Pancreatic Adenocarcinoma: Real World Evidence of Care Delivery in AccessHope Data.

BACKGROUND: Pancreatic adenocarcinoma is an aggressive disease and the delivery of comprehensive care to individuals with this cancer is critical to achieve appropriate outcomes. The identification of gaps in care delivery facilitates the design of interventions to optimize care delivery and improve outcomes in this population. METHODS: AccessHope™ is a growing organization that connects oncology subspecialists with treating providers through contracts with self-insured employers. Data from 94 pancreatic adenocarcinoma cases (August 2019-December 2022) in the AccessHope dataset were used to describe gaps in care delivery. RESULTS: In all but 6% of cases, the subspecialist provided guideline-concordant recommendations anticipated to improve outcomes. Gaps in care were more pronounced in patients with non-metastatic pancreatic cancer. There was a significant deficiency in germline testing regardless of the stage, with only 59% of cases having completed testing. Only 20% of cases were receiving palliative care or other allied support services. There was no difference in observed care gaps between patients receiving care in the community setting vs. those receiving care in the academic setting. CONCLUSIONS: There are significant gaps in the care delivered to patients with pancreatic adenocarcinoma. A concurrent subspecialist review has the opportunity to identify and address these gaps in a timely manner.

Local responses to global sustainability agendas: learning from experimenting with the urban sustainable development goal in Cape Town.

The success of the Sustainable Development Goal 11 (SDG 11) depends on the availability and accessibility of robust data, as well as the reconfiguration of governance systems that can catalyse urban transformation. Given the uneven success of the Millennium Development Goals, and the unprecedented inclusion of the urban in the SDG process, the feasibility of SDG 11 was assessed in advance of its ratification through a series of urban experiments. This paper focusses on Cape Town's participation in piloting SDG 11, in order to explore the role of urban experimentation in highlighting the partnership arrangements necessary to allow cities to meet the data and governance challenges presented by the SDG 11. Specifically, we focus on the relationship between data and governance that lie at the heart of the SDG 11. The urban experiment demonstrates the highly complex and multi-level governance dynamics that shape the way urban experiments are initiated, executed and concluded. The implications of these dependencies illustrate that more attention needs to be paid at the global level to what data are important and how and where the data are generated if SDG 11 is to be met. Overall, this paper makes the case that the success of SDG 11 rests on effecting local level change and enabling real opportunities in cities.

Soft on sticks: an evidence-based practice approach to reduce children's needlestick pain.

Soft on Sticks is a comprehensive, interdisciplinary, evidence-based practice initiative that was implemented to ensure consistent use of pharmacologic and nonpharmacologic interventions to reduce pain associated with needlestick procedures performed on children. Pre- and postimplementation data from children, parents, and nurses showed positive results from the practice change and identified areas for further improvement.

Acute oropharyngeal and esophageal stick injury in forty-one dogs.

OBJECTIVE: To report clinical findings, treatment, and outcome in dogs with acute (<7 days) oropharyngeal or esophageal stick injury. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=41) with acute oropharyngeal or esophageal injury. METHODS: Dogs had clinical and radiographic examination, and frequently, cervical surgical exploration. The decision to operate was based on radiographic findings of cervical emphysema. Outcome was determined by owner or veterinarian interview. RESULTS: Of 41 dogs, 27 had oropharyngeal injury and 14 had esophageal injury. Five dogs with esophageal injury died. All dogs with radiographic evidence of cervical emphysema (n=34) had ventral median cervical exploration or necropsy; 11 had wood fragment(s) retrieved. In 7 dogs without radiographic signs of cervical emphysema, wounds involving the pharynx or soft palate were treated by local debridement and lavage using an oral approach. Mean follow-up time was 36.4 months. All wounds healed without complication; however, 1 dog that was not surgically explored had a piece of wood surgically retrieved 3 months later. CONCLUSIONS: Radiographic evidence of cervical emphysema is a frequent finding in dogs with acute penetrating oropharyngeal or esophageal injury and indicates trauma to the deeper cervical tissues. Acute penetrating injury of the oropharyngeal region, when treated appropriately, has a better prognosis than acute esophageal penetration. CLINICAL RELEVANCE: Ventral median cervical surgical exploration is recommended in dogs with acute penetrating injury of the oropharynx or esophagus if there is radiographic evidence of tissue emphysema.

Emergency consults in the setting of transplant medicine: dilemmas for social workers and bioethicists.

Transplant medicine is a setting filled with emotions and uncertainty. The clinical cases are frequently complex and affected by psychosocial and ethics variables as well as time constraints. For the nonurgent patient, there is usually ample time to complete the necessary evaluations. In urgent situations, however, time is limited and social workers and ethicists often find themselves racing to conduct assessments that provide information that is important for decision making regarding a patient's suitability for organ transplantation. The same can be said for decisions about insertion of ventricular assist devices and living organ donation. Using 2 cases, we explore the practice of emergency consultation (distinguished from "curbside consultation") and offer guidance for conducting these assessments.