bluuebunny/crossref_metadata_2025_split huggingface dataset:
Four-year overview of enrollment and participation in research studies conducted at the Prostate Cancer Supportive Care (PCSC) Program.
Authors: Wu Eugenia , Arsovska Olga , Sundar Monita , Vivar Michaela , Pang Christopher , Spillane Maria , Hedden Lindsay , Goldenberg Larry , Higano Celestia S. 
Published: November 2019

39 Background: The mission of the Prostate Cancer Supportive Care (PCSC) Program at the Vancouver Prostate Centre (VPC) is to provide clinical care focused on the needs of prostate cancer patients and partners. It is comprised of six modules that are administered by medical professionals in urology, radiation oncology, sexual health nurses, registered dieticians, certified exercise physiologist, male pelvic floor physiotherapists, and couples’ counselling. Incorporation of research into daily care provides evidence for these practices, identifies areas for improvement, and tests new approaches. In order to evaluate the interface between the clinical and research programs, we reviewed the metrics of our PCSC program. Methods: Research studies were grouped by type. Screening and enrollment logs were reviewed to tally the total number of patients approached versus enrolled. Reasons for non-participation based on data in our enrollment logs were categorized. Results: Between Feb 2015 and Mar 2019, PCSC Program participated in 22 research studies: 9 therapeutic or lifestyle intervention studies (3 RCTs), 3 observational studies, 2 registries, 1 survey, 1 genetic study, 1 databank , 2 collaborative programmatic studies, 3 “permission to contact” studies (referral to the study team only). 8 of the 22 studies included recruitment of dyads (both patient and their partner or caregiver). Of 1080 consenting patients, 760 (70.4%) enrolled in 1 study, 210 (19.4%) in 2 studies, and 110 (10.2%) in > 3 studies. 583 patients did not consent due to lack of interest (43.7%), not available (21.1%), time constraints (10.3%), travel distance (6.7%). Conclusions: Our data show that a subspecialty supportive care program can provide a rich environment in which to conduct clinical research. We believe that the integration of the research program and personnel into the clinical setting is key to our success. Current on-going studies are evaluating the impact of and patient satisfaction with all PCSC modules.
Racial/ethnic disparities in hospice utilization among Medicare beneficiaries dying from pancreatic cancer.
Authors: Paredes Anghela , Hyer Madison , Palmer Elizabeth , Lustberg Maryam B. , Pawlik Timothy M. 
Published: November 2019

41 Background: While racial/ethnic treatment disparities among patients with pancreatic cancer have been documented, variation in other aspects of care including hospice utilization have not. As such, we sought to define the incidence, as well as characterize the timing, of hospice utilization among racial/ethnic minority patients following pancreatectomy for pancreatic cancer. Methods: The Medicare Standard Analytic Files were used to identify white and racial/ethnic minorities (African Americans and Hispanics) who underwent pancreatectomy for pancreatic cancer. Trends and timing related to overall hospice utilization among racial/ethnic minority and white patients were analyzed. Results: Among the 6,530 individuals (median age: 73, IQR 69-78; 51.5% female; 6.6% % racial/ethnic minority) who underwent a pancreatectomy for pancreatic cancer, 64.6% (n = 4221) had died by the end of the follow-period. Among deceased individuals, three-fourths of patients (n = 3149, 74.6%) had used hospice leading up to the time of death. Among individuals who died, age and comorbidity burden were similar among racial/ethnic minority and white patients; racial/ethnic minority patients were less likely, however, to have used hospice services compared with white patients (racial/ethnic minorities: n = 188, 68.9%, whites: n = 2,961, 75.0%; p = 0.024). On multivariable analysis, after controlling for clinical factors, racial/ethnic minority patients remained 27% less likely than whites to initiate hospice services prior to death (OR 0.73, 95%CI 0.56-0.95, p = 0.021). Despite overall lower use of hospice, racial/ethnic minority patients had comparable odds of late hospice utilization (i.e. within 3 days of death) versus white patients (OR 0.75, 95% CI 0.49-1.14, p = 0.18). Conclusions: While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, ethnic/racial minority were less likely to use hospice services than whites. Further research should seek to better understand possible barriers to hospice initiation among racial/ethnic minority patients with cancer.
Impact of mortality reviews on supportive care utilization, end-of-life care, and inpatient mortality.
Authors: Karimi Yasmin , Divi Vasu , Srinivas Sandy , Segura Smith Andrea , Hansen Jennifer , Tokareva Irina , Tulu Zeynep , Hedlin Haley , Fronk Joshua , Rosenthal Eben Lloyd , Blayney Douglas W. 
Published: November 2019

45 Background: 22% of US patients with cancer die in a hospital setting. As part of an effort to reduce unexpected inpatient (inpt) mortality, we reviewed records of all inpt cancer deaths at Stanford Hospital and reported findings to the treatment teams. Methods: Deaths with a cancer related ICD 9/10 code between 5/2017 and 6/2019 were reviewed by a multidisciplinary team. Findings and potential opportunities for improvement were communicated to the pt’s primary outpt oncologist, inpt oncologists and other involved providers. Observed to expected (O:E) mortality for the year prior to the intervention (5/2016–4/2017), Year 1 (5/2017–4/2018) and Year 2 (5/2018–4/2019) of the intervention were compared with two sided t test, α=0.05 (Vizient Inc, Irving TX). Changes in supportive care utilization and end of life care between cases reviewed in Year 1 and Year 2 were compared with chi square analysis. Results: There were 236 inpatient deaths reviewed. The median age was 64 years; 76% had solid tumors; 68% had metastatic disease; 33% had a previous inpt admission; 34% received chemotherapy in the last 2 weeks of life. Median length of stay was 7 days and 37% were admitted to the intensive care unit (ICU). The O:E mortality ratio significantly decreased between the year prior to intervention and Year 2 (0.95 vs. 0.69; p = .019), and Years 1 and 2 (0.90 vs. 0.69; p = .003). There was no noted difference in number of palliative care consults or resuscitation status at the time of death between Years 1 and 2. There was an increased frequency of advance care plan documentation on admission in Year 2 (p = .007). Conclusions: Cancer pts who die in the hospital have high rates of recent hospitalizations, chemotherapy/radiation use in the last 2 weeks of life and ICU admissions. Decrease in O:E is likely multifactorial. Potential factors are improved documentation of comorbidities, increased access to palliative care services, and facilitation of hospice referrals which were partially driven by results of our reviews and resulting awareness around end of life care. Work is ongoing to standardize documentation of goals of care conversations in the electronic medical record and employ lay health workers for earlier end of life discussions.
Describing the pediatric resident experience in caring for dying patients.
Authors: Umaretiya Puja J. , Spellun Arielle , Feraco Angela Marie 
Published: November 2019

51 Background: Cancer remains the leading cause of childhood death beyond infancy. Though growing subspecialty palliative care provides expertise in caring for dying children, all pediatricians encounter dying patients and should feel adequately prepared to participate in their care. Clinicians who feel insufficiently trained in communication or end-of-life care are more likely to distance themselves from seriously ill patients and report higher levels of distress and burnout. Pediatric residents are often responsible for the frontline care of dying children in the hospital and yet, most pediatric residencies lack a formal end-of-life curriculum. Here, we aim to understand the experience of pediatric residents caring for dying patients. Methods: A thirty-four item survey instrument was administered to residents in a large pediatric residency program at a tertiary care center at Rising Junior Orientation and Rising Senior Orientation in spring 2018. All residents present completed the survey. Results: Seventy-six residents completed surveys including 46 rising juniors and 30 rising seniors. Only 19 residents (25%) reported receiving any training in caring for dying children; most of which was by noon/morning conferences or informal teaching. Nearly all (70/74; 95%) residents felt that their training in caring for dying children was not sufficient. A majority of residents reported minimal to no comfort with discussion of goals of care (73%) or resuscitation status (69%), managing pain (76%), anxiety (79%), and dyspnea (80%) at the end-of-life, performing a death exam (81%), and reaching out to families after the death of a child (85%). A majority of residents anticipate continuing to care for dying children after residency (50/76; 66%). Conclusions: Pediatric residents are uncomfortable with caring for dying patients and receive minimal training, suggesting that end-of-life care is a large gap in the pediatric residency training experience.
Effect of inpatient palliative care on supportive care measures in patients undergoing hematopoietic cell transplantation (HCT).
Authors: El-Jawahri Areej , VanDusen Harry , Fenech Alyssa L. , Kavanaugh Alison , Jackson Vicki A. , Traeger Lara , Greer Joseph , Spitzer Thomas R. , Chen Yi-Bin Albert , Temel Jennifer S. 
Published: November 2019

70 Background: Inpatient palliative care integrated with transplant care has been shown to improve patient-reported quality of life (QOL), symptom burden, and psychological distress during hospitalization for HCT. However, the impact of palliative care on supportive care practices during HSCT remains unknown. Methods: This secondary analysis is based on a single-site randomized clinical trial of 160 patients with hematologic malignancies undergoing HSCT between 8/2014 and 1/2016. Participants received either inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). We used the electronic health record to obtain data on supportive care measures during HSCT including the use of patient-controlled analgesia (PCA), intravenous pain medications, atypical antipsychotics (used to treat nausea/anxiety), psychostimulants, antidepressants, hypnotics, and the use of standing orders (as opposed to as needed ‘PRN’) for supportive care medications. We compared the proportion of subjects in each group receiving these supportive care measures using Fisher’s exact test. Results: Patients randomized to the palliative care intervention were more likely to use PCA (32.1% vs. 15.19%, P = 0.015), and atypical antipsychotics (35.8% vs. 17.7%, P = 0.012) compared to those receiving transplant care alone. Intervention participants were also more likely to have standing orders for their supportive care medications (74.1% vs. 56.9%, P = 0.030) compared to those receiving transplant care alone. Study groups did not differ in the of intravenous pain medications, psychostimulants, antidepressants, or hypnotics. Conclusions: Patients receiving inpatient integrated palliative and transplant care were more likely to utilize PCA and atypical antipsychotics during HCT compared to those receiving transplant care alone. Future work should examine whether these differences in supportive care practices mediate the effect of the palliative care intervention on patient-reported outcomes. Clinical trial information: NCT02207322.
Physiological and psychological associations of early childhood adversity in lung cancer.
Authors: McFarland Daniel Curtis , Jutagir Devika R , Rosenfeld Barry , Nelson Christian J. 
Published: November 2019

80 Background: Early Childhood Adversity (ECA) explains the presence of psychological issues such as depression in many chronic disease settings but has not been measured in lung cancer. ECA may increase the positive predictive value for detecting lung cancer related psychological problems. ECA is associated with inflammation in adulthood independent of psychological outcomes or other chronic diseases. Similarly, depression is associated with inflammation. Patients with lung cancer have elevated physical symptoms, which are increased in the presence of depression, but have not been measured in the presence of ECA. We hypothesized that psychological issues and physical symptoms are worse in lung cancer patients who experienced ECA and that this relationship is explained by inflammation. Methods: Patients with stage IV lung cancer (n = 92) were evaluated for ECA using the Risky Families Questionnaire. Concomitant assessments were made of distress (Distress Thermometer and Problem List [DT&PL]), anxiety (Generalized Anxiety Disorder-7), depression (Patient Hospital Questionniare-9), physical symptoms (DT&PL), and inflammation (C-reactive protein [CRP]). Multivariate models were created to explain associations with depression, anxiety, and distress. Results: ECA was associated with younger age (p = .006), elevated CRP (p = .042), distress (p = .032), anxiety (p = .004), depression ( = .001) and greater physical problems (p = .025). Multivariate analyses of psychological outcomes found that ECA (p = .017) explained depression severity, but not distress or anxiety, while controlling for age, sex, and physical symptoms. No interaction effects were seen between inflammation, physical symptoms, and ECA. Conclusions: ECA places lung cancer patients at a higher risk of developing depression, which complicates lung cancer treatment, quality of life, and overall survival outcomes. ECA should be factored into lung cancer patient psychological assessments.
A comparison of treatment preferences, decision making, and psychosocial outcomes in advanced cancer patients with and without minor children: A matched cohort study.
Authors: Park Eliza Myung , Deal Allison Mary , Hanson Laura C. , Rosenstein Donald L. , Quillen Laura J. , Hailey Claire E. , Chien Stephanie A. , Sanoff Hanna Kelly , Carey Lisa A. , Song Mi-Kyung 
Published: November 2019

91 Background: Patients with advanced cancer who have minor children face unique challenges when coping with their life-limiting illness and the impact of their illness on their families. The goal of this study was to examine whether psychosocial functioning, treatment preferences, and treatment decisions in advanced cancer differ by parental status. Methods: A cohort of 60 parents with metastatic solid tumors age-matched with 60 non-parents (N = 120) participated in three structured interviews assessing treatment preferences and decisions over six months with complementary medical record review. Participants also completed validated measures of psychosocial functioning. Results: Seventy percent (n = 85) of the sample completed all study assessments. Mean age (45 years, SD 8), mean performance status score (ECOG = 1.2, SD 0.9), median duration of metastatic illness (19 months, range 1-115), gender ratio (66% female), and dropout rates were similar between groups. Parents and non-parents reported similar overall health-related quality of life, but parents were more likely to report poorer emotional well-being (p = 0.006) and more symptoms of depression (p = 0.04) and anxiety (p = 0.04) than non-parents. Parents and non-parents were equally likely to describe life-extension as their primary goal of anti-neoplastic treatment. Parents reported greater willingness to live in pain (48% “very willing” vs 27%, p = 0.007) and accept intubation/ventilation (40% vs 20%, p = 0.01) for life-extension. Compared to non-parents, parents were more likely to report their family members as the most influential factor in their decision-making (44% vs 12%) and less likely to cite their oncologist’s recommendation (25% vs 41%). There were no significant differences between groups for completion of a health care power of attorney or living will. Conclusions: Compared to similarly aged adults with metastatic cancer, parents experience greater psychological distress, are more willing to live in pain for life extension, and place greater importance on family-related factors in their cancer treatment decision-making.
Real-world experience with electronic patient reported outcomes and missing items: "Don't ask me irrelevant questions".
Authors: Rosett Heather A , Locke Susan C. , Wolf Steven Paul , Herring Kris , Samsa Greg P. , Troy Jesse D , LeBlanc Thomas William 
Published: November 2019

99 Background: Electronic patient-reported outcomes (ePROs) can improve quality of life and prolong survival in patients with cancer by enhancing the detection and tracking of unmet supportive care needs. However, there remain unanswered questions about how to handle missing ePRO data. We hypothesized that patients may skip specific questions they feel do not apply to them. We aimed to examine the relationship between patient demographics and missing items in a real-world ePRO dataset. Methods: We utilized a prospectively collected database of ePROs from oncology clinics administering Patient Care Monitor 2.0 (PCM), a validated symptom survey of 78 items for men and 86 for women. We tabulated the frequency of missing items by item and domain (emotional, functional and symptom-related), and examined these by age, gender, education, race and marital status. Results: In 20,986 encounters there were responses to at least 1 PCM item from 6,933 patients. On average just 1% of items were skipped per encounter. By domain, 12.3% of functional, 8.4% of symptom-related, and 1.6% of emotional constructs contained at least one missing item. The highest frequency of item non-response was seen in older patients (>60yo) and those with high school education or less. The most frequently skipped items included: “attend a paid job” (10.7%), “reduced sexual enjoyment” (3.8%), and “running” (3.7%). These questions may be less relevant to older individuals, who, for example, quit running years earlier or are retired. Men had less missingness overall, except for “cooks for self” and “house work”, which may reflect traditional gender roles in the Southeast US. Conclusions: In a real-world ePRO implementation, items pertaining to more universal issues for cancer patients, like emotional well-being, have much lower rates of missingness, especially compared to functional items like “attend a paid job.” These results suggest that patients differentially complete ePROs based on perceived question relevance to them. The underlying driver behind individual item non-response may itself be an important data point in clinical care, warranting further study and discussion during clinic visits.
The Acute:Chronic Workload Ratio Is Associated with Injury in Junior Tennis Players
Authors: MYERS NATALIE L. , AGUILAR KRISTIN V. , MEXICANO GUADALUPE , FARNSWORTH JAMES L. , KNUDSON DUANE , KIBLER W. BEN 
Published: November 2019

ABSTRACT

Purpose
Session RPE (sRPE) is used to track internal training/competition load in athletes using a metric known as the acute to chronic workload ratio (ACWR). Research that reported on team sports has determined that if the acute load is higher than the chronic load, athletes are likely to sustain injury. No studies, however, have attempted to investigate internal load and injury in a tennis population despite the rigorous training loads. Therefore, the purpose of this study was to investigate if sRPE ACWR is associated with injury in junior tennis players over a 7-month time period.

Methods
Forty-two junior tennis players were recruited to participate, 26 were included in the final analysis. Players provided a rating of RPE as an estimate of training intensity every day after training/match sessions. sRPE, a measure of internal and external training load was calculated by multiplying the training/match sRPE by the session duration in minutes. Players self-reported all injuries. The ACWR was the primary independent variable. Acute load was determined as the total sRPE for 1 wk, whereas a 4-wk rolling average sRPE represented chronic load.

Results
Seventeen players sustained injuries. The model indicated that ACWR from the previous week (P < 0.001) and previous injury history (P = 0.003) were significant predictors of injury the following week. In the week preceding injury, the average ACWR was 1.57 (SD, 0.90).

Conclusion
Injured players had on average 1.5 times more training load in the past week compared with the previous 4 wk. A majority of players who went on to sustain an injury were not prepared for the load endured. These results were similar to previous studies investigating ACWR where an acute increase in load was associated with increased injury risk.
Time-Motion Analysis and Physiological Responses to Taekwondo Combat in Juvenile and Adult Athletes: A Systematic Review
Authors: Santos Jonatas Ferreira da Silva , Dias Wilson Vinicius , Herrera-Valenzuela Tomas , Sander Mansur Machado Frederico 
Published: November 2019

ABSTRACTTaekwondo is a complex combat sport characterized by high-intensity short activity and low-intensity activity and/or pause. This systematic review focused on which type of physical capacities and the main physiological adjustments that are demanded during official taekwondo matches. The search was performed in electronic databases in which 38 articles were selected. Taekwondo matches' characteristics, time-motion analysis, physical and physiological responses during prematch and postmatch were described. After analysis, practical recommendations were suggested regarding physical training prescriptions oriented to performance optimization of taekwondo athletes.
Security analysis of key agreement protocol based on matrix power function
Authors: Vitkus Paulius , Sakalauskas Eligijus 
Published: November 2019

Key agreement protocol (KAP) using Burau braid groups representation and matrix power function (MPF) is analyzed. MPF arguments are Burau representation matrices defined over finite field or ring. It is shown that KAP security relies on the solution of matrix multivariate quadratic system of equations over the ring with additional commutation constraints for matrices to be found. We are making a conjecture that proposed KAP is a candidate one-way function since its inversion is related with the solution of known multivariate quadratic problem which is NP-complete over any field. The one of advantages of proposed KAP is its possible effective realization even in restricted computational environments by avoiding arithmetic operations with big integers.
The basic solution ellipsoid method approach for the efficiency measurement problems
Authors: Laurinavičius Eligijus , Rimkuvienė Daiva , Sakalauskaitė Aurelija 
Published: November 2019

The efficiency is a measure of a performance of a decision making units (DMUs can be a firm, a person, an organization). The data envelopment analysis (DEA) is a datadriven non-parametric approach for measuring the efficiency of a set of DMUs. The DEA is a linear programming (LP) based technique which deals with the basic models (CCR, BCC, SBM, additive) of the efficiency evaluation. This paper presents basic solution ellipsoid method approach associated with some problems of initial basic solution and the steps of it.