Our Pathway To A Successful Non-Medical Research Strategy – A Culture Shift Five Years On

2019 ◽  
Vol 26 (6) ◽  
pp. 2-2 ◽  
Author(s):  
Anju Jaggi ◽  
Anthony Gilbert ◽  
Mindy Cairns ◽  
Rachel Dalton
Keyword(s):  
Health Research ◽  
Research Training ◽  
Clinical Care ◽  
Quality Care ◽  
Treatment Options ◽  
Research Strategy ◽  
Professional Staff ◽  
Research Activity ◽  
Strategic Objective ◽  
Research Programmes

Background/Aims There is increasing evidence that research-active healthcare provider organisations provide better quality care, increased treatment options and improved clinical outcomes. Delivering evidence based clinical care and a high academic profile was identified as a key strategic objective at a tertiary orthopaedic hospital in the UK. Methods In 2013, the organisation appointed a Director of Therapies and a Consultant physiotherapist with protected time to develop a therapies research strategy. Focus groups were held across the directorate (140 staff across all pay bands and grades including non-professional staff) to identify current research activity, barriers and enablers to developing a research active department. Data were analysed thematically and findings used to inform a 5-year research strategy. Results Five key actions were identified: (1) identifying research programmes in clinical teams; (2) research as a key team objective; (3) provide appropriate research training and education; (4) identify talent and research champions; (5) develop external collaborations with appropriate academic and commercial partners. In 2014, a commercial grant was successful and a therapies research coordinator was appointed to support staff training and research processes. In 2016, a 2-year grant received from the hospital charity supported this ongoing role alongside funding with a higher education institute to provide methodological support, writing skills and grant applications. To date, this has resulted in six peer-reviewed articles and further external funding. Novice researchers have been supported resulting in a National Institute for Health Research PhD fellowship and two National Institute for Health Research internships to build capability. Clinical teams have identified research programmes to maximise resources and time. Of the total number of registered projects, 41% of were submitted to national/international scientific conferences compared to only 16% in 2014. Conclusions The key to a successful research strategy in a clinical setting requires clear strategic support, leadership, talent spotting and training. However, dedicated resources and investment is required for delivery of projects to publications.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 118
Author(s):  
Linda Xing Yu Liu ◽  
Marina Golts ◽  
Virginia Fernandes
Keyword(s):  
Current Practice ◽  
Quality Care ◽  
Treatment Options ◽  
Critical Role ◽  
Transitions Of Care ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Multiple Treatments ◽  
The Impact

The impact of depression is well described in the literature, and it is most prominent in patients who have trialed multiple treatments. Treatment-resistant depression (TRD) is particularly debilitating, and it is associated with significant morbidity and mortality. Despite this, there seems to be therapeutic inertia in adopting novel therapies in current practice. Ketamine is an N-methyl-D-aspartate receptor antagonist and anesthetic agent which has recently been shown to be effective in the management of TRD when administered intravenously or intranasally. The treatments, however, are not easily accessible due to restrictions in prescribing and dispensing, high costs, and the slow uptake of evidence-based practice involving ketamine within the Canadian healthcare system. Given the limited treatment options for TRD, novel approaches should be considered and adopted into practice, and facilitated by a multi-disciplinary approach. Pharmacists play a critical role in ensuring access to quality care. This includes dissemination of evidence supporting pharmacological treatments and facilitating translation into current practice. Pharmacists are uniquely positioned to collaborate with prescribers and assess novel treatment options, such as ketamine, address modifiable barriers to treatment, and triage access to medications during transitions of care. Extending the reach of these novel psychiatric treatments in both tertiary and primary care settings creates an emerging role for pharmacists in the collaborative effort to better manage treatment-resistant depression.

scholarly journals Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carlijn G. N. Voorend ◽  
Noeleen C. Berkhout-Byrne ◽  
Yvette Meuleman ◽  
Simon P. Mooijaart ◽  
Willem Jan W. Bos ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Qualitative Study ◽  
Clinical Outcomes ◽  
Geriatric Assessment ◽  
Clinical Care ◽  
Treatment Options ◽  
Routine Care ◽  
Treatment Team ◽  
Dutch Hospital ◽  
Additional Support

Abstract Background Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment. Methods In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis. Results In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment. Conclusions Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.

Statement on Pediatric Fellowship Training

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 265-265
Author(s):  
Keyword(s):  
Research Training ◽  
Clinical Care ◽  
Fellowship Training ◽  
The Body ◽  
Pediatric Residents ◽  
Pediatric Society ◽  
Research Fellowship ◽  
Research Activities ◽  
Fellowship Programs ◽  
Interest In Research

The following statement was adopted by the Federation of Pediatric Organizations in February, 1990. The Federation consists of the following pediatric organizations: Ambulatory Pediatric Association, American Academy of Pediatrics, American Board of Pediatrics, American Pediatric Society, Association of Medical School Pediatric Department Chairmen, Association of Pediatric Program Directors, Society for Pediatric Research. The Federation supports the concept that "the principal goal of fellowship training should be the development of future academic pediatricians." Graduates of pediatric fellowship programs usually work in academic centers with significant time set aside for research. Some fellowship-trained pediatricians, particularly neonatologists, allergists, and neurologists, may not work in hospitals or ambulatory settings that are associated closely with academic programs. Fellowship-trained pediatricians in all settings should be encouraged to continue their interest in research to add to the body of pediatric knowledge. To achieve the goal of training pediatric scientists, the following guidelines for fellowship education are recommended: 1. Upon completion of a pediatric fellowship, the trainee should be proficient in clinical care, teaching, and research. Fellowship training should prepare a pediatrician to care for children with complex illnesses within his/her area of special expertise and to serve as a consultant for the general pediatrician. In addition, the fellowship-trained pediatrician should be responsible for the education of pediatric residents and the continuing education of practicing pediatricians. For this reason, fellowship training should include interpersonal skills and pedagogical techniques. 2. Research training should begin as soon as possible; premedical students, medical students, and pediatric residents should be encouraged strongly to participate in meaningful research, and research activities should be carried out throughout fellowship training.

scholarly journals Does the phthisioophthalmology section of our Ophthalmologic Society contribute in the promotion of quality care for patients with ocular tuberculosis?

2016 ◽  
Vol 9 (1) ◽  
pp. 56-63
Author(s):  
Elena I Ustinova ◽  
Olga P Ilkova
Keyword(s):  
Positive Impact ◽  
Clinical Care ◽  
Quality Care ◽  
Social Activity ◽  
Diagnosis And Treatment ◽  
Treatment Quality ◽  
Medical Society ◽  
Care Process ◽  
System Reform ◽  
Ocular Tuberculosis

The phthisioophthalmology section work over the last 15 years is analyzed. Due to the antituberculous care system reform the number of section members decreased from 27 to 17. Scientific meetings are regular, their frequency decreased up to 5-6/year. Ever and again presentations are made at plenary sessions of the St.Petersburg Scientific Medical Society of Ophthalmology (6 presentations in 15 years) and at the congresses of associations of ophthalmologists and phthisiologists. In 15 years, session members performed and published 102 studies on ocular tuberculosis, including 38 articles in scientific magazines, 5 teaching editions for doctors, 4 monographs. Based on work reports and inspection results of several institutions, it follows that the section makes positive impact on the formation in clinicians of a scientific approach to clinical care process. Some shortcomings are revealed in the application of recommended methods. We believe that for their elimination, besides social activity of the section, it is necessary to publish teaching editions at federal level on ocular tuberculosis diagnosis and treatment, as well as enhancement of diagnosis and treatment quality control by local administration.

scholarly journals The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

2021 ◽  
Author(s):  
Chandani Patel Chavez ◽  
Kenneth Cusi ◽  
Sushma Kadiyala
Keyword(s):  
Evidence Synthesis ◽  
Clinical Care ◽  
Treatment Options ◽  
Critical Role ◽  
Risk Groups ◽  
The United States ◽  
Multidisciplinary Teams ◽  
Consensus Statements ◽  
Meta Analyses

Abstract Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

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