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Introduction Solitary pulmonary nodules (SPNs) are common, but the clinical relevance of these nodules is unknown. Utilizing current screening guidelines, we sought to better characterize the national incidence of clinically important SPNs within the largest universal health care system in the nation. Materials and Methods TRICARE data were queried to identify SPNs for ages 18–64 years. SPNs that had been diagnosed within a year with no prior oncologic history were included to ensure true incidence. A proprietary algorithm was applied to determine clinically significant nodules. Further analysis characterized incidence by age grouping, gender, region, military branch, and beneficiary status. Results A total of 229,552 SPNs were identified with a 60% reduction seen after application of the clinical significance algorithm (N = 88,628). The incidence increased in each decade of life (all P Conclusions This analysis represents the largest evaluation of SPNs to date combined with clinical relevance adjustment. These data suggest a higher incidence of clinically significant SPNs starting at an age of 44 years in nonmilitary or retired women localized to the Midwest and Western regions of the United States.

BACKGROUND Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital systems to monitor postoperative symptom burden have been developed; however, barriers to routine clinical implementation remain, particularly in complex and vulnerable populations. This study sought to determine end-user (patient) barriers and facilitators of using an electronic patient-reported outcome (ePRO) monitoring platform designed to detect complications from thoracic surgery post-discharge. OBJECTIVE To determine the barriers to electronic patient-reported outcomes use after discharge from surgery METHODS Patients planned for thoracic surgery were recruited to participate in web-based ePRO monitoring. Participants experienced in ePRO use (n=16) underwent semi-structured interviews, which were analyzed by deductive team-based coding. Themes were mapped onto the three domains of the COM-B model of behavior framework (Capability, Opportunity, and Motivation). ePRO design and implementation improvements to respond to these themes were identified. RESULTS Analysis demonstrated seven dominant themes reported by ePRO participants. These included barriers (postoperative patient physical and mental health, lack of access to email and poor internet connectivity, lack of clarity on ePRO use in routine clinical care, and symptom item redundancy) and facilitators (ease of the ePRO assessment completion, engagement with the surgical care team on ePRO use, and increased awareness of symptom experience through ePRO use). The following ePRO intervention design improvements were identified: offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient-facing materials linking ePROs to other systems for perioperative care. CONCLUSIONS ePROs have the promise of improved care outcomes for postoperative patients. Addressable barriers and facilitators to implementation in the thoracic surgical patient population have been identified. Future work on testing the impact of intervention design improvements on implementation outcomes of feasibility and acceptability is ongoing. CLINICALTRIAL ClinicalTrials.gov NCT04342260

PURPOSE Symptoms are common in patients receiving systemic treatment for metastatic cancer. Monitoring patients with electronic patient-reported outcomes (ePROs) detects severe and worsening symptoms early, enabling care teams to intervene and prevent downstream complications and thereby improving outcomes. The Centers for Medicare & Medicaid Services will require patient-reported outcome (PRO) monitoring in the upcoming Enhancing Oncology Model, and many practices will likely attempt to implement PROs in patient care for the first time. METHODS To assist practices with the design and implementation of ePRO remote symptom monitoring programs, tenets were drawn from prior ePRO program experiences and research. RESULTS Successful implementation requires a quality improvement approach to change management with attention to software functionality, measured outcomes, personnel deployment, leadership and culture, workflow, equity, and patient engagement. Specific approaches in each of these areas can optimize program participation and effectiveness. Continuous program monitoring to identify and address barriers is essential to success. Initial challenges with personnel acceptance and patient participation are common and can be overcome by using these tenets. CONCLUSION Remote symptom monitoring with ePROs is a key component of quality cancer care and population health management that requires organizational commitment and a deliberate approach by practices using established tenets to assure successful implementation.

The cytogenetic evaluation of a female infant with congenital anomalies led to the identification of the second reported case of a ring-11 chromosome. Unlike the previously described case, in which the patient had only minimal clinical findings and no demonstrable loss of material from the ring, our patient had numerous anomalies that were associated with a substantial deficiency of 11q material. The different phenotypes in these two cases represent variation in the amount and location of the chromosomal material lost during the genesis of the ring. The manifestations of this patient and the deletion of region q24 leads to qter from the ring-11 identify a specific chromosome deletion syndrome referred to as del (11q) syndrome.

Peripheral arterial embolism is, to our knowledge, a heretofore unreported complication of paroxysmal atrial tachycardia. Our observation of one such association is presented with a postulation regarding its pathogenesis. The patient also had unilateral facial paresis suggesting cardiac conduction anomaly as a previously unrecognized cardiac defect with this cardiofacial syndrome.