bluuebunny/crossref_metadata_2025_split huggingface dataset:
Innovation in cancer policy & health systems education during hematology-oncology (HO) fellowship training: Single center experience.
Authors: Hussaini S. M. Qasim , Chen Krista Y. , Donehower Ross C. , Marrone Kristen A. 
Published: October 2023

446 Background: Cancer care delivery and outcomes in the US are influenced by a complex health system and regulatory environment. To our knowledge, a structured approach to education on these topics during HO training is lacking. We sought to evaluate baseline knowledge and establish a longitudinal curriculum aimed at educating HO trainees on cancer policy. Methods: First year HO trainees at Johns Hopkins were surveyed on their prior education related to affordability, social determinants of health, and oncologic drug development. Based on these results, a longitudinal curriculum with 10 didactic sessions led by invited content experts was developed and implemented into the 2022-23 academic year schedule. Impact of curriculum was evaluated through anonymous surveys at the beginning and end of each teaching session. Results: Pre-curricular intervention survey was completed by 12 fellows (100% response rate; 58% female, 41.6% White; 16.6% IMGs). All had treated patients that were uninsured (100%, n = 12), unable to afford care (100%, n = 12), or lacked stable housing, transportation, food and employment (100%, n = 12). Smaller number had counseled patients on clinical trial enrollment (50%, n = 6) or discussed trial endpoints (33%, n = 4). Systems education prior to fellowship varied by topic: social determinants of health (33%, n = 4), critical appraisal of clinical trials (33%, n = 4), oncologic care in low-resource settings (41.6%, n = 5), high-value care (66%, n = 8), health insurance (91%, n = 11). Pre and post-surveys demonstrated each teaching session was associated with a significant improvement in fellows’ confidence in understanding pre-set lecture objectives (Table; cumulative mean improvement 1.14 from “neutral” pre-intervention, to “agree” or “strongly agree” post-intervention). Conclusions: We demonstrate lack of education on practice-relevant systems topics in HO trainees at time of subspecialty education initiation. Our longitudinal systems education curriculum improved trainee awareness and understanding of these complex topics. Future efforts will build on this scalable curriculum utilizing trainee feedback and departmental buy-in with the goal of training an oncologic workforce better equipped to counsel patients, navigate structural barriers, and appraise evidence.[Table: see text]
Improving the hematology/oncology paging system at Northwestern University.
Authors: Melody Megan Elizabeth , Swaroop Alok , Odetola Oluwatobi , Bungo Brandon , Serritella Anthony V. , Mulcahy Mary Frances , Moreira Jonathan , Chandra Sunandana 
Published: October 2023

45 Background: To page specific services within the Division of Hematology and Oncology (Heme/Onc) at Northwestern Memorial Hospital previously required hospital staff to enter the specific service name into the web-based paging system. Turnover of faculty and staff, hospital growth, and use of locums staffing contributed to an increasing number of erroneous pages (pages intended for a different service). In this quality improvement initiative, we restructured the paging system so that all services within the Division of Heme/Onc populated when “hem” was entered into the web-based system. We aimed to decrease the number of erroneous pages received by heme/onc fellows by 20% with a subsequent improvement in perceived workload burden and job satisfaction. Methods: Pre- and post-intervention surveys were administered to all heme/onc fellows to assess impact on workload burden and job satisfaction. Fellows were asked to log all erroneous pages for a five-month period pre- and post-intervention. Results: Pre-intervention, fellows logged a total of 48 erroneous pages with 10 pages (21%) occurring between the hours of 10 PM and 6 AM. Post-intervention, a total of 37 erroneous pages were logged with only 3 pages (8%) occurring overnight. Of the 12 (92.3%) fellows that responded to the pre-intervention survey, one (8.3%) reported that the number of incorrect pages significantly increased workload burden, 9 (75%) increased workload burden, and 2 (16.7%) neither increased nor decreased workload burden. Five responders (41.7%) reported the number of incorrect pages significantly decreased job satisfaction, 5 (41.7%) decreased job satisfaction, and 2 (16.7%) neither increased nor decreased job satisfaction. 100% of fellows responded to the post-intervention survey. One (7.7%) reported that the number of incorrect pages significantly increased workload burden, 8 (61.5%) increased workload burden, and 4 (30.8%) neither increased nor decreased workload burden. Two responders (16.4%) reported the number of incorrect pages significantly decreased job satisfaction, 6 (46.2%) decreased job satisfaction, and 5 (38.4%) neither increased nor decreased job satisfaction. Conclusions: By changing the departmental nomenclature to a structured format, we decreased the number of erroneous pages received over a 5-month period by 23% with a 70% reduction in overnight pages resulting in an improvement in perceived workload burden and job satisfaction among Hematology/Oncology fellows.
Understanding over- and under-screening of cervical cancer among a national sample of commercially insured women: Implications for health equity.
Authors: Shin Michelle , Axeen Sarah , Tsui Jennifer 
Published: October 2023

451 Background: Cervical cancer screening guidelines have changed frequently in recent years. Different adherence patterns by screening modalities (e.g., cytology-only, HPV testing-only, co-testing) could lead to overuse and underuse of care. It is unclear if receipt of guideline adherent screening varies among racial/ethnic minorities and those with low socioeconomic status (SES), which can exacerbate existing disparities. Methods: Optum Clinformatics Data Mart from 2013-2021 was used to identify women aged 30-65 to examine over- and under-screening to understand national patterns of guideline adherence. Average-risk women with continuous enrollment for 6 years for years starting in 2012-2016 and at least one claim were included. Those with history of hysterectomy and cervical cancer were excluded. According to the 2012 U.S. Preventive Services Task Force guideline, adherence was defined as screening interval of 4.5-5.5 years for co-testing/HPV testing as the index screening modality and 2.5-3.5 years for cytology-only, and over-screening as <4.5 years and <2.5 years, and under-screening as > 5.5 years and > 3.5 years including lack of subsequent screening, respectively. We compared distribution of screening adherence by screening modality, race, education level, and household net worth using chi-squared test. Results: A total of 1,422,258 individuals ages 30-65 were included. Among the eligible sample, 1,016,067 women received at least one cervical cancer screening from 2013-2017. Of these, 830,549 (81.7%) were considered average-risk. About half (48.4%) received an index screening with cytology-only, 51.0% with co-testing and 0.6% with HPV testing. Overall, 7.4% were guideline adherent, 62.1% were over-screened and 30.5% were under-screened. 12.7% of the women screened with cytology-only were adherent compared to 2.5% of those screened with co-testing, 59.2% vs. 64.9% were over-screened, and 28.1% vs. 32.6% were under-screened, respectively. Unadjusted differences in the distribution of adherence were statistically significant by race, education level, and household net worth (p < 0.01). Conclusions: The study identified high rates of over-screening and under-screening among a national cohort of commercially insured women, signaling the need for interventions to improve guideline adherent screening. Furthermore, over- and under-screening varied by screening modalities, race and SES factors, which highlights the need to study specific patterns of adherence among subpopulations to address cervical cancer inequities.
Introducing a multidisciplinary approach to medication optimization for geriatric oncology inpatients.
Authors: Goggin Caitriona , Walsh Darren J. , Cronin Emer , Dunne Emily , Hannan Michelle , Buckley Carol , Horgan Anne 
Published: October 2023

455 Background: Drug-related complications have been associated with adverse outcomes in older adults with cancer. This pilot interventional study aimed to assess the feasibility of introducing an inpatient multidisciplinary (MDT) comprehensive medication assessment focussing on the specific needs of older adults with cancer, in addition to standard hospital medication review and reconciliation. Methods: Patients≥70 years with a solid tumour diagnosis, admitted under the medical oncology service, were discussed at a weekly MDT meeting involving geriatric oncology physicians, nurses and pharmacists. Relevant data including age, cancer type and stage, Rockwood clinical frailty scale, comorbidities, medications on admission and initiated during hospitalisation, systemic anti-cancer therapy (SACT), falls history, cognitive screening, and laboratory parameters were prospectively collected. An MDT medication review was conducted including SACT toxicity assessment, drug-drug interactions (DDI), potentially inappropriate medication (PIM) assessment using STOPP/START criteria, and anticholinergic burden (ACB) scoring. A summary of medication review findings and recommendations was provided to the primary inpatient team to support medication optimisation. Results: Sixty patients were included over a 4 month period, with a median age of 76.5 years (range 65-88). Most patients had lung cancer (36.7%), 80% had stage IV disease. Twenty-five patients (42%) were moderately or severely frail. Most patients (61.7%) were on systemic anti-cancer therapy (SACT). Seven patients (11.7%) had a fall in the previous 3 months and 15 patients (25%) experienced acute confusion during the hospitalisation. ADEs were identified in 26 patients (43%), PIMs in 33 (55%), excessive ACB in 43 (72%) and DDIs in 53 (88%). MDT medication optimisation recommendations were made in 59 patients (98%) in addition to standard of care review. Based on review findings, medication interventions included recommendations to deprescribe, start drug, amend drug dose, route or frequency, perform additional laboratory monitoring, and SACT-specific recommendations (Table 1). Conclusions: Implementing an interprofessional geriatric oncology MDT approach to medication review in hospitalised older adults with cancer can result in additional medication recommendations alongside standard of care.[Table: see text]
Cost effective quality improvement initiative in lung cancer screening: A single institutional pilot program.
Authors: Ibodeng Gogo , Mohammad Juwairiah , Kutsche William , Hogan Ekemini , Mansour Charles , Roy Josh , Galeas Jose Nahun 
Published: October 2023

458 Background: US Preventive Services Task Force (USPSTF) recommends lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) screening for individuals aged 50-80 years with ≥20 pack-year smoking history. Nevertheless, only 4%-13% of eligible individuals are screened nationally. Lung cancer mortality is higher in the South where low socioeconomic status and racial minorities predominate and the screening rate in Alabama is between 4.7% - 7.7%. Thomas Hospital belongs to this catchment area and the goal of our study was to improve LCS with LDCT by embarking on a quality improvement initiative which was commenced as a pilot program for a larger healthcare system (>5 large outpatient clinics with over 12,000 visits/month). Methods: Data were obtained retrospectively by reviewing the electronic medical records of eligible patients for LCS from 01/22 to 01/23 who visited the Thomas Hospital Internal Medicine Residency Clinic (pilot study site). A multidisciplinary team was created involving Thoracic oncologists, radiologists, Thoracic surgeons, resident physicians, and PCPs to identify barriers to LCS and discuss methods on how to improve LCS. We identified areas to be improved on and utilized performance improvement tools such as a Pareto chart and a PICK chart. Data was then collected prospectively. Results: In the initial 12-month period, only 6.95% (total n=185) of patients who qualified for LCS had LDCT done for LCS. The major barriers to screening were poor smoking history documentation, lack of proper identification of screening candidates, lack of awareness of screening guidelines, infrequent follow-up, discrepancies in smoking history within the EMR, and lack of a consistent system for LDCT referral. We identified 4 main initiatives which were introduced monthly, one at a time. The interventions include Educational services/Awareness campaigns on LCS, Distribution of current LCS guidelines in the clinic rooms/offices, Patient self-reported questionnaire on smoking history, and Implementation of an EPIC flag tool for LCS. We reviewed our performance after the interventions and the total LCS after 4 interventions included 48 (47%) patients compared to 102 patients who fit the screening criteria. 5 patients had LDCT ordered but yet to be completed and 6 patients had findings that needed immediate evaluation and received appropriate referrals. Conclusions: Lung cancer screening remains suboptimal in the United States, especially in the southern region. With our approach, the screening rates have increased exponentially only within a few months compared to the previous year and this model is to be adopted by other clinics affiliated with the umbrella health system. LDCT does carry certain risks including false positive results and unnecessary biopsies; hence shared decision-making is needed before ordering the test.
Improving rates of referrals for fertility preservation among adult patients with cancer.
Authors: Maldonado Edward , Jacob Saya , Ragavan Meera Vimala , Kennedy Vanessa Elaine , Dahle Justice , Banerjee Rahul , Chan Hilary , Lin Amy M. , Velazquez Manana Ana I. 
Published: October 2023

462 Background: Urgent fertility preservation (FP) represents a critical unmet need for patients of child-bearing potential undergoing cancer-directed therapies. A retrospective review of electronic medical record (EMR) based FP referrals placed prior to initiation of systemic cancer-directed therapies in patients aged 18-50 years, identified only 26 referrals to urology and 2 referrals to reproductive endocrinology during 2020. To address this issue, we conducted a division-wide survey to identify barriers to FP and designed and implemented a new FP referral EMR order set to facilitate timely fertility evaluation in patients about to begin cancer-directed therapy. Methods: We conducted a division-wide survey of faculty and fellows to identify barriers to FP (PDSA cycle 1), which identified that 50% of respondents did not know how to make a referral and 85% did not know the correct pre-requisite labs. Based on these results, we gathered multi-stakeholder input from reproductive endocrinology, urology, and stakeholders from different hematology/oncology disease groups to develop and design a common FP referral EMR order set (PDSA 2). The FP order set was tested and refined based on stakeholder input. Once the order set was implemented, we gave educational presentations at division-wide and disease group-specific conferences, placed informational flyers throughout the Cancer Center, and Cancer Center-wide communications via email to increase provider awareness (PDSA 3). The primary objective of the study was to increase in number of referrals for FP evaluation in patients aged 18-50 years undergoing cancer-directed therapy. We tracked number of FP referrals pre and post-intervention using EMR data. Results: In PDSA Cycle 2 and 3, the number of referrals increased further to 62 for urology and 35 for reproductive endocrinology. Of those referred, 35/97 (36.1%) were female. Regarding race/ethnicity, the largest percentage of patients referred identified as White and Asian with the lowest percentage being of Southwest Asian/North African or Black/African American (see Table 1). Conclusions: The development and implementation of a FP order set greatly increased the number of patients who underwent fertility evaluation prior to starting cancer-directed therapy. We did identify differences in groups with regards to referral rates with fewer women being referred, and fewer number of racial/ethnic minorities being referred. Further analysis is needed to identify potential areas of intervention to increase referrals and access to FP, particularly in under-represented groups.[Table: see text]
QI Connect: Matching researchers to projects.
Authors: Alin James , Fang Jerrell , Tucker Jennifer 
Published: October 2023

464 Background: At any given health system, there are often quality improvement (QI) projects without enough manpower to complete the work, and students and trainees who are looking for projects to work on but can’t find any. The question becomes how we connect these two groups in a win-win situation. Many job search websites use a “matching” function in which profiles of applicants are matched with requirements from employers to make connections. Our goal is to apply a similar software/data-basing solution to QI projects in healthcare systems to improve project completion rates, increase QI experience among medical students, residents, and fellows, and improve continuity of projects. Methods: We created a dual facing database, with one branch aimed at collecting projects, and the other side aimed at recruiting trainees/students. Faculty or QI departments approach the project side and are asked to provide the following types of data about their QI project: field, clinical vs basic, onsite vs virtual, role of the trainee, timing (business hours or flexible), IRB approval, description, and main point of contact. Trainees who are interested in matching a project, fill out a set of profile questions that mirror the project parameters. Trainees and projects are matched in an algorithmic order based on prioritization we have selected in discussion with faculty and student interests. One key is that the project point of contact is NOT made available until after a successful “match” to avoid “carpet bomb” emailing of faculty members. In order to fill the database we have networked with physicians, department chairs, interest group listservs, and chief residents across our hospital and medical school. Results: In our first year’s pilot run we collected 17 projects, and had profound student interest with 70 profiles filled. We limited the number of matched projects to just 5 that best fit, and received positive feedback from students and mentors. Since then we have grown the database to 47 projects and 153 students/trainee profiles. These initial promising results have also prompted the creation of a new elected position in the medical school for two Research VP’s in each class. Conclusions: We have built a clear proof of concept that virtual match making for QI projects can close the gap between unfilled projects, and trainees seeking opportunities. Although the metrics suggest that trainees seeking research are far outpacing available projects, we believe that far more projects currently exists, and a major area of improvement will be to continue to bring visibility to the database. Nonetheless without acquiring any additional funding or manpower, we are able to increase the scholarly profiles of trainees, and overall QI productive output at our institution.
Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.
Authors: Lubas Maryanne , Lukez Alexander P. , Henry Elizabeth , Housri Nadine , Egleston Brian L. , Howell Krisha 
Published: October 2023

465 Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p<0.001) before trending down during the COVID pandemic (p<0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.