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.

Advancing evidence-based decisions in the management of pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 506-506
Author(s):  
Tara Herrmann ◽  
Gwen Littman ◽  
Leah Piatt
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Guidelines ◽  
Advanced Pancreatic Cancer ◽  
Patient Simulation ◽  
Educational Interventions ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Brca Mutations ◽  
P Values

506 Background: As a result of updates to pancreatic cancer treatment guidelines, oncologists face a host of escalating treatment challenges that may hinder their abilities to select the most appropriate regimen for patients. A study was conducted to determine if simulation-based educational interventions could improve decisions of oncologists in the management of pancreatic cancer. Methods: A cohort of US-practicing oncologists who participated in a virtual patient simulation (VPS)-based education initiative was evaluated. The VPS consisted of 2 cases presented on a platform that allowed oncologists to assess each patient and make decisions limited only by an extensive database of 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 (CG) employing current evidence-based and expert faculty recommendations was provided immediately after each decision. Oncologists were allowed a second chance at each decision point; decisions before and after CG were compared using a 2-tailed paired T-test. P values are shown as a measure of significance; P values < .05 are statistically significant. Results: 410 oncologists made clinical decisions within the VPS. Significant improvements were observed in: Selecting the most appropriate first-line regimen in a patient with a PS of 2 (29%, P< 0.001); Ordering an anti-emetic in patients who are receiving chemotherapy (24% , P< 0.001); Evidence-based treatment selection for individuals whose disease progressed on therapy (17%, P= .003); and Ordering adverse event education and counseling (11% and 16%, P= .001). In addition, this study revealed that up to 55% of oncologists would test patients for BRCA mutations while 52% would consider enrolling a patient in a clinical trial if they have progressed on therapy. Conclusions: This study showed improvements in evidence-based practices of oncologists in the management of advanced pancreatic cancer across the continuum of care, thus demonstrating that VPS-based instruction can result in an increase in evidence-based clinical decisions. Therefore, VPS may have a role in improving the quality of care and patient outcomes.

Oncologist management of NTRK fusion-positive NSCLC improves after virtual patient simulation participation.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23008-e23008
Author(s):  
Michelle Arielle Worst ◽  
Brittany Cain ◽  
Tipp Nelson ◽  
Jacob Cohen ◽  
Alexander E. Drilon
Keyword(s):  
Targeted Therapies ◽  
Advanced Nsclc ◽  
Learning Experience ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Current Evidence ◽  
P Value ◽  
Clinical Decisions ◽  
Academic Settings ◽  
Improved Performance

e23008 Background: Although relatively rare, neurotrophic receptor tyrosine kinase (NTRK) fusions, represent a clinically relevant subgroup of NSCLC that can derive benefit from targeted therapies. Relatively quick and durable responses have been achieved with these targeted therapies in advanced NSCLC and intracranial activity has also been observed. The objective of this study was to determine if an online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention improved performance of oncologists in using appropriate strategies to diagnose and manage patients with NTRK fusion-positive advanced NSCLC. Methods: The CME intervention consisted of two patient cases presented in a VPS platform that allowed learners to order lab tests, diagnoses and treatments in a manner matching the scope and depth of actual practice. Clinical decisions made by the learners using open field entries within an EHR interface were analyzed and, after each decision, tailored clinical guidance (CG) was provided based on current evidence and expert recommendation. Learner decisions were collected post-CG and compared with each user’s baseline (pre-CG) data using a McNemar’s test to determine P values. Results were then aggregated for the two cases based on clinical decisions and stratified by practice setting. The activity posted July 31, 2020; data were collected through December 1, 2020. Results: Overall significant improvements were seen after CG in clinical decisions made by oncologists in both the community and academic settings [reported as % absolute improvement (% correct pre-CG vs % correct post-CG); P value]. Conclusions: This analysis demonstrated that VPS that immerses and engages oncologists in an authentic and practical learning experience can significantly improve evidence-based clinical decisions related to the diagnosis and management of patients with NTRK fusion-positive advanced NSCLC. Despite the improvements, additional educational activities are needed to address any residual gaps and further increase oncologists’ ability in this clinical setting.[Table: see text]

scholarly journals 28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 189-190
Author(s):  
Jovana Lubarda ◽  
Martin Warters ◽  
Piyali Chatterjee ◽  
Marlene P. Freeman ◽  
Roger S. McIntyre
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Postpartum Depression ◽  
Clinical Decision Making ◽  
Patient Simulation ◽  
Clinical Decision ◽  
Virtual Patient ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Practice Gaps

AbstractObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

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.

scholarly journals Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Mark Stares ◽  
Amanda Swan ◽  
Kirsten Cumming ◽  
Tze-En Ding ◽  
James Leach ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Targeted Therapy ◽  
Small Cell Lung Cancer ◽  
Progressive Disease ◽  
Treatment Resistance ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Metastatic Nsclc ◽  
Pre Treatment

Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albumin in patients receiving first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC.Methods: All patients treated with first-line targeted therapy or immunotherapy-based SACT for metastatic NSCLC at a regional Scottish cancer centre were identified. Serum albumin at pre-treatment, after 12-weeks of treatment, and at the time of progressive disease were recorded. The relationship between albumin (≥ 35g/L v &lt;35g/L) and overall survival (OS) was examined.Results: Data were available for 389 patients of both targeted therapy cohort (n = 159) and immunotherapy-based therapy cohort (n = 230). Pre-treatment albumin was predictive of OS in each cohort at HR1.82 (95%CI 1.23–2.7) (p =0.003) and HR2.55 (95%CI 1.78–3.65) (p &lt; 0.001), respectively. Pre-treatment albumin &lt;35 g/L was associated with a significantly higher relative risk of death within 12 weeks in each cohort at RR9.58 (95%CI 2.20–41.72, p = 0.003) and RR3.60 (95%CI 1.74–6.57, p &lt; 0.001), respectively. The 12-week albumin was predictive of OS in each cohort at HR1.88 (95%CI 1.86–4.46) (p &lt; 0.001) and HR2.67 (95%CI 1.74–4.08) (p &lt; 0.001), respectively. 46 out of 133 (35%) evaluable patients treated with targeted therapy and 43 out of 169 (25%) treated with immunotherapy-based therapy crossed over albumin prognostic groups between pre-treatment and 12-week. The prognostic value of 12-week albumin was independent of pre-treatment albumin status. A majority of patients had albumin &lt;35g/L at the time of progressive disease when it was also predictive of survival following progressive disease at HR2.48 (95%CI 1.61–3.82) (p &lt; 0.001) and HR2.87 (95%CI 1.91–4.31) (p &lt; 0.001) respectively).Conclusions: Albumin is a reliable prognostic factor in patients with metastatic NSCLC, predicting survival independent of the class of drug treatment at various time points during the patient journey. Tracking albumin concentrations during systemic therapy may indicate disease activity or treatment response over time.

scholarly journals Virtual Patient Simulation in DKD: Successful Strategy for Improving Recognition and Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A423-A423
Author(s):  
Amy Larkin ◽  
Michael LaCouture
Keyword(s):  
Patient Education ◽  
Learning Experience ◽  
Sglt2 Inhibitor ◽  
Patient Simulation ◽  
Virtual Patient ◽  
Current Evidence ◽  
Patient Identification ◽  
Improve Performance ◽  
Ckd Stage

Abstract Intro: we sought to determine if virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of diabetologists/endocrinologists related to recognition and management of diabetes kidney disease (DKD). Methods: The intervention comprised a patient presenting at two different time points in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. The activity posted August 30, 2019; initial data was collected through November 7, 2019. Results: 270 diabetologists/endocrinologists completed the activity (all decisions within at least 1 case) and were included. Significant improvements were observed after CG: 1st Patient: • Diagnose CKD stage 3b: 29% absolute improvement (5% pre-CG vs 34% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 50% improvement (24% pre-CG vs 74% post-CG; P&lt;.01) • Order patient education: 19% improvement (52% pre-CG vs 71% post-CG; P&lt;.01) • Order follow-up appointment: 18% improvement (53% pre-CG vs 71% post-CG; P&lt;.01) 2nd Patient: • Diagnose CKD stage 3a: 49% absolute improvement (10% pre-CG vs 59% post-CG; P&lt;.01) • Initiate SGLT2 inhibitor: 36% improvement (51% pre-CG vs 87% post-CG; P&lt;.01) • Initiate ACE inhibitor: 11% improvement (85% pre-CG vs 96% post-CG; P&lt;.01) • Order patient education: 12% improvement (66% pre-CG vs 78% post-CG; P&lt;.01). Conclusion: VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of DKD.

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.

Advanced Psychopharmacology: Practical Strategies for Rational Polypharmacy in Mood Disorders

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Fagiolini
Keyword(s):  
Mood Disorders ◽  
Treatment Resistance ◽  
Evidence Based ◽  
Clear Understanding ◽  
Treatment Resistant ◽  
First Line ◽  
Dose Time ◽  
Pharmacodynamic Interactions ◽  
Risks And Benefits ◽  
Traditional Therapies

Patients with mood disorders frequently present with treatment resistant syndromes or develop tolerance to once effective first line medications. Refractory depressive, manic or mixed episodes challenge psychiatrists to find means of augmenting traditional therapies, despite the paucity of evidence based data that support this practice. The balance between risks and benefits in most cases seems acceptable, provided that the physician and the patients have a clear understanding of the possible adverse and therapeutic interactions and that treatment resistance is not the result of inadequate (dose/time) prescription of a first line monotherapy. The workshop will review the pharmacokinetic and pharmacodynamic interactions among the psychotropic drugs and the strategies to safely and successfully use a rational polypharmacy for the management of treatment resistant mood disorders.

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