Background
Cancer patients are often malnourished pre‐operatively. The present study aimed to establish whether current screening was appropriate for use in prehabilitation and investigate any ...association between nutritional risk, functionality and quality of life (QoL).
Methods
This cohort study used routinely collected data from September 2020 to August 2021 from patients in a Prehab4cancer programme. Included patients were aged ≥ 18 years, had colorectal, lung or oesophago‐gastric cancer and were scheduled for surgery. Nutritional assessment included Patient‐Generated Subjective Global Assessment (PG‐SGA) Short‐Form and QoL with a sit‐to‐stand test. Association between nutritional risk and outcomes was analysed using adjusted logistic regression.
Results
From 928 patients referred to Prehab4Cancer service over 12 months, data on nutritional risk were collected from 526 patients. Pre‐operatively, 233 out of 526 (44%) patients were at nutritional risk (score ≥ 2). During prehabilitation, 31% of patients improved their PG‐SGA and 74% of patients maintained or improved their weight. Odds ratios (OR) with confidence intervals (CI) showed that patients with better QoL using EuroQol‐5 Dimensions (OR = 0.05, 95% CI = 0.01, 0.45, p = 0.01), EuroQol Visual Analogue Scale (OR = 0.96, 95% CI = 0.93, 1.00, p = 0.04) or sit‐to‐stand (OR = 0.96, 95% 0.93, 1.00, p = 0.04) were less likely to be nutritional at risk.
Conclusions
Almost half of patients in Prehab4Cancer programme assessed using PG‐SGA were at risk of malnutrition. However, almost half of the sample did not have their risk assessed. Patients at risk of malnutrition were more likely to have a poorer QoL and sit‐to‐stand test than those who were not at risk.
Key points
Colorectal, lung or oesopho‐gastric cancer patients referred to the Prehab4Cancer service underwent a nutritional assessment. Almost half of patients assessed using the Patient‐Generated Subjective Global Assessment (i.e., PG‐SGA) were at risk of malnutrition. Patients at risk of malnutrition were more likely to have a worse quality of life and sit‐to‐stand test indicating reduced physical function than those who were not at risk of malnutrition. This indicates that optimising the nutritional status of cancer patients in the prehabilitation period can maximise the nutritional status, functionality and quality of life of patients.
Postgraduate engagement in delivering outreach activities is more commonplace than it once was. However, the impact on postgraduate students (typically studying for a Ph.D. degree) of participating ...in the delivery of these outreach activities has rarely, if ever, been recorded. The Bristol ChemLabS Outreach program has been running for ca. 17 years, and in that time, many postgraduate students have been involved (approximately 500), with around 250 typically for up to 3 years. We sought to investigate the impact of outreach engagement on postgraduate alumni who were involved in the program for over 3 years (32) and how the experiences and training of the outreach program had impacted on their careers postgraduation. Thirty of the 32 postgraduates engaged and ∼70% reported that their outreach experience had influenced their decision making on future careers. Many respondents reported that the skills and experiences gained through outreach participation had contributed to success in applying for and interviewing at their future employers. All respondents reported that outreach had helped them to develop key skills that were valued in the workplace, specifically, communication, teamwork, organizational skills, time planning, event planning, and event management. Rather than a pleasant distraction or an opportunity to supplement income, all participants noted that they felt there were many additional benefits and that this was time well spent. Outreach should not be viewed as a distraction to science research but rather an important enhancement to it provided that the program is well constructed and seeks to develop those delivering the outreach activities.
Objective: To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings.
Design: ...Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes.
Results: The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users.
Conclusion: The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.
The research questions, strategies, and results of a 7-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative ...nature of qualitative inquiry stimulates a consecutive stream of research foci, which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question “what are the success factors for implementing CPOE?” Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process.
To identify success factors for implementing computerized physician order entry (CPOE), our research team took both a top-down and bottom-up approach and reconciled the results to develop twelve ...overarching principles to guide implementation. A consensus panel of experts produced ten Considerations with nearly 150 sub-considerations, and a three year project using qualitative methods at multiple successful sites for a grounded theory approach yielded ten general themes with 24 sub-themes. After reconciliation using a meta-matrix approach, twelve Principles, which cluster into groups forming the mnemonic CPOE emerged. Computer technology principles include: temporal concerns; technology and meeting information needs; multidimensional integration; and costs. Personal principles are: value to users and tradeoffs; essential people; and training and support. Organizational principles include: foundational underpinnings; collaborative project management; terms, concepts and connotations; and improvement through evaluation and learning. Finally, Environmental issues include the motivation and context for implementing such systems.
Objective: To assess the definitions of success and failure as defined by the participants of the Menucha Consensus Conference on Computerized Provider Order Entry (CPOE).
Design: Thirteen experts ...from various fields participated in Menucha Consensus Conference. Though they belonged to different fields, all of them had some kind of experience in CPOE implementation.
Measurements: The stories of these experts were analyzed using a constant comparison method and partially ordered display.
Results: Each participant told a success and a failure story. Definitions of success and failure, as well as variables contributing to the success and failure of CPOE implementations, were extracted from the transcripts.
Conclusion: Analysis reveals that what is considered a failure is context dependent and that it often is an antecedent to success.
The research questions, strategies, and results of a six-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative ...nature of qualitative inquiry stimulates a consecutive stream of research foci which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question "what are the success factors for implementing CPOE?" Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process.
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