Recent Publications by CFE Educators
Recent Published articles, books, and other scholarship by Academy members, CFE Education Scientists, and CFE Faculty.
No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations.
2016
Authors: Daly B, Hantel A, Wroblewski K, Balachandran JS, Chow S, DeBoer R, Fleming GF, Hahn OM, Kline J, Liu H, Patel BK, Verma A, Witt LJ, Fukui M, Kumar A, Howell MD, Polite BN
PURPOSE
Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs.
METHODS
This was a retrospective case series of patients cared for in an academic medical center's ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient's electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations.
RESULTS
Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05).
CONCLUSION
Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care.
View on PubMedSimilarities in the Retinal Appearance of Patients With Zika Virus Compared With Cobalamin C Deficiency.
2016
Authors: Rasool N, Odel JG
Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's): An ARChiVe Cohort Study.
2016
Authors: Cabral DA, Canter DL, Muscal E, Nanda K, Wahezi DM, Spalding SJ, Twilt M, Benseler SM, Campillo S, Charuvanij S, Dancey P, Eberhard BA, Elder ME, Hersh A, Higgins GC, Huber AM, Khubchandani R, Kim S, Klein-Gitelman M, Kostik MM, Lawson EF, Lee T, Lubieniecka JM, McCurdy D, Moorthy LN, Morishita KA, Nielsen SM, O'Neil KM, Reiff A, Ristic G, Robinson AB, Sarmiento A, Shenoi S, Toth MB, Van Mater HA, Wagner-Weiner L, Weiss JE, White AJ, Yeung RS, ARChiVe Investigators Network within the PedVas Initiative
OBJECTIVE
To uniquely classify children with microscopic polyangiitis (MPA), to describe their demographic characteristics, presenting clinical features, and initial treatments in comparison to patients with granulomatosis with polyangiitis (Wegener's) (GPA).
METHODS
The European Medicines Agency (EMA) classification algorithm was applied by computation to categorical data from patients recruited to the ARChiVe (A Registry for Childhood Vasculitis: e-entry) cohort, with the data censored to November 2015. The EMA algorithm was used to uniquely distinguish children with MPA from children with GPA, whose diagnoses had been classified according to both adult- and pediatric-specific criteria. Descriptive statistics were used for comparisons.
RESULTS
In total, 231 of 440 patients (64% female) fulfilled the classification criteria for either MPA (n = 48) or GPA (n = 183). The median time to diagnosis was 1.6 months in the MPA group and 2.1 months in the GPA group (ranging to 39 and 73 months, respectively). Patients with MPA were significantly younger than those with GPA (median age 11 years versus 14 years). Constitutional features were equally common between the groups. In patients with MPA compared to those with GPA, pulmonary manifestations were less frequent (44% versus 74%) and less severe (primarily, hemorrhage, requirement for supplemental oxygen, and pulmonary failure). Renal pathologic features were frequently found in both groups (75% of patients with MPA versus 83% of patients with GPA) but tended toward greater severity in those with MPA (primarily, nephrotic-range proteinuria, requirement for dialysis, and end-stage renal disease). Airway/eye involvement was absent among patients with MPA, because these GPA-defining features preclude a diagnosis of MPA within the EMA algorithm. Similar proportions of patients with MPA and those with GPA received combination therapy with corticosteroids plus cyclophosphamide (69% and 78%, respectively) or both drugs in combination with plasmapheresis (19% and 22%, respectively). Other treatments administered, ranging in decreasing frequency from 13% to 3%, were rituximab, methotrexate, azathioprine, and mycophenolate mofetil.
CONCLUSION
Younger age at disease onset and, perhaps, both gastrointestinal manifestations and more severe kidney disease seem to characterize the clinical profile in children with MPA compared to those with GPA. Delay in diagnosis suggests that recognition of these systemic vasculitides is suboptimal. Compared with adults, initial treatment regimens in children were comparable, but the complete reversal of female-to-male disease prevalence ratios is a provocative finding.
View on PubMedTF9 Video Self-Assessment: Describing Resident Experience.
2016
Authors: V. Madia, J. Mongelluzzo, E. Chen, C. Fee, P. O'Sullivan
338 Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature.
2016
Authors: P. Armenian, R.R. Gerona, C. Ives-Tallman, W.Z.D. Zeng, T. Lin, G. Stroh, D.D. Campagne
Updated Analysis of a Multi-Institutional Radiation Oncology Clerkship Curriculum: A Report From the Radiation Oncology Education Collaborative Study Group.
2016
Authors: Kauffmann G, Gunther JR, Braunstein SE, Hara W, Spektor A, Brower JV, Stahl JM, Rao YJ, Vargo J, Ye JC, Fields EC, Thomas CR, Du KL, Kruser TJ, Jimenez RB, Hirsch AE, Currey AD, Yechieli R, Mohindra P, Golden DW
The Impact of Targeted Therapy and Immunotherapy on Melanoma Brain Metastases Treated With Stereotactic Radiosurgery.
2016
Authors: Paulsson AK, Garcia MA, Tinkle CL, Nakamura JL, Fogh SE, Sneed PK, Braunstein SE
The Effect of Gene Mutations on Survival in Patients With Melanoma Following the Development of Brain Metastases.
2016
Authors: Sperduto PW, Jiang W, Brown PD, Braunstein SE, Sneed PK, Wattson DA, Shih HA, Bangdiwala A, Shanley R, Lockney NA, Beal K, Lou E, Amatruda T, Sperduto WA, Kirkpatrick JP, Yeh N, Gaspar LE, Molitoris JK, Masucci L, Roberge D, Yu JB, Chiang VL, Mehta MP
Patterns of Failure after Adjuvant Radiosurgery for Surgically Resected Brain Metastases: Surgical Tract Failures and Implications for Target Delineation.
2016
Authors: Yu Y, Garcia MA, Braunstein SE, Sneed PK
Pain Assessment at Radiation Oncology Consultation for Bone Metastases.
2016
Authors: Garcia MA, Fogh SE, Anderson W, Hertan LM, Balboni TA, Haas-Kogan DA, Braunstein SE
