted by EGFR inhibitors and are a biomarker for response to EGFR inhibitor therapies. Initial data have indicated an increased frequency of activating EGFR mutations in nonsmoking Asian females. However, there are very few studies of global scope that address the question of mutation distribution across the population of lung cancer.Objective.-To determine the frequency of EGFR mutations in exons 18 through 21 detected in clinical laboratories participating in the College of American Pathologists proficiency testing program for EGFR in calendar year 2013.Design.-We reviewed the surveys from 170 clinical laboratories from 20 countries that participated in the College of American Pathologists EGFR proficiency testing program. The proficiency testing includes questions regarding the total numbers of tests performed at each common mutation site, including both activating and resistance mutations, and their frequency. Countries were grouped into regional groups in order to assess frequency of mutation by type, and to indirectly assess ethnic differences in mutation frequencies.Results.-Among the treatment-sensitive activating mutations, the most common are exon 19 mutations (n ¼ 10 802 of 136 533 cases; 7.9% of total cases tested) and the exon 21 L858R mutation (n ¼ 10 351 of 136 533 cases; 7.6% of total cases tested) and the least common are exon 20 mutations (n ¼ 466 of 136 533 cases; 0.3% of total cases tested). The T790M mutation in exon 20 is the more common resistance mutation (n ¼ 1010 of 136 533 cases; 0.7% of all cases tested). The highest activating mutation frequency is seen in southern Asia (n ¼ 4260 of 9337 cases; 46%) and the lowest activating mutation frequencies are in South and North America (n ¼ 113 of 1439 cases and 7926 of 86 654 cases; 8% and 9%, respectively).Conclusions.-Our data confirm that activating EGFR mutations are more common in southern Asia and that the distribution of activating EGFR mutations varies significantly across the regions. Similarly, the frequency and distribution of resistance mutations also show significant variation when comparing southern Asia with other regions.
Background Bowel urgency, the sudden or immediate need to have a bowel movement, is a common, bothersome and disruptive symptom of ulcerative colitis (UC). UC treatment goals include control of urgency; however, it is not consistently assessed in UC clinical trials. The Urgency Numeric Rating Scale (NRS) is a new patient-reported measure to assess severity of bowel urgency in adults with UC developed in accordance with Food and Drug Administration guidelines. Methods Qualitative interviews were used to develop Urgency NRS. The scale asks patients to report the immediacy status of their UC symptom over the past 24 h on an 11-point horizontal numeric rating scale [0 (No urgency) to 10 (Worst possible urgency)]. Higher scores indicate worse urgency severity. A 2-week diary study assessed floor and ceiling effects, test–retest reliability (intraclass correlation coefficient (ICC) (2,1) between Week 1 and 2), and construct validity (Spearman correlation using Week 1 scores). Weekly scores were calculated as mean score over each 7-day period. Results Qualitative interviews with 16 UC patients (mean age 37.9 ± 11.6 years; 50% female; 56% White) confirmed relevance, content, and comprehensiveness. The 2-week diary study included 41 UC patients (mean age 44.2 ± 14.6 years; 51% female; 56% White). No ceiling or floor effects were identified. Test–retest reliability was high (ICC = 0.877). Average Urgency NRS and patient global rating of severity scores were highly correlated, with a moderate correlation between average Urgency NRS and stool frequency, demonstrating construct validity. Conclusions Bowel urgency is a distinct symptom of UC. The Urgency NRS is a well-defined, content-valid, and reliable measurement of bowel urgency in adults with UC.
Purpose To measure the effect of a pharmacist-initiated transitions of care (TOC) program on rates of 30-day all-cause readmissions and primary care follow-up. Methods A retrospective cohort study was conducted to evaluate a pharmacist-initiated TOC program for patients discharged from hospitals of a large health system from September 2015 through July 2016. Discharged patients of 13 primary care physicians (the intervention cohort) received TOC program services, and discharged patients seen by 12 other primary care physicians (the control cohort) received usual care. Patients in both cohorts were followed for 90 days. The primary outcome was 30-day all-cause readmissions, and secondary outcomes were 14-day primary care visits, TOC pharmacist identification and resolution of medication therapy problems (MTPs), and transition care management (TCM) billing. Multivariable modeling was performed to test the associations of patient receipt of TOC services with 30-day readmissions and 14-day primary care visits, with controlling for patient demographics and baseline healthcare utilization. Results A total of 492 patients received the TOC intervention, and 379 were followed in the usual care cohort. Among intervention patients, 960 MTPs were identified, and 85.7% of identified MTPs were resolved. Moreover, 9% of intervention cohort patients were readmitted within 30 days, compared to 15% of control cohort patients, and this effect was significant in the multivariable model (odds ratio, 1.82; 95% confidence interval, 1.15-2.89; P = 0.0108). Rates of primary care visits did not differ significantly between the groups; 65% of intervention group visits were billed using TCM codes. Conclusion A pharmacist-initiated TOC program was effective in reducing 30-day all-cause readmissions.
Objective In patients with ulcerative colitis (UC) and Crohn’s disease (CD), this research examined: prevalence of fecal urgency (hereafter urgency), association of urgency with inflammatory bowel disease (IBD) symptoms and fecal calprotectin, and association between well-being and urgency. Methods In this cross-sectional study from the Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease, urgency was categorized as none, mild, and moderate-severe. We examined the prevalence of urgency; association of urgency with IBD symptoms and fecal calprotectin (in a subset) using multinomial logistic regression; and association of well-being (not feeling well vs. generally well) with urgency using logistic regression. Results Among 576 UC patients, 31.4% reported mild and 28.1% moderate-severe urgency. Among 1,330 CD patients, 33.8% reported mild and 31.4% moderate-severe urgency. In UC, moderate-severe urgency was associated with: increased average bowel movements/day (odds ratio (OR) 1.23; 95% confidence interval: 1.09–1.23), increased stool frequency relative to normal (OR, 9.95; 3.21–30.87), rectal bleeding (OR, 3.36; 1.79–6.34), moderate-severe abdominal pain (OR, 17.5; 5.38–56.89), and calprotectin ≥ 250 μg/g (OR, 4.36, 1.50, 12.66). In CD, moderate-severe urgency was associated with: increased average bowel movements/day (1.23; 1.14–1.34), increased stool frequency relative to normal (7.57; 3.30–17.34), rectal bleeding (1.77; 1.13–2.78), moderate-severe abdominal pain (7.52; 4.31–13.14). Reduced well-being was associated with moderate-severe urgency in both UC (OR, 4.20; 1.69–20.40) and CD patients (OR, 2.52; 1.51–4.22). Conclusion Urgency was common and associated with symptoms and biomarkers suggesting active IBD and reduced well-being.
Linking MOW data to Medicare claims has the potential to shed additional light on the relationships among social services, health status, health care use, and benefits to clients' well-being.
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