bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis
Authors: Tyler Natasha , Wright Nicola , Waring Justin 
Published: November 2019

Abstract
Background
The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve.

Methods
The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient to community services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions relating to discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique.

Results
The total number of papers from which data were extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis.

Conclusions
The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.
Opioid use disorder and treatment: challenges and opportunities
Authors: Hoffman Kim A. , Ponce Terashima Javier , McCarty Dennis 
Published: November 2019

AbstractBackgroundAddiction health service researchers have focused efforts on opioid use disorder (OUD) and strategies to address the emerging public health threats associated with the epidemics of opioid use and opioid overdose. The increase in OUD is associated with widespread access to prescription opioid analgesics, enhanced purity of heroin, the introduction of potent illicit fentanyl compounds, and a rising tide of opioid overdose fatalities. These deaths have become the face of the opioid epidemic.Main TextOUD is a chronic disorder that usually requires both medications for opioid use disorder (MOUD) and psychosocial treatment and support. Research has found that MOUD with an opioid receptor agonist (methadone), partial agonist (buprenorphine), or opioid antagonist (extended-release naltrexone) can support recovery. Despite compelling evidence that MOUD are effective, they remain underutilized. More research is needed on these therapies to understand the feasibility of implementation in clinic settings.ConclusionThis special issue focuses on how health services research has emerged as an important contributor to efforts to control the opioid epidemic in North America and Europe.
The effects of androgen deprivation therapy and radiation therapy on cancer-related fatigue.
Authors: Saligan Leorey 
Published: November 2019

10 Background: Fatigue is a common symptom characterized by incapacitating tiredness. Androgen deprivation therapy (ADT) in combination with radiotherapy (RT) is one of the standard treatments for prostate cancer. Fatigue often worsens during RT with concomitant ADT and it persists long after treatment completion. The purpose of this study is to examine the effects of combined ADT and RT on fatigue in prostate cancer men and in a fatigue mouse model. Methods: 64 participants were recruited and followed at baseline, midpoint, completion, and 1 year post-RT. Two cohorts of men: +ADT cotinued after RT (n=27), +ADT during RT only (n=20), and -ADT (n=17). Fatigue was measured using FACT-F. Male C57BI/6 mice (n=55) were randomly placed into 2 groups: +ADT and –ADT (control). Mice were further subdivided into +RT and –RT (sham) groups. Voluntary Wheel Running Activity (VWRA) data from all mice were recorded for 6 days post-irradiation and the total average of all 6 days was used for analysis. Results: Fatigue (n=64) worsened during RT ( p=.02 at midpoint, p=.04 at completion). ADT significantly affected fatigue development over time (F3,42 = 3.80, p=.02) with the most significant difference occurring at midpoint ( p<.001) and completion of RT ( p<0.001). VWRA significantly decreased in mice that received the combination of ADT and irradiation, compared to those that received only ADT + sham radiation ( p=.001) and no ADT + sham radiation ( p=.004). Transcription factor A, mitochondrial (TFAM) in brain cortical samples was significantly reduced in irradiated mice compared to control mice ( p=.014). Glucose transported type 4 (GLUT4) in brain cortices was significantly reduced in irradiated mice compared to non-irradiated mice ( p=.0057). GLUT4 was also significantly reduced in irradiated mice receiving ADT compared to control mice receiving sham RT ( p=.043). Conclusions: There is a significant combined effect of ADT and RT on fatigue in both humans and mice. Mitochondrial function/neuronal bioenergetic markers were altered in the cortices of irradiated mice that received concomitant ADT. These findings suggest that fatigue experienced by subjects who receive ADT + RT could be attributable to impaired cortical energy production.
Derivation and implementation of a machine learning approach to prompt serious illness conversations among outpatients with cancer.
Authors: Parikh Ravi Bharat , Manz Chris , Chivers Corey , Regli Susan B , Braun Jennifer , Jones Joshua Adam , Mamtani Ronac , Draugelis Michael , Bekelman Justin E. , Navathe Amol S. , Patel Mitesh S. , Shulman Lawrence N. , Schuchter Lynn Mara , O'Connor Nina 
Published: November 2019

131 Background: Machine learning (ML) algorithms can accurately identify patients with cancer at risk of short-term mortality and facilitate timely conversations about treatment and end-of-life preferences. We developed, validated, and implemented a ML algorithm to predict mortality in a general oncology setting, using electronic health record (EHR) data prior to a clinic visit. Methods: Our cohort consisted of patients aged ≥18 years who had an encounter in outpatient oncology practices within a large academic health system between February 1st and July 1st, 2016. We randomly split the sample into training (70%) and validation (30%) cohorts at the patient-encounter level. We trained three ML algorithms to predict 180-day mortality and describe performance in the holdout validation cohort. From October 2018 to February 2019, we used the best-performing algorithm to generate weekly lists of high-risk patients at a single community oncology practice and studied the impact on rates of documented serious illness conversations (SICs). Results: Among 62,377 encounters used to train the algorithms, 7.4% involved a patient who died within 180 days. Gradient boosting and/or random forest outperformed logistic regression in all metrics (Table), and the gradient boosting model had superior discrimination and calibration. In the gradient boosting model, observed 180-day mortality was 45.5% (95% CI 39.0-52.3%) in the high-risk group vs. 3.3% (95% CI 2.9-3.7%) in the low-risk group. In a survey of oncology clinicians, 59% of patients flagged as high-risk were appropriate for a serious illness conversation in the upcoming week (response rate 52%). Five months after implementing the intervention, average monthly documented SICs increased by 23% (31.7 to 39). Conclusions: A ML algorithm based on EHR data accurately identified patients with cancer at risk of short-term mortality, was concordant with oncologists’ assessments, and was associated with more SICs. [Table: see text]
Results of a pilot randomized controlled trial: A couple-based meditation intervention for patients with metastatic lung cancer and their partners.
Authors: Milbury Kathrin , Li Yisheng , Durrani Sania , Liao Zhongxing X. , Yang Claire Chunyi , Tsao Anne S. , Cohen Lorenzo , Bruera Eduardo 
Published: November 2019

135 Background: Although mindfulness-based interventions have been widely examined in patients with early stage cancer, the feasibility and efficacy of these types of programs are largely unknown in the palliative care setting. We developed a couple-based intervention integrating meditation training with emotional disclosure exercises to target psychological distress in patients with metastatic lung cancer and their partners. Methods: Dyads completed baseline self-report measures and were then randomized to a couple-based meditation (CBM), a supportive-expressive (SE), or a waitlist control (WLC) group. Couples in the CBM and ES groups attended 4 weekly, 60 min. therapist-led sessions that were delivered via FaceTime. All groups were reassessed 1 month and 3 months later. Results: Seventy-five patients (51% female; mean age = 64 years) and their partners’ (52% female; mean age = 64 years) were randomized (63% consent rate) of which 79% completed the first and 65% completed the second follow-up assessments. Attrition was mainly due to patients’ death (44%). Although attendance was high in both groups (means: CBM = 3.12; SE = 3.08), dyads in the CBM group indicated greater benefit (P < .003) and usefulness (P < .05) of the sessions compared to those in the SE group. Compared with the WLC group, patients in the CBM group reported significantly lower depressive symptoms (P = .02; d = .49; CES-D means: CBM = 7.87; SE = 11.51; WLC = 12.76) and cancer specific distress (P = .05; d = .44; IES means: CBM = 12.40; SE = 16.34; WLC = 18.22). Similarly, compared with the WLC group, partners in the CBM group reported significantly lower depressive symptoms (P = .02; d = .58; means: CBM = 7.18; AC = 8.91; WLC = 11.62). For both patients and partners, there were no effects between SE and WLC groups. While small effects (d = .22-.42) in favor of the CBM group relative to the SE group were revealed, these differences were not significant. Conclusions: It seems to be feasible, acceptable and possibly efficacious to deliver dyadic interventions via FaceTime to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to manage symptom burden in the palliative care setting. Clinical trial information: NCT02596490.
Piloting workshops to enhance hope among patients with advanced breast cancer and oncologists.
Authors: Shah Mirat , Ferguson Anna K. , Gutfeld Orit , Corn Dvora , Varadhan Ravi , Stearns Vered , Smith B. Douglas , Smith Thomas J. , Corn Benjamin W. 
Published: November 2019

137 Background: Hope is a modifiable entity that can be separated from cancer outcome. Increasing hopefulness in patients with advanced breast cancer and oncologists may be of intrinsic value. The feasibility and efficacy of a short intervention to increase hopefulness in these groups are unknown. Methods: We enrolled eligible participants at 2 medical centers into 2 cohorts- 1 for patients with advanced breast cancer and 1 for oncologists. The intervention, a half-day hope enhancement workshop (HEW), was conducted in groups of 10-15 participants within each cohort. Participants completed evaluations including the Adult Hope Scale (AHS) and Herth Hope Index (HHI) pre-workshop, post-workshop, and at 3 months. Mean scores were compared across time points within each cohort using paired t-tests. Results: Ten out of 13 consented patients (76.9%) and all 26 consented physicians (100%) participated in the HEW, meeting our feasibility threshold. In patients, the mean AHS score increased significantly from 50.60 (SD 4.88) pre-workshop to 56.50 (SD 4.74) post-workshop (t = 3.99, p = 0.003); the mean HHI score also increased but this trend was not significant. In oncologists, the increases in mean AHS and HHI scores post-workshop were smaller and not significant. A summary is shown in the table. Post-workshop, patients and physicians were inclined to apply what they learned. However, at 3 months, less than half of participants responded to the evaluation. Mean AHS and HHI scores in patients fell back to baseline values. Conclusions: A short intervention to enhance hope was feasible and associated with increased hopefulness in patients, which was not maintained. Next steps for patients include “maintenance hope therapy” with earlier follow-up and more sustained contact post-workshop. Among oncologists, we hypothesize that for those not grappling with poor prognoses, reframing hope may be less effective, and they may feel less urgency to augment their hopefulness. [Table: see text]
Depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer.
Authors: El-Jawahri Areej , Greer Joseph , Jackson Vicki A. , Gallagher Emily R. , Kamdar Mihir , Rinaldi Simone , Temel Jennifer S. 
Published: November 2019

17 Background: Caregivers of patients with advanced cancer experience substantial caregiving burden and psychological distress during the illness course. However, data on depression and anxiety symptoms in bereaved caregivers and factors associated with their psychological distress are lacking. Methods: We conducted a secondary analysis of 168 caregivers enrolled in a randomized trial of early palliative care integrated with oncology care versus oncology care alone for patients newly-diagnosed with incurable lung and non-colorectal gastrointestinal cancers and their caregivers who completed bereavement assessments at 3 months after their loved one’s death. We used the Hospital Anxiety and Depression Scale (HADS) to assess patients’ and caregivers’ depression and anxiety symptoms at baseline within 8 weeks of diagnosis, and at 3-4 months after the patient’s death (for caregivers). We asked caregivers to rate patient’s physical and psychological distress in the last week of life on a 10-point scale. We used linear regression adjusting for randomization and cancer type to explore associations between patient and caregiver factors and bereaved caregivers’ depression and anxiety. Results: 30.4% (51/168) and 43.4% (73/168) of bereaved caregivers reported clinically significant depression and anxiety symptoms, respectively. Younger patient age (B = -0.06, P = 0.041), higher patient baseline anxiety (B = 0.28, P = 0.002), and caregiver rating of worse physical (B = 0.28, P = 0.035) and psychological (B = 0.41, P < 0.001) distress experienced by the patient at the end of life (EOL) were associated with worse depression symptoms in bereaved caregivers. Only caregiver factors, including age (B = -0.07, P = 0.004), female sex (B = 1.60, P = 0.024), and rating of worse psychological distress experienced by the patient at the EOL (B = 0.42, P < 0.001) were associated with worse bereaved caregivers’ anxiety symptoms. Conclusions: Bereaved caregivers of patients with advanced cancer experience substantial psychological distress which is associated with their perceptions of their loved one’s distress at the EOL. Interventions to optimize EOL care for patients and reduce bereaved caregivers’ psychological distress are needed.
Accrual and retention trends among diverse patients in a supportive cancer care trial.
Authors: Hanvey Grace A. , Padron Adaixa , Kacel Elizabeth L. , Ulfig Chantel , Pereira Deidre B. 
Published: November 2019

40 Background: Despite reporting similar levels of willingness to participate in clinical trials, minority cancer patients remain underrepresented in research interventions. The purpose of this analysis was to examine participant age, race, and ethnicity as predictors of study interest, eligibility, enrollment decision, and attrition in an intervention providing supportive care for women with cancer. Methods: Patients from the UF&Shands Gynecologic Oncology Service (N = 568) were approached for recruitment to either a six-week cognitive-behavioral intervention for insomnia and pain or a psychoeducational control condition. These women were queried about their willingness to participate in the study, interest level, and reasons for declining participation if they did not wish to enroll in the trial. Among enrolled patients (N = 64), predictors of attrition were explored. Results: Of approached patients, 57.2% were older than age 60, 14.7% were non-White, and 3.2% were Hispanic. Chi-square analyses indicated that there were no significant differences in interest level by age [χ2(2,441) = 2.732, p = .255], race [χ2(2,439) = 2.019, p = .364], or ethnicity [χ2(2,431) = 3.242, p = .198]. Eligible minority patients were significantly more likely to enroll than were non-Hispanic Whites [χ2(1,364) = 4.125, p = .042], with Hispanic recruitment driving this difference (p = .011). Survival analyses demonstrated no differences in attrition hazard based on age (B = -.088, p = .825), race (B = .583, p = .275), or ethnicity (B = -19.518, p = .999) among enrolled patients. Conclusions: In our supportive cancer clinical trial (CCT), there were no significant differences in trial interest across racial and ethnic minority groups. In fact, Hispanics were more likely to enroll than non-Hispanics. Furthermore, neither race nor ethnicity was a significant predictor of trial attrition. Future investigation is needed to better understand racial and ethnic disparities in cancer research enrollment, motivators and barriers to participation in supportive cancer care trials, potential inconsistencies in accrual patterns among minority cancer patients, and best practices for enrolling and retaining diverse participants for supportive CCTs. Clinical trial information: NCT02609880.
Multiple chronic conditions and intensity of end-of-life care among patients with cancer.
Authors: McDermott Cara L. , Engelberg Ruth , Sorror Mohamed Lotfy , Sibley James , Curtis J. Randall 
Published: November 2019

47 Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care in many conditions but their effect has not been well explored in patients with cancer. We examined intensity of EOL care and advance care planning (ACP) by patients with cancer and MCCs versus those without MCCs to better understand how MCCs affect EOL healthcare use in this population. Methods: Our sample included patients with cancer in the UW Medicine system who died between 2010-2017. MCCs were defined using the Dartmouth Atlas of Healthcare for the most common categories of severe illness in the last two years of life. These included chronic pulmonary disease, coronary artery disease (CAD), heart failure, severe chronic liver disease, chronic renal disease, dementia, diabetes with end organ damage, or peripheral vascular disease. Patients were categorized as having none or 1+ MCCs. We used a claims-based indicator for the presence of functional limitation. Outcomes included ACP documentation in the electronic health record, death in hospital, and inpatient or ICU admission in the last month of life. We performed logistic regression for all outcomes controlling for confounders defined a priori (age at death, race, sex, marital status, insurance, education, functional limitation). Results: Of 15,092 patients with cancer, 10,596 (70%) had 1+MCCs (range 1-8 MCCs). Common MCCs were pulmonary (25%), CAD (23%), and renal (18%). Those with MCCs were older (median 66 years (range 18-104) vs 63 years (range 18-102)), with more functional limitations (65% vs 43%). Those with 1+ MCC had more ACP documentation (43% vs. 23%) compared to those with no MCCs. Patients with 1+ MCC were more likely to die in hospital (OR 1.86, 95% CI 1.72-2.02) and to have inpatient (OR 2.45, 95% CI 2.20-2.72) or ICU admissions (OR 2.95, 95% CI 2.55-3.42) in their last 30 days versus patients with cancer and no MCCs. Conclusions: Among patients with cancer in a single healthcare system, patients with cancer and MCCs were more likely to have ACP documentation, die in hospital and experience high-intensity hospital-based care at or near EOL. Further research is needed to explore if such high-intensity care is aligned with patient and family goals for care.
Movement in the wrong direction: Inaccurate change in prognostic understanding and its predictors.
Authors: George Login , Epstein Andrew S. , Prigerson Holly Gwen 
Published: November 2019

54 Background: Prognostic understanding research has primarily focused on improvements in the accuracy of patient understanding and factors driving such improvements. However, could patients with a terminal prognosis become more inaccurate in their understanding, and what factors predict such change? Methods: In a multi-site prospective study, 184 advanced cancer patients, whom oncologists expected to die within 6 months, were assessed twice (median time 5 weeks apart). Potential predictors were examined at the first assessment: age, gender, education, marital and insurance status, race, ethnicity, geographical region, cancer type, physical and psychological quality of life, and religious beliefs in end-of-life care. The accuracy of prognostic understanding was measured at both assessments using a 4-item index (understanding of terminal illness status, shortened life-expectancy, disease incurability, and advanced stage). Patients with lower prognostic understanding scores at the second assessment compared to the first assessment were categorized as demonstrating more inaccurate understanding. Results: 18.5% ( n = 34) of patients became more inaccurate in their prognostic understanding. Race ( p < .01), geographic region ( p = 0.03), and religious beliefs ( p < .01) emerged as significant correlates. Specifically, being non-white, being from South-Western/Western United States, and holding stronger religious beliefs were associated with higher likelihood of prognostic understanding becoming more inaccurate. Simultaneously examining these three predictors in a logistic regression model showed likely overlap in their predictive ability, with race ( p = 0.45) and geographic region ( p = .32 & .72, dummy coded) becoming non-significant, and religious beliefs retaining marginal significance ( p = .06). Conclusions: Some patients with a terminal prognosis may become more inaccurate in their prognostic understanding, and this may be more likely among those with stronger religious beliefs. The findings additionally raise the potential role of inaccurate prognostic understanding in contributing to the racial, religious, and regional disparities currently found in end-of-life care.