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Marks N, Singer L, Wickerson L, Chaparro C, Zilinskas G, Masino C, Won L, Dalton P, Keshavjee S, Sidhu A. Interdisciplinary Approach to Comprehensive Virtual Patient Care in Lung Transplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Yennurajalingam S, Kang DH, Hwu WJ, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study. J Pain Symptom Manage 2018; 55:198-206. [PMID: 28870799 DOI: 10.1016/j.jpainsymman.2017.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). OBJECTIVES The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. METHODS In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4. RESULTS Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment. CONCLUSION In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Duck-Hee Kang
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikhil S Padhye
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Charles Masino
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh S Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Yennu S, Kang DH, Hwu WJ, Padhye NS, Masino C, Liu DD, Dibaj S, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: A preliminary study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
229 Background: Cranial Electrotherapy Stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACP).The aim of the study was to determine the feasibility and preliminary efficacy of a 4-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. Methods: In this one group open label pre- and post-intervention study with a 4-week CES intervention, ACP’s with one or more of four moderate intensity (≥3/10) ESAS symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0-100%), satisfaction rates(0-10), and safety were assessed. ESAS, HADS, PSQI, BPI, and salivary levels (cortisol, alpha amylase, CRP, and IL-1 beta and IL-6) were assessed from baseline to week 4. Results: 33/38(87%) completed the CES. Median (IQR) adherence for days with 60 min CES use and satisfaction scores were 93(89-100)% and 10(9-10) respectively. CES use was safe (no grade 3 or higher adverse events). HADS anxiety (p < 0.001), HADS depression (p = 0.024), ESAS anxiety (p = 0.001), depression (p = 0.025), BPI pain (p = 0.013), PSQI daytime dysfunction (p = 0.002), and Medication use (p = 0.006) scores improved after 4 week CES treatment. There was no significant change in the salivary cortisol, alpha-amylase, CRP, IL-1β, and IL-6 levels after 4 weeks of CES. Conclusions: In this preliminary study we found that the use of cranial Electrotherapy stimulation (CES) was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Duck Hee Kang
- Center for Nursing Research, University of Texas Health School of Nursing, Houston, TX
| | - Wen-Jen Hwu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nikhil S Padhye
- University of Texas Health Science Center at Houston, Houston, TX
| | - Charles Masino
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane D Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Seyedeh Dibaj
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Zhanni Lu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
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Tanco K, Rhondali W, Perez-Cruz P, Tanzi S, Chisholm GB, Baile W, Frisbee-Hume S, Williams J, Masino C, Cantu H, Sisson A, Arthur J, Bruera E. Patient Perception of Physician Compassion After a More Optimistic vs a Less Optimistic Message. JAMA Oncol 2015; 1:176-83. [DOI: 10.1001/jamaoncol.2014.297] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kimberson Tanco
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Wadih Rhondali
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston2Clinique La Chavannerie, Groupe Orpea, Chaponost, France3Laboratoire EA 4129, Santé-Individu-Société, Université Lyon 1, Lyon, France
| | - Pedro Perez-Cruz
- Programa Medicina Paliativa, Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Silvia Tanzi
- Palliative Care Unit-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Gary B. Chisholm
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
| | - Walter Baile
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
| | - Susan Frisbee-Hume
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Janet Williams
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Charles Masino
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Hilda Cantu
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Amy Sisson
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston
| | - Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston
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Rossos PG, St-Cyr O, Purdy B, Toenjes C, Masino C, Chmelnitsky D. Hype, harmony and human factors: applying user-centered design to achieve sustainable telehealth program adoption and growth. Stud Health Technol Inform 2015; 209:121-127. [PMID: 25980714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite decades of international experience with the use of information and communication technologies in healthcare delivery, widespread telehealth adoption remains limited and progress slow. Escalating health system challenges related to access, cost and quality currently coincide with rapid advancement of affordable and reliable internet based communication technologies creating unprecedented opportunities and incentives for telehealth. In this paper, we will describe how Human Factors Engineering (HFE) and user-centric elements have been incorporated into the establishment of telehealth within a large academic medical center to increase acceptance and sustainability. Through examples and lessons learned we wish to increase awareness of HFE and its importance in the successful implementation, innovation and growth of telehealth programs.
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Affiliation(s)
- P G Rossos
- UHN Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto
| | - O St-Cyr
- Department of Mechanical and Industrial Engineering, University of Toronto
| | - B Purdy
- UHN Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto
| | - C Toenjes
- UHN Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto
| | - C Masino
- UHN Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto
| | - D Chmelnitsky
- UHN Telehealth Program, Centre for Global eHealth Innovation, University Health Network, Toronto
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Dalal S, Bruera S, Masino C, Williams JL, Zhang Y, Obasi E, Schuren N, Bruera E. Timing of access to outpatient palliative care services: What’s in a name? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.31_suppl.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10 Background: We have previously shown the name “palliative” to be a barrier to early palliative care (PC) referral. Further, following service name change to supportive care (SC) in late 2007, we immediately observed an increased survival time of about 1.5 months from PC consultation suggesting earlier referral following the name change. This study was conducted to determine the timing of patient access to outpatient PC services over several years period after the name change. Methods: Records of consecutive outpatient referrals in fiscal years (FY) 2007 (pre-name change), 2008 (transition period), 2009-2013 (post-name change) were reviewed. Timing of PC access was determined by 3 time intervals: (a) survival from PC consultation; (b) advanced cancer diagnosis to PC (c) hospital registration to PC; Kruskal-Wallis, Kaplan Meir and Cox regression models were used. Results: 6,624 patients had their first outpatient PC consultation during FY 2007 to 2013. Each year we observed a consistent increase in new patient referrals, as well as a longer median survival time from PC consultation (logrank <0.0001). The table below shows median survival and hazard ratio (HR) for FYs 2008-2013 as compared to FY 2007. In FY 2013 there were 63% greater number of outpatient referrals as compared to FY 2007 (p <0.0001), longer median survival (months) (7.9 vs 4.8; p <0.001), and shorter median interval (months) from advanced cancer diagnosis (5.9 vs 7.8; p< 0.002) and from hospital registration (6.6 vs 14.8; p< 0.0001) to PC consultation. Conclusions: Following the name change of service from PC to SC, there has been consistent annual increase in new patient referrals as well as earlier access to outpatient PC services. The outpatient setting facilitates earlier patient access to SC/PC services and should be established in more centers. [Table: see text]
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Affiliation(s)
- Shalini Dalal
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sebastian Bruera
- Baylor College of Medicine - Department of Internal Medicine, Houston, TX
| | - Charles Masino
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yi Zhang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Emmanuel Obasi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Natalie Schuren
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Cassano-Piché A, Fan M, Sabovitch S, Masino C, Easty AC. Multiple intravenous infusions phase 1b: practice and training scan. Ont Health Technol Assess Ser 2012; 12:1-132. [PMID: 23074426 PMCID: PMC3377572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Minimal research has been conducted into the potential patient safety issues related to administering multiple intravenous (IV) infusions to a single patient. Previous research has highlighted that there are a number of related safety risks. In Phase 1a of this study, an analysis of 2 national incident-reporting databases (Institute for Safe Medical Practices Canada and United States Food and Drug Administration MAUDE) found that a high percentage of incidents associated with the administration of multiple IV infusions resulted in patient harm. OBJECTIVES The primary objectives of Phase 1b of this study were to identify safety issues with the potential to cause patient harm stemming from the administration of multiple IV infusions; and to identify how nurses are being educated on key principles required to safely administer multiple IV infusions. DATA SOURCES AND REVIEW METHODS A field study was conducted at 12 hospital clinical units (sites) across Ontario, and telephone interviews were conducted with program coordinators or instructors from both the Ontario baccalaureate nursing degree programs and the Ontario postgraduate Critical Care Nursing Certificate programs. Data were analyzed using Rasmussen's 1997 Risk Management Framework and a Health Care Failure Modes and Effects Analysis. RESULTS Twenty-two primary patient safety issues were identified with the potential to directly cause patient harm. Seventeen of these (critical issues) were categorized into 6 themes. A cause-consequence tree was established to outline all possible contributing factors for each critical issue. Clinical recommendations were identified for immediate distribution to, and implementation by, Ontario hospitals. Future investigation efforts were planned for Phase 2 of the study. LIMITATIONS This exploratory field study identifies the potential for errors, but does not describe the direct observation of such errors, except in a few cases where errors were observed. Not all issues are known in advance, and the frequency of errors is too low to be observed in the time allotted and with the limited sample of observations. CONCLUSIONS The administration of multiple IV infusions to a single patient is a complex task with many potential associated patient safety risks. Improvements to infusion and infusion-related technology, education standards, clinical best practice guidelines, hospital policies, and unit work practices are required to reduce the risk potential. This report makes several recommendations to Ontario hospitals so that they can develop an awareness of the issues highlighted in this report and minimize some of the risks. Further investigation of mitigating strategies is required and will be undertaken in Phase 2 of this research.
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Masino C. [Not Available]. Atti Mem Accad Ital Stor Farm 1988; 5:7-10. [PMID: 11634618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Masino C. [Not Available]. Atti Mem Accad Ital Stor Farm 1986:220-30. [PMID: 11634616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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