Over the past decade, a great deal of research has established the importance of cognitive processes in the control of energy intake and body weight. The present paper begins by identifying several of these cognitive processes. We then summarize evidence from human and nonhuman animal models, which shows how excess intake of obesity-promoting Western diet (WD) may have deleterious effects on these cognitive control processes. Findings that these effects may be manifested as early-life deficits in cognitive functioning and may also be associated with the emergence of serious late-life cognitive impairment are described. Consistent with these possibilities, we review evidence, obtained primarily from rodent models, that consuming a WD is associated with the emergence of pathophysiologies in the hippocampus, an important brain substrate for learning, memory, and cognition. The implications of this research for mechanism are discussed within the context of a “vicious-cycle model,” which describes how eating a WD could impair hippocampal function, producing cognitive deficits that promote increased WD intake and body weight gain, which could contribute to further hippocampal dysfunction, cognitive decline, and excess eating and weight gain.
362 Background: Despite current guidelines, less than 50% of patients with metastatic (m) non-squamous (NSq) NSCLC undergo comprehensive molecular genotyping. At our institution, based on improved comprehensiveness of genotyping with use of concurrent tissue (T) and plasma (P) next generation sequencing (NGS), we designed an electronic medical record (EMR)-based nudge intervention to auto-generate an order for P NGS at the time of initial consultation, while T NGS was carried out reflexively based on institutional pathways. Methods: A prospective study was conducted at the Abramson Cancer Center and 2 community sites within the University of Pennsylvania Health System after IRB approval. A provider team-focused EMR-based nudge intervention was designed to order P NGS at the time of new patient consultation. Eligible patients for the nudge were identified using an EMR based checklist, that included 3 criteria i. newly diagnosed, ii. treatment naïve, iii. mNSq NSCLC. Results from the intervention period (4/2021-12/2021) were compared to baseline data from similar patients treated at our institution between 01/2019 and 03/2021. Categories of NCCN guideline recommended molecular genotyping were defined as: i) comprehensive: EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, and ii) incomplete or no testing performed. The proportion of patients with comprehensive molecular genotyping prior to 1st-line therapy were compared in the pre- and post-intervention groups using the chi-square test. Results: 526 patients with mNSq NSCLC were included in this analysis: 381 in the pre-intervention cohort, 145 in the post-intervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent concurrent T+P testing resulting in improved comprehensive molecular genotyping. In addition, a greater proportion of patients had comprehensive genotyping available prior to 1st-line therapy in the post-intervention vs pre-intervention cohort (Table). Conclusions: Across 3 practice sites, a provider team-focused EMR-based nudge intervention was associated with a significantly higher proportion of patients with mNSq NSCLC undergoing comprehensive molecular genotyping, both overall and prior to 1st-line therapy. These findings demonstrate that behavioral, EMR-based nudges can promote guideline concordant diagnostic testing at both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC.[Table: see text]
Background To ensure safe delivery of oncologic care during the COVID-19 pandemic, telemedicine has been rapidly adopted. However, little data exist on the impact of telemedicine on quality and accessibility of oncologic care. This study assessed whether conducting an office visit for thoracic oncology patients via telemedicine affected time to treatment initiation and accessibility. Methods This was a retrospective cohort study of patients with thoracic malignancies seen by a multidisciplinary team during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease, were included. Results 240 distinct patients with thoracic malignancies were seen: 132 patients (55.0%) were seen initially in-person vs 108 (45.0%) via telemedicine. The majority of visits were for a diagnosis of a new thoracic cancer (87.5%). Among newly diagnosed patients referred to the thoracic oncology team, the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (median 5.0 vs. 6.5 days, p < 0.001). Patients received surgery (32.5%), radiation (24.2%), or systemic therapy (30.4%). Time from initial visit to treatment initiation by modality did not differ by telemedicine vs in-person: surgery (22 vs 16 days, p = 0.47), radiation (27.5 vs 27.5 days, p = 0.86, systemic therapy (15 vs 13 days, p = 0.45). Conclusions Rapid adoption of telemedicine allowed timely delivery of oncologic care during the initial surge of the COVID19 pandemic by a thoracic oncology multi-disciplinary clinic.
125 Background: Patients with a suspicious scan or confirmed cancer diagnosis are anxious to be seen by an oncology provider. It’s important that patients are scheduled to see the most appropriate providers in the right order and timing for their clinical needs. At one large academic medical center, where patient volumes are high, the system is complex, and patients often travel. It was identified that patients were being scheduled out of order, had incomplete information, or could have been scheduled with improved timing and with additional support. This occurred in multiple disease sites. Methods: Based on this assessment, a process has been initiated to where the intake forms completed on each new patient scheduled are routed to the oncology nurse navigators via the electronic medical record. The nurse navigators then reach out to the patient prior to their appointment to further triage their needs, identify barriers and provide education and additional resources. Results: This intervention, while in early stages, has improved nurse navigator involvement with the new oncology patients to ensure they are set up appropriately, with accurate information, and has decreased providers scrambling to add patients on the same day. Outcomes from the navigator’s assessment can include any of the following: leave the appointment as is, reschedule it with the same or different provider, coordinate with another provider, or add additional information to the chart as the patient’s story evolves. Regardless, the patient receives an introduction to the nurse navigator, education, and support prior to being seen. Conclusions: By identifying an area where nurse navigators can improve patient care processes, patients are now able to get personalized assessment and appropriate appointments, no matter how they present to the cancer center. Not only are patients able to be seen by the most appropriate provider at correct timing, but the assessment for clinical needs and barriers to care can be addressed proactively. This wouldn’t be possible without the collaboration of staff and providers, willing and eager to improve the process for patient care.
117 Background: The oncology nurse navigators (ONNs) at Penn Medicine’s Abramson Cancer Center (ACC) observed that patients seen in the Emergency Room (ER) and found to have a suspicion of cancer were being told to call a medical oncologist. The oncologist in the ACC are highly specialized and since the patient has not had a confirmed cancer diagnosis, they were being told they couldn’t schedule an appointment. Some patients waited for the ACC to call them to schedule. When this didn’t happen they would call the ACC a week later. These barriers led to delays in care, poor patient experience, and a financial loss for the health system. The ONNs identified this as an opportunity to change the process to improve patient care. Methods: The initiative formally began in June 2021 when the ONNs reached out to the ER leadership to collaborate on a quality improvement project to streamline the process from ER visit to oncology work up and diagnosis. Direct referral to oncology nurse navigation from the ER facilitates timely navigation assessment and coordination of care. The Plan Do Study Act (PDSA) methodology was utilized. A “Consult to Nurse Navigation” order was built into the electronic medical record (EMR) for ER providers to directly refer patients to the navigation team. The ONNs contacted the patient within one business day to assess next steps. The ONNs scheduled the patient with the appropriate oncology specialist. The ONNs follows the patient through the diagnostic phase of care and assists with decreasing barriers to care. Data collection is ongoing to assess the impact of the interventions. Results: The EMR consult to ONNs went live April 2022. It includes 3 hospital ERs in the health system with diverse populations that often have limited access to health care. To date, 90% were appropriate referrals and triaged to cancer specialists for diagnostic workup and treatment. 90% had insurance accepted by the health system. Patients with unacceptable insurance plans were referred to ER social work and financial advocates. 70% were diagnosed with cancer and began treatment. Conclusions: ONNs are vital in identifying and removing barriers to care. The ONN team’s clinical knowledge, assessment skills, and expertise of the Penn health system have closed a gap in care while increasing patient satisfaction, patient retention, and downstream revenue. The ONNs leadership has directly enhanced the diagnostic process and timeliness to care for patients newly effected by cancer.
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