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Cleveland clinic review

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https://www.readbyqxmd.com/read/28210553/impact-of-value-based-breast-cancer-care-pathway-implementation-on-pre-operative-breast-magnetic-resonance-imaging-utilization
#1
Devina K S McCray, Stephen R Grobmyer, Holly J Pederson
BACKGROUND: Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data...
February 2017: Gland Surgery
https://www.readbyqxmd.com/read/28156576/embedded-palliative-medicine-model-for-inpatient-solid-tumor-oncology-patients-utilizing-corounding-and-consultation-criteria-a-quality-improvement-pilot
#2
Bassam N Estfan, Alberto J Montero
: 148 Background: Hospitalized patients (pts) on solid tumor oncology (STO) services have palliative needs including pain management. This quality improvement project sought to establish a new STO-specific co-rounding PM consult service, evaluate the use of consult criteria for STO inpatients, assess the impact/interest in an embedded service, improve access to PM for STO pts and improve palliative education to STO teams. METHODS: During October 2015 to January 2016, a new PM consult service was established for the 2 STO inpatient services at Cleveland Clinic...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152966/analysis-of-the-results-of-implementation-of-a-pregnancy-screening-policy-at-a-comprehensive-cancer-center
#3
David Cleveland, Alma Yvette DeJesus, Lee Cheng, Elizabeth Ann Wagar, Charles F Levenback, Maria Alma Rodriguez
: 256 Background: Institutional implementation of a standard pregnancy screening policy for women will enhance the safe and timely delivery of treatment throughout the care continuum. In 2012, we developed and implemented an initial policy on pregnancy screening test (PST). The policy indicated that all providers should fully discuss with their female patients of child bearing potential regarding the potential risks of cancer treatment on fertility and the adverse effects on the fetus...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152944/a-single-institution-s-experience-with-the-value-of-fdg-pet-ct-imaging-in-patients-with-newly-diagnosed-stage-iib-iiib-breast-cancer
#4
Katherine Glass, Chad W Cummings, Alberto J Montero, Jame Abraham, Halle C F Moore, G Thomas Budd
: 123 Background: The Cleveland Clinic is utilizing disease specific teams to craft care paths for value based disease management. The report by Groheux (JNCI 2012; 104:1879-1887), reported (18) FDG-PET-CT detected distant metastasis in 10.7, 17.5 and 36.5% of stage IIB- IIIB breast cancer patients. Based on this report, the breast team incorporated (18) FDG-PET- CT imaging for initial staging of IIB-IIIB patients. METHODS: Treatment algorithms were developed by a multi-disciplinary breast cancer team...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152895/effects-of-admission-adm-source-time-and-provider-on-inpatient-inpt-oncology-onc-outcomes-at-the-cleveland-clinic-foundation-ccf
#5
Lindsey Martin Goodman, Lisa A Rybicki, Alberto J Montero, Bassam N Estfan, Carolyn Best, James Stevenson
: 140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. METHODS: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152866/leveraging-web-based-interface-systems-with-institutional-databases-to-improve-compliance-with-survivorship-care-plans
#6
Patricia Chapman, David Cleveland, Paula A Lewis-Patterson, Guadalupe R Palos, Maria Alma Rodriguez
: 161 Background: ASCO's Clinical Oncology Clinical Expert Statement on Cancer Survivorship Planning addressed the importance of using survivorship care plans (SCPs) to improve survivors' care. Evolving information technology strategies, such as web-based systems, offer real-time reporting tools to track providers' adherence for completion of SCPs. Our abstract reports on the creation of a web-based system to monitor survivors' care. METHODS: Ongoing audits of SCPs indicated broad variation in compliance rates with SCPs...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152742/prophylactic-use-of-granulocyte-colony-stimulating-factors-g-csf-in-cancer-patients-adherence-to-nccn-guidelines
#7
Vyshak Alva Venur, Shraddha Narechania, Paul Elson, Hamed Daw, Timothy Peter Spiro, Abdo Haddad
: 209 Background: G-CSF are used for prophylactic and therapeutic treatment of febrile neutropenia (FN). NCCN guidelines (version 1.2015) recommend prophylactic use of G-CSF based on the chemotherapy regimen and patient related risk factors, especially for the high (> 20%) and intermediate (10-20%) risk groups for developing FN. This study investigates the practice patterns and adherence to NCCN guidelines for use of G-CSF at a community based academic outpatient facility. METHODS: Cleveland Clinic IRB was obtained...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152714/data-collection-for-care-pathways-in-the-cleveland-clinic-health-system
#8
Chad W Cummings, Marc A Shapiro, Dennis Urbanek, Brian James Bolwell
: 115 Background: Care pathways are established methods of reducing healthcare costs and disparities in oncology care. To demonstrate their impact, health systems must measure and report data on care pathway adherence and outcomes in near real-time. Automating data abstraction across a health system for oncology is difficult due to the amount and detail of data required. Manual abstraction of data is considered slow and costly. Many consider Electronic Medical Record (EMR) integration of care pathways essential in order to successfully implement and assess...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152686/patient-centered-outcomes-with-post-approval-nivolumab-in-metastatic-nsclc-at-the-cleveland-clinic-taussig-cancer-institute-tci
#9
Katherine Glass, Alicia M Redden, Nathan A Pennell, James Stevenson, Vamsidhar Velcheti, Emily Van Wagoner, Chad W Cummings, Brian James Bolwell
: 29 Background: Patient-centered outcomes are important quality metrics of value-based cancer care. For NSCLC, these include chemotherapy administration within 30 days of death and end of life hospitalizations. Nivolumab was initially FDA approved in March 2015 for second-line therapy of squamous NSCLC and subsequently for non-squamous NSCLC. To evaluate the impact of post-approval nivolumab use on patient-centered outcomes, a retrospective review was performed of patients (pts) with metastatic NSLCC receiving nivolumab at TCI main campus and regional centers...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28093377/ten-year-experience-of-retrievable-inferior-vena-cava-filters-in-a-tertiary-referral-center
#10
George Tse, Trevor Cleveland, Stephen Goode
PURPOSE: A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed. METHODS: Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital...
January 17, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/28058733/acral-and-digital-angioleiomyomata-fourteen-year-experience-at-the-cleveland-clinic-and-review-of-the-literature
#11
Margaret I Hammond, Andrew G Miner, Melissa P Piliang
BACKGROUND: Angioleiomyoma is a benign neoplasm thought to derive from the tunica media of small venous vessels. Angioleiomyomata most frequently occur in the lower extremities with less common occurrences on the trunk, head, and upper extremities. Few cases of acral and digital angioleiomyoma have been described in the literature. METHODS: We add a series of twenty-one patients with acral angioleiomyoma including six cases of digital angioleiomyoma to the body of clinical and histologic findings along with a review of the literature of digital angioleiomyomata...
January 5, 2017: Journal of Cutaneous Pathology
https://www.readbyqxmd.com/read/27943639/genetic-prion-disease-experience-of-a-rapidly-progressive-dementia-center-in-the-united-states-and-a-review-of-the-literature
#12
REVIEW
Leonel T Takada, Mee-Ohk Kim, Ross W Cleveland, Katherine Wong, Sven A Forner, Ignacio Illán Gala, Jamie C Fong, Michael D Geschwind
Although prion diseases are generally thought to present as rapidly progressive dementias with survival of only a few months, the phenotypic spectrum for genetic prion diseases (gPrDs) is much broader. The majority have a rapid decline with short survival, but many patients with gPrDs present as slowly progressive ataxic or parkinsonian disorders with progression over a few to several years. A few very rare mutations even present as neuropsychiatric disorders, sometimes with systemic symptoms such as gastrointestinal disorders and neuropathy, progressing over years to decades...
January 2017: American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics
https://www.readbyqxmd.com/read/27861834/an-algorithm-for-opioid-and-barbiturate-reduction-in-the-acute-management-of-headache-in-the-emergency-department
#13
Zubair A Ahmed, Dimitrios A Nacopoulos, Seby John, Nancy Papesh, David Levine, Cynthia C Bamford
OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications...
January 2017: Headache
https://www.readbyqxmd.com/read/27818366/aicardi-syndrome-epilepsy-surgery-as-a-palliative-treatment-option-for-selected-patients-and-pathological-findings
#14
Irina Podkorytova, Ajay Gupta, Elaine Wyllie, Ahsan Moosa, William Bingaman, Richard Prayson, Elia M Pestana Knight
The optimal treatment for medically refractory epilepsy in Aicardi syndrome (AS) is still unclear. Palliative surgical treatment, including vagus nerve stimulation and corpus callosotomy, has therefore been used. There is limited data on the role of resective epilepsy surgery as a treatment choice in patients with AS. Here, we describe the seizures, anatomo-pathological findings, and neurodevelopmental outcome of palliative epilepsy surgery in two children with AS who had resective epilepsy surgery at the Cleveland Clinic...
December 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
https://www.readbyqxmd.com/read/27659600/process-improvement-in-thoracic-donor-organ-procurement-implementation-of-a-donor-assessment-checklist
#15
Gabriel Loor, Sara J Shumway, Kenneth R McCurry, Suresh Keshavamurthy, Syed Hussain, Garry D Weide, John R Spratt, Mazin Al Salihi, Colleen G Koch
BACKGROUND: Donor organs are often procured by junior staff in stressful, unfamiliar environments where a single adverse event can be catastrophic. A formalized checklist focused on preprocedural processes related to thoracic donor organ procurement could improve detection and prevention of near miss events. METHODS: A checklist was developed centered on patient identifiers, organ compatibility and quality, and team readiness. It went through five cycles of feedback and revision using a panel of expert procurement surgeons...
December 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27636576/the-association-between-mild-intraoperative-hypotension-and-stroke-in-general-surgery-patients
#16
Jason K Hsieh, Jarrod E Dalton, Dongsheng Yang, Ehab S Farag, Daniel I Sessler, Andrea M Kurz
BACKGROUND: Intraoperative hypotension may contribute to perioperative strokes. We therefore tested the hypothesis that intraoperative hypotension is associated with perioperative stroke. METHODS: After institutional review board approval for this case-control study, we identified patients who had nonneurological, noncardiac, and noncarotid surgery under general anesthesia at the Cleveland Clinic between 2005 and 2011 and experienced a postoperative stroke. Control patients not experiencing postoperative stroke were matched in a 4-to-1 ratio using propensity scores and restriction to the same procedure type as stroke patients...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27625016/clinical-effect-of-dose-escalation-after-disease-progression-in-patients-with-metastatic-renal-cell-carcinoma
#17
Moshe C Ornstein, Laura Wood, Paul Elson, Kimberly Allman, Jennifer Beach, Allison Martin, Timothy Gilligan, Jorge A Garcia, Brian I Rini
BACKGROUND: Given the variability in drug levels with tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma (mRCC), dose escalation at the occurrence of progressive disease (PD) might have antitumor effects. PATIENTS AND METHODS: The data from patients with mRCC who were treated at the Cleveland Clinic with TKIs and received a dose escalation after PD in accordance with Response Evaluation Criteria In Solid Tumors (RECIST), version 1...
August 18, 2016: Clinical Genitourinary Cancer
https://www.readbyqxmd.com/read/27540042/thirty-day-readmission-rate-is-high-for-hospitalized-patients-discharged-with-home-parenteral-nutrition-or-intravenous-fluids
#18
Hiren Vallabh, Denise Konrad, Robert DeChicco, Gail Cresci, Rocio Lopez, Ezra Steiger, Donald F Kirby
BACKGROUND: Reducing hospital readmissions decreases healthcare costs and improves quality of care. There are no published studies examining the rate of, and risk factors for, 30-day readmissions for patients discharged with home parenteral support (HPS). OBJECTIVE: Determine the rate of 30-day readmissions for patients discharged with HPS and whether malnutrition and other demographic or clinical factors increase the risk. MATERIALS AND METHODS: Retrospective review of patients discharged with HPS from the Cleveland Clinic between July 1, 2013, and June 30, 2014, and followed by the Cleveland Clinic Home Nutrition Support Service...
August 18, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/27518727/a-nomogram-for-predicting-the-need-for-sciatic-nerve-block-after-total-knee-arthroplasty
#19
Rovnat Babazade, Thilak Sreenivasalu, Pankaj Jain, Matthew T Hutcherson, Amanda J Naylor, Jing You, Hesham Elsharkawy, Ali Sakr Esa Wael, Alparslan Turan
PURPOSE: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10-20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB...
October 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27495828/subjective-sleep-measures-for-adolescents-a-systematic-review
#20
X Ji, J Liu
BACKGROUND: Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice...
August 6, 2016: Child: Care, Health and Development
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