The Effects of a Survivorship Care Plan on Hospital Readmission Rates in Allogenic Stem Cell Transplant Patients

Stem cell transplants (SCTs) are complicated treatments utilized to treat hematologic malignancies and other disorders, such as multiple myeloma, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, acute myeloid leukemia, neuroblastomas, germ cell tumors, amyloidosis, and autoimmune disorders such as systemic lupus erythematosus and systemic sclerosis. The complex care of patients undergoing SCTs place them at high risk for adverse outcomes, including infection, cytomegalovirus, graft vs host disease, secondary new cancers, infertility, and sexual dysfunction (American Cancer Society, 2020). Survivorship care plans (SCPs) are a vital part of the discharge process to educate allogenic SCT patients about post-transplantation care. SCPs are implemented to reduce the risk of common complications and hospital re-admissions in post-SCT patients. The purpose of this project is to use SCPs to reduce 30-day re-admission rates of allogenic SCT patients. A review of literature was conducted to analyze the impact of SCPs on post-transplantation knowledge of preventative measures and common complications. The SCP Questionnaire was created to measure knowledge received from the SCP to highlight the effectiveness of preventative measures and common complications post-transplantation. Kurt Lewin’s Change Theory provided the underlying theoretical framework for this project’s implementation process. The methodology used was a non-randomized quasi-experiment with purposive sampling of allogenic patients that included a retrospective chart review measuring 30-day readmissions, demographics, and the number of patients discharged post-transplant. The Wilcoxon Signed Ranked Test was utilized to demonstrate statistical significance in 30-day readmission rates through post-transplant knowledge and managed care

Implementing a key competency in Physician Assistant palliative care education: simulated pain assessment

Palliative care has become an integral part of healthcare throughout the United States. The goals of this discipline are focused on improving patient quality of life during times of illness. These goals are universal throughout medicine and apply to all practicing providers. An interdisciplinary council developed core competencies for this discipline which includes pain assessment and management as a key component. Throughout healthcare, the assessment and management of pain continues to be a challenge for providers. A review of the literature has demonstrated that untreated pain has become an increasing burden on the patient population. Many providers feel training during their medical education is insufficient and they entered the workforce unprepared. An evaluation of current standards put forth by educational governing bodies has shown the regulations regarding palliative care, pain assessment in particular, to be scattered and non-specific. It is apparent a more concise curriculum, dedicated to palliative care and pain assessment is needed for all future medical providers to hone the essential tools needed to properly evaluate and treat pain. The proposed intervention consists of an educational module which combines a didactic session and student role playing module focused on pain assessment. This intervention will focus on Physician Assistant students in particular, as this profession will continue to play a large role in healthcare. Didactic sessions focused on pain assessment, a core competency of palliative care, will be presented to the students. A role playing exercise following these didactics will allow students to practice such pain assessment skills and also explore what it may be like to be a patient in pain and provide them with insight on the importance of adequately assessing related symptoms. The current model of education regarding palliative care has proven to be ineffective, especially regarding pain assessment. A more concise, dedicated module for this essential skill is needed for students to become more efficient, effective providers. With the ability to assess patients more effectively, providers will be able to manage patients’ pain and decrease the burden untreated pain has put on the population as a whole

Standardizing the Oral Chemotherapy Prescription and Administration Process in the Inpatient Setting.

D.N.P. Thesis. University of Hawaiʻi at Mānoa 2018

Immunochromatographic diagnostic test analysis using Google Glass.

We demonstrate a Google Glass-based rapid diagnostic test (RDT) reader platform capable of qualitative and quantitative measurements of various lateral flow immunochromatographic assays and similar biomedical diagnostics tests. Using a custom-written Glass application and without any external hardware attachments, one or more RDTs labeled with Quick Response (QR) code identifiers are simultaneously imaged using the built-in camera of the Google Glass that is based on a hands-free and voice-controlled interface and digitally transmitted to a server for digital processing. The acquired JPEG images are automatically processed to locate all the RDTs and, for each RDT, to produce a quantitative diagnostic result, which is returned to the Google Glass (i.e., the user) and also stored on a central server along with the RDT image, QR code, and other related information (e.g., demographic data). The same server also provides a dynamic spatiotemporal map and real-time statistics for uploaded RDT results accessible through Internet browsers. We tested this Google Glass-based diagnostic platform using qualitative (i.e., yes/no) human immunodeficiency virus (HIV) and quantitative prostate-specific antigen (PSA) tests. For the quantitative RDTs, we measured activated tests at various concentrations ranging from 0 to 200 ng/mL for free and total PSA. This wearable RDT reader platform running on Google Glass combines a hands-free sensing and image capture interface with powerful servers running our custom image processing codes, and it can be quite useful for real-time spatiotemporal tracking of various diseases and personal medical conditions, providing a valuable tool for epidemiology and mobile health

Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework

This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM).The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed.The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition.Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients

Peer-to-Peer Emotional Support for Second Victims of Hospital Adverse Events

Abstract Problem: Psychological impact of trauma on healthcare workers is profound, and if left unaddressed can debilitate its victims, depress morale, and undermine safety culture. When adverse events occur and focus is placed on providing care and support to patients and their families, the emotional support needs of healthcare workers must also be acknowledged. Context: Frontline workers in the oncology unit of the medical center that is the setting for this project experience emotional distress as “second victims” of adverse patient events. Close relationships develop between providers and patients during long-term treatments. When unanticipated or adverse patient events there can be significant psychological impact on quality care at the bedside. Interventions: Ten nurses or physicians from the oncology unit were recruited and trained to be peer-to-peer responders in the Team RISE program from Johns Hopkins. Measures:. The outcome measure was to foster awareness of second victims of unanticipated events and provide immediate emotional support to frontline healthcare workers. Two process measures evaluated the change in awareness and support provided by a peer responder team trained in Team RISE curriculum from Johns Hopkins Hospital. Results: Ten peer responders (100% of recruits) participated fully in the meetings and two-day training, and completed pre and post implementation surveys at 100%. Knowledge of the second victim phenomenon increased by 23% from 78% pre-survey to 96% post-survey. Pre-implementation only 65% of participants would reach out to a peer compared to 100% post-implementation, a 54% increase. Willingness to engage a peer for support increased by 31%, from 60% before training to 91% after training. Conclusions: This project displayed the effective implementation of a peer to peer support program in addressing second victim phenomenon from an organizational approach. A peer responder program fosters a greater awareness of second victims and provides support to frontline healthcare workers who experience trauma from adverse patient events. Key words: second victim, trauma, resilience, emotional distres

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk

INTERACTIVE CLINICAL EVENT PATTERN MINING AND VISUALIZATION USING INSURANCE CLAIMS DATA

With exponential growth on a daily basis, there is potentially valuable information hidden in complex electronic medical records (EMR) systems. In this thesis, several efficient data mining algorithms were explored to discover hidden knowledge in insurance claims data. The first aim was to cluster three levels of information overload(IO) groups among chronic rheumatic disease (CRD) patient groups based on their clinical events extracted from insurance claims data. The second aim was to discover hidden patterns using three renowned pattern mining algorithms: Apriori, frequent pattern growth(FP-Growth), and sequential pattern discovery using equivalence classes(SPADE). The SPADE algorithm was found to be the most efficient method for the dataset used. Finally, a prototype system named myDietPHIL was developed to manage clinical events for CRD patients’ and visualize the relationships of frequent clinical events. The system has been tested and visualization of relationships could facilitate patient education

Increasing Access To Interventional Pain Management Therapies For Palliative Care Patients With Cancer Through Referral System Improvement

Introduction: The need for palliative care increases as the number of patients continues to grow due to the aging population and rising cancer rates. Pain management is one of the essential components of palliative care. Anesthesia providers are well-positioned to become active members of palliative care teams and to provide pain management services, including regional and interventional therapies to patients in the acute care setting. Due to lack of awareness of the need, there have been few referrals for these services. Consequently, despite anesthesia providers’ knowledge of pain management and anesthesia care delivery, they have not been consistently involved in contributing to palliative care services. Purpose: The overall goal of this project was to improve the current referral system of patients to the Smilow Pain Clinic, and as a result to improve access to highly specialized pain management interventions. Methods: 1. Two-phase review of literature, pertaining to: a. palliative care, interventional pain management therapies, and involvement of anesthesia providers; b. protocols for referral of patients for interventional pain management therapies, general protocols for referral for treatment, components of a protocol, and protocol evaluation. 2. Assessment and evaluation of the current referral system to the Smilow Pain Clinic via the following methods: a. retrospective chart review of patients referred to the Smilow Pain Clinic; b. assessment of the frequency of use; c. interview of providers referring patients to the Smilow Pain Clinic and the receiving providers. 3. Dissemination of findings to appropriate stakeholders, strengthening of the current referral system through application of the assessment findings and evidence-based strategies. Results: Data revealed varying degrees of understanding of the referral process and its components among providers; consistent expression of the need for education about the referral process, patient selection, and interventions the clinic provides; and opportunities to incorporate data use to drive the referral process. Findings were consistent with the need for an educational intervention for providers pertaining to the referral process. Conclusion: Implementation of educational interventions (Fast Fact Sheet, educational course, data dashboard creation) has the potential to increase providers’ knowledge level about the referral process and interventional pain management therapies, and as a result increase referral rate to the clinic

E-health ecosystem with integrated and stepped psychosocial services for breast cancer survivors: study protocol of a multicentre randomised controlled trial

Introduction: Psychosocial interventions for patients with breast cancer (BC) have demonstrated their effectiveness at reducing emotional distress and improving quality of life. The current digitisation of screening, monitoring and psychosocial treatment presents the opportunity for a revolution that could improve the quality of care and reduce its economic burden. The objectives of this study are, first, to assess the effectiveness of an e-health platform with integrated and stepped psychosocial services compared with usual psychosocial care, and second, to examine its cost-utility. Methods and analysis: This study is a multicentre randomised controlled trial with two parallel groups: E-health intervention with integrated and stepped psychosocial services vs usual psychosocial care. An estimated sample of 338 patients with BC in the acute survival phase will be recruited from three university hospitals in Catalonia (Spain) and will be randomly assigned to one of two groups. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include number of clinical cases detected, waiting time from detection to psychosocial intervention and proportion of cases successfully treated in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth, treatment adherence and therapeutic alliance. Secondary outcomes will include the acceptability of the platform, patients' satisfaction and usability. For the cost-utility analysis, we will assess quality-adjusted life years and costs related to healthcare utilisation, medication use and adherence, work absenteeism and infrastructure-related and transport-related costs. Ethics and dissemination: This study was approved by the Ethics committee of the Institut Català d'Oncologia network in Hospitalet, Spain. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences among the scientific community, workshops with patients and media press releases