The objective of these 4 studies was to describe the effects of protein source, time of consumption, quantity, and composition of protein preloads on food intake in young men. Young men were fed isolates of whey, soy protein, or egg albumen in sweet and flavored beverages (400 mL) and provided a pizza meal 1-2 h later. Compared with the water control, preloads (45-50 g) of whey and soy protein, but not egg albumen, suppressed food intake at a pizza meal consumed 1 h later. Meal energy intake after egg albumen and soy, but not after control or whey treatments, was greater when the treatments were given in the late morning (1100 h) compared with earlier (0830-0910 h). Suppression of food intake after whey protein, consumed as either the intact protein or as peptides, extended to 2 h. Altering the composition of the soy preload (50 g) by reducing the soy protein content to 25 g and by adding 25 g of either glucose or amylose led to a loss in suppression of food intake by the preload. Egg albumen, in contrast to whey and soy preloads, increased cumulative energy intake (sum of the energy content of the preload plus that in the test meal) relative to the control. We conclude that protein source, time of consumption, quantity, and composition are all factors determining the effect of protein preloads on short-term food intake in young men.
Objective The National Comprehensive Cancer Network guidelines recommend an interval between surgery and adjuvant radiation therapy of less than 6 weeks, but only 44% of patients meet this metric nationally. We sought to identify key components of an improvement process focused on starting adjuvant radiation therapy within 6 weeks of surgery. Methods This project used an A3 model to improve a defined process measure. We studied a consecutive sample of 56 patients with oral cavity carcinoma who were treated at our institution with upfront surgical resection followed by adjuvant radiation therapy. Twelve proposed interventions tested during the study period focused on 3 key drivers of delays: delayed dental evaluation and teeth extraction, delayed radiation oncology consults, and inadequate patient engagement. The primary outcome measure was the number of days from surgery to the start of radiation therapy. Results Prior to the intervention, 62% of patients received adjuvant radiation within 6 weeks of surgery. Following the intervention, 73% of patients achieved this metric. The percentage of patients with avoidable delays decreased from 24% to 9%. The percentage of patients with unavoidable delays was relatively constant before and after the intervention (15% and 18%, respectively). Discussion Defining disease-specific metrics is critical to improving care in our head and neck cancer patient population. We demonstrate several key components to develop and improve self-defined metrics. Implications for Practice As we transition to a system of value-based care, structured quality improvement projects can have a measurable impact on cancer patient process measures.
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