scholarly journals The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine

2016 ◽  
Vol 8 ◽  
pp. BIC.S37548 ◽  
Author(s):  
Louis D. Fiore ◽  
Mary T. Brophy ◽  
Sara Turek ◽  
Valmeek Kudesia ◽  
Nithya Ramnath ◽  
...  
Keyword(s):  
New England ◽  
Point Of Care ◽  
Veterans Affairs ◽  
Molecular Medicine ◽  
Precision Oncology ◽  
Patient Centered ◽  
Rapid Learning ◽  
Clinical Program ◽  
Oncology Practice ◽  
Modern Genomic

The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning healthcare system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans. The program assures access to modern genomic oncology practice in the veterans affairs (VA), removes disparities of access across the VA network of clinical centers, disseminates the products of learning that are generalizable to non-VA settings, and systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics.

scholarly journals Integrating molecular profiles into clinical frameworks through the Molecular Oncology Almanac to prospectively guide precision oncology

Nature Cancer ◽  
2021 ◽  
Author(s):  
Brendan Reardon ◽  
Nathanael D. Moore ◽  
Nicholas S. Moore ◽  
Eric Kofman ◽  
Saud H. AlDubayan ◽  
...  
Keyword(s):  
Point Of Care ◽  
Single Gene ◽  
Knowledge Bases ◽  
Computational Method ◽  
Precision Oncology ◽  
Clinical Interpretation ◽  
First Order ◽  
Molecular Features ◽  
Molecular Oncology ◽  
Molecular Profiles

AbstractTumor molecular profiling of single gene-variant (‘first-order’) genomic alterations informs potential therapeutic approaches. Interactions between such first-order events and global molecular features (for example, mutational signatures) are increasingly associated with clinical outcomes, but these ‘second-order’ alterations are not yet accounted for in clinical interpretation algorithms and knowledge bases. We introduce the Molecular Oncology Almanac (MOAlmanac), a paired clinical interpretation algorithm and knowledge base to enable integrative interpretation of multimodal genomic data for point-of-care decision making and translational-hypothesis generation. We benchmarked MOAlmanac to a first-order interpretation method across multiple retrospective cohorts and observed an increased number of clinical hypotheses from evaluation of molecular features and profile-to-cell line matchmaking. When applied to a prospective precision oncology trial cohort, MOAlmanac nominated a median of two therapies per patient and identified therapeutic strategies administered in 47% of patients. Overall, we present an open-source computational method for integrative clinical interpretation of individualized molecular profiles.

Evaluation of the Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program at initial test sites

2021 ◽  
Author(s):  
Olivia M Dong ◽  
Megan C Roberts ◽  
R Ryanne Wu ◽  
Corrine I Voils ◽  
Nina Sperber ◽  
...  
Keyword(s):  
Implementation Research ◽  
Health Informatics ◽  
Veterans Affairs ◽  
Change Strategies ◽  
Implementation Barriers ◽  
Expert Recommendation ◽  
Implementing Change ◽  
Clinical Program ◽  
Implementation Resources ◽  
Survey Responses

Aim: The first Plan-Do-Study-Act cycle for the Veterans Affairs Pharmacogenomic Testing for Veterans pharmacogenomic clinical testing program is described. Materials & methods: Surveys evaluating implementation resources and processes were distributed to implementation teams, providers, laboratory and health informatics staff. Survey responses were mapped to the Consolidated Framework for Implementation Research constructs to identify implementation barriers. The Expert Recommendation for Implementing Change strategies were used to address implementation barriers. Results: Survey response rate was 23–73% across personnel groups at six Veterans Affairs sites. Nine Consolidated Framework for Implementation Research constructs were most salient implementation barriers. Program revisions addressed these barriers using the Expert Recommendation for Implementing Change strategies related to three domains. Conclusion: Beyond providing free pharmacogenomic testing, additional implementation barriers need to be addressed for improved program uptake.

The MOBEL Project

2011 ◽  
pp. 1171-1190
Author(s):  
Inger Dybdahl Sorby ◽  
Line Melby ◽  
Yngve Dahl ◽  
Gry Seland
Keyword(s):  
Communication Systems ◽  
Information Needs ◽  
System Development ◽  
Point Of Care ◽  
User Involvement ◽  
Clinical Information ◽  
Problem Area ◽  
Patient Centered ◽  
Mobile Information ◽  
Information And Communication

This chapter presents results and experiences from the MOBEL (MOBile ELectronic patient record) project at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. MOBEL was a multidisciplinary research project established in 2000. The problem area of the project was communication and information needs in hospital wards, and the aim of the project was to develop and explore methods and prototypes for point of care clinical information systems (PoCCS) that support clinicians in their patient-centered activities. The chapter summarizes four sub studies performed during the project. Each study presents different approaches to user-centered design of PoCCS. Findings from these studies confirm the need for mobile information and communication technology (ICT) in hospitals. Furthermore, the studies demonstrate how more user involvement and complementary approaches to traditional requirements engineering (RE) and system development methods can be useful when developing mobile information and communication systems for clinicians.

The MOBEL Project

2010 ◽  
pp. 52-73
Author(s):  
Inger Dybdahl Sorby ◽  
Line Melby ◽  
Yngve Dahl ◽  
Gry Seland
Keyword(s):  
Communication Systems ◽  
Information Needs ◽  
System Development ◽  
Point Of Care ◽  
User Involvement ◽  
Clinical Information ◽  
Problem Area ◽  
Patient Centered ◽  
Mobile Information ◽  
Information And Communication

This chapter presents results and experiences from the MOBEL (MOBile ELectronic patient record) project at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. MOBEL was a multidisciplinary research project established in 2000. The problem area of the project was communication and information needs in hospital wards, and the aim of the project was to develop and explore methods and prototypes for point of care clinical information systems (PoCCS) that support clinicians in their patient-centered activities. The chapter summarizes four sub studies performed during the project. Each study presents different approaches to user-centered design of PoCCS. Findings from these studies confirm the need for mobile information and communication technology (ICT) in hospitals. Furthermore, the studies demonstrate how more user involvement and complementary approaches to traditional requirements engineering (RE) and system development methods can be useful when developing mobile information and communication systems for clinicians.

Implementing Precision Medicine Programs and Clinical Trials in the Community-Based Oncology Practice: Barriers and Best Practices

2018 ◽  
pp. 188-196 ◽  
Author(s):  
Jennifer L. Ersek ◽  
Lora J. Black ◽  
Michael A. Thompson ◽  
Edward S. Kim
Keyword(s):  
Clinical Trials ◽  
Best Practices ◽  
Precision Medicine ◽  
Community Setting ◽  
Successful Implementation ◽  
Precision Oncology ◽  
Community Based ◽  
Molecular Tests ◽  
Core Components ◽  
Oncology Practice

There has been a rapid uptick in the pace of oncology precision medicine advancements over the past several decades as a result of increasingly sophisticated technology and the ability to study more patients through innovative trial designs. As more precision oncology approaches are developed, the need for precision medicine trials is increasing in the community setting, where most patients with cancer are treated. However, community-based practices, as well as some academic centers, may face unique barriers to implementing precision medicine programs and trials within their communities. Such challenges include understanding the tissue needs of molecular tests (e.g., tumor, blood), identifying which molecular tests are best used and when tissue should be tested, interpreting the test results and determining actionability, understanding the role of genetic counseling and/or follow-up testing, determining clinical trial eligibility, and assessing patient attitudes and financial concerns. The purpose of this article is to provide guidance to community-based oncology practices currently conducting clinical trials who want to expand their research program to include precision medicine trials. Here, we describe the core components of precision medicine programs and offer best practices for successful implementation of precision medicine trials in community-based practices.

scholarly journals Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study

2020 ◽  
Vol 34 (6) ◽  
pp. 587-598
Author(s):  
Katherine D. Hoerster ◽  
Lamont Tanksley ◽  
Tracy Simpson ◽  
Brian E. Saelens ◽  
Jürgen Unützer ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Medical Center ◽  
Qualitative Interviews ◽  
Veterans Affairs ◽  
Management Program ◽  
Clinical Psychologist ◽  
Behavioral Weight Loss ◽  
Post Traumatic Stress ◽  
Patient Centered

Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design: Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting: Veterans Affairs Medical Center. Participants: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = “Development” and cohort 5 [n = 8] = “Final” MOVE!+UP). Intervention: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. Analysis: Baseline to 16-week paired t tests and template analysis. Results: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [ M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight ( M = −14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD ( M = −17.9 [SD = 12.2]) improvements, P < .05. Conclusions: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.

Use of Venipuncture Blood Sample for INR Testing on a Point of Care Machine.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4159-4159
Author(s):  
Mandeep S. Dhami ◽  
Anca Bulgaru ◽  
K. Jagathambal ◽  
Dinesh Kapur ◽  
Francine Norris ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Sample ◽  
Warfarin Therapy ◽  
Point Of Care ◽  
Test Strip ◽  
International Normalized Ratio ◽  
Blood Draw ◽  
Number Of Patients ◽  
Obtain Blood Sample ◽  
Oncology Practice

Abstract Point of care (POC) testing of International Normalized Ratio (INR) for monitoring warfarin therapy is rapidly becoming procedure of choice for patients requiring long term oral anticoagulation. This method allows for fingerstick blood sample to be used for INR testing at the point of service with immediate dose modification as needed. Most patients prefer a fingerstick method for blood draw to venipuncture. It is not known if venipuncture blood sample can be used for testing on POC machines. A significant number of patients in an oncology practice need additional laboratory testing on the same day as INR testing. These patients therefore get a fingerstick for POC INR testing and a venipuncture for other tests. We compared results of INR from venipuncture sample run on a POC machine (CoaguChek monitor) using CoaguChek test strips (ISI-2.0) with the INR performed on MDA analyzer (ISI-2.0). Blood samples from 24 patients on warfarin therapy were drawn from antecubital vein by a clean stick in a 10 cc plastic syringe. A drop of blood was immediately placed on the CoaguCheck test strip. Next the same blood sample was used to fill a 3.2% sodium citrate tube for testing on MDA analyzer. Results were analyzed using regression analysis; the correlation coefficient (r), slope and intercept were determined and following graph of the regression analysis was generated (see figure 1). Conclusions: These results show a good correlation (r-value&gt; 0.9) between the results of INR obtained on CoaguChek POC machine and the MDA analyzer using venipuncture blood sample. The preferred method to obtain blood sample for POC INR monitoring must remain fingerstick sample as per manufacturer’s recommendations. However, for those patients who need more than one blood sample done on the same day, a venipuncture sample as described above gives acceptable results when tested on CoaguCheck machine. Figure Figure

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