Critical Incident Debriefings and Community-Based Clinical Care

2005 ◽  
pp. 529-542
Author(s):  
Joshua Miller
Keyword(s):  
Critical Incident ◽  
Clinical Care ◽  
Community Based

Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice

2019 ◽  
Vol 15 (2) ◽  
pp. 100-109 ◽  
Author(s):  
Kirsten Suderman ◽  
Carolyn McIntyre ◽  
Christopher Sellar ◽  
Margaret L. McNeely
Keyword(s):  
Cancer Survivors ◽  
Research Evidence ◽  
Clinical Care ◽  
Preliminary Evidence ◽  
Model Of Care ◽  
Community Based ◽  
Exercise Rehabilitation ◽  
Barriers To Exercise ◽  
Growing Body ◽  
After Cancer

A growing body of research evidence supports the benefit of exercise for cancer survivors both during and after cancer treatment. The purpose of this paper is to provide an update on our previously published review in 2006 on the state of the evidence supporting exercise for survivors of cancer as well as guidelines for integrating exercise programming in the cancer clinical setting. First, we provide a brief overview on the benefits of exercise as well as preliminary evidence supporting the implementation of community-based exercise programs. Second, we summarize the principles and goals of exercise, and the identified barriers to exercise among cancer survivors. Finally, we propose an interdisciplinary model of care for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.

Adoption and utilization of NGS-based molecular profiling in community-based oncology practices: Insights from Sarah Cannon.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18064-e18064
Author(s):  
Andrew McKenzie ◽  
Daniel Schlauch ◽  
Yasha Sharma ◽  
David R. Spigel ◽  
Howard A. Burris ◽  
...  
Keyword(s):  
Clinical Care ◽  
Community Setting ◽  
Standard Of Care ◽  
Molecular Profiling ◽  
Community Based ◽  
Sequencing Technologies ◽  
Community Oncology ◽  
Medical Oncologists ◽  
Tumor Types ◽  
Ngs Data

e18064 Background: As the price of NGS-based sequencing technologies falls, adoption of those technologies is predicted to increase. To date, a survey of the adoption and utilization of NGS-based technologies as a part routine oncology clinical care has not been performed. Thus, a comprehensive analysis of physician adoption and utilization of commercial NGS testing in the community-setting between 2012 and 2018 was performed. Methods: Medical Oncologists in the Sarah Cannon Research Institute network ordered commercially-available NGS-based molecular profiling for their patients as standard of care. Data use agreements were initiated between SCRI, affiliated medical oncology practices, and commercial NGS testing providers, and patient NGS data were subsequently analyzed starting in 2012. Results: Community-based NGS testing rates within the Sarah Cannon network were 5.75/month in 2012 and 440/month in 2018. Plasma-based NGS testing began in 2014 and comprised 4.9% of total testing compared to 40.1% in 2018. The number of oncologists ordering molecular profiles increased from 11 in 2012 to 269 in 2018. Physician test utilization grew from an average of 6 tests/physician to 22 tests/physician in 2012 and 2018, respectively. NGS tests were performed on 34 different tumor types and biopsies were taken from both primary (~40%) and metastatic (~60%) sites . Tissue-based tests averaged 14 mutations/sample while plasma-based tests averaged 4 mutations/sample. There was a 74% decrease in median time between biopsy collection and NGS test results between 2012 and 2018 (131 and 34 days, respectively), indicating a shift toward the use of fresh – non-archival – tissue in recent years. Conclusions: These data establish NGS-based testing trends in community oncology practices and show that NGS-based tumor testing utilization has increased in the community-setting between 2012 and 2018. NGS testing is performed on a wide array of tumor types and oncologists utilize fresher biopsies.

scholarly journals Adoption and utilization of NGS-based molecular profiling in community-based oncology practices: Insights from Sarah Cannon.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 34-34
Author(s):  
Howard A. Burris III ◽  
Daniel Schlauch ◽  
Andrew McKenzie ◽  
Yasha Sharma ◽  
David R. Spigel ◽  
...  
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Community Setting ◽  
Standard Of Care ◽  
Molecular Profiling ◽  
Community Based ◽  
Primary Tumors ◽  
Sequencing Technologies ◽  
Tumor Types

34 Background: The price of NGS-based sequencing technologies is falling, and the adoption of NGS-based testing is increasing in oncology practices. To date, a survey of the adoption and utilization of NGS-based technologies as a part routine oncology clinical care has not been performed. Thus, a comprehensive analysis of physician adoption and utilization of commercial NGS testing in the non-academic medical center, community-setting between 2012 and 2018 was performed. Methods: Medical Oncologists in the Sarah Cannon Research Institute network ordered commercially-available NGS-based molecular profiling for their patients as standard of care. Data use agreements were initiated between SCRI, affiliated medical oncology practices, and commercial NGS testing providers, and patient NGS data was subsequently analyzed starting in 2012. Results: Community-based NGS testing rates with the Sarah Cannon network were 5.75/month in 2012 and 440/month in 2018. Plasma-based NGS testing began in 2014 and comprised 4.9% of total testing compared to 40.1% in 2018. The number of oncologist ordering molecular profiles increased from 11 in 2012 to 269 in 2018. Physician test utilization grew from an average of 6 tests/physician to 22 tests/physician in 2012 and 2018, respectively. NGS tests were performed on 34 different tumor types and biopsies were taken from both primary tumors (~40%) and metastatic sites (~60%). Tissue-based tests averaged 14 mutations/sample while plasma-based tests averaged 4 mutations/sample. There was a 74% decrease in median time between biopsy collection and NGS test results between 2012 and 2018 (131 and 34 days, respectively), indicating a shift toward the use of fresh – non-archival – tissue in recent years. Conclusions: These data establish NGS-based testing trends in community oncology practices and show that NGS-based tumor testing utilization has increased in the community-setting between 2012 and 2018. NGS testing is performed on a wide array of tumor types and oncologists order tests earlier and utilize fresher biopsies.

scholarly journals A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study (Preprint)

2018 ◽  
Author(s):  
Michael McCreary ◽  
Armen C Arevian ◽  
Madeline Brady ◽  
Ana E Mosqueda Chichits ◽  
Lily Zhang ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Program Evaluation ◽  
Data Collection ◽  
Integrated Care ◽  
Clinical Care ◽  
Data Collection Tool ◽  
Community Based ◽  
Care Services

BACKGROUND National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. OBJECTIVE The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. METHODS Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. RESULTS A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. CONCLUSIONS Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. CLINICALTRIAL ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW)

scholarly journals Spatial and temporal dynamics of superspreading events in the 2014–2015 West Africa Ebola epidemic

2017 ◽  
Vol 114 (9) ◽  
pp. 2337-2342 ◽  
Author(s):  
Max S. Y. Lau ◽  
Benjamin Douglas Dalziel ◽  
Sebastian Funk ◽  
Amanda McClelland ◽  
Amanda Tiffany ◽  
...  
Keyword(s):  
Spatial Information ◽  
Temporal Dynamics ◽  
Clinical Care ◽  
Infected Individual ◽  
Significant Proportion ◽  
Control Measures ◽  
Community Based ◽  
Infectious Individual ◽  
Targeted Interventions ◽  
Care Systems

The unprecedented scale of the Ebola outbreak in Western Africa (2014–2015) has prompted an explosion of efforts to understand the transmission dynamics of the virus and to analyze the performance of possible containment strategies. Models have focused primarily on the reproductive numbers of the disease that represent the average number of secondary infections produced by a random infectious individual. However, these population-level estimates may conflate important systematic variation in the number of cases generated by infected individuals, particularly found in spatially localized transmission and superspreading events. Although superspreading features prominently in first-hand narratives of Ebola transmission, its dynamics have not been systematically characterized, hindering refinements of future epidemic predictions and explorations of targeted interventions. We used Bayesian model inference to integrate individual-level spatial information with other epidemiological data of community-based (undetected within clinical-care systems) cases and to explicitly infer distribution of the cases generated by each infected individual. Our results show that superspreaders play a key role in sustaining onward transmission of the epidemic, and they are responsible for a significant proportion (∼61%) of the infections. Our results also suggest age as a key demographic predictor for superspreading. We also show that community-based cases may have progressed more rapidly than those notified within clinical-care systems, and most transmission events occurred in a relatively short distance (with median value of 2.51 km). Our results stress the importance of characterizing superspreading of Ebola, enhance our current understanding of its spatiotemporal dynamics, and highlight the potential importance of targeted control measures.

Standard of Care of Patients with CML Treated in Community Based Oncology Group Practices in Rhineland-Palatinate (Germany)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2376-2376
Author(s):  
Rudolf Weide ◽  
Bernhard Rendenbach ◽  
Monika Grundheber ◽  
Oswald Burkhard ◽  
Joachim Behringer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Standard Of Care ◽  
Fish Analysis ◽  
Line Treatment ◽  
Oncology Group ◽  
Community Based ◽  
Group Practices

Abstract Introduction: Significant progress has been made in CML-therapy since the introduction of imatinib and other tyrosine kinase inhibitors (TKI) into clinical care. The aim of this study was to assess diagnosis, treatment and outcome of CML-patients who received their treatment in community based oncology practices in Rhineland-Palatinate and whether European LeukemiaNET-guidelines were followed. Methods: All Ph-/BCR-ABL-positive CML-patients who were treated between 12/2001-12/2015 in 9 oncology group practices were analyzed retrospectively concerning diagnosis, treatment and outcome according to European LeukemiaNET-guidelines. Data were collected from patient files into a central data base and analyzed statistically with SPSS. Results: 264 patients (pts) with a median age of 60 (18-90) were analyzed. 126 (48%) were female, 138 (52%) were male. At initial diagnosis bone marrow biopsy was performed in 213 pts (81%). Cytogenetics was applied in 204 pts (77%) (38% in blood, 56% in bone marrow). FISH-analysis was used in 155 pts (59%) (33% in blood, 36% in bone marrow). PCR-testing to detect a BCR-ABL1-rearrangement was applied in 200 pts (76%) (52% blood, 37% bone marrow). 258 pts (98%) were in chronic phase, 5 (2%) in accelerated phase and 1 (0.4%) in blast crisis at diagnosis. EUTOS score could be calculated in 131 pts (50%). 20% were high risk, 80% low risk. 252 pts (95%) received some form of TKI-therapy. Out of 416 TKI-therapies 308 (74%) were PCR-based monitored, 148 (36%) were monitored by cytogenetics. First line treatment was imatinib in 201 pts (80%), 51 pts (20%) received a second generation TKI. Second line treatment consisted of dasatinib in 59%, nilotinib in 32%, imatinib in 6% and bosutinib in 3%. Third line treatment was nilotinib in 56%, dasatinib in 35%, ponatinib in 6% and imatinib in 3%. 62 pts (23%) were treated within a study protocol. 13 pts (5%) received an allogeneic transplantation. Overall survival probability was 88% after 5 years and 72% after 10 years. Disease specific survival was 95% after 5 years and 86% after 10 years. Conclusion: The overwhelming majority of CML-patients treated in oncology group practices receive standard of care as suggested by European LeukemiaNET-guidelines. Overall survival in routine care is comparable to international studies. Disclosures No relevant conflicts of interest to declare.

scholarly journals Telephone triage and seizure management for community-based ID/DD: A research synthesis

2017 ◽  
Vol 8 (2) ◽  
pp. 46
Author(s):  
Kathy Summers Auberry
Keyword(s):  
Clinical Care ◽  
Cochrane Collaboration ◽  
Research Synthesis ◽  
Telephone Triage ◽  
Community Based ◽  
Management Tools ◽  
Intellectual And Developmental Disability ◽  
Study Results ◽  
Research Findings ◽  
The Cochrane Collaboration

Nurse and physician clinicians often guide seizure care for individuals with intellectual and developmental disability (ID/DD) through telephone triage. This article evaluated the evidence for epilepsy management tools with a focus on the telephone triage tool. Studies were included in the systematic review, data was extracted, followed by meta-aggregated findings. A rigorous methodological protocol was used as described by The Cochrane Collaboration. All quantitative or descriptive studies that included epilepsy management tools or protocols for persons with ID/DD living in a community-based setting were considered. No tools specific to ID/DD seizure management via telephone triage were discovered. Study results reveal a possible gap in clinical care. Research findings did support the use of telephone triage tools and epilepsy protocols for clinicians. These findings may improve seizure management by focusing ID/DD clinicians on the advantages of using such tools. Findings may also illuminate the need for seizure management tools specific to the ID/DD population.

Reduction in Cardiovascular Risk Among Latino Participants in a Community-Based Intervention Linked With Clinical Care

2017 ◽  
Vol 53 (2) ◽  
pp. e71-e75 ◽  
Author(s):  
Mori J. Krantz ◽  
Brenda Beaty ◽  
Stephanie Coronel-Mockler ◽  
Bonnie Leeman-Castillo ◽  
Kelly Fletcher ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Clinical Care ◽  
Community Based

scholarly journals Description of the EUROBIS Program: A Combination of an Epode Community-Based and a Clinical Care Intervention to Improve the Lifestyles of Children and Adolescents with Overweight or Obesity

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Claudia Mazzeschi ◽  
Chiara Pazzagli ◽  
Loredana Laghezza ◽  
Dalila Battistini ◽  
Elisa Reginato ◽  
...  
Keyword(s):  
Obesity Prevention ◽  
Primary Schools ◽  
Intervention Program ◽  
Clinical Care ◽  
Care Program ◽  
Overweight And Obesity ◽  
Healthy Lifestyles ◽  
Community Based ◽  
Umbria Region ◽  
Family Based

The present paper describes the Epode Umbria Region Obesity Prevention Study (EUROBIS) and aims to implement the C.U.R.I.A.MO. model through the EPODE methodology. The main goal of the EUROBIS is to change the pendency of slope of the actual trend towards the increase in the yearly rates of childhood overweight and obesity in Umbria and to improve healthy lifestyles of children and their parents. The project is the first EPODE program to be performed in Italy. The aims of the Italian EUROBIS study are: (1) a community-based intervention program (CBP) carrying out activities in all primary schools of the Umbria Region and family settings as first step, to reverse the current obesity trend on a long-term basis, and (2) a clinical care program for childhood and adolescent by C.U.R.I.A.MO. model. C.U.R.I.A.MO. model is a multidisciplinary approach to improve three key aspects of healthy lifestyles: nutrition, exercise, and psychological aspects with the strategy of a family-based approach. The community-based intervention and clinical trial provide an innovative valuable model to address the childhood obesity prevention and treatment in Italy.

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