Quality Improvement Initiative to Improve Tobacco Cessation Efforts in Radiation Oncology.

PURPOSE: Although continued tobacco use in patients who are treated with radiation therapy is associated with inferior outcomes and increased treatment-related toxicity, multiple studies have shown that current tobacco cessation efforts in oncology are insufficient. A quality improvement (QI) initiative was developed with the goal of improving tobacco cessation efforts in radiation oncology. METHODS: Using iterative plan-do-study-act cycles, barriers to tobacco cessation were identified and then addressed with a single-institutional QI initiative designed to improve physician assessment of patient readiness to quit tobacco by 50% or more. Residents assessed readiness to quit tobacco during new patient consultations and recorded this assessment in prespecified fields within the electronic health record. Feedback on assessment efforts was provided to our department via an automated search of the electronic health record. RESULTS: From December 2014 to February 2015, before the initiation of the QI initiative, 4% of patients were assessed for their readiness to quit tobacco. After implementing the initiative, 67% of patients were assessed for their readiness to quit. CONCLUSION: After instituting a QI initiative at our institution, significantly more patients were assessed for readiness to quit tobacco before treatment with radiation therapy. Ongoing efforts in our department are aimed at improving the efficacy of this intervention.

A rare case of choroid plexus carcinoma that led to the diagnosis of Lynch syndrome (hereditary nonpolyposis colorectal cancer).

Lynch syndrome (hereditary nonpolyposis colorectal cancer) is an autosomal dominant disorder characterized by a significant risk of colorectal and endometrial cancers. A variety of other epithelial cancers may be associated with this syndrome. Brian tumors are infrequent, but have been reported in series. Here, we report a case of a 34-year-old Caucasian woman with WHO grade III choroid plexus carcinoma (CPC). Comprehensive genomic profiling of the patient's resected brain tumor revealed mutations in six genes: PTEN, VHL, MSH6, NOTCH1, RB1, and TP53. Family history is significant for endometrial cancer in her mother and sister as well as colon cancer in her maternal grandfather suggestive of Lynch syndrome. Site-specific mutational analysis showed the MSH6 mutation (p.R482*) in peripheral lymphocytes. Subsequently we performed immunohistochemical staining of the tumor tissue which demonstrated widespread loss of MSH6 with intact MSH2, MLH1, and PMS2. The diagnosis of Lynch syndrome due to a mutation in MSH6 was therefore established. Our patient elected to have adjuvant radiation to the surgical bed only followed by prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy and is doing very well. To our knowledge, this is the first case report of CPC in an adult patient with a germline MSH6 mutation. We believe our data have provided molecular evidence to suggest that CPC could potentially be part of the Lynch syndrome spectrum.

Earlier and more specific detection of persistent neck disease with diffusion-weighted MRI versus subsequent PET/CT after definitive chemoradiation for oropharyngeal squamous cell carcinoma.

BACKGROUND: The purpose of this study was to test if diffusion-weighted imaging (DWI) identified persistent neck disease after chemoradiotherapy (CRT) for oropharyngeal cancer earlier and as accurately as subsequent positron emission tomography (PET)/CT. METHODS: We performed a review of patients with oropharyngeal cancer treated with definitive CRT who underwent DWI and PET/CT at a median of 8 and 14 weeks posttreatment. Imaging characteristics were correlated with pathologically proven neck failure. RESULTS: Forty-one patients and 58 hemi-necks were analyzed. With a median follow-up of 120 weeks, 4 neck failures were identified. The apparent diffusion coefficient (ADC) of lymph node failures was lower (1220 vs 1910 µm2 /s; p = .003) than non-failures. Using an ADC threshold of 1500 µm2 /s, the sensitivity, specificity, and positive and negative predictive values (PPV; NPV) were 100% (4/4), 92% (46/50), 50% (4/8), and 100% (46/46) for DWI, respectively, and 100% (3/3), 71% (22/31), 25% (3/12), and 100% (22/22) for PET/CT, respectively. CONCLUSION: Earlier DWI produced similar sensitivity and better specificity in identifying persistent neck disease as 3-month PET/CT. © 2016 Wiley Periodicals, Inc. Head Neck 39: 432-438, 2017.

Direct measurement of the electric-field distribution in a light-emitting electrochemical cell.

The interplay between ionic and electronic charge carriers in mixed conductors offers rich physics and unique device potential. In light-emitting electrochemical cells (LEECs), for example, the redistribution of ions assists the injection of electronic carriers and leads to efficient light emission. The mechanism of operation of LEECs has been controversial, as there is no consensus regarding the distribution of electric field in these devices. Here, we probe the operation of LEECs using electric force microscopy on planar devices. We show that obtaining the appropriate boundary conditions is essential for capturing the underlying device physics. A patterning scheme that avoids overlap between the mixed-conductor layer and the metal electrodes enabled the accurate in situ measurement of the electric-field distribution. The results show that accumulation and depletion of mobile ions near the electrodes create high interfacial electric fields that enhance the injection of electronic carriers.

Dependence of charge injection on temperature, electric field, and energetic disorder in an organic semiconductor.

In order to determine energetic disorder's role in facilitating charge injection from gold into a molecularly doped polymer, we have examined the dependence of current on the local electric field, measured using electric force microscopy, at temperatures ranging from 250 to 330 K. From these data we infer, in a single experiment, the temperature dependence of the main factors governing the injection current: the electric-field induced lowering of the image-potential barrier, the interfacial charge density, and the mobility. In this system, the Schottky effect is anomolously large, and the interfacial charge density is larger than expected and strikingly non-Arhennius. Our analysis indicates that these effects are all a consequence of the Gaussian density of states in the organic.

Microscopic view of charge injection in an organic semiconductor.

We have measured the chemical potential and capacitance in a disordered organic semiconductor by electric force microscopy, following the electric field and interfacial charge density microscopically as the semiconductor undergoes a transition from Ohmic to space-charge limited conduction. Electric field and charge density at the metal-organic interface are inferred from the chemical potential and current. The charge density at this interface increases with electric field much faster than is predicted by the standard diffusion-limited thermionic emission theories.