Evaluation of the clinical outcomes and patient satisfaction related to the use of internal eye shields for electron external beam radiation therapy.

INTRODUCTION: Cancers around the eye are often treated using orthovoltage machines or by plastic surgery, neither of which are widely available in regional Australia. External beam radiation therapy (EBRT) using electrons and an internal eye shield is an alternative, relatively underreported technique which can provide similar cosmetic and functional outcomes. This report aimed to describe the process for the use of internal eye shields at GenesisCare Fraser Coast Radiation Oncology (GCFCRO) and the associated clinical outcomes and patient perceptions of the delivery and results of this procedure. METHODS: This project was conducted in two phases. Phase I was an audit of the departmental technique and short-term clinical outcomes of 17 patients who received EBRT for skin cancer near the eyes at GCFCRO in partnership with Wide Bay Hospital and Health Service (WBHHS). Phase II was a survey of nine of those patients to elicit the patient perspective of the delivery and long-term outcomes of the treatment. RESULTS: Phase I revealed the departmental procedures for simulation, planning and treatment at GCFCRO are consistent with other departments published protocols. Phase II results detailed positive patient perspectives regarding cosmetic outcomes and receipt of EBRT for skin cancer near their eyes. CONCLUSION: EBRT with an internal eye shield is an acceptable alternative modality to surgery for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) around the eye in the definitive and adjuvant setting. This is particularly important in regional locations to facilitate patients receiving high-quality care and outcomes locally.

Student evaluation of an instructional video on how to use a national medicines information resource.

OBJECTIVES: The objective of this project was to obtain students' perception of an educational companion video designed to increase the understanding of a national medicines information resource. METHODS: An instructional video was developed to guide students in utilizing the online version of the Australian Medicines Handbook (AMH). All students enrolled in the Bachelor of Pharmacy program during 2021 were given access to this video. A cross-sectional electronic survey was administered to evaluate the video's effectiveness and its impact on students' confidence. The survey results were analysed using both descriptive and inferential statistics, in addition to qualitative analysis to identify common themes. Ethics approval was obtained prior to conducting the study. KEY FINDINGS: Most students (78%; n = 72/92) reported that watching the video increased their understanding. The most growth in confidence was seen by students in their first or second year of study. Fifty-four percent (n = 48/89) of students was very likely or extremely likely to recommend the video to others, and 37% (n = 33/89) of students were somewhat likely. Students found the instructional video to be useful and expressed a desire for similar content to be integrated into other facets of teaching. The audio-visual mode of delivery was regarded as effective for this context. Constructive feedback included suggestions of incorporating more advanced educational features such as how to interpret comparative medication charts and interaction checkers. CONCLUSIONS: The 'How to use the AMH' video is a good introductory resource for undergraduate Australian healthcare students. Our results indicate that this video would be best suited to complement the teaching of students early on in their studies.

Influence of medication risks and benefits on treatment preferences in older patients with multimorbidity.

Multimorbidity is associated with use of multiple medicines, increased risk of adverse events and treatment conflicts. This study aimed to examine how older patients with multimorbidity and clinicians balance the benefits and harms associated with a medication and in the presence of competing health outcomes. Interviews were conducted with 15 participants aged ≥65 years with 2 or more chronic conditions. Three clinical scenarios were presented to understand patient preference to take a medicine according to i) degree of benefit, ii) type of adverse event and impact on daily living and iii) influence of comorbid conditions as competing health outcomes. Semi-structured interviews were also conducted with participants (n=15) and clinicians (n=5) to understand patient preferences and treatment decisions, in the setting of multimorbidity. The median age of participants was 79 years, 55% had 5 or more conditions and 47% took 8 or more medicines daily. When the level of benefit of the medicine ranged from 14% to 70%, 80% of participants chose to take the medicine, but when adverse effects were present, this was reduced to 0-33% depending upon impact on daily activities. In the presence of competing health outcomes, 13%-26% of patients chose to take the medicine. Two-thirds of patients reported that their doctor respects and considers their preferences and discussed medication benefits and harms. Interviews with clinicians showed that their overall approach to treatment decision-making for older individuals with multimorbidity was based upon 2 main factors, the patients' prognosis and their preferences. The degree of benefit gained was not the driver of patients' preference to take a medicine; rather, this decision was influenced by type and severity of adverse effects. Inclusion of patient preferences in the setting of risks and benefits of medicines with consideration and prioritization of competing health outcomes may result in improved health outcomes for people with multimorbidity.