ABSTRACT
Radiation therapy has an increasing role in the management of patients with metastatic cancer. The integration of ablative versus palliative techniques with surgical and systemic approaches is complex, and inefficient care delivery can lead to prolonged hospitalizations that are inconsistent with palliative goals. A dedicated Inpatient Radiation Oncology Consult (IROC) service was created to provide rapid access to palliative radiotherapy. We previously reported the short-term impact of the IROC service in reducing hospital length of stay (LOS), and here we provide an update on long-term improvements in patient care, focusing on quality-of-care metrics including hospital LOS, use of hypofractionated approaches, and prognosis-appropriate care. We retrospectively compared inpatient radiation oncology consults placed in the 12 months preceding IROC (N = 1,507) to those placed during a 12-month period after IROC implementation (N = 1,509). The dates for calendar-matched cohorts were selected to minimize potential confounding from practice changes related to the first peak of the COVID-19 pandemic. We analyzed continuous variables using the Mann-Whitney test and categorical variables using the Fisher's exact test. The IROC service was associated with reduced hospital length of stay for all consults (mean difference 1.0 day, P = 0.045). IROC led to shorter inpatient radiotherapy courses (mean 5.8 vs. 5.0 days, P = 0.007, and this reduction was greatest for patients discharged to hospice (mean 5.2 vs. 3.7 days, P = 0.033). Compared to pre-IROC patients, IROC patients were more likely to receive hypofractionated treatment (≤ 5 fractions;pre-IROC, N = 405/551 (74%) vs. IROC, N = 433/528 (82%), P = 0.001). Notably, the trend toward fewer prescribed fractions was not due to increased uptake of inpatient stereotactic regimens (N = 84/551 (15%) vs. N = 87/528 (16%), pre-IROC vs. IROC, respectively, P = 0.560). Death within 60 days of inpatient radiation therapy decreased under IROC (pre-IROC, N = 227/551 (41%) vs. IROC, N = 184/528 (35%), P = 0.033). A dedicated inpatient radiation oncology consult (IROC) service was associated with long-term reductions in hospital length of stay. Prognosis-appropriate care was improved through shorter treatment courses and decreased delivery of radiation to patients discharged to hospice or with limited survival. Our findings demonstrate the value of a dedicated program addressing the appropriate delivery of radiotherapy to hospitalized patients and highlight opportunities to stratify patients appropriate for ablative versus palliative treatments. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Purpose or Objective Radiation therapy has an expanding role in the management of patients with advanced cancers, including in the palliative and oligometastatic settings. We previously described an inpatient radiation oncology consult (IROC) service created to deliver rapid, specialized metastatic cancer care to hospitalized patients. Here we report an 18-month update on IROC patient outcomes to test the hypothesis that IROC decreased hospital length of stay (LOS) and led to more prognosis-appropriate care, including during the first peak of the COVID-19 pandemic. Materials and Methods The IROC service started in January 2020 and comprises faculty, advanced practice providers, nurses and resident trainees. Faculty are specialists in palliative and metastatic cancer care with certification in ablative radiation techniques. We compared inpatient radiation oncology consults placed from January to December 2019 (pre-IROC, N = 1,507) to those placed from June 2020 to June 2021 (IROC, N = 1,509). In a separate analysis, we examined consults during a non-overlapping period from March to June 2020 (N = 302) to assess changes in IROC practice patterns related to the peak of the COVID-19 pandemic in New York City. Statistical significance was assessed using the Mann-Whitney test. Results Hospital LOS decreased among all inpatient radiation oncology consult patients after implementation of IROC (N = 1,509 patients) by an average of 1.0 day compared to patients treated prior to IROC (N = 1,507 patients;P = 0.045). With IROC, consults were staffed an average of 0.6 days sooner (P < 0.001). Death within 60 days of inpatient RT decreased under IROC (35.4%, N = 187/528 patients) compared to prior (43.7%, N =241/551 patients, P = 0.005). Among patients discharged to hospice, inpatient treatment duration decreased after IROC (median 4 vs. 2 days, pre-IROC (N = 64 patients) vs. IROC (N = 82 patients), respectively, P = 0.033). The IROC service received consults for 21 patients infected with SARS-CoV-2, and 17 patients had active COVID-19 during treatment. Notably, hospital LOS for patients receiving inpatient RT under IROC was significantly shorter during the COVID-19 peak (median LOS 9 days, P < 0.001), when time to treatment decreased by an (Figure Presented) Conclusion A dedicated inpatient radiation oncology consult (IROC) service was associated reduced hospital LOS, faster care delivery, and more prognosis-appropriate care. It enabled rapid implementation of emergency RT guidelines, including abbreviated treatment durations, during the first COVID-19 peak in a pandemic hotspot
ABSTRACT
This collection of original essays explores the myriad expressions of austerity since the 2008 financial crisis. Case studies drawn from Canada, Australia and the European Union provide extensive comparative analysis of fiscal consolidation and the varied political responses against austerity. Contributions examine such themes as privatization, class mobilization and resistance, the crisis of liberal democracy and the rise of the far right. The potential impact of the COVID-19 pandemic in shaping future austerity and alternatives is signalled. Given the rapidly shifting terrain, this comprehensive handbook provides important insights into a complex and fast-changing period of politics and policy. © Bristol University Press 2021.
ABSTRACT
Secondary and post-secondary science and engineering educators share common class arrangements with both a laboratory and lecture component, coordinating both components so they build upon each other to create meaningful learning experiences. The COVID-19 pandemic forced educators to convert lectures and exams to online delivery. Doing so came with trade-off decisions about sacrificing laboratory experience goals of hands-on practice, problem-solving, and learning concepts at a deeper, tactile level. Due to rapidly changing conditions, educators faced course redesign to accommodate social distancing and virtual learning requirements. In this study, a team of undergraduate college students including one secondary science preservice teacher planned a set of lessons for STEM outreach to a K-12 audience. The team faced challenges in planning meaningful learning experiences in the face of COVID-19 uncertainty. Options for secondary and post-secondary educators to consider are provided in this article.
ABSTRACT
The emergence of social media has transformed today's society by affecting the way people communicate and establish social relationships. The sport industry has not been unaffectedby these changes, ensuring to embrace these communication tools. Indeed, social media is a key management element in the daily routine of sport managers, as well as for all other sport actors (e.g. athletes, coaches, clubs, professional leagues, federations, journalists, sports brands). Therefore, the mastery of digital skills linked to the use of social media is one of the aspects most sought after by employers. In fact, the COVID-19 pandemic has recently boosted these demands as well as having further accelerated the process of digitalisation of the sport sector. Nevertheless, there is a lack of studies that go deeper into the impact that these types of tools produced in the field of sport management education have, as well as guidelines for teachers to incorporate them into the different areas of the teaching-learning process. Consequently, this article analyses the presence that social media have in sport management studies, as well as presents a proposal for the classification and possible applications of social media which, due to their characteristics and their educational/labour potential, are considered suitable for introducing them into sport management courses. Furthermore, this paper aims to encourage the sport management teaching community to introduce social media into the dynamics of their courses, given their pedagogical value and the positive impact they will have on student education. © JPES.