scholarly journals Hodgkin Lymphoma: Differences in Treatment Between Europe and the United States/North America: Evolving Trends in Protocol Therapy

2018 ◽  
Vol 12 ◽  
pp. 117955491875488 ◽  
Author(s):  
Thomas J FitzGerald ◽  
Maryann Bishop-Jodoin
Keyword(s):  
Patient Care ◽  
Hodgkin Lymphoma ◽  
Normal Tissue ◽  
Common Ground ◽  
Clinical Care ◽  
Management Strategies ◽  
Improve Patient Care ◽  
The United States ◽  
Tumor Burden ◽  
Late Treatment

With continued progress and success in clinical care, the management of patients with Hodgkin lymphoma (HL) has undergone continuous revision to improve patient care outcomes and limit acute and late treatment effects on normal tissue imposed by therapy. Hodgkin lymphoma is a disease that affects children, adolescents, and adults. Clinical management strategies are influenced by the patient’s age at diagnosis, tumor burden, response to induction therapy, and potential expectation of treatment impact on normal tissue. The approach to patient management varies in many parts of the world and is influenced by treatment availability, physician training, and medical culture. Differences in approach are important to understand for accurately comparing and contrasting outcome studies. In this article, we will identify current areas of common ground and points of separation in patient care management for HL. Opportunities for clinical trial strategies will be defined for future clinical trials.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

A Preliminary Study of Nursing Practice Patterns Concerning Dysphagia Diet Modification: Implications for Interprofessional Education With SLPs

2021 ◽  
pp. 1-15
Author(s):  
Naomi Gurevich ◽  
Danielle R. Osmelak ◽  
Sydney Osentoski
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Practice Patterns ◽  
Improve Patient Care ◽  
Treatment Method ◽  
The United States ◽  
Diet Modification ◽  
Work Settings ◽  
Swallowing Dysfunction

Purpose Speech-language pathologists (SLPs) are trained to evaluate and treat dysphagia. One treatment method is to modify diet consistency or viscosity to compensate for swallowing dysfunction and promote a safer intake; this typically involves softening solids and thickening liquids. Thickening liquids is not safer for all patients, and modification of dysphagia diets without adequate training may reduce the quality of dysphagia patient care. Over 90% of SLPs working in health care report exposure to nurses who regularly downgrade dysphagia diets without an SLP consult. This study explores dysphagia diet modification practices of nursing staff with and without dysphagia training. Method Practicing nurses and student nurses ( N = 298) in the United States were surveyed regarding their dysphagia diet modification training and practice patterns. Additionally, a pre-/posttest design was used to determine the efficacy of a short general tutorial on willingness to modify diets without an SLP consult. Results Downgrading diets without an SLP consult is a common practice. Fewer than one third of nurses (31.41%) would avoid it, whereas 73.65% would avoid upgrading without SLP consult. Formal dysphagia training made little difference to this practice. The short general tutorial also had no beneficial effect, in fact slightly reducing the willingness to consult SLPs. Conclusions Dysphagia diet modification practice by nurses is pervasive in U.S. health care. This is a previously unexplored but common issue SLPs face in work settings. This study identifies a need to clarify guidelines and increase interprofessional education between both professions to improve patient care.

scholarly journals Implementation, Evolution and Impact of ICU Telepharmacy Services Across a Health care System

2019 ◽  
Vol 54 (4) ◽  
pp. 232-240 ◽  
Author(s):  
Desiree E. Kosmisky ◽  
Sonia S. Everhart ◽  
Carrie L. Griffiths
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Healthcare System ◽  
Improve Patient Care ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Use Of Technology ◽  
American Society ◽  
The Impact

Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.

Translating evidence into practice; utilising quality analysis data and clinical care guidelines to improve patient care outcomes

2017 ◽  
Vol 4 (Suppl 2) ◽  
pp. s4-s4
Author(s):  
Robin Baschal ◽  
Susan Graham ◽  
Karen Whalen ◽  
Deborah Burke ◽  
Patrick Carry ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Improve Patient Care ◽  
Analysis Data ◽  
Quality Analysis ◽  
Care Guidelines ◽  
Care Outcomes ◽  
Improve Patient

scholarly journals Understanding the Role of Advanced Practice Providers in Oncology in the United States

2018 ◽  
Vol 14 (9) ◽  
pp. e518-e532 ◽  
Author(s):  
Suanna S. Bruinooge ◽  
Todd A. Pickard ◽  
Wendy Vogel ◽  
Amy Hanley ◽  
Caroline Schenkel ◽  
...  
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Clinical Care ◽  
Gynecologic Oncology ◽  
Physician Assistants ◽  
The United States ◽  
Direct Patient Care ◽  
Advanced Practice ◽  
Patient Counseling ◽  
Number Of Patients

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

scholarly journals A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development (Preprint)

2020 ◽  
Author(s):  
Timo Schinköthe ◽  
Mariano Rolando Gabri ◽  
Manfred Mitterer ◽  
Pedro Gouveia ◽  
Volker Heinemann ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Outpatient Care ◽  
Digital Health ◽  
Improve Patient Care ◽  
The United States ◽  
Application Development ◽  
Absolute Minimum ◽  
First Choice

BACKGROUND From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. OBJECTIVE The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. METHODS Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. RESULTS Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. CONCLUSIONS The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19.

scholarly journals 1453 Assessing Procedure-Specific Risk Discussion in Elective Arthroplasty

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Heylen ◽  
V Antoniou ◽  
O Kemp ◽  
J Roberts ◽  
A Vats
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Improve Patient Care ◽  
District General Hospital ◽  
Consent Forms ◽  
Risk Of Death ◽  
Reduce Healthcare Cost ◽  
Standard Quality ◽  
Almost All

Abstract Introduction Improper consent is a failure of clinical care and also a major cause of litigation within health care authorities. 4% of surgical negligence claims are attributed to improper consenting in the NHS, with an average settlement fee of approximately £40,000 per claim. Improving quality of consenting therefore not only improves patient care but could also reduce healthcare cost. Method A retrospective analysis of 100 elective hip and knee arthroplasties at a district general hospital in the South of England. Clinic letters and consent forms were reviewed, using the British Orthopaedic Association (BOA) consent proforma as a comparison standard. Quality of consent was reviewed based upon inclusion of BOA associated risks. Results 40% of hip arthroplasty clinic letters and 20% of knee arthroplasty clinic letters did not include a risk discussion. Common risks on consent forms when compared to BOA standards were 84.8% compliant in knees and 88.8% in hips. Less common risks on consent forms were 100% compliant in knees and 96% in hips. Rare risks on consent forms were 74.8% compliant in knees and 57.7% in hips. Notably blood clots and infection were consented for in almost all patients. Risk of death meanwhile, was only consented for 62% of the time, across both procedures. Conclusions Standard of consenting in this audit falls short of BOA standards. Improvement is needed to improve patient care and avoid medical litigation. An integrated electronic form linking consent process of both outpatient and pre-operative review could be a beneficial intervention.

scholarly journals The Risks of Renal Angiomyolipoma: Reviewing the Evidence

2017 ◽  
Vol 4 (4) ◽  
pp. 13-25 ◽  
Author(s):  
Raouf Seyam ◽  
Waleed AlKhudair ◽  
Said Kattan ◽  
Mohamed Alotaibi ◽  
Hasan Alzahrani ◽  
...  
Keyword(s):  
Vascular Tissue ◽  
Management Strategies ◽  
Mammalian Target Of Rapamycin ◽  
Diagnostic Techniques ◽  
Tumor Burden ◽  
Treatment Modalities ◽  
Renal Angiomyolipoma ◽  
Selective Embolization ◽  
Characteristic Appearance ◽  
Late Treatment

Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at risk of bleeding and provide a prophylactic treatment. According to the clinical presentation, different treatment modalities, prophylactic or therapeutic, are available that span the spectrum of observation, embolization, or surgery. Renal impairment may result from extensive tumor burden or as a complication of the management itself. Improvement of diagnostic techniques, super-selective embolization, nephron-sparing surgery, and late treatment with the mammalian target of rapamycin inhibitors have provided more effective and safe management strategies. In this review, we examine the evidence pertaining to the risks imposed by RAML to the patients and identify merits and hazards associated with different treatment modalities.

scholarly journals Patterns and Perceptions of Smartphone Use Among Academic Neurologists in the United States: Questionnaire Survey (Preprint)

2020 ◽  
Author(s):  
William Zeiger ◽  
Scott DeBoer ◽  
John Probasco
Keyword(s):  
United States ◽  
Patient Care ◽  
Cranial Nerve ◽  
Clinical Care ◽  
The United States ◽  
Neurologic Examination ◽  
App Development ◽  
Smartphone Technology ◽  
Smartphone Use ◽  
Attending Physicians

BACKGROUND Smartphone technology is ubiquitous throughout neurologic practices, and numerous apps relevant to a neurologist’s clinical practice are now available. Data from other medical specialties suggest high utilization of smartphones in routine clinical care. However, the ways in which these devices are used by neurologists for patient care–related activities are not well defined. OBJECTIVE This paper aims to characterize current patterns of smartphone use and perceptions of the utility of smartphones for patient care–related activities among academic neurology trainees and attending physicians. We also seek to characterize areas of need for future app development. METHODS We developed a 31-item electronic questionnaire to address these questions and invited neurology trainees and attendings of all residency programs based in the United States to participate. We summarized descriptive statistics for respondents and specifically compared responses between trainees and attending physicians. RESULTS We received 213 responses, including 112 trainee and 87 attending neurologist responses. Neurology trainees reported more frequent use of their smartphone for patient care–related activities than attending neurologists (several times per day: 84/112, 75.0% of trainees; 52/87, 59.8% of attendings; <i>P</i>=.03). The most frequently reported activities were internet use, calendar use, communication with other physicians, personal education, and health care–specific app use. Both groups also reported regular smartphone use for the physical examination, with trainees again reporting more frequent usage compared with attendings (more than once per week: 35/96, 36.5% of trainees; 8/58, 13.8% of attendings; <i>P</i>=.03). Respondents used their devices most commonly for the vision, cranial nerve, and language portions of the neurologic examination. The majority of respondents in both groups reported their smartphones as “very useful” or “essential” for the completion of patient care–related activities (81/108, 75.0% of trainees; 50/83, 60.2% of attendings; <i>P=</i>.12). Neurology trainees reported a greater likelihood of using their smartphones in the future than attending neurologists (“very likely”: 73/102, 71.6% of trainees; 40/82, 48.8% of attendings; <i>P</i>=.005). The groups differed in their frequencies of device usage for specific patient care–related activities, with trainees reporting higher usage for most activities. Despite high levels of use, only 12 of 184 (6.5%) respondents reported ever having had any training on how to use their device for clinical care. Regarding future app development, respondents rated vision, language, mental status, and cranial nerve testing as potentially being the most useful to aid in the performance of the neurologic examination. CONCLUSIONS Smartphones are used frequently and are subjectively perceived to be highly useful by academic neurologists. Trainees tended to use their devices more frequently than attendings. Our results suggest specific avenues for future technological development to improve smartphone use for patient care–related activities. They also suggest an unmet need for education on effectively using smartphone technology for clinical care.

scholarly journals Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care

2018 ◽  
Vol 09 (01) ◽  
pp. 205-220 ◽  
Author(s):  
Steven Lane ◽  
Holly Miller ◽  
Elizabeth Ames ◽  
Lawrence Garber ◽  
David Kibbe ◽  
...  
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Data Exchange ◽  
Consensus Statement ◽  
Clinical Care ◽  
The United States ◽  
Care Providers ◽  
Consensus Recommendation ◽  
Policy Makers ◽  
And Function

Background Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct interoperability) has been widely implemented in health information technology (HIT) applications including electronic health records (EHRs) and by health care providers and organizations in the United States. While Direct interoperability has allowed clinicians and institutions to satisfy regulatory requirements and has facilitated communication and electronic data exchange as patients transition across care environments, feature and function enhancements to HIT implementations of the Direct Protocol are required to optimize the use of this technology. Objective To describe and address this gap, we developed a prioritized list of recommended features and functions desired by clinicians to utilize Direct interoperability for improved quality, safety, and efficiency of patient care. This consensus statement is intended to inform policy makers and HIT vendors to encourage further development and implementation of system capabilities to improve clinical care. Methods An ad hoc group of interested clinicians came together under the auspices of DirectTrust to address challenges of usability and create a consensus recommendation. This group drafted a list of desired features and functions that was published online. Comments were solicited from interested parties including clinicians, EHR and other HIT vendors, and trade organizations. Resultant comments were collected, reviewed by the authors, and incorporated into the final recommendations. Results This consensus statement contains a list of 57 clinically desirable features and functions categorized and prioritized for support by policy makers, development by HIT vendors, and implementation and use by clinicians. Conclusion Fully featured, standardized implementation of Direct interoperability will allow clinicians to utilize Direct messaging more effectively as a component of HIT and EHR interoperability to improve care transitions and coordination.

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