bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing patient experience in an outpatient multidisciplinary clinic setting.
Authors: Denny Diane , Hartman Scott
Published: February 2017

224

Background: Cancer Treatment Centers of America (CTCA), a national network of five hospitals, implemented a new survey instrument and methodology to gather patient experience data in the outpatient setting. While borrowing many questions from its vendors’ client base, the network also added questions considered pivotal to understanding the critical dimensions of care deemed most relevant to the oncology patient. Surveying includes 100% of all patients first contacted via the U.S. mail and subsequently using e-surveys. Methods: Data is collected, with the ability to be segmented by cancer type; for medical, surgical and radiation oncologists with respect to confidence and likelihood of recommending. For each specialty, an open ended question has been added for the patient to elaborate upon his/her rating. Further, several questions have been added to reflect key dimensions of care specific to the oncology such as emotional needs, family involvement and information, sensitivity to personal difficulties associated with treatment, drawing blood and IV discomfort, and involvement in care decisions, to name a few. Results: The revised approach has resulted in greater than a 200% increase in responses, at a cost reduction, cognizant of the growing sophistication of the population served in using technology as part of the patient experience feedback process. Results at three months post-implementation have yielded the findings in the Table. Conclusions: Since implementation, not only have completed surveys increased with respect to easily accessible discrete quantitative data, qualitative information has grown exponentially. This has resulted in more meaningful and robust data around which to focus, including specialty data at the disease and provider levels. The revisions also substantially support CTCA centers’ Magnet journey, including question dimensions and unit level reporting. [Table: see text]
Utilization of an innovative tool to improve oncology patient outcomes.
Authors: McNeil Dana , O'Driscoll Jessica , Patel Jaimika , Decker Marie , McGovern Joanne
Published: February 2017

231

Background: Introduction of an electronic board can improve interdisciplinary communication to ensure early intervention and improve patient outcomes. Early detection and prevention is key. The early stages of physiologic demise may be demonstrated by subtle changes in the patient’s vital signs. The purpose of this study was to implement a visual tool to indicate and update the acuity of patients on the oncology unit. The parameters displayed included vital signs, Hendrich, and Braden scale. The goal of the electronic board was to create a continuously accessible resource for the interdisciplinary team for rapid assessment of the patient’s condition throughout rounds and all shifts. Methods: This electronic board produces a color-coded alarm for abnormal parameters. Vital signs highlighted in red indicate the urgency for assessment and intervention. The Hendrich score displayed in yellow alerts all disciplines of fall risk patients. The Braden scale, color-coded purple, identifies patients at risk for skin breakdown. Improvement in early and rapid identification of patient deterioration and risk was analyzed using two months of post implementation data from the electronic health record. A survey was sent to all disciplines to qualitatively measure the value of this tool. Results: Abnormal vital signs identified from the facility board led to clinician interventions impacting 27% of admitted patients in the first two months. Falls decreased by 33% after the first month of implementation. The number of specialty beds ordered increased by 32% for patients identified at risk for skin breakdown. Twenty-five survey responses illustrated 71% of the interdisciplinary team that replied used the facility board and 68% confirmed improvement in interdepartmental communication. Conclusions: There is a significant association between early intervention and decreased mortality rate in acutely ill cancer patients. The continuous display of pertinent patient data on an electronic board holds clinicians accountable to recognize and provide early intervention thus impacting oncology patient outcomes. This innovative tool will further enhance outcomes as we move to interfacing our vital signs monitor into our electronic health record.
Characterization of unplanned 30-day medical oncology readmissions after discharge at an academic medical center with a comprehensive cancer center.
Authors: Lennes Inga Tolin , Eusebio Justin , Bohlen Nie , Ruddy Margaret , Ryan David P.
Published: February 2017

269

Background: Hospital readmission rate is increasingly suggested as a quality care metric. Currently there are no standard criteria for an avoidable readmission in oncology. Although patients with cancer have been identified as being at increased risk of readmission, there has been little to examine the reasons for the oncology patient readmission. The aim was to examine the profiles of patients with an unplanned readmission within 30 days after discharge by an oncology provider and to measure the unplanned 30-day readmission rate. Methods: A retrospective review of oncology provider discharge encounters resulting in a 30-day unplanned readmission during the 2012 calendar year at a tertiary hospital with a comprehensive cancer center was conducted. Planned readmissions for chemotherapy, radiation therapy, hematopoietic stem cell transplantation, dialysis, and surgical procedures, as well as readmissions for rehabilitation, hospice, and psychiatry were excluded. Medical oncologists analyzed medical records for the primary reason of readmission and if the readmission was possibly preventable. Results: Of the 2,944 admissions, a final cohort of 441 unplanned readmissions from 321 unique patients for an unplanned 30-day readmission rate of 14.9% was observed. The average age at admission was 59 (SD 15.9). The cohort was mostly male (56.9%) and White/Caucasian (84.4%). Gastrointestinal (24.0%), lymphoma (18.6%), and leukemia (17.5%) were the most common cancer types. Of those with solid tumors types (n = 225), approximately 70% had metastatic disease. The median time to readmission was 10 days and 10.7% died within 30 days of readmission. Oncology reviewers most commonly assessed that readmission was primarily due to treatment-related effects (46.7%) and the progression of disease (42.2%). Approximately 20% of 30-day readmissions were determined to be possibly preventable, representing 3% of all admissions for the year. Conclusions: Oncology patients readmitted within 30-days frequently present with complicated, advanced disease. A review by medical oncologists suggests there is margin for intervention to reduce 30-day unplanned admissions.
Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry.
Authors: Henry Norah Lynn , Braun Thomas , Lusk Elizabeth , Munir Khan , Griggs Jennifer J. , Gorski David H. , Silver Samuel M. , Breslin Tara M. , Ali Haythem Y. ,   Michigan Breast Oncology Quality Initiative
Published: February 2017

287

Background: Advanced imaging for diagnosis of metastatic disease at the time of diagnosis of stage 0-II breast cancer is not recommended according to national guidelines. The purpose of this study was to examine the variation in ordering of CT chest, abdomen, and pelvis, PET, and bone scans across the state of Michigan, and to investigate clinical and non-clinical factors associated with test ordering. Methods: We prospectively collected data from all patients diagnosed with stage 0-II breast cancer from 2008-2014 in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI), a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality initiative. Demographic, imaging, and pathologic data were abstracted from the medical record. The primary endpoint was the percentage of patients with at least one advanced imaging test performed within 90 days after diagnosis of breast cancer. Analyses were performed using the chi-squared test of association. Results: Of the 27,011 patients, 4799 (17.8%) had at least one staging exam performed within 90 days of diagnosis. Imaging tests were primarily performed post-operatively. The average percentage of patients who had at least one staging exam performed varied by stage and by site (Table). The rate of testing decreased over time for stage 0-IIA cancers but not for stage IIB. On multivariate analysis, younger age, black race, hormone receptor negativity, HER2 positivity, and higher grade were associated with increased likelihood of undergoing imaging. Conclusions: There is considerable variability in ordering of staging scans at the time of diagnosis of early stage breast cancer across Michigan. Factors underlying use of imaging in stage IIB disease should be examined in order to develop interventions for rate reduction. [Table: see text]
Patterns of comorbidity among older U.S. patients with non-Hodgkin lymphoma.
Authors: Hester Laura , Park Steven I. , Lund Jennifer Leigh
Published: February 2017

304

Background: Evidence suggests that the number and type ofcomorbidities at cancer diagnosis influences cancer treatment and mortality, especially among older patients.We sought to describe comorbidity patterns and identify how patterns predict all-cause mortality among older non-Hodgkin lymphoma (NHL) patients. Methods: Using the linked Surveillance, Epidemiologic, and End Results (SEER)-Medicare databases, we identified patients aged > 66 with a first diagnosis of stage I-IV NHL from 2007-2009. Codes for individual comorbidities in the Charlson Comorbidity Index (CCI) were identified in the 12 months before NHL diagnosis, during which patients were required to have continuous Medicare Parts A, B, and D enrollment and no managed care. The prevalence of single and concurrent comorbidities was calculated. Medicare enrollment files contained vital status. We used multivariable Cox proportional hazard models to estimate adjusted hazard ratios (aHR) for all-cause mortality in each comorbidity group versus no comorbidity controlling for age, sex, race/ethnicity, stage, tumor growth category, and other comorbidities. Results: Among 4901 older NHL patients, 52% had ≥ 1 comorbidity and 26% had a CCI > 2. The most prevalent comorbidities were diabetes (25%), chronic obstructive pulmonary disorder (COPD) (16%), and congestive heart failure (CHF) (12%). All-cause mortality was greater among patients with CHF (aHR = 1.44; 95%CI = 1.26, 1.65), diabetes (aHR = 1.16; 95%CI = 1.03,1.29), or dementia (aHR = 1.20; 95%CI = 1.03, 1.41) compared to those without each comorbidity. More than half of diabetes patients, two-thirds of COPD patients, and three-quarters of CHF patients had > 1 additional non-cancer comorbidity. All-cause mortality was higher among NHL patients with CHF who had co-occurring COPD (aHR = 1.56; 95%CI = 1.19, 2.05), diabetes (aHR = 1.66; 95%CI = 1.29, 2.14), or both COPD and diabetes (aHR = 2.61; 95%CI = 1.97, 3.46). Conclusions: Comorbidity is common among older, newly-diagnosed NHL patients and should be carefully considered when making treatment decisions. Given the known cardiotoxicity of the main NHL chemoimmunotherapy, providers should discuss comorbidity management, particularly for CHF, before initiating therapy.
Comparison of real-world acute care interventions (ACI) in patients (pts) with advanced non-small cell lung cancer (adv NSCLC) treated with chemotherapy versus targeted therapies.
Authors: Radtchenko Janna , Korytowsky Beata , Bhor Menaka , Tuell Ken , Feinberg Bruce A.
Published: February 2017

37

Background: This analysis compared the frequency of ACI for any cause (emergency room [ER] visits, hospitalizations, and readmissions) to better understand the burden of treatment in adv NSCLC pts treated with chemotherapy (chemo) vs targeted therapy (TT). Methods: Using Inovalon’s MORE2 Registry claims data, adv NSCLC pts treated with antineoplastics identified by ICD-9 codes from July 2013-2014 were selected. Inclusion: pts >18 y who received first-line (1L) systemic therapy within 6 mo of diagnosis. Exclusion: pts with small cell lung cancer or secondary malignancies and pts in clinical trials. TT was defined as erlotinib, ceritinib, afatinib, crizotinib, ramucirumab, or bevacizumab monotherapy. Analysis included frequency distributions, chi-square, and t-tests. Results: Of 5319 pts included, 1304 (25%) received 1821 total lines of TT. Overall, median age was 66 y, 48% were male, 56% were on Medicare, and 41% received ≥ 2 L of therapy. Mean Charlson Comorbidity Index (CCI) was 2.2 (lower in pts on TT [2.1 vs. 2.2, P<.0001]). Pts on TT were older, more likely to be female, and less likely to have Medicare (Table). Overall, 45% of pts were hospitalized, of whom 50% were readmitted (43% while on the same line); 62% of pts had an ER visit, of whom 62% were readmitted (56% while on the same line). Pts on TT were less likely to be hospitalized, have ER visits, and be readmitted (hospital or ER). Conclusions: Pts with adv NSCLC had considerable ACI. Readmission was common for both hospitalizations and ER visits, with many pts readmitted while on the same line. Pts on TT had fewer ACI and readmissions vs pts on chemo; however, nearly half of pts in this study required hospitalization, highlighting the need for novel therapies with improved safety and efficacy. [Table: see text]
Real-world treatment patterns and outcomes in HER2 positive MBC patients with brain metastasis in the U.S. community oncology setting.
Authors: Patt Debra A. , Fonseca Eileen , Yoo Bongin , Wilson Thomas , Goertz Hans-Peter , Lai Catherine
Published: February 2017

92

Background: Patients (pts) with HER2 positive (HER2+) metastatic breast cancer (MBC) have different patterns of disease and treatment (tx) from HER2 negative MBC. Brain metastasis (BM) frequently occurs and txs vary. Methods: This retrospective study included adult HER2+ MBC pts from a community oncology network electronic health record (EHR) database and diagnosed between 2009-2011, with follow-up until 11/2014. Pts with other primary tumors were excluded. Two cohorts were defined: pts diagnosed with BM and pts with no evidence of BM (NBM), and were initially matched on age and performance status at MBC diagnosis (dx) and stage. Eligibility and txs were examined in electronic chart review. Overall survival (OS) from MBC dx was estimated using a weighted Kaplan-Meier method. Results: The final sample consisted of 86 BM and 101 NBM pts. All baseline MBC demographics were similar across cohorts. Median age was 54 and 52 years for BM and NBM, respectively. The cohorts (BM:NBM) included 57%:75% Caucasians, 12%:6% Blacks, and 31%:19% other/unknown. There were fewer estrogen receptor positive pts in the BM cohort (58%:74%; p = 0.02). Except for bone (p = 0.01), both cohorts had similar prevalence of metastatic sites: liver 35%:35%; lung 31%:30%; bone 41%:62. Of all the BM pts, 54% had first CNS imaging after symptoms, 37% were first imaged for other known reasons. After BM dx, 20% had surgical resection, 67% whole brain radiation (XRT), 37% stereotactic XRT, and 22% palliative XRT (not mutually exclusive). 25% of pts had both XRT and surgery while 72% had only XRT. Among pts receiving systemic therapy after BM dx, the first regimen contained trastuzumab in 55% of pts and lapatinib in 41% of pts. Among pts changing txs after BM dx, 1/3 switched to a trastuzumab but not lapatinib-based regimen; 1/3 to a lapatinib but not trastuzumab-based regimen; 17% to a lapatinib + trastuzumab-based regimen; and 17% to non-HER2-based therapy. Weighted median OS from MBC dx for BM vs. NBM pts was 30.2 and 46.1 months (p = 0.01). Conclusions: For HER2+ MBC pts, survival was shorter for pts with BM vs. NBM and a high degree of tx variability for BM existed. Understanding how detection and tx impacts outcomes will improve care of BM pts.
E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx— ECOG-ACRIN Cancer Research Group
Authors: Marur Shanthi , Li Shuli , Cmelak Anthony J. , Gillison Maura L. , Zhao Weiqiang J. , Ferris Robert L. , Westra William H. , Gilbert Jill , Bauman Julie E. , Wagner Lynne I. , Trevarthen David R. , Balkrishna Jahagirdar , Murphy Barbara A. , Agrawal Nishant , Colevas A. Dimitrios , Chung Christine H. , Burtness Barbara
Published: February 2017

Purpose

Human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC) is treatment-responsive. Definitive chemoradiation results in high cure rates but causes long-term toxicity and may represent overtreatment of some patients. This phase II trial evaluated whether complete clinical response (cCR) to induction chemotherapy (IC) could select patients with HPV-associated OPSCC for reduced radiation dose as a means of sparing late sequelae.

Methods

Patients with HPV16 and/or p16-positive, stage III-IV OPSCC received three cycles of IC with cisplatin, paclitaxel, and cetuximab. Patients with primary-site cCR to IC received intensity-modulated radiation therapy (IMRT) 54 Gy with weekly cetuximab; those with less than cCR to IC at the primary site or nodes received 69.3 Gy and cetuximab to those regions. The primary end point was 2-year progression-free survival.

Results

Of the 90 patients enrolled, 80 were evaluable. Their median age was 57 years (range, 35 to 73 years), with the majority having stage T1-3N0-N2b OPSCC and a history of ≤ 10 pack-years of cigarette smoking. Three cycles of IC were delivered to 77 of the 80 patients. Fifty-six patients (70%) achieved a primary-site cCR to IC and 51 patients continued to cetuximab with IMRT 54 Gy. After median follow-up of 35.4 months, 2-year progression-free survival and overall survival rates were 80% and 94%, respectively, for patients with primary-site cCR treated with 54 Gy of radiation (n = 51); 96% and 96%, respectively, for patients with < T4, < N2c, and ≤ 10 pack-year smoking history who were treated with ≤ 54 Gy of radiation (n = 27). At 12 months, significantly fewer patients treated with a radiation dose ≤ 54 Gy had difficulty swallowing solids (40% v 89%; P = .011) or had impaired nutrition (10% v 44%; P = .025).

Conclusion

For IC responders, reduced-dose IMRT with concurrent cetuximab is worthy of further study in favorable-risk patients with HPV-associated OPSCC. Radiation dose reduction resulted in significantly improved swallowing and nutritional status.
Results From the Phase III Randomized Trial of Onartuzumab Plus Erlotinib Versus Erlotinib in Previously Treated Stage IIIB or IV Non–Small-Cell Lung Cancer: METLung
Authors: Spigel David R. , Edelman Martin J. , O’Byrne Kenneth , Paz-Ares Luis , Mocci Simonetta , Phan See , Shames David S. , Smith Dustin , Yu Wei , Paton Virginia E. , Mok Tony
Published: February 2017

Purpose

The phase III OAM4971g study (METLung) examined the efficacy and safety of onartuzumab plus erlotinib in patients with locally advanced or metastatic non–small-cell lung cancer selected by MET immunohistochemistry whose disease had progressed after treatment with a platinum-based chemotherapy regimen.

Patients and Methods

Patients were randomly assigned at a one-to-one ratio to receive onartuzumab (15 mg/kg intravenously on day 1 of each 21-day cycle) plus daily oral erlotinib 150 mg or intravenous placebo plus daily oral erlotinib 150 mg. The primary end point was overall survival (OS) in the intent-to-treat population. Secondary end points included median progression-free survival, overall response rate, biomarker analysis, and safety.

Results

A total of 499 patients were enrolled (onartuzumab, n = 250; placebo, n = 249). Median OS was 6.8 versus 9.1 months for onartuzumab versus placebo (stratified hazard ratio [HR], 1.27; 95% CI, 0.98 to 1.65; P = .067), with a greater number of deaths in the onartuzumab arm (130 [52%] v 114 [46%]). Median progression-free survival was 2.7 versus 2.6 months (stratified HR, 0.99; 95% CI, 0.81 to 1.20; P = .92), and overall response rate was 8.4% and 9.6% for onartuzumab versus placebo, respectively. Exploratory analyses using MET fluorescence in situ hybridization status and gene expression showed no benefit for onartuzumab; patients with EGFR mutations showed a trend toward shorter OS with onartuzumab treatment (HR, 4.68; 95% CI, 0.97 to 22.63). Grade 3 to 5 adverse events were reported by 56.0% and 51.2% of patients, with serious AEs in 33.9% and 30.7%, for experimental versus control arms, respectively.

Conclusion

Onartuzumab plus erlotinib did not improve clinical outcomes, with shorter OS in the onartuzumab arm, compared with erlotinib in patients with MET-positive non–small-cell lung cancer.
When, What, and Why of Perioperative Treatment of Potentially Curable Pancreatic Adenocarcinoma
Authors: Perez Kimberly , Clancy Thomas E. , Mancias Joseph D. , Rosenthal Michael H. , Wolpin Brian M.
Published: February 2017

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

A 64-year-old woman with a history of hypertension and type 2 diabetes had been in her usual state of health until she developed symptoms of diarrhea, abdominal bloating, and discomfort in the midepigastrium. Evaluation with a contrast-enhanced abdominopelvic computed tomography (CT) scan demonstrated a mass in the pancreatic body that was approximately 3.1 cm × 2 cm × 2.1 cm in size with abutment of the portal vein–superior mesenteric vein confluence for less than 180°. The confluence was narrowed but without thrombosis. No tumor–vessel interface was noted at the superior mesenteric artery, celiac artery, or common hepatic artery. Several peripancreatic lymph nodes were observed that measured up to 11 mm × 5 mm. No evidence for distant spread of disease was identified. An upper endoscopy with endoscopic ultrasound was performed and fine-needle aspirates of the pancreas mass were positive for malignant cells that were consistent with adenocarcinoma. Chest CT scan without intravenous contrast demonstrated no evidence of metastatic disease. The patient came to the clinic to discuss management of her newly diagnosed malignancy.
Radiation Therapy for Glioblastoma: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Guideline
Authors: Sulman Erik P. , Ismaila Nofisat , Armstrong Terri S. , Tsien Christina , Batchelor Tracy T. , Cloughesy Tim , Galanis Evanthia , Gilbert Mark , Gondi Vinai , Lovely Mary , Mehta Minesh , Mumber Matthew P. , Sloan Andrew , Chang Susan M.
Published: February 2017

Purpose

The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on radiation therapy for glioblastoma. Because of its relevance to the ASCO membership, ASCO reviewed the guideline and applied a set of procedures and policies used to critically examine guidelines developed by other organizations.

Methods

The ASTRO guideline on radiation therapy for glioblastoma was reviewed for developmental rigor by methodologists. An ASCO endorsement panel updated the literature search and reviewed the content and recommendations.

Results

The ASCO endorsement panel determined that the recommendations from the ASTRO guideline, published in 2016, are clear, thorough, and based on current scientific evidence. ASCO endorsed the ASTRO guideline on radiation therapy for glioblastoma and added qualifying statements.

Recommendations

Partial-brain fractionated radiotherapy with concurrent and adjuvant temozolomide is the standard of care after biopsy or resection of newly diagnosed glioblastoma in patients up to 70 years of age. Hypofractionated radiotherapy for elderly patients with fair to good performance status is appropriate. The addition of concurrent and adjuvant temozolomide to hypofractionated radiotherapy seems to be safe and efficacious without impairing quality of life for elderly patients with good performance status. Reasonable options for patients with poor performance status include hypofractionated radiotherapy alone, temozolomide alone, or best supportive care. Focal reirradiation represents an option for select patients with recurrent glioblastoma, although this is not supported by prospective randomized evidence. Additional information is available at www.asco.org/glioblastoma-radiotherapy-endorsement and www.asco.org/guidelineswiki .
Racial Comparison of Outcomes and Costs for Inpatient Neutropenic Patients: A Multicenter Evaluation
Authors: Motl Susannah E. , Suda Katie J. , Kuth John C. , Gladney Thomas J.
Published: February 2017

Purpose

Racial disparities have been reported in the care and outcome of cancer patients. We evaluated whether race would influence the cost and outcomes of inpatient neutropenic cancer patients in a multicenter study from a large health care system in the southern United States.

Methods

Data was collected on all cancer inpatients with a diagnosis code for neutropenia in a 16-hospital system between October 1, 2002, and September 30, 2003. Demographics, treatment outcomes, and costs were compared between white and minority patients. A P value less than .05 was considered statistically significant.

Results

Two hundred seventy-nine cancer patients (0.29% of all admits) had a diagnosis of neutropenia. Demographics were similar between white and minority patients. However, minorities were more likely to be younger than whites (P = .002). With regards to outcomes, length of stay (LOS), LOS in the intensive care unit, and discharge status were not statistically different. Total hospital, medication, laboratory, radiation, surgery, and respiratory costs were also similar (P > .05), although minorities were less likely to receive myeloid colony-stimulating factors (P = .032) and more likely to have higher nursing care costs (P = .048).

Conclusion

In light of the escalating reports of racial disparities in cancer care, these minimal differences are encouraging.
Study of Medication Errors on a Community Hospital Oncology Ward
Authors: Ford Clyde D. , Killebrew Julie , Fugitt Penelope , Jacobsen Janet , Prystas Elizabeth M.
Published: February 2017

Purpose

Medication errors (MEs) have been a significant problem resulting in excessive patient morbidity and cost, especially for cancer chemotherapeutic agents. Although some progress has been made, ME measurement methods and prevention strategies remain important areas of research.

Methods

During a 2-year period (2003-2004), we conducted a prospective study on the oncology ward of a large community hospital, with the goals of (1) complete nurse reporting of observed medication administration errors (MAEs), (2) classifying observed MAEs, and (3) formulating improvement strategies. We also conducted a retrospective review of a randomly chosen sample of 200 chemotherapy orders to assess the appropriateness of ordering, dispensing, and administration.

Results

Our nurses reported 141 MAEs during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted.

Conclusions

Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits.
Endocrine Therapy in Premenopausal Hormone Receptor–Positive Breast Cancer
Authors: Tevaarwerk Amye J. , Wisinski Kari B. , O’Regan Ruth M.
Published: February 2017

Systemic therapy for premenopausal women with hormone receptor–positive breast cancer has evolved in the last 5 years, but critical questions remain. Recent randomized trials have demonstrated a benefit for the addition of ovarian suppression to endocrine therapy in patients with breast cancers considered to be at high risk for recurrence, whereas those with lower-risk cancers seem to have a favorable outcome with tamoxifen alone. Two large randomized trials have demonstrated a benefit for extending adjuvant tamoxifen beyond 5 years. Currently the choice of systemic therapy is selected empirically but molecular profiling may, in the near future, provide a more conclusive means of selecting an endocrine therapeutic approach for premenopausal patients. Given that a significant subset of hormone receptor–positive cancers are intrinsically resistant to endocrine agents, as well as the finding that inhibiting cyclin-dependent kinases 4 and 6 and mammalian target of rapamycin appears to potentially reverse this resistance in patients with metastatic disease, evaluation of these agents in the early-stage setting is ongoing.
Transcriptome sequencing reveals maelstrom as a novel target gene of the terminal system in the red flour beetle Tribolium castaneum
Authors: Pridöhl Fabian , Weißkopf Matthias , Koniszewski Nikolaus , Sulzmaier Andreas , Uebe Steffen , Ekici Arif B. , Schoppmeier Michael
Published: February 2017

Terminal regions of the Drosophila embryo are patterned by the localized activation of the Torso-RTK pathway, which promotes the downregulation of Capicua. In the short-germ beetle Tribolium, the function of the terminal system appears to be rather different, as the pathway promotes axis elongation and, in addition, is required for patterning the extra-embryonic serosa at the anterior. Here, we show that Torso signalling also induces gene expression by relieving Capicua-mediated repression in Tribolium. Given that the majority of Torso target genes remain to be identified, we established a differential gene-expression screen. A subset of 50 putative terminal target genes was screened for functions in early embryonic patterning. Of those, 13 genes show early terminal expression domains and also phenotypes were related to terminal patterning. Among others, we found the PIWI-interacting RNA factor Maelstrom to be crucial for early embryonic polarization. Tc-mael is required for proper serosal size regulation and head morphogenesis. Moreover, Tc-mael promotes growth-zone formation and axis elongation. Our results suggest that posterior patterning by Torso may be realized through Maelstrom-dependent activation of posterior Wnt domains.
Effect of the signaling lymphocytic activation molecule (SLAM) in the modulation of T cells in immune response to Leishmania braziliensis in vitro
Authors: Coêlho Zirlane Castelo Branco , Teixeira Maria Jania , Vilar Maria do Livramento Leitão , Matos Jesamar Correia , Matos Jesamar Correia , Coêlho Ivo Castelo Branco , Andrade Geanne Matos , Pompeu Margarida Maria Lima
Published: February 2017

Introduction: Signaling lymphocyte activation molecule (SLAM) is a self-ligand receptor on the surface of activated T- and B-lymphocytes, macrophages, and DC. Studies have shown PBMC from healthy individuals exposed to Leishmania differ in IFN-γ production. Objective: We investigated the role of SLAM signaling pathway in PMBC from high (HP) and low (LP) IFN-γ producers exposed to L. braziliensis in vitro. Methods: PBMC from 43 healthy individuals were cultured with or without antigen, α-SLAM, rIL-12 and rIFN-γ. The cytokines production was evaluated by ELISA, and SLAM expression by flow cytometry. Results: L. braziliensis associated with rIFN-γ or rIL-12 reduced early SLAM but did not modify this response later in HP. α-SLAM did not alter CD3+SLAM+ expression, and not affected IFN-γ and IL-13 production, in both groups, but increased significantly IL-10 in HP. Leishmania associated with α-SLAM and rIL-12 increased IFN-γ in LP, as well as IL-13 in HP. LP group presented low IFN-γ and IL-13 production, and low SLAM expression. Conclusion: Collectively, these findings suggest that when PBMC from healthy individuals are sensitized with L. braziliensis in vitro, SLAM acts in modulating Th1 response in HP individuals and induces a condition of immunosuppression in LP individuals.
Avaliação da exposição ambiental ao monóxido de carbono, material particulado e ao ruído no Terminal Central de Transporte Coletivo de Uberlândia, Minas Gerais
Authors: Oliveira Alesca Prado de , Matos Maria Clara Nunes de , Pereira Boscolli Barbosa
Published: February 2017

Introdução: A exposição aos poluentes derivados do desenvolvimento urbano tem sido de grande preocupação para a Saúde Pública. Em Uberlândia - MG, o Terminal Central de Transporte Coletivo de Uberlândia (TCTU) recebe diariamente grande quantidade de usuários, além dos trabalhadores, que estão diretamente expostos aos riscos causados por contaminantes atmosféricos e ruído. Objetivo: Avaliar a exposição ambiental ao monóxido de carbono (CO), material particulado (MP10) e produção de ruído. Métodos: A exposição foi analisada por meio da coleta de dados das concentrações dos poluentes nas plataformas de embarque do TCTU. Resultados: Os níveis de poluição atmosférica e sonora encontrados não ultrapassaram os limites estabelecidos nas resoluções adotadas pelo município, entretanto, as emissões de ruído ultrapassaram o critério para incômodo e perda auditiva da Organização Mundial da Saúde (OMS). Conclusões: O ambiente avaliado não oferece conforto acústico para seus usuários e trabalhadores; evidencia-se, então, a necessidade do uso de equipamentos de proteção coletiva e individual para que se evitem danos à saúde dos trabalhadores e aos usuários. O estudo reforça a necessidade de reavaliação de parâmetros e leis que melhorem a qualidade de vida dos indivíduos expostos aos riscos da poluição sonora e atmosférica nos terminais de transporte coletivo.
Riscos e complicações do uso de piercing oral: uma revisão sistemática
Authors: Santos José Wittor de Macêdo , Gonçalves Diego Henrique Pires , Gordón-Núñez Manuel Antonio
Published: February 2017

Introdução: O uso de piercing oral tem despertado o interesse dos profissionais da Odontologia devido à associação com diversas complicações locais e sistêmicas. Objetivo: Este trabalho objetivou realizar uma revisão sistemática da literatura sobre riscos e complicações associadas ao uso de piercings orais e periorais. Métodos: Foi realizada uma pesquisa nas bases de dados MEDLINE, Google acadêmico e LILACS utilizando-se os seguintes critérios: artigos publicados na íntegra, no período de 2000 a 2016, em inglês, português e espanhol, case report, classical articles e reviews sobre o tema utilizando os seguintes descritores: body piercing, risks management, complications, risk e seus mesh terms. Resultados: Foram incluídos um total de 39 artigos relevantes que cumpriam com todos os critérios. Foi observado que os locais mais frequentemente utilizados para a colocação de piercing oral são os lábios e a língua. As complicações incluem inflamação, infecções locais e sistêmicas, lesões mucocutâneas, lesões vasculares, trauma dental, problemas periodontais, reações de hipersensibilidade, disfonia, deglutição e aspiração do piercing, e até morte etc. Conclusão: Conclui-se que o cirurgião dentista deve exercer um papel importante na orientação da população em geral sobre os riscos e as complicações associadas ao uso de piercing oral, visando evitar tal prática ou minimizar ao máximo os riscos e as complicações naqueles indivíduos que os possuem.
Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus
Authors: Khan Abidullah , Haider Iqbal , Ayub Maimoona , Khan Salman
Published: February 2017

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study.  On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Pearson’s correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis.   Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant (P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (r= -0.94, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (r=0.95, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% (P< 0.001). Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.
Stochastic Optimization Models for Transferring Delay Along Flight Trajectories to Reduce Fuel Usage
Authors: Jones James C. , Lovell David J. , Ball Michael O.
Published: February 2017

In a typical aviation environment today, the precise landing times of en route aircraft are not set until each aircraft approaches the airspace adjacent to the destination airport. In times of congestion, it is not unusual for air traffic controllers to subject arriving aircraft to various maneuvers so as to create an orderly flow of aircraft onto an arrival runway. Typical maneuvers might include flying in zigzag patterns and flying in circular holding patterns, as well as others. These maneuvers serve to delay the arrival time of the flight. On the other hand, if the arrival time was established much earlier, then that delay could be realized by having the aircraft fly slower while still at a higher altitude, which would burn much less fuel than the described maneuvers. Three integer programming models are proposed to assign delay to aircraft approaching a single airport, well in advance of each aircraft’s entry into the terminal airspace. The baseline model is deterministic and seeks to maximize the available throughput at the runway over a rolling horizon. The latter two models are stochastic and account for uncertainty regarding the status and controllability of certain flights. The first stochastic model is scenario based, while the second relies on a functional approximation of uncertainty. The results of computational experiments show that these approaches can transfer a considerable portion of the delay that would otherwise occur in the terminal area to the en route phase of flight, and also that the stochastic models are noticeably more effective. The model relying on functional approximation shows particular promise because of its efficient run time. The delay transfer yielded by each model resulted in significant predicted fuel savings. The functional approximation model performed particularly well under declining operational conditions, demonstrating itself to be a promising means of achieving delay transfer.

The online appendix is available at https://doi.org/10.1287/trsc.2016.0689 .
Correction of lower limb deformities in children with renal osteodystrophy by guided growth technique
Authors: Gigante C. , Borgo A. , Corradin M.
Published: February 2017

Purpose

Renal osteodystrophy (ROD) may cause severe lower limb deformities in children. The purpose of this study is to evaluate the efficacy of the temporary hemiepiphysiodesis for the correction of lower limb deformities in children with ROD.

Methods

Guided growth correction by hemiepiphysiodesis has been performed in skeletally immature patients with deformities of the lower limbs caused by ROD. The correction of the mechanical axes of the lower limbs and its correction speed have been evaluated.

Results

A total of seven patients with ROD, five males and two females, were treated with the above technique. The average age of the patients at their first surgery was 7.8 years (2.9 to 13.6). The average follow-up time 5.2 years (2.3 to 8). There were 13 valgus deformities and one varus deformity of the knee. The measure of the lower limb angular deformity was in the range of 10° to 47°. Restoration of normal mechanical axis was achieved in all patients at the final follow-up. Three patients relapsed and required further hemiepiphysiodesis. The average time for correction was 20 months (7 to 30). The average speed of correction was 0.49° per month for a tibia and 1.73° per month for a femur. There were two minor complications: a screw mobilisation and a screw breakage occurred during removal.

Conclusion

Guided growth technique by hemiepiphysiodesis is a mini-invasive surgical procedure that has been found to be effective for the correction of misalignment due to ROD in skeletally immature patients. The method has allowed progressive correction of the deformities at any age in childhood. These patients are predisposed to relapse to their deformities, thus a strict follow-up is required.
The tactics and technique of musculoskeletal biopsy
Authors: Exner G. Ulrich , Kurrer Michael O. , Mamisch-Saupe Nadja , Cannon Stephen R.
Published: February 2017

The treatment of musculoskeletal neoplasms and infection is usually based on an initial diagnostic biopsy. Prior to biopsy, a hypothesis should be formed about the most likely diagnosis and a differential diagnosis. These deliberations should consider whether the lesion is a primary benign or malignant tumour, a metastasis, a haematological problem or an infection. A tactical plan should be developed which evaluates the necessity, the risk, the approach and finally defines the technique of biopsy most likely to achieve a representative result in the clinical case. In developing this technical approach, the pitfalls should be anticipated, i.e. inadequate sampling, difficulty of pathological interpretation and contamination. The tactical approach should be developed in conjunction with a multi-disciplinary team together with appropriate pre-biopsy imaging.

Cite this article: EFORT Open Rev 2017;2:51–57. DOI: 10.1302/2058-5241.2.160065
Active Use of Electronic Health Records (EHRs) and Personal Health Records (PHRs)
for Epidemiologic Research: Sample Representativeness and Nonresponse Bias in a Study of
Women During Pregnancy
Authors: Bower Julie K. , Bollinger Claire E. , Foraker Randi E. , Hood Darryl B. , Shoben Abigail B. , Lai Albert M.
Published: February 2017

Introduction: With the growing use of electronic medical records, electronic
health records (EHRs), and personal health records (PHRs) for health care delivery, new
opportunities have arisen for population health researchers. Our objective was to
characterize PHR users and examine sample representativeness and nonresponse bias in a
study of pregnant women recruited via the PHR.Design: Demographic characteristics were
examined for PHR users and nonusers. Enrolled study participants (responders, n=187)
were then compared with nonresponders and a representative sample of the target
population.Results: PHR patient portal users (34 percent of eligible persons) were older
and more likely to be White, have private health insurance, and develop gestational
diabetes than nonusers. Of eligible persons (all PHR users), 11 percent (187/1,713)
completed a self-administered PHR‑based questionnaire. Participants in the research
study were more likely to be non-Hispanic White (90 percent versus 79 percent) and
married (85 percent versus 77 percent), and were less likely to be Non-Hispanic Black (3
percent versus 12 percent) or Hispanic (3 percent versus 6 percent). Responders and
nonresponders were similar regarding age distribution, employment status, and health
insurance status. Demographic characteristics were similar between responders and
nonresponders.Discussion: Demographic characteristics of the study population differed
from the general population, consistent with patterns seen in traditional
population-based studies. The PHR may be an efficient method for recruiting and
conducting observational research with additional benefits of efficiency and
cost-effectiveness.
Ice-Bentonite Powder Mixing Method to Improve the Homogeneity of Compacted Bentonite in An Initial Sample Preparation Stage
Authors: Peng Yu , Zhang Huyuan , Yang Bingzhuo , Wang Xuewen , Shao Xianxian , Liu Ping
Published: February 2017

Bentonite is considered as an ideal buffer/backfill material for preparing an engineering barrier for high-level radioactive waste (HLW) disposal. During initial sample preparation, the tendency of wet bentonite powder to gather into large agglomerates and the water to be spread unevenly in the traditional water content adjustment process decreases the homogeneity of compacted bentonite. The main purpose of this study was to solve this problem by applying a new wetting method, which mixes ice powder with bentonite powder (the ice-bentonite mixing method). This new method was used to adjust the water distribution in Gaomiaozi County, China (GMZ) bentonite powder and was compared to the traditional spray method. The screening method was used to separate macro-agglomerates (≥ 0.25 mm) from the water and bentonite mixture. The properties, the content of the various size agglomerates in loose mixtures, and the heterogeneity defects observed in compacted bentonite were compared. An index (P) was defined to quantitatively evaluate the water distribution in a loose bentonite/water mixture. Macro-agglomerates in loose mixtures produced heterogeneities in water content, density, and shrinkage. By using the ice-bentonite mixing method, fewer macro-agglomerates were formed and a homogeneous distribution of water was produced in the compacted bentonite. A homogeneous water distribution had the tendency to decrease the number of shrinkage cracks after the drying process and to maintain high mechanical strength in the compacted bentonite. Although the production of ice powder was laborious, the ice-bentonite mixing method has workability advantages: (i) a high mixing efficiency, (ii) a low mass loss rate, and (iii) a small deviation between measured water content and target water content. The low thawing efficiency of ice-bentonite mixtures can be solved by using a microwave-assisted thawing method. This research can improve the sample preparation method used to produce compacted buffer/backfill materials for HLW disposal.
Turpeentuhka kangasmaan lannoituksessa
Authors: Oikarinen Matti , Pasanen Jorma
Published: February 2017

Puuntuhkalla on typpirikkailla turvemailla saatu aikaan voimakas ja pitkäaikainen maanparannusvaikutus. Puuntuhkan vaikutus johtuu sen tasapainoisesta ja monipuolisesta ravinnesisällöstä, joka samalla pienentää turpeen happamuutta, minkä tuloksena on turpeen omien ravinnevarojen tehokas mobilisaatio vilkkaan pieneliöstötoiminnan seurauksena.