scholarly journals Fears, feelings and findings about COVID-19 disease in hospitalized cancer patients in a tertiary Hospital in Spain.

2020 ◽  
Author(s):  
Benjamin Domingo Arrue ◽  
Domingo de Guzmán Ordaz Jurado ◽  
Rosa María Pastor Marí ◽  
Ana Tarazona Ortega ◽  
Lucía Fos Saus ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Correlation Coefficient ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rank Correlation ◽  
Tertiary Hospital ◽  
Educational Background ◽  
Moderate Correlation ◽  
Exact Test ◽  
Systemic Treatments

Abstract IntroductionOn March 11th, COVID-19 was categorized as a pandemic. Risk factors for poor outcome in COVID-19 disease include personal history of cancer. The purpose of this research is to explore what do cancer patients know about COVID-19 and their perception of infection risk.MethodsA pilot questionnaire was initiated in hospitalized cancer patients at a large academic medical center to explore fears and other issues related with COVID-19 disease and cancer patients. A stratified analysis by age, sex, marital status, educational background, number of previous systemic treatments received and hospitalization cause was carried out. χ² test, Fisher’s exact test, Spearman's rank correlation coefficient and Kendall rank correlation coefficient were performed when indicated on each category.Results33 patients were included. 66.7% of patients were male and 33.3% female, with a median age of 57 years old. Natural origin hypothesis of novel coronavirus and high educational levels (tau-c = 0.260, p = 0.040) had a positive moderate correlation. Young cancer patients are more afraid of a SARS-CoV-2 infection than elderly people (p=0.034). Thinking there are differences in COVID-19 symptoms due to cancer treatments had a positive moderate correlation with the number of treatments received (tau-b = 0.342, p = 0.005).ConclusionCancer patients need more information about coronavirus and how can affect them. Some of them are not aware of how can cancer increase their risk of infection. However, they agree with measures that hospitals have implemented and don’t feel they affect the quality of care they receive when admitted.

Abstract P257: Getting to the Golden Hour: Correlating “Door-To” Times with 60-Minute Administration of tPA in an Academic Medical Center

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Ann M Leonhardt ◽  
Curtis G Benesch ◽  
Kate C Young
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Time Frame ◽  
Arrival Times ◽  
Golden Hour ◽  
Stroke Team ◽  
Time Standards ◽  
Scheduling Protocols

Introduction: The efficacy of intravenous tPA for the treatment of acute stroke diminishes over time. The AHA/ASA and NINDS recommend a goal door to needle time of 60 minutes or less. Objective: Identify potential barriers to tPA administration within 60 minutes of arrival. Methods: Retrospective review of tPA adsinistration using “Get With the Guidelines” (GWTG) and institutional records from January 1, 2009 through December 31, 2010 (n=100). Spearman rank correlation coefficients were calculated for the NINDS recommended time standards, age and NIH Stroke Scale (NIHSS) score. We used a receiver-operator curve (ROC) to identify the door to CT time predictive of tPA administration ≤ 60 minutes. Results: Median door to physician, door to CT, and door to stroke team times were within the recommended goals. Door to CT (ρ=0.53, p<0.0001), and door to stroke team (ρ=0.33, p<0.01) times were positively correlated with door to tPA times. Last known well to arrival (ρ= -0.28, p<0.01) and NIHSS (ρ= -0.32, p<0.01) were negatively correlated with door to tPA times; patients with higher NIHSS and longer last-known-well to arrival times received tPA in a shorter time frame. Age and door to physician time were not correlated with tPA treatment times. After adjusting for the other benchmarks and NIHSS, only door to CT remained significantly correlated with door to IV tPA (partial correlation coefficient=0.40, p<0.001). The ROC curve showed that a goal time of 20 minutes or less for door to CT initiation had the best sensitivity and specificity for predicting tPA administration within 60 minutes. Conclusion: In keeping with the recommended time goals, median times for the intermediate steps were within target. Our median tPA times, however, did not meet the 60 minute goal. Door to CT initiation was the variable that most strongly correlated with door to needle times. Process issues such as order entry and scheduling protocols may be barriers to obtaining CT within the 20 minute time frame identified by our analysis. Other barriers after the CT scan is obtained must be identified to facilitate faster tPA administration. Further evaluation of these factors is warranted to better ensure the timely delivery of tPA to stroke patients, thereby improving patient outcomes.

scholarly journals Essential Oil Olfactory Test: Comparison of Affordable Rapid Olfaction Measurement Array (AROMA) to Sniffin’ Sticks 12

OTO Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 2473974X2096246
Author(s):  
Jennifer Li ◽  
Gracie Palmer ◽  
Suraj Shankar ◽  
Mark R. Villwock ◽  
Alexander G. Chiu ◽  
...  
Keyword(s):  
Essential Oil ◽  
Medical Center ◽  
Low Cost ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Moderate Correlation ◽  
Cross Sectional ◽  
Percent Correct ◽  
Olfactory Testing ◽  
Snot 22

Objectives To further demonstrate the validity of Affordable Rapid Olfaction Measurement Array (AROMA), an essential oil−based smell test, and compare it to the Sniffin’ Sticks 12 Test (SST12). Study Design Prospective cross-sectional study. Setting Academic medical center. Methods Fifty healthy individuals without sinonasal disease were recruited to the study. AROMA has been previously validated against the University of Pennsylvania Smell Identification Test. The current study tests 2 additional higher concentrations to increase the ability to detect olfactory reserve. Healthy participants completed AROMA, SST12, Sino-Nasal Outcome Test (SNOT-22), and Questionnaire of Olfactory Disorders (QoD). Spearman correlations were used to evaluate AROMA, SST, SNOT-22, and QoD. Results AROMA demonstrated strong test-retest reliability ( r = 0.757, P < .01). AROMA showed a moderate correlation to SST12 (ρ = 0.412, P < .01). Age and SNOT-22 were significantly correlated ( P < .05) with AROMA (ρ = −0.547, −0.331, respectively), and age was weakly correlated with SST (ρ = −0.377, P < .01). Median percent correct scores were as follows: SST12 identification, 92%; AROMA detection, 90%; and AROMA identification, 81%. Median correct odor identification of AROMA concentrations at 1×, 2×, 4×, and 8× were 64%, 75%, 92%, and 92%, respectively. Conclusion AROMA has a moderate correlation with SST12. AROMA is more strongly correlated than SST12 to age and SNOT-22. AROMA’s stronger correlation with subjective olfactory status, low cost, and adaptability may help remove barriers to routine olfactory testing in the clinic.

scholarly journals 1036. Clinical impact of an antibiotic time out initiative at an academic medical center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S364-S365
Author(s):  
Amy P Taylor ◽  
Kelci E Coe ◽  
Kurt Stevenson ◽  
Lynn Wardlow ◽  
Zeinab El Boghdadly ◽  
...  
Keyword(s):  
Infection Type ◽  
Medical Center ◽  
Academic Medical Center ◽  
Kidney Injury ◽  
Primary Objective ◽  
Clinical Impact ◽  
Exact Test ◽  
Time Out ◽  
The Ohio State University ◽  
Infection Types

Abstract Background The Infectious Diseases Society of America’s guideline for implementing antibiotic (abx) stewardship recommends routine review of abx use. Several studies demonstrate antibiotic time out (ATO) programs result in de-escalation, but there is limited evidence of improved outcomes. The aim of this study was to evaluate the clinical impact of ATO. Methods This retrospective study included hospitalized patients at The Ohio State University Wexner Medical Center receiving abx and a documented ATO from 7/1/2017 to 6/30/2018. ATO patients were matched by infection type to abx-treated patients lacking an ATO note. Patients were excluded if they were identified as a protected population, were in the ICU at the time of ATO, had an ATO within 48 hours of discharge, cystic fibrosis, or febrile neutropenia. The primary objective was to evaluate abx optimization in patients with documented ATO vs. those without ATO. Abx optimization was defined as the selection of ideal abx based on guidelines, culture and susceptibility results, or expert opinion when undefined. Secondary outcomes included vancomycin-associated acute kidney injury (VAN-AKI), infection-related length of stay (LOS), all-cause 30-day readmission or mortality, abx days, and nosocomial C. difficile infection (CDI) rates. The Student t-test/Fisher’s exact test and Wilcoxon-rank sum were utilized as appropriate. Results One hundred ATO patients were compared with 100 non-ATO patients. Baseline characteristics and infection types were similar between groups. ATO resulted in improved optimization of abx selection (P = 0.05) and duration (P < 0.01), and reduced piperacillin/tazobactam (P/T) and vancomycin (VAN) utilization. No difference was observed in VAN-AKI (22 vs. 20%, P = 0.73), 30-day readmission (28 vs. 27%, P = 0.87), mortality (5 vs. 5%, P = 1), or CDI rates (6 vs. 5%, p = 0.76) in the ATO vs. non-ATO group. However, inpatient abx days (12 vs. 8, P = 0.004) and infection-related LOS (10 vs. 8, P = 0.0006) were shorter in the non-ATO group. Conclusion ATO improved optimization of abx selection and duration, and reduced P/T and VAN use. Despite this, clinical outcomes were not improved. Disclosures All authors: No reported disclosures.

scholarly journals Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Divya A. Parikh ◽  
Rani Chudasama ◽  
Ankit Agarwal ◽  
Alexandar Rand ◽  
Muhammad M. Qureshi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Primary Language ◽  
Breast Cancer Patients ◽  
Patient Demographics ◽  
Academic Medical ◽  
Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

Prevalence of self-reported cognitive dysfunction in breast cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20701-e20701
Author(s):  
Heidi Skirbe ◽  
Gabriela Hohn ◽  
Paula Klein ◽  
Mary Ann Juliano ◽  
Jeremy Winell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cognitive Dysfunction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cognitive Changes ◽  
Convenience Sample ◽  
Cognitive Difficulties ◽  
Cognitive Services ◽  
Emotional Dysfunction

e20701 Background: A series of four time-limited, psycho-educational workshops was piloted by a neuropsychologist at an urban academic medical center, providing information, coping strategies, and resources to women who had been treated for breast cancer (BrCa) and who then sought cognitive treatment. Based on positive evaluations of these workshops, we assessed the prevalence of self-reported cognitive dysfunction in BrCa patients with the goal of assessing the need for and interest in the expansion of cognitive services to affected patients. Methods: The study was IRB approved. A convenience sample of 50 BrCa patients in a medical oncology waiting area completed a 16 item questionnaire which assessed potential cognitive problems on a 4-point Likert scale, with responses ranging from 0 (no problem) to 3 (serious problem). Results: Fifty patients completed the survey, of whom 46% requested further information on cognitive services. Conclusions: An unexpectedly large proportion of BrCa patients perceived cognitive difficulties, possibly compounded by fatigue and emotional dysfunction, and expressed interest in cognitive supportive services. Others may have failed to report cognitive difficulties, unaware of their onset. Quality of life of cancer patients is diminished by cognitive decline. Our data indicate a need for and interest in formal assessment and intervention programs to identify patients with cognitive and emotional dysfunction and offer remediation via workshops and therapy. Formal neuropsychological assessment and treatment resourcestargeting cognitive changes associated with cancer should be expanded to meet documented need. Further research will optimize the scheduling and structure of interventions. [Table: see text]

Prevalence of self-reported cognitive dysfunction in breast cancer patients.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 131-131
Author(s):  
Heidi Skirbe ◽  
Gabriela Hohn ◽  
Paula Klein ◽  
Mary Ann Juliano ◽  
Jeremy Winell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cognitive Dysfunction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Breast Cancer Patients ◽  
Cognitive Changes ◽  
Convenience Sample ◽  
Cognitive Difficulties ◽  
Emotional Dysfunction

131 Background: In 2011 a series of four time-limited, psycho-educational workshops was conducted by a neuropsychologist at a major urban academic medical center, providing information, coping strategies, and resources to women who had been treated for breast cancer (BrCa) and who then sought cognitive treatment. Based on positive evaluations of these workshops, we assessed the prevalence of self-reported cognitive dysfunction in BrCa patients with the goal of expanding cognitive services to all affected cancer patients. Methods: The study was IRB approved. We surveyed a convenience sample of 50 BrCa patients in a single medical oncology waiting room over several weeks. Subjects completed a 16 item questionnaire assessing potential cognitive problems on a 4 point-scale. Results: Fifty patients completed the survey, of whom 46% were currently employed. Sixty-eight percent of respondents were currently receiving cancer treatment and of those, 61.8% had also received prior treatment. Conclusions: An unexpectedly large proportion of BrCa patients perceived cognitive difficulties that may have been compounded by fatigue and emotional dysfunction. Others may have failed to report cognitive difficulties, unaware of their onset. Quality of life of cancer patients is diminished by cognitive decline. The current data indicate a need for formal assessment and intervention programs that will identify patients with cognitive and emotional dysfunction and remediate the difficulties via workshops and therapy. Formal neuropsychological assessment and treatment resourcestargeting cognitive changes associated with cancer should be expanded to meet documented need. Further research will optimize the scheduling and structure of therapeutic interventions. [Table: see text]

Benefits of an early mobility program for hospitalized cancer patients: A pilot study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7008-7008
Author(s):  
Cardinale B. Smith ◽  
Melissa Gunning ◽  
Margie Hubman ◽  
Christine Conklin ◽  
Nicole Wells ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Healthcare Utilization ◽  
Patient Experience ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Bed Rest ◽  
Ordinal Scale ◽  
Time Period ◽  
Willingness To Recommend

7008 Background: Cancer patients are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning which likely contributes to increased length of stay (LOS) and excess days, increased readmissions and decreased patient experience. We aimed to determine whether a mobility program project would improve quality of care and decrease healthcare utilization. Methods: We implemented a mobility aide program on an oncology unit in a large academic medical center between April 2, 2019 to December 31, 2019. The program consisted of nursing evaluation using the Activity Measure for Postacute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥250 feet, was used to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing and a mobility aide, a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day seven days a week. Using descriptive statistics we evaluated the programs impact on excess days, readmissions, changes in mobility and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) during this time period compared to the 6 month interval prior to implementation. Results: During the study interval, 988 patients were admitted and received the mobility program. There was a 6% reduction in excess days (p = 0.04). Similarly, readmission rates decreased from 25% to 19% (p = 0.03). Overall 76% of patients wither maintained or improved their mobility score. During this time period HCAHPS scores (willingness to recommend hospital) increased from 63% at baseline to 91% (p = 0.01). Conclusions: Use of this mobility program resulted in a significant decrease in healthcare utilization and improvement in patient experience. This demonstrates that non-PT professionals can mobilize hospitalized cancer patients decreasing the burden of PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with healthcare costs.

Redesigning care coordination from the patient’s perspective.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Mark Liu ◽  
Aarti Bhardwaj ◽  
Carol Kisswany ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Healthcare Utilization ◽  
Patient Experience ◽  
Medical Center ◽  
Single Point ◽  
Academic Medical Center ◽  
Care Transitions ◽  
Healthcare Providers ◽  
Active Role ◽  
Chemotherapy Administration

6 Background: Cancer patients are frequently admitted to the hospital requiring medical oncologists to take an active role in coordinating with multiple teams. In an effort to redesign care to put patients at the center and address increasing demands on our medical oncologist’s time, we created the Oncology Coordinator (OC) role focused on care setting transitions. We aimed to evaluate whether the OC would improve quality of care and decrease healthcare utilization. Methods: The OCs, are non-clinical and serve as a single point of contact for disease-based teams as patients prepare for elective admissions or discharge from the hospital. The 3 OCs received specialized training in systems and processes in both settings. They coordinate outpatient appointments, prescription delivery, transportation while also providing clinical support. Additionally, they facilitate two interdisciplinary rounds per day across three dedicated oncology units and assist with patients off-unit. We evaluated all patient discharges facilitated by the OCs during 1/1/19-2/29/20 and compared that to non-OC facilitated discharges. Using descriptive statistics, we evaluated the OCs impact on 7- and 30-day readmissions, discharge before noon rate (DBN), average time from admission to chemotherapy start and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Results: We had a total of 2,818 discharges between 1/1/19-2/29/20; 1,032 (36.6%) facilitated by the OCs. For those OC facilitated discharges we observed a 5.07% reduction in 7-day readmissions and 30-day readmissions (2.6%). We observed an overall higher average monthly rate of DBN (4.85%) compared to non-OC facilitated discharges. In addition, the average time from admission to chemotherapy administration decreased by 1 hour 31 minutes (6.8%) for the OC facilitated admissions. In the HCAHPS survey, there were improvements in Discharge Information and Care Transitions on the inpatient units where OCs were most active. Conclusions: At our academic medical center, the OCs have contributed to reduction in readmissions, time from admission to chemotherapy administration as well as improvements in discharges before noon and patient experience. This pilot demonstrates that investment in dedicated lay staff to facilitate admissions and discharges for cancer patients across care settings could lead to meaningful improvements in healthcare utilization, quality and the patient experience. Future work will evaluate the sustainability of this program and evaluate association with healthcare costs.

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