Geoheritage Values Assessment in Aring, Gua Musang, Kelantan

Abstract Context Discordant growth hormone (GH) and insulin-like growth factor-1 (IGF-1) values are frequent in acromegaly. Objective To evaluate the impact of different GH cutoffs on discordance rate. To investigate whether the mean of consecutive GH measurements impacts discordance rate when matched to the last available IGF-1 value. Design Retrospective study. Setting Referral center for pituitary diseases. Patients Ninety acromegaly patients with at least 3 consecutive evaluations for GH and IGF-1 using the same assay in the same laboratory (median follow-up 13 years). Interventions Multimodal treatment of acromegaly. Main Outcome Measures Single fasting GH (GHf) and IGF-1 (IGF-1f). Mean of 3 GH measurements (GHm), collected during consecutive routine patients’ evaluations. Results At last evaluation GHf values were 1.99 ± 2.79 µg/L and age-adjusted IGF-1f was 0.86 ± 0.44 × upper limit of normality (mean ± SD). The discordance rate using GHf was 52.2% (cutoff 1 µg/L) and 35.6% (cutoff 2.5 µg/L) (P = 0.025). “High GH” discordance was more common for GHf <1.0 µg/L, while “high IGF-1” was predominant for GHf <2.5 µg/L (P < 0.0001). Using GHm mitigated the impact of GH cutoffs on discordance (GHm <1.0 µg/L: 43.3%; GHm <2.5 µg/L: 38.9%; P = 0.265). At receiver-operator characteristic curve (ROC) analysis, both GHf and GHm were poor predictors of IGF-1f normalization (area under the curve [AUC] = 0.611 and AUC = 0.645, respectively). The prevalence of disease-related comorbidities did not significantly differ between controlled, discordant, and active disease patients. Discussion GH/IGF-1 discordance strongly depends on GH cutoffs. The use of GHm lessen the impact of GH cutoffs. Measurement of fasting GH levels (both GHf and GHm) is a poor predictor of IGF-1f normalization in our cohort.

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Science of quality: Communication, decision making, and behavior.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.22 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 22-22 ◽

Cited By ~ 1

Author(s):

Deb Harrison ◽

J. Russell Hoverman ◽

Sabrina Q. Mikan ◽

Kevin Donald Olson ◽

Cynthia Taniguchi ◽

...

Keyword(s):

Decision Making ◽

Pilot Study ◽

End Of Life ◽

Advance Directives ◽

Assessment Tool ◽

Cancer Center ◽

Measurement Tool ◽

Physician Referral ◽

Code Status ◽

Values Assessment

22 Background: Addressing advance care planning (ACP) early in metastatic disease is a challenge for providers across oncology. Providing a systematic method to engage providers and patients in these discussions offers opportunities to improve end of life outcomes, improve patient quality of life and engage in shared decision making that supports effective transition to appropriate palliative care and hospice. Methods: A multidisciplinary group of oncology providers developed a framework for ACP which included defining a target population for early introduction, utilizing a standard patient-centered measurement tool (Values Assessment), reviewing practice workflow to schedule ACP conversations, and incorporating documentation elements embedded in the electronic health record. The model included physician referral of patients to a nurse practitioner or social worker who scheduled meetings with patients to assess values, assist patients with advance directives (AD), and explore patient end-of-life wishes based on disease. Seven cancer center sites of service engaged in the pilot study for a 90-day period to test tools, workflow and effectiveness of implementation methods. Documented values assessments, code status, and advance directives were pilot outcomes measures. Results: All sites in the pilot study implemented the framework and participated for 90 days. Workflows were validated to support scheduling of ACP conversations. Use of the values assessment tool was slow to be incorporated in ACP process as was physician referral for introduction. Conclusions: Engaging in a systematic approach to gather and assimilate information provides an opportunity to comparatively assess adoption of an ACP program. Providers are not inherently experienced in basic ACP introduction or deeper ACP discussions. Communications training, including conversations for values assessment and ACP, is in development for use with pilot and new practices engaging in the program, which supports program scalability. [Table: see text]

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Using a values assessment as a bridge to advance care planning: Results of 1286 patient reports.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.12 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 12-12

Author(s):

John Russell Hoverman ◽

Cynthia Taniguchi ◽

Kathryn J Eagye ◽

Susan Ash-Lee ◽

Angela Kalisiak ◽

...

Keyword(s):

End Of Life ◽

Cancer Patients ◽

Advance Care Planning ◽

Metastatic Cancer ◽

Care Planning ◽

Continuous Variables ◽

Exact Test ◽

Patient Reports ◽

Values Assessment ◽

Advance Care

12 Background: Recent studies have shown that formal Palliative Care (PC) improves care at the end of life for cancer patients. The role of communication in PC is not defined. Other studies have shown that communication alone can be associated with better end of life outcomes. The US Oncology Network developed and tested a Values Assessment (VA) instrument for routinely broaching difficult topics to facilitate more formal advance care planning (ACP). The results of the first 28 months of the program on over 1200 patients are reported here. Methods: The VA consists of 10 questions of the format “How valuable is it to me to….”, for example “know that I am not a burden to my family, friends or helpers?” Responses were on a 4 point scale from unsure to very valuable. The VA was completed either in person in the clinic or telephonically. VA participation by n = 1286 metastatic cancer patients treated at participating practices from 4/1/2013-7/31/2015 were extracted from the EHR and confirmed by chart review, as were demographic (age, gender, ethnicity), clinical (diagnosis and stage), chemotherapy treatment and outcomes (hospice enrollment and place of death). Demographics and outcomes were compared using the Chi-Squared or Fisher’s Exact Test, or Wilcoxon Rank Sums test for continuous variables. Results: 1268 patients completed the VA. 56.7% were 65 or over. 57.8% went on to complete Advance Directives (AD). 52% had colon or lung cancer. There were 438 deaths of which 431 had a date of last chemotherapy recorded. Of these 431 patients, 78% died at home or inpatient hospice, 14.6% in the hospital. Hospice enrollment with AD was 76.1%, without 60.9%. (p = .008) Median LOS in hospice was 21 days vs. 12.5 (p = .025). Chemotherapy in the last 14 days of life was 7.05% with AD, 13.4% without. The VA was well accepted by patients. Conclusions: A VA as a routine part of practice is feasible and scalable. It can be delivered successfully either face to face or telephonically. It facilitates ACP discussion leading to AD. The results suggest VA and ACP lead to less aggressive care at the end of life.

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Assessment of Sulfonylurea Adherence and Metabolic Control

The Diabetes Educator ◽

10.1177/014572179502100109 ◽

1995 ◽

Vol 21 (1) ◽

pp. 52-57 ◽

Cited By ~ 42

Author(s):

Barbara J. Mason ◽

Joy R. Matsuyama ◽

Sandra G. Jue

Keyword(s):

Metabolic Control ◽

Insulin Dependent Diabetes Mellitus ◽

Self Report ◽

Dependent Diabetes Mellitus ◽

Medication Monitoring ◽

Adherence Assessment ◽

Values Assessment ◽

Pill Counts ◽

Insulin Dependent ◽

Electronic Medication Monitoring

This study was designed to compare sulfonylurea adherence assessment by providers, patients' self-report, pill counts, and a medication event monitoring system (MEMS-3®) device, and correlate the estimates of metabolic control by provider, patient, and laboratory. Forty-seven outpatient veterans with fair to poor metabolic control of non-insulin-dependent diabetes mellitus were enrolled and received monthly refills of sulfonylurea in vials with a cap containing an electronic medication monitoring microprocessor. Pill counts and fasting plasma glucoses were measured monthly, and glycohemoglobin and a 24-hour diet recall were obtained at 0 and 60 days. Investigators then asked providers and patients to assess adherence and metabolic control. Forty-seven percent were nonadherent to medication using MEMS-3®, 29% using pill counts, 29% using provider assessment, and 31 % using self-report. Thirty-one percent of providers and 53% of patients assessed metabolic control differently than laboratory values. Assessment of medication adherence by provider, patient, and pill counts did not explain metabolic control as closely as assessment by MEMS-3®.

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Building patient-centered care through values assessment integration with advance care planning

Community Oncology ◽

10.12788/j.cmonc.0043 ◽

2013 ◽

Vol 10 (7) ◽

pp. 209-211

Author(s):

Sabrina Mikan ◽

Cynthia Taniguchi ◽

J Russell Hoverman

Keyword(s):

Advance Care Planning ◽

Patient Centered Care ◽

Care Planning ◽

Patient Centered ◽

Values Assessment ◽

Centered Care ◽

Advance Care

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ASSESSMENT OF MULTIRESOLUTION SEGMENTATION FOR EXTRACTING GREENHOUSES FROM WORLDVIEW-2 IMAGERY

ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences ◽

10.5194/isprs-archives-xli-b7-145-2016 ◽

2016 ◽

Vol XLI-B7 ◽

pp. 145-152 ◽

Cited By ~ 1

Author(s):

M. A. Aguilar ◽

F. J. Aguilar ◽

A. García Lorca ◽

E. Guirado ◽

M. Betlej ◽

...

Keyword(s):

Image Objects ◽

Object Based Image Analysis ◽

Local Variance ◽

Sensing Applications ◽

Object Based ◽

Optimum Scale ◽

Values Assessment ◽

Segmentation Approach ◽

Optimal Setting ◽

Multiresolution Segmentation

The latest breed of very high resolution (VHR) commercial satellites opens new possibilities for cartographic and remote sensing applications. In this way, object based image analysis (OBIA) approach has been proved as the best option when working with VHR satellite imagery. OBIA considers spectral, geometric, textural and topological attributes associated with meaningful image objects. Thus, the first step of OBIA, referred to as segmentation, is to delineate objects of interest. Determination of an optimal segmentation is crucial for a good performance of the second stage in OBIA, the classification process. The main goal of this work is to assess the multiresolution segmentation algorithm provided by eCognition software for delineating greenhouses from WorldView- 2 multispectral orthoimages. Specifically, the focus is on finding the optimal parameters of the multiresolution segmentation approach (i.e., Scale, Shape and Compactness) for plastic greenhouses. The optimum Scale parameter estimation was based on the idea of local variance of object heterogeneity within a scene (ESP2 tool). Moreover, different segmentation results were attained by using different combinations of Shape and Compactness values. Assessment of segmentation quality based on the discrepancy between reference polygons and corresponding image segments was carried out to identify the optimal setting of multiresolution segmentation parameters. Three discrepancy indices were used: Potential Segmentation Error (PSE), Number-of-Segments Ratio (NSR) and Euclidean Distance 2 (ED2).

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