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South Bend, IN, United States

Jean-Pierre P.,Harper Cancer Research Institute | Jean-Pierre P.,University of Notre Dame | Winters P.C.,University of Rochester | Clark J.A.,Boston University | And 6 more authors.
Journal of Cancer Education | Year: 2013

Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care. The sample included 1,593 adults (85.8%with abnormal cancer screening and 14.2 % with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator scale.We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care (PSCC) scale. We controlled for patient and site characteristics using backward selection logistic regression analyses. Among patients with abnormal screening, having a better-rated navigator was associated with high r score on the PSCC (p<0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction [odds ratio (OR), 1.38; 95 % confidence interval (CI), 1.05-1.82]. Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR, 3.06; 95 % CI, 1.56-6.0). Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care. © Springer Science+Business Media New York 2013. Source

Bikorimana E.,Harper Cancer Research Institute | Bikorimana E.,Indiana University | Lapid D.,Indiana University | Choi H.,Indiana University | And 3 more authors.
Journal of Visualized Experiments | Year: 2014

Embryonic stem cells (ESCs) are an outstanding model for elucidating the molecular mechanisms of cellular differentiation. They are especially useful for investigating the development of early hematopoietic progenitor cells (HPCs). Gene expression in ESCs can be manipulated by several techniques that allow the role for individual molecules in development to be determined. One difficulty is that expression of specific genes often has different phenotypic effects dependent on their temporal expression. This problem can be circumvented by the generation of ESCs that inducibly express a gene of interest using technology such as the doxycycline-inducible transgene system. However, generation of these inducible cell lines is costly and time consuming. Described here is a method for disaggregating ESC-derived embryoid bodies (EBs) into single cell suspensions, retrovirally infecting the cell suspensions, and then reforming the EBs by hanging drop. Downstream differentiation is then evaluated by flow cytometry. Using this protocol, it was demonstrated that exogenous expression of a microRNA gene at the beginning of ESC differentiation blocks HPC generation. However, when expressed in EB derived cells after nascent mesoderm is produced, the microRNA gene enhances hematopoietic differentiation. This method is useful for investigating the role of genes after specific germ layer tissue is derived. © JoVE 2006-2014. All Rights Reserved. Source

Navari R.M.,Indiana University | Navari R.M.,Harper Cancer Research Institute
Drugs | Year: 2013

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles, and patient risk factors significantly influence CINV. The use of a combination of a serotonin 5-HT 3 receptor antagonist, dexamethasone and a neurokinin 1 (NK 1) receptor antagonist has significantly improved the control of acute and delayed emesis in single-day chemotherapy. Palonosetron, a second-generation 5-HT3 receptor antagonist with a different half-life, a different binding capacity and a different mechanism of action than the first-generation 5-HT3 receptor antagonists appears to be the most effective agent in its class. Aprepitant, the first and only agent clinically available in the NK1 receptor antagonist drug class has been used effectively as an additive agent to the 5-HT3 receptor antagonists and dexamethasone to control CINV. Rolapitant and netupitant are other NK1 receptor antagonists that are currently in phase III clinical trials. Despite the control of emesis, nausea has not been well controlled by current agents. Olanzapine, a US-FDA approved antipsychotic, has emerged in recent trials as an effective preventative agent for CINV, as well as a very effective agent for the treatment of breakthrough emesis and nausea. Clinical trials using gabapentin, cannabinoids and ginger have not been definitive regarding their efficacy in the prevention of CINV. Additional studies are necessary for the control of nausea and for the control of CINV in the clinical settings of multiple-day chemotherapy and bone marrow transplantation. © 2013 Springer International Publishing Switzerland. Source

Jean-Pierre P.,University of Notre Dame | Jean-Pierre P.,Harper Cancer Research Institute | Cheng Y.,University of Notre Dame | Paskett E.,Ohio State University | And 10 more authors.
Supportive Care in Cancer | Year: 2014

Background: We developed and validated a Patient Satisfaction with Cancer-Related Care (PSCC) measure using classical test theory methods. The present study applied item response theory (IRT) analysis to determine item-level psychometric properties, facilitate development of short forms, and inform future applications for the PSCC. Methods: We applied unidimensional IRT models to PSCC data from 1,296 participants (73 % female; 18 to 86 years). An unconstrained graded response model (GRM) and a Rasch Model were fitted to estimate indices for model comparison using likelihood ratio (LR) test and information criteria. We computed item and latent trait parameter estimates, category and operating characteristic curves, and tested information curves for the better fitting model. Results: The GRM fitted the data better than the Rasch Model (LR=828, df=17, p<0.001). The log-likelihood (-17,390.38 vs. -17,804.26) was larger, and the AIC and BIC were smaller for the GRM compared to the Rash Model (AIC=34,960.77 vs. 35,754.73; BIC=35,425.80 vs. 36,131.92). Item parameter estimates (IPEs) showed substantial variation in items' discriminating power (0.94 to 2.18). Standard errors of the IPEs were small (threshold parameters mostly around 0.1; discrimination parameters 0.1 to 0.2), confirming the precision of the IPEs. Conclusion: The GRM provides precise IPEs that will enable comparable scores from different subsets of items, and facilitate optimal selections of items to estimate patients' latent satisfaction level. Given the large calibration sample, the IPEs can be used in settings with limited resources (e.g., smaller samples) to estimate patients' satisfaction. © 2014 Springer-Verlag. Source

Balsara R.D.,University of Notre Dame | Chapman S.E.,University of Notre Dame | Sander I.M.,University of Notre Dame | Donahue D.L.,University of Notre Dame | And 4 more authors.
Journal of Visualized Experiments | Year: 2014

Stroke is the third leading cause of death among Americans 65 years of age or older1. The quality of life for patients who suffer from a stroke fails to return to normal in a large majority of patients2, which is mainly due to current lack of clinical treatment for acute stroke. This necessitates understanding the physiological effects of cerebral ischemia on brain tissue over time and is a major area of active research. Towards this end, experimental progress has been made using rats as a preclinical model for stroke, particularly, using non-invasive methods such as 18F-fluorodeoxyglucose (FDG) coupled with Positron Emission Tomography (PET) imaging3,10,17. Here we present a strategy for inducing cerebral ischemia in rats by middle cerebral artery occlusion (MCAO) that mimics focal cerebral ischemia in humans, and imaging its effects over 24 hr using FDG-PET coupled with X-ray computed tomography (CT) with an Albira PET-CT instrument. A VOI template atlas was subsequently fused to the cerebral rat data to enable a unbiased analysis of the brain and its sub-regions4. In addition, a method for 3D visualization of the FDG-PET-CT time course is presented. In summary, we present a detailed protocol for initiating, quantifying, and visualizing an induced ischemic stroke event in a living Sprague-Dawley rat in three dimensions using FDG-PET. © JoVE 2006-2015. All Rights Reserved. Source

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