Objectives:
Non-pharmaceutical interventions (e.g. quarantine and isolation) are used to mitigate and control viral infectious disease, but their effectiveness has not been well studied. For ...COVID-19, disease control efforts will rely on non-pharmaceutical interventions until pharmaceutical interventions become widely available, while non-pharmaceutical interventions will be of continued importance thereafter.
Methods:
This rapid evidence-based review provides both qualitative and quantitative analyses of the effectiveness of social distancing non-pharmaceutical interventions on disease outcomes. Literature was retrieved from MEDLINE, Google Scholar, and pre-print databases (BioRxiv.org, MedRxiv.org, and Wellcome Open Research).
Results:
Twenty-eight studies met inclusion criteria (n = 28). Early, sustained, and combined application of various non-pharmaceutical interventions could mitigate and control primary outbreaks and prevent more severe secondary or tertiary outbreaks. The strategic use of non-pharmaceutical interventions decreased incidence, transmission, and/or mortality across all interventions examined. The pooled attack rates for no non-pharmaceutical intervention, single non-pharmaceutical interventions, and multiple non-pharmaceutical interventions were 42% (95% confidence interval = 30% – 55%), 29% (95% confidence interval = 23% – 36%), and 22% (95% confidence interval = 16% – 29%), respectively.
Conclusion:
Implementation of multiple non-pharmaceutical interventions at key decision points for public health could effectively facilitate disease mitigation and suppression until pharmaceutical interventions become available. Dynamics around R0 values, the susceptibility of certain high-risk patient groups to infection, and the probability of asymptomatic cases spreading disease should be considered.
The causes, degree and disruptive nature of mid-study database updates and other pain points were evaluated to understand if and how the clinical data management function is managing rapid growth in ...data volume and diversity.
Tufts Center for the Study of Drug Development (Tufts CSDD)-in collaboration with IBM Watson Health-conducted an online global survey between September and October 2020.
One hundred ninety four verified responses were analyzed. Planned and unplanned mid-study updates were the top challenges mentioned and their management was time intensive. Respondents reported an average of 4.1 planned and 3.7 unplanned mid-study updates per clinical trial.
Mid-study database updates are disruptive and present a major opportunity to accelerate cycle times and improve efficiency, particularly as protocol designs become more flexible and the diversity of data, most notably unstructured data, increases.
This study aims to characterize the aggregate learning curves of US surgeons for robotic thoracic procedures and to quantify the impact on productivity.
National average console times relative to ...cumulative case number were extracted from the My Intuitive application (Version 1.7.0). Intuitive da Vinci robotic system data for 56,668 lung resections performed by 870 individual surgeons between 2021 and 2022 were reviewed. Console time and hourly productivity (work relative value units/hour) were analyzed using linear regression models.
Average console times improved for all robotic procedures with cumulative case experience (P = .003). Segmentectomy and thymectomy had the steepest initial learning curves with a 33% and 34% reduction of the average console time for proficient (51-100 cases) relative to novice surgeons (1-10 cases), respectively. The hourly productivity increase for proficient surgeons ranged from 11.4 work relative value units/hour (+26%) for lobectomy to 17.0 work relative value units/hour (+50%) for segmentectomy. At the expert level (101+ cases), average console times continued to decrease significantly for esophagectomy (−18%) and lobectomy (−23%), but only minimally for wedge resections (−1%) (P = .003). The work relative value units/hour increase at the expert level reached 50% for lobectomy and 40% for esophagectomy. Surgeon experience level, dual console use, system model, and robotic stapler use were factors independently associated with console time for robotic lobectomy.
The aggregate learning curve for robotic thoracic surgeons in the United States varies significantly by procedure type and demonstrate continued improvements in efficiency beyond 100 cases for lobectomy and esophagectomy. Improvements in efficiency with growing experiences translate to substantial productivity gains.
Display omitted
Abstract
Background: Watson for Oncology (WfO) is an artificial intelligence (AI)-based clinical decision-support system (CDSS) that presents personalized therapeutic options to support ...cancer-treating physicians in making treatment decisions for cancer patients. WfO was released in 2015, and it has been deployed in over 200 institutions across the world. Many academic centers have examined WfO’s performance by measuring concordance between WfO therapeutic options and treatment recommendations by multidisciplinary tumor boards (MTBs) or individual clinicians (ICs). This study systematically reviewed the results of such concordance studies for breast cancer.
Methods: We conducted a review of the WfO publication database and a PubMed search to identify WfO concordance studies in breast cancer patients, published from 01/01/2015 to 06/30/2019. Studies were excluded if they measured concordance for multiple cancer types but did not include individual concordance for breast cancer. Concordance was defined as agreement between WfO “Recommended” and “For Consideration” treatment options and treatments prescribed by MTBs or ICs. Mean concordance rates were calculated as an average, weighted by the number of patients in each study. Concordance rates between MTBs and ICs were compared with z-test of two proportions. Subgroup analyses for larger studies were summarized.
Results: Table 1 presents the results of nine identified breast cancer concordance studies (4,427 patients) from China, India, and Thailand. Five studies (1,528 patients) determined concordance with MTB and 4 (2,899 patients) with ICs. WfO treatment options were compared to historical treatment recommendations by MTBs and ICs. Mean concordance for all studies was 70.8% (range 55 - 98%). Mean concordance with MTBs of 90.7% (range 79 - 98%) was significantly higher than the concordance between WfO and ICs of 59.9% (range 55-76%) p<0.0001.
Table 1Study/LocationNumber of patientsConcordance Multidisciplinary Tumor Board Studies (MTBs)Zhang XC, et al. Ann Oncol 2017;28:x170 / China11979%Yue L, Yang L. Ann Oncol 2017;28:x162 / China3198%Somashekhar SP, et al. Ann Oncol 2018 1; 29(2):418-423 / India63893%Zhou N, et al. The Oncologist 2018;23:1-8 / China12082%Somashekhar SP, et al. J Clin Oncol 2019; 37 (suppl; abstr 6533) / India62092%MTB subtotals152890.7%Individual Clinicians Studies (ICs)Suwanvecho S, et al. J Clin Oncol 2017;35 (suppl; abstr 6589) / Thailand21176%Jiang Z, et al. J Clin Oncol 2018;36 (suppl; abstr 18566) / China1,99755%Suwanrusme H, et al. J Clin Oncol 2018;36 (suppl; abstr 18584) / Thailand26470%32672%Suwanvecho S et al. J Clin Oncol 2019; 37 (suppl; abstr 6553) / Thailand10160%ICs subtotals289959.9%
Mean concordance in China, Thailand and India were 78.5%, 69.5%, and 92.5%, respectively. A large IC study from China including 1,997 patients found concordance in triple negative, high risk non-metastatic, and metastatic breast cancers of 69%, 66%, and 50%, respectively. A MTB study from China in 120 patients found concordance for luminal A, luminal B and triple negative breast cancers of 63%, 87% and 79%, respectively. Reported reasons for discordance varied among studies and included locally unavailable treatments, individual physician or MTB management preferences, and age older than 75 years.
Conclusions
Overall concordance between the WfO therapeutic options and decisions of both MTBs and ICs was high, demonstrating performance comparable with experts across the world. Higher concordance was observed between WfO and MTBs versus WfO and ICs, likely reflecting the multidisciplinary expertise having greater agreement with evidence and guideline-based recommendations of WfO than decisions of individual clinicians. This finding illustrates a role for clinical decision support in practice. Concordance varied across countries, reflecting the need for localization to address regional differences in practice.
Citation Format: Yull Arriaga, Rezzan Hekmat, Karlis Draulis, Suwei Wang, Winnie Felix, Irene Dankwa-mullan, Kyu Rhee, Gretchen Jackson. A systematic review of concordance studies using Watson for Oncology (WfO) to support breast cancer treatment decisions: A four-year global experience abstract. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-05.
Abstract only
250
Background: Watson for Oncology (WfO), a cognitive CDSS, provides therapeutic options to cancer-treating physicians. We reviewed the concordance of WfO therapeutic options in ...gastrointestinal cancers with experts’ treatment decisions. Methods: Systematic review to identify WfO concordance studies in gastrointestinal cancers, published from June 2015 to June 2019. Concordance was defined as agreement between WfO “Recommended” and “For Consideration” treatment options and decisions made by experts. Mean concordance rates were calculated as an average, weighted by the number of patients in each study. Results: 2,407 patients were identified (Table). Overall treatment decision concordance was 67.2% (SD 25.7%). Concordance for rectal, colon, hepatocellular, and gastric cancers were 90.5% (SD 9.4%), 80.9% (SD 24.3%), 58.5%, and 47.5% (SD 33.9%), respectively. Concordance with WfO were significantly higher for rectal versus colon cancer ( p = .001), rectal versus gastric cancer ( p < .0001) and for colon versus gastric cancer ( p <.0001). Conclusions: Concordance between WfO and treatment decisions by experts for rectal and colon cancers were high. Concordance for HCC and gastric cancer were the lowest. A higher discordance in gastric cancer is likely related to disease-specific and management differences compared to United States practice. Variable concordance between expert clinical decisions and CDSS suggestions and can be minimized by localization efforts.
Table: see text
Supervised exercise training improves outcomes in patients with pulmonary arterial hypertension (PAH). The effect of an unsupervised activity intervention has not been tested.
Can a text-based mobile ...health intervention increase step counts in patients with PAH?
We performed a randomized, parallel arm, single-blind clinical trial. We randomized patients to usual care or a text message-based intervention for 12 weeks. The intervention arm received three automated text messages per day with real-time step count updates and encouraging messages rooted in behavioral change theory. Individual step targets increased by 20% every 4 weeks. The primary end point was mean week 12 step counts. Secondary end points included the 6-min walk test, quality of life, right ventricular function, and body composition.
Among 42 randomized participants, the change in raw steps between baseline and week 12 was higher in the intervention group (1,409 steps interquartile range, –32 to 2,220 vs –149 steps interquartile range, –1,010 to 735; P = .02), which persisted after adjustment for age, sex, baseline step counts, and functional class (model estimated difference, 1,250 steps; P = .03). The intervention arm took a higher average number of steps on all days between days 9 and 84 (P < .05, all days). There was no difference in week 12 six-minute walk distance. Analysis of secondary end points suggested improvements in the emPHasis-10 score (adjusted change, –4.2; P = .046), a reduction in visceral fat volume (adjusted change, –170 mL; P = .023), and nearly significant improvement in tricuspid annular plane systolic excursion (model estimated difference, 1.2 mm; P = .051).
This study demonstrated the feasibility of an automated text message-based intervention to increase physical activity in patients with PAH. Additional studies are warranted to examine the effect of the intervention on clinical outcomes.
ClinicalTrials.gov; No. NCT03069716; URL: www.clinicaltrials.gov
Display omitted
Abstract only
e19193
Background: Artificial intelligence-driven clinical decision-support systems such as Watson for Oncology (WfO) may aid cancer care in economically challenged health systems. ...Evidence of the applicability of such tools in resource-constrained settings is limited. The study objective was to evaluate treatment agreement between physician-prescribed therapy and WfO recommended treatment options in thyroid cancer in Brazil. An in-depth evaluation of discordant cases by a blinded expert panel of medical oncologists and cancer surgeons was performed to identify preferred therapies and predictors of discordance. Methods: Thyroid cancer patients treated at the Instituto do Câncer do Ceará, Brazil from July 2018 to June 2019, but not processed in WfO, were selected for entry into WfO in January 2020. Blinded to treatment-plan source (i.e., WfO or historical), the expert panel reviewed all WfO therapeutic options and historical physician-prescribed treatment plans for discordant cases and selected their preferred treatment options. Clinical and demographic characteristics were analyzed using logistic regression. Results: Thyroid cancer patients (n = 83) evaluated for concordance between WfO therapeutic options and historical treatments were mostly female (91%) and between the ages of 18 - 78 years (mean 47.7). Concordance between historical physician-prescribed treatment decisions and WfO was 73.5% (61/83). Demographics and clinical characteristics associated with discordance are shown in Table. For all discordant cases (n = 22), preferred treatment decisions, as determined by the expert panel, were in agreement with WfO. Conclusions: High concordance between WfO recommended treatment options and historical treatment decisions for thyroid cancer was observed at Instituto do Câncer do Ceará. For discordant cases, a blinded expert panel agreed with WfO recommended treatment options in all cases, demonstrating there may be a role for decision support in aiding individual oncologists to make best-practice and evidence-informed treatment decisions. Table: see text
Abstract only
e14070
Background: Watson for Oncology (WfO) is an artificial intelligence-based clinical decision-support system that offers potential therapeutic options to cancer-treating ...physicians. We reviewed studies of concordance between therapeutic options offered by WfO and treatment decisions made by individual clinicians (IC) and multidisciplinary tumor boards (MTB) in practice in gynecological cancers. Methods: We searched PubMed and an internal database to identify peer-reviewed WfO concordance studies of gynecological cancers published between 01/01/2015 and 06/30/2019. Concordance was defined as agreement between therapeutic options recommended or offered for consideration by WfO and treatment decisions made by IC or MTB. Mean concordance was calculated as a weighted average based on the number of patients per study. Statistical significance was evaluated by z-test of two proportions. Results: Our search identified 5 retrospective studies with 635 patients with cervical and ovarian cancers in China and Thailand; 4 compared WfO to MTB and 1 to IC. Overall WfO concordance with MTB and IC for both cancers was 77.2% (SD 11.6%). The concordance between MTB and WfO in cervical and ovarian cancers was 80.5% and 86.2%, respectively ( P = .21); IC concordance with WfO in cervical and ovarian cancers was 65.2% and 73.2%, respectively ( P = .18). MTB concordance with WfO for both cancers combined was 81.5%, significantly higher than the 67.9% IC concordance with WfO for both cancers ( P = .01). Conclusions: Studies of cervical and ovarian cancers demonstrated a statistically significantly higher concordance of MTB and WfO than IC and WFO, suggesting a role for WfO in supporting treatment-decision making in gynecological cancers that aligns with decisions made by MTB. Larger prospective studies are needed to evaluate the technical performance, usability, workflow integration, and clinical impact of WfO in gynecological cancers.Table: see text
Abstract
BackgroundAll UK cancer patients undergo required assessments by a full Multidisciplinary Tumor Board (fMTB) at key treatment decision points, placing a resource burden on the healthcare ...system. Watson for Oncology (WfO) is a decision-support system that presents therapeutic options to cancer-treating clinicians. This study is an initial phase of an evaluation at Guys and St. Thomas’ NHS Hospital (GSTT), designed to explore the extent to which WfO can be used by the fMTB to triage less complex patient cases and ultimately reduce workload and time pressures currently experienced by fMTBs. We conducted a concordance study with two minimal MTB teams (mMTB) for Stage I-III breast cancer patients.
MethodsBreast cancer cases (N=63) treated from 2017-2018 at GSTT were evaluated by 2 independent mMTBs, blinded to each other and previous fMTB decisions rendered prior to this study. Each mMTB consisted of a senior medical oncologist and surgeon; GSTT’s 12+ member fMTB is comprised of oncologists, surgeons, radiologists, pathologists and others. mMTBs were shown options that were either listed as ‘recommended’ or ‘for consideration’ by WfO and given the opportunity to revise prior decisions. The combined 4-person minimal MTB (cmMTB) consisting of both 2-person mMTBs provided a current consensus best-practice plan and systemic therapy recommendations for discordant cases. We evaluated the concordance of WfO’s systemic therapeutic recommendations and mMTBs, as well as concordance with the cmMTB. Previous decisions by the fMDTB were also compared to decisions by the cmMTB. Univariate logistic regression explored characteristics predictive of concordance with the cmMTB.
ResultsFor treatment plans, WFO’s therapeutic options had higher concordance with cmMTB decisions than either mMTB alone (concordance 93.7% vs. 92.1%) or the previous decisions by the fMTB (87.3). For systemic therapy decisions, the WfO-cmMDTB concordance was 70.2%; however, adjusting for non-NICE approved drugs and the common practice of Carboplatin use in the UK, concordance increased to 91.5%. Previous decisions by the fMTB had the lowest concordance with the cmMTB (87.3%). Adjusting for the UK-practice related use of Carboplatin, WfO had slightly higher concordance with cmMTB systemic therapy decisions than either mMTB alone (89.4% and 87.2%). Univariate analysis with this limited sample revealed non-significant trends in association between mMTB’s concordance with WfO and stage of cN at diagnosis, HER2 status, tumor location and grade. For example, mMTBs concordance with WfO tended to improve when tumor grade was high. Non-significant trends were also identified in the association between WfO-treatment concordance and tumor location, where treatment concordance increased with medial tumor location.
ConclusionIn this small cohort study, a clinical decision-support tool demonstrated better agreement with UK best practice treatment than a 2-person mMTB and may have a role in triaging breast cancer cases in the UK.
Citation Format: Hartmut Kristeleit, Martha Martin, Christina Karampera, Rezzan Hekmat, Bertha IntHout, Ashutosh Kothari, Majid Kazmi, Amanda Clery, Yanzhong Wang, Bolaji Coker, Winnie Felix, Anita Preininger, Suwei Wang, Roy Vergis, Tom Eggebraaten, Christopher Gloe, Irene Dankwa-Mullan, Gretchen Jackson, Anna Rigg, Danny Ruta. Augmentation of a minimal multidisciplinary tumor board with clinical decision support to triage breast cancer patients in the UK abstract. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-22.
PDF
