Applying the SEIPS Framework to Redesign Chemotherapy Desensitization Within the Intensive Care Unit.

Chemotherapy desensitization (CD) enables patients with allergic reactions to receive chemotherapy safely. However, ineffective workflows, delays, and communication gaps between the oncology unit and the intensive care unit c.

ED to ED transfer does not prolong emergency department stays in a rural trauma system.

BACKGROUND: In many rural trauma systems injured patients are initially evaluated at a local hospital, and once stabilized transferred to a trauma center for definitive care. In the U.S. most trauma transfers occur as emergency department (ED) to ED transfers, however there is little evidence to guide systems in whether this is beneficial. We implemented a practice change in August 2018, changing from commonly admitting trauma transfers directly to the floor, to a protocol for ED to ED transfer for all trauma patients. We aimed to evaluate this practice change and its effects on outcomes and ED length of stay. METHODS: We retrospectively reviewed all trauma transfers to our Level 1 trauma center between 8/1/2017-8/30/2020. Study groups were created based on the presence of a transfer protocol: a control group with no protocol, a selective ED pitstop protocol group and a systemwide ED pitstop protocol group. We compared patient and injury factors between groups, and evaluated each group's hospital mortality, unplanned ICU admission within 24 h, need for return to radiology for imaging, and ED length of stay. RESULTS: 1,987 patients were transferred during the study period. In our control group 37% of transfers were directly admitted. Implementing a selective ED pitstop decreased direct admissions to 17% and a systemwide ED pitstop decreased direct admissions to 10%. There was no difference in mortality between groups. Protocol implementation decreased unplanned ICU admissions from 2% to 1% in the selective protocol and 0.8% in the systemwide protocol, as well as decreasing the need for further diagnostic imaging (5% to 2.5% and 2%; in each group respectively). ED length of stay was not different between time periods. CONCLUSIONS: Implementing an ED pitstop protocol for trauma transfers led to decreased direct admissions, without increasing the ED length of stay, and less need for delayed imaging.

Sexual Health Education: Knowledge Level of Oncology Nurses and Barriers to Discussing Concerns With Patients.

BACKGROUND: Cancer treatment has a significant impact on a patient's sexual health and function. However, numerous communication barriers deter healthcare professionals from initiating a sexual health conversation with patients. OBJECTIVES: This study assessed the effects of a nurse-focused sexual health education workshop on change in knowledge of sexual concerns, barriers to discussing sexuality, and frequency of bringing up sexual concerns. METHODS: A train-the-trainer approach was used to educate oncology nurse managers, who then trained oncology nurses (N = 65) at 10 education workshops. Each workshop provided four hours of content on sexual health and incorporated role-play and lecture. FINDINGS: Mean knowledge scores were improved, and barriers to discussing sexuality at the three- and six-month follow-ups were reduced. Frequency in discussing sexual concerns increased at three months and was sustained at six months.

Targeting AXL and mTOR Pathway Overcomes Primary and Acquired Resistance to WEE1 Inhibition in Small-Cell Lung Cancer.

Purpose: Drugs targeting DNA repair and cell-cycle checkpoints have emerged as promising therapies for small-cell lung cancer (SCLC). Among these, the WEE1 inhibitor AZD1775 has shown clinical activity in a subset of SCLC patients, but resistance is common. Understanding primary and acquired resistance mechanisms will be critical for developing effective WEE1 inhibitor combinations.Experimental Design: AZD1775 sensitivity in SCLC cell lines was correlated with baseline expression level of 200 total or phosphorylated proteins measured by reverse-phase protein array (RPPA) to identify predictive markers of primary resistance. We further established AZD1775 acquired resistance models to identify mechanism of acquired resistance. Combination regimens were tested to overcome primary and acquired resistance to AZD1775 in in vitro and in vivo SCLC models.Results: High-throughput proteomic profiling demonstrate that SCLC models with primary resistance to AZD1775 express high levels of AXL and phosphorylated S6 and that WEE1/AXL or WEE1/mTOR inhibitor combinations overcome resistance in vitro and in vivo Furthermore, AXL, independently and via mTOR, activates the ERK pathway, leading to recruitment and activation of another G2-checkpoint protein, CHK1. AZD1775 acquired resistance models demonstrated upregulation of AXL, pS6, and MET, and resistance was overcome with the addition of AXL (TP0903), dual-AXL/MET (cabozantinib), or mTOR (RAD001) inhibitors.Conclusions: AXL promotes resistance to WEE1 inhibition via downstream mTOR signaling and resulting activation of a parallel DNA damage repair pathway, CHK1. These findings suggest rational combinations to enhance the clinical efficacy of AZD1775, which is currently in clinical trials for SCLC and other malignancies. Clin Cancer Res; 23(20); 6239-53. ©2017 AACR.

Data collection, processing, validation, and verification.

The collection, processing, validation, verification, formatting, filing, and storage of the required input data are some of the most important components in the National Institute for Occupational Safety and Health (NIOSH) Radiation Dose Reconstruction Program. Without question, the quality and scientific validity of the reconstructed dose estimates are totally dependent on these aspects of the program. Of equal importance is that the data be filed not only in a readily accessible format, but also in one that facilitates error-free retrievability. One often unrecognized key factor is that each and every item of data must be collected with careful consideration of the use to which it is to be applied. Two important databases have been established in support of the dose reconstruction operations. They are the NIOSH Office of Compensation Analysis and Support Claims Tracking System and the Site Research Database. The former contains information directly relating to individual workers. When such information is not available, surrogate sources (i.e., area monitoring data) are used to establish the "radiation environment" in which the worker was employed. This information is uploaded into the Site Research Database. Procedures for these systems entail identifying, collecting, and processing information from more than 300 Department of Energy and Atomic Weapons Employer related facilities. To date, more than one million worker-related employment and dosimetry records and more than 33,000 research documents have been uploaded into the associated computer systems.

Interplanetary crew dose estimates for worst case solar particle events based on historical data for the Carrington flare of 1859.

Over the past two decades, hypothetical models of "worst-case" solar particle event (SPE) spectra have been proposed in order to place an upper bound on radiation doses to critical body organs of interplanetary crews on deep space missions. These event spectra are usually formulated using hypothetical extrapolations of space measurements for previous large events. Here we take a different approach. Recently reported analyses of ice core samples indicate that the Carrington flare of 1859 is the largest event observed in the past 500 years. These ice core data yield estimates of the proton fluence for energies greater than 30 MeV, but provide no other spectrum information. Assuming that the proton energy distribution for such an event is similar to that measured for other recent, large events, interplanetary crew doses are estimated for these hypothetical worst case SPE spectra. These estimated doses are life threatening unless substantial shielding is provided.

Space radiation protection: comparison of effective dose to bone marrow dose equivalent.

In many instances, bone marrow dose equivalents averaged over the entire body have been used as a surrogate for whole-body dose equivalents in space radiation protection studies. However, career radiation limits for space missions are expressed as effective doses. This study compares calculations of effective doses to average bone marrow dose equivalents for several large solar particle events (SPEs) and annual galactic cosmic ray (GCR) spectra, in order to examine the suitability of substituting bone marrow dose equivalents for effective doses. Organ dose equivalents are computed for all radiosensitive organs listed in NCRP Report 116 using the BRYNTRN and HZETRN space radiation transport codes and the Computerized Anatomical Man (CAM) model. These organ dose equivalents are then weighted with the appropriate tissue weighting factors to obtain effective doses. Various thicknesses of aluminum shielding, which are representative of nominal spacecraft and SPE storm shelter configurations, are used in the analyses. For all SPE configurations, the average bone marrow dose equivalent is considerably less than the calculated effective dose. For comparisons of the GCR, there is less than a ten percent difference between the two methods. In all cases, the gonads made up the largest percentage of the effective dose.