bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and Cost-effectiveness of Topical Vancomycin Powder in Primary Cementless Total Hip Arthroplasty
Authors: Cohen Eric M. , Marcaccio Stephen , Goodman Avi D. , Lemme Nicholas J. , Limbird Richard
Published: March 2019

Topical vancomycin has been shown to effectively reduce infections after spinal surgery while remaining safe and cost-effective; however, there are few studies evaluating topical vancomycin in total hip arthroplasty. The authors hypothesized that the incidence of periprosthetic joint infection would decrease with the use of topical vancomycin in total hip arthroplasty and that topical vancomycin would be cost-effective. A retrospective patient chart review was performed to evaluate consecutive primary cementless total hip arthroplasties performed in the authors' hospital system between April 2015 and December 2016. Demographic data were collected. Periprosthetic joint infection was defined by Musculoskeletal Infection Society criteria. Statistical analysis included
t
test, Fisher's exact test, and logistic regression. The costs of vancomycin and postoperative infection were used to determine the absolute risk reduction (1/number needed to treat) threshold needed for topical vancomycin to be cost-effective. In this study, 309 patients (55.7%) undergoing total hip arthroplasty were treated with topical vancomycin, and 246 patients (44.3%) did not receive treatment. There were 2 infections in the vancomycin group (0.6% incidence), and 4 in the no vancomycin group (1.6% incidence). There was no statistical difference in infection rate between the 2 cohorts (
P
=.414). The absolute risk reduction was 0.98%, and the number needed to treat with topical vancomycin was 102 patients to prevent 1 periprosthetic joint infection. Topical vancomycin ($12 per vial) resulted in an expected cost savings of $904 per patient. Topical vancomycin is inexpensive and cost-effective. Although not statistically significant, the topical vancomycin group had a 60% lower incidence of infection. Further research regarding appropriate prophylactic topical and intravenous antibiotic use is needed prior to widespread adoption. [
Orthopedics
. 2019; 42(5):e430–e436.]
Trading Votes for Votes. A Dynamic Theory
Authors: Casella Alessandra , Palfrey Thomas
Published: March 2019

We develop a framework to study the dynamics of vote trading over multiple binary issues. We prove that there always exists a stable allocation of votes that is reachable in a finite number of trades, for any number of voters and issues, any separable preference profile, and any restrictions on the coalitions that may form. If at every step all blocking trades are chosen with positive probability, convergence to a stable allocation occurs in finite time with probability 1. If coalitions are unrestricted, the outcome of vote trading must be Pareto optimal, but unless there are three voters or two issues, it need not correspond to the Condorcet winner.
World Tendencies of Higher Education Development and Foreign Language Training in Russian Engineering Education
Authors: Polyakova Tatiana , Prikhodko Viacheslav
Published: March 2019

The paper reveals the main world tendencies of higher education development and their content. It describes their influence on the trends of foreign language training development as a component of Russian engineering education system .
Güvencesiz Çalışma ve Mücadele Biçimleri Açısından José Luis Valle’nin Workers (İşçiler) Filminin Değerlendirilmesi
Authors: DOĞAN Elif Tuğba
Published: March 2019

20. yüzyılın son çeyreğinden günümüze, neoliberalizm küresel ölçekte politik, ekonomik ve toplumsal alanı etkilemiştir. Ayrıca sosyal hakların sınırlandığı, kayıtdışı istihdamın arttığı ve işçilerin güvencesizleştiği yeni bir istihdam rejimi yaratmıştır. Bu yeni rejim, işçilerin hem çalışma koşullarını ağırlaştırmıştır hem de emeklilik dönemleri belirsizleştirmiştir. Makalede, kayıtdışı istihdama, göçmen emeğine ve güvencesiz çalışanların haksızlıklara karşı mücadele etme biçimlerine odaklanılarak, Jose Luis Valle’nin Workers (İşçiler) filmi değerlendirilecektir. Film, Meksikanın kuzey sınır kenti Tijuana’nın, neoliberal politikalarla şekillenmiş istihdam rejiminde emekli olmaya çalışan iki işçiyi anlatmaktadır.
Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees
Authors: Ameh Pius O. , Yakubu Kenneth , Miima Miriam , Popoola Olugbemi , Mohamoud Gulnaz , Von Pressentin Klaus B.
Published: March 2019

Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies.Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA.Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA.Methods: A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants’ CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed.Results: Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates.Conclusion: Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study.
Prototyp_ome. (Re)articular la biomedicina desde la investigación artística
Authors: Benítez Valero Laura
Published: March 2019

A lo largo de 2015 y 2017 ha tenido lugar Prototy_ome en Hangar. Un proyecto inter(in)disciplinar con formato de colaboratorio basado en la bio(info)tecnología Do it yourself [DIY] y Do it together [DIT]. En colaboración con Pechblenda Lab, el parque de Investigación Biomédica de Barcelona, DIYBioBcn, Faboratory y subvencionado por la Fundación Nina Caruso, Protoyp_ome ha reunido a artistas, científicas, (bio)hackers, makers, teóricas y diferentes colectivos sociales para re-visitar, re-pensar, co-diseñar y desarrollar procesos, herramientas y tecnologías de exploración biológica, especialmente aquellas relacionadas con la biomedicina. A partir de la premisa de la colaboración, Prototyp_ome ha reunido a un equipo híbrido, abarcando distintas competencias y saberes entorno a sus laboratorios, así como las comunidades que se generan en estos espacios comunes. La inter(in)disciplinariedad como condición de posibilidad de la producción colaborativa de conocimiento(s) ha abierto una grieta desde la que tomar como punto de partida la perspectiva de la usuaria, anteponiendo ésta a la articulación histórica, en términos de jerarquía, de las instituciones y disciplinas reconocidas como únicas generadoras de concimiento válido. En este proceso compartido, la investigación artística no sólo ha tenido un papel fundamental sino que ha posibilitado un trabajo donde la experimentación ha desplazado a los parámetros cuantitavos, configurando formas de contacto-experiencia desde las que re-pensar las relaciones que median los cuerpos, trabajando desde la coimplicación de materia y forma, generando procesos de constitución transversales que abren la posibilidad de articular, otros vínculos y otros modos de operar.
Los “espacios cualesquiera” de Gordon Matta-Clark: building cuts bajo una óptica deleuziana (I)
Authors: Bouille de Vicente Luis
Published: March 2019

Las intervenciones artísticas en edificios realizadas por Gordon Matta-Clark en los años 70 son una fuente constante de interpretaciones críticas por la especial naturaleza de su producción y experimentación. Una de esas posibles interpretaciones es considerar, siguiendo a Gilles Deleuze, “espacios cualesquiera” a los cortes en edificios (building cuts) practicados por Matta-Clark. Para ello, este artículo presenta el concepto de paracinema, desarrollado por Esperanza Collado, por el cual diversas prácticas artísticas contemporáneas pueden considerarse como experiencias cinematográficas externas al medio cine, al emplear en ellas materiales procesuales y conceptuales específicos del dispositivo cinematográfico por otros medios ajenos al cinematográfico; el concepto de paracinema funciona como mediador entre la idea de creación artística de un territorio (“ritornelo”), introducida por Deleuze y Guattari, aplicada a los building cuts, y los espacios cualesquiera deleuzianos, espacios vacíos y desconectados que, presentados en imágenes cinematográficas, son capaces de generar “imágenes-tiempo” o "presentaciones directas del tiempo". De esta manera, las intervenciones artísticas en edificios, por su condición de "espacios cualesquiera" paracinemáticos, eran capaces de producir "imágenes-tiempo" localizadas en un lugar.
Seroprevalence of viral infections in captive rhesus and cynomolgus macaques
Authors: Kaul Artur , Schönmann Uwe , Pöhlmann Stefan
Published: March 2019

Abstract. Macaques serve as important animal models for biomedical research. Viral infection of macaques can compromise animal health as well as the results of biomedical research, and infected animals constitute an occupational health risk. Therefore, monitoring macaque colonies for viral infection is an important task. We used a commercial chip-based assay to analyze sera of 231 macaques for the presence of antibody responses against nine animal and human viruses. We report high seroprevalence of cytomegalovirus (CMV), lymphocryptovirus (LCV), rhesus rhadinovirus (RRV) and simian foamy virus (SFV) antibodies in all age groups. In contrast, antibodies against simian retrovirus type D (SRV/D) and simian T cell leukemia virus (STLV) were detected only in 5 % and 10 % of animals, respectively, and were only found in adult or aged animals. Moreover, none of the animals had antibodies against herpes B virus (BV), in keeping with the results of in-house tests previously used for screening. Finally, an increased seroprevalence of measles virus antibodies in animals with extensive exposure to multiple humans for extended periods of time was observed. However, most of these animals were obtained from external sources, and a lack of information on the measles antibody status of the animals at the time of arrival precluded drawing reliable conclusions from the data. In sum, we show, that in the colony studied, CMV, LCV, RRV and SFV infection was ubiquitous and likely acquired early in life while SRV/D and STLV infection was rare and likely acquired during adulthood.
Management of Higher Education Institutions in Uncertain Times: The Perspectives of University College
Authors: Kongolo Mukole
Published: March 2019

The purpose of this paper is to determine the state of management in university college, based on a review of academic literature. The aim is to provide university college with the best management evidence that inform their focus and models for quality improvement. Despite the growing role and importance of university colleges, they still strive to compete in increasingly uncertainty, difficult and challenging conditions. This paper is framed as a research informed analysis of key capabilities that managers will need to draw on in times of uncertainty. It is based on higher education literature as well as the researchers own observations. A framework of university college domain of practice is proposed to assist managers to deal with foreseeable future. The said domains or capabilities include: Setting Direction; develop the institution; develop staff; focus on teaching, learning and research; self management; influence others, and taking it into a broader context.
Incidencia de la evasión del impuesto cuota fija y basura domiciliar en la ejecución presupuestaria de la alcaldía municipal y la administración de rentas Estelí para el año 2016
Authors: Morán Moreno Yasuara Melixa , Centeno Zamora Karen Lisbet , López Casco Kathering Fabiola , Alfaro Manzanares Jeyling María
Published: March 2019

El tema abordado es Incidencia de la evasión del impuesto cuota fija y basura domiciliar en la ejecución presupuestaria de la alcaldía municipal y la administración de rentas Estelí para el año 2016. Esta investigación describe los procesos de recaudación de ambos, tanto del impuesto cuota fija, así como el servicio de recolección de basura domiciliar y la influencia en el presupuesto aprobado por ambas instituciones. Con esta investigación se pretende demostrar cómo influye la evasión en el presupuesto que realiza tanto la alcaldía municipal y administración de renta Estelí con la recaudación del impuesto cuota fija y el servicio de recolección de basura domiciliar. Para obtener la información se aplicaron encuestas a los contribuyentes de ambas instituciones. Así mismos se realizaron entrevistas a los responsables de cada institución. También se hizo uso de bibliografías de internet, así como monografías de la biblioteca Urania Zelaya de Farem Estelí. De acuerdo a los resultados obtenidos reflejan información acerca del proceso de recaudación y las principales causas por las que los contribuyentes evaden sus obligaciones. De igual forma se da a conocer lo que se recaudó del servicio de recolección de basura domiciliar y como este influyó en el presupuesto que realizo la alcaldía municipal de Estelí para el año 2016.
GEOMARKETING NO PROCESSO DE TOMADA DE DECISÕES DE MERCADO
Authors: Salgado Roberto Resende , Libório Matheus Pereira , Martin Carlos Augusto Paiva da Silva , Bernardes Patrícia
Published: March 2019

Decisões mercadológicas envolvem, geralmente, muitos dados e critérios, tornando-as, quase sempre, uma tarefa complexa. Além disso, essas decisões mercadológicas são, em grande parte, influenciadas pelo fator distância. Este fator é um elemento essencial da análise espacial, exigindo das empresas o estudo e a análise dos fenomenos socio-economicos sob a perspectiva geográfica. Consierando as complexidades citadas, propomos nesta pesquisa o desenvolvimento de um protótipo de geomarketing Web. Esse prototipo, criado na liguagem de programação javascript, permite, considerando dados do mercado de interesse, determinar a localização ideal para um conjunto de lojas-filiais e da loja matriz. Neste caso, observando a evolução dos métodos de análise espacial, discutidos na pesquisa, adotamos, para a contruçao do prototipo, os métodos diagrama de voronoi e ponto médio ponderado. Em uma simulaçao para um segmento de mercado especifico o protótipo de geomarketing, sem a necessidade do uso de outros sistemas, localizou clientes potenciais, e, conforme a distribuição espacial destes clientes, determinou a localização das lojas-filiais e suas respectivas áreas de influência. Finalmente, a partir da localização das lojas-filiais com seus respectivos clientes (pesos ou importância) foi determinada a localização ideal para a loja matriz. Com isso, demonstramos a relevância da análise dos elementos de mercado sob uma perspectiva integrada ao espaço geográfico. Podendo este protótipo contrubuir para decisões de mercado mais racionais, por exemplo, para aumentar a região de atuação do comércio, reduzir o deslocamento dos clientes para as lojas-filiais, bem como reduzir custos de transporte entre as lojas-filiais e a matriz.
Dementia and elder abuse: Understanding public health nurses’ experiences
Authors: Cooke P.J. , Day Mary Rose , Mulcahy Helen
Published: March 2019

Elder abuse (EA) within the population of community dwelling older people living with dementia is significantly more prevalent when compared with the population of older adults without cognitive impairment. Public Health Nurses (PHNs) in Ireland are a key professional service provider group in safeguarding vulnerable populations. Interpretative Phenomenological Analysis (IPA) was utilized to explore the experiences of PHNs in identifying and addressing abuse, among community dwelling older adults living with dementia that was perpetrated by informal caregivers. Semi-structured interviews were conducted with PHNs (n = 5) in Ireland that had in the previous 12 months dealt with a case of elder abuse involving an older adult living with dementia. Analysis of the data revealed three super-ordinate themes; identifying hidden abusive relationships; Complexity – ‘where do I start’; and Isolation. This study provides unique insights from PHNs relevant to safeguarding this particularly vulnerable group. Specific implications for practice and recommendations are presented.
Use of Variators in Applying the Cost Calculation Methodology in Small and Medium Furniture Enterprises Based on Changes in Human Body Dimensions
Authors: Potkány Marek , Hitka Miloš , Lorincová Silvia , Krajčírová Lucia , Štarchoň Peter
Published: March 2019

Based on the research of anthropometric measures of
Slovak adult population, it can be observed that during the last 25 years,
anthropometric data have been rising by about 4.5-5 % in most analysed
characters. As data on human body dimensions changes, the requirements for
material consumption and production time, expressed by the rate of labour cost,
are changing. In this context, sustainable profitability of the company can be
achieved through each segment of a value chain. One of these segments is the product
and its price, which is based on costs allocated in the system of full or
variable costing. As the value of quantiles characteristics of anthropometric
characters was used to create ergonomic, health and construction norms and
standards in the furniture industry, it is necessary to review the adequacy of
existing standard-size single bed. Since the dimensions of single bed are
standardised, 200 cm x 90 cm or 200 cm x 100 cm, it is clear that due to the
secular trend of anthropometric measure of a man, the dimensions are currently inadequate.
This paper presents the use of variators when applying the most commonly used
absorption costing in small and medium furniture enterprises. It shows the
costs involved, when the input parameters are changed.
Influence of Finishing Materials on Viscous Elastic Properties of Wooden Structures
Authors: Albrektas Darius , Revuckaitė Elvyra , Dobilaitė Vaida , Jucienė Milda
Published: March 2019

In this study, the effect of finishing process on the mechanical properties of oak and pine wood elements were investigated. A special test stand was used for this purpose. Specimens were divided into subgroups, the resonance frequency of the specimens was determined (when they vibrate in mode of a theoretic isotope beam), and the modulus of elasticity (MOE) and damping coefficient were estimated. It was determined that MOE of oak and pine specimens was 8415-10570 MPa and 8220-14104 MPa, respectively, while damping coefficients were 0.014-0.019 r. u. and 0.013-0.026. Afterwards, some specimens were varnished (pentaftal varnish was used), while the specimens from others subgroups were oiled (water-based outdoor wood oil was used) and after each processing step, the viscous elastic properties of the specimen were recorded. The specimens were finished four times – first, one side was finished in two layers, and then the other side. For the determination of elastic properties of the finishing materials, films were prepared separately. The fi lm formation was carried out by casting liquid on a smooth, siliconised surface of a test panel. The tensile test was carried out using the universal testing machine. It was established that MOE of films varied in the range of 4-7 MPa. After the varnishing process, the MOE of oak and pine elements decreased by 5 % and 7 %, respectively, while the damping coefficient decreased (in varnish case) by 60 %. The impact of oil on viscous elastic properties of the specimens was quite marginal.
Combined effects of strain and cooling path on hot deformation response and microstructure of low-carbon structural steel
Authors: Morawiec M. , Borek W. , Mroziński M. , Grajcar A.
Published: March 2019

Combined effects of strain and cooling path on hot deformation response and microstructure of low-carbon structural steel
Tools for Facilitating Meaningful Mathematics Discourse
Authors: Steele Michael D.
Published: March 2019

This article explores facilitating meaningful mathematics discourse, one of the research-based practices described in Principles to Actions: Ensuring Mathematical Success for All. Two tools that can support teachers in strengthening their classroom discourse are discussed in this, another installment in the series.
QIM19-118: Oral Anti-Cancer Therapy Initiation: A Standardized Approach for Patient Care and Education
Authors: Corbett Megan , Arcieri Cynthia , Dann Emma , Durney Jeff , Fuller Frances , Leonard Frances , O’Connor Susan , Robinson Inez , Sweeney Jill , Weeks Kristie , White Jamie , Worrell Jane
Published: March 2019

Background: The availability and popularity of oral anti-cancer therapy has recently increased. In this shift of delivery, control over downstream steps in the process moves to patients, families, and the extended care team. Unique challenges have been identified including effective patient education, adherence, and monitoring. The purpose of this quality improvement project was to standardize the approach to initiating oral anti-cancer patient care. Methods: A quality improvement team developed and implemented a standard approach for before, during, and after initiation of oral anti-cancer therapy. Key components included ensuring completion of informed consent, electronic orders within an evidence-based treatment plan, and adherence monitoring with a specific emphasis on patient education. Education prior to initiating therapy was standardized through both an education folder and one-on-one teaching sessions with an oncology nurse. A voluntary, anonymous 4-question paper survey (deemed clinical quality improvement by the IRB) solicited feedback from patients to assess both the educational materials and teaching session. Questions included perceived acceptability of the content and whether materials guided conversation, provoked questions, and complimented the teaching. An opportunity for comments was provided. Results: A 3-month collection period yielded overwhelmingly positive results. 100% of patients (n=18) felt the education materials provided were “just right” and provoked discussion with the care team. 94% of patients felt the educational materials and teaching session were complimentary. Conclusions: As oral anti-cancer therapy becomes more common, it is vital to form a collaborative partnership with the patient, family, and the extended care team to ensure overall success. Standardized educational content supports the transfer of expert knowledge to ensure adherence, management, and patient safety, ultimately improving patient outcomes. A standard approach that includes informed consent, orders within a treatment plan, adherence monitoring, and patient education prior to initiating oral anti-cancer therapy is one way to ensure quality, comprehensive patient care.
QIM19-116: Barriers and Trends in Cancer Patients’ referrals to Pain Management in Qatar: A Randomized Cohort Prospective Study
Authors: Abdelwahab Rehab , Hamad Anas , Azzaz Shereen El , Okka Randa Al , Wahid Mohd A. , Shibli Khalil Ullah , Geziry Ahmed El , Saleh Fathi , Rasul Kakil , Saleem Wael
Published: March 2019

Background: Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008), beside the challenges to accurately assess pain, which might affect drug selection and pain control (Stewart, Ulster Med J 2014). In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain Management Team (PMT), based on evaluation or as requested by patients. This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred cases whether they need to be refereed or not. Objectives: To determine the efficiency of the referral pathway to the pain clinic by PMT. Methods: PMT is going to assess the referred patient to their clinics according to pain assessment methods. Patients will be evaluated whether they have been appropriately referred or not, any unnecessary referral will be documented based on the following;

• If the patient was referred by hematologist or oncologist

• If the patient required specialized treatment

• If the patient required urgent treatment/prescription or advanced pain management techniques

• If the patient required further consultation by pain management

• If the patient could be managed by PP

Results: 195 patients were newly referred to the pain clinic during the period from March 8, 2018 to August 31, 2018. 12% (23/195) were deemed as unnecessary referrals based on PMT assessment; 43% (10/23) of them were hematology patients, while 57% (13/23) were oncology. The majority was for breast cancer and sickle cell disease patients with 35% for each. According to the PMT assessment, 61% (14/23) patients (95% CI, 40.79%–77.84%) considered unnecessary referrals due to improper basic pain assessment and management by PP, while 30% (7/23) patients (95%CI, 15.60%–50.87%) asked for refill medications. Conclusion: There is 12% unnecessary referrals to PMT, which need further improvement in the referral pathway, via the development of a definite referral criteria to PMT. PP should be encouraged to provide basic pain treatment and to consider multidisciplinary management with appropriate coordination for better improvements in patients’ quality of life.
QIM19-145: Overcoming a Barrier to Exercise With the James Exercise Program Quality Initiative With Surgical Oncology Nursing
Authors: Utendorf Cari , Stump Tiffany , Wolfe Sara , Brophy Lynne , Gerardi Jennie , Hock Karen
Published: March 2019

Background: Research has consistently demonstrated the benefits of exercise in the oncology patient (Blaney et al, Psychooncology 2013; Garcia and Thomson, Nutr Clin Pract 2014; Rock et al, CA Cancer J Clin 2012). Despite the benefits of exercise for cancer survivors, only 20%–30% of them will be active after cancer treatment (Rock et al, CA Cancer J Clin 2012). The known barriers to exercise in oncology are lack of patient education, lack of knowledge, fatigue, decreased motivation, and comorbidities (Blaney et al, Psychooncology 2013). Objectives: This quality initiative program between oncology rehabilitation physical therapy department and surgical oncology nursing aims to improve the quality of care provided to our patients by reducing the barriers to exercise. One main barrier for the patients is their lack of knowledge of how to begin an exercise program. This is overcome by prescribing physical therapy and designing an individualized exercise program that can be performed in their home. Secondary objectives are to determine a change in fatigue, compliance, and/or any barriers after physical therapy. Methods: Patients are identified by the breast surgical oncology team, and a referral for physical therapy is placed. A comprehensive evaluation is completed, including: past exercise preferences, 2-minute walk test, a fatigue questionnaire, and a 30-second sit to stand test, with these same outcome measures obtained at discharge. The James Exercise Program is provided via 4 1-hour sessions. A nurse from surgical oncology calls the patient, administers the fatigue questionnaire, and determines any barriers to exercise that the patient is facing at the 8- and 12-week mark. Results: The preliminary results of the program demonstrate compliance with exercise, reduction in fatigue, improvement in endurance and strength. Conclusion: This innovative quality initiative between physical therapy and surgical oncology nursing has benefitted our patients. We leverage the expertise of the physical therapists to provide personalized exercise regimens and the professional clearance/recommendation for physical therapy from oncology team, to minimize barriers to exercise in the oncology population. Limitations to this program are that some participants fail to arrive at the initial session, lack of support and resources in the participants hometown to allow adherence to the exercise program (despite all efforts to encourage the fact that the program can be completed in their own home), and the low number of participants.
HSR19-095: Healthcare Resource Utilization and Costs in Patients Treated with Systemic Therapies in Metastatic Melanoma
Authors: Klink Andrew J , Feinberg Bruce , Liu Frank Xiaoqing , Ahsan Sama , Nero Damion , Chmielowski Bartosz
Published: March 2019

Background: The treatment (tx) landscape for patients (pts) with metastatic melanoma (MM) has changed dramatically from systemic chemotherapy (chemo) to novel therapies, including targeted therapies (TT) and immunotherapies (IO mono- and combination therapy) in recent years. Healthcare resource utilization (HCRU) and cost data are needed to further evaluate tx in a value-based healthcare system. The study aimed to describe HCRU and total cost of care among first line (1L) US MM pts treated with IO, TT, or chemo. Methods: A retrospective observational study was conducted using a U.S. claims database. Adults with ≥2 claims for melanoma and ≥1 claim for metastasis between January 1, 2012 and June 30, 2017 were identified. Pts had pharmacy and medical enrollment ≥6 months pre and ≥3 months post 1L tx start. Per pt per month (PPPM) HCRU and costs were calculated by 1L tx drug class: PD-1, CTLA-4, CTLA-4+PD-1, mono-TT, combo-TT, and chemo. Adjusted odds ratios (OR) for HCRU were estimated by logistic regressions, and adjusted costs were estimated by generalized linear models to control for differences in pt characteristics across groups. Results: Among 1,599 MM pts (255 PD-1, 555 CTLA-4, 88 CTLA-4+PD-1, 210 mono-TT, 102 combo-TT, 389 chemo), mean age ranged from 59–68 years across tx groups, and the majority was male (62%). Any hospitalization during 1L was less frequent among PD-1 (26%) compared to 35%–46% of all other groups (all P<.05). CTLA-4, CTLA-4+PD-1, and combo-TT had increased odds of hospitalization compared to PD-1 (adjusted ORs: 2.10, 2.35, 2.15, respectively; all P<.05). Total adjusted PPPM costs were significantly lower for PD-1 compared to CTLA-4, CTLA-4+PD-1 and combo-TT and higher compared to mono-TT and chemo (Table 1). Conclusions: Hospitalizations represent an important healthcare resource for MM pts and were lowest among PD-1. Total monthly costs varied substantially across 1L regimens and were significantly lower in PD-1 compared to CTLA-4, CTLA-4+PD-1, and combo-TT. HCRU and costs differentiate 1L MM regimens.
QIM19-143: Reducing Risk of IV Chemotherapy Administration Errors Utilizing Pump Integration Technology
Authors: Stillman Robert C. , Konerman Emily
Published: March 2019

Background: The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solve Research Institute is a 356-bed cancer care hospital that is part of The Ohio State University Medical Center. In addition to the inpatient beds, the hospital services 175 ambulatory infusion chairs. Each month, we administer over 6,000 chemotherapy infusions on an IV pump. Smart IV pumps in tandem with hospital information technology infrastructure integrate IV drug administration pump data with the electronic medical record (EMR) and computerized physician order entry to decrease risk of error and increase patient safety. The closed loop system transmits the medication infusion rate and the prescribed dose to the smart pump to deliver the medication. The smart pump in turn transmits the dose and volume delivered to the EMR to accurately capture what the patient received. The ability to wirelessly transmit clinical information from the EMR to automatically program the IV pump with specific data was implemented in March 2018 as part of a system-wide safety initiative to enhance patient safety via the reduction of error during medication administration. Methods: IV pump integration has been in use since March 2018; the organization has robust data on the use of smart pump technology that allowed for comparison of data pre- and postimplementation of pump integration. This includes: total suite usage, count of basic infusions, severe harm averted, total good catches, and event-reporting data. Post-integration, the overall compliance of utilizing pump integration (sending an order from the EMR to the smart IV pump) is also continuously monitored. Results: The implementation of pump interoperability resulted in a safer delivery of infused medications (Figure 1). The use of “basic Infusion” or unprotected infusion function decreased while our use of the appropriate safeguarded pump program increased. The compliance at the medical center increased from about 86% to almost 94%. With increased usage of the pump interoperability, the potential for severe harm as well as human programming errors decreased significantly. Conclusion: The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solve Research Institute is able to deliver infused medications via a smart pump in a safer, more automated system with the implementation of pump integration. We are able to reduce the “human factor” in medication delivery by reducing keystrokes and opportunities for manual programming errors. Pre-integration data cannot be isolated for the cancer hospital only, from our post-implementation data we can infer that our chemotherapy infusions are subsequently safer for our patients.
EPR19-071: Risk of Hematologic Toxicities and Health-Related Quality of Life Events in Patients With Hematologic Malignancies Treated With Ibrutinib: A Combined Analysis of 6 Phase III Trials
Authors: Quirch Miguel , Swarup Sriman , Sultan Anita , Thein Wai L. , Oo Zayar M. , Yu Nyein H. , Zaw Myo H. , Quick Donald P. , Thein Kyaw Z.
Published: March 2019

Background: Bruton’s tyrosine kinase (BTK) is essential for signaling of B-cell and chemokine receptors. Ibrutinib targets BTK and has become frontier in many hematologic malignancies. We undertook systematic review and pooled analysis of randomized controlled trials (RCTs) to determine the risk of hematologic toxicities and health-related quality of life (HRQOL) events associated with ibrutinib. Methods: We performed a comprehensive literature search using MEDLINE, EMBASE databases, and meeting abstracts through September 2018. Phase III RCTs that mention hematologic toxicities and HRQOL events as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% CI. Random effects model was applied. Results: 6 phase III RCTs with a total of 1,811 patients with chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle-cell lymphoma, and Waldenstrom’s macroglobulinemia were eligible. Studies compared Ibrutinib (I) vs ofatumumab, I vs chlorambucil, I+ bendamustine (B) + rituximab (R) vs placebo + B+ R, I vs temsirolimus and I vs R were included in the analysis. The relative risks (RR) of all-grade side effects were as follows: anemia, 0.812 (95% CI: 0.565–1.168; P=.261); neutropenia, 0.956 (95% CI: 0.720–1.268; P=.754); thrombocytopenia, 1.054 (95% CI: 0.450–2.470; P=.904); fatigue, 0.896 (95% CI: 0.761–1.056; P=.192); pyrexia, 1.123 (95% CI: 0.893–1.413; P=.322); and arthralgia, 1.863 (95% CI: 1.101–3.152; P=.020). The RR of high-grade adverse effects were as follows: anemia, 0.522 (95% CI: 0.371–0.733; P<.0001); neutropenia, 0.969 (95% CI: 0.751–1.249; P=.807); thrombocytopenia, 0.608 (95% CI: 0.252–1.470; P=.270); fatigue, 0.618 (95% CI: 0.396–0.964; P=.034); pyrexia, 1.165 (95% CI: 0.534–2.542; P=.701); and arthralgia, 3.623 (95% CI: 0.743–17.663; P=.111). Conclusion: Ibrutinib increased the risk of all-grade arthralgia whereas the risks of high-grade anemia and fatigue were significantly lower in the study arm, favoring ibrutinib.
CLO19-053: Incidence of Cabozantinib-Associated Palmar-Plantar Erythrodysesthesia and Hypertension in Patients With Metastatic Solid Tumors: A Combined Analysis of 4 Phase III Randomized Controlled Trials
Authors: Thein Kyaw Z. , Swarup Sriman , Sultan Anita , Thavaraputta Subhanudh , Zaw Myo H. , D’Cunha Nicholas , Awasthi Sanjay , Hardwicke Fred , Tijani Lukman
Published: March 2019

Background: Tyrosine kinases such as VEGFR, KIT, RET, MET are implicated in development and progression of several solid tumors. Cabozantinib is an oral multiple tyrosine kinase inhibitor and has shown survival benefits in several solid tumors. Yet, there are notable toxicities. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to determine the risk of palmar-plantar erythrodysesthesia (PPE) and hypertension in patients with metastatic solid tumors treated with cabozantinib. Methods: We systematically conducted a comprehensive literature search using MEDLINE, EMBASE databases, and meeting abstracts through September 2018. Phase III RCTs that mention PPE and hypertension as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio (RR), and risk difference (RD) with 95% CI. Random effects model was applied. Heterogeneity was assessed using I2 statistic. Results: 4 phase III RCTs with total of 2,703 patients, comparing cabozantinib (C) vs everolimus, C vs placebo, C vs prednisone, were included. I2 statistic was 70.70, suggesting some heterogeneity among RCTs. All grade-PPE incidence was 666 (39.3%) in cabozantinib arm vs 38 (3.76%) in control arm with a RR of 11.378 (95% CI: 6.545–19.782; P<.0001). The absolute RD was 0.383 (95% CI: 0.294–0.473; P<.0001). High-grade PPE was reported in 172 (10.15%) in cabozantinib group vs 3 (0.29%) in control group with a RR of 19.077 (95% CI: 5.733–63.476; P<.0001). The RD was 0.105 (95% CI: 0.049–0.160; P<.0001). The overall incidence of hypertension was noted at 524 (30.95%) in cabozantinib arm vs 84 (8.31%) in control arm. The pooled RR of hypertension was 4.131 (95% CI: 2.656–6.425; P<.0001) and RD was 0.240 (95% CI: 0.186–0.295; P<.0001). High-grade hypertension was reported in 276 (16.30%) in cabozantinib group vs 41 (4.05%) in control group with a RR of 4.324 (95% CI: 2.484–7.525; P<.0001) and RD was 0.115 (95% CI: 0.085–0.144; P<.0001). Conclusion: Our meta-analysis demonstrated that cabozantinib contributed to significant toxicity of any-grade and high-grade PPE as well as hypertension, with a RR of 19.07 for grade 3 and 4 PPE. Recognizing these toxicities and prompt intervention with proper supportive care may enhance patients’ quality of life, ultimately leading to better compliance.
QIM19-121: Improving Testing for Hepatitis B Before Treatment With Rituximab Through Automated Electronic Health Record Alert System: A Single Institutional Retrospective Review and Quality Improvement Project
Authors: Boddhula Sowmya , Boddhula Satish Kumar , Shrestha Bishesh , Morris Kelly , Gnanajothy Rosana
Published: March 2019

Introduction: Individuals with chronic hepatitis B virus infection (HBV) or previous infection with HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti-CD20 monoclonal antibodies like rituximab (RTX). HBV screening and appropriate use of prophylactic antiviral therapy is recommended to prevent reactivation. A software program named Beacon Oncology was integrated into Epic, which creates an automated alert for HBV screening before starting first dose of chemotherapy with RTX and results the previously resulted HBV test results. Retrospective data analysis for screening was done after implementation of the software and its impact was assessed. Methods: We conducted retrospective chart review on screening for HBV before starting treatment with RTX before and after implementation of the electronic health record (EHR) alert system. Results: A baseline review (before software introduction) of 165 patients showed that only 40 (24%) had screening tests for HBV (hepatitis B surface antigen [HBsAg] and hepatitis B core antibody [anti-HBcAb]) before receiving rituximab. Following introduction of the automated electronic alert system, chart review for HBV testing rates among patients being initiated onto rituximab was performed. There was a marked increase in pre-rituximab testing for HBsAg from 24% to 88% and for anti-HBcAb from 24% to 76%. The remainder cases also had the HBV screening done but after the first dose of the RTX chemotherapy between 1.3 to 7.5 days. There was one patient identified as anti-HBcAb-positive after the implementation of the protocol. Conclusions: This retrospective single-institution study clearly indicates that simple strategies can markedly improve appropriate HBV screening. There was a more than 3-fold increase in HBV testing before the first dose of HBV after implementation of the EHR alert system. There has been increased use of EHR alert systems recently to improve implementation of clinical guidelines, and they have been shown to improve patient outcomes. In conclusion, an automated EHR alert directed toward screening for HBV before initiating RTX effectively increased the number of HBV screening tests completed, and similar protocols could be implemented to identify other at-risk patient groups.
HSR19-083: Treatment Heterogeneity and Overall Survival (OS) in Patients With Advanced/Metastatic Gastric/Gastroesophageal Junction Cancer (aGC/GEJ) in the United States
Authors: Davis Jessica A. , Cui Zhanglin Lin , Ghias Madiha , Li Xiaohong , Goodloe Robert , Liepa Astra M. , Ogburn Kenyon , Hess Lisa M.
Published: March 2019

Background: Previous work has demonstrated treatment (tx) heterogeneity in the care of patients with aGC/GEJ. This study was designed to examine heterogeneity temporal trends and OS in patients with aGC/aGEJ in the United States from 2011 to 2018. Methods: The Flatiron Advanced/metastatic gastric/esophageal cohort electronic medical records (EMR) data were used for this study. Eligible patients were adults receiving anticancer therapy for aGC/GEJ during the study period. Tx patterns were summarized by line of therapy. Drugs were grouped by class. Heterogeneity was measured using the Herfindahl-Hirschman index (HHI); HHI scores range from 0.0000 (complete heterogeneity) to 1.0000 (complete homogeneity). A difference of 0.1000 in HHI scores is considered to be practically meaningful. HHI scores were calculated for each clinic with ≥10 patients. OS was estimated using Kaplan-Meier method. Trend analyses were conducted for HHI scores over time using a linear regression model. Results: There were 2,912 patients who met eligibility criteria. The median age of the study cohort was 67 years; majority were male (70.9%) and white (61.1%). aGC patients comprised the majority (n=1,630, 55.9%). Median OS from the start of first-line (1L) therapy was 12.7 months (95% CI: 12.07, 13.6). The most common 1L regimens were fluoropyrimidine + oxaliplatin (n=651, 22.4%), platinum (ie, cisplatin or carboplatin) + taxane (n=511, 17.5%), and single-agent fluoropyrimidine (n=280, 9.6%). 1,230 patients received second line (2L) and the most common regimens were ramucirumab + taxane (n=203, 16.5%), fluoropyrimidine + oxaliplatin (n=155, 12.6%), and platinum + taxane (n=101, 8.2%). Overall median HHI for 1L was 0.1728 (min/max: 0.0926–0.4380). Median 1L HHI for 2011–2012 was 0.21665 (min/max: 0.1626–0.3156) and was 0.2419 (min/max 0.1716–0.4583) for 2017–2018. There were no significant differences in HHI score over time (P=.078). Overall median HHI for 2L was 0.1309 (min/max: 0.0694–0.2400). Due to small number of sites with ≥10 patients, data in 2L were too limited to conduct time trend analyses. Conclusions: Heterogeneity in 1L treatment of gastric/GEJ cancer persists, despite the continued refinement of guidelines and approval of new drugs in subsequent lines of therapy. Further analyses are needed to examine the relationship between heterogeneity, guideline adherence, and patient outcomes. These future data will shed light on the persistence of heterogeneous treatment patterns observed in the United States.
CLO19-046: Follow-Up and Diagnosis of Breast Incidentalomas on Abdominal and Chest MRI
Authors: Rios Samantha , Larson Kelsey
Published: March 2019

With the increasing use of medical imaging, it is important to report and appropriately recommend work up for incidental findings. The aim of the study was to understand how often incidental breast findings are identified on MRI chest/abdomen protocols, how these findings are followed, and the final diagnosis (benign vs malignant) of these lesions. A single institution retrospective review was performed of women who underwent abdominal or chest MRI from January 2007–January 2017 for a non–breast cancer reason with a radiologic report containing the key word “breast.” Incidental breast findings were defined as lesions not known or suspected prior to imaging. For all patients where a breast lesion was identified, the radiologic reports, follow-up imaging and procedures, and final breast pathology were reviewed. Descriptive points were analyzed using counts and percentages versus mean with standard deviation where applicable. After review, 261 patients met inclusion and exclusion criteria with demographics in Table 1. Most patients (92%) had a known or benign breast finding, but 8% (n=21) had a breast finding for which follow-up was recommended. Recommendation for follow-up included ultrasound (n=4), mammogram (n=8), per clinician (n=14), and breast MRI (n=2). Only 7/21 (33.3%) completed recommended follow-up: 86% (6/7) had normal imaging and 14% (1/7) had a new breast cancer diagnosed. Thus, the rate of new breast cancer diagnosis from abnormal abdominal or chest MRI was 4.7%. Recommendation for specific imaging follow-up (56%) (mammogram/ultrasound/MRI) in the original MRI report was 39% more likely to be completed versus “per clinician” (17%) recommendation (P=.15). Incidental breast findings on abdominal and chest MRI are uncommon, but follow-up is important to exclude new breast cancer diagnosis. Specific imaging recommendations (versus “per clinician”) appeared to improve rate of follow-up. Prior studies have looked at incidental breast findings on CT but few have assessed breast incidentalomas on abdominal MRIs, with similar rates of new breast cancer diagnosis documented in our study. Studies assessing breast incidentalomas on chest MRIs are lacking. Going forward, multi-institutional studies may further define the rate of breast cancer diagnosis after breast incidentalomas identified on abdominal/chest MRI. In addition, studies focusing on improving follow-up imaging rates are important for patient safety and quality of care.