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Yackel HD, Halpenny B, Abrahm JL, Ligibel J, Enzinger A, Lobach DF, Cooley ME. A qualitative analysis of algorithm-based decision support usability testing for symptom management across the trajectory of cancer care: one size does not fit all. BMC Med Inform Decis Mak 2024; 24:63. [PMID: 38443870 PMCID: PMC10913367 DOI: 10.1186/s12911-024-02466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adults with cancer experience symptoms that change across the disease trajectory. Due to the distress and cost associated with uncontrolled symptoms, improving symptom management is an important component of quality cancer care. Clinical decision support (CDS) is a promising strategy to integrate clinical practice guideline (CPG)-based symptom management recommendations at the point of care. METHODS The objectives of this project were to develop and evaluate the usability of two symptom management algorithms (constipation and fatigue) across the trajectory of cancer care in patients with active disease treated in comprehensive or community cancer care settings to surveillance of cancer survivors in primary care practices. A modified ADAPTE process was used to develop algorithms based on national CPGs. Usability testing involved semi-structured interviews with clinicians from varied care settings, including comprehensive and community cancer centers, and primary care. The transcripts were analyzed with MAXQDA using Braun and Clarke's thematic analysis method. A cross tabs analysis was also performed to assess the prevalence of themes and subthemes by cancer care setting. RESULTS A total of 17 clinicians (physicians, nurse practitioners, and physician assistants) were interviewed for usability testing. Three main themes emerged: (1) Algorithms as useful, (2) Symptom management differences, and (3) Different target end-users. The cross-tabs analysis demonstrated differences among care trajectories and settings that originated in the Symptom management differences theme. The sub-themes of "Differences between diseases" and "Differences between care trajectories" originated from participants working in a comprehensive cancer center, which tends to be disease-specific locations for patients on active treatment. Meanwhile, participants from primary care identified the sub-theme of "Differences in settings," indicating that symptom management strategies are care setting specific. CONCLUSIONS While CDS can help promote evidence-based symptom management, systems providing care recommendations need to be specifically developed to fit patient characteristics and clinical context. Findings suggest that one set of algorithms will not be applicable throughout the entire cancer trajectory. Unique CDS for symptom management will be needed for patients who are cancer survivors being followed in primary care settings.
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Affiliation(s)
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Janet L Abrahm
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Jennifer Ligibel
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - Andrea Enzinger
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA
| | - David F Lobach
- Elimu Informatics, 1709 Julian Court, 94530, El Cerrito, CA, USA
| | - Mary E Cooley
- Dana-Farber Cancer Institute, 450 Brookline Ave, LW-508, 02215, Boston, MA, USA.
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Gholamzadeh M, Abtahi H, Safdari R. The Application of Knowledge-Based Clinical Decision Support Systems to Enhance Adherence to Evidence-Based Medicine in Chronic Disease. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:8550905. [PMID: 37284487 PMCID: PMC10241579 DOI: 10.1155/2023/8550905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 06/08/2023]
Abstract
Among the technology-based solutions, clinical decision support systems (CDSSs) have the ability to keep up with clinicians with the latest evidence in a smart way. Hence, the main objective of our study was to investigate the applicability and characteristics of CDSSs regarding chronic disease. The Web of Science, Scopus, OVID, and PubMed databases were searched using keywords from January 2000 to February 2023. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, an analysis was done to determine the characteristics and applicability of CDSSs. The quality of the appraisal was assessed using the Mixed Methods Appraisal Tool checklist (MMAT). A systematic database search yielded 206 citations. Eventually, 38 articles from sixteen countries met the inclusion criteria and were accepted for final analysis. The main approaches of all studies can be classified into adherence to evidence-based medicine (84.2%), early and accurate diagnosis (81.6%), identifying high-risk patients (50%), preventing medical errors (47.4%), providing up-to-date information to healthcare providers (36.8%), providing patient care remotely (21.1%), and standardizing care (71.1%). The most common features among the knowledge-based CDSSs included providing guidance and advice for physicians (92.11%), generating patient-specific recommendations (84.21%), integrating into electronic medical records (60.53%), and using alerts or reminders (60.53%). Among thirteen different methods to translate the knowledge of evidence into machine-interpretable knowledge, 34.21% of studies utilized the rule-based logic technique while 26.32% of studies used rule-based decision tree modeling. For CDSS development and translating knowledge, diverse methods and techniques were applied. Therefore, the development of a standard framework for the development of knowledge-based decision support systems should be considered by informaticians.
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Affiliation(s)
- Marsa Gholamzadeh
- Medical Informatics, Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Lobach DF, Boxwala A, Kashyap N, Heaney-Huls K, Chiao AB, Rafter T, Lomotan EA, Harrison MI, Dymek C, Swiger J, Dullabh P. Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards. Appl Clin Inform 2022; 13:1163-1171. [PMID: 36516969 PMCID: PMC9750793 DOI: 10.1055/s-0042-1758736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperability Resources (FHIR) offers a standards-based application programming interface (API) that may support such integration. OBJECTIVE We aimed to use interoperability standards to integrate a patient mobile application (coronavirus 2019 [COVID-19] Tracker) with an EHR. The COVID-19 Tracker engages patients by sending introductory and reminder text messages, collecting vital signs and symptom data from COVID-19 patients, and providing actionable guidance if concerning issues are identified. This case report explored the use of FHIR APIs to integrate the app into EHR-enabled clinical workflows. METHODS The authors used notes from project meetings and from semistructured discussions among the application development team to track the design and implementation processes. Seven points of integration between the application and the EHR were identified, and approaches using FHIR to perform these integrations were delineated. RESULTS Although this clinical decision support integration project benefited from its standards-based approach, many challenges were encountered. These were due to (1) partial implementation of the FHIR standard in the EHR, particularly, components needed for patient engagement applications; (2) limited experience with the adoption of FHIR standards; and (3) gaps in the current FHIR standard. Alternative approaches, often not based on interoperability standards, were developed to overcome these limitations. CONCLUSION Despite the challenges encountered due to the early stages of FHIR development and adoption, FHIR standards provide a promising mechanism for overcoming longstanding barriers and facilitating the integration of patient engagement apps with EHRs. To accelerate the integration of apps into clinical workflows, additional components of the FHIR standard must be implemented within the EHR and other clinical systems. Continued expansion of available FHIR resources will help with tighter workflow integration.
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Affiliation(s)
- David F. Lobach
- Elimu Informatics, El Cerrito, California, United States
- Address for correspondence David F. Lobach, MD, PhD, MS Elimu Informatics 1709 Julian Ct., El Cerrito, CA 94530United States
| | - Aziz Boxwala
- Elimu Informatics, El Cerrito, California, United States
| | - Nitu Kashyap
- Yale New Haven Health, New Haven, Connecticut, United States
| | | | - Andrew B. Chiao
- NORC at the University of Chicago, Bethesda, Maryland, United States
| | - Thomas Rafter
- Yale New Haven Health, New Haven, Connecticut, United States
| | - Edwin A. Lomotan
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | - Michael I. Harrison
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | - Chris Dymek
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | - James Swiger
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | - Prashila Dullabh
- NORC at the University of Chicago, Bethesda, Maryland, United States
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Jones EK, Hultman G, Schmoke K, Ninkovic I, Dodge S, Bahr M, Melton GB, Marquard J, Tignanelli CJ. Combined Expert and User-Driven Usability Assessment of Trauma Decision Support Systems Improves User-Centered Design. Surgery 2022; 172:1537-1548. [PMID: 36031451 DOI: 10.1016/j.surg.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trauma clinical decision support systems improve adherence with evidence-based practice but suffer from poor usability and the lack of a user-centered design. The objective of this study was to compare the effectiveness of user and expert-driven usability testing methods to detect usability issues in a rib fracture clinical decision support system and identify guiding principles for trauma clinical decision support systems. METHODS A user-driven and expert-driven usability investigation was conducted using a clinical decision support system developed for patients with rib fractures. The user-driven usability evaluation was as follows: 10 clinicians were selected for simulation-based usability testing using snowball sampling, and each clinician completed 3 simulations using a video-conferencing platform. End-users participated in a novel team-based approach that simulated realistic clinical workflows. The expert-driven heuristic evaluation was as follows: 2 usability experts conducted a heuristic evaluation of the clinical decision support system using 10 common usability heuristics. Usability issues were identified, cataloged, and ranked for severity using a 4-level ordinal scale. Thematic analysis was utilized to categorize the identified usability issues. RESULTS Seventy-nine usability issues were identified; 63% were identified by experts and 48% by end-users. Notably, 58% of severe usability issues were identified by experts alone. Only 11% of issues were identified by both methods. Five themes were identified that could guide the design of clinical decision support systems-transparency, functionality and integration into workflow, automated and noninterruptive, flexibility, and layout and appearance. Themes were preferentially identified by different methods. CONCLUSION We found that a dual-method usability evaluation involving usability experts and end-users drastically improved detection of usability issues over single-method alone. We identified 5 themes to guide trauma clinical decision support system design. Performing usability testing via a remote video-conferencing platform facilitated multi-site involvement despite a global pandemic.
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Affiliation(s)
- Emma K Jones
- Department of Surgery, University of Minnesota, Minneapolis, MN.
| | - Gretchen Hultman
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
| | - Kristine Schmoke
- Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | | | - Sarah Dodge
- Fairview Health Services IT, Minneapolis, MN
| | - Matthew Bahr
- Trauma Services, Fairview Health Services, Minneapolis, MN
| | - Genevieve B Melton
- Department of Surgery, University of Minnesota, Minneapolis, MN; Institute for Health Informatics, University of Minnesota, Minneapolis, MN; Fairview Health Services IT, Minneapolis, MN; Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
| | - Jenna Marquard
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN; Institute for Health Informatics, University of Minnesota, Minneapolis, MN; Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
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Dullabh P, Sandberg SF, Heaney-Huls K, Hovey LS, Lobach DF, Boxwala A, Desai PJ, Berliner E, Dymek C, Harrison MI, Swiger J, Sittig DF. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:1233-1243. [PMID: 35534996 PMCID: PMC9196686 DOI: 10.1093/jamia/ocac059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/12/2022] [Accepted: 04/22/2022] [Indexed: 02/05/2023] Open
Abstract
Objective We conducted a horizon scan to (1) identify challenges in patient-centered clinical decision support (PC CDS) and (2) identify future directions for PC CDS. Materials and Methods We engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. We qualitatively analyzed literature and interview transcripts, mapping findings to the 4 phases for translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Results We identified 12 challenges for PC CDS development. Lack of patient input was identified as a critical challenge. The key informants noted that patient input is critical to prioritizing topics for PC CDS and to ensuring that CDS aligns with patients’ routine behaviors. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. We found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in our understanding of PC CDS’ impact. Across all phases of CDS development, there is a lack of patient and provider trust and limited attention to patients’ and providers’ concerns. Discussion These challenges suggest opportunities for advancing PC CDS. There are opportunities to develop industry-wide practices and standards to increase transparency, standardize terminologies, and incorporate patient input. There is also opportunity to engage patients throughout the PC CDS research process to ensure that outcome measures are relevant to their needs. Conclusion Addressing these challenges and embracing these opportunities will help realize the promise of PC CDS—placing patients at the center of the healthcare system.
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Affiliation(s)
- Prashila Dullabh
- Corresponding Author: Prashila Dullabh, MD, NORC at the University of Chicago, 4350 East-West Hwy 8th Floor, Bethesda, MD 20814, USA;
| | | | | | - Lauren S Hovey
- NORC at the University of Chicago, Bethesda, Maryland, USA
| | | | | | | | | | - Chris Dymek
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Michael I Harrison
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - James Swiger
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
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Sezgin MG, Bektas H. The effect of web-based intervention programs on self-management and symptom management in patients with lymphoma: A systematic review of randomized controlled trials. Jpn J Nurs Sci 2021; 19:e12460. [PMID: 34738318 DOI: 10.1111/jjns.12460] [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: 05/20/2021] [Revised: 08/18/2021] [Accepted: 09/21/2021] [Indexed: 11/27/2022]
Abstract
AIM This systematic review aimed to systematically summarize studies obtained through a database search and examine the effect of web-based intervention programs on self-management and symptom management in patients with lymphoma. METHODS A systematic review of randomized controlled trials was carried out. Cochrane Central Register of Controlled Trials, Web of Science, PubMed, CINAHL, Scopus, ProQuest, Science Direct, and Ovid databases were reviewed until January 2021. The flow chart of the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was used in the search procedure without setting a year limit. Population, Intervention, Comparison, Outcomes and Study criteria were determined by two independent investigators and published randomized controlled studies in English with lymphoma diagnosis and web-based intervention programs for self-management and symptom management were included in the systematic review. The included studies were examined for their risk of bias with the help of the Cochrane Collaboration tool. A narrative synthesis of study findings was performed. RESULTS Six randomized controlled trials with 2382 participants were included in the systematic review. Web-based intervention programs in patients diagnosed with lymphoma were found to be generally implemented for determining the levels of self-management and symptom management. In all of the studies reviewed, it was found that the interventions had treatment outcomes. The risk of Bias 2 was evaluated as high risk in two studies that did not meet the criteria for blinding outcome evaluations. The included studies, while evaluating the effects of web-based intervention programs on patient outcomes, could not provide information about the underlying mechanisms by which these effects occur and how they occur. CONCLUSIONS All of the studies included were found to apply a technology designed to improve outcomes in patients with lymphoma. It is recommended that web-based intervention programs be individualized by adapting them to lymphoma types and stages, and serve as a guide for effective symptom management.
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Affiliation(s)
- Merve Gozde Sezgin
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Hicran Bektas
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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Van Cleave JH, Fu MR, Bennett AV, Concert C, Riccobene A, Tran A, Most A, Kamberi M, Mojica J, Savitski J, Kusche E, Persky MS, Li Z, Jacobson AS, Hu KS, Persky MJ, Liang E, Corby PM, Egleston BL. The usefulness of the Electronic Patient Visit Assessment (ePVA) © as a clinical support tool for real-time interventions in head and neck cancer. Mhealth 2021; 7:7. [PMID: 33634190 PMCID: PMC7882269 DOI: 10.21037/mhealth-19-250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) experience painful, debilitating symptoms and functional limitations that can interrupt cancer treatment, and decrease their health-related quality of life (HRQoL). The Electronic Patient Visit Assessment (ePVA) for head and neck is a web-based mHealth patient-reported measure that asks questions about 21 categories of symptoms and functional limitations common to HNC. This article presents the development and usefulness of the ePVA as a clinical support tool for real-time interventions for patient-reported symptoms and functional limitations in HNC. METHODS Between January 2018 and August 2019, 75 participants were enrolled in a clinical usefulness study of the ePVA. Upon signing informed consent, participants completed the ePVA and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) general (C30) questionnaire v3.0 (scores range from 0 to 100 with 100 representing best HRQoL). Clinical usefulness of the ePVA was defined as demonstration of reliability, convergent validity with HRQoL, and acceptability of the ePVA (i.e., >70% of eligible participants complete the ePVA at two or more visits and >70% of ePVA reports are read by providers). Formal focus group discussions with the interdisciplinary team that cared for patients with HNC guided the development of the ePVA as a clinical support tool. Qualitative and quantitative methods were used throughout the study. Descriptive statistics consisting of means and frequencies, Pearson correlation coefficient, and Student's t-tests were calculated using SAS 9.4 and STATA. RESULTS The participants were primarily male (71%), White (76%), diagnosed with oropharyngeal or oral cavity cancers (53%), and undergoing treatment for HNC (69%). Data analyses supported the reliability (alpha =0.85), convergent validity with HRQoL scores, and acceptability of the ePVA. Participants with the highest number of symptoms and functional limitations reported significantly worse HRQoL (sum of symptoms: r=-0.50, P<0.0001; sum of function limitations: r=-0.56, P<0.0001). Ninety-two percent of participants (59 of 64) who had follow-up visits within the 6-month study period completed the ePVA at two or more visits and providers read 89% (169 of 189) of automated ePVA reports. The use of the ePVA as a clinical support tool for real-time interventions for symptoms and functional limitations reported by patients is described in a clinical exemplar. CONCLUSIONS This research indicates that the ePVA may be a useful mHealth tool as a clinical support tool for real-time interventions for patient-reported symptoms and functional limitations in HNC. The study findings support future translational research to enhance the usefulness of the ePVA in real world settings for early interventions that decrease symptom burden and improve the QoL of patients with HNC.
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Affiliation(s)
| | - Mei R. Fu
- Boston College Connell School of Nursing, Boston, MA, USA
| | - Antonia V. Bennett
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Concert
- Department of Radiation Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ann Riccobene
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Anh Tran
- Department of Radiation Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Allison Most
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Maria Kamberi
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Jacqueline Mojica
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Justin Savitski
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Elise Kusche
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Mark S. Persky
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Zujun Li
- Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Adam S. Jacobson
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Kenneth S. Hu
- Department of Radiation Oncology, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Michael J. Persky
- Department of Otolaryngology-Head and Neck Surgery, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Eva Liang
- New York University Meyers College of Nursing, New York, NY, USA
| | - Patricia M. Corby
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Wilson CM, Mooney K. Advancing Oncology Nursing Practice Through the Adoption of Patient Monitoring Digital Tools. Semin Oncol Nurs 2020; 36:151087. [PMID: 33218884 DOI: 10.1016/j.soncn.2020.151087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this paper is to describe the use of oncology digital symptom monitoring and patient self-management coaching tools, how nurses and nurse practitioners (NPs) can optimize their use as an adjunct in improving oncology care and discuss issues and strategies needed for adoption within a variety of clinical settings. DATA SOURCES A review of the research literature regarding digital health in oncology symptom management in PubMed provided the foundation for this paper. CONCLUSION Digital symptom monitoring technology provides a variety of opportunities for oncology nurses and NPs to efficiently extend and improve symptom management in multiple settings including cancer patients at home between clinic visits, at clinic visits, and during inpatient stays. Digital monitoring and patient engagement make possible frequent symptom assessments, just-in-time personalized self-management reinforcement, and judiciously alert nurses and NPs about key times for follow-up with patients supported with evidenced-based guidelines. Oncology nurses at all levels have the opportunity to be leaders in the adoption and expansion of digital tools to enhance their practice. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses and NPs can lead practice changes that improve patient outcomes through understanding and shaping the use of digital tools.
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Affiliation(s)
| | - Kathi Mooney
- University of Utah College of Nursing, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
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Pellegrini C, Daniele S, Antonioli L, Benvenuti L, D’Antongiovanni V, Piccarducci R, Pietrobono D, Citi V, Piragine E, Flori L, Ippolito C, Segnani C, Palazon-Riquelme P, Lopez-Castejon G, Martelli A, Colucci R, Bernardini N, Trincavelli ML, Calderone V, Martini C, Blandizzi C, Fornai M. Prodromal Intestinal Events in Alzheimer's Disease (AD): Colonic Dysmotility and Inflammation Are Associated with Enteric AD-Related Protein Deposition. Int J Mol Sci 2020; 21:ijms21103523. [PMID: 32429301 PMCID: PMC7278916 DOI: 10.3390/ijms21103523] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
Increasing evidence suggests that intestinal dysfunctions may represent early events in Alzheimer’s disease and contribute to brain pathology. This study examined the relationship between onset of cognitive impairment and colonic dysfunctions in a spontaneous AD model before the full development of brain pathology. SAMP8 mice underwent Morris water maze and assessment of faecal output at four, six and eight months of age. In vitro colonic motility was examined. Faecal and colonic Aβ, tau proteins, α-synuclein and IL-1β were assessed by ELISA. Colonic citrate synthase activity was assessed by spectrophotometry. Colonic NLRP3, caspase-1 and ASC expression were evaluated by Western blotting. Colonic eosinophil density and claudin-1 expression were evaluated by immunohistochemistry. The effect of Aβ on NLRP3 signalling and mitochondrial function was tested in cultured cells. Cognitive impairment and decreased faecal output occurred in SAMP8 mice from six months. When compared with SAMR1, SAMP8 animals displayed: (1) impaired in vitro colonic contractions; (2) increased enteric AD-related proteins, IL-1β, active-caspase-1 expression and eosinophil density; and (3) decreased citrate synthase activity and claudin-1 expression. In THP-1 cells, Aβ promoted IL-1β release, which was abrogated upon incubation with caspase-1 inhibitor or in ASC-/- cells. Aβ decreased mitochondrial function in THP-1 cells. In SAMP8, enteric AD-related proteins deposition, inflammation and impaired colonic excitatory neurotransmission, occurring before the full brain pathology development, could contribute to bowel dysmotility and represent prodromal events in AD.
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Affiliation(s)
- Carolina Pellegrini
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Simona Daniele
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Luca Antonioli
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.A.); (L.B.); (V.D.); (M.F.)
| | - Laura Benvenuti
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.A.); (L.B.); (V.D.); (M.F.)
| | - Vanessa D’Antongiovanni
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.A.); (L.B.); (V.D.); (M.F.)
| | - Rebecca Piccarducci
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Deborah Pietrobono
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Valentina Citi
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Eugenia Piragine
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Lorenzo Flori
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Chiara Ippolito
- Unit of Histology and Medical Embryology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (C.S.); (N.B.)
| | - Cristina Segnani
- Unit of Histology and Medical Embryology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (C.S.); (N.B.)
| | - Pablo Palazon-Riquelme
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester M13 9PL, UK; (P.P.-R.); (G.L.-C.)
| | - Gloria Lopez-Castejon
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester M13 9PL, UK; (P.P.-R.); (G.L.-C.)
| | - Alma Martelli
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Rocchina Colucci
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy;
| | - Nunzia Bernardini
- Unit of Histology and Medical Embryology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.I.); (C.S.); (N.B.)
- Interdepartmental Research Centre “Nutraceuticals and Food for Health”, University of Pisa, 56126 Pisa, Italy
| | - Maria Letizia Trincavelli
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
| | - Claudia Martini
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (C.P.); (S.D.); (R.P.); (D.P.); (V.C.); (E.P.); (L.F.); (A.M.); (M.L.T.); (V.C.)
- Correspondence: (C.M.); (C.B.); Tel.: +39-050-221-2115 (C.M.); +39-050-221-8753 (C.B.)
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.A.); (L.B.); (V.D.); (M.F.)
- Correspondence: (C.M.); (C.B.); Tel.: +39-050-221-2115 (C.M.); +39-050-221-8753 (C.B.)
| | - Matteo Fornai
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.A.); (L.B.); (V.D.); (M.F.)
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