206 results on '"Romano, A."'
Search Results
202. Repurposing Clinical Decision Support System Data to Measure Dosing Errors and Clinician-Level Quality of Care.
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Chin, David L., Wilson, Michelle H., Trask, Ashley S., Johnson, Victoria T., Neaves, Brittanie I., Gojova, Andrea, Hogarth, Michael A., Bang, Heejung, and Romano, Patrick S.
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DRUG dosage , *ACADEMIC medical centers , *ALGORITHMS , *AUTOMATION , *CONCEPTUAL structures , *CRITICAL care medicine , *DECISION support systems , *DRUG allergy , *DRUG interactions , *TEST validity , *EXPERIMENTAL design , *INFORMATION storage & retrieval systems , *MEDICAL databases , *RESEARCH methodology , *EVALUATION of medical care , *MEDICAL quality control , *MEDICAL informatics , *MEDICAL protocols , *MEDICATION errors , *PATIENT safety , *PEDIATRICS , *PHARMACEUTICAL arithmetic , *PHYSICIANS , *RISK assessment , *STATISTICS , *THERAPEUTICS , *DATA analysis , *JOB performance , *MULTITRAIT multimethod techniques , *RESEARCH methodology evaluation , *DESCRIPTIVE statistics , *INAPPROPRIATE prescribing (Medicine) - Abstract
We aimed to develop and validate an instrument to detect hospital medication prescribing errors using repurposed clinical decision support system data. Despite significant efforts to eliminate medication prescribing errors, these events remain common in hospitals. Data from clinical decision support systems have not been used to identify prescribing errors as an instrument for physician-level performance. We evaluated medication order alerts generated by a knowledge-based electronic prescribing system occurring in one large academic medical center's acute care facilities for patient encounters between 2009 and 2012. We developed and validated an instrument to detect medication prescribing errors through a clinical expert panel consensus process to assess physician quality of care. Six medication prescribing alert categories were evaluated for inclusion, one of which – dose – was included in the algorithm to detect prescribing errors. The instrument was 93% sensitive (recall), 51% specific, 40% precise, 62% accurate, with an F1 score of 55%, positive predictive value of 96%, and a negative predictive value of 32%. Using repurposed electronic prescribing system data, dose alert overrides can be used to systematically detect medication prescribing errors occurring in an inpatient setting with high sensitivity. [ABSTRACT FROM AUTHOR]
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- 2020
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203. Impact of Intercurrent Introduction of Steroids on Clinical Outcomes in Advanced Non-Small-Cell Lung Cancer (NSCLC) Patients under Immune-Checkpoint Inhibitors (ICI).
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De Giglio, Andrea, Mezquita, Laura, Auclin, Edouard, Blanc-Durand, Félix, Riudavets, Mariona, Caramella, Caroline, Martinez, Gala, Benitez, Jose Carlos, Martín-Romano, Patricia, El-Amarti, Lamiae, Hendriks, Lizza, Ferrara, Roberto, Naltet, Charles, Lavaud, Pernelle, Gazzah, Anas, Adam, Julien, Planchard, David, Chaput, Nathalie, and Besse, Benjamin
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THERAPEUTIC use of antineoplastic agents , *STEROID drugs , *LUNG cancer prognosis , *CANCER patients , *COMPARATIVE studies , *CONFIDENCE intervals , *IMMUNOTHERAPY , *LUNG cancer , *EVALUATION of medical care , *STEROIDS , *SURVIVAL analysis (Biometry) , *RETROSPECTIVE studies , *DESCRIPTIVE statistics - Abstract
Simple Summary: Recently, the introduction of immunotherapy radically changed the therapeutic algorithm of non-small-cell lung cancer as an upfront or secondary strategy. Unfortunately, the small amount of patient benefits from immune-checkpoint inhibitors (ICI) and the prognostic role of concomitant treatments are a burning open issue. The use of steroids was associated with poor outcomes during ICI. We investigated the impact of intercurrent steroids, according to clinical indication, which is actually unclear. Interestingly, the use of intercurrent steroids given for cancer-unrelated symptoms has no survival impact on our study cohort. Background: Baseline steroids before ICI have been associated with poor outcomes, particularly when introduced due to cancer symptoms. Methods: Retrospective analysis of advanced NSCLC patients treated with ICI. We collected the use of intercurrent steroids (≥10 mg of prednisone-equivalent) within the first eight weeks of ICI. We correlated steroid use with patient outcomes according to the indications. Results: 413 patients received ICI, 299 were steroids-naïve at baseline. A total of 49 patients received intercurrent steroids (16%), of whom 38 for cancer-related symptoms and 11 for other indications, such as immune-related events. Overall, median (m) progression-free survival (PFS) was 1.9 months (mo.) [95% CI, 1.8-2.4] and overall survival (OS) 10 mo. [95% CI, 8.1–12.9]. Intercurrent steroids under ICI correlated with a shorter PFS/OS (1.3 and 2.3 mo. respectively, both p < 0.0001). Intercurrent steroids for cancer-related symptoms correlated with poorest mPFS [1.1 mo.; 95% CI, 0.9–1.5] and mOS [1.9 mo.; 95%CI, 1.5–2.4; p < 0.0001)]. No mOS and mPFS differences were found between cancer-unrelated-steroid group and no-steroid group. Steroid use for cancer-related symptoms was an independent prognostic factor for poor PFS [HR 2.64; 95% CI, 1.2–5.6] and OS [HR 4.53; 95% CI, 1.8–11.1], both p < 0.0001. Conclusion: Intercurrent steroids during ICI had no detrimental prognostic impact if the indication was unrelated to cancer symptoms. [ABSTRACT FROM AUTHOR]
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- 2020
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204. Study of Ras Mutations' Prognostic Value in Metastatic Colorectal Cancer: STORIA Analysis.
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Ottaiano, Alessandro, Normanno, Nicola, Facchini, Sergio, Cassata, Antonino, Nappi, Anna, Romano, Carmela, Silvestro, Lucrezia, De Stefano, Alfonso, Rachiglio, Anna Maria, Roma, Cristin, Maiello, Monica R., Scala, Stefania, Delrio, Paolo, Tatangelo, Fabiana, Di Mauro, Annabella, Botti, Gerardo, Avallone, Antonio, and Nasti, Guglielmo
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DNA analysis , *COLON tumors , *COMPUTER software , *MULTIVARIATE analysis , *GENETIC mutation , *SURVIVAL , *DESCRIPTIVE statistics , *LOG-rank test ,RECTUM tumors - Abstract
Background: Colorectal cancer (CRC) is the second most common cause of cancer-specific death in both sexes in Western countries. KRAS mutations occur in about 50% of metastatic CRCs (mCRCs). The prognostic value of specific KRAS mutations still remains unexplored and unclear. Methods: Two hundred and forty KRAS wild-type and 206 KRAS/NRAS mutant consecutive unresectable mCRC patients with PS Eastern Cooperative Oncology Group (ECOG) 0 or 1, aged < 80 years, and with a life expectancy >3 months entered into this study. DNA was extracted from paraffin-embedded formalin-fixed tumour tissues, and it was sequenced with the Oncomine Solid Tumour DNA kit (Thermo Fisher Scientific, Waltham, MA, USA). Data were analysed using the Torrent Suite Software v5.0 (Thermo Fisher Scientific). The primary outcome was the analysis of the prognostic role of different KRAS mutations in terms of overall survival (OS). Results: There were no significant differences among the most prevalent mutations (p.G12D, p.G12V, p.G13D, p.G12A, p.G12C, and p.G12S) in terms of age (<65 vs. ≥65 years), gender (male vs. female), grading (G1/G2 vs. G3), side of primary tumour (left vs. right), pT, and pN. At the median follow-up of 25.6 months, there were 77 deaths in KRAS-mutated patients and 94 in wild-type patients. Three homogeneous prognostic groups were identified: wild-type patients (group A, median survival: 27.5 months), p.G13D/p.G12A/p.G12V/p.G12D mutants (group B, median survival: 17.3 months), and p.G12C/p.G12S mutants (group C, median survival: 5.0 months, p < 0.0001 according to Log Rank test). Upon multivariate analysis, metastatic involvement and p.G12C/p.G12S KRAS mutation group C (vs. other mutations) emerged as independent prognostic variables for survival. Conclusions: We show that mutant KRAS is a negative prognostic factor and that p.G12C/p.G12S variants present the worst clinical courses. This information suggests a clear difference among KRAS mutations, and it will be useful to test potentiated and/or innovative therapeutic strategies in p.G12C/p.G12S metastatic CRC patients. [ABSTRACT FROM AUTHOR]
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- 2020
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205. Liquid Biopsy Testing Can Improve Selection of Advanced Non-Small-Cell Lung Cancer Patients to Rechallenge with Gefitinib.
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Esposito Abate, Riziero, Pasquale, Raffaella, Sacco, Alessandra, Piccirillo, Maria Carmela, Morabito, Alessandro, Bidoli, Paolo, Finocchiaro, Giovanna, Chiari, Rita, Foltran, Luisa, Buosi, Roberta, Tiseo, Marcello, Giannetta, Laura, Battiloro, Ciro, Fasola, Gianpiero, Romano, Gianpiero, Ciuffreda, Libero, Frassoldati, Antonio, de Marinis, Filippo, Cappuzzo, Federico, and Normanno, Nicola
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CANCER chemotherapy , *CANCER patients , *CELL receptors , *CLINICAL trials , *CONFIDENCE intervals , *DRUG resistance in cancer cells , *EXTRACELLULAR space , *LUNG cancer , *MEDICAL cooperation , *GENETIC mutation , *NUCLEIC acids , *RESEARCH , *SURVIVAL analysis (Biometry) , *PROTEIN-tyrosine kinase inhibitors , *RETROSPECTIVE studies , *PATIENT selection , *DESCRIPTIVE statistics , *GEFITINIB , *BLOOD ,BODY fluid examination - Abstract
The ICARUS trial is a phase II, open label, multicenter, single arm study conducted to investigate the efficacy, safety, and tolerability of a rechallenge treatment with the first-generation tyrosine kinase inhibitor (TKI) gefitinib in advanced non-small-cell lung cancer (NSCLC) patients carrying activating mutations of the epidermal growth factor receptor (EGFR). The ICARUS trial enrolled 61 patients who were rechallenged with gefitinib at progression after second-line chemotherapy. Serum-derived circulating cell-free DNA (cfDNA) collected before the rechallenge from a cohort of 29 patients, was retrospectively analyzed for the EGFR exon 19 deletions and for the p.L858R and p.T790M single nucleotide variants (SNV). The analysis of cfDNA detected the same EGFR activating mutation reported in the tumor tissue in 20/29 patients, with a sensitivity of 69%. Moreover, a p.T790M variant was found in 14/29 patients (48.3%). The median progression-free survival (PFS) was 2.7 months for p.T790M positive patients (CI 95% 1.4–3.1 months) versus 3.5 months for the p.T790M negative patients (CI 95% 1.6–5.3 months), resulting in a statistically significant difference (Long rank test p = 0.0180). These findings confirmed the role of the p.T790M mutation in the resistance to first-generation TKIs. More importantly, our data suggest that TKI rechallenge should be guided by biomarker testing. [ABSTRACT FROM AUTHOR]
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- 2019
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206. Postpartum depression symptoms associated with Val158Met COMT polymorphism.
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Alvim-Soares, A., Miranda, D., Campos, S., Figueira, P., Romano-Silva, M., and Correa, H.
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POSTPARTUM depression , *ALLELES , *CONFIDENCE intervals , *EPIDEMIOLOGY , *GENETIC polymorphisms , *POLYMERASE chain reaction , *PSYCHOLOGICAL tests , *T-test (Statistics) , *TRANSFERASES , *DATA analysis , *EDINBURGH Postnatal Depression Scale , *DESCRIPTIVE statistics , *GENETICS - Abstract
A letter to the editor is presented regarding the symptoms of postpartum depression (PPD) linked with methionine (Val158Met) cathecol-O-methyltransferase (COMT) gene polymorphism.
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- 2013
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