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Lane, Jordan D.

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Lane

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Jordan D.

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Lane, Jordan D.

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2014 - 20153

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Author's Publications: search.filters.isAuthorOfPublication.f0e657be-42bf-49a0-a0c8-c17f7afdc3ba

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Now showing 1 - 3 of 3
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    High-dose-rate Interstitial Brachytherapy Boost with a Pedicled Latissimus Dorsi Myocutaneous Flap for Myxofibrosarcoma of the Arm
    (Wolters Kluwer Health, 2014) Lane, Jordan D.; Pomahac, Bohdan; Raut, Chandrajit; Baldini, Elizabeth; Devlin, Phillip
    Summary: A 71-year-old man was found to have a 7.4 × 2.9 × 7.0 cm myxofibrosarcoma of the right medial arm close to neurovascular structures. He received 50 Gray (Gy) of preoperative external beam radiation. Radical resection resulted in a 15 × 10 cm defect. Nine brachytherapy catheters were placed, and a pedicled latissimus dorsi myocutaneous flap was used in reconstruction. Final pathology confirmed myxofibrosarcoma, high grade. The tumor was <1 mm from 2 margins. A total of 17.5 Gy of brachytherapy was delivered to the surgical bed from postoperative days 7 to 9. The flap developed fat necrosis distally which eventually required surgical debridement on postoperative day 58. It subsequently healed well and maintained good function of the limb. The patient remains under surveillance without evidence of recurrence.
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    Influence of providers and nurses on completion of non-targeted HIV screening in an urgent care setting
    (BioMed Central, 2014) Bender Ignacio, Rachel A; Chu, Jacqueline; Power, Melinda C; Douaiher, Jeffrey; Lane, Jordan D.; Collins, Jeffrey; Stone, Valerie
    Introduction: Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic. Methods: We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing. Results: Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses. Conclusions: Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates.
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    Publication
    Associations Between Funding Source and Results of Cost Effectiveness Analyses of Drugs Used in Breast Cancer
    (2015-05-13) Lane, Jordan D.
    Background: Cost effectiveness studies are increasingly included in the regulatory decisions of many countries and in formulary decisions in the United States. Pharmaceutical company sponsorship of economic analyses of oncology drugs previously has been associated with reduced likelihood of reporting unfavorable results. Demonstrating persistence of this relationship may help enable better interpretation of study results and development of strategies to address potential bias. Methods: Breast cancer was selected for analysis since it is the cancer with the largest number of cost effectiveness studies and the cost of recent drugs has caused questioning of their incremental cost effectiveness. Search of the Tufts Medical Center Cost Effectiveness Analysis Registry resulted in 105 studies published between 1991-2012 that evaluated the cost effectiveness of drugs used to prevent or treat breast cancer. Overall study conclusions regarding cost effectiveness of the investigated drugs were evaluated using three thresholds: $50,000 per quality adjusted life-year (QALY), $100,000 per QALY, and $150,000 per QALY. A logistical regression was performed to determine how study characteristics including funding source were associated with study findings. Results: Overall, 65 studies were funded by industry (62%). Studies with pharmaceutical company funding were more likely than studies with other funding to report favorable cost effectiveness estimates (75.4% vs 40.0%, OR=4.07 CI=1.44-12.26 at the $50,000 threshold; 80.0% vs 57.5%, OR=3.15, CI=1.07-9.84 at the $100,000 threshold; and 87.7% vs 67.5%, OR=3.65, CI=1.02-14.66 at the $150,000 threshold). Conclusions: Industry sponsorship continues to be associated with a higher likelihood of reporting favorable results. These findings suggest that steps are necessary to ensure that the cancer cost effectiveness literature is not biased by sponsorship. Expanding funding sources other than pharmaceutical companies for these studies or pre-registering cost effectiveness studies may help mitigate this potential source of bias.