bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting receipt of invasive pain management among Medicaid beneficiaries with cancer.
Authors: Halpern Michael T. , Fiero Mallorie 
Published: February 2017

7 Background: Previous studies have reported that a substantial proportion of cancer patients do not receive appropriate pain management. Inadequate pain management may be greater among Medicaid beneficiaries with cancer. However, it is unknown whether Medicaid policies or patient characteristics affect the likelihood of receiving pain management services. Methods: We used 2006-2008 Medicaid claims data for individuals diagnosed with breast or colon cancer to assess patient characteristics and state-level policy factors associated with receipt of invasive pain management (IPM). Generalized estimating equations (GEE) were used to examine factors influencing receipt of IPM, including patient age, race/ethnicity, comorbidities, Medicaid reimbursements, redetermination period for Medicaid eligibility, required patient co-payments. Separate analyses were performed for the breast and colon cancer study populations. Results: Overall, 3% of Medicaid beneficiaries in the study population with breast cancer and 6% with colon cancer received IPM. Among the breast cancer population, non-white patients were significantly less likely to receive IPM compared with white breast cancer patients (Odds Ratio (OR) = 0.88, p < 0.0001). Increased comorbidity score was associated with significantly increased likelihood of IPM (OR = 1.27, p < 0.0001). Among the colon cancer population, older age was associated with significantly increased likelihood of IPM (OR = 1.36 for 10 years of age, p = 0.02). Patients in states with a Medicaid eligibility re-determination period of 12 months were less likely to receive IPM compared to those in states with a period < 12 months (OR = 0.60, p = 0.046). Conclusions: Patient characteristics and (for colon cancer patients) state Medicaid policies predict receipt of IPM among Medicaid beneficiaries with cancer. As many of these factors are not associated with the need for pain management, quality improvements in supportive care are needed for this underserved population.
Preparedness for surgery as a quality indicator.
Authors: Kiely Deirdre , Pego Kristin D. , Schnabel Freya Ruth 
Published: February 2017

80 Background: There has been growing attention to the informational priorities of patients in a shared decision making model of care. Patients report adequate information provision as an unmet need throughout their cancer experience. This is especially of concern when faced with complex decision making based on an understanding of medical information in an unfamiliar learning environment. This project is designed to identify informational priorities of patients related to diagnosis and treatment decisions. Methods: Patients’ perceived preparedness for surgery was measured to determine whether information needs were addressed and illustrate overall satisfaction with the surgical experience. A self-administered questionnaire was used to measure satisfaction with information related to diagnosis, treatment and recovery. Results: An active role in decision making that considers patients’ information needs increases satisfaction with treatment choices, preparedness for surgery and outcomes. Methods of providing information are often limited to written and verbal with written generally non-specific and not tailored to patients’ informational needs. Providers are also unable to control for access to other information sources such as the internet. Conclusions: A treatment plan developed through a shared decision making model should be evidence based including an assessment of the patient’s informational priorities. A combination of written and verbal information may be optimal with the written building on the verbal and not introducing new information. Encouraging recording of meetings may be helpful when stress becomes a barrier to comprehending and retaining the information. The patient should also be provided with reliable websites to supplement this information. This results in greater patient satisfaction with the interaction and overall surgical experience.
Patient support call center: Interaction with the oncology clinic.
Authors: Neubauer Marcus A. , Jameson Melissa , Eagye Kathryn , Abdullahpour Mitra , Kolodziej Michael A. , Sipala Maria , Supraner Amy , Hoverman J. Russell 
Published: February 2017

84 Background: Cancer patients receiving chemotherapy can become ill, often leading to hospitalization, adding huge costs to care. This is especially true with older cancer patients. Innovent Oncology (IO), an oncology disease management program, and Texas Oncology (TO) are conducting a novel program, funded by Aetna. Patients who begin IV chemotherapy are called by an IO nurse, working remotely, but with access to TO’s Electronic Medical Record. If the call center nurse detects a concern she notifies the practice. IO then tracks the action taken by the practice. We report on the incidence of practice notification, intervention that occurred, and incidence of hospitalization within 7 days of practice contact. Methods: This pilot program enrolls patients of Medicare age (Aetna Medicare Advantage members). Intervention calls (IC) to the practice are made at the discretion of the IO nurse. We identified all IC’s made from June 2013 to June 2015. We then categorized the actions taken by the practice and report on the four most common actions. IO receives a daily file from Aetna with hospital data. We looked at hospitalizations within 7 and 14 days from the IC. Results: 430 patients were enrolled over the above time period. 164 had at least one IC (215 total); 38% of patients had at least one IC. The four most common actions taken by the practice were: new medication prescription (N = 128); education over the phone (76); office visit within 24 hours (45); lab work ordered (22). 14 patients were admitted within 7 days of IC and 18 (inclusive of the 14) admitted within 14 days of IC. Conclusions: The IC’s are made when the IO nurse detects a problem during telephonic outreach. Therefore, this group of patients is at some risk for deterioration. Out of 215 IC’s made, 14 patients were admitted within 7 days of the call. We believe this number is low in this Medicare-age population and the results are promising. We believe the coordination between the patient support nurse and the clinic is partly responsible. This is a novel program so we can’t compare the IC/hospitalization rate to other data bases but, at the least, we can use this as a baseline going forward.
Reducing patient wait time on an inpatient hematology and transplant unit.
Authors: Mattison Ryan J. , Makielski Rory Joseph , Osterby Kurt , Fallon Mike , Domask Nicole , Hubbard Vicki , Allen Eva , Gage Blythe , Hettrick Gail , Fischer Jessica , Brown Andrew , Grahn Brianna , Welhouse Brett , Draayers Hannah , Juckett Mark , Ligocki Jean , O'Regan Ruth , Kaufman Laurie 
Published: February 2017

87 Background: The University of Wisconsin Hematology and Bone Marrow Transplant services admit 250 patients per year for scheduled treatment. Time from patient arrival to chemotherapy initiation averages 7 hours. This long time leads to patient dissatisfaction and prolonged length of stay. Chemotherapy often begins in the evening when physicians and pharmacists are not on site to clarify treatment questions. Methods: A multidisciplinary team was formed in April 2015 as part of the ASCO Quality Training Program. The team developed the aim to reduce time from 7 hours to 5 hours to allow for more daytime nursing shift chemotherapy starts. The group created a process map and an Ishikawa diagram to identify causes of treatment delays. The team observed that treatment orders were often written and signed after hospital admission, though the plan of care was available prior to admission. Using a prioritized list, the initial process change was to have physicians write and sign chemotherapy treatment plans prior to admission. The process measure was the percentage of orders signed before admission. The outcome measure was time from arrival to chemotherapy start. Balance measures included narrative comments from physician and nursing staff about the process change. Data were obtained from EHR time stamps. Physicians were asked to begin making signed treatment plans available after August 1, 2015. Results: Data from 55 patients prior to the change (May 1-July 31) and 52 patients post-change (August 1-October 16) were analyzed. The number of treatment plans signed prior to admission increased from 27% to 58% (p = 0.0018). Mean time from admission to treatment pre-process change was 404 minutes and 383 minutes post-change. When plotted on a control chart, a sustained shift in the process was not apparent. Feedback from physician and nursing staff did not identify efficiency or safety concerns with the new process. Conclusions: Though the percentage of orders signed prior to admission increased, there was no improvement in the time from patient admission to treatment initiation with this change. Future PDSA cycles will include increasing the percentage of orders signed prior to admission as well as address other sources of delay identified in the process map.
A multidisciplinary team approach to efficient breast cancer diagnosis.
Authors: Cianfrocca Mary E. , Shelby Melissa , Birdi Shefali , Byrum Stephanie Costa , Billar Julie Annie Yee , McCabe Kevin , Patel Jignesh , Loving Vilert A 
Published: February 2017

88 Background: System inefficiencies result in delayed breast cancer diagnoses. Inefficiencies include any non-value added steps between symptom onset/imaging abnormality to cancer diagnosis and treatment. Diagnostic delays can lead to more advanced disease and may negatively impact survival. Further, optimizing the efficiency of diagnostic evaluation models can reduce barriers to care and improve patient satisfaction. To achieve these efficiency goals, Banner MD Anderson Cancer Center (BMDACC) instituted the Undiagnosed Breast Clinic (UBC). The UBC expedites patient evaluation through a multidisciplinary diagnostic team of internists, surgeons, pathologists and radiologists. Patients with an abnormality on physical exam or imaging are promptly evaluated by the UBC team and any necessary diagnostic tests are performed. If malignancy is diagnosed, the BMDACC breast team swiftly institutes multidisciplinary care. Methods: We conducted a retrospective chart review of patients seen in the UBC from 12/2012 - 12/2013. We tallied patient demographics, diagnostic data, and treatment information. Results: 177 patients (174 females; 3 males) were identified. Mean age was 54 years (range: 16-91). Patient racial breakdown was 144 (81%) Caucasian; 8 (5%) Black, 6 (3%) Latina, 4 (2%) Asian, and 15 (8%) Other. Malignant diagnoses (invasive carcinoma or ductal carcinoma in situ) were found in 28 patients (16%), and high-risk lesions (atypia or lobular carcinoma in situ) were found in 8 patients (5%). Of the 46 patients who underwent needle biopsy as part of the UBC evaluation, 28 (61%) underwent biopsy the same day as the initial visit. An additional 5 patients (11%) underwent biopsy the next day.Genetics consults were obtained in 11 patients (6%). Of these 11 patients, one tested positive for BRCA 1 and one for BRCA2. Conclusions: A multidisciplinary team approach to breast cancer diagnosis is feasible. The resultant evaluation eliminates non-value added steps in the patients’ workup, thereby expediting time from presentation to diagnosis and, if needed, treatment.
Standardization of oral chemotherapy delivery to improve patient safety: A pilot study.
Authors: Desai Tejas , Carvalho Maritza , Fung Ron , Ahuja Devi , Gollee Simerjit , Almeida Bernadette , Grewal Gurpreet , Enright Katherine 
Published: February 2017

90 Background: Oral chemotherapy (OC) presents unique challenges to patient safety. In contrast with parenteral chemotherapy, patient education and comprehension are crucial to the safe administration of OC, appropriate toxicity interventions and patient adherence. At Trillium Health Partners we identified a lack of standardization to OC education and monitoring, that resulted in gaps in patient care. Using the American Society of Clinical Oncology/Oncology Nursing Society 2013 chemotherapy safety standards as guidance, we developed and piloted a multi-disciplinary oral chemotherapy care pathway (OCCP) to improve the approach to education and monitoring of patients newly started on OC. Methods: Patients newly started on OC between 03/15–06/15 were enrolled by 2 participating physicians representing a predominantly lung/GI practice. Baseline data was abstracted retrospectively in the 3 months prior to the pilot to reflect all study participants. The OCCP included in-person and telephone assessments by an oncology pharmacist and nurse over 2 cycles of OC. Pilot outcomes included pharmacy interventions, dose modification for toxicity, medication errors, the percent of prescriptions on computerized physician order entry (CPOE), adherence documentation and comprehension of treatment plan. Results: The pilot enrolled 20 patients and compared them against 21 baseline patients. During the pilot there were improvements in the percentage of patients who had pharmacy interventions, documentation of adherence and assessment of comprehension of the treatment plan as well as a reduction in dose modifications due to toxicity (Table 1). Conclusions: Use of a newly developed oral chemotherapy care pathway demonstrated both feasibility as well as improvements in a variety of key patient safety indicators. These results suggest that implementation of a standardized oral chemotherapy care pathway can feasibly improve patient safety outcomes. [Table: see text]
Electronic operative reports to support quality improvement and patient-centered care.
Authors: Mukhi Shaheena , Maloney Elaine , Agent-Katwala Mary , Porter Geoff 
Published: February 2017

95 Background: Operative reports (OP) for cancer surgery are usually narrated, although they provide inconsistent and incomplete information for patient care. National standards for cancer OP were unavailable until 2007. Over 10 years, surgeons in four Canadian provinces have transitioned from narrative to electronic synoptic reporting (ESP) for specific cancers. The electronic OP are now considered a patient medical record and integral to subsequent patient care. Surgeons are using electronic reports for quality assurance, billing, medical-legal conflict resolution and research. Methods: Disease-site expert panels were formed to bring together surgeons to discuss, identify, develop and form consensus on a core set of elements for breast, colorectal, ovary, endometrial, lung, prostate, and thyroid cancer surgeries and 64 quality indicators to set practice standards to consistently and comprehensively record pre-operative, operative procedures, intra-operative observations and pathology, clinical stage findings, complications and outcomes. These standards were implemented using ESP in four provinces and a mixed methods evaluation was carried out. Results: 245 surgeons in academic and community hospitals piloted and implemented pan-Canadian standards and generated 2000 synoptic reports and 729 discharge summaries over six months. In comparison to narrative reports, surgeons reported that the electronic synoptic reports: Capture complete and essential content (89% - 96%), 50% more; Contain 25 – 50 items vs. 2000 narrated words; Faster completion and turnaround time (5- 15 minutes) vs. 5 days; Rapid transmission to patient charts (91% in 1 hour and 97% within 24 hours) vs. 30 – 90 days; Result in cost savings $90/case; Enable performance measurement of surgical care to assess quality and outcome of surgery (e.g., residual disease and survival in patients) and length of aggressive vs. non-aggressive surgery and hospital stay (5.49 hours and 8.39 days vs. 3.06 hours and 6.83 days). Conclusions: Surgeons are building partnerships with key players to strategize best approaches to enable a system-wide adoption and implementation of synoptic operative reporting and quality of care measurement across Canada.
Survival After Early-Stage Breast Cancer of Women Previously Treated for Depression: A Nationwide Danish Cohort Study
Authors: Suppli Nis P. , Johansen Christoffer , Kessing Lars V. , Toender Anita , Kroman Niels , Ewertz Marianne , Dalton Susanne O. 
Published: February 2017

Purpose The aim of this nationwide, register-based cohort study was to determine whether women treated for depression before primary early-stage breast cancer are at increased risk for receiving treatment that is not in accordance with national guidelines and for poorer survival. Material and Methods We identified 45,325 women with early breast cancer diagnosed in Denmark from 1998 to 2011. Of these, 744 women (2%) had had a previous hospital contact (as an inpatient or outpatient) for depression and another 6,068 (13%) had been treated with antidepressants. Associations between previous treatment of depression and risk of receiving nonguideline treatment of breast cancer were assessed in multivariable logistic regression analyses. We compared the overall survival, breast cancer–specific survival, and risk of death by suicide of women who were and were not treated for depression before breast cancer in multivariable Cox regression analyses. Results Tumor stage did not indicate a delay in diagnosis of breast cancer in women previously treated for depression; however, those given antidepressants before breast cancer had a significantly increased risk of receiving nonguideline treatment (odds ratio, 1.14; 95% CI, 1.03 to 1.27) and significantly worse overall survival (hazard ratio, 1.21; 95% CI, 1.14 to 1.28) and breast cancer–specific survival (hazard ratio, 1.11; 95% CI, 1.03 to 1.20). Increased but nonsignificant estimated risks were also found for women with previous hospital contacts for depression. In subgroup analyses, the association of depression with poor survival was particularly strong among women who did not receive the indicated adjuvant systemic therapy. Conclusion Women previously treated for depression constitute a large subgroup of patients with breast cancer who are at risk for receiving nonguideline breast cancer treatment, which probably contributes to poorer overall and breast cancer–specific survival.
Family Perspectives on Hospice Care Experiences of Patients with Cancer
Authors: Kumar Pallavi , Wright Alexi A. , Hatfield Laura A. , Temel Jennifer S. , Keating Nancy L. 
Published: February 2017

Purpose To determine whether hospice use by patients with cancer is associated with their families’ perceptions of patients’ symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients’ wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received “just the right amount” of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients’ EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and “excellent” quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families.
Kymen metsäkeskuksen alueen metsävarat ja niiden kehitys 1966–98
Authors: Tomppo Erkki , Korhonen Kari , Henttonen Helena , Ihalainen Antti , Tonteri Tiina , Heikkinen Juha 
Published: February 2017

Tässä julkaisussa esitetään valtakunnan metsien yhdeksänteen inventointiin (VMI9) perustuvat Kymen metsäkeskuksen alueen metsävaratiedot ja niiden muutokset 1966–1998 sekä analysoidaan muutosten syitä. Lisäksi artikkelissa kuvataan yleispiirteet otantamenetelmästä. Inventoinnin otantamenetelmää, maastomittauksia ja tuloslaskentaa kehitettiin yhdeksättä inventointia varten. Menetelmä on kuvattu Etelä-Pohjanmaan tulosjulkaisun yhteydessä (Metsätieteen aikakauskirja 2B/1998). Kymen metsäkeskuksen alue muuttui vuonna 1996, minkä vuoksi tähän julkaisuun laskettiin uudelleen nykyisen alueen tulokset viidennestä inventoinnista lähtien. Alue on poikkeuksellinen koko maassa, koska sinne on keskittynyt suuri osa maan puunjalostuskapasiteetista. Metsäteollisuus käytti Kymen metsäkeskuksen alueella vuonna 1997 kotimaista raakapuuta 11,48 milj. m ja tuontipuuta 4,66 milj. m sekä sahahaketta ym. yli 4 milj. m. Koko maan metsäteollisuuden puunkäyttö oli 64,20 milj. m. Laajan teollisuuskapasiteetin vuoksi alueen metsät ovat olleet tehokkaassa käytössä. Metsiä hakattiin 1950- ja 1960-luvuilla yli kestävän suunnitteen. Metsien uudistaminen ja soiden ojitus alkoivat lisätä kasvua ja poistuman jäätyä entiselle tasolle tai jopa laskettua myös varanto alkoi lisääntyä. Se on noussut 1960-luvun puolen välin 78 milj. m:sta 113 milj. m:iin (45 %). Puuston vuotuinen kasvu on samaan aikaan noussut 3,44 milj. m:sta 4,88 milj. m:iin (42 %). Hakkuut ovat 1990-luvulla vilkastuneet, mutta poistumaa suurempi kasvu on lisännyt varantoa edelleen. Metsien uudistamisen seurauksena kasvatushakkuiden tarpeessa olevia metsiä on runsaasti. Metsälain tarkoittamia erityisen tärkeitä elinympäristöjä on 1,2 % ja kaikkia metsien monimuotoisuuden kannalta tärkeitä habitaatteja, avainbiotooppeja, 6,8 % yhdistetystä metsä-, kitu- ja joutomaan alasta.33333333
Patrullajes marítimos en el occidente de la Nueva España. Propuesta naval, defensiva y comercial de un funcionario novohispano (1742)
Authors: Ríos Guadalupe Pinzón 
Published: February 2017

Este trabajo analiza un proyecto enviado al rey por parte del gobernador de la Nueva Galicia donde se proponía la construcción de dos goletas financiadas por el erario real con las que se patrullarían las costas de Nueva Galicia y la California. Con ello se enviarían refuerzos diversos al noroeste a combatir las revueltas indígenas, fomentar navegaciones locales y reducir la presencia de embarcaciones enemigas. El proyecto permite reflexionar sobre las problemáticas y posibilidades económicas existentes en las costas del Pacífico novohispano durante la primera parte del siglo XVIII y apreciar las primeras medidas reformistas que alcanzaron las costas novohispanas.
This article analyzes a proposal sent to the king by the governor of Nueva Galicia to construct two barquentines, financed by the royal treasury, to patrol the coasts of Nueva Galicia and California. These barquentines would provide reinforcements to the northeast areas to combat indigenous revolts, foment local exploration, and reduce the presence of enemy ships. The project reveals the economic problems and possibilities present, as well as the early reformist measures implemented, in the novohispanic Pacific coasts during the first half of the eighteenth century.