A Standardized Clinical Pathway Approach to Esophageal Cancer

2019 ◽  
Author(s):  
Andrea Wirsching ◽  
Donald E Low
Keyword(s):  
Esophageal Cancer ◽  
Clinical Pathway ◽  
Postoperative Morbidity ◽  
Enhanced Recovery ◽  
Clinical Pathways ◽  
Early Mobilization ◽  
Postoperative Recovery ◽  
Tumor Board ◽  
Enteral Feedings ◽  
Insight Into

Clinical pathways associated with the surgical treatment of esophageal cancer patients represent an important development to maximize the opportunity for clinical and cost efficiency in patient care. The main goals implemented in standardized clinical pathways are a comprehensive preoperative workup and tumor board presentation; anesthesia management dedicated to enable enhanced recovery and standardized steps of postoperative recovery, including early mobilization; efficient removal of tubes, catheters, and lines; and early enteral feedings. Recent studies report a decreased length of hospital and intensive care unit stay and decreased costs associated with the routine application of these pathways. Some reports have also shown a decrease in postoperative morbidity and mortality related to the implementation and refinement of standardized clinical pathways. The present review is dedicated to all aspects of standardized clinical pathways for esophagectomy and aims to give an insight into key components of the clinical pathway, which have evolved over the last 20 years at our institution.   This review contains 3 figures, 8 tables, and 33 tables. Key words: clinical pathway, costs, enhanced recovery, esophageal cancer, esophagectomy, hospital stay, implementation, length of stay, outcome, standardized pathway

A Standardized Clinical Pathway Approach to Esophageal Cancer

2019 ◽  
Author(s):  
Andrea Wirsching ◽  
Donald E Low
Keyword(s):  
Esophageal Cancer ◽  
Clinical Pathway ◽  
Postoperative Morbidity ◽  
Enhanced Recovery ◽  
Clinical Pathways ◽  
Early Mobilization ◽  
Postoperative Recovery ◽  
Tumor Board ◽  
Enteral Feedings ◽  
Insight Into

Clinical pathways associated with the surgical treatment of esophageal cancer patients represent an important development to maximize the opportunity for clinical and cost efficiency in patient care. The main goals implemented in standardized clinical pathways are a comprehensive preoperative workup and tumor board presentation; anesthesia management dedicated to enable enhanced recovery and standardized steps of postoperative recovery, including early mobilization; efficient removal of tubes, catheters, and lines; and early enteral feedings. Recent studies report a decreased length of hospital and intensive care unit stay and decreased costs associated with the routine application of these pathways. Some reports have also shown a decrease in postoperative morbidity and mortality related to the implementation and refinement of standardized clinical pathways. The present review is dedicated to all aspects of standardized clinical pathways for esophagectomy and aims to give an insight into key components of the clinical pathway, which have evolved over the last 20 years at our institution.   This review contains 3 figures, 8 tables, and 33 tables. Key words: clinical pathway, costs, enhanced recovery, esophageal cancer, esophagectomy, hospital stay, implementation, length of stay, outcome, standardized pathway

Virtual Clinical and Precision Medicine Tumor Boards: A Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era. (Preprint)

2020 ◽  
Author(s):  
Livio Blasi ◽  
Roberto Bordonaro ◽  
Vincenzo Serretta ◽  
Dario Piazza ◽  
Alberto Firenze ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Pathways ◽  
Prospective Trial ◽  
Banking System ◽  
Outcome Data ◽  
Tumor Board ◽  
Time Saving ◽  
Tumor Boards ◽  
Multidisciplinary Tumor Board

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

ERAS Improves Postoperative Recovery in Children

2021 ◽  
Author(s):  
Tingmei Wu ◽  
Haiwen Li ◽  
Huixia Zhou ◽  
Xuemei Hao ◽  
Xiaojun Wang ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Robot Assisted ◽  
Cytokine Levels ◽  
Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

scholarly journals STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL, EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA

2015 ◽  
Vol 28 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Marina ZAMUNER ◽  
Fernando A. M. HERBELLA ◽  
José L. B. AQUINO
Keyword(s):  
Clinical Pathways ◽  
Early Mobilization ◽  
Sao Paulo ◽  
Work Team ◽  
Multidisciplinary Teams ◽  
São Paulo ◽  
Clinical Practices ◽  
Paulo State ◽  
High Prevalence ◽  
São Paulo State

Background: The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies. Aim: To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil. Methods: Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care. Results: Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%). Conclusion: The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.

scholarly journals Downregulation of miR-135b-5p Suppresses Progression of Esophageal Cancer and Contributes to the Effect of Cisplatin

2021 ◽  
Vol 11 ◽  
Author(s):  
Yuzhu Di ◽  
Yanan Jiang ◽  
Xiuyun Shen ◽  
Jing Liu ◽  
Yang Gao ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Western Blot ◽  
Real Time ◽  
Real Time Pcr ◽  
High Morbidity ◽  
Complementary Gene ◽  
Enhanced Expression ◽  
Direct Binding ◽  
Esophageal Epithelial Cells ◽  
Insight Into

Esophageal cancer (EC) is one of the commonest human cancers, which accompany high morbidity. MicroRNAs (miRNAs) play a pivotal role in various cancers, including EC. Our research aimed to reveal the function and mechanism of miR-135b-5p. Our research identified that miR-135b-5p was elevated in EC samples from TCGA database. Correspondingly real-time PCR assay also showed the miR-135b-5p is also higher expressed in Eca109, EC9706, KYSE150 cells than normal esophageal epithelial cells (Het-1A). CCK8, Edu, wound healing, Transwell assay, and western blot demonstrated miR-135b-5p inhibition suppresses proliferation, invasion, migration and promoted the apoptosis in Eca109 and EC9706 cells. Moreover, the miR-135b-5p inhibition also inhibited xenograft lump growth. We then predicted the complementary gene of miR-135b-5p using miRTarBase, TargetScan, and DIANA-microT. TXNIP was estimated as a complementary gene for miR-135b-5p. Luciferase report assay verified the direct binding site for miR-135b-5p and TXNIP. Real-time PCR and western blot assays showed that the inhibition of miR-135b-5p remarkably enhanced the levels of TXNIP in Eca109 and EC9706 cells. Furthermore, cisplatin (cis-diamminedichloroplatinum II, DDP) decreased miR-135b-5p expression and increased TXNIP expression. Enhanced expression of miR-135b-5p attenuated the inhibitory ability of cisplatin (cis-diamminedichloroplatinum II, DDP) in Eca109 cells, accompanied by TXNIP downregulation. In conclusion, the downregulation of miR-135b-5p suppresses the progression of EC through targeting TXNIP. MiR-135b-5p/TXNIP pathway contributes to the anti-tumor effect of DDP. These findings may provide new insight into the treatment of EC.

scholarly journals Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

2021 ◽  
Vol 4 (2) ◽  
pp. 593-599
Author(s):  
Annisa Fitria ◽  
Andri Sofa Armani ◽  
Thinni Nurul Rochmah ◽  
Bangun Trapsila Purwaka ◽  
Widodo Jatim Pudjirahardjo
Keyword(s):  
Action Research ◽  
Caesarean Section ◽  
Length Of Stay ◽  
Cesarean Section ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Average Length Of Stay ◽  
Length Of Hospitalization

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient.   Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

Clinical Pathway Enhanced by Knowledge Management Technology

2014 ◽  
pp. 138-157
Author(s):  
Weizi Li
Keyword(s):  
Knowledge Management ◽  
Patient Safety ◽  
Clinical Pathway ◽  
Treatment Process ◽  
Improve Patient Safety ◽  
Clinical Pathways ◽  
Building Blocks ◽  
Patient Treatment ◽  
Accurate Information ◽  
Complex Processes

Clinical pathways are complex processes based on knowledge and personal experience, which are essential for high quality patient treatment. However, the insufficient knowledge coverage and representation for detailed clinical pathways makes it difficult to provide accurate information to improve patient safety. The gap between the dynamic practical treatment process and the predefined clinical pathways knowledge becomes an important issue. This chapter discusses how knowledge management enhances the implementation of clinical pathway to achieve medical quality improvement. The relationship between patient safety and the effectiveness of clinical pathway knowledge is discussed. The clinical pathway knowledge management pattern is derived in the context of healthcare knowledge management. More specifically, a norm-based approach is proposed to represent and manage clinical pathway knowledge. Types of knowledge can be represented comprehensively with the taxonomy of norms as useful building blocks to construct the dynamic and accurate clinical pathway knowledge. The multi-agent system embedded with norms is developed to enhance clinical pathway management in the context of complicated healthcare environment. Finally, social-technical issues of implementing knowledge management technologies in practical treatment process are discussed.

Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

2020 ◽  
Author(s):  
Jun Takatsu ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Masahiro Yoshida ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Enhanced Recovery ◽  
Intervention Group ◽  
Oral Intake ◽  
Control Group ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Postoperative Stay

Summary Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech–language–hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient’s dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient’s subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.

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