bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving oral chemotherapy adverse event reporting: Listening to pediatric oncology patients and parents.
Authors: Zerillo Jessica A. , Barysauskas Constance , Catalano Paul J. , Jacobson Joseph O. , Billett Amy 
Published: April 2017

45 Background: Medication-related adverse events and near misses are underreported, particularly in the ambulatory setting. Our aim was to assess pediatric oncology parent and patient-reported oral chemotherapy errors and near misses. Methods: A survey of parent and patient-reported oral chemotherapy errors and near misses over the past month was developed and validated in a subgroup and administered to parents/patients at an academic pediatric hematology-oncology clinic. Parents and patients were included if the patient received any commercially available oral chemotherapy agent within the past month, dispensed by an onsite retail pharmacy, and agreed to participate. Results: Forty-eight of 69 parents and 11 of 17 patients responded (ten from the same household). Fifteen of 59 respondents (25%) reported at least one event, miss, or error (twelve (25%) parents and three (27%) patients). Of five events described by parents and patients of the same household, one was co-reported. Of the errors that occurred in the home, the most common were missed (n=5, 8%) and late (n=3, 5%) doses. Forty-six percent of respondents did not report events to the medical team. Two respondents perceived minor harm as a result of the event. Conclusions: Patients and parents are willing to share information about oral chemotherapy-related adverse events and near misses. Twenty-five percent of respondents noted an oral chemotherapy event, near miss, or error over the preceding month. Importantly, many of these events were unreported to care teams. Missed doses were the most common safety event, and interventions should target this need.[Table: see text]
Reviewing systemic treatment regimens to reduce unintentional errors.
Authors: Crespo Andrea , Redwood Erin , Vu Kathy , Kukreti Vishal 
Published: April 2017

51 Background: Use of systemic treatment computerized prescriber order entry (ST CPOE) and pre-printed orders (PPO) are proven error reduction measures. Such systems are not failsafe, as regimen development depends on cognitive input at critical points and is susceptible to human error. No known guidance currently exists in oncology to ensure regimens are of high quality and built as intended. The purpose of this initiative was to improve the quality of oncology regimens in Ontario. Methods: A review of 35 centres, representing 75 treatment centres in a hub-and-spoke model, was conducted for all active regimens (PPO and CPOE) to ensure they were built as intended, with respect to drugs and doses. Centres completed an exploratory survey to report any unintentional discrepancies and existing maintenance review processes. The survey collected centre demographics and contained descriptive questions to document details of the regimen review and maintenance processes. Results: The review yielded an 86% response rate (12 regional and 18 community cancer centres). Upwards of 700 regimens were reviewed by a multidisciplinary team at each participating centre. Unintentional discrepancies were reported by 7 of the 30 (23%) centres (range of 2 – 141 per centre); types and examples are presented in the Table. Only 2 of 30 centres (7%) had an established regimen maintenance process. Conclusions: The review identified unintentional discrepancies and, due to the potential for patient harm, corrective action has been taken. There is a need for guidance and adoption of a standardized approach in order to sustain a high-quality regimen build and review process across the province. Consensus-based recommendations for ST CPOE and PPO regimen development and maintenance have been developed. Identified discrepancies have been amended and maintenance review processes are now implemented to improve the quality and safety of systemic treatment delivery. [Table: see text]
Improving documentation of surrogate decision makers in medical oncology clinic.
Authors: Wong Melisa L. , Borno Hala , Mahajan Reena , Bischoff Kara E. , Calton Brook , Bergsland Emily K. , Kim Won , Aggarwal Rahul Raj , Tsai Katy K. , Cinar Pelin 
Published: April 2017

63 Background: Advance care planning (ACP) is an important component of high quality care for cancer patients. A measurable and early step in the ACP process is for patients to identify a surrogate decision maker and document this information in the medical record. Methods: To improve documentation of surrogate decision makers for stage IV cancer patients, we designed a hematology/oncology fellow-led multidisciplinary quality improvement (QI) initiative including: 1) ACP education for fellows, 2) ACP patient education materials and online resources, and 3) standardized note templates for surrogate documentation. We aimed to document surrogate decision makers or discussions for > 50% of stage IV cancer outpatients evaluated by a fellow cumulatively over the 2016-2017 academic year. Patients seen for second opinion visits were excluded. Audit and feedback of individual fellow and group results were conducted twice a month. During each audit period, we randomly selected 2 medical oncology clinic sessions per outpatient fellow and reviewed all new patient and follow-up notes for surrogate decision maker documentation. Results: Prior to implementation, baseline surrogate decision maker documentation by fellows was 2% (1 out of 55 stage IV cancer patients seen during 2 randomly selected clinic sessions per outpatient fellow from January to March 2016). Since implementation in July 2016, 20 fellows have participated during outpatient rotations. During randomly selected clinic sessions from July to October 2016, 156 eligible stage IV cancer patients were evaluated by fellows. Surrogate decision makers or discussions were documented for 64 patients (41%). Overall, fellows felt comfortable discussing surrogate decision making with patients but often forgot to address it during the visit. Conclusions: Our fellow-led QI initiative improved surrogate decision maker documentation for stage IV cancer patients from 2% to 41%. A centralized ACP navigator (which includes a surrogate decision maker section) was recently added to our electronic medical record. As part of the ongoing efforts to achieve our cumulative goal, we will leverage this new feature to engage clinic staff in documentation of surrogate decision making as well.
Real-world treatment patterns and characteristics in patients with chronic lymphocytic leukemia.
Authors: Schenkel Brad , Rider Alex , Macomson Brian , Hallworth Pam 
Published: April 2017

65 Background: CLL is the most prevalent form of adult leukemia. In recent years, there have been a number of newly approved therapies for the management of patients with CLL in both the 1st line (1L) and relapsed/refractory settings, including ibrutinib (approved for 1L CLL, March 2016). Methods: USphysicians involved in CLL treatment decision-making were recruited into the Adelphi CLL Disease Specific Programme (February-May 2016). Physicians completed record forms on consecutively presenting patients > 18 years currently on active CLL treatment. Descriptive statistics analyzed demographics, clinical characteristics, and antineoplastic treatment patterns. Results: 700 patients diagnosed with CLL for an average of 3.0 years were captured. Patients’ mean age was 68.3 years, 53% were male, 75% were Caucasian, 25% had 17p deletion, and 55% were Medicare insured. Of the 81 physicians, 35% were based in an academic hospital setting, 51% in a non-academic hospital setting, 4% in both, and 9% were office-based. Within the overall cohort, BR was the most common 1L regimen (25%), while ibrutinib was the most common 2nd line (2L) regimen (42%). Among patients with 17p deletion, BR was the most common 1L regimen (25%) and ibrutinib was the most common 2L regimen (50%). Older patients ( ≥ 65) were most likely to receive BR at 1L (28%), while 1L younger patients ( < 65) received FCR (24%). Conclusions: This analysis of real world treatment patterns identified BR, FCR, and ibrutinib as the most common 1L regimens in US CLL patients. Ibrutinib, BR, and idelalisib + rituximab were the most common 2L regimens. Choice of therapy varied depending on age and 17p deletion status. For example, FCR was more frequently used as 1L therapy in patients < 65 years, and the proportion of ibrutinib use as 1L therapy was higher in those with 17p deletion. [Table: see text]
Administration of the ASCO Pain Survey to identify patient education deficiencies in patients with cancer.
Authors: Hagmann Chelsea , Ma Joseph , Cramer Arlene , Russell Michelle , Dullea Alexandra , Cohen-Arazi Yael , Roeland Eric 
Published: April 2017

68 Background: The Doris Howell Palliative Care (PC) Outpatient Consultation Service consists of a multidisciplinary team. Reasons for consultation include pain management, treatment of other physical symptoms, education about non-drug options for pain, and advanced care planning. To assess methods used for patient education, the PC team administered the ASCO pain survey to those prescribed opioid pain medications. Methods: The survey was a 26-item questionnaire evaluating patient education content communicated by a provider to a patient during a routine clinic visit. Twenty surveys were completed anonymously. After survey review, the outpatient PC team developed an intervention to address patient education concerns. The intervention consisted of written and verbal instructions on pain medication management reviewed by the PC nurse with the patient and/or caregiver at the end of the outpatient visit. Another twenty surveys were completed anonymously with patients after intervention implementation. Time required to complete the intervention was less than two minutes per patient. The Fisher’s exact test was used to analyze the differences between surveys completed with or without the intervention. Results: The majority of patients stated that his/her provider adequately explained the use (n = 40, 100%), side effects (n = 37, 93%), and storage (n = 32, 80%) of pain medications, regardless of the intervention. Both groups also indicated that the provider and/or nurse adequately explained the risks associated with medical history (n = 34, 85%) and other medications while taking pain medications (n = 33, 83%). The intervention did increase understanding to avoid sharing pain medications (75% vs. 85%, p < 0.05) and to use a lock box to secure pain medications (45% vs. 60%, p < 0.05). Additionally, asking patients if family members have a history of alcohol or substance abuse was also significant (p < 0.05). Conclusions: Written and verbal instructions as an intervention improved patient understanding to avoid sharing pain medications and to secure pain medications in a lock box.
Pharmaceutical assistance foundations in the financing of cancer care.
Authors: Mitchell Aaron Philip 
Published: April 2017

8 Background: The rising cost of cancer drugs may make treatment unaffordable for some patients. Patients often rely on drug manufacturer-administered Pharmaceutical Assistance Programs (PAPs) to obtain drugs at reduced or no cost. The overall impact of PAPs on cancer care delivery is unknown. Methods: We identified all patients obtaining cancer drugs across an academically affiliated, integrated health system in the state of North Carolina during 2014. The proportion of patients receiving PAP assistance, and the retail value of the assistance, were quantified for each oncology drug. Cancer drugs were analyzed with respect to route of administration. Results: 215 unique patients submitted a total of 478 successful PAP requests for cancer drugs. The majority of the retail value of drugs obtained was for oral cancer drugs, particularly targeted therapies including tyrosine kinase inhibitors. Among all cancer patients who received medical treatment, 5.5% required PAP assistance, whereas 10.6% receiving an oral agent required PAP assistance (Table). The proportion receiving PAP assistance varied substantially by drug, ranging from <1% of patients (e.g., carboplatin, methotrexate) to 50% of patients (e.g., ponatinib, temsirolimus). Patients obtained a total of $1,556,575 of imatinib and $1,449,633 of dasatinib, which were the two drugs with the highest aggregate retail value. 40% of PAP-utilizing patients were uninsured, 26% had Medicaid coverage, 20% had Medicare coverage, and 14% were commercially insured. Conclusions: A substantial proportion of patients with cancer receive private charitable assistance through PAPs in order to obtain standard-of-care treatments. In particular, a disproportionate share of patients treated with orally-available cancer drugs require PAP assistance. This includes patients with federal and private insurance, suggesting an inability of patients to meet cost-sharing requirements. [Table: see text]
Determining needs for nonmedical support during cancer care.
Authors: Neuss Michael N. , Shyr Yu , Washburn Anne , Elliott Stephanie L , Carson Kristin , Carson Kate , Friedman Debra L. 
Published: April 2017

82 Background: The need for supportive care services during cancer treatment appears obvious but ranges from 7 to 100% are reported. (McMurray 2001) (Soothill K, 2001). The Commission on Cancer (CoC) requires programs to assess these needs. We report on the rates of identified needs and our survey methodology. Methods: VICC members developed a 41 element survey to assess financial, emotional, and educational needs. Surveys were made available to patients with instructions, but no facilitators (Method 1). Then the same surveys were personally given to patients by two trained research coordinators who randomly selected, instructed and helped patients to complete the survey (Method 2). We report the responses using the two study methodologies. The difference between the two studies was examined using the two-sided chi-square test. Results: Results are presented in Table below. Conclusions: The rate of self-reported need for supportive and educational services in our study was small, but a meaningful minority of patients require assistance with supportive care. Simple unsupervised surveys led to results which were very similar to those supported by more complex and expensive methodologies. These data will inform the design of future survey methodology as well as intervention targets for patient navigators. [Table: see text]
Improving survivors' outcomes in cancer survivorship clinics.
Authors: Palos Guadalupe R. , Gilmore Katherine Ramsey , Chapman Patricia , Lewis-Patterson Paula A. , Rodriguez Maria Alma 
Published: April 2017

93 Background: A core measure of the ASCO Quality Oncology Practice Initiative and Commission on Cancer Program Standard is adherence to use of written treatment summaries (TSs) and care plans (CPs) for cancer survivors. Previous data from ASCO’s quality improvement (QI) studies indicate inconsistent use and distribution of treatment summaries and care plans. Audits conducted of adherence rates among our survivorship providers indicated use varied across clinics. We developed a plan to improve use of TSs and CPs among providers and improve survivors’ outcomes. Methods: The Plan-Do-Study-Act QI model was used to identify gaps in performance and process failures that led to those gaps. The project used stratified purposive sampling to select clinics. Based on the disease site, staffing structure, and clinical infrastructure, the breast, genitourinary, and head/neck survivorship clinics were chosen. First, we identified primary elements of the processes detailed in clinical practice algorithms specific to each site. Next qualitative interviews were conducted with providers to identify strengths and barriers to the use of TSs and CPs. Interviews were audio-recorded, transcribed verbatim and analyzed to confirm themes. Descriptive statistics were used to summarize demographic and clinical data. Results: A total of 16 members of the 3 clinics were interviewed. Of these, 37.5% were providers, 31.3% administrators, 18.8% support staff, and 12.4% faculty champions. Major themes identified as hindering adherence rates centered on cumbersome scheduling processes i.e. “there’s so many people that have to “touch an order” to get it to happen”, fragmentation among electronic medical records systems, i.e. “the way to fix it would be if it was a smart automated document that took the information…there in the chart," limited support among other health care professionals about survivorship care, i.e. “when push comes to shove Survivorship gets pushed. That’s the nature of the beast.” Conclusions: The barriers identified can be used to develop feasible solutions to improve adherence rates among survivorship clinic providers. Findings from this QI project contribute to deeper understanding of the complex issues involved in improving outcomes for survivors.
An educational program to improve cancer survivorship research.
Authors: Palos Guadalupe R. , Chapman Patricia , Gilmore Katherine Ramsey , Lewis-Patterson Paula A. , Rodriguez Maria Alma 
Published: April 2017

94 Background: ASCO has recognized the need to expand its educational portfolio to focus on long-term care of cancer survivors. Academic programs across health care professions overlook this topic in their curricula. To address this gap, we developed a survivorship research internship for undergraduate students enrolled in public health or health education programs. Here we present the results of an evaluation to assess the level of satisfaction of trainees and improve the curriculum. Methods: All students who completed the internship were eligible to participate in the evaluation. The authors conducted the survey using an electronic data system. Respondents were asked to rate their level of satisfaction with the curriculum and specific assignments, i.e. conducting their own survivorship research project, taking classes about PubMed or EndNotes, and abstracting data from medical records to use in survivorship care plans. Other measures were whether a trainee had written/published an abstract/manuscript, pursued an advanced degree, or obtained a job in health care after completing the program. Descriptive statistics were used to summarize results. Results: An 85% response rate was achieved (34/40 respondents). The majority were female (82.4%), Caucasian (56.3%), and enrolled in public health programs (41.2%). Almost all respondents (90.9%) strongly agreed or agreed they had a better understanding of the process needed to conduct survivorship research. 50.0% reported being most satisfied with the internship experience. 36.4% reported data abstraction and participating in PubMed or EndNotes classes were least useful. 35.3% reported observing health care professionals in the clinical setting was the most useful. 88.2% strongly agreed or agreed that the training was useful in their current work position.18.8% have achieved advanced degrees in medicine, nursing, or public health. Two of the 34 trainees have published a paper in a peer-reviewed journal or presented a poster at a scientific conference. Conclusions: Results indicated the vast majority of trainees had a positive experience engaging in the survivorship research internship. This strategy is one method that can be used to build and enhance education in survivorship care and research.
Mitigating Cybersecurity Risks
Authors: Rose Rachel V. , Kass Joseph S. 
Published: April 2017

ABSTRACT
Cybersecurity issues and their impact on compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act are becoming more of an enforcement focus for a variety of government agencies, including the US Department of Health and Human Services, the Federal Trade Commission, and the Department of Justice. In the case presented in this article, a nurse in a neurology practice opted to speak with a patient about human immunodeficiency virus testing procedures in a manner audible to others in the waiting room. Computer screens with patient information were visible to anyone approaching a desk, the staff had not been trained on cybersecurity issues, and malware infected the computers used in the practice. In light of these circumstances and the launch of Phase 2 of the HIPAA Audit Program by the US Department of Health and Human Services Office for Civil Rights, the neurology practice must consider the following questions. First, could the gaps in the technical, administrative, and physical requirements of HIPAA and the HITECH Act result in an adverse audit and penalties? Second, what course of action does the law mandate in response to a ransomware attack?
Trigeminal Neuralgia
Authors: Cruccu Giorgio 
Published: April 2017

ABSTRACT

Purpose of Review: Although trigeminal neuralgia is well known to neurologists, recent developments in classification and clinical diagnosis, new MRI methods, and a debate about surgical options necessitate an update on the topic.

Recent Findings: Currently, a worldwide controversy exists regarding the classification, diagnostic process, and surgical treatment of trigeminal neuralgia. This controversy has been caused on one side by the recognition that some 50% of patients with trigeminal neuralgia, apart from characteristic paroxysmal attacks, also have continuous pain in the same territory, which results in greater diagnostic difficulties and is associated with a lower response to medical and surgical treatments. In contrast, recent developments in MRI methods allow differentiation between a mere neurovascular contact and an effective compression of the trigeminal root by an anomalous vessel, which implies more difficulties in the choice of surgical treatment, with the indication for microvascular decompression becoming more restricted.

Summary: This article proposes that the diagnosis of trigeminal neuralgia, with or without concomitant continuous pain, must rely on clinical grounds only. Diagnostic tests are necessary to distinguish three etiologic categories: idiopathic trigeminal neuralgia (nothing is found), classic trigeminal neuralgia (an anomalous vessel produces morphologic changes of the trigeminal root near its entry into the pons), and secondary trigeminal neuralgia (due to major neurologic disease, such as multiple sclerosis or tumors at the cerebellopontine angle). Carbamazepine and oxcarbazepine (ie, voltage-gated, frequency-dependent sodium channel blockers) are still the first-choice medical treatment, although many patients experience significant side effects, and those with concomitant continuous pain respond less well to treatment. The development of sodium channel blockers that are selective for the sodium channel 1.7 (Nav1.7) receptor will hopefully help. Although all the surgical interventions (percutaneous ganglion lesions, gamma knife radiosurgery, and microvascular decompression) are very efficacious, precise MRI criteria for differentiating a real neurovascular compression from an irrelevant contact will be of benefit in better selecting patients for microvascular decompression.