Developing and implementing a Radiotherapy Research Activity Assessment Tool (RAAT): a prospective feasibility study

2016 ◽  
Vol 15 (3) ◽  
pp. 223-231
Author(s):  
Simon Goldsworthy ◽  
Benjamin Roe ◽  
Stuart McGrail ◽  
Stephen McCormack ◽  
Julie Walther
Keyword(s):  
Cancer Research ◽  
Clinical Practice ◽  
Quality Function Deployment ◽  
Assessment Tool ◽  
Clinical Settings ◽  
Research Activity ◽  
Activity Assessment ◽  
User Friendly ◽  
The Impact

AbstractAimCancer research in the National Health Service has increased by 10·5% in 3 years since the formation of the National Cancer Research networks in 2000. The initial enthusiasm from clinical staffs to embark on a project has to be balanced against the implications of resources, costs and other developments. There is no standardised method to assess the impact of research projects on clinical practice. The aim of this project was to develop and implement a Radiotherapy Research Activity Assessment Tool (RAAT) to assess the feasibility of newly proposed projects within clinical settings.Methods and materialsA multi-step development method was used. The steps involved the principles of quality function deployment. The consecutive steps involved developing a user-friendly and replicable tool and would fit on one A4 page. The process involved multi-professionals and patients throughout the design process. The tool was preliminary tested on usability among eight stakeholders on a ten-point scale (1=poor; 10=very good). Percentage agreement was evaluated at 6 month post initial RAAT assessment scoring by the seven multi-disciplinary team (MDT) members.FindingsThe RAAT was developed in an e-form available in Microsoft Excel. The tool scored a mode of 6 for usability. Interrater reliability testing between the radiotherapy MDT resulted in 88% agreement. The RAAT seems to be feasible in clinical practice, and provide a framework to guide the decision-making process. The study calls for further testing of usability and review of long-term implications on all stakeholders.

scholarly journals Undertaking Procedure-Based Assessment is Feasible in Clinical Practice

2009 ◽  
Vol 91 (2) ◽  
pp. 110-112 ◽  
Author(s):  
K James ◽  
K Cross ◽  
ME Lucarotti ◽  
AL Fowler ◽  
TA Cook
Keyword(s):  
Clinical Practice ◽  
Pilot Study ◽  
Anterior Resection ◽  
Assessment Tool ◽  
Right Hemicolectomy ◽  
Time Constraints ◽  
Main Study ◽  
Minimal Impact ◽  
The Impact ◽  
Colorectal Procedures

INTRODUCTION With the development of a new curriculum, workplace based assessments such as procedure-based assessment (PBA) are becoming increasingly common within surgical training. However, there have been concerns about the impact of these assessments on clinical practice. This study assessed the time taken to complete PBA forms to determine whether it is feasible in clinical practice. MATERIALS AND METHODS PBAs for three colorectal procedures (anterior resection, right hemicolectomy and anal fistula) were undertaken by various trainers and trainees. A pilot study was performed to identify potential reasons for incomplete forms and procedural modifications subsequently applied in the main study. Times taken to complete the consenting and operative components of the forms were recorded. RESULTS Incomplete forms in the pilot were mainly attributable to time constraints. In the main study, all assessments were completed within 30 min. Assessment times increased with complexity of the procedure. Median times for completing the consenting and operative components in anterior resection were 13 min (range, 8–15 min) and 15 min (range, 10–18 min), respectively. CONCLUSIONS PBAs are feasible in clinical practice and are valued by trainees as a means of enabling focused feedback and targeted training. Commitment from trainers and trainees will be required but, with adequate planning, the assessment tool is effective with minimal impact on clinical practice.

scholarly journals Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

2012 ◽  
Vol 32 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Nobuhiro Ayuzawa ◽  
Yoshitaka Ishibashi ◽  
Yutaka Takazawa ◽  
Haruki Kume ◽  
Toshiro Fujita
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
University Hospital ◽  
Dialysis Therapy ◽  
Compact Zone ◽  
Peritoneal Biopsy ◽  
The Mean ◽  
The Impact ◽  
Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

scholarly journals 3575 Assessing Research Activity and Capacity of Community Based Organizations: Field Testing of the Community Research Activity Assessment Tool (CREAT)

2019 ◽  
Vol 3 (s1) ◽  
pp. 84-84
Author(s):  
Mahaya Allie Walker ◽  
Natasha Ray ◽  
David Fiellin ◽  
Debbie Humphries
Keyword(s):  
Assessment Tool ◽  
Field Testing ◽  
Research Capacity ◽  
Knowledge Generation ◽  
Community Research ◽  
Structured Interviews ◽  
Self Administration ◽  
Research Activity ◽  
Research Partnerships ◽  
Activity Assessment

OBJECTIVES/SPECIFIC AIMS: 1. To assess the acceptability and feasibility and of an online self-assessment version of the Community REsearch Activity Assessment Tool (CREAT), an instrument to measure research capacity of CBOs. 2. To elicit CBO perspectives on their research and knowledge generation activities. METHODS/STUDY POPULATION: Thirteen CBOs who had previously partnered with an academic course on practice-based community health research were contacted and asked to participate in the field testing of the CREAT and provide feedback on areas of strength and areas for potential improvement. Eleven organizations completed the field testing, which began and ended with an in-person semi-structured interview with the online self-administration of the CREAT in the middle. The semi-structured interviews were audio-recorded with questions pertaining to topics such as: strengths and challenges of previous academic research partnerships, perceptions around the importance of research within the organization, thoughts and reactions to the CREAT, and general feedback about the CREAT. Results from the self-administered CREAT were used to test a scoring algorithm. Semi-structured interviews are being transcribed, pre-post responses to questions of strengths and challenges in engaging in research partnerships will be compared, and overall qualitative transcripts will be coded using grounded theory. RESULTS/ANTICIPATED RESULTS: Anticipated Results: The CREAT was acceptable and self-administration was feasible. Average time for completion of the online CREAT was 41 ± 13 min, and respondents did not need assistance from the interviewer to complete the online instrument. Suggestions for improvements focused on word choices and scale options. Respondents were aware of the importance of research activities for their CBOs, particularly for optimizing programmatic quality and services. Access to staff and financial resources were key barriers to strengthening research capacity, and respondents noted that engaging in research partnerships can also bring in additional resources. Interview transcription is still in progress along with the refinement of the codebook for the qualitative data collected. In alignment with objectives/goals outlined above, the results will be separated into the following four sections: CBO Research and Knowledge Generation Activities, Acceptability of the Tool, Feasibility of the Tool, and Refinement of the Tool. DISCUSSION/SIGNIFICANCE OF IMPACT: The online, self-administered CREAT instrument is acceptable and feasible for CBO respondents. Availability of a validated tool to assess research capacity of CBOs, developed and refined with input from community researchers, will support targeted research capacity building for CTSAs, community organizations and partners, thus strengthening collaborations. Translational scientists, public health systems and community health improvement depend on CBOs as partners in community-engaged research (CEnR). The CREAT will allow community members to more fully contribute their expertise to the development, implementation and evaluation of interventions, and to develop more equitable partnerships with researchers.

scholarly journals The Human Cost of 'Caring' Care for Registered Nurses in Clinical Practice

2021 ◽  
Author(s):  
◽  
Sylvia Margaret Shona Blair
Keyword(s):  
Clinical Practice ◽  
Registered Nurses ◽  
Public Hospital ◽  
Elderly Population ◽  
Nursing Practice ◽  
Clinical Settings ◽  
Health Reforms ◽  
The Core ◽  
Human Cost ◽  
The Impact

<p>This research utilised a focus group methodology to discover what nurses in clinical practice considered 'caring' care meant for them. Six registered nurses volunteered to participate in the project. They practised over a variety of clinical settings within a public hospital, which provided both acute and elective surgical and medical services to the community, including an extensive elderly population.  Taking these important 'caring' care statements, I then explored with the group what factors in their work environment hindered or enhanced their identified 'caring' care. New Zealand nurses identified similar themes and concepts important to their 'caring' in clinical practice as did their overseas counterparts.  This study also highlighted the impact the health reforms had on individual clinical practice at this hospital. The effects of the institutional changes in response to the health reforms were far reaching at both a personal and professional level.  Caring is an important concept found in nursing practice. It has been widely documented by nurse scholars, researchers and nurse authors that care is at the core of nursing practice. Some have even referred to care as being the heart of nursing. The findings from the present research indicates the importance nurses place on caring in their day to day encounters with patients. It also demonstrates how nurses express their care and their perceptions of the importance care has in their clinical practice.</p>

scholarly journals Endoscopic and Histologic Predictors of Outcomes in Pediatric Ulcerative Colitis—Caveat Emptor

2021 ◽  
Vol 9 ◽  
Author(s):  
Lorraine Stallard ◽  
Séamus Hussey
Keyword(s):  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Term Treatment ◽  
Clinical Settings ◽  
Adult Disease ◽  
Long Term Treatment ◽  
Acute Severe Colitis ◽  
The Impact ◽  
Severe Colitis

The impact of endoscopic and histological mucosal healing on outcomes in adult settings is impressive. Despite many clinical parallels, pediatric ulcerative colitis (UC) is set apart from adult disease in several respects. Many frequently used indices are not fully validated, especially in pediatric settings, and consensus on precise definitions in clinical settings are lacking. Endoscopic mucosal healing is an acceptable long-term treatment goal in pediatrics, but not histologic normalization. Early prediction of disease course in UC may allow treatment stratification of patients according to risks of relapse, acute severe colitis, and colectomy. Putative endoscopic and histologic predictors of poor clinical outcomes in adults have not held true in pediatric settings, including baseline endoscopic extent, endoscopic severity, and specific histologic characteristics which are less prevalent in pediatrics at diagnosis. In this mini-review we appraise predictive endoscopic and histologic factors in pediatric UC with reference to relapse, severe colitis, and colectomy risks. We recommend that clinicians routinely use endoscopic and histologic sores to improve the quality of clinical and research practice. The review summarizes differences between adult and pediatric prediction data, advises special consideration of those with primary sclerosing cholangitis, and suggests areas for future study in this field.

scholarly journals Deep inspiration breath hold versus free breathing technique in mediastinal radiotherapy for lymphoma

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20200067
Author(s):  
Orla Anne Houlihan ◽  
Guhan Rangaswamy ◽  
Mary Dunne ◽  
Christine Rohan ◽  
Louise O'Neill ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Clinical Practice ◽  
Organs At Risk ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
The Impact

Objective: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. Methods: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. Results: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). Conclusion: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. Advances in knowledge: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.

scholarly journals Small Reservoir Impact on Simulated Watershed-Scale Nutrient Yield

2007 ◽  
Vol 2007 ◽  
pp. 1-4 ◽  
Author(s):  
Shane J. Prochnow ◽  
Joseph D. White ◽  
Thad Scott ◽  
Christopher Filstrup
Keyword(s):  
Total Phosphorus ◽  
Nutrient Loading ◽  
Assessment Tool ◽  
Agricultural Runoff ◽  
Surface Flow ◽  
Long Term Storage ◽  
Nutrient Yield ◽  
Potential Strategy ◽  
The Impact

The soil and water assessment tool (SWAT) is used to assess the influence of small upland reservoirs (PL566) on watershed nutrient yield. SWAT simulates the impact of collectively increasing and decreasing PL566 magnitudes (size parameters) on the watershed. Totally removing PL566 reservoirs results in a 100%increase in total phosphorus and an 82%increase in total nitrogen, while a total maximum daily load (TMDL) calling for a 50%reduction in total phosphorus can be achieved with a 500%increase in the magnitude of PL566s in the watershed. PL566 reservoirs capture agriculture pollution in surface flow, providing long-term storage of these constituents when they settle to the reservoir beds. A potential strategy to reduce future downstream nutrient loading is to enhance or construct new PL566 reservoirs in the upper basin to better capture agricultural runoff.

scholarly journals A Pan-Canadian Framework for Cancer Survivorship Research

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 179s-179s ◽  
Author(s):  
R. Urquhart ◽  
J. Kontak ◽  
M. Rothfus ◽  
G. Collier ◽  
E. Green ◽  
...  
Keyword(s):  
Cancer Research ◽  
Cancer Survivorship ◽  
Research Funding ◽  
Online Survey ◽  
Research Priorities ◽  
Long Term Effects ◽  
Framework Development ◽  
The Impact ◽  
National Framework

Background and context: Across all cancer types, two-thirds of Canadians diagnosed with cancer today will survive long-term, reflecting great progress in cancer detection and treatment. Many survivors, however, will experience substantial and long-term impacts of their diagnosis and treatment. Within this context, the Canadian Cancer Research Alliance (CCRA) sought to inform the cancer research funding community on how, and what kinds of research are needed, to enable research that will make a difference to patients as they move from treatment to the posttreatment phase. Aim: To develop and implement a national framework and recommendations to enable coordinated and strategic action among cancer research funders that advances cancer survivorship research in Canada in ways that improve survivors' care and experiences. Strategy/Tactics: Multiple approaches were used to inform framework development: a strategic literature review; an analysis of cancer survivorship research funding from 2005-13; and an online survey and key informant interviews from the broader stakeholder community. An Expert Panel and Patient Advisory Committee were also engaged to provide guidance and feedback. Program/Policy process: Over the course of one year, the project team and a working group of CCRA members met regularly to steer framework development. This involved activities such as developing data collection approaches and tools, reviewing data and emerging findings, and translating findings into priority areas and recommendations. In total, > 200 Canadian and international stakeholders provided input through the survey and interviews. Outcomes: Released March 2017, the Pan-Canadian Framework for Cancer Survivorship Research provides four recommendations for cancer research funders: 1) ensure ongoing and meaningful involvement of cancer survivors; 2) align funding calls with existing needs and potential for impact; 3) create opportunities for the translation of research into practice and policy; and 4) build and maintain infrastructure and expertise to advance research. Specific research priorities were emphasized across three research domains: survivors' experiences and outcomes; late and long-term effects; and models of care. The priorities ranged from investigating the mechanisms of late/long-term effects to conducting intervention research to improve psychosocial outcomes, prevent and ameliorate late effects, and improve integration of follow-up care. What was learned: A broad range of stakeholders came together to develop a national framework to maximize the impact of shared targeted research investment in cancer survivorship research. Survivors' voices were key to agreeing on definitional issues of survivorship, identifying priority research areas, and ultimately lending credibility to the resulting framework. Implementation of the framework is the next step of work for CCRA members. Planning has commenced on identifying an initial priority for joint action.

scholarly journals Psychological and Medico-Legal Perspectives on Electroconvulsive Therapy and Patient-Centered Care: A Short Review of Cross-Cutting Issues

2020 ◽  
Vol 13 (1) ◽  
pp. 253-263
Author(s):  
Valeria Tullio ◽  
Stefania Zerbo ◽  
Antonietta Lanzarone ◽  
Salvatore Procaccianti ◽  
Antonina Argo
Keyword(s):  
Electroconvulsive Therapy ◽  
Short Review ◽  
Point Of View ◽  
Clinical Settings ◽  
Patient Centered ◽  
Medical Settings ◽  
Scientific World ◽  
Centered Care ◽  
The Impact

Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines, etc. From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in recent times. Therefore, the aim of this article is to focus on the following cross-cutting issues: the therapist-patient relationship, the patient’s perspective, the attitude on electroconvulsive therapy, and informed consent. This short review refers to the international literature on ECT published since 2000. Analyses of the three previously listed topics are, in part, made within the context of Italian medical settings.

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