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Rizzo M, Pezzicoli G, Tibollo V, Premoli A, Quaglini S. Clinical outcome predictors for metastatic renal cell carcinoma: a retrospective multicenter real-life case series. BMC Cancer 2024; 24:804. [PMID: 38970009 PMCID: PMC11225140 DOI: 10.1186/s12885-024-12572-4] [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: 09/28/2023] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
Over the last decades, the therapeutic armamentarium of metastatic renal cell carcinoma (mRCC) has been revolutionized by the advent of tyrosin-kinase inhibitors (TKI), immune-checkpoint inhibitors (ICI), and immune-combinations. RCC is heterogeneous, and even the most used validated prognostic systems, fail to describe its evolution in real-life scenarios. Our aim is to identify potential easily-accessible clinical factors and design a disease course prediction system. Medical records of 453 patients with mRCC receiving sequential systemic therapy in two high-volume oncological centres were reviewed. The Kaplan-Meier method and Cox proportional hazard model were used to estimate and compare survival between groups. As first-line treatment 366 patients received TKI monotherapy and 64 patients received ICI, alone or in combination. The mean number of therapy lines was 2.5. A high Systemic Inflammation Index, a BMI under 25 Kg/m2, the presence of bone metastases before systemic therapy start, age over 65 years at the first diagnosis, non-clear-cell histology and sarcomatoid component were correlated with a worse OS. No significant OS difference was observed between patients receiving combination therapies and those receiving exclusively monotherapies in the treatment sequence. Our relapse prediction system based on pathological stage and histological grade was effective in predicting the time between nephrectomy and systemic treatment. Our multicentric retrospective analysis reveals additional potential prognostic factors for mRCC, not included in current validated prognostic systems, suggests a model for disease course prediction and describes the outcomes of the most common therapeutic strategies currently available.
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Affiliation(s)
- Mimma Rizzo
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Consorziale, Policlinico di Bari, Bari, Italy.
| | - Gaetano Pezzicoli
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Tibollo
- Laboratory of Informatics and Systems Engineering for Clinical Research, Scientific Clinical Institute Maugeri, Pavia, Italy
| | - Andrea Premoli
- Division of Translational Oncology, Scientific Clinical Institute Maugeri (ICS Maugeri), Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
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Wu Y, Wang X, Gao F, Liao J, Zeng J, Fan L. Mobile nutrition and health management platform for perioperative recovery: an interdisciplinary research achievement using WeChat Applet. Front Med (Lausanne) 2023; 10:1201866. [PMID: 37293309 PMCID: PMC10244757 DOI: 10.3389/fmed.2023.1201866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
Background In recent years, the number of people using mobile applications to promote health and welfare has exponentially increased. However, there are fewer applications in the field of ERAS. How to promote the rapid rehabilitation of patients with malignant tumor surgery during perioperative period and the mastery of its long-term nutritional state is a problem to be solved. Objective The purpose of this study is to design and develop a mobile application, and use Internet technology to better manage nutritional health to achieve rapid recovery of patients with malignant tumor surgery. Methods This study is divided into three stages: (1) Design: use participating design to make the MHEALTH APP adapt to the clinical practice of nutritional health management; (2) Development: the WeChat Applet of Nutrition and Health Assessment (WANHA) developed using the Internet technology development, and web management programs. (3) Procedure test: patients and medical staff evaluate WANHA's quality (UMARS), availability (SUS), and satisfaction, and conduct semi-structured interviews. Results In this study, 192 patients with malignant tumor surgery, 20 medical staff used WANHA. Patients with nutritional risks are supported by supporting treatment. The results show that patients who have not been treated during the perioperative period, the incidence of postoperative complications (22.4%) and the average hospitalization time after surgery decreased significantly. The incidence of nutritional risks is nearly more than the preoperative level. 45 patients and 20 medical staff participated in the survey of WANHA's SUS, UMARS, and satisfaction. In the interview, most patients and medical personnel believe that the procedure can improve the current medical services and nutritional health knowledge levels, promote the communication of medical staff and patients, and strengthen the nutritional health management of patients with malignant tumors under the concept of ERAS. Conclusion WeChat Applet of Nutrition and Health Assessment is a MHEALTH APP that enhances the nutrition and health management of patients with perioperative period. It can play a huge role in improving medical services, increasing patient satisfaction, and ERAS.
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Affiliation(s)
- YuJia Wu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xin Wang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Feng Gao
- Department of Anesthesiology, The Sixth People’s Hospital of Chongqing, Chongqing, China
| | - JinRong Liao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Hassan MM, Al-Marzooq D, Al-Habsi H, Al-Hashar A, Al-Khabori M, Al-Moundhri M, Al-Zakwani I. Patients' knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman. J Oncol Pharm Pract 2023; 29:112-118. [PMID: 34791932 DOI: 10.1177/10781552211056238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home. METHOD This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020. RESULTS A total of 257 patients (50 ± 15 years; range: 18-93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container. CONCLUSION While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.
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Affiliation(s)
- Moataz M Hassan
- Department of Pharmacy, 37611Sultan Qaboos University Hospital, Oman
| | - Dhabya Al-Marzooq
- 194179Department of pharmacy, Sultan Qaboos University Hospital, Oman
| | - Hanan Al-Habsi
- 194179Department of pharmacy, Sultan Qaboos University Hospital, Oman
| | - Amna Al-Hashar
- 588250Sultan Qaboos Comprehensive Cancer Care and Research Center, Oman
| | - Murtadha Al-Khabori
- Hematology Department, 37611College of Medicine and Health Science, Sultan Qaboos University, Oman
| | - Mansour Al-Moundhri
- 588250Sultan Qaboos Comprehensive Cancer Care and Research Center, Oman.,College of Medicine and Health Science, 108707Sultan Qaboos University College of Medicine and Health Science, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, 37611Sultan Qaboos University, Oman
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Huang X, Zeng J, Zhao N, Fan L, Ruan D, Wang J, Hong X, Yu C. Experience of using a smartphone WeChat applet for dental anxiety assessment and preoperative evaluation: A nationwide multicenter study. Front Public Health 2022; 10:900899. [PMID: 35923975 PMCID: PMC9342676 DOI: 10.3389/fpubh.2022.900899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionDental anxiety is a multivariate phenomenon that regularly occurs during a dental procedure. Although it may lead to patients' safety concerns and adverse events in routine treatment, it is often ignored. The purpose of this research is to develop a novel WeChat Applet for dental anxiety (WADA) with the following features and aims: (1) to help patients with dental anxiety management; (2) provide patient with a physical status self-evaluation; and(3) provide a platform for online assessment and tele-consultancy by dentists. We aimed to test and verify whether such an applet could play a beneficial role before and after a dental procedure and facilitate management of high-risk patients during the COVID-19 pandemic.Materials and methodsDuring the 12-month survey period (August 2020 to July 2021), a total of 180 patients aged 3–74 years from eight different cities (n = 180 at the end of treatment, n = 25 for the System Usability Scale (SUS) and follow-up interview) and 20 medical staff from eight different cities (n =20 for follow-up interview) were evaluated by WADA. At the end of the survey period, the results of the interviews were analyzed thematically.ResultsWADA assessment results from 180 patients and follow-up interview results from 45 participants were analyzed. In this study with a male to female ratio of 2:3, 75% were found to be suffering from dental anxiety, 86% were found with postoperative complications, and 11 cases were found to have contraindications to surgery. The total SUS score for WADA is 72.25 above the mean score, proving that WADA is a relevant and useful tool before and after dental treatment. Based on the results of the interviews, the following themes were identified: patient satisfaction; dentists' effectiveness; multi-center data integration; and increase its frequency of usage.ConclusionsThe WADA was developed for dental procedures and is effective for reducing treatment risks, improving patients' satisfaction and dentists' convenience, especially in terms of facilitating management of high-risk patient during the COVID-19 pandemic.
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Affiliation(s)
- Xilu Huang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Nan Zhao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Dijiao Ruan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jing Wang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiaomei Hong
- Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College, Xiamen, China
| | - Cong Yu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- *Correspondence: Cong Yu
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Zhang C, Ran L, Chai Z, Yu C, Song J. The design, development and usability testing of a smartphone-based mobile system for management of children's oral health. Health Informatics J 2022; 28:14604582221113432. [PMID: 35817593 DOI: 10.1177/14604582221113432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study was to design and develop a mobile system for better management of children's oral health by using the internet technology. This study was followed in a three-step approach. (1) Design stage: participatory design (including patients, dentists and computer scientists) was taken in order to adapt the system to the clinical practice of dentistry; (2) Development stage: dentists and computer scientists were involved in this stage to develop the system by using internet technology; (3) Usability testing stage: the quality (MARS), usability (SUS) and satisfaction of the system were assessed by children's caregivers. The system contains patient-side app, doctor-side app and Web side program for manager. Children and their caregivers could acquire many useful services through the app, such as oral healthcare education, brushing management, dietary record, online consultation, online appointment, feedback of adverse events. The overall value of SUS was 67.75. The final quality mean score was 3.44 ± 0.95, with the highest mean score of functionality. The majority of caregivers were satisfied with the system. They expressed the system could improve the current medical services and their oral health literacy.
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Affiliation(s)
- Chao Zhang
- 12550Chongqing Medical University, Chongqing, China
| | - Longkuan Ran
- 12550Chongqing Medical University, Chongqing, China
| | - Zhaowu Chai
- 12550Chongqing Medical University, Chongqing, China
| | - Cong Yu
- 12550Chongqing Medical University, Chongqing, China
| | - Jinlin Song
- 12550Chongqing Medical University, Chongqing, China
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Shumilov E, Vehling-Kaiser U, Damnali G, Schulz X, Kaiser U, Bacher U, Kaiser F. Oral and Subcutaneous Anticancer Therapy Training Course for Non-physician Healthcare Professionals: a Survey Evaluating the Relevance of its Content and its Implications in the Practice of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:120-127. [PMID: 32588349 DOI: 10.1007/s13187-020-01794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The creation of antitumor agents with an oral or subcutaneous route of administration has had important positive implications in the development of drugs to treat cancers, but issues such as false drug intake, uncontrolled side effects, and limited supervision may jeopardize the ability of these agents to improve treatment. A potential solution is the recruitment of non-physician healthcare professionals (i.e., nurses and physician assistants) and a special training course for them that focuses on the improvement of patient compliance. We developed and implemented three special professional training modules for non-physician healthcare professionals, which focus on the pharmacological aspects and side effects of oral and subcutaneous antitumor medications in regard to management strategies and communication issues that these non-physician healthcare professionals should address. Subsequently, we administered a questionnaire survey evaluating the course content and the implementation of the course in practice to the training participants to collect data for its implementation. Of 165 questionnaires that were administered, 44 (27%) were answered. The participants rated the course as being highly useful for their daily work. The participants reported a significant improvement in their professional expertise from the course. They emphasized the importance of medical topics and practical content to be included in the course delivery. The course encouraged 75% of the responders to start independent consultations with cancer patients that focused on questions of medication adherence for oral and subcutaneous antitumor medications, as well as the management of their side effects. Based on our results, at least a portion of the non-physician healthcare workforce is highly interested in engaging in active and autonomous co-supervision of patients who are treated with oral and subcutaneous antitumor medications. In addition to the theoretical basics of the treatment modalities, educational courses on oral and subcutaneous antitumor medications for non-physician healthcare professionals should focus on practical training and topics relevant to patient care.
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Affiliation(s)
- Evgenii Shumilov
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Robert-Koch Strasse 40, 37075, Göttingen, DE, Germany
| | | | - Gamze Damnali
- Day Care Clinic for Hematology and Oncology Landshut (HOT), Landshut, Germany
- Conference of Oncological Nursing Care and Child Nursing Care (KOK) of German Cancer Society (DKG), Hamburg, Germany
| | - Xenia Schulz
- Department of Medical Statistics, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Ulrich Kaiser
- Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Ulrike Bacher
- University Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
- Center of Laboratory Medicine (ZLM)/University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Florian Kaiser
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Robert-Koch Strasse 40, 37075, Göttingen, DE, Germany.
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Passardi A, Foca F, Caffo O, Tondini CA, Zambelli A, Vespignani R, Bartolini G, Sullo FG, Andreis D, Dianti M, Eccher C, Piras EM, Forti S. A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training-Validation Trial. J Med Internet Res 2022; 24:e27349. [PMID: 35080505 PMCID: PMC8829690 DOI: 10.2196/27349] [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: 01/22/2021] [Revised: 06/10/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient–health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective The overall aims of the trial are to customize the platform; assess the system’s ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods Patients aged ≥18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results A total of 40 patients were enrolled, 38 (95%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3% (95% CI 86.1%-99.9%) between the investigator and system pill count. Only 60% (3/5) of grade 3, 54% (13/24) of grade 2, and 19% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94% (33/35) of patients had ≥1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71% (27/38) and 68% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carlo Alberto Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Alberto Zambelli
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale "Papa Giovanni XXIII", Bergamo, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Francesco Giulio Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Dianti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Claudio Eccher
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Enrico Maria Piras
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
| | - Stefano Forti
- Center for Information and Communication Technology, eHealth Unit, Fondazione "Bruno Kessler", Trento, Italy
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Passardi A, Serra P, Caffo O, Masini C, Brugugnoli E, Vespignani R, Giardino V, Petracci E, Bartolini G, Sullo F, Anesi C, Dianti M, Eccher C, Piras EM, Gios L, Campomori A, Oberosler V, Forti S. Use of the ONCO-TreC electronic diary compared with a standard paper diary to improve adherence to oral cancer therapy in patients with solid and haematological tumours: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055814. [PMID: 35017254 PMCID: PMC8753414 DOI: 10.1136/bmjopen-2021-055814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION ONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours. METHODS AND ANALYSIS This is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher's exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs. ETHICS AND DISSEMINATION Ethical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. PROTOCOL VERSION Version 2, 6 April 2021. TRIAL REGISTRATION NUMBER NCT04826458.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Patrizia Serra
- Unit of Biostatistic and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Erika Brugugnoli
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Valeria Giardino
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Francesco Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Cecilia Anesi
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marco Dianti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
| | | | | | - Lorenzo Gios
- Competence Center for Digital Health, TrentinoSalute 4.0, Trento, Italy
| | - Annalisa Campomori
- Hospital Pharmacy Unit, Presidio Ospedaliero Santa Chiara, Trento, Italy
| | | | - Stefano Forti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
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Mason M, Harris MR, Greer JA, Jiang Y. A Concept Analysis of Oral Anticancer Agent Self-management. Cancer Nurs 2022; 45:E374-E387. [PMID: 33654013 PMCID: PMC8390565 DOI: 10.1097/ncc.0000000000000934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The rapid development and adoption of oral anticancer agents (OAAs) for cancer management have shifted patients' roles from recipient to owner of their care delivery, assuming their responsibilities for self-managing their OAA treatments at home, while the concept of oral anticancer agent self-management (OAA-SM) has not been well clarified and defined. OBJECTIVE This study was to clarify the concept of OAA-SM and identify major components, influential factors, and consequences of OAA-SM, as well as propose a representative conceptual model of OAA-SM. METHODS A literature review was conducted concerning the concept and application of OAA-SM. The Walker and Avant method for concept analysis was utilized to guide the examination of OAA-SM. RESULTS OAA-SM is a multifaceted and dynamic process that requires continuous adaptation by patients as multiple self-management challenges can emerge throughout OAA treatments. The defining attributes of OAA-SM include OAA adherence, adverse-effect self-management, patient-provider communication, and OAA safe storage, handling, and administration practices. Oral anticancer agent-SM is potentially influenced by a variety of patient-related, OAA-related, and healthcare system factors. Effective OAA-SM is associated with better patient and healthcare outcomes. CONCLUSIONS The clarification of the concept of OAA-SM and the identification of attributes of OAA-SM and their interrelationships contribute to the body of knowledge in OAA-SM. IMPLICATIONS FOR PRACTICE This concept analysis provides the foundation to increase healthcare providers' understanding of patients' needs for OAA-SM support and guides the development of patient-centered interventions to empower and engage patients and their families in effective OAA-SM, and improve patients' quality of life and care.
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Affiliation(s)
- Madilyn Mason
- Department of Systems, Populations, and Leadership, University of
Michigan School of Nursing, Ann Arbor, Michigan
| | - Marcelline R. Harris
- Department of Systems, Populations, and Leadership, University of
Michigan School of Nursing, Ann Arbor, Michigan
| | - Joseph A. Greer
- Center for Psychiatric Oncology & Behavioral Sciences,
Massachusetts General Hospital Cancer Center
| | - Yun Jiang
- Department of Systems, Populations, and Leadership, University of
Michigan School of Nursing, Ann Arbor, Michigan
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10
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Testa S, Mayora-Ibarra O, Piras EM, Balagna O, Micocci S, Zanutto A, Forti S, Conforti D, Nicolini A, Malfatti G, Moz M, Gios L, Benetollo PP, Turra E, Orrasch M, Zambotti F, Del Greco M, Maines M, Filippi L, Ghezzi M, Romanelli F, Racano E, Marin M, Betta M, Bertagnolli E. Implementation of tele visit healthcare services triggered by the COVID-19 emergency: the Trentino Province experience. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:77-92. [PMID: 34150467 PMCID: PMC8203489 DOI: 10.1007/s10389-021-01609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/27/2021] [Indexed: 12/05/2022]
Abstract
Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.
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Affiliation(s)
- Sara Testa
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | | | | | - Olivia Balagna
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Stefano Micocci
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Alberto Zanutto
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Stefano Forti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Diego Conforti
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Andrea Nicolini
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Giulia Malfatti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Monica Moz
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Lorenzo Gios
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Pier Paolo Benetollo
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Ettore Turra
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimo Orrasch
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Francesca Zambotti
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Maurizio Del Greco
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimiliano Maines
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Lorena Filippi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Monica Ghezzi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Mauro Marin
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Marta Betta
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Bertagnolli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
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11
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Petracca F, Ciani O, Cucciniello M, Tarricone R. Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters. J Med Internet Res 2020; 22:e21815. [PMID: 33351777 PMCID: PMC7775375 DOI: 10.2196/21815] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/29/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.
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Affiliation(s)
- Francesco Petracca
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy
| | - Oriana Ciani
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Rosanna Tarricone
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milan, Italy
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12
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Magalhães B, Fernandes C, Martinez-Galiano JM, Santos C. Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review. Int J Med Inform 2020; 144:104293. [PMID: 33091832 DOI: 10.1016/j.ijmedinf.2020.104293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/15/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
PROPOSE Advancements in mobile technology, primarily through the use of applications, may support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients undergoing chemotherapy treatment. This study aims to assemble the available knowledge regarding the use of mobile applications by cancer patients undergoing chemotherapy treatment. METHODS A literature review based on the Joanna Briggs Institute model(s) for Scoping Review was conducted. All articles published until 30 May 2019, were identified in the MEDLINE®, CINAHL®, and PsycINFO® electronic databases using the related Boolean logical operators and key terms. Extracted data included research aims, methodological design, application name, the functionalities of the applications, and major results. RESULTS A total of 26 articles were included in this study. The search identified 16 different mobile applications, some of which were addressed in various publications, demonstrating different characteristics in design, use, and development. CONCLUSION The use of mobile applications can be seen as an important and effective way to monitor adherence and support in the self-management of complications associated with chemotherapy treatments. Notwithstanding, these applications should be tested outside the academic environment, outreaching this group of people to effectively investigate its applicability, allowing the assessment of the impact of this "new" technological intervention process.
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Affiliation(s)
- Bruno Magalhães
- Portuguese Institute for Oncology of Porto (IPO-Porto), Porto, Portugal; Health School Santa Maria (ESSSM), Porto, Portugal; CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal.
| | - Carla Fernandes
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
| | - Juan Miguel Martinez-Galiano
- Department of Nursing, University of Jaén, Jaén, Spain; Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Spain.
| | - Célia Santos
- CINTESIS - Center for Health Technology and Services Research (NursID: Innovation and Development in Nursing), Porto, Portugal; Nursing School of Porto (ESEP), Porto, Portugal.
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13
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Gambalunga F, Iacorossi L, Notarnicola I, Serra V, Piredda M, De Marinis MG. Mobile Health in Adherence to Oral Anticancer Drugs: A Scoping Review. Comput Inform Nurs 2020; 39:17-23. [PMID: 32568900 DOI: 10.1097/cin.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In oncology, adherence to oral antineoplastic medication is a key element of treatment, on which the success of any therapeutic intervention depends. Given their widespread use in clinical practice, it is important to identify tools that can facilitate the monitoring and self-management of the patient at home, to avoid the consequences of employing ineffective treatment. One of the tools available today to take action on this phenomenon is mobile health technology. The aim of this review is to describe published studies relating to the use of mobile health to promote adherence to oral antineoplastic medication. This scoping review was conducted using the framework proposed by Arksey and O'Malley, adapted according to Levac et al. Of 1320 articles identified, only seven met the eligibility criteria and therefore were included in the review. All seven articles involved the use of digital means to measure adherence to treatment, patient satisfaction, acceptability and feasibility of the digital means used, and presence of symptoms, but not the effectiveness of the digital instrument used. In conclusion, the use of digital means to assist adherence of cancer patients to oral antineoplastic medication is widely recognized, but its effectiveness in clinical practice is poorly supported by the nature of the published studies.
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Affiliation(s)
- Francesca Gambalunga
- Author Affiliations: Department of Health Professions (DAPS), University Hospital "Policlinico Umberto I" (Ms Gambalunga); IRCCS "Regina Elena" National Cancer Institute (Dr Iacorossi and Ms Serra); Centre of Excellence for Nursing Scholarship OPI Rome Italy (Dr Notarnicola); and Research Unit Nursing Science, Campus Bio-Medico of Rome University (Drs Piredda and De Marinis), Rome, Italy
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14
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Ferrua M, Minvielle E, Fourcade A, Lalloué B, Sicotte C, Di Palma M, Mir O. How to Design a Remote Patient Monitoring System? A French Case Study. BMC Health Serv Res 2020; 20:434. [PMID: 32429987 PMCID: PMC7236289 DOI: 10.1186/s12913-020-05293-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. METHODS This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. RESULTS Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. CONCLUSION In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).
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Affiliation(s)
- Marie Ferrua
- Capri program, Research Division, Gustave Roussy, Villejuif, France.
| | - Etienne Minvielle
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- I3, CRG, Ecole Polytechnique, CNRS, Palaiseau, France
| | - Aude Fourcade
- Capri program, Research Division, Gustave Roussy, Villejuif, France
| | | | - Claude Sicotte
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- EHESP, Department of Health Care Management, Rennes, France
| | - Mario Di Palma
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- American Hospital, Neuilly-sur-Seine, France
| | - Olivier Mir
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- Outpatient Department, Gustave Roussy, Villejuif, France
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15
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Eccher C, Gios L, Zanutto A, Bizzarri G, Conforti D, Forti S. TreC platform. An integrated and evolving care model for patients' empowerment and data repository. J Biomed Inform 2020; 102:103359. [PMID: 31917253 DOI: 10.1016/j.jbi.2019.103359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/12/2019] [Accepted: 12/15/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Health care has been deeply revolutionized by the new wave of information and communication technology (ICT) development, particularly related to the electronic/personal health record (PHR). The present paper describes the original design and implementation approach followed in the Trentino Province (Italy) to promote an Integrated Care Model for patients' empowerment and data repository, by means of an evolving Personal Health Record - PHR platform, named TreC (Trentino Citizens Clinical Record). MATERIALS AND METHODS The TreC Platform is conceived as a communication hub among different stakeholders. The core assumption of the TreC platform strategy is to consider the citizen/patient as main manager and owner of both his/her own health and his/her contacts with the health care systems. RESULTS Over the years, the TreC platform has represented the core pillar in the digitalization process promoted at Province level. This has been strategically embedded in the multi-faceted e-government strategy endorsed by the Province of Trento. So far (October 2018), more than 89,000 citizens within the Province of Trento are using TreC platform as a way to communicate with the health care system and access their own personal health records. CONCLUSIONS The experience gained through the TreC platform implementation and its results are promising, supporting the idea that a PHR platform can represent a key driving factor in improving health care quality and efficiency, both from a patient and a health care staff perspective.
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Affiliation(s)
- Claudio Eccher
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy.
| | - Lorenzo Gios
- TrentinoSalute 4.0, Competence Center for Digital Health, Trento, Italy
| | - Alberto Zanutto
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy
| | | | | | - Stefano Forti
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy
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16
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Bazi Y, Al Rahhal MM, AlHichri H, Ammour N, Alajlan N, Zuair M. Real-Time Mobile-Based Electrocardiogram System for Remote Monitoring of Patients with Cardiac Arrhythmias. INT J PATTERN RECOGN 2019. [DOI: 10.1142/s0218001420580136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, we propose an electrocardiogram (ECG) system for the simultaneous and remote monitoring of multiple heart patients. It consists of three main components: patient, sever, and monitoring units. The patient unit uses a wearable miniature sensor that continuously measures ECG signals and sends them to a smart mobile phone via a Bluetooth connection. In the mobile device, the ECG signals can be stored, displayed on screen, and automatically transmitted to a distant server unit over the internet; the server stores ECG data from several patients. Health care stakeholders use a monitoring unit to retrieve the ECG signals of multiple patients at any time from the server for display and real-time automatic analysis. The analysis includes segmentation of the ECG signal into separate heartbeats followed by arrhythmia detection and classification. When compared to existing real-time ECG systems, where the detection of abnormalities is usually performed using simple rules, the proposed system implements a real-time classification module that is based on a support vector machine (SVM) classifier. Extensive experimental results on ECG data obtained from a TechPatientTM simulator, a real person, and 20 records from the MIT arrhythmia database are reported and discussed.
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Affiliation(s)
- Yakoub Bazi
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Mohamad M. Al Rahhal
- Information Science Department, College of Applied Computer Science, King Saud University, Riyadh 11543, Saudi Arabia
| | - Haikel AlHichri
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Nassim Ammour
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Naif Alajlan
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
| | - Mansour Zuair
- Computer Engineering Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
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17
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Warrington L, Absolom K, Conner M, Kellar I, Clayton B, Ayres M, Velikova G. Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review. J Med Internet Res 2019; 21:e10875. [PMID: 30679145 PMCID: PMC6365878 DOI: 10.2196/10875] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in the features they offer to patients, which may affect how patients engage with them and how they improve patient-centered outcomes. OBJECTIVE This review aimed to (1) describe the features and functions of existing electronic symptom reporting systems (eg, symptom monitoring, tailored self-management advice), and (2) explore which features may be associated with patient engagement and patient-centered outcomes. METHODS The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed guidelines from the Centre for Reviews and Dissemination (University of York, United Kingdom). Primary searches were undertaken of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data were extracted and summarized using Microsoft Excel. In order to meet the aims, the study selection, data extraction, and data synthesis comprised two stages: (1) identifying and characterizing available systems and (2) summarizing data on patient engagement and patient-centered outcomes. RESULTS We identified 77 publications relating to 41 distinct systems. In Stage 1, all publications were included (N=77). The features identified that supported clinicians and care were facility for health professionals to remotely access and monitor patient-reported data (24/41, 58%) and function to send alerts to health professionals for severe symptoms (17/41, 41%). Features that supported patients were facility for patients to monitor/review their symptom reports over time (eg, graphs) (19/41, 46%), general patient information about cancer treatment and side effects (17/41, 41%), tailored automated patient advice on symptom management (12/41, 29%), feature for patients to communicate with the health care team (6/41, 15%), and a forum for patients to communicate with one another (4/41, 10%). In Stage 2, only publications that included some data on patient engagement or patient-centered outcomes were included (N=29). A lack of consistency between studies in how engagement was defined, measured, or reported, and a wide range of methods chosen to evaluate systems meant that it was not possible to compare across studies or make conclusions on relationships with system features. CONCLUSIONS Electronic systems have the potential to help patients manage side effects of cancer treatment, with some evidence to suggest a positive effect on patient-centered outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by introducing a taxonomy for characterizing system features. TRIAL REGISTRATION PROSPERO CRD42016035915; www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016035915.
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Affiliation(s)
- Lorraine Warrington
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Kate Absolom
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Beverly Clayton
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Michael Ayres
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
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18
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Skrabal Ross X, Gunn KM, Patterson P, Olver I. Mobile-Based Oral Chemotherapy Adherence-Enhancing Interventions: Scoping Review. JMIR Mhealth Uhealth 2018; 6:e11724. [PMID: 30578182 PMCID: PMC6320412 DOI: 10.2196/11724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone–based interventions improve adherence to oral chemotherapy is unknown. Objective This scoping review aims to explore what is known about mobile phone–delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods This study followed Arksey and O’Malley’s scoping review methodological framework. Results The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence–enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders’ engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone–delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence–enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone–delivered interventions that can be translated into oncology settings.
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Affiliation(s)
- Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, Australia.,School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Pandora Patterson
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia.,Research, Evaluation, and Social Policy Team, CanTeen Australia, Sydney, Australia
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, Australia
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19
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Cox SM, Lane A, Volchenboum SL. Use of Wearable, Mobile, and Sensor Technology in Cancer Clinical Trials. JCO Clin Cancer Inform 2018; 2:1-11. [PMID: 30652590 DOI: 10.1200/cci.17.00147] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As the availability and sophistication of mobile health (mHealth) technology (wearables, mobile technology, and sensors) continues to increase, there is great promise that these tools will be transformative for clinical trials and drug development. This review provides an overview of the current landscape of potential measurement options, including the various types of data collected, methods/tools for collecting them, and a crosswalk of available options. The opportunities and potential drawbacks of mHealth in cancer clinical trials are discussed. Specific concerns related to data accuracy, provenance, and regulatory issues are highlighted, with suggestions for how to address these in future research. Next steps for establishing mHealth methods and tools as legitimate and accepted measures in oncology clinical trials include continuation of regulatory definition by the FDA; establishment of security standards and protocols; refinement and implementation of methods to establish and document data accuracy; and finally, creation of feedback loops wherein regulators receive updates from researchers with better and more timely data, which should decrease trial times and lessen drug development costs. Implementing mHealth technologies into cancer clinical trials has the potential to transform and propel oncology drug development and precision medicine to keep pace with the rapidly increasing developments in genomics and immunology.
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Affiliation(s)
- Suzanne M Cox
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
| | - Ashley Lane
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
| | - Samuel L Volchenboum
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
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Jupp JCY, Sultani H, Cooper CA, Peterson KA, Truong TH. Evaluation of mobile phone applications to support medication adherence and symptom management in oncology patients. Pediatr Blood Cancer 2018; 65:e27278. [PMID: 29943893 DOI: 10.1002/pbc.27278] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 01/19/2023]
Abstract
Mobile phone applications (apps), may support pediatric oncology patients with medication and disease management. A scoping review of the literature, a search of the iTunes App and Google Play Stores, was conducted to identify medication and symptom management apps for adult and pediatric oncology patients. Pooled results yielded 28 apps which were assessed for quality using the Mobile Application Rating Scale, with mean overall scores ranging from 2.8 to 4.3. Most apps received low scores in the Engagement domain. Our study assessed the quality of available mobile oncology apps and identified areas for improvement in design and function.
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Affiliation(s)
- Jennifer C Y Jupp
- Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta, Children's Hospital, Alberta, Canada.,Pharmacy Services, Alberta Health Services, Alberta, Canada
| | | | - Cassandra A Cooper
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta, Canada
| | | | - Tony H Truong
- Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta, Children's Hospital, Alberta, Canada.,Department of Oncology and Pediatrics, University of Calgary, Alberta, Canada
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Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
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