bluuebunny/crossref_metadata_2025_split huggingface dataset:
A primary care education program regarding cancer survivorship care plans at the University of Wisconsin (UW).
Authors: Haine James Edward , Trowbridge Elizabeth R , Kamnetz Sandra A , Feldstein David , Wilke Lee G. , Sosman James , Donohue SarahMaria Hill , Sesto Mary E , Tevaarwerk Amye 
Published: March 2017

69 Background: Survivorship care plans (SCPs) have been recommended as a tool to improve cancer patients’ (pts) care coordination and outcomes. The UW routinely provides SCPs. However, a prior project indicated most PCPs were unaware of these SCPs, limiting SCPs potential benefits. Best methods for educating PCPs regarding SCP existence and content are needed. We developed an educational program to inform PCPs of SCP existence, content, and potential uses. Methods: The program - a 10 minute presentation with slides - was developed to make PCPs aware of the basics of SCPs as listed above. The program was presented at UW general internal medicine (GIM) and family medicine (FM) scheduled meetings and emailed to UW PCPs afterwards. Two anonymous online surveys were administered to evaluate PCP previous use and basic knowledge of SCPs. Baseline surveys were sent 1 week prior to the first presentation and a follow-up survey was sent 4 weeks later via UW GIM and FM listservs (n = 286 addresses). Results: 101 PCPs completed the baseline survey: 27% reported not knowing what SCPs were; 50% knew but reported never receiving one; 23% reported having received one. 66 PCPs that attended or reviewed the program completed the follow-up survey. 40 “matched” PCPs completed both surveys. See Table 1 for results. Conclusions: A brief educational program containing information about existence of, content, and location in electronic medical record (EMR) increased PCP knowledge in these areas, which are prerequisites for PCP use. Ongoing work will assess whether PCP review of SCPs at point of care influences clinical decision making. [Table: see text]
Do patients learn from survivorship care plans?
Authors: Bodmann Joanna , Harr Bridgett Ann , Rybicki Lisa A. , Koyfman Shlomo A. , Geiger Jessica Lyn , Funchain Pauline , Joshi Nikhil Purushottam , Woody Neil McIver , Ives Denise I. , Hamker Jean F , Adelstein David J. 
Published: March 2017

73 Background: At the Cleveland Clinic, a formal, patient (pt) specific survivorship care plan (SCP) is given to all pts who have completed definitive treatment (DT) for loco-regionally advanced head and neck cancer (HNC). We sought to assess the impact of this SCP on pt understanding of disease and treatment, potential symptoms of recurrence, and follow up (FU) expectations. Methods: In an unselected series of HNC survivorship eligible pts, the same IRB approved survey was administered both before SCP delivery and again at the next routine FU. The survey evaluated pts’ pre-existing knowledge of the information included in the SCP, and whether it had improved and was retained over time. Results: Pre and post-survey responses were collected from 29 pts who had completed DT between 7-23 months (mo) prior. Eighteen (62%) had a diagnosis of oropharyngeal cancer, all were treated with intensity modulated radiation therapy and most (93%) received concurrent cisplatin. Only 24 of the 29 pts (83%) recalled receiving a SCP when queried at their next FU. However, even before SCP administration, most were well educated about their disease, its treatment, symptoms of recurrence, and FU expectations; all of which were reviewed in the SCP. The post-survey, administered at next FU, suggested that the only group to benefit from SCP administration were those who received it within 6 mo of DT. Conclusions: Pt understanding of disease, treatment and future expectations appears to improve after SCP administration only in those receiving their SCP within 6 mo of DT, likely reflecting ongoing pt education during subsequent FU visits. This small study supports current recommendations to administer SCPs within 6-12 mo of DT.[Table: see text]
Using a mobile app to enhance the uptake of survivorship care plans (SCP) for adolescent and young adult survivors of childhood cancer.
Authors: Schwartz Lisa , Szalda Dava , Psihogios Alexandra M , Ver Hoeve Elizabeth Shea , Daniel Lauren , Butler Eliana , Hobbie Wendy , Jacobs Linda A. , Ginsberg Jill P. , Fleisher Linda , Vachani Carolyn , Hampshire Margaret K. , Metz James M. , Hill-Kayser Christine E. 
Published: March 2017

74 Background: Survivorship self-management, including adherence to survivorship care plans (SCPs), is variable, especially among adolescents and young adults (AYA). Methods:The present study describes the development of a mobile application (app) for AYA survivors (AYA STEPS), which strives to improve survivorship self-management via a combined texting self-management program (THRIVE 2.0) and an electronic survivorship care plan generator (Smart-ALACC [Smart-Adult Living After Childhood Cancer], hosted on Oncolink.org). Results: AYA STEPS was developed by modifying an existing disease management app, LSTCare. The main feature of the app is the delivery of two-way text messages that are tailored to an individual’s SCP. The messages are designed to enhance uptake of the SCP with information, strategies for adherence, motivational messages, and appointment reminders. Patients may also text back with questions. The SCP and its related text information are customized based on input of patient characteristics and treatment history, such as age, time off treatment, and type of treatment (e.g., anthracycline chemotherapy, mediastinal radiation, cranial radiation). The app also houses a copy of the complete SCP document. The SCP is generated, via patient or provider, via an electronic platform that incorporates patient demographic information, cancer diagnosis, and cancer treatments received with checklist of options. Feedback on the app was provided by AYA ages 15 to 21 via a focus group (n = 5) and interviews (n = 5), through which qualitative data were collected. AYA reported high acceptability of a mHealth intervention to improve self-care as cancer survivors, especially the inclusion of tailored content from an individualized SCP as text messages. They also reported the app as feasible to download and maintain on their phones. Conclusions: We are about to begin a RCT that will test adherence to SCP for those who received the app and the SCP versus the SCP alone. We will report details of the app and the launch of the RCT. We expect high acceptability and feasibility with measured benefit to receiving the self-management app.
Use of telemedicine in the delivery of survivorship care plans among breast cancer survivors: Lessons learned at Kaiser Permanente East Bay.
Authors: Washington Pamela Kim , Tews Heather , Nguyen Dan-Thanh , Wade Leeina , Phan Trang , Reddy Mala N. , Lai Janet , Barnett Nicole M , Greer Jennifer , Shim Veronica 
Published: March 2017

77 Background: Beginning in 2015, the National Accreditation Program for Breast Centers (NAPBC) requires accredited facilities to provide Survivorship Care Plans (SCP) to breast cancer patients treated with curative intent. Here we describe lessons learned with the use of telemedicine in the delivery of SCPs at Kaiser Permanente East Bay. Methods: SCP implementation followed a two-step process: patients who are diagnosed and complete treatment in 2016 are given a SCP at their last surgical or medical oncology appointment (YTD, n=8); 2) patients diagnosed in 2015 who completed treatment in 2015-2016 were contacted by a physician assistant and offered an appointment by telephone or in-person to deliver the care plan (n=152). Both clinic and telemedicine appointments consist of a detailed review of treatment received, post-treatment follow-up care, discussion of health education resources, and provision of referrals as appropriate. Patients also have the opportunity to ask questions about treatment and follow-up care. Results: Among patients diagnosed in 2015 who were offered a TAV or in-person visit, 44.0% preferred a telephone appointment. Actual appointment duration ranged from 10 to 30 minutes. Lack of co-payment and fees associated with transportation as well as loss of income due to taking time off work were the primary factors cited choosing telemedicine over in-person clinic appointments. Interestingly, no differences in member satisfaction scores for in-person vs. telephone visits were observed. Conclusions: Findings suggest telemedicine may be effective in the delivery of SCPs. Similar to rural settings, use of telemedicine in urban settings has a unique capacity to increase service to breast cancer patients.
Cancer costs and trends for newly diagnosed malignancies at an academic institution.
Authors: Lindauer Stephanie Purkat , Hinojosa Barbara , Jones Jessica Trevino , Mazo- Canola Marcela , Gelfond Jonathan , Lathrop Kate Ida 
Published: March 2017

8 Background: The financial cost of cancer is a large burden and continues to rise substantially. Expenditures can be divided into the initial phase after diagnosis, the continuing phase, and the last year of life. Typically costs are greatest in the initial phase and last year of life. The major determinant of cost during the initial phase is hospitalizations. We sought to examine cancer costs of patients with newly diagnosed malignancies at an academic institution during the initial phase and compare outcomes based on insurance status. Our institution serves a significant portion of South Texas, a population facing serious cancer health disparities. Methods: This was a prospective, non-randomized study evaluating patients with new cancer diagnoses from 2014-2016 at an academic hospital. Patients meeting eligibility criteria were screened and consented for participation. A total of 74 patients were included in analysis. Results: The average age was similar in both the self-pay group and the insurance group (including government-sponsored, private, and county funding); 51.1 vs 54.8 years respectively (p = 0.09). Ethnicity between the two groups was not significantly different, 46.2% were Hispanic in the self-pay group vs 45.8% in the insurance group (p = 0.94). The majority of patients in both groups presented with advanced disease, 61.5% in the self-pay group vs 70.8% in the insurance group (p = 0.44). The average number of days of hospitalization was significantly higher in the insurance group compared to the self-pay group, 15.4 days vs 10.6 (p = 0.04). Congruently, average total cost of hospitalization was higher in the insurance group, $96,200 vs $64,200 (p = 0.05). 26.9% of patients in the self-pay group enrolled in hospice within 6 months of their diagnosis vs 20.8% in the insurance group (p = 0.26). Conclusions: With the limitation of a small sample size, our study demonstrates a statistically significant difference in hospitalization days and cost in insured vs uninsured patients with new cancer diagnoses at an academic hospital.
Caregiver needs during transition from acute cancer: Findings from focus group discussions with cancer survivors and caregivers.
Authors: Tolbert Elliott , Bowie Janice , Snyder Claire Frances , Makia Barraw , Smith Katherine Clegg 
Published: March 2017

84 Background: The Institute of Medicine recommends that all cancer patients receive a survivorship care plan to help alleviate challenges faced when transitioning from acute treatment to long-term survivorship. As nearly three million Americans act as caregivers for a loved one with cancer, it is important that the survivorship care planning process consider the needs of not only the survivor, but also caregivers. Methods: In preparation for a randomized controlled trial of survivorship care planning, we conducted four focus groups with adult survivors of breast, prostate, and colorectal cancer (n = 28) and two with self-identified caregivers of people who had been treated for these three cancers (n = 20). Focus group participants were recruited from a large, urban academic medical center and a rural community cancer center. Discussions focused on needs and expectations during the transition from cancer treatment to survivorship. Each discussion was recorded, transcribed, and analyzed qualitatively. Data analysis also included review of findings by an advisory board of patients and caregivers. Results: Six themes emerged, some raised by both survivors and caregivers, and some only by caregivers. The need for information on side effects and follow-up care recommendations, confusion regarding the role each provider plays once treatment is complete, and the need for resources and support to help deal with issues such as physical and emotional distress and living a healthy lifestyle were brought up by both caregivers and survivors. In addition, caregivers discussed uncertainty about their role as a caregiver, their own mental and emotional health needs, and the idea that adjusting to ‘a new normal’ is not just for the patient, but also caregivers. Conclusions: Caregivers have distinct needs in addition to those of the patient. These caregiver concerns may need to be addressed during the survivorship care planning process. Based on these findings, we are including a caregiver-specific resource in our survivorship care planning randomized controlled trial.
Survivors’ stories are the teacher: Narrative mapping and survivorship care plans as educational innovation for pre-clerkship medical students.
Authors: McManamon Alyssa Claire , Thompson Marie 
Published: March 2017

90 Background: The IOM’s recommendation for Survivorship Care Plans (SCPs) has met slow adoption, further hampered by growth in survivorship. Inviting patients into SCP creation supports individualized care goals. Narrative mapping is a visual tool to navigate challenging communicative landscapes. We describe an educational innovation that values SCP completion, engages physicians & trainees to solicit patient narrative, and allows emergence of collaborative care. We hypothesized it is feasible to: provide preclerkship medical students “legitimate peripheral participation” via meaningful use of the electronic health record (EHR) to review an individual patient’s cancer history; engage survivors and learners through narrative mapping to improve the SCP process; provide a student-prepared, clinician/survivor vetted SCP, leveraging UME in support of survivors’ needs. Methods: 170 second-year students at the Uniformed Services University were invited to enroll in a pilot curriculum on cancer survivorship. Oncology providers identified patients without an SCP and interested in sharing their stories since time of diagnosis. Survivors and students (in separate 90 min workshops) created and shared drawn maps of personal health stories. Students received EHR training to inform use of the ASCO SCP template for an assigned survivor. Following student-survivor review of survivors’ narrative maps, triads (student-survivor-oncologist) met to finalize SCPs for EHR upload. Results: Over three months, 18 medical students drafted an SCP on behalf of an assigned survivor. 19 survivors received an SCP following creation and sharing of their narrative map. Post-pilot, 95% of participating students submitted written reflections (uniformly positive) and survivors requested to remain involved in UME, finding meaning in sharing their stories. Conclusions: Survivors are enthusiastic educational partners in complex care environments. It is feasible to engage medical students with cancer survivors to create SCPs, with narrative mapping as a contextualizing approach. UME learning needs dovetail with those of survivors to address the call for SCP adoption.
Primary care providers' awareness and utilization of survivorship care plans.
Authors: Rosales Alicia R. , Schaal Tina , Darland Shelby , Zuckerman Dan Sayam 
Published: March 2017

94 Background: The Commission on Cancer (CoC) standard 3.3 requires that all patients who complete cancer treatment receive a survivorship care plan (SCP). To aid in care coordination, the standard also requires that the SCP be provided to the patient’s primary care provider (PCP). St. Luke’s Mountain States Institute (MSTI) has been providing patients and PCPs with SCPs for more than 5 years. Other local accredited cancer centers also provide SCPs for their patients. Methods: In partnership with the local chapter of the American Cancer Society, MSTI created an online survey aimed at assessing the utilization of the SCP in primary care clinics and the PCP’s comfort level carrying out the recommended surveillance. The survey link was distributed through email to approximately 300 PCPs across a large geographical area in varying sized practices. Results: Sixty three responses were received in 3 weeks with 46 responses from physicians and 17 responses from advanced practice providers. All of the respondents said they care for cancer survivors in their practice but 54% have never received a SCP. Twenty nine reported having received a SCP and answered 8 questions related to how they use the SCP in practice. The majority refer to the SCP to monitor for recurrence and 52% use it as a tool for coordination of care. Forty eight percent use the SCP to manage co-morbid conditions. Ninety-five percent of all respondents indicated they feel comfortable carrying out a surveillance plan provided by the oncologist for patients 2 years out from treatment. Sixty-four percent indicated they would like additional education about caring for cancer survivors. A common theme in comments included the desire for improved communication between the oncologists and PCPs. Conclusions: This standard was created in part to improve care coordination between oncologists and PCPs. More than have of the PCPs in the MSTI service area have not seen a SCP for their patients. Most indicated they are comfortable providing surveillance if they have a clear follow-up care plan from the oncologist. More than half want additional information about caring for cancer survivors. Future exploration could include assessment of barriers to communication and utilizing the SCP in practice.
Gastric Fluid Volume Change After Oral Rehydration Solution Intake in Morbidly Obese and Normal Controls: A Magnetic Resonance Imaging-Based Analysis
Authors: Shiraishi Toshie , Kurosaki Dai , Nakamura Mitsuyo , Yazaki Taiji , Kobinata Satomi , Seki Yosuke , Kasama Kazunori , Taniguchi Hideki 
Published: March 2017

BACKGROUND:
Although preoperative fluid intake 2 hours before anesthesia is generally considered safe, there are concerns about delayed gastric emptying in obese subjects. In this study, the gastric fluid volume (GFV) change in morbidly obese subjects was investigated after ingesting an oral rehydration solution (ORS) and then compared with that in nonobese subjects.

METHODS:
GFV change over time after the ingestion of 500 mL of ORS containing 2.5% carbohydrate (OS-1) was measured in 10 morbidly obese subjects (body mass index [BMI], >35) scheduled for bariatric surgery and 10 nonobese (BMI, 19–24) using magnetic resonance imaging. After 9 hours of fasting, magnetic resonance imaging scans were performed at preingestion, 0 min (just after ingestion), and every 30 minutes up to 120 minutes. GFV values were compared between morbidly obese and control groups and also between preingestion and postingestion time points.

RESULTS:
The morbidly obese group had a significantly higher body weight and BMI than the control group (mean body weight and BMI in morbidly obese, 129.6 kg and 46.3 kg/m2, respectively; control, 59.5 kg and 21.6 kg/m2, respectively). GFV was significantly higher in the morbidly obese subjects compared with the control group at preingestion (73 ± 30.8 mL vs 31 ± 19.9 mL, P = .001) and at 0 minutes after ingestion (561 ± 30.8 mL vs 486 ± 42.8 mL; P < .001). GFV declined rapidly in both groups and reached fasting baseline levels by 120 minutes (morbidly obese, 50 ± 29.5 mL; control, 30 ± 11.6 mL). A significant correlation was observed between preingestion residual GFV and body weight (r = .66; P = .001).

CONCLUSIONS:
Morbidly obese subjects have a higher residual gastric volume after 9 hours of fasting compared with subjects with a normal BMI. However, no differences were observed in gastric emptying after ORS ingestion in the 2 populations, and GFVs reached baseline within 2 hours after ORS ingestion. Further studies are required to confirm whether the preoperative fasting and fluid management that are recommended for nonobese patients could also be applied to morbidly obese patients.
The Postmasters' Piggy Bank
Authors: Ahrendt Rebekah , Van der Linden David 
Published: March 2017

AbstractOur rediscovery of a seventeenth-century postmasters' trunk in the Museum voor Communicatie in The Hague, containing some twenty-six hundred undelivered letters mostly sent from France, offers the opportunity to think from the ground up about what constitutes an archive and how to approach it. We argue that understanding the process of loss, destruction, and survival of collections is a crucial exercise for historians. Practicing this “archaeology of the archive” makes us keenly aware that the questions we ask are often dictated by the genesis and structure of the archive. Although document survival is often the result of intentional safekeeping, in other cases it can be attributed to sheer accident. Addressing questions of materiality, mobility, and preservation, this article explores the notion of the “accidental archive” to consider what best practices should be developed to ensure responsible access to this unique collection.Notre redécouverte d'un coffre postal du dix-septième siècle au Museum voor Communicatie à La Haye, contenant quelque 2 600 lettres au rebut envoyées principalement de France, offre l'occasion de repenser ce que constituent les archives et comment il faut les aborder. Nous soutenons que comprendre les processus de perte, de destruction et de survie des collections est un exercice crucial pour les historiens. Pratiquer cette « archéologie de l'archive » nous rappelle vivement que les questions que l'on pose sont souvent dictées par la genèse et la structure accidentelles des archives. Car, bien que la survie documentaire soit souvent le résultat d'un geste de conservation intentionnelle, dans d'autres cas elle peut être attribuée au pur hasard. En abordant des questions de matérialité, de mobilité et de préservation, cet article explore la notion des « archives accidentelles » afin de considérer les meilleures pratiques à développer pour assurer un accès responsable à cette collection unique.