Patients’ perspectives and outcomes on an oral chemotherapy education and electronic monitoring program.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18007-e18007
Author(s):  
Noah Xavier Tocci ◽  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
...  
Keyword(s):  
Electronic Monitoring ◽  
Medical Center ◽  
Academic Medical Center ◽  
Monitoring Program ◽  
Management Program ◽  
Oral Chemotherapy ◽  
P Value ◽  
Online Tool ◽  
Significant Difference ◽  
Patient Reported

e18007 Background: Patients on oral chemotherapy (OC) often lack consistent education and monitoring, risking toxicity and poor adherence. We developed an OC management program including education and an online tool for active outreach. Methods: In November 2017, we initiated pharmacist-led education for patients newly prescribed OC at a community practice and in the gastrointestinal oncology group at an academic medical center (AMC). An online tool assessing adherence, symptoms, and financial toxicity was emailed to patients three days after starting OC. Non-responders were contacted for phone interviews. A random sample of 28 patients newly started on OC at both sites before the intervention in 2017 was analyzed at baseline. A retrospective chart analysis was done to collect time to symptom assessment, identification and action. A report generated date of first emergency department (ED) visit or hospitalization within the AMC. We conducted a Mann Whitney U-Test, using a one-sided p value of 0.025 with Bonferroni correction. Results: Sixty-nine of 106 eligible patients (66%) received education, of whom 36 (52.1%) received the online tool, and 13 (36.1%) responded. There was a significant difference between the intervention and baseline median times to first new/worsening symptoms (p = 0.0105) but otherwise there were no outcome improvements. Eight of 23 patients who did not respond to the electronic tool were interviewed and indicated that their illness impeded their ability to check email (n = 2), and that they never check email (n = 2). Conclusions: This OC management program improved time to detect new/worsening symptoms and could potentially improve outcomes after further patient accrual. Future investigation should examine ways to improve patient responsiveness to electronic patient-reported symptom tools. [Table: see text]

Electronic monitoring of patient-reported adherence and symptoms on oral chemotherapy at an academic and a community site.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 283-283
Author(s):  
Jim Doolin ◽  
Daniel Aaron Roberts ◽  
Christina Cibotti ◽  
Scott M Devlin ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Median Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptom Assessment ◽  
Oral Chemotherapy ◽  
Community Practice ◽  
Financial Toxicity ◽  
Online Tool ◽  
Academic Medical ◽  
Patient Reported

283 Background: Monitoring of toxicity and adherence is often lacking for patients recently started on oral chemotherapy. National guidelines recommend active outreach to patients within a week after treatment start. We developed an online tool to actively reach out to patients newly started on oral chemotherapy at one academic medical center and community practice. Methods: A multi-disciplinary team, including patients, developed an online oral chemotherapy adherence, symptom, and financial toxicity assessment tool within REDCap. We implemented this tool for new oral chemotherapy prescriptions in May 2018 in the gastrointestinal oncology group of an academic medical center and a general community practice. To quantify the impact of this tool on symptom management, we completed a retrospective analysis of patients receiving new oral chemotherapy prescriptions at these same sites, in the 13 months immediately preceding clinical implementation of the online tool, May 2017 to May 2018. Results: In the pre-intervention historical cohort (n = 58) the median time to first symptom assessment by a clinician was 7 days (range 1 – 41 days, SD 7 days), median time to identifying a new or worsening symptom was 10 days (range 1-55 days, SD 10 days), and median time to clinical action regarding a new or worsening symptom was 10 days (range 1-104, SD 20 days). Our first intervention patient used the online tool in May 2018 to report symptoms of “nausea and fatigue,” 4 days after starting oral chemotherapy. This resulted in an oncology clinical nurse calling the patient to review symptom management by phone. Conclusions: The median time to first symptom assessment in our historical control cohort is 7 days, with standard deviation of 7 days, suggesting potential room for improvement. Thus far, the online tool has been completed by one patient. Further data will be reported regarding the uptake of this tool, the tool’s impact on quality measures, and patient reported symptoms, adherence, and financial toxicity.

scholarly journals Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program

2018 ◽  
Vol 14 (6) ◽  
pp. e324-e334 ◽  
Author(s):  
Benyam Muluneh ◽  
Molly Schneider ◽  
Aimee Faso ◽  
Lindsey Amerine ◽  
Rowell Daniels ◽  
...  
Keyword(s):  
Closed Loop ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Possession Ratio ◽  
Response Rates ◽  
Management Program ◽  
Oral Chemotherapy ◽  
Molecular Response ◽  
Major Molecular Response ◽  
Patient Reported

Purpose: To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. Methods: An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. Results: After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). Conclusion: An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

scholarly journals Implementation of Machine Learning Software on the Radiology Worklist Decreases Scan View Delay for the Detection of Intracranial Hemorrhage on CT

2021 ◽  
Vol 11 (7) ◽  
pp. 832
Author(s):  
Daniel Ginat
Keyword(s):  
Artificial Intelligence ◽  
Intracranial Hemorrhage ◽  
Medical Center ◽  
Academic Medical Center ◽  
P Value ◽  
Head Ct ◽  
Significant Difference ◽  
The Difference ◽  
Learning Software ◽  
The Impact

Background and Purpose: Prompt identification of acute intracranial hemorrhage on CT is important. The goal of this study was to assess the impact of artificial intelligence software for prioritizing positive cases. Materials and Methods: Cases analyzed by Aidoc (Tel Aviv, Israel) software for triaging acute intracranial hemorrhage cases on non-contrast head CT were retrospectively reviewed. The scan view delay time was calculated as the difference between the time the study was completed on PACS and the time the study was first opened by a radiologist. The scan view delay was stratified by scan location, including emergency, inpatient, and outpatient. The scan view delay times for cases flagged as positive by the software were compared to those that were not flagged. Results: A total of 8723 scans were assessed by the software, including 6894 cases that were not flagged and 1829 cases that were flagged as positive. Although there was no statistically significant difference in the scan view time for emergency cases, there was a significantly lower scan view time for positive outpatient and inpatient cases flagged by the software versus negative cases, with a reduction of 604 min on average, 90% in the scan view delay (p-value < 0.0001) for outpatients, and a reduction of 38 min on average, and 10% in the scan view delay (p-value <= 0.01) for inpatients. Conclusion: The use of artificial intelligence triage software for acute intracranial hemorrhage on head CT scans is associated with a significantly shorter scan view delay for cases flagged as positive than cases not flagged among outpatients and inpatients at an academic medical center.

Oral chemotherapy education sessions at an academic and community cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 254-254
Author(s):  
Daniel Aaron Roberts ◽  
Jim Doolin ◽  
Christina Cibotti ◽  
Rebekah A Hartwell ◽  
Mary Yenulevich ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Community Setting ◽  
Oral Chemotherapy ◽  
Cancer Center ◽  
P Value ◽  
Specific Information ◽  
Education Session ◽  
Academic Medical ◽  
Oral Agents

254 Background: Oral chemotherapy is becoming more widely utilized within oncology. Concerns regarding poor adherence and toxicity may be addressed by providing patient education. Methods: We developed and implemented a pharmacist-led initial education session for patients newly prescribed oral chemotherapy in both an academic medical center gastrointestinal oncology clinic and an affiliated community oncology cancer center. We provided an education packet including drug-specific information, clinic contact telephone numbers, and a drug schedule calendar. Standardized teaching and documentation templates were used. Patients completed each education session with the MOATT teaching tool for patients receiving Oral Agents for Cancer V1.2. Assessment of compliance with the ASCO/ONS Chemotherapy Administration Safety Standards on Oral Chemotherapy Education was assessed through use of Quality Oncology Practice Initiative (QOPI) quality measures where applicable and compared to historical QOPI data from the academic medical center from 2015-2017. Results: Thirty-one patients were newly prescribed oral chemotherapy and received the initial education session from November 2017 through May 2018. Based on a monthly report generated of new oral chemotherapy prescriptions, after a seven-month run-in, the rate reached 100% of patients at both sites for the most recent month. When comparing the intervention cohort to the historical QOPI cohort using a one-sided P value of 0.017 with bonferroni correction, there was improvement in safe handling/storage (pre: 19%, post 100%, P = 0.0001), drug-drug and food interactions (pre: 31%, post 100%, P = 0.0001), and plan for missed doses (pre: 37%, post: 97%, P = 0.0001). A trend toward improvement was found for schedule/start date discussion (pre: 87%, post: 100% P = 0.018) and side effect/toxicities (pre: 87%, post: 100% P = 0.018). Conclusions: Implementation of an oral chemotherapy education session in both an academic and community setting was feasible and improved adherence to QOPI measures of oral chemotherapy education and ASCO/ONS standards for oral chemotherapy. Further data regarding time to clinical outcomes is forthcoming.

Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

2021 ◽  
pp. 019459982198960
Author(s):  
Tiffany V. Wang ◽  
Nat Adamian ◽  
Phillip C. Song ◽  
Ramon A. Franco ◽  
Molly N. Huston ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Medical Center ◽  
Characteristic Curve ◽  
Academic Medical Center ◽  
Vocal Fold Paralysis ◽  
Control Group ◽  
Large Patient ◽  
Patient Reported ◽  
Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

Endoscope-Assisted Superior Semicircular Canal Dehiscence Repair: Single Institution Outcomes

2021 ◽  
pp. 000348942110412
Author(s):  
Douglas J. Totten ◽  
Miriam R. Smetak ◽  
Nauman F. Manzoor ◽  
Elizabeth L. Perkins ◽  
Nathan D. Cass ◽  
...  
Keyword(s):  
Surgical Management ◽  
Semicircular Canal ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Middle Cranial Fossa ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
Significant Difference ◽  
Patient Reported ◽  
Canal Dehiscence

Objective: To compare outcomes of endoscope-assisted middle cranial fossa MCF) repair of superior semicircular canal dehiscence (SSCD) compared to microscopic MCF repair. Study design: Retrospective cohort. Setting: Tertiary medical center neurotology practice. Methods: Retrospective chart review and cohort study of patients who underwent surgical repair of SSCD via MCF approach from 2010 to 2019 at our institution. Patients were categorized according to use of endoscope intraoperatively. Pre- and post-operative symptom number was calculated from 8 patient-reported symptoms. Pre- and post-operative changes in symptom number were assessed using paired t-tests. Single-predictor binary logistic regression was used to compare final reported symptoms between cohorts. Linear regression was performed to assess air-bone gap (ABG) changes postoperatively between cohorts. Results: Forty-six patients received surgical management for SSCD. Of these, 27 (59%) were male and 19 (41%) were female. Bilateral SSCD was present in 14 cases (29%), of which 3 underwent surgical management bilaterally, for a total of 49 surgical ears. Surgery was performed on the right ear in 19 cases (39%) and on the left in 30 cases (61%). Forty ears (82%) underwent microscopic repair while 9 (18%) underwent endoscope-assisted repair. Microscopic and endoscope-assisted MCF repair both demonstrated significantly improved symptom number postoperatively ( P < .001 for each). There was no significant difference in change in ABG between the 2 cohorts. On average, patient-reported symptoms and audiometrically-tested hearing improved postoperatively in both groups. Conclusion: While endoscopic-assisted MCF repair has the potential to provide better visualization of medial and downslope defects, repair via this technique yields similar results and is equivalent to MCF repair utilizing the microscope alone.

scholarly journals 301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Mohammed Aldhaeefi ◽  
Jeffrey Pearson ◽  
Sanjat Kanjilal ◽  
Brandon Dionne
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Similar Distribution ◽  
Clinical Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy &gt;72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

Prevalence of Helicobacter Pylori Antibody among Outpatients of Federal Medical Center, Yenagoa, Niger Delta Region of Nigeria

2021 ◽  
Vol 8 (07) ◽  
pp. 5521-5527
Author(s):  
Dr Oluwayemisi Agnes Olorode ◽  
Ofonime M. Ogba ◽  
Williams E. Ebisin
Keyword(s):  
Helicobacter Pylori ◽  
Blood Test ◽  
Medical Center ◽  
P Value ◽  
World Population ◽  
Age Group ◽  
Test Kit ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Helicobacter Pylori Antibody

Helicobacter Pylori is the most common chronic bacterial infection (acquired early childhood) in humans affecting 50% of the world population and much attention has not been paid to this. This study was carried out between February and October 2019 to test for the presence of Helicobacter Pylori antibody among asymptomatic individuals attending Federal Medical Center, Yenagoa, Bayelsa State. A total of 200 {114(57%) males, 86(43%) females} blood samples were collected at ramdom into Ethylene diamine tetraacetic acid (EDTA) bottles and immediately transported to the laboratory for analysis using Helicobacter pylori Serology rapid blood test kit. Age was stratified to allow for comparison because the entire outcome was age dependent. Chi square analysis was conducted for the categorical variable. Findings showed that out of 200 samples examined, 88(44%) forty (40 (45%) males and 48(55%) females were positive to Helicobacter pylori infection while 112(56%) were negative. Females of age range 24 -33 had the highest prevalence of 24 (27%) while male of age group 14 to 23 had 21(24%); females of 34 to 44 was 16(18%); 54-63 had 4(05%) and the least was 44 to 53 years with prevalence of 3(03%).  There was a significant difference across the age group and socio-demographic characteristic at p-value = 0.0001 < 0.05 and p-value =0.002068 < 0.05, p-value = 0.000916 <0.05 respectively. Observations showed the higher prevalence in females (53%) than their males (47%) counterparts; likewise the infected individuals host this organism ignorantly and busy treating out of line.  Study with more than one diagnostic technique is recommended to determine the presence of Helicobacter pylori, as rapid blood test is limited due to the presence of antibody in the serum for long after eradication. In conclusion, routine medical examination on Helicobacter pylori is encouraged among individuals in respective of age and status.

scholarly journals Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shayan Moosa ◽  
Lindsay Bowerman ◽  
Ellen Smith ◽  
Mindy Bryant ◽  
Natalie Krovetz ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Population ◽  
Medical Center ◽  
Academic Medical Center ◽  
Readmission Rates ◽  
Academic Medical ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

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