bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of a breast cancer diagnosis on women’s work status.
Authors: Barry Lucinda , Storer Leanne , Pitcher Meron
Published: May 2018

23

Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.
Patterns of concordance with clinical algorithms for survivors of head and neck cancers.
Authors: Gilmore Katherine Ramsey , Palos Guadalupe R. , Chapman Patricia , Lewis-Patterson Paula A. , Bi Weiqi , Rodriguez Maria Alma
Published: May 2018

26

Background: Research indicates survivors of head and neck cancers (HNC) are at greater risk for recurrences and adverse late effects. HNC survivorship algorithms are available to provide consistent and optimal care to this at-risk group. Here, we describe practitioners’ concordance with algorithms aimed at survivors diagnosed with cancers of the oral cavity (OC) oropharynx (OP), and larynx/hypopharynx (LH). Methods: We reviewed medical records, treatment summaries, and survivorship care plans of patients seen in the HNC Survivorship Clinic from 09/01/2011 to 08/31/2014. The primary outcome was providers’ rate of concordance (> 90%) with 3 HNC algorithms. Concordance rates (CRs) were measured and compared within and between groups. Results: 145 patients met the eligibility criteria. Demographics varied by cancer sub-type: 19.3% OC, 58.6% OP, and 22.1% LH. Most were white males with the mean age of 62.7 years at first visit during the study period. Table 1 indicates clinicians’ CRs ranged from 9.2% to 99.7%. Overall, CRs were highly consistent and met or exceeded the benchmark for H & P, chest x-ray, and dysphagia and lymphedema assessment. Body image assessment had the lowest CRS. Wide variation in CRs existed within and between sites for: T4/TSH, head/neck CTs, xerostomia assessments. Conclusions: Our findings indicate providers’ practice did deviate from recommendations listed in the HNC algorithms. Increasing clinicians' awareness and education may help achieve optimal adherence to survivorship algorithms. [Table: see text]
Come back: Identifying targets to engage young adult survivors who have been lost to follow-up.
Authors: Beaupin Lynda M. , Boldt Anne , Amato Katharine
Published: May 2018

29

Background: Despite national survivorship guidelines, follow-up care after treatment has ended is generally lacking for AYA survivors. Our previous pilot study involving 27 AYA in a focus group found that the major barriers to follow-up included loss of health insurance, poor communication with their oncologist, and on-going adjustment challenges. The current study aimed to determine the proportion of young adult survivors who no longer continued with follow-up care at our institution and examine which factors contributed to the lack of follow-up. Our objectives were: 1. Evaluate how many AYAs who completed treatment may be lost to follow up over time; 2. Determine which AYAs are most at risk of being lost to follow-up. Methods: Data Analysis: 1. AYA Survivorship Dataset – Tumor Registry used to include the following: Current age, age at diagnosis (captured those 18 and 39 years of age), gender, date of diagnosis, date of most recent visit, disease type and histology. 2. Compare follow-up appointments and insurance status between two sets of survivors: Cohort A - 852 patients diagnosed between 2010-2014; Cohort B - 783 patients diagnosed between 2005-2009. Results: 2367 AYAs were diagnosed between 2000-2015; 37% did not have a follow-up visit since 2015 and no significant variation across disease types Regardless of insurance coverage, 33% of Cohort A and 48% of Cohort B survivors were not seen in 2016. Follow-up status was not related to disease type or insurance status. Conclusions: Many AYAs do not continue with survivorship care. Health insurance status did not predict follow-up adherence, nor did disease type. The longer survivors are from the end of their treatment, the less likely they are to have follow-up care at a cancer center. Further research is needed to determine other implicating factors, such as age at diagnosis and type and intensity of cancer treatment received. [Table: see text]
Seeing results: Outcomes from offering breast cancer survivorship care for more than 10 years.
Authors: Ward Andrew Joseph , Lloyd Jillian , Pospiech Emily , Wheelon Cystal , Orucevic Amila , Bell John Lawrence
Published: May 2018

32

Background: The University of Tennessee Medical Center (UTMCK), Knoxville Tennessee is the region’s sole academic medical center. Annually, 3000 new patients are seen within the Cancer Institute (CI) of UTMCK, and over 13% are breast cancer patients. Under the leadership of our director, Surgical Oncologist Dr. John L. Bell, survivorship care has been offered to these patients for almost twenty years. This combination has created a unique opportunity for us to look at long term results of offering disease-specific survivorship care, and what effect it has made upon detection of recurrence. Methods: Tumor registry data was utilized to examine the influence of survivorship care upon detection of recurrence. All patients treated from 1999 – 2015 with a diagnosis of recurrent breast cancer were selected out of the tumor registry. These patients were then stratified by time to recurrence, and mean, median, and range were calculated in time to recurrence (TR) by month. Results: A total of 223 patients with recurrent breast cancer were identified in our tumor registry out of 4422 total breast cancer patients treated by UTMCK from 1999 – 2015, recurrence rate of 5.04%. The mean TR for this cohort was 43.9 months. The median TR was 33 months, and the range of TR varied from 4 months to 166 months. All patients were followed for a minimum of five years following their diagnosis, and by 60 months, 73.99% of all recurrences were identified. Conclusions: Offering disease specific survivorship care to breast cancer patients is beneficial to both patients and our institution. When recurrence is diagnosed, survivorship care is valuable by helping to identify these cases as early as possible, to get patients back into active treatment sooner in the disease process. We have demonstrated that this is not a recent phenomenon reflective of current practice changes and accreditation requirements, and have validated this with our institution’s long history of providing survivorship care services for breast cancer patients dating back to the last century.
Primary and subspecialty care trends for adults with a history of childhood cancer.
Authors: Lowry Becky N. , Alsman Kyla , Hein Wendy , Shankweiler Caylin , Krebill Hope , Gibson Cheryl , Mount Rebecca , Doolittle Gary C.
Published: May 2018

33

Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]
Survivorship of a survivorship clinic: System-wise lessons and challenges.
Authors: Caspi Opher , Haber Karmit , Attias Ruth , Sela Noga , Dreyer Juliet , Brenner Baruch
Published: May 2018

40

Background: Since the most efficient means by which cancer survivorship services should be delivered remain elusive, we conducted a qualitative study with key personnel at a Comprehensive Cancer Center in Israel in order to identify barriers and facilitators that need to be addressed system-wise so that the survivorship clinic gets truly integrated in the day-to-day operation of the Cancer Center. Methods: In-depth 1x1 interviews with 21 key personnel (oncologists, nurses, psycho-oncologists, and survivorship clinic staff) and 13 survivors who attended the clinic in one focus group plus a descriptive analyses of clinic visits. Results: 1,012 visits (out of 1,578 referrals; 64%) were made to the survivorship clinic from 12/2016 to 4/2017. Main reasons for decline to attend the clinic were: no interest, logistics, and no need for further visits beyond the initial visit. 16/21 (76%) personnel and all survivors supported the need for a specialized survivorship clinic, yet many thought its modus operandi should be restructured. Perceived strengths included: its multidisciplinary structure, its commitment to emotionally support survivors throughout their journey, and its focus on QOL in addition to medical issues. Main barriers identified were: sense of redundancy and overlap with other services, oncologists' lack of time to discuss survivorship issues and proactively refer to the clinic, and no real understanding of the exact goals of the clinic. Questions rose regarding the best time to first refer survivors to the clinic and regarding who is in charge of survivors in terms of who focuses on what issues. Suggestions for future directions included: improved communication with oncologists and the disease management teams, case selection based on needs rather than on time since treatment, and production of reports that show the clinic's added value. Conclusions: Studies like these can help define the optimal modes of function of a designated survivorship clinic. While both survivors and personnel express interest in such a clinic, its struggle to survive even 3.5 years after it opened its door stem from significant gaps which need to be addressed system-wise.
A model of an advanced practice provider led melanoma survivorship clinic at a NCI-designated cancer center.
Authors: Henderson Ro , Doolittle Gary C.
Published: May 2018

41

Background: Melanoma cancer survivors present unique challenges for survivorship care due to their increasing numbers as well as the rapidly expanding options for adjuvant treatment including immunotherapy and targeted therapies for which the long term sequelae is relatively unknown. For this reason, the melanoma program at a NCI-designated cancer center elected to create an Advanced Practice Provider (APP) led dedicated Melanoma Survivorship Clinic. Methods: Patients are transferred to the APP led Melanoma Survivorship Clinic following the completion of definitive treatment for their cancer. The surgical and medical oncology specialists dedicated to the management of melanoma at this institution identify and include those requiring surgical intervention only as well as those who have received surgery followed by adjuvant treatment. Results: Patients meet with the APP who reviews the recommended stage specific National Comprehensive Cancer Network (NCCN) guidelines, completes and reviews the survivorship care plan (SCP). The SCP is provided to the patient and primary care provider. Patients continue to follow in the APP led clinic for at least the next 5 years to monitor for disease recurrence and the unique long term and late effects of new immune related and targeted agents. Surveillance includes history taking, physical examination including detailed skin examination, screening for genetic counseling, and Quality of Life tool. Imaging may be indicated if the patient develops symptoms that warrant or in those with higher risk disease . Five year risk of recurrence is calculated and reviewed using on-line tool. In addition, tools have been built in the electronic medical record to support documentation for melanoma survivorship patients as well as the SCP. Conclusions: Since its inception in March 2016, the APP led Melanoma Survivorship Clinic has been a successful collaboration between the APP, medical and surgical oncologists. There have been over 200 new survivorship patient referrals from surgical and medical oncology. Tools are continually modified and updated according to latest evidence, NCCN guidelines and SCP requirements.
Effects of community-embedded care management model on patients, providers, and payors.
Authors: Riley Sheryl , Manns Samantha
Published: May 2018

44

Background: Comprehensive oncology care management is commonly built on expert clinical support and coordinated services, but lacks a community focus during critical phases of the cancer journey. However, a community-embedded approach extends past practice walls by incorporating local resources and identifying barriers to care in-between office visits. The cycle of care management adheres to the following objectives: Improve health outcomes; Engage the patient, their family and healthcare team; Advance payor efficiency and cost savings; Support the treatment plan in the community. Methods: Stratification Technology Platform & Levels of Care: A risk-based process is implemented through proprietary stratification software, which combines all data points of the healthcare system. A three-step risk acuity score is calculated for each patient based on claims data, diagnoses and disabilities to assure care is tailored to meet individual needs. Patients are then designated to care programs in accordance to their various risk levels. This allows for personalized care plans and staff workflows. Care Teams: Teams of a care coordinator, registered nurse and social worker provide consistent healthcare navigation, monitor patients’ treatment adherence and improve health outcomes. They act as a safety net for patients and their families at all times. Results: 31% decrease in ER visits; 51% decrease in hospital admissions; Hospice conversion at 8x national average; Improved side effects management; ROI of 3:1. Conclusions: Through community-embedded oncology care management, patients not only receive the proper level of care, but also show various improved health outcomes. Providers and patients see decreased emergency room visits, shorter hospital stays and improved quality of life, while payers experience tremendous cost savings due to smarter spending and utilization management. Practices continue to recognize community-embedded care management as a transformative standard of treatment that is central to positive health outcomes. However, there is always more to learn and improve upon, so constant evaluations of quality metrics are essential to provide the very best to patients, providors and payers.
Tailored survivorship care plans for head and neck cancer patients.
Authors: Salner Andrew L. , Baxi Shrujal S. , Fortier Elizabeth , Salz Talya
Published: May 2018

51

Background: Survivorship care plans SCPs typically include generic advice for cancer surveillance, management of late effects (LEs), wellness recommendations (WRs), and cancer screening. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based management guidelines to generate tailored SCPs for head and neck cancer survivors (HNCSs), a population particularly vulnerable to various LEs. We surveyed HNCSs and their primary care providers (PCPs) regarding the SCP to assess its acceptability and usefulness. Methods: HNCSs at 2 cancer hospitals used HN-STAR. Prior to a routine clinic visit, HNCSs used a validated ePRO measure (PRO-CTCAE) to report 22 physical LEs and other measures to assess wellness. Based on the visit discussion, HN-STAR generated an SCP that included a treatment summary, WRs, and LE management plans. HNCSs indicated their perceptions of the SCP and intentions to adhere to WR and LE management recommendations. PCPs reported on the SCP utility and their comfort in managing WRs and LEs. Results: 47 HNCSs completed surveys (mean 5.4 yrs. from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). 51% experienced at least 9 of the 22 LEs in the last month (mean 8.2/person). 91% of HNCSs felt the SCP was easy to follow. 98% intended to follow recommendations for LEs management and 98% reported they would refer back to the SCP. 87% said they plan to share the SCP with a PCP. 23 PCPs completed the survey. 95% were satisfied with the SCP and 95% reported they would like to have one for every cancer patient. PCPs expressed varying levels of comfort in managing specific LEs of head and neck cancer (30-80%). Conclusions: Among HNCSs, an automatically generated SCP that was tailored to their WRs and LEs was acceptable, was trusted, and provided recommendations they intended to follow. PCPs found the SCP useful, and SCPs may help improve their comfort with LE management. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors and PCPs manage survivorship issues.
Implementation of a survivorship clinic in a medically underserved comprehensive community cancer center.
Authors: Lopez Carrie , Chandra Abhinav , Sweigart Mary
Published: May 2018

54

Background: Historically, preparation of Survivorship Care Plans (SCPs) had been a cumbersome challenge that resulted in a limited number of plans delivered to eligible patients. In 2015, eleven breast SCPs were prepared and delivered by an RN. Upon review, it was determined the process of preparation and delivery of SCPs required refinement. Methods: Initially, we identified the barriers to our practice, which included limited knowledge, process, personnel, and software interfacing. We implemented a quality improvement project with the goal of delivery of SCPs to an increased number of cancer survivor patients. The project targeted staff education to identify eligible patient populations, create awareness of the Commission on Cancer accreditation requirements, and the knowledge necessary to create a SCP. We coordinated with the information technology department to attempt interfacing software programs, track the delivery of plans, and use provider notes to export data. We increased communication between departments to identify eligible patient populations. A nurse practitioner was assigned the responsibility for preparation and delivery of the document during a scheduled appointment, which focused on review and education in relation to the patient’s diagnosis, treatment plan, sequelae and recommended surveillance. Results: Through close coordination of interdisciplinary teams, we were able to implement strategies to develop a streamlined process to create and deliver SCPs. These interventions resulted in the Survivorship Clinic going from 11 breast cancer SCPs delivered in 2015 to 98 and counting, of all types of cancer, delivered in 2016. Patients requested follow up visits to the Survivorship clinic. Conclusions: We have successfully developed a Survivorship Clinic within a federally designated medically underserved community setting. Implementation of best practices resulted in nine-fold increase in delivery of SCPs. Most importantly, we have increased patient education and satisfaction. Our practices can be replicated by other programs and thereby curb the disparity of cancer survivorship care in rural areas.
Enhancing provider engagement and accountability: A strategy for survivorship care plan implementation within a large hospital network.
Authors: Garces Natalie , Eaton Tara , Goto Daisuke
Published: May 2018

56

Background: Challenges to Survivorship Care Plan (SCP) implementation persist and guidelines to facilitate provider engagement and accountability are needed. In 2014, Levine Cancer Institute (LCI), part of one of the largest Commission on Cancer (COC) hospital networks, instituted a SCP delivery model. The patient’s LCI or LCI-affiliated physician or advanced care provider (ACP) is responsible to create and deliver the SCP. This presentation updates and extends prior work presented at the 2017 ASCO Cancer Survivorship Symposium to demonstrate the utility of enhanced provider engagement and accountability in SCP program expansion at LCI. Methods: The Survivorship Section partnered with the Cancer Committee to develop a system to enhance provider engagement and accountability. Strategies to improve engagement included: emailed SCP metrics (monthly goals and volume reports) and poster presentations to demonstrate SCP value to Tumor Site Section Leaders (TSSLs), administrators and providers. Strategies to promote accountability included: (1) partnered with TSSLs to clarify SCP eligibility criteria, set monthly goals and identify methods to optimize delivery; (2) discussed SCP metrics within each TSSL to highlight participation rates of providers or clinics; (3) presented Section- and clinic-specific SCP performance at quarterly Cancer Committee, National Accreditation Program for Breast Cancer leadership and Operational meetings; and (4) required all newly hired outpatient ACPs to receive SCP training and included SCP delivery in yearly ACP goals. Results: Since 2014, the total number of SCPs, participating providers, clinics and cancer types has grown 25-, 17-, 7- and 22-fold, respectively. Conclusions: LCI developed a multilayer partnership strategy that enhanced engagement and accountability at the leadership and provider level. This partnership significantly increased numbers of SCPs delivered over four years and allowed us to meet COC goals. [Table: see text]
Patterns and predictors of attendance at a comprehensive, multi-disciplinary supportive care program for men with prostate cancer and their partners.
Authors: Hedden Lindsay , Pollock Phil , Spillane Maria , Sundar Monita , So Alan , Black Peter C. , Gleave Martin , Goldenberg Larry , Higano Celestia S.
Published: May 2018

6

Background: Men diagnosed with prostate cancer (PC) face treatment-related sequlae that affect their health and quality of life. The Vancouver Prostate Centre’s (VPCs) Prostate Cancer Supportive Care (PCSC) Program is a comprehensive program for men and their partners that aims to address these challenges. Our objective is to examine registration rates, and the timing/intensity of follow-up with the program, and to explore clinical/sociodemographic factors associated with participation and non-participation. Methods: We used charts for all men who registered with the PCSC program (“registrants”), and a random sample of men who sought PC-related care at the VPC but did not register with the program (“non-registrants”) from Jan 2013-Dec 2016. Registrants were classified as “attenders” (came to PCSC information session/clinic visit), or “non-attenders” (did not attend). We used multivariate logistic regression to quantify the effect of diagnostic, treatment and sociodemographic characteristics on registration. We produced an unadjusted Kaplan-Meier estimator to assess the probability of program attendance over the disease trajectory for those who registered. We used Cox proportional hazards regression to examine impact of the same factors on timing of program participation and a binary logistic model to examine which factors impact program attendance. Results: Preliminary results suggest that 17% of the men who enroll in the program do not subsequently use any services. Program participation continues for more than four years after diagnosis and varies based on Gleason score (Chi Square (CS) = 20.9, p = 0.01), risk score (CS = 11.5, p = 0.02), and clinical T stage (CS = 14.0, p < 0.001). We found no difference participation by age, age at diagnosis, travel distance to clinic or treatment modality. Complete results will be available at the time of presentation. Conclusions: One in six men who register for supportive care do not end up using any despite the program being free of charge. Drivers of non-participation appear to be clinical, with lower risk patients being more likely to chose not to participate, though further investigation is required.
Effect of physical activity (PA) before and after diagnosis on overall survival (OS) for patients (pts) with lymphoma.
Authors: Ip Andrew , Pophali Priyanka Avinash , Larson Melissa C. , Rosenthal Allison Claire , Maurer Matthew John , Link Brian K. , Farooq Umar , Feldman Andew L. , Allmer Cristine , Slager Susan L. , Habermann Thomas Matthew , Flowers Christopher , Cerhan James Robert , Cohen Jonathon Brett , Thompson Carrie A.
Published: May 2018

95

Background: While PA is known to improve quality of life in lymphoma pts, its impact on OS is not known. We studied the effect of PA on OS in lymphoma pts enrolled at diagnosis in the Iowa/Mayo Molecular Epidemiology Resource. Methods: Godin Leisure Score Index (LSI; Range 0-50) was calculated based on level of PA pre-diagnosis (baseline) and 3 years post diagnosis (FU3), with pts grouped by tertile into high, moderate, or low PA. At FU3, pts also reported perceived change in PA since diagnosis. OS was measured as time from assessment (baseline or FU3) until death from any cause. Associations between LSI tertiles and OS were assessed using Cox models adjusted for lymphoma subtype, age and sex. Results: PA level was available for 3060 pts at baseline and 1371 pts at FU3. 95% had an ECOG performance status < 2, 37% had an aggressive subtype, 29% had BMI ≥ 30, and 54% were age > 60. Indolent lymphoma pts with higher PA at baseline had no difference in OS. Higher PA at FU3 had improved OS (moderate vs low HR 0.63, CI 0.42-0.93; high vs low HR 0.53, CI 0.33-0.86). Pts with BMI < 30 who had higher PA at baseline showed no difference in OS. Higher PA at FU3 had improved OS for pts with BMI < 30 (moderate vs low HR 0.68 CI, 0.48-0.98; high vs low HR = 0.41, CI 0.26-0.64). For pts > 60 years, high vs low baseline PA showed improved OS (HR 0.77, CI 0.63-0.93). Higher PA at FU3 (moderate vs low HR 0.68 CI 0.48-0.96, high vs low HR 0.53 CI 0.34-0.83) was associated with OS. At FU3, compared to no change, perceived reduction of PA was associated with worse OS for indolent lymphoma (HR 2.13, CI 1.56-2.91), BMI < 30 (HR 1.95, CI 1.45-2.62), BMI > 30 (HR 2.00, CI 1.21-3.30), age ≤ 60 (HR 3.06, CI 1.72-5.46), and age > 60 (HR 1.98, CI 1.52-2.58). Perceived increase in PA was not associated with OS. Higher PA in pts with aggressive lymphoma, BMI ≥30, and age < 60 was not significantly associated with OS but trended similarly. All results were similar when analyzing by continuous LSI score. Conclusions: Higher levels of PA, especially at FU3, were associated with superior OS. The effect was more pronounced in pts with indolent lymphoma, BMI < 30, or age > 60. Perceived reduction in PA was associated with worse outcomes. PA should be incorporated into lymphoma survivorship plans.
Improving the Safety and Quality of Systemic Treatment Regimens in Computerized Prescriber Order Entry Systems
Authors: Crespo Andrea , Redwood Erin , Vu Kathy , Kukreti Vishal
Published: May 2018

Purpose:

Systemic treatment (ST) computerized prescriber order entry (CPOE) and preprinted orders (PPO) are proven to reduce errors. There is no known guidance in oncology to facilitate high-quality, accurate regimen development and review; hence, this was identified as a system-wide gap. This provincial initiative aimed to improve the quality of oncology regimens through a comprehensive review of systemic treatment (ST) regimens and the development of standards.

Methods:

A system-wide analysis of all active regimens (both CPOE and PPO) to ensure they were built as intended was conducted in 2015. Thirty-five hospitals (on behalf of 75 treatment facilities) were asked to report any unintentional discrepancies and details of the maintenance review process. Discrepancies were compiled, categorized, and analyzed for potential to cause harm. In addition, a multidisciplinary expert working group was formed to create best practice recommendations.

Results:

The review yielded a 94% response rate and took a total of 18 months to complete (70% completed within 9 months). The average number of regimens reviewed was 336 (range, 15 to 700; n = 9). Unintentional discrepancies were reported by nine hospitals (27%). A total of 369 discrepancies were reported (average, 55 per hospital), and 28 were deemed to have a moderate potential for harm. Only two hospitals (6%) had an established maintenance process; now, all have standard processes for review. Consensus-based recommendations for ST-CPOE and PPO regimen development and maintenance were developed.

Conclusion:

The review identified unintentional discrepancies and, because of the potential for patient harm, corrective action has been taken. Identified discrepancies have been amended, and standard regimen development and maintenance review processes are now implemented system-wide to improve the quality and safety of systemic treatment delivery.
A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia
Authors: Musa Ahmad Farouk , Gandhi Vignaa Prashanth , Dillon Jeswant , Nordin Rusli Bin
Published: May 2018

Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS).

Methods: The information was obtained from the patient records from 1st January 2011 until 31st December 2016. Pertinent information was extracted and keyed into a study proforma.

Results:  150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up.

Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis  with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.
Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol
Authors: Munar Wolfgang , Snilstveit Birte , Stevenson Jennifer , Biswas Nilakshi , Eyers John , Butera Gisela , Baffour Theresa , Aranda Ligia E.
Published: May 2018

Background.For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries.

Methods.The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest.

Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.
Reflections of Research: Butterfly in a cell, by Nicoletta Surdo
Authors: Surdo Nicoletta
Published: May 2018

The British Heart Foundation (BHF) annual image competition, Reflections of Research, provides a glimpse into the cutting-edge research that the BHF funds
Goverment follows Market Authority's recommendations
Authors: Frankova Helena
Published: May 2018

The Competition and Markets Authority's report on the care home market highlighted major issues with funding and customer proctection. Helena Frankova discusses the Government's response and evaluates whether planned measures will be sufficient
Achieving full potential
Authors: Ross Isla
Published: May 2018

Special educational needs specialist Isla Ross explains how an established training model in Scotland is increasing school support for pupils with Down Syndrome.
Sex-Specific Versus Overall Clinical Decision Limits for Cardiac Troponin I and T for the Diagnosis of Acute Myocardial Infarction: A Systematic Review
Authors: Kimenai Dorien M , Janssen Emma B N J , Eggers Kai M , Lindahl Bertil , den Ruijter Hester M , Bekers Otto , Appelman Yolande , Meex Steven J R
Published: May 2018

BACKGROUND

The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations.

CONTENT

We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23–30 ng/L; hs-cTnT, 13–25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower female-specific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively).

Our data show substantially lower female-specific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.
Landucciren hiztegiko bosgarren eskua / The fifth hand of Landucci's dictionary
Authors: Babiano Mikel , Basterrika Iker , Echeverria Iker , Galarraga Ageda
Published: May 2018

Lan hau Landucciren hiztegiaren kanpo historia finkatzeko hasi berri dugun ikerketaren lehen emaitza da. Bi helburu nagusi izan ditugu: eskuizkribuak Liburutegi Nazionalera heldu bitartean egin zuen bidea argitzea eta azken orrietan dauden hiztegiaz kanpoko oharrak aztertzea, liburuaren jatorria zehazte aldera. Horretarako, ohar horien transkripzioa egin dugu. Orain badakigu hiztegia XVII. mendean Felipe IV.aren liburutegian egon zela, eta oharrak Aguilar de Campoon (Palentzia) 1604 eta 1607 bitartean beharrean aritu zen sendagile batek idatzitakoak direla. Medikua bertako markeserriko agintariekin harremanetan egon zen, baita garai hartako markesarekin ere. Aintzat hartzekoa da XVI. mendean Aguilarreko markesak Karlos V.a eta Felipe II.a erregeen hurbileko kolaboratzaileak izan zirela eta zenbait zerbitzu bete zutela Italian, Luccan besteak beste. Beraz, litekeena da Landucci bera eta hiztegiaren jatorria haiekin lotu behar izatea.
Euskal kanta bat 1783ko antzerki-lan batean / A Basque song in a 1783 play
Authors: Zuloaga Eneko
Published: May 2018

Lan honetan euskaraz idatzitako euskal kanta labur baten edizio kritikoa aurkezten dut. Pieza umoretsua eta ezaguna da, gaur egun ere kantatzen dena, eta Rita Barnetxeak bere antzerki-lanetako batean (Catalin, 1783) txertatu zuen. Bada, kantuak biltzen dituen zenbait ezaugarri interesgarri askoak dira hizkuntzaren ikuspegitik. Labur azalduta, testuan nahasturik ageri dira zenbait erabilera moderno eta ez 18. mendearen amaieran baina 200 edo 250 urte lehenago arrunt ziren arkaismo batzuk. Alde batetik, lan honek testuaren bertsio kritikoa finkatu nahi du. Beste alde batetik, berrikuntzen (bereizketa grafikoak eta arau fonologikoak) eta arkaismoen (ezaugarri morfosintaktikoak eta aldaera lexikoak) azterketa zehatza ematen da, testuaren berezitasuna nabarmentzeko.
Cristavaren cortesia eskuizkribuaz (XIX. m.) – Ohar bibliografikoa / About the manuscript entitled "Cristavaren cortesia" (19th century) - A bibliographical note
Authors: Hidalgo Bittor
Published: May 2018

Patxi Altunak 1992an argitaratu zuen ASJU aldizkarian ordura arte argitaratu gabea zen Cristavaren Cortesia izeneko euskarazko eskuizkribu anonimoa. Bertan nahikoa indarrez hipotetizatzen da eskuizkribua 1750 ingurukoa izan ote litekeen, eta are agian Kardaberazen eskukoa. Orain aurkitu dokumentuek berriz, erakutsiko lukete Kortesia eskuizkribua, aurretik espainolez Torcuato Torio de la Riva eta Herrero jaunak, lehenbizikoz 1798an Arte de escribir por reglas... liburu ondo zabalduaren eranskin gisa-edo argitaratuko duen Urbanitate-edo idazkiaren itzulpen literal estua dela, eta autore ‘ezezagunak’ sortua —eta gero Loiolako artxiboan utzia— seguru asko 1816-1840 urteen artean.
Volando hacia el futuro tecnológico del periodismo
Authors: Paredes-Otero Guillermo
Published: May 2018

Reseña del libro El periodismo que vuela. Drones, 3D, smartphones y robots, tecnologías emergentes para la profesión periodística.
Orto y ocaso del buen vivir en la planificación nacional del desarrollo en Ecuador (2007-2021)
Authors: Hidalgo-Capitán Antonio Luis , Cubillo-Guevara Ana Patricia
Published: May 2018

En este artículo se presenta un análisis hermenéutico de los cuatro últimos planes nacionales de desarrollo del Ecuador que abarcan el período 2007-2021. El objetivo de este análisis es valorar la variable importancia real que el concepto de buen vivir ha tenido como orientador de las políticas públicas de desarrollo en Ecuador, en el contexto de la Revolución Ciudadana implementada por Alianza pais bajo el liderazgo de Rafael Correa (2007-2017) y Lenin Moreno (2017-2021).
Moradas del ser. Notas sobre arte y testimonio en el pensamiento de Hannah Arendt y la escritura de Nora Strejilevich
Authors: Acedo Alonso Noemí
Published: May 2018

En este artículo se analiza el capítulo «La permanencia del mundo y la obra de arte», perteneciente al ensayo La condición humana, de Hannah Arendt. Está dedicado al sentido que adquiere el arte en la época que sucede a los totalitarismos del siglo xx. La idea de considerar la actividad artística como una morada habitable, uno de los pocos lugares que procuran la permanencia en un mundo en perpetuo movimiento, sirve como marco teórico en el análisis de uno de los relatos testimoniales menos conocidos de la escritora argentina Nora Strejilevich. En él se habla de lo que he denominado las moradas del ser –cuerpo, casa y país–, y de cómo se destruyeron por parte del terrorismo de Estado en la Argentina de los setenta.
Activity Test of Suji Leaf Extract (Dracaena angustifolia Roxb.) on in vitro cholesterol lowering
Authors: Anggraini Devina Ingrid , Nabillah Lily Fathrah
Published: May 2018

Cholesterol is a natural substance with physical characteristic similar to fat but has a steroidal group. The body requires cholesterol in normal amount; however, it will harm the body in excess amount. High cholesterol levels in the blood are dangerous because of the precipitation of cholesterol and other fatty substances resulting in atherosclerosis. Suji leaf (Dracaena angustifolia Roxb.) used as a natural dye has a high flavonoid content that is inferred to have cholesterol-lowering activity. This study aims to test the in vitro activity of suji leaf (Dracaena angustifolia Roxb.) extract in decreasing cholesterol level with various concentrations and to find the effective concentration (EC50). The method of extraction used was remaceration method with 70% ethanol solvent. Analysis of cholesterol-lowering activity was done by Lieberman-Burchard method by making variation of ethanol extract 400 ppm, 500 ppm, 600 ppm, 700 ppm, and 800 ppm. The results showed the percentage of cholesterol-lowering activity by 33.62%, 36.15%, 46.61%, 56.39% and 64.05% respectively. Value of EC50 activity of suji leaf extract is 632.50 ppm.
Chitosan succinate/PVA-PEG Membrane: Preparation, Characterization and Permeation Ability Test on Creatinine
Authors: Lusiana Retno Ariadi , Sangkota Vivi Dia Ahmad , Santosa Sri Juari
Published: May 2018

Evaluation character of chitosan membrane-succinate / poly vinyl alcohol-poly ethylene glycol (PVA-PEG) were prepared in acetic acid solvent through a phase inversion method has been performed. The study began with the preparation of crosslinked chitosan compounds with succinic acid, followed by preparation into membrane by combining PVA-PEG. Character analysis of the resulting material using FTIR, EDX, TGA, water absorption test, tensile strength, membrane hydrophilicity. The ability of membrane permeation was tested against creatinine. The results showed that the succinate had reacted with chitosan. Chitosan modification through cross link and polymer alloys increases tensile strength and membrane strain of 1.7-2.5 x of pure chitosan membrane. In addition, the modified membrane also has higher water absorption and hydrophilicity values than the unmodified membrane, and this implies the ability of membrane-induced creatinine permeation. Permeable permeation values were 13.8% in chitosan, 24.84% on chitosan-succinate and 25% in chitosan-succinate / PVA-PEG. Chitosan-succinate membranes have the ability to use more than 4x repeated use.
Interaction Studies Between Cyclic Peptide ADT-C3 (Ac-CADTPC-NH2) with E-Cadherin Protein using the Molecular Docking Method Simulated on 120ns
Authors: Siahaan Parsaoran , Prasasty Vivitri Dewi , Manna Atiatul , Hudiyanti Dwi
Published: May 2018

The treatment of diseases that attack the brain is very difficult, because the delivery of drug molecules to the brain is often hindered by the blood-brain barrier (BBB). So that the drug delivery is not right on the target cell. Thus, was developed a method in modulation of intercellular junctions using ADTC3 cadherin peptide, Where the cadherin peptide is derived from the cadherin sequence itself. The method used in this research is molecular dynamics (DM) and molecular docking. In this study have been evaluated some peptide conformation in modulating intercellular junction. The results show that cyclic peptide ADT-C3 (Ac-CADTPC-NH2) was conducted DM for 120 ns (120000 ps), which has considerable activity in modulating intercellular junctions with binding energies of -33.10 kJ.mol-1 and Ki of 1.58 μM at the 79187 ps conformation. The binding site on residues Asp1, Trp2, Ile4, Lys25, Ser26, Asn27, Met92 in the adhesion arm-acceptor pocket region.