bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics
Authors: Abdulla Irfan , Langohr Daniel G , Giles Joshua W. , Johnson James A. , Athwal George S. 
Published: April 2017

Background There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion. Methods A custom RSA implant capable of measuring forces across the joint with varying polyethylene constraint was tested in six cadaveric shoulders. Standard-, low- and high-constraint (retentive) polyethylene liners were tested, and joint kinematics, loads and muscle forces were recorded. Results When polyethylene constraint was altered, joint load and load angle during active abduction were not affected significantly ( p > 0.19). Additionally, the force required by the deltoid for active abduction was not affected significantly by cup constraint ( p = 0.144). Interestingly, active abduction range of motion was also not affected significantly by changes in cup constraint ( p > 0.45). Conclusions Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.
Systemic therapy in the curative treatment of head and neck squamous cell cancer: A systematic review
Authors: Winquist Eric , Agbassi Chika , Meyers Brandon M. , Yoo John , Chan Kelvin K. W. ,   the Head and Neck Disease Site Group
Published: April 2017

Objective To review the available evidence and make recommendations regarding use of systemically administered drugs in combination or in sequence with radiation (RT) and/or surgery for cure and/or organ preservation in patients with locally advanced nonmetastatic (Stage III to IVB) squamous cell carcinoma of the head and neck (LASCCHN). Method Recognizing the Meta-analysis of Chemotherapy in Head and Neck Cancer (MACH-NC) group reports have de facto guided practice since 2000, we searched for systematic reviews in the MEDLINE, EMBASE and Cochrane Database of Systematic Reviews published from January 2000 to February 2015 in reference to 4 research questions. A search was also conducted for randomized trials (RCTs) up to February 2015 not included in the meta-analyses. Result The MACH-NC reports, 5 additional meta-analyses, and 30 RCTs not included by MACH-NC were identified. For chemotherapy, MACH-NC findings showing improved overall survival with concomitant chemoRT did not require modification. High-dose cisplatin was most commonly studied. We confirmed this benefit with cisplatin monotherapy in patients treated with with postoperative concurrent chemoRT. Other than cetuximab, no targeted agents and radiosensitizers studied in RCTs were shown effective. TPF induction chemotherapy was superior to PF for tumor response and larynx preservation but not survival. Larynx preservation was reported with both CRT and induction chemotherapy approaches. Conclusion ChemoRT with cisplatin at least 40 mg/m2 per week given as radical or postoperative adjuvant remains a standard treatment approach for LASCCHN that improves overall survival but increases toxicity. 5-FU plus platinum is supported by less data but may be a reasonable alternative for patients unsuitable for cisplatin. Of note, stratification of outcomes by HPV-status was not available but outcomes for oropharynx cancer appeared similar to other subsites in chemoRT RCTs. No RCTs have yet demonstrated superiority or non-inferiority of cetuximab-RT to CRT. In view of this, cetuximab-RT is suggested only for patients not candidates for CRT. Taxane-based triplet induction chemotherapy is superior to doublets for rapid tumour downsizing and for larynx preservation, but does not improve overall survival and should be used with primary G-CSF prophylaxis. Further investigation of induction approaches for larynx preservation may be warranted.
Upper Paleocene ultramafic igneous rocks offshore mid-Norway: Reinterpretation of the Vestbrona Formation as a sill complex
Authors: Hafeez Amer , Planke Sverre , Jerram Dougal A. , Millett John M. , Maharjan Dwarika , Prestvik Tore 
Published: April 2017

Continental breakup between northwest Europe and Greenland (approximately 56 Ma) was associated with widespread magmatism. Silica undersaturated alkaline porphyritic igneous rocks of a similar age have previously been dredged near the mid-Norwegian coast. These igneous rocks of the Vestbrona Formation have previously been interpreted as either igneous plugs or volcanic flows. New 3D seismic data indicate that relatively small sill complexes are abundant in the same region. In total, 36 sills with a size of [Formula: see text] have been mapped. In addition, 10 seismic horizons were interpreted and tied to nearby wells to obtain a robust stratigraphic framework. The sills mainly intrude Cretaceous and Paleocene sequences; however, one sill is also identified in the pre-Cretaceous sequences. The sills locally form erosional remnants on the seabed due to massive uplifting and erosion of the continental margin. Vintage igneous and sedimentary dredge samples have been reanalyzed, including petrography, geochemistry (X-ray fluorescence [XRF], X-ray diffraction [XRD]), biostratigraphy, and Ar-Ar geochronology. The new Ar-Ar data suggest that the sills are 1–2 Ma older than breakup (approximately 57–58 Ma). Furthermore, the biostratigraphy and petrography of two sediment samples suggest that the samples were collected from near in situ subcrops and not of an ice rafted origin. The sediment samples are of Danian age and are strongly metamorphosed, most likely by contact metamorphism resulting from heating during sill emplacement. The newly identified sills have implications for the petroleum prospectivity of the study area including source rock maturation within thermal aureoles and the long-term alteration of fluid migration pathways.
Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality
Authors: Lu Donghao , Ludvigsson Jonas F. , Smedby Karin E. , Fall Katja , Valdimarsdóttir Unnur , Cnattingius Sven , Fang Fang 
Published: April 2017

Purpose To examine whether maternal cancer during pregnancy is associated with increased risks of stillbirth and infant mortality. Methods On the basis of nationwide health registers, we conducted a study of 3,947,215 singleton births in Sweden from 1973 through 2012. Exposure was defined as maternal cancer diagnosed during pregnancy (number of births = 984) or during the year after pregnancy (number of births = 2,723). We calculated incidence rate ratios (IRRs) for stillbirth and infant mortality, comparing exposed births to unexposed births. Small-for-gestational-age (SGA) and preterm births were examined as secondary outcomes. Results Maternal cancer diagnosed during pregnancy was positively associated with stillbirth (IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as SGA (IRR, 4.9; 95% CI, 2.2 to 11.0), and with preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Positive associations of maternal cancer diagnosed during pregnancy or the year after pregnancy were noted for both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality. Conclusion Maternal cancer during pregnancy is associated with increased risks of rare but fatal outcomes, including stillbirth and neonatal mortality. This may be due to conditions associated with fetal growth restriction and iatrogenic preterm birth. Careful monitoring of fetal growth and cautious decision making on preterm delivery should therefore be reinforced.
Risk of Second Cancer in Hodgkin Lymphoma Survivors and Influence of Family History
Authors: Sud Amit , Thomsen Hauke , Sundquist Kristina , Houlston Richard S. , Hemminki Kari 
Published: April 2017

PurposeAlthough advances in Hodgkin lymphoma (HL) treatment have led to improved disease-free survival, this has been accompanied by an increased risk of second cancers. We sought to quantify the second cancer risks and to investigate the impact of family history.Patients and MethodsUsing the Swedish Family-Cancer Project Database, we identified 9,522 individuals with primary HL diagnosed between 1965 and 2012. We calculated standardized incidence ratios and cumulative incidence of second cancer in HL survivors and compared the standardized incidence ratios of lung, breast, colorectal, and all second cancers in HL survivors with and without a site-specific family history of cancer. Interactions between family history of cancer and HL treatment were evaluated under additive and multiplicative models.ResultsOverall, the risk of a second cancer in HL survivors was increased 2.39-fold (95% CI, 2.29 to 2.53). The 30-year cumulative incidence of breast cancer in women diagnosed with HL at younger than 35 years of age was 13.8%. We observed no significant difference in cancer risk over successive time periods. The risk of all second cancers was 1.3-fold higher for HL survivors with a first-degree relative with cancer ( P < .001), with 3.3-fold, 2.1-fold, and 1.8-fold differences shown for lung, colorectal, and breast cancers, respectively. Moreover, a greater than additive interaction between family history of lung cancer and HL treatment was shown ( P = .03).ConclusionHL survivorship is associated with a substantive risk of a second cancer. Notably, the risk is higher in individuals with a family history of cancer. This information should be used to inform risk-adapted therapy and to assist in screening to reduce long-term morbidity and mortality in patients with HL.
Preparing for bundled payments in urology: Defining episodes, evaluating variations in care, and demonstrating improved value.
Authors: Skinner Eila C. , Tang Ning , Stevenson Kerri , Guo David , Hu Jui-Shan , Hendershott Joan , Krishna Purnima 
Published: April 2017

11 Background: As payors introduce APMs, there is little guidance on how episodes will be defined in subspecialty areas. We set out to define clinically relevant episodes of care, develop standardized approachs toward reducing variations in care, and implement evidence-based standardized care pathways. We chose two urologic cancer procedures- Radical Cystectomy and Robotic Radical Prostatectomy. Methods: Episode timeframes were defined: Radical Cystectomy (14 days prior, index hospitalization, 90 days post) and RALP (30 days prior, index hospitalization, 30 days post). To identify variations in care, we compared evidence-based guidelines with practice patterns, analyzed episode and index hospitalization direct costs for various surgeons, and reviewed the utilization of high cost supplies and drugs. Length of stay (LOS), readmissions, complications, and acuity were benchmarked against comparable academic medical centers. Faculty, trainees, APPs, and staff collaborated to develop care pathways, modify workflows and EPIC order sets to reduce variation, improve outcomes, and increase efficiency. Results: Variation in care was reflected in wide standard deviations in episode direct costs. Six months after implementing care pathways, we achieved the following: RALP average cost per episode decreased by 15%. Standard deviation in episode direct costs decreased by 77%. The percentage of patients with 1-day LOS increased from 21% to 67%. The medical surgical supply costs during hospitalization decreased by 22.5%. Standard deviation in episode direct costs for Radical Cystectomy decreased by 27%. Readmissions to SHC decreased from 15.6% to 12.5%. The percentage of patients with less than 6-day LOS increased from 46% to 66%. Conclusions: Across two episodes, our care redesign efforts had actualized direct cost savings of $692,000 annually. As we prepare for future APMs, similar multidisciplinary approaches can be applied to other areas to reduce costs and improve quality of care.
A quality improvement initiative to reduce low-value red blood cell transfusions in hospitalized oncology patients.
Authors: Wong Tiffany , Dubin Perry Harris , Davenport Michael , Bass Geoffrey D , Myers Jennifer , Wagner Jason 
Published: April 2017

116 Background: Red blood cell (RBC) transfusions are costly, a limited resource, and pose serious medical risk. While most disciplines now transfuse sparingly, hospitalized oncology patients at our institution are often transfused liberally. We conducted a QI initiative to reduce practice variation by adopting a standardized restrictive transfusion strategy. Methods: We performed a retrospective analysis of the total number of pre-transfusion hemoglobin-adjusted RBC transfusions from 02/2015 to 08/2015. Patients with severe gastrointestinal bleeding and acute coronary syndrome were excluded. Extensive feedback from providers was solicited and a comprehensive review of the evidence was performed to understand the process driving existing practices. This information and a root cause analysis were presented to key members of Oncology leadership to gain consensus on a RBC transfusion algorithm. The final algorithm recommended transfusing to a Hg goal of 8 g/dL if the platelet count was ≤ 50K; otherwise the Hg goal was 7 g/dL. We defined low-value RBC transfusions as a transfusion occurring outside the parameters of this algorithm. A multifaceted educational campaign comprising in-person meetings and web-based postings was launched to target ward nurses, advanced practitioners, residents, and attending physicians. RBC transfusions were then tracked to monitor adherence to the algorithm. Results: Analysis of the current process using QI methods found that RBC transfusion practices are most influenced by uncertainty of best practice and variation in attending preference. After the implementation of a RBC transfusion algorithm, the overall number of low-value RBC transfusions decreased from 29.6% to 19.7% (p < 0.001). This reduction was most marked in patients with platelet counts > 50K where there was a reduction from 78.7% to 55.6% (p < 0.001). A 9.9% overall reduction corresponds to roughly 520 fewer RBC transfusions per year, which suggests an annual estimated cost savings of $520,000. Conclusions: By using a standardized QI framework, we were able to successfully decrease variation in practice that results in low-value RBC transfusions in hospitalized oncology patients.
Quality, clinician and information technology (IT) partnership for metric reporting.
Authors: Segura Smith Andrea , Porter Julie , Badwe Amogh , Kiamanesh Eileen F , Blayney Douglas W. 
Published: April 2017

128 Background: Reporting of physician defined quality metrics, using manual data abstraction, is labor intensive and not always timely. We developed a multidisciplinary team to develop a metric reporting system. Methods: The Senior Quality Consultant (SQC) partnered with the Research Data Analyst using data extracted from the electronic data warehouse, Bone Marrow Transplant Registry, Cancer Registry, Aria (Varian, Palo Alto) and Epic (Verona, WI) and the Social Security Death index. The Plan, Do, Check Act model was used to guide the team. Results: Fourteen metrics were developed in a seven-month period. Sample of metrics: Blood Marrow Transplant patient referral to Survivorship by Day 100; Genetic counseling referral for ovarian cancer; Cytogenetic testing of acute leukemia, myeloma; Chemotherapy in the last two weeks of life; Hospice enrollment at death; > 10 radiation fractions for bone metastases palliation. Conclusions: The PDCA model created a shared framework for metric development. Standard definitions were developed and applied to promote consistent design. 72% (10/14) of the metrics are on a reporting system for automated data extraction and reporting. The limitation of the project is negative results are reviewed manually by the SQC because not all data elements are discrete and may require review of items (ex. progress notes or media). [Table: see text]
Cancer patients' answers to surveys: Incorporation into the electronic health record (EHR) can decrease manual data entry and increase patient-centered information.
Authors: French Katy E. , Feeley Thomas W. , Andrabi Tayab A. , Guzman Alexis B. , Calhoun John D. 
Published: April 2017

130 Background: Delivery of value-based cancer care has centered on the use of EHR’s and how these applications can document health information, including patient reported outcomes (PRO’s), (1-4). Survey information must be incorporated into the medical record with minimal staff intervention. Our institution, and many cancer centers are currently using “EPIC” as their EHR platform. Although this is a data driven platform, and data can be extracted and reported as desired, certain things need to be done prior to going live in order to ensure this occurs. Surveys must be built using standardized “smart data elements” (SDE’s). If patient data is gathered, but not integrated correctly into the EHR, one will find themselves manually entering data. The goal is to allow patients to answer questions about their health history 1 time, validate answers, incorporate into the EHR, and report data. Methods: We engaged our technology team prior to “go-live” to build patient survey questionnaires. 40 survey questions, were mapped to 72 specific EHR/“EPIC” SDE’s. The SDE’s included cancer diagnoses and past medical history. Patients received and completed the electronic survey via the patient portal. Clinic providers validated patient answers from the surveys and the information was incorporated into the EHR. Results: Patient entered survey data collected, documented, and reported within the EHR. Decreased data entry by providers, efficiently incorporating the patient cancer diagnosis and medical history into the EHR. Data collected for review/reporting/research as needed. Conclusions: EHR’s can gather specific/discrete patient data to benefit both patients and providers. Cancer patients can participate in providing health information easily incorporated and documented by the provider. Data can be updated as needed, and used for patient reported outcomes (PRO’s) and other research endeavors. EHR’s should enhance care by allowing providers to spend more face to face time with patients and providing data that is most important to patients from which they may make informed decisions about their health care.
Monitoring inbaskets with feedback to providers enhances the timeliness of patient care.
Authors: Adelson Kerin B. , Trant Amelia Anne , Strait Michael , Kaplan Rory , Dest Vanna , Roshka Adam , Lyons Catherine A. , Vest Kevin A. , Steffen Tessa , Lilenbaum Rogerio 
Published: April 2017

132 Background: The adoption of Electronic Health Records (EHRs) has changed the workflow for providers. The “inBasket” feature supplants telephone and email communications, replaces paper results review and has become the way to track incomplete encounters. Failure to promptly complete medical records leads to unread notes and impairs multidisciplinary communication. Also, unclosed encounters lead to potential penalties and uncollected fees. One benefit of the inBasket, is that it can be monitored. Methods: We created a report that tracked EPIC inBasket activities by provider including numbers of open charts, unchecked results, phone calls, incomplete dictations and orders needing cosign. The report shows the number and length of time each activity has been delinquent. In December 2015 we began emailing automated reports to all providers with their monthly results. In January 2016 we began an enforcement process for providers with >50 open charts: 30 days to complete charts or practice would be closed to new patients; if >50 remained after 30 days providers had 60 days before complete suspension from practice. We modeled the financial impact of chart closure by creating a weighted average by payor of fees collected per visit. For charts that would have been delinquent beyond payor filing deadlines this represents actual increased revenue. For charts that would have eventually been closed before the filing deadline this represents earlier revenue capture. Results: See table. Conclusions: Inbasket monitoring with structured feedback to providers led to improvement in the number of open charts, the focus of corrective action. We did not see consistent improvements in the other inbasket metrics. Future work will involve a similar approach to all inBasket metrics. Closing charts also has a significant financial impact; we estimate that $483,049 in fees that could have been lost due to exceeding payor deadlines became collectable. [Table: see text]
Developing and piloting an electronic telephone triage application.
Authors: Ellis Peter G. , Rushford Justin S. , Krebs Melinda , Carlisle Christine , Ford Colleen F. , Nikolajski Peggy , Reidmiller Carol , Stewart Leslie , Barry Amanda 
Published: April 2017

137 Background: With the shift of cancer care to the outpatient setting, telephone triage is a vital part of today’s oncology practice. UPMC CancerCenter (UPMC) desires to streamline the current telephone triage process across its 31 outpatient clinics. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting, and workflow management. Methods: A prototype application, Symptom Manager (SM), was developed and piloted with 4 nurses at 3 outpatient clinics. Front office staff registered inbound calls in SM, which populated a phone triage queue. The nurse was prompted to enter information about the call. Decision support materials were displayed for reference, including algorithms for symptom assessment, adjudication, and treatment. The output was a structured summary of the encounter that was copied to the patient’s chart. From the queue, the nurse was also prompted to make outbound calls for symptom reassessment. A feedback session with the nurse users and institution leadership was held following the pilot. Results: A total of 235 inbound calls were captured in the application, of which 74 (31.5%) were symptom-related. Additional data fields collected during the pilot included symptom, adjudication, time elapsed for callback, and symptom status at follow up. The ability to extract and report on data of this type was viewed as valuable for quality and process improvement. The nurse users praised SM’s ease of use, but prototype performance issues shortened the pilot. They indicated that the standardized documentation increased efficiency. Requests for future enhancements included deeper EHR integration and additional fields for data capture. Conclusions: This pilot provided the feedback necessary to develop the latest version of SM which begins roll out across UPMC in November 2016 and includes EMR integration. An update on the software and additional data captured during the pilot will be provided at presentation.