Diana Almader-Douglas

Second-line treatment in patients with pancreatic ductal adenocarcinoma: A meta-analysis

There are limited therapeutic options for treatment‐refractory pancreatic ductal adenocarcinoma (PDAC), with a paucity of data to support the best option after progression on gemcitabine‐based regimens. The authors performed a meta‐analysis to determine the effectiveness of adding oxaliplatin (OX) or various irinotecan formulations to a fluoropyrimidine (FP) after first‐line treatment progression in patients with PDAC.

Retinal Microvascular Abnormalities as Surrogate Markers of Cerebrovascular Ischemic Disease: A Meta-Analysis

BACKGROUND To determine the predictive value of retinal microvascular abnormalities for cerebrovascular ischemic diseases (CVDs), we aimed to investigate the quantitative association between retinal microvascular changes and CVD subcategories: white matter hyperintensities (WMHIs), lacunar infarcts (LIs), and cerebral infarctions (CIs). METHODS Using Meta-analyses Of Observational Studies in Epidemiology guidelines, we searched 6 databases through September 2016 for studies evaluating the linkage between retinal microvascular abnormalities and WMHI, and LI and CI. Studies were included if they reported odds ratios (ORs) and 95% confidence intervals or raw patient level data (that were computed into ORs). Unadjusted and vascular risk-factor adjusted ORs were pooled into meta-analysis using DerSimonian Laird random effects model. Study quality and dissemination biases were assessed and integrated. RESULTS From 24,444 search-identified records, 28 prospective studies encompassing 56,379 patients were eligible for the meta-analysis. After vascular risk-factor adjustment, focal arteriolar narrowing was associated with WMHI (OR, 1.24 [1.01-1.79]), LI (OR, 1.77 [1.14-2.74]), and CI (OR, 1.75 [1.14-2.69]). Venular dilation was associated with LI (OR, 1.46 [1.10-1.93]), and retinal hemorrhages with WMHI (OR, 2.23 [1.34-3.70]). Any retinopathy exhibited significant association with CI (OR, 1.96 [1.65-2.50]). Heterogeneity was significant (I2>50%) for all syntheses except retinal hemorrhages and WMHI, and retinopathy and CI (I2=0 ⋅ 0%). Associations remained significant after adjustments for quality and publication bias. CONCLUSIONS We found the most significant association between retinal hemorrhages and WMHI. Focal arteriolar narrowing and retinopathy predicted CVD subtypes after risk-factor adjustment, suggesting that features different than traditional vascular risk factors, are involved in CVD pathophysiology.

Adjuvant Antiangiogenic Agents in Post-nephrectomy Renal Cell Carcinoma: A Systematic Review and Meta-analysis

Context The role of antiangiogenic agents in advanced renal cell carcinoma (RCC) is well established. However, it is still not clear whether this benefit can be extrapolated to the adjuvant setting. Objective To determine the efficacy and safety of antiangiogenic agents in patients with RCC and a high risk of relapse after nephrectomy. Evidence acquisition We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) evaluating the use of any oral antiangiogenic agent compared to placebo in post-nephrectomy RCC patients. Prespecified data elements were extracted from each trial. Outcomes of interest included overall survival (OS) and disease-free survival (DFS). The overall effect was pooled using the DerSimonian and Laird random-effects models. Evidence synthesis Three RCTs comparing antiangiogenics to placebo among 3693 patients met our inclusion criteria and were used in meta-analyses. Overall, antiangiogenics did not improve DFS (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.78-1.07) or OS (HR 0.99, 95% CI 0.79-1.25). These results persisted when restricting the analysis to patients with clear cell carcinoma and patients with highest risk of relapse. Similarly, sunitinib did not show any improvement in the entire cohort for either DFS (HR 0.89, 95% CI 0.67-1.19) or OS (HR 1.11, 95% CI 0.90-1.37). Conclusions In this meta-analysis, antiangiogenics did not improve OS and DFS over placebo in high-risk RCC after nephrectomy. Further studies are needed to identify the patient population that might derive a benefit from antiangiogenics in the adjuvant setting. Patient summary In this article, we found that there is currently insufficient evidence to support the use of oral antiangiogenics in nonmetastatic renal cell carcinoma after nephrectomy. In addition, the use of oral antiangiogenics was associated with a 2.7-fold higher rate of significant side effects compared to placebo.

Rituximab maintenance therapy for mantle cell lymphoma: A systematic review and meta-analysis

Mantle cell lymphoma is characterized by relapse and progressive disease, despite initial response to chemoimmunotherapy. We conducted a systematic review and meta‐analysis to determine the efficacy of rituximab maintenance (RM) therapy in patients with mantle cell lymphoma. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials from database inception through November 1, 2017. Only full‐text articles were included. Prespecified data elements were extracted from each trial. Outcomes of interest included progression‐free survival (PFS) and overall survival (OS). The overall effect was pooled using the Der Simonian‐Laird random effects model. Three randomized controlled trials and four observational studies met our inclusion criteria and were identified in the analyses. Six studies compared RM therapy to observation, and one compared RM therapy to interferon alfa. Meta‐analysis evaluating outcomes of patients treated after ASCT revealed that RM improved for both PFS (HR = 0.33, 95% CI = 0.23‐0.49) and OS (HR of death = 0.35, 95% CI = 0.17‐0.69). A second meta‐analysis of studies evaluating outcomes of patients who are ASCT‐ineligible treated with anthracycline‐based induction therapy revealed that RM improved PFS (HR = 0.38, 95% CI = 0.25‐0.58). There is a paucity of data on the role of RM in ASCT‐ineligible patients and those with relapsed disease. Overall, RM therapy appears to improve PFS and OS in previously untreated patients with mantle cell lymphoma who undergo induction chemoimmunotherapy followed by ASCT.

iPads for Patients: Sharing Authoritative Health Care Resources

Consumer health information is readily available on web sites, Application Program Interfaces (APIs) and applications, but often health consumers are less able to find authoritative, up-to-date health resources on which to review health conditions to make more informed health care decisions. The medical librarian’s role in consumer health can assist health information seekers to become more comfortable with mobile devices, and improve their knowledge of mobile devices, therefore improving access to 24/7 health information. Mayo Clinic Arizona is a unique setting in that it is comprised of two campuses that treat patients. The Scottsdale campus is an outpatient, ambulatory care clinic, while the Phoenix campus is a 268-bed hospital, adjacent to two outpatient centers including specialty services like orthopedics and neurology, and a new cancer center that is home to a proton beam therapy facility as well as other medical practices. It is common for patients seeking health care to have more than one appointment per day, many times at both campuses. This leads to periods of time in between clinician visits, and often, patients visit the Patient and Health Education Library during these unscheduled time frames. The Patient and Health Education Library staff recognized an opportunity to utilize this time in between appointments to assist patients, family members and caregivers find reliable and authoritative health information resources on a mobile device. An iPad lending program would allow patients to borrow an iPad for the day while they were being seen by clinicians at both campus locations. This article describes a 2015–2016 iPad project to help patients access health information and help them become more confident in their ability to navigate and use mobile technology in their everyday lives. Patients were able to borrow iPads with pre-loaded health information content and resources, and library staff was made available to help patients navigate and use the tablets.

Drop-in Fridays: Literature Searching for All

In the spring of 2015, the Library Staff of Mayo Clinic Library Services in Arizona noticed a trend in requests for literature searching for school and other non-work-related projects. Not knowing what, if anything was being taught in the curriculum on the Phoenix Hospital or Scottsdale Clinic Campus, the authors thought it would be worthwhile to try office hours or drop in time to assist with literature searching. The goals of the pilot were for patrons to improve self-sufficiency in researching by exposing them to the Library’s services and resources, improve their literature searching skills, and reduce the number of non-work related literature search requests. This dropin time would be open to any and all staff that felt the need for some assistance with searching the nursing, allied health and medical literature. A preand postassessment of each drop in session was taken. Results of the assessment and other aspects of Drop-in Fridays are presented here and were presented as a poster at MLA2016 in Toronto.