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SummaryAnaesthesia is a critical and complex process that extends from the pre-operative assessment through to the postoperative management of patients. Handover of responsibility for logistical as opposed to patient-orientated reasons may compromise that process of care. If such handover becomes inevitable with shift-based patterns of working, the implications need to be considered and procedures developed in order to minimise adverse consequences. This survey of national practice reveals little formalisation of procedure and a spectrum of opinion on the relevance of the key considerations. There is, however, a majority view amongst respondents that national guidelines would be of value and that professional defensibility would be aided by standardisation and documentation of any handover.

PURPOSE: Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non–safety-net institutions. METHODS: Ten institutions (five safety-net and five non–safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort. RESULTS: Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non–safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non–safety-net patients, even after controlling for all other variables. CONCLUSION: 4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non–safety-net patients, indicating that 4R may reduce care disparities.

The adsorption behavior of bovine insulin on a C(8)-bonded silica stationary phase was investigated at different column pressures and temperatures in isocratic reversed-phase HPLC. Changes in the molar volume of insulin (deltaV(m)) upon adsorption were derived from the pressure dependence of the isothermal retention factor (k'). The values of deltaV(m) were found to be practically independent of the temperature between 25 and 50 degrees C at -96 mL/mol and to increase with increasing temperature, up to -108 mL/mol reached at 50 degrees C. This trend was confirmed by two separate series of measurements of the thermal dependence of ln(k'). In the first series the average column pressure was kept constant. The second series involved measurements of ln(k') under constant mobile-phase flow rate, the average column pressure varying with the temperature. In both cases, a parabolic shape relationship was observed between ln(k') and the temperature, but the values obtained for ln k' were higher in the first than in the second case. The relative difference in ln(k'), caused by the change in pressure drop induced by the temperature, is equivalent to a systematic error in the estimate of the Gibbs free energy of 12%. Thus, a substantial error is made in the estimates of the enthalpy and entropy of adsorption when neglecting the pressure effects associated with the change in the molar volume of insulin. This work proves that the average column pressure must be kept constant during thermodynamic measurements of protein adsorption constants, especially in RPLC and HIC. Our results show also that there is a critical temperature, T(c) approximately equals 53 degrees C, at which ln(k') is maximum and the insulin adsorption process changes from an exothermic to an endothermic one. This temperature determines also the transition point in the molecular mechanism of insulin adsorption that involves successive unfolding of the protein chain.