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Background: Pancreatic Ductal Adenocarcinoma (PDAC) has historically been an important diagnostic and therapeutic challenge. The multidisciplinary approach and new diagnostic techniques' implementation have modified this process. Method(s): We conducted a retrospective analysis based on clinical data of patients with PDAC between the years 2010 to 2021, analyzing the diagnosis and initial treatment evolution. Result(s): 673 patients between 2010-2021 with a suspected diagnosis of pancreatic adenocarcinoma were reviewed. Most of them were metastatic (n=362;53.8%), followed by locally advanced unresectable (n=166;24.7%) and resectable or borderline resectable (n=145;21.5%). Regarding the pathological diagnosis, it was not possible in 62 patients (9.2%), varying over time from 21.2%in 2010-2012 to 1% in 2019-2021 (p<0,0001). Moreover, the number of biopsies has decreased with a mean number of biopsies to obtain a pathological diagnosis of 1.55 (2010-2012) vs 1.31 (2019-2021). During this last period, most of the diagnoses were made by cytological analysis (61.4%;n=121). Specifically in the 2019-2021 patients subgroup, we found that 18 NGS (9,1%) were performed in this period (solid tumor), with 4 patients having actionable mutations (22.2%;3 KRAS G12C). Germline (g) mutational panels were carried out in 89 patients, finding only 9 positive cases (10.1%), being 3 of them gBRCA1/2 mutated (3,4%). In our study, a decrease in palliative management was evidenced over time. In 2010-2012, 28,8% of patients received exclusively palliative care against 9,6% in 2019-21 (p, 0.0001). An increase in PDAC diagnosis was observed since 2010, 44 patients/year in 2010-12 vs. 66 patients/year in 2019-21 (including COVID-19 pandemic period). All previous results are summarized. Conclusion(s): The diagnosis of PDAC has changed throughout the last decade, increasing the percentage of patients with a pathological diagnosis without increasing the number of invasive procedures. The number of patients suitable for anti-cancer therapy has also increased among time. In our cohort, the implementation of molecular testing would change the therapeutic approach in more than 20% of patients.
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RATIONALE: Patient transfers from the intensive care unit (ICU) to the hospital ward are a vulnerable time for patients recovering from critical illness. Our prior work showed that ICU-ward transfers vary widely across sites. Previously, we used Human-Centered Design-an iterative, collaborative process for user-focused solutions-to develop a prototype structured ICU-ward transfer communication tool for clinicians at three academic Internal Medicine residency programs. We describe here an iterative approach to rapid prototyping and updating of this novel tool for integration into the electronic health record (EHR), based on structured focus groups using Design Thinking methodology. METHODS: In spring 2020, we conducted voluntary focus groups of PGY-2 and PGY-3 Internal Medicine Residents to co-create new iterations of an ICUward transfer tool created through prior focus groups. Each site conducted 2 focus groups with 4-10 participants per session. All focus groups were conducted via videoconference due to the COVID-19 pandemic. We used participant feedback to iteratively modify the ICU-ward transfer tool towards an ideal state. With participants' consent, we recorded and anonymously transcribed the focus group discussions conducted over the Zoom platform. We performed qualitative inquiry on transcripts for coding and thematic content analysis. Coding was performed independently by two coders (LS, BG) using both a theory-driven (deductive) and data-driven (inductive) approach;disparate coding was reconciled via in-depth discussion between coders. RESULTS: Focus groups identified several main themes around the role, content, and workflows related to an ideal ICU-wards handoff tool: (1) how the tool can best serve the needs of ICU and wards teams;(2) that the ICU-ward handoff process must balance thoroughness and usability;and (3) that design and implementation must consider user experience and training in best practices. Under these themes, participants identified specific attributes of an ideal handoff tool (Table 1), which coalesced around 3 main goals: (1) to synthesize key details and communicate the ICU team's thought process (summarized in Table 1A);(2) to integrate the new tool into the EHR within a customizable note template that minimizes click burden and redundancy (1B);and (3) to serve as a standardized outline to reduce errors of omission in written and verbal handoffs processes (1C). CONCLUSIONS: Participants valued organization of handoff information, EHR integration and user experience, and standardization and adaptability of workflows when modifying a framework based on prior resident user input to create a more user-friendly ICU-ward transfer tool using a Design Thinking Methodology.