Nutritional and Metabolic Diseases

Gland and Hormone Related Diseases

All Conditions

Neoplasms

Digestive System Diseases

Rare Diseases

Diabetes Mellitus

Carcinoma

Pancreatic Neoplasms

Carcinoma, Pancreatic Ductal

Diabetes Complications

Diabetes Mellitus, Type 2

Metabolic Diseases

Glucose Metabolism Disorders

Endocrine System Diseases

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Gastrointestinal Neoplasms

Digestive System Neoplasms

Endocrine Gland Neoplasms

Gastrointestinal Diseases

Pancreatic Diseases

Carcinoma, Ductal

Adenocarcinoma

Pancreatic Cancer

Antihypertensive Agents

Cardiotonic Agents

Vasodilator Agents

Respiratory System Agents

All Drugs and Chemicals

Adrenomedullin

Newly diagnosed diabetic patients with high Adrenomedullin serum levels

Newly diagnosed diabetic patients with low Adrenomedullin serum levels

Laura Antolino, MD

Pancreatic Cancer is a leading cause of cancer-related death. To date, only one fifth of patients at diagnosis is presented resectable because the diagnosis is often delayed making the 5-year survival of this disease globally less than 5%. An early diagnosis in these patients is currently not possible given the economic disadvantages of a population-wide screening. New evidences identify patients with new-onset diabetes as a subgroup of patients at high risk of developing this disease (RR 5:38). In a subset of these patients a mediator secreted by the tumor, the Adrenomedullin, could be responsible for the onset of diabetes. Our goal is therefore to assess the different impact of Pancreatic Cancer depending on Adrenomedullin values in patients with newly diagnosed diabetes mellitus.

The study is defined as prospective observational. The research project involves the recruitment prospectively for all consecutive patients aged between 45 and 75 years receiving a new diagnosis of diabetes, according to the criteria established by the American Diabetes Association (ADA) (fasting glucose greater than or equal 126 mg / dl, or random blood glucose greater than or equal to 200 mg / dl, or glycated hemoglobin greater than or equal to 6.25%). The recruitment will take place at the Sant'Andrea Hospital. The suitability of a subject to be included in the study will be evaluated by medical history, physical examination and any further investigations carried out by a medical researcher of the team, according to the inclusion and exclusion criteria. The research team will be multidisciplinary, translational, composed of medical specialists belonging to the departments of General Surgery, Internal Medicine, Diabetology and Occupational Medicine. An informed consent will be mandatory for the recruitment in the study. At recruitment Adrenomedullin serum levels will be recorded along with every relevant clinical and laboratory data. An annual telephone follow-up will be applied and if necessary the patient will benefit of an outpatient examination. A sample size of 440 patients will achieve 80% power to detect a statistically significant difference. The 3 years clinical follow-up will allow the detection of symptoms and signs that could be related to the presence of a pancreatic mass (jaundice, pain, weight loss), further investigations will follow in such cases to confirm Pancreatic cancer diagnosis and proceed to the treatment.

Pancreatic Cancer Can be Detected by Adrenomedullin in New Onset Diabetes Patients

Role of Adrenomedullin in Early Diagnosis of Pancreatic Cancer in New Onset Diabetes Patients

University of Roma La Sapienza

Heart and Blood Diseases

Respiratory Tract (Lung and Bronchial) Diseases

Blood and Lymph Conditions

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Symptoms and General Pathology

Nervous System Diseases

Behaviors and Mental Disorders

Immune System Diseases

Heart Failure

Peripheral Arterial Disease

Peripheral Vascular Diseases

Vascular Diseases

Lung Diseases

Leukemia

Renal Insufficiency, Chronic

Renal Insufficiency

Dementia

Leukemia, Lymphocytic, Chronic, B-Cell

Hepatic Insufficiency

Liver Failure

Leukemia, Lymphoid

Liver Diseases

End Stage Liver Disease

Heart Diseases

Respiratory Tract Diseases

Kidney Diseases

Urologic Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Male Urogenital Diseases

Atherosclerosis

Arteriosclerosis

Arterial Occlusive Diseases

Chronic Disease

Disease Attributes

Hematologic Diseases

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Leukemia, B-Cell

Chronic Graft Versus Host Disease

Chronic Lymphocytic Leukemia

The intervention has 4 steps: use electronic medical record (EHR) to identify seriously ill, hospitalized patients with no documentation of a goals-of-care (GOC) discussion during their current admission; the enrolled patient or his/her surrogate completes a survey assessing preferences for discussions about GOC, barriers to having such discussions, and current GOC which is used to create a "Jumpstart" form designed to prompt and guide a GOC discussion between the patient or surrogate and the clinicians caring for the patient; use natural language processing/machine learning (NLP/ML) approach to identify GOC discussions or advance directives in the EHR that occurred prior to admission and include this information on the Jumpstart form; and, deliver the Jumpstart form to the primary clinician team. The patient or surrogate is also provided with a version of the form.

Jumpstart Intervention

J. Randall Curtis, MD, MPH

This two-year pilot study will test whether a one-page "Jumpstart Form" will affect goals-of-care discussions in the hospital. This form will be provided to clinicians and will include patient-specific information about preferences for goals-of-care communication and for care, as well as tips to improve this communication. Jumpstart forms will also be provided to patients or, if they are unable to communicate, their surrogates/family members. The information on the form will be obtained from questionnaires. The form is tailored to help patients and surrogates talk with clinicians about goals of care. This study is based on a successful application of Jumpstart Form in the outpatient clinic setting.

Project to Improve Communication About Serious Illness - Pilot Study

Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication

Presence or absence of documentation of goals of care discussions in the patient's electronic health record during the current hospitalization

University of Washington

Professor, Department of Medicine, SOM: Department of Medicine: Pulmonary, Critical Care and Sleep Medicine

Skin and Connective Tissue Diseases

Sclerosis

Neoplasm Metastasis

Lung Diseases, Obstructive

Pulmonary Disease, Chronic Obstructive

Kidney Failure, Chronic

Parkinson Disease

Motor Neuron Disease

Amyotrophic Lateral Sclerosis

Lung Diseases, Interstitial

Death

Parkinsonian Disorders

Ganglion Cysts

Synovial Cyst

Basal Ganglia Diseases

Brain Diseases

Central Nervous System Diseases

Movement Disorders

Synucleinopathies

Neurodegenerative Diseases

Neuromuscular Diseases

Spinal Cord Diseases

TDP-43 Proteinopathies

Proteostasis Deficiencies

Primary Lateral Sclerosis

In the structured advance care planning approach, patients will participate in a 60 to 90 minute facilitated advance care planning conversation with a trained person using Respecting Choices (First Steps) guide and will receive a state advance directive form. The advance care planning facilitator will follow-up as needed after the session to answer additional questions.

In the patient-driven advance care planning approach, patients receive a Five Wishes Form (easy to understand advance directive written in plain language), a state advance directive form, and at least two follow-up phone calls with an advance care planning contact who will answer questions.

Respecting Choices First Steps

Five Wishes Form

Kimberly Johnson, MD

This study compares the effectiveness of two different approaches to advance care planning among older African Americans and older Whites living in the community. The two approaches are a structured approach with an advance care planning conversation led by a trained person using Respecting Choices (First Steps) and a patient-driven approach which includes a Five Wishes advance care planning form written in plain language. The study will determine which approach is more effective at increasing advance care planning within each racial group and reducing differences between the two groups in advance care planning.

Advance care planning (ACP) involves patients making decisions about the kind of medical care they would want to receive if they became unable to speak for themselves. Patients share their wishes in a written document (living will or healthcare proxy) and/or discuss their wishes with family, friends, and doctors. ACP improves the quality of end-of-life care by increasing the likelihood that patients receive care that reflects their preferences and values. Seriously ill African Americans are less likely to take part in advance care planning and experience lower quality care at the end of life, including poorer communication with clinicians and a lower likelihood of receiving the kind of care that they would want.

This study will include 800 seriously or chronically ill community-dwelling older adults (equal number of African Americans and whites) and their caregivers from 10 primary care practices at five medical centers in the Deep South. Eligible patients include those with cancer, advanced heart disease, advanced lung disease, end-stage kidney disease, cirrhosis, diabetes with severe complications, recurrent hospitalizations, or difficulty with basic activities of daily living. For each enrolled patient, one caregiver who is likely to assist the patient with healthcare decisions is also eligible to participate.

The goals of the study are to:

* Compare the effectiveness of two approaches to increasing formal advance care planning (completing written documents like living wills, health care proxies, medical orders for life-sustaining treatments, or other advance directives) and informal advance care planning (having conversations with doctors, family, friends, and others about wishes for future healthcare) for African Americans and for Whites.
* Determine which intervention is most effective in reducing differences between African Americans and Whites in rates of advance care planning.
* Determine whether the effectiveness of the advance care planning approach differs based on whether the person assisting with advance care planning is of the same or different race as the patient.

Administered by community health workers, the two advance care planning approaches which will be compared are:

* Patient-driven approach which includes a Five Wishes Form (advance directive written in easy to understand language)
* Structured approach with an advance care planning conversation led by a trained person using Respecting Choices (First Step) conversation guide.

Mixed-methods, longitudinal, multi-site study, cluster randomized trial

Reducing Disparities in the Quality of Advance Care Planning for Older Adults

REducing Disparities in the QUALity of Palliative Care for Older African Americans Through Improved Advance Care Planning (EQUAL ACP)

completion of an advance care planning document (living will, healthcare proxy, medical orders, Five Wishes, other); discussion with clinician documented in chart, patient report of advance care planning discussion (designated decision-maker, discussed values, goals, preferences) with family, friends, or others

Difference of proportion in whites versus African Americans who complete formal or informal advance care planning

Measure assessing patient's readiness to name decision-maker, discuss care preferences, complete legal advance directive

Measure (Promis 29) assessing quality of life, including domains of physical functional, emotional, and social well-being

Duke University

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Pancreatic Cancer Can be Detected by Adrenomedullin in New Onset Diabetes Patients	NCT02456051	Diabetes Mellit... Diabetes Compli... Carcinoma, Panc... Pancreatic Neop...		45 Years - 75 Years	University of Roma La Sapienza
Project to Improve Communication About Serious Illness - Pilot Study	NCT03746392	Malignant Neopl... Leukemia, Lymph... Lung Disease Ch... Congestive Hear... Liver Failures,... Renal Insuffici... Dementia Diabetes Compli... Peripheral Vasc... Frail Elderly	Jumpstart Inter...	18 Years -	University of Washington
Project to Improve Communication About Serious Illness - Pilot Study	NCT03746392	Malignant Neopl... Leukemia, Lymph... Lung Disease Ch... Congestive Hear... Liver Failures,... Renal Insuffici... Dementia Diabetes Compli... Peripheral Vasc... Frail Elderly	Jumpstart Inter...	18 Years -	University of Washington
Reducing Disparities in the Quality of Advance Care Planning for Older Adults	NCT03516994	Metastatic Canc... Congestive Hear... Chronic Obstruc... Parkinson Disea... Interstitial Lu... Amyotrophic Lat... End Stage Liver... End Stage Renal... Diabetes Compli...	Respecting Choi... Five Wishes For...	65 Years -	Duke University

Spots Global Cancer Trial Database for diabetes complications