Publications by authors named "Erika E Ramsdale"

5 Publications

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Providing Optimal Multidisciplinary Care to Older Patients With Cancer.

J Oncol Pract 2017 02;13(2):105-106

University of Rochester, James P. Wilmot Cancer Institute, Rochester, NY.

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http://dx.doi.org/10.1200/JOP.2016.019695DOI Listing
February 2017

Improving Quality and Value of Cancer Care for Older Adults.

Am Soc Clin Oncol Educ Book 2017 ;37:383-393

From the University of Rochester Medical Center, Rochester, NY; The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA; University of California, Los Angeles, Los Angeles, CA; Cancer and Aging Research Group, Rhinebeck, NY.

The concepts of quality and value have become ubiquitous in discussions about health care, including cancer care. Despite their prominence, these concepts remain difficult to encapsulate, with multiple definitions and frameworks emerging over the past few decades. Defining quality and value for the care of older adults with cancer can be particularly challenging. Older adults are heterogeneous and often excluded from clinical trials, severely limiting generalizable data for this population. Moreover, many frameworks for quality and value focus on traditional outcomes of survival and toxicity and neglect goals that may be more meaningful for older adults, such as quality of life and functional independence. A history of quality and value standards and an evaluation of some currently available standards and frameworks elucidate the potential gaps in application to older adults with cancer. However, narrowing the focus to processes of care presents several opportunities for improving the care of older adults with cancer now, even while further work is ongoing to evaluate outcomes and efficiency. New models of care, including the patient-centered medical home, as well as new associated bundled payment models, would be advantageous for older adults with cancer, facilitating collaboration, communication, and patient-centeredness and minimizing the fragmentation that impairs the current provision of cancer care. Advances in information technology support the foundation for these models of care; these technologies facilitate communication, increase available data, support shared decision making, and increase access to multidisciplinary specialty care. Further work will be needed to define and to continue to tailor processes of care to achieve relevant outcomes for older patients with cancer to fulfill the promise of quality and value of care for this vulnerable and growing population.
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http://dx.doi.org/10.1200/EDBK_175442DOI Listing
December 2017

A Comprehensive Look at Polypharmacy and Medication Screening Tools for the Older Cancer Patient.

Oncologist 2016 06 5;21(6):723-30. Epub 2016 May 5.

Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia, USA.

Unlabelled: : Inappropriate medication use and polypharmacy are extremely common among older adults. Numerous studies have discussed the importance of a comprehensive medication assessment in the general geriatric population. However, only a handful of studies have evaluated inappropriate medication use in the geriatric oncology patient. Almost a dozen medication screening tools exist for the older adult. Each available tool has the potential to improve aspects of the care of older cancer patients, but no single tool has been developed for this population. We extensively reviewed the literature (MEDLINE, PubMed) to evaluate and summarize the most relevant medication screening tools for older patients with cancer. Findings of this review support the use of several screening tools concurrently for the elderly patient with cancer. A deprescribing tool should be developed and included in a comprehensive geriatric oncology assessment. Finally, prospective studies are needed to evaluate such a tool to determine its feasibility and impact in older patients with cancer.

Implications For Practice: The prevalence of polypharmacy increases with advancing age. Older adults are more susceptible to adverse effects of medications. "Prescribing cascades" are common, whereas "deprescribing" remains uncommon; thus, older patients tend to accumulate medications over time. Older patients with cancer are at high risk for adverse drug events, in part because of the complexity and intensity of cancer treatment. Additionally, a cancer diagnosis often alters assessments of life expectancy, clinical status, and competing risk. Screening for polypharmacy and potentially inappropriate medications could reduce the risk for adverse drug events, enhance quality of life, and reduce health care spending for older cancer patients.
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http://dx.doi.org/10.1634/theoncologist.2015-0492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912369PMC
June 2016

Interprofessional training enhances collaboration between nursing and medical students: A pilot study.

Nurse Educ Today 2016 May 4;40:33-8. Epub 2016 Feb 4.

Department of Medicine, Emily Couric Cancer Center, Charlottesville, VA 22903, United States. Electronic address:

Background: Effective collaboration among healthcare providers is an essential component of high-quality patient care. Interprofessional education is foundational to ensuring that students are prepared to engage in optimal collaboration once they enter clinical practice particularly in the care of complex geriatric patients undergoing surgery.

Study Design: To enhance interprofessional education between nursing students and medical students in a clinical environment, we modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients. This experience culminated with students performing skills independently in a clinic setting.

Results: Nine nursing students and six medical students completed the pilot project. At baseline and after the final clinic visit we administered a ten question geriatric assessment test. Post-test scores (M=90.33, SD=11.09) were significantly higher than pre-test scores (M=72.33, SD=12.66, t(14)=-4.50, p<0.001. Nursing student post-test scores improved a mean of 22.0 points and medical students a mean of 11.7 points over pre-test scores. Analysis of observational notes provided evidence of interprofessional education skills in the themes of shared problem solving, conflict resolution, recognition of patient needs, shared decision making, knowledge and development of one's professional role, communication, transfer of interprofessional learning, and identification of learning needs.

Conclusions: Having nursing and medical students "learn about, from and with each other" while conducting a preoperative geriatric assessment offered a unique collaborative educational experience for students that better prepares them to integrate into interdisciplinary clinic teams.
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http://dx.doi.org/10.1016/j.nedt.2016.01.024DOI Listing
May 2016

Treatment of leptomeningeal carcinomatosis: current challenges and future opportunities.

J Clin Neurosci 2015 Apr 9;22(4):632-7. Epub 2015 Feb 9.

University of Chicago, Department of Neurology, 5841 S. Maryland Avenue, MC 2030, Chicago, IL 60637, USA. Electronic address:

Leptomeningeal metastasis (LM) in breast cancer patients confers a uniformly poor prognosis and decreased quality of life. Treatment options are limited and often ineffective, due in large part to limitations imposed by the blood-brain barrier and the very aggressive nature of this disease. The majority of studies investigating the treatment of LM are not specific to site of origin. Conducting randomized, disease-specific clinical trials in LM is challenging, and much clinical outcomes data are based on case reports or retrospective case series. Multiple studies have suggested that chemo-radiotherapy is superior to either chemotherapy or radiation therapy alone. Attempts to overcome current obstacles in the treatment of breast cancer LM hold promise for the future. We review the epidemiology, diagnosis, and prognosis of LM in breast cancer, and discuss the treatment options currently available as well as those under investigation.
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http://dx.doi.org/10.1016/j.jocn.2014.10.022DOI Listing
April 2015