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Berardi R, Morgese F, Rinaldi S, Torniai M, Mentrasti G, Scortichini L, Giampieri R. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res 2020; 12:9363-9374. [PMID: 33061625 PMCID: PMC7533227 DOI: 10.2147/cmar.s220976] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients' management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients' management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.
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Affiliation(s)
- Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesca Morgese
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Silvia Rinaldi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giulia Mentrasti
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Laura Scortichini
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
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Jonokuchi AJ, Knopman J, Radwanski RE, Martinez MA, Taylor BES, Rothbaum M, Sullivan S, Robison TR, Lo E, Christophe BR, Bruce EM, Khan S, Kellner CP, Sigounas D, Youngerman B, Bagiella E, Angevine PD, Lowy FD, Sander Connolly E. Topical vancomycin to reduce surgical-site infections in neurosurgery: Study protocol for a multi-center, randomized controlled trial. Contemp Clin Trials 2017; 64:195-200. [PMID: 29030268 DOI: 10.1016/j.cct.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/23/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Abstract
Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. However, a randomized controlled trial assessing its efficacy in the general neurosurgical population has yet to be done. The principle aim of "Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is to determine whether prophylactic, topical vancomycin reduces the risk of SSIs in the adult neurosurgical population. This prospective, multicenter, patient-blinded, randomized controlled trial will enroll patients to receive the standard of care plus topical vancomycin, or the standard of care alone. The primary endpoint of this study is a SSI by postoperative day (POD) 30. Patients must be over 18years of age. Patients are excluded for renal insufficiency, vancomycin allergy, and some ineligible procedures. Univariate analysis and logistic regression will determine the effect of topical vancomycin on SSIs at 30days. A randomized controlled trial is needed to determine the efficacy of this treatment. Results of this trial are expected to directly influence the standard of care and prevention of SSIs in neurosurgical patients.
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Affiliation(s)
- Alexander J Jonokuchi
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Jared Knopman
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
| | - Ryan E Radwanski
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Moises A Martinez
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Blake Eaton Samuel Taylor
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States
| | - Michael Rothbaum
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States.
| | - Sean Sullivan
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - Trae R Robison
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Eric Lo
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Brandon R Christophe
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Eliza M Bruce
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States
| | - Sabrina Khan
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - Christopher P Kellner
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Dimitri Sigounas
- Department of Neurological Surgery, Weill Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065, United States
| | - Brett Youngerman
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Emilia Bagiella
- Center for Biostatistics, Department of Population Health Science & Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, United States.
| | - Peter D Angevine
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
| | - Franklin D Lowy
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, 630 W 168th Street, New York, NY 10032, United States.
| | - E Sander Connolly
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, 710 W 168th Street, New York, NY 10032, United States.
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Rose TL, Deal AM, Basch E, Godley PA, Rathmell WK, Kim WY, Whang YE, Dunn MW, Wang A, Chen RC, Nielsen ME, Pruthi RS, Wallen EM, Woods ME, Smith AB, Milowsky MI. Neoadjuvant chemotherapy administration and time to cystectomy for muscle-invasive bladder cancer: An evaluation of transitions between academic and community settings. Urol Oncol 2015; 33:386.e1-6. [PMID: 26122712 DOI: 10.1016/j.urolonc.2015.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Many patients are referred to an academic medical center (AMC) for cystectomy but receive NAC in the community setting. This study examines if administration of NAC in the community is associated with differences in type of NAC received, pathologic response rate (pT0), and time to cystectomy as compared to NAC administered at an AMC. METHODS We performed a retrospective study of patients with MIBC (cT2a-T4-Nx-M0) referred to a single AMC between 1/2012 and 1/2014 who received NAC. We analyzed chemotherapy received, time to cystectomy, pT0, and survival in patients who received NAC in our AMC compared to those treated in the community. RESULTS In all, 47 patients were analyzed. A similar total dose of cisplatin (median: 280 mg/m(2) for both groups, P = 0.82) and pT0 rate (25% vs. 29%, P = 0.72) were seen in patients treated in our AMC and the community. However, administration of NAC in the community was associated with a prolonged time to cystectomy compared with that in our AMC (median number of days 162 vs. 128, P<0.01). This remained significant after adjusting for stage, comorbidity status, and distance to the AMC (P = 0.02). Disease-free survival and overall survival did not differ. CONCLUSION Patients with MIBC treated with NAC in the community as compared to an AMC received similar chemotherapy and achieved comparable pT0 rates, indicating effective implementation of NAC in the community. However, NAC in the community was associated with longer time to cystectomy, suggesting a delay in the transition of care between settings.
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Affiliation(s)
- Tracy L Rose
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Allison M Deal
- Biostatistics and Clinical Data Management Core, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ethan Basch
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Paul A Godley
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - W Kimryn Rathmell
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - William Y Kim
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Young E Whang
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mary W Dunn
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Andrew Wang
- Department of Radiation Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Matthew E Nielsen
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Raj S Pruthi
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Eric M Wallen
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Michael E Woods
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Angela B Smith
- Urologic Oncology Program, Department of Urology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Matthew I Milowsky
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
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Klipin M, Mare I, Hazelhurst S, Kramer B. The process of installing REDCap, a web based database supporting biomedical research: the first year. Appl Clin Inform 2014; 5:916-29. [PMID: 25589907 DOI: 10.4338/aci-2014-06-cr-0054] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/26/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Clinical and research data are essential for patient care, research and healthcare system planning. REDCapTM is a web-based tool for research data curatorship developed at Vanderbilt University in Nashville, USA. The Faculty of Health Sciences at the University of the Witwatersrand, Johannesburg South Africa identified the need for a cost effective data management instrument. REDCap was installed as per the user agreement with Vanderbilt University in August 2012. OBJECTIVES In order to assist other institutions that may lack the in-house Information Technology capacity, this paper describes the installation and support of REDCap and incorporates an analysis of user uptake over the first year of use. METHODS We reviewed the staffing requirements, costs of installation, process of installation and necessary infrastructure and end-user requests following the introduction of REDCap at Wits. The University Legal Office and Human Research Ethics Committee were consulted regarding the REDCap end-user agreement. Bi-monthly user meetings resulted in a training workshop in August 2013. We compared our REDCap software user numbers and records before and after the first training workshop. RESULTS Human resources were recruited from existing staff. Installation costs were limited to servers and security certificates. The total costs to provide a functional REDCap platform was less than $9000. Eighty-one (81) users were registered in the first year. After the first training workshop the user numbers increased by 59 in one month and the total number of active users to 140 by the end of August 2013. Custom software applications for REDCap were created by collaboration between clinicians and software developers. CONCLUSION REDCap was installed and maintained at limited cost. A small number of people with defined skills can support multiple REDCap users in two to four hours a week. End user training increased in the number of users, number of projects created and the number of projects moved to production.
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Affiliation(s)
- M Klipin
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, Republic of South Africa
| | - I Mare
- Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, Republic of South Africa
| | - S Hazelhurst
- School of Electrical and Information Engineering, University of the Witwatersrand , Johannesburg, Republic of South Africa
| | - B Kramer
- Health Sciences Research Office, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, Republic of South Africa
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Hanauer DA, Hruby GW, Fort DG, Rasmussen LV, Mendonça EA, Weng C. What Is Asked in Clinical Data Request Forms? A Multi-site Thematic Analysis of Forms Towards Better Data Access Support. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:616-25. [PMID: 25954367 PMCID: PMC4419980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many academic medical centers have aggregated data from multiple clinical systems into centralized repositories. These repositories can then be queried by skilled data analysts who act as intermediaries between the data stores and the research teams. To obtain data, researchers are often expected to complete a data request form. Such forms are meant to support record-keeping and, most importantly, provide a means for conveying complex data needs in a clear and understandable manner. Yet little is known about how data request forms are constructed and how effective they are likely to be. We conducted a content analysis of ten data request forms from CTSA-supported institutions. We found that most of the forms over-emphasized the collection of metadata that were not considered germane to the actual data needs. Based on our findings, we provide recommendations to improve the quality of data request forms in support of clinical and translational research.
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Affiliation(s)
- David A Hanauer
- Dept. of Pediatrics, University of Michigan, Ann Arbor, MI ; School of Information, University of Michigan, Ann Arbor, MI
| | - Gregory W Hruby
- Dept. of Biomedical Informatics, Columbia University, New York, NY
| | - Daniel G Fort
- Dept. of Biomedical Informatics, Columbia University, New York, NY
| | - Luke V Rasmussen
- Dept. of Preventive Medicine, Northwestern University, Chicago, IL
| | - Eneida A Mendonça
- Dept. Pediatrics, University of Wisconsin, Madison, WI ; Dept. of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI
| | - Chunhua Weng
- Dept. of Biomedical Informatics, Columbia University, New York, NY
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