The experience of financial toxicity among advanced melanoma patients treated with immunotherapy.

To measure financial toxicity and explore its association with quality of life (QOL) in an emerging population of survivors: advanced melanoma patients treated with immunotherapy. Cross-sectional survey and medical record review. 106 survivors (39% response).

The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery.

Hospitalists, rather than oncologists, are increasingly providing inpatient medical care to hospitalized patients with cancer, yet the opinions of oncologists regarding this model of care delivery are unknown. A survey was conducted assessing these opinions and experiences with inpatient cancer care delivery at a tertiary cancer center. Only 30% of oncologists agreed that caring for hospitalized patients with cancer was an efficient use of their time, and most believed a hospitalist service allowed them to pursue other interests.

The Clinical Challenge of Clonal Hematopoiesis, a Newly Recognized Cardiovascular Risk Factor.

Importance: Despite current standards of cardiovascular care, a considerable residual burden of risk remains in both primary and secondary prevention. Clonal hematopoiesis of indeterminate potential (CHIP) has recently emerged as a common, potent, age-associated, independent risk factor for myocardial infarction, stroke, heart failure events, and survival following percutaneous aortic valve intervention. The presence of CHIP results from the acquisition of somatic mutations in a small number of leukemia driver genes found in bone marrow stem cells, leading to the expansion of leukocytes clones in peripheral blood.

Quality of life in long-term survivors of advanced melanoma treated with checkpoint inhibitors.

Background: Immune checkpoint inhibitors (CIs) have revolutionized treatment of advanced melanoma, leading to an emerging population of long-term survivors. Survivors' quality of life (QOL) and symptom burden are poorly understood. We set out to evaluate symptom burden and QOL in patients with advanced melanoma alive more than 1 year after initiating CI therapy.

The Clinical Management of Clonal Hematopoiesis: Creation of a Clonal Hematopoiesis Clinic.

The acquisition of mutations in hematologic stem cells (clonal hematopoiesis) is common with normal aging and can be identified as an incidental finding through clinical genetic testing. Clonal hematopoiesis is associated with a heightened risk of developing hematologic neoplasms (especially myeloid) and accelerated atherosclerotic cardiovascular disease. This article discusses a multidisciplinary clinical approach to the management of patients with clonal hematopoiesis.

Clonal Hematopoiesis: Crossroads of Aging, Cardiovascular Disease, and Cancer: JACC Review Topic of the Week.

A novel, common, and potent cardiovascular risk factor has recently emerged: clonal hematopoiesis of indeterminate potential (CHIP). CHIP arises from somatic mutations in hematopoietic stem cells that yield clonal progeny of mutant leukocytes in blood. Individuals with CHIP have a doubled risk of coronary heart disease and ischemic stroke, and worsened heart failure outcomes independent of traditional cardiovascular risk factors.

Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States.

This survey study uses data from the National Health Interview Survey to investigate the prevalence of, and socioeconomic risk factors for, chronic pain and high-impact chronic pain among cancer survivors in the United States.

Comparison of Magnetic Resonance Imaging-stratified Clinical Pathways and Systematic Transrectal Ultrasound-guided Biopsy Pathway for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Context: Recent studies suggested that magnetic resonance imaging (MRI) followed by targeted biopsy ("MRI-stratified pathway") detects more clinically significant prostate cancers (csPCa) than the systematic transrectal ultrasound-guided prostate biopsy (TRUS-Bx) pathway, but controversy persists. Several randomized clinical trials (RCTs) were recently published, enabling generation of higher-level evidence to evaluate this hypothesis.

Objective: To perform a systematic review and meta-analysis of RCTs comparing the detection rates of csPCa in the MRI-stratified pathway and the systematic TRUS-Bx pathway in patients with a suspicion of prostate cancer (PCa).

Cardiovascular Complications Associated with Mediastinal Radiation.

Purpose Of Review: Radiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late consequences of mediastinal radiation has led to the development of strategies for cardiac risk reduction to improve outcomes through active surveillance and early detection of RIHD. This review aims to discuss the current knowledge on the presentation, diagnosis, and management of RIHD.

Acupuncture versus medication for pain management: a cross-sectional study of breast cancer survivors.

Aim Of The Study: Breast cancer survivors who take aromatase inhibitors (AI) often suffer from chronic pain. Emerging evidence supports the use of acupuncture as an effective pain management strategy for this condition, but its acceptability among cancer survivors is unknown. We evaluated breast cancer survivors' preferences for acupuncture as compared with medication use and identified factors predictive of this preference.

Influence of family on expected benefits of complementary and alternative medicine (CAM) in cancer patients.

Background: Cancer patients often use complementary and alternative medicine (CAM) based on recommendations from family. However, the relationship between family endorsement of CAM and the patient's expectation of its benefits has never been quantified.

Methods: Between 2010 and 2011, we conducted a cross-sectional survey study among patients with a diagnosis of cancer recruited from thoracic, breast, and gastrointestinal medical oncology clinics at a single academic cancer center.

Improving Hepatitis C Virus Screening Rates in Primary Care: A Targeted Intervention Using the Electronic Health Record.

Purpose: With the advent of effective treatments for hepatitis C virus (HCV), it has become a public health priority to increase the identification of HCV carriers and link them to systems of care. As a result, in 2012, the Centers for Disease Control and Prevention recommended that all adults born between 1945 and 1965 should receive one-time testing for HCV. In response to this mandate, we sought an effective nonintrusive means to increase HCV screening rates in our busy primary care practices.

Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction.

Background: While there are numerous benefits of smartphone use for physicians, little is known about the negative effects of using these devices in the context of patient care.

Objective: To assess resident and faculty smartphone use during inpatient attending rounds and its potential as a source of distraction during transfer of clinical information.

Design: Cross-sectional survey.

"The MICU is full": one hospital's experience with an overflow triage policy.

Background: Coronary care units (CCUs) are designed and staffed to care for patients with cardiovascular disease, while medical intensive care units (MICUs) are specially organized and staffed for the care of patients with noncardiovascular critical illness. Because the demand for MICU beds often exceeds their availability, patients in need of critical care often experience delays in admission and transfer to such specialized units, which may result in preventable harm. In response to this challenge, during times of MICU bed nonavailability Jacobi Medical Center (Bronx, New York) activates a policy whereby patients with noncardiovascular critical illness are admitted to a cardiology-staffed CCU for critical care to be delivered in a timely manner.

Using a computerized sign-out system to improve physician-nurse communication.

Background: Communication problems among health care workers are a common, preventable source of hospital-related morbidity and mortality. Internal medicine residents at Jacobi Medical Center (Bronx, NY) began using an electronic sign-out program that had been incorporated into the computerized medical record. This new system had been developed to improve the quality of information transfer between cross-covering residents.

A look at the pediatrician as parent: experiences with the introduction of varicella vaccine.

Many physicians voiced reservations about routine use of the varicella vaccine for healthy children after its licensing in 1995. Anecdotal evidence suggested that some pediatricians who were parents themselves were electing not to vaccinate their own children against chickenpox. Little has been written about pediatrician-parents' behaviors in caring for their own children, and how these practices may differ from the behavior that these same pediatricians apply in practice.

The internal medicine subinternship: a curriculum needs assessment.

Despite broad acceptance of the internal medicine subinternship rotation by the undergraduate medical education community, only a small fraction of programs provide students with explicit learning objectives. To design a curriculum for the medical subinternship, we surveyed 3 different groups of educational stakeholders--subinternship directors, residency program directors, and housestaff--in order to identify and prioritize the competencies that should be learned during this rotation. This study provides a starting point for the development of a structured curriculum for the fourth-year subinternship rotation.