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P.R. Theodore



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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.01 - Health Informatics and Oncology in Global Health: A Pilot Program in Affordable Network technologies in Haiti (ID 1478)

      10:30 - 10:40  |  Author(s): P.R. Theodore

      • Abstract
      • Presentation
      • Slides

      Background
      A projected 75% increase in cancer deaths are expected in Low and Middle Income Countries (LMIC) by 2020. As successful battles against infectious disease and malnutrition deaths are waged, the demands on poor healthcare systems to create affordable oncology infrastructure will become ever more acute. Effective and efficient collaborative technologies that permit presentation of cases from resource limited environments to healthcare professionals in the developed world can aid in decision making, treatment planning and education. In this trial a novel clinical platform was launched in Haiti and we present a case of a chest wall malignancy demonstrating the platform's capacity for collaboration and clinical management between a resource limited community hospital in Haiti and Academic Medical Centers in the United States.

      Methods
      An Extensible Markup Language (XML) based system was built according to specifications of clinicians in the Thoracic Oncology Service of University of California San Francisco Medical Center. In a community hospital in Saint Marc, Haiti 30 cases involving a variety of clinical conditions across adult and pediatric oncology and traumatic disease were presented to Academic Medical Center volunteer physicians in the United States on a web-based asynchronous clinical collaboration system. The infrastructure required transfer over a wireless network in Haiti followed by secure transmission via internet to the dedicated servers in the United States.

      Results
      Case 1: A 32 year old Haitian Male presented to the Hopital Saint Nicholas in Saint Marc, Haiti with posterior chest and shoulder pain and a chest wall mass extending to the scapula. X-rays revealed a destructive lesion of the chest wall without frank mass within the pulmonary parenchyma. An open biopsy was performed and the specimen transferred for pathologic evaluation at The University of California San Francisco. Clinicians from 3 medical centers in the US came to a consensus opinion regarding diagnosis (unicentric plasmacytoma of chest wall) and treatment strategy within 3 days. Digital images of Immunohistochemical staining, X-rays uploaded to the collaboration platform via a smartphone photo app and literature reviews of the case were transmitted to Haitian physicians including a treatment plan recommendations . 29 additional patients have been offered evaluation in a web based environment and will be discussed.

      Conclusion
      Oncology cases in the developing world are increasingly prominent in light of advances in combating infectious disease and poverty related malnutrition. However resource limited environments may not have access to clinical decision tools, diagnostic measures or treatments commonplace in fully developed countries. Inexpensive collaborative technologic tools as demonstrated in this pilot can serve as a bridge between developed and developing countries in combination with the will to improve health among the planet's poorest communities

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-001 - Validation of a Novel Superior Vena Cava Syndrome Identification, Classification, and Management Algorithm (ID 307)

      09:30 - 09:30  |  Author(s): P.R. Theodore

      • Abstract

      Background
      Superior vena cava (SVC) syndrome results from great vessel extrinsic compression or intraluminal obstruction resulting in facial erythema, edema, or venous distension. This presentation can escalate into a life threatening condition. The Yale SVC classification system and management algorithm was proposed for tumor-related causes. We hypothesized its inclusion criteria may be limited in scope and not capture common causes and symptoms of SVC. The specific aim was to develop a SVC identification, classification, and management algorithm.

      Methods
      Retrospective data from Oregon Health & Science University pts diagnosed with ICD-9 code 459.2, compression of vein, between 2008-11 were collected. Pt demographics, vital signs, physical examination findings, hospitalization records, and outcomes were analyzed. ANOVA and Mann-Whitney U tests were utilized to assess significant between genders, p ≤ 0.05.

      Results
      The study population consisted of 207 pts; 157 were removed due to compression of a vessel other than the SVC. SVC syndrome was secondary to a malignancy (n=30), fibrotic stricture (n=5), or indwelling catheter-related thrombus (n=11). Dyspnea (n=31), facial edema (n=24), and cough (n=18) were the most common physical examination findings. Patients who presented with cough or dyspnea secondary to a malignancy, without facial, neck, or extremity edema (n=7) or those with a post-procedure fibrotic stricture (n=5) or an indwelling catheter-related thrombus (n=11) did not meet the Yale classification system inclusion criteria.

      Conclusion
      A SVC classification system, which accounts for non-oncologic causes and symptoms due to the mass effect on surrounding tissues (vasculature, trachea, and esophagus) is a more comprehensive approach to SVC treatment.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-022 - A Novel Web-Based, Mobile-Device Enabled Clinical Collaboration Platform in Lung Cancer - Multidisciplinary Patient Evaluations Via Networking Technology (ID 1465)

      09:30 - 09:30  |  Author(s): P.R. Theodore

      • Abstract

      Background
      Background: Expenditures in the United States on health care have reached and estimated $2.5 trillion and cost control measures have become major features of the current health care reform debate in this country. An approach to reducing ballooning health care costs has been to focus on quality and uniformity of standards of care using health informatic technologies. We have designed and implemented a web- based clinician-to-clinician communication and collaboration platform that is mobile device enabled. The system permits asynchronous communication among clinicians in conjunction with robust sharing of the content of the Electronic Medical Record (EMR) including X-rays, digital histopathologic images and molecular diagnostics. Principle aims of the project incluided (1) documenting accurate diagnoses (2) appropriate consultation and input from specialty services (3) treatment plan optimization spanning disciplines and (4) archiving the results of multidisciplinary decision making in a virtual environment.

      Methods
      Methods: Using Extensible Markup Language (XML) based system; a federal patient privacy regulation (HIPAA) compliant secure platform for communication was built according to specifications designated by clinicians in the Thoracic Oncology Section of UCSF Medical Center. The web based platform was approved by a committed on human research. The system was designed with integration of a Picture Archives Viewing System (PACS) and digitized pathology images to permit specific file upload, and annotation in a scalable manner allowing collaborations between two clinicians or among a group as large as 35. User group questionnaires and focus groups were performed to refine the computer-human interface and customize user experience. Members of the Thoracic Oncology Program (N=35) at the University of California at San Francisco were invited to participate in pilot study of the efficiency and ease of use of a novel web-based collaborative system for the purposes of an asynchronous “Virtual Tumor Board”.

      Results
      Results: A Trial of 50 patients had care plans coordinated via the virtual tumor board with input of the multi-disciplinary focus groups used in the development of the computer - human interface. 20% of clinicians related concerns over ease of use. 10% related concerns regarding excessive electronic messaging as a disruption of work flow. 15% voiced a main concern regarding clinician reimbursement for web based consultation. Of the cases presented on the virtual tumor board platform 100% achieved clinician consensus opinion with 5 days (mean 2.5 days). Patient Satisfaction assays suggested patient comfort with protected health information transfer on a secure platform. No adverse events were directly referable to system use.

      Conclusion
      Conclusion: A novel web based system for collaboration among clinicians holds the promise for reducing delays in optimized treatment planning and is regarded by clinicians as worthy approach to error reduction and reduction in delay to definitive treatment plan determination. Consensus opinions were rapidly obtained and archived records of discussion facilitates outcome reviews. Clinician concern included reimbursement patterns and efficiency but patient opinion was favorable toward this approach to collaborative decision making in oncology.