Penggunaan Metode SBAR untuk Komunikasi Efektif antara Tenaga Kesehatan dalam Konteks Klinis

Abstract—Interprofessional collaboration is a collaboration in health services between health professionals from diverse backgrounds. One of the most important aspects of collaborative practice in health services is the communication between health professionals. Lack of communication can cause a delay in treatment and medical errors. Ineffective communication can also represent a lack of coordination. SBAR method is an effective communication technique for health professionals. The SBAR method is useful to improve team communication in general, improve communication skills in certain situations, and also helpful during shift handover. Keywords: interprofessional collaboration, communication, SBAR method Abstrak—Kolaborasi interprofesional merupakan suatu kerja sama dalam pelayanan kesehatan antara profesional kesehatan yang memiliki latar belakang pendidikan berbeda. Dalam pelayanan kesehatan, salah satu hal terpenting dari praktik kolaborasi yaitu komunikasi antara tenaga kesehatan. Kurangnya komunikasi dapat menyebabkan terjadinya keterlambatan dalam melayani pasien dan kesalahan dalam menangani pasien. Komunikasi yang kurang efektif juga dapat menggambarkan koordinasi tenaga kesehatan yang kurang baik. Teknik komunikasi efektif yaitu SBAR ditetapkan sebagai standar komunikasi antara tenaga kesehatan yang berfokus terhadap pasien. Metode SBAR bermanfaat untuk meningkatkan komunikasi tim secara umum, meningkatkan keterampilan komunikasi saat situasi tertentu, dan juga berguna pada saat operan dinas. Kata kunci: kolaborasi interprofesional, komunikasi, metode SBAR

Anemia Requiring Transfusion in Breast Cancer Patients on Dose-dense Chemotherapy: Prevalence, Risk Factors, Cost and Effect on Disease Outcome.

Purpose: Dose dense chemotherapy improves survival but also increases toxicity and treatment related cost. Here we report the prevalence of anemia, understand the risk factors of chemotherapy related anemia and determine the cost and time-delay associated with transfusion requirement in Indian non-metastatic breast cancer patients on dose dense preoperative chemotherapy.Methods: In this study, 116 triple negative breast cancer (TNBC) patients were treated preoperatively with Docetaxel and Cyclophosphamide alternating with Epirubicin and Cisplatin every 2-weekly. Patients were evaluated for anemia pre- and post-chemotherapy. We examined trends in the cell counts, transfusion requirement, time to transfusion as well as risk factors associated with transfusion during treatment, along with delay in treatment due to anemia and the additional cost incurred.Results: One hundred and sixteen women with high-risk non-metastatic TNBC were treated. Median age was 44.5 years. 56.1% had stage III disease. Delivery of 6/8 planned doses was achieved in 98.3% of patients, and all 8 doses in 86% patients. Anemia was detected at baseline in 54(46.5%) patients with mild(10-12g/dl) anemia in 42(36.2%) patients and moderate(8-10g/dl) in 12(10.3%) patients. Forty-four patients (37.9%) required transfusion during chemotherapy with 55(47.4%) patients having grade 1-2 anemia and 40(34.5%) patients having grade 3 anemia. The factors associated with transfusion were low grade of tumor (OR 2.48 (95% CI 1.08 - 5.68), p = 0.025), hemoglobin post 2 cycles of chemotherapy (OR 1.74 (95% CI 1.21- 2.51), p = 0.003), thrombocytopenia grade 3 or 4 (OR 4.35 (95% CI 1.062-17.827), p = 0.034) and drop in hemoglobin after 2 cycles (OR 1.65 (95% CI 1.09-2.48), p = 0.017). Nearly one fourth of the study population had a delay between two cycles of chemotherapy due to anemia. A median additional cost of Rs 7000 (IQR-Rs 7000 – Rs 14000) was incurred on transfusion.Conclusion: Anemia is a common toxicity associated with dose dense chemotherapy during curative breast cancer treatment leading to delay in treatment and increased cost. Low grade tumor, grade 3 or 4 thrombocytopenia and Grade 2 or higher anemia after 2 cycles of chemotherapy are risk factors for blood transfusions during treatment.

Comparison of Lymph Node Involvement in Carcinomas during Precovid and Covid Era

Background: This is a clinicopathological study comparing the involvement of lymph nodes in various carcinomas before and during the COVID-19 period. During the pandemic the access to healthcare and timely detection and intervention of carcinomas were severely affected. This delay in treatment has led to the progression of malignancies and metastasis to lymph nodes. Methods: A retrospective study was conducted of 40 patients (20 from 2019 and 20 from 2021) with carcinomas who were treated by surgical excision of tumour combined with lymph node resection. Histopathological examination of the nodes was done to detect malignant metastasis and the average node positivity rate was calculated. Results: Lymph node metastasis was observed in 10 patients in 2019 (50%) and 16 patients in 2021 (80%). The average node positivity rate is significantly higher in 2021 than in 2019, in 2019 it is 31% and in 2021 it is 43%. Lymph node metastasis is expected to increase by 43% in 2021. Conclusion: In the Covid-19 pandemic, a significant decrease and delay of patients presenting to the OPD for neoplasms, resulting in a delay in the diagnosis and treatment of advanced-stage neoplasms that manifest as metastases in the regional lymph nodes. Surgeons need to be vigilant and extensively explore the all draining affected lymph nodes and resect them.

Drug-Induced Tardive Dyskinesia

Drug-induced movement disorders could be classified into acute, subacute, and chronic based on the time of occurrence. Tardive dyskinesia (TD) is one of the most frequent long-term drug-induced movement disorders. Delay in treatment often caused TD to be irreversible. In this review, we will discuss TD in-depth to enhance clinician knowledge regarding the diagnosis, prevention, and comprehensive management of patients with TD. Keywords: tardive dyskinesia, movement, disorder, antipsychotic.

442 COVID-19 And the Oral Surgery/Orthodontic Interface: Has A Delay in Treatment Complicated the Position of Unerupted And Ectopic Teeth Planned for Surgical Removal or Exposure?

Aim To evaluate whether there has been a change in clinical or radiographic position and the resultant occurrence of complications of unerupted and ectopic teeth due to delayed treatment during the COVID-19 pandemic Method Data was collected over a three-month period at the Royal United Hospital, Bath, Oral and Maxillofacial Surgery Department. This was via a questionnaire distributed to clinicians and prospectively completed for each surgical procedure planned for the removal or exposure of ectopic canines, premolars, and supernumerary teeth. Results A total of 20 surgical extractions or exposures were performed during the three-month period, with 33% (n = 6) having a marked difference between their expected and final position. Complications occurred in 66.6% (n = 4) of cases that demonstrated a discrepancy in location. These were an increased surgical time, increased removal of bone or a cancellation of intended treatment. This cancellation occurred as the tooth had erupted enough for non-surgical management. In cases where there was no discrepancy (n = 14), no complications were reported. Conclusions These findings suggest the delay in treatment caused by the COVID-19 pandemic has resulted in a clinically significant change in the position of ectopic teeth planned for surgical removal or exposure. Given these findings, it is crucial that clinicians be aware that radiographic investigations are diagnostic and recent. The threshold for repeat imaging in all cases which have been delayed should be low to avoid unexpected surgical complications arising from inaccuracy in tooth localisation.

430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era

Aim The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak. Method The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes. Results Patient selection was restructured to prioritise patients with performance status of < 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p < 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups. Conclusions The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen

Challenges in the Diagnosis of a Case of Granulomatosis with Polyangeitis

Granulomatosis with polyangiitis is a multisystem disease characterized by a necrotizing granulomatous vasculitis, typically associated with the presence of anti-neutrophil cytoplasmic antibodies. The lung is the most common organ involved in comparison to other vasculitis, but in the case presented by us the onset is otorhinolaryngology field, with a multitude of symptoms and immunological tests are initially negative. Over time, immunological tests become positive, but all this leading to a delay in diagnosis by 4 years and of course to a delay in treatment. In this paper we emphasize the usefulness of biopsy for diagnosis and use of anti-neutrophil cytoplasmic antibodies to classify the disease.

Lung cancer mortality due to delayed treatment: Literature review

Lung cancer is still leading in the structure of cancer incidence and mortality worldwide. Delay in appropriate treatment increases the probability of death from this disease. Purpose: to study foreign scientific publications of recent years on the mortality from lung cancer due to delayed treatment. Results: The analysis of global literature for 2010-2020 shows that any delay in lung cancer treatment after establishing the diagnosis reduces the survival rates. Recent studies provide a qualitative assessment of the effect of delay in treatment on cancer mortality for prioritization and modeling. The indications for surgery, systemic treatment, and radiation therapy in seven types of cancer, including lung cancer, evidence a significant association between delay in treatment and increased mortality. The researchers believe that early diagnostics increase the treatment efficacy. Conclusion: Analyzing the barriers to timely treatment for lung cancer can help clarify and assess the impact of delayed treatment on survival. Policies designed to minimize delays in treatment can improve survival outcomes.