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1.
JBJS Rev ; 12(7)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38991098

RESUMO

¼ Artificial intelligence is an umbrella term for computational calculations that are designed to mimic human intelligence and problem-solving capabilities, although in the future, this may become an incomplete definition. Machine learning (ML) encompasses the development of algorithms or predictive models that generate outputs without explicit instructions, assisting in clinical predictions based on large data sets. Deep learning is a subset of ML that utilizes layers of networks that use various inter-relational connections to define and generalize data.¼ ML algorithms can enhance radiomics techniques for improved image evaluation and diagnosis. While ML shows promise with the advent of radiomics, there are still obstacles to overcome.¼ Several calculators leveraging ML algorithms have been developed to predict survival in primary sarcomas and metastatic bone disease utilizing patient-specific data. While these models often report exceptionally accurate performance, it is crucial to evaluate their robustness using standardized guidelines.¼ While increased computing power suggests continuous improvement of ML algorithms, these advancements must be balanced against challenges such as diversifying data, addressing ethical concerns, and enhancing model interpretability.


Assuntos
Neoplasias Ósseas , Aprendizado de Máquina , Humanos , Neoplasias Ósseas/diagnóstico por imagem , Tomada de Decisão Clínica , Ortopedia , Oncologia
2.
BMC Med Educ ; 24(1): 715, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38956512

RESUMO

BACKGROUND: Sickle cell disease (SCD) exemplifies many of the social, racial, and healthcare equity issues in the United States. Despite its high morbidity, mortality, and cost of care, SCD has not been prioritized in research and clinical teaching, resulting in under-trained clinicians and a poor evidence base for managing complications of the disease. This study aimed to perform a needs assessment, examining the perspectives of medical trainees pursuing hematology/oncology subspecialty training regarding SCD-focused education and clinical care. METHOD: Inductive, iterative thematic analysis was used to explore qualitative interviews of subspecialty hematology-oncology trainees' attitudes and preferences for education on the management of patients with SCD. Fifteen trainees from six programs in the United States participated in 4 focus groups between April and May 2023. RESULTS: Thematic analysis resulted in 3 themes: 1. Discomfort caring for patients with SCD. 2. Challenges managing complications of SCD, and 3. Desire for SCD specific education. Patient care challenges included the complexity of managing SCD complications, limited evidence to guide practice, and healthcare bias. Skill-building challenges included lack of longitudinal exposure, access to expert clinicians, and didactics. CONCLUSIONS: Variations in exposure, limited formal didactics, and a lack of national standardization for SCD education during training contributes to trainees' discomfort and challenges in managing SCD, which in turn, contribute to decreased interest in entering the SCD workforce. The findings underscore the need for ACGME competency amendments, dedicated SCD rotations, and standardized didactics to address the gaps in SCD education.


Assuntos
Anemia Falciforme , Grupos Focais , Avaliação das Necessidades , Pesquisa Qualitativa , Humanos , Anemia Falciforme/terapia , Masculino , Feminino , Estados Unidos , Atitude do Pessoal de Saúde , Hematologia/educação , Oncologia/educação , Adulto , Competência Clínica , Educação de Pós-Graduação em Medicina
3.
4.
JCO Clin Cancer Inform ; 8: e2400039, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38950323

RESUMO

Randomized trials provide high-quality, internally consistent data on selected clinical questions, but lack generalizability for the aging population who are most often diagnosed with cancer and have comorbid conditions that may affect the interpretation of treatment benefit. The need for high-quality, relevant, and timely data is greater than ever. Promising solutions lie in the collection and analysis of real-world data (RWD), which can potentially provide timely insights about the patient's course during and after initial treatment and the outcomes of important subgroups such as the elderly, rural populations, children, and patients with greater social health needs. However, to inform practice and policy, real-world evidence must be created from trustworthy and comprehensive sources of RWD; these may include pragmatic clinical trials, registries, prospective observational studies, electronic health records (EHRs), administrative claims, and digital technologies. There are unique challenges in oncology since key parameters (eg, cancer stage, biomarker status, genomic assays, imaging response, side effects, quality of life) are not recorded, siloed in inaccessible documents, or available only as free text or unstructured reports in the EHR. Advances in analytics, such as artificial intelligence, may greatly enhance the ability to obtain more granular information from EHRs and support integrated diagnostics; however, they will need to be validated purpose by purpose. We recommend a commitment to standardizing data across sources and building infrastructures that can produce fit-for-purpose RWD that will provide timely understanding of the effectiveness of individual interventions.


Assuntos
Registros Eletrônicos de Saúde , Oncologia , Neoplasias , Humanos , Oncologia/métodos , Oncologia/normas , Neoplasias/terapia , Neoplasias/diagnóstico , Sistema de Registros
6.
Acta Oncol ; 63: 518-525, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38946287

RESUMO

AIM: The study aims to investigate the impact of the COVID-19 pandemic on cancer patients' perceptions of the quality of their oncological treatment and care. BACKGROUND: The COVID-19 pandemic disrupted healthcare delivery and oncological resources were repurposed, potentially leading to prolonged treatment and reduced access to innovative therapies and clinical trials. Still, little is known about how patients perceived the quality of their treatment. METHODS: A cross-sectional study was conducted in the spring of 2020 among cancer patients at the Department of Oncology, Aarhus University Hospital and Rigshospitalet, Denmark. Patients were invited to complete an online questionnaire on clinical, socioeconomic, emotional, behavioural, and quality-related aspects of oncological cancer care. Patients who experienced reduced treatment quality and those who reported no or slight reductions were compared using multiple logistic regression, exploring the associations with patient characteristics, behaviours, and fear of cancer progression or recurrence. RESULTS: A total of 2,040/5,372 patients experienced changes in their treatment plans during the pandemic, and 1,570/5,372 patients experienced reduced treatment quality, with 236 reporting a high degree of reduction. Patients with breast, head and neck, and upper gastrointestinal cancers were more likely to experience reduced treatment quality. Altered interactions with healthcare providers, along with isolation, lack of social support, and heightened fear of cancer progression, were significant risk factors for experiencing reduced cancer care quality. INTERPRETATION: We identified subgroups of cancer patients needing targeted communication and care during health crises affecting cancer treatment. The findings underscore the importance of safeguarding the needs of vulnerable patient populations in future healthcare emergencies.


Assuntos
COVID-19 , Neoplasias , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde , Humanos , COVID-19/epidemiologia , Estudos Transversais , Feminino , Masculino , Neoplasias/terapia , Neoplasias/psicologia , Neoplasias/epidemiologia , Pessoa de Meia-Idade , Idoso , Dinamarca/epidemiologia , Qualidade da Assistência à Saúde/normas , Adulto , SARS-CoV-2 , Inquéritos e Questionários , Oncologia/normas , Pandemias
8.
Support Care Cancer ; 32(7): 476, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38954101

RESUMO

CONTEXT: Home palliative care service increases the chance of dying at home, particularly for patients with advanced cancer, but late referrals to home palliative care services still exist. Indicators for evaluating programs that can facilitate the integration of oncology and home palliative care have not been defined. OBJECTIVES: This study developed quality indicators for the integration of oncology and home palliative care in Japan. METHODS: We conducted a systematic literature review (Databases included CENTRAL, MEDLINE, EMBASE, and Emcare) and a modified Delphi study to develop the quality indicators. Panelists rated a potential list of indicators using a 9-point scale over three rounds according to two criteria: appropriateness and feasibility. The criterion for the adoption of candidate indicators was set at a total mean score of 7 or more. Final quality indicators with no disagreement were included. RESULTS: Of the 973 publications in our initial search, 12 studies were included. The preliminary list of quality indicators by systematic literature review comprised 50 items. In total, 37 panelists participated in the modified Delphi study. Ultimately, 18 indicators were identified from the following domains: structure in cancer hospitals, structure in home palliative care services, the process of home palliative care service delivery, less aggressive end-of-life care, patient's psychological comfort, caregiver's psychological comfort, and patient's satisfaction with home palliative care service. CONCLUSION: Comprehensive quality indicators for the integration of oncology and home palliative care were identified. These indicators may facilitate interdisciplinary collaboration between professional healthcare providers in both cancer hospitals and home palliative care services.


Assuntos
Técnica Delphi , Serviços de Assistência Domiciliar , Neoplasias , Cuidados Paliativos , Indicadores de Qualidade em Assistência à Saúde , Humanos , Cuidados Paliativos/normas , Cuidados Paliativos/organização & administração , Cuidados Paliativos/métodos , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/organização & administração , Japão , Neoplasias/terapia , Oncologia/organização & administração , Oncologia/normas
10.
Cancer Med ; 13(13): e7447, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38984669

RESUMO

OBJECTIVES: Randomized controlled trials (RCTs) are the gold standard for evaluating the comparative efficacy and safety of new cancer therapies. However, enrolling patients in control arms of clinical trials can be challenging for rare cancers, particularly in the context of precision oncology and targeted therapies. External Control Arms (ECAs) are a potential solution to address these challenges in clinical research design. We conducted a scoping review to explore the use of ECAs in oncology. METHODS: We systematically searched four databases, namely MEDLINE, EMBASE, Web of Science, and Scopus. We screened titles, abstracts, and full texts for eligible articles focusing on patients undergoing therapy for cancer, employing ECAs, and reporting clinical outcomes. RESULTS: Of the 629 articles screened, 23 were included in this review. The earliest included studies were published in 1996, while most studies were published in the past 5 years. 44% (10/23) of ECAs were employed in blood-related cancer studies. Geographically, 30% (7/23) of studies were conducted in the United States, 22% (5/23) in Japan, and 9% (2/23) in South Korea. The primary data sources used to construct the ECAs involved pooled data from previous trials (35%, 8/23), administrative health databases (17%, 4/23) and electronic medical records (17%, 4/23). While 52% (12/23) of the studies employed methods to align treatment and ECAs characteristics, 48% (11/23) lacked explicit strategies. CONCLUSION: ECAs offer a valuable approach in oncology research, particularly when alternative designs are not feasible. However, careful methodological planning and detailed reporting are essential for meaningful and reliable results.


Assuntos
Oncologia , Neoplasias , Humanos , Neoplasias/terapia , Oncologia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
11.
JCO Clin Cancer Inform ; 8: e2300245, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38959448

RESUMO

Primer that helps clarify large-scale clinical data sets and participant demographics for oncologists.


Assuntos
Neoplasias , Oncologistas , Humanos , Neoplasias/epidemiologia , Oncologia/métodos , Conjuntos de Dados como Assunto , Bases de Dados Factuais
14.
BMC Med Educ ; 24(1): 646, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858656

RESUMO

BACKGROUND: Mentoring is vital to career development in academic medicine, and communication underlies all aspects of the mentoring relationship. Although training research mentors has been shown to be effective, few academic medicine faculties have received training in how to mentor. The investigators developed a novel intervention, the Mentor Communication Skills Training for Oncology Faculty ("Comskil Mentor Training") and examined feasibility and preliminary efficacy. METHODS: The study was a single arm pre-post intervention design. The intervention (Comskil Mentor Training) was offered in one virtual 3-hour session and included a didactic lecture with exemplary skill demonstration videos, facilitator-led small group role plays with trained actors, and evaluation. 19 faculty members from 12 departments participated in the training. RESULTS: All participants completed the training. Overall, the training was rated favorably, with more than 80% of participants indicating that they "agreed" or "strongly agreed" with training evaluation. From pre- to post-training, significant improvement was seen in participants' overall self-efficacy to communicate with mentees, as well as participants' overall use of communication skills and mentoring-specific language. CONCLUSIONS: Our findings support the feasibility and preliminary efficacy of a virtually delivered experiential mentor communication skills training program for multidisciplinary clinical and research faculty in oncology.


Assuntos
Comunicação , Docentes de Medicina , Estudos de Viabilidade , Tutoria , Mentores , Humanos , Masculino , Feminino , Oncologia/educação , Avaliação de Programas e Projetos de Saúde , Adulto
15.
J Natl Compr Canc Netw ; 22(2 D)2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38862008

RESUMO

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. Management of disseminated metastatic CRC involves various active drugs, either in combination or as single agents. The choice of therapy is based on consideration of the goals of therapy, the type and timing of prior therapy, the mutational profile of the tumor, and the differing toxicity profiles of the constituent drugs. This manuscript summarizes the data supporting the systemic therapy options recommended for metastatic CRC in the NCCN Guidelines for Colon Cancer.


Assuntos
Neoplasias do Colo , Humanos , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/terapia , Neoplasias do Colo/patologia , Neoplasias do Colo/tratamento farmacológico , Oncologia/normas , Oncologia/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Estados Unidos
16.
J Natl Compr Canc Netw ; 22(2D)2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38862005

RESUMO

Mastocytosis is a heterogeneous group of disorders comprising cutaneous mastocytosis, systemic mastocytosis, and mast cell sarcoma. It is associated with a variety of symptoms related to the release of mast cell mediators and mast cell tissue infiltration. Referral to specialized centers with expertise in the management of mastocytosis and multidisciplinary collaboration with subspecialists (eg, allergists for the management of anaphylaxis and drug hypersensitivities, anesthesiologists for invasive procedures or surgery, high-risk obstetrician for pregnancy) is recommended. The NCCN Guidelines for Systemic Mastocytosis provide evidence- and consensus-based recommendations for the diagnosis and comprehensive care of patients with systemic mastocytosis. The multidisciplinary panel of experts convenes at least once a year to review requested changes to the guidelines from both internal and external entities as well as to discuss data on existing and new therapies. These NCCN Guidelines Insights focus on some of the recent updates to the guidelines.


Assuntos
Mastocitose Sistêmica , Humanos , Mastocitose Sistêmica/diagnóstico , Mastocitose Sistêmica/terapia , Gerenciamento Clínico , Oncologia/normas , Oncologia/métodos
17.
Am Soc Clin Oncol Educ Book ; 44(3): e432104, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38862140

RESUMO

Cancer care in low- and middle-income countries (LMICs) faces numerous challenges, such as limited resources, infrastructure constraints, and a shortage of specialized training. To address these challenges, innovative quality improvement (QI) approaches are required. The Quality Oncology Practice Initiative (QOPI) by the ASCO provides a framework for improving care quality through evidence-based standards. This article explores how QOPI has been adapted to the local context of the Uganda Cancer Institute (UCI) and highlights the importance of aligning international best practices with local health care realities to bridge disparities in care standards. The adaptation of the QOPI program at UCI commenced with a collaborative meeting with the ASCO-QOPI team in 2020. A tailored implementation plan was developed focusing on incorporating ASCO's QOPI measures and additional metrics relevant to the Ugandan context, engaging multidisciplinary teams, and optimizing resource use by leveraging existing resources for data collection and analysis. The execution of the plan relied heavily on staff training, participatory data collection, and continuous quality improvement processes that utilized data-driven methodologies. A retrospective analysis of QOPI data of UCI from 2020 to 2023 shows significant improvements in oncology care quality, highlighted by an upward trend in QOPI assessment scores across various metrics. These reflect the journey of UCI toward aligning its oncology care practices with international standards despite facing significant challenges. UCI's experience demonstrated the feasibility and impact of implementing international QI programs in LMICs. The success demonstrates that significant improvements in cancer care quality can be achieved in resource-constrained settings through adaptability, stakeholder engagement, and strategic resource optimization. UCI's journey is a model for other LMICs seeking to raise their cancer care standards, demonstrating that QI is necessary and attainable worldwide.


Assuntos
Oncologia , Neoplasias , Melhoria de Qualidade , Humanos , Uganda , Oncologia/normas , Neoplasias/terapia , Qualidade da Assistência à Saúde , Atenção à Saúde/normas
18.
JCO Glob Oncol ; 10: e2300405, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38870438

RESUMO

Executing global clinical trials for cancer is a long, expensive, and complex undertaking. While selecting countries global studies, sponsors must consider several aspects including patient pool, quality of trained investigators, competing trials, availability of infrastructure, and financial investment versus returns. With a large, often treatment-naïve, and diverse patient pool, relatively low cost, good quality health care facilities in urban areas, and a robust and well-trained workforce, India offers several advantages for conducting oncology clinical trials. However, there remains challenges, including a shifting regulatory environment in recent decades. With the implementation of the New Drugs and Clinical Trial Rules in 2019, India's regulatory atmosphere seems to have stabilized. In this article, we present a review of the evolving clinical trial landscape in India, highlight the current regulatory scenario, and discuss the advantages and challenges of selecting India as a potential location for conducting global oncology clinical trials.


Assuntos
Ensaios Clínicos como Assunto , Neoplasias , Índia , Humanos , Neoplasias/terapia , Oncologia/normas
19.
Am Soc Clin Oncol Educ Book ; 44(3): e432102, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38870439

RESUMO

Quality cancer care is efficient, accessible, coordinated, and evidence-based. Recognizing the necessary key components, development of pathways and guidelines to incorporate these key domains, and finally respectful adaptation to cultural differences can ensure that cancer care globally is of the highest quality. This quality care should be judged not only on how it optimizes health outcomes for patients, but also its impact on the care providers and the global community.


Assuntos
Oncologia , Neoplasias , Qualidade da Assistência à Saúde , Humanos , Atenção à Saúde/normas , Saúde Global , Oncologia/normas , Neoplasias/terapia
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