scholarly journals The Inpatient Unit in a Cancer Center

2021 ◽  
pp. 15-20
Author(s):  
Mohamed A. Kharfan-Dabaja
Keyword(s):  
Hospital Setting ◽  
Hematologic Malignancies ◽  
Inpatient Unit ◽  
Cancer Center ◽  
Inpatient Setting ◽  
Cancer Therapies ◽  
Efficient Manner ◽  
Delivery Of Care ◽  
Complex Needs ◽  
Main Components

AbstractDespite emergence of effective novel cancer therapies that can be administered outside the hospital setting for various solid tumor and hematologic malignancies, a significant number of patients still require treatment in the inpatient setting, owing to the nature of the treatment, duration, and frequency, or to the level of supportive care required to administer such treatments, among others. Apart from specialized trained physicians and nurses, the number of inpatient team services has expanded significantly to meet the complex needs of patients and their families. We acknowledge that there is no universal model for how an inpatient unit should be built and developed; it depends on financial resources, population density, and societal factors, among others. Here, we describe the main components of an inpatient unit in a cancer center. The ultimate goal must be to provide a safe environment for cancer patients and to facilitate delivery of care in an efficient manner.

scholarly journals Epigenetic Regulation of MicroRNA Clusters and Families during Tumor Development

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1333
Author(s):  
Jana Gregorova ◽  
Petra Vychytilova-Faltejskova ◽  
Sabina Sevcikova
Keyword(s):  
Histone Modifications ◽  
Sequence Similarity ◽  
Tumor Development ◽  
Hematologic Malignancies ◽  
Seed Region ◽  
Cancer Therapies ◽  
Rna Molecules ◽  
Physiological Processes ◽  
Close Relationship ◽  
Aberrant Dna Methylation

MicroRNAs are small non-coding single-stranded RNA molecules regulating gene expression on a posttranscriptional level based on the seed sequence similarity. They are frequently clustered; thus, they are either simultaneously transcribed into a single polycistronic transcript or they may be transcribed independently. Importantly, microRNA families that contain the same seed region and thus target related signaling proteins, may be localized in one or more clusters, which are in a close relationship. MicroRNAs are involved in basic physiological processes, and their deregulation is associated with the origin of various pathologies, including solid tumors or hematologic malignancies. Recently, the interplay between the expression of microRNA clusters and families and epigenetic machinery was described, indicating aberrant DNA methylation or histone modifications as major mechanisms responsible for microRNA deregulation during cancerogenesis. In this review, the most studied microRNA clusters and families affected by hyper- or hypomethylation as well as by histone modifications are presented with the focus on particular mechanisms. Finally, the diagnostic and prognostic potential of microRNA clusters and families is discussed together with technologies currently used for epigenetic-based cancer therapies.

scholarly journals Guided Self-help Teletherapy for Behavioural Difficulties in Children with Epilepsy

2021 ◽  
Author(s):  
Sophie Bennett ◽  
Isobel Heyman ◽  
Sophia Varadkar ◽  
Anna Coughtrey ◽  
Fahreen Walji ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Unmet Need ◽  
Hospital Setting ◽  
Physical And Mental Health ◽  
Paediatric Hospital ◽  
Complex Needs ◽  
Self Help ◽  
Behavioural Difficulties

AbstractBehavioural difficulties impact greatly upon quality of life for children with chronic illness and their families but are often not identified or adequately treated, possibly due to the separation of physical and mental health services. This case study describes the content and outcomes of guided self-help teletherapy for behavioural difficulties in a child with epilepsy and complex needs using an evidence-based behavioural parenting protocol delivered within a paediatric hospital setting. Behavioural difficulties and progress towards the family’s self-identified goals were monitored at each session. Validated measures of mental health and quality of life in children were completed before and after intervention and satisfaction was measured at the end of treatment. Measures demonstrated clear progress towards the family’s goals and reduction in weekly ratings of behavioural difficulties. This case demonstrates that a guided self-help teletherapy approach delivered from within the paediatric setting may be one way of meeting unmet need.

scholarly journals Finding Consensus About the Level of Medication Safety in a Hospital Setting: Development and an Example of Application of a Modified Delphi Method

2021 ◽  
Vol 9 ◽  
Author(s):  
Birgit Böhmdorfer-McNair ◽  
Wolfgang Huf ◽  
Reinhard Strametz ◽  
Michael Nebosis ◽  
Florian Pichler ◽  
...  
Keyword(s):  
Delphi Method ◽  
Medication Safety ◽  
Synthesis Method ◽  
Hospital Setting ◽  
Inpatient Setting ◽  
Group Level ◽  
Safety Level ◽  
Healthcare Facilities ◽  
Information Synthesis ◽  
Level Ii

A version of the Institute for Safe Medication Practices (ISMP) questionnaire adapted to the Austrian inpatient setting was used to sample the estimates of a group of experts regarding the level of medication safety in a level II hospital. To synthesize expert opinions on a group level reproducibly, classical Delphi method elements were combined with an item weight and performance weight decision-maker. This newly developed information synthesis method was applied to the sample dataset to examine method applicability. Method descriptions and flow diagrams were generated. Applicability was then tested by creating a synthesis of individual questionnaires. An estimate of the level of medication safety in an Austrian level II hospital was, thus, generated. Over the past two decades, initiatives regarding patient safety, in general, and medication safety, in particular, have been gaining momentum. Questionnaires are state of the art for assessing medication practice in healthcare facilities. Acquiring consistent data about medication in the complex setting of a hospital, however, has not been standardized. There are no publicly available benchmark datasets and, in particular, there is no published method to reliably synthesize expertise regarding medication safety on an expert group level. The group-level information synthesis method developed in this study has the potential to synthesize information about the level of medication safety in a hospital setting more reliably than unstructured approaches. A medication safety level estimate for a representative Austrian level II hospital was generated. Further studies are needed to establish convergence characteristics and benchmarks for medication safety on a larger scale.

scholarly journals Expression of the oncofetal ED-B–containing fibronectin isoform in hematologic tumors enables ED-B–targeted 131I-L19SIP radioimmunotherapy in Hodgkin lymphoma patients

Blood ◽  
2009 ◽  
Vol 113 (10) ◽  
pp. 2265-2274 ◽  
Author(s):  
Stefanie Sauer ◽  
Paola A. Erba ◽  
Mario Petrini ◽  
Andreas Menrad ◽  
Leonardo Giovannoni ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Hodgkin Lymphoma ◽  
Hematologic Malignancies ◽  
Current Treatment ◽  
Cancer Therapies ◽  
Bone Marrow Biopsies ◽  
Normal Tissues ◽  
Non Hodgkin Lymphoma ◽  
Promising Target

Abstract Current treatment of hematologic malignancies involves rather unspecific chemotherapy, frequently resulting in severe adverse events. Thus, modern clinical research focuses on compounds able to discriminate malignant from normal tissues. Being expressed in newly formed blood vessels of solid cancers but not in normal mature tissues, the extradomain B of fibronectin (ED-B FN) is a promising target for selective cancer therapies. Using immunohistology with a new epitope retrieval technique for paraffin-embedded tissues, ED-B FN expression was found in biopsies from more than 200 Hodgkin and non-Hodgkin lymphoma patients of nearly all entities, and in patients with myeloproliferative diseases. ED-B FN expression was nearly absent in normal lymph nodes (n = 10) and bone marrow biopsies (n = 9). The extent of vascular ED-B FN expression in lymphoma tissues was positively correlated with grade of malignancy. ED-B FN expression was enhanced in lymph nodes with severe lymphadenopathy and in some hyperplastic tonsils. The in vivo accessibility of ED-B FN was confirmed in 3 lymphoma patients, in whom the lymphoma lesions were visualized on scintigraphy with 131I-labeled L19 small immunoprotein (131I-L19SIP). In 2 relapsed Hodgkin lymphoma patients131I-L19SIP radioimmunotherapy induced a sustained partial response, qualifying ED-B FN as a promising target for antibody-based lymphoma therapies.

Delays in time to antibiotics in inpatient oncologic neutropenic fever do not predict decreased overall survival.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18765-e18765
Author(s):  
Jordan Villars ◽  
Christopher Anand Gardner ◽  
Tingting Zhan ◽  
Adam F Binder
Keyword(s):  
Overall Survival ◽  
Black People ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Neutropenic Fever ◽  
Cancer Center ◽  
Common Disease ◽  
Inpatient Setting ◽  
Oncologic Patients ◽  
Time To Antibiotics

e18765 Background: Neutropenic fever (NF) is relatively common oncologic emergency. Present expert consensus is that anti-pseudomonas gram-negative antibiotics should be administered within 60 minutes of detecting NF. To date studies investigating this relationship in neutropenic fever patients have been either limited in size, or have failed to reliably establish a relationship between time to antibiotics (TTA) and clinical outcomes.While some studies have shown an association between TTA and outcomes in NF patients admitted from the Emergency Department, such studies do not control for the time that patients may have been febrile in the community. To address these factors, we conducted a retrospective study on the effect of TTA on mortality in oncologic patients who developed NF as inpatients. Methods: We performed retrospective chart review of all cases of NF at an NCI designated Cancer Center between 7/1/2016 and 3/27/2019. NF was defined as temperature of 101˚ F on one occasion, or 100.4˚ F sustained over 60 minutes, with an absolute neutrophil count (ANC) less than 500. TTA and survival were calculated via chart abstraction; patients lost to follow up within 180 days were censored to the 180-day mortality group. Relationship between TTA and overall survival (OS) was analyzed via multivariable Cox regression. We excluded patients that had non-cancer related NF, were transferred from another institution with NF, were admitted from the ED with NF, or transitioned to hospice. Only the first instance of NF in any admission was analyzed. Results: A total of 187 eligible cases were identified during the study period, mean age was 57.6 +/- 13.6, 100 (53.5%) cases were in males, 114 (61.0%) cases in Caucasians, 53 (28.3%) in Black People. The 3 most common disease subtypes were acute leukemia (42.8%), plasma cell dyscrasias (27.8%), and lymphoma (16.6%). TTA showed no significant correlation with OS at any timeframe studied. Low Charlson Comorbidity Index ( < 3) correlated with increased survival through ̃360 days, however the effect was non-significant at longer timeframes. Immediate antibiotic treatment ( < 40 mins) correlated with poorer patient prognosis and significantly decreased OS (HR 3.08;CI: 1.30-7.28; p 0.010). Conclusions: TTA was not associated with OS in our study. For inpatients with NF, even hours long TTA may not be long enough to result in adverse clinical outcomes. Unlike NF patients presenting to the ED, where true TTA may often be many hours or even days prior to arrival, a few hours-long TTA in the hospital may not be sufficiently long enough to cause significant patient harm. Interestingly, in our cohort, those who received antibiotics quickly had adverse outcomes. It may be that in patients who were clinically unstable, TTA was shorter given the urgency of the situation. Ultimately, this study’s findings question the applicability of the 60-minute guideline when used in the inpatient setting.

scholarly journals Definition and Coordination of Roles and Responsibilities Among Cancer Center Clinic and Research Personnel

2020 ◽  
Vol 16 (1) ◽  
pp. e64-e74
Author(s):  
Simon J. Craddock Lee ◽  
Torsten Reimer ◽  
Sandra Garcia ◽  
Erin L. Williams ◽  
Mary West ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Physician Attitudes ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Research Staff ◽  
Research Personnel ◽  
Delivery Of Care ◽  
Roles And Responsibilities ◽  
Clinic Staff ◽  
Staff Members

PURPOSE: Effective enrollment and treatment of patients in cancer clinical trials require definition and coordination of roles and responsibilities among clinic and research personnel. MATERIALS AND METHODS: We developed a survey that incorporated modified components of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. Surveys were administered to clinic nursing staff and research personnel at a National Cancer Institute–designated comprehensive cancer center. Results were analyzed using χ2-tests, t tests, and analyses of variance. RESULTS: Surveys were completed by 105 staff members (n = 50 research staff, n = 55 clinic staff; 61% response rate). Research staff were more likely to feel that they had the skills to answer questions, convey information, and provide education for patients on trials (all P < .05). Both clinic and research staff reported receipt of communication about responsibilities in fewer than 30% of cases, although research staff reported provision of such information in more than 60% of cases. Among 20 tasks related to care of patients in trials, no single preferred model of responsibility assignment was selected by the majority of clinic staff for nine tasks (45%) or by research staff for three tasks (15%). Uncertainty about which team coordinates care was reported by three times as many clinic staff as research staff ( P = .01). There was also substantial variation in the preferred model for delivery of care to patients in trials ( P < .05). CONCLUSION: Knowledge, attitudes, and perception of care and responsibilities for patients on clinical trials differ between and among clinic and research personnel. Additional research about how these findings affect efficiency and quality of care on clinical trials is needed.

scholarly journals COVID-19–Related Ethics Consultations at a Cancer Center in New York City: A Content Review of Ethics Consultations During the Early Stages of the Pandemic

2020 ◽  
pp. OP.20.00440
Author(s):  
Danielle Novetsky Friedman ◽  
Liz Blackler ◽  
Yesne Alici ◽  
Amy E. Scharf ◽  
Martin Chin ◽  
...  
Keyword(s):  
New York ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Cancer Center ◽  
Care Providers ◽  
Delivery Of Care ◽  
Code Status ◽  
Patients With Cancer ◽  
Early Stages ◽  
Content Review

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has raised a variety of ethical dilemmas for health care providers. Limited data are available on how a patient’s concomitant cancer diagnosis affected ethical concerns raised during the early stages of the pandemic. METHODS: We performed a retrospective review of all COVID-related ethics consultations registered in a prospectively collected ethics database at a tertiary cancer center between March 14, 2020, and April 28, 2020. Primary and secondary ethical issues, as well as important contextual factors, were identified. RESULTS: Twenty-six clinical ethics consultations were performed on 24 patients with cancer (58.3% male; median age, 65.5 years). The most common primary ethical issues were code status (n = 11), obligation to provide nonbeneficial treatment (n = 3), patient autonomy (n = 3), resource allocation (n = 3), and delivery of care wherein the risk to staff might outweigh the potential benefit to the patient (n = 3). An additional nine consultations raised concerns about staff safety in the context of likely nonbeneficial treatment as a secondary issue. Unique contextual issues identified included concerns about public safety for patients requesting discharge against medical advice (n = 3) and difficulties around decision making, especially with regard to code status because of an inability to reach surrogates (n = 3). CONCLUSION: During the early pandemic, the care of patients with cancer and COVID-19 spurred a number of ethics consultations, which were largely focused on code status. Most cases also raised concerns about staff safety in the context of limited benefit to patients, a highly unusual scenario at our institution that may have been triggered by critical supply shortages.

scholarly journals Better together: a day hospital's move towards integrated care

2019 ◽  
Vol 26 (6) ◽  
pp. 1-9
Author(s):  
Michele Board ◽  
Lisa Pigott ◽  
Heather Olive ◽  
Vanessa Heaslip
Keyword(s):  
Hospital Setting ◽  
Interdisciplinary Team ◽  
Shared Vision ◽  
Professional Staff ◽  
Day Hospital ◽  
Complex Needs ◽  
Rigorous Approach ◽  
Team Working ◽  
Principles Of Practice ◽  
Practice Development

Background/AimsThis article will present how an interdisciplinary team working within a day hospital in an acute NHS Foundation Trust embraced the opportunities of practice development to work ‘better together’ to meet the complex needs of individuals using the service.MethodsBy working closely with key stakeholders, the team developed an integrated service intersecting both primary and secondary care boundaries.ResultsThe principles of practice development, including shared vision and focus, ensured changes made to the service were patient centred. These changes included a 360-degree assessment by professional staff with extended skills beyond their own professional role, and a virtual ward round, where individual patients are reviewed by an interdisciplinary team in the community with a focus on avoiding hospital admission, with quicker access to the day hospital. The team worked closely with their local university towards achieving practice development unit status, demonstrating a rigorous approach to the development of services provided by the day hospital.ConclusionsThe article highlights both the value of practice development and significantly the value of an interdisciplinary team working within a day hospital setting.

scholarly journals Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006–2014

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joumana Kmeid ◽  
Prathit A. Kulkarni ◽  
Marjorie V. Batista ◽  
Firas El Chaer ◽  
Amrita Prayag ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cancer Patients ◽  
Hematopoietic Cell Transplantation ◽  
Average Rate ◽  
Hematologic Malignancies ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Mycobacterium Tuberculosis Infection ◽  
Patients With Cancer ◽  
Disseminated Disease

Abstract Background Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

scholarly journals The Impact of Patient Interactive Systems on the Management of Pain in an Inpatient Hospital Setting: A Systematic Review

2019 ◽  
Vol 10 (04) ◽  
pp. 580-596 ◽  
Author(s):  
Raniah N. Aldekhyyel ◽  
Caitlin J. Bakker ◽  
Michael B. Pitt ◽  
Genevieve B. Melton
Keyword(s):  
Pain Management ◽  
Outcome Measures ◽  
User Satisfaction ◽  
Hospital Setting ◽  
Interactive Systems ◽  
Management Systems ◽  
Interactive System ◽  
Inpatient Setting ◽  
Patient Reported ◽  
The Impact

Background While some published literature exists on the use of interactive patient care systems, the effectiveness of these systems on the management of pain is unclear. To fill this gap in knowledge, we aimed to understand the impact and outcomes of pain management patient interactive systems in an inpatient setting. Methods A systematic literature review was conducted across seven databases, and results were independently screened by two researchers. To extract relevant data, critical appraisal forms were developed and each paper was examined by two experts. Information included patient interactive system category, patient population and number of participants/samples, experiment type, and specific outcome measures. Results Out of 58 full-text articles assessed for eligibility, 18 were eligible and included in the final qualitative synthesis. Overall, there were two main types of pain management interactive systems within the inpatient setting (standalone systems and integrated platform systems). While systems were diverse especially for integrated platforms, most reported systems were entertainment distraction systems. Reports examined a variety of outcome measures, including changes in patient-reported pain levels, patient engagement, user satisfaction, changes in clinical workflow, and changes in documentation. In the 13 systems measuring pain scores, 12 demonstrated a positive impact on pain level scores. Conclusion Pain management systems appear to be effective in lowering patient level scores, but research comparing the effectiveness and efficacy of one type of interactive system versus another in the management of pain is needed. While not conclusive, pain management systems integrated with other technology platforms show potentially promising effects with improving patient communication, education, and self-reporting.

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