bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing radiation oncology time to treatment for definitive cancers.
Authors: Young Ronald , Yu Naichang , Patt Molly 
Published: October 2019

84 Background: Time to first treatment intervention has been associated with improved patient outcomes. Although, radiation therapy is not always the first treatment intervention, a reduced time to treatment for radiation therapy patients reduces the anxiety and worry of the patient and their family. At the Cleveland Clinic, TTT is considered an important metric that is reviewed by our Cancer Committee and is considered within our tumor boards as well as our multi-disciplinary clinics. Methods: A value stream mapping exercise starting at the time of diagnosis and ending at the first scheduled treatment date allowed us to understand where our opportunities were to improve our TTT. Analytics and reporting was developed to track and report objective data that was incorporated into our operational huddles. Process improvements were implemented to improve clinical template access for our physicians, we eliminated the sequential nature of insurance authorization after consult and created reporting tools that our teams could monitor our success. Results: We improved our median time of consult to first treatment by 29% . Driving our consults to treatment times down a full 4 days on average. We have sustained this improvement with team based visual management boards, team huddles and incorporating TTT into our culture. Conclusions: Radiation therapy time to treat was reduced with the use of continuous improvement tools, analytics, and team based huddles.
Implementation of a geriatric oncology screening tool (G8) in an academic oncology practice serving a Hispanic-rich population.
Authors: Salazar Mary , James Deborah , Welch Carolyn , Viles Jeremy , Karnad Anand B. , Arora Sukeshi Patel 
Published: October 2019

87 Background: ASCO recommends utilization of the G8 screening tool to assist in predicting mortality, but there are limited data in Hispanic patients. Our practice utilizes the G8 to identify patients who may need additional support and/or treatment modifications to decrease risk of mortality. Therefore, we built the G8 in our Electronic Medical Record (EMR) with reflex to geriatric consultation in our Hispanic-rich patient population. Methods: This is an implementation study with a team-based approach to improve the utilization and increase geriatric oncology assessments in our practice. The G8 is a geriatric screening tool of eight questions (completion time: 3 to 5 minutes). If the score is </=14, a reflexive geriatric consultation box appears on the screen to recommend a referral to Geriatrics for a Comprehensive Geriatric Assessment (CGA). Nurses were empowered to complete the G8 on all new cancer patients 65+ years. Results: 215 patients had a G8 recorded in the EMR between August 2018 - March 2019. Providers completing: 10 (5%) MD/APP, 205 (95%) RNs. 119 patients were non-Hispanic, 96 were Hispanic. Of Hispanic patients, 74 (77%) spoke English, 5 (5%) spoke English and Spanish, 16 (17%) spoke Spanish, 1 (1%) spoke other. 205 patients (95.3%) were 65+ years. Average G8 score for all patients 65+ was 11.1. Of patients 65+, 169 patients (82%), scored </=14, indicating higher mortality risk. Conclusions: Integration of the G8 into our practice has been slow and steady. We believe this is partly due to lack of awareness of the benefit of the G8. Empowering nurses to complete the G8 has improved screening at our cancer center. To further improve awareness and utilization, we have initiated an interprofessional education lecture series regarding care of geriatric oncology patients, which provides nurses CNE. As we gather data on the reflex referrals to geriatricians for CGA, we will work on goals to increase MD/APP engagement. [Table: see text]
Collaboration with commercial payor to eliminate prior authorization.
Authors: Sharma Mallika , Gustafson Annika , Jagels Barbara , Wong Tracy 
Published: October 2019

9 Background: For commercial insurance plans, there is often a requirement to obtain prior-authorization for specific services. Prior-authorization though intended to ensure medical necessity, can cause significant delays in patient care and create an unnecessary administrative burden. It often leads to undue anxiety in patients, dissatisfaction among providers and substantial waste in the system. To increase our efficiency and improve patient and provider experience, we partnered with one of our region’s largest commercial payors to eliminate prior-authorization. Methods: A Lean Six-sigma DMAIC approach was adopted: Define- created a process map. Measure- calculated baseline for prior-authorization denials. Analyze- conducted retrospective analysis to identify areas to improve. Improve- conducted provider training for appropriate imaging guidelines. Control- established internal auditing to check provider compliance. Results: At SCCA, we found that 94.8% of prior-authorizations were approved instantly or after providing more documentation, thus prior-authorization did not add value. Moreover, 2.15% were approved after peer-to-peer review that involves significant administrative burden and delay in care. Only 3% prior-authorizations did not meet medical necessity criteria, major reasons being- PET/CT and CT CAP ordered in combination, or PET/CT ordered without clear justification. 2.46% prior-authorizations led to a patient receiving a letter of denial. SCCA and the payor agreed to eliminate prior-authorizations for all imaging (except PET and PET/CT). This required all ordering providers to attest to completion of training on the NCCN Imaging Appropriate Use Criteria. In addition, a quarterly internal audit was put in place to check provider compliance to NCCN guidelines for ordering Imaging tests. SCCA achieved a 100% provider training completion rate and 100% provider compliance to NCCN guidelines in the first two internal audits. Conclusions: A strong partnership and shared vision with a payor enabled us to eliminate wasteful prior-authorizations. Our high training completion rate and compliance rate implies strong support from our providers and leadership to provide value-based care to our patients.
Streamlining bortezomib regimen: A quality improvement project for cost-effective and patient-friendly protocol.
Authors: Guntupalli Srinandan , Kallam Deepti Bala , Master Samip R. , Mansour Richard P. 
Published: October 2019

94 Background: Bortezomib is a novel first-in-class proteasome inhibitor and received it’s FDA approval with twice weekly dosing on day 1, 4, 8 and 11 of a 21-day cycle with weekly complete blood count (CBC). However, subsequent studies have shown that weekly dosing has equal drug efficacy. Our clinical practice at Feist-Weiller cancer center is to administer weekly subcutaneous bortezomib injection after reviewing the CBC. Objective: To analyze hematological toxicities with weekly bortezomib and assess the need for CBC prior to administration of bortezomib. Methods: A retrospective analysis of CBC results was done for every patient receiving bortezomib as part of bortezomib and dexamethasone +/- lenalidomide regimens in a 2-year period (2017-2018). The data extraction was done using Epic Clarity database using an SQL script which identified each treatment duration in minutes between check in and check out, Absolute neutrophil count (ANC) and platelet count on each treatment day. Results: A total of 38 patients received 626 treatment doses of bortezomib. The average patient stay between check-in and check-out was 227 mins. There was very low incidence of grade 3 thrombocytopenia (0.64%) and grade 3 neutropenia (0.32%). There is no evidence of grade 4 cytopenia’s or any dose changes from cytopenia’s. This data suggests that weekly lab monitoring may not be necessary prior to drug administration. Conclusions: Using this data, we have streamlined our approach for monitoring patients receiving weekly bortezomib. During weekly bortezomib administration, we propose to obtain a CBC on day 1 of every 4 weeks. If either platelet count is less than 75,000 /μl and ANC is less than 1000/μl on day 1, we will monitor labs weekly until count recovery. We believe that this new protocol may result in 75% reduction in the average patient stay for the treatment. It will reduce the need for phlebotomy and lab services. We believe that this change will improve patient satisfaction and an another step forward to efficient and safe patient care at our institute.
Standardized acquisition and post-processing of dynamic susceptibility contrast perfusion in patients with brain tumors, cerebrovascular disease and dementia: comparability of post-processing software
Authors: Schmidt Manuel Alexander , Knott Michael , Hoelter Philip , Engelhorn Tobias , Larsson Elna Marie , Nguyen Than , Essig Marco , Doerfler Arnd 
Published: October 2019

Objective:
MR-perfusion post-processing still lacks standardization. This study evaluates the results of perfusion analysis with two established software solutions in a large series of patients with different diseases when a highly standardized processing workflow is ensured.

Methods:
Multicenter data of 260 patients (80 with brain tumors, 124 with cerebrovascular disease and 56 with dementia examined with the same MR protocol) were analyzed. Raw data sets were processed with two software suites: Olea sphere and NordicICE. Group differences were analyzed with paired t-tests and one-way ANOVA.

Results:
Perfusion metrics were significantly different for all examined diseases in the unaffected brain for both software suites [ratio cortex/white matter left hemisphere: mean transit time (MTT) 0.991 vs 0.847, p &lt; 0.05; relative cerebral bloodflow (rBF) 3.23 vs 4.418, p &lt; 0.001; relative cerebral bloodvolume (rBVc) 2.813 vs 3.884, p &lt; 0.001; right hemisphere: MTT 1.079 vs 0.854, p &lt; 0.05; rBF 3.262 vs 4.378, p &lt; 0.001; rBVc 2.762 vs 3.935, p &lt; 0.001)]. Perfusion results were also significantly different in patients with stroke (ratio cortex/white matter affected hemisphere: MTT 1.058 vs 0.784; p &lt; 0.001), dementia (ratio cortex/white matter left hemisphere: rBVc 1.152 vs 1.795, p &lt; 0.001; right hemisphere: rBVc 1.396 vs 1.662, p &lt; 0.05) and brain tumors (ratio cortex/whole tumor rBVc: 0.778 vs 0.919, p &lt; 0.001 and ratio cortex/tumor hotspot rBVc: 0.529 vs 0.512, p &lt; 0.05).

Conclusion:
Despite a highly standardized workflow, parametric perfusion maps are depended on the chosen software. Radiologists should consider software related variances when using dynamic susceptibility contrast perfusion for clinical imaging and research.

Advances in knowledge:
This multicenter study compared perfusion parameters calculated by two commercial dynamic susceptibility contrast perfusion post-processing software solutions in different central nervous system disorders with a large sample size and a highly standardized processing workflow. Despite, parametric perfusion maps are depended on the chosen software which impacts clinical imaging and research.
Evaluation of treatment response in oral chronic graft-versus-host patients by power doppler ultrasound: a prospective study
Authors: Liu Yiqun , Zhu Jiaan , Guo Huijie , Li Wenxue , Wang Xiuming , Chen Zheng , Liu Fang , Bilig Ariun 
Published: October 2019

Objective: To date, imaging and non-invasive examination methods for evaluating the oral tissue of patients who with oral chronic graft-versus-host disease (GVHD) are still lacking. Herein, we assessed the ultrasonography imaging characteristics of chronic GVHD patients’ buccal soft tissue and evaluated the response to treatment using gray-scale and power Doppler (PD) ultrasound. The overall objective of the study was to determine the potential of ultrasonography to provide an early and objective indication of a therapeutic response to treatment intervention in oral chronic GVHD. Methods: Buccal mucosa in 21 patients with clinically diagnosis of oral chronic GVHD were assessed before and after 14 day treatment between 2016 and 2018. Ultrasonography assessment included thickness and echogenicity evaluation, and PD. Echogenicity and PD were measured and scored according to a semi-quantitative method. Ultrasonography parameters were compared with clinical activity assessments of disease activity and patient-reported measures. Results: Following 14 day therapy, a significant decrease in PD scores and patient-reported measures was observed (p < 0.01), and clinical assessment scores also decreased (p < 0.05). Changes from baseline PD scores correlated significantly with patient-reported measures (r = 0.85, p < 0.01). Changes in PD scores correlated moderately with the changes in the clinical assessments from baseline (r = 0.46, p < 0.05). A significant decrease in PD scores was observed in the buccal soft tissue of patients that responded clinically to the treatment. A significant decrease in PD scores was also observed in patients that were failed to show clinical improvement (p < 0.05). Conclusion: Ultrasonography is a novel and feasible imaging technique for measurement of the response of oral chronic GVHD to therapy. Ultrasonography yields additional information about buccal mucosa and is a complementaty to clinical examination.
Case Report: Importance of dietary modification in successful management of eosinophilic gastroenteritis
Authors: Kudaravalli Pujitha , Saleem Sheikh A. , Riaz Sana , Sapkota Bishnu 
Published: October 2019

Introduction: Eosinophilic gastroenteritis (EGE) is an extremely rare inflammatory disorder with an estimated prevalence of 22-28/100 000. We herein, present a case of EGE in an elderly patient which was successfully managed with dietary restriction. Case report: A 70-year-old male with a history of gastroesophageal reflux disorder (GERD), atopic dermatitis and asthma presented with 2 weeks history of foul-smelling non-bloody diarrhea associated with nausea, vomiting and weight loss. Physical examination was significant for dry oral mucosa and loss of skin turgor. Lab findings were significant for a hemoglobin of 13.2 g/dl, hematocrit of 38.5%, mean corpuscular volume of 86.3%, white blood cell count of 24,200/mm3, albumin of 2.2 g/L, stool fat of 70g, stool osmolar gap of 115, C-reactive protein 1.47. Erythrocyte sedimentation rate, HIV test were unremarkable. Infectious stool work-up was negative. Computed tomography of the abdomen was unremarkable. The mucosa appeared mildly inflamed on upper endoscopy and colonoscopy, and biopsies showed eosinophilic infiltration of the mucosal and muscular layers. A diagnosis of eosinophilic gastroenteritis was made after other causes such as parasitic infection, drug use and malignancy were ruled out. The patient was counseled on a six-food elimination diet which successfully resolved his diarrhea. The patient did not have any relapses with dietary modification on follow-up. Discussion: The recurrence rate of EGE is 50%. Steroids improve symptoms in 90% of cases but the recurrence rates are high. The type, dose and duration of steroid therapy is unclear. Sodium cromoglicate, ketotifen, and Montelukast are other proposed treatments, the results being inconclusive. Bowel resection is performed in intestinal obstruction, but medical therapy is needed as recurrence in other segments in common. Dietary modification, a therapy with no side-effects should be the first line of treatment as it can result in resolution sparing the patient of steroid induced side effects.
Investigation of Risk Of Bias due to Unreported and SelecTively included results in meta-analyses of nutrition research: the ROBUST study protocol
Authors: Page Matthew J. , Bero Lisa , Kroeger Cynthia M. , Dai Zhaoli , McDonald Sally , Forbes Andrew , McKenzie Joanne E. 
Published: October 2019

Background: Dietary guidelines should be informed by systematic reviews (SRs) of the available scientific evidence. However, if the SRs that underpin dietary guidelines are flawed in their design, conduct or reporting, the recommendations contained therein may be misleading or harmful. To date there has been little empirical investigation of bias due to selective inclusion of results, and bias due to missing results, in SRs of food/diet-outcome relationships. Objectives: To explore in SRs with meta-analyses of the association between food/diet and health-related outcomes: (i) whether systematic reviewers selectively included study effect estimates in meta-analyses when multiple effect estimates were available; (ii) what impact selective inclusion of study effect estimates may have on meta-analytic effects, and; (iii) the risk of bias due to missing results (publication bias and selective non-reporting bias) in meta-analyses. Methods: We will systematically search for SRs with meta-analysis of the association between food/diet and health-related outcomes in a generally healthy population, published between January 2018 and June 2019. We will randomly sort titles and abstracts and screen them until we identify 50 eligible SRs. The first reported meta-analysis of a binary or continuous outcome in each SR (the ‘index meta-analysis’) will be evaluated. We will extract from study reports all study effect estimates that were eligible for inclusion in the index meta-analyses (e.g. from multiple instruments and time points) and will quantify and test for evidence of selective inclusion of results. We will also assess the risk of bias due to missing results in the index meta-analyses using a new tool (ROB-ME). Ethics and dissemination: Ethics approval is not required because information will only be extracted from published studies. Dissemination of the results will be through peer-reviewed publications and presentations at conferences. We will make all data collected from this study publicly available via the Open Science Framework.
TRAUMATIC HEALTH EFFECTS DUE TO A STORM: AN OBSERVATIONAL CASE-STUDY ON PATIENTS RECEIVED AT THE COUNTY EMERGENCY CLINICAL HOSPITAL FROM TIMISOARA
Authors: Petrescu Cristina , Grecu Mihai , Barbu Silvia , Craina Marius 
Published: October 2019

Objective: The aim of the performed study was to investigate the traumatic health effects in patients received at the emergency service due to a storm event that happened on the 17th of September 2017 in Timisoara.
Material of study consisted of a sample of 75 patients (62.67% males, 37.33% females) who came to the emergency service of the County Hospital with traumatic health effects.
The method was an observational case-study with an investigation of traumatic health effects.
Results: Traumatic health effects due to the storm were caused by patients falling (51.78% of diagnostics: fractures, contusions, sprains) and by being hit by flying objects (42.85% of diagnostics: craniocerebral traumatisms and contusive wounds). The patients were either sent home (54.66%), admitted (25.34%) and hospitalized (13.33% more than 10 days) or transferred (12%).
Conclusion: Traumatic health effects due to the storm were severe and involved substantial recovery time and considerable expense of resources.
RESISTANCE TO ANTIPLATELET DRUGS IN PATIENTS WITH CEREBROVASCULAR DISEASE
Authors: Pucite Elina , Novasa Arina , Ievina Renija , Muravska Tatjana , Miglane Evija , Millers Andrejs 
Published: October 2019

INTRODUCTION: Cardiovascular diseases and stroke are steadily the leading causes of death in Latvia. Therefore, the greatest efforts should be given to recognize associative factors which may be modifiable to decrease the burden of ischemic events.
OBJECTIVES: The aim of this study was to examine the frequency of aspirin and clopidogrel resistance and its associated risk factors in patients with acute cerebrovascular events.
METHODS: The prospective, descriptive study included 204 patients. Patients were considered biochemical resistant to aspirin if platelet aggregation was ≥550 ARU, whereas biochemical clopidogrel resistance was defined when platelet inhibition was >230 PRU.
RESULTS: Biochemical aspirin resistance was found in 27 (13%) patients, whereas clopidogrel resistance - in 44 (22%) patients. Five patients (2%) had resistance to both antiplatelet drugs. In the analysis of blood parameters, none were associated with aspirin resistance, except the level of triglycerides which were lower in the aspirin resistance group (p=0.001; r=0.26). In the analysis of clopidogrel sensitivity there was a difference in diabetes prevalence where it was more frequent in the clopidogrel resistance group (15.6% vs. 40.9%; p=0.001; r=0.255). Patients with clopidogrel resistance had higher levels of triglycerides 1.7 (1.3-2.6) than patients grouped as sensitive 1.4 ((1.1-2.0), p=0.033; r=0.16).
CONCLUSION: Biochemical aspirin and clopidogrel resistance are quite common in patients with cerebrovascular diseases in Latvia. Our study found that patients with diabetes and elevated glycosylated hemoglobin level were more prone to clopidogrel biochemical resistance. However, the association between aspirin resistance and clinical, laboratory data remains inconclusive.
ADVERSE EFFECTS OF GONADOTROPINS USED IN INFERTILITY TREATMENT
Authors: Vintilă Bogdan Ioan , Butucă Anca , Morgovan Claudiu , Vonica Andreea Loredana , Liviu Rus Luca , Muntean Andrei Cătălin , Juncan Anca Maria , Gligor Felicia Gabriela 
Published: October 2019

Introduction: Infertility represents a problem for more and more couples all over the world, including in Romania. Thus, more and more women need to resort to drugs to treat infertility, treatments which are not without adverse reactions (Boivin et al., 2007). Modern therapy brings significant benefits in the treatment of infertility. Despite all the benefits, the controlled ovarian stimulation treatment does not lack the possibility of adverse reactions to the administered drugs.
Objectives: The aim of this study was to determine the potential adverse reactions experienced by patients during the treatment with gonadotropins followed by assisted conception
Methods: A study was done based on a questionnaire which included the adverse reactions comprised in the SmPCs (Summaries of Product Characteristics) of the original drugs, and also based on the adverse reactions frequently reported in clinical studies. The questionnaire was distributed in the online environment, from May 2018 to July 2018, in Romania, to patients to whom at least one of the analysed gonadotropins (corifollitropin alpha, follitropin alpha, follitropin beta, follitropin alpha/follitropin beta, menotropin, urofollitropin) was administered during the controlled ovarian stimulation treatment, in the routine practice of assisted human reproduction technology.
Results: The results show that a total number of 319 events suspected of being adverse reactions was reported, grouped on the highest MedDRA level, SOC (system – organ- class), with an average of 8.18 adverse reactions (AR)/patient.
Conclusions: The results of the study demonstrate the fact the disorders appeared after drug administration in the controlled ovarian stimulation treatment in the context of the routine practice of assisted human reproduction technology, were considered adverse reactions by the patients.