tbuckley/cabot-search huggingface dataset:
Introducing enhanced navigation and supportive care into the curative treatment of cancer (SCOOP pathway).
Authors: Christopher Koprowski, Ej Johnson, Kenneth Trzepkowski, Karen Sites, Nicholas J. Petrelli
Journal: Journal of Clinical Oncology (2018)

142 Background: We hypothesized that introducing supportive care management and enhanced electronic aids to nurse navigation in selective curative cases could result in cost savings and enhanced patient experience of the sort demonstrated in patients with advanced disease. Methods: To test this hypothesis, we introduced a clinical pathway in November 2016 called the Supportive Care of Oncology Patients (SCOOP) program. We limited the scope to patients receiving radiation and chemotherapy concurrently at the Helen F. Graham Cancer Center and diagnosed with potentially curable thoracic, colorectal or head and neck malignancies and seen in our mulitdisciplinary clinics (MDCs). 1. A nurse navigation check list was developed for nurse navigators in the Aerial information system to support standardization of care. The navigator has to opt out of ancillary service consults such as nutrition, behavioral health and social work. The check list includes other mandatory tasks that must be completed at various time points before, during and after the patient’s concurrent treatment. Examples include: Prescribed communication dates with the patient; capturing of scheduled consults; assessing additional/unmet needs before, during and after treatment phase. 2. A mandatory supportive and palliative care service screening during the MDC visit, and, if indicated, urgent or timely consultation. 3. Flags in the inpatient information system that alert in real time the supportive care service, the navigators and the oncologists whenever a patient is seen in the emergency room, admitted or discharged. Results: During the first year nurse navigation compliance increased from 94% to 99%.ED visits declined from 54% to 32% of SCOOP patients , admissions from 34% to 25% and readmissions from 32% to 20% . Opportunity cost savings were $1500.00 per patient. Conclusions: Much like the results observed in advanced disease, the early introduction of enhanced nurse navigation and palliative/supportive care in high acuity patients treated curatively improves the patient experience and reduces societal costs.
Mortality attributable to different Klebsiella susceptibility patterns and to the coverage of empirical antibiotic therapy: a cohort study on patients admitted to the ICU with infection
Authors: Guido Bertolini, Giovanni Nattino, Carlo Tascini, Daniele Poole, Bruno Viaggi, Greta Carrara, Carlotta Rossi, Daniele Crespi, Matteo Mondini, Martin Langer, Gian Maria Rossolini, Paolo Malacarne
Journal: Intensive Care Medicine (2018)
PROeverywhere: Bridging the implementation gap of patient-reported outcomes with a mobile app.
Authors: Kin Wai (Tony) Hung, Natasha Banerjee, Jeffrey M. Miller
Journal: Journal of Clinical Oncology (2018)

203 Background: Patient reported outcome (PRO) data are critical for informing patient-centered care and have been shown to enhance our ability to communicate with patients, to control their symptoms, and to impact their survival. However, PRO data are not commonly collected in routine cancer care due to implementation challenges such as cost, technological rigidity of existing electronic health records, and misalignment of stakeholders’ incentives. Methods: In an effort to bridge the unmet needs of PRO collection and integration into routine cancer care, we aim to develop an effective, scalable, and sustainable symptom monitoring and management system that can be accessible worldwide. The system was developed using Xcode, the integrative development environment of Apple Inc., with the Swift programing language. Results: On Nov 28 th , 2017, we launched a free, mobile PRO application on the Apple App Store – PROeverywhere. PROeverywhere is designed for reporting twelve common symptoms from the National Cancer Institute’s Common Terminology Criteria for Adverse Events. These symptoms include pain, fatigue, nausea/vomiting, appetite loss, diarrhea, constipation, shortness of breath, depression, anxiety, insomnia, memory problems, and neuropathy. Symptoms are reported in a 5-point scale – no symptom, mild, moderate, severe, and disabling. PROeverywhere has the functions to record symptoms, summarize the reporting in printout, and automatically store and analyze the input into graphical interpretations. Updates to PROeverywhere will be released in July 2018, with additional features that include longitudinal tracking dashboard, emoji scale, Spanish questionnaire, and “social networking” capability to connect users with potential to allow remote, real-time, reporting and monitoring. PROeverywhere is downloadable worldwide and securely powered by Google Firebase. Conclusions: PROeverywhere is developed to enable PRO data to be shared more easily and regularly in routine cancer care. Implementation of this free mobile application would allow for consistency in collection of PRO data with the potential to impact patient outcomes globally.
Impact of travel time on hospitalizations and patient cost responsibility by phase of care for older patients with cancer.
Authors: Courtney Williams, Kelly Kenzik, Maria Pisu, Stacey A. Ingram, Aidan Gilbert, Rodney Paul Rocconi, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2018)

37 Background: Healthcare reimbursement changes are contributing to increased closures of community hospitals and oncology practices, which may lead cancer patients to travel greater distances for care. Limited data exists on the impact of travel time on hospitalization rates and patient cost responsibility by phase of care for older cancer patients. Methods: This was a secondary analysis of Medicare claims from 2012-2015 for cancer patients age ≥65 receiving care in the University of Alabama at Birmingham Cancer Community Network. Patient addresses were obtained from network data, hospitalizations from inpatient claims, and patient cost responsibility from inpatient, outpatient, skilled nursing facility, carrier, and durable medical equipment claims. Drive time was calculated from patient home to cancer care site (CCS). Phase of care-specific (initial, survivorship, end-of-life [EOL]) rates of hospitalizations overall and by CCS vs. other care site (OCS) were calculated per 100 person-years. Hierarchical linear models compared average monthly phase-specific costs by drive time to CCS. Results: Of 23,605 older cancer patients, median drive time to CCS was 32 minutes (IQR 18-59), with 24% driving ≥1 hour to CCS. Rates of hospitalizations by initial (n = 14,225), survivorship (n = 18,805), and EOL (n = 8,211) phases of care were 54, 26, and 301 per 100 person-years, respectively. Higher rates of hospitalizations at OCS vs. CCS were shown for patients traveling ≥1 hour to CCS (initial, survivorship, and EOL rate of 41 vs. 20, 21 vs. 6, and 220 vs. 95 per 100 person-years, respectively). Median monthly costs by phase were $401 (IQR $182-$814) for initial, $369 (IQR $123-$1046) for survivorship, and $2075 (IQR $1123-$3723) for EOL. Patients traveling ≥1 hour to their CCS had higher cost responsibility, with patients in initial, survivorship, and EOL phases having $303 (95% CI $130-$476), $75 (95% CI $46-$105), and $736 (95% CI $308-$1164) higher average costs per month than those traveling &lt; 1 hour, respectively. Conclusions: Cancer patients traveling further to receive care are potentially vulnerable to higher cost responsibility and limited access to care if community hospitals close, especially at EOL.
Abstract 271: NF-kB Mediated Modulation of mir-23b/-130a-axis is Critical for Cardiac Remodeling
Authors: Sudhiranjan Gupta, Li Li
Journal: Circulation Research (2016)

Cardiac remodeling is a process that alters structural and functional determinants of myocardium in response to hemodynamic stress resulted in left ventricular hypertrophy, fibrosis leading to heart failure. Pressure overload that induces cardiac remodeling involves both cardiomyocytes (CM) and cardiac fibroblasts (CF) cross-talk for the development of adverse remodeling. The miRNAs are a new class of post-transcriptional regulator capable of repressing gene expression by base pairing to the 3' UTR of mRNA targets; involved in diverse cardiac diseases. However, the function of miRNAs in cellular cross-talk leading to cardiac remodeling remains elusive. Previously, we showed that inhibition of NF-kB prevents cardiac remodeling; however, NF-κB mediated miRNAs’ role in cardiac remodeling remains elusive. We will test the hypothesis that NF-κB dependent miR-23b/-130a is a pathogenic niche regulating the cardiac remodeling; and inhibition of miR-23b/-130a abrogates the adverse remodeling by restoring PPARg-PTEN-axis. We have identified a panel of novel dysregulated miRNAs in the left ventricle of wild type mice subjected to thoracic aortic constriction (TAC). The dysregulated miRNAs were restored in cardiac-specific IκBα triple-mutant transgenic mice (3M) subjected to TAC indicated NF-kB dependent regulation. We observed that miR-130a and miR-23b were significantly upregulated in TAC and Ang II infusion and were inhibited in 3M-TAC mice. We identified PPARg-PTEN-axis, a bona-fide target for miR-23b/-130a after unbiased in vitro screening. Inhibition of NF-kB normalized miR-23b/-130a expression and the target genes in Ang II and TGFb1 stimulated CM and CF. Inhibition of miR-130a showed reduction of cell sizes in CM and decrease cellular proliferation in CF indicated a cellular cross-talk. The in vivo inhibition of miR-130a in wild-type mice after Ang II infusion significantly reduced cardiac remodeling, restoring PPARg-PTEN level and improved cardiac function. Our findings provide evidence that miR-23b/-130a displays a critical role in the pathogenesis of cardiac remodeling. We conclude that miR-23b/-130a could be a triggering factor in cardiac remodeling and providing new mechanistic information for therapeutic benefit.
Improving end-of-life care in GI oncology patients.
Authors: Lindsey Jackson Hathaway, Tim Rose, Michelle Sekunda, Yi Qin, Julio Silvestre, Michael Kenneth Keng
Journal: Journal of Clinical Oncology (2018)

172 Background: In FY17, there were 108 patients with cancer who died on an inpatient unit at UVA, and of these, 17 patients (16%) died with incurable advanced stage GI cancer. In addition, 54% of these GI cancer patients did not have an outpatient palliative care consult prior to their time of death. Lack of early palliative care consultation leads to poor end of life care, compromises quality of life for patients and their families, and promotes the overutilization of healthcare. Methods: We participated in the ASCO Quality Training Program for this project. Our first aim (AIM#1) was to increase inpatient palliative care consults by 25% in patients with advanced stage GI cancers who were considered unscheduled admissions by hospital day 2. Our second aim (AIM#2) was to increase outpatient palliative care referrals by 25% in patients with pancreatic and hepatobiliary cancers by the second visit. We conducted these aims at UVA from August 2017 to February 2018. The intervention was to remind the GI oncologists and the house staff to place the palliative care consult. Results: From our pre-intervention data for AIM#1, 33 patients with advanced GI cancer (34%) had a palliative care consult in the inpatient setting from July 2017 to July 2018. Post intervention data showed that 14 patients (73%) had a palliative care consult, 10 patients (71%) with palliative care consult went to hospice, 11 patients (59%) have died since our intervention with only 1 death occuring in the inpatient setting and 1 patient with an readmission. From our pre-intervention data for AIM#2, 24 advanced GI cancer patients (5.5%) had a palliative care referral, and post-intervention 11 patients (21%) had a palliative care referral. Of the 11 patients with palliative care referrals, 6 patients (55%) went to hospice. Conclusions: We met both of our primary inpatient and outpatient aims to increase palliative care consults for advanced stage GI oncology patients. Our data clearly shows a benefit of early palliative care referral in GI oncology patients both in the outpatient and inpatient setting. We plan to continue to collect data on long-term outcomes for our patients, and investigate future directions to improve sustainability and to expand to other cancer service line populations.
Increasing the percentage of advance directives in patient medical records.
Authors: Christopher A. Waynick, Jan Conwill, Victor Gian
Journal: Journal of Clinical Oncology (2018)

226 Background: Advance care planning is often initiated too late, which leads to added stress and high resource utilization at the end of life which is contrary to many patients’ wishes. Ideally, discussing patient’s wishes should start early. An advance directive (AD) documents patient preferences for end-of-life care. Methods: In order to improve this process, the team used the DMAIC process: Define, Measure, Analyze, Improve, and Control. In the define phase, 79 new cancer diagnosis patients’ medical records were reviewed and completed. This revealed that 25.58% of these patients claim to have an AD, but only 5% have an AD documented in their record within 30 days of their first visit. Upon further discussion with staff, there was no standard process. The focus performance metric for the project was to have the AD in the chart within 30 days of their first visit. Goal was set at 20%. Analyzing the process was as follows: Process map, Fishbone diagram to determine potential improvements. Priority pay-off matrix. The most effective process change would be to add a notice in the new patient packet for the patient to bring their AD with them to their first visit. Results: The first iteration of the improve phase included the notice created in the analyze phase. After completion, 60% of patients had an AD in their chart within 30 days of their first visit. For the second iteration, the team worked with psychology staff to create a letter to the patient explaining the advantages of having an AD in the chart. Results were 100% of the performance improvement metric. Controlling this process change is simple, but continuing a 100% target is difficult. Some patients who do not have an AD in their chart feel uncomfortable with it or do not understand what it is. Future improvements include patient education processes and provider discussions with the patients to ensure an 80% target is maintained. Conclusions: The team learned developing and communicating a formal process is imperative to achieving the target. Also important is to communicate clearly with the patients, enabling them to understand what (and why) their provider needs from them.
Abstract 16811: Phospholamban Immunostaining is a Highly Sensitive and Specific Method for Diagnosing Phospholamban p.Arg14del Cardiomyopathy
Authors: W.P. te Rijdt, Z.J. van der Klooster, J.P. van Tintelen, D. Dooijes, F.W. Asselbergs, M.P. van den Berg, A. Vink, A.J.H. Suurmeijer
Journal: Circulation (2016)

Introduction: The pathogenic p.Arg14del phospholamban (PLN) mutation causes dilated and/or arrhythmogenic cardiomyopathy and is associated with increased risk of malignant ventricular arrhythmias and severe heart failure. Recently, we showed that PLN p.Arg14del cardiomyopathy may be diagnosed in whole heart specimens by PLN immunohistochemistry which allowed microscopic detection of PLN-containing aggregates in cardiomyocytes in dense perinuclear aggresomes. Objective: To determine the accuracy (sensitivity and specificity) of PLN immunohistochemistry in apical left ventricular myocardial specimens, harvested during left ventricular assist device (LVAD) implantation, to diagnose PLN p.Arg14del cardiomyopathy. Methods: Included were myocardial LVAD specimens from 26 diverse genetic cardiomyopathy cases with known gene mutations (5 PLN p.Arg14del cases and 21 cases with other pathogenic cardiomyopathy mutations). Immunohistochemistry (IHC) with monoclonal phospolamban antibody 2D12 (1:10000, Abcam, Cambridg...
Utilizing a two nurse timeout process to eliminate errors during chemotherapy administration.
Authors: Joseph Hooley, Diana Karius, Christina Colvin, Patti Akins, Carolyn Best, Allyson Brinker
Journal: Journal of Clinical Oncology (2018)

237 Background: Chemotherapeutic agents are listed as high risk medications at Cleveland Clinic, and have long been included on the Institute for Safe Medication Practices (ISMP) List of High Alert Medications due to the heightened risk of causing significant patient harm if they are used in error. Following a series of significant adverse events involving chemotherapy administration in 2012 at Cleveland Clinic, a two nurse timeout process (modeled after surgical and procedural timeout practices) was established to eliminate interruptions and decrease the risk of error. Methods: A written protocol was established to formalize a two nurse timeout process which must be completed prior to administration of chemotherapy. In order to eliminate unnecessary distractions during order review and medication administration, nurses hand off their phone and/or pager and coverage is provided for the nurses who are checking in the chemotherapy. A designated distraction-free area is utilized chemotherapy verification and order review. Following comparison of the chemotherapy agents to the orders, the nurses proceed to the patient’s room with the chemotherapy and the order pulled up on a computer. A procedure stop sign is placed on the door and the door is closed to eliminate interruptions. During the in-room timeout process, each step in the chemotherapy documentation flow sheet is reviewed by both nurses. After proper patient identification, one nurse will read the chemotherapeutic agent label and the other nurse will program the infusion pump. The two nurses will then switch roles with re-verification of the label and the infusion pump. The tubing set-up is then verified and the infusion is initiated. Results: Since the two nurse timeout process was established in 2013, there have been zero serious chemotherapy errors resulting in patient harm. Conclusions: Results have shown that implementation of the chemotherapy timeout process has increased the safety of administration of chemotherapeutic agents. It has now been more than five years since the last significant adverse event involving chemotherapy has occurred at Cleveland Clinic.
Abstract 16112: In Hospital Triage of ST Segment Myocardial Infarction Patients Results in Favorable Clinical Outcomes and Reduced ICU and Overall Hospital Length of Stay
Authors: Nicole M Reilly, Sverrir I Gunnarsson, Benjamin Ciske, Stacey Saari, Miguel Leal, Amish Raval, Anne O’Connor
Journal: Circulation (2016)

Introduction: The conventional length of stay after ST-segment elevation myocardial infarction (STEMI) was 7-10 days in the thrombolytic era. Data on optimal length of hospital stay in patients und...
Abstract 13724: Intravascular Ultrasound and Angiographic Predictors for 5-Year Target Lesion Revascularization After Second Generation Drug-Eluting Stent Implantation
Authors: Hideki Kitahara, Kenji Sakamoto, Kozo Okada, Yuhei Kobayashi, Takumi Kimura, Paul G Yock, Alan C Yeung, Peter J Fitzgerald, Yasuhiro Honda
Journal: Circulation (2015)

Background: Late target lesion revascularization (TLR) remains an unresolved problem in drug-eluting stents (DES). This study aimed to evaluate whether angiography and IVUS at mid-term can predict late-TLR in lesions treated with 2nd generation DES. Methods: Clinical outcomes were followed for 5 years in 1265 lesions with no TLR within the 1st year after Endeavor zotarolimus- (E-ZES, n=748), Resolute zotarolimus- (R-ZES, n=195), and everolimus-eluting stent (EES, n=322) implantation. Quantitative coronary angiography (QCA) and IVUS were performed at baseline and mid-term (8-12 months) follow-up. Results: During 1 to 5 years, R-ZES and EES showed equivalent late-TLR rates, while E-ZES demonstrated significantly less late-TLR than other stents (4.6%, 4.3% and 1.5%, respectively. Log Rank p=0.002). In E-ZES, no QCA or IVUS variables predicted late-TLR. In contrast, the late-TLR group in R-ZES and EES had smaller minimum lumen diameter (MLD), greater neointima and more late-acquired incomplete stent apposition (LISA) at mid-term follow-up, as well as greater increases of vessel and peri-stent plaque volumes during the follow-up. Multiple logistic regression analysis determined follow-up MLD, LISA and the increase of peri-stent plaque at mid-term as independent predictors of late-TLR in R-ZES and EES. In particular, with ROC-determined cutoff values, lesions with ≥2 predictors had a relative risk of 14.4 for late-TLR. Conclusion: The incidence and determinants of late-TLR can vary depending on the drug, carrier and release kinetics. Despite a trend for more TLR within the 1st year, E-ZES with phosphorylcholine coating was associated with an extremely low incidence of late-TLR and stable vessel response surrounding the stent. R-ZES and EES with durable polymer and longer release kinetics showed similar rates of late-TLR, possibly related to pathological responses of the stented artery that may be detectable by IVUS within the 1st year after implantation.
The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study
Authors: Cédric B Chesnais, Hugues C Nana-Djeunga, Alfred K Njamnshi, Cédric G Lenou-Nanga, Charlotte Boullé, Anne-Cécile Zoung-Kanyi Bissek, Joseph Kamgno, Robert Colebunders, Michel Boussinesq
Journal: The Lancet Infectious Diseases (2018)
Navigation models in diverse outpatient settings: Shared themes, challenges, and opportunities.
Authors: Narcessa Gail-Rosales Greenwood, Cynthia B. Taniguchi, Amy Sheldrick, Leslie Hurley
Journal: Journal of Clinical Oncology (2018)

134 Background: Navigation has been recognized by the Centers for Medicare and Medicaid Services (CMS) as a component of quality oncology care. This discussion highlights progress of Nurse Navigation implementation within 3 US Oncology Network practices. A team-based approach optimizing patient care coordination and providing enhanced services has been identified. Study practices demonstrate common navigation goals and desired outcomes, despite variations in practice size, dissimilar workflows, and unclear best-practice guidelines for navigation in the outpatient setting. Methods: The US Oncology Network formed a committee to study and develop evidence-based nurse navigation processes for recommendation to the greater Network. The committee includes 6 members, each a lead Oncology Nurse Navigator, practicing in different US geographical regions. Preliminary steps were to seek evidence-based support through: Existing models for Oncology Nurse Navigation that are adaptable for the community setting Best-practice in navigation recommendations from esteemed professional organizations Challenges and solutions identified and implemented Scope of practice for the Nurse Navigator in a community setting Performance metrics targeting effective, value-driven navigation Results: Focusing on scientific Nursing Process, study practices provided navigation services to 3762 patients. Gaps in navigation processes were identified, as well as barriers throughout the continuum of care. Scope of Practice for the community-based Nurse Navigator was defined. Navigation framework was established to include patient/family education, psychosocial interventions, referral outsourcing, and patient advocacy. A formal job description was created for the role of the Oncology Nurse Navigator. The Interdisciplinary Care Team Conference Standard was finalized to support coordination of care. Conclusions: Work remains to define, implement, and test effective navigational models to support challenges of patients receiving care in the outpatient setting. Benefits resulting from Nurse Navigation processes are emerging as healthcare trends advance quality of care while decreasing total cost of care.