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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Liu C, Liu X, Zhao S, Li W. Port-exposure management of totally implantable venous access ports: A case report. J Cancer Res Ther 2023; 19:1064-1069. [PMID: 37675738 DOI: 10.4103/jcrt.jcrt_666_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Totally implantable venous access ports (TIVAP) are widely utilized in chemotherapy, parenteral nutrition, and long-lasting intravenous therapy in cancer patients. However, port exposure occurs due to skin damage around the port. Thus, managing port exposure is of great importance; however, it is full of challenges. We reported two cases of port exposure due to TIVAP. In these two patients, the catheters were inserted into the internal jugular or axillary vein under local anesthesia and ultrasound guidance and were connected to the port implanted on the ipsilateral chest through the subcutaneous tunnel. Chemotherapy and targeted drug therapy were administered using these ports. During the treatment intermission, the ports of two patients were partially exposed. Hence, external fixation of the port exposure approach was utilized to successfully retain the TIVAP through collaborative discussion. These findings provide good references for the prevention and management of postoperative port-exposure complications associated with TIVAP in patients with cancer.
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Affiliation(s)
- Chunqin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong; School of Medicine, Jinggangshan University, Ji'an, Jiangxi, Jinan, Shandong, China
| | - Xiaohua Liu
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shunying Zhao
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Weifeng Li
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Vermeulin T, Lucas M, Marini H, Di Fiore F, Loeb A, Lottin M, Daubert H, Gray C, Guisier F, Sefrioui D, Michel P, de Mil R, Czernichow P, Merle V. Totally implanted venous access-associated adverse events in oncology: Results from a prospective 1-year surveillance programme. Bull Cancer 2018; 105:1003-1011. [PMID: 30322697 DOI: 10.1016/j.bulcan.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer. METHODS Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions. RESULTS We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days [0.19-0.27]), there were 50 infectious AE (incidence 0.09 [0.06-0.11]) and 83 non-infectious AE (incidence 0.14 [0.11-0.17]). Compared to non-metastatic solid cancers, metastatic cancers (aOR=2.3 [0.9-6.0]), and hematologic malignancies (aOR=3.2 [1.1-8.8]) tended to be associated with a higher risk of infectious TIVA-AE (P=0.087). Solid cancer type was associated with non-infectious TIVA-AE (P=0.030), especially digestive cancers. DISCUSSION We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.
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Affiliation(s)
- Thomas Vermeulin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France.
| | - Mélodie Lucas
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hélène Marini
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Frédéric Di Fiore
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Agnès Loeb
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Marion Lottin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hervé Daubert
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Christian Gray
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Florian Guisier
- Rouen University Hospital, Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care, CIC Inserm U 1404, 1, rue de Germont, 76031 Rouen cedex, France
| | - David Sefrioui
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Pierre Michel
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Rémy de Mil
- Normandie Université, UNICAEN, Inserm U 1086, 3, avenue Général-Harris, 14076 Caen, France
| | - Pierre Czernichow
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Véronique Merle
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
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Benassi P, MacGillivray L, Silver I, Sockalingam S. The role of morbidity and mortality rounds in medical education: a scoping review. MEDICAL EDUCATION 2017; 51:469-479. [PMID: 28294382 DOI: 10.1111/medu.13234] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/21/2016] [Accepted: 10/11/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT There is increasing focus on how health care professionals can be trained effectively in quality improvement and patient safety principles. The morbidity and mortality round (MMR) has often been used as a tool with which to examine and teach care quality, yet little is known of its implementation and educational outcomes. OBJECTIVES The objectives of this scoping review are to examine and summarise the literature on how the MMR is designed and delivered, and to identify how it is evaluated for effectiveness in addressing medical education outcomes. METHODS A literature search of the PubMed, MEDLINE, PsycInfo and Cochrane Library databases was conducted for articles published from 1980 to 1 June 2016. Publications in English describing the design, implementation and evaluation of MMRs were included. A total of 67 studies were identified, including eight survey-based studies, four literature reviews, one ethnographic study, three opinion papers, two qualitative observation studies and 49 case studies of education programmes with or without formal evaluation. Study outcomes were categorised using Donald Moore's framework for the evaluation of continuing medical education (CME). RESULTS There is much heterogeneity within the literature regarding the implementation, delivery and goals of the MMR. Common design components included explicit programme goals and objectives, the case selection process, case presentation models and some form of case analysis. Evaluation of CME outcomes for MMR were mainly limited to learner participation, satisfaction and self-assessed changes in knowledge. CONCLUSIONS The MMR is widely utilised as an educational tool to promote medical education, patient safety and quality improvement. Although evidence to guide the design and implementation of the MMR to achieve measurable CME outcomes remains limited, there are components associated with positive improvements to learning and performance outcomes.
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Affiliation(s)
- Paul Benassi
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lindsey MacGillivray
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ivan Silver
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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