Simulation in oncologic care: Advancing evidence-based decisions in the management of metastatic castration resistant prostate cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 322-322 ◽  
Author(s):  
Tara Herrmann ◽  
Martin Warters ◽  
Douglas Blevins
Keyword(s):  
Prostate Cancer ◽  
Patient Outcomes ◽  
Current Evidence ◽  
Considerable Proportion ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Clinical Guidance ◽  
Online Simulation ◽  
Simulation Based ◽  
The Impact

322 Background: A considerable proportion of prostate cancer cases among men progress to mCRPC. As a result, appropriate treatment selection and sequencing is crucial to maximizing patient outcomes. A study was conducted to determine if simulation-based educational interventions to address underlying clinical practice gaps could improve clinical decisions of oncologists in the management of mCRPC. Methods: A cohort of US-practicing oncologists who participated in online simulation-based education was evaluated. The intervention consisted of two cases presented in a platform that allowed learners to assess the patient and choose from an extensive database of diagnostic and treatment possibilities matching the scope and depth of actual practice. Clinical decisions made by participants were analyzed using a decision engine, and instantaneous clinical guidance employing current evidence-based and expert faculty recommendations was provided at each decision point. Participant decisions before and after clinical guidance were compared using a 2-tailed paired T-test to provide p-values for assessing the impact of simulation-based education on the clinical decisions made by participants between 2/25/2014 and 9/12/2014. Results: The assessment sample consisted of 107 oncologists who made clinical decisions within the simulation. As a result of clinical guidance, significant improvements were observed in: a) Selection of an evidence-based regimen that included mCRPC targeted therapy (17%, p = 0.027) and treatment for bone metastases (26%, p < 0.0001), in an individual with a 6-year history of prostate cancer whose disease presented with bone metastasis; and b) Starting a bone resorption inhibitor (25%, p < 0.001) and switching mCRPC therapies (28%, p < 0.001) in a patient whose PSA levels were rising despite treatment. Conclusions: This study showed improvements in clinical decisions of oncologists in selecting evidence-based therapeutic regimens for patients with mCRPC. This study demonstrates that online, simulation-based instruction can result in an increase in appropriate clinical decisions, and may play a role in improving the quality of care and patient outcomes.

Abstract 210: Improving Evidence-Based Decisions in SIHD Management: Simulation in Continuing Education

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Jelena Spyropoulos ◽  
Catherine C Capparelli
Keyword(s):  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Patient Assessment ◽  
Improve Performance ◽  
Evidence Based Practices ◽  
Online Simulation ◽  
Appropriate Treatment ◽  
Simulation Based ◽  
The Impact

Background: Guideline-directed medical therapy (GDMT) to manage angina is widely underused in patients with stable ischemic heart disease (SIHD), and patients are often misdiagnosed and not managed appropriately. Goals: This study was conducted to determine if an online, simulation-based continuing medical education (CME) intervention could improve performance of cardiologists in medical management of patients with SIHD. Methods: The CME intervention consisted of two cases presented in a platform that allowed learners to choose from numerous lab tests, diagnoses and treatments matching the scope and depth of actual practice. The clinical decisions made by the learners were analyzed using an artificial intelligence engine, and clinical guidance (CG) was then provided based on current evidence and expert recommendation. Learner decisions were collected after CG and compared with each user’s baseline (pre-CG) data using a 2-tailed paired T-test to determine P values for assessing the impact of education on clinical decisions. Results: As a result of CG, significant improvements were observed among cardiologists post- CG compared to pre-CG, related to patient assessment, diagnosis and appropriate treatment of SIHD (Table). Conclusion: This study demonstrated that simulation-based CME can improve evidence-based practices of cardiologists related to management of SIHD. In addition, ongoing educational gaps were uncovered related to appropriate patient assessment, ability to diagnose SIHD, as well as ability to appropriately order step-up antianginal therapy.

scholarly journals Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

2015 ◽  
Vol 61 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Mike J Hallworth ◽  
Paul L Epner ◽  
Christoph Ebert ◽  
Corinne R Fantz ◽  
Sherry A Faye ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Effectiveness ◽  
Laboratory Medicine ◽  
Current Evidence ◽  
Patient Centered ◽  
Definition Of ◽  
Current Utilization ◽  
Measures Of Effectiveness ◽  
The Impact ◽  
Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

Management of the deteriorating adult patient: does simulation-based education improve patient safety?

2021 ◽  
pp. 1-8
Author(s):  
Jacqueline Bennion ◽  
Stephanie K Mansell
Keyword(s):  
Human Factors ◽  
Adult Patient ◽  
Patient Outcomes ◽  
Improve Patient Safety ◽  
Low Grade ◽  
Contributing Factors ◽  
Educational Method ◽  
Simulation Based ◽  
The Impact

Failure to recognise the deteriorating patient can cause severe harm and is related to preventable death. Human factors are often identified as contributing factors. Simulation-based education is used to develop clinicians' human factors skills. This article discusses the evidence concerning the efficacy of simulation-based education for improving the recognition and management of the acutely deteriorating adult patient, and the limitations of simulation-based education. Findings demonstrated simulation-based education was the most effective educational method identified for training staff in recognising unwell patients. The evidence demonstrating the impact of simulation-based education on patient outcomes was equivocal. The quality of the evidence was low grade regarding the efficacy of simulation-based education on human factors. Further research is required to confirm the efficacy of simulation-based education for human factors and patient outcomes.

Advancing evidence-based decisions in the management of EGFR-mutated metastatic NSCLC.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20663-e20663
Author(s):  
Tara Herrmann ◽  
Martin Warters ◽  
Douglas Blevins ◽  
Panos Fidias
Keyword(s):  
Learning Experience ◽  
Patient Simulation ◽  
Treatment Resistance ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
First Line ◽  
Metastatic Nsclc ◽  
Egfr Mutated

e20663 Background: In patients diagnosed with metastatic NSCLC it is now essential to identify targetable mutations and markers of treatment resistance in order to determine the appropriate therapy. A study was conducted to determine if simulation-based educational interventions to address clinical practice gaps could improve decisions of oncologists in the management of EGFR-mutated metastatic NSCLC. Methods: A cohort of US-oncologists who participated in a virtual patient simulation (VPS)-based education was evaluated. The VPS consisted of 2 cases that allowed oncologists to assess the patient and choose from a database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions were analyzed using a decision engine, and instantaneous clinical guidance (CG) employing current evidence-based and expert faculty recommendations was provided after each decision. Oncologists were allowed a second chance at each decision point and decisions before and after CG were compared using a 2-tailed paired T-test to determine differences from pre- to post CG. P values are shown as a measure of significance; with P < .05 statistically significant. Results: 197 oncologists made clinical decisions within the simulation. As a result of CG, significant improvements were observed in: Ordering EGFR mutational testing (16%, P= 0.008) and making an accurate diagnosis (36%) Selecting an EGFR TKI in the first-line setting (24%, P< 0.001) Ordering a PET scan to assess disease progression (10%) and in diagnosing patients with EGFR T790M disease that is resistant (29% , P< 0.001) Evidence-based treatment selection for individuals whose disease progressed on first-line therapy (19%, P= .003) Number of oncologists who ordered adverse event education and counseling (23%, P< .001) Conclusions: This study showed improvements in evidence-based practices of oncologists in the diagnosis and management of EGFR-mutated NSCLC; demonstrating that VPS-based instruction that immerses and engages oncologists for an authentic, practical and16. consequence-free learning experience can result in an increase in appropriate clinical decisions. Therefore, VPS may have a role in improving the quality of patient care.

Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination

2020 ◽  
pp. 095646242095857
Author(s):  
Georgios Tyros ◽  
Styliani Mastraftsi ◽  
Stamatis Gregoriou ◽  
Electra Nicolaidou
Keyword(s):  
Risk Factors ◽  
Human Papillomavirus ◽  
Hpv Vaccination ◽  
Real Life ◽  
Current Evidence ◽  
Evidence Based ◽  
Anogenital Warts ◽  
Psychological Burden ◽  
Increased Risk ◽  
The Impact

Anogenital warts (AGWs) rank among the most frequent sexually transmitted infections in young adults. They are benign lesions, but they pose a significant economic cost to health care systems and a substantial psychological burden on patients, who need evidence-based counselling. Human papillomavirus (HPV) vaccination has shown very high protection rates against AGWs in clinical trials and real-world settings but vaccination coverage remains low in many countries. The aim of this review is to summarize the current evidence on the risk factors for AGW development and to present the available real-life data on the impact of HPV vaccination on AGW incidence. An increased number of lifetime sexual partners, a new sexual partner in the last 12 months, smoking, and immunosuppression have been associated with increased risk for AGWs. HPV vaccination has led to a dramatic decline in AGW incidence in populations that have achieved high vaccination rates. These conclusions can contribute to primary prevention of AGWs and evidence-based counselling of AGW patients.

scholarly journals The Impact of Radiation Cost on Patient Outcomes After Definitive Radiation Therapy in Prostate Cancer

2016 ◽  
Vol 96 (2) ◽  
pp. S161-S162
Author(s):  
K.E. Fero ◽  
A.J. Paravati ◽  
N. Panjwani ◽  
I.J. Boero ◽  
L. Hwang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Patient Outcomes ◽  
The Impact

scholarly journals The Impact of Malocclusion/Orthodontic Treatment Need on the Quality of Life

2009 ◽  
Vol 79 (3) ◽  
pp. 585-591 ◽  
Author(s):  
Zhijian Liu ◽  
Colman McGrath ◽  
Urban Hägg
Keyword(s):  
Quality Of Life ◽  
Orthodontic Treatment ◽  
Meta Analysis ◽  
Current Evidence ◽  
Future Research ◽  
Evidence Based ◽  
Treatment Need ◽  
Methodologic Quality ◽  
The Impact

Abstract Objective: To assess the current evidence of the relationship between malocclusion/orthodontic treatment need and quality of life (QoL). Materials and Methods: Four electronic databases were searched for articles concerning the impact of malocclusion/orthodontic treatment need on QoL published between January 1960 and December 2007. Electronic searches were supplemented by manual searches and reference linkages. Eligible literature was reviewed and assessed by methodologic quality as well as by analytic results. Results: From 143 reviewed articles, 23 met the inclusion criteria and used standardized health-related QoL (HRQoL) and orthodontic assessment measures. The majority of studies (18/23) were conducted among child/adolescent populations. Seventeen of the papers were categorized as level 1 or 2 evidence based on the criteria of the Oxford Centre for Evidence-Based Medicine. An observed association between HRQoL and malocclusion/orthodontic treatment need was generally detected irrespective of how they were assessed. However, the strength of the association could be described as modest at best. Key findings and future research considerations are described in the review. Conclusions: Findings of this review suggest that there is an association (albeit modest) between malocclusion/orthodontic treatment need and QoL. There is a need for further studies of their relationship, particularly studies that employ standardized assessment methods so that outcomes are uniform and thus amenable to meta-analysis.

scholarly journals Death from COVID-19 in a Hispanic postpartum woman and review of the literature

2021 ◽  
Vol 14 (7) ◽  
pp. e242819
Author(s):  
Janardhan Mydam ◽  
Laila Younes ◽  
Mohammed Siddiqui ◽  
Thana Tarsha
Keyword(s):  
Pregnancy Outcomes ◽  
Current Knowledge ◽  
Obese Woman ◽  
Clinical Care ◽  
Current Evidence ◽  
Postpartum Woman ◽  
Postpartum Women ◽  
Evidence Based ◽  
Review Of The Literature ◽  
The Impact

There is still much we do not know about the impact of COVID-19 on the health of pregnant and postpartum women and pregnancy outcomes. Current evidence suggests that there is biological plausibility for worse outcomes among this population. This case report details the clinical care given to a postpartum Hispanic and obese woman diagnosed with COVID-19 in April 2020. We report the care she and her newborn received and her progression through the virus. We discuss the current knowledge surrounding COVID-19 among pregnant and postpartum women. While research supports COVID-19 outcomes being comparable to the general population, there is limited research in this area. Clinical trials, acting on the side of caution, have tended to exclude pregnant women from participation. Therefore, there is a need for further research that can inform evidence-based policy decisions related to COVID-19 in pregnant and postpartum women.

scholarly journals Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

2019 ◽  
Author(s):  
Kate Honeyford ◽  
Graham S Cooke ◽  
Anne Kinderlerer ◽  
Elizabeth Williamson ◽  
Mark Gilchrist ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Patient Outcomes ◽  
Natural Experiment ◽  
Research Centre ◽  
Current Evidence ◽  
Prolonged Hospital Stay ◽  
Lower Odds ◽  
Improved Outcomes ◽  
Prolonged Hospital ◽  
The Impact

ABSTRACTObjectiveTo determine the impact of a digital sepsis alert on patient outcomes in a UK multi-site hospital network.MethodsA natural experiment utlising the phased introduction of a digital sepsis alert into a multi-site hospital network. Sepsis alerts were either visible to clinicans (the ‘intervention’ group) or running silently and not visible (the control group). Inverse probability of treatment weighted multivariable logistic regression was used to estimate the effect of the intervention on patient outcomes.Outcomes: In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the Emergency Department.ResultsThe introduction of the alert was associated with lower odds of death (OR:0.76; 95%CI:(0.70, 0.84) n=21,183); lower odds of prolonged hospital stay ≥7 days (OR:0.93; 95%CI:(0.88, 0.99) n=9988); and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57,1.87) n=4622).DiscussionCurrent evidence that digital sepsis alerts are effective is mixed. In this large UK study a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics, which may suggest a causal pathway. It is not known whether the presence of alerting is responsible for improved outcomes, or whether the alert acted as a useful driver for quality improvement initiatives.ConclusionsThese findings strongly suggest that the the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.FundingImperial NIHR Biomedical Research Centre: NIHR-BRC-P68711.

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