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Interpretability and fairness evaluation of deep learning models on MIMIC-IV dataset.

The recent release of large-scale healthcare datasets has greatly propelled the research of data-driven deep learning models for healthcare applications. However, due to the nature of such deep black-boxed models, concerns about interpretability, fairness, and biases in healthcare scenarios where human lives are at stake call for a careful and thorough examination of both datasets and models. In this work, we focus on MIMIC-IV (Medical Information Mart for Intensive Care, version IV), the largest publicly available healthcare dataset, and conduct comprehensive analyses of interpretability as w

Barriers to Treg therapy in Europe: From production to regulation.

There has been an increased interest in cell based therapies for a range of medical conditions in the last decade. This explosion in novel therapeutics research has led to the development of legislation specifically focused on cell and gene based therapies. In Europe, the European medicines agency (EMA) designates any medicines for human use which are based on genes, tissues, or cells as advanced therapy medicinal products or advanced therapy medicinal products (ATMPs). In this article we discuss the hurdles to widespread adoption of ATMPs in Europe, with a focus on regulatory T cells (Tregs).

Clinician and administrator perspectives on outpatient administration of ciltacabtagene autoleucel in relapsed or refractory multiple myeloma.

IntroductionChimeric antigen receptor (CAR) T-cell therapy (CAR T therapy) is a treatment option for patients with relapsed or refractory multiple myeloma that has led to unprecedented treatment outcomes. Among CAR T therapies available, ciltacabtagene autoleucel (cilta-cel) is a good candidate for outpatient administration due to its generally predictable safety profile. There are multiple advantages of outpatient administration of cilta-cel, including reduced healthcare burden, expanded access, and patient autonomy. This mixed methods qualitative study aimed to identify key factors for outpa

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… Proposals to cap Medicare Part B payments will limit outpatient access to CAR-T STAT (2021). Available online at: https://www.statnews.com/2021/09/22/medicare-part-b-payment-caps-limit-outpatient-access-to-car-t/ . 37. Paludo J, Bansal R, Holland AT, Haugen KL, Spychalla MT, McClanahan AL, et al. …

Teams, Tools, Processes and Resources to Manage Oncologic Clinical Decision Support: Lessons Learned from City of Hope's Multistate, Academic, and Community Oncology Enterprise.

Background/Objectives: Clinical decision support systems (CDSSs) consisting of Computerized Physician Order Entry (CPOE) and oncology pathways serve as the foundation of high-quality cancer care. However, the resources needed to develop and maintain these systems have not been characterized for oncology enterprises. Methods: Executive leadership appointed a medical director and clinical pharmacist to develop and lead a Pathways and Protocols Program for the City of Hope (COH) enterprise. This involved developing a program charter and governance committee and a business case for resources to su

Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience.

As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed

R WE ready for reimbursement? A round-up of developments in real-world evidence relating to health technology assessment: part 25.

In this update, we discuss the use of real-world data in the Haute Autorité de Santé assessment of economic evaluations, review how real-world evidence is supporting regulatory approvals in multiple myeloma, and consider lessons from the failed EVOKE trials of semaglutide in Alzheimer's disease for the broader application of target trial emulation.

Cardiac toxicities in multiple myeloma: an updated and a deeper look into the effect of different medications and novel therapies.

With the continuous improvement in survival of cancer patients, including those with multiple myeloma, related to the novel treatment agents and therapeutic approaches, the probability for patients to develop cardiovascular disease has significantly increased, especially in elderly patients and those with additional risk factors. Multiple myeloma is indeed a disease of the elderly population and so these patients are, solely by age, at an increased risk of cardiovascular disease. Risk factors for these events can be patient-, disease- and/or therapy-related, and they have been shown to adverse

Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024.

Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals) or 21-valent PCV (PCV21; CAPVAXIVE; Merck Sharp & Dohme) alone or 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax

Scaling PatientsLikeMe via a "Generalized Platform" for Members with Chronic Illness: Web-Based Survey Study of Benefits Arising.

BackgroundLaunched in 2006 for patients with amyotrophic lateral sclerosis, PatientsLikeMe is an online community offering patient-reported outcomes, symptom tracking, and social features. Every member of the site can see all the data reported by every other member, view aggregated reports, identify "patients like them," and learn about treatment options in order to live better with their condition. In previous studies, members reported benefits such as improved condition knowledge, increased medication adherence, and better management of side effects. However, the site evolved in 2011 from co

Быстрый обзор мер по улучшению ухода за людьми, страдающими множественным склерозом, диабетической ретинопатией и раком легких.

В Соединенных Штатах пациенты, страдающие хроническими заболеваниями, сталкиваются с различиями в показателях здоровья по всему спектру услуг по уходу. Среди пациентов с множественным склерозом, диабетической ретинопатией и раком легких не хватает доказательств, резюмирующих меры по улучшению ухода и сокращению этих различий. Цель этого оперативного обзора литературы заключалась в том, чтобы определить меры, принимаемые пациентами с такими хроническими заболеваниями в целях улучшения состояния здоровья и сокращения неравенства в плане выявления, диагностики, доступа к лечению и специалистам, с

MASTering systemic mastocytosis: Lessons learned from a large patient cohort.

BACKGROUND: Systemic mastocytosis (SM), a rare condition affecting about 32,000 individuals in the United States, is often misdiagnosed or underdiagnosed owing to its nonspecific symptoms and the need for invasive biopsies. OBJECTIVE: Our aim was to identify, classify, and characterize the natural history of patients with SM. METHODS: In a retrospective cohort study, administrative data from a large managed care organization was used to identify patients with confirmed SM, based on World Health Organization criteria. Demographic data, delay to diagnosis, disease progression, and health care

Incidence of Pneumocystis jirovecii pneumonia utilizing a polymerase chain reaction-based diagnosis in patients receiving bendamustine.

BackgroundPneumocystis jirovecii pneumonia (PJP) is a life-threatening infection occurring in patients receiving bendamustine. The poorly defined incidence, particularly when utilizing polymerase chain reaction (PCR)-based diagnostic techniques, precipitates unclear prophylaxis recommendations. Our objective was to determine the cumulative incidence of PJP diagnosed by single copy target, non-nested PCR in patients receiving bendamustine.MethodsPatients were evaluated for PJP from initiation of bendamustine through 9 months after the last administration. The cumulative incidence of PJP was est

Connect MDS/AML: design of the myelodysplastic syndromes and acute myeloid leukemia disease registry, a prospective observational cohort study.

BackgroundMyelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are myeloid neoplasms in which outgrowth of neoplastic clones disrupts normal hematopoiesis. Some patients with unexplained persistent cytopenias may not meet minimal diagnostic criteria for MDS but an alternate diagnosis is not apparent; the term idiopathic cytopenia of undetermined significance (ICUS) has been used to describe this state. MDS and AML occur primarily in older patients who are often treated outside the clinical trial setting. Consequently, our understanding of the patterns of diagnostic evaluation, mana

CardioMEMS guided heart failure management in cardio-oncology patients: a tertiary care cancer center experience.

AimsCancer patients and survivors are at increased risk of developing heart failure (HF) and heart failure hospitalization (HFH). Yet, the utilization of wireless pulmonary artery pressure sensing devices (PAPSD), like CardioMEMS, in this group is limited.ObjectivesWe aimed to explore the utilization of CardioMEMS in managing HF among oncology patients.MethodsWe conducted a single-center retrospective study reviewing consecutive patients implanted with the CardioMEMS device between November 11, 2015, and February 21, 2023. We analyzed the device's impact on pulmonary artery pressures and HFH u

Assessment of Bone Health Education in US Multiple Myeloma and Solid Tumor Patients at Risk for Skeletal-Related Events.

PURPOSE: Cancer patients with bone metastasis (BM) from solid tumors or multiple myeloma (MM) have an increased risk of painful skeletal-related events (SREs), which can decrease quality of life and increase mortality. Bone targeting agents (BTAs) can help delay or prevent SREs; however, a significant portion of eligible patients are not receiving BTA therapy. This study was conducted to understand patient awareness of cancer-related bone health and to identify opportunities to improve bone health education in cancer patients at risk of SREs. METHODS: The online BonE heAlth eduCatiOn Needs as

Anticancer drug prices and clinical outcomes: a cross-sectional study in Italy.

ObjectiveTo investigate whether the prices of new anticancer drugs correlated with their relative benefit despite negotiation.DesignRetrospective cross-sectional study correlating new anticancer drugs prices with clinical outcomes.SettingWe did a retrospective cross-sectional study including all new anticancer drugs approved by the European Medicines Agency (EMA) (2010-2016) and reimbursed in Italy.Main outcomes and measuresInformation on clinical outcomes-in terms of median overall survival (OS), median progression-free survival (PFS) and objective response rate (ORR)-was extracted from pivot

Short-term associations between ambient air pollution and emergency department visits for Parkinson disease, multiple sclerosis, migraine, and seizure in California, 2005-2018.

BACKGROUND: Previous studies have linked ambient air pollution to worsening neurological conditions, but research in the United States is limited. This study aims to investigate short-term associations between emergency department (ED) visits for four disorders affecting the nervous system (Parkinson disease, multiple sclerosis, migraine, and seizure) and three major air pollutants: fine particulate matter (PM2.5), carbon monoxide (CO), and nitrogen dioxide (NO2). METHODS: Daily estimated exposure concentrations at 12 km were aggregated to the ZIP-code level and linked to 6 million ED visits

Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis.

PurposeExisting research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer.MethodsMedline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-effects meta-analyses and

Навигация экономического бремени множественной миеломы: понимание экономической эффективности терапии CAR-T и биконкретной антителной терапии.

Цель обзора Multiple mieloma - хроническая злокачественность, и с учетом изменяющихся вариантов лечения понимание экономического бремени и экономической эффективности лечения имеет решающее значение для врачей и исследователей. В этой связи мы рассматриваем недавнее утверждение биконкретных антител и CAR-T для миэломы и их финансовые последствия, включая прямые и косвенные издержки. Мы сравниваем это с нынешними режимами и представляем в настоящем обзоре сопоставление затрат. Мы пришли к выводу о том, что использование более эффективных методов лечения, таких, как CAR-T, в более ранних направл

Множественный опыт и предпочтения в области миеломы: исследование смешанных методов лечения пациентов и партнеров по уходу в Соединенных Штатах.

ЦЕЛЬ: Множественная миелома (ММ) характеризуется рецидивом лечения и сопротивлением, что требует принятия последовательных решений о лечении на протяжении всего курса лечения. Для того чтобы понять, каким образом состояние заболеваний и изменение условий лечения влияют на решения, принимаемые пациентами и партнерами по уходу, было проведено исследование по изучению неинтервенционных смешанных методов. ПАТИЕНТЫ И МЕТОДЫ: Пациенты, самоотчитывающиеся MM и партнеры по уходу, были набраны через Гритское сообщество по борьбе с раком, социальные сети и снежные шары для участия в этом исследовании, п