Focal Spot, Spring 1995

https://digitalcommons.wustl.edu/focal_spot_archives/1069/thumbnail.jp

Development of a Web Platform for Surgical Oncologists in Portugal

In an age of enormous access to clinical data and rapid technological development, ensuring that physicians have computational tools to navigate a sea of information and improve health outcomes is vital. A major advance in medical practice is the incorporation of Clinical Decision Support Systems (CDSSs) to assist and support the healthcare team in clinical decision making, thus improving the quality of decisions and overall patient care, while minimizing costs. Postsurgical complications of cancer surgery are hard to predict, although there are several traditional risk scores available. However, there is an urgent need to improve perioperative risk assessment to reduce the growing postoperative burden in the Portuguese population. Understanding the individual risks of performing surgical procedures is essential to customizing preparatory, intervention, and aftercare protocols to minimize post-surgical complications. This knowledge is essential in oncology, given the nature of the interventions, the fragile profile of patients with comorbidities and drug exposure, and the possible recurrence of cancer. This thesis aims to develop an user-friendly web platform to support the collaboration and manage clinical data among oncologists at the Portuguese Institute of Oncology, Porto. The work integrates both a database to register/store the clinical data of cancer patients in a structured format, visualization tools and computational methods to calculate a specific risk score of postoperative outcomes for the Portuguese population. The platform named IPOscore will not only to manage the clinic data but also offer a predictive healthcare system, as an valuable instrument for the oncologists.Numa época de grande acesso a dados e rápido desenvolvimento tecnológico, garantir que os médicos tenham as ferramentas de apoio à decisão clínica para se deslocar em um mar de informação para encontrar o que é mais relevante para as necessidades dos pacientes é vital para otimizar os resultados de saúde. Um grande avanço na prática médica é a incorporação de Sistemas de Apoio à Decisão Clínica (CDSSs) para auxiliar e apoiar a equipe de saúde na tomada de decisão clínica, melhorando assim a qualidade das decisões e o atendimento geral ao paciente, minimizando custos. As complicações pós-operatórias da cirurgia do cancro ainda são difíceis de prever, embora existam muitos scores de risco destinados a fazer tais previsões. Compreender os riscos individuais de realizar procedimentos cirúrgicos é essencial para personalizar os protocolos preparatórios, de intervenção e pós-atendimento para minimizar as complicações pós-cirúrgicas. Esse conhecimento é fundamental em oncologia, dada a natureza das intervenções, o perfil frágil dos pacientes com comorbidades e exposição a drogas e a possível recorrência do cancro. Este trabalho propõe a construção duma plataformaweb de fácil utilização para apoiar a colaboração e dispor uma gestão de dados clínicos entre oncologistas. O trabalho integra uma base de dados para registrar / armazenar os dados clínicos, fisiológicos e biopatológicos de pacientes com cancro num formato estruturado e métodos computacionais para calcular um grau de risco específico de complicações pós-operatórias para a população portuguesa. A plataforma denominada IPOscore servirá para a gestão de dados clinicos, mas também oferecerá um sistema preditivo e preventivo, como uma ferramenta de apoio à decisão médica no contexto clínico diário

Integration of Tobacco Treatment Services into Cancer Care at Stanford.

As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated "opt-out" referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center

Community access to primary care is an important geographic disparity among ovarian cancer patients undergoing cytoreductive surgery

OBJECTIVE: Given the importance of understanding neighborhood context and geographic access to care on individual health outcomes, we sought to investigate the association of community primary care (PC) access on postoperative outcomes and survival in ovarian cancer patients. METHODS: This was a retrospective cohort study of Stage III-IV ovarian cancer patients who underwent surgery at a single academic, tertiary care hospital between 2012 and 2015. PC access was determined using a Health Resources and Services Administration designation. Outcomes included 30-day surgical and medical complications, extended hospital stay, ICU admission, hospital readmission, progression-free and overall survival. Descriptive statistics and chi-squared analyses were used to analyze differences between patients from PC-shortage vs not PC-shortage areas. RESULTS: Among 217 ovarian cancer patients, 54.4 % lived in PC-shortage areas. They were more likely to have Medicaid or no insurance and live in rural areas with higher poverty rates, significantly further from the treating cancer center and its affiliated hospital. Nevertheless, 49.2 % of patients from PC-shortage areas lived in urban communities. Residing in a PC-shortage area was not associated with increased surgical or medical complications, ICU admission, or hospital readmission, but was linked to more frequent prolonged hospitalization (26.3 % vs 14.1 %, p = 0.04). PC-shortage did not impact progression-free or overall survival. CONCLUSIONS: Patients from PC-shortage areas may require longer inpatient perioperative care in order to achieve the same 30-day postoperative outcomes as patients who live in non-PC shortage areas. Community access to PC is a critical factor to better understanding and reducing disparities among ovarian cancer patients

Better Medicine

https://scholarlyworks.lvhn.org/better-medicine/1020/thumbnail.jp

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Lymphoedema: lymphoscintigraphy versus other diagnostic techniques - a clinician’s point of view

This paper overviews the problem of the clinical basis, diagnosis and available therapy modalities for lymphoedema. Regarding diagnostics, the measurement of circumference, volume and thickness of the limb are presented, as well as diagnostic imaging modalities. These include direct and indirect lymphography, MRI, CT, ultrasound imaging and lymphoscintigraphy, which is currently considered the leading technique in primary diagnosis of lymphoedema and its follow-up. This paper discusses the treatment of lymphoedema and the role of lymphoscintigraphy in the follow-up of patents with lymphoedema

Focal Spot, Spring 1978

https://digitalcommons.wustl.edu/focal_spot_archives/1020/thumbnail.jp