Publications by authors named "Adam F Binder"

11 Publications

  • Page 1 of 1

Long-term Outcomes of team-based learning.

Clin Teach 2021 Feb 4. Epub 2021 Feb 4.

Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.

Background: Team-based learning (TBL) is associated with improved end-of-course exam performance, but the impact on long-term retention is unknown. We compared the impact of three teaching methods: traditional case-based small group discussion (TSG), TBL or no small group reinforcement on short-term understanding and long-term retention after a haematology course.

Methods: Knowledge assessments were conducted prior to, immediately after and 14 months after course completion. Several topics covered by TSG were switched to TBL and could be directly compared.

Results: We recruited 24% of eligible students (n = 70). Of these, 48 completed the final assessment (69% retention). Pre-course, participants scored 31% correctly, which increased to 78% post-course with significant differences: TBL 87%; TSG 78%; no small group 76% (p < 0.01 for both comparisons). At long-term follow-up, the effect of the teaching method was no longer significant: TBL 75%; TSG 67% (p = 0.14); no small group 70% (p = 0.36). When restricted to topics converted from TSG to TBL, the long-term benefit was not shown: TSG 59%; TBL 54% (p = 0.47).

Findings And Discussion: We confirm increased understanding gained by using TBL, but this did not lead to better long-term retention. Improved scores on short-term testing has value for student well-being and competitiveness for residency application. TBL may still be of long-term benefit through modelling team decision making and self-directed learning that are core features of how clinical medicine is practiced. However, our findings argue against justifying the adoption of TBL on the basis of superior long-term retention.
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February 2021

Medical Oncology Professionals' Perceptions of Telehealth Video Visits.

JAMA Netw Open 2021 01 4;4(1):e2033967. Epub 2021 Jan 4.

Sidney Kimmel Cancer Center, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.

Importance: Telehealth has emerged as a means of improving access and reducing cost for medical oncology care; however, use by specialists prior to the coronavirus disease 2019 (COVID-19) pandemic still remained low. Medical oncology professionals' perceptions of telehealth for cancer care are largely unknown, but are critical to telehealth utilization and expansion efforts.

Objective: To identify medical oncology health professionals' perceptions of the barriers to and benefits of telehealth video visits.

Design, Setting, And Participants: This qualitative study used interviews conducted from October 30, 2019, to March 5, 2020, of medical oncology health professionals at the Thomas Jefferson University Hospital, an urban academic health system in the US with a cancer center. All medical oncology physicians, physicians assistants, and nurse practitioners at the hospital were eligible to participate. A combination of volunteer and convenience sampling was used, resulting in the participation of 29 medical oncology health professionals, including 20 physicians and 9 advanced practice professionals, in semistructured interviews.

Main Outcomes And Measures: Medical oncology health professionals' perceptions of barriers to and benefits of telehealth video visits as experienced by patients receiving cancer treatment.

Results: Of the 29 participants, 15 (52%) were women and 22 (76%) were White, with a mean (SD) age of 48.5 (12.0) years. Respondents' perceptions were organized using the 4 domains of the National Quality Forum framework: clinical effectiveness, patient experience, access to care, and financial impact. Respondents disagreed on the clinical effectiveness and potential limitations of the virtual physical examination, as well as on the financial impact on patients. Respondents also largely recognized the convenience and improved access to care enabled by telehealth for patients. However, many reported concern regarding the health professional-patient relationship and their limited ability to comfort patients in a virtual setting.

Conclusions And Relevance: Medical oncology health professionals shared conflicting opinions regarding the barriers to and benefits of telehealth in regard to clinical effectiveness, patient experience, access to care, and financial impact. Understanding oncologists' perceptions of telehealth elucidates potential barriers that need to be further investigated or improved for telehealth expansion and continued utilization; further research is ongoing to assess current perceptions of health professionals and patients given the rapid expansion of telehealth during the COVID-19 pandemic.
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January 2021

Case Report: Tocilizumab for the Treatment of SARS-CoV-2 Infection in a Patient With Aplastic Anemia.

Front Oncol 2020 18;10:562625. Epub 2020 Sep 18.

Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States.

While cytokine storm develops in a minority of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, novel treatment approaches are desperately needed for those in whom it does. Tocilizumab, an interleukin-6 receptor antibody, has been utilized for the treatment of cytokine storm in a number of severe inflammatory conditions, including in patients with severe coronavirus disease 2019 (COVID-19). Here, we present the first published case utilizing this therapy in a patient with underlying immunodeficiency. Our patient with aplastic anemia developed cytokine storm due to COVID-19 manifested by fever, severe hypoxia, pulmonary infiltrates, and elevated inflammatory markers. Following treatment with tocilizumab, cytokine storm resolved, and the patient was ultimately safely discharged from the hospital.
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September 2020

The Home is the New Cancer Center.

J Natl Compr Canc Netw 2020 Oct 1;18(10):1297-1299. Epub 2020 Oct 1.

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October 2020

Treating Hematologic Malignancies During a Pandemic: Utilizing Telehealth and Digital Technology to Optimize Care.

Front Oncol 2020 26;10:1183. Epub 2020 Jun 26.

Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States.

In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality of care delivered. These care models provide the right treatment, to the right patient, at the right time, . Whether these patient-centered models of care will continue to be embraced by key stakeholders after the pandemic remains uncertain.
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June 2020

Decreasing Cost and Decreasing Length of Stay After Implementation of Updated High-Dose Methotrexate Discharge Criteria.

JCO Oncol Pract 2020 08 25;16(8):e791-e796. Epub 2020 Feb 25.

Department of Pharmacy, Thomas Jefferson University, Philadelphia, PA.

Purpose: High-dose methotrexate (HD-MTX) is commonly used for the treatment of osteosarcoma or for CNS involvement in lymphoproliferative neoplasms. It is often given in the inpatient setting because of monitoring requirements after administration. We conducted a process improvement initiative to change our institutional discharge criteria for HD-MTX from 0.05 µmol/L to ≤ 0.1 µmol/L to reduce cost and length of stay (LOS) for this patient population.

Methods: After an assessment of drivers of LOS among patients receiving HD-MTX, we identified discharge criteria as an actionable factor. We developed a workflow to discharge patients with 3 days of oral leucovorin and sodium bicarbonate when the methotrexate level reached ≤ 0.1 µmol/L. Patient demographics, chemotherapy regimen, cycle, dose, and LOS data were collected for a 7-month period before and a 4-month period after the intervention. Cost savings were estimated on the basis of the daily cost of a hospital bed at the institution.

Results: Mean LOS for the pre-intervention and postintervention group was 4.84 days (n = 49) and 3.67 days (n = 42), respectively, resulting in a 24.4% reduction in LOS, with a mean ratio of 0.756 (95% CI, 0.615 to 0.927; = .007). Reduced LOS resulted in a decrease in cost of $1,828.73 per admission, with a 4-month savings of $76, 806.56 and projected annualized savings of $230,419.67. No patient experienced complications because of the change in discharge criteria.

Conclusion: Liberalizing discharge criteria for HD-MTX was feasible and safe and reduced cost. Additional efforts to reduce LOS for elective chemotherapy admissions or to safely transition some of these complex regimens to the home setting are currently underway at our institution.
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August 2020

Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service.

J Oncol Pract 2019 10 8;15(10):e906-e915. Epub 2019 Aug 8.

Thomas Jefferson University Hospital, Philadelphia, PA.

Purpose: Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients who were admitted for elective chemotherapy experienced a delay-more than 6 hours-with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions.

Methods: Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention.

Results: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours ( = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission.

Conclusion: By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.
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October 2019

The Use of Filgrastim in Patients with Hodgkin Lymphoma Receiving ABVD.

Int J Hematol Oncol Stem Cell Res 2017 Oct;11(4):286-292

Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Place New York, New York, NY, 10029, USA.

There is conflicting data about the increased risk of pulmonary toxicity when granulocyte-stimulating factor (G-CSF) is given in combination with bleomycin. No clear consensus for management of patients with Hodgkin lymphoma (HL) who require G-CSF support exists. Our objective was to evaluate whether there is an increase in pulmonary toxicity in patients who receive bleomycin and G-CSF during treatment for HL. We conducted a single-center retrospective analysis of patients with Hodgkin Lymphoma from January 2003 until July 2015. All patients who received at least 1 dose of bleomycin and followed at our institution were included. Patients were evaluated for pulmonary toxicity starting from the day of first dose of bleomycin until 1 year after initiation of bleomycin. Data on pre-identified risk factors for pulmonary toxicity were also collected. Fifty-four patients met inclusion criteria. Twenty-one patients received bleomycin alone, and 33 patients received bleomycin and G-CSF. There was no statistically significant (p = 0.50) difference in the development of pulmonary toxicity between the two groups. Crude hazard ratio for development of pulmonary toxicity in the bleomycin and G-CSF cohort was 1.58 (95% confidence interval, CI: 0.41-6.12). On multivariate analysis, the hazard ratio for development of pulmonary toxicity was 1.71 (95% CI: 0.43-6.81). : This study does not find evidence that the combination of bleomycin and G-CSF increases the risk for bleomycin- induced pulmonary toxicity. We recommend G-CSF use in HL patients receiving bleomycin when needed to maintain dose intensity.
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October 2017

Hispanic ethnicity is associated with younger age at presentation but worse survival in acute myeloid leukemia.

Blood Adv 2017 Nov 26;1(24):2120-2123. Epub 2017 Oct 26.

Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.

SEER data and a Bronx validation cohort demonstrate that Hispanics present with AML at younger age but have shorter survival than whites.Increased frequency of high-risk mutations in Hispanics provides a potential biologic explanation for poorer outcomes in Hispanics.
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November 2017

A path forward: Global health, telemedicine, and hematology.

Am J Hematol 2016 Aug;91(8):E333-4

Icahn School of Medicine at Mount Sinai Hospital, New York, New York.

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August 2016

Uninformed consent: Do medicine residents lack the proper framework for code status discussions?

J Hosp Med 2016 Feb 16;11(2):111-6. Epub 2015 Oct 16.

Ambulatory Palliative Care Services, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Background: Conversations eliciting patient preferences about cardiopulmonary resuscitation (CPR) are among the most common examples of informed consent. However, this is rarely recognized and therefore may not include all key elements of informed consent, namely, details and benefits of the procedure, significant risks involved, likelihood of the outcome, and alternative therapeutic options.

Objective: Assess the content of code status discussions as reported by residents to examine whether residents meet requirements of informed consent.

Design: Prospective, observational, single-center survey study.

Setting: Internal medicine residents at an academic medical center.

Intervention: Medicine residents were surveyed and data were anonymously collected.

Measurements: Content of code status discussions and knowledge of CPR outcomes.

Results: Among 100 respondents, 66% have code status discussions with most patients upon hospital admission. Two main barriers to discussing code status were lack of time (49%) and lack of rapport (29%). Only 8% reported discussing all 5 elements of informed consent. Less than 10% of the residents correctly answered questions testing knowledge regarding outcomes after cardiac arrest. In logistical regression analyses, residents who included all key elements of informed consent reported more confidence that they provided the information needed for patients to make an informed decision (odds ratio 1.7 [95% confidence interval: 1.2-2.3]).

Conclusions: Resident conversations regarding CPR are insufficient in the 5 key elements of informed consent. Framing code status discussions as examples of informed consent may be an effective strategy for educating residents or may improve the quality of these discussions, potentially leading to better patient decisions.
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February 2016