A multi‐method review of home‐based chemotherapy

This study summarises research‐ and practice‐based evidence on home‐based chemotherapy, and explores existing delivery models. A three‐pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home‐based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home‐based chemotherapy as a safe and patient‐centred alternative to hospital‐ and outpatient‐based service. This paper consolidates information on home‐based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient‐centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence‐informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes.     

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Objective To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research.     

Visual Cueing with Context Relevant Information for Reducing Change Blindness

Objective  Physiological monitoring is a requisite for optimal care to ensure that the condition of a patient is maintained within safe levels. Monitoring can be jeopardized by the inability of a clinician to recognize important changes in the visual display of data throughout the duration of the monitoring task. We hypothesized that the addition of a visual cue imparting contextual information to a physiological display would improve the detection ability and response time of a clinician to a change in a patient variable. Methods  Contextual information based on trend information was added to a physiological display in the form of a visual cue. Following IRB approval, the resulting enhanced display was evaluated by 22 anesthesiologists in a simulated operating room, through the observation of six simulated scenarios using a standard anesthesia display and the enhanced display. Demographic information, response time, accuracy of detection, and usability data were collected. Results  The enhanced display reduced the detection time to a change in the simulated scenarios by 14.4 s (95% CI: −26.4 to −2.38), and reduced the expected number of missed events per scenario by 0.23 (95% CI: −0.439 to −0.0203), based on the repeated measures analysis (Poisson model). Conclusions  The data collected and analyzed in this study supports the addition of a visual cue to future physiological monitors. The graphic representation and the context relevant information that it transmits appears to aid clinicians. While the results indicate that enhanced visualization of context relevant information can lead to a significant improvement in event recognition and identification, further evaluation in clinical settings is required. Presented at the Society for Technology in Anesthesia Annual Meeting, San Diego, CA, USA; January 16–19, 2008. Tappan JM, Daniels J, Slavin B, Lim J, Brant R, Ansermino JM. Visual cueing with context relevant information for reducing change blindness.     

The introduction of vaginal microbicides must also target men

Vaginal microbicides hold great hope of reducing the spread of HIV and other sexually transmitted infections, as they provide women with a female-controlled protection option. The design and testing of vaginal microbicides thus far has been targeted primarily towards women. We argue that such thinking is limited and that, by ignoring men's needs and attitudes to microbicides, the burden of health responsibility will fall solely on women and may increase their vulnerability to the HIV epidemic. We suggest that a greater understanding of the range of men's responses to microbicides may be usefully incorporated into the research, development and marketing of microbicides. Demonstrating that men's responses to microbicides depend on a number of factors – including cultural difference, attitudes toward pregnancy, biological ramifications, and the nature of their relationship towards their sexual partner(s) – we propose a number of parameters that would be useful in the study of men's attitudes towards microbicides.     

Mechanical and structural characteristics of the new BONE-LOK cortical-cancellous internal fixation device

The purpose of this study was to evaluate the structural and mechanical characteristics of a new and unique titanium cortical-cancellous helical compression anchor with BONE-LOK (Triage Medical, Inc., Irvine, CA) technology for compressive internal fixation of fractures and osteotomies. This device provides fixation through the use of a distal helical anchor and a proximal retentive collar that are united by an axially movable pin (U.S. and international patents issued and pending). The helical compression anchor (2.7-mm diameter) was compared with 3.0-mm diameter titanium cancellous screws (Synthes, Paoli, PA) for pullout strength and compression in 7# and 12# synthetic rigid polyurethane foam (simulated bone matrix), and for 3-point bending stiffness. The following results (mean +/- standard deviation) were obtained: foam block pullout strength in 12# foam: 2.7-mm helical compression anchor 70 +/- 2.0 N and 3.0-mm titanium cancellous screws 37 +/- 11 N; in 7# foam: 2.7-mm helical compression anchor 33 +/- 3 N and 3.0-mm titanium cancellous screws 31 +/- 12 N. Three-point bending stiffness, 2.7-mm helical compression anchor 988 +/- 68 N/mm and 3.0-mm titanium cancellous screws 845 +/- 88 N/mm. Compression strength testing in 12# foam: 2.7-mm helical compression anchor 70.8 +/- 4.8 N and 3.0-mm titanium cancellous screws 23.0 +/- 3.1 N, in 7# foam: 2.7-mm helical compression anchor 42.6 +/- 3.2 N and 3.0-mm titanium cancellous screws 10.4 +/- 0.9 N. Results showed greater pullout strength, 3-point bending stiffness, and compression strength for the 2.7-mm helical compression anchor as compared with the 3.0-mm titanium cancellous screws in these testing models. This difference represents a distinct advantage in the new device that warrants further in vivo testing.     

A contemporary review of machine learning in otolaryngology–head and neck surgery

One of the key challenges with big data is leveraging the complex network of information to yield useful clinical insights. The confluence of massive amounts of health data and a desire to make inferences and insights on these data has produced a substantial amount of interest in machine-learning analytic methods. There has been a drastic increase in the otolaryngology literature volume describing novel applications of machine learning within the past 5 years. In this timely contemporary review, we provide an overview of popular machine-learning techniques, and review recent machine-learning applications in otolaryngology–head and neck surgery including neurotology, head and neck oncology, laryngology, and rhinology. Investigators have realized significant success in validated models with model sensitivities and specificities approaching 100%. Challenges remain in the implementation of machine-learning algorithms. This may be in part the unfamiliarity of these techniques to clinician leaders on the front lines of patient care. Spreading awareness and confidence in machine learning will follow with further validation and proof-of-value analyses that demonstrate model performance superiority over established methods. We are poised to see a greater influx of machine-learning applications to clinical problems in otolaryngology–head and neck surgery, and it is prudent for providers to understand the potential benefits and limitations of these technologies. Laryngoscope, 130:45–51, 2020