The impact of continuing medical education (CME) programs in metastatic castration-resistant prostate cancer (CRPC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18280-e18280
Author(s):  
Hamsa Jaganathan ◽  
Anne Roc ◽  
Andrew J. Armstrong ◽  
Daniel J. George ◽  
Wendy Turell
Keyword(s):  
Clinical Practice ◽  
Positive Impact ◽  
Practice Change ◽  
Castration Resistant Prostate Cancer ◽  
Sequential Approach ◽  
Short Period ◽  
Concurrent Development ◽  
Practice Knowledge ◽  
Investigational Agents ◽  
The Impact

e18280 Background: The concurrent development of many CRPC treatments within a short period of time has made prospective data on their sequential use and efficacy complicated, which have challenged clinician confidence, knowledge, and competency. Four hours of CME focused on the therapeutic management of CRPC were developed and participant responses analyzed to determine if these challenges were addressed. Methods: PlatformQ Health developed and executed 4 hours of virtual CME programs in CRPC. The 1st 2-hours, broadcast in May 2015 and offered online for 6 months, attracted a total of 545 learners. The 2nd 2-hours, broadcast in July 2016 and offered for 12 months, attracted a total of 345* learners. Survey-based evaluations targeted self-reported clinician data on satisfaction, clinical practice change and observed patient outcome. Clinician participation data and self-reported patients with CRPC seen per week were used in extrapolations of patients impacted by the CME education per week. Results: Between the 2015 and 2016 CME programs, learners gained confidence in their ability to employ a personalized, sequential approach to treat CRPC (12% vs 35%). Overall, 68% of all learners reported a positive clinical practice impact and 59% reported a positive impact on patient experience and/or outcomes as a result of CME participation. Learner commitment to change was consistently observed in both 2015 and 2016 programs in: medical and practice knowledge (90% and 94%, respectively), care attitudes (83% and 85%), practice behavior (79% and 77%), and their patients’ clinical outcomes (76% and 78%). An estimated 4,066 patients in 2015 and 3,374 patients in 2016 were impacted as a result of the education. Conclusions: Outcomes results of 2 years of education on evolving treatment paradigms of metastatic CRPC demonstrate learner improvements in both clinical practice and patient outcomes. Continuing education in the management of CRPC is recommended, particularly on strategies to appropriately sequence treatments, treatment of bone metastases, keeping abreast of new data, and understanding the rationale for investigational agents. *As of Jan 2017, data collection is ongoing

Incorporation of plasma-based next-generation sequencing to improve guideline-concordant molecular testing in patients with newly diagnosed metastatic nonsquamous non-small cell lung cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 14-14
Author(s):  
Charu Aggarwal ◽  
Melina Elpi Marmarelis ◽  
Wei-Ting Hwang ◽  
Dylan G. Scholes ◽  
Aditi Puri Singh ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Change ◽  
Molecular Testing ◽  
Tier 2 ◽  
Newly Diagnosed ◽  
Next Generation ◽  
First Line ◽  
Tier 1 ◽  
Tier 3 ◽  
The Impact

14 Background: Current NCCN guidelines recommend comprehensive molecular profiling for all newly diagnosed patients with metastatic non-squamous NSCLC to enable the delivery of personalized medicine. We have previously demonstrated that incorporation of plasma based next-generation gene sequencing (NGS) improves detection of clinically actionable mutations in patients with advanced NSCLC (Aggarwal et al, JAMA Oncology, 2018). To increase rates of comprehensive molecular testing at our institution, we adapted our clinical practice to include concurrent use of plasma (P) and tissue (T) based NGS upon initial diagnosis. P NGS testing was performed using a commercial 74 gene assay. We analyzed the impact of this practice change on guideline concordant molecular testing at our institution. Methods: A retrospective cohort study of patients with newly diagnosed metastatic non-squamous NSCLC following the implementation of this practice change in 12/2018 was performed. Tiers of NCCN guideline concordant testing were defined, Tier 1: complete EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, Tier 2: included above, but with incomplete NTRK testing, Tier 3: > 2 genes tested, Tier 4: single gene testing, Tier 5: no testing. Proportion of patients with comprehensive molecular testing by modality (T NGS vs. T+P NGS) were compared using one-sided Fisher’s exact test. Results: Between 01/2019, and 12/2019, 170 patients with newly diagnosed metastatic non-Sq NSCLC were treated at our institution. Overall, 98.2% (167/170) patients underwent molecular testing, Tier 1: n = 100 (59%), Tier 2: n = 39 (23%), Tier 3/4: n = 28 (16.5%), Tier 5: n = 3 (2%). Amongst these patients, 43.1% (72/167) were tested with T NGS alone, 8% (15/167) with P NGS alone, and 47.9% (80/167) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS: 95.7% (79/80) compared to T alone: 62.5% (45/72), p < 0.0005. Prior to the initiation of first line treatment, 72.4% (123/170) patients underwent molecular testing, Tier 1: n = 73 (59%), Tier 2: n = 27 (22%) and Tier 3/4: n = 23 (18%). Amongst these, 39% (48/123) were tested with T NGS alone, 7% (9/123) with P NGS alone and 53.6% (66/123) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS, 100% (66/66) compared to 52% (25/48) with T NGS alone (p < 0.0005). Conclusions: Incorporation of concurrent T+P NGS testing in treatment naïve metastatic non-Sq NSCLC significantly increased the proportion of patients undergoing guideline concordant molecular testing, including prior to initiation of first-line therapy at our institution. Concurrent T+P NGS should be adopted into institutional pathways and routine clinical practice.

Cancer Cachexia: Beyond Weight Loss

2016 ◽  
Vol 12 (11) ◽  
pp. 1163-1171 ◽  
Author(s):  
Andrew R. Bruggeman ◽  
Arif H. Kamal ◽  
Thomas W. LeBlanc ◽  
Joseph D. Ma ◽  
Vickie E. Baracos ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Composition ◽  
Clinical Practice ◽  
Physical Functioning ◽  
Early Identification ◽  
Cancer Cachexia ◽  
Psychosocial Support ◽  
Investigational Agents ◽  
Pharmacologic Agents ◽  
The Impact

Cancer cachexia is a multifactorial syndrome characterized by skeletal muscle loss leading to progressive functional impairment. Despite the ubiquity of cachexia in clinical practice, prevention, early identification, and intervention remain challenging. The impact of cancer cachexia on quality of life, treatment-related toxicity, physical function, and mortality are well established; however, establishing a clinically meaningful definition has proven challenging because of the focus on weight loss alone. Attempts to more comprehensively define cachexia through body composition, physical functioning, and molecular biomarkers, while promising, are yet to be routinely incorporated into clinical practice. Pharmacologic agents that have not been approved by the US Food and Drug Administration but that are currently used in cancer cachexia (ie, megestrol, dronabinol) may improve weight but not outcomes of interest such as muscle mass, physical activity, or mortality. Their routine use is limited by adverse effects. For the practicing oncologist, early identification and management of cachexia is critical. Oncologists must recognize cachexia beyond weight loss alone, focusing instead on body composition and physical functioning. In fact, becoming emaciated is a late sign of cachexia that characterizes its refractory stage. Given that cachexia is a multifactorial syndrome, it requires early identification and polymodal intervention, including optimal cancer therapy, symptom management, nutrition, exercise, and psychosocial support. Consequently, oncologists have a role in ensuring that these resources are available to their patients. In addition, in light of the promising investigational agents, it remains imperative to refer patients with cachexia to clinical trials so that available options can be expanded to effectively treat this pervasive problem.

scholarly journals Hospital ethics reflection groups: a learning and development resource for clinical practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
H. Bruun ◽  
L. Huniche ◽  
E. Stenager ◽  
C. B. Mogensen ◽  
R. Pedersen
Keyword(s):  
Clinical Practice ◽  
General Hospital ◽  
Positive Impact ◽  
Reflection Group ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Reflection Groups ◽  
Patient Admissions ◽  
The Impact ◽  
Ethics Reflection

Abstract Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.

scholarly journals Complaints concerning communication reported by users of healthcare in a specific region in Sweden

2015 ◽  
Vol 4 (3) ◽  
pp. 39 ◽  
Author(s):  
Emina Hadziabdic ◽  
Gina Higginbottom
Keyword(s):  
Positive Impact ◽  
Healthcare Services ◽  
Participatory Approach ◽  
Specific Region ◽  
Healthcare Staff ◽  
Quality Healthcare ◽  
Healthcare Practice ◽  
Practice Knowledge ◽  
The Impact

Introduction: Effective communication between patients and healthcare staff is important in all healthcare services. Previousstudies investigating criticism and complaints concerning treatment reported by patients and relatives in a healthcare context pointto the most common complaints were unsatisfactory information, unsatisfactory respect and unsatisfactory empathy, but furtherinvestigation is needed. Objective: The aim of this study was to explore complaints reported by patients and relatives in a countycouncil area in the context of communication between patients and healthcare staff, and to investigate the impact complaints canhave on the safety and quality of healthcare.Methods: An exploratory descriptive design was used with a participatory approach. 115 complaints from patients and relatives,collected from various contexts relating to healthcare, were analyzed through qualitative content analysis.Results: Four categories emerged from the analysis of complaints: 1) inadequate communication; 2) inadequate individualisticand holistic healthcare; 3) unprofessional attitude of healthcare staff; and 4) the complaints had both a negative and positiveimpact on the organization of healthcare. The study showed that complaints were related to a lack of adequate verbal and writtencommunication, the patients’ feelings that the healthcare staff did not taking their experiences seriously, and an unprofessional,indifferent and discriminatory attitude among the healthcare staff. The complaints had both a negative and positive impact on theorganization of healthcare.Conclusions: This study highlights how it is possible to learn from complaints about healthcare, and demonstrates that this is aprerequisite for improving healthcare practice. Knowledge about where healthcare practice is failing can be increased, and thiscan be fed into policies for patient safety and quality healthcare.

scholarly journals The Impact Of Internship Programme And Its Effects On The Physiotherapy Practice In Nigeria

2007 ◽  
Author(s):  
Ayodele Teslim Onigbinde
Keyword(s):  
Clinical Practice ◽  
Clinical Training ◽  
Positive Impact ◽  
Training Programme ◽  
Working Environment ◽  
University Teaching ◽  
Teaching Hospitals ◽  
One Year ◽  
The Impact ◽  
Internship Training

Background: The recent introduction of one year internship training programme is one of the few steps taken to update standard and knowledge of upcoming physiotherapists in Nigeria. It is a compulsory one-year clinical training post-graduation from the university under the supervision of the clinicians. The major importance of introducing the new policy is to promote acquisition and utilization of new skills, and as well, develop skills and confidence already acquired during undergraduate days. Objectives: The aim of this study was to assess and evaluate the new internship-training programme considering welfare package like salary and wages, accommodation, employment opportunities, acceptability and working environment. The study also evaluated the opinion of the supervisors on the impact of the new policy on the profession, government and clinical practice. Method: Structured copies of self-administered questionnaires were distributed to forty-four interns at three accredited University Teaching Hospitals in Nigeria while 30 questionnaires were distributed to supervising physiotherapists in these hospitals. The response rate for interns was 100% while it was 60% for the supervisors. The data obtained from the designed questionnaire were analyzed by descriptive analysis. Results: The result showed that the 52% of the interns were satisfied with the support from their senior colleagues, work load (80%), freedom to plan and manage patients (100%), and supervision from senior colleagues (62%). They were grossly dissatisfied with their salaries (91%), equipment available (79%), pattern of conducting ward rounds (89%), and office environment (58%). The result also revealed that all the supervising physiotherapists (100%) were satisfied with the skill and clinical practice of the interns. The result further showed that the programme has a positive impact in terms of clinical practice, confidence employment opportunity, productivity and government policy (66–100%). Conclusion: This study concluded that the internship programme has a remarkable positive impact on the profession of physiotherapy in Nigeria. However, the intern physiotherapists were not satisfied most especially with their monthly income and pattern of conducting clinical rounds. KEY WORDS: Physiotherapy Internship Programme, Nigerian Physiotherapists.

scholarly journals Measuring the Impact of an Open Online Prescribing Data Analysis Service on Clinical Practice: a Cohort Study in NHS England Data

2018 ◽  
Author(s):  
Alex J Walker ◽  
Helen J Curtis ◽  
Richard Croker ◽  
Seb Bacon ◽  
Ben Goldacre
Keyword(s):  
Clinical Practice ◽  
Confidence Interval ◽  
Fixed Effects ◽  
Positive Impact ◽  
Fixed Effects Model ◽  
Practice Level ◽  
Prescribing Quality ◽  
Two Measures ◽  
Clinically Significant ◽  
The Impact

AbstractBackgroundOpenPrescribing is a freely accessible service that enables any user to view and analyse NHS primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing.ObjectivesWe set out to measure the impact of OpenPrescribing being viewed on subsequent prescribing.MethodsHaving pre-registered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see if they changed after CCG and practice pages were viewed. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, to those who were not. We used fixed effects and between effects linear panel regression, to isolate change over time and differences between practices respectively. We adjusted for month of prescribing in the fixed effects model, to remove underlying trends in outcome measures.ResultsWe found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at the practice level (−£40.42 per thousand patients per month, 95% confidence interval −54.04 to −26.01) than at CCG level (−£14.70 per thousand patients per month, 95% confidence interval −25.56 to −3.84). We estimate a total saving since launch of £243k at practice level and £1.47m at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8m in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs/practices were viewed. Practices which were viewed had worse prescribing quality scores overall, prior to viewing.ConclusionsWe found a clinically significant positive impact from use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. We also show that it is possible to conduct a robust analysis of the impact of such an online service on clinical practice.

scholarly journals Mental healthcare clinician engagement with point of care testing; a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph Butler ◽  
Simone de Cassan ◽  
Phil Turner ◽  
Belinda Lennox ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Positive Impact ◽  
Point Of Care ◽  
Mental Healthcare ◽  
Successful Implementation ◽  
Point Of Care Testing ◽  
Structured Interviews ◽  
The Impact

Abstract Background Point of Care Testing (POCT) is being increasingly used to augment the delivery of physical health care in a variety of settings, but their use in mental health has been limited. Research into understanding the barriers faced for successful implementation of POCT in these settings is lacking. We aimed to identify factors affecting engagement and implementation of POCT within mental health teams by exploring the attitudes to POCT, and the perceived impact POCT has on the practice of mental healthcare clinicians. Methods Alongside a study evaluating the impact of a point of care device in Community Mental Health Teams (CMHTs), qualitative interviews were carried out with CMHT clinicians using POCT as part of annual physical checks for patients with severe and enduring mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis. Results Fifteen clinicians were interviewed across a range of professional backgrounds. Clinicians identified usability of the technology, positive impact on their patient’s experience and improved self-efficacy as drivers for successful implementation of POCT into their clinical practice. Issues with device functioning and the potential for a negative effect on the therapeutic relationship with their patients were identified as barriers. Level of physical heath training was not found to be a barrier by mental health professionals to using POCT. Conclusions Understanding barriers and drivers for engagement is important to allow co-production of POCT and guidelines to facilitate introduction of POCT into routine clinical practice.

scholarly journals Measuring the Impact of an Open Web-Based Prescribing Data Analysis Service on Clinical Practice: Cohort Study on NHS England Data (Preprint)

2018 ◽  
Author(s):  
Alex J Walker ◽  
Helen J Curtis ◽  
Richard Croker ◽  
Seb Bacon ◽  
Ben Goldacre
Keyword(s):  
Clinical Practice ◽  
Fixed Effects ◽  
Positive Impact ◽  
Fixed Effects Model ◽  
Web Based ◽  
Practice Level ◽  
Prescribing Quality ◽  
Two Measures ◽  
The Impact

BACKGROUND OpenPrescribing is a freely accessible service that enables any user to view and analyze the National Health Service (NHS) primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing. OBJECTIVE We aimed to measure the impact of OpenPrescribing being viewed on subsequent prescribing. METHODS Having preregistered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see whether they changed after the viewing of Clinical Commissioning Group (CCG) and practice pages. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, compared with those who were not. We used fixed-effects and between-effects linear panel regression to isolate change over time and differences between practices, respectively. We adjusted for the month of prescribing in the fixed-effects model to remove underlying trends in outcome measures. RESULTS We found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at practice level (−£40.42 per thousand patients per month; 95% CI −54.04 to −26.81) than at CCG level (−£14.70 per thousand patients per month; 95% CI −25.56 to −3.84). We estimate a total saving since launch of £243 thosand at practice level and £1.47 million at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8 million in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs or practices were viewed. Practices that were viewed had worse prescribing quality scores overall prior to viewing. CONCLUSIONS We found a positive impact from the use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. Furthermore, we show that it is possible to conduct a robust analysis of the impact of such a Web-based service on clinical practice.

scholarly journals Attitudes towards Islamic Banks: The Impact of Religiosity and the Moderating Role of Trust

2019 ◽  
Vol 4 (2) ◽  
pp. 29-36
Author(s):  
Zaid Zaid
Keyword(s):  
Positive Impact ◽  
Future Research ◽  
Islamic Banks ◽  
Correlation And Regression Analysis ◽  
Islamic Financial Institutions ◽  
Practice Knowledge ◽  
Muslim Religiosity ◽  
The Impact ◽  
Moderating Role

The purpose of this study is to analyze the impact of Muslim religiosity on attitudes towards Islamic Banks, considering the moderating role of public trust that exists towards these Islamic financial institutions. It identifies how trust towards Islamic banks in terms of their conformity with Shari’ah principles and their safe handling of deposits would affect common attitudes towards them. Data for the study was collected through questionnaires from 113 individuals participated in the survey. The data was analyzed through correlation and regression analysis. Results showed that religiosity (belief, practice, knowledge, experience and consequence) has positive impact on attitudes towards Islamic banks. It proved that the more a person is religion conscious the more he/she is inclined towards Islamic banks. Moreover, it was confirmed that trust has positive relationship with attitudes towards Islamic banks. However, results could not identify any significant moderating role of trust on the relationship between religiosity and attitudes towards Islamic banks. Practical implications of the results and avenues for further investigation are discussed for future research.

scholarly journals STEM Outreach via Science Forensic Module: The Impact of the Near-peer Mentoring Approach

2019 ◽  
Vol 9 (1) ◽  
pp. 77-80
Author(s):  
Hazeeq Hazwan Azman ◽  
Maegala Nallapan Maniyam ◽  
Marini Ibrahim ◽  
Hasdianty Abdullah ◽  
Khairil Bariyyah Hassan ◽  
...  
Keyword(s):  
Stem Education ◽  
Peer Mentoring ◽  
Positive Impact ◽  
Real Life ◽  
Dna Profiling ◽  
School Students ◽  
Pure Science ◽  
Short Period ◽  
Level Of Understanding ◽  
The Impact

STEM education emphasizes the integrated study of science passing the boundaries of traditionally labelled disciplines while demonstrating its application in real life. Science forensic is an eye-catching subject for students, which implements the knowledge of biology, physics, and chemistry. The purpose of this study was to identify students’ interest towards STEM through science forensic module and the impact of the near-peer mentoring approach in the module for STEM outreach. This pilot study was conducted for the students of Sekolah Berasrama Penuh Integrasi (SBPI) Gombak with 36 participants. By using the Statistical Package for the Social Science (SPSS), the analysis revealed that 94.5% of students found the module interesting and 77% of participants agreeing that the module increased their interest to pursue their future study in the STEM-field. Focusing on demographics, this module received more positive responses from females and pure science stream students as compared to males and Islamic science stream, respectively. This result is consistent with the higher number of female students and pure science stream students in STEM-field study at university level. The near-peer mentoring approach showed a promising impact with 88% of students giving positive feedback on the credibility of mentors. The science forensic modules consisted of 8 main stations with the Fingerprinting station being the most popular (94.5%) and DNA profiling being the least popular (77.8%). One possible explanation of this is that the level of understanding for DNA profiling is harder with larger amounts of knowledge needed to be learned in a short period of time. Overall, the outcomes of this study suggest that exposing secondary school students to science forensic has a positive impact on their level of interest towards STEM education.

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