Measurement of quality of care for adjuvant chemotherapy of colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6071-6071
Author(s):  
M. Morse ◽  
R. Prosnitz ◽  
C. Mantyh ◽  
D. Fisher ◽  
G. Samsa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Quality Care ◽  
Future Research ◽  
Inclusion Criteria ◽  
Policy Makers ◽  
Leverage Points ◽  
Stage Iii Colon Cancer ◽  
Crucial Component

6071 Background: Although adjuvant chemotherapy (CT) is a crucial component of the therapy for stage III colon cancer and stage II and III rectal cancer patients, little is known about how best to measure whether quality care is being delivered. We sought to provide policy-makers and stake-holders with an inventory of the available measures and their usefulness. Methods: The MEDLINE and Cochrane databases were searched for all publications which might contain quality measures (QMs) pertaining to the diagnosis and treatment of patients with colorectal cancer (CRC). Our analysis was confined to QMs pertaining to adjuvant CT for CRC, based on US data, and published after 1990. Identified QMs were quantitatively rated based on the concepts of importance/usability, scientific acceptability, and validity or how well they had been tested. Results: 3,429 abstracts were reviewed, of which 843 articles underwent full text evaluation. Ultimately 74 articles met the established inclusion criteria for containing QMs, 32 of which pertained to adjuvant CT. These 32 articles contained 10 QMs, 8 of which had major flaws limiting their applicability. The two most ideal measures are presented in the table . Among the reasons some measures did not rate highly was the failure to utilize standard staging definitions or reliance on administrative inpatient databases, which do not account for chemotherapy administered on an out-patient basis. Conclusions: Very few measures of the quality of adjuvant CT for CRC have been published to date and fewer rate highly with regard to the concepts of importance/usability, scientific acceptability, and validity. Future research should focus on refining existing QMs and on developing new QMs which target important leverage points with respect to the provision of adjuvant therapy for CRC. [Table: see text] [Table: see text]

scholarly journals Down Syndrome and Quality of Life: A Case Report

2015 ◽  
Vol 3 (2) ◽  
pp. 112-114
Author(s):  
Hilary L. Schroeder ◽  
Marianinha Joanes ◽  
Andre Small ◽  
Raghu Maramraj,
Keyword(s):  
Quality Of Life ◽  
Down Syndrome ◽  
Early Onset ◽  
Quality Care ◽  
Well Being ◽  
Cardiac Complications ◽  
African American Female ◽  
Crucial Component ◽  
Patient’S History

  Background: Quality of life is considered a crucial component to the well-being of patients with Down syndrome. The strength of quality care through stable social and psychological interactions has built a framework for a positive well-being for patients with Down syndrome, improving their quality of life. Case: A 55-year-old African American female with a history of Down syndrome, congenital heart disease, and newly-diagnosed early onset Alzheimer’s disease presented with an arm contusion resulting from regular caretaking. The patient’s history was reviewed, and the complexity of her condition was discovered. While a subset of Down syndrome patients have cardiac complications and others have early-onset Alzheimer’s, our patient had both. We believe this complicated her condition. After the diagnosis of Alzheimer’s was made, the caregivers noticed a significant decline in her ability to communicate and continue day-to-day activities. Despite the decline in functions, a positive mood was apparent. Conclusion: Multiple medical interventions, along with strong family support, positively contributed to the patient’s quality of life. Therapies targeting cognition could result in the maintenance of quality of life and, ultimately, lower health care costs.

Clinical efficacy and safety of early adjuvant chemotherapy for stage III colon cancer: Short-term outcomes of a multicenter, randomized, open-label, phase 3 trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3598-3598
Author(s):  
Jun Seok Park ◽  
Soo Yeun Park ◽  
Gyu-Seog Choi ◽  
Hye Jin Kim ◽  
Jong Gwang Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adverse Events ◽  
Surgical Complication ◽  
Phase Iii ◽  
Stage Iii ◽  
Survival Outcomes ◽  
Stage Iii Colon Cancer

3598 Background: Adjuvant chemotherapy (AC) is recommended to commence within 8 weeks since after surgical resection of stage II or III colon cancer. Results of many retrospective studies showed inferior survival outcomes following delay of AC delay. Moreover, preclinical studies showed that the progression of disseminated cancer cells is profound during the postoperative period. This study is the first prospective trial to evaluate early (≤ 14 days postoperative) AC for patients (pts) with stage III colon cancer. Methods: This study is a prospective, multicenter, randomized phase III trial. Pts with pathological stage III colon cancer were enrolled and randomized 1:1 to early AC (starting AC ≤ 14 days after surgery) or conventional AC (starting AC > 14 days after surgery). Pts were recommended to receive 12 cycles of FOLFOX-6 for AC. The primary endpoint was disease-free survival. The secondary endpoints were overall survival, adverse events, surgical complication during AC, and patient-reported outcomes (quality of life) during 1 year after surgery. Herein, safety data, chemotherapy delivery, and quality of life are presented. Results: This study randomized 443 pts either early AC arm (221pts) or early AC arm (222 pts) to the during September 2011 to March 2020. 380 pts who received at least one cycle of FOLFOX-6 were included in the safety analysis (192 and 188 in the early and conventional AC arms, respectively). The baseline characteristics of the two groups were well-balanced except for the interval from the surgery to the initial AC. The early and conventional AC arms started their first chemotherapy at median of 13 (4-43 days) and 29 (17-53 days) after surgery (p < 0.001), respectively. No significant differences were seen in the median chemotherapy cycles, AC completion, and relative oxaliplatin dose intensity between groups. AC Completion without any change of dose or schedule delay was seen in 18% and 20% in early and conventional AC arms respectively, while dose reduction or delay was 65% and 61%, respectively. Toxicities of grade 3 or more were seen in 28% in both groups. One patient in the early AC arm underwent an emergent operation for anastomotic leakage on the second day of 5-fluorouracil infusion (postoperative day 14). However, the surgical complication was not seen in any other patient. The scores of the European Organization for Research and Treatment of Cancer Quality of Life core 30 questionnaire were similar in both arms at baseline (before starting AC), and 1 month, 3 months, 6 months, and 12 months after surgery. Conclusions: Early AC was safe and did not increase either chemotherapy-related adverse events or surgery-related complications during treatment. Moreover early AC did not reduce the quality of life of the pts during 1 year after surgery. This study continues to follow-up the patients for survival outcomes. Clinical trial information: NCT01460589.

Development a Palliative Care Program for Colorectal Cancer Patients: A Mixed Methods Protocol study (Preprint)

2021 ◽  
Author(s):  
Masoumeh Masoumy ◽  
Masoud Bahrami ◽  
Alireza sadeghi ◽  
Rohallah Mosavizadeh
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Cultural Context ◽  
Care Program ◽  
Future Research ◽  
Palliative Care Program ◽  
Colorectal Cancer Patients

BACKGROUND Introduction: Colorectal cancer (CRC) is the third most common cancer in Iranian men and the second in Iranian women and it is a serious health problem in the Iran health system. OBJECTIVE Objective: The purpose is to develop a holistic palliative care program in order to improve the health and quality of life of colorectal cancer patients. METHODS Methods: This is an exploratory mixed methods study which will be conducted using a sequential qualitative-quantitative design (QUAL quan) consists of four sequential steps using the approach proposed by Ewles & Sminett to develop the program. In the first step, a qualitative study (semi-structured interview), the researcher discovers the needs of colorectal cancer patients from the perspective of patients, family members and care providers. In the second step, the literature review will be performed with the aim of confirming and completing the discovering new needs. In the third step, a initial draft of the palliative care program will be developed based on data extracted from qualitative study and literature review, experts’ panel opinions. In the fourth step, according to the opinions of the panel of experts, the part of the developed program will be implemented as quasi-experimental intervention and the effect of intervention on quality of life will be evaluated. RESULTS This study can will provide a better understanding of the demands and problems of colorectal cancer patients and their families through providing a holistic care and improve their quality of life in the socio-cultural context of Iran. This program can be useful in providing care, education, policy making, future research and colorectal cancer patients' health promotion. CONCLUSIONS This study can will provide a better understanding of the demands and problems of colorectal cancer patients and their families through providing a holistic care and improve their quality of life in the socio-cultural context of Iran. This program can be useful in providing care, education, policy making, future research and colorectal cancer patients' health promotion.

scholarly journals Microplastic contamination of salt intended for human consumption: a systematic review and meta-analysis

2020 ◽  
Vol 2 (12) ◽  
Author(s):  
Evangelos Danopoulos ◽  
Lauren Jenner ◽  
Maureen Twiddy ◽  
Jeanette M. Rotchell
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Future Research ◽  
Human Consumption ◽  
Inclusion Criteria ◽  
Research Findings ◽  
Human Health Effects ◽  
Potential Human Health

Abstract Microplastics (MPs) are an emerging contaminant ubiquitous in the environment. There is growing concern regarding potential human health effects, a major human exposure route being dietary uptake. We have undertaken a systematic review (SR) and meta-analysis to identify all relevant research on MP contamination of salt intended for human consumption. Three thousand nine hundred and nineteen papers were identified, with ten fitting the inclusion criteria. A search of the databases MEDLINE, EMBASE and Web of Science, from launch date to September 2020, was conducted. MP contamination of salt varied significantly between four origins, sea salt 0–1674 MPs/kg, lake salt 8–462 MPs/kg, rock and well salt 0–204 MPs/kg. The majority of samples were found to be contaminated by MPs. Corresponding potential human exposures are estimated to be 0–6110 MPs per year (for all origins), confirming salt as a carrier of MPs. A bespoke risk of bias (RoB) assessment tool was used to appraise the quality of the studies, with studies demonstrating moderate to low RoB. These results suggest that a series of recurring issues need to be addressed in future research regarding sampling, analysis and reporting to improve confidence in research findings.

scholarly journals Better Sleep Experience for the Critically Ill: A Comprehensive Strategy for Designing Hospital Soundscapes

2019 ◽  
Vol 3 (2) ◽  
pp. 36 ◽  
Author(s):  
Dilip Birdja ◽  
Elif Özcan
Keyword(s):  
Critical Care ◽  
Medical Device ◽  
Design Approach ◽  
Future Research ◽  
Comprehensive Strategy ◽  
Research Directions ◽  
Policy Makers ◽  
Future Research Directions ◽  
Knowledge Deficits

In this paper, the sleep phenomenon is considered in relation to critical care soundscapes with the intention to inform hospital management, medical device producers and policy makers regarding the complexity of the issue and possible modes of design interventions. We propose a comprehensive strategy based on soundscape design approach that facilitates a systematic way of tackling the auditory quality of critical care settings in favor of better patient sleep experience. Future research directions are presented to tackle the knowledge deficits in designing for critical care soundscapes that cater for patient sleep. The need for scientifically-informed design interventions for improving patient sleep experience in critical care is highlighted. The value of the soundscape design approach for resolving other sound-induced problems in critical care and how the approach allows for patient-centred innovation that is beyond the immediate sound issue are further discussed.

scholarly journals Virtual care: Enhancing access or harming care?

2020 ◽  
Vol 33 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Lorian Hardcastle ◽  
Ubaka Ogbogu
Keyword(s):  
Quality Care ◽  
Family Doctor ◽  
Healthcare Services ◽  
Policy Makers ◽  
Virtual Care ◽  
Established Relationship ◽  
Privacy Issues ◽  
Improve Access

COVID-19 has catalyzed the adoption of virtual medical care in Canada. Virtual care can improve access to healthcare services, particularly for those in remote locations or with health conditions that make seeing a doctor in person difficult or unsafe. However, virtual walk-in clinic models that do not connect patients with their own doctors can lead to fragmented, lower quality care. Although virtual walk-in clinics can be helpful for those who temporarily lack access to a family doctor, they should not be relied on as a long-term substitute to an established relationship with a primary care provider. Virtual care also raises significant privacy issues that policy-makers must address prior to implementing these models. Patients should be cautious of the artificial intelligence recommendations generated by some virtual care applications, which have been linked to quality of care concerns.

scholarly journals Cardiovascular Disease Self-Care Interventions

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Victoria Vaughan Dickson ◽  
Jill Nocella ◽  
Hye-Won Yoon ◽  
Marilyn Hammer ◽  
Gail D’Eramo Melkus ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Intervention Studies ◽  
Self Care ◽  
Future Research ◽  
Inclusion Criteria ◽  
Care Intervention ◽  
Rigorous Study ◽  
Study Designs ◽  
Combined Interventions

Background. Cardiovascular disease (CVD) is a major cause of increased morbidity and mortality globally. Clinical practice guidelines recommend that individuals with CVD are routinely instructed to engage in self-care including diet restrictions, medication adherence, and symptom monitoring.Objectives. To describe the nature of nurse-led CVD self-care interventions, identify limitations in current nurse-led CVD self-care interventions, and make recommendations for addressing them in future research.Design. Integrative review of nurse-led CVD self-care intervention studies from PubMed, MEDLINE, ISI Web of Science, and CINAHL. Primary studies (n=34) that met the inclusion criteria of nurse-led RCT or quasiexperimental CVD self-care intervention studies (years 2000 to 2012) were retained and appraised. Quality of the review was assured by having at least two reviewers screen and extract all data.Results. A variety of self-care intervention strategies were studied among the male (57%) and Caucasian (67%) dominated samples. Combined interventions were common, and quality of life was the most frequent outcome evaluated. Effectiveness of interventions was inconclusive, and in general results were not sustained over time.Conclusions. Research is needed to develop and test tailored and inclusive CVD self-care interventions. Attention to rigorous study designs and methods including consistent outcomes and measurement is essential.

Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort

2003 ◽  
Vol 21 (7) ◽  
pp. 1293-1300 ◽  
Author(s):  
John Z. Ayanian ◽  
Alan M. Zaslavsky ◽  
Charles S. Fuchs ◽  
Edward Guadagnoli ◽  
Cynthia M. Creech ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Population Based ◽  
Stage Ii ◽  
Stage Iii Colon Cancer ◽  
Adjuvant Therapies

Purpose: Randomized trials have demonstrated that adjuvant chemotherapy improves survival for patients with stage III colon cancer and that chemotherapy combined with radiation therapy improves survival for patients with stage II or III rectal cancer. This population-based study was designed to assess use of these treatments in clinical practice. Patients and Methods: From the California Cancer Registry, we identified all patients diagnosed during 1996 to 1997 with stage III colon cancer (n = 1,422) and stage II or III rectal cancer (n = 534) in 22 northern California counties. To supplement registry data on adjuvant therapies and ascertain reasons they were not used, we surveyed physicians or reviewed office records for 1,449 patients (74%). Results: Chemotherapy rates varied widely by age from 88% (age < 55 years) to 11% (age ≥ 85 years), and radiation therapy varied similarly. Adjusting for demographic, clinical, and hospital characteristics, chemotherapy was used less often among older and unmarried patients, and radiation therapy was used less often among older patients, black patients, and those initially treated in low-volume hospitals. Adjusted rates of chemotherapy varied significantly (P < .01) among individual hospitals: 79% and 51%, respectively, at one SD above and below average (67%). Physicians’ reasons for not providing adjuvant therapy included patient refusal (30% for chemotherapy, 22% for radiation therapy), comorbid illness (22% and 14%, respectively), or lack of clinical indication (22% and 45%, respectively). Conclusion: Use of adjuvant therapy for colorectal cancer varies substantially by age, race, marital status, hospital volume, and individual hospital, indicating opportunities to improve care. With enhanced data on adjuvant therapies, population-based registries could become a valuable resource for monitoring the quality of cancer care.

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