bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing blood culture contamination in adult patients with cancer presenting to the emergency department.
Authors: Abdeldaem Karim Samir , Wechsler Adriana H. , Santos Mymimilami , Nguyen Kim U. , Cameron Brian , Ayers Holly , Richardson Goley B. , Zaghian Maryam , Spallone Amy , Bhatti Micah M. 
Published: October 2023

393 Background: Fever and leukocytosis are among the most common complaints for cancer patients presenting to the Emergency Department (ED). Most patients admitted for fever or infection come through the ED, which is therefore a primary site for blood culture collection. Contamination of these cultures can increase the clinical and financial burdens for the patients, the medical team, and laboratory staff. It may lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was more than twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses rather than phlebotomists draw the majority of blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the contamination rate in the ED by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared contamination rates of the ED versus other hospital floors and outpatient centers over three months. We then evaluated the contamination rates of ED nurses versus phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and then potential interventions were ranked on a prioritization matrix. Results: We identified the use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as the critical contributors to the increased contamination rates in the ED. Our intervention was to create premade blood culture kits that promoted the use of chlorhexidine swabs by ensuring availability and easy access in the fast-paced ED environment. Ten cc syringes in the kits encouraged the withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off the ED nurses at the bedside, implementing education and adherence to the use of blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. Following two months of these interventions, there was a reduction in blood culture contamination from 2.46 percent to 1.89 percent. Conclusions: A guideline driven, standardized blood culture collection process adhered to by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available and premade blood culture kits improve compliance with the materials and techniques associated with best practices.
Assessing reliability of quality measures across oncology practices: Implications for value-based payment.
Authors: Bromley-Dulfano Rebecca A. , Landrum Mary Beth , Brooks Gabriel A. , Wright Alexi A. , Keating Nancy Lynn 
Published: October 2023

4 Background: Identifying reliable measures that distinguish care quality at the medical oncology practice level is crucial to ensuring delivery of high-value cancer care, particularly as alternative payment models in oncology become more frequent. We assessed reliability of several claims-based quality measures across oncology practices. Methods: Using 100% Medicare claims data for fee-for-service beneficiaries with cancer, we identified 6-month chemotherapy episodes starting in four 6-month performance periods (PPs) from July 2017 to June 2019. We assessed quality measures of acute care utilization among all episodes and end-of-life (EOL) care among decedents who died during or by 90 days of the episode’s end. We estimated practice-level adjusted rates from hierarchical linear models with practice-level random effects, PP fixed effects, and clinical/demographic controls. We documented intraclass correlation (ICC, variation attributed to practice) and calculated reliability (reproducibility) for the most recent 6-month PP for each measure from the between-measure variance, within-measure variance, and number of episodes per practice, excluding practices with <20 episodes. We considered reliability ≥70% (ie, <30% of variation in practices’ performance due to chance instead of true quality differences) to be adequate. Results: Among 443,865 patients from 2,307 practices, 90% were >65 years old, 84% were White, 31% had lung or breast cancer. The median (IQR) number of patients in practices with ≥20 episodes was 59 (17-195). Most ICCs were low, suggesting limited variation across practices (Table). All the utilization and EOL measures had a practice-level reliability of <70% for the average-sized practice (Table). Most measures demonstrated little variation over time (<2 percentage point difference over 4 PPs). Conclusions: None of the measures studied were reliable for average-sized practices, suggesting limited ability to distinguish care quality across practices treating fee-for-service Medicare patients within a single PP, except among larger practices. Several measures would be reliable for many practices over an evaluation period of 1-2 years, with a tradeoff of using less current data to monitor performance. [Table: see text]
Analysing the colorectal cancer screening patterns during the COVID-19 pandemic and their effects on patient outcomes.
Authors: Ling Joshua , Kang Justin , Read Daniel , Parmar Vivek Singh , Ahmed Fawad , Hamm Caroline M. 
Published: October 2023

40 Background: In Canada, colorectal cancer (CRC) ranks as the third most prevalent cancer and second leading cause of cancer mortality (1). The potential to prevent a significant proportion of colorectal cancers and associated mortality through effective screening is widely acknowledged (Han-Mo Chiu, 2021). Notably, fecal immunohistochemistry testing (FIT) has led to improved early detection of CRC (2). However, FIT screening was suspended in Canada in the initial phase of the COVID-19 pandemic response. Specifically, in Ontario, the collection of FIT samples was suspended between March 23rd, 2020 and August 26th, 2020 (3). During this 3-month period, an estimated 540,000 Canadians would have participated in screening, as indicated by OncoSim, a microsimulation model for cancer (4). The primary objective was to evaluate the consequences of screening cessation, through comparison of asymptomatic and symptomatic CRC diagnoses at the Windsor Regional Cancer Centre in Windsor, Ontario. Methods: A retrospective chart review was performed for patients admitted to the Windsor Regional Cancer Centre of Windsor Regional Hospital between December 2016 and June 2021. Demographic data, risk factors for CRC, cancer operability status, and the presence of symptoms at diagnosis of CRC were recorded. Results: 771 patient charts were reviewed and 77 (10%) were excluded due to duplication or insufficient chart data. Of the remaining 694 patients, 545 (79%) were classified as the pre-COVID group (December 2016 to February 2020) and 149 (21%) as the COVID group (March 2020 to June 2021). We found a 2.5% increase in symptomatic diagnoses of CRC in patients diagnosed after March 2020 (pre-COVID group vs. COVID group). However, we did not observe a significant difference in proportion of inoperable CRC cases between groups. Conclusions: The observed trend of symptomatic diagnoses of CRC underscores the importance of FIT screening for early CRC detection and the need for increased catch-up screening to mitigate the potential risks and mortality associated with CRC screening interruptions. For this, it is presumed that a population of patients exists who would have tested positive through FIT screening but instead presented symptomatically at a later stage of the disease. It is also important to note that our study data did not extend beyond June 2021, so we could not capture the complete impact of FIT cessation. (1) Canadian Cancer Statistics, 2021. (2) Zauber, 2015. (3) Ontario Health, 2021. (4) StatCan, 2021.
Social determinants of health profiles and survival among US cancer survivors: A cluster analysis.
Authors: Chen Fangyuan , Nipp Ryan David , Han Xuesong , Yabroff Robin , Jiang Changchuan 
Published: October 2023

402 Background: Healthcare payers and clinicians increasingly focus on social determinants of health (SDOH) to reduce disparities in care and improve patient outcomes in US. Prognostic value of single SDOH factors has been described, but not for clusters of multiple SDOHs. We characterize cancer survivors by their SDOH profiles and examine associations with survival. Methods: 11,237 cancer survivors were identified from the 2013-2018 National Health Interview Survey (NHIS) with linkage to NHIS Mortality Files. 9 SDOHs were included in 5 a priori identified domains: 1) healthcare access (medical financial hardship, delayed care due to transportation and/or other barriers); 2) economic instability (unemployment, food insecurity, housing insecurity); 3) social isolation (marital status); 4) education and literacy (< high school education); and 5) neighborhood quality (low neighborhood social cohesion (nSC) based on 4 item scale developed by the Project on Human Development in Chicago Neighborhoods Community Survey). The most significant SDOH in each domain was identified with Cox regressions. We then clustered patients into 5 groups using the inter-person Gower distance of the 5 selected SDOHs and examined survival among each cluster adjusting for age, sex, race, region, and survey era. Results: 5 distinct clusters of cancer survivors were identified with top-ranking SDOHs in each domain: 1) Healthy Hopefuls: young, employed, and married with fewer socio-economic and health burdens; 2) Independent Phoenixes: single, employed rising above adversity, maintaining health and financial wellness; 3) Enduring Companions: older, unemployed, and married navigating health challenges while maintaining financial stability; 4) Solo Warriors: older, single, unemployed with health complications and financial hardships; and 5) Resilient Overcomers: unemployed minorities in low-quality neighborhoods, overcoming the obstacles of higher health and socio-economic challenges. Groups 3, 4, and 5 had worse survival than group 1 in adjusted analyses (Table). Conclusions: SDOH profiles were strongly associated with survival in US cancer survivors. Findings support the need to identify SDOH profiles in efforts to personalize mitigation strategies and enhance long-term wellness.[Table: see text]
Chemo-Toxicity Calculator use in shared decision-making for chemotherapy treatment planning.
Authors: Pacheco Alonso Victor , Gress Jean A , Mcfarlane Tamar , Garcia Marcus , Markley Lora 
Published: October 2023

403 Background: Chemotherapy related symptoms and toxicities are frequent among cancer patients, especially those ≥ 65 years old. These symptoms and toxicities can contribute to patients having a decreased quality of life and unmet treatment outcomes. The modified CARG, Chemo-Toxicity Calculator, is an assessment of function, comorbidity, cognition, psychological state, social activity/support and nutrition. The goal of using the calculator, was to improve shared decision-making between the physician, patient and caregiver. Discussions focused on treatment, modifying treatment regimens and other alternatives such as palliative or hospice. Methods: Rocky Mountain Cancer Centers introduced the modified CARG, Chemo-Toxicity Calculator, in 2022 as part of cancer patient workflow for 10 physicians. In 2022, 156 patients completed the Chemo-Toxicity Calculator to identify and predict the risk of initiation or continuation of chemotherapy treatment in patients ≥ 65 years old. Using the CARG assessment allowed the physician and patient to have open discussions about the pros and cons of initiation or continuation of chemotherapy treatment or if they should pursue alternative treatment. 27 of these patients (17.3%) elected to receive hospice care in lieu of traditional treatment. The Chemo-Toxicity Calculator link was added in the electronic health record (EHR) for access at the point of care. Process: 1. Review patients at the time of initial treatment and subsequent lines of therapy. 2. CARG assessment completed for patients ≥ 65 years old. 3. Shared decision-making discussion including the voice of the patient. 4. Psychosocial interventions and care coordination. Results: As of May 2023,10 providers administered the modified CARG assessment on 244 patients. The tool identified patients that would not benefit from treatment and instances where cycle one dose reduction would be appropriate to reduce toxicity risk. Of the 244 patients who completed the assessment, 47 (19.2%) elected alternative treatment. Conclusions: The Chemo-Toxicity Calculator is a functional, practical first step toward the inclusion of a geriatric assessment for all patients ≥ 65 years old. Patients understand it, and it sets the stage for shared decision-making discussions. This valued intervention aids subsequent discussions about dose reduction and ongoing risks of treatment. Actions taken based on the results of the Chemo-Toxicity Calculator, reduced toxicity by dose reductions and helped patients choose an alternative to chemotherapy.
An initiative to increase referrals for germline testing after tumor sequencing.
Authors: Jacobs Michelle F , Spranger Elizabeth , Wright Nunes Julie 
Published: October 2023

413 Background: Tumor sequencing (TS) represents an opportunity to detect hereditary cancer syndromes (HCS), as HCS may be identified or suspected from TS results. Detecting HCS can affect patient treatment and allow genetic testing of relatives. Our institution noted low numbers of referrals for germline genetic testing (GGT) following TS. A quality improvement project assessed current practices and barriers for referring patients with TS findings suspicious for HCS, with the goal of building an initiative to increase referrals for this indication. Methods: Oncologists’ input was sought via two Qualtrics surveys and semi-structured interviews. We asked about demographics, familiarity with TS reports and guidelines about when to recommend follow-up GGT, TS result review workflows, cancer genetics referral practices, preferences for receiving education/updates on cancer genetics, and perceived ability to contact genetics providers. A current state process map and root cause analysis were developed based on findings. Results: Responses identified several barriers to GGT referral based on TS results. Provider-related issues included uncertainty about what TS findings necessitate referral, discrepancies in results return workflows, low priority of GGT in the care plan, absence of guidance from genetics providers, and being uncertain how to consult providers with expertise in GGT. System-level concerns included lack of integration of lab results into the electronic medical record and difficulties scheduling cancer genetics appointments. Patients may also decline referral. Provider-level concerns were seen as the most readily addressable. We used survey/interview findings to design an initiative. Most oncologists prefer to receive information on this topic from cancer genetics clinic providers (79%) and identified email (79%) and presentations at tumor boards (71%) as preferred methods for delivery. A brief presentation, tip sheet, and frequently asked questions document focused on addressing topics identified by our survey/interviews were developed. Provider education is being delivered at tumor boards with written resources provided by email. Conclusions: There are many reasons why patients with potential germline findings on TS may not be referred for GGT despite its value in patient care. We developed an educational initiative for oncologists based on survey/interview findings with the aim of increasing referrals for GGT following TS. Referral trends will be monitored to assess effectiveness of this initiative.
Comprehensive molecular testing prior to first treatment among patient with metastatic non-small cell lung cancer.
Authors: Kropf Jacqueline , Kuo Elim , Cusco Jorge , Tseng Jennifer , Laughlin Amy Iarrobino , Cheung Wang L. 
Published: October 2023

431 Background: Nearly 60% of patients with non-small cell lung cancer will have actionable mutations identified via molecular testing. Of these patients, those treated with targeted therapy had longer overall survival than those who did not. Therefore, it is imperative molecular testing is both sent and resulted at time of first treatment. Despite this, multiple barriers remain with reported community rates of <50% with comprehensive molecular testing. We sought to understand testing practices at our institution. Methods: In this retrospective chart review, patients with stage IV, non-small cell, non-squamous cell lung cancer treated at Orlando Regional Medical Center between 1/2021-5/31/2022 were identified. Primary endpoints included rate of comprehensive molecular testing (EGFR, ALK, ROS1, RET, MET, BRAF, KRAS, ErbB2 and NTRK, either tissue or plasma) available prior to first line treatment. Results: Of the 73 patients who were included, 69 patients (94.8%) had comprehensive molecular testing results available prior to first line treatment. 48 (65.8%) patients had tissue testing results prior to first treatment. 44 (60.2%) patients had plasma testing results prior to first treatment. 14 (19.2%) patients had tissue testing sent, without results at time of first treatment. Conclusions: The comprehensive molecular testing rate at a large tertiary hospital is 94.8%, substantially higher than the rates reported in the literature. Despite this, 19.2% of patients had tissue testing sent but not resulted at time of first treatment. Future studies are needed to improve turnaround time of tissue based molecular testing results and evaluate concurrent versus sequential tissue and plasma testing.
Colonoscopy withdrawal times and adenoma detection rates in a large, multi-site colorectal surgery practice.
Authors: Downs J Marcus , Djenic Brano , Rodriguez-Ruesga Roberto , Dwyer Christopher 
Published: October 2023

433 Background: Colonoscopy withdrawal times (CWT) and adenoma detection rates (ADR) have been extensively correlated in medical literature. The American College of Gastroenterology (ACG) 2021 guidelines recommend measuring quality indicators for screening colonoscopy that achieve minimum benchmarks for ADR (>=25%) and CWT (>=6 minutes). In October 2022, M Desai et al reported in a sample of 1142 patients (46% screening and 54% surveillance), ADR increased as withdrawal time increased from 6 to 13 minutes. Results demonstrated a 6% increase per minute in the likelihood of detecting an additional patient with at least 1 adenoma. Texas Colon and Rectal Specialists routinely reviews ADR’s and CWT’s. This retrospective descriptive study presents a concise review of the correlation between CWT’s and ADR’s in a homogenous set of screening and surveillance patients. Methods: We examined 7164 abstracted colonoscopy records from 31 colorectal surgeons. Diagnostic colonoscopies were excluded. We studied patients between 45 and 84 years of age at the time of the colonoscopy. Each patient was noted for the colonoscopy CWT as well as whether at least one adenomatous polyp was detected. These data were reported in a scatter plot of ADR over CWT as well as a bubble chart of ADR over CWT by each surgeon. A two-sample t-test confirmed a statistical difference between the mean CWT of the adenoma-positive patients and those that were not positive. Results: Consistent with the literature, ADR increased with CWT. The mean CWT was 14.2 minutes in the group where an adenoma was detected (n=3289) and 10.6 minutes in the group where an adenoma was not detected (n=3875), (p<0.05 and CI of 95%). Mean CWT was 12.3 minutes, mode was 7 minutes, median was 10.25 minutes, and the mean ADR was 45.9%. The best ADR performance was 62.5% at a mean of 26.8 minutes CWT and the worst performance was 27.7% at 10 minutes CWT. A bubble chart demonstrates the relationship between CWT and ADR by surgeon with the bubbles representing individual colonoscopy volumes. Consistent with the literature, ADR increased with CWT. The mean CWT was 14.2 minutes in the group where an adenoma was detected (n=3289) and 10.6 minutes in the group where an adenoma was not detected (n=3875), (p<0.05 and CI of 95%). Mean CWT was 12.3 minutes, mode was 7 minutes, median was 10.25 minutes, and the mean ADR was 45.9%. The best ADR performance was 62.5% at a mean of 26.8 minutes CWT and the worst performance was 27.7% at 10 minutes CWT. Conclusions: Our data indicate a significant relationship between CWT and ADR, and may suggest that CWT well beyond six minutes may yield better ADR’s. Furthermore, scope volume appears to play a role in the achievement of higher ADR’s, though this would require further investigation for optimal CWT, minimum expected ADR, optimal techniques and bowel prep, and emerging assistive technology.
Frailty screening in head and neck cancer care: Implementation outcomes and clinician perspectives.
Authors: Brauer Eden , Lazaro Stephanie , Erman Andrew , Rapkin David , Jeong Jennifer , Surampudi Vijaya , Abemayor Elliot , Wong Deborah J.L. , St. John Maie 
Published: October 2023

453 Background: Frailty is a complex medical syndrome characterized by an increased vulnerability to stressors, distinct from age or comorbidity. Among patients with head and neck cancers, frailty is a significant predictor of post-operative complications, reduced quality of life, and increased rates of morbidity and mortality. Despite these known risks, frailty status is rarely assessed in routine oncology care or considered systematically in treatment planning. In this study, we evaluated the implementation of a frailty screening protocol as a new standard of care for patients with head and neck cancers at a large academic medical center. Methods: Frailty screening was embedded into an existing telephone-based intake workflow for newly referred patients, using the patient-reported Risk Analysis Index (RAI). RAI data was scored, documented in the health record, and presented at weekly case conferences. To evaluate the implementation, medical record data, including frailty status and sociodemographic and clinical information, between August 2020 and November 2022 was abstracted, and feedback from clinicians was collected using a brief survey on perceived clinical value. For the chart review and clinician survey, quantitative data was analyzed using descriptive statistics; thematic analysis was used to identify key findings in the qualitative data. Results: During the evaluation period, 488 of 585 eligible patients completed the frailty screening questionnaire, resulting in a compliance rate of 83.4%. Of those screened, the mean age was 63.1 years (SD: 16.2), 64% were male, and 20.5% had > 3 comorbid conditions. For the total sample, the mean RAI score was 38.4 (SD: 6.52), with 43% deemed not frail, 52.7% frail, and 4.3% very frail. For the survey, the majority of respondents (11/14) believed that frailty screening added clinical value. Key qualitative themes emphasized how frailty screening facilitated a “whole patient” approach and a “valuable heads-up regarding a patient’s vulnerability.” Potential enhancements focused on making RAI data more clinically actionable. Conclusions: Overall, findings suggest that frailty is common in patients with head and neck cancer, and that frailty screening is achievable in routine care and provides clinical value to multidisciplinary oncology teams at the time of treatment planning. Future work may extend these findings to inform targeted pre-habilitation interventions for frail HNC patients and examine their impact on clinical outcomes.