Recent metanalyses have shown that delays in surgical, systemic, or radiation treatments as short as 4 weeks are associated with decreased overall survival for certain cancers.4,5 Furthermore, there ...has been an undeniable disruption of cancer services through provider reassignment to other duties or decreased practice volume; postponed screenings; delayed surgical, radiation, or chemotherapeutic interventions; suspended clinical trial programs; and prioritization of patients with potentially curable disease.2,3,6–8 For these reasons, it is essential to better understand the impact of COVID-19 on the communication and timing of cancer-related care. ...the median time elapsed from surgery until the next non-surgical oncology appointment was 34 days (range 4–108) in the pre-COVID-19 period and 21 days (range 3–83) in the post-COVID-19 period, p < 0.0001. ...following a surgical procedure for cancer, patients were informed of their pathology 3 days faster and were seen at least 7 days sooner at their next oncology appointment during the COVID-19 pandemic. ...our single institution results suggest that small changes can preserve or even improve the timeliness of cancer care during periods of crisis.
Abstract
This study was designed to increase our understanding about characteristics and the impact of sensory symptoms (SS) and signs of hyperarousal (HA) in individuals with fragile X syndrome ...(FXS) from childhood through early adulthood and by gender. Data derived from the Fragile X Online Registry With Accessible Research Database (FORWARD), a natural history study of FXS, were analyzed using descriptive statistics and multivariate linear and logistic regression models to examine SS and signs of HA, their impact on behavioral regulation and limitations on the subject/family. The sample (N = 933) consisted of 720 males and 213 females. More males were affected with SS (87% vs. 68%) and signs of HA (92% vs. 79%). Subjects who were endorsed as having a strong sensory response had more comorbidities, including behavioral problems. The predominant SS was difficulty with eye gaze that increased with age in both genders. As individuals age, there was less use of non-medication therapies, such as occupational therapy (OT)/physical therapy (PT), but there was more use of psychopharmacological medications and investigational drugs for behaviors. Multiple regression models suggested that endorsing SS and signs of HA was associated with statistically significantly increased ABC-C-I subscale scores and limited participation in everyday activities. This study improves our understanding of SS and signs of HA as well as their impact in FXS. It supports the need for more research regarding these clinical symptoms, especially to understand how they contribute to well-known behavioral concerns.
Cancer therapies are highly specialized and complex necessitating nurses acquire advanced knowledge and competent skills. Meeting Commission on Cancer accreditation standards for nursing credentials ...requires cancer programs measure competency based on oncology continuing education (CEUs) or oncology specialty certification. Our Cancer Program had an 11% reduction during 2020 for professional certification across the oncology division (-230 nurses), largely due to retirement or staff turnover. A needs assessment by the Oncology Unit Based Practice Council (UBPC) identified the biggest barriers to achieving specialty certification were study-time (26%) followed by lackof-drive/nurse-burnout (14.5%). Preparation materials cost (11%) and exam fees (11%) were also factors influencing nurse's decision to become certified. The purpose of this project is to increase the percentage of oncology nurses with a unit designated professional specialty certification for the Oncology division from 48% to 52% by January 2022. This Oncology UBPC project utilized surveys from over 100 oncology nurses to understand barriers and support needed to obtain specialty certification. Based on survey responses we prioritized and implemented several solutions aimed at meeting nurses needs and accreditation requirements. Strategies included hosting a low cost review course providing 14 oncology CEUs, contracting with ONCC Freetake to alleviate test anxiety and reduce financial burden of exam fees, and providing financial assistance for study courses/materials. Newly certified nurses were recognized in the Oncology UBPC newsletter distributed to oncology nurses. A total of 94 nurses attended the review course from the Greater Sacramento region. Twenty-four nurses were from our Cancer Program with 50% taking the exam and 100% passing. During 2021,16 total nurses acquired a new oncology specific certification. Specialty certification increased to 53% for 2021 exceeding our goal. Solutions to support nurses on their path to specialty certification were implemented enabling us to meet our goal. Fewer than expected nurses from our facility attended the review course and COVID played a considerable role in nurse-burnout causing some nurses to postpone certification. To provide additional support during 2022 we have established nurse "certification champions" as an additional resource. Since achieving our goal, we adopted a 54% maintenance goal for 2022. This work may provide a framework for other programs seeking to develop knowledge and skills needed to deliver complex care and support specialty certification.
To evaluate readmission rates and associated factors to identify potentially preventable readmissions.
The decision to penalize hospitals for readmissions is compelling health care systems to develop ...processes to minimize readmissions. Research to identify preventable readmissions is critical to achieve these goals.
We performed a retrospective review of University HealthSystem Consortium database for cancer patients hospitalized from January 2010 to September 2013. Outcome measures were 7-, 14-, and 30-day readmission rates and readmission diagnoses. Hospital and disease characteristics were evaluated to evaluate relationships with readmission.
A total of 2,517,886 patients were hospitalized for cancer treatment. Readmission rates at 7, 14, and 30 days were 2.2%, 3.7%, and 5.6%, respectively. Despite concern that premature hospital discharge may be associated with increased readmissions, a shorter initial length of stay predicted lower readmission rates. Furthermore, high-volume centers and designated cancer centers had higher readmission rates. Evaluating institutional data (N = 2517 patients) demonstrated that factors associated with higher readmission rates include discharge from a medical service, site of malignancy, and emergency primary admission. When examining readmission within 7 days for surgical services, the most common readmission diagnoses were infectious causes (46.3%), nausea/vomiting/dehydration (26.8%), and pain (6.1%).
A minority of patients after hospitalization for cancer-related therapy are readmitted with potentially preventable conditions such as nausea, vomiting, dehydration, and pain. However, most factors associated with readmission cannot be modified. In addition, high-volume centers and designated cancer centers have higher readmission rates, which may indicate that readmission rates may not be an appropriate marker for quality improvement.
Abstract Background/purpose Reimbursement penalties for excess hospital readmissions have begun for the pediatric population. Therefore, research determining incidence and predictors is critical. ...Methods A retrospective review of University HealthSystem Consortium database (N = 258 hospitals; 2,723,621 patients) for pediatric patients (age 0–17 years) hospitalized from 9/2011–3/2015 was performed. Outcome measures were 7-, 14-, and 30-day readmission rates. Hospital and patient characteristics were evaluated to identify predictors of readmission. Results Readmission rates at 7-, 14-, and 30-days were 2.1%, 3.1%, and 4.4%. For pediatric surgery patients (N = 260,042), neither index hospitalization length of stay (LOS) nor presence of a complication predicted higher readmissions. Appendectomy was the most common procedure leading to readmission. Evaluating institutional data (N = 5785), patients admitted for spine surgery, neurosurgery, transplant, or surgical oncology had higher readmission rates. Readmission diagnoses were most commonly infectious (37.2%) or for nausea/vomiting/dehydration (51.1%). Patients with chronic medical conditions comprised 55.8% of patients readmitted within 7 days. 92.0% of patients requiring multiple re-hospitalizations had co-morbidities. Conclusions Readmission rates for pediatric patients are significantly lower than adults. Risk factors for adult readmissions do not predict pediatric readmissions. Readmission may be a misnomer for the pediatric surgical population, as most are related to chronic medical conditions and other non-modifiable risk factors. Level of Evidence: Level IV
The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID‐19) pandemic. During the early phase of the pandemic, ...recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID‐19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full‐scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre‐pandemic cancer care delivery.
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