Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer.

PURPOSE: The use of multiple and/or inappropriate medications in seniors is a significant public health problem, and cancer treatment escalates its prevalence and complexity. Existing studies are limited by patient self-report and medical record extraction compared with a pharmacist-led comprehensive medication assessment. PATIENTS AND METHODS: We retrospectively examined medication use in ambulatory senior adults with cancer to determine the prevalence of polypharmacy (PP) and potentially inappropriate medication (PIM) use and associated factors. PP was defined as concurrent use of five or more and less than 10 medications, and excessive polypharmacy (EPP) was defined as 10 or more medications. PIMs were categorized by 2012 Beers Criteria, Screening Tool of Older Person\u27s Prescriptions (STOPP), and the Healthcare Effectiveness Data and Information Set (HEDIS). RESULTS: A total of 248 patients received a geriatric oncology assessment between January 2011 and June 2013 (mean age was 79.9 years, 64% were women, 74% were white, and 87% had solid tumors). Only 234 patients (evaluated by pharmacists) were included in the final analysis. Mean number of medications used was 9.23. The prevalence of PP, EPP, and PIM use was 41% (n = 96), 43% (n = 101), and 51% (n = 119), respectively. 2012 Beers, STOPP, and HEDIS criteria classified 173 occurrences of PIMs, which were present in 40%, 38%, and 21% of patients, respectively. Associations with PIM use were PP (P \u3c .001) and increased comorbidities (P = .005). CONCLUSION: A pharmacist-led comprehensive medication assessment demonstrated a high prevalence of PP, EPP, and PIM use. Medication assessments that integrate both 2012 Beers and STOPP criteria and consider cancer diagnosis, prognosis, and cancer-related therapy are needed to optimize medication use in this population

Evaluation of patient perceptions of team based care in a Geriatric Oncology Clinic

Purpose: To measure patient perceptions of collaborative practice in an interprofessional team providing geriatric oncology assessments to older patients with cancer. Background: The Senior Adult Oncology Clinic (SAOC) at Thomas Jefferson University’s Kimmel Cancer Center utilizes an interprofessional team approach to provide comprehensive geriatric oncology assessments and treatment plans for older patients with cancer. The importance of team-based healthcare delivery is well documented, however, experts agree that there is a need for more tools to assess the skills required to become a high-functioning team and a need to study the impact of collaborative practice on patient reported outcomes and satisfaction. For this study, we sought to evaluate patients’ experience and perception of our SAOC team function. Description of Intervention: Upon completion of a SAOC visit, patients were asked to participate in a short voluntary survey to assess team performance. The Jefferson Teamwork Observation Guide (JTOG) is a validated survey used with learners that has been adapted to elicit patient perspectives of five domains of interprofessional collaborative practice, including communication (C), values/ethics (V/E), teamwork (T), roles/responsibilities (R) and patient-centeredness (PC). The Patient JTOG includes eight competency–based Likert Scale questions as well as one open-ended question. The survey was administered on secure mobile tablets by trained research assistants (RAs) who were not part of the healthcare team. The study received exempt approval by our Institutional Review Board. Results: A total of 13 patients completed the survey. Seven respondents were female, and six were male. Seven identified as Caucasian, four as African American and two as other. One hundred percent responded “Strongly Agree” to a global question about the importance of teamwork in patient care (mean 4.0). Overall satisfaction with the SAOC team was 3.92 out of 4.0. For the eight questions relating to each of the five collaborative practice competencies noted above, the team received an average score ranging from 3.69 to 3.77 out of 4.0, for a global score of 29.66 (out of 32 possible), placing this team in the highest quartile of teams surveyed at our institution to date (n=407). In addition, all 13 respondents completed the open-ended qualitative comments with 12 out of the 13 being positive with multiple references to effective listening and communication, team coordination, and patient-centered care. Conclusion: The SAOC has a relatively unique model of providing interprofessional geriatric oncology assessments. The Patient JTOG tool was easy to incorporate into a busy clinic and provided valuable feedback to our providers, demonstrating that our patient’s perceive the team as highly functioning and effective. Based on these early results, our high functioning interprofessional consultative team model may serve as a model for replication for team based care delivery at other institutions Relevance: Incorporation of an easy to use tool to assess interprofessional team function and patient perceptions of collaborative practice Learning Objectives: Define methods for evaluating patient perceptions of collaborative practice in an outpatient geriatric oncology practice (Knowledge) Describe a replicable model for interprofessional collaborative practice (Comprehension/Application) Apply lessons learned for engaging students in and preparing faculty for interprofessional team-based care delivery (Comprehension/Application

Experience with a Comprehensive Multidisciplinary Geriatric Oncology Center

Research Goals 1. Describe the population seen in the SAOC over the past 6 years Remediate and complete the EPIC flowsheets Merge data with existing RedCAP dat

The Association of the G8 Questionnaire with Treatment Side Effects and Unscheduled Care Among Older Breast Cancer Patients: A Retrospective Cohort Study

Introduction Nearly half of the patients diagnosed with breast cancer are ≥ 65 years. Older patients with breast cancer are at higher risk for experiencing treatment side effects and unplanned health care. This can compromise treatment outcomes and increase the cost of care. The G8 is among the most sensitive screening tools for frailty and mortality. The aim of this study is to evaluate the association of the G8 questionnaire with treatment side effects and unscheduled care in older breast cancer women.https://jdc.jefferson.edu/medoncposters/1017/thumbnail.jp

Whey protein drink ingestion before breakfast suppressed energy intake at breakfast and lunch, but not during dinner, and was less suppressed in healthy older than younger men

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The CDM-Net Project: The Development, Implementation and Evaluation of a Broadband-Based Network for Managing Chronic Disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS). Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. Methods. A single cohort before and after study. Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined

MMC Fall with Injury Prevention Project

Problem/Impact Statement: Patients falls with injury remains an elusive problem at MMC. Over the past 8 quarter, (2016 and 2017) MMC has outperformed 3 of the last 8 Quarters of data. The average rate for the past 8 quarters is .57/1000 patient days with the mean benchmark of .54/per 1000 patient days. MH has determined a focus goal for all the MH hospitals to be below .70/MH 100 patient days as a goal for falls with injury. MMC having the largest volume must be below NDNQI mean to drive this change as the .70 is the average of all MH hospitals. A fall with injury costs on Average cost of a fall with injury is $14,000., more importantly the cost to the patient may be an increase in hospital stay, and increase in level of care. Injuries range from lacerations to fractures and head trauma and death. Approximately 50% of all falls incur an injury. Putting interventions in place to decrease total falls will decrease injuries at MMC

Concert recording 2019-10-27

[Track 1]. Now sleeps the crimson petal / Roger Quilter -- [Track 2]. Ideale / Paolo Tosti -- [Track 3]. Intorno all\u27idol mio / Anthony Cesti -- [Track 4]. Chanson triste / Henri Duparc -- [Track 5]. Son tutta duolol / Alessandro Scarlatti -- [Track 6]. Aprile / P. Tosti -- [Track 7]. Ah, love, but a day! / Amy Beach -- [Track 8]. So shall the lute and harp awake from An Oratorio-Judas Maccebaeus / George Frideric Handel -- [Track 9]. Come again / John Dowland -- [Track 10]. Der kuss / Ludwig van Beethoven -- [Track 11]. An Chloe / W. A. Mozart -- [Track 12]. Auf dem Wasser zu singen / Franz Schubert --[Track 13]. Allerseelen / Richard Strauss -- [Track 14]. I never saw another butterfly. II. Yes, that\u27s the way things are ; [Track 15]. III. Birdsong / Lori Laitman -- [Track 16]. Je dis que rien m\u27epouvante from Carmen / Georges Bizet -- [Track 17]. Che gelinda manina from La Boheme / Giacomo Puccini -- [Track 18]. Kristine Mezines, piano Granada / Agustin Lara -- [Track 19]. My name from Eve-Song / Jake Heggie -- [Track 20]. Do not go, my love / Richard Hageman

Metabolic shift underlies recovery in reversible infantile respiratory chain deficiency.

Reversible infantile respiratory chain deficiency (RIRCD) is a rare mitochondrial myopathy leading to severe metabolic disturbances in infants, which recover spontaneously after 6-months of age. RIRCD is associated with the homoplasmic m.14674T>C mitochondrial DNA mutation; however, only ~ 1/100 carriers develop the disease. We studied 27 affected and 15 unaffected individuals from 19 families and found additional heterozygous mutations in nuclear genes interacting with mt-tRNAGlu including EARS2 and TRMU in the majority of affected individuals, but not in healthy carriers of m.14674T>C, supporting a digenic inheritance. Our transcriptomic and proteomic analysis of patient muscle suggests a stepwise mechanism where first, the integrated stress response associated with increased FGF21 and GDF15 expression enhances the metabolism modulated by serine biosynthesis, one carbon metabolism, TCA lipid oxidation and amino acid availability, while in the second step mTOR activation leads to increased mitochondrial biogenesis. Our data suggest that the spontaneous recovery in infants with digenic mutations may be modulated by the above described changes. Similar mechanisms may explain the variable penetrance and tissue specificity of other mtDNA mutations and highlight the potential role of amino acids in improving mitochondrial disease

A National Spinal Muscular Atrophy Registry for Real-World Evidence.

BACKGROUND: Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population. METHODS: The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials. RESULTS: The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner. CONCLUSION: Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients