bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fitness Trends and Disparities Among School-Aged Children in Georgia, 2011-2014
Authors: Bai Yang , Saint-Maurice Pedro F. , Welk Gregory J. 
Published: November 2017

Objectives: Although FitnessGram fitness data on aerobic capacity and body mass index (BMI) have been collected in public schools in Georgia since the 2011-2012 school year, the data have not been analyzed. The primary objective of our study was to use these data to assess changes in fitness among school-aged children in Georgia between 2011 and 2014. A secondary objective was to determine if student fitness differed by school size and socioeconomic characteristics. Methods: FitnessGram classifies fitness into the Healthy Fitness Zone (HFZ) or not within the HFZ for aerobic capacity and BMI. We used data for 3 successive school years (ie, 2011-2012 to 2013-2014) obtained from FitnessGram testing of students in >1600 schools. We calculated the percentage of students who achieved the HFZ for aerobic capacity and BMI. We used growth curve models to estimate the annual changes in these proportions, and we determined the effect of school size and socioeconomic status on these changes. Results: Both elementary school boys (β = 1.31%, standard error [SE] = 0.23%, P < .001) and girls (β = 1.53%, SE = 0.26%, P < .001) had significant annual increases in achievement of HFZ for aerobic capacity. Elementary school boys (β = 3.11%, SE = 0.32%, P < .001) and girls (β = 3.09%, SE = 0.32%, P < .001) also had significant increases in their BMI HFZ achievement proportions, although these increases occurred primarily between 2011-2012 and 2012-2013. Body mass index HFZ achievement proportions were mixed for middle school students, and we did not observe increases for high school students. Larger school size and higher school socioeconomic status were associated with better aerobic capacity and BMI fitness profiles. Conclusions: Surveillance results such as these may help inform the process of designing state and local school-based fitness promotion and public health programs and tracking the results of those programs.
Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation
Authors: Hedberg Berith , Malm Dan , Karlsson Jan-Erik , Årestedt Kristofer , Broström Anders 
Published: November 2017

Background: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. Aim: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms. Methods: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data. Results: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication. Conclusion: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
Real-world clopidogrel utilization in acute coronary syndromes: patients selection and outcomes in a single-center experience
Authors: Castini Diego , Persampieri Simone , Cazzaniga Sara , Ferrante Giulia , Centola Marco , Lucreziotti Stefano , Salerno-Uriarte Diego , Sponzilli Carlo , Carugo Stefano 
Published: November 2017

Background: With this study, we sought to identify patient characteristics associated with clopidogrel prescription and its relationship with in-hospital adverse events in an unselected cohort of ACSs patients. Materials and Methods: We studied all consecutive patients admitted at our institution for ACSs from 2012 to 2014. Patients were divided into two groups based on clopidogrel or novel P2Y12 inhibitors (prasugrel or ticagrelor) prescription and the relationship between clopidogrel use and patient clinical characteristics and in-hospital adverse events was evaluated using logistic regression analysis. Results: The population median age was 68 years (57–77 year) and clopidogrel was prescribed in 230 patients (46%). Patients characteristics associated with clopidogrel prescription were older age, female sex, non-ST-elevation ACS diagnosis, the presence of diabetes mellitus and anemia, worse renal and left ventricular functions and a higher Killip class. Patients on clopidogrel demonstrated a significantly higher incidence of in-hospital mortality (4.8%) than prasugrel and ticagrelor-treated patients (0.4%), while a nonstatistically significant trend emerged considering bleeding events. However, on multivariable logistic regression analysis female sex, the presence of anemia and Killip class were the only variables independently associated with in-hospital death. Conclusion: Patients treated with clopidogrel showed a higher in-hospital mortality. However, clinical variables associated with its use identify a population at high risk for adverse events and this seems to play a major role for the higher in-hospital mortality observed in clopidogrel-treated patients.
Cancer Patients’ Recommendations for Nature-Based Design and Engagement in Oncology Contexts: Qualitative Research
Authors: Blaschke Sarah , O’Callaghan Clare C. , Schofield Penelope 
Published: November 2017

Objectives: To explore cancer patients’ recommendations for nature engagement based on their subjective nature experiences and observations in the cancer setting. The rationale was to gain practical insight for delineating relevant and translatable nature-based care and design opportunities in oncology contexts. Background: Innovative cancer care services are needed to respond to growing demand and shifting healthcare needs. Engagement with nature has shown multiple health benefits and presents a promising opportunity for application in healthcare to improve outcomes. Method: Qualitative research design using content analysis was used. Eligible adults with any cancer diagnosis participated in semistructured and audio-recorded interviews. Transcribed textual data included responses to two open-ended questions querying about participants’ recommendations related to nature-based opportunities in the cancer setting. Deductive analysis used three predetermined categories: “recommendation: features,” “recommendation: functions,” and “cautions.” Results: Twenty patients with cancer (nine female) participated. Broad recommendations incorporated (1) using nature for vital sensory stimulation and engagement, (2) using nature for personal space and freedom to enable private and social exploration, (3) using views to nature for distraction and comfort, and (4) accessing nature for physical activity and movement. Three critical factors were determined for avoiding adverse experiences: determining appropriate expenditure and resourcing, selection of appropriate nature-based design materials, and exercising caution around demanding nature engagement and harsh weather conditions. Conclusions: Cancer patients’ recommendations reveal the importance of engaging with nature in their experiences of health and recovery. The findings can inform planning appropriate and safe integration of beneficial nature engagement in cancer settings and support services.
Coronary artery anomalies: Unusually high incidence of anomalies with a malignant course in an Asian population
Authors: Alkhulaifi Abdulaziz M , Chooriyil Nidheesh , Alkuwari Maryam , Ghareep Abdelnasser N , Carr Cornelia 
Published: November 2017

Objectives: Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes. Methods: We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms. Results: During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery. Conclusion: There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.
Decitabine enhances targeting of AML cells by CD34+ progenitor-derived NK cells in NOD/SCID/IL2Rgnull mice
Authors: Cany Jeannette , Roeven Mieke W. H. , Hoogstad-van Evert Janneke S. , Hobo Willemijn , Maas Frans , Franco Fernandez Rosalia , Blijlevens Nicole M. A. , van der Velden Walter J. , Huls Gerwin , Jansen Joop H. , Schaap Nicolaas P. M. , Dolstra Harry 
Published: November 2017

Key Points
CD34+ progenitor-derived NK cells and HMAs potently cooperate against AML cells. DAC-mediated modulation of CD34-derived NK cell phenotype, function, and trafficking results in enhanced anti-leukemic effect in vivo.
The utilization of inpatient palliative care services (PCS) in patients with metastatic cancer receiving critical care therapies (CCTs).
Authors: Loh Kah Poh , Shieh Meng-Shiou , Abdallah Maya , Pekow Penelope , Lindenauer Peter , Stefan Mihaela , Mohile Supriya Gupta , Lagu Tara 
Published: November 2017

103 Background: PCS have been shown to improve symptom management, quality of life and survival in patients with metastatic cancer as well as reduce healthcare costs. We aimed to investigate the utilization pattern of inpatient PCS and outcomes in metastatic cancer patients across the various cancer subtypes who received CCTs. Methods: We used the 2010 California Healthcare Cost and Utilization Project - State Inpatient Database to identify patients (≥18 years) and above with metastatic cancer who received CCTs, defined as the use of invasive mechanical ventilation, acute dialysis, total parenteral nutrition, percutaneous endoscopic gastrostomy or tracheostomy. We examined the use of inpatient PCS and outcomes including inpatient mortality, length of stay, discharge to skilled nursing facility, cost of care and presence of do-not-resuscitate. Results: A total of 9,348 hospitalizations were identified. The cancer subtypes were lung (14%), breast (5%), colorectal (13%), genitourinary (8%) and others (37%). Overall, 19% had documented involvement of inpatient PCS. Patients with lung cancer had the highest utilization of inpatient PCS (25%), compared to breast (20%), genitourinary (17%) and colorectal (13%) cancers. Other outcomes are shown in Table. Conclusions: Inpatient PCS were underutilized in patients with metastatic cancer who were critically ill. Future studies should look into the benefits of early integration of inpatient PCS in this population who are at high-risk of mortality. [Table: see text]
Engaging oncologists toward integrating a shared mental model for palliative oncology within a large academic oncology practice.
Authors: Walling Anne Margaret , Pietras Christopher , Ahmed Kauser , Coscarelli Anne , Hurvitz Sara A. , Simon Wendy , Phung Peter , Nechrebecki Meghan , DAmbruoso Sarah F. , Wenger Neil , Kung Jennie , Goldman Jonathan Wade , Rosen Lee S. , Alexandra Drakaki , Peddi Parvin F. , Wong Deborah J. , Glaspy John A. ,   Oncology Communication Collaborative Team Members
Published: November 2017

105 Background: We aimed to engage oncologists to disseminate a successful pilot-tested shared mental model (SMM) for the integration of early advance care planning (ACP) and identification of palliative care (PC) needs across a health system’s oncologic practice. Methods: Our Oncology Communication Collaborative Team (OCCT) had oncology leadership support and included a multidisciplinary team representing leaders in oncology, ACP, PC, psycho-social oncology and quality. To communicate the SMM developed by our team, the OCCT developed an interactive Saturday session (1-hr didactic, 3-hr small group role-play) that focused on early ACP and the cognitive and emotional aspects of communication. Before and after the training, we asked participants to rate their ability to communicate with patients as well as their readiness, self-efficacy, and need for help to improve communication regarding prognosis, ACP, end of life care and symptom management using a previously validated survey. We computed means and compared matched pairs of pre and post surveys using a paired t-test. We also surveyed participants about whether they would recommend the course to others and planned changes to practice. Results: All but one oncologist (52/53), 3/4 invited fellows, and 12/14 oncology nurse practitioners participated and 90% of attendees completed pre and post surveys. Participants rated their communication ability higher (6.7 v. 7.6, p < 0.01) on a 10-point scale after the training. Readiness to improve communication in this domain (9.1 v. 9.2, p = 0.35) was similar before and after the training. Self-efficacy (1.5 v. 1.5, p = 0.70) and needing help to improve (1.6 v. 1.7, p = 0.37) were rated highly (1 = A lot and 4 = Not at all) but did not change with training. All but one participant reported they would recommend the course to others and free text responses about changes they planned to make to their practice based on the training included: having earlier ACP discussions, focusing on patient goals/priorities and asking open-ended questions. Conclusions: Conducting a training to disseminate a SMM of oncology and PC is feasible, valuable, and can be the first step for partnered continuous quality improvement.
The expanding role of patients in integrated cancer network governance.
Authors: Tremblay Dominique , Marchand Jean-Sébastien , Lévesque Lise 
Published: November 2017

106 Background: The expanding role of patients (including family) at all levels of healthcare systems is increasingly recognized to favour changes in cancer services delivery. The province of Quebec (Canada) is no exception and promotes patients involvement in governance activities such as the implementation of the National cancer program, local integrated cancer networks, practice guidelines, and patient information material. Generally speaking, network governance refers to the steering process carried out to ensure goals’ achievement. However, we lack sufficient understanding of how patients contribute to this process, at local and national levels. This presentation seeks to report on patients involvement in governance activities within integrated cancer networks. Methods: Design: Qualitative data comprising semi‐structured interviews, focus groups and review of documents. Setting: Four Integrated Local Cancer Networks (ILCN) in Quebec purposively selected to provide variation in size, geographic location and time since implementation of the ILCN. Participants: Key stakeholders including policy-makers (n = 8), managers (n = 56), clinicians (n = 39), patients and their family members (n = 28). Analysis: Content analysis using open-ended coding. Results: This study shows the added value of the formalization of patients involvement in the governance committees at local and national levels of the cancer network. It illustrates the operationalization of the political will to translate the Quebec cancer program ideas into concrete patient-centred practice. Enlightening patients experience through discussion leads to shared decision making, building a “community of patients”, the diffusion of supportive tools, and the development, use and interpretation of performance indicators. Conclusions: Patients involvement is a major, but manageable, change in the integration of care across the cancer continuum. Formalizing the expending role of patients in local and national levels governance committees narrows the macro (hierarchical) and micro (relational) governance divide, which in turn contributes to patient-centred and integrated cancer care.
Comparison of hydration events in patients (pts) receiving highly (HEC) or moderately (MEC) emetogenic chemotherapy treated with granisetron extended-release subcutaneous (GERSC) or palonosetron (PALO).
Authors: Vacirca Jeffrey , Caruana Dennis , Calcanes George , Mosier Michael , Boccia Ralph V. , McBride Ali 
Published: November 2017

108 Background: Breakthrough CT-induced nausea and vomiting (CINV) may increase resource needs, eg, hydration. GERSC (SUSTOL) + other antiemetics prevent CINV associated with MEC or anthracycline + cyclophosphamide–based therapy. This retrospective analysis evaluated CINV-related hydration in pts treated with PALO or GERSC antiemetic therapy. Methods: Pts at a multisite community practice had MEC or HEC and a 3-drug antiemetic regimen: NK-1 receptor antagonist (RA), dexamethasone, and 5-HT3 RA (PALO only, GERSC only, or PALO then GERSC). CT emetogenicity (HEC, MEC), number of cycles, and CINV-related hydration were extracted from medical records. Hydration rate (events per cycle) was analyzed for pts who had PALO vs GERSC (group 1; nonparametric 2-sided Wilcoxon rank sum test) and pts who had PALO then GERSC (group 2; paired t-test). Results: There were 93 PALO, 91 GERSC, and 48 PALO-then-GERSC pts. Group 1 had mean (SD) CT cycles of 5.4 (2.8) on PALO vs 4.1 (2.2) on GERSC. The whole group ( P<.0001) and HEC subgroup ( P<.0001) had significantly higher hydration rates with PALO vs GERSC (Table). Overall, 22% (PALO) vs 58% (GERSC) of pts had no hydration. In HEC/MEC subgroups, respectively, 19%/33% (PALO) vs 60%/56% (GERSC) of pts had no hydration. Group 2 switched pts had mean (SD) 3.5 (3.2) cycles on PALO vs 3.1 (2.2) on GERSC. All pts and MEC subgroup had no differences in hydration rate with PALO vs GERSC. HEC subgroup hydration rates were significantly higher for PALO vs GERSC ( P=.028; Table). Conclusions: In a multisite practice, CINV-related hydration was ~3 times less per CT cycle for pts receiving GERSC vs PALO as part of a 3-drug antiemetic regimen. Pts on HEC and treated with PALO then GERSC had significantly reduced hydration needs with GERSC. Reduced hydration needs may improve quality of life and simplify pt management. [Table: see text]
Palliative care in the ambulatory setting: Bon Secours St. Francis Hospital (BSSFH).
Authors: Ashley Jennifer , Bayne Jennifer Huggins , Weems John , Spann Terra , Stinnett Leigh , Strobel Maryjane , Hegedus Patricia , Siegel Robert D. 
Published: November 2017

109 Background: Palliative care is integral to holistic cancer therapy. Early integration of palliative principles results in improvements in quality of life and survival. Despite the evident value of specialized palliative services, the conventional delivery paradigm, particularly in community centers, has remained episodic, crisis driven, and principally provided in the acute care setting. BSSFH opened its cancer center in October 2014. We chose to embed palliative services in the ambulatory setting to introduce patients early in their cancer journey to an integrated program of symptom management. Methods: The BSSFH Cancer Center is a 65,000 sq ft facility located in Greenville, SC. The analytic caseload for 2016 was approximately 1250. One palliative care practitioner per day sees patients both independently and concurrently with medical, gynecological and radiation oncology colleagues. These individuals also participate in Lean projects optimizing care in a variety of disease states. Mandatory referrals at presentation were initially codified for patients with stage 4 lung , and subsequently for pancreatic and all patients receiving multimodality therapy for head and neck carcinomas. Additional patients are referred from our weekly Interdisciplinary Care Rounds or otherwise at the discretion of their attendings. Results: The program showed ongoing growth through 2016, shortly following its inception. Total outpatient encounters in 2015 were 559 while in 2016 were 928. Total new referrals were 158 in 2015 and 190 in 2016 implying that the increase in total visits had less to do with new patient referrals and were more a result of visit-to-visit management of complex circumstances. Conclusions: Palliative medicine is optimally provided with consistency and not episodically. This is best accomplished when such care occurs in both the acute and ambulatory settings through an ongoing therapeutic relationship. BSSFH has created a model in which such care is feasible in the community setting. We are now trying to assess what impact this intervention has had on quality of life, simplifying transitions of care, and on the economics of health care within our system.