Using standardized patients to improve delivery of bad news by pediatric hematology-oncology fellows.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 29-29
Author(s):  
Julienne Brackett ◽  
Ernest Frugé ◽  
Martin Lorin
Keyword(s):  
Adult Learners ◽  
Bad News ◽  
First Year ◽  
Immediate Feedback ◽  
Goals Of Care ◽  
Safe Environment ◽  
Pediatric Hematology ◽  
New Diagnosis ◽  
Compassionate Communication

29 Background: First-year pediatric hematology-oncology fellows frequently must deliver difficult news to patients and families, possibly with little prior experience. Training in this area is often via didactic lectures and by “trial and error”. This can lead to significant discomfort on the part of fellows and potentially increased distress on the part of families if information is poorly communicated. Standardized patient (SP) encounters provide a safe environment for fellows to practice effective and compassionate communication skills. SPs can provide feedback to the fellows that may not otherwise be available from patients, families or peers. Methods: During the 4 hour course, fellows receive didactic sessions on delivery of bad news, disclosure of medical errors, and discussion of prognosis and goals of care. Half of the fellows receive the didactic sessions, while the other half participate in the SP cases involving 7-10 minute encounters followed by 10-15 minute confidential debriefings including the fellow, SP and a faculty member. Three cases are completed by each fellow: new diagnosis of an incurable brain tumor, tumor progression and goals of care discussion regarding the same patient 6 months later, and disclosure of a chemotherapy error. At the end, fellows complete an evaluation of the course and their perceived post-course skills. Results: Fellows in the first course (n = 8) strongly agreed that the course improved their ability to deliver bad news (mean = 5 on 5 point scale), was an appropriate method for this material (mean = 4.6) and that the confidential debriefing was useful without being stressful (mean = 4.7). Most comments supported the utility of receiving immediate feedback from the SPs and faculty. The didactic sessions were listed as the least helpful part of the course. Conclusions: Simulated encounters with immediate feedback from SPs and faculty can improve perceived competence in the delivery of bad news. Like many adult learners, course participants did not find the didactic sessions to be as helpful as interactive experiences. Follow-up surveys after the fellows complete the first year of training will further assess the utility of this instructional method.

Ready for the Worst? Negative Emotional Anticipation is Associated with Greater Reactivity to an Emotional Event

2021 ◽  
Author(s):  
Elise Katherine Kalokerinos ◽  
Ella Moeck ◽  
Koen Rummens ◽  
Kristof Meers ◽  
Merijn Mestdagh
Keyword(s):  
Time Scale ◽  
Research Finding ◽  
Negative Emotion ◽  
Experience Sampling ◽  
Bad News ◽  
First Year ◽  
First Year Students ◽  
First Semester ◽  
Emotional Outcomes

Lay wisdom suggests feeling negative in advance of an outcome – anticipatory negative emotion – shields against the blow of bad news. However, evidence is mixed, with different lines of research finding that anticipatory negative emotion is helpful, harmful, or has no effect on emotional outcomes. We set out to reconcile the competing findings by examining effects over a longer, but more granular, time-scale. First-year students (N=101) completed 9 days of experience sampling (10 surveys/day) as they received their first-semester exam grades, and a follow-up survey 5 months later. We investigated the association between anticipatory negative emotion and three negative emotional outcomes: (1) reactivity immediately after receiving grades, (2) recovery across the following week, and (3) recovery after 5 months. Anticipatory negative emotion was associated with increased reactivity and negative emotion 5 months later, suggesting that being emotionally ready for the worst has psychological costs.

Incremental oncology workload generated by immunotherapy in the first-year of treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14143-e14143
Author(s):  
Marika Cinausero ◽  
Silvio Ken Garattini ◽  
Alessandro Marco Minisini ◽  
Francesca Valent ◽  
Chiara Riosa ◽  
...  
Keyword(s):  
Metastatic Cancer ◽  
Rapid Development ◽  
Cancer Center ◽  
First Year ◽  
Number Of Patients ◽  
Clinical Episode ◽  
Student’S T ◽  
Few Data ◽  
New Diagnosis

e14143 Background: The rapid development of immunotherapy (IO) has transformed the cancer therapy landscape with growing impact on oncology workload. Given the few data on this topic, we conducted a study to estimate the shift in workload generated by any new metastatic cancer patient treated with IO and referred to the Oncology Department of the Academic Academic Cancer Center of Udine, Italy, within the 12 months of first consultation. Methods: We collected from our “Data Warehouse” electronic accountability system all new diagnosis of metastatic cancer between 01.01.2017 and 31.12.2018, resulting in a first consultation and leading to a second clinical episode during the following year, in order to assess the oncology workload. The population was divided into patients that received IO (anti-CTLA-4/PD-1/PDL1) versus patients treated with “other treatments”. Mean number per patient and standard deviation were calculated for clinical episodes (first consultations, treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up and inpatient oncology advices). The total number of patients treated and the number of episodes were recorded. Mean numbers of episodes in the IO group and “other treatments” group were compared using Student’s t-test (significance p < 0.005). Follow-up data was collected up to 31.12.2019. Results: A total number of 969 patients were considered (854 “other treatments” group and 115 IO group), resulting in a total of 12407 clinical episodes over the period of 12 months (first consultations excluded). Compared to “other treatments” group, patients in the IO group generated a greater workload in terms of treatment sessions (9.59 vs 6.83 per patient, p < 0.0001), re-evaluations (2.55 vs 1.88, p = 0.0002), and unplanned presentations (2.19 vs 1.51, p = 0.08). On the other hand, follow-up visits workload was greater for “other treatments” group (0.83 vs 0.63, p = 0.0002). No differences were found regarding hospitalizations and inpatient oncology advices. Further analysis will be presented. Conclusions: IO represents a new frontier in oncology landscape, leading to outcome’s improvement and longer lasting treatment periods. The estimate of oncology workload generated by new diagnosis of metastatic cancer requiring IO, is crucial for implementing more sustainable systems and for planning clinical activities.

Chronic exposure to psychotropic medication and incidence of new-onset type 2 diabetes mellitus in young adults: a retrospective cohort from Colombia v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Psychotropic Drugs ◽  
Retrospective Cohort ◽  
Baseline Risk ◽  
First Year ◽  
Drug Induced ◽  
New Diagnosis

Background:Drug-induced diabetes is an increasingly important cause of diabetes mellitus worldwide. Certain psychotropic drugs may cause weight gain, but the long-term effect of this on the incidence of type 2 diabetes (T2DM) is not clear. The objective was to assess the association between psychotropic drugs and new diagnosis T2DM. Methods:  Retrospective cohort study using a prescription claims database. Adults 18-65 years old exposed (N=2,118) and unexposed (N=1,877) chronically to psychotropic drugs were followed between 2012-2016. Incidence rate ratio (IRR) and survival analysis were used to compare the occurrence of diabetic events (first prescription of drugs for the treatment of diabetes) among groups. Results:Patients were followed during 14,524 person-years. The cumulative incidence of T2DM was 3.6% in unexposed and 6.5% in exposed participants, with an IRR=1.875 (95%CI: 1.409–2.494). The IRR of T2DM was significantly higher for exposed in the first year of follow up (IRR=2.378, IC95%: 1.291–4.379) and second (IRR=2.009, 95%CI: 1.084–3.726) years of follow-up and for the entire follow up (IRR=1.661, IC95%: 1.240-2.225). Age group 45-64 years (HR=1.839, 95%CI: 1.281-2.640) compared to 18-44 years, and hypertension (HR=2.046, 95%CI: 1.388-3.017) were significant predictors of diabetic events. Conclusions:Chronic users of psychiatric drugs had a higher incidence of diabetic events than unexposed patients. Baseline risk factors of diabetes were the main predictors of the outcome, suggesting that risk assessment before and during treatment could mitigate the excessive risk of drug-induced diabetes.

The First Year Experience of Ankara Child Follow up Center

2012 ◽  
Author(s):  
Fadime Yuksel ◽  
Safa Celik ◽  
Filiz Daskafa ◽  
Nilufer Keser ◽  
Elif Odabas ◽  
...  
Keyword(s):  
First Year Experience ◽  
First Year

Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol

2019 ◽  
Vol 24 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Bianca K. den Ottelander ◽  
Robbin de Goederen ◽  
Marie-Lise C. van Veelen ◽  
Stephanie D. C. van de Beeten ◽  
Maarten H. Lequin ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
First Year ◽  
Ventricular Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Skull Growth ◽  
Muenke Syndrome ◽  
First Year Of Life

OBJECTIVEThe authors evaluated the long-term outcome of their treatment protocol for Muenke syndrome, which includes a single craniofacial procedure.METHODSThis was a prospective observational cohort study of Muenke syndrome patients who underwent surgery for craniosynostosis within the first year of life. Symptoms and determinants of intracranial hypertension were evaluated by longitudinal monitoring of the presence of papilledema (fundoscopy), obstructive sleep apnea (OSA; with polysomnography), cerebellar tonsillar herniation (MRI studies), ventricular size (MRI and CT studies), and skull growth (occipital frontal head circumference [OFC]). Other evaluated factors included hearing, speech, and ophthalmological outcomes.RESULTSThe study included 38 patients; 36 patients underwent fronto-supraorbital advancement. The median age at last follow-up was 13.2 years (range 1.3–24.4 years). Three patients had papilledema, which was related to ophthalmological disorders in 2 patients. Three patients had mild OSA. Three patients had a Chiari I malformation, and tonsillar descent < 5 mm was present in 6 patients. Tonsillar position was unrelated to papilledema, ventricular size, or restricted skull growth. Ten patients had ventriculomegaly, and the OFC growth curve deflected in 3 patients. Twenty-two patients had hearing loss. Refraction anomalies were diagnosed in 14/15 patients measured at ≥ 8 years of age.CONCLUSIONSPatients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension, in accordance with the very low prevalence of its causative factors (OSA, hydrocephalus, and restricted skull growth). This illustrates that there is no need for a routine second craniofacial procedure. Patient follow-up should focus on visual assessment and speech and hearing outcomes.

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study

2021 ◽  
pp. 140349482110076
Author(s):  
Lotus S. Bast ◽  
Lisbeth Lund ◽  
Stine G. LauemØller ◽  
Simone G. Kjeld ◽  
Pernille Due ◽  
...  
Keyword(s):  
Preventive Intervention ◽  
First Year ◽  
Difference In Difference ◽  
Current Smoking ◽  
Smoking Intervention ◽  
School Time ◽  
School Based ◽  
Inequality In Health ◽  
Baseline Response

Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases ( N=1190) and imputation of missing data at follow-up ( N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.

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