Medicine and Health Sciences Commons^™

Altered Domain Functional Network Connectivity Strength And Randomness In Schizophrenia., Victor M Vergara, Eswar Damaraju, Jessica A Turner, Godfrey Pearlson, Aysenil Belger, Daniel H Mathalon, Steven G Potkin, Adrian Preda, Jatin G Vaidya, Theo G M Van Erp, Sarah C Mcewen, Vince D Calhoun

Articles, Abstracts, and Reports

Functional connectivity is one of the most widely used tools for investigating brain changes due to schizophrenia. Previous studies have identified abnormal functional connectivity in schizophrenia patients at the resting state brain network level. This study tests the existence of functional connectivity effects at whole brain and domain levels. Domain level refers to the integration of data from several brain networks grouped by their functional relationship. Data integration provides more consistent and accurate information compared to an individual brain network. This work considers two domain level measures: functional connectivity strength and randomness. The first measure is simply an average of …

Implantable Biomaterials To Provide Local Immunotherapy Following Surgical Resection., Michael J Gough, Jason R Baird, R Bryan Bell

Articles, Abstracts, and Reports

No abstract provided.

The Current Understanding Of Microrna's Therapeutic, Diagnostic, And Prognostic Role In Chordomas: A Review Of The Literature., Paul J Choi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Chordomas are primary low-grade bone tumors derived from the embryonic notochord that make up less than 5% of all osseous malignancies and commonly affect the spine at its vertebral body and at its two ends i.e., skull base and the sacrum. Although histologically defined to be low-grade, chordoma is locally destructive, metastatic, and has a serious recurrence rate, which all contribute to the dismal median survival rate of six years. Its locally destructive nature places the adjacent vital neurovascular structures at risk, making an en-bloc resection a challenge. This tumor is also known to show high resistance to currently available …

Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy For Prescribing Recommendations And Community Safety., Vance Gardner, David Gazzaniga, Michael Shepard, Robert Grumet, Benjamin Rubin, Michael Dempewolf, Camille Bray, Carlos Prietto

Articles, Abstracts, and Reports

Background: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described.

Methods: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter …

Spio Enhance The Cross-Presentation And Migration Of Dcs And Anionic Spio Influence The Nanoadjuvant Effects Related To Interleukin-1Β., Hui Liu, Heng Dong, Na Zhou, Shiling Dong, Lin Chen, Yanxiang Zhu, Hong-Ming Hu, Yongbin Mou

Articles, Abstracts, and Reports

Superparamagnetic iron oxide nanoparticles (SPIO) have been synthesized and explored for use as carriers of various nanoadjuvants via loading into dendritic cells (DCs). In our study, homogeneous and superparamagnetic nanoparticles are susceptible to internalization by DCs and SPIO-pulsed DCs showed excellent biocompatibility and capacity for ovalbumin (OVA) cross-presentation. Herein, we found that SPIO-loaded DCs can promote the maturation and migration of DCs in vitro. SPIO coated with 3-aminopropyltrimethoxysilane (APTS) and meso-2,3-dimercaptosuccinic acid (DMSA), which present positive and negative charges, respectively, were prepared. We aimed to investigate whether the surface charge of SPIO can affect the antigen cross-presentation of the DCs. …

Tumor Cell-Released Autophagosomes (Traps) Promote Immunosuppression Through Induction Of M2-Like Macrophages With Increased Expression Of Pd-L1., Zhi-Fa Wen, Hongxiang Liu, Rong Gao, Meng Zhou, Jie Ma, Yue Zhang, Jinjin Zhao, Yongqiang Chen, Tianyu Zhang, Fang Huang, Ning Pan, Jinping Zhang, Bernard A Fox, Hong-Ming Hu, Li-Xin Wang

Articles, Abstracts, and Reports

BACKGROUND: Tumor-associated macrophages (TAMs) facilitate tumor progression via establishment of an immunosuppressive tumor microenvironment (TME). However, it is poorly understood how tumor cells could functionally modulate TAMs. Our previous work indicated that tumor cell-released autophagosomes (TRAPs), a type of LC3-II

METHODS: TRAPs isolated from multiple murine tumor cell lines and pleural effusions or ascites of cancer patients were incubated with bone marrow-derived macrophages (BMDMs) and monocytes, respectively. Cellular phenotypes were examined by flow cytometry, ELISA and quantitative PCR. TRAPs treated BMDMs were tested for the ability to suppress T-cell proliferation in vitro, and for promotion of tumor growth in vivo. …

Evidence For Minimal Cardiogenic Potential Of Stem Cell Antigen 1-Positive Cells In The Adult Mouse Heart., Lauren E Neidig, Florian Weinberger, Nathan J Palpant, John Mignone, Amy M Martinson, Daniel W Sorensen, Ingrid Bender, Natsumi Nemoto, Hans Reinecke, Lil Pabon, Jeffery D Molkentin, Charles E Murry, Jop H Van Berlo

Articles, Abstracts, and Reports

No abstract provided.

Rare But Recurrent Ros1 Fusions Resulting From Chromosome 6q22 Microdeletions Are Targetable Oncogenes In Glioma., Monika A Davare, Jacob J Henderson, Anupriya Agarwal, Jacob P Wagner, Sudarshan R Iyer, Nameeta Shah, Randy Woltjer, Romel Somwar, Stephen W Gilheeney, Ana Decarvalo, Tom Mikkelson, Erwin G Van Meir, Marc Ladanyi, Brian J Druker

Articles, Abstracts, and Reports

PURPOSE: Gliomas, a genetically heterogeneous group of primary central nervous system tumors, continue to pose a significant clinical challenge. Discovery of chromosomal rearrangements involving kinase genes has enabled precision therapy, and improved outcomes in several malignancies.

EXPERIMENTAL DESIGN: Positing that similar benefit could be accomplished for patients with brain cancer, we evaluated The Cancer Genome Atlas (TCGA) glioblastoma dataset. Functional validation of the oncogenic potential and inhibitory sensitivity of discovered ROS1 fusions was performed using three independent cell-based model systems, and an

RESULTS:

CONCLUSIONS: Our findings highlight that CNS tumors should be specifically interrogated for these rare intrachromosomal 6q22 microdeletion …

Author Correction: Extracting Intercellular Signaling Network Of Cancer Tissues Using Ligand-Receptor Expression Patterns From Whole-Tumor And Single-Cell Transcriptomes., Joseph X Zhou, Roberto Taramelli, Edoardo Pedrini, Theo Knijnenburg, Sui Huang

Articles, Abstracts, and Reports

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Teamwork, Communication, And Data: 3 Keys To Large- Scale Practice Change In Opioid Prescribing, Linda Cruz, Ryan Dix

Books, Presentations, Posters, Etc.

This session will share lessons learned from the four-year implementation of a pain-care pathway across 45 patient-centered medical home (PCMH) clinics in Oregon. Leveraging the PCMH team, communication, and data to improve pain management and reduce risk, Providence Medical Group was able to realize a 68% reduction of patients on high-dose opioids. After this presentation you will be able to:

1. Explain a scalable approach, using CDC guidelines, to implement a pathway to reduce opioid prescribing in primary care
2. Discuss three key principles of implementing a pain-care pathway in a team-based care environment
3. Develop an opioid care pathway action plan at …

Don’T Wait: Find And Address Behavioral Health Issues, Patrick Triplett, Amy Nist

Books, Presentations, Posters, Etc.

Medical/Surgical units often lack behavioral health specialty resources to identify and support individuals with mental health and substance misuse conditions. Not addressing these issues increases costs, imposes undue burdens on staff, intensifies patient agitation, and impairs the care experience for individuals and their families. Our behavioral health teams proactively identify, assess and intervene on patients in our medical/surgical units while supporting and teaching medical/surgical staff how to more effectively interact with these populations.

Objectives
Objectives for Johns Hopkins:

• Describe some of the considerations that go into formation of a pro-active psychiatric consultation service
• Review metrics and purported quality measures used …

High Risk, High Reward: How Team-Based Care Helps The Most Complex Patients, Deborah Satterfield, Kathleen Fraser, Mary Mclaughlin-Davis, Vanessa Casillas

Books, Presentations, Posters, Etc.

Complex patients, challenging patients, costly patients, we all have them. With a team-based care model, caring for these patients can become gratifying, even fun. Led by a primary care physician, a psychologist, and case managers from three organizations, this session will explore an integrated case management approach that uses case managers, behavioral health, and PharmDs.

After this presentation you will be able to:

1. 1. Discuss the value of an integrated case management approach in complex populations
2. Describe the value and use of behavioral health providers and PharmDs in the care of complex patients
3. Explain how to structure and lead complex …

Standardized Outcome Measures For Pregnancy And Childbirth, An Ichom Proposal., Malini Anand Nijagal, Stephanie Wissig, Caleb Stowell, Elizabeth Olson, Isis Amer-Wahlin, Gouke Bonsel, Allyson Brooks, Matthew Coleman, Shamala Devi Karalasingam, James M N Duffy, Tracy Flanagan, Stefan Gebhardt, Meridith E Greene, Floris Groenendaal, J Ravichandran R Jeganathan, Tessa Kowaliw, Marije Lamain-De-Ruiter, Elliott Main, Michelle Owens, Rod Petersen, Irwin Reiss, Carol Sakala, Anna Maria Speciale, Rachel Thompson, Oluwakemi Okunade, Arie Franx

Articles, Abstracts, and Reports

BACKGROUND: Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families.

METHODS: An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi …

#Work2bewell Powered By Providence Health & Services, Robin Henderson, Mary Renouf-Hanson

Books, Presentations, Posters, Etc.

Improving mental health and emotional well-being is the focus of many community health assessments and prevention efforts. This session will focus on innovative ideas that engage youth and their families where they are—in schools, communities and while seeking healthcare. Learn from healthcare leaders at Bellin Health, Cincinnati Children’s, Providence St Joseph Health and East London NHS Foundation Trust and their community partners as they share their successful efforts to change the conversation with today’s youth.

High Reliability + Value Improvement = Learning Organization, Sheri Feeney, Liga Mezaraups, Douglas Meyer, Glenda Battey, Linda Severs

Books, Presentations, Posters, Etc.

Experience how the 3^rd largest nonprofit health-system is becoming a learning organization. Engaging frontline staff in high reliability and improvement skills is critical to a High Reliability Learning Organization (HRLO). Leaders and staff pursuing daily improvement deliver greater value to patients, each other, business operations, and their communities. Participants will learn how to combine HRO and improvement science so everyone has the skills, will, and freedom to provide more affordable care and attain zero harm.

Objectives:

1. Identify successful elements and challenges of implementation and spread of our high reliability behaviors.
2. Demonstrate how HRO behaviors are the foundation for daily …

Regional Strategies To Collaboratively Measure Affordability, Meredith Roberts Tomasi, Katie Dobler, Pamela Mariea-Nason

Books, Presentations, Posters, Etc.

Learn how Oregon and other states and regions are addressing health care quality and affordability with multi-payer regional data, cost reporting, and community stakeholder collaborations. This session will create a common understanding of terminology and share reports in use today. Participants will draft an affordability roadmap, deepen their knowledge of how to identify meaningful partnerships, and understand how any organization fits into the conversation.

After this presentation you will be able to:

1. 1. Discuss the terminology, data elements, and regional resources already working with quality and cost data across the country, and explain how Oregon uses regional data and multi-stakeholder …

Integrate Behavioral Health In The Ed And Upstream, Katie Gilligan, Heidi Beazizo

Books, Presentations, Posters, Etc.

This interactive session will describe the changes being tested by 10 hospitals in the Integrating Behavioral Health in the ED and Upstream Learning Community, convened by IHI and Well Being Trust, to achieve meaningful improvements for patients with mental health and substance abuse conditions, their families, and ED staff. Participants will learn from experts and participating team members, share learning with other participants, and develop action plans for bringing this critical work to their organizations.

After this presentation you will be able to:

1. Describe a theory of change and set of core measures to improve patient outcomes, experience, and staff …

Perilymphatic Irx-2 Cytokine Therapy To Enhance Tumor Infiltrating Lymphocytes And Pd-L1 Expression Preceding Curative-Intent Therapy In Early Stage Breast Cancer, Joanna Pucilowska, Venkatesh Rajamanickam, Katherine Sanchez, Valerie Conrad, Alison Conlin, Shagheyegh Aliabadi-Wahle, Shu-Ching Chang, Gary Grunkemeier, Nikki Moxon, Staci Mellinger, Maritza Martel, James Egan, Monil Shah, David B Page

Books, Presentations, Posters, Etc.

Background: Cytokines are being explored as a therapeutic strategy to modulate the tumor microenvironment and facilitate immunotherapy benefit in breast cancer. Here, we investigate a locoregional therapeutic approach whereby cytokines (IRX-2) are administered into the subcutaneous peri-areolar tissue (in an anatomic distribution similar to sentinel lymph node mapping) to facilitate immune cell recruitment/activation within the draining lymph nodes and tumor in ESBC. IRX-2 is derived from ex vivo phytohemagglutinin-stimulated lymphocytes and contains multiple cytokines including IL-1β, IL-2, TNF-α, IFN-γ, IL-6, IL-8, and GM-CSF, with stable concentrations from lot to lot. Preclinically, IRX-2 activates T-cells and natural killer (NK) cells, facilitates …

Updated Efficacy Of First Or Second-Line Pembrolizumab Plus In Metastatic Triple Negative Breast Cancer And Correlations With Baseline Lymphocyte And Naïve Cd4+ T-Cell Count, David Page, Joanna Pucilowska, Laura Bennetts, I Kim, Katherine Sanchez, Maritza Martel, Alison Conlin, Nikki Moxon, Staci Mellinger, Anupama Acheson, K Kemmer, Z Mitri, J Vuky, J Ahn, C Abaya, T Manigault, R Basho, Walter Urba, Hl Mcarthur

Books, Presentations, Posters, Etc.

Background: In mTNBC, anti-PD-1/L1 monotherapy is most effective when administered early in the course of disease, with recent trials demonstrating overall response rates (ORR) of 23-26% in the first-line setting and 5-6% in later lines. This may reflect iatrogenic lymphopenia from preceding cytotoxic chemotherapy. Furthermore, curative-intent chemotherapy is associated with prolonged suppression of naïve CD4+ cells, a T-cell subset that may play a critical role in the generation of de novo anti-tumor immune responses. We present the final clinical results of a pilot study evaluating the safety and efficacy of combining pembrolizumab plus standard-of-care capecitabine in the first/second-line mTNBC …

Sitc 2018 Workshop Report: Immuno-Oncology Biomarkers: State Of The Art., Lisa H Butterfield, Mary L Disis, Bernard A Fox, David R Kaufman, Samir N Khleif, Ena Wang

Articles, Abstracts, and Reports

Identification of biomarkers in cancer immunotherapy that predict therapeutic response and/or limit adverse events are a critical need in the field. To address recent progress and hurdles around cancer biomarker development and utilization, the Society for Immunotherapy of Cancer (SITC) convened a workshop, "Immuno-Oncology Biomarkers: State of the Art," on May 16-17, 2018. Topics discussed included challenges in handling biospecimens, identification and validation of new biomarkers, data sharing, and collaborating across disciplines to advance biomarker development. Panel discussions followed session presentations to help foster participant conversation and discuss future projects and collaborations. The results of the Workshop include the development …

Service Operations Center Improves Hospital Flow And Reduces Ed Boarding!, Jeanne Rhynsburger, Patty Palmer, Michelle Hansen

Books, Presentations, Posters, Etc.

Swedish Edmonds 3 year journey to optimize hospital flow by opening a Service Operations Center – flow management hub.

Notable improvements included:

1. Patient visit times decreased 27 minutes per patient
2. Emergency department (ED) admit times decreased 68 minutes per patient
3. Boarding hours decreased 20%.

Infant Fall Prevention, Kristin Jensen, Nicole Roehrig, Caroline Truong, Jacklyn Wallace

Books, Presentations, Posters, Etc.

No abstract provided.

Changing Culture One Pdsa At A Time: The Creation Of An Innovation Unit, Jennifer Hoople, Gale Arnold, Jennifer Bletscher, Shawna Bolgen, Andy Branca, Tana Case, Matthew Dietz, Jennifer Ferenczy, Heather Haake, Janine Holbrook, Ingrid Jonely, Liga Mezaraups, Jessica Osantowski, Jessica Sehorn, Linda Severs, Dina Shepelyuk

Books, Presentations, Posters, Etc.

An inpatient unit in an acute care hospital was designated as an Innovation Unit. This unit was challenged with the creation of culture change in regards to process improvement. The team learned to use Improvement Science to facilitate rapid and innovative process improvements. These changes have enhanced the quality of healthcare provided while decreasing cost. The poster highlights some of the Improvement Science processes, forms, and roles of the team as well as some of the projects and successes.

Moving Slow To Move Fast-Nursing Handovers-Implementing Electronic To Ed Report To Improve Throughput, Dawn Gilbert, Roni Lyons, Patrick Mugrage, Linda Severs

Books, Presentations, Posters, Etc.

No abstract provided.

What Health Care Leaders Can Learn From Amazon, Amy Compton-Phillips, Goran Henricks

Books, Presentations, Posters, Etc.

Leading change in the internet economy takes different thinking and skills then those that got us the healthcare miracles we have today. Tech companies learned they needed to perfect the product, get serious about costs, remove friction, control the last mile, and accelerate careers to disrupt their industry. Healthcare leaders, and the systems they run, can use the same concepts to re-think our entrenched care models of today. Design thinking coupled with a scrupulous focus on value can help create the nimble systems we all want to work (and receive care) in. Learn how to go from idea to action …

250 Miles Apart, Saving Lives Together: Stop Sepsis, Ann C. Eells, Christiana Paul, Caroline Williams, Robert Fitting, Mauren Disbot, Bradley Shroeder, Jenifer Rofkahr, Amy Samolis

Books, Presentations, Posters, Etc.

No abstract provided.

Clabsi Rangers: A Team Approach To Extinguishing Clabsi, Alisa Bowman, Christine Bartlett, Sarah Gattis, Staci Hartmann, Eddie Lesage, Heidi Mosher, Joya Picket, Sarah Potts

Books, Presentations, Posters, Etc.

Purpose: Decrease incidence of Central line Associated Bloodstream Infection (CLABSI) in the ICU/IMCU at Swedish Medical Center by August 31^st 2018, with the overall goal of zero CLABSI stemming from the ICU’s.

Synthesis of Evidence: A review of CLABSI costs, the problem as a whole, and products that help decrease CLABSI was completed. Swedish’s current CLABSI state was discussed and ways to improve existing practices investigated. Ideas to engage and educate patients, family and staff in order to bolster infection prevention practices was reviewed.

Change in practice: Based on the evidence and our protocols we began reviewing patient charts …

Knowledge Management & Data Literacy, Sony Shah

Books, Presentations, Posters, Etc.

Using Knowledge Management and Data Literacy to enable caregivers to have ready access to Organizations’ documented base of facts, source of information and solutions.

Sofosbuvir, Velpatasvir, And Voxilaprevir For Treatment Of Recurrent Hepatitis C Virus Infection After Liver Transplantation., Maria G Cardona-Gonzalez, Jason D Goldman, Lawrence Narayan, Diana M Brainard, Kris V Kowdley

Articles, Abstracts, and Reports

There are limited data on direct-acting antiviral (DAA) treatment options for previously treated patients with recurrent genotype 3 (GT3) hepatitis C virus (HCV) after liver transplantation. Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is currently approved for treatment of HCV in patients with prior treatment with DAAs. We report the first published experience using SOF/VEL/VOX after liver transplantation for a DAA-experienced patient with severe hepatitis due to early recurrent GT3 HCV. The patient was treated with SOF/VEL/VOX that was extended to a total duration of 16 weeks and was intensified with ribavirin (RBV) starting at week 8 due to persistent viremia during treatment. Sustained virologic …

The Sin Of Missing Data: Is All Forgiven By Way Of Imputation?, Joseph R Dettori, Daniel C Norvell, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.