bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduction in Chemotherapy Mixing Errors Using Six Sigma: Illinois CancerCare Experience
Authors: Heard Bridgette , Miller Laura , Kumar Pankaj 
Published: March 2012

Purpose: Chemotherapy mixing errors (CTMRs), although rare, have serious consequences. Illinois CancerCare is a large practice with multiple satellite offices. The goal of this study was to reduce the number of CTMRs using Six Sigma methods. Patients and Methods: A Six Sigma team consisting of five participants (registered nurses and pharmacy technicians [PTs]) was formed. The team had 10 hours of Six Sigma training in the DMAIC (ie, Define, Measure, Analyze, Improve, Control) process. Measurement of errors started from the time the CT order was verified by the PT to the time of CT administration by the nurse. Data collection included retrospective error tracking software, system audits, and staff surveys. Results: Root causes of CTMRs included inadequate knowledge of CT mixing protocol, inconsistencies in checking methods, and frequent changes in staffing of clinics. Initial CTMRs (n = 33,259) constituted 0.050%, with 77% of these errors affecting patients. The action plan included checklists, education, and competency testing. The postimplementation error rate (n = 33,376, annualized) over a 3-month period was reduced to 0.019%, with only 15% of errors affecting patients. Initial Sigma was calculated at 4.2; this process resulted in the improvement of Sigma to 5.2, representing a 100-fold reduction. Financial analysis demonstrated a reduction in annualized loss of revenue (administration charges and drug wastage) from $11,537.95 (Medicare Average Sales Price) before the start of the project to $1,262.40. Conclusion: The Six Sigma process is a powerful technique in the reduction of CTMRs.
Countering the Misincentivization of Cancer Medicine by Real-Time Personal Professional Education
Authors: Hrushesky William , Kumar Akhil , Davis Sharon , Fishman Marc 
Published: March 2012

Purpose: In the United States, public and private payer misincentivization of medical care and the invisibility of costs to the consumers of that care have conspired to create unsustainable growth in health care expenditure that undermines our economy, diminishes our productivity, and limits our international competitiveness. Cancer medicine provides a small yet salient example. On average, Medicare reimburses oncologists 6% above the average acquisition price for essential anticancer agents and supportive therapies. The costs of these agents vary across a stunning five orders of magnitude, from a few dollars to more than $400,000 per course of treatment. The profitability to providers varies across approximately four orders of magnitude, from cents to thousands of dollars per treatment. National guidelines (National Comprehensive Cancer Network [NCCN], American Society of Clinical Oncology [ASCO]) help providers select the most effective therapies without regard for cost. Methods: We created an oncologist-to-oncologist professional education program to help cancer physicians optimally use expensive long-acting white blood cell growth factors, in accordance with these national guidelines. We then compared their use across a population of approximately 97,000 Medicare members before and after our intervention. Baseline use was recorded over two consecutive quarters (2009 to 2010). In March 2010, our oncologists initiated real-time discussions with the oncologists of 22 separate groups if these agents were ordered for use with regimens that placed patients at less than 10% risk of febrile neutropenia, according to NCCN guidelines. Neither NCCN nor ASCO recommend the routine use of these agents in this low-risk group. The care of 82 such patients was thoroughly discussed in the following 6 months. Results: The monthly costs for these agents decreased by more than 50% by the final month of our intervention, although savings began immediately, reducing costs by more than $150,000 per quarter. No episode of febrile neutropenia was recorded in any patient in the intervention group. These savings generalize to the entire Medicare population at $30 million each month. Conclusion: We conclude that personal, oncologist-to-oncologist, real-time professional education will favorably modify oncologic prescribing behavior and can do so with significant immediate savings at no risk to patients with cancer.
High-fat-diet-induced obesity causes an inflammatory and tumor-promoting microenvironment in the rat kidney
Authors: Stemmer Kerstin , Perez-Tilve Diego , Ananthakrishnan Gayathri , Bort Anja , Seeley Randy J. , Tschöp Matthias H. , Dietrich Daniel R. , Pfluger Paul T. 
Published: March 2012

Summary
Obesity and concomitant comorbidities have emerged as public health problems of the first order. For instance, obese individuals have an increased risk for kidney cancer. However, direct mechanisms linking obesity with kidney cancer remain elusive. We hypothesized that diet-induced obesity (DIO) promotes renal carcinogenesis by inducing an inflammatory and tumor-promoting microenvironment. We compared chow-fed lean Wistar rats with those that were sensitive (DIOsens) or partially resistant (DIOres) to DIO to investigate the impact of body adiposity versus dietary nutrient overload in the development of renal preneoplasia and activation of tumor-promoting signaling pathways. Our data clearly show a correlation between body adiposity, the severity of nephropathy, and the total number and incidence of preneoplastic renal lesions. However, similar plasma triglyceride, plasma free fatty acid and renal triglyceride levels were found in chow-fed, DIOres and DIOsens rats, suggesting that lipotoxicity is not a critical contributor to the renal pathology. Obesity-related nephropathy was further associated with regenerative cell proliferation, monocyte infiltration and higher renal expression of monocyte chemotactic protein-1 (MCP-1), interleukin (IL)-6, IL-6 receptor and leptin receptor. Accordingly, we observed increased signal transducer and activator of transcription 3 (STAT3) and mammalian target of rapamycin (mTOR) phosphorylation in tubules with preneoplastic phenotypes. In summary, our results demonstrate that high body adiposity induces an inflammatory and proliferative microenvironment in rat kidneys that promotes the development of preneoplastic lesions, potentially via activation of the STAT3 and mTOR signaling pathways.
Selecting clinical quality indicators for laboratory medicine
Authors: Barth Julian H 
Published: March 2012

Background Quality in laboratory medicine is often described as doing the right test at the right time for the right person. Laboratory processes currently operate under the oversight of an accreditation body which gives confidence that the process is good. However, there are aspects of quality that are not measured by these processes. These are largely focused on ensuring that the most clinically appropriate test is performed and interpreted correctly. Methods Clinical quality indicators were selected through a two-phase process. Firstly, a series of focus groups of clinical scientists were held with the aim of developing a list of quality indicators. These were subsequently ranked in order by an expert panel of primary and secondary care physicians. Results The 10 top indicators included the communication of critical results, comprehensive education to all users and adequate quality assurance for point-of-care testing. Laboratories should ensure their tests are used to national standards, that they have clinical utility, are calibrated to national standards and have long-term stability for chronic disease management. Laboratories should have error logs and demonstrate evidence of measures introduced to reduce chances of similar future errors. Laboratories should make a formal scientific evaluation of analytical quality. Conclusions This paper describes the process of selection of quality indicators for laboratory medicine that have been validated sequentially by deliverers and users of the service. They now need to be converted into measureable variables related to outcome and validated in practice.
T2* relaxometry mapping of the uterine zones
Authors: Imaoka Izumi , Nakatsuka Takayuki , Araki Tetsuro , Katsube Takashi , Okada Masahiro , Kumano Seishi , Ishii Kazunari , Ashikaga Ryuichiro , Okuaki Tomoyuki , Van Cauteren Marc , Murakami Takamichi 
Published: March 2012

Background Previous literature demonstrated that the T2* value of the uterine junctional zone was lower than that of peripheral myometrium by using BOLD MR imaging. We expect T2* mapping image may add more information to T2-weighted images of the uterine myometrium. Purpose To evaluate whether T2* mapping software would reproduce the result of previous report, and to apply the software to benign uterine diseases. Material and Methods Five healthy volunteers and 19 patients clinically suspected of having benign pelvic disease were imaged using a 1.5T MR system. All women were of reproductive age, and all provided informed consent. Sagittal T2* images using a multishot EPI sequence were obtained. T2* values were calculated and color T2* maps reconstructed using a T2* fitting tool. Results The uterine zones could be identified in all 24 examinations on the T2* maps. In addition, a thin “4th zone” was seen between the endometrium and the JZ (junctional zone) in 19 of 24 examinations. The T2* value of JZ was significantly lower than that of peripheral myometrium (PM) ( P < 0.001). No significant difference in the T2* value of the JZ or of PM was noted between normal uterus and uterus with leiomyomas and/or adenomyosis. Conclusion A quantitative T2* map can easily be obtained using the PRIDE software T2* fitting tool, and the software reproduces the result from previous report. T2* value of the junctional zone was lower than that of peripheral myometrium regardless of having benign myometrial diseases.
Magnetic Field Effect on Photoconductivity of Single-Crystalline Pentacene and Perfluoropentacene Field-Effect Transistors
Authors: Pham Song-Toan , Kawasugi Yoshitaka , Tada Hirokazu 
Published: March 2012

ABSTRACTOrganic magnetoresistance (OMAR) of single-crystalline (SC) pentacene (C22H14) and perfluoropentacene (C22F14) was studied using field-effect transistor structures. The gate voltage effect showed that the OMAR originates from photo-induced current and requires both electrons and holes in the transport channel. The temperature dependence showed the maximum magnetoresistance (MR) ratio up to -6% under light irradiation at approximately 200 K and magnetic field of 80 mT. The charge carrier mobility and the exciton diffusion length were not important factors to determine the MR ratios. The interaction between triplet excitons and traps was thought to govern the OMAR behaviors.
Low phonon energy BaCl2 nanocrystals in Nd3+-doped fluorozirconate glasses and their influence on the photoluminescence properties
Authors: Pfau Charlotte , Skrzypczak Ulrich , Miclea Manuela , Bohley Christian , Miclea Paul-Tiberiu , Schweizer Stefan 
Published: March 2012

ABSTRACTNd3+-doped fluorozirconate glasses, which were additionally doped with chlorine ions, were investigated for their photoluminescence (PL) properties. Upon heat treatment of the as-made glass, hexagonal phase BaCl2 nanocrystals are formed within the material, which undergo a phase transformation to orthorhombic BaCl2 upon annealing at a higher temperature. The glasses with hexagonal phase BaCl2 nanocrystals show an enhanced Nd3+ PL in the visible spectral range. Time-resolved spectroscopy on the 4G5/2 / 2G7/2 → 4I9/2 transition shows that the existence of hexagonal BaCl2 nanocrystals results in a significantly longer decay time. The temperature dependence of the lifetime yielded that the enhanced PL is due to a reduced multi-phonon relaxation rate.
Pneumatization of the Skull Base Due to Valsalva Maneuver
Authors: Lacout Alexis , Yves Marcy Pierre , Yves Carlier Robert , Thariat Juliette 
Published: March 2012

Objectives We herewith report the case of a 43-year-old patient who experienced a skull base fracture associated with minimal trauma. The computed tomography scan examination showed unusual extensive pneumatization of the skull base. This patient used to perform repeated Valsalva maneuvers on a daily basis since childhood. Methods A literature search and analysis of pneumatization mechanisms was performed. Results Extensive skull base pneumatization has already been reported in patients performing daily Valsalva maneuver. Two pathogenic hypotheses are discussed: the bone cavity expansion through communicating spaces and cavitation secondary to increased intra-osseous pressure transmitted via the venous network with subsequent bone marrow ischemia. Conclusion Valsalva maneuver may be the cause of an extensive skull base pneumatization. We hypothesize that the Valsalva maneuver may induce bone marrow ischemia that may, if repeated and prolonged, lead to pneumatization.
Update of the Case Definitions for Population‐Based Surveillance of Periodontitis
Authors: Eke Paul I. , Page Roy C. , Wei Liang , Thornton‐Evans Gina , Genco Robert J. 
Published: March 2012

Background: This report adds a new definition for mild periodontitis that allows for better descriptions of the overall prevalence of periodontitis in populations. In 2007, the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology developed and reported standard case definitions for surveillance of moderate and severe periodontitis based on measurements of probing depth (PD) and clinical attachment loss (AL) at interproximal sites. However, combined cases of moderate and severe periodontitis are insufficient to determine the total prevalence of periodontitis in populations.Methods: The authors proposed a definition for mild periodontitis as ≥2 interproximal sites with AL ≥3 mm and ≥2 interproximal sites with PD ≥4 mm (not on the same tooth) or one site with PD ≥5 mm . The effect of the proposed definition on the total burden of periodontitis was assessed in a convenience sample of 456 adults ≥35 years old and compared with other previously reported definitions for similar categories of periodontitis.Results: Addition of mild periodontitis increases the total prevalence of periodontitis by ≈31% in this sample when compared with the prevalence of severe and moderate disease.Conclusion: Total periodontitis using the case definitions in this study should be based on the sum of mild, moderate, and severe periodontitis.
Toothbrushing Education via a Smart Software Visualization System
Authors: Graetz Christian , Bielfeldt Jule , Wolff Lars , Springer Claudia , Fawzy El‐Sayed Karim M. , Sälzer Sonja , Badri‐Höher Sabah , Dörfer Christof E. 
Published: March 2012

Background: The aim of this study is to evaluate the efficiency of a recently developed smart digital toothbrush monitoring and training system (DTS) in terms of correct brushing motion and grip axis orientation in an at‐home environment.Methods: Twenty‐one participants (11 test individuals [DTSG] and 10 control individuals [COG]) received instructions on the modified Bass technique (MBT) after their toothbrushing performance was monitored and they received professional tooth cleaning (T0). After 36 hours (T1), without mechanical oral hygiene measures, plaque and gingival indices were recorded, and the brushing technique was reviewed. After randomization, participants individually performed oral hygiene for 6 weeks (T2) with the provided oral hygiene kits. The DTSG group additionally used DTS. During the following 8 weeks (T3), participants used their original brushing devices without any additional interference. Investigators at each visit were masked regarding group identity. Data were statistically evaluated using Mann‐Whitney U, Friedman, Wilcoxon, and paired tests and Pearson correlation.Results: At T0, 27.27% of DTSG participants used the MBT correctly (COG, 50%), increasing to 54.55% (COG, 60%) after professional instruction (T1) and further to 90.91% at T2 (COG, 60%) (P <0.001). Plaque scores were reduced in DTSG (P <0.05). At T3, 80% of the DTSG (COG, 40%) totally adopted the MBT (P <0.05). The plaque scores on buccal surfaces of the DTSG showed an additional slight improvement between T2 and T3, in contrast to a decline on oral surfaces (P <0.001). At T2 and T3, the DTSG brushed >120 seconds (COG, 90% and 50%) (P <0.05).Conclusion: Apparently, the tested DTS effectively improves the brushing technique and leads to a prolonged learning effect, including improved oral hygiene.
Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning
Authors: Hall Yoshio N. , Larive Brett , Painter Patricia , Kaysen George A. , Lindsay Robert M. , Nissenson Allen R. , Unruh Mark L. , Rocco Michael V. , Chertow Glenn M. 
Published: March 2012

Summary

Background and objectives
Relatively little is known about the effects of hemodialysis frequency on the disability of patients with ESRD.

Design, setting, participants, & measurements
This study examined changes in physical performance and self-reported physical health and functioning among subjects randomized to frequent (six times per week) compared with conventional (three times per week) hemodialysis in both the Frequent Hemodialysis Network daily (n=245) and nocturnal (n=87) trials. The main outcome measures were adjusted change in scores over 12 months on the short physical performance battery (SPPB), RAND 36-item health survey physical health composite (PHC), and physical functioning subscale (PF) based on the intention to treat principle.

Results
Overall scores for SPPB, PHC, and PF were poor relative to population norms and in line with other studies in ESRD. In the Daily Trial, subjects randomized to frequent compared with conventional in-center hemodialysis experienced no significant change in SPPB (adjusted mean change of −0.20±0.19 versus −0.41±0.21, P=0.45) but experienced significant improvement in PHC (3.4±0.8 versus 0.4±0.8, P=0.009) and a relatively large change in PF that did not reach statistical significance. In the Nocturnal Trial, there were no significant differences among subjects randomized to frequent compared with conventional hemodialysis in SPPB (adjusted mean change of −0.92±0.44 versus −0.41±0.43, P=0.41), PHC (2.7±1.4 versus 2.1±1.5, P=0.75), or PF (−3.1±3.5 versus 1.1±3.6, P=0.40).

Conclusions
Frequent in-center hemodialysis compared with conventional in-center hemodialysis improved self-reported physical health and functioning but had no significant effect on objective physical performance. There were no significant effects of frequent nocturnal hemodialysis on the same physical metrics.
Midterm Outcome of Modified Kidner Procedure
Authors: Lee Kyung Tai , Kim Ki Chun , Park Young Uk , Park Seung Min , Lee Young Koo , Deland Jonathan T. 
Published: March 2012

Background: The results of modified Kidner procedures have generally been satisfactory at short-term followup. The objective of this study was to evaluate the midterm followup results including medial longitudinal arch height. Methods: Forty-one patients (50 feet) with a symptomatic accessory navicular who underwent the modified Kidner procedure between July 1999 and December 2004 were evaluated. A midfoot AOFAS score, VAS score, and satisfaction rate were recorded. The talo-first metatarsal (T-MT1), talo-calcaneal (TC), and calcaneal pitch (CP) angles were measured on plain radiographs. Average clinical and radiological followup periods were 88.4 ± 17.0 months and 85.7 ± 15.0 months, respectively. Results: The mean preoperative and followup AOFAS scores were 40.8 ± 7.1 (range, 32 to 57), and 88.4 ± 7.9 (range, 72 to 100), respectively ( p < 0.01). The mean preoperative and followup VAS scores were 7.1 ± 1.0 (range, 4 to 9) and 1.8 ± 1.0 (range, 0 to 5), respectively ( p < 0.01). At last followup, the satisfaction rate was 82.0%. There were no significant differences between preoperative and followup T-MT1 ( p = 1.00), TC ( p = 0.84), and CP ( p = 0.08) angles. Increased medial longitudinal arch was found in four of 16 feet in patients 15 years of age or younger with followup radiographs. Conclusion: We found the modified Kidner procedure could result in symptomatic relief and high satisfaction rate without a loss of arch height in any patient. Level of Evidence: IV, Retrospective Case Series
Cranial nerve dysfunction following Gamma Knife surgery for pituitary adenomas: long-term incidence and risk factors
Authors: Cifarelli Christopher P. , Schlesinger David J. , Sheehan Jason P. 
Published: March 2012

Object
Gamma Knife surgery (GKS) has become a significant component of neurosurgical treatment for recurrent secretory and nonsecretory pituitary adenomas. Although the long-term risks of visual dysfunction following microsurgical resection of pituitary adenomas has been well studied, the comparable risk following radiosurgery is not well defined. This study evaluates the long-term risks of ophthalmological dysfunction following GKS for recurrent pituitary adenomas.

Methods
An analysis of 217 patients with recurrent secretory (n = 131) and nonsecretory (n = 86) pituitary adenomas was performed to determine the incidence of and risk factors for subsequent development of visual dysfunction. Patients underwent ophthalmological evaluation as part of post-GKS follow-up to assess for new or worsened cranial nerve II, III, IV, or VI palsies. The median follow-up duration was 32 months. The median maximal dose was 50 Gy, and the median peripheral dose was 23 Gy. A univariate analysis was performed to assess for risk factors of visual dysfunction post-GKS.

Results
Nine patients (4%) developed new visual dysfunctions, and these occurred within 6 hours to 34 months following radiosurgery. None of these 9 patients had tumor growth on post-GKS neuroimaging studies. Three of these patients had permanent deficits whereas in 6 the deficits resolved. Five of the 9 patients had prior GKS or radiotherapy, which resulted in a significant increase in the incidence of cranial nerve dysfunction (p = 0.0008). An increased number of isocenters (7.1 vs 5.0, p = 0.048) was statistically related to the development of visual dysfunction. Maximal dose, margin dose, optic apparatus dose, tumor volume, cavernous sinus involvement, and suprasellar extension were not significantly related to visual dysfunction (p >0.05).

Conclusions
Neurological and ophthalmological assessment in addition to routine neuroimaging and endocrinological follow-up are important to perform following GKS. Patients with a history of radiosurgery or radiation therapy are at higher risk of cranial nerve deficits. Also, a reduction in the number of isocenters delivered, along with volume treated, particularly in the patients with secretory tumors, appears to be the most reasonable strategy to minimize the risk to the visual system when treating recurrent pituitary adenomas with stereotactic radiosurgery.