RESUMEN
BACKGROUND: Advanced practice nursing was introduced in France in 2018, in response to health needs. The first advanced practice nurses were graduated since 2019 and were trained in one among four medical areas including oncology and onco-hematology. The purpose of this article is to make an early assessment of the development of the profession of oncology Advanced Practice Nurse in France. METHOD: An exploratory study was conducted. A sample of 44 onco-hematology IPA graduated in 2019 and 2020 was recruited from June 2021 to end of July 2021. The 44 participants completed a questionnaire, by phone interviews or self-administered. RESULTS AND CONCLUSION: The distribution of the 44 participants concerns 12 of the 13 regions of metropolitan France. This profession shows an employability for 86% of the first graduates. These professionals practice in health care institutions and rather in oncology, 71% in the framework of an organizational protocol established with the oncologist. They appear to be well accepted by patients and oncology teams. Further studies on performance and quality indicators will make it possible to evaluate the added value of the oncology Advanced Practice Nurses in the cancer patient's pathway.
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Hematología , Personal de Enfermería/provisión & distribución , Enfermería Oncológica , Encuestas y Cuestionarios/estadística & datos numéricos , Empleo/estadística & datos numéricos , Francia , Hematología/educación , Hematología/organización & administración , Hematología/estadística & datos numéricos , Humanos , Proceso de Enfermería/estadística & datos numéricos , Enfermería Oncológica/educación , Enfermería Oncológica/organización & administración , Enfermería Oncológica/estadística & datos numéricosRESUMEN
PURPOSE: Large-panel genomic tumor testing (GTT) is an emerging technology with great promise but uncertain clinical value. Previous research has documented variability in academic oncologists' perceptions and use of GTT, but little is known about community oncologists' perceptions of GTT and how perceptions relate to clinicians' intentions to use GTT. METHODS: Community oncology physicians (N = 58) participating in a statewide initiative aimed at improving access to large-panel GTT completed surveys assessing their confidence in using GTT, attitudes regarding the value of GTT, perceptions of barriers to GTT implementation, and future intentions to use GTTs. Descriptive and multivariable regression analyses were conducted to characterize these perceptions and to explore the relationships between them. RESULTS: There was substantial variability in clinicians' perceptions of GTT. Clinicians generally had moderate confidence in their ability to use GTT, but lower confidence in patients' ability to understand test results and access targeted treatment. Clinicians had positive attitudes regarding the value of GTT. Clinicians' future intentions to use GTT were associated with greater confidence in using GTT and greater perceived barriers to implementing GTT, but not with attitudes about the value of GTT. CONCLUSIONS: Community oncologists' perceptions of large-panel genomic tumor testing are variable, and their future intentions to use GTT are associated with both their confidence in and perceived barriers to its use, but not with their attitudes towards GTT. More research is needed to understand other factors that determine how oncologists perceive and use GTT in clinical practice.
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Actitud del Personal de Salud , Pruebas Genéticas/estadística & datos numéricos , Neoplasias/genética , Oncólogos/psicología , Comprensión , Femenino , Predicción , Encuestas de Atención de la Salud/estadística & datos numéricos , Hematología/estadística & datos numéricos , Humanos , Intención , Maine , Masculino , Análisis de Regresión , Servicios de Salud Rural , Autoimagen , IncertidumbreAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Hematología/estadística & datos numéricos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bases de Datos Factuales , Progresión de la Enfermedad , Estudios de Seguimiento , Hematología/normas , Humanos , India/epidemiología , Infecciones/epidemiología , Infecciones/mortalidad , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Neoplasia Residual/epidemiología , Evaluación de Resultado en la Atención de Salud , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Estudios Retrospectivos , Factores Socioeconómicos , Análisis de Supervivencia , Adulto JovenRESUMEN
Despite both enthusiasm and concern regarding data sharing from clinical trials, few studies have documented the outputs of data sharing. The FDA has a considerable collection of raw data from drugs for their marketing authorization. An examination of data sharing with the FDA provides a snapshot into studies that this may facilitate.
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Antineoplásicos/administración & dosificación , Difusión de la Información , Neoplasias/tratamiento farmacológico , Estudios de Casos Únicos como Asunto/estadística & datos numéricos , Acceso a la Información , Antineoplásicos/efectos adversos , Aprobación de Drogas , Hematología/métodos , Hematología/estadística & datos numéricos , Humanos , Oncología Médica/métodos , Oncología Médica/estadística & datos numéricos , Estados Unidos , United States Food and Drug AdministrationRESUMEN
BACKGROUND: The histopathological diagnosis of MF is challenging, and there is significant overlap with benign inflammatory processes. Clinical features may be relevant in the assessment of skin biopsies. METHODS: We provided photomicrographs to board-certified dermatopathologists and one hematopathologist with and without accompanying clinical photographs and assessed accuracy and confidence in diagnosing MF. RESULTS: We found that access to clinical photographs improved diagnostic accuracy in both MF and non-MF (distractors); the degree of improvement was significantly higher in the non-MF/distractor category. Across all categories, diagnostic confidence level was higher when clinical images were available. CONCLUSION: These findings suggest that clinical images are useful in making an accurate diagnosis of MF, and may be particularly helpful in ruling it out when an inflammatory disorder is clinically suspected.
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Inflamación/patología , Micosis Fungoide/diagnóstico , Fotomicrografía/métodos , Neoplasias Cutáneas/patología , Adulto , Biopsia/métodos , Dermatólogos/psicología , Diagnóstico Diferencial , Hematología/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Micosis Fungoide/patología , Micosis Fungoide/ultraestructura , Variaciones Dependientes del Observador , Patólogos/psicología , Competencia Profesional/estadística & datos numéricos , Reproducibilidad de los Resultados , Autoimagen , Piel/patologíaAsunto(s)
COVID-19/epidemiología , Neoplasias Hematológicas/complicaciones , Sistema de Registros/estadística & datos numéricos , SARS-CoV-2/inmunología , Adulto , Factores de Edad , Anciano , Antivirales/uso terapéutico , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/virología , Prueba de COVID-19/estadística & datos numéricos , Femenino , Neoplasias Hematológicas/inmunología , Neoplasias Hematológicas/terapia , Hematología/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Prevalencia , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Sociedades Científicas/estadística & datos numéricos , Análisis de Supervivencia , Estados Unidos/epidemiología , Adulto Joven , Tratamiento Farmacológico de COVID-19RESUMEN
Aim: To report the results of a patient epidemiology model for multiple myeloma (MM) treatment by line of therapy (LOT) in the USA. Materials & methods: Surveillance, Epidemiology and End Results registry data and physician surveys were combined to project the incidence, prevalence and the number of MM patients treated with systemic therapy by LOT between 2020 and 2025. Results: Projected complete MM prevalence in the USA in 2020 was 144,922, increasing to 162,339 in 2025. Corresponding unique MM patients by LOT in 2020 were: 53,176 (1st; minimum-maximum: 47,304-59,212), 19,407 (2nd; 15,935-23,273), 6,481 (3rd; 5143-8877), 1649 (4th; 1146-2667) and 426 (5th; 217-876). Conclusion: MM incidence and prevalence by LOT is projected to continue to increase in the USA between 2020 and 2025.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Mieloma Múltiple/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Femenino , Hematología/estadística & datos numéricos , Humanos , Incidencia , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/terapia , Prevalencia , Supervivencia sin Progresión , Estudios Retrospectivos , Programa de VERF/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: The main objective of the present study is to examine a number of suicides among Italian doctors. We further compared data from our sample with those of suicide in the general population and in the literature, in order to detect any differences that can provide preventive recommendations. METHODS: This is a retrospective study of 60 suicides committed by doctors from 2009 to 2019, in Italy. RESULTS: The sample was constituted mainly by men (77%, 46 cases) aged between 50 and 69 years (70%, n=42). Most of the suicides took place in Northern Italy (50%, n=30). Among known medical specialization, 26% (n=14) concerned general practitioners, the remaining 74% (n=39) were specialized doctors, with a prevalence of anesthetists (9%, n=5), haematologists (8 %, n=4), pediatricians (6%, n=3), psychiatrists (6%, n=3) and oncologists (6%, n=3). Regarding the suicide method, the most used was precipitation (30%, n=16), followed by poisoning/overdose (24%, n=13), firearm (19%, n=10), suffocation/hanging (19%, n=10) and self-induced injuries (8%, n=4)). The most frequent place of suicide is in 35 cases was at home (59%), followed by the hospital (18%; n=11), or others (23%; n=14). When possible, any reported risk factors and predisposing conditions for suicide were studied, and divided into five categories: depression/psychiatric pathology (28%, n=16); other organic disease (8%, n=5); work-related problems (stress, burn-out, mobbing, work-related judicial problems) (20%, n=12); judicial problems unrelated to the medical profession (8%, n=5); family and relationship problems (12%, n=7). CONCLUSIONS: The risk factors for suicide in our sample of doctors overlap with data from literature for doctors in western countries. Clinical recommendations and prevention strategies for suicide risk are therefore similar.
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Médicos/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Anestesiólogos/estadística & datos numéricos , Causas de Muerte , Femenino , Médicos Generales/estadística & datos numéricos , Hematología/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Oncólogos/estadística & datos numéricos , Pediatras/estadística & datos numéricos , Psiquiatría/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Prevención del SuicidioRESUMEN
Digital morphology hematology analyzers are becoming more prevalent in laboratories Aims: investigate practices and assess the benefits and limits of digital automated microscopy in hematology. METHODS: questionnaire sent by e-mail in 2018 to French public and private laboratories. RESULTS: out of 118 responses (56 private, 62 public), 117 participants had a CellaVision® microscope, 1 had a West Medica®. Practices were sometimes different, especially in the choice of smears to be digitized or for quality controls (16.1% had internal quality controls, 48.3% external quality controls); 62.1% never used the red blood cell (RBC) characterization tool; the number of cells counted varied from 100 to 400. The study reported a high rate of agreement for these benefits: traceability (95.7%), staff training (94.1%), eye strain (91.4%), risk of error (87.2%), time saving (83.6%). Among the disadvantages, apart from the inadequate search for platelets clumps (93.2%), the agreement rates were often lower: adaptation to digital images (61.2%), difficult assessment of atypical morphologies (49.6%) or RBC morphology (49.6%). CONCLUSION: despite well-established benefits, standardization of practices and technical improvement are still needed.
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Automatización de Laboratorios , Pruebas Hematológicas/instrumentación , Hematología/instrumentación , Procesamiento de Imagen Asistido por Computador , Microscopía/instrumentación , Actitud del Personal de Salud , Automatización de Laboratorios/instrumentación , Automatización de Laboratorios/métodos , Automatización de Laboratorios/estadística & datos numéricos , Computadores , Pruebas Diagnósticas de Rutina/instrumentación , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Pruebas Diagnósticas de Rutina/tendencias , Francia/epidemiología , Pruebas Hematológicas/métodos , Pruebas Hematológicas/estadística & datos numéricos , Pruebas Hematológicas/tendencias , Hematología/métodos , Hematología/estadística & datos numéricos , Hematología/tendencias , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Procesamiento de Imagen Asistido por Computador/métodos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Procesamiento de Imagen Asistido por Computador/tendencias , Satisfacción en el Trabajo , Microscopía/métodos , Microscopía/estadística & datos numéricos , Microscopía/tendencias , Práctica Profesional/estadística & datos numéricos , Práctica Profesional/tendencias , Control de Calidad , Encuestas y CuestionariosRESUMEN
Mugil curema is a teleost fish often found in coastal, estuarine and lagoon regions throughout the Brazilian coast. Blood parameters may be used as health and welfare indicators of the fish, as well as the environment they live in. The aim of this study was to verify the hematologic profile of the M.curema along 18 months in estuary waters from the north coast of the state of Santa Catarina in the south of Brazil. A total of 133 M. curema fish were captured from March 2016 to August 2017. Erythrogram, leukogram, thrombocytogram, hematocrit percentage, hemoglobin dosage, total plasma protein dosage, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and medium corpuscular hemoglobin concentration (MCHC) were analyzed. There was no significant difference (P>0.05) on the total number of erythrocytes between the fish gender. However, there was difference on the hematocrit between males and indefinite gender fish. The influences of temporal and geographical space, among the values of hematological parameters, in the different studies of the Brazilian coast are discussed.. The present research is an important contribution to establish a hematological pattern for M. curema. The local population of the studied fish has a proper behavior in hematological descriptors, which is different from other Brazilian coast studies with the same fish species.
Mugil curema é um peixe teleósteo, abundante em regiões costeiras, estuarinas e lagunares, em todo o litoral brasileiro. Os parâmetros sanguíneos podem ser usados como indicadores da saúde e do bem-estar dos peixes, bem como do ambiente onde estes vivem. O objetivo deste estudo foi verificar o perfil hematológico de M. curema ao longo de 18 meses, em águas estuarinas, no Litoral norte do estado de Santa Catarina, sul do Brasil. Um total de 133 peixes foram capturados, entre março de 2016 e agosto de 2017, para realização de eritrograma, leucograma, trombocitograma, porcentagem de hematócrito, dosagem de hemoglobina, dosagem de proteína plasmática total, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM) e concentração de hemoglobina corpuscular média (CHCM). Não houve diferença significativa (P>0,05) entre o número total de eritrócitos entre machos e fêmeas. No entanto, houve diferença no hematócrito, entre machos e peixes de sexo indeterminado. As influências do espaço temporal e geográfico, entre os valores dos parâmetros hematológicos, nos diferentes estudos do litoral brasileiro são discutidas. A presente investigação é importante contribuição para o estabelecimento de um padrão hematológico para M. curema. A população local de peixes estudada tem comportamento próprio em descritores hematológicos, diferenciado de outros estudos no litoral brasileiro para a mesma espécie.
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Animales , Recuento de Células Sanguíneas/veterinaria , Recolección de Muestras de Sangre/veterinaria , Peces/sangre , Pruebas Hematológicas/veterinaria , Hematología/estadística & datos numéricos , Estándares de Referencia , Estuarios , Análisis Espacio-TemporalRESUMEN
Hospitals within the UK are paid for services provided by 'Payment-by-Results'. In a system that rewards productivity, effective collaboration between coders and clinicians is crucial. However, clinical coding is frequently error prone and has been shown to impact negatively on departmental revenue. Our aim was to increase the median number of diagnostic codes per sickle cell inpatient admission at Guy's Hospital by 3. Three interventions were implemented using the Plan, Do, Study, Act structure. This consisted of student doctors searching for diagnoses along with comorbidities that clinical coders had missed, distributing laminated cards with common clinical codes and implementing discharge pro formas. Through auditing, student doctors generated a total of £58 813 over 16 weeks. We observed an increase in the median number of codes by ≥2 additional codes. We improved coding accuracy where we identified errors in an average of 32.5% of admissions each month, improving the quality of patient documentation. We have demonstrated student doctor involvement in clinical coding as a potentially sustainable means of achieving accurate payment for services provided; increasing departmental revenue. We are the first to report the efficacy of student-coder collaboration in improving the accuracy of clinical coding.
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Codificación Clínica/métodos , Organización y Administración , Reembolso de Incentivo/tendencias , Estudiantes de Medicina , Codificación Clínica/tendencias , Conducta Cooperativa , Hematología/organización & administración , Hematología/estadística & datos numéricos , Humanos , Mejoramiento de la CalidadRESUMEN
This study examined the impact of Syrian refugees on 1 area of the Canadian health care sector. We predicted that pediatric hematology clinics across Canada would see a spike in their Syrian refugee patient population in proportion to their recent migration and, as a result, an increase in perceived workload. Data on the number of refugee patients, types of diseases, and perceived workload were gathered from hematology clinics across Canada using a clinical survey (Supplemental Digital Content 1, http://links.lww.com/JPHO/A315). The results showed that Ontario had the most Syrian refugee patients, followed by the Quebec, Western Canadian, and Atlantic regions. The results also showed that perceived workload ranged from "no increase" (4 programs) to "minimal increase" <25% (1 program), "moderate increase" 25% to 75% (4 programs), and "significant increase" >75% (3 programs, 2 of which had no transfusion-dependent thalassemia patients before the immigration).
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Atención a la Salud/estadística & datos numéricos , Hematología/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Neoplasias/terapia , Refugiados/estadística & datos numéricos , Carga de Trabajo , Canadá/epidemiología , Niño , Accesibilidad a los Servicios de Salud , Humanos , Neoplasias/epidemiología , SiriaAsunto(s)
Anemia de Células Falciformes/terapia , Hematología/estadística & datos numéricos , Médicos Hospitalarios/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Transfusión Sanguínea , Precios de Hospital/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación , Evaluación de Procesos y Resultados en Atención de Salud , Factores Socioeconómicos , Estados UnidosRESUMEN
BACKGROUND: Ensuring that patients with hematologic malignancies have an accurate understanding of their likelihood of cure is important for informed decision making. In a multicenter, longitudinal study, the authors examined discordance in patients' perception of their chance of cure versus that of their hematologists, whether patient-hematologist discordance changed after a consultation with a hematologist, and factors associated with persistent discordance. METHODS: Before and after consultation with a hematologist, patients were asked about their perceived chance of cure (options were <10%, 10%-19%, and up to 90%-100% in 10% increments, and "do not wish to answer"). Hematologists were asked the same question after consultation. Discordance was defined as a difference in response by 2 levels. The McNemar test was used to compare changes in patient-hematologist prognostic discordance from before to after consultation. A generalized linear mixed model was used to examine associations between factors and postconsultation discordance, adjusting for clustering at the hematologist level. RESULTS: A total of 209 patients and 46 hematologists from 4 sites were included in the current study. Before consultation, approximately 61% of dyads were discordant, which improved to 50% after consultation (P < .01). On multivariate analysis, lower educational level (Asunto(s)
Consenso
, Neoplasias Hematológicas/terapia
, Hematología/estadística & datos numéricos
, Adaptación Psicológica
, Toma de Decisiones Clínicas
, Negación en Psicología
, Escolaridad
, Femenino
, Neoplasias Hematológicas/psicología
, Humanos
, Estudios Longitudinales
, Masculino
, Persona de Mediana Edad
, Análisis Multivariante
, Oportunidad Relativa
, Calidad de Vida
, Apoyo Social
, Factores Socioeconómicos
, Encuestas y Cuestionarios/estadística & datos numéricos
, Resultado del Tratamiento
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Atención Ambulatoria/psicología , Hematología/estadística & datos numéricos , Enfermería Oncológica/estadística & datos numéricos , Pacientes Ambulatorios/psicología , Prioridad del Paciente/psicología , Prioridad del Paciente/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricosRESUMEN
PURPOSE OF REVIEW: We summarise the current development of autologous haematopoietic stem cell transplantation (AHSCT) in treating multiple sclerosis (MS) and discuss future directions for the general neurologist, transplant haematologist and oncologist. RECENT FINDINGS: AHSCT was initially performed to treat MS over 20 years ago. Over recent years, the evidence base has grown, especially in relapsing-remitting MS (RRMS), with significant improvements in safety and efficacy through better patient selection, choice of transplant technique and increase in centre experience. AHSCT is now a treatment option in very carefully selected patients with severe, treatment-resistant RRMS. However, it is important for transplant haematologists and oncologists to work closely with specialist MS neurologists in patient selection, during transplant and in long-term follow-up of patients. Data should be registered into international transplant registries and, ideally, patients should be enrolled on prospective clinical trials in order to build the evidence base and refine transplant techniques.
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Trasplante de Células Madre Hematopoyéticas/métodos , Oncología Médica/métodos , Esclerosis Múltiple/terapia , Grupo de Atención al Paciente , Predicción , Hematología/métodos , Hematología/estadística & datos numéricos , Trasplante de Células Madre Hematopoyéticas/tendencias , Humanos , Oncología Médica/estadística & datos numéricos , Oncología Médica/tendencias , Neurólogos/estadística & datos numéricos , Oncólogos/estadística & datos numéricos , Trasplante AutólogoRESUMEN
PURPOSE: Effective, timely and evidence-based nutritional management is important in patients receiving autologous haematopoietic stem cell transplant (HSCT) to prevent the negative consequences of developing malnutrition. This study describes a robust process for development and implementation of an evidence-based nutrition care pathway for HSCT patients in a tertiary cancer centre. METHODS: A comprehensive review of the literature was completed to identify relevant articles and evidence-based guidelines to inform the development of the pathway. Evidence from the literature review was assessed and utilised to underpin the development of pathway. The pathway was implemented in the haematology service in collaboration with the multidisciplinary haematology team. Dietetic resource requirements for implementation of the pathway were determined and clinician compliance with the care pathway was assessed to evaluate the feasibility of the pathway in supporting delivery of evidence-based care. RESULTS: The evidence-based care pathway was implemented in 2011 with the final care pathway based on recommendations from five international evidence-based guidelines. Overall clinician compliance with delivering nutrition management described in the care pathway was high at 84%. The dietetic resource requirement for implementation of the care pathway was 300 to 400 h per 100 patients depending on conditioning chemotherapy regimen. CONCLUSION: A robust process for developing and implementing a nutrition care pathway for HSCT patients was effective in supporting the delivery of evidence-based nutritional management for patients treated with HSCT.
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Trasplante de Células Madre Hematopoyéticas , Desnutrición/prevención & control , Terapia Nutricional/métodos , Vías Clínicas/organización & administración , Medicina Basada en la Evidencia , Utilización de Instalaciones y Servicios , Hematología/organización & administración , Hematología/estadística & datos numéricos , Departamentos de Hospitales/organización & administración , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Necesidades Nutricionales , Estado Nutricional , Apoyo Nutricional/métodos , Cooperación del Paciente , Trasplante AutólogoRESUMEN
Environmental factors have an impact on the effectiveness of treatments for chronic lymphocytic leukemia: vulnerability, organization of the supply of care and proximity of the patient to health professionals. The disparity of care was assessed; vulnerability by the European index of deprivation, the provision of care by values of localized potential accessibility to general practitioners, nurses and pharmacists and hospital supply by the density of hematologists and time access to the center. The data, extracted from the public databases for each grouped island for statistical information, were cross-referenced to apply a principal component analysis and group them into 4 clusters. Cluster 1 has an average EDI, easy access to city professionals, remote access to the referral center, and a good density of hematologists. Cluster 2 has low EDI, satisfactory access to professionals, satisfactory proximity to the referral center and average density of hematologists. Cluster 3 has good EDI, access to professionals is difficult, access to the reference center is long, and the density of hematologists remains average. Cluster 4 has a good EDI, with access to professionals easier than in Cluster 3 but still difficult. The access time to the reference center is better than that of cluster 3 but remains elongated, the density of hematologists remaining average. Mapping is a tool for hospitals and institutions to evaluate care and compare it to other territories.
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Mapeo Geográfico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Hematología/estadística & datos numéricos , Leucemia Linfocítica Crónica de Células B/terapia , Adulto , Anciano , Europa (Continente) , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Factores de TiempoRESUMEN
Pediatric hematology/oncology units (PHOUs) are highly paced, stressful environments and can be difficult areas to work. Thus, these units can present issues when it comes to both recruiting and retaining health care professionals (HCPs). There is scant research addressing how the environment of a PHOU contribute to a HCP's desire to stay or leave this environment. To conduct this project, a critical ethnographic approach was used. The researcher conducted semistructured interviews ( n = 29), which included nurses ( n = 21), physicians ( n = 4), and allied health care staff ( n = 4). This sample represented approximately one third of staff in each category. Participants identified that their ability to develop long-term relationships with children and families as a significant source of satisfaction. Belonging to the oncology team was seen as extraordinarily important to all the participants. The majority of the participants also felt that working in this ever-evolving dynamic medical field afforded them with ongoing learning opportunities. The main frustration described by participants pertained to administrative involvement in the everyday workings of the PHOU, potentially leading to attrition. It is important to note that there was also diversity among and between the categories of HCPs when describing the work environment and the issues that most influence them. While similarities among participants were found between satisfaction and dissatisfaction, significant differences between them led us to believe it would be unreasonable to attempt to compare the three groups here. Thus, in this article the author focused primarily on nursing while noting related observations from physicians and allied health professions.
Asunto(s)
Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Hematología/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Lealtad del Personal , Reorganización del Personal/estadística & datos numéricos , Determinantes Sociales de la Salud , Adulto , Actitud del Personal de Salud , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: As there are few data worldwide concerning the frequency and relevance of interactions of prescribed drugs in hemato-oncology, we analyzed the medication prescribed to patients at a clinic within a comprehensive cancer center. METHODS: Details of the medication prescribed for all patients in 2011 were extracted from their discharge letters. All potential medication combinations were assess with respect to the risk of interaction using 3 specialized websites. RESULTS: The files of 202 patients receiving 275 drugs were extracted; 4,303 drug combinations were created. Overall, 88% of these combinations were found to be harmless with an interaction value (IV) of 1. However 10% showed potential risk of probable interaction (IV 2 + 3). 47% of the patients had at least 1 drug combination with a risk of interaction. A maximum of 29 drugs with 15 probable and possible interactions were found. CONCLUSION: Awareness for this topic should be raised in physicians and patients. An important step for avoiding risks of interactions is a systematic check of all drugs prescribed. There is urgent need for reliable data on clinically relevant interactions and for a better network in which physicians and pharmacists can exchange data about relevant interactions.