Validation of onco-assist survival prediction tool in stage I, II and IIIcolon cancer among Asian patients

Clinical calculators and predictors are now commonly used in clinical practice to predict most accurate clinical outcome and provide guidance for appropriate therapy. One of the most used calculator is Onco-assist. This study was conducted to compare onco-assist prediction of the patients diagnosed with colon cancer Stage I, II and III. Data was retrospectively collected from 88 patients of colon cancer diagnosed over the period of 11 years (2008 to 2018) and registered at Nuclear Institute of medicine and radiotherapy (NIMRA), Hospital, Jamshoro Sindh. These patients received primary surgical therapy without any neo-adjuvant systemic chemotherapy. Survival assessed on onco-assist prediction algorithm using the defined parameters and compared with the actual survival according to the grade of the tumour. The clinical calculator onco-assist incorporated seven variables: gender, age number of lymph nodes examined, number of tumor-involved lymph nodes, T = (1-4), grade (low / high), adjuvant chemo received (yes / no) if yes then only 5FU or 5FU plus Oxaliplatin based. Onco-assist predicted five-year survival rate in well differentiated tumours with and without chemotherapy as 84% and 80% respectively, in moderately differentiated tumour with and without chemotherapy as 78% and 76% respectively. For poorly differentiated tumours the predicted survival rate with and without chemotherapy was 73%. While actual achieved survival was 35%, 52% and 17% for well, moderately and poorly differentiated cancers. This clinical calculator onco-assist includes limited parameters and limited adjuvant therapy options thus the prediction of cancer survival following surgery in stage I –III colon cancer does not appear to accurately predict outcome in Asian population.

Addressing Black Infant Mortality Through Harnessing the Power of Community

In Hamilton County, Ohio, the infant mortality rate is above the national average and the Black infant mortality rate is more than 3 times the white infant mortality rate. These racial disparities in infant mortality cannot be explained through other socio-economic characteristics like education, income, housing, or medical insurance. Research has shown that racism, not race itself, is the driving force behind the high disparity in infant mortality rates in Hamilton County and the nation as well. The World Health Organization (WHO) and the Institute of Medicine have long cited institutional/structural racism and cultural racism as a key factor in health disparity. A paradigm shift needed to occur to address the consequences of racism within the lives of Black women, namely disempowerment and agency. The Commission on Social Determinants of Health (CSDH) model was which engaged Black women and positioned them as an asset, to share in the process of strategizing, creating, and implementing a plan. Queens Village was founded to implement the CSDH model and address the upstream determinants of infant mortality through cultivating a sense of community.

The Manchester Framework For The Evaluation of Emergency Department Pharmacy Services

Background: Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as practitioners. They provide both traditional pharmaceutical care and novel practitioner care i.e. clinical examination, yet their impact on quality of care is unknown.Aim: To develop a framework of structures, processes and potential outcome indicators to support evaluation of the quality of ED pharmacy services in future studies.Method: Framework components (structures, processes and potential outcome indicators) were identified in three ways, from a narrative review of relevant international literature identified through systematic searches; a panel meeting with ED pharmacists; and a panel meeting with other ED healthcare professionals. Structures and processes were collated into categories developed iteratively throughout data collection, with outcome indicators collated into six domains of quality as proposed by the Institute of Medicine. These raw data were then processed e.g. outcome indicators screened for clarity i.e. those which explicitly stated what would be measured were included in the framework.Results: A total of 190 structures, 533 processes, and 503 outcome indicators were identified. Through data processing a total of 153 outcome indicators were included in the final framework divided into the domains safe (32 outcome indicators), effective (50), patient centred (18), timely (24), efficient (20) and equitable (9). Fewer potential outcome indicators were identified for the patient centred, efficient and equitable domains than others. Conclusion: Whilst frameworks to support evaluation of general ED care exist, this is the first framework specific to ED pharmacy services. Although included in the framework, potential outcome indicators require further development prior to their use in evaluation studies. To that end, evaluation teams should be multidisciplinary and ideally involve researchers with expertise in outcome measurement. Finally, evaluation should not neglect some domains of quality at the expense of others, as previously found by the Institute of Medicine. High quality health services are not only safe, effective and timely, but also patient centred, efficient and equitable.

Pocus as a tool to avoid diagnostic errors in covid-19 era

X-ray flips and wrong labelling has been uncomfortably common, and often results in wrong side intervention. Wrong side surgery is indeed the most dramatic and visible form of human errors. Until the 1999 Institute of Medicine report ‘To Err is Human’, the medical fraternity was largely unaware of such preventable medical errors and near misses. We herein, describe a case where X-ray flip and mislabelling led to wrong side intervention in a COVID-19 ICU. Active errors in human performance are inevitable while practising medicine in the current COVID-19 pandemic where difficulties in performing comprehensive systemic examination with the protective gear on, long working hours, work stress, emotions, and fatigue interplay with the errors in technology and increase the chances of errors. We propose the use of point of care ultrasound (POCUS) in COVID-19 ICU’s to aid in the diagnosis and management.

Nursing Theory Makes a Practice Turn in the 21st Century

The author assumes that practice became prominent in nursing theory in the first two decades of the 21st century. The end of the last century saw a burgeoning of literature on what is known as grand theories, their implementation, and evaluation. The era of healthcare quality research began when the Institute of Medicine issued a report on building a safer health system. At this time, the 21st-century literature in nursing took a distinct turn toward practice, influencing nursing theory. The movement to individualize care acted to further this influence. The nurse and patient relationship is the source of data for knowledge development. Established research approaches such as grounded theory and new approaches such as story theory were being used to create nursing theory from practice. Grand theory work moved to the development of instruments to measure the effects of theory in practice, such as that of Watson and Roy. The middle-range theories were developed and seen as closer to and easier to use in practice. The evidence-based practice movement also contributed to the role of theory in practice. These knowledge developments led to nurses having expanded roles in nursing.

Racial-Ethnic Disparities in Access to Preventive Services Among Privately Insured Adults With Disabilities

Introduction Cerebral palsy (CP) and spina bifida (SB) are congenital disabilities. Due to life-long disability, adults with CP/SB are with greater needs for preventative care. Little is known about racial/ethnic disparities in use of preventative services in this population. Our objective was to examine racial/ethnic disparities in use of preventative care. Methods Using 2007-2017 private claims data, we identified White, Black, and Hispanic adults (18+) with CP/SB [n=11,635; White=8,935; Black=1,457; Hispanic=1,243)]. We quantified the National Institute of Medicine (NAM) definition of disparity by matching health related variables (age, sex, comorbid conditions, and Elixhauser index) between Whites and each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and U.S. Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical therapy/ occupational therapy (PT/OT); (3) annual wellness visit; (4) bone density screening; (5) cholesterol screening; (6) diabetes screening. Results Rate of recommended services for all adults with CP/SB were low and no significant results were found for most preventative services across race/ethnicity. Compared with Whites, Hispanics had lower odds of annual wellness visit (OR: 0.71; 95% CI: 0.53, 0.96) but higher odds of diabetes screening (OR: 1.48; 95% CI: 1.13, 1.93). Blacks had lower odds of bone density screening (OR: 0.54; 95% CI: 0.31-0.95), and annual wellness visit (OR: 0.50; 95% CI: 0.24-1.00). Conclusions There were no substantial racial/ethnic disparities in use of preventive services among privately insured adults with CP/SB who had a higher-than-average income and education level.

Optimizing the Geriatric Mental Health Workforce Through Innovative Approaches

The drastic demand for geriatrics-trained providers in medical and mental healthcare persists years after the Institute of Medicine first highlighted this need (2008; 2012). New innovative approaches must instead optimize the current workforce through leveraging existing geriatric experts’ knowledge and skills related to working aging adults. This symposium will highlight four approaches spanning post-licensure education to using technology to deliver specialized services and training. First, Dr. Gregg will discuss the evaluation of an advanced topics workshop in Geropsychology which has significantly enhanced depth of Geropsychology competencies for psychologists working in primarily rural areas. Next, Dr. Asghar-Ali will describe the multi-modal interactive geriatric educational opportunities for interprofessional staff developed by the South East Texas Geriatric Workforce Enhancement Program (SETx GWEP). He will discuss how these training opportunities have been tailored to address the impact of COVID-19 and healthcare disparities among older adults. Third, Dr. Filips will present an evaluation of a consultation model in which a geriatric psychiatrist provides tele-consultation in a 5-state region to rural aging Veterans with complex medical and behavioral comorbidities. Finally, Dr. Beaudreau will describe adaptations to a national VA Problem Solving Training program for mental health clinicians of older Veterans with complex comorbidities. Dr. Karel, VA National Geriatric Mental Health Director, will serve as discussant and comment on the ways in which these novel approaches are meeting the ever-growing need for competent geriatric mental health providers.

Strategies for Developing an Inclusive Geriatric Physician Workforce for Older Adults in the U.S

The “geriatric imperative” has been part of the aging discourse for more than 30 years but neither geriatric practice nor older adults are homogenous. As the U.S. population ages, elders will become more racially and ethnically diverse; and, their health outcomes will be shaped by lifetime experiences with systemic discrimination and racism. Already, COVID-19 has made clear that older adults and non-Whites, particularly African Americans and Hispanics, disproportionately bear the burden of disease and illness. Research suggests health disparities will continue unless there is change within the health care system. The Institute of Medicine (2001) reported on the problematic nature of the stark contrast between the diversity of patients and the physicians caring for them, including issues with patient trust and communication, yet no significant movement has been made to diversify the physician workforce. Despite being 13% and 16% of the U.S. population, respectively, African Americans and Hispanics make up just 5% and 6% of the practicing physician workforce. Further, practicing geriatricians represent less than 1% of physicians with very few physicians of color. There is a need for more African American and Hispanic geriatricians. In this systematic review, we examine recruitment and retention efforts targeting students of color, and curricula of geriatric medical programs in the U.S. We offer recommendations toward incentivizing physicians of color to enter geriatrics, strategies to support decolonization of geriatric medical curricula in undergraduate medical education programs, and the development of mentorship and pipeline programs to increase diversity in the geriatric physician workforce.

FATORES ASSOCIADOS À SÍNDROME DE BURNOUT ENTRE ENFERMEIROS EMERGENCISTAS: UMA REVISÃO INTEGRATIVA

Introdução: A Síndrome de Burnout se caracteriza como um problema importante para os profissionais de saúde, uma vez que causa uma redução do bem-estar ocupacional além de distúrbios patológicos de ordem física e psicológica. Os enfermeiros emergencistas podem ser mais vulneráveis a esta Síndrome pois suas rotinas de trabalho são caracterizadas pela imprevisibilidade, superlotação e enfrentamento contínuo de uma ampla gama de doenças e eventos traumáticos. Objetivo: Identificar os principais fatores associados à ocorrência da Síndrome de Burnout entre enfermeiros emergencistas. Materiais e métodos: Estudo de revisão integrativa realizado nas seguintes bases de dados: Scientific Eletronic Libray Online (SciELO), Scopus, Nacional institute of Medicine (NIH-PUBMED) e Web of Science. A busca na literatura foi organizada pelos seguintes descritores: “Burnout”, “Occupational stress”, “Mental health”, “Emergency servisse” e “Emergency nursing”. Foram incluídos artigos publicados entre 2016 e 2021. A busca encontrou inicialmente 563 artigos e a leitura de seus resumos levou a seleção de 63, ao qual foram lidos na íntegra totalizando em 14 artigos na amostra final. Resultados: Das 14 publicações analisadas, observou-se maior frequência de publicação do ano 2018 (n: 05) e o país que mais publicou sobre o tema foi o Reino Unido (n: 06) seguido do Brasil (n: 03). Os tipos de estudos mais frequentes foram: estudo transversal quantitativo (n: 05) e qualitativo (n: 04). Entre os estudos analisados o percentual de Burnout entre os enfermeiros emergencistas variou de 15% à 64%. Os fatores individuais identificados estavam relacionados às variáveis ​​demográficas e características de personalidade, enquanto os fatores relacionados ao trabalho foram: exposição a eventos traumáticos, características do trabalho e variáveis ​​organizacionais. Conclusões: Verificou-se uma elevada taxa de Síndrome de Burnout entre enfermeiros emergencistas, de modo que os principais fatores preditores da Síndrome estavam relacionados a aspectos individuais e de trabalho do profissional, demandando a formulação de estratégias de enfrentamento e prevenção das equipes de gestão hospitalar.

Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of four. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty ● Linear programming is a mathematical approach to evaluating the diets of First Nations ● The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.