Category: Physician Training
To limit coronavirus exposure to patients and healthcare workers, healthcare facilities are decreasing the number of procedures performed as well as the length of procedure time for those that remain scheduled. This includes replacing surgical care with less-invasive interventional radiology procedures.
New hospital protocols may prove challenging for patients who need multistep care, as seen with individuals who suffer with severe ureteral or biliary obstructions. Traditionally, these patients require two separate interventional procedures to successfully place a temporary internal drainage: a first procedure to place a drainage catheter and a second to place a stent.
To simplify treatment for these patients, Merit Medical offers a temporary internal nephroureteral and biliary drainage stent system called the ReSolve ConvertX Stent System. A less-invasive option than conventional treatment, the ReSolve ConvertX completely eliminates the need for a second drain-to-stent procedure. Instead, stent conversion can be done in an office or at bedside in less than one minute.1
WATCH HOW THE RESOLVE CONVERTX WORKS
Eliminating a second interventional procedure has several advantages, particularly in the present healthcare crisis. Without the need for a lengthy, additional drain-to-stent procedure, hospital visits may be shorter for patients,2 potentially resulting in less risk of exposure to other patients, physicians, and hospital staff. Because treatment with the ReSolve ConvertX can be completed in a less-intense care setting, it can free up physicians and hospital staff to care for an increasing caseload outside of the interventional radiology suite. This may also leave the interventional radiology suite open for an influx of new interventional cases.
The ReSolve ConvertX is also designed with other clinical benefits in mind, such as reduced procedural challenges for the patient. Furthermore, with fewer procedures, there is less radiation exposure for patients, physicians, and hospital staff.
FIRST IMPRESSIONS OF RESOLVE CONVERTX
SCOUT Localization can help alleviate future workflow challenges
As a result of the effect of the COVID-19 pandemic in the US, screening, diagnostic exams, and surgical procedures are being severely restricted or postponed at hospitals and breast centers across the country. This is causing a disruption never experienced before in the diagnosis and treatment of the 325,000 projected cases of breast cancer in 2020 in the US.1
These delays and closures will impact care delivery well into the foreseeable future. While this health crisis clearly needs immediate management, we also need to think long term on how to effectively manage the backlog of breast cancer patients once restrictions have been lifted.
Merit Oncology is connecting physicians across the county to share their experiences, challenges, and solutions with managing breast patients during COVID-19. Merit Café is a forum for healthcare providers to come together to share best practices and experiences in an online, interactive forum moderated by a radiologist and a surgeon. Discussion focuses on relevant topics including triaging breast patient care during the COVID-19 pandemic, procedure efficiency, minimizing patient/provider exposure, and planning for downstream challenges anticipated post-pandemic.
Joining Merit for this Q&A is Vincent Reid, MD, Surgical Oncologist at Mercy’s Hall-Perrine Cancer Center, Cedar Rapids, Iowa and one of the first moderators of Merit Café
Does your institution have guidelines established for the surgical management of breast cancer patients?
There has been guidance published from different organizations and societies on the management of elective surgeries. It is important to note that they all share the common goal of minimizing patient and physician exposure and preserving personal protective equipment (PPE). The guidelines are mostly based on the assumption of a low to moderate COVID-19 census at your facility. Once a surge of COVID-19 occurs, the guidelines become more restrictive. The guidelines are also constantly being updated, so it is important to stay on top of the latest revisions.
At the current time, in our community, we are at that low to moderate stage. However, as I talk to colleagues on Merit Café from other parts of the country, particularly on the East coast, their situation is very different. Having the opportunity to learn what they are doing has been helpful to me in planning for different scenarios.
Access the most recent guidelines from the COVID-19 Pandemic Breast Cancer Consortium, comprised of representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology (ACR) here.
Based on your hospital’s and your region’s exposure, what are some of the plans you are putting into place now to help patients and staff when restrictions are lifted at your hospital?
Our number one priority is to help ease the stress and anxiety of our patients during this difficult time, not only about their cancer but now COVID-19. All our breast cancer patients are being evaluated by a multidisciplinary group to develop a recommended care plan. Some patients are having surgery delayed and for those patients where it is appropriate, they are going to either neoadjuvant chemotherapy (NAC) or endocrine therapy prior to surgery. We are localizing these patients with SCOUT®, which can safely and effectively be placed, even though they will not go surgery for several months. This will streamline the process once they are ready to go to surgery. If immediate surgery is indicated those patients proceed to surgery.
Where appropriate, we are also localizing with SCOUT at time of biopsy. At Mercy, a number of our patients drive long distances for treatment. When we can eliminate an entire procedure, we eliminate a travel day, decrease patient and physician interaction, and preserve PPE. That is significant all around.
How do you anticipate the strategies you are implementing now will help with overrun schedules in all hospital departments?
I see two things, first the placement of SCOUT in our surgical patients. Our radiology department is going to be slammed just catching up with routine mammography screening. Patients who have been waiting for cancer surgery for 2-4 months are not going to want to wait any longer than needed if they have to go and be localized prior to surgery. They will get very impatient if radiology scheduling resulted in an additional delay.
The second is telemedicine. Our cancer program was about two years out on the horizon for implementing a meaningful telemedicine program. Now fast forward to a pandemic and we have progressed leaps and bounds in this implementation. We are conducting video telemedicine consultations with patients now, so they do not have to be delayed waiting for a consult. It is an excellent tool and allows me quality time with my patients discussing options.
Have you seen any unexpected outcomes of the COVID-19 restrictions?
I am seeing more patients opting for a lumpectomy over mastectomy. Clearly there are clinical cases where a mastectomy is the only option, but with the current surgical restrictions we are not able to do reconstruction – that part of the procedure is being delayed. Women who are candidates for lumpectomy, who were leaning toward a mastectomy of their own choice are now opting for a lumpectomy.
The outcome that I find most enlightening is that we are all united in a powerful way. I am virtually connecting with colleagues, that I might have never had the opportunity to meet, and we are sharing and learning from each other. I look forward to the day our medical societies come together again, and we can all meet in person.
What are you telling your breast cancer patients during this difficult time?
I think the most important message for patients is the reassurance that no matter what the recommended course of treatment is they are not being put at risk. We are thoughtfully evaluating all the options, and even in the COVID-19 environment as we are working to keep everyone safe, we are not compromising their cancer care. I also reassure them that once restrictions are lifted everything possible has been done to assure, they can move on to the next step of treatment as quickly as possible.
There has been a recent shift in kidney care with both industry leaders and the White House showing support of home dialysis. This forward momentum is due to several advantages home dialysis offers patients, such as lower mortality rates,1 flexible treatment schedules,2 and reduced cost.3 Merit Medical is pleased to support this transition by providing dialysis patient education, clinician training, and a number of therapeutic products.
Heading the movement are international industry leaders DaVita® Kidney Care and Fresenius Kidney Care with an initiative called 20% by 2020, a program that aims to have 20% of dialysis patients on home dialysis therapy by the year 2020. Both DaVita and Fresenius provide two types of home dialysis options: peritoneal dialysis (PD) and hemodialysis.
“The initiative is important from several standpoints,” says John H. Crabtree, MD, general surgeon, chair of PD University for Surgeons-North America, and visiting clinical faculty at Harbor-UCLA Medical Center in Torrance, CA. “Number one, patients do better on home dialysis.”
Patients on PD therapy in particular, a group that comprises the majority of the home dialysis-treatment population, “have improved survival over the early years on treatment,” Dr. Crabtree told Merit Medical.4 Moreover, for individuals who receive a kidney transplant, “the results tend to be better when they were on peritoneal dialysis prior to the surgery as opposed to hemodialysis.”5
Home dialysis also offers greater autonomy. Because patients are properly trained and therapy can be done overnight, home dialysis allows for a regular work schedule.3 Moreover, the average cost of care for home dialysis is less.3 PD in particular, Dr. Crabtree went on to explain, is approximately $15,000 less per patient per year compared to hemodialysis.6
The White House recently announced a new government-sponsored payment approach for treating kidney disease that favors lower cost home dialysis. The U.S. Centers for Medicare and Medicaid Services is considering a trial program design that would improve care in the early stages of kidney disease, increase access to kidney transplants, and favor home dialysis over clinic-based treatment.3 It is particularly looking at the benefits of PD.3
Despite these advantages and the fact that many physicians believe 25%–35% of patients would do better on home dialysis therapy, the number of people receiving home dialysis in the US still remains low, with only 7% receiving PD and less than 1% choosing home hemodialysis.7 The 20% by 2020 initiative plans to change this through several avenues.
“The way that we can drive this is by improving patient education…Many patients aren’t provided information about home dialysis,” Dr. Crabtree explains. In addition to patient education, Dr. Crabtree says many physician education programs lack the training needed to take care of PD patients. “[I]t’s important to provide courses [and] educational opportunities that allow them to have hands-on training.”
Merit Medical is ready to address these needs through its Ask4PD™ patient education site and ThinkDialysisAccess™ hands-on physician training experiences. Merit also offers high-quality dialysis products, such as the Flex-Neck® Peritoneal Dialysis Catheter, a premium catheter that allows for up to 30% higher flow rates than other catheters currently on the US market.8
The support for home dialysis is expanding. By providing the tools and education needed to advance the 20% by 2020 initiative, Merit shows its ongoing evolution as a healthcare company as well as its vision to continually find ways to improve patient care.
Watch Dr. Crabtree’s interview to learn more about the benefits of home dialysis and how Merit supports it.
Dr. Crabtree is a paid consultant of Merit Medical.
- DaVita® Kidney Care. (n.d.). Top 5 benefits of home dialysis treatment. Retrieved from https://www.davita.com/treatment-services/home-dialysis/home-benefits/top-5-benefits-of-home-dialysis-treatment.
- Fresenius Kidney Care. (2019). Learn more about home dialysis treatment options. Retrieved from https://www.freseniuskidneycare.com/ckd-treatment/benefits-of-home-dialysis.
- Copley, C., & Humer, C. (2019, March 3). U.S. seeks to cut dialysis costs with more home care versus clinics. Retrieved from https://www.reuters.com/article/us-usa-healthcare-dialysis/us-seeks-to-cut-dialysis-costs-with-more-home-care-versus-clinics-idUSKCN1QL0G6.
- Teixeira, J.P., Combs, S. A., & Teitelbaum, I. (2015). Peritoneal dialysis: Update on patient survival. Clin Nephrol, Jan;83(1):1-10.
- Joachim, E., Gardezi, A. I., Chan, M. R., et al. (2017). Association of pre-transplant dialysis modality and post-transplant outcomes: A meta-analysis. Perit Dial Int, May-Jun;37(3):259-265.
- United States Renal Data System. (2018). 2018 annual data report (Chapter 9: Healthcare expenditures for persons with ESRD). Retrieved from https://www.usrds.org/2018/view/v2_09.aspx
- DaVita Kidney Care. (n.d.). Majority of nephrology professionals prefer home dialysis. Retrieved from https://www.davita.com/treatment-services/home-dialysis/recommended-approach.
- Data on file.