scholarly journals Bringing specialist radiotherapy to the patient: The use of teleconsultations in a regional Stereotactic Radiosurgery service (Preprint)

2019 ◽  
Author(s):  
Micheal O'Cathail ◽  
Luis Aznar ◽  
Mayuran Sivanandan ◽  
Judith Christian
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
User Satisfaction ◽  
Service Evaluation ◽  
Face To Face ◽  
Travel Costs ◽  
Specialist Services ◽  
Travel Restrictions ◽  
Improve Access

BACKGROUND The NHS’ ‘Long term plan’ details plans to make digital interactions available to all patients in five years. Teleconsultations can improve access to specialist services however there is a lack of UK evidence for the use of teleconsultations in an Oncology setting. Here we describe a service evaluation of teleconsultations for patients attending a regional brain metastases (BM) clinic. These patients have unique travel restrictions that prevent them from driving. OBJECTIVE To assess the feasibility and acceptability of a teleconsultation service in this setting. METHODS From April 2018 to October 2018 all patients attending the BM clinic were offered the choice of a teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire and data was collected on all clinic attendances. RESULTS Sixty-nine individual patients had 119 appointments over the duration of the pilot. Of these, 36 were new patient appointments and 73 were follow ups. Of these, 24 patients (35%) took part in 41 (34%) teleconsultations. User satisfaction was high and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital associated travel and travel costs of £441.48 (£10.78 per appointment). CONCLUSIONS Teleconsultations appear to be acceptable in this cohort of patients who have brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses evident.

RADT-05. PROSPECTIVE LONG-TERM EVALUATION OF MRI- AND CLINICAL CHANGES FOLLOWING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES – IS REPEAT SRS A CONSEQUENCE, OR ALSO A CAUSE OF LONG-TERM SURVIVAL?

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi41-vi42
Author(s):  
Bente Skeie ◽  
Per Øyvind Enger ◽  
Geir Olve Skeie ◽  
Jan Ingemann Heggdal
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Whole Brain Radiotherapy ◽  
Cancer Site ◽  
Response Patterns ◽  
Primary Cancer ◽  
Term Survival ◽  
Cover Ratio ◽  
Primary Cancer Site

Abstract The use of stereotactic radiosurgery (SRS) for brain metastases are increasing. Response assessment is challenging and the clinical significance of radiological response and retreatments are poorly defined. Ninety-seven patients with a total of 406 brain metastases were followed prospectively for 10 years or until death. Volume changes over time and clinical outcome in response to first time SRS and SRS retreatments were analyzed. Tumors grew significantly before (p = 0.004), but shrunk at 1 and 3 months (p = 0.001) following SRS. Four response-patterns of were observed; tumors either continuously reduced in size (A, 62%), pseudo-progressed (PP, B, 13%), temporarily reduced in size (C, 24%), or grew continuously (D, 2%); corresponding to 75% local control (LC) at initial SRS. Predictors for LC were primary cancer site (p = 0.001), tumor volume (p = 0.002) and target cover ratio (p = 0.005). Subsequent SRS for new lesions resulted in 94% LC (87% A) and repeat-SRS for local failures in 80% LC (57% B), predicted by higher prescribed dose, p = 0.001 and p = 0.042, respectively. Overall survival was only 4.5 months if A-response for all lesions, 13.3 months if at least one B-response, 17.1 months if retreated C- or D-response (p < 0.001), (7.5 and 4.7 months if untreated). Quality of life (p = 0.003), steroid use (p = 0.019) and prior whole brain radiotherapy (p = 0.026) were predictors for survival. There are 4 response patterns to SRS predicted by tumor size, primary cancer site, target cover ratio and prescribed dose. Long-term survivors experienced a higher incidence of PP and were more often retreated for new lesions and local failures. The immune response induced by PP seems beneficial but further studies are needed.

Patients with Long-Term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases with Stereotactic Radiosurgery Alone

2017 ◽  
Vol 98 ◽  
pp. 266-272 ◽  
Author(s):  
Daniel K. Ebner ◽  
Daniel Gorovets ◽  
Paul Rava ◽  
Deus Cielo ◽  
Timothy J. Kinsella ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Systemic Disease ◽  
Prognostic Group

scholarly journals Admiral Nurse Case Management within Enhanced Health in Care Homes

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Zena Aldridge ◽  
◽  
Karen Harrison Dening ◽  
◽  
◽  
...  
Keyword(s):  
Service Provision ◽  
Quality Care ◽  
Care Home ◽  
Care Homes ◽  
Care Home Staff ◽  
Nurse Case Management ◽  
Specialist Services ◽  
Health And Social Care ◽  
Improve Access

The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.

scholarly journals A service evaluation of e-triage in the osteoporosis outpatient clinic—an effective tool to improve patient access?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
John R. Lindsay ◽  
G. Lawrenson ◽  
S. English
Keyword(s):  
Patient Flow ◽  
Outpatient Service ◽  
Service Evaluation ◽  
Bisphosphonate Therapy ◽  
Patient Access ◽  
Specialist Service ◽  
Face To Face ◽  
Referral Management ◽  
Specialist Services ◽  
Improve Patient

Abstract Summary We introduced an electronic triage system into our osteoporosis service to actively manage referral demand in a busy outpatient service. Our study demonstrated the effectiveness of e-triage in supporting alternative management pathways, through use of virtual advice and direct to investigation services, to improve patient access. Purpose Osteoporosis referrals are increasing with awareness of the potential for prevention of fragility fracture and with complex decision making around management with long-term bisphosphonate therapy. We examined whether active triage of referrals might improve referral management processes and patient access to osteoporosis services. Methods We implemented electronic triage (e-triage) of referrals to our osteoporosis service using the Northern Ireland electronic health care record. This included the option of ‘advice only’, direct to investigation with DXA or face-to-face appointments at the consultant-led complex osteoporosis service. We anticipated that there was scope to manage patient flow direct to investigation, or to provide referring clinicians with clinical advice without the need for a face-to-face assessment, at the consultant-led specialist service. Results We reviewed e-triage outcomes of 809 referrals (692 F; 117 M) to osteoporosis specialist services (mean age 65 ± 16.5 years) over a 12-month period. There was a high degree of agreement for the triage category between the referring clinician and specialist services (741/809). 73.3% attended a face-to-face appointment at the consultant-led clinic, while active triage enabled direct to investigation (18.4%) or discharge (8.3%) in the remainder. The mean time between receipt of an electronic referral and e-triage was 3 days over the 12-month period as compared with 2.1 days (median 1.1 days) when annual leave periods were excluded. Conclusion E-triage supports effective referral management in a busy osteoporosis service. Efficiency is limited by reliance on a sole clinician and 5 day working at present. There is scope to further improve systems access through multidisciplinary team working, virtual clinics and future information technology developments.

Adding an app-based intervention to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Concept and Feasibility in a Pilot Routine Clinical Trial (Preprint)

2021 ◽  
Author(s):  
Anna-Lena Netter ◽  
Ina Beintner ◽  
Eva-Lotta Brakemeier
Keyword(s):  
User Satisfaction ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Cognitive Behavioral ◽  
Added Value ◽  
Behavioral Analysis ◽  
Situational Analysis ◽  
Face To Face ◽  
Analysis System

BACKGROUND The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), developed specifically for the treatment of persistent depressive disorder (PDD), is an empirically supported treatment. However, given the high rates of non-response and relapse, there is need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose, e.g., by constant online-based application of therapy strategies between sessions. The highly structured nature of CBASP encourages augmenting it with online interventions, which are of increasing importance for mental health care. OBJECTIVE We developed the app-based intervention "CBASPath", which is designed to be used in addition to face-to-face CBASP therapy in terms of blended therapy. CBASPath offers eight sequential modules with interactive exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. METHODS CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients (n=13) were asked to report their usage patterns and blended use (integrated use of app as part of therapy sessions) at three assessment points over the 6-month test period and to rate the usability, quality, and their satisfaction with CBASPath. RESULTS Results of the pilot trial show that 12 participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favourable engagement with CBASPath, but with frequency of use differing widely among participants and assessment points. The situational analysis was used by all participants, while the number of completed modules ranged between 1 and 7. All participants reported blended use, although the frequency of integration in face-to-face sessions varied widely. CONCLUSIONS Our findings suggest that a digital augmentation of the complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to the high adherence and increase patients’ self-management. Few adjustments within the app could facilitate higher user engagement. A randomized controlled trial to investigate the efficacy and the added value of this blended approach is now needed. In the long term, CBASPath could help optimize PDD treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app. CLINICALTRIAL No Registration due to pilot character of the study.

scholarly journals Predictors of Radiation Necrosis in Long-term Survivors of Stereotactic Radiosurgery for Brain Metastases

2016 ◽  
Vol 96 (2) ◽  
pp. E104 ◽  
Author(s):  
Z.A. Siddiqui ◽  
M.D. Johnson ◽  
A.M. Baschnagel ◽  
P.Y. Chen ◽  
D.J. Krauss ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Long Term Survivors

scholarly journals Long-Term Survivorship Following Stereotactic Radiosurgery Alone for Brain Metastases: Risk of Intracranial Failure and Implications for Surveillance and Counseling

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 203-209
Author(s):  
Emile Gogineni ◽  
John A Vargo ◽  
Scott M Glaser ◽  
John C Flickinger ◽  
Steven A Burton ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Cox Regression ◽  
Primary Study ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Relapse Rates

Abstract BACKGROUND Historically, survival for even highly select cohorts of brain metastasis patients selected for SRS alone is <2 yr; thus, limited literature on risks of recurrence exists beyond 2 yr. OBJECTIVE To investigate the possibility that for subsets of patients the risk of intracranial failure beyond 2 yr is less than the commonly quoted 50% to 60%, wherein less frequent screening may be appropriate. METHODS As a part of our institutional radiosurgery database, we identified 132 patients treated initially with stereotactic radiosurgery (SRS) alone (± pre-SRS surgical resection) with at least 2 yr of survival and follow-up from SRS. Primary study endpoints were rates of actuarial intracranial progression beyond 2 yr, calculated using the Kaplan–Meier and Cox regression methods. RESULTS The median follow-up from the first course of SRS was 3.5 yr. Significant predictors of intracranial failure beyond 2 yr included intracranial failure before 2 yr (52% vs 25%, P < .01) and total SRS tumor volume ≥5 cc (51% vs 25%, P < .01). On parsimonious multivariate analysis, failure before 2 yr (HR = 2.2, 95% CI: 1.2-4.3, P = .01) and total SRS tumor volume ≥5 cc (HR = 2.3, 95% CI: 1.2-4.3, P = .01) remained significant predictors of intracranial relapse beyond 2 yr. CONCLUSION Relapse rates beyond 2 yr following SRS alone for brain metastases are low in patients who do not suffer intracranial relapse within the first 2 yr and with low-volume brain metastases, supporting a practice of less frequent screening beyond 2 yr. For remaining patients, frequent (every 3-4 mo) screening remains prudent, as the risk of intracranial failure after 2 yr remains high.

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