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1.
J Med Radiat Sci ; 66(3): 212-217, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31317665

RESUMO

One of the largest change operations to take place in South Australia was the moving of the Royal Adelaide Hospital (RAH) to its new site in 2017. Change can influence workplace effectiveness and staff satisfaction and morale. Understanding the stages of change, staff experience and carefully managing the process is important. This paper aims to describe the successful move of the radiation therapy department at the RAH to its new site, focusing on the staff experience and management strategies to ensure the success of the move. A four-stage model of change was used to guide understand, manage and reflect upon the transition of the RAH radiation therapy department to a new site. Key change events and management strategies are described and aligned with the four stages of change. The move to the new site was a great success with a transition period working across two sites enabling a slower ramp up of activity at the new site supporting staff and patients in adjusting to the new environment. The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology. At the RAH, innovation and development are encouraged, along with management having a comprehensive understanding of organisational change enabling the radiation oncology department to successfully navigate rapid change.


Assuntos
Gestão de Mudança , Serviço Hospitalar de Oncologia/organização & administração , Radio-Oncologistas/organização & administração , Serviço Hospitalar de Radiologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Radio-Oncologistas/normas , Serviço Hospitalar de Radiologia/normas , Austrália do Sul
2.
Nurs Adm Q ; 43(3): 280-288, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162348

RESUMO

Traditional quality assurance processes provide significant opportunities for positive disruption. Doctor of Nursing Practice (DNP) students are well positioned to apply program learning to large-scale change in complex organizations. This article presents an innovative approach for creating a point-of-care interdisciplinary approach to address high fall risk frequencies in ambulatory oncology clinics using complexity leadership principles. Processes for nurse executives to consider for replication of this approach for other challenging clinical situations are suggested using the emerging competence of DNP educated nurses. Adults with cancer who are older than 65 years are at a higher risk for falls than older adults without cancer. Oncology providers and nurses are not routinely screening, documenting, and preventing falls. A fall injury in an older adult with cancer may not only delay or impact cancer treatment but also result in hospitalization, loss of function, and/or death. Increasing awareness of the impact of falls and implementing change within a large ambulatory health care organization requires an interdisciplinary team approach. Complexity theory supports nonlinear change initiated at the grassroots level to create a dynamic movement to bring forth emergence and adaptation. The use of the Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative will enable oncology professionals to screen, assess, and intervene by collaborating, communicating, and coordinating with other health care specialists to introduce a fall prevention quality improvement system process. Nurse executives need to know about STEADI.


Assuntos
Acidentes por Quedas/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/normas , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria/métodos , Geriatria/normas , Humanos , Masculino , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/normas , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
3.
Bull Cancer ; 106(6): 514-526, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31126678

RESUMO

The emergence of oral cancer treatment in oncology has shifted patient follow-up from the hospital to the home. This trend has resulted in an increase in phone and e-mail interactions initiated by patients, but also by pharmacists, by liberal nurses, by general practitioners, and an increase in calls to the emergency response services (SAMU) both for real or perceived emergencies. This increased volume of patient and pharmacist communication has caused significant disruption in the daily activity of affected oncology departments and in particular of the secretariats. The procedures for formulating and securing appropriate responses within a short time frame are generally not established, and as a result, there is a risk that decisions made could be inappropriate for the patient's situation, especially in the case of complications.. Tracking responses to phone calls is necessary and answers should be noted in the medical file, including side effects, in particular the serious AEs for a good quality of care. This guideline describes best practices for oncologists who manage "incoming" calls from patients or professionals involved in the care pathway.


Assuntos
Antineoplásicos/uso terapêutico , Correio Eletrônico , Serviço Hospitalar de Emergência/organização & administração , Sistemas de Comunicação no Hospital/organização & administração , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia/organização & administração , Guias de Prática Clínica como Assunto , Telefone , Administração Oral , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Continuidade da Assistência ao Paciente , Serviço Hospitalar de Emergência/estatística & dados numéricos , Assistência Domiciliar , Humanos , Comunicação Interdisciplinar , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente
5.
Nurs Health Sci ; 21(2): 164-170, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30345585

RESUMO

The everyday landscape of occupational therapy (OT) in oncology is underexplored, hindering targeted improvements. The purpose of the present study was to identify the OT interventions commonly provided and reimbursed in oncology. A survey utilizing snowball sampling was disseminated online to OT working in oncology care; 167 surveys were received from 21 states in the United States. Results found that over 90% of therapists reported focusing on physical impairment, weakness, fatigue, and activities of daily living. Interventions for emotional/social support, self-advocacy, quality of life, lifestyle management, and cognitive impairment were not directly billed. More than 90% of therapists reported that, in the absence of barriers, they would address quality of life, emotional difficulties, lifestyle management, and home safety. Overall, the findings suggested that OT in the United States primarily provide physical interventions for oncology patients. However, they also provide psychosocial services and client/caregiver education, but often do not bill directly for this care. Reimbursement structures should be modified to allow for the direct billing of mental/psychosocial and educational interventions in OT for cancer care.


Assuntos
Terapia Ocupacional/métodos , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/tendências , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/tendências , Qualidade de Vida , Inquéritos e Questionários , Estados Unidos
6.
Eur J Cancer Care (Engl) ; 28(1): e12918, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30284337

RESUMO

This study was designed to focus on the patient perspective in a reorganisation of care processes at a cancer day care unit (CDU). The effects of dose banding and of taking blood samples one day (or more) before the day care treatment (on Day -1) are investigated in terms of throughput efficiency and perceived service quality. Data were collected by mapping patient processes in detail and surveying patients in two CDUs at a university hospital (n = 308). A univariate model was used to investigate the effect of these factors on patient throughput time, and perceived service quality was examined with multiple linear regression. Taking blood samples on Day -1 decreases patient throughput time and increases the perceived service quality by improving the patient's perception of technical expertise and the outcome. This has a globally positive effect on patients' perceived service quality. Dose banding affected neither patient throughput time nor perceived service quality. Taking the pretreatment blood sample on Day -1 can be considered an important process design characteristic, as it increases both efficiency and service quality.


Assuntos
Antineoplásicos/administração & dosagem , Hospital Dia/organização & administração , Eficiência Organizacional , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia/organização & administração , Qualidade da Assistência à Saúde , Assistência Ambulatorial , Humanos , Modelos Lineares , Fatores de Tempo
7.
Scand J Prim Health Care ; 36(4): 437-445, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30375906

RESUMO

INTRODUCTION: While close collaboration between general practitioners (GPs) and hospital specialists is considered important, the sharing of care responsibilities between GPs and oncologists during palliative chemotherapy has not been clearly defined. OBJECTIVE: Evaluate the opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy. DESIGN: We conducted semi-structured interviews using six hypothetical scenarios with purposively sampled GPs (n = 12) and oncologists (n = 10) in the Netherlands. Each represented an example of a clinical problem requiring different aspects of care: problems likely, or not, related to cancer or chemotherapy, need for decision support, and end-of-life care. RESULTS: GPs and oncologists agreed that GPs should provide end-of-life care and that they should be involved in decisions about palliative chemotherapy; however, for the other scenarios most participants considered themselves the most appropriate provider of care. Themes that emerged regarding who would provide the best care for the patients in the different scenarios were expertise, continuity of care, accessibility of care, doctor-patient relationship, and communication. Most participants mentioned improved communication between the GP and oncologist as being essential for a better coordination and quality of care. CONCLUSION: GPs and oncologists have different opinions about who should ideally provide different aspects of care during palliative chemotherapy. Findings raise awareness of the differences in reasoning and approaches and in current communication deficits between the two groups of health professionals. These findings could be used to improve coordination and collaboration and, ultimately, better patient care as results demonstrated that both disciplines can add value to the care for patients with advanced cancer. Key points This study identified contrasting opinions of GPs and oncologists about who should provide different aspects of care for patients receiving palliative chemotherapy. Important themes that emerged were expertise, continuity of care, doctor-patient relations, accessibility of care, and communication. Although frequently using the same arguments, GPs and oncologists often considered themselves to be the most appropriate providers of palliative care.


Assuntos
Antineoplásicos/uso terapêutico , Assistência à Saúde/organização & administração , Medicina de Família e Comunidade/organização & administração , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia/organização & administração , Cuidados Paliativos/organização & administração , Adulto , Atitude do Pessoal de Saúde , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Papel do Médico , Relações Médico-Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/organização & administração , Assistência Terminal/organização & administração
8.
Pflege ; 31(6): 331-337, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-30183508

RESUMO

Evaluation of the implementation process of family nursing in oncology Abstract. BACKGROUND: The confrontation with a life-threatening cancer disease and the resulting consequences are a great burden for patients as well as for their family members. Family nursing based on the Calgary Model was implemented on a German oncological inpatient unit in order to strengthen the family's ability to self-help. AIM: The objectives were a) to systematically record, evaluate and if necessary to modify the implementation process, b) to highlight promoting and inhibiting factors and c) to derive recommendations for transferability to other oncological units. METHODS: The implementation process was examined by means of two group interviews with nurses, five interviews with other members of the treatment team, and observations of, in each case four, family assessments, family interviews and family-related team meetings. RESULTS: Family nursing could be implemented in a modified form. Genograms and ecomaps have become part of the admission interview. In family interviews, needs of the entire family were determined with the help of circular communication. Family-related team meetings were carried out according to an adapted method of the reflecting team. The complete implementation of family nursing was impeded by the lack of professional consulting competences of the nursing staff, the system of nursing care delivery and lack of time. CONCLUSION: An implementation of family nursing in other oncological units is recommended under modified preconditions.


Assuntos
Enfermagem Familiar/organização & administração , Serviço Hospitalar de Oncologia/organização & administração , Humanos , Pesquisa em Avaliação de Enfermagem
9.
Curr Oncol Rep ; 20(10): 81, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30203261

RESUMO

PURPOSE OF REVIEW: This review aims to outline the general principles of how to build a cardio-onco-hematology clinic, acknowledging that there are diverse practices ranging from private community settings to academic hospitals and each practice environment has to build its own program. RECENT FINDINGS: The refinement of regimens and introduction of molecularly directed therapies have substantially increased survival rates for patients with cancer. In fact, a number of previous imminently fatal malignant disease processes have been turned into chronic diseases, such that patients now live with certain incurable cancers as they do, for instance, with rheumatoid arthritis. Improved cure rates and longer survivals have raised side effects of cancer treatments to a completely new level of significance. Cardiovascular toxicities are of particular concern given their impact on morbidity and mortality. In most extreme cases, patients might be cured from cancer but remain debilitated or die prematurely because of cardiovascular disease. Furthermore, not an insignificant proportion of cancer patients start cancer therapy with cardiovascular risk factors and diseases at baseline. With the aging of the population, this "joint venture" is only expected to increase with important implications for the management of cancer patients. Given the need for familiarity with both, cancer and cardiovascular diseases and their ever-evolving start-of-the-art therapy and interaction potential, specialized efforts have been invoked, which may collectively be termed "onco-cardiology," "cardio-oncology," or "cardio-onco-hematology." Herein, we provide recommendations for the creation and optimization of any such programmatic efforts.


Assuntos
Serviço Hospitalar de Cardiologia/organização & administração , Doenças Cardiovasculares/prevenção & controle , Neoplasias Hematológicas/prevenção & controle , Hematologia/organização & administração , Serviço Hospitalar de Oncologia/organização & administração , Doenças Cardiovasculares/etiologia , Neoplasias Hematológicas/complicações , Humanos
10.
Interface (Botucatu, Online) ; 22(66): 939-949, jul.-set. 2018. ilus
Artigo em Português | LILACS | ID: biblio-954316

RESUMO

O presente estudo apresenta o planejamento e implementação de um produto educacional em Saúde na modalidade Residência Multiprofissional Integrada em Onco-Hematologia, com enfoque teórico da gestão estratégica. Trata-se de uma intervenção aplicada que integra ensino e serviço, conforme o processo do Project Management Institute. O cenário foi uma universidade federal brasileira em parceria com um centro de alta complexidade em Oncologia. Em 2014, o programa foi planejado orientado pela gestão estratégica das instituições, sendo implementado em 2015. A residência oportuniza qualificação multiprofissional, oferecendo oito vagas por ano. Este produto resultou de um trabalho desenvolvido no Mestrado Profissional em Ensino na Saúde, financiado pelo Governo Federal. A academia e o serviço potencializaram esforços para promover ações colaborativas atendendo às necessidades da sociedade, alinhados às políticas de Estado que priorizam a atenção ao câncer, seguindo as diretrizes do Sistema Único de Saúde (SUS).(AU)


Este estudio presenta la planificación e implementación de un producto educativo en salud en la modalidad Residencia Multi-profesional integrada en Onco-Hematología, con enfoque teórico de la gestión estratégica. Se trata de una intervención aplicada que integra enseñanza y servicio, conforme el proceso del Project Management Institute. El escenario fue una universidad federal brasileña en alianza con un centro de alta complejidad en Oncología. En 2014, se planificó el programa orientado por la gestión estratégica de las instituciones, implementándose en 2015. La residencia proporciona la oportunidad de calificación multi-profesional, ofreciendo ocho plazas por año. Este producto fue resultado de un trabajo desarrollado en la Maestría Profesional en Enseñanza en Salud, financiado por el Gobierno Federal Brasileño. La academia y el servicio potenciaron esfuerzos para promover acciones colaborativas atendiendo las necesidades de la sociedad, alineados a las políticas de Estado que priorizan la atención al cáncer, siguiendo las directrices del del Sistema Brasileño de Salud (SUS).(AU)


In this paper we share details about the planning and implementation of a health education product deployed in a multi-professional residency in onco-hematology, using strategic management as the theoretical framework. The study represents an applied intervention that integrates teaching and service provision, based on processes established by the Project Management Institute. The study took place at a Brazilian Federal University in partnership with a center for high complexity oncology. Planning for the program began in 2014, based on the strategic management of the institutions involved, and implementation started in 2015. The residency provides an opportunity for professional training, with eight places made available each year. The product was the result of work carried out in the Professional Master's for Health Teaching that is financed by the Brazilian Federal Government. The academic institution and the service provider joined forces to promote collective actions that meet societal needs and are aligned with public policies that place a priority on cancer care, based on guidelines laid out by the Brazilian National Health System (SUS).(AU)


Assuntos
Humanos , Ensino , Serviço Hospitalar de Oncologia/organização & administração , Gestão em Saúde , Internato não Médico
11.
Rev Gaucha Enferm ; 39: e20170102, 2018 Jul 23.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30043944

RESUMO

OBJECTIVE: To identify scientific literature on oncology nurses who provide patient navigation services as nurse navigators. METHODS: Integrative review of literature searches in the databases LILACS, MEDLINE/PubMed, SCOPUS, SciELO, Web of Science and Science Direct based on the descriptors patient; navigation; nurse; professional; cancer; oncology; navigator; and navigators. RESULTS: Seventeen articles were identified and grouped according to the following thematic approach: Care Processes; Patients; and Health Workers. It was observed that scientific literature on nurse navigators mostly comes from the United States, Australia, Canada, Sweden, and Demark, where the first nurse navigator programmes were introduced. No studies were found in local journals or populations. CONCLUSIONS: The nurse navigator offer a unique service for the provision of quality care. Although international research is recent, further studies on the role of these professionals are clearly needed.


Assuntos
Papel do Profissional de Enfermagem , Enfermagem Oncológica , Navegação de Pacientes , Austrália , Estudos Epidemiológicos , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Neoplasias/enfermagem , Neoplasias/reabilitação , Neoplasias/terapia , América do Norte , Relações Enfermeiro-Paciente , Processo de Enfermagem , Serviço Hospitalar de Oncologia/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Países Escandinavos e Nórdicos
13.
Eur J Cancer Care (Engl) ; 27(5): e12869, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29956859

RESUMO

To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR] = 1.18, 95%CI = 1.12-1.25) and higher distress (OR = 1.68, 95%CI = 1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR = 1.12, 95%CI = 1.06-1.19) and lower distress (OR = 0.58, 95%CI = 0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.


Assuntos
Neoplasias , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Apoio Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Neoplasias/complicações , Neoplasias/psicologia , Neoplasias/terapia , Serviço Hospitalar de Oncologia/organização & administração , Cuidados Paliativos/estatística & dados numéricos , Psicoterapia , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia , Triagem/organização & administração , Adulto Jovem
14.
Radiología (Madr., Ed. impr.) ; 60(supl.1): 64-81, mayo 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-175339

RESUMO

Los avances recientes en la biología y la genética han acelerado nuestro conocimiento sobre el desarrollo, el crecimiento y la diseminación del cáncer, generando grandes expectativas de poder trasladar esos nuevos descubrimientos a tratamientos efectivos para los pacientes. Las técnicas de imagen ocupan un lugar central en la asistencia del paciente oncológico, dado que se han convertido en herramientas capaces de valorar importantes características tumorales y la respuesta de los tumores a las distintas terapias. El objetivo de este artículo es evaluar los diferentes criterios de respuesta tumoral basados en la imagen, conociendo sus ventajas y limitaciones, e ilustrar la posible aportación de las nuevas técnicas de imagen como biomarcadores de respuesta


Recent advances in biology and genetics have accelerated our knowledge about the development, growth, and dissemination of cancer, generating great expectations that these new discoveries will be translated into effective treatments for patients. Imaging techniques play a central role in the care of oncologic patients, since they have become tools capable of evaluating important characteristics of tumors and the response of tumors to different treatments. The objective of this article is to evaluate the different imaging-based criteria for assessing tumor response, discussing their advantages and limitations and illustrating the possible contribution of new imaging techniques as biomarkers of tumor response


Assuntos
Humanos , Antineoplásicos/farmacocinética , Neoplasias/terapia , Quimiorradioterapia/estatística & dados numéricos , Terapia Combinada/estatística & dados numéricos , Serviço Hospitalar de Oncologia/organização & administração , Resultado do Tratamento , Neoplasias/diagnóstico por imagem , Progressão da Doença
15.
Clin. transl. oncol. (Print) ; 20(4): 443-447, abr. 2018.
Artigo em Inglês | IBECS | ID: ibc-171636

RESUMO

Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Precision medicine is transforming clinical and biomedical research, as well as health care itself from a conceptual, as well as a methodological viewpoint, providing extraordinary opportunities to improve public health and lower the costs of the healthcare system. However, the implementation of precision medicine poses ethical–legal, regulatory, organizational, and knowledge-related challenges. Without a national strategy, precision medicine, which will be implemented one way or another, could take place without the appropriate planning that can guarantee technical quality, equal access of all citizens to the best practices, violating the rights of patients and professionals, and jeopardizing the solvency of the healthcare system. With this paper from the Spanish Societies of Medical Oncology, Pathology, and Hospital Pharmacy, we highlight the need to institute a consensual national strategy for the development of precision medicine in our country, review the national and international context, comment on the opportunities and challenges for implementing precision medicine, and outline the objectives of a national strategy on precision medicine in cancer (AU)


No disponible


Assuntos
Humanos , Medicina de Precisão/tendências , Radioterapia (Especialidade)/organização & administração , Oncologia Cirúrgica/organização & administração , Oncologia/organização & administração , Serviço Hospitalar de Oncologia/organização & administração , Estratégias Nacionais
16.
BMJ ; 360: k668, 2018 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514787

RESUMO

OBJECTIVE: To determine the differences between recommendations by the National Comprehensive Cancer Network (NCNN) guidelines and Food and Drug Administration approvals of anticancer drugs, and the evidence cited by the NCCN to justify recommendations where differences exist. DESIGN: Retrospective observational study. SETTING: National Comprehensive Cancer Network and FDA. PARTICIPANTS: 47 new molecular entities approved by the FDA between 2011 and 2015. MAIN OUTCOME MEASURES: Comparison of all FDA approved indications (new and supplemental) with all NCCN recommendations as of 25 March 2016. When the NCCN made recommendations beyond the FDA's approvals, the recommendation was classified and the cited evidence noted. RESULTS: 47 drugs initially approved by the FDA between 2011 and 2015 for adult hematologic or solid cancers were examined. These 47 drugs were authorized for 69 FDA approved indications, whereas the NCCN recommended these drugs for 113 indications, of which 69 (62%) overlapped with the 69 FDA approved indications and 44 (39%) were additional recommendations. The average number of recommendations beyond the FDA approved indications was 0.92. 23% (n=10) of the additional recommendations were based on evidence from randomized controlled trials, and 16% (n=7) were based on evidence from phase III studies. During 21 months of follow-up, the FDA granted approval to 14% (n=6) of the additional recommendations. CONCLUSION: The NCCN frequently recommends beyond the FDA approved indications even for newer, branded drugs. The strength of the evidence cited by the NCCN supporting such recommendations is weak. Our findings raise concern that the NCCN justifies the coverage of costly, toxic cancer drugs based on weak evidence.


Assuntos
Antineoplásicos/farmacologia , Aprovação de Drogas/métodos , Serviço Hospitalar de Oncologia/organização & administração , Administração dos Cuidados ao Paciente/normas , Medicina Baseada em Evidências/métodos , Humanos , Organizações sem Fins Lucrativos/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , United States Food and Drug Administration
17.
Rev. Rol enferm ; 41(3): 176-187, mar. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171218

RESUMO

Introducción. Vivir la experiencia de tener un hijoa con cáncer es una situación que genera una crisis en la familia que afecta no solo a nivel estructural, sino también emocional. Las enfermeras son las profesionales miembros del equipo multidisciplinar que se relacionan más tiempo con estas familias, por lo que es interesante saber cómo evidencian esta experiencia para poder mejorar la práctica asistencial, que debe contemplar una orientación holística dentro de los cuidados de alta complejidad que precisa un niño oncológico. Objetivos. Analizar el impacto en las familias producido por el debut de una enfermedad oncológica infantil; describir la percepción de las enfermeras sobre el impacto y la vivencia de las familias en el inicio de una enfermedad oncológica infantil y comparar la percepción que tienen las familias con la percepción de las enfermeras con respecto al debut de la enfermedad oncológica infantil. Ámbito de estudio. Unidad de Oncología y Hospital de Día del Hospital Sant Joan de Déu de Barcelona. Metodología. Estudio cualitativo siguiendo un enfoque basado en la fenomenología hermenéutica de Heidegger. Los participantes serán las familias de niños con cáncer y las enfermeras dedicadas a su cuidado. Para la recogida de datos se utilizará la entrevista en profundidad y, si se considerara pertinente, el grupo de discusión. El tipo de análisis utilizado será el de la temática bajo el método de análisis del contenido, siguiendo el método de análisis Guía QUAGOL (Qualitative Analysis Guide of Leuven) (AU)


Introduction. Going through the experience of having a child with cancer often results in a structural and emotional crisis for the family. Nurses, as professional members of a multidisciplinary team, interrelate the most with the families of oncologic pediatric patients. It is of great interest to provide evidence of nurses’ experience, in order to improve the care practice for children with cancer. Due to these patients’ highly complex needs in terms of care, a holistic approach is required. Objectives. To design a study which will determine the impact that the debut of an oncologic disease on a child has on families, by comparing nurses’ perception on the impact and experience of families going through this process to those of the actual family. Field of study. Oncology Unit and Day Hospital Sant Joan de Déu, Barcelona. Methodology. A qualitative study based on Heidegger’s hermeneutic phenomenology. The subjects of study will be parents of children with cancer and nurses involved in their care. For data collection, interviews and group discussions (if considered relevant) will be collected. The type of analysis used will be content analysis, following the QUAGOL Guide (Qualitative Analysis Guide of Leuven) (AU)


Assuntos
Humanos , Criança , Enfermagem Oncológica/tendências , Serviço Hospitalar de Oncologia/organização & administração , Oncologia/tendências , Perfil de Impacto da Doença , Criança Hospitalizada/psicologia , Sistemas de Apoio Psicossocial , Apoio Social , Incerteza , Cuidadores/psicologia , Cuidados de Enfermagem/organização & administração
18.
BMC Health Serv Res ; 18(1): 85, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415717

RESUMO

BACKGROUND: In general, patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. Using various "operations management" techniques a few fast track diagnostic services were implemented in the Netherlands Cancer Institute (NKI) in 2006. Growing patient numbers and increasing process complexity, led to diminished service levels. To decrease the amount of patient visits and to extend these services beyond the (obvious) breast cancer services, fast track diagnostics is now implemented for all 18 cancer types that present with a frequency of minimally one per week. METHODS: The throughput time (first visit to diagnosis conversation) was measured before, and after implementation of fast track diagnostics. The process was redesigned closely involving the multidisciplinary teams. In an eclectic approach elements from lean management, theory of constraints and mathematical analysis were used to organize slots per tumor type for MRI, CT, PET and echography. A post measurement was performed after 3 and 6 months. RESULTS: In pre measurement access time was calculated to be 10 to 15 workdays, mean throughput time was 6.0 workdays. It proved possible to design the process of 18 tumors as a fast track, of which 7 as "one stop shop" (diagnosis completed in one visit). Involvement of clinical- and board leadership, massive communication efforts and commitment of physicians to reschedule their work proved decisive. After 3 and 6 months of implementation, the mean access time was 8.2 and 8.7 workdays respectively and mean throughput time was 3.4 and 3.3 workdays respectively. CONCLUSIONS: Throughput- and access time were considerably shortened after implementation of fast track diagnostics for 18 cancer types. The involvement of physicians in reorganizing their work and rapid responding to their needs during the implementation phase were a crucial success factor.


Assuntos
Procedimentos Clínicos/organização & administração , Detecção Precoce de Câncer , Pesquisa sobre Serviços de Saúde , Neoplasias/diagnóstico , Serviço Hospitalar de Oncologia/organização & administração , Comunicação , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Países Baixos
20.
Am J Infect Control ; 46(2): 229-231, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29031430

RESUMO

To prevent central line-associated bloodstream infections (CLABSIs), leadership line care rounds (LLCRs) used the engage, educate, execute, and evaluate improvement model to audit compliance, identify barriers and opportunities, empower patients and families, and engage leadership. Findings of excellence and improvement opportunities were communicated to unit staff and managers. LLCRs contributed to compliance with CLABSI prevention interventions.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/prevenção & controle , Liderança , Serviço Hospitalar de Oncologia/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Bacteriemia/prevenção & controle , Criança , Humanos , Garantia da Qualidade dos Cuidados de Saúde/normas
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