Follow-up Report on Burned Hands, Treatment Plans

PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive ( v 30 minutes, importance weights [95% CI] of –0.54 [–0.80 to –0.27], –0.57 [–0.84 to –0.29], and –0.17 [–0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.

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Differences in rituximab use between pediatric rheumatologists and nephrologists for the treatment of refractory lupus nephritis and renal flare in childhood-onset SLE

Pediatric Rheumatology ◽

10.1186/s12969-021-00627-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Mileka Gilbert ◽

Beatrice Goilav ◽

Joyce J. Hsu ◽

Paul J. Nietert ◽

Esra Meidan ◽

...

Keyword(s):

Lupus Nephritis ◽

Induction Therapy ◽

Pediatric Nephrology ◽

Response To Treatment ◽

Individual Treatment ◽

Induction Treatment ◽

Childhood Onset ◽

Renal Flare ◽

Treatment Plans

Abstract Background Consensus treatment plans have been developed for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in childhood-onset systemic lupus erythematosus. However, patients who do not respond to initial therapy, or who develop renal flare after remission, warrant escalation of treatment. Our objective was to assess current practices of pediatric nephrologists and rheumatologists in North America in treatment of refractory proliferative LN and flare. Methods Members of Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the American Society for Pediatric Nephrology (ASPN) were surveyed in November 2015 to assess therapy choices (other than modifying steroid dosing) and level of agreement between rheumatologists and nephrologists for proliferative LN patients. Two cases were presented: (1) refractory disease after induction treatment with corticosteroid and cyclophosphamide (CYC) and (2) nephritis flare after initial response to treatment. Survey respondents chose treatments for three follow up scenarios for each case that varied by severity of presentation. Treatment options included CYC, mycophenolate mofetil (MMF), rituximab (RTX), and others, alone or in combination. Results Seventy-six respondents from ASPN and foty-one respondents from CARRA represented approximately 15 % of the eligible members from each organization. Treatment choices between nephrologists and rheumatologists were highly variable and received greater than 50 % agreement for an individual treatment choice in only the following 2 of 6 follow up scenarios: 59 % of nephrologists, but only 38 % of rheumatologists, chose increasing dose of MMF in the case of LN refractory to induction therapy with proteinuria, hematuria, and improved serum creatinine. In a follow up scenario showing severe renal flare after achieving remission with induction therapy, 58 % of rheumatologists chose CYC and RTX combination therapy, whereas the top choice for nephrologists (43 %) was CYC alone. Rheumatologists in comparison to nephrologists chose more therapy options that contained RTX in all follow up scenarios except one (p < 0.05). Conclusions Therapy choices for pediatric rheumatologists and nephrologists in the treatment of refractory LN or LN flare were highly variable with rheumatologists more often choosing rituximab. Further investigation is necessary to delineate the reasons behind this finding. This study highlights the importance of collaborative efforts in developing consensus treatment plans for pediatric LN.

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Incorporating HER2/HER3 targeted therapies across solid tumors: Assessing the impact of digital education on clinician practice patterns.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.11036 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 11036-11036

Author(s):

Tariqa Ackbarali ◽

Wendy Turell ◽

Elizabeth L. del Nido ◽

Adam Brufsky ◽

Stephen V. Liu

Keyword(s):

Breast Cancer ◽

Gastric Cancer ◽

Clinical Practice ◽

Patient Experience ◽

Targeted Therapies ◽

Her2 Breast Cancer ◽

Treatment Plans ◽

Tumor Types ◽

Behavioral Impact

11036 Background: Improved understanding of the interactions between HER2 and HER3, the heterogeneity of HER-expressing disease, and mechanisms of resistance to anti-HER2 therapy has led to increasing number of treatment options to address clinical needs. Tumor types of interest, impacted by HER2/HER3 expression and pathophysiology were breast cancer, non-small cell lung cancer (NSCLC), gastric cancer, and colorectal cancer (CRC). Increasing competency in these areas is deemed critical to clinician’s ability to individualize treatment plans and improve patient outcomes. Methods: A 2-hour CME activity was broadcast live-online in September 2020 and remains on-demand through September 2021 at OMedLive.com. The educational initiative was divided into one hour addressing HER2 and HER3, testing guidelines, resistance mechanisms and emerging data elucidating recent and ongoing clinical trials across NSCLC, gastric cancer, and CRC. The second hour focused on individualizing metastatic HER2+ breast cancer, HER2-low breast cancer as an emerging subtype, and management of side effects. Knowledge and competence questions were administered pre-, immediate post-, and 2 mos. post-activity. Behavioral impact questions were also asked at follow-up. Data from these questions were analyzed to determine engagement and clinical impact. Results: To date, 448 clinicians participated in the activity. Across the seven CME test questions, improvements in knowledge and competence were observed in the clinical applications of HER2-directed agents and HER3 antibody drug conjugates (ADCs), first-line standard of care for HER2+ breast cancer, and adverse event management for HER2 ADCs. At 2-mos. follow-up, 67% reported improved behavioral impact on both clinical practice and patient experience and outcomes. Clinicians provided specific write-in examples of these changes, noting improved patient-reported outcomes, improved treatment adherence, improved competence developing treatment plans, and increased understanding of HER2/HER3 pathophysiology. Updated and expanded results will be shared. Conclusions: The activity was successful in improving clinician understanding of the relationship between HER2/HER3, pathophysiology across tumor types, and applications of emerging targeted therapies. Open-ended responses to behavioral impact questions illustrated clear improvements in clinician-reported patient experience and outcomes, clinical practice management, and knowledge of emerging HER2/HER3 therapies and their uses across multiple solid tumors.

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The Implementation of State-Mandated Standards for Batterer Intervention Programs: The Colorado Experience

Violence and Victims ◽

10.1891/0886-6708.vv-d-15-00091 ◽

2017 ◽

Vol 32 (2) ◽

pp. 279-298 ◽

Cited By ~ 8

Author(s):

Tara N. Richards ◽

Angela R. Gover ◽

Elizabeth A. Tomsich ◽

Jesse Hansen ◽

Cheryl R. Davis

Keyword(s):

Decision Making ◽

Domestic Violence ◽

Multidisciplinary Treatment ◽

Future Research ◽

Offender Treatment ◽

Treatment Team ◽

Treatment Plans ◽

Domestic Violence Treatment ◽

Using Data

The current research examines Colorado’s experience implementing evidence-based mandated treatment Standards, which use a uniform risk assessment, differentiated treatment levels, offender competencies, and a multidisciplinary treatment team (MTT) composed of a victim advocate, probation officer, and treatment provider to manage offender treatment. Using data from MTT member surveys (n = 107) and follow-up interviews (n = 14), the study investigates perceptions of implementation and treatment fidelity, MTT decision making and communication, and the process of successful treatment completion. Results demonstrate that full implementation of Colorado’s standards for domestic violence treatment has not yet been achieved and that many MTT members report challenges to communication and decision making regarding offender treatment plans and successful achievement of competencies. Recommendations for further improvements in Colorado’s domestic violence treatment model are made and directions for future research are discussed.

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The biopsychosocial (BPS) model of dementia as a tool for clinical practice. A pilot study

International Psychogeriatrics ◽

10.1017/s1041610215002379 ◽

2016 ◽

Vol 28 (7) ◽

pp. 1079-1089 ◽

Cited By ~ 6

Author(s):

Catherine Revolta ◽

Martin Orrell ◽

Aimee Spector

Keyword(s):

Quality Care ◽

Preliminary Evidence ◽

Sense Of Competence ◽

Positive Attitudes ◽

People With Dementia ◽

Within Subjects ◽

Treatment Plans ◽

Practical Tool ◽

The Impact

ABSTRACTBackground:Equipping staff with the skills to provide high quality care in dementia is essential. The Biopsychosocial (BPS) model of dementia (Spector and Orrell, 2010) is a practical tool designed to encourage staff to develop personalized interventions and treatment plans for people with dementia. This feasibility study aimed to examine the impact of training staff to use the BPS model on skills of formulation, attitude towards dementia and sense of role competence.Method:A within-subjects design was used. Thirty-seven staff working in dementia care across a community mental health team (CMHT), inpatient wards, and residential care homes were trained to use the BPS model. Outcomes were measured at baseline, post-training, and four week follow-up.Results:The ability of staff to understand, formulate, and develop interventions for people with dementia increased significantly following training. There were small, non-significant improvements in positive attitudes, and sense of competence following training. Staff also reported that training improved their understanding of biological and psychosocial factors in dementia.Conclusions:This study provides preliminary evidence that training staff to use the BPS model can lead to improvements in their ability to understand and develop interventions for people with dementia. Further research would be required to draw firm conclusions about its effectiveness.

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“If you don’t get better, you may come back here”: proposing conditioned follow-ups to the doctor’s office

Text & Talk - An Interdisciplinary Journal of Language Discourse Communication Studies ◽

10.1515/text-2017-0038 ◽

2018 ◽

Vol 38 (2) ◽

pp. 217-242 ◽

Cited By ~ 4

Author(s):

Søren Beck Nielsen

Keyword(s):

General Practice ◽

General Practitioners ◽

Analytic Method ◽

Institutional Interaction ◽

Care Continuity ◽

Naturally Occurring ◽

Treatment Plans ◽

Doctor's Office ◽

Audio Video

Abstract Previous research has established that conversationalists treat “arrangement making” as closure implicative contributions. This study adds “conditioned arrangement making” to the list with an examination of how general practitioners propose conditioned follow-ups to patients, that is, the opportunity to return to the clinic if their condition does not improve or if it should worsen. The data consists of 52 audio-/video-recorded naturally occurring general practice consultations in Denmark. Using the conversation analytic method, the paper examines why the hypotheticality of this particular kind of proposition making is a resource for practitioners in terms of accomplishing progression towards termination of the consultation, and also in terms of accomplishing agreement upon appropriate, responsible and reassuring treatment plans. Among other things, conditioned follow-up propositions enable doctors to communicate “no problem” diagnoses while preserving care continuity. The study, therefore, contributes to the understanding of how use of grammatical formats such as conditional clauses influences institutional interaction.

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Risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces: A retrospective observational study of 238 cases

Indian Journal of Dermatology Venereology and Leprology ◽

10.25259/ijdvl_529_20 ◽

2021 ◽

Vol 0 ◽

pp. 1-5

Author(s):

Hsiao-Han Wang ◽

Yu-Chen Huang

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Poor Control ◽

Reasonable Expectation ◽

Nail Changes ◽

Treatment Plans ◽

Suitable Treatment ◽

The Mean ◽

Ingrown Toenails

Background: Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims: In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods: We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results: There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations: This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion: Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.

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Characteristics of Older Adults Who Were Early Adopters of Medical Cannabis in the Florida Medical Marijuana Use Registry

Journal of Clinical Medicine ◽

10.3390/jcm9041166 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1166 ◽

Cited By ~ 4

Author(s):

Joshua D. Brown ◽

Brianna Costales ◽

Sascha van Boemmel-Wegmann ◽

Amie J. Goodin ◽

Richard Segal ◽

...

Keyword(s):

Older Adults ◽

Adult Population ◽

Medical Marijuana ◽

Marijuana Use ◽

The United States ◽

Medical Cannabis ◽

Early Adopters ◽

Treatment Plans ◽

Medical Marijuana Use

Use of medical marijuana is increasing in the United States and older adults are the fastest growing user group. There is little information about the characteristics and outcomes related to medical marijuana use. This study is a descriptive analysis of older adults (aged ≥50 years old) who were early adopters of a medical marijuana program in the U.S. state of Florida. Per state legislation, initial and follow-up treatment plans were submitted to the University of Florida College of Pharmacy. Data collection included demographics, clinical history, medical conditions, substance use history, prescription history, and health status. Follow-up treatment plans noted changes in the chief complaint and actions taken since the initial visit. Of the state’s 7548 registered users between August 2016 and July 2017, N = 4447 (58.9%) were older adults. Patients utilized cannabidiol (CBD)-only preparations (45%), preparations that had both tetrahydrocannabinol (THC) and CBD (33.3%) or were recorded to use both CBD-only and THC + CBD products (21.7%). The chief complaints indicating medical cannabis treatment were musculoskeletal disorders and spasms (48.4%) and chronic pain (45.4%). Among other prescription medications, patients utilized antidepressants (23.8%), anxiolytics and benzodiazepines (23.5%), opioids (28.6%), and cardiovascular agents (27.9%). Among all drug classes with potential sedating effects, 44.8% of the cohort were exposed to at least one. Patients with follow-up visits (27.5%) exhibited marked improvement as assessed by the authorizing physicians. However, the patient registry lacked detailed records and linkable information to other data resources to achieve complete follow up in order to assess safety or efficacy. Future improvements to registries are needed to more adequately capture patient information to fill knowledge gaps related to the safety and effectiveness of medical marijuana, particularly in the older adult population.

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Care coordination for oral oncolytics through pharmacy integration and cycle 1-day 1 documentation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.260 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 260-260

Author(s):

Nancy Walker Peacock ◽

Stacey McCullough ◽

Jared Crumb ◽

Leah Owens ◽

Laura Kaufman ◽

...

Keyword(s):

Process Improvement ◽

Treatment Plan ◽

Processing System ◽

Subsequent Treatment ◽

Pharmacy Staff ◽

Drug Counseling ◽

Medical Oncologists ◽

Treatment Plans ◽

Oral Oncolytics

260 Background: The growing number of oral oncolytic therapies (OOTs) necessitates a standardized EMR workflow that integrates pharmacy activities for dispense and patient management and standardizes cycle-1/day-1 (C1D1) documentation. Our practice’s treatment plans contain appropriately timed OOT follow-up activities including labs, physician follow-up visits, and pharmacy calls for toxicity and adherence checks, however complications in prescription fulfillment such as prior authorization, co-pay assistance, or inability of in-practice pharmacy to dispense limit the predictability of C1D1 dates of OOTs. Methods: An EMR query identified patients at a single clinic location of 5-medical oncologists (MDs) for whom oral oncolytic treatment plans were entered from January 1 to June 30, 2018. C1D1 date entered by the MD in the EMR was compared to the pharmacy processing system dispense date. Ten patients were identified, and 10% (1/10) had an accurate C1D1 documented within the EMR. As part of the ASCO Quality Training Program, to improve the accuracy of C1D1 documentation, a new workflow was implemented whereby: (1) a “hold” activity was added to new EMR treatment plans so that C1D1 remained pending until patients had received medication; (2) clinic checkout staff provided patients with information on the in-practice pharmacy and expectations for next steps; (3) pharmacists utilized existing reporting tools to identify newly entered treatment plans and transcribed orders into e-prescriptions sent to our practice pharmacy; (4) the pharmacy workflow ensued with pharmacy staff leading patient engagement, drug counseling; (5) pharmacists confirm C1D1, document within EMR (6) subsequent treatment plan activities were scheduled. Results: Following education and process changes within the clinic and pharmacy, accurate C1D1 documentation occurred in 90% (9/10) of patients initiating OOTs. Conclusions: Including pharmacy fulfillment time in EMR workflow can improve C1D1 documentation accuracy and associated management of OOTs. Education regarding roles and processes of prescribing MDs, pharmacy staff and clinic staff will be required to scale this process improvement throughout the organization.

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A supine cranio-spinal irradiation technique using moving field junctions

Polish Journal of Medical Physics and Engineering ◽

10.1515/pjmpe-2016-0014 ◽

2016 ◽

Vol 22 (4) ◽

pp. 79-83 ◽

Cited By ~ 1

Author(s):

Karthick Raj Mani ◽

Shantanu Sapru ◽

K. J. Maria Das ◽

Ayan Basu

Keyword(s):

Supine Position ◽

Laser System ◽

Dynamic Wedge ◽

Thermoplastic Mask ◽

Ct Simulation ◽

Treatment Plans ◽

Homogeneous Dose ◽

Cold Spots ◽

Posterior Field

Abstract Aim: To demonstrate a simple technique of cranio-spinal irradiation (CSI) in supine position using inter fraction moving field junctions to feather out any potential hot and cold spots. Materials and Methods: Fifteen patients diagnosed with medulloblastoma were treated during the period February 2011 to June 2015 were included in this study. Out of fifteen patients in the study nine were male and 6 were female with a median age of 13.4 years (range 5-27 years). All the patients were positioned supine on CT simulation, immobilized using thermoplastic mask and aligned using room based laser system. Two parallel opposed lateral fields for the whole brain using an asymmetrical jaw with isocenter at C2 vertebral body. A posterior field also placed to cover the cervical and dorsal field using the same isocenter at C2. The second isocenter was placed at lumbar vertebral region to cover the remaining dorsal, lumbar and sacral region using an inter-fraction moving junction. Field-in-field and enhanced dynamic wedge used to homogeneous dose distribution when required. Results and Discussion: In this study, we found that only two patients failed in the primary site, no radiation myelitis or recurrences in the filed junctions were reported in these fifteen patients with a median follow-up of 36.4 months. The automated sequence of treatment plans with moving junctions in the comfortable supine position negating the need for manual junction matching or junction shifts avoiding potential treatment errors and also facilitating delivery of anesthesia where necessary.

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