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Park SH, Pinto-Powell R, Thesen T, Lindqwister A, Levy J, Chacko R, Gonzalez D, Bridges C, Schwendt A, Byrum T, Fong J, Shasavari S, Hassanpour S. Preparing healthcare leaders of the digital age with an integrative artificial intelligence curriculum: a pilot study. Med Educ Online 2024; 29:2315684. [PMID: 38351737 PMCID: PMC10868429 DOI: 10.1080/10872981.2024.2315684] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Artificial intelligence (AI) is rapidly being introduced into the clinical workflow of many specialties. Despite the need to train physicians who understand the utility and implications of AI and mitigate a growing skills gap, no established consensus exists on how to best introduce AI concepts to medical students during preclinical training. This study examined the effectiveness of a pilot Digital Health Scholars (DHS) non-credit enrichment elective that paralleled the Dartmouth Geisel School of Medicine's first-year preclinical curriculum with a focus on introducing AI algorithms and their applications in the concurrently occurring systems-blocks. From September 2022 to March 2023, ten self-selected first-year students enrolled in the elective curriculum run in parallel with four existing curricular blocks (Immunology, Hematology, Cardiology, and Pulmonology). Each DHS block consisted of a journal club, a live-coding demonstration, and an integration session led by a researcher in that field. Students' confidence in explaining the content objectives (high-level knowledge, implications, and limitations of AI) was measured before and after each block and compared using Mann-Whitney U tests. Students reported significant increases in confidence in describing the content objectives after all four blocks (Immunology: U = 4.5, p = 0.030; Hematology: U = 1.0, p = 0.009; Cardiology: U = 4.0, p = 0.019; Pulmonology: U = 4.0, p = 0.030) as well as an average overall satisfaction level of 4.29/5 in rating the curriculum content. Our study demonstrates that a digital health enrichment elective that runs in parallel to an institution's preclinical curriculum and embeds AI concepts into relevant clinical topics can enhance students' confidence in describing the content objectives that pertain to high-level algorithmic understanding, implications, and limitations of the studied models. Building on this elective curricular design, further studies with a larger enrollment can help determine the most effective approach in preparing future physicians for the AI-enhanced clinical workflow.
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Affiliation(s)
- Soo Hwan Park
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Thomas Thesen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Joshua Levy
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Rachael Chacko
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Connor Bridges
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Adam Schwendt
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Travis Byrum
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Justin Fong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Chacko R, Davis MJ, Levy J, LeBoeuf M. Integration of a deep learning basal cell carcinoma detection and tumor mapping algorithm into the Mohs micrographic surgery workflow and effects on clinical staffing: A simulated, retrospective study. JAAD Int 2024; 15:185-191. [PMID: 38651039 PMCID: PMC11033206 DOI: 10.1016/j.jdin.2024.02.014] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 04/25/2024] Open
Abstract
Background Artificial intelligence (AI) enabled tools have been proposed as 1 solution to improve health care delivery. However, research on downstream effects of AI integration into the clinical workflow is lacking. Objective We aim to analyze how integration of an automated basal cell carcinoma detection and tumor mapping algorithm in a Mohs micrographic surgery unit impacts the work efficiency of clinical and laboratory staff. Methods Slide, staff, and histotechnician waiting times were analyzed over a 20-day period in a Mohs micrographic surgery unit. A simulated AI workflow was created and the time differences between the real and simulated workflows were compared. Results Simulated nonautonomous algorithm integration led to savings of 35.6% of slide waiting time, 18.4% of staff waiting time, and 18.6% of histotechnician waiting time per day. Algorithm integration on days with increased reconstruction complexity resulted in the greatest time savings. Limitations One Mohs micrographic surgery unit was analyzed and simulated AI integration was performed retrospectively. Conclusions AI integration results in reduced staff waiting times, enabling increased productivity and a streamlined clinical workflow. Schedules containing surgical cases with either increased repair complexity or numerous tumor removal stages stand to benefit most. However, significant logistical challenges must be addressed before broad adoption into clinical practice is realistic.
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Affiliation(s)
- Rachael Chacko
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Matthew J. Davis
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire
| | - Joshua Levy
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire
| | - Matthew LeBoeuf
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Dermatology, Dartmouth Health, Lebanon, New Hampshire
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Davis MJ, Srinivasan G, Chacko R, Chen S, Suvarna A, Vaickus LJ, Torres VC, Hodge S, Chen EY, Preum S, Samkoe KS, Christensen BC, LeBoeuf MR, Levy JJ. A deep learning algorithm to detect cutaneous squamous cell carcinoma on frozen sections in Mohs micrographic surgery: A retrospective assessment. Exp Dermatol 2024; 33:e14949. [PMID: 37864429 DOI: 10.1111/exd.14949] [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: 07/22/2023] [Revised: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 10/22/2023]
Abstract
Intraoperative margin analysis is crucial for the successful removal of cutaneous squamous cell carcinomas (cSCC). Artificial intelligence technologies (AI) have previously demonstrated potential for facilitating rapid and complete tumour removal using intraoperative margin assessment for basal cell carcinoma. However, the varied morphologies of cSCC present challenges for AI margin assessment. The aim of this study was to develop and evaluate the accuracy of an AI algorithm for real-time histologic margin analysis of cSCC. To do this, a retrospective cohort study was conducted using frozen cSCC section slides. These slides were scanned and annotated, delineating benign tissue structures, inflammation and tumour to develop an AI algorithm for real-time margin analysis. A convolutional neural network workflow was used to extract histomorphological features predictive of cSCC. This algorithm demonstrated proof of concept for identifying cSCC with high accuracy, highlighting the potential for integration of AI into the surgical workflow. Incorporation of AI algorithms may improve efficiency and completeness of real-time margin assessment for cSCC removal, particularly in cases of moderately and poorly differentiated tumours/neoplasms. Further algorithmic improvement incorporating surrounding tissue context is necessary to remain sensitive to the unique epidermal landscape of well-differentiated tumours, and to map tumours to their original anatomical position/orientation.
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Affiliation(s)
- Matthew J Davis
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | - Sophie Chen
- Caddo Parish Magnet High School, Shreveport, Louisiana, USA
| | - Anish Suvarna
- Thomas Jefferson School for Science and Technology, Alexandria, Virginia, USA
| | - Louis J Vaickus
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Veronica C Torres
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Sassan Hodge
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Eunice Y Chen
- Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sarah Preum
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Kimberley S Samkoe
- Geisel School of Medicine, Hanover, New Hampshire, USA
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Brock C Christensen
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Matthew R LeBoeuf
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joshua J Levy
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Dartmouth College, Hanover, New Hampshire, USA
- Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
- Program in Quantitative Biomedical Science, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
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Davis MJ, Srinivasan G, Chacko R, Chen S, Suvarna A, Vaickus LJ, Torres VC, Hodge S, Chen EY, Preum S, Samkoe KS, Christensen BC, LeBoeuf M, Levy JJ. A deep learning algorithm to detect cutaneous squamous cell carcinoma on frozen sections in Mohs micrographic surgery: a retrospective assessment. medRxiv 2023:2023.05.14.23289960. [PMID: 37293008 PMCID: PMC10246018 DOI: 10.1101/2023.05.14.23289960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Importance Intraoperative margin analysis is crucial for the successful removal of cutaneous squamous cell carcinomas (cSCC). Artificial intelligence technologies (AI) have previously demonstrated potential for facilitating rapid and complete tumor removal using intraoperative margin assessment for basal cell carcinoma. However, the varied morphologies of cSCC present challenges for AI margin assessment. Objective To develop and evaluate the accuracy of an AI algorithm for real-time histologic margin analysis of cSCC. Design A retrospective cohort study was conducted using frozen cSCC section slides and adjacent tissues. Setting This study was conducted in a tertiary care academic center. Participants Patients undergoing Mohs micrographic surgery for cSCC between January and March 2020. Exposures Frozen section slides were scanned and annotated, delineating benign tissue structures, inflammation, and tumor to develop an AI algorithm for real-time margin analysis. Patients were stratified by tumor differentiation status. Epithelial tissues including epidermis and hair follicles were annotated for moderate-well to well differentiated cSCC tumors. A convolutional neural network workflow was used to extract histomorphological features predictive of cSCC at 50-micron resolution. Main Outcomes and Measures The performance of the AI algorithm in identifying cSCC at 50-micron resolution was reported using the area under the receiver operating characteristic curve. Accuracy was also reported by tumor differentiation status and by delineation of cSCC from epidermis. Model performance using histomorphological features alone was compared to architectural features (i.e., tissue context) for well-differentiated tumors. Results The AI algorithm demonstrated proof of concept for identifying cSCC with high accuracy. Accuracy differed by differentiation status, driven by challenges in separating cSCC from epidermis using histomorphological features alone for well-differentiated tumors. Consideration of broader tissue context through architectural features improved the ability to delineate tumor from epidermis. Conclusions and Relevance Incorporating AI into the surgical workflow may improve efficiency and completeness of real-time margin assessment for cSCC removal, particularly in cases of moderately and poorly differentiated tumors/neoplasms. Further algorithmic improvement is necessary to remain sensitive to the unique epidermal landscape of well-differentiated tumors, and to map tumors to their original anatomical position/orientation. Future studies should assess the efficiency improvements and cost benefits and address other confounding pathologies such as inflammation and nuclei. Funding sources JL is supported by NIH grants R24GM141194, P20GM104416 and P20GM130454. Support for this work was also provided by the Prouty Dartmouth Cancer Center development funds. Key Points Question: How can the efficiency and accuracy of real-time intraoperative margin analysis for the removal of cutaneous squamous cell carcinoma (cSCC) be improved, and how can tumor differentiation be incorporated into this approach?Findings: A proof-of-concept deep learning algorithm was trained, validated, and tested on frozen section whole slide images (WSI) for a retrospective cohort of cSCC cases, demonstrating high accuracy in identifying cSCC and related pathologies. Histomorphology alone was found to be insufficient to delineate tumor from epidermis in histologic identification of well-differentiated cSCC. Incorporation of surrounding tissue architecture and shape improved the ability to delineate tumor from normal tissue.Meaning: Integrating artificial intelligence into surgical procedures has the potential to enhance the thoroughness and efficiency of intraoperative margin analysis for cSCC removal. However, accurately accounting for the epidermal tissue based on the tumor's differentiation status requires specialized algorithms that consider the surrounding tissue context. To meaningfully integrate AI algorithms into clinical practice, further algorithmic refinement is needed, as well as the mapping of tumors to their original surgical site, and evaluation of the cost and efficacy of these approaches to address existing bottlenecks.
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Georgy J, Singh A, Joel A, Chacko R, John A, Ninan F, Paul A, John G. A high rate of pathological complete response is possible by incorporating cisplatin in neoadjuvant therapy of locally advanced triple-negative breast cancer: A single-institution experience. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30687-0] [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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Thomas S, Chacko R, Khanapur GD, Kattula D, Rose A. Oral health status and treatment needs of school going children in a tribal area in Southern India. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.455] [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: 11/13/2022] Open
Abstract
Abstract
Background
Children suffer a significant burden of oral diseases which impacts their quality of life, and general health. Many epidemiological studies have looked at oral health status and treatment needs among children in urban and rural areas across different age groups. There was limited literature assessing the oral health status among children in tribal areas, which presents unique challenges in terms of: topography, availability of health services, and complex socio-cultural health practices.
Methods
Cross-sectional study was conducted among 655 children across six schools between 12-15 years in Jawadhi Hills, Tamil Nadu, India. World Health Organization's, Oral Health Surveys were used for clinical and risk factor assessments. Clinical examination was conducted, and self-assessed questionnaire was administered to the children to assess the risk factors to poor oral health. Since dental fluorosis was common, drinking water samples were collected to assess fluoride levels in the community.
Results
Prevalence of dental caries and gingivitis (gum disease) was found to be 22.3% and 87.3% respectively. Dental Pain was reported by 57% of children as the most common reason to visit the dentist. Prevalence of dental fluorosis was found to be 53.6%. Multiple logistic regression showed: gender, dental fluorosis, diet, and maternal education significantly associated (p < 0.005) with dental caries. Fluoride levels in water was found to be higher than permissible limits (>1.5 ppm).
Conclusions
Children requiring treatment (∼ 200) were referred to the local hospital, and treatment was done free-of-cost. School authorities were informed about the current oral health status of children and advised to conduct regular health education & dental camps; the importance of girls' education was emphasized. Local authorities were alerted about the fluoride-rich water situation in the community and educated about defluoridation methods that the community can employ at household level.
Key messages
Evidence-based burden of oral diseases was presented to the local authorities for the first time, with a call for action. A referral system was established between the schools and the local hospital, to ensure continuity of oral health care for the children.
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Affiliation(s)
- S Thomas
- Public Health Foundation of India, The Ramalingaswami Centre on Equity and Social Determinants of Health, Bengaluru, India
| | - R Chacko
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, India
| | - G D Khanapur
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, India
| | - D Kattula
- Department of Conservative Dentistry and Endodontics, Ragas Dental College and Hospital, Chennai, India
| | - A Rose
- Department of Community Health, Christian Medical College and Hospital, Vellore, India
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Sudeep G, Sanjoy C, Jagdish N, Shyam A, Manish S, Alurkar SS, Anil K, Smruti BK, Shona N, Amit A, Vijay A, Chacko R, Chirag D, Chanchal G, Pavithran K, Poonam P, Krishna P, Rejiv R, Rao RR, Sahoo TP, Ashish S, Randeep S, Sankar S, Arun W, Binay S, Priyanka B, Advani SH. Current Treatment Options for Human Epidermal Growth Factor Receptor 2-Directed Therapy in Metastatic Breast Cancer: An Indian Perspective. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_201_17] [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: 11/04/2022] Open
Abstract
AbstractHuman epidermal growth factor receptor 2 (HER2)-positive is an aggressive subtype of breast cancer and has historically been associated with poor outcomes. The availability of various anti-HER2 therapies, including trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (TDM-1), has remarkably improved the clinical outcomes in patients with HER2-positive metastatic breast cancer (mBC). However, there is a need to optimize treatment within this population, given the wide variability in clinical presentation. Additionally, geographical and socio-economic considerations too need to be taken into account. To clarify and collate evidence pertaining to HER2-positive metastatic breast cancer, a panel of medical and clinical oncologists from across India developed representative clinical scenarios commonly encountered in clinical practice in the country. This was followed by two meetings wherein each clinical scenario was discussed in detail and relevant evidence appraised. The result of this process is presented in this manuscript as evidence followed by therapeutic recommendations of this panel for management of HER2-positive mBC in the Indian population.
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Affiliation(s)
- Gupta Sudeep
- Department of Medical Oncology, Tata Memorial Centre, ACTREC, Navi Mumbai, Maharashtra, India
| | - Chatterjee Sanjoy
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Nigade Jagdish
- Medical, Roche Products (India) Pvt. Ltd., Mumbai, Maharashtra, India
| | - Aggarwal Shyam
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Singhal Manish
- Department of Medical Oncology, Indraprastha Apollo Hospitals, New Delhi, India
| | - SS Alurkar
- Department of Oncology, Apollo Hospitals, Ahmedabad, Gujarat, India
| | - Kukreja Anil
- Medical, Roche Products (India) Pvt. Ltd., Mumbai, Maharashtra, India
| | - BK Smruti
- Department of Medical Oncology, Bombay Hospital, Mumbai, Maharashtra, India
| | - Nag Shona
- Department of Oncology, Jehangir Hospital, Pune, Maharashtra, India
| | - Agarwal Amit
- Department of Medical Oncology, BL Kapoor Hospital, Delhi, India
| | - Agarwal Vijay
- Department of Medical Oncology, Healthcare Global, Bengaluru, Karnataka, India
| | - R Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Desai Chirag
- Hemato-Oncology Clinic, Vedanta Super Speciality Hospital, Ahmedabad, India
| | - Goswami Chanchal
- Department of Oncology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Patil Poonam
- Department of Medical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
| | - Prasad Krishna
- Department of Medical Oncology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Rajendranath Rejiv
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - RR Rao
- Department of Medical Oncology, Max Super Speciality Hospital, Delhi, India
| | - TP Sahoo
- Department of Medicine, Chirayu Medical College, Bhopal, Madhya Pradesh, India
| | - Singh Ashish
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Singh Randeep
- Department of Oncology, Artemis Hospital, Gurgaon, Haryana, India
| | - Srinivasan Sankar
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - Warrier Arun
- Department of Medical Oncology, Aster Medicity Hospital, Kochi, Kerala, India
| | - Swarup Binay
- Medical Roche Products (India), Mumbai, Maharashtra, India
| | | | - SH Advani
- Medical Oncology, Mumbai, Maharashtra, India
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Parikh PM, Gupta S, Dawood S, Rugo H, Bhattacharyya GS, Agarwal A, Chacko R, Sahoo TP, Babu G, Agarwal S, Munshi A, Goswami C, Smruti BK, Bondarde S, Desai C, Rajappa S, Somani N, Singh M, Nimmagadda R, Pavitran K, Mehta A, Parmar V, Desai S, Nair R, Doval D. ICON 2013: Practical consensus recommendations for hormone receptor-positive Her2-negative advanced or metastatic breastcancer. Indian J Cancer 2014; 51:73-9. [DOI: 10.4103/0019-509x.134650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reck M, Bondarenko I, Luft A, Serwatowski P, Barlesi F, Chacko R, Sebastian M, Lu H, Cuillerot JM, Lynch TJ. Ipilimumab in combination with paclitaxel and carboplatin as first-line therapy in extensive-disease-small-cell lung cancer: results from a randomized, double-blind, multicenter phase 2 trial. Ann Oncol 2012; 24:75-83. [PMID: 22858559 DOI: 10.1093/annonc/mds213] [Citation(s) in RCA: 479] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ipilimumab, an anti-CTLA4 monoclonal antibody, demonstrated survival benefit in melanoma with immune-related (ir) adverse events (irAEs) managed by the protocol-defined guidelines. This phase 2 study evaluated ipilimumab+paclitaxel (Taxol)/carboplatin in extensive-disease-small-cell lung cancer (ED-SCLC). DESIGN Patients (n=130) with chemotherapy-naïve ED-SCLC were randomized 1: 1: 1 to receive paclitaxel (175 mg/m2)/carboplatin (area under the curve=6) with either placebo (control) or ipilimumab 10 mg/kg in two alternative regimens, concurrent ipilimumab (ipilimumab+paclitaxel/carboplatin followed by placebo+paclitaxel/carboplatin) or phased ipilimumab (placebo+paclitaxel/carboplatin followed by ipilimumab+paclitaxel/carboplatin). Treatment was administered every 3 weeks for a maximum of 18 weeks (induction), followed by maintenance ipilimumab or placebo every 12 weeks. End points included progression-free survival (PFS), irPFS, best overall response rate (BORR); irBORR, overall survival (OS), and safety. RESULTS Phased ipilimumab, but not concurrent ipilimumab, improved irPFS versus control [HR (hazard ratio)=0.64; P=0.03]. No improvement in PFS (HR=0.93; P=0.37) or OS (HR=0.75; P=0.13) occurred. Phased ipilimumab, concurrent ipilimumab and control, respectively, were associated with median irPFS of 6.4, 5.7 and 5.3 months; median PFS of 5.2, 3.9 and 5.2 months; median OS of 12.9, 9.1 and 9.9 months. Overall rates of grade 3/4 irAEs were 17, 21 and 9% for phased ipilimumab, concurrent ipilimumab and control, respectively. CONCLUSION These results suggest further investigation of ipilimumab in ED-SCLC.
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Affiliation(s)
- M Reck
- Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany.
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Dalal S, Hui D, Nguyen LMT, Chacko R, Bruera E. Achievement of personalized pain goal (PPG) in cancer patients referred to a supportive care clinic. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9060] [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: 11/20/2022] Open
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Dalal S, Palla SL, Chacko R, Nguyen L, Fadul NA, Li Z, Bruera E. Impact of the change in service name from “palliative” to “supportive” care on patient referral at a comprehensive cancer center. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9052] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
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Bush SH, Wearne HJ, Reilly PE, Chacko R, Palmer JL. Clinical findings and recommendations made during home visits by a palliative care specialist physician. Palliat Med 2009; 23:635-41. [PMID: 19581338 DOI: 10.1177/0269216309106752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little has been reported regarding the nature of home visits by palliative care specialist physicians to assist in the management of complex cases. We determined the characteristics, actionable clinical findings and recommendations made during consecutive home visits conducted by a specialist physician for patients registered with a community palliative care service. Patient demographic information and clinical records were reviewed. Ninety-one patients received a total of 104 home and residential facility visits. Median patient age was 59 (Q1-Q3, 43-72). Ten children (under the age of 14) received a total of 15 visits. Seventy-three patients (80%) had a cancer diagnosis. Median visit duration was 60 min (Q1-Q3, 45-60). The major actionable clinical findings were pain (120), gastrointestinal (115), neuropsychiatric (58), mouth and skin (33) and respiratory (29). One-third of recommendations involved changes in analgesia regimen (opioids 67, adjuvants 44). The specialist physician home visit resulted in multiple patient care recommendations. This information may help palliative care programmes improve their care for patients and families in the community.
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Affiliation(s)
- S H Bush
- South East Palliative Care, Cranbourne Integrated Care Centre, Cranbourne, Melbourne, Victoria.
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Bush SH, Parsons HA, Palmer JL, Chacko R, Li Z, Scott C, Bruera E. Single- versus multiple-item assessment of quality of life in patients with advanced cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20528] [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
e20528 Background: The main objective of palliative cancer care is to improve quality of life (QOL). As multiple dimensions impact on the construct of QOL, multi-dimensional instruments are usually used in its measurement. These are time consuming and burdensome for repeated use. Recent authors have suggested that brief single-item global assessments can provide a reliable measure of QOL. We assessed the performance of the Edmonton Symptom Assessment System ‘feeling of well-being’ item (ESAS WB) using the Functional Assessment of Cancer Therapy - General (FACT-G) instrument as a gold standard. Methods: After obtaining IRB approval, we reviewed the data from 213 advanced cancer patients who had participated in six studies from March 2006 to June 2008 and determined the level of association between baseline ESAS WB and FACT-G total score and subscale domains (Physical (Pwb), Social/Family (Swb), Emotional (Ewb), and Functional (Fwb) Well-Being) and also the 9 ESAS symptom intensity scores using Spearman correlation coefficients. We also calculated the change between the baseline (T1) and second (T2) observations of ESAS WB and of FACT-G total score and determined their level of association using a Pearson correlation coefficient. In addition, we predicted the change in FACT-G as predicted by the change in ESAS WB score using regression analysis. Results: Mean age was 60 (SD 12) years and 48% were female. At T1, the Spearman correlation coefficient of ESAS WB and FACT-G was -0.48 (p<0.0001). Spearman correlation coefficients for ESAS WB and FACT-G subscale domains and ESAS symptom intensity scores were also highly significant (p<0.0001) for all physical and emotional symptoms (other than p=0.003 for nausea) except for FACT Swb (p=0.08). The Pearson correlation coefficient for difference between T1 and T2 in ESAS WB and FACT-G for 146 patients was -0.36 (p<0.0001). The regression analysis was highly significant (p<0.0001). The change in ESAS WB corresponding to FACT-G published minimally important difference (MID) was -0.24 for 3, -1.55 for 5, and -2.87 for 7, respectively. Conclusions: ESAS WB is a practical instrument for clinical use and best reflects the Pwb, Ewb and Fwb domains of FACT-G as compared to Swb. No significant financial relationships to disclose.
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Affiliation(s)
- S. H. Bush
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | | | - R. Chacko
- UT M. D. Anderson Cancer Center, Houston, TX
| | - Z. Li
- UT M. D. Anderson Cancer Center, Houston, TX
| | - C. Scott
- UT M. D. Anderson Cancer Center, Houston, TX
| | - E. Bruera
- UT M. D. Anderson Cancer Center, Houston, TX
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Parsons HA, de La Cruz M, Delgado-Guay MO, Akitoye AE, Chacko R, Poulter V, Bruera E. Characteristics of patients who refuse medically appropriate do not resuscitate orders (DNR) upon admission to a palliative care (PC) unit in a comprehensive cancer center. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9589] [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
9589 Background: Cardiopulmonary resuscitation (CPR) has limited benefit in advanced cancer patients (pts). Refusal of medically appropriate DNR (maDNR) may cause harm and distress for pts, families, and the medical team. We conducted a retrospective study to determine the frequency of refusals of maDNR in a tertiary PC unit in a comprehensive cancer center, and characterize the differences between maDNR acceptors (A) and refusers (R). Methods: We reviewed 2538 consecutive admissions to the PC unit to find refusals of maDNR. Data were collected regarding demographical/clinical factors, 0–10 Edmonton Symptom Assessment System, DNR, CPR, and death for the first 100 R and 200 A pts. Results: DNR was considered medically appropriate for 2530/2538 (99%) admissions. 2374/2530 admissions were of unique pts, and 100/2374 (4%) refused maDNR. 3/3 (100%) R pts who coded underwent CPR versus 0/87 A pts who coded (0%, p<0.0001). 2/3 CPR pts survived code and were discharged but died in less than 10 days. Median age (62), female gender (54%), and religious affiliation were not different between R and A. African-Americans and pts with head and neck malignancies were more frequently R than others (OR=1.99, CI=1.13–3.51, p=0.02 and OR=2.62, CI=1.05–6.56, p=0.04, respectively). A had more hematological malignancies and advance directives (OR=2.66, CI=1.07–6.63, p=0.02, and OR=2.80, CI=1.68–4.66, p<0.0001, respectively). Multivariate regression analysis revealed that pts with hematologic malignancies (OR 2.69, CI=1.05–6.90 p= 0.04) and advance directives (OR 1.46, CI=1.46–4.27, p= 0.001) were associated with A. R pts presented with median (interquartile range, IR) pain of 7(4–9) vs 5(3–8, p=0.0005) nausea of 2(0–7) vs 1(0–4, p=0.05), and dyspnea of 1(0–5) vs 4(0–7, p=0.002). Median (IR) time between PC consult and death and discharge and death were 143 (49–329) days for R vs 25(10–77) for A (p<0.0001) and 85 (25–206) for R and 18 (8–35) for A (p<0.0001). Conclusions: DNR refusal in pts after PC consult is low, more frequent among African Americans, pts with head and neck cancers, pts with more pain or nausea, and is associated with longer survival. This study demonstrates possible predictors of complicated DNR discussions. No significant financial relationships to disclose.
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Affiliation(s)
- H. A. Parsons
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - M. de La Cruz
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - M. O. Delgado-Guay
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - A. E. Akitoye
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - R. Chacko
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - V. Poulter
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
| | - E. Bruera
- University of Texas M. D. Anderson Cancer Center, Houston, TX; University of Texas Medical School at Houston, Houston, TX
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Yennurajalingam S, Urbauer DL, Chacko R, Hui D, Amin YA, Evans AC, Orihuela C, Casper KL, Poulter V, Coldman B, Bruera E. Impact of an outpatient interdisciplinary team (IDT) consultation on symptom clusters in advanced cancer patients seen at a supportive care outpatient clinic (OSC) in a tertiary cancer center. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
e20542 Background: Advanced cancer patients develop severe physical and psychosocial symptom clusters. There is limited data on the impact of an outpatient interdisciplinary team (IDT) consultation lead by palliative care specialists on symptom clusters. Cluster composition and consistence, response rate and predictors of response are unknown. Methods: 914 consecutive patients with advanced cancer presenting in the OSC from Jan 2003 to Oct 2008 with a complete Edmonton symptom assessment scale at the initial and follow-up visit (median 14 days, range 1–4 wks), and CAGE status (alcohol screening) were reviewed. Wilcoxon ranked sign test was used to determine whether symptoms changed over time. Principal components factor analysis with varimax rotation was used to determine clusters of symptoms at baseline and at follow-up. The number of factors calculated was determined based upon the number of eigen values that were greater than one. Results: Median age was 59 yrs, female were 46%. The most common primary cancer was Lung (19%). Baseline and follow-up visit scores (mean, SD) were: fatigue 5.7 (2.1) and 5.2 (2.2, p<0.0001), pain 4.9 (2.6) and 4.1 (2.6 p<0.0001), nausea 1.8 (2.4) and 1.7 (2.3, p=0.1), depression 2.6 (2.5) and 2.2(2.4,p<0.0001), anxiety 2.9 (2.7) and 2.4 (2.4, p<0.0001), drowsiness 3.2 (2.8) and 3.2 (2.6, p=0.7), dyspnea 2.6 (2.7) and 2.4 (2.6), p=0.0027), appetite 4.2(2.7) and 3.9 (2.7, p<0.0001), sleep 4.2 (2.6) and 3.8 (2.6, p<0.0001) and well being 4.3 (2.5) and 3.9 (2.3, p<0.0001). During the follow- up the symptom clusters varied from a 3 factor to a 2 factor model, reflecting the impact of the IDT on symptom burden. CAGE positive and CAGE negative patients had a significantly different symptom cluster model. Conclusions: Cluster composition differs when patients are assessed and managed by an IDT and among patients who screen positive for alcoholism. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- S. Yennurajalingam
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - D. L. Urbauer
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - R. Chacko
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - D. Hui
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - Y. A. Amin
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - A. C. Evans
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - C. Orihuela
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - K. L. Casper
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - V. Poulter
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - B. Coldman
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
| | - E. Bruera
- UT M. D. Anderson Cancer Center, Houston, TX; M. D. Anderson Cancer Center, Houston, TX
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Parsons HA, Delgado-Guay MO, El Osta BE, Chacko R, Poulter V, Li Z, Palmer JL, Bruera E. Alcoholism screening in advanced cancer patients: Impact on symptom burden and opioid use. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9543] [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: 11/20/2022] Open
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El Osta B, Palmer J, Paraskevopoulos T, Pei B, Roberts L, Poulter V, Chacko R, Bruera E. Interval between first palliative care consultation and death in patients with advanced cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
9028 Background: Most referrals to acute palliative care (PC) services occur late in the trajectory of the disease, although an earlier intervention can decrease patients’ (pts) symptoms distress. The purpose of this study was to determine the time interval between first palliative care consultation (PC1) and death (D) in pts diagnosed with advanced cancer (aCA) at our comprehensive cancer center and whether such interval has increased over time. Methods: The study group was 2,868 consecutive pts who had their PC1 during a 30-month period. We reviewed the charts for information about demographics, cancer type, date of cancer diagnosis, aCA diagnosis, PC1, and D. aCA was defined as locally recurrent or metastatic. Results: 1,404 pts (49%) were female, 1,791 (62%) were < 65 years old, 2,563 (89%) had solid cancer, and 2,004 (70%) were white. The median PC1-D, aCA- PC1, and aCA-D intervals were 40, 114, and 243 days respectively. The median PC1-D interval (days) was: 47 for pts with solid cancer vs 14 for pts with hematological malignancy (p < 0.0001); 44 for pts < 65 years old vs 36 for pts = 65 years old (p = 0.002); 45 for females vs 37 for males (p = 0.004); 40 for white pts vs 41 for pts from other ethnicities (p = 0.42). The median PC1-D interval in 5 consecutive half-years was 46, 56, 42, 41, and 34 days respectively (p = 0.02). The total number of pts referred for PC1 in this period increased 20%, from 544 to 654. The ratio of PC involvement period in the aCA-D interval (PC1-D/aCA-D) decreased from 0.30 to 0.26 over the 5 half-year periods (p = 0.0004) ( Table ). Conclusions: Patients with solid cancers, younger pts, and females pts were referred earlier to acute PC. Referral timing was not affected by ethnicity. The interval between first palliative care consult and death has decreased over time. Education is needed among referring physicians to increase this interval. Further research on increasing acute PC access and its impact on PC1-D interval is needed. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- B. El Osta
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - J. Palmer
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - B. Pei
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - L. Roberts
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - V. Poulter
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Chacko
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - E. Bruera
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Chacko R, Klinge SA, Luminari S, Fotis M, McKoy J, Belknap SM, Raisch DW, Schumock G, Tallman MS, Bennett CL. Completeness and effectiveness of reporting on three drugs: Lessons learned from RADAR, a novel pharmacosurveillance and pharmacovigilance program. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3201] [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: 11/20/2022] Open
Affiliation(s)
- R. Chacko
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - S. A. Klinge
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - S. Luminari
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - M. Fotis
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - J. McKoy
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - S. M. Belknap
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - D. W. Raisch
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - G. Schumock
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - M. S. Tallman
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
| | - C. L. Bennett
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; UIC Center for Pharmacoeconomic Research, Chicago, IL; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL; VA Chicago/Northwestern Unversity, Chicago, IL
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Singh V, Klinge SA, Luminari S, Belknap SM, Raisch DW, Yarnold PR, Kim B, Chacko R, Tallman MS, Bennett CL. Understanding thalidomide-associated deep vein thrombosis/pulmonary emboli (DVT/PE): Comparison of quality and information included in adverse event reports from clinical trials, clinical practice, STEPS, and the medical literature. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3142] [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: 11/20/2022] Open
Affiliation(s)
- V. Singh
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - S. A. Klinge
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - S. Luminari
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - S. M. Belknap
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - D. W. Raisch
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - P. R. Yarnold
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - B. Kim
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - R. Chacko
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - M. S. Tallman
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
| | - C. L. Bennett
- Northwestern University, Feinberg School of Medicine, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; VA Cooperative Studies Program/University of New Mexico, Albuquerque, NM; Robert H. Lurie Cancer Center Northwestern University, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL
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Klinge SA, Chacko R, Bennett CL, Luminari S, Lyons EA, Trifilio S, McKoy J, Yarnold PR, Raisch DW, Tallman MS. Gemtuzumab ozogamicin (GO)-associated veno-occlusive disease (VOD): An analysis of adverse drug reaction (ADR) reports in the clinical trials, clinical practice, and in the medical literature. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6616] [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: 11/20/2022] Open
Affiliation(s)
- S. A. Klinge
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - R. Chacko
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - C. L. Bennett
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - S. Luminari
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - E. A. Lyons
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - S. Trifilio
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - J. McKoy
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - P. R. Yarnold
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - D. W. Raisch
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
| | - M. S. Tallman
- Northwestern Univ. Feinberg School of Medicine, Chicago, IL; VA Chicago/Northwestern University, Chicago, IL; Università di Modena e Reggio Emilia, Modena, Italy; Dept. of Pharmacy Northwestern Memorial Hospital, Chicago, IL; VA Cooperative Studies Center/Univ. of New Mexico, Albuquerque, NM; Robert H Lurie Cancer Center Northwestern Univ., Chicago, IL
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Thomas N, Seshadri MS, Thomas G, Chacko R, Samraj T, Nair S, Ponnaiya J, Cherian T. Association of central giant-cell granuloma of the maxilla with pyknodysostosis. Br J Oral Maxillofac Surg 2000; 38:159-60. [PMID: 10864715 DOI: 10.1054/bjom.1998.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rangarajan S, Chacko R, Shankar V. Active site characterization of RNase Rs from Rhizopus stolonifer: involvement of histidine and lysine in catalysis and carboxylate in substrate binding. Biochim Biophys Acta 1999; 1428:372-80. [PMID: 10434056 DOI: 10.1016/s0304-4165(99)00072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chemical modification studies on purified RNase Rs revealed the involvement of a single histidine, lysine and carboxylate residue in the catalytic activity of the enzyme. RNA could not protect the enzyme against DEP- and TNBS-mediated inactivation whereas, substrate protection was observed in case of EDAC-mediated inactivation of the enzyme. K(m) and k(cat) values of the partially inactivated enzyme samples suggested that while histidine and lysine are involved in catalysis, carboxylate is involved in substrate binding. Active site nature of RNase Rs suggests that the inability of the enzyme to readily convert 2',3'-cyclic nucleotides to 3'-mononucleotides is probably due to the absence of catalytically active second histidine residue.
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Affiliation(s)
- S Rangarajan
- Division of Biochemical Sciences, National Chemical Laboratory, Pune 411 008, India
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Chacko R, Shankar V. Extracellular ribonuclease from Rhizopus stolonifer: characteristics of an atypical--guanylic acid preferential--enzyme from ribonuclease T2 family. Biochim Biophys Acta 1998; 1379:264-72. [PMID: 9528662 DOI: 10.1016/s0304-4165(97)00103-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An extracellular ribonuclease from Rhizopus stolonifer (designated as RNase Rs) was purified to homogeneity by chromatography on DEAE-cellulose followed by CM-cellulose. The Mr of the purified enzyme determined by gel filtration and SDS-PAGE is 25,000 and 28,200, respectively. RNase Rs is a glycoprotein and contains 10.5% neutral sugar. It is an acidic protein with a pI of 5.0 and has a blocked N-terminus. The optimum pH and temperature are 5.5 and 45 degrees C, respectively. RNase Rs shows high stability between pH 6.0-10.0. Divalent cations like Zn2+, Hg2+ and Cu2+ inhibit the enzyme activity whereas, mononucleotides does not have any significant effect. The enzyme cleaves RNA to 3'-mononucleotides via 2',3'-cyclic nucleotides, with preferential liberation of 2',3'-cyclic GMP, suggesting that RNase Rs is a guanylic acid preferential cyclizing RNase. Moreover, cyclic nucleotides generated are highly resistant to further hydrolysis.
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Affiliation(s)
- R Chacko
- Division of Biochemical Sciences, National Chemical Laboratory, Pune, India
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Srivastava A, Chacko R, John L. Isolated gingival tuberculosis. Indian J Chest Dis Allied Sci 1986; 28:166-8. [PMID: 3596671] [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: 01/06/2023]
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Abstract
Data on the incidence of Paranoid Disorders according to modified DSM-III criteria in an outpatient geriatric clinic are presented. Results are consistent with previous research data which find paranoid symptomatology to be common in elderly psychiatric patients. The current definition of paranoid disorders is too narrow to encompass those elderly with good premorbid adjustment whose later life paranoid disorders often include hallucinations. The DSM-III paranoid subtype system does not have a separate category for chronic paranoid symptomatology which, although commonly seen in the old, is now subsumed under an atypical paranoid disorder classification. Further research into late life psychopathology may provide refinement of other diagnostic categories and a better understanding of the developmental relationship between personality disorder and major psychopathology.
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Abstract
Patterns of reflective LEM's have been correlated to a number of cognitive and personality variables, bu the relationship to sex, education, and mental illness is unclear. In this study females produced significantly more R-LEM overall indicating a preferential use of left hemisphere mechanisms when they initiate reflective thought. Females also produced more R-LEM for verbal nonemotional material, suggesting stronger lateralization of language abilities to their left hemisphere. Emotional and spatial stimuli were less well lateralized to the right hemisphere in females, and education was an unimportant variable for both sexes. Schizophrenia was independently associated with increases in total R-LEM indicating increased left hemisphere activity in this group.
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Chacko R. Depressive illness in children-a review. Indian J Psychiatry 1980; 22:129-34. [PMID: 22058455 PMCID: PMC3013300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- R Chacko
- Professor and Head, Department of Psychiatry, Christian Medical College, Vellore-632 002
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Chacko R, Viswanathan J. Prolapse of the rectum in amoebiasis. Indian Pediatr 1972; 9:816-8. [PMID: 4661557] [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: 01/11/2023]
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Chacko R. Psychiatric consultation in pediatric practice. Indian Pediatr 1970; 7:670-1. [PMID: 5500018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Chacko R. Childhood psychosis. Indian Pediatr 1970; 7:402-5. [PMID: 5492565] [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: 01/15/2023]
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Chacko R. Mental retardation--early recognition and management. Christ Nurse (Mysore) 1968; 219:9-14. [PMID: 5188628] [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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