The application of the PDCA cycle in the nutritional management of patients with nasopharyngeal carcinoma

The influence of evidence-based nutritional support plans on the nutritional status and adverse effects of radiotherapy in individuals with nasopharyngeal carcinoma

Objective

Radiotherapy serves as the primary treatment for patients with nasopharyngeal carcinoma (NPC). However, it frequently results in a progressive decline in nutritional status, which is linked to unfavorable clinical outcomes. This study aims to evaluate the effects of an evidence-based nutritional support program on nutritional status, radiotherapy-related side effects, and quality of life (QoL) in NPC patients undergoing radiotherapy.

Methods

A historical control trial was conducted. Patients with NPC admitted between May 2023 and August 2023 were allocated to the control group and received routine care, whereas those admitted between September 2023 and December 2023 were assigned to the intervention group and provided with a multidisciplinary, professional, individualized, and comprehensive evidence-based nutritional support program. Nutritional status was assessed through anthropometric measurements (e.g., body mass index, BMI), laboratory indicators (hemoglobin and albumin levels), the Nutritional Risk Screening 2002 (NRS2002), and the Patient-Generated Subjective Global Assessment (PG-SGA). Additionally, radiotherapy-related side effects, radiotherapy interruption rates, and QoL were monitored.

Results

Both groups comprised 40 patients each. By the conclusion of radiotherapy, a decline in nutritional status was observed in both groups; however, BMI was higher in the intervention group (23.14 ± 2.62) compared to the control group (21.38 ± 2.73). The NRS2002 score (2.73 ± 1.45) and PG-SGA score (6.13 ± 3.22) in the intervention group were significantly lower than in the control group (3.33 ± 1.16 and 7.73 ± 2.72, respectively; p < 0.05). The incidence of severe malnutrition was significantly lower in the intervention group (52.5%) compared to the control group (75%) (p < 0.05). Albumin and hemoglobin levels were significantly higher in the intervention group (albumin: 120.75 ± 16.52 vs. 113.50 ± 12.08, p = 0.028; hemoglobin: 41.24 ± 4.54 vs. 37.62 ± 5.04, p = 0.001). The severity of radiotherapy-related side effects, including radiation-induced oral mucositis, dermatitis, and myelosuppression, was significantly lower in the intervention group (p < 0.05). All patients completed radiotherapy, and no significant difference was observed in radiotherapy interruption rates between groups (control group: 6 interruptions; intervention group: 1 interruption; p > 0.05). Post-radiotherapy QoL scores demonstrated that the intervention group achieved superior outcomes in physical, role, emotional, cognitive, and social functioning (p < 0.05).

Conclusion

Implementing evidence-based nutritional support programs has the potential to prevent the decline in nutritional status among NPC patients receiving radiotherapy, reduce the occurrence of treatment-related side effects, and enhance overall quality of life.

Construction of a stroke green channel process based on the PDCA cycle management model and its impact on stroke prognosis

OBJECTIVE

To evaluate the impact of implementing a stroke green channel process (GCP) based on the PDCA (Plan-Do-Check-Act) cycle on stroke prognosis.

METHODS

A retrospective analysis was conducted at the Second Affiliated Hospital of Guizhou Medical University by reviewing data of 259 stroke patients from January 2021 to December 2023. Patients were divided into two cohorts: 114 patients managed by the PDCA-based GCP and 145 patients receiving standard care (non-green channel process, NGCP). Key metrics assessed included demographic data, rescue indicators, and prognostic outcomes - neurological function, life ability, and quality of life.

RESULTS

The GCP group demonstrated significantly reduced triage (P = 0.009) and computed tomography (CT) scan completion times (P = 0.042), leading to shorter hospital stay durations (P = 0.022) and fewer transfer incidents (P = 0.001). Neurological and cognitive functions improved in the GCP group, evidenced by lower National Institute of Health stroke scale (NIHSS) scores (P = 0.011) and higher Mini-Mental State Examination (MMSE) (P = 0.008) and Montreal Cognitive Assessment (MoCA) scores (P = 0.032). Functional abilities and independence also improved, with higher Activities of Daily Living (ADL) (P = 0.007) and Barthel scores (P = 0.003), alongside lower Modified Rankin Scale (mRS) scores (P < 0.001). Adverse reactions were less frequent in the GCP group (total incidence rate P < 0.001).

CONCLUSION

Implementing a stroke GCP managed with the PDCA cycle significantly improves stroke prognosis, enhancing clinical outcomes.

Enhancing the timeliness of EMR documentation in resident doctors: the role of PDCA cycle management

BACKGROUND

The impact of the Plan-Do-Check-Act (PDCA) cycle in improving the timeliness of electronic medical record documentation (EMRd) remains uncertain. EMRd that is completed beyond the specified time is classified as late EMRd, while unqualified EMRd refers to electronic medical records with important sections that are not completed on time according to the Chinese Basic Norms of Medical Records Writing. This study aimed to evaluate the effectiveness of PDCA management in improving the timeliness of EMRd among resident doctors.

METHOD

This study utilized a before and after design. Resident doctors rotating in the Head and Neck Oncology Department of West China Hospital, Sichuan University, from November 2021 to August 2022 were classified as the control group and did not receive specific training on the timeliness of EMRd. Those rotating from September 2022 to June 2023 were assigned to the PDCA group, which was managed using the PDCA cycle. The effectiveness of PDCA cycle management was evaluated by comparing the incidence of late EMRd and unqualified EMRd between two groups. Univariate and multivariate binary logistic regression analyses were conducted tocontrol for confounding factors.

RESULTS

A total of 245 resident doctors were included, with 162 doctors in the PDCA group and 152 doctors in the control group. The incidences of late EMRd (5.40% vs. 2.56%, P = 0.005) and unqualified EMRd (1.05% vs. 0.00%, P < 0.001) were significantly lower in the PDCA group than those in the control group. After adjusting confounding factors, PDCA management still significantly reduced the occurrence of unqualified EMRd (P < 0.001) with an adjusted odds ratio (OR) of 0.166 (95% CI 0.067-0.416) and late EMRd (P < 0.001) with an adjusted OR of 0.318 (95% CI 0.181-0.557).

CONCLUSION

This study successfully developed PDCA management and demonstrated its effectiveness in improving the timeliness of EMRd while concurrently reducing the incidence of unqualified and late entries among resident doctors.

Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial

Background

As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted.

Objective

This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC.

Methods

Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects.

Results

A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02).

Conclusions

This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy.

Symptom clusters and nutritional status in primary liver cancer patients receiving transcatheter arterial chemoembolization

Introduction

Introduction: symptom clusters (SCs) are highly prevalent among patients diagnosed with primary liver cancer. Malnutrition poses a heightened risk for a more pronounced total symptom cluster score. Objective: this study aimed to identify SCs and assess the nutritional status of patients undergoing transcatheter arterial chemoembolization (TACE). Furthermore, it aimed to investigate the association between nutritional status and symptom clusters. Methods: primary liver cancer patients who were scheduled to receive TACE were recruited. Symptoms data were collected using the MD Anderson Symptom Inventory (MDASI-C) and the Symptom Module specific to Primary Cancer (TSM-PLC). Nutritional assessment relied on the Nutritional Risk Screening-2002 (NRS-2002) and blood biochemistry. The SCs were extracted using exploratory factor analysis, while the relationship between SCs and nutritional status was evaluated using Spearman correlation analysis. Results: the study included 226 patients, four distinct symptom clusters emerged: emotional-psychological symptom cluster, upper gastrointestinal symptom cluster, post-embolization-related symptom cluster, and liver function impairment symptom cluster. 68.14 % of patients were found to be at high risk of malnutrition. Our study revealed significant differences in Scs scores between patients at risk of malnutrition and those without such risk (p < 0.050). Notably, we observed a positive correlation between NRS-2002 scores and the scores of all symptom clusters (r = 0.205 to 0.419, p < 0.001), while a negative correlation was observed between prealbumin levels and the scores of all symptom clusters (r = -0.183 to -0.454, p < 0.001). Conclusion: the study highlights the high risk of malnutrition among liver cancer patients receiving TACE and the positive correlation between high malnutrition risk and Scs scores.

Summary of the best evidence for nutritional support programs in nasopharyngeal carcinoma patients undergoing radiotherapy

Objective

To evaluate and summarize the best evidence for nutritional support in patients receiving radiotherapy for nasopharyngeal carcinoma and to offer guidance for clinical practice.

Background

Patients with nasopharyngeal carcinoma undergoing radiotherapy often experience a high prevalence of malnutrition, and there is a lack of compiled guideline recommendations, which complicates the provision of a reference for clinical nursing.

Methods

A systematic literature search revealed the best evidence of nutritional support for nasopharyngeal carcinoma patients undergoing radiotherapy. Included in the review were various types of literature, such as clinical guidelines, expert consensus, systematic evaluations, meta-analyses, evidence summaries, and original studies. The evidence was graded according to the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Evidence Pre-Grading System (2016 version). Data were gathered from a range of sources, including BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Web of Science, CINAL, CNKI, the WanFang database, SinoMed, the Yi Maitong Guidelines Network, Dingxiangyuan, the Chinese Nutrition Society, the European Society for Clinical Nutrition and Metabolism website, and the American Society for Parenteral and Enteral Nutrition website. The search spanned from January 2013 to 2023.

Results

A comprehensive review identified a total of 3,207 articles, comprising six guidelines, eight expert consensus articles, four systematic evaluations, five randomized controlled trials, two cohort trials, and two observational studies. From these articles, we synthesized 63 pieces of evidence spanning six domains: nutritional risk screening and assessment, nutrient requirements, nutritional support, management of nutritional symptoms, functional exercise, and nutritional monitoring and follow-up.

Conclusion

A total of lines of evidence supporting nutritional support for nasopharyngeal carcinoma patients receiving radiotherapy were summarized. However, the evidence should be combined with the actual clinical situation, and it should be validated in the future by combining large-sample and multicenter studies to provide a more scientific and beneficial nutritional support program for nasopharyngeal carcinoma patients receiving radiotherapy.