scholarly journals Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care

2021 ◽  
Author(s):  
Carla M. Prado ◽  
Alessandro Laviano ◽  
Chelsia Gillis ◽  
Anthony D. Sung ◽  
Maureen Gardner ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Nutrition Status ◽  
Care Process ◽  
Current Evidence ◽  
Patient Centered ◽  
Nutrition Screening

Abstract Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies’ recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies’ recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.

Value-based healthcare: the role of laboratory medicine

2019 ◽  
Vol 57 (6) ◽  
pp. 798-801 ◽  
Author(s):  
Federico Pennestrì ◽  
Giuseppe Banfi
Keyword(s):  
Health Care ◽  
Laboratory Data ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Laboratory Medicine ◽  
Patient Specific ◽  
Control Cost ◽  
Patient Centered ◽  
Quality Health Care ◽  
Health Demands

Abstract The global increase of health demands pushes administrators and policy makers to provide good quality health care at sustainable costs. Many approaches have been developed, among which value-based health care (VBHC) is one of the most promising: value is given by outcomes achieved per dollar spent. Best value is given by shared benefits between all the stakeholders involved in the process: patients, providers, suppliers, payers and citizens. However, VBHC implementation is a current challenge for hospitals and healthcare providers, that may find it difficult to adapt their organization into a patient-centered clinical pathway based on both classical outcomes and innovative patient-evaluation. If any contribution to improve cost-effectiveness over the full cycle of care is welcome, laboratory medicine is achieving increasing importance, by generating useful knowledge to reduce costs and improve patient care, provided by a biunivocal relationship with clinicians. On the one hand, pathologists have to emphasize the importance of laboratory data to improve diagnostic and prognostic traditional thinking. On the other hand, the same data are useful only when supported by strong evidence. Introducing laboratory medicine professionals to VBHC would be useful to achieve better skills on data outline, comparable methodologies, quality control, cost assessment, multidisciplinary coordination and patient-specific procedures.

scholarly journals RarERN Path: a methodology towards the optimisation of patients’ care pathways in rare and complex diseases developed within the European Reference Networks

2020 ◽  
Author(s):  
Rosaria Talarico ◽  
Sara Cannizzo ◽  
Valentina Lorenzoni ◽  
Diana Marinello ◽  
Ilaria Palla ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Complex Diseases ◽  
Cost Effective ◽  
Care Process ◽  
Care Pathways ◽  
Patient Centered ◽  
European Reference Networks ◽  
Reference Networks ◽  
Organisational Model ◽  
Disease Specific

Abstract Background In 2017, the European Commission has launched the European Reference Networks (ERNs), virtual networks involving healthcare providers across Europe. The aim of the ERNs is to tackle complex and rare diseases and conditions that require highly specialized treatment and a concentration of knowledge and resources. The ERN ReCONNET is one of the 24 ERNs approved that aims to improve the management of Rare and Complex Connective Tissue and Musculoskeletal Diseases.ResultsThe need to develop a specific methodology for the implementation of an organisational model for patients’ care pathways aligns with the mission of the ERNs to improve the care of rare and complex diseases in Europe. In this framework, ERN ReCONNET developed the RarERN Path methodology that is aimed at creating an organisational model for patients’ care pathways taking advantage of the unique setting of ERNs, represented by the large community of experts (researchers, clinicians, healthcare professionals, patients, health economists, hospital managers, etc.) involved in the Networks. The specific aim of RarERN Path is to provide a valid organisational model for patient-centered care in rare and complex diseases that enables the integration of the different stakeholders involved in the care process, and that adapts in a flexible way to different disease-specific and geographical contexts across Europe.The RarERN Path methodology foresees six consecutive phases that, if applied in different contexts, helps to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases. ConclusionThe application of RarERN Path to the different disease-specific and geographical contexts would help to ensure an improved, cost-effective and patient-centred equal care to rare and complex diseases across Europe as well as a possible tangible action towards the integration of ERNs into the different European healthcare systems.

scholarly journals Wound care during the COVID-19 emergency in Padua Hospital (Italy)

2020 ◽  
pp. 1-12
Author(s):  
Giampiero Avruscio ◽  
Sonia Ragazzo ◽  
Chiara Tonello ◽  
Giuseppe Camporese ◽  
Fabiana Nalin ◽  
...  
Keyword(s):  
Social Impact ◽  
Wound Care ◽  
Healthcare Providers ◽  
High Standard ◽  
Standard Of Care ◽  
University Hospital ◽  
Current Evidence ◽  
Hospital Patients ◽  
Standard Of Practice ◽  
Difficult Challenge

Abstract Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. The COVID-19 outbreak has represented a difficult challenge to face for healthcare providers and fragile patients, such as for outpatients and Day-Hospital patients needing continuous care at the Angiology Unit of the University Hospital of Padova in Italy, one of the most crucial areas worldwide. The project consisted in a critical revision of all the procedures from the patient’s arrival to their discharge after completing the entire course of treatment. The previous standard of practice was modified according to the current evidence-based guidelines and the national and local Government’s indications.1 The new standard of practice allowed our Unit to protect every patient and staff member from the coronavirus infection, providing the same high standard of care as before the COVID-19 outbreak.

scholarly journals A61 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE ACROSS CANADA

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 73-74
Author(s):  
C Heisler ◽  
R Mirza ◽  
O Kits ◽  
S Zelinsky ◽  
S Veldhuyzen van Zanten ◽  
...  
Keyword(s):  
Focus Groups ◽  
Diagnostic Delay ◽  
Healthcare Providers ◽  
Multidisciplinary Care ◽  
Specialty Care ◽  
Nutrition Support ◽  
Patient Centered ◽  
Care Access ◽  
Qualitative Approaches ◽  
Timely Access

Abstract Background Canada has the highest global age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD). Resulting from compounding prevalence and limited resources, timely access to specialty care is a challenge faced by patients and healthcare providers. Despite this issue, there has been no published research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. Aims To elicit a qualitative data stream to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, and British Columbia. All focus groups were audio recorded, transcribed, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of IBD specialty care access experiences. Results A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Conclusions The complexity of specialty care access for IBD patients in Canada cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in Canada can be better understood and improved on both a provincial and national scale. Funding Agencies CIHRNova Scotia Health Authority Research Fund

scholarly journals Medialization Laryngoplasty: A Review for Speech-Language Pathologists

2021 ◽  
Vol 64 (2) ◽  
pp. 481-490 ◽  
Author(s):  
Azure Wilson ◽  
Emily E. Kimball ◽  
Lea Sayce ◽  
Haoxiang Luo ◽  
Sid M. Khosla ◽  
...  
Keyword(s):  
Voice Disorders ◽  
Improve Patient Care ◽  
Multidisciplinary Care ◽  
Current Evidence ◽  
Anesthetic Technique ◽  
Speech Language Pathologists ◽  
Current State ◽  
State Of The Science ◽  
Improve Patient ◽  
Medialization Laryngoplasty

Purpose The purpose of this study is to familiarize speech-language-pathologists with the current state of the science regarding medialization laryngoplasty in the treatment of voice disorders, with emphasis on current evidence-based practice, voice outcomes, and future directions for research. Method A literature review was performed in PubMed and Embase using the keywords vocal fold/cord and laryngoplasty, thyroplasty, augmentation, or laryngeal framework . Articles published between 2010 and 2020 were reviewed for data about clinical applications, technical approach, voice-related outcomes, and basic science or clinical innovations with the potential to improve patient care. A synthesis of data was performed from articles meeting the outlined search criteria. Conclusions As key members in the multidisciplinary care of voice disorders, speech-language pathologists need to be informed of current research in medialization laryngoplasty, a procedure commonly used for patients with glottic insufficiency. Advances in anesthetic technique, office-based procedures, and the development of materials with increased bio-tolerability over the past decade have led to innovations in treatment and improved patient outcomes. Recent applications of computational and bioengineering approaches have the potential to provide new directions in the refinement of currently available techniques and the improvement of patient-based treatment outcomes.

scholarly journals The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1938
Author(s):  
Davide Biondini ◽  
Marco Damin ◽  
Martina Bonifazi ◽  
Elisabetta Cocconcelli ◽  
Umberto Semenzato ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Standard Of Care ◽  
Risk Exposure ◽  
Current Evidence ◽  
Risk Of Infection ◽  
Diagnosis And Management ◽  
Infectious Risk ◽  
Increased Risk ◽  
Diagnostic Management

Bronchoscopy has several major diagnostic and therapeutic indications in pulmonology. However, it is an aerosol-generating procedure that places healthcare providers at an increased risk of infection. Now more than ever, during the spread of the coronavirus disease 2019 (COVID-19) pandemic, the infectious risk during bronchoscopy is significantly raised, and for this reason its role in diagnostic management is debated. In this review, we summarized current evidence regarding the indications for bronchoscopy and the measures that should be applied to decrease risk exposure. Indeed, seeing the long-lasting period of the pandemic, resuming standard of care for all patients is required.

scholarly journals 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

scholarly journals Best Practices in Specialized Amyloidosis Centers in the United States: A Survey of Cardiologists, Nurses, Patients, and Patient Advocates

2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Healthcare Providers ◽  
Multidisciplinary Care ◽  
The United States ◽  
Comprehensive Care ◽  
Patient Support ◽  
Patient Support Group ◽  
Patient Advocates

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.

scholarly journals Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab

2021 ◽  
Vol 13 ◽  
pp. 175883592110311
Author(s):  
Chiun Hsu ◽  
Lorenza Rimassa ◽  
Hui-Chuan Sun ◽  
Arndt Vogel ◽  
Ahmed O. Kaseb
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Kinase Inhibitor ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Safety Data ◽  
Standard Of Care ◽  
Antiangiogenic Agents ◽  
Efficacy And Safety ◽  
First Line

In light of positive efficacy and safety findings from the IMbrave150 trial of atezolizumab plus bevacizumab, this novel combination has become the preferred first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Several additional trials are ongoing that combine an immune checkpoint inhibitor with another agent such as a multiple kinase inhibitor or antiangiogenic agent. Therefore, the range of first-line treatment options for unresectable HCC is likely to increase, and healthcare providers need succinct information about the use of such combinations, including their efficacy and key aspects of their safety profiles. Here, we review efficacy and safety data on combination immunotherapies and offer guidance on monitoring and managing adverse events, especially those associated with atezolizumab plus bevacizumab. Because of their underlying liver disease and high likelihood of portal hypertension, patients with unresectable HCC are at particular risk of gastrointestinal bleeding, and this risk may be exacerbated by treatments that include antiangiogenic agents. Healthcare providers also need to be alert to the risks of proteinuria and hypertension, colitis, hepatitis, and reactivation of hepatitis B or C virus infection. They should also be aware of the possibility of rarer but potentially life-threatening adverse events such as pneumonitis and cardiovascular events. Awareness of the risks associated with these therapies and knowledge of adverse event monitoring and management will become increasingly important as the therapeutic range broadens in unresectable HCC.

scholarly journals Harnessing COVID-Driven Technical Innovations for Improved Multi-Disciplinary Cancer Care in the Post-COVID Era: The Virtual Patient Room

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482096480 ◽  
Author(s):  
Austin J. Sim ◽  
Gage Redler ◽  
Jeffrey Peacock ◽  
Cristina Naso ◽  
Stuart Wasserman ◽  
...  
Keyword(s):  
New Technology ◽  
Multidisciplinary Care ◽  
Virtual Patient ◽  
Paradigm Shifts ◽  
Patient Room ◽  
Patient Centered ◽  
Team Members ◽  
The Road ◽  
Centered Care ◽  
Virtual Visits

Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine. Even after the initial wave of the virus subsides, a wholesale return to the prior status quo is not prudent. As a specialty that values the proper application of new technology, radiation oncology should strive to be at the forefront of harnessing telehealth as an important tool to further optimize patient care. We remain cognizant that telehealth cannot and should not be a comprehensive replacement for in-person patient visits because it is not a one for one replacement, dependent on the intention of the visit and patient preference. However, we envision the opportunity for the virtual patient “room” where multidisciplinary care may take place from every specialty. How we adapt is not an inevitability, but instead, an opportunity to shape the ideal image of our new normal through the choices that we make. We have made great strides toward genuine multidisciplinary patient-centered care, but the continued use of telehealth and virtual visits can bring us closer to optimally arranging the spokes of the provider team members around the central hub of the patient as we progress down the road through treatment.

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