bluuebunny/crossref_metadata_2025_split huggingface dataset:
Engagement in a statewide oral oncolytic collaborative and practice impact.
Authors: Severson Jane Alcyne , Mackler Emily R. , Galiyas Grayce , Petersen Laura , Lindsay Jamie , Salgado Teresa M , Davis Emily , Farris Karen B 
Published: February 2017

89 Background: The rapid shift to oral oncolytic therapy presents challenges to oncology practitioners. The purpose of this study is to describe how participation in a statewide oral oncolytic improvement collaborative where best practices and resources were shared can readily impact quality of care as measured by national standards. Methods: The Michigan Oncology Quality Consortium (MOQC) hosted a series of learning collaborative sessions focused on topics and deployment of resources specific to oral oncolytic management and quality improvement. Participating practices performed pre/post self-assessments in Oct. 2013 and Apr. 2015 (n = 3). Concordance with national ASCO QOPI and ONS standards was compared, including documentation (5 measures), patient education (7 measures), and follow-up/monitoring (4 measures). A response scale of always, sometimes, and never was used. Specifically, practices were surveyed to assess which evidence-based MOQC resources were implemented: patient intake template, drug-specific self-management guides, start date mailer, medication calendar, primary care physician communication template, Edmonton Symptom Assessment Scale (ESAS), and patient adherence questionnaires. Results: Practice A showed improvement in documentation, patient education, and monitoring. This practice used the initial oral chemotherapy template, ESAS, patient education templates, and patient calendar (Table). Practice B implemented 6 resources and demonstrated improvements in 15 metrics. Practice C implemented 4 resources, namely patient-focused resources, to improve all patient education and monitoring metrics. Conclusions: Use of the collaborative model and supplying oncology teams with scientific evidence, standard workflows, and resources improves concordance with national standards of care. Large-scale deployment of this model program may provide a clinically efficient and effective mechanism to enhance widespread change. [Table: see text]
Implementing patient-reported outcome surveys as part of routine care: Lessons from an academic radiation oncology department.
Authors: Agarwal Ankit , O'Neil Kelly , Kelly Andrea , Keaty Maureen , Whitehouse Colleen , Kalinowski Barbara , Orio Peter F. , Martin Neil E. 
Published: February 2017

97 Background: We sought to implement patient reported outcomes (PRO) surveys to measure the acute and late effects of radiation treatment at a multisite academic medical center. Methods: Over the course of 18 months we addressed survey identification and implementation hurdles. Many existing validated instruments were designed for clinical research and are not ideally suited for either routine care or for the tracking of acute toxicities of radiation therapy. A physician and a nurse champion for each disease site identified or created situation- and site-specific tools based on validated questionnaires form the literature. Our aim was for questionnaires to be no longer than 20 - 30 questions. Using iPads, we deployed an institutionally-developed survey platform integrated with scheduling within the clinic. We surveyed physicians, nurses, and residents 3 months following the implementation of PROMs to assess their general response to the initiative. Results: Thirty-seven PRO measures comprised of 640 questions were implemented for all disease sites in adult patients at 6 departmental locations treating a total of 350 patients daily. Following implementation in January of 2015, > 13,000 surveys have been completed through the end of September 2015. Each question took on average approximately 14 seconds to complete and common surveys took approximately 10 minutes. Of 36 departmental provider respondents (50% response rate overall), 47% stated that they use the PROMs in their daily practice. The majority of respondents felt that the PROs were valuable (67%) and relevant (75%) either usually, most of the time or always. Only 33% felt the quality of their care was enhanced usually or most of the time while 53% felt the PROs engaged patients in a better understanding of their own care. Conclusions: We successfully implemented disease site- and context-specific PROs across a large, academic radiation oncology department. Although we have achieved widespread adoption and some subjective impression of care improvement among providers, further work is necessary to reduce barriers to their clinical use and to leverage them for systematic improvements in care.
Has venous thromboembolism (VTE) prophylaxis made any difference for solid tumor inpatients at Princess Margaret Cancer Center (PM)?
Authors: Wang Tian Qi , Tan Carmen , Atenafu Eshetu G. , Seki Jack Toshimine 
Published: February 2017

98 Background: VTE represents a significant risk for morbidity and mortality in cancer patients. Hospitalized solid tumor patients at PM are especially at risk (15% of inpatients experienced a VTE event in 2004 when prophylaxis rate was 19%). Institution-wide VTE prophylaxis policy was implemented, and prophylaxis uptake reached nearly 97% in Sept 2012. We are interested in whether the prophylaxis policy made any impact in reducing VTE incidences over time. Our objective is to compare inpatient VTE frequency before and after the implementation of the VTE prophylaxis policy (IPP) in Sept 2012 at PM. Methods: This retrospective study evaluated VTE frequency before and after IPP for all inpatients admitted to the 17A/B solid tumor units during the fiscal years 2007 to 2015. Eligible patients were those who became symptomatic and diagnosed 48 hours post hospital admission, as identified through the Discharge Abstract Database (DAD). Prophylaxis recipients were those without active bleeding and were not receiving treatment anticoagulant for a previous VTE. Results: 66 inpatients were identified to have developed VTE (table). The majority of inpatients who developed VTE had brain, lung, colorectal, pancreatic, or ovarian cancer. 83.3% of patients had a PADUA risk score of 4 or greater. From April 2007 to Sept 2012, 1 patient developed VTE every 105.7 patient visits (48 patients developed VTE in 5075 patient visits). From Sept 2012 to March 2015, 1 patient developed VTE every 112.6 patient visits (18 patients developed VTE in 2026 patient visits). Odds ratio of 0.9388 (CI = 0.5448-1.6177) showed lower VTE risk for patients on prophylaxis during admission. Conclusions: There appeared to be a decreasing trend in the frequency of VTE post-IPP, for cancer inpatients within a limited population. [Table: see text]
Development of an integrated practice unit: Utilizing a lean approach to impact value of care for brain tumor patients.
Authors: Kwon Ivy , Ahn Christine , White Preston , Liau Linda M. , Cloughesy Timothy Francis , Nghiemphu Phioanh Leia 
Published: February 2017

99 Background: Lack of care coordination across subspecialty departments involved in the treatment of brain tumor patients at our institution has negatively impacted patient outcomes, patient experience, and costs. Meanwhile, value-based health care has become increasingly relevant as a means to respond to changing payment structures and improve quality. With the aim to increase value, we restructured medical practice across the continuum of care for brain tumor patients by developing a virtual (non co-located) Integrated Practice Unit (IPU). Methods: From June 2014 to August 2015, we engaged a core team of physicians and administrators from Neurosurgery, Neuro-Oncology, Radiation Oncology, Neuroradiology and Neuropathology to re-design care pathways for the following diagnoses: glioma, metastatic cancer to the brain, and meningioma. We applied lean methodology to map out current state, identify root causes, and develop an implementation plan based on our analyses. Results: Root causes uncovered included: 1) multiple entry points into the system, 2) silo-ed intake processes, 3) varied scheduling processes across and within departments, and 4) no consensus regarding timing and ownership of follow-up care for patients for each diagnosis. Preliminary solutions generated included: 1) developing a centralized communication point and triage process, 2) standardizing requests at intake and obtaining blanket authorizations for select services, 3) standardizing scheduling workflows across departments, 4) delineating the timing and nature of necessary post-operative appointments, and 5) onboarding a nurse navigator to optimize care coordination. Shared metrics to be monitored over time were developed and include time from scheduled-to-seen for initial consults, proportion of patients with post-operative appointments scheduled prior to discharge, number of readmissions within 30 days, patient satisfaction, and costs. Conclusions: Value-based care redesign around the development of an IPU for brain tumor patients has the potential to meaningfully impact patient outcomes, patient experience, and reduce costs in the delivery of care.
Activating NOTCH1 Mutations Define a Distinct Subgroup of Patients With Adenoid Cystic Carcinoma Who Have Poor Prognosis, Propensity to Bone and Liver Metastasis, and Potential Responsiveness to Notch1 Inhibitors
Authors: Ferrarotto Renata , Mitani Yoshitsugu , Diao Lixia , Guijarro Irene , Wang Jing , Zweidler-McKay Patrick , Bell Diana , William William N. , Glisson Bonnie S. , Wick Michael J. , Kapoun Ann M. , Patnaik Amita , Eckhardt Gail , Munster Pamela , Faoro Leonardo , Dupont Jakob , Lee J. Jack , Futreal Andrew , El-Naggar Adel K. , Heymach John V. 
Published: February 2017

Purpose Adenoid cystic carcinomas (ACCs) represent a heterogeneous group of chemotherapy refractory tumors, with a subset demonstrating an aggressive phenotype. We investigated the molecular underpinnings of this phenotype and assessed the Notch1 pathway as a potential therapeutic target. Methods We genotyped 102 ACCs that had available pathologic and clinical data. Notch1 activation was assessed by immunohistochemistry for Notch1 intracellular domain. Luciferase reporter assays were used to confirm Notch1 target gene expression in vitro. The Notch1 inhibitor brontictuzumab was tested in patient-derived xenografts from patients with ACC and in a patient with ACC who was enrolled in a phase I study. Results NOTCH1 mutations occurred predominantly (14 of 15 patients) in the negative regulatory region and Pro-Glu-Ser-Thr–rich domains, the same two hotspots seen in T-cell acute lymphoblastic leukemias, and led to pathway activation in vitro. NOTCH1-mutant tumors demonstrated significantly higher levels of Notch1 pathway activation than wild-type tumors on the basis of Notch1 intracellular domain staining ( P = .004). NOTCH1 mutations define a distinct aggressive ACC subgroup with a significantly higher likelihood of solid subtype ( P < .001), advanced-stage disease at diagnosis ( P = .02), higher rate of liver and bone metastasis ( P ≤ .02), shorter relapse-free survival (median, 13 v 34 months; P = .01), and shorter overall survival (median 30 v 122 months; P = .001) when compared with NOTCH1 wild-type tumors. Significant tumor growth inhibition with brontictuzumab was observed exclusively in the ACC patient-derived xenograft model that harbored a NOTCH1 activating mutation. Furthermore, an index patient with NOTCH1-mutant ACC had a partial response to brontictuzumab. Conclusion NOTCH1 mutations define a distinct disease phenotype characterized by solid histology, liver and bone metastasis, poor prognosis, and potential responsiveness to Notch1 inhibitors. Clinical studies targeting Notch1 in a genotype-defined ACC subgroup are warranted.
Surgical Management of Wild-Type Gastrointestinal Stromal Tumors: A Report From the National Institutes of Health Pediatric and Wildtype GIST Clinic
Authors: Weldon Christopher B. , Madenci Arin L. , Boikos Sosipatros A. , Janeway Katherine A. , George Suzanne , von Mehren Margaret , Pappo Alberto S. , Schiffman Joshua D. , Wright Jennifer , Trent Jonathan C. , Pacak Karel , Stratakis Constantine A. , Helman Lee J. , La Quaglia Michael P. 
Published: February 2017

Purpose Wild-type gastrointestinal stromal tumors (WT-GISTs) that lack KIT or PDGFRA mutations represent a unique subtype of GIST that predominantly affects children. We sought to determine the effect on event-free survival (EFS) of staging variables, extent of resection, and repeat resection of tumors. Methods In 2008, a WT-GIST clinic was established at the National Cancer Institute, allowing the development of a large clinical database. We included participants who underwent resection of WT-GIST. Associations with EFS (ie, freedom from disease progression or recurrence) were evaluated using the Kaplan-Meier method and Cox proportional hazards modeling. Results Among 76 participants with WT-GISTs, the median follow-up was 4.1 years. Overall EFS (± SE) was 72.6 ± 5.4% at 1 year, 57.6 ± 6.2% at 2 years, 23.7 ± 6.0% at 5 years, and 16.3 ± 5.5% at 10 years postoperatively. Hazard of disease progression or recurrence was significantly increased for patients with metastatic disease (adjusted hazard ratio [AHR], 2.3; 95% CI, 1.0 to 5.1; P = .04) and > 5 mitoses per 50 high-power fields (AHR, 2.5; 95% CI, 1.1 to 6.0; P = .03), whereas there was no significant effect of negative microscopic resection margins (AHR, 0.9; 95% CI, 0.4 to 2.2; P = 0.86). There was no association between type of gastric resection (ie, anatomic v partial/wedge) and EFS ( P = .67). Repeated resection after the initial resection was significantly associated with decreasing postoperative EFS ( P < .01). Five patients (6%) died after initial enrollment in 2008. Conclusion WT-GIST is an indolent disease, and most patients survive with disease progression. We found no improvement in EFS with more extensive or serial resections. Disease progression or recurrence may be more closely related to tumor biology than surgical management. These data suggest that resections for WT-GISTs be restricted to the initial procedure and that subsequent resections be performed only to address symptoms such as obstruction or bleeding.
Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update
Authors: Lyman Gary H. , Somerfield Mark R. , Bosserman Linda D. , Perkins Cheryl L. , Weaver Donald L. , Giuliano Armando E. 
Published: February 2017

Purpose To provide current recommendations on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. Methods PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from 2012 through July 2016. An Update Panel reviewed the identified abstracts. Results Of the eight publications identified and reviewed, none prompted a change in the 2014 recommendations, which are reaffirmed by the updated literature review. Conclusion Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND (in most cases). Women with SLN metastases who will undergo mastectomy should be offered ALND. These three recommendations are based on randomized controlled trials. Women with operable breast cancer and multicentric tumors, with ductal carcinoma in situ, who will undergo mastectomy, who previously underwent breast and/or axillary surgery, or who received preoperative/neoadjuvant systemic therapy may be offered SNB. Women who have large or locally advanced invasive breast cancer (tumor size T3/T4), inflammatory breast cancer, or ductal carcinoma in situ (when breast-conserving surgery is planned) or are pregnant should not undergo SNB.
Experience With Computerized Chemotherapy Order Entry
Authors: DuBeshter Brent , Walsh Carolyn J. , Altobelli Kim , Loughner John , Angel Cynthia 
Published: February 2017

Purpose The elimination of errors related to chemotherapy administration remains an elusive goal. Computerized order entry has been shown to reduce errors. We assessed a chemotherapy computer order entry system for errors related to dosing and for the time required to prepare chemotherapy orders. Methods A prospective study of all patients treated with chemotherapy over a 12-month period was performed. Chemotherapy order sets done via computerized order entry were reviewed for errors related to drug selection, dose calculations, decimal-point errors, and for exceeding a warning level set within the system. We also measured the time required to produce three order sets by hand versus by computer. Results There were no errors in dose calculations, decimal points, or drug selection for 2,558 drug administrations in 235 patients treated with 26 different chemotherapy regimens. The dose warning level was exceeded in 152 (6%) of drug administrations, but never without user permission to override the warning. The average time saved per order set using computer order entry was 10 minutes (P < .05). Conclusion By using computer order entry with error-checking algorithms, it may be possible to eliminate a number of types of errors associated with chemotherapy administration without sacrificing efficiency.
Quality Performance Improvement With the Implementation of Standard Chemotherapy Order Forms
Authors: Dumasia Lena , Harris Ellen , Drelichman Anibal 
Published: February 2017

Purpose Before October 2000, physicians in our institution handwrote chemotherapy orders on blank order sheets. There was no standard to which the physician could include variables that were crucial to the completeness of a chemotherapy order. For this reason, chemotherapy orders were frequently incomplete and had to be adjusted by the pharmacist after discussing the missing variables with the ordering physician. As a part of our goal to minimize errors, standard chemotherapy forms were initiated at our institution in October 2000. Methods The first standard form implemented was a written order form that constituted a standard of the ideal variables necessary to accurately complete chemotherapy orders. These variables were the diagnosis, regimen, height, weight, body surface area (BSA), route, frequency, duration and chemotherapy dose and calculation based upon BSA. The next updated form was an electronic version similar to the original, and was implemented in April 2002. Results From February 1999 to March 2000, using the traditional unstandardized blank order sheets, the average order completeness was 45%. After the standard written forms were introduced, from October 2000 to March 2002, the average chemotherapy order completeness was 81%, an improvement of 36%. Completeness improved to an average of 93% from April 2002 to December 2003, after the implementation of the electronic chemotherapy form. Conclusion Chemotherapy order completeness improves considerably through the standardization of chemotherapy order forms. The electronic forms show an additional improvement over handwritten forms. Electronic standardization of chemotherapy forms should be adopted as a best-practice model in hematology-oncology practices throughout the country.
Food Insecurity Among Cancer Patients in Kentucky: A Pilot Study
Authors: Simmons Leigh Ann , Modesitt Susan C. , Brody Amanda C. , Leggin Allison B. 
Published: February 2017

Purpose Food insecurity is defined as being uncertain of having enough food due to insufficient money or other resources. The purpose of this study was to examine the construct and correlates of food insecurity in a sample of cancer patients in Kentucky. Patients and Methods Data were collected in the waiting rooms of the chemotherapy, hematology/oncology, and gynecology/oncology clinics of a university cancer center, and included 115 cancer patients actively receiving treatment (mean age, 55.85 years; range, 23 to 88 years) who completed a series of standardized measures to assess food insecurity status and psychological and nutritional well-being. Descriptive statistics and independent samples t tests were used to assess the prevalence of food insecurity in the sample, and to identify differences between the persons who were food insecure and food secure. Results The prevalence rates of food insecurity and food insecurity with hunger in the sample were 17.4% and 7.8%, respectively, which are higher than in the general population. Food-insecure patients had statistically significant higher levels of nutritional risk, depression, and financial strain, and lower quality of life compared with food secure patients. Fifty-five percent of food insecure patients reported not taking a prescribed medication because they could not afford it, versus 12.8% of food-secure patients (P = .002). Conclusion Food insecurity may be an important consideration for clinical oncology practice, especially when caring for individuals of lower socioeconomic status. Further study is warranted, including prospective studies of cancer patients to identify causal relationships among food insecurity, cancer incidence, cancer treatments, and patient outcomes and well-being.
El cooperativismo y la industria chiclera en la época posrevolucionaria
Authors: Kawakami Ei 
Published: February 2017

A finales de la década de 1920 el gobierno del territorio federal de Quintana Roo intentó introducir el sistema de cooperativas en la industria del chicle, que estaba controlada por las compañías estadounidenses productoras del chewing gum y los contratistas, intermediarios entre las compañías y los trabajadores chicleros. Pero el proyecto fracasó debido a una variedad de factores como la influencia de la Gran Depresión, el boicot por parte de las compañías estadounidenses, la competencia del chicle con otras materias primas, la corrupción e ineficiencia en el gobierno o la distancia entre los gobiernos central y local.
In the late 1920s the government of the Federal Territory of Quintana Roo introduced the cooperative system in the chicle industry, which was controlled by U.S. chewing-gum companies and its contratistas, intermediaries between the companies and the chicle producers. However, the project ended in failure, because of various factors, including the impact of the Great Depression, U.S. companies’ boycott, the competition between chicle and other raw materials for chewing-gum, the corruption and inefficiencies in the government, or the discord between the local and federal governments.
Fan Mail to Fidel
Authors: Keller Renata 
Published: February 2017

This article analyzes the newly-declassified letters that Mexicans and people residing in Mexico sent to the Cuban government in the first decade after the Cuban Revolution. The letters reveal that the Cuban Revolution found supporters among a variety of Mexicans because the events in Cuba reflected their own nation’s history of revolution and U.S. intervention. In addition to praising the Cuban Revolution, the Mexicans who put pen to paper confessed their hopes and fears for their own country. While these letters were ostensibly about Cuba, they in fact reveal more about political culture in 1960s Mexico.
Este artículo analiza las cartas que mexicanos y foráneos residentes en México enviaron al gobierno cubano en la primera década después de la Revolución Cubana. Las cartas revelan que varios mexicanos apoyaron a la revolución porque los eventos en Cuba reflejaban la historia de revolución e intervencionismo estadounidense en México. Asimismo, estos mexicanos describían las ilusiones y miedos sobre su propio país. A pesar de tratar sobre Cuba, estas cartas revelan aún más sobre la cultura política de México en los años sesenta.