bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing treatment planning workflow in radiation oncology.
Authors: Khudanyan Arpine , Jaboin Jerry Jeff , Agrimson Barb , Brown Simon , Laub Wolfram , Price Jo , Junell Stephanie , Hanson Jeff , Ryan Dorothy , Ruocco Jennifer , Thomas Charles R. 
Published: April 2017

84 Background: The treatment planning process is the most impactful and complex aspect of radiation oncology care. In order to provide short turn around times from patient CT simulation to treatment plan QA, requires a level of strain and haste for multiple members of the treatment team. We evaluated 18 months of data to determine the percentage of Quality Assurance (QA) approvals of nonemergent complex plans (including 3D/IMRT/Arc/SBRT/SRS) that are not completed by 8:00a the day prior to a patient's first treatment appointment, and found that this occcurred on time 62% of the time. We utilized the ASCO Quality Training Process (QTP) process to brainstorm methods to enhance workflow, and create an action plan that would allow for small Plan-Do-Study-Act cycles to reach our ideal state of > 90% On Time Treatment Plan Delivery. Methods: We utilized LEAN tools from the ASCO QTP progam (June 2016 cycle). We created an Ishikawa diagram to determine the areas of greatest potential. We subsequently developed a highly detailed flow chart of our work processes. Then we utilized Mosaiq scripts to establish baselines for our process measures. Results: From our Ishikawa diagram, the initial most impact was in generate target volume contours after the CT simulation. Our first measure was to visually manage the CT simulation process. We established a computer based quality control list (QCL) to enhance the communication process, and provided a "reminder" at the time of simulation of the target contour delivery date. After collection of data points, there was a significant improvement in on time delivery (now 89%, and approaching the ideal state), as illustrated by our Run Chart, and a coincident decrease in variability between providers and cases was noted in this cohort. Conclusions: Our preliminary change effort is promising, but further data will enhance our findings. Our next steps are to collect an additional two weeks of data, and initiate another PDSA cycle with a new measure of automated reminders from the QCL system. In achieving our project goals and making it sustainable, we believe that we will be providing high quality, high value patient care, while enhancing the healthiness of the work environment for our staff.
Feasibility of lay cancer patient navigation in an academic medical center on unmet needs of cancer patients.
Authors: Wood William Allen , Sellers Jean B , Shea Thomas C. , Mayer Deborah 
Published: April 2017

87 Background: Lay cancer patient navigators (LCPN) are volunteers from the community who assist cancer patients in overcoming barriers to receiving quality cancer care. LCPN can address issues such as. financial burden and psychosocial distress, and can reduce disparities in access to resources. There is little data regarding LCPN within academic medical centers. Methods: In 2013, 24 breast cancer patients at our center were surveyed to determine unmet needs. 82% reported feeling alone and 55% reported lack of awareness about available patient resources. These data supported the development of an LCPN program, in January 2015. Volunteers were provided with comprehensive training that focused on supportive communication, identification of barriers to care, and provision of available cancer resources to address unmet patient needs. Volunteers were integrated within clinical workflows to identify and interact with patients felt to potentially benefit from LCPN. Results: A total of 30 volunteer lay patient navigators were trained between January 2015 – June 2016. Of the 30, 14 elected to staff a weekly disease oriented clinic volunteering 3-4 hours per week. There have been 1,034 patient encounters with 484 encounters in new patients and 550 in repeat patients through June 2016. LCPN completed an encounter form after each patient visit. As a result of these encounters, referrals were provided to the following resources: patient and family resource center (74% ); community resource information (30%); financial counseling (27%); and social work (25%). LCPN report that they feel adequately trained to provide information and meet needs of cancer patients during these visits. Conclusions: We have developed an infrastructure to support an LCPN program within our academic medical center, and have found that this infrastructure facilitates provision of information to cancer patients that addresses their unmet needs. The model is cost-effective and requires few internal resources other than training and ongoing supervision. Future steps will include development of specific interventions to enhance the dissemination of this model throughout North Carolina.
Inpatient 100% mortality review at a NCI Comprehensive Cancer Center Hospital.
Authors: Jain Angela , Pendleton Delinda , Doyle Jamie , Barta Stefan K. , Hallman Mark A , Kloth Dwight D. , Patrick Kenneth , Ridge John A. 
Published: April 2017

88 Background: Fox Chase Cancer Center set about to identify opportunities to improve care (OIC) for cancer patients dying in the hospital. The team developed and tested a mortality review decision tree and paradigm that helped to identify OICs. Volunteer members of hospital staff representing most domains of patient care comprised the committee. Monthly meetings defined the review process, developed the form, initiated the program and refined the process as experience accumulated. Methods: Forms incorporated information from Temple University Hospital, Comprehensive Cancer Center Consortium for Quality Improvement(C4QI), and measures to be monitored by CMS. Deaths were considered “anticipated” or “unanticipated,” and with or without OIC. Issues in cases with OIC were recorded for each death. Level 1 review was completed by a research student or a member of the risk management team to organize clinical data. A level 2 review was then performed by a member of the committee and deaths were categorized. Level 3 review was undertaken at monthly meetings and action items determined. Results: From March 2014 to December 2015, 246 cases were reviewed. The elements were chosen for the level 1 & 2 review and collating objective data. Whether the patient was treated with curative intent, procedures were definitive or palliative, if chemotherapy, radiation or surgery were delivered, or if there was a complication within the last 2 weeks of life were recorded. Hospitalization features such as institution of palliative care, appropriate advanced directives, code status on admission and at death, and ICU admission were noted. Issues often arose when deaths were expected and predicted at admission. Increased need for inpatient palliative care teams and hospice support have been recognized. Better communication between patients, families, and oncologists should reduce hospitalization for patients whose death is imminent. Conclusions: Submitting 100% of inpatient deaths to formal mortality review discloses opportunities to improve care and allows focus on problems that occurred even when the patient’s death was expected.
A virtual tumor board-driven synaptic knowledge network.
Authors: Heifetz Laurence J. , Koppel Ahrin B. , Kaime Elaine Melissa , Palmer Daphne , Semrad Thomas John , Bervid Cathey , Potter Christina , Goodall Janet , Truscott Ann , Christensen Scott 
Published: April 2017

89 Background: In 2006, Tahoe Forest Hospital District—a 25-bed hospital in Truckee, CA, a mountain resort community one hour from regional and two hours from academic cancer services—designed and implemented an oncology program utilizing effective telecommunications with a committed academic partner, the UC Davis Comprehensive Cancer Center in Sacramento. Methods: The UC Davis Cancer Care Network was established with four remote cancer programs, enabling participation in daily virtual tumor boards, clinical trial enrollment, and quality assurance assistance. (Richard J. Bold, et. al., Virtual tumor boards: community-university collaboration to improve quality of care. Community Oncol 10(11):310-315, November 2013.; Laurence J. Heifetz, MD, et. al., A Model for Rural Oncology. J Oncol Pract, 7:168-171, May 2011.). An increasing number of patients were observed to in-migrate to Truckee from even more remote rural areas in the mountains. In 2013, the now Gene Upshaw Memorial Tahoe Forest Cancer Center developed four remote telemedicine clinics to allow even more physically distant patients the capacity to be followed locally. Results: Since we opened the remote telemedicine clinics, our Sullivan-Luallin patient satisfaction scores have averaged 4.82/5.00 for “overall satisfaction with the practice” and 4.90/5.00 for “recommending your provider to others”; our in-migration rate of patients from outside our primary catchment area increased from 43% to 52%: and clinical trial accrual rate averaged 10%. Conclusions: Reducing cancer health disparities is an ASCO mission. (cover, ASCO Connection, July 2014; Laurence J. Heifetz, MD. Country Docs with City Technology Can Address Rural Cancer Care Disparities. Oncol, 29(9):641-644, September 2015.). We believe this synaptic knowledge network effectively addresses that mission for rural communities. This model can be scaled in many configurations to address the inherent degradation of quality care as a function of physical distance to an academic center that rural doctors and patients deal with on a daily basis. The key is to insist on a cultural shift – Do something smart at lunch every day. Attend a virtual tumor board.
Identification of Lynch syndrome cohort in a hospital system.
Authors: Salner Andrew L. , Sekerak Richard , Yu Peter Paul 
Published: April 2017

91 Background: Lynch Syndrome (LS) is a genetically inherited autosomal dominant disease that is the result of germline mutations in mismatch repair (MMR) genes. LS is the most common cause of inherited colorectal cancer (CRC), causes cancer at a younger age, and increases other cancer risk (pancreas, endometrium). Thus, it is important to identify patients who have LS so that patients and affected family members can receive the proper surveillance and care. Hartford HealthCare Cancer Institute (HHCCI) has developed a standard of care to screen patients who may have LS by testing CRC specimens for loss of expression of MMR genes, as well as to refer all patients under 50 for counseling. The aim of this research project is to determine how well each of our healthcare system's five hospitals is meeting the standard. Methods: This retrospective study explored all cases of CRC at each of the five HHCCI hospitals from 2014-2015. Patients were identified from the Cancer Registry and data was extracted from patient charts, pathology and genetics reports. The study analyzed: age, gender, stage, presence of MMR testing, and genetics counseling and testing for MMR positive patients and patients under 50. Results: 423 CRC patients were diagnosed at HHC cancer centers, 45% male, 55% female, average age of 68.2. In total, HHCCI tested 81.3% of patients diagnosed with CRC in 2014-2015, ranging from 30.8 to 94.5% among the hospitals. 7.6% of patients had abnormal MMR results. Of patients with MMR+ results, 57.7% had genetic consult and 10 of the 15 consulted had a germline test. Seven patients (70%) tested positive for LS. Patients with LS were younger (average age 47.6), and the majority were male. Ten of 45 patients under 50 were referred for genetics consult (22%), with a range of 0-67% amongst the hospitals. Three were LS positive on testing. Conclusions: Clinicians on our GI cancer team assumed that the agreed upon standard of MMR testing in CRC and referral of younger patients for genetics counseling would result in 100% compliance. The study outcomes suggest a need for improved implementation strategies for CRC testing at HHCCI hospitals. Overall, the study demonstrates the importance and need of quality improvement measures to inform and improve patient care.
Impact of triggered palliative care consultation approaches on palliative care consult implementation in inpatient oncology.
Authors: Dimartino Lisa , Weiner Bryan J , Hanson Laura C , Weinberger Morris , Birken Sarah , Reeder-Hayes Katherine Elizabeth , Trogdon Justin G 
Published: April 2017

95 Background: Studies show palliative care (PC) delivered concurrently with cancer treatment improves outcomes, yet integration of PC with inpatient oncology is lacking. A promising approach to improve integration is a triggered palliative care consultation (TPCC), which is primarily based on clinical criteria (e.g. metastatic disease) and may include multiple strategies to support its use. This study evaluated the impact of two TPCC approaches on PC consult implementation (uptake and timeliness) in the solid tumor medical (MED) and gynecologic oncology (GYN) services at an academic medical center. Methods: MED TPCC used multiple strategies (chart review to identify eligible patients, training, clinician prompting); GYN TPCC used a single strategy (written guideline of clinical criteria for initiating a consult). PC consult information was obtained from medical charts and linked to all hospital encounter data for MED and GYN. The timeframe was 2010-2016 with TPCC onset in 2014 (GYN) and 2015 (MED). We compared PC consult implementation in GYN (single strategy) vs no strategy and MED (multiple strategies) vs GYN (single strategy). Difference-in-differences and modified Poisson regression was used to evaluate whether PC consult implementation differed after initiating strategies, adjusting for patient demographic and clinical characteristics. Results: Our sample included 5,873 MED and 3,889 GYN hospitalizations. Overall 8.8% of MED and 11.0% of GYN hospitalizations involved a PC consult. In regression analyses, use of a single strategy was associated with increased PC consult uptake vs no strategy (aRR: 1.45, p < .05), while use of multiple strategies was associated with increased PC consult uptake vs use of a single strategy (aRR: 2.34, p < .001). Across all comparisons, the strategies did not significantly impact PC consult timeliness. Conclusions: This study compared PC consult implementation across two inpatient oncology services and found a TPCC approach supported by multiple strategies had the greatest impact on uptake. Questions remain regarding which TPCC approach can most effectively achieve sustainability of uptake and PC consult timeliness in inpatient settings.
Effect of cancer nurse navigators (CNN) on physician engagement in multidisciplinary discussions prior to head and neck cancer treatment.
Authors: Werner Valerie , Barry-Weers Anne , Weese James Leighton , Corsten Martin 
Published: April 2017

98 Background: Aurora Health Care, a 15 hospital integrated system has recognized a multidisciplinary approach is the best practice for treatment of head and neck (H&N) cancers. We tested whether CNNs and system wide high definition video conferencing facilitates multidisciplinary collaboration in the treatment of H&N cancers. Methods: Baseline data identified the percent of newly diagnosed H&N cancer cases with prospective multidisciplinary discussion prior to initiation of treatment (Phase I). Then, performance improvement initiatives were identified to increase the percent of patients discussed during a multidisciplinary conference (MDC). The initiatives included: weekly review of all H&N cancer cases by a lead CNN found by Cancer Registry through EPATH; electronic communication from the CNN requesting physician presentation of their patients at the MDC; engagement of site-specific CNNs to schedule their provider’s patients for the MDC; collaboration with cancer registrars to place their site-specific patients with H&N cancer on their local or system MDC case list; follow-up with providers on patients not presented at MDC; and timely feedback (< 24 hours) to referring providers on recommendations for patients presented at MDC . After implementation of performance improvement initiatives, comparison data was obtained (Phase II) and analyzed utilizing a chi square test. Results: From January through September 2015 (Phase I) and October 2015 through June 2016 (Phase II), 75 and 102 H&N cancer cases were reviewed, respectively. A significant rise (p=0.005) in the percentage of patients being presented at an MDC occurred between phases I (77%, N=75) and II (93%, N=102). Conclusions: Through a coordinated process by CNNs, providers engaged in multidisciplinary discussions prior to the initiation of treatment. This increased engagement, changed practice patterns with patient assessment, aligned the institution with best practice guidelines and aided in therapy selection for the best possible patient outcomes.
Identifying genes for neurobehavioural traits in rodents: progress and pitfalls
Authors: Baud Amelie , Flint Jonathan 
Published: April 2017

ABSTRACTIdentifying genes and pathways that contribute to differences in neurobehavioural traits is a key goal in psychiatric research. Despite considerable success in identifying quantitative trait loci (QTLs) associated with behaviour in laboratory rodents, pinpointing the causal variants and genes is more challenging. For a long time, the main obstacle was the size of QTLs, which could encompass tens if not hundreds of genes. However, recent studies have exploited mouse and rat resources that allow mapping of phenotypes to narrow intervals, encompassing only a few genes. Here, we review these studies, showcase the rodent resources they have used and highlight the insights into neurobehavioural traits provided to date. We discuss what we see as the biggest challenge in the field – translating QTLs into biological knowledge by experimentally validating and functionally characterizing candidate genes – and propose that the CRISPR/Cas genome-editing system holds the key to overcoming this obstacle. Finally, we challenge traditional views on inbred versus outbred resources in the light of recent resource and technology developments.
Algorithms for Generalized Clusterwise Linear Regression
Authors: Park Young Woong , Jiang Yan , Klabjan Diego , Williams Loren 
Published: April 2017

Clusterwise linear regression (CLR), a clustering problem intertwined with regression, finds clusters of entities such that the overall sum of squared errors from regressions performed over these clusters is minimized, where each cluster may have different variances. We generalize the CLR problem by allowing each entity to have more than one observation and refer to this as generalized CLR. We propose an exact mathematical programming-based approach relying on column generation, a column generation–based heuristic algorithm that clusters predefined groups of entities, a metaheuristic genetic algorithm with adapted Lloyd’s algorithm for K-means clustering, a two-stage approach, and a modified algorithm of Späth [Späth (1979) Algorithm 39 clusterwise linear regression. Comput. 22(4):367–373] for solving generalized CLR. We examine the performance of our algorithms on a stock-keeping unit (SKU)-clustering problem employed in forecasting halo and cannibalization effects in promotions using real-world retail data from a large supermarket chain. In the SKU clustering problem, the retailer needs to cluster SKUs based on their seasonal effects in response to promotions. The seasonal effects result from regressions with predictors being promotion mechanisms and seasonal dummies performed over clusters generated. We compare the performance of all proposed algorithms for the SKU problem with real-world and synthetic data. The online supplement is available at https://doi.org/10.1287/ijoc.2016.0729 .
When Waiting to See a Doctor Is Less Irritating: Understanding Patient Preferences and Choice Behavior in Appointment Scheduling
Authors: Liu Nan , Finkelstein Stacey R. , Kruk Margaret E. , Rosenthal David 
Published: April 2017

This paper examines patient preferences and choice behavior in scheduling medical appointments. We conduct four discrete choice experiments on two distinct populations and identify several “operational” attributes (e.g., delay to care and choice of doctor) that affect patient choice. We observe an interesting gender effect with respect to how patients trade off speed (delay to care) and quality (doctor of choice), and demonstrate that risk attitudes mediate the impact of gender on the perception of speed and quality. Specifically, females (versus males) are more averse to not seeing their own doctor, and, when delay to care is relatively long, females perceive greater utility loss than males. As many operational strategies in outpatient care aim to improve the patient experience by making trade-offs between speed and quality, we make suggestions for when managers should intervene to improve their practice and how such interventions might look based on the patient mix and current delay level. The online appendix is available at https://doi.org/10.1287/mnsc.2016.2704 . This paper was accepted by Gad Allon, operations management.
Characteristics and clinical assessment of antibiotic delivery by chitosan sponge in the high-risk diabetic foot: a case series
Authors: Patel N. , Hatch D. , Wells C.M. , Ahn D. , Harris M. , Jennings J.A. , Haggard W. , Armstrong D.G. 
Published: April 2017

Objective: The local delivery of antimicrobials is attractive for a number of reasons. Chitosan, a biodegradable polysaccharide sponge material, has been proposed as medium to deliver antibiotics directly to wounds. In this report we evaluate the safety and practicality of antimicrobial delivery via chitosan sponge. Method: We present the clinical course and systemic absorption characteristics of three cases of people with diabetic foot wounds treated with antibiotic soaked chitosan sponge (Sentrex BioSponge, Bionova Medical, Germantown, TN). The antibiotic sponge was made by reconstituting 1.2g tobramycin or 100mg doxycycline in 10–15ml saline and saturating the sponge with the solution. The sponge was then applied to the wounds. Serum levels of each respective antibiotic were evaluated after application. Additional in vitro studies were conducted evaluating elution of antibiotics from the chitosan sponge at established minimum inhibitory concentrations (MIC) for Staphylococcus aureus over 28 days. Results: No patient experienced adverse local or systemic effects due to the sponge treatment. The measured serum levels applied antibiotics remained far less than established minimums after intravenous therapy. Each patient required further treatment, however local infection or contamination resolved during the course of their hospital stay after the chitosan/antibiotic application. Conclusion: The use of antibiotic-impregnated chitosan sponges appears a safe and effective mechanism of local delivery of antimicrobials in wounds. Future studies and clinical trials are ongoing to confirm these results and to guide clinical applications.
Publication Review
Authors: Dillon Pat 
Published: April 2017

Abstract
Crafting Textiles in the Digital Age, Nithikul Nimkulrat, Faith Kane and Kerry Walton (eds) (2016) London and New York: Bloomsbury Academic, 240pp., ISBN-13: 9781472532046, h/bk, £85.00; ISBN: 9781474286206, p/bk, £19.99