Tools to assess employment readiness for colorectal cancer survivors: A scoping review.

BACKGROUND: The ability to return to work and remain at work is an important recovery milestone after a cancer diagnosis. With the projected number of colorectal cancer patients of working age likely to increase, it is important to identify when a person is ready to resume work. There are many employment-related tools available to help people return to work after injury or illness; however, it is unknown which may be suitable for a person with colorectal cancer. AIM: To identify tools related to employment readiness in colorectal cancer survivors and to chart the relevant factors of employment assessed by these tools. METHOD: Literature searches were performed in PubMed, CINAHL, Embase and Medline, the Cochrane library and PsycINFO using search terms around cancer, survivorship and employment to identify all peer-reviewed articles published in English up to June 2022. RESULTS: Thirty-five studies used a total of 77 tools focused on assessing employment issues experienced by people with cancer in general. Four tools were used with colorectal cancer survivors. None considered all relevant employment-related factors for colorectal cancer survivors. CONCLUSION: Tools used to identify return-to-work and remain-at-work were not specific to colorectal cancer. There are a range of existing tools that collate some, but not all, of the domains and outcome criteria required to meet the employment needs of colorectal cancer survivors. To optimize work outcomes for the working colorectal cancer population, a specified tool is warranted.

Establishment and evaluation of a nomogram for predicting the survival outcomes of patients with diffuse large B-cell lymphoma based on International Prognostic Index scores and clinical indicators.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma, treatment outcomes of patients vary greatly. The current International Prognostic Index (IPI) is not enough to distinguish patients with poor prognosis, and genetic testing is very expensive, so a inexpensive risk prediction tool should be developed for clinicians to quickly identify the poor prognosis of DLBCL patients. Methods: DLBCL patients (n=420; 18-80 years old) who received a combination of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) with or without rituximab (R-CHOP) at our hospital between 2008 and 2017 were included in the study. Potential predictors of survival were determined by univariate and multivariate Cox regression analyses, and significant variables were used to construct predictive nomograms. The new prediction models were assessed using concordance indexes (C-indexes), calibration curves, and their clinical utility was assessed by decision curve analyses (DCAs). Results: The 5-year overall survival (OS) rate was 70.62% and the 5-year progression-free survival (PFS) rate was 59.02%. The multivariate Cox analysis indicated that IPI, Ki-67, the lymphocyte/monocyte ratio, and first-line treatment with rituximab were significantly associated with survival. The C-index results indicated that a predictive model that included these variables had better discriminability for OS (0.73 vs. 0.67) and PFS (0.68 vs. 0.63) than the IPI-based model. The calibration plots showed good agreement with observations and nomogram predictions. The DCAs demonstrated the clinical value of the nomograms. Conclusions: Our study identified prognostic factors in patients who were newly diagnosed with DLBCL to construct an individualized risk prediction model, combined IPI with common clinical indicators. Our model might be a valuable tool that could be used to predict the prognosis of DLBCL patients who receive standard first-line treatment regimens. It enables clinicians to quickly identify some patients with possible poor prognosis and choose more active treatment for patients, such as chimeric antigen receptor T-cell (CART) Immunotherapy and other new drugs therapy, so as to prolong the PFS and OS of patients.

A Survey of Emergency Department Quality Improvement Activities: Effective Fast Track Waiting Area Management.

This article describes the quality improvement process used to implement a waiting area within fast track. Staff and patient survey data indicated a significant decrease in workload, with a subsequent high satisfaction of both groups following the redesign process.

Collaborative, Innovative Quality Improvement Activity: Development of Queensland Ambulance Service Stickers: Drivers, Approaches, Implementation, and Outcomes.

This article discusses the implementation of 3 targeted interventions aimed at reducing infection rates in patients due to prolonged in situ intravascular catheters (IVCs) during their admission to the hospital. These IVCs are inserted by paramedics with Queensland Ambulance Service (QAS) in prehospital settings. The 3 interventions involved were the application of "QAS-IVC" stickers by QAS paramedics to indicate QAS-inserted IVCs, the implementation of mandatory IVC documentation during patient handover, and clinician engagement to provide patient education on IVC infection signs. Audits undertaken in wards reflected that the interventions were apparent and beneficial; this is evident from the limited number of patients having in-dwelling QAS-IVC and increased awareness among medical staff and patients alike. We, however, did not have comparative data to objectively quantify the success of the interventions implemented.

Do consumers who identify as Muslim experience culturally safe care (CSC) in the Emergency Department (ED)? A scoping review.

Lack of awareness about cultural and religious values and beliefs of patients presenting to Emergency Departments (ED) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade. The changing face of the Australian population requires that Australian health care carefully consider the dominant Western cultural paradigm currently influencing health care delivery. This predominance is particularly critical in the ED, as it is a common gateway into health care services. This scoping review explores the evidence of key components and impacts of culturally safe care (CSC) in the ED for staff and care consumers who identify as Muslim. A systematic search using electronic (five databases) and heading searching methods for primary research was undertaken; followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, and the subsequent content was grouped, synthesized and tested for clinical salience using the six stages of the Arksey and O'Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature. Three studies were included in the analysis. Religious beliefs and practices are common among the individuals who identify as Muslim. Such beliefs and practices could influence patients' understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. These ideals could also impact on a patient's care seeking behaviors and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in the ED locally and internationally. While many EDs may have procedure documents or staff care guidelines, it is unclear as to how these guides were derived, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers.

Effectiveness of educational communication interventions for health professionals to improve quality of care in emergency departments: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to evaluate the effectiveness of educational communication interventions for health professionals in emergency departments. The end result is to identify the specific types of communication based educational strategies utilized by emergency department health care professionals to enhance the quality of care for patients.

Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial.

STUDY OBJECTIVE: We determine whether emergency physician-provided deep sedation with 1:1 ketofol versus propofol results in fewer adverse respiratory events requiring physician intervention when used for procedural sedation and analgesia. METHODS: Consenting patients requiring deep sedation were randomized to receive either ketofol or propofol in a double-blind fashion according to a weight-based dosing schedule. The primary outcome was the occurrence of a respiratory adverse event (desaturation, apnea, or hypoventilation) requiring an intervention by the sedating physician. Secondary outcomes included hypotension and patient satisfaction. RESULTS: Five hundred seventy-three patients were enrolled and randomized, 292 in the propofol group and 281 in the ketofol group. Five percent in the propofol group and 3% in the ketofol group met the primary outcome, an absolute difference of 2% (95% confidence interval [CI] -2% to 5%). Patients receiving propofol were more likely to become hypotensive (8 versus 1%; difference 7%; 95% CI 4% to 10%). Patient satisfaction was very high in both groups (10/10; interquartile range 10 to 10/10), and although the ketofol group was more likely to experience severe emergence delirium (5% versus 2%; difference 3%; 95% CI 0.4% to 6%), they had lower pain scores at 30 minutes postprocedure. Other secondary outcomes were similar between groups. CONCLUSION: Ketofol and propofol resulted in a similar incidence of adverse respiratory events requiring the intervention of the sedating physician. Although propofol resulted in more hypotension, the clinical relevance of this is questionable, and both agents are associated with high levels of patient satisfaction.

Communication and Influencing for ED Professionals: A training programme developed in the emergency department for the emergency department.

OBJECTIVE: The objective of the present study is to develop and pilot a communication and influencing skills training programme that meets ED health professionals' needs at an urban district hospital. METHODS: Qualitative methods within a participatory action research framework were utilised. An interdisciplinary team guided the programme's design and development. A training needs analysis saw team meetings, interviews, focus groups and observations conducted across the ED. Thematic analysis of the data identified health professionals' communication and influencing challenges. The training needs analysis informed the training programme curriculum's development. The pilot programme involved an interdisciplinary group of seven health professionals across 5 × 2 h sessions over 3 months, followed by a post-training survey. RESULTS: Five themes of communication and influencing challenges were identified: participating in effective handovers, involving patients in bedside handovers, effectively communicating with interdepartmental colleagues, asking ED colleagues to do tasks and understanding ED colleagues' roles, expectations and assumptions. Based on these challenges, the formulated RESPECT model (which stands for Relationships, Expectations, Styles, Partnerships, Enquiry, Coaching and Teamwork) informed the training curriculum. The peer coaching model used in the training programme was highly regarded by participants. CONCLUSIONS: Communication and Influencing for ED Professionals™ (Babel Fish Group Pty Ltd, Melbourne, Victoria, Australia) addresses a gap for communication programmes developed in the ED for the ED. Future research will evaluate the programme's impact in this ED.

A systematic review of the evidence for topical use of ginger.

BACKGROUND: The use of ginger as a topical intervention is widely advocated in the popular media. However, there has been no attempt to date to synthesize the evidence for topically administered ginger. OBJECTIVE: To systematically review and synthesize the best available evidence of effectiveness for topical ginger in any condition. DATA SOURCES: CAM on PubMed, CINAHL, Google Scholar, MEDLINE, National Library of Australia, The Cochrane Library, TRIP, pertinent texts, and bibliographies of relevant papers. STUDY SELECTION: Data sources were systematically searched for studies investigating the clinical effectiveness of topical ginger, in any form and for any condition, regardless of study design. Studies were limited to those published between 1980 and 2010, and published in English, Mandarin, Cantonese, or Taiwanese. DATA EXTRACTION: Data were extracted by two authors, independently, using standardized templates. DATA SYNTHESIS: Four studies met the inclusion criteria, including three randomized controlled trials and one non-randomized controlled trial. All studies differed in terms of study population, outcome measures, comparative interventions, and dose and form of ginger used, and thus, were not amenable to meta-analysis. Findings from all trials favored usage of ginger for most outcomes. However, the small sample sizes and inadequate methodological reporting indicate a high risk of bias and the need for caution when interpreting these results. CONCLUSIONS: Few studies have investigated the effectiveness of topically administered ginger for any condition. Until the findings of these studies are corroborated by more robust research, and the safety of ginger is adequately established, clinicians should remain cautious about using topical ginger in clinical practice.

The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review.

BACKGROUND: Ginger has been used throughout the world as a therapeutic agent for centuries. The herb is increasingly used in Western society also, with one of the most common indications being pregnancy-induced nausea and vomiting (PNV). OBJECTIVES: To examine the evidence for the safety and effectiveness of ginger for PNV. METHODS: Randomised controlled trials (RCTs) of ginger and PNV were sourced from CINAHL, the Cochrane library, MEDLINE and TRIP. The methodological quality of RCTs was assessed using the Critical Appraisal Skills Programme (CASP) tool. RESULTS: Four RCTs met the inclusion criteria. All trials found orally administered ginger to be significantly more effective than placebo in reducing the frequency of vomiting and intensity of nausea. Adverse events were generally mild and infrequent. CONCLUSION: The best available evidence suggests that ginger is a safe and effective treatment for PNV. However, there remains uncertainty regarding the maximum safe dosage of ginger, appropriate duration of treatment, consequences of over-dosage, and potential drug-herb interactions; all of which are important areas for future research.