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Jeff you make a great point when you mention making easier to find the assessments. Some clinics have signature papers in a folder, others have them located in a certain pod. Wouldn’t it make sense to be able to see these electronically? Should we at the James have a standard operative procedure regarding uploading these documents each visit into the chart?
Greg- I agree, determining if regimens should be inpatient vs. outpatient is waaay above my paygrade. My only thoughts center around how we can make sure outpatient is just as safe as inpatient. For example, a few months ago a patient drove himself to his appointment that he was to receive ifos. My concern was what if he started neuro toxing while driving himself home is that safest for him or those out on the road. Should we have safety measures like if someone who is getting a neurotoxic medication not drive themselves?
1. What was the knowledge gained from the articles?
ONS’s article regarding nursing led assessments on ifosomide highlights that ifosfamide, a chemotherapy drug used to treat various cancers, can affect the central nervous system because it crosses the blood-brain barrier. This can lead to side effects like headaches, movement difficulties, urinary incontinence, agitation, and changes in memory or cognition.
A key point from the article is the importance of nursing in recognizing these side effects early. Early detection through thorough and regular nursing assessments can help prevent more serious complications and improve patient safety. The article emphasizes that nurses should closely monitor neurological signs and symptoms during ifosfamide treatment, especially in outpatient settings where patients might not be under constant supervision.
It also stresses the need for nurses to be knowledgeable about these risks so they can educate patients and their families on what symptoms to watch for. Overall, the article underlines how improved nursing assessment and awareness can help manage ifosfamide-related toxicities more effectively.2. Will the research information in this article change or influence your practice? If so how?
Yes, the information from these articles will definitely influence my practice. I now have a deeper understanding of the benefits of administering ifosfamide in the outpatient setting, not only in terms of patient convenience but also in improving their quality of life by allowing them more time at home with loved ones. Additionally, outpatient treatment can be more sustainable financially, reducing costs for both healthcare facilities and patients. Not to mention the second article from Cancer Support Care pointed out that ifosomide toxicity occurrence occurred statistically higher in the first two administrations. Those two adminstirations are given in the hospital, decreasing the chance of a patient neurotoxing in the clinic setting.
At the same time, the articles have highlighted the importance of vigilant nursing assessment to identify early signs of neurotoxicity and other side effects. This means I will be more proactive in monitoring patients closely, educating them and their families about symptoms to watch for, and ensuring timely interventions when needed. Overall, this knowledge encourages me to balance patient safety with the advantages of outpatient care, aiming to provide safe, effective, and patient-centered chemotherapy administration.3. What other questions does the article raise about current practice?
The articles raise important questions about current outpatient practices, especially regarding patient safety after ifosfamide infusions. I find myself wondering what specific safety measures are in place for patients once they leave the clinic. For example, if a patient passes a neurotoxicity assessment before discharge, is it safe for them to drive themselves home? Are there clear guidelines on this?
Additionally, I question whether it’s safe for patients to be alone at home after receiving ifosfamide, given the risk of delayed neurotoxic effects. If it’s not safe, how are we—as the healthcare providers who administered or ordered the medication—ensuring that patients have adequate support at home and are monitored closely to catch any emerging neurotoxicity?
These questions highlight the need for clear protocols and patient education to ensure that outpatient administration of ifosfamide remains safe and effective beyond the clinic setting.Kelly- You asked of an example of AI that is used here at OSU. I’m not sure if this is exactly AI but OSU uses data (I feel like the word algorithms are appropriate to use in this situation but not sure) such as rising white blood counts, other labs and current vital signs and a MEWS number is computed. That number is computed in EPIC and alerts nursing staff that the patient has potential to deteriorate. STAT nurses are able change their epic views to specify patients with high MEWS scores. From there they are flagged as someone who needs closer observations and or interventions.
Jennifer-
I couldn’t help but think about an AI situation regarding EKGs. The information I was reading an article that discussed that AI can start to interpret EKGs so accurately that they can identify if the patient is male or female. This is leading to a more detailed report and the ability to determine disease processes in females vs males. Knowing the CTU uses EKGs so frequently, I wonder if that could be another tool to help learn even more about the trial.
Brandi-
It is very interesting thinking about what liability nurses assume with AI generated care. One would hope that more standardize care will result in better outcomes for patients.
Hello! My name is Katie Conrad and I am a nurse from OP JCRU. AI in healthcare is an interesting topic that I am glad we are discussing.
1. What was the knowledge gained from the article?
Both articles made it clear that AI is already changing how nurses work, not something that’s just coming “someday.” Billingsley et al. (2024) talked about how AI can make health care more efficient and improve patient outcomes, but they also pointed out that we have to be really careful with how we handle patient data and make sure we’re thinking about ethics. It’s not just about using new tech — it’s about using it responsibly.
Gallegos (2023) focused more on urologic nursing and gave examples of how AI is helping with things like diagnostics and saving time. They stressed that nurses need to keep learning and stay flexible because the technology is moving fast.
2. What other questions does the article raise about current practice?
Both articles raise some big questions about how ready we actually are for AI in nursing. Billingsley et al. (2024) made me wonder: are our current policies strong enough to protect patient data when AI systems are involved? They also made me think about whether nurses are getting enough training to recognize bias in AI tools — and what happens if we start trusting technology too much and lose some of our critical thinking skills.
Gallegos (2023) raised the question of whether nurses in specialty areas like urology are really prepared to use AI tools day-to-day. Are we getting the right education and support to use these tools effectively without losing the personal connection we have with patients? And how do we make sure AI helps nurses rather than just adding another layer of complexity?
3. Do you agree/disagree with the conclusions of the author, why?
I do agree that nursing needs to be involved with AI and how nursing care will evolve regarding AI. I also agree that AI has some concerns as well. These concerns arise when ethical concerns like algorithm bias and fairness comes to mind. Gallegos (2023) article shows that AI can improve diagnostic accuracy, assist in treatment planning, and save time on repetitive tasks, freeing up nurses to spend more time with their patients. However, Gallegos also points out that the fast pace of AI development means nurses must stay proactive about learning new systems and skills to keep up. There’s a concern that without enough training and support, technology could create more stress instead of reducing it. I am all for efficiency that the articles mention but worried at what cost are we trading efficiency for.Kasey thanks for sharing that story regarding your CTU patient. Hearing how good the patient looked verses how sick she really was is an eye opener. I recently had a patient at the Breast Center that experienced pretty significant adrenal fatigue. The patient was refusing her immunotherapy and the team discussed with her that due to her severity of adrenal fatigue, she will live with adrenal fatigue for the rest of her life. The patient was refusing her immunotherapy but the team shared with her that the damage was already done and they encouraged her to continue with the treatment. Ultimately she refused.
@ Strickland- You mentioned oncology cardiac team. Hearing we added this clinic to The James several years ago made me really want to delve deeper into cardiac related issues in Oncology. Now after reading these journals I realize that there’s more to oncology cardiology than what I thought. I would love to spend a day in that clinic and pick their brains.
Hello! My name is Katie Conrad and I am a nurse in the JCRU. Wow! I found these journals interesting to read!
1. What was the knowledge gained from the article?
Both articles are very insightful. Generally, when administering an immunotherapy I assess for inflammatory symptoms or adrenal fatigue. Now I realized I shouldn’t limit my assessment to the typical thyroid, pneumonitis, or colitis. Cardio myocarditis should be a concern as well. I also learned that ICI-associated myocarditis frequently fails to respond to steroids and other immunosuppressants. Which is pretty frighting. More importantly I learned generally myocarditis from ICI generally occurs within the first 3 months of therapy initiation and most prominently 2-4 weeks after the start of therapy. Being primarily an oncology nurse, I sometimes forget how life altering other diseases like mycocarditis can be. Myocarditis can lead to cardiomyopathy, arrhythmias, heart blocks and much more.
2. Will the research/information in this article change or influence your practice? If so, how?
Yes, I will now be more mindful of toxicities related to immunotherapies. To be honest I generally feel like patient’s tolerate immunotherapies pretty well but what I am learning is that rarely when the treatment is not tolerated well it can be pretty life altering. An example of this is adrenal fatigue. I also learned that patients with autoimmune disorders are more at risk for developing adverse effects. Because of this I will be more aware during nursing check ins and notify providers when risk factors are present. Also, I will brush up on my knowledge regarding myocarditis and things I can look for to help patients who might be experiencing that.3. What other questions does the article raise about current practice?
I am more curious now about future research on immunotherapy and adverse effects. Could things that cause inflammation be avoided resulting in better tolerance of the treatments? Would an anti-inflammatory diet help decrease the chances of adverse problems?
4. Do you agree/disagree with the conclusions of the author, why?
I agree with the authors that more research is needed regarding toxicities related to immunotherapy. As with any new treatment time will tell what things we can expect regarding patients who are on these therapies for a longer period. Also, I agree cardiac clearance should be something considered especially with patients who has a history of autoimmune disorders.
Greg you mentioned saving our patient’s time and money with liquid biopsies. I found it interesting that certain mutations like KRAS was detected in patient’s sputum up to 2 years prior. With that in mind, could you imagine how much better early detection and prescreening could be with our patients?
Jeff thanks for leading this journal club and thanks for picking an interesting topic. I agree and am also looking forward to more research in this area. When discussing this with another nurse they mentioned a patient who was recently diagnosed with colon cancer after a home colon cancer screening. Although she still had to have a colonoscopy and biopsy, she was able to identify a problem earlier and in an less invasive way. I do not know if that kit is considered a liquid biopsy but it seems to correlate with how this article describes a liquid biopsy.
1. What information did I learn?
I have to admit the term liquid biopsy is new to me and pretty interesting. After reading this article I learned a liquid biopsy utilizes blood sampling to identify cancer cells from a tumor that are circulating in the blood or for pieces of DNA from tumor cells located in the blood.
2. How will the information gained change my practice?
It is clear after reading this article that liquid biopsies are continuing to improve in accuracy and have potential to help change diagnostic standards in testing . Going forward I will seek out new information regarding liquid biopsies to better my knowledge. More specific how are the providers at the James currently using this information towards treatment. I understand there are reliability concerns, as pointed out in the article, but the more information that is studied the more we are able to utilize these tests in a less invasive way to help our patients. In the future I would like to pay closer attention to the ” why” and “how” we are currently using the test results.
3. What questions does the article raise about current practice?
Currently we check CEA 19, 125 ect from my understanding to see response to treatments. I would like to know are these labs considered liquid biopsies? More so what labs am I already checking that are liquid biopsies?4. Do you agree or disagree with the conclusions of the author, why?
Considering I have limited knowledge (outside of what was gained through this journal club) regarding liquid biopsies, I would have to agree liquid biopsies will make future impact in the oncology world. Anytime we are able to study cell breakdowns in other areas of the body the more knowledge and better treatments we can offer to patients. This is one more tool to help.
Greg you bring up a good point when you mention you do not want to be a nurse unable to enjoy retirement because of the professions physical toll on the body. The first article brings that to life so much and makes me realize that my choices I make now have profound effects on my future. I was looking into the LSA account information and found this link https://yp4h.osu.edu/resources/get-active/fitness-discounts/ which is discounted health and wellness services OSU employees can use. Wanted to share just in case someone was interested in these services and wanted a discount.
Jeff- You bring up a good point with LSA. I am happy OSU is moving a positive direction with reimbursing employees for healthier lifestyle. When there is money to specifically spend towards something I am most likely to follow through. Have you seen the mindfulness studies? I received information on one study that is starting in the Spring and involved movement and moods.
Hello! I am Katie Conrad from ambulatory JCRU.
1. Will the research/information in this article change or influence your practice? If so how?
It is a no brainer that stress is bad for one’s overall health. As pointed out in the article “Dying to retire or living to work: Challenges facing aging nurses”, stress can lead to poor immune responses, cardiovascular disease, body injuries and much more. I for one am not immune to this and am starting see very unhealthy results from adverse effects of stress on myself. I have made this my number one priority this year and both articles are strong reminders that if I would like to have a long healthy future I need to take initiative. One thing that I have looked into is joining the mindfulness study through OSU. This study involves individualized data obtained through the Oura Ring.
2. What other questions does the article raise about current practice?
Currently OSU has some supportive and resiliency programs, and I can remember going through a program called Heart Math at an outside hospital. I also can remember participating in programs here at OSU and the OSH and still struggling with resiliency. My question is does facilities look at these programs as a tool to help with resiliency or does it look at it as an answer? I say this because it seems staffing issues and higher demand for the profession contributes the most to loss of resiliency and stress.
3. What was the knowledge gained from the article?
I found a lot of information from both articles interesting specifically regarding agism. I found it interesting that the first article points out that nurses who have longer years of service can be excluded from valuable education. Perhaps managers feel that more experienced nurses are already knowledgeable in a certain subject matter and won’t benefit quit as much as an inexperienced RN. This doesn’t make sense as we all know there are new things to learn every day and expanding everyone’s knowledge should be fair and equal. I can’t say that I am shocked that more nurses will be retiring earlier. In fact, I am a little jealous. I do hope we as professionals can have open conversations regarding agism and take away all around understanding.
