Understanding Patients’ Attitudes Toward Cancer Multidisciplinary Meetings: A Mixed Methods Study

2020 ◽  
Vol 16 (2) ◽  
pp. e175-e182
Author(s):  
Bianca Devitt ◽  
Jennifer Philip ◽  
Madhu Singh ◽  
Sue-Anne McLachlan
Keyword(s):  
Mixed Methods ◽  
Medical Treatment ◽  
Treatment Plan ◽  
Quality Care ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Theory Approach ◽  
Previous Diagnosis ◽  
Diagnosis Of Cancer ◽  
A Current

PURPOSE: Multidisciplinary cancer meetings (MDMs) are an integral component of quality care; however, little research exists regarding patients’ views on this model of care. We aimed to explore and understand the attitudes of patients toward MDMs. METHODS: A mixed methods exploratory design was used. Qualitative data from patients with a current or previous diagnosis of cancer were collected and analyzed using a grounded theory approach. Results informed the development of a questionnaire survey that was administered to patients with a current or previous diagnosis of cancer. Results were analyzed using descriptive statistics. RESULTS: Nine patients participated in 3 focus groups, and 152 patients (response rate, 90%) completed the questionnaire. Patients were strongly supportive of MDMs and thought that all patients with cancer should be routinely discussed. More than 90% of surveyed patients believed MDMs were reassuring, meant all treatment modalities were considered, and led to evidence-based treatment recommendations. Patients wanted MDMs to focus on medical treatment planning rather than psychosocial issues, and 87% regarded the meeting as confidential. Patients described a preference for doctor-led decision making, and most (84%) wanted MDM treatment decisions to be discussed with them in a subsequent consultation, with 73% of patients also wanting this in a written format. CONCLUSION: Patients strongly endorse MDMs as a means to develop an evidence-based, medical treatment plan agreed to by consensus. They want to be purposely informed of the meeting and its outcomes. Results from this study can help inform future guidelines on the conduct of MDMs.

History and Examination of the Spine

2018 ◽  
Author(s):  
Maggie Henjum ◽  
Jodi Young
Keyword(s):  
Systematic Approach ◽  
Treatment Plan ◽  
Current Evidence ◽  
Evidence Based ◽  
Strength Testing ◽  
Objective Data ◽  
History Taking ◽  
Thoracic And Lumbar Spine ◽  
Assessment And Treatment ◽  
A Current

An efficient model for history-taking and physical examination of the spine using a current evidence-based approach provides the foundation for a targeted assessment and treatment plan. Taking a history and examining the cervical, thoracic, and lumbar spine may be complex, especially if the clinician does not use a systematic approach for collecting subjective and objective data. Included in this chapter are best evidence strategies for observing a patient’s posture and movement patterns, assessing active and passive range of motion, and performing neurologic testing, strength testing, special tests, and palpation. Special attention is given to test clusters and examination items with strong psychometric properties that provide efficient and accurate examination results. By incorporating these strategies into the history and examination, the examiner should be able to rule in or out particular diagnoses that will direct overall management of the patient’s symptoms.

scholarly journals Molar Incisor Hypomineralization from Inception to Intervention–Evidence Based Review

2021 ◽  
pp. 113-125
Author(s):  
Rana A. Alamoudi
Keyword(s):  
Oral Health ◽  
Wide Spectrum ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Tailored Treatment ◽  
Dental Practitioners ◽  
Molar Incisor Hypomineralization

Background: Molar Incisor Hypomineralization (MIH) is considered a highly prevalent clinical problem worldwide. The etiology of MIH involves a complex interaction between systemic and environmental insults with possible genetic contribution. Early diagnosis is facilitated by collaboration between clinicians responsible for oral health management of the patient and is the key for enhancing the long-term prognosis and quality of life of affected children. MIH management is a formidable oral health challenge due to the wide spectrum of clinical presentation with the need for tailored treatment for the child affected by MIH condition. Objective: To provide dental practitioners with an updated and evidence-based overview of MIH etiology, diagnosis, and treatments modalities available for its management. Conclusion: In this review, recent clinical evidence on MIH etiology, diagnosis and treatment is presented. Given recent availability of sophisticated technologies there is an increasing number of treatment modalities now at the fingertips of all oral health clinicians alike, ranging from preventive measures, management of hypersensitivity to advanced restorative techniques. The tailored treatment plan should encompass a short and long-term approach requiring more frequent dental check-ups in order to achieve better outcomes and prognosis. Future translational clinical research to best practice that will enhance our understanding of the exact causes of MIH and allow development of standardized diagnostic criteria as well as optimal treatment strategies are warranted.

scholarly journals Venous Thromboembolism – Current Diagnostic and Treatment Modalities

2016 ◽  
Vol 4 (3) ◽  
pp. 523-525 ◽  
Author(s):  
Marijan Bosevski ◽  
Elizabeta Srbinovska-Kostovska
Keyword(s):  
Venous Thromboembolism ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Clinical Information ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Therapeutic Modalities ◽  
Single Drug ◽  
A Current

BACKGROUND: Pulmonary embolism and deep venous thrombosis, known as venous thromboembolism (VTE), are associated with a high proportion of morbidity and mortality.AIM: Aim of this review is to emphasise current diagnostic and therapeutic modalities for VTE.RESULTS: No differences have been noticed in European and American guidelines in diagnostic approach of this disorder. Today there is enough clinical information for the use of heparin (either, unfractionated or low molecular) and vitamin K antagonists in the treatment of acute and chronic phases of VTE. Novel oral anticoagulants seem to have some advantages in the treatment of this disorder. Rivaroxaban has been approved widespread, for use as a single-drug approach of VTE.CONCLUSION: Both guidelines are almost similar and good basis for evidence-based treatment of this disorder.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

scholarly journals Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Elizabeth A. McGuier ◽  
David J. Kolko ◽  
Mary Lou Klem ◽  
Jamie Feldman ◽  
Grace Kinkler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Human Service ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Implementation Outcomes ◽  
Services Implementation ◽  
Team Functioning

Abstract Background Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review will identify and summarize empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings. Methods We will conduct a comprehensive search of bibliographic databases (e.g., MEDLINE, PsycINFO, CINAHL, ERIC) for articles published from January 2000 or later. We will include peer-reviewed empirical articles and conference abstracts using quantitative, qualitative, or mixed methods. We will include experimental or observational studies that report on the implementation of an innovation in a healthcare or human service setting and examine associations between team functioning and implementation outcomes. Implementation outcomes of interest are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Two reviewers will independently screen all titles/abstracts, review full-text articles, and extract data from included articles. We will use the Mixed Methods Appraisal Tool to assess methodological quality/bias and conduct a narrative synthesis without meta-analysis. Discussion Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change. The results of this systematic review will inform efforts to implement evidence-based practices in team-based service settings. Systematic review registration PROSPERO CRD42020220168

scholarly journals Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Murat Gözüküçük ◽  
Esra Gülen Yıldız
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Medical Treatment ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Laboratory Findings ◽  
Factors Affecting ◽  
Laboratory Infection ◽  
Major Factors

Abstract Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

scholarly journals Implementing Delirium Prevention in the Era of COVID-19

2021 ◽  
Vol 79 (1) ◽  
pp. 31-36
Author(s):  
Nila S. Radhakrishnan ◽  
Mariam Mufti ◽  
Daniel Ortiz ◽  
Suzanne T. Maye ◽  
Jennifer Melara ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Quality Care ◽  
Tertiary Care ◽  
Cognitive Stimulation ◽  
Evidence Based ◽  
Care Hospital ◽  
Future Studies ◽  
Delirium Prevention ◽  
Prevention Model ◽  
Prevention Methods

Patients admitted with COVID-19 can develop delirium due to predisposing factors, isolation, and the illness itself. Standard delirium prevention methods focus on interaction and stimulation. It can be challenging to deliver these methods of care in COVID settings where it is necessary to increase patient isolation. This paper presents a typical clinical vignette of representative patients in a tertiary care hospital and how a medical team modified an evidence-based delirium prevention model to deliver high-quality care to COVID-19 patients. The implemented model focuses on four areas of delirium-prevention: Mobility, Sleep, Cognitive Stimulation, and Nutrition. Future studies will be needed to track quantitative outcome measures.

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