Racial Differences in Access to New Technology 4.29.08
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This document summarizes a study that analyzed Medicare claims data to compare rates of carotid stent placement (CSS) versus carotid endarterectomy (CE) among white and black patients from 2005-2006. The study found no evidence of racial differences in receiving CSS in the initial period of Medicare coverage. A logistic regression model controlling for patient and hospital characteristics found black patients had similar odds of receiving CSS compared to whites. Additional models found no significant interaction between patient race and geographic variability in CSS utilization rates.
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![[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Racial Differences in Access to New Technology: The Case of Carotid Stent Systems Peter W. Groeneveld, MD, MS · Alexis P. Greenhut, MPH · Janell Olah, MFA· Christine Camacho, BA · Feifei Yang, MS Philadelphia VA Medical Center; Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine Background Objectives Methods Results (continued) Conclusions Implications Results ,[object Object],Study Participants Characteristic CS n=18,631 CE n=115,976 p value Age, mean (SD) 76 (7) 76 (6) 0.01 Female 10860 (58) 66068 (57) <0.001 Black 792 (4) 4091 (4) <0.001 Academic hospital 6412 (34) 22358 (19) <0.001 Urban hospital 10411 (56) 47908 (41) <0.001 DxCG Risk Score (SD) 0.8 (1) 0.7 (1) <0.001 Cardiovascular disease Congestive heart disease 2185 (12) 9357 (8) <0.001 Valvular heart disease 1622 (9) 10009 (9) 0.73 Peripheral vasc. disease 5712 (31) 18492 (16) <0.001 Hypertension 10495 (56) 77449 (67) <0.001 Coronary artery disease 9689 (52) 51400 (44) <0.001 Stroke 419 (2) 1867 (2) <0.001 Transient isch. attack 475 (3) 2926 (3) <0.001 Non-cardiovascular clinical co-morbidity Chronic pulm. disease 3617 (19) 24228 (21) <0.001 Diabetes 4255 (23) 29047 (25) <0.001 Hypothyroidism 1219 (7) 9898 (9) <0.001 Renal disease 1754 (9) 6676 (6) <0.001 Cancer (no metastases) 1371 (7) 10097 (9) <0.001 Fluid/e-lyte disorder 682 (4) 5165 (5) <0.001 Predictor Model 1 odds ratio* p value Model 2 odds ratio p value Model 3 odds ratio p value Positive predictors of CSS receipt Perph vasc dis 2.45 <0.001 2.44 <0.001 2.44 <0.001 Acad hosp 1.93 <0.001 1.77 <0.001 1.77 <0.001 Urban hosp 1.64 <0.001 1.14 0.13 1.14 0.12 Concur stroke 1.52 <0.001 1.53 <0.001 1.53 <0.001 CHF 1.27 <0.001 1.28 <0.001 1.28 <0.001 Renal disease 1.24 <0.001 1.27 <0.001 1.27 <0.001 CAD 1.24 <0.001 1.22 <0.001 1.22 <0.001 Age (decade) 1.04 0.009 1.04 0.01 1.04 0.01 Negative predictors of CSS receipt Diabetes 0.88 <0.001 0.89 <0.001 0.89 <0.001 Cancer 0.87 <0.001 0.89 0.002 0.89 0.002 Pulm dis 0.84 <0.001 0.85 <0.001 0.85 <0.001 Hypothyr 0.80 <0.001 0.79 <0.001 0.79 <0.001 Fluid/e-lyte 0.73 <0.001 0.73 <0.001 0.73 <0.001 HTN 0.65 <0.001 0.66 <0.001 0.66 <0.001 Gender, Race, and CSS uptake HRR quintile Female 1.03 0.1 1.03 0.09 1.03 0.09 Black 0.99 0.85 0.88 0.08 - - Top 20% HRR - - 15.6 <0.001 19.1 <0.001 2 nd 20% HRR - - 8.35 <0.001 15.9 <0.001 3 rd 20% HRR - - 5.61 <0.001 13.0 <0.001 4 th 20% HRR - - 3.19 <0.001 8.9 <0.001 Black • Top 20% - - - - 0.92 0.81 Black • 2 nd 20% - - - - 1.28 0.50 Black • 3 rd 20% - - - - 1.26 0.53 Black • 4 th 20% - - - - 1.40 0.38 Black • 5 th 20% - - - - 0.80 0.53](https://image.slidesharecdn.com/groeneveldpeter-racialdifferencesinaccesstonewtechnology-4-29-08-100818145114-phpapp02/85/Racial-Differences-in-Access-to-New-Technology-4-29-08-1-320.jpg)
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This document discusses treatments for radial artery occlusion (RAO) following transradial catheterization. It describes pharmacological treatments including low molecular weight heparin and anticoagulation as well as non-pharmacological options such as ulnar artery compression, percutaneous interventions, and surgery. Ulnar artery compression is highlighted as a simple, safe, and effective method for treating RAO. A new combined approach using balloon angioplasty and localized intra-arterial abciximab is also discussed but requires further validation. Overall, the best approach is prevention of RAO by ensuring patent hemostasis and using slender techniques.EchoAdherence_Poster_ACC2016_FINAL
- Of 200 asymptomatic patients with severe aortic stenosis, 140 (70%) adhered to guidelines of serial evaluations every 12 months over 3 years of follow up.
- Patients adhering to guidelines had aortic valve replacement more frequently (47.2% vs 18.3%; p=0.001) and lower incidence of heart failure hospitalization (59.2% vs 52.6%; p=0.02) compared to non-adherent patients.
- There was no difference in mortality or inpatient costs between adherent and non-adherent groups. Adherence to guidelines was associated with greater rates of aortic valve replacement and reduced heart failure hospitalization without impacting survival or costs.
Ludwig J 20150319
Radial access for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients reduces bleeding complications compared to femoral access. Several randomized controlled trials showed lower all-cause mortality with radial versus femoral access when performed by experienced radial operators. However, the studies only included radial operators, so it is unclear if the benefits seen with radial access would apply if femoral operators performed radial procedures or vice versa. Additionally, radial access requires experienced operators at high-volume centers, and the definition of an experienced radial operator remains uncertain due to the steep learning curve for radial procedures. The primary goal of primary PCI in STEMI is restoring blood flow to the heart, not avoiding access site complications.
CHF Team Quality Report
Heart failure is the most common reason for hospitalization among those over 65 years old, and the most expensive diagnosis for Medicare. A hospital implemented several initiatives to improve care for heart failure patients based on evidence-based guidelines and quality measures. This resulted in improved processes of care, increased adherence to quality measures, stabilization of readmission rates, and recognition as a community leader in heart failure care.
TCT 2010: COMPARE Trial
This document summarizes the Compare Trial, which compared the Taxus Liberté and Xience V drug-eluting stents. The trial included 1,800 patients and found that at the 2-year follow up:
1) Xience V was superior to Taxus Liberté for reducing the primary endpoint of death, heart attack, and repeat procedures.
2) Xience V also significantly reduced the risks of heart attack, repeat procedures, and stent thrombosis compared to Taxus Liberté.
3) While both stents significantly reduced risks overall, neither showed a significant difference for diabetic patients specifically.
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudin
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudinInternational Chair on Interventional Cardiology and Transradial Approach
Bivalirudin or heparin and provisional IIb/IIIa inhibitors in primary angioplasty performed through transradial approach04 FFR Johnson aimradial2017 - Hyperhemia
04 FFR Johnson aimradial2017 - HyperhemiaInternational Chair on Interventional Cardiology and Transradial Approach
- The document discusses contrast-based fractional flow reserve (cFFR) which uses intracoronary contrast to induce hyperemia rather than intravenous adenosine.
- Studies have shown cFFR has higher diagnostic accuracy than resting physiology measures like iFR and Pd/Pa, correctly identifying around 85% of lesions compared to around 80% for resting measures.
- cFFR provides an alternative approach to assessing coronary physiology that is faster and avoids the side effects of intravenous medications like adenosine.Kwok CS - AIMRADIAL 2014 - Gender, syndrome, clinical outcomes
Kwok CS - AIMRADIAL 2014 - Gender, syndrome, clinical outcomesInternational Chair on Interventional Cardiology and Transradial Approach
The impact of gender, syndrome and vascular access site on clinical outcomes following percutaneous coronary interventionWhat's hot (20)
Dzavik V - AIMRADIAL 2014 - Rotablator and radial approach
Dzavik V - AIMRADIAL 2014 - Rotablator and radial approach
Jolly S - Radiation exposure and transradial - 201507
Jolly S - Radiation exposure and transradial - 201507
Hahalis G - AIMRADIAL 2013 - Ulnar catheterization
Hahalis G - AIMRADIAL 2013 - Ulnar catheterization
De Andrade PB - AIMRADIAL 2015 - Angio-Seal vs radial approach
De Andrade PB - AIMRADIAL 2015 - Angio-Seal vs radial approach
Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusion
Bernat I - AIMRADIAL 2014 Technical - Radial artery occlusion
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudin
Sciahbasi A - AIMRADIAL 2013 - Heparin vs bivalirudin
Kwok CS - AIMRADIAL 2014 - Gender, syndrome, clinical outcomes
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Similar to Racial Differences in Access to New Technology 4.29.08
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The Role of Technology in Cardiovascular Health Care Cost Growth 4.21.10Leonard Davis Institute of Health Economics
New technologies like drug-eluting stents and implantable cardioverter-defibrillators significantly increased healthcare costs for Medicare beneficiaries between 2003-2006, adding nearly $4 billion annually. While these technologies provided benefits, they disproportionately drove up costs for lower-acuity patients. The study found that 43% of increased costs from drug-eluting stents were for patients without acute coronary syndromes, and growth in costs from implantable cardioverter-defibrillators for non-hospitalized heart failure patients was minimal. Technologies that increase spending most for low-acuity cases may not be providing optimal value.What is the place of CT coronary angiography in ED chest pain?
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...Texas Children's Hospital
Restrictive thresholds for red blood cell (RBC) transfusion have not been shown to be inferior to liberal transfusion thresholds after cardiac surgery in pediatric or adult patients.1,2
RBC transfusions are associated with readmission due to heart failure (HF) in adults after aortic valve replacements, and with increased risk of right ventricle-pulmonary artery conduit failure in pediatric patients.3,4
Data are limited about RBC transfusions in pediatric patients with HF.
HOST-EXAM-
This trial describes the use of Aspirin or Clopidogrel as a monotherapy after percutaneous coronary intervention in myocardial infarction patients. Though the guidelines have not said anything strictly but trials have shown Clopidogrel to be better than Aspirin.
Stable ischemic heart disease how is it different from acs..
Lecture presented by Dr. Dev Pahlajani at the ACS Conference on Stable Ischemia Heart Disease, Mumbai, 2015
PROSPER trial journal club
The study compared outcomes of ischemic stroke patients prescribed direct oral anticoagulants (DOACs) versus warfarin at discharge. Patients prescribed DOACs had more days at home within one year of discharge, fewer major adverse cardiovascular events, and lower rates of death, readmissions, hemorrhagic strokes, and bleedings compared to warfarin. However, DOACs were associated with a higher risk of gastrointestinal bleeding. The retrospective study was limited by potential selection biases from its exclusion criteria and inability to account for differences in warfarin dosage adjustments compared to DOACs.
Zest Park
The ZEST trial was a randomized controlled trial that compared the efficacy and safety of the zotarolimus-eluting stent (ZES) to the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) in patients requiring percutaneous coronary intervention. Over 2,600 patients undergoing stent placement for coronary artery disease across 19 centers in Korea were randomized to receive one of the three drug-eluting stents. The primary endpoint was the composite of death, myocardial infarction, or ischemia-driven target vessel revascularization at 12 months. Secondary outcomes included safety endpoints like stent thrombosis. Baseline patient characteristics were similar between groups. Results showed the ZES group had a
Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...Christos Argyropoulos
Presentation focused on pre-operative evaluation of Major Adverse Cardiac Events prior to renal transplantation.
Modified from a presentation I gave in 2007; compared to the original there is a less enthusiastic endorsement of a peri-operative fixed dose beta blockade administration strategy given the discrepant results of the POISE and DECREASE-II studiesCT coronary angiography in ED chest pain patients
CTCA shows promise in reducing length of stay and costs for ED chest pain patients, but more research is needed. While CTCA is highly sensitive for detecting CAD, it may overestimate lesion severity and has radiation risks. Current evidence does not clearly support CTCA as a routine test for ED chest pain patients without known CAD who have normal ECG and biomarkers. CTCA may be useful in select subgroups, but how to define these subgroups is unclear.
Which Chest Pain Can Be Safely Discharged From Ed
This document discusses strategies for evaluating and safely discharging chest pain patients from the emergency department (ED). It notes that over 30% of medical admissions are for chest pain, but only 50% actually have acute coronary syndrome (ACS). The diagnostic challenges include non-specific symptoms, limitations of electrocardiograms and cardiac markers in the early stages of ACS. Risk prediction tools like the TIMI score can help determine which low-risk patients may be safely discharged. Younger patients with no cardiac risk factors and normal initial tests have a very low 0.14% risk of ACS. Stress tests and echocardiography have limitations in the ED setting but may help rule out problems in some patients. The goal is to
Appropriteness Criteria for Coronary Revascularization
The document discusses guidelines for determining the appropriateness of revascularization procedures like angioplasty and coronary artery bypass grafting. It summarizes several major clinical trials that have compared medical therapy to revascularization and PCI to CABG. The guidelines developed by an expert panel rate 180 clinical scenarios on appropriateness based on factors like symptoms, risk level, coronary anatomy, and response to medical therapy. Revascularization is deemed appropriate for high-risk patients but uncertain or inappropriate for low-risk, asymptomatic patients or late interventions after heart attacks.
Appropriteness Criteria for Coronary Revascularization
The document discusses guidelines for determining the appropriateness of revascularization procedures like angioplasty and coronary artery bypass grafting. It summarizes several major clinical trials that have compared medical therapy to revascularization and PCI to CABG. The guidelines developed by an expert panel rate 180 clinical scenarios on appropriateness based on symptoms, risk level, coronary anatomy and medical therapy. Revascularization is deemed appropriate for high-risk patients but uncertain for intermediate-risk asymptomatic patients. CABG is preferred over PCI for left main stenosis and multi-vessel disease.
Incremental predictive value of vascular assessments combined with the Framin...
Presented by:
Kui-Kai Lau, Yap-Hang Chan, Kai-Hang Yiu, MBBS, Sidney Tam, MD, Sheung-Wai Li, MBBS, Chu-Pak Lau, MD, Hung-Fat Tse, MD,PhD.
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad ateroscleróticaSociedad Española de Cardiología
Focus en el diagnóstico y tratamiento de las enfermedades coronarias. Evolución no invasiva de la enfermedad aterosclerótica2014session5 3
The document discusses the lack of consensus around treating asymptomatic carotid artery disease. While surgery reduces the risk of stroke, the absolute benefit is small given the already low risk with medical management alone. More recent data favors a purely medical approach for most asymptomatic patients. The evidence for invasive treatments like carotid endarterectomy (CEA) or stenting is considered weak, with no clear benefits shown for subgroups like women, those over 75, or different degrees of stenosis. Treating asymptomatic disease at a population level may lead to many unnecessary interventions that provide little benefit given evolving medical therapies.
13 FFR Piroth aimradial2017 - Post-PCI FFR
13 FFR Piroth aimradial2017 - Post-PCI FFRInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a study investigating the ability of post-PCI FFR measurements to predict clinical outcomes. The study found:
1) Vessels with lower post-PCI FFR values (<0.92) were associated with higher rates of adverse cardiac events at 2 years compared to vessels with higher FFR values (>0.92).
2) However, post-PCI FFR had low sensitivity, specificity, and likelihood ratios for predicting individual patient outcomes.
3) Therefore, while lower post-PCI FFR was associated with worse population-level outcomes, it cannot be used to reliably predict or optimize outcomes for individual patients.SISTEMA NERVIOSO
This document summarizes guidelines for evaluating patients presenting with chest pain. It discusses the initial risk stratification process, which involves obtaining a history, physical exam, and electrocardiogram (ECG). The ECG is critical for identifying ST-segment elevation, which indicates need for immediate reperfusion therapy. Biomarkers such as troponin are also important to detect cardiac injury. Various imaging modalities can further risk stratify patients with no initial evidence of acute coronary syndrome, including myocardial perfusion imaging, computed tomography, and cardiac magnetic resonance imaging. The goal is to safely identify low-risk patients who can be managed as outpatients.
Stable angina
Coronary heart disease is best addressed by a comprehensive approach aimed at halting atherosclerotic disease and reducing the risk of thrombosis. Unfortunately, our success in optimal risk factor modification in patients with stable CHD remains poor: only 41% of patients achieved all basic goals in the recent ISCHEMIA trial, with success rates likely even lower outside the rigorous clinical trial context. A greater focus on achieving prevention goals in patients with CHD will have a substantial impact on patient outcome and rates of hospitalization and more resources and incentives should be allocated for improved secondary prevention.
The ISCHEMIA trial suggests that even selected, high-risk patients with extensive ischemic burden do not benefit from revascularization barring unacceptable angina despite OMT. As ISCHEMIA excluded patients with unacceptable angina, advanced heart failure, and those with unprotected left main disease, our evaluation may be geared to identify such patients for consideration of revascularization alongside an initial strategy of OMT.
Atherosclerosis is a systemic disease of the arterial circulation, with focal areas of more severe manifestation. From an imaging standpoint, the paradigm of ischemia testing may have come to an end. Recent evidence from COURAGE, PROMISE, SCOT-HEART, and ISCHEMIA has demonstrated that functional testing for inducible myocardial ischemia is inferior to anatomic assessment for risk stratifying and managing patients with suspected or known CHD. Consistent with a large body of evidence, risk from CHD is mediated by the extent of atherosclerotic disease burden and not by the extent of inducible ischemia. Given that 55% of patients had nonobstructive CHD by CT in PROMISE, which was associated with 77% of cardiovascular deaths and myocardial infarctions at follow-up, there is immense opportunity to impact the disease at an earlier stage in a very large population of patients with occult CHD.
ACS & AMI Update WIN Program - SCAI 2010
1) Women with coronary artery disease often experience delays in diagnosis and treatment compared to men. They are less likely to receive timely reperfusion therapy and invasive procedures.
2) Outcomes following procedures like PCI are generally similar for men and women now if treated aggressively and according to guidelines. However, women still face higher risks of vascular complications.
3) Presentation of acute coronary syndromes can differ between men and women. Women tend to be older with more comorbidities but may have less obstructive coronary disease. Outcomes improve when treatment is administered irrespective of gender according to clinical condition.
Mean platelet volume and other platelet volume indices in patients with acute...
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Similar to Racial Differences in Access to New Technology 4.29.08 (20)
The Role of Technology in Cardiovascular Health Care Cost Growth 4.21.10
The Role of Technology in Cardiovascular Health Care Cost Growth 4.21.10
What is the place of CT coronary angiography in ED chest pain?
What is the place of CT coronary angiography in ED chest pain?
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...
BLOOD TRANSFUSIONS ARE ASSOCIATED WITH MORTALITY IN PEDIATRIC PATIENTS WITH S...
Stable ischemic heart disease how is it different from acs..
Stable ischemic heart disease how is it different from acs..
Cardiovascular risk evaluation and management before renal transplantation sl...
Cardiovascular risk evaluation and management before renal transplantation sl...
Appropriteness Criteria for Coronary Revascularization
Appropriteness Criteria for Coronary Revascularization
Appropriteness Criteria for Coronary Revascularization
Appropriteness Criteria for Coronary Revascularization
Incremental predictive value of vascular assessments combined with the Framin...
Incremental predictive value of vascular assessments combined with the Framin...
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Dr. Jose Luis Zamorano. Evolución no invasiva de la enfermedad aterosclerótica
Mean platelet volume and other platelet volume indices in patients with acute...
Mean platelet volume and other platelet volume indices in patients with acute...
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This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
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2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
3) This suggests that concerns about parity greatly increasing health care costs related to substance use disorder treatment were unfounded.Epstein,andy ispor poster_2013
This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
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2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
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June 14, 2024Nano-gold for Cancer Therapy chemistry investigatory project
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
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cosmetics and cosmeceuticals
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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