Abstract The link between cancer and thrombosis, especially venous thromboembolism, is well established and thrombotic risk is exacerbated by cancer treatments, such as surgery and chemotherapy. This ongoing study aims to determine the impact of pre-analytic variables (PAVs) on thrombosis biomarkers in a diverse cancer patient and non-cancer subject population at an urban safety net hospital. Citrated blood from newly diagnosed, treatment-naïve patients of 11 cancer types or from non-cancer controls was processed to examine these variables: time to fractionation (2 and 4 hrs), plasma freeze-thaw cycles (2 and 3 cycles), and plasma delay to testing (24 or 72 hrs at 4oC). Regular processing (< 1 hour to centrifuge or 1 freeze-thaw cycle) served as the control sample for the variables. Current interim data presents biomarker data for D-dimer (DDE), Factor VIII activity (FVIII), soluble P-selectin (sP-Sel), prothrombin fragment 1+2 (F1+2), plasma DNA (DNA) and myeloperoxidase (MPO). Assays are performed in the hospital clinical lab (DDE, FVIII) or in our research lab following 30 detailed standard operating procedures (SOPs). Cancer patient demographics are 60% male, 40% Black/African-American, 38% Caucasian, 18% Hispanic, 3% Native American, and 1% Asian with an age range of 38-86 years. Non-cancer controls are 52% male, 59% Caucasian, 15% Black/African-American, 19% Asian, and 7% Hispanic with an age range of 23-64 years. Interim project data shows increased thrombosis biomarker levels in cancer subjects, except for sP-Sel and F1+2. Biomarker levels in cancer patients (n=9-52) were increased by approximately 300ng/ml DNA, 100ng/ml DDE, and 5ng/mL MPO with a trending increase in FVIII (~30%) when compared to non-cancer controls (n=17-22). Freeze-thaw of plasma had no effect, while a 2hr time to fractionation resulted in significantly increased MPO (~10ng/mL), FVIII (~14%) and F1+2 (~310 pg/mL). Delay to testing done for DNA and DDE showed with no apparent effect on biomarker levels after 24 or 72 hrs at 4oC. Current data show biomarker levels are impacted by presence of cancer rather than ethnicity of the patient. Donor recruitment is ongoing with shifting strategies to meet recruitment goals of non-cancer donors for greater diversity and older age to more closely reflect our cancer patient population. Rigorous control of sample handling and assay performance using SOPs that are compatible with a hospital setting contribute to identifying PAVs that matter for design of generalizable procedures. Citation Format: Morgan P. Thompson, Elizabeth R. Duffy, DJ Stearns-Kurosawa, Jasmin Bavarva, Shinichiro Kurosawa, Jiyoun Kim, Cheryl Spencer, Daniel Remick, Mark Sloan, Joel Henderson, Kerrie P. Nelson, Joseph Y. Tashjian, Yibing Wei, Rachana Agarwal, Michelle A. Berny-Lang, Chris Andry. Effect of preanalytic variables on established and emerging thrombosis-related biomarkers in an ethnically and racially diverse population of cancer patients and healthy subjects at a safety net hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4529.
Project SOAR (Sharing Opinions and Advice on Research), is examining issues of aging, ethnically-diverse, and underserved individuals facing health and mental health disparities. Using Community-Based Participatory Research (CBPR) enables research-community partnerships to address persistent problems of health care disparities among these populations. SOAR partnered with one rural community and one urban community, and recruited and trained 15 community members into Project Advisory Councils (PACs). PAC members show high levels of psychological flexibility (M = 12; SD = 5.44) in comparison with college-aged samples and international norms (Bond et al., 2011). On the CIROP measure (King et al., 2009), PAC members reported high levels of personal knowledge (M = 22.5 high of 35), group access to information (M = 63 high of 70), and community development (M = 74.5 high of 84). The urban site provides an example of a community engaging in healthier practices as a result of research community partnerships. CBPR has enabled the urban community PAC to allocate resources to implement a Potted Plant Project to meet the physical health concerns of their community. The project allows community members to grow healthy fruits and vegetables in their home, while promoting physical activity and nutrition education. The rural community PAC members have focused on increasing knowledge of diabetes and other chronic health conditions by enhancing the resources available to them at their local hospital. These initiatives have helped generate new research partnerships that address the specific needs of these communities.
Abstract OBJECTIVE. African-American elders were recruited from a transitional unit after hospitalization and tracked for 6 months in the community after discharge to (a) examine functional outcomes on the unit and in the community and (b) identify patterns of participation in daily life activities. The International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) framework provided the structure to examine the connections among body systems, functional outcomes, and social participation for this population that has been underrepresented in past research. METHOD. A mixed design combined qualitative and quantitative methods, including qualitative interviews to document personal adaptive experience, a standardized functional assessment to identify functional outcomes, and a structured format to record activity participation. RESULTS. Findings revealed that 11 of the 17 participants improved their functional outcomes after discharge. Three patterns of activity participation identified were self-care, self-care and household management, and mixed activities. Contextual influences were diverse family support arrangements. CONCLUSION. Complex relationships were identified among body systems, functional outcomes, and daily life activities that were influenced by individual values and support arrangements.
Abstract Appropriate and diverse representation of minority populations in clinical research studies improves long-term outcomes for all demographics and requires targeted solutions to recruitment challenges. During a two year project at Boston Medical Center (BMC), 191 newly diagnosed, treatment-naïve cancer patients and 76 non-cancer control donors were consented to study relationships between cancer and thrombosis biomarkers. 56% of the cancer patients self-identified as minorities (32% Black, 17% Hispanic, 3% Asian, 4% other or multiple), which reflect the overall demographics of patients undergoing surgery at BMC. However, control donor recruitment for the study was only 36% minorities during the first 6 months (n=9 of 25). These control subjects were younger and white, in part because the study was only advertised on the Boston University Medical Campus. Recognizing potential bias and lack of appropriate representation, two initiatives were developed and executed to balance the cancer and control populations with respect to ethnicity and age. First, active recruitment for older, minority-identifying control subjects expanded into the surrounding community of largely African American and Hispanic populations, by hosting donor recruitment days, with one of the days targeted to older males (≥ 50 years) to better reflect the ongoing cancer patient cohort. Second, consent forms were translated into Haitian Creole and Spanish to enable improved communications with these patients who frequent the hospital. To encourage participation from individuals with a negative perception of research, study coordinators received training in consenting and applied it to provide enhanced patient education. This resulted in a significant improvement in the control’s minority percentage to 64% over the project timeline (n=49, 44% Black, 11% Hispanic, 9% Asian). This approach also helped to balance age distributions in the cancer and control populations. The majority of cancer patients were in their 50s and older (81%, mean 59 ± 12 years; n=155). Control subjects in their fifth decade or above was only 32% in the first 6 months, but improved to 55% (mean 46+ 14 years, n=42) by the end of the project. The study was not designed to match comorbidities, but human immunodeficiency virus (HIV) infection, and hepatitis which are known to affect coagulation are highly prevalent in the BMC population. Of the consented cancer patients, 5% had hepatitis and 2% reported active HIV infection, while in the control population 6% had hepatitis and 5% had HIV. Patient demographic, clinical data, analysis results, follow-up data on treatment and thrombotic events, as well as plasma and cell pellets from this study are freely available to the research community from: cssi.cancer.gov/cancer-thrombosis. Overall, frequent data monitoring and adjusting recruitment strategies to emphasize community outreach contributed to balancing ethnic and age distributions in the study populations during this two year study. Citation Format: Morgan P Thompson, Elizabeth R Duffy, Jasmin H Bavarva, Cheryl Spencer, DJ Stearns-Kurosawa, Rachana Agarwal, Michelle A Berny-Lang, Chris Andry. Consenting challenges toward age, ethnicity, and co-morbidity matching of cancer patient and control populations at a minority-majority safety net hospital [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A091.
DURING GRAND rounds, healthcare professionals report and review their patients' clinical findings and outcomes to their peers and mentors. They present a position, receive feedback, and explore treatment modalities. In this context, simulated nursing grand rounds (NGRs) were created at the authors' institution to enhance senior nursing students' ability to understand patients and analyze complex situations in a practice setting. This article provides background on the role of grand rounds in healthcare environments, discusses the benefits of NGRs for nursing staff and students, and offers an example project to incorporate simulated NGRs for nursing students. Background Grand rounds emerged as a central teaching activity in US medical schools during the first half of the 20th century. The concept was founded in medical residency training as an educational approach to introduce new resources and improve clinical reasoning through discussion of patient cases. The practice has remained a staple of healthcare education for decades; however, Health Insurance Portability and Accountability Act concerns related to patient dignity and confidentiality in hallways or rooms with multiple patients have led to conducting grand rounds in more confidential environments. Similar to other healthcare professionals, nurses also have rounds at the patient's bedside or in small groups as case presentations. In one 2015 study, nursing rounds were described as “a deliberate method to reduce preventable adverse outcomes.”1 NGRs can be conducted at the patient's bedside (provided the patient is in a single room), in health facility conference rooms, or through presentations via the internet and intranet to highlight clinical expertise and promote best practices.2 Today, nursing education has moved primarily to classrooms and online education.3 The format of NGRs has shifted from case-oriented presentations to expert lectures with an emphasis on recent evidence. Approximately 60% of hospitals still conduct NGRs to educate participants, showcase faculty as role models, and enhance the collegial environment for nursing students.4 Quality and Safety Education for Nurses (QSEN) competencies support evidence-based practices and critical reasoning skills in education.5,6 When NGRs are performed at the bedside, nurses have the opportunity to interact with, learn from, and discuss plans of care with colleagues, as well as to cultivate nursing skills and promote professional development.7 Nurses can also evaluate specific patient conditions, assess changes in patient data, and plan interventions.5 Additionally, NGRs are a valuable tool for evaluating the challenges facing patients and their families. NGRs are one of the most effective educational approaches, as they provide opportunities to collaborate and share ideas related to clinical nursing and the current dynamics of the healthcare system.8 NGRs may involve various healthcare professionals as part of an interdisciplinary team, which exposes nursing students to a range of conditions that they may experience in their career.3 NGRs also represent a creative teaching strategy that is critical for engaging students, enhancing education related to common healthcare challenges, and emphasizing teamwork.5 NGRs help nursing students develop presentation skills, improve critical thinking, and increase knowledge of disease processes. Additionally, NGRs teach the value of sharing ideas with colleagues to improve collegiality and collaboration in patient care.4 By utilizing simulated NGRs, nursing students can identify patient health concerns, address clinical challenges, share personal experiences, and identify gaps in clinical understanding. Student practice An educational project at the City University of New York aimed to create an opportunity for senior nursing students to participate in simulated NGRs. After discussing the opportunity with their clinical professor, 20 students who were enrolled in the nursing program volunteered to participate. The project was exempted by the Institutional Review Board. Three clinical groups participated, and presentations were not graded. Students were given clinical assignments on patients with complex conditions and comorbidities in a medical-surgical clinical setting. Participants first observed NGRs in a clinical setting with nurses and other healthcare professionals. They were then instructed to prepare presentations on specific patients, including admission assessment data, prescribed medications, lab results, consultations, discharge plans, and any discussion of provider involvement from the multidisciplinary team.Table: Survey responsesThe nursing students presented on real patients under their care in a format similar to the NGR presentations they had previously observed. Instead of doing so in the healthcare facilities, however, the presentations were simulated in the classroom. Other nursing students were invited to attend, and faculty members served as experts. The participating students answered questions from both the faculty and their peers, simulating professional NGRs. After the presentations, a six-item online survey was distributed to all participating students to determine their satisfaction with the experience (see Survey responses). They rated their answers on a five-point Likert scale, with 1 representing “strongly disagree” and 5 representing “strongly agree.” All 20 participating nursing students from the three clinical groups responded to the six-item survey: All 20 strongly agreed that the NGRs helped promote professional development and recommended simulated NGRs for other students. All participants either agreed or strongly agreed that the simulated NGRs had helped them analyze complex patients. All participants either agreed or strongly agreed that the feedback they received from faculty and peers was valuable. All participants also agreed that the program incorporated the previous semester's course objectives, which detailed the role of nurses in medical-surgical units. Summary Simulated NGRs offer nursing students an opportunity to evaluate patients, discuss assessment data, and propose any changes to the plan of care. Through participation, nursing students and faculty members can increase their understanding of the roles of the multidisciplinary team. Simulated NGRs give students an opportunity to exchange ideas related to patient care with staff, other students, and the clinical faculty. It also promotes professional development, encourages collaboration, and improves clinical assessments in accordance with the Quality and Safety Education for Nurses' competencies of teamwork, cooperation, and patient-centered care.6 The project had several limitations. Although the results point to the potential benefits of simulated NGRs, the sample size was small. Additionally, the survey questions were subjective and faculty responses were not taken into account. Simulated NGRs represent one way to engage students as future healthcare professionals and enhance nursing education, but the outcome of this project suggests a need for further research.
