scholarly journals Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit

2021 ◽  
Vol 14 (7) ◽  
Author(s):  
Antonio Faiella ◽  
Livia Onofrio ◽  
Filomena Liccardi ◽  
Fiorella Paladino ◽  
Martina Chiurazzi ◽  
...  
Keyword(s):  
Health Services ◽  
Emergency Room ◽  
Public Healthcare ◽  
Cancer Treatments ◽  
Patients With Cancer ◽  
Oncological Emergency ◽  
Diagnosis Of Cancer ◽  
Therapeutic Assistance ◽  
Oncology Unit ◽  
Diagnostic Delays

Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.

Enzyme-Instructed Self-assembly in Biological Milieu for Theranostics Purpose

2019 ◽  
Vol 26 (8) ◽  
pp. 1351-1365 ◽  
Author(s):  
Zhentao Huang ◽  
Qingxin Yao ◽  
Simin Wei ◽  
Jiali Chen ◽  
Yuan Gao
Keyword(s):  
Small Molecules ◽  
Precision Medicine ◽  
Self Assembly ◽  
Public Healthcare ◽  
Enzymatic Conversion ◽  
Vaccine Adjuvants ◽  
New Paradigm ◽  
Cancer Treatments ◽  
The Past ◽  
Biological Milieu

Precision medicine is in an urgent need for public healthcare. Among the past several decades, the flourishing development in nanotechnology significantly advances the realization of precision nanomedicine. Comparing to well-documented nanoparticlebased strategy, in this review, we focus on the strategy using enzyme instructed selfassembly (EISA) in biological milieu for theranostics purpose. In principle, the design of small molecules for EISA requires two aspects: (1) the substrate of enzyme of interest; and (2) self-assembly potency after enzymatic conversion. This strategy has shown its irreplaceable advantages in nanomedicne, specifically for cancer treatments and Vaccine Adjuvants. Interestingly, all the reported examples rely on only one kind of enzymehydrolase. Therefore, we envision that the application of EISA strategy just begins and will lead to a new paradigm in nanomedicine.

Cancer-related fatigue: an overview

2021 ◽  
Vol 30 (4) ◽  
pp. S36-S43
Author(s):  
Mohammed Al Maqbali
Keyword(s):  
Negative Impact ◽  
Management Strategies ◽  
Background Information ◽  
Clinical Settings ◽  
Measurement Scales ◽  
Major Life ◽  
Patients With Cancer ◽  
Cancer Related Fatigue ◽  
Diagnosis Of Cancer ◽  
Life Stressor

A diagnosis of cancer is a major life stressor that can affect the physiological, psychological and physical state of the person concerned. Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness. The aim of this review is to provide background information on cancer-related fatigue. This review discusses cancer-related fatigue (CRF) in terms of the definition, prevalence, risk factors, aetiology, and the measurement scales used. The differences between definitions of symptoms and relevant theories will be explored and discussed to help explain the variety of instruments used in its measurement. The prevalence of fatigue will be assessed by looking critically at the evidence of fatigue and the factors that affect it. Potential treatment and management strategies for CRF will also be discussed. Finally, there will be an overview of the instruments used to measure fatigue. This review also provides important evidence for measuring and managing CRF that can help nurses to understand fatigue among patients with cancer. Assessing CRF should be routinely undertaken in clinical settings to help identify the proper interventions, treatments and management to reduce fatigue among cancer patients.

scholarly journals A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

2019 ◽  
Vol 31 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Shakilu Jumanne
Keyword(s):  
Leukocyte Count ◽  
Myeloproliferative Disorders ◽  
Middle Lobe ◽  
Total Leukocyte Count ◽  
Necrotizing Pneumonia ◽  
Diagnosis Of Cancer ◽  
Right Middle Lobe ◽  
Laboratory Investigations ◽  
The Right ◽  
Oncology Unit

BackgroundNecrotizing pneumonia and hyperleukocytosis, to the extent of that seen in leukaemia, is a rarely reported presentation. The commonest trigger of such a presentation is an inflammatory process caused by an overwhelming infection which leads to bone marrow irritation. However, the misdiagnosis of this clinical entity as leukaemia should be avoided at all costs so as to avoid the anxiety associated with a diagnosis of cancer, both to the patients and their families.Case presentationHere, we report the case of a 22-month-old boy who was referred to our Pediatric Oncology Unit (POU). Owing to a high total leukocyte count (TLC) of 98,000 cells/µl, there was a strong suspicion of leukaemia. The boy had been reviewed at another hospital where he presented with fever and cough refractory to the commencement of tuberculosis medications as a result of chest radiography findings. Laboratory investigations performed on admission in the POU were negative for leukaemia and other myeloproliferative disorders. A chest computer tomography (CT) scan was performed to delineate opacification in the right middle lobe. This revealed multiple necrotic and emphysematous foci in line with a diagnosis of necrotizing pneumonia. Subsequently, the patient responded well to a course of piperacillin- tazobactam. The TLC normalized and the cough and fever resolved over a period of 2 weeks. ConclusionHere, we describe a particularly rare case of leukaemoid reaction with a massive leukocyte count. Such patients can be easily misdiagnosed as having leukaemia or other myeloproliferative disorders, especially in settings with limited diagnostic availability. Such misdiagnosis can cause undue stress on the patient and their families. Thus, it is important that patients presenting with these symptoms should undergo a thorough review of history, physical examination and a structured workup.

Digital Governance and the NHS

2020 ◽  
pp. 192-216
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health Services ◽  
Healthcare System ◽  
Digital Health ◽  
Public Healthcare ◽  
Coordinated Care ◽  
Informal Networks ◽  
Technological Advances ◽  
Remote Health

The benefits of a fully-digitalised public healthcare system are significant. Digital health is an essential tool in order to improve efficiency, provide coordinated care, and make real health improvements. However, the National Health Service (NHS) has yet to provide a fully digitalised system to patients and providers despite technological advances in recent years. This chapter will thus describe the progress which has already been made in providing remote health services within the NHS. It will also explore problems arising from digitalising health services and the management of health both within the institution and through more informal networks beyond the NHS.

Interventional radiology in the palliation of cancer

2021 ◽  
pp. 861-871
Author(s):  
Tarun Sabharwal ◽  
Nicos I. Fotiadis ◽  
Andy Adam
Keyword(s):  
Palliative Care ◽  
Interventional Radiology ◽  
Diagnostic Procedures ◽  
Venous Access ◽  
Patients With Cancer ◽  
Therapeutic Procedures ◽  
Potential Benefits ◽  
Diagnosis Of Cancer ◽  
Interventional Radiology Procedures

Interventional radiology uses image guidance to perform minimally invasive therapeutic and diagnostic procedures. It is an integral part of the multidisciplinary team managing patients with cancer. Interventional radiology is involved in all stages of the cancer patient’s journey starting from performing image-guided biopsies for the diagnosis of cancer, venous access procedures, and therapeutic procedures, and focuses on the palliation of symptoms and improvement in the quality of life. All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks. This chapter presents the drainage, stenting, feeding, embolization, ablation, and supportive interventional radiology procedures which could potentially benefit patients undergoing palliative care. The focus will be on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.

scholarly journals Cancer- and Cancer Treatment–Associated Cognitive Change: An Update on the State of the Science

2012 ◽  
Vol 30 (30) ◽  
pp. 3675-3686 ◽  
Author(s):  
Tim A. Ahles ◽  
James C. Root ◽  
Elizabeth L. Ryan
Keyword(s):  
Breast Cancer ◽  
Conceptual Framework ◽  
Animal Studies ◽  
Cognitive Change ◽  
Post Treatment ◽  
Cancer Treatments ◽  
Cognitive Changes ◽  
Patients With Cancer ◽  
State Of The Science ◽  
Cognitive Problems

Cognitive changes associated with cancer and cancer treatments have become an increasing concern. Using breast cancer as the prototype, we reviewed the research from neuropsychological, imaging, genetic, and animal studies that have examined pre- and post-treatment cognitive change. An impressive body of research supports the contention that a subgroup of patients is vulnerable to post-treatment cognitive problems. We also propose that models of aging may be a useful conceptual framework for guiding research in this area and suggest that a useful perspective may be viewing cognitive change in patients with cancer within the context of factors that influence the trajectory of normal aging.

P1574Predictors of mortality in hospitalized atrial fibrillation patients with cancer

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A H Malik ◽  
S Shetty ◽  
S Malik
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Cancer Diagnosis ◽  
Multivariate Regression ◽  
Nationwide Inpatient Sample ◽  
Kidney Injury ◽  
Teaching Hospitals ◽  
Multivariate Regression Model ◽  
Patients With Cancer ◽  
Diagnosis Of Cancer

Abstract Background Recent reports indicate an important interplay between Atrial fibrillation (AF) and cancer. There is little information regarding the outcomes of these patients. Hence, we performed a study to identify predictors of in-hospital mortality to help guide goals of care discussions. Methods The Nationwide Inpatient Sample was used to identify patients with a diagnosis of cancer, who were found to have AF from 2002–2014. Trend rate, patients' and hospital characteristics along with in-hospital complications and predictors of in-hospital mortality were assessed. Backward stepwise elimination technique was used to fit the multivariate regression model. Results Over the 13-year study period, 12,410,290 (national estimate) patients with a cancer diagnosis were identified. 1,013,735 had AF, and 10.2% of the AF patients with cancer died while hospitalised. A variety of comorbidities, in-hospital procedures and in-hospital complications increased the odds of in-hospital mortality in these patients. Also, weekend admissions, elective admissions, and rural hospitals in comparison to urban teaching and non-teaching hospitals were associated with higher in-hospital mortality. Conclusion Stroke, myocardial infarction, pulmonary embolism, deep venous thrombosis, acute kidney injury, congestive heart failure, sepsis, and cardiogenic shock are most significant predictors of in-hospital mortality in AF patients with cancer. Acknowledgement/Funding None

Differentiating between average and high-performing public healthcare managers: implications for public sector talent management

2020 ◽  
Vol 44 (3) ◽  
pp. 434
Author(s):  
Sandra G. Leggat ◽  
Zhanming Liang ◽  
Peter F. Howard
Keyword(s):  
Public Sector ◽  
Health Service ◽  
Health Services ◽  
Talent Management ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
High Performing ◽  
The Public ◽  
Public Healthcare Sector ◽  
Service Managers

ObjectiveEnsuring sufficient qualified and experienced managers is difficult for public sector healthcare organisations in Australia, with a limited labour market and competition with the private sector for talented staff. Although both competency-based management and talent management have received empirical support in association with individual and organisational performance, there have been few studies exploring these concepts in the public healthcare sector. This study addresses this gap by exploring the perceived differences in demonstration of core competencies between average and higher-performing managers in public sector healthcare organisations. MethodsMixed methods were used to define and measure a set of competencies for health service managers. In addition, supervisors of managers were asked to identify the differences in competence between the average and high-performing managers reporting to them. ResultsSupervisors could clearly distinguish between average and higher-performing managers and identified related competencies. ConclusionsThe consistent pattern of competence among community health and hospital public sector managers demonstrated by this study could be used to develop a strategic approach to talent management for the public healthcare sector in Australia. What is known about this topic?Although there are validated competency frameworks for health service managers, they are rarely used in practice in Australia. What does this paper add?This paper illustrates the perceived differences in competencies between top and average health services managers using a validated framework. What are the implications for practitioners?The public health sector could work together to provide a more effective and efficient approach to talent management for public hospitals and community health services.

scholarly journals FAK is Required for Tumor Metastasis-Related Fluid Microenvironment in Triple-Negative Breast Cancer

2019 ◽  
Vol 8 (1) ◽  
pp. 38 ◽  
Author(s):  
Mei-Ren Pan ◽  
Ming-Feng Hou ◽  
Fu Ou-Yang ◽  
Chun-Chieh Wu ◽  
Shu-Jyuan Chang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Fluid Shear Stress ◽  
Physical Factors ◽  
Interstitial Fluid Flow ◽  
Cancer Treatments ◽  
Significant Independent Predictor ◽  
Patients With Cancer ◽  
Cell Metastasis

Cancer cell metastasis is the main cause of death in patients with cancer. Many studies have investigated the biochemical factors that affect metastasis; however, the role of physical factors such as fluid shear stress (FSS) in tumorigenesis and metastasis have been less investigated. Triple-negative breast cancer (TNBC) has a higher incidence of lymph node invasion and distant metastasis than other subtypes of breast cancer. In this study, we investigated the influence of FSS in regulating the malignant behavior of TNBC cells. Our data demonstrate that low FSS promotes cell migration, invasion, and drug resistance, while high FSS has the opposite results; additionally, we found that these phenomena were regulated through focal adhesion kinase (FAK). Using immunohistochemistry staining, we show that FAK levels correlate with the nodal stage and that FAK is a significant independent predictor of overall survival in patients. Altogether, these data implicate FAK as a fluid mechano-sensor that regulates the cell motility induced by FSS and provide a strong rationale for cancer treatments that combine the use of anti-cancer drugs and strategies to modulate tumor interstitial fluid flow.

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