bluuebunny/crossref_metadata_2025 huggingface dataset:
Contemporary analysis of bone mineral density in men initiating androgen deprivation therapy for prostate cancer.
Authors: Hu Jason , Aprikian Armen G. , Vanhuyse Marie , Dragomir Alice
Published: October 2019

38

Background: Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk. The objective was to examine the proportion of BMD testing in men initiating long-term ADT in Quebec. Methods: The cohort consists of men extracted from Quebec public healthcare insurance administrative databases who were diagnosed with PCa from 2001-2012 and treated by ADT for at least one continuous year. The primary study outcome was the receipt of baseline BMD testing (defined as a BMD test identified in the period from 6 months prior to and up to 12 months after ADT initiation). Multivariable generalized linear mixed with a logit link was performed to identify variables associated with baseline BMD testing accounting for physician clustering. Results: We identified 7,069 patients, of which 887 (12.6%) underwent baseline BMD testing. Baseline BMD testing varied by year of ADT initiation, from 7.7% in 2001-2003 to 12.3% in 2013-2012. Following multivariable analyses, later years of ADT initiation (2004-2006, 2007-2009, 2010-2012, 2013-2015) remained associated with higher odds of baseline BMD testing compared to the earlier years (2001-2003) (ORs ranging from 1.43-1.88; p < 0.001). Conversely, age > 80 (OR 0.73; 95% CI 0.57-0.94; p = 0.001), greater Charlson comorbidity score (OR 0.51; 95%CI 0.34-0.75; p = 0.001), and rural residence (OR 0.60; 95%CI 0.48-0.75; p < 0.001) were associated with lower odds of baseline BMD testing. Conclusions: In our study population, rates of baseline BMD testing in men initiating ADT are low, although the rates increased over the course of the study period. Potential gaps identified in baseline BMD testing include older, more comorbid patients, and rural residence. Additional efforts emphasizing the importance of BMD testing in PCa guidelines may be needed.
Timely administration of antibiotics in febrile neutropenia per updated ASCO/IDSA guidelines.
Authors: Ghimire Krishna Bilas , Lin Po-Hung , Khan Irum , Cadman Kasandra , Valero LeeAnn , Golick Janet , Walker Maria , Knightly Eileen , Windhorst Jennifer , Owens Jovonne , Fleming Patrick Joseph , Cuellar Sandra , Crawford John , Feldman Lawrence Eric , Venepalli Neeta K.
Published: October 2019

41

Background: Current ASCO guidelines for management of febrile neutropenia (FN) recommend initial antibiotic administration within one hour of triage, and initial assessment within 15 minutes of triage for patients presenting with FN within 6 weeks of chemotherapy. The University of Illinois Cancer Center (UICC) implemented an early identification and management strategy in the ambulatory setting for FN in 2017, with success in increasing the percentage of FN patients receiving antibiotics within 2 hours from 50% to 92% over a 6 months (05/2017-11/2017) period. Given updated joint ASCO/IDSA guidelines, we aimed to increase percentage of FN patients receiving antibiotics within 1 hour from 56% to more than 90% over 16 months. Methods: A multidisciplinary team involving oncology, hematology (attendings and fellows), pharmacy, and nursing met quarterly to review FN cases including time to antibiotic administration and documentation of prompt assessment. Two Plan-Do-Study-Act (PDSA) cycles were completed, including development and deployment of an electronic medical record automated order set and targeted education for fellows and nurses. Results: Between 12/17 and 04/19, of 7 patients with FN, 100% (N = 7) received antibiotics in clinic. The percentage of FN patients receiving antibiotics within 1 hour of triage post first and second interventions was as follows: 25% (N = 1), 100% (N = 4). 100% (N = 7) of FN patients had documentation of prompt assessment, but time from triage was not specified. Conclusions: We were successful in improving the percentage of FN patients receiving antibiotics from 56% to more than 90% over 16 months. We are targeting our next PDSA cycle to increase assessments within 15 minutes of triage. Additional future interventions include tailoring antibiotics based on FN with low or high risk of complication via focus group and root case analyses discussion with our attendings, fellows, and nurses, and collaborating with ED on a standard care pathway for FN management.
Co-management of elevated glucose in chemotherapy patients in the community: Working with primary care physicians.
Authors: Shander Ellen , Ronnen Ellen A. , Peng Eileen Ruey-Fun , Cruz Melissa Isabel , Balinski Beth , Ryan Sharon
Published: October 2019

53

Background: Approximately 8-18% of oncology patients also have diabetes. A diabetes diagnosis increases the risk of recurrence by 21% and decreases both overall and cancer-related 5-year survival. Chemotherapy has also been associated with hyperglycemia in non-diabetic patients. At one office in a multi-site outpatient oncology practice in central New Jersey, 13% of 904 chemotherapy patients treated between August 1, 2018 and October 31, 2018 had blood glucose greater than 200 mg/dL. Community practice models post a challenge to coordinated multidisciplinary care. Methods: Between 12/1/18 and 4/1/19, weekly lab reports were run revealing all active chemotherapy patients with glucose levels greater than 200. The initial run in period was 12/1/18-1/31/19, and follow up for the group (while on chemotherapy) was from 2/1/19-4/1/19. Patients and their primary medical doctors (PMDs) were contacted within 2 weeks of lab draw, labs and recent chemotherapy history shared and all communication was documented. Patients with > one blood glucose above 200 were contacted monthly. Concurrent steroid use with chemotherapy and addition/adjustment of antihyperglycemics was also studied. Results: Of 324 patients who entered into the study between 12/1/18 and 1/3/19, 42 had baseline elevated glucose levels. 36 (85%) of the 42 were on concomitant corticosteroids. During the follow up period, 10 (23%) had elevated glucose levels over 200, 32 (76%) patients had levels under 200 consistently. 12 of the 32 (30%) of those patients had documented diabetic medication adjustments. Oncology/PCP communication was documented in 35 (83%) charts compared with 0% prior to the intervention, amongst our office and PMDs. Percentage of patients who saw their PCP during the intervention time will also be presented. Conclusions: Working more closely with PCPs and better electronic data sharing is needed in the community setting. Accurate medication lists and history sharing are critical to optimal multidisciplinary community care. Management of elevated glucose in oncology patients is challenging and multi factorial.
Successful implementation of a quality improvement intervention towards a QOPI-compliant breast cancer center in Mexico.
Authors: Peña-Curiel Omar , Villarreal-Garza Cynthia , Canavati-Marcos Mauricio , Velazquez-Ayala Karen M. , Castro-Carrasco Janeth , Garza-Ledezma María Alejandra , Zarzar-Handal Katia , Díaz-Pérez Héctor , Rodriguez David Omar , Guerrier Vedner
Published: October 2019

59

Background: Ensuring quality of care in our breast cancer center (BCC) at Hospital Zambrano Hellion in Monterrey, Mexico has been one of the main objectives since its commencement in 2016. To achieve this goal, we evaluated our compliance to ASCO’s Quality Oncology Practice Initiative (QOPI) 84 breast cancer related metrics as a part of a quality improvement (QI) project undertaken during the 2018 Quality Training Program (QTP) in Alexandria, VA. Methods: We established a multidisciplinary QI team engaged in data acquisition, process improvement and implementation in our BCC. We developed a Microsoft Word medical record template and established a new “first time visit” model to achieve our objective of 80% documentation rate of 13 identified reasonably achievable QOPI metrics. Monthly Plan-Do-Study-Act cycles were conducted for 6 months from August through December 2018. Results: After a sample data abstraction of 20 patients’ medical records, our baseline QOPI-compliance resulted in 40/84 QOPI metrics being met by our BCC program. The remaining 44/84 were distributed in two categories, the first 13/44 were labeled as “done/not documented” metrics, and the second set of 31/44 metrics were labeled as “not done/not documented” metrics given they were not performed at all. We approached the 13/44 “done/not documented” metrics for this project based on our priority matrix. After our QI intervention, we surpassed our objective by the third PDSA cycle. Furthermore, by March 2019 we reached 95% cumulative compliance of those metrics. Conclusions: The development of a systematic QI approach enhanced our BCC QOPI-compliance in 13 reasonably achievable metrics to 95% over a 6-month period. Currently, we are targeting the remaining 40/84 metrics to ultimately adhere to all breast cancer QOPI standards. To our knowledge, we are the first Mexican BCC pursuing a QOPI-compliant practice through ASCO’s QTP initiative.
Oncology multidisciplinary clinic development.
Authors: Jacobs Sheila , Mashanic Kathy
Published: October 2019

62

Background: In 2014 it was decided that a multidisciplinary approach would be beneficial for our breast cancer patients. A pre-conference for a multidisciplinary discussion on the treatment plan for the patients and their ability to see medical oncology, surgical oncology, and radiation oncology in one visit was the goal. Methods: A multidisciplinary planning committee was established to discuss operational issues. Location of the pre-conference and exam rooms were assigned along with the development of the MDC schedule templates for the physicians. The staffing resources were identified along with any additional equipment or supplies. Key staff were engaged to determine a new scheduling workflow including how patient referrals would be handled between departments, phone numbers the patient/family or physician would call for an appointment, and scripted messages to educate all on this model of care. Physicians developed triage questions to direct the caller to appropriate clinic and schedule an MDC appointment. A single phone number was created to ensure adequate access. Physician leadership and the managers of the affected areas worked with marketing on developing a variety of communication strategies to introduce the multidisciplinary initiative to providers, staff, referral networks, and patients. Results: Since the pilot in 2014, additional breast, thyroid/endocrine, thoracic, genitourinary, and gastrointestinal/colorectal MDC clinics have been launched as the outcomes have been very positive. Total MDC’s visits have increased by 200% from 132 in 2017 to 399 projected in 2019. Market share in the MDC programs has increased an average of 3.6 points. There has been a 44% increase in diagnosis at an earlier stage and both patient and provider satisfaction have trended upwards. Conclusions: The MDC’s have been a positive addition to our cancer program. The comprehensive approach to care has resulted in quality experience for all touched by cancer.
Efficacy of systemic treatment for metastatic renal cell carcinoma (mRCC) guided by comprehensive genomic profiling (CGP).
Authors: Bergerot Paulo Gustavo , Bergerot Cristiane Decat , Dizman Nazli , Salgia Nicholas , Hsu Joann , Pal Sumanta K.
Published: October 2019

63

Background: Comprehensive genomic profiling (CGP) has been used to guide treatment selection in metastatic renal cell carcinoma (mRCC). This study sought to determine if genomic alterations guided treatment and contributed to improved outcomes. Methods: From a single institution, patients (pts) diagnosed with mRCC who had CGP in the course of clinical care were identified. Pts were tested on a CLIAA-certified platform (FoundationOne; Cambridge, MA). Pts who died/initiated hospice within the 30 days after the test was performed or who were lost to follow-up were excluded. Duration of therapy (DOT) was measured as months between first and last day of therapy following CGP test. The Kaplan-Meier method was undertaken to estimate the association of CGP-directed therapy with overall survival (OS). Cox regression was also performed and adjusted for histologic subgroup. Results: A total of 64 patients underwent CGP between February 2014 and August 2018. From this group, 15 patients were excluded due to death/hospice within 30 d (n = 10) and lack of follow-up (n = 5). Median age at diagnosis was 60 years (range, 24-84), and 79% were male. Most patients (69%) were diagnosed with clear cell RCC. The median identified genomic alterations (GAs) was 3 (range, 0-7). The most common GAs were VHL (54%), PBRM1 (28%), TERT (21%), TP53 (15%), BAP1 (13%), and SETD2 (13%). Of the 49 patients included in this analysis, 47% had actionable mutations based on their CGP results. Of those, 13 patients received directed-therapy of whom 57% had stable disease, 28% had partial response, and 14% had progressive disease. The median time from CGP test to treatment was 1 month (range, 0-17). The median duration of directed-therapy was 12 months (range, 1-28) and of non-directed therapy was 4 months (range, 1-40) (P = 0.04). Directed-therapy was significantly associated with better OS (adjusted HR, 0.32 [95% CI, 0.13 to 0.82]; P = 0.018) compared to non-directed therapy. Conclusions: This study provides preliminary evidence to justify CGP-guided therapy in mRCC. Forthcoming studies should prospectively explore the use of CGP in treatment allocation for mRCC to validate these findings.
Implementing individualized care plans in high-risk oncology patients: A team-based model to increase hospice utilization.
Authors: Lee Sarah , Switzer Benjamin , Khan Mohammad , Pinnamaneni Pramod , Hooley Joseph , Kunapareddy Girish Chandra , Lagman Ruth , Poole Christa , Montero Alberto J.
Published: October 2019

64

Background: In the era of increasing therapeutic options and complexity of disease, some cancer patients (pts) continue aggressive treatment even within days of death. Previous studies report 30-66% of pts do not receive hospice or palliative services in the last month of life and many are enrolled in hospice < 3 days before death. Quality measures are endorsed by ASCO, National Quality Forum, and Oncology Care Model to increase hospice utilization. It is shown that pts enrolled in hospice have increased survival time with reduced in-hospital resources. These benefits increase the longer pts are in hospice. We hypothesize early identification of high risk pts by a multidisciplinary group and formulation of a care plan will prompt early discussion for hospice eligibility, increasing referrals to hospice and the number of days spent in hospice. Methods: As reported (ASCO 2018, Abst 6547), an Interdisciplinary Care Team (ICT) was created with palliative medicine and oncology physicians, nurses, and social workers. Twice monthly pts with high utilization over a 60-day period were identified. Care plans (CP) were created using a team based approach with parallel input from outpatient teams. CP was communicated back to the primary team. Results: 112 pts were discussed over 24 months; 39 pts died with a solid tumor malignancy and this was our study cohort. 85% pts (33/39) were referred to or had a hospice discussion and 82% pts (27/33) enrolled. 6 pts declined and 6 acutely died. Of the 27 pts that entered hospice 78% (21/27) were enrolled > 3 days and 22 % (6/27) < 3 days. Average number days in hospice was 19.7 (median 11) for all who entered hospice. In the subgroup that were enrolled for > 3 days, average number days was 25 (median 21). 62% pts (17/27) entered hospice within 60 days of ICT meeting and CP. Conclusions: Early identification of high-utilizing cancer patients along with review by ICT may correlate with early recognition of hospice eligibility, enrollment, and therefore greater number days spent in hospice. This increases hospice utilization allowing patients and families to experience the full benefit of hospice-directed care. Further interventions should be explored in optimizing transitions of care.
Time driven activity-based costing methods used in radiation oncology clinics.
Authors: Moningi Shalini , Mesko Shane , Moreno Amy Catherine , Ning Matthew S. , Aloia Thomas A. , Choi Seungtaek , Jeter Melenda , Martinez Wendi , Recinos Iris , Nguyen Thai , Frenzel John C. , French Katy E. , Nguyen Quynh , Herman Joseph M.
Published: October 2019

79

Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results.

[Table: see text]
Expansion of an oncology care coordination nurse model to reduce hospitalizations and emergency department utilization.
Authors: Rodgers Georgina T. , Brusio Michelle , Lindberg Jacob , Savage Craig , Hooley Joseph , Young Ronald
Published: October 2019

82

Background: Comprehensive, coordinated care is a key driver of care transformation within the Oncology Care Model. Care coordination provides deliberate, organized, patient centered care initiatives aimed to improve care transitions, patient education, patient engagement and quality of care throughout the care continuum. Methods: Specialty care coordinator nurses were a part of our heath system’s model of care but over the course of our participation in the OCM we have implemented care coordination in our regional locations across 15 additional sites of care. Standardized templates for initial and follow up education were created for oral and parenteral therapies with an emphasis on symptom management education. A patient education tool was developed through a partnership with nursing, pharmacy and physicians across disease groups to outline when a patient should contact their physician or RN care coordinator with symptom issues. Targeted outreach calls and associated documentation templates were created for symptom assessment and adequate follow up. Templates include a pre-chemo orientation call, post treatment follow up phone call within seven days, and post hospital discharge/ED treat and release follow up calls. A team based huddle guideline was developed to provide a means for interdisciplinary communication to assess patients for high risk based upon medical, functional, social, cognitive and behavioral factors that might lead to a hospitalization. Results: Our teams worked closely with EMR specialists and internal data analysts to build appropriate templates and subsequent reports to monitor compliance with documentation, evaluate the number of outreach touch points and effectiveness of interventions on a reduction of hospitalizations and ED utilization. We have noted an a modest decrease in hospitalizations and ED utilization through OCM feedback reports and reconciliation reports. Conclusions: We continue to monitor our monthly hospital admissions and ED utilization across the health system and drill down into the data to determine if there are any opportunities where care coordination outreach and incoming telephone triage could have prevented the admission.
Measuring financial toxicity of cancer in the Italian health care system: Initial results of the patient reported outcome for fighting financial toxicity of cancer project (proFFiT).
Authors: Bryce Jane , Riva Silvia , Di Maio Massimo , Efficace Fabio , Frontini Luciano , Gallo Ciro , Giannarelli Diana , Montesarchio Vincenzo , De Lorenzo Francesco , Del Campo Laura , Iannelli Elisabetta , Traclò Francesca , Gitto Lara , Jommi Claudio , Vaccaro Concetta Maria , Gimigliano Anna , Sparavigna Lucia , Perrone Francesco
Published: October 2019

91

Background: Financial toxicity in cancer patients has been initially reported in the United States and subsequently in other countries, including Italy, despite its health care system is grounded on universal coverage. Considering that the way healthcare and welfare systems are shaped does impact on financial problems faced by cancer patients, we are developing an instrument for evaluating occurrence, gravity, and consequences of financial toxicity in Italy, and hopefully for fighting it. Methods: Concept elicitation, item generation and qualitative analyses represented the initial tasks of the project. Literature review, focus groups with 34 cancer patients or caregivers in three regions located in nothern, central, and southern Italy, and semi-structured interviews with 97 oncologists were conducted for concept elicitation. A recursive process was used to identify themes in the data to inform instrument until saturation was reached. Importance analysis questionnaires were administered to further 44 cancer patients to evaluate and revise the draft item pool. A multi-disciplinary committee (including oncologists, psychologists, statisticians, patient association’s representatives, nurses, social science researchers and economists) oversights the project. Results: Overall, 156 concepts were distributed among 10 themes (bureaucracy, medical care, domestic economy, emotion, family, job, health workers, welfare state, free time, transportation). After controlling for redundancy, 55 candidate items were generated and 30 items, with at least one per each theme, remained after importance analysis. Out of the 30 items, 23 (77%) refer to material conditions, 4 (13%) to psychological response and 3 (10%) to coping behaviors. Conclusions: The first results of the proFFiT project show that most of the items selected by patients are related to material conditions that cause, or derive from, financial hardship. The final questionnaire will be ready by the end of 2019. Supported by Fondazione AIRC IG grant 2017-20402. Clinical trial information: NCT03473379 .
Development of an MCDA framework for evaluation and positioning of oncological treatments in clinical practice.
Authors: Camps Carlos , Badia Xavier , Chugani Divya , García Campelo Rosario , Garcia-Foncillas Jesus , Lopez Rafael , Massuti Bartomeu , Provencio-Pulla Mariano , Salazar Ramon , Virizuela Juan , Guillem Vicente
Published: October 2019

95

Background: Ensuring that effective innovations are accessible in a timely and affordable manner to all cancer patients is a challenge that stakeholders face today. Several oncology frameworks (ASCO, ESMO, ICER, NCCN) have been developed to define and quantify the value of oncological therapies to support clinicians and patients at the time of selection and as a basis for decision-making. However, current frameworks only define treatment value in terms of clinical benefit, creating a need for one that allows holistic evaluation of treatments and supports decision-making in clinical practice. The ECO Foundation led this study to develop a reflective multi-criteria decision analysis (MCDA) based framework for evaluation and positioning of new oncological drugs from the clinical oncology perspective. Methods: The framework was developed following EVIDEM methodology. Systematic literature review was performed to identify most relevant criteria used for evaluation of innovative treatments to complement the EVIDEM V4.0 framework. The criteria compendium was presented to a group of clinical oncologists from ECO. The Expert Group assessed each criterion for its inclusion in the framework and suggested modifications in their definition and/or response scale. This framework was then tested with two case studies (Abemaciclib for metastatic HER-/HR+ breast cancer and TAS for metastatic colorectal cancer). The objective was to validate the criteria selected alongside their definitions and response scale with practical examples. A reflective discussion based on the score assigned to each criterion was also carried out. Results: Out of 15 criteria presented to the Expert Group, 8 were included in the final framework, and definition and/or response scale of 7 of these criteria were modified: Disease severity, Unmet needs, Efficacy comparison, Safety/tolerability comparison, Treatment intention, Treatment cost comparison, Comparison of other medical costs and Quality of evidence. Conclusions: A reflective MCDA framework has been developed and validated, based on the value of the treatment, for assessment and positioning of oncological therapies in the context of clinical practice in Spain.
Detection of Circulating Tumor DNA in Patients With Uterine Leiomyomas
Authors: Przybyl Joanna , Spans Lien , Lum Deirdre A. , Zhu Shirley , Vennam Sujay , Forgó Erna , Varma Sushama , Ganjoo Kristen , Hastie Trevor , Bowen Raffick , Debiec-Rychter Maria , van de Rijn Matt
Published: October 2019

PURPOSE

The preoperative distinction between uterine leiomyoma (LM) and leiomyosarcoma (LMS) is difficult, which may result in dissemination of an unexpected malignancy during surgery for a presumed benign lesion. An assay based on circulating tumor DNA (ctDNA) could help in the preoperative distinction between LM and LMS. This study addresses the feasibility of applying the two most frequently used approaches for detection of ctDNA: profiling of copy number alterations (CNAs) and point mutations in the plasma of patients with LM.

PATIENTS AND METHODS

By shallow whole-genome sequencing, we prospectively examined whether LM-derived ctDNA could be detected in plasma specimens of 12 patients. Plasma levels of lactate dehydrogenase, a marker suggested for the distinction between LM and LMS by prior studies, were also determined. We also profiled 36 LM tumor specimens by exome sequencing to develop a panel for targeted detection of point mutations in ctDNA of patients with LM.

RESULTS

We identified tumor-derived CNAs in the plasma DNA of 50% (six of 12) of patients with LM. The lactate dehydrogenase levels did not allow for an accurate distinction between patients with LM and patients with LMS. We identified only two recurrently mutated genes in LM tumors ( MED12 and ACLY).

CONCLUSION

Our results show that LMs do shed DNA into the circulation, which provides an opportunity for the development of ctDNA-based testing to distinguish LM from LMS. Although we could not design an LM-specific panel for ctDNA profiling, we propose that the detection of CNAs or point mutations in selected tumor suppressor genes in ctDNA may favor a diagnosis of LMS, since these genes are not affected in LM.
Quality of Life During and After Completion of Neoadjuvant Chemoradiotherapy for Esophageal and Junctional Cancer
Authors: Noordman B. J. , Verdam M. G. E. , Onstenk B. , Heisterkamp J. , Jansen W. J. B. M. , Martijnse I. S. , Lagarde S. M. , Wijnhoven B. P. L. , Acosta C. M. M. , van der Gaast A. , Sprangers M. A. G. , van Lanschot J. J. B.
Published: October 2019

Background

The course of health-related quality of life (HRQOL) during and after completion of neoadjuvant chemoradiotherapy (nCRT) for esophageal or junctional carcinoma is unknown.

Methods

This study was a multicenter prospective cohort investigation. Patients with esophageal or cancer to be treated with nCRT plus esophagectomy were eligible for inclusion in the study. The HRQOL of the patients was measured with European Organization for Research and Treatment of Cancer QLQ-C30, QLQ-OG25, and QLQ-CIPN20 questionnaires before and during nCRT, then 2, 4, 6, 8, 10, 12, 14, and 16 weeks after nCRT and before surgery. Predefined end points were based on the hypothesized impact of nCRT. The primary end points were physical functioning, odynophagia, and sensory symptoms. The secondary end points were global quality of life, fatigue, weight loss, and motor symptoms. Mixed modeling analysis was used to evaluate changes over time.

Results

Of 106 eligible patients, 96 (91%) were included in the study. The rate of questionnaires returned ranged from 94% to 99% until week 12, then dropped to 78% in week 16 after nCRT. A negative impact of nCRT on all HRQOL end points was observed during the last cycle of nCRT (all p < 0.001) and 2 weeks after nCRT (all p < 0.001). Physical functioning, odynophagia, and sensory symptoms were restored to pretreatment levels respectively 8, 4, and 6 weeks after nCRT. The secondary end points were restored to baseline levels 4–6 weeks after nCRT. Odynophagia, fatigue, and weight loss improved after nCRT compared with baseline levels at respectively 6 (p < 0.001), 16 (p = 0.001), and 12 weeks (p < 0.001).

Conclusion

After completion of nCRT for esophageal cancer, HRQOL decreases significantly, but all HRQOL end points are restored to baseline levels within 8 weeks. Odynophagia, fatigue, and weight loss improved 6–16 weeks after nCRT compared with baseline levels.
Development of a Novel Time-Resolved Synchrotron-Radiation X-ray Diffraction Measurement System for In Situ Observation of Crystal Structure in Aqueous Solution during Chemical Reaction: Application to the Anion-Exchange Reaction of a Layered Double Hydroxide from Chloride to Nitrate
Authors: Sasai Ryo , Fujimura Takuya , Onda Nobuhiko , Nakayashiki Yu-to , Sumiyoshi Hidenobu , Hagura Koki , Abe Tomohiro , Moriyoshi Chikako , Kawaguchi Shogo
Published: October 2019

We successfully developed a novel time-resolved synchrotron-radiation X-ray diffraction (t-SXRD) measurement system with high temporal resolution (minimum time: 50 ms) at the BL02B2 facility at SPring-8 for the in situ observation of the crystal structure changes of inorganic compounds in aqueous solution during chemical reactions. For evaluating the performance of this novel system, we applied it to observe the crystal structure change of a layered double hydroxide consisting of Mg and Al (Mg/Al = 2) with chloride as the exchangeable anion species (Cl−-MgAl(1/3)LDH) during the anion-exchange reaction from Cl− and NO3− in aqueous solution under various [NO3−] conditions. The t-SXRD patterns from the MgAl(1/3)LDH crystal particles dispersed in aqueous solution were recorded every 0.2 s using our measurement system; that is, we obtained t-SXRD data for kinetic analysis. Thus, we identified the features for the anion-exchange reaction of Cl−-MgAl(1/3)LDH from Cl− and NO3− in aqueous solution under various [NO3−] conditions. All the present results revealed that the novel t-SXRD measurement system developed herein is very useful and effective for monitoring the in situ structural changes of crystalline compounds dispersed in solution during chemical reactions with a fast time constant.
Recent advances in the understanding of Nipah virus immunopathogenesis and anti-viral approaches
Authors: Pelissier Rodolphe , Iampietro Mathieu , Horvat Branka
Published: October 2019

Nipah virus (NiV) is a highly lethal zoonotic paramyxovirus that emerged at the end of last century as a human pathogen capable of causing severe acute respiratory infection and encephalitis. Although NiV provokes serious diseases in numerous mammalian species, the infection seems to be asymptomatic in NiV natural hosts, the fruit bats, which provide a continuous virus source for further outbreaks. Consecutive human-to-human transmission has been frequently observed during outbreaks in Bangladesh and India. NiV was shown to interfere with the innate immune response and interferon type I signaling, restraining the anti-viral response and permitting viral spread. Studies of adaptive immunity in infected patients and animal models have suggested an unbalanced immune response during NiV infection. Here, we summarize some of the recent studies of NiV pathogenesis and NiV-induced modulation of both innate and adaptive immune responses, as well as the development of novel prophylactic and therapeutic approaches, necessary to control this highly lethal emerging infection.
DYNAMICS OF THE CREATIVE INTERPRETATION IN EARLY CHILDHOOD COMMUNICATION WITH ART IN A MUSEUM ENVIRONMENT
Authors: Zlateva Any , Tineva-Gyurkovska Katya
Published: October 2019

Introduction: The research paper tracks the changes in the regular development of the way children perceive visual arts. It views the dynamics of the creative interpretation of children at the pre-school age when directly communicating with pieces of art in a museum environment. An important stage of this study is related to the role of the informal gallery environment, which suggests an intense visual stimulation and reinforces children’s desire to actively take part in it.  This imposes the application of specific integrated pedagogical approaches and methods, close to museum pedagogy and visual arts education.

Purpose of the study: The research aims at tracing some of the main processes pertaining to the dynamics of the visual reaction of children of 6 to 7 years of age when directly communicating with visual arts and their level of creative interpretation in the process of drawing afterwards.

Methods: For achieving the aims of the research we used some interdisciplinary methods. In the theoretical part we present some of the fundamental works on the subject. We emphasize the methods that integrate the history of art and pedagogy, which include: the description of the paintings with elements of formalism is the study of art and analysis of the visual reaction when communicating with pieces of art. This description should be adapted to the age of the children and some empirical and proximity pedagogical methods for evaluating the achieved results.

Findings and results: In the first part of the research the accent is put on the different levels of reaction children have at the age of 6-7, regarding the recognition of separate compositional elements, objects, colours, forms, seasons, hours of the day, finding out emotional conditions and other important elements of composition sings in the observed pieces of art.

In the second part we show the results and we systematize and analyze children’s free creative modulations. They concern different aspects of the visual stimulation and the following creative interpretation through the art activity of children at the age of 6-7. We observed the correlation between the drawings of the children and the perceived pieces of art, as a consequence of the stimulation of their visual perceptions and views. We analyzed the influence of a museum environment on children’s graphic, colourful and emotional expression through drawing.

Conclusiоn: The summary and conclusion of the research provide the basis for development and optimization the methodological-pedagogical system of working with children in a formal and informal environment.
SUICIDES IN LITHUANIA: RATES, METHODS AND DISTRIBUTION BY AGE, GENDER AND SETTLEMENT, 2012-2016
Authors: Vasiljevaitė Diana , Stasiūnienė Jurgita , Laima Sigitas , Chmieliauskas Sigitas , Fomin Dmitrij , Jasulaitis Algimantas
Published: October 2019

INTRODUCTION: According to the World Health Organisation regarding suicide rate, Lithuania was on the top in 2016 with 31.9 suicide events per 100 000 people of the population. This research was aimed at analysing the situation including methods of suicide and its distribution between different age, gender and settlement groups in Lithuania.

METHODS: 4610 particular suicide cases were found and analysed from the given retrospectively collected data by the Hygiene Institute’s Register of Death Causes in Lithuania from 2012 till 2016. These cases have been categorised into age (10-19 years old, 20-69 years old and >70 years old), gender and settlement groups. Chi-squared and Fisher tests were used to analyse the associations between the suicide methods used, sex, as well as age. A significance level of p<0.05 was used.

RESULTS: In total, 4610 suicide cases were registered in Lithuania in 2012-2016. People aged 20-69 years had the biggest proportion with 80%, followed by 16% for people older than 70 and 4% people aged 10-19. 82% of all cases were men. The most common method of suicides in all age groups was hanging, self-strangulation and self-suffocation; 92%. There is no statistical significant difference in methods used by the 10-19 years old group and above 20 years of age (20-70+).A difference was found between the groups under 70 years and above 70 years old. Moreover, the following difference was found between their genders (p=0.0002). In terms of using drugs and biological substances, women (54.24%) are more likely to commit suicide through these means than men in all age groups, while 100% of suicide methods by gas, steam or solvents were used by men. Though slightly more suicides were registered in cities, there was no statistically significant difference between people living in cities and in villages.

CONCLUSIONS: Despite the fact that incidences of suicides are gradually decreasing every year, the situation is not yet satisfactory. The pattern almost has not changed for years – the most inclinable person to commit suicide is a 50-59 years old man living in a city and the most used method is still hanging.
USE OF MOBILE NETWORKS FOR THE PURPOSE OF PROTECTING PERSONS AND PROPERTY
Authors: Boroš Martin , Kučera Matej , Mariš Ladislav
Published: October 2019

Mobile networks have been around us for decades, and life without them is difficult to reconstruct. Their gradual evolution has varied over time, depending on the requirements of their users. Originally, they were used only for the transmission of telephony, but transmission in the speech band today is mainly used for data transmission and telephony is in moderate attenuation. Various types of data can be transmitted via mobile networks due to their size or importance.

In the area of ​​security, mobile networks are used from two basic points of view. The first aspect is the use for communication between the components of the electrical security system and the second is the transmission of information from the monitored object to the monitoring and alarm receiving center.

The aim of the paper will be to point out the composition of mobile networks focusing on the functioning of cellular systems and the course of communication between individual parts of the system. The main view will be to the base station of the system without which the functionality of the system would not be possible. In addition to the principle of functionality, we will also focus on utilizing the possibilities of information transmission via mobile networks in terms of property protection and we will focus on the possibility of their use in the future.
AN ANALYSIS OF FOREST GROWTH FEATURES OF LOW-PRODUCTIVE GREY FOREST SANDY SOILS OF UKRAINE WITH REGARD TO THEIR RELEVANCE FOR FOREST CULTIVATION
Authors: Kijovský Peter , Lisnyak Anatoliy , Utkina Kateryna , Kraynukov Alexey , Michaeli Eva
Published: October 2019

A comparative analysis of the forest growth features of low-productive grey forest sandy soils of the Polissia, the Forest-Steppe and the Northern Steppe of Ukraine was performed. Although grey forest soils from different natural zones are distinguished in the genesis of their soil rocks, as well as typical and zonal belongings, at the same time they are united by an important general characteristic, light texture, determining the similarity of physical, physico-chemical and agrochemical indicators and, in general, forest site capacity. A package of markers to assess the forest site capacity of sandy soils (pine habitats) with such soil quality indicators as the content of physical clay, the coarseness of the humified layer of soil profile and K2O content was revealed.
SUSTAINABILITY IN THE BUSINESS ENVIRONMENT THROUGH INTERCULTURAL DIALOGUE
Authors: Kyurova Vyara , Kiryakova-Dineva Teodora
Published: October 2019

In the contexts of global economy and the increasing necessity for sustainable development of the business connections all over the world, the relations between the partners often involves not only the foreign language communication but also the dialogue between their cultures. International economic activity takes place in a set of business environments (business arrangements, timelines, quality output, sales, cash flows) which are also largely determined by additional cultural business conditions (culture as communication, attitude towards power, organizational hierarchy, interpersonal relations, etc.). In this sense, intercultural dialogue is a particularly important tool for achieving excellence and sustainable business relations between economic partners from different countries.

In this paper, we suggest that intercultural dialogue in the international business environment is an indispensable tool for achieving economic effectiveness and goals, and can be assessed on the same scale as business performance. In order to identify the need of awareness-raising concerning the importance of intercultural dialogue as a business environment facilitator, a survey regarding the sewing industry in southwestern Bulgaria was conducted. The survey involved 16 small enterprises (participating with professionals from four different positions) working with firms from Greece. The evaluation of the business relations was actualized at two levels: the level of assessing the ability of professional communication and the level of assessing the ability of intercultural dialogue. Following the results obtained, the authors suggest a more active inclusion of intercultural dialogue in business practices and in negotiation. This recommendation fully corresponds to the Global goals of sustainable development because it contributes to the improvement of global partnership.
RAPD-ANALYSIS OF CYCLAMEN SPP. GENOME POLYMORPHISM
Authors: Makaradze Elza , Meparishvili Galina , Varshanidze Natela , Diasamidze Inga , Dolidze Ketevan , Jakeli Eteri , Zarnadze Nana
Published: October 2019

Wild plants form the basis of biological resources both for Georgia and the whole world. A strategic task of any country is to preserve the biological diversity of plants. In the territory of Ajara, a large species diversity of plants grows, among which there are rare, endemic and relict plants. In particular, Cyclamen adzharicum.

Modern systematics of wild plants in Georgia is based on classical methods of botany. In this regard, it is relevant to conduct genetic studies of species diversity and genetic polymorphism of species and populations using molecular genetic markers, in particular RAPD-PCR methods. The purpose of this study was to identify genetic polymorphism in Cyclamen L species using RAPD methods. As a result of the conducted research the 65 RAPD-markers in length from 150 to 1500 BP have been revealed. The number of the amplified fragments DNA varied depending on the primer from 6 (OPA-2) to 11 (OPB-4). The results of grouping Cyclamen adzharicum and C. coum samples allowed two clusters to be identified. In the first cluster were samples of three populations Cyclamen adzharicum and showed a low stubble in the intra-species variability. Cyclamen coum was attributed to the second cluster. The used primers gave the opportunity to identify polymorphism between the tested types of cyclamen.
DESIGNING A SMALL CLIMATE CHAMBER TO CHARACTERIZE PEOPLE AS A SOURCE OF DETERIORATION OF INDOOR AIR QUALITY BY RESPIRATION
Authors: Markov Detelin Ganchev , Mijorski Sergey , Stankov Peter , Simova Iskra , Angelova Radositna A. , Velichkova Rositsa
Published: October 2019

: People are one of the sources for deterioration of the indoor air quality. They worsen indoor air quality by their presence (respiration, bio-effluents), activities and habits. Through respiration, people decrease the oxygen concentration in the air of the occupied space and increase carbon dioxide and water vapor concentration in the indoor air as well as its temperature. The goal of the AIRMEN project is to find out if the rate of consumption of oxygen and emission of carbon dioxide (and water vapor) by people depends on the indoor air temperature as well as carbon dioxide concentration in the inhaled air. In order to achieve this goal a small climate chamber must be designed and constructed which allows for controlling and measuring both inflow and exposure parameters as well as for measuring outflow parameters. The principal goal of this paper is to present some important details, obtained by CFD simulations, from the design process of the climate chamber which precondition the air distribution in the chamber and hence the exposure parameters.
Journal Scan
Authors: Welyczko Nikki
Published: October 2019

Nikki Welyczko, Associate Professor at the Faculty of Health and Life Sciences, De Montfort University, provides a brief overview of recently published nursing and health articles
Using convex stoma appliances
Authors: Burch Jennie
Published: October 2019

Jennie Burch, Head of Gastrointestinal Nurse Education at St Mark's Hospital, London, discusses the what, why, when and how of convex ostomy appliances
The Watford low anterior resection syndrome pathway for pre- and post-stoma reversal patients
Authors: Sumner Deborah , Collins Brigitte
Published: October 2019

There is increasing awareness of the high incidence of bowel dysfunction experienced by patients after sphincter-preserving rectal resection, termed low anterior resection syndrome (LARS); there remains no agreement on effective methods of treatment or effective management strategies. In West Hertfordshire Hospitals NHS Trust, there were no set protocols in place prior to the development of a nurse-led LARS clinic, which has ensured that all patients undergoing anterior resection surgery are monitored, encouraged and empowered to take an active role in their own care. While being the first point of contact for these patients, the nurse works as part of a wider multidisciplinary team (MDT) and the surgical consultants continue to have overall responsibility for patient care. The Watford LARS pathway is a guide with a method of how best to approach management of patients prior to stoma reversal and in preventing symptoms of LARS. In spite of only being set up in 2018, the pathway and clinics are already showing great success.
Deprescribing: opportunities for proactive care
Authors: Harrison Penny
Published: October 2019

Penny Harrison, Senior Lecturer in Adult Nursing at De Montfort University, Leicester, discusses deprescribing, a relatively new concept in nursing