bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing individualized care plans in high-risk oncology patients: A team-based model to increase hospice utilization.
Authors: Lee Sarah , Switzer Benjamin , Khan Mohammad , Pinnamaneni Pramod , Hooley Joseph , Kunapareddy Girish Chandra , Lagman Ruth , Poole Christa , Montero Alberto J. 
Published: October 2019

64 Background: In the era of increasing therapeutic options and complexity of disease, some cancer patients (pts) continue aggressive treatment even within days of death. Previous studies report 30-66% of pts do not receive hospice or palliative services in the last month of life and many are enrolled in hospice < 3 days before death. Quality measures are endorsed by ASCO, National Quality Forum, and Oncology Care Model to increase hospice utilization. It is shown that pts enrolled in hospice have increased survival time with reduced in-hospital resources. These benefits increase the longer pts are in hospice. We hypothesize early identification of high risk pts by a multidisciplinary group and formulation of a care plan will prompt early discussion for hospice eligibility, increasing referrals to hospice and the number of days spent in hospice. Methods: As reported (ASCO 2018, Abst 6547), an Interdisciplinary Care Team (ICT) was created with palliative medicine and oncology physicians, nurses, and social workers. Twice monthly pts with high utilization over a 60-day period were identified. Care plans (CP) were created using a team based approach with parallel input from outpatient teams. CP was communicated back to the primary team. Results: 112 pts were discussed over 24 months; 39 pts died with a solid tumor malignancy and this was our study cohort. 85% pts (33/39) were referred to or had a hospice discussion and 82% pts (27/33) enrolled. 6 pts declined and 6 acutely died. Of the 27 pts that entered hospice 78% (21/27) were enrolled > 3 days and 22 % (6/27) < 3 days. Average number days in hospice was 19.7 (median 11) for all who entered hospice. In the subgroup that were enrolled for > 3 days, average number days was 25 (median 21). 62% pts (17/27) entered hospice within 60 days of ICT meeting and CP. Conclusions: Early identification of high-utilizing cancer patients along with review by ICT may correlate with early recognition of hospice eligibility, enrollment, and therefore greater number days spent in hospice. This increases hospice utilization allowing patients and families to experience the full benefit of hospice-directed care. Further interventions should be explored in optimizing transitions of care.
Time driven activity-based costing methods used in radiation oncology clinics.
Authors: Moningi Shalini , Mesko Shane , Moreno Amy Catherine , Ning Matthew S. , Aloia Thomas A. , Choi Seungtaek , Jeter Melenda , Martinez Wendi , Recinos Iris , Nguyen Thai , Frenzel John C. , French Katy E. , Nguyen Quynh , Herman Joseph M. 
Published: October 2019

79 Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results. [Table: see text]
Expansion of an oncology care coordination nurse model to reduce hospitalizations and emergency department utilization.
Authors: Rodgers Georgina T. , Brusio Michelle , Lindberg Jacob , Savage Craig , Hooley Joseph , Young Ronald 
Published: October 2019

82 Background: Comprehensive, coordinated care is a key driver of care transformation within the Oncology Care Model. Care coordination provides deliberate, organized, patient centered care initiatives aimed to improve care transitions, patient education, patient engagement and quality of care throughout the care continuum. Methods: Specialty care coordinator nurses were a part of our heath system’s model of care but over the course of our participation in the OCM we have implemented care coordination in our regional locations across 15 additional sites of care. Standardized templates for initial and follow up education were created for oral and parenteral therapies with an emphasis on symptom management education. A patient education tool was developed through a partnership with nursing, pharmacy and physicians across disease groups to outline when a patient should contact their physician or RN care coordinator with symptom issues. Targeted outreach calls and associated documentation templates were created for symptom assessment and adequate follow up. Templates include a pre-chemo orientation call, post treatment follow up phone call within seven days, and post hospital discharge/ED treat and release follow up calls. A team based huddle guideline was developed to provide a means for interdisciplinary communication to assess patients for high risk based upon medical, functional, social, cognitive and behavioral factors that might lead to a hospitalization. Results: Our teams worked closely with EMR specialists and internal data analysts to build appropriate templates and subsequent reports to monitor compliance with documentation, evaluate the number of outreach touch points and effectiveness of interventions on a reduction of hospitalizations and ED utilization. We have noted an a modest decrease in hospitalizations and ED utilization through OCM feedback reports and reconciliation reports. Conclusions: We continue to monitor our monthly hospital admissions and ED utilization across the health system and drill down into the data to determine if there are any opportunities where care coordination outreach and incoming telephone triage could have prevented the admission.
Measuring financial toxicity of cancer in the Italian health care system: Initial results of the patient reported outcome for fighting financial toxicity of cancer project (proFFiT).
Authors: Bryce Jane , Riva Silvia , Di Maio Massimo , Efficace Fabio , Frontini Luciano , Gallo Ciro , Giannarelli Diana , Montesarchio Vincenzo , De Lorenzo Francesco , Del Campo Laura , Iannelli Elisabetta , Traclò Francesca , Gitto Lara , Jommi Claudio , Vaccaro Concetta Maria , Gimigliano Anna , Sparavigna Lucia , Perrone Francesco 
Published: October 2019

91 Background: Financial toxicity in cancer patients has been initially reported in the United States and subsequently in other countries, including Italy, despite its health care system is grounded on universal coverage. Considering that the way healthcare and welfare systems are shaped does impact on financial problems faced by cancer patients, we are developing an instrument for evaluating occurrence, gravity, and consequences of financial toxicity in Italy, and hopefully for fighting it. Methods: Concept elicitation, item generation and qualitative analyses represented the initial tasks of the project. Literature review, focus groups with 34 cancer patients or caregivers in three regions located in nothern, central, and southern Italy, and semi-structured interviews with 97 oncologists were conducted for concept elicitation. A recursive process was used to identify themes in the data to inform instrument until saturation was reached. Importance analysis questionnaires were administered to further 44 cancer patients to evaluate and revise the draft item pool. A multi-disciplinary committee (including oncologists, psychologists, statisticians, patient association’s representatives, nurses, social science researchers and economists) oversights the project. Results: Overall, 156 concepts were distributed among 10 themes (bureaucracy, medical care, domestic economy, emotion, family, job, health workers, welfare state, free time, transportation). After controlling for redundancy, 55 candidate items were generated and 30 items, with at least one per each theme, remained after importance analysis. Out of the 30 items, 23 (77%) refer to material conditions, 4 (13%) to psychological response and 3 (10%) to coping behaviors. Conclusions: The first results of the proFFiT project show that most of the items selected by patients are related to material conditions that cause, or derive from, financial hardship. The final questionnaire will be ready by the end of 2019. Supported by Fondazione AIRC IG grant 2017-20402. Clinical trial information: NCT03473379 .
Development of an MCDA framework for evaluation and positioning of oncological treatments in clinical practice.
Authors: Camps Carlos , Badia Xavier , Chugani Divya , García Campelo Rosario , Garcia-Foncillas Jesus , Lopez Rafael , Massuti Bartomeu , Provencio-Pulla Mariano , Salazar Ramon , Virizuela Juan , Guillem Vicente 
Published: October 2019

95 Background: Ensuring that effective innovations are accessible in a timely and affordable manner to all cancer patients is a challenge that stakeholders face today. Several oncology frameworks (ASCO, ESMO, ICER, NCCN) have been developed to define and quantify the value of oncological therapies to support clinicians and patients at the time of selection and as a basis for decision-making. However, current frameworks only define treatment value in terms of clinical benefit, creating a need for one that allows holistic evaluation of treatments and supports decision-making in clinical practice. The ECO Foundation led this study to develop a reflective multi-criteria decision analysis (MCDA) based framework for evaluation and positioning of new oncological drugs from the clinical oncology perspective. Methods: The framework was developed following EVIDEM methodology. Systematic literature review was performed to identify most relevant criteria used for evaluation of innovative treatments to complement the EVIDEM V4.0 framework. The criteria compendium was presented to a group of clinical oncologists from ECO. The Expert Group assessed each criterion for its inclusion in the framework and suggested modifications in their definition and/or response scale. This framework was then tested with two case studies (Abemaciclib for metastatic HER-/HR+ breast cancer and TAS for metastatic colorectal cancer). The objective was to validate the criteria selected alongside their definitions and response scale with practical examples. A reflective discussion based on the score assigned to each criterion was also carried out. Results: Out of 15 criteria presented to the Expert Group, 8 were included in the final framework, and definition and/or response scale of 7 of these criteria were modified: Disease severity, Unmet needs, Efficacy comparison, Safety/tolerability comparison, Treatment intention, Treatment cost comparison, Comparison of other medical costs and Quality of evidence. Conclusions: A reflective MCDA framework has been developed and validated, based on the value of the treatment, for assessment and positioning of oncological therapies in the context of clinical practice in Spain.
Detection of Circulating Tumor DNA in Patients With Uterine Leiomyomas
Authors: Przybyl Joanna , Spans Lien , Lum Deirdre A. , Zhu Shirley , Vennam Sujay , Forgó Erna , Varma Sushama , Ganjoo Kristen , Hastie Trevor , Bowen Raffick , Debiec-Rychter Maria , van de Rijn Matt 
Published: October 2019

PURPOSE The preoperative distinction between uterine leiomyoma (LM) and leiomyosarcoma (LMS) is difficult, which may result in dissemination of an unexpected malignancy during surgery for a presumed benign lesion. An assay based on circulating tumor DNA (ctDNA) could help in the preoperative distinction between LM and LMS. This study addresses the feasibility of applying the two most frequently used approaches for detection of ctDNA: profiling of copy number alterations (CNAs) and point mutations in the plasma of patients with LM. PATIENTS AND METHODS By shallow whole-genome sequencing, we prospectively examined whether LM-derived ctDNA could be detected in plasma specimens of 12 patients. Plasma levels of lactate dehydrogenase, a marker suggested for the distinction between LM and LMS by prior studies, were also determined. We also profiled 36 LM tumor specimens by exome sequencing to develop a panel for targeted detection of point mutations in ctDNA of patients with LM. RESULTS We identified tumor-derived CNAs in the plasma DNA of 50% (six of 12) of patients with LM. The lactate dehydrogenase levels did not allow for an accurate distinction between patients with LM and patients with LMS. We identified only two recurrently mutated genes in LM tumors ( MED12 and ACLY). CONCLUSION Our results show that LMs do shed DNA into the circulation, which provides an opportunity for the development of ctDNA-based testing to distinguish LM from LMS. Although we could not design an LM-specific panel for ctDNA profiling, we propose that the detection of CNAs or point mutations in selected tumor suppressor genes in ctDNA may favor a diagnosis of LMS, since these genes are not affected in LM.
Quality of Life During and After Completion of Neoadjuvant Chemoradiotherapy for Esophageal and Junctional Cancer
Authors: Noordman B. J. , Verdam M. G. E. , Onstenk B. , Heisterkamp J. , Jansen W. J. B. M. , Martijnse I. S. , Lagarde S. M. , Wijnhoven B. P. L. , Acosta C. M. M. , van der Gaast A. , Sprangers M. A. G. , van Lanschot J. J. B. 
Published: October 2019

Abstract

Background
The course of health-related quality of life (HRQOL) during and after completion of neoadjuvant chemoradiotherapy (nCRT) for esophageal or junctional carcinoma is unknown.

Methods
This study was a multicenter prospective cohort investigation. Patients with esophageal or cancer to be treated with nCRT plus esophagectomy were eligible for inclusion in the study. The HRQOL of the patients was measured with European Organization for Research and Treatment of Cancer QLQ-C30, QLQ-OG25, and QLQ-CIPN20 questionnaires before and during nCRT, then 2, 4, 6, 8, 10, 12, 14, and 16 weeks after nCRT and before surgery. Predefined end points were based on the hypothesized impact of nCRT. The primary end points were physical functioning, odynophagia, and sensory symptoms. The secondary end points were global quality of life, fatigue, weight loss, and motor symptoms. Mixed modeling analysis was used to evaluate changes over time.

Results
Of 106 eligible patients, 96 (91%) were included in the study. The rate of questionnaires returned ranged from 94% to 99% until week 12, then dropped to 78% in week 16 after nCRT. A negative impact of nCRT on all HRQOL end points was observed during the last cycle of nCRT (all p < 0.001) and 2 weeks after nCRT (all p < 0.001). Physical functioning, odynophagia, and sensory symptoms were restored to pretreatment levels respectively 8, 4, and 6 weeks after nCRT. The secondary end points were restored to baseline levels 4–6 weeks after nCRT. Odynophagia, fatigue, and weight loss improved after nCRT compared with baseline levels at respectively 6 (p < 0.001), 16 (p = 0.001), and 12 weeks (p < 0.001).

Conclusion
After completion of nCRT for esophageal cancer, HRQOL decreases significantly, but all HRQOL end points are restored to baseline levels within 8 weeks. Odynophagia, fatigue, and weight loss improved 6–16 weeks after nCRT compared with baseline levels.
Development of a Novel Time-Resolved Synchrotron-Radiation X-ray Diffraction Measurement System for In Situ Observation of Crystal Structure in Aqueous Solution during Chemical Reaction: Application to the Anion-Exchange Reaction of a Layered Double Hydroxide from Chloride to Nitrate
Authors: Sasai Ryo , Fujimura Takuya , Onda Nobuhiko , Nakayashiki Yu-to , Sumiyoshi Hidenobu , Hagura Koki , Abe Tomohiro , Moriyoshi Chikako , Kawaguchi Shogo 
Published: October 2019

Abstract
We successfully developed a novel time-resolved synchrotron-radiation X-ray diffraction (t-SXRD) measurement system with high temporal resolution (minimum time: 50 ms) at the BL02B2 facility at SPring-8 for the in situ observation of the crystal structure changes of inorganic compounds in aqueous solution during chemical reactions. For evaluating the performance of this novel system, we applied it to observe the crystal structure change of a layered double hydroxide consisting of Mg and Al (Mg/Al = 2) with chloride as the exchangeable anion species (Cl−-MgAl(1/3)LDH) during the anion-exchange reaction from Cl− and NO3− in aqueous solution under various [NO3−] conditions. The t-SXRD patterns from the MgAl(1/3)LDH crystal particles dispersed in aqueous solution were recorded every 0.2 s using our measurement system; that is, we obtained t-SXRD data for kinetic analysis. Thus, we identified the features for the anion-exchange reaction of Cl−-MgAl(1/3)LDH from Cl− and NO3− in aqueous solution under various [NO3−] conditions. All the present results revealed that the novel t-SXRD measurement system developed herein is very useful and effective for monitoring the in situ structural changes of crystalline compounds dispersed in solution during chemical reactions with a fast time constant.
DYNAMICS OF THE CREATIVE INTERPRETATION IN EARLY CHILDHOOD COMMUNICATION WITH ART IN A MUSEUM ENVIRONMENT
Authors: Zlateva Any , Tineva-Gyurkovska Katya 
Published: October 2019

Introduction: The research paper tracks the changes in the regular development of the way children perceive visual arts. It views the dynamics of the creative interpretation of children at the pre-school age when directly communicating with pieces of art in a museum environment. An important stage of this study is related to the role of the informal gallery environment, which suggests an intense visual stimulation and reinforces children’s desire to actively take part in it. This imposes the application of specific integrated pedagogical approaches and methods, close to museum pedagogy and visual arts education.
Purpose of the study: The research aims at tracing some of the main processes pertaining to the dynamics of the visual reaction of children of 6 to 7 years of age when directly communicating with visual arts and their level of creative interpretation in the process of drawing afterwards.
Methods: For achieving the aims of the research we used some interdisciplinary methods. In the theoretical part we present some of the fundamental works on the subject. We emphasize the methods that integrate the history of art and pedagogy, which include: the description of the paintings with elements of formalism is the study of art and analysis of the visual reaction when communicating with pieces of art. This description should be adapted to the age of the children and some empirical and proximity pedagogical methods for evaluating the achieved results.
Findings and results: In the first part of the research the accent is put on the different levels of reaction children have at the age of 6-7, regarding the recognition of separate compositional elements, objects, colours, forms, seasons, hours of the day, finding out emotional conditions and other important elements of composition sings in the observed pieces of art.
In the second part we show the results and we systematize and analyze children’s free creative modulations. They concern different aspects of the visual stimulation and the following creative interpretation through the art activity of children at the age of 6-7. We observed the correlation between the drawings of the children and the perceived pieces of art, as a consequence of the stimulation of their visual perceptions and views. We analyzed the influence of a museum environment on children’s graphic, colourful and emotional expression through drawing.
Conclusiоn: The summary and conclusion of the research provide the basis for development and optimization the methodological-pedagogical system of working with children in a formal and informal environment.
SUICIDES IN LITHUANIA: RATES, METHODS AND DISTRIBUTION BY AGE, GENDER AND SETTLEMENT, 2012-2016
Authors: Vasiljevaitė Diana , Stasiūnienė Jurgita , Laima Sigitas , Chmieliauskas Sigitas , Fomin Dmitrij , Jasulaitis Algimantas 
Published: October 2019

INTRODUCTION: According to the World Health Organisation regarding suicide rate, Lithuania was on the top in 2016 with 31.9 suicide events per 100 000 people of the population. This research was aimed at analysing the situation including methods of suicide and its distribution between different age, gender and settlement groups in Lithuania.
METHODS: 4610 particular suicide cases were found and analysed from the given retrospectively collected data by the Hygiene Institute’s Register of Death Causes in Lithuania from 2012 till 2016. These cases have been categorised into age (10-19 years old, 20-69 years old and >70 years old), gender and settlement groups. Chi-squared and Fisher tests were used to analyse the associations between the suicide methods used, sex, as well as age. A significance level of p<0.05 was used.
RESULTS: In total, 4610 suicide cases were registered in Lithuania in 2012-2016. People aged 20-69 years had the biggest proportion with 80%, followed by 16% for people older than 70 and 4% people aged 10-19. 82% of all cases were men. The most common method of suicides in all age groups was hanging, self-strangulation and self-suffocation; 92%. There is no statistical significant difference in methods used by the 10-19 years old group and above 20 years of age (20-70+).A difference was found between the groups under 70 years and above 70 years old. Moreover, the following difference was found between their genders (p=0.0002). In terms of using drugs and biological substances, women (54.24%) are more likely to commit suicide through these means than men in all age groups, while 100% of suicide methods by gas, steam or solvents were used by men. Though slightly more suicides were registered in cities, there was no statistically significant difference between people living in cities and in villages.
CONCLUSIONS: Despite the fact that incidences of suicides are gradually decreasing every year, the situation is not yet satisfactory. The pattern almost has not changed for years – the most inclinable person to commit suicide is a 50-59 years old man living in a city and the most used method is still hanging.