scholarly journals EP.TU.369Straight to Test (STT) vs. Traditional Colorectal Target Investigations Pathway - A Local Audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michelle Fong ◽  
Sophie Shepherd ◽  
Luluwa Dixon ◽  
Loukis Meleagros ◽  
Lee Dvorkin ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cancer Treatment ◽  
Definitive Diagnosis ◽  
T Test ◽  
National Standards ◽  
Patient Contact ◽  
Time To Treatment ◽  
Time To Diagnosis ◽  
Fit Testing ◽  
Standard Of Practice

Abstract Aims The STT pathway was borne out of the National Cancer Strategy 2015 and faster diagnosis standard to rule in, or out, cancer within 28 days of referral. We aimed to review local target standard of practice, including comparison of STT vs Traditional pathways towards reaching the national standards. Methods The Somerset Database for all target referrals to the department was accessed. We chose October 2019 as a period unaffected by COVID-19. Time to investigation, results and treatment were reviewed. SPSS v.16 was used to perform an unpaired T-test of Traditional vs. STT time to diagnosis. Results 212 patients were referred for target investigations. 53 declined, DNA-ed or were unfit. 159 proceeded to investigations of which 7 cancers were diagnosed: 4 colorectal, 1 gastric and 2 lung. Time to diagnosis averaged 45.8 days and only 47/159 (29.6%) had their definitive diagnosis in 28 days. 52 patients were streamed to STT and 107 traditional pathways. STT patients were diagnosed at 36.3 days (95% CI 28.1-44.6) and traditional patients 50.5 days (95% CI 45.4-55.7) (P = 0.005). Cancer treatment was received median day 59 (range 27-189) and 4/7 received this within 62 days. Conclusion Target investigations have low pick up rates of cancers with ever increasing referrals. Our centre did not meet aspirational national targets of time to treatment or diagnosis, although STT patients were diagnosed significantly faster. With COVID-19, rationalisation of patient contact with maintained diagnosis rates must be strategised. Stricter FIT testing with risk stratification and STT expansion is one strategy.

Predictive Modeling for Adverse Events and Risk Stratification Programs for People Receiving Cancer Treatment

2021 ◽  
pp. OP.21.00198
Author(s):  
Chelsea K. Osterman ◽  
Hanna K. Sanoff ◽  
William A. Wood ◽  
Megan Fasold ◽  
Jennifer Elston Lafata
Keyword(s):  
Clinical Practice ◽  
Risk Stratification ◽  
Cancer Treatment ◽  
Acute Care ◽  
Predictive Modeling ◽  
Predictive Models ◽  
Emergency Department Visits ◽  
Targeted Interventions ◽  
Risk Algorithm ◽  
Oncology Care

Emergency department visits and hospitalizations are common among people receiving cancer treatment, accounting for a large proportion of spending in oncology care and negatively affecting quality of life. As oncology care shifts toward value- and quality-based payment models, there is a need to develop interventions that can prevent these costly and low-value events among people receiving cancer treatment. Risk stratification programs have the potential to address this need and optimally would consist of three components: (1) a risk stratification algorithm that accurately identifies patients with modifiable risk(s), (2) intervention(s) that successfully reduce this risk, and (3) the ability to implement the risk algorithm and intervention(s) in an adaptable and sustainable way. Predictive modeling is a common method of risk stratification, and although a number of predictive models have been developed for use in oncology care, they have rarely been tested alongside corresponding interventions or developed with implementation in clinical practice as an explicit consideration. In this article, we review the available published predictive models for treatment-related toxicity or acute care events among people receiving cancer treatment and highlight challenges faced when attempting to use these models in practice. To move the field of risk-stratified oncology care forward, we argue that it is critical to evaluate predictive models alongside targeted interventions that address modifiable risks and to demonstrate that these two key components can be implemented within clinical practice to avoid unplanned acute care events among people receiving cancer treatment.

scholarly journals Times to Diagnosis, Staging, and Treatment of Head and Neck Cancer Before and During COVID-19

OTO Open ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 2473974X2110594
Author(s):  
Peter Yao ◽  
Victoria Cooley ◽  
William Kuhel ◽  
Andrew Tassler ◽  
Victoria Banuchi ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Head And Neck Cancers ◽  
Newly Diagnosed ◽  
Time To Treatment ◽  
Time To Diagnosis ◽  
The Times

Objective The coronavirus disease 2019 (COVID-19) pandemic has reduced the demand for, and supply of, head and neck cancer services. This study compares the times to diagnosis, staging, and treatment of head and neck cancers before and during the COVID-19 pandemic. Study Design Retrospective cohort study. Setting Tertiary academic medical center in New York City (NYC). Methods The times to diagnosis, staging, and treatment of head and neck cancer for patients presenting to the clinics of 4 head and neck oncology surgeons with newly diagnosed head and neck cancers were compared between pre–COVID-19 and COVID-19 periods. Results Sixty-eight patients in the pre–COVID-19 period and 26 patients in the COVID-19 period presented with newly diagnosed head and neck cancer. Patients in the COVID-19 group had a significantly longer time to diagnosis than the pre–COVID-19 group after adjustment for age and cancer diagnosis ( P = .02; hazard ratio [HR], 0.54; 95% CI, 0.32-0.92). Patients in the pre–COVID-19 and COVID-19 groups had no statistically significant differences in time to staging ( P > .9; HR, 1.01; 95% CI, 0.58-1.74) or time to treatment ( P = .12; HR, 1.55; 95% CI, 0.89-2.72). Conclusion This study found that time to diagnosis for head and neck cancers was delayed during a COVID-19 period compared to a pre–COVID-19 period. However, there was no evidence of delays in time to staging and time to treatment during the COVID-19 period. Our results prompt further investigations into the factors contributing to diagnostic delays but provide reassurance that despite COVID-19, patients were receiving timely staging and treatment for head and neck cancers.

scholarly journals Echocardiography with Elevated Central Venous Pressure Diagnosing Constrictive Pericarditis More Accurately Than Chest CT Scan: A Retrospective Study in 36 Cases

2018 ◽  
Vol 21 (3) ◽  
pp. 190
Author(s):  
Liwen Bao ◽  
Jiechun Huang ◽  
Fangrui Wang ◽  
Liewen Pang ◽  
Yiqing Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Function ◽  
Central Venous Pressure ◽  
Constrictive Pericarditis ◽  
Venous Pressure ◽  
Definitive Diagnosis ◽  
Central Venous ◽  
Imaging Results ◽  
Time To Diagnosis

Background: Constrictive pericarditis (CP) is defined as impaired diastolic cardiac function caused by a calcified and thickened pericardium. We assessed the clinical characteristics and time to diagnosis, as well as patient prognosis after pericardiectomy. Methods: We analyzed the records of 36 CP patients who underwent pericardiectomy at Huashan Hospital, China, between 2012 and 2015. Clinical manifestations, length of time to diagnosis, laboratory parameters, and diagnostic imaging results were examined. All patients underwent pericardiectomy, and were assessed post-operatively for quality of life and improvement of cardiac function using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: All patients displayed shortness of breath and polyserous effusion, as well as elevated pro B-type natriuretic peptide and thickened pericardium. Mean time between onset of symptoms and a definitive diagnosis of CP was 9.5 ± 2.1 months. Pericardiectomy was performed within one week of diagnosis. Mean central venous pressure decreased from a pre-operative 19.92 ± 6.6 mmHg to a post-operative 8.5 ± 2.7 mmHg. Within 1.5 ± 0.7 years of surgery, all patients maintained good quality of life and cardiac function, which resulted in a mean score of 0.9 ± 0.6 on the MLHFQ. Conclusion: A definitive diagnosis of CP is usually made long after the onset of symptoms. Early detection and diagnosis by echocardiography with elevated central venous pressure and early treatment by surgery are key to an improved prognosis and resumption of good cardiac function.

Diagnosis, risk stratification, and therapeutic choices

2020 ◽  
pp. 16-44
Author(s):  
Tom Boterberg ◽  
Edmund Cheesman ◽  
Felice D’Arco ◽  
Karin Dieckmann ◽  
Mark Gaze ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cancer Diagnosis ◽  
Significant Proportion ◽  
Definitive Diagnosis ◽  
Pathological Examination ◽  
Second Primary ◽  
Treatment Schedule ◽  
Tumour Type ◽  
Children And Young People ◽  
The Family

Chapter 3 discusses cancer diagnosis, risk stratification, and therapeutic choices in children and young people. Radiological investigations support the diagnosis and provide staging information for accurate risk stratification. Interventional radiology is useful for obtaining tissue for pathological examination. Histopathology and molecular studies define the precise tumour type and subtype and are used to confirm or rule out the presence of metastatic disease. Post-operative histopathology defines the extent of spread and is important for the staging of some tumours. Together, these findings inform multidisciplinary team discussion and help to identify the best treatment schedule. A significant proportion of cancers have a genetic basis, and it is important to identify these from the family history, predisposing syndromes, or tumour type. Modern molecular genomic techniques have made definitive diagnosis easier. Some genetic conditions lead to increased radiosensitivity and may predispose the patient to excessive radiation-related morbidity and a high risk of second primary tumours.

Building a population management informatics infrastructure for oncology care.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 315-315
Author(s):  
Jennifer Elston Lafata ◽  
Stephen Harris ◽  
Megan Fasold ◽  
Audrey Holdren ◽  
Hanna Kelly Sanoff
Keyword(s):  
Quality Improvement ◽  
Risk Stratification ◽  
Cancer Treatment ◽  
Academic Medical Center ◽  
Population Management ◽  
Care Quality ◽  
Quality Monitoring ◽  
Treatment Episode ◽  
Oncology Patients ◽  
Informatics Infrastructure

315 Background: While most primary care practices have informatics infrastructures to support population management, such infrastructures are not commonplace in oncology. Yet, value-based care requires that oncology practices be able to identify patients in real time, use risk stratification to target care efficiently, and monitor care quality to identify improvement opportunities. We describe an oncology informatics infrastructure development initiative in a large academic medical center. Methods: We convened a quality improvement team of administrators, analysts, clinicians, health services researchers and performance improvement staff. The team was sponsored by a senior leadership committee convened for a strategic planning initiative. We used PDSA cycles to develop and test ways to leverage data from an electronic health record (EHR) and billing system for oncology patient identification, risk stratification, and routine quality monitoring. We used clinician engagement, medical record review, and tumor registry comparisons to validate query strategies. Results: After considering different query strategies, we opted to identify patients via a new cancer treatment episode (as defined by a cancer diagnosis combined with evidence of pharmaceutical, radiation, and/or surgical treatment for cancer with no evidence of such treatment in the prior six months). This was done using diagnostic and procedural codes for chemo/immunotherapy and radiation treatment, and pathology reports and procedural codes for surgery. Using this approach, we identified over 7800 cancer treatment episodes within the health system in 2018. These episodes corresponded to 4178 chemo/immunotherapy, 1437 radiation, and 3440 surgical treatments. Quality monitoring has identified opportunities to enhance data capture, harmonize documentation processes across practitioners and practices, and initiate quality improvement efforts. Conclusions: Using data from the EHR and billing systems we are able to identify oncology patients as they initiate a cancer treatment episode. In so doing, we are able to track the quality of care delivered to oncology patients as they move across the care continuum from treatment to survivorship.

Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction

1999 ◽  
Vol 84 (11) ◽  
pp. 1281-1286 ◽  
Author(s):  
E.Magnus Ohman ◽  
Paul W Armstrong ◽  
Harvey D White ◽  
Christopher B Granger ◽  
Robert G Wilcox ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Point Of Care ◽  
T Test ◽  
Cardiac Troponin T

scholarly journals Racial Comparisons in Timeliness of Colon Cancer Treatment in an Equal-Access Health System

2019 ◽  
Vol 112 (4) ◽  
pp. 410-417 ◽  
Author(s):  
Yvonne L Eaglehouse ◽  
Matthew W Georg ◽  
Craig D Shriver ◽  
Kangmin Zhu
Keyword(s):  
Colon Cancer ◽  
Health System ◽  
Cancer Treatment ◽  
Medical Care ◽  
Confidence Intervals ◽  
Equal Access ◽  
Treatment Delays ◽  
Time To Treatment ◽  
Delayed Treatment ◽  
Access To Medical Care

Abstract Background Non-Hispanic black (NHB) adults with cancer may have longer time-to-treatment than non-Hispanic whites (NHW) in the United States. Unequal access to medical care may partially account for this racial disparity. This study aimed to investigate whether there were racial differences in time-to-treatment and in treatment delays for patients diagnosed with colon cancer in the equal-access Military Health System (MHS). Methods Patients age 18–79 years diagnosed with colon adenocarcinoma between January 1, 1998, and December 31, 2014, were identified in the Department of Defense Central Cancer Registry and the MHS Data Repository–linked databases. Median time-to-treatment (surgery and chemotherapy) and 95% confidence intervals were compared between NHBs and NHWs in multivariable quantile regression models. Odds ratios and 95% confidence intervals of receiving delayed treatment defined by guidelines for NHBs relative to NHWs were estimated using multivariable logistic regression. Results Patients (n = 3067) had a mean age at diagnosis of 58.4 (12.2) years and the racial distribution was 76.7% NHW and 23.3% NHB. Median adjusted time-to-treatment was similar for NHB compared to NHW patients. The likelihood of receiving delayed treatment was similar between NHB and NHW patients. Conclusions In the MHS, there was no evidence of treatment delays for NHBs compared to NHWs, suggesting the role of equal access to medical care and insurance coverage in reducing racial disparities in colon cancer treatment.

scholarly journals Evaluation of AccuFIT 9000: A Novel Apparatus for Quantitative Fit Testing of Particulate Respirators

2020 ◽  
Author(s):  
Sergey A Grinshpun ◽  
Michael Yermakov ◽  
Minoru Kano
Keyword(s):  
National Standards ◽  
The Novel ◽  
Frontline Workers ◽  
Fit Testing ◽  
Respiratory Protective Devices ◽  
Cost Efficient ◽  
Novel Coronavirus ◽  
Testing Instruments ◽  
Condensation Particle Counting ◽  
Saturation Chamber

Abstract Various strategies developed for protecting frontline workers and the general public from the novel coronavirus, SARS-CoV-2, largely rely on respiratory protective devices (RPDs), especially considering recent evidence about the aerosol transmission route of COVID-19. Performance of an RPD primarily depends on how well the protective device fits the wearer. Therefore, quantitative fit testing of particulate respirators is crucial for achieving the intended protection level. Millions of fit tests are conducted every year using a US OSHA-accepted standard protocol involving a PortaCount® (TSI Inc., Shoreview, MN, USA) which measures a respirator fit factor. Recently, several alternative fit testing instruments have been developed and introduced to the market. Among them is an AccuFIT 9000 (Kanomax-Japan Inc., Suita-city, Osaka, Japan), which, like the PortaCount®, utilizes the condensation particle counting principle, but features an advanced saturation chamber design allowing for a longer residence time and greater flow stability. It is also claimed to have a more cost-efficient assembly than its predecessors. In this study, the novel AccuFIT apparatus was extensively evaluated against the PortaCount® (the reference instrument) using the traditional standard fit testing protocol and following the American National Standards Institute (ANSI) standard (Z88.10-2010 Annex A2). The evaluation was performed with three types of respirators, N95 filtering facepiece respirator (FFR), P100 FFR, and half-mask elastomeric facepiece, of different models and manufacturers donned on 25 subjects. The comparative testing and analysis showed that the AccuFIT 9000 is capable of identifying an inadequate fit of the tested respirators with a sensitivity 0.95 and specificity of 0.97, which meets the ANSI requirement of ≥0.95. The other ANSI requirements/recommendations were also met. It was concluded that the novel fit testing apparatus demonstrated an acceptable performance and, thus, can be successfully deployed for the quantitative respirator fit testing.

Sign in / Sign up

Export Citation Format

Share Document