Integrating a paradigm shift into treatment of renal cell cancer: Effect of online CME on oncologists' knowledge and competence.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 651-651
Author(s):  
Tara Herrmann ◽  
Charlotte Warren ◽  
Haleh Kadkhoda ◽  
Erin Pacheco ◽  
David F. McDermott
Keyword(s):  
Disease Management ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Clinical Decision Making ◽  
Cell Cancer ◽  
Clinical Decision ◽  
Evidence Based ◽  
Chi Square ◽  
The Impact ◽  
Case Based

651 Background: The objective of this study was to determine the effect of online, case-based, continuing medical education (CME) on the knowledge and competence of oncologists regarding the management of metastatic renal cell cancer (mRCC). Methods: Oncologists participated in a text-based online CME activity composed of 2 patient cases with interactive questions. Evidence-based educational feedback was provided following each response. Three multiple-choice knowledge/competence and 1 self-efficacy question were selected from the set of intra-activity questions to be repeated after participation. These were used to assess the impact of the education in the form of a repeated pairs, in which each participant served as his/her own control. The analysis included: For all questions combined, McNemar’s chi-square test assessed the differences from pre- to post-assessment; P values <.05 are considered statistically significant; Effect size was calculated using Cramer’s V by determining the change in proportion of participants who answered questions correctly; The activity launched online 9/2016 and data collected through 10/2016. Results: Upon completion of the activity, an improvement was observed in oncologists’ ability to: Identify the most appropriate evidence-based regimen for a patient with mRCC that has progressed on a first line TKI (60% vs 18%, P =0.019); Recognize the symptoms of an irAE in a patient receiving an immune checkpoint inhibitor (55% vs 85%, P <0.001); Elicit patient preferences, goals, and values to help decide the best course of action in their care and disease management (26% vs 83%, P <0.001); Feel more confident in selecting the most appropriate option for a patient with mRCC whose disease has progressed on therapy (+17%). Conclusions: An online, interactive, case-based CME activity improved the knowledge/competence of oncologists, showing that unique educational methodologies and platforms, available on-demand, can be effective tools for advancing clinical decision making in the rapidly changing environment of mRCC disease management. Additional studies are needed to assess whether improved aptitude translates to improved performance during clinical practice.

scholarly journals Influenza With and Without Fever: Clinical Predictors and Impact on Outcomes in Patients Requiring Hospitalization

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Benjamin J Smith ◽  
David J Price ◽  
Douglas Johnson ◽  
Bruce Garbutt ◽  
Michelle Thompson ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Antiviral Treatment ◽  
Delayed Diagnosis ◽  
Clinical Decision ◽  
Case Definition ◽  
Influenza B ◽  
Clinical Predictors ◽  
Chi Square ◽  
Chi Square Test ◽  
The Impact

Abstract Background The Infectious Diseases Society of America influenza guidelines no longer require fever as part of their influenza case definition in patients requiring hospitalization. However, the impact of fever or lack of fever on clinical decision-making and patient outcomes has not been studied. Methods We conducted a retrospective review of adult patients admitted to our tertiary health service between April 2016 and June 2019 with laboratory-confirmed influenza, with and without fever (≥37.8ºC). Patient demographics, presenting features, and outcomes were analyzed using Pearson’s chi-square test, the Wilcoxon rank-sum test, and logistic regression. Results Of 578 influenza inpatients, 219 (37.9%) had no fever at presentation. Fever was less likely in individuals with a nonrespiratory syndrome (adjusted odds ratio [aOR], 0.44; 95% CI, 0.26–0.77), symptoms for ≥3 days (aOR, 0.53; 95% CI, 0.36–0.78), influenza B infection (aOR, 0.45; 95% CI, 0.29–0.70), chronic lung disease (aOR, 0.55; 95% CI, 0.37–0.81), age ≥65 (aOR, 0.36; 95% CI, 0.23–0.54), and female sex (aOR, 0.69; 95% CI, 0.48–0.99). Patients without fever had lower rates of testing for influenza in the emergency department (64.8% vs 77.2%; P = .002) and longer inpatient stays (median, 2.4 vs 1.9 days; P = .015). These patients were less likely to receive antiviral treatment (55.7% vs 65.6%; P = .024) and more likely die in the hospital (3.2% vs 0.6%; P = .031), and these differences persisted after adjustment for potential confounders. Conclusions Absence of fever in influenza is associated with delayed diagnosis, longer length of stay, and higher mortality.

scholarly journals Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey

2019 ◽  
Vol 15 (3) ◽  
pp. 276-285
Author(s):  
Adam P. Schumaier ◽  
Yehia H. Bedeir ◽  
Joshua S. Dines ◽  
Keith Kenter ◽  
Lawrence V. Gulotta ◽  
...  
Keyword(s):  
Decision Making ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Specific ◽  
Cuff Tear Arthropathy ◽  
Cuff Tear ◽  
Specific Factors ◽  
The Impact ◽  
Case Based

Temporal changes in the survival of metastatic renal cell cancer patients and the impact of targeted agents: Single center experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 519-519
Author(s):  
Mustafa Erman ◽  
Zafer Arik ◽  
Saadettin Kilickap ◽  
Cenk Yucel Bilen ◽  
Sertac Yazici ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Indirect Evidence ◽  
Cancer Center ◽  
Interferon Α ◽  
Targeted Agents ◽  
Metastatic Renal Cell Cancer ◽  
The Impact

519 Background: Though targeted agents have dramatically changed the outcome of metastatic renal cell cancer (mRCC) patients, it has not been possible to show any survival advantage, probably due to substantial cross-over in randomized trials. The change in survival times following the introduction of targeted agents may yield indirect evidence of an improvement in overall survival (OS). Methods: First targeted agents were available in Turkey in 2007. Data from the hospital charts of adult mRCC patients treated between January 2003 and December 2012 were included. Demographic and clinical findings along with patient, tumor, and treatment-related prognostic factors and their correlation with progression-free survival (PFS), and OS were analyzed. Results: One hundred and seventy six patients had metastatic disease. Of these, 107 patients received at least one dose of interferon-α and 74 patients received at least one targeted therapy. Median follow-up was 19.1 months (range 1-97 months) and median OS was 24.6 months (95% CI, 20.4-28.9). Median OS of patients who received any targeted therapy was significantly better than those who did not (29.1 mths [95% CI, 21.4-36.8] vs 19.4 mths [95% CI, 14.2-24.6]; p=0.036). The study period of 2003-2012 was subdivided into 4 consecutive groups. Although not statistically significant, a trend toward better survival was observed with advancing years and increasing targeted therapy use (p=0.09). For example, median OS of patients diagnosed in 2006 and 2007 was 14.1 months (95% CI, 10.4-17.8) while median OS of those diagnosed in 2010 or later was 30.8 months (95% CI, 18.3-43.3). Patients in intermediate and poor Memorial Sloan-Kettering Cancer Center risk groups benefited more from targeted therapies (p=0.001). Conclusions: Patients who received any targeted therapy lived longer than those who did not. Trend toward better survival was associated with advancing years and increasing targeted therapy use. The introduction of targeted agents appear to benefit mRCC patients in terms of OS as well.

A population-based study evaluating the impact of sunitinib on overall survival in the treatment of patients with metastatic renal cell cancer

Cancer ◽  
2009 ◽  
Vol 115 (4) ◽  
pp. 776-783 ◽  
Author(s):  
Daniel Y. C. Heng ◽  
Kim N Chi ◽  
Nevin Murray ◽  
Tao Jin ◽  
Jorge A Garcia ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Population Based ◽  
Population Based Study ◽  
Metastatic Renal Cell Cancer ◽  
The Impact

scholarly journals Review of the Interaction Between Body Composition and Clinical Outcomes in Metastatic Renal Cell Cancer Treated with Targeted Therapies

2016 ◽  
Vol 3 (1) ◽  
pp. 12-22 ◽  
Author(s):  
Steven M Yip ◽  
Daniel Y. C. Heng ◽  
Patricia A. Tang
Keyword(s):  
Overall Survival ◽  
Body Composition ◽  
Targeted Therapy ◽  
Clinical Outcomes ◽  
Renal Cell Cancer ◽  
Targeted Therapies ◽  
Renal Cell ◽  
Cell Cancer ◽  
Metastatic Renal Cell Cancer ◽  
The Impact

Treatment of metastatic renal cell cancer (mRCC) currently focuses on inhibition of the vascular endothelial growth factor pathway and the mammalian target of rapamycin (mTOR) pathway. Obesity confers a higher risk of RCC. However, the influence of obesity on clinical outcomes in mRCC in the era of targeted therapy is less clear. This review focuses on the impact of body composition on targeted therapy outcomes in mRCC. The International Metastatic Renal Cell Carcinoma Database Consortium database has the largest series of patients evaluating the impact of body mass index (BMI) on outcomes in mRCC patients treated with targeted therapy. Overall survival was significantly improved in overweight patients (BMI ? 25 kg/m2), and this observation was externally validated in patients who participated in Pfizer trials. In contrast, sarcopenia is consistently associated with increased toxicity to inhibitors of angiogenesis and mTOR. Strengthening patients with mRCC and sarcopenia, through a structured exercise program and dietary intervention, may improve outcomes in mRCC treated with targeted therapies. At the same time, the paradox of obesity being a risk factor for RCC while offering a better overall survival in response to targeted therapy needs to be further evaluated.

scholarly journals The impact of neutrophil-lymphocyte ratio on risk reclassification of patients with advanced renal cell cancer to guide risk-directed therapy

2019 ◽  
Vol 59 (1) ◽  
pp. 20-27
Author(s):  
Angelina Tjokrowidjaja ◽  
David Goldstein ◽  
H. Malcolm Hudson ◽  
Sarah J. Lord ◽  
Val Gebski ◽  
...  
Keyword(s):  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Risk Reclassification ◽  
The Impact ◽  
Advanced Renal Cell Cancer

The Impact of a Less Restrictive Poststernotomy Activity Protocol Compared With Standard Sternal Precautions in Patients Following Cardiac Surgery

2020 ◽  
Vol 100 (7) ◽  
pp. 1074-1083
Author(s):  
Caitlyn Holloway ◽  
Neeti Pathare ◽  
Jean Huta ◽  
Dana Grady ◽  
Andrea Landry ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Median Sternotomy ◽  
Clinical Decision ◽  
Functional Mobility ◽  
Pain Rating ◽  
Chi Square ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Alternative Approaches ◽  
The Impact

Abstract Objective Guidelines following median sternotomy typically include strict sternal precautions (SP). Recently, alternative approaches propose less functional restrictions while avoiding excessive stress to the sternum. The study aimed to determine the effect of a less restrictive (LR) approach versus a standard SP protocol after median sternotomy. Methods The study was a cross-sectional design (n = 364; SP: n = 172, 66.3 [SD = 11.2] years; LR: n = 196, 65.2 [SD = 11.2] years). This study ran in 2 consecutive phases and compared 2 groups after median sternotomy at a community-based hospital. The LR group received instructions on the Keep Your Move in the Tube approach. At 2 to 3 weeks after discharge, sternal instability was assessed using the Sternal Instability Scale, and patients completed a self-reported survey (perceived pain rating/frequency, sternal instability, and functional mobility). The 2 groups were compared using the Mann-Whitney U test and chi-square test (P &lt; .05). Results There were no significant differences between the 2 groups for all the outcomes, Sternal Instability Scale, pain rating, pain frequency, perceived sternal instability, difficulty with functional mobility, length of stay, and discharge disposition. Conclusions In our study, the implementation of the LR approach, Keep Your Move in the Tube, had no adverse effect on outcomes 2 to 3 weeks following median sternotomy. Although no statistically significant differences were noted for all outcomes, patients with the LR approach reported less difficulty with functional mobility. Impact Statement These data are useful in clinical decision-making regarding alternative approaches for mobility following sternotomy.

Systemic immune-inflammation index to predict the clinical outcome in patients with metastatic renal cell cancer treated with sunitinib.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 547-547
Author(s):  
Cristian Lolli ◽  
Marco Maruzzo ◽  
Lisa Derosa ◽  
Teodoro Sava ◽  
Matteo Santoni ◽  
...  
Keyword(s):  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cox Regression ◽  
Cell Cancer ◽  
Progression Free Survival ◽  
Bioinformatic Analysis ◽  
First Line ◽  
Logrank Test ◽  
Metastatic Renal Cell Cancer ◽  
The Impact

547 Background: A systemic immune-inflammatory index (SII) based on lymphocyte (L), neutrophil (N), and platelet (P) counts has been recently developed. In this retrospective analysis, we explored its prognostic and predictive value at baseline and changes at week 6 during first-line sunitinib in patients (pts) with metastatic renal cell cancer (mRCC). Methods: We included 335 consecutive pts mRCC treated with first-line sunitinib for which P,N, and L data were available at start of therapy, and 6 weeks thereafter. The SII was defined as follows: SII = P x N/L. The X-tile 3.6.1 software (Yale University, New Haven, CT) was used for bioinformatic analysis of the baseline data to determine the cutoff value of SII. Progression-free survival (PFS), overall survival (OS) and their 95% confidence interval (95% CI) were estimated by Kaplan-Meier method and compared with logrank test. The impact of SII conversion on PFS and OS was evaluated by Cox regression analyses. Results: An optimal cutoff point for the SII of 730 x 109stratified these pts into high (≥ 730) and low SII (<730) groups. Median age was 63 years (range, 27 to 88); histotype clear cell carcinoma was reported in 94% of cases; 29.6%, 59.4% and 11% were classified in the favorable, intermediate and poor Motzer prognostic groups, respectively. The median PFS was 6.2 months (mo) (95% CI=5.5-9.5) in pts with baseline SII ≥730 and 17.7 mo (14.3-21.8) in those with SII <730, P<0.0001. The median OS was 13.7 mo (95% CI=9.6-20.3) in pts with baseline SII ≥730 and 41.8 mo (95% CI=34.5-51.8) in those with baseline SII <730, P<0.0001. Data for SII at baseline and change in SII by week 6 using a cut-off of 730 are shown in the table. Conclusions: The SII is a powerful prognostic and predictive indicator of poor outcome in pts with mRCC. A validation study from prospective data is warranted. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document