bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prototype mobile application to improve communication about symptom management.
Authors: LeBlanc Matthew Roger , LeBlanc Thomas William , Smith Sophia Kustas 
Published: November 2019

27 Background: Cancer patients report many physical and emotional symptoms which can go unreported and underestimated resulting in unmet needs. Research suggests systematic collection of symptom data is associated with decreased emergency department use, increased quality of life, treatment toleration and overall survival. The multiple myeloma (MM) patient population is noted to have high symptom burden and represent an important target for intervention. This project aimed to develop a prototype app to facilitate MM patient/clinician communication about symptom management. Methods: 15 MM patients and 11 MM clinicians were interviewed to better understand patients’ symptom experience and management practices and preferences. Insights gained guided development of a prototype MM Coach mobile app. The think aloud protocol and cognitive interviewing were used to test usability and the prototype was iteratively refined. Results: Subjects highlighted a need for better symptom tracking over time, medication adherence tools, and real-time feedback to help patients self-manage symptoms. Our prototype app contains several modules designed to facilitate MM patient symptom management. 1) Track Symptoms; Using the Edmonton Symptom Assessment Scale patients track bothersome symptoms whenever they occur. 2) Track Medications; Patients can set up medication alerts and log medication use. 3) Track Mood; Patients record and track their distress level using the Distress Thermometer. 4) Relaxation Tools; This module contains a number of useful mind body activities such as guided imagery. 5) Get Support; Links to MM and non-MM related sources of support. 6) Prepare for Appointments; This module facilitates patients’ prioritizing issues to facilitate productive clinical encounters. 7) Insights; Patients and clinicians can review trends in symptom burden and medication adherence. 8) Learn; Educational content on topics relevant to MM symptoms such as pain, fatigue, depression. Conclusions: Our team is currently working with mobile app developers to build a version for the iOS AppStore and Android GooglePlay store. A pilot will be conducted to evaluate acceptability and feasibility in preparation for a clinical trial.
Factors associated with time to palliative radiotherapy in an academic radiation oncology clinic.
Authors: Hughes Ryan T. , Nagatsuka Moeko , Glenn Chase , Johnson Adam G. , Brown Doris R. 
Published: November 2019

56 Background: Palliative radiotherapy (PRT) is a common and effective modality for the relief of symptoms due to malignancy. Members of the supportive care team may be hesitant to refer for PRT due to concerns regarding timeliness of treatment and patient/caregiver time burden. The current structure of most radiation oncology clinics is not conducive to the delivery of timely PRT and few metrics aimed at quality improvement have been reported. Methods: We reviewed all courses of PRT delivered at our institution between January 2017 and December 2018. Hematologic/myeloma primary and postoperative cases were excluded. The dates of referral, consultation, PRT planning simulation, PRT start and end were recorded. An inherent delay was noted if PRT was purposefully delayed (workup, imaging). Time to PRT (TTPRT) was defined as the number of days between referral and start of PRT. A remaining life ratio (RLR) representing TTPRT as a proportion of survival from the time of referral, was developed as a practical metric to represent timeliness of PRT with respect to prognosis. Results: 338 courses of PRT were included from 67% outpatient and 33% inpatient referrals. Indications included pain (55%), neurologic deficits/brain metastases (23%), respiratory symptoms (10%), bleeding (6%) and other (7%). Median TTPRT was 13 d (IQR 4-19), comprised of: referral to consult (3 d), consult to simulation (4 d), and simulation to PRT (6 d). Factors associated with TTPRT included ECOG, PRT indication, site (non-spine bone, chest, or brain), outpatient referral and delay. TTPRT was not associated with age, gender, rural residence, distance to hospital, race, median household income, insurance or marital status. Of 229 patients who died, factors associated with increased RLR were outpatient referral (13% v. 5%), abdomen/pelvis treatment site (16% v. 9%) and delay (17% v. 8%). Conclusions: TTPRT is associated with patient, treatment, and systematic factors, some of which are associated with increased RLR, elucidating several opportunities for improvement. Based on these results, our group has established a dedicated Palliative Radiation Oncology Clinic focused on timely, quality PRT, the outcomes of which will be assessed prospectively.
Comparative analysis of internal medicine physicians’ perspectives and attitudes when addressing palliative care needs in heart failure and cancer patients.
Authors: Katiyar Vatsala , Araujo Tiago , Vohra Ishaan , Pichardo Rayli , Mukthinuthalapati Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar , Yadav Neha 
Published: November 2019

7 Background: Palliative care (PC) is heavily centered on patients with advanced and often incurable malignancies. Despite having a comparable symptomatic burden and worse mortality rates than some types of cancer, heart failure (HF) patients have decreased rate of palliative service referral of approximately 7%, as opposed to 48% in those with malignancies. We aim to understand the differences in the attitudes of physicians when addressing the PC needs for patients with advanced HF and malignancies. Methods: All the internal medicine residents at our institute were asked to fill out a structured paper-based questionnaire. The survey tool consisted of both Likert-type scales and open-ended questions focused on their attitude and perceptions while managing patients with advanced HF and Stage IV malignancy. Descriptive statistics and intergroup comparisons were then made for all quantifiable variables (Table). Results: Of the 137 medicine residents, 120 (87.6%) completed the survey. 70% were males and 96.6% residents were in the age group of 25-34 years. 62.5% residents had done a PC rotation prior to answering the survey and they were more comfortable in initiating goals of care (GOC) discussion for these patients. More residents were comfortable communicating the prognosis of patients with HF as compared to cancer patients irrespective of the level of training. Of the 26 residents interested in pursuing cardiology as a subspecialty, only 5 (19.2%) thought that the 5-year mortality of advanced HF ≥50%. Conclusions: Physicians often underestimate the symptom burden and mortality of HF patients and are less likely to consult PC for them. Early integration of PC in the management of HF patients is recommended and physicians need to be educated on these guidelines. [Table: see text]
Feasibility of a collaborative palliative and oncology care intervention to improve symptoms and coping during head and neck chemoradiation.
Authors: Bauman Jessica Ruth , Panick Jessie , Galloway Thomas James , Ridge John A. , McShane Melissa , Chwistek Marcin , Collins Molly , Kinczewski Leigh , Murphy Kathleen , Welsh Marie , Farren Matthew , Clark Mollie , Kelly Jacqueline , Schuster Katherine , Stokes Lauren , Amrhein Sheila , Bender Florence , Egleston Brian L. , El-Jawahri Areej , Fang Carolyn Y 
Published: November 2019

73 Background: Patients receiving curative chemoradiation treatment (CRT) for head and neck cancer (HNC) undergo one of the most intensive treatments in oncology, resulting in immense physical and psychological symptoms. Integrated palliative care can improve symptoms and coping in patients with advanced cancer, but has not been evaluated in patients with curable solid tumors. Thus, we are conducting the first pilot study of a collaborative palliative and oncology care intervention among patients receiving CRT to assess feasibility and acceptability. Methods: Eligible participants include newly diagnosed HNC patients starting curative-intent CRT. The intervention entails weekly in-person palliative care (PC) visits integrated with standard oncology care during CRT, followed by 4 weekly phone calls after CRT ends. The PC visits are conducted primarily by a PC RN, with a supervising MD or NP available. Visits focus on coping and managing prominent symptoms during CRT. PC clinicians also receive a weekly patient-reported symptom assessment. Acceptability of the intervention is assessed at 1 month post CRT. The primary outcome is feasibility, defined as a >50% enrollment rate with >70% of participants attending at least half of the PC visits. Planned accrual is 20 patients. Results: We have enrolled 88% (14/16) of eligible patients to date. 11/14 (79%) have p16+ disease. All 14 have completed CRT and are evaluable for feasibility. Participants attended 98% (94/96) of all possible PC visits and completed 99% (95/96) of weekly symptom assessments. PC clinicians spent an average of 35.5 minutes (SD 15.1) per visit with participants. Among the 10 participants who completed the intervention and are evaluable for acceptability, 100% found the intervention “very helpful” and would “definitely recommend” it to others undergoing CRT. Conclusions: An integrated PC intervention to improve symptoms and coping during CRT for HNC is both feasible and acceptable with a high enrollment rate, excellent intervention compliance, and high patient satisfaction. Future studies will evaluate the effects of the integrated intervention on patient-reported outcomes and health care utilization. Clinical trial information: NCT03760471.
Frequency of burn-out among palliative care physicians participating in continuing medical education.
Authors: Reddy Suresh , Yennu Sriram , Tanco Kimberson Cochien , Anderson Aimee Elizabeth , Guzman Diana , Williams Janet L. , Liu Diane D. , Bruera Eduardo 
Published: November 2019

77 Background: There is a growing concern about high frequency of burn out (BO) among physicians, and higher among palliative care providers, reported to be in the range of 62%. There are very limited studies done among Palliative Care (PC) physicians. Objective: The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC Continuing Medical Education (CME). Secondary objectives included determining characteristics of physicians who expressed higher BO and also to determine overall attitudes towards PC practice. Methods: During 2018 Annual Hospice & Palliative Medicine Board Review Course, we conducted a survey of 41 questions to determine the frequency of BO among physicians. This included Maslach Burn Inventory ( MBI )–General. The survey was given to both the in house and webinar participants. Results: Of 110 physicians who were given the surveys, 91/110 (83%) completed surveys. The median age was 48 years with 59 (65%) being females, 74 (81%) married. Majority, 41 (46%) were in community practice. 24 (38%) were in practice for more than 6 years, and 52 (57%) were board certified. 56 (62%) practiced PC for more than 50 % of time. Majority, 69 (76%) were doing clinical work. The median number of physician in the group practice was 3. 35 (38 %) of participants reported at least one symptom burnout based on MBI criteria. Only being single/separated correlated significantly with burn-out (p = 0.056). PC work is appreciated at their place of work by 73 (80%), 58 (64%) reported insurance was a burden, electronic medical record as a burden by 58 (64%), and 82 (90%) of physicians felt optimistic about continuing PC in future. Conclusions: BO among palliative care physicians who attended a board review course tends to be high, but lower than previously reported. Physicians who choose to attend CME may have unique motivating characteristics to cope better with stress and BO. More research is needed to better characterize BO among PC physicians.
Factors associated with improvement in uncontrolled cancer pain without increasing opioid daily dose among patients seen by an inpatient palliative care team.
Authors: Haider Ali , Qian Yu , Lu Zhanni , Naqvi Syed M. , Zhuang Amy , Nguyen Kristy , Reddy Akhila Sunkepally , Arthur Joseph Anthony , Tanco Kimberson Cochien , Williams Janet L. , Wu Jimin , Liu Diane D. , Bruera Eduardo 
Published: November 2019

9 Background: Increasing total opioid dose is the standard approach for managing uncontrolled cancer pain. Other than simply increasing the opioid dose, palliative care interventions are multidimensional and may improve pain control in the absence of opioid dose increase. The purpose of this study was to determine the proportion of patients referred to our inpatient palliative care (IPC) team who achieved clinically improved pain (CIP) without opioid dose increase. Methods: We reviewed consecutive patients referred to our IPC team. Eligibility criteria included: 1) taking opioid medication; 2) having ≥ 2 consecutive visits with the IPC team; 3) Edmonton Symptom Assessment Scale (ESAS) pain score ≥ 4 at consultation. We assessed patient demographics and clinical variables, including cancer type, opioid prescription data (type, route, oral morphine equivalent daily dose [MEDD]), presence of opioid rotation, psychological consultation, changes in adjuvant medications (e.g., corticosteroids, benzodiazepines, and neuroleptics), and achievement of CIP. Results: Of the 300 patients enrolled, CIP was achieved in 196 (65%) patients. Of CIP patients, 85 (43%) achieved CIP without an increase in MEDD. CIP without MEDD increase was associated with more adjuvant medication changes (P = 0.003), less opioid rotation (P = 0.005), and lower symptom distress scale of ESAS (P = 0.04). Conclusions: Nearly half of patients achieved CIP without MEDD increase, suggesting that multidimensional palliative care intervention is effective in improving pain control in many opioid-tolerant patients without the need to increase the opioid dose.
Routine Edmonton Symptom Assessment System (ESAS) scores in epithelioid malignant pleural mesothelioma (eMPM) patients undergoing palliative systemic therapy.
Authors: Dietrich Kristen , Zhan Luna Jia , Herman Michael , Nagaratnam Subiksha , Corbett Kathryn , Patel Devalben , Hueniken Katrina , Xu Wei , Brown M. Catherine , de Perrot Marc , Cho John , Leighl Natasha B. , Bradbury Penelope Ann , Liu Geoffrey 
Published: November 2019

96 Background: Palliative chemotherapy, the mainstay for incurable eMPM, is offered to patients with good standing performance status (ECOG 0-1). We determined the proportion of eMPM patients experiencing moderate (Mod) to severe (Sev) symptoms while on palliative chemotherapy using ESAS symptom scores at diagnosis and during first and subsequent lines of systemic therapy. Methods: ESAS scores (0=no symptom; 10=worst symptom) were routinely captured in eMPM patients at Princess Margaret (Toronto, Canada). Retrospective chart review collected ESAS, clinical, treatment and outcome data. ESAS scores and proportions were summarized within baseline, firstline, and subsequent lines of therapy. Mod symptom was defined as ESAS scores of 4-6, and Sev as 7-10. ESAS scores between treatment lines were analyzed by Mann-Whitney U tests. Locally weighted smoothing (LOESS) plots assessed ESAS scores over treatment duration. Results: Of 37 palliative eMPM patients, the most frequent baseline symptoms were fatigue (33% Mod, 25% Sev), dyspnea (27% Mod; 17% Sev), anxiety (21% Mod; 21% Sev) and depression (34% Mod; 4% Sev). Overall well-being was poor in 45% of patients (31% Mod; 14% Sev). Compared to baseline, patients on firstline therapy reported increased pain ( p = 0.002), poor appetite ( p = 0.005) and nausea ( p = 0.02); decreased depression ( p = 0.03) and anxiety ( p = 0.006); and stable well-being ( p = 0.27). In patients well enough for subsequent therapy, patients reported reduced drowsiness ( p = 0.01) and improved overall well-being ( p = 0.04) compared to firstline therapy. LOESS plot patterns were similar between firstline and subsequent lines of treatment. Conclusions: eMPM patients had high symptom scores at the time of diagnosis. However, patients’ depression and anxiety decreased when starting initial treatment, and general well-being was stable. Of patients fit enough for subsequent lines of therapy, there were improvements in drowsiness and overall well-being. When selectively used, palliative systemic therapy of all lines are associated with some improved symptoms, but pain, poor appetite, and nausea need to be monitored and managed more effectively.
Time-Driven, Activity-Based Cost Analysis of Radiation Treatment Options for Spinal Metastases
Authors: Boyce-Fappiano David , Ning Matthew S. , Thaker Nikhil G. , Pezzi Todd A. , Gjyshi Olsi , Mesko Shane , Anakwenze Chidinma , Olivieri Nicholas D. , Guzman Alexis B. , Incalcaterra James R. , Tang Chad , McAleer Mary F. , Herman Joseph , Ghia Amol J. 
Published: November 2019

PURPOSE: Several treatment options for spinal metastases exist, including multiple radiation therapy (RT) techniques: three-dimensional (3D) conventional RT (3D-RT), intensity-modulated RT (IMRT), and spine stereotactic radiosurgery (SSRS). Although data exist regarding reimbursement differences across regimens, differences in provider care delivery costs have yet to be evaluated. We quantified institutional costs associated with RT for spinal metastases, using a time-driven activity-based costing model. METHODS: Comparisons were made between (1) 10-fraction 3D-RT to 30 Gy, (2) 10-fraction IMRT to 30 Gy, (3) 3-fraction SSRS (SSRS-3) to 27 Gy, and (4) single-fraction SSRS (SSRS-1) to 18 Gy. Process maps were developed from consultation through follow-up 30 days post-treatment. Process times were determined through panel interviews, and personnel costs were extracted from institutional salary data. The capacity cost rate was determined for each resource, then multiplied by activity time to calculate costs, which were summed to determine total cost. RESULTS: Full-cycle costs of SSRS-1 were 17% lower and 17% higher compared with IMRT and 3D-RT, respectively. Full-cycle costs for SSRS-3 were only 1% greater than 10-fraction IMRT. Technical costs for IMRT were 50% and 77% more than SSRS-3 and SSRS-1. In contrast, personnel costs were 3% and 28% higher for SSRS-1 than IMRT and 3D-RT, respectively ( P < .001). CONCLUSIONS: Resource utilization varies significantly among treatment options. By quantifying provider care delivery costs, this analysis supports the institutional resource efficiency of SSRS-1. Incorporating clinical outcomes with such resource and cost data will provide additional insight into the highest value modalities and may inform alternative payment models, operational workflows, and institutional resource allocation.
Comparison of Hemoglobin Measurements by 3 Point-of-Care Devices With Standard Laboratory Values and Reliability Regarding Decisions for Blood Transfusion
Authors: Johnson Marianne , Marwick Peter C. , Coetzee Johan F. 
Published: November 2019

BACKGROUND:We compared the accuracy of 3 point-of-care testing (POCT) devices with central laboratory measurements and the extent to which between-method disagreements could influence decisions to transfuse blood.METHODS:Hemoglobin concentrations [Hb] were measured in 58 adult patients undergoing cardiothoracic surgery using 2 Ilex GEM Premier 3500 blood gas analyzers (BG_A and BG_B) and a HemoCue Hb-201+device (HemoCue). Measurements were compared with our central laboratory’s Siemens Advia 2120 flow cytometry system (laboratory [Hb] [Lab[Hb]]), regarded as the gold standard. We considered that between-method [Hb] differences exceeding 10% in the [Hb] range 6–10 g/dL would likely erroneously influence erythrocyte transfusion decisions.RESULTS:The 70 Lab[Hb] measurements ranged from 5.8 to 16.7 g/dL, of which 25 (36%) were <10.0 g/dL. Measurements by all 4 devices numbered 57. Mean POCT measurements did not differ significantly (P> .99). Results of the Bland–Altman analyses revealed statistically significant bias, with predominant underestimations by all 3 POCTs predominating. HemoCue upper and lower limits of agreement (LOA) were narrower, and the 95% confidence intervals (95% CIs) of the LOAs did not overlap with those of BG_A and BG_B. Similarly, a narrow mountain plot demonstrated greater precision for the HemoCue. Comparing BG_A with BG_B revealed no bias and narrow LOA. Error grid analysis within the [Hb] range 6–10 g/dL revealed that 5.3% of HemoCue measurements were beyond the permissible 10.0% error zone in contrast to 19.0% and 16.0% of the blood gas measurements. Possible inappropriate transfusion decisions based on POCT values generally erred toward unnecessary transfusions. Calculations of Cohen κ statistic indicated better chance-corrected agreement between HemoCue and Lab[Hb] regarding erythrocyte transfusions than the blood gas analyzers.CONCLUSIONS:All 3 POCT devices underestimated the Lab[Hb] and cannot be used interchangeably with standard laboratory measurements. BG_A and BG_B can be considered to be acceptably interchangeable with each other. Whereas the HemoCue had little bias and good precision, the blood gas analyzers revealed large bias and poor precision. We conclude that the tested HemoCue provides more reliable measurements, especially within the critical 6–10 g/dL range, with reduced potential for transfusion errors. Decisions regarding erythrocyte transfusions should also be considered in the light of clinical findings.
Synthesis of a Novel Re(I)-Ru(II)-Re(I) Trinuclear Complex as an Effective Photocatalyst for CO2 Reduction
Authors: Umemoto Akinari , Yamazaki Yasuomi , Saito Daiki , Tamaki Yusuke , Ishitani Osamu 
Published: November 2019

Abstract
Supramolecular photocatalysts, which consist of redox photosensitizer and catalyst units, have recently attracted attention in the field of artificial photosynthesis. Aiming to construct a durable supramolecular photocatalyst for CO2 reduction, a new Re–Ru–Re trinuclear complex was successfully developed, where one Ru unit, acting as photosensitizer, was linked to two Re units, acting as catalysts, through ethylene chains. The novel complex was synthesized by creating two chelate moieties on the ligand of a Ru complex using the Negishi-coupling reaction, which were then coordinated to Re complexes. This trinuclear complex selectively photocatalyzed the reduction of CO2 to CO under visible light irradiation, with high durability compared with the corresponding Ru–Re binuclear complex and a mixed system of model mononuclear complexes. Absorption spectra and mass spectroscopic data of the reaction solutions revealed a rapid consumption of the electrons on the one-electron reduced species of the Ru unit, which led to suppression of the Ru unit decomposition, thereby maintaining its photosensitizing ability and product selectivity.