Shared medical appointment for early stage melanoma survivorship.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 69-69 ◽  
Author(s):  
Pauline Funchain ◽  
Jung Min Song ◽  
Carolyn Stanek ◽  
Michael J. McNamara ◽  
Ahmad A. Tarhini ◽  
...  
Keyword(s):  
Psychosocial Support ◽  
Early Stage ◽  
Cost Effective ◽  
Cancer Surveillance ◽  
Management Tool ◽  
Cancer Center ◽  
Long Term Effects ◽  
Group Setting ◽  
High Risk Behaviors

69 Background: Shared medical appointments (SMA) are a newer patient care format that involve both education and creation of individualized medical plans for multiple patients in a group setting. SMAs have been found to be cost-effective with high patient satisfaction scores. Methods: We describe an SMA model for early stage melanoma surveillance. The development of our SMA required multidisciplinary input from oncology, psychology, social work, schedulers, business, nursing and cancer center administration. We emphasized creation of a nonjudgmental environment to educate and promote healthy behavior. Results: Our early stage melanoma SMA involves 4-6 patients with an APP as group leader, RN as facilitator, and PsyD to provide psychosocial support. The 90-minute visit starts with a private physical exam followed by group education, activities, and formation of an individualized surveillance plan. An integral component of our SMA is the use of a self-assessment Melanoma Risk tool that has been found to be an efficient method to promote sun protective behaviors. Patients self-identify behavioral risks and personalize strategies to combat long-term effects of unhealthy behaviors. Psychosocial aspects are monitored with the NCCN distress management tool to identify areas of distress. The primary goals of care are to diminish isolation, enhance self-management, and provide professional expertise in combination with first-hand information from peers. Long-term goals are to decrease anxiety and increase survival with prevention. Conclusions: The first project to our knowledge utilizing an SMA format for cancer surveillance, this effort identifies a population at risk and provides education and psychosocial support to change high-risk behaviors. Future areas of research include quantifying outcomes of SMA-based surveillance and the addition of significant others to enhance surveillance.

Health behaviors and survivorship needs of short- versus long-term melanoma survivors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9061-9061
Author(s):  
Susan M. Swetter ◽  
Arianna Aldridge Gerry ◽  
Kelly Bugos ◽  
Ralph Steven Greco ◽  
Katherine L. McGurk ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Sleep Problems ◽  
Psychosocial Support ◽  
Sun Protection ◽  
Long Term Results ◽  
Cancer Center ◽  
Long Term Effects ◽  
Short Term ◽  
Sun Protection Practices

9061 Background: Little is known about melanoma survivors and their long-term symptoms, sun protection practices and support needs from health professionals. Methods: Melanoma survivors previously treated at Stanford Cancer Center completed a quality improvement survey to explore the value of a melanoma survivorship clinic, as part of the Stanford Cancer Survivorship Program. The survey period ranged from July 2012 to September 2012, and 17% of the 893 invited survivors responded. We compared responses of melanoma survivors diagnosed between 2006-2011 (short-term) and 1995-2005 (long-term). Results: 153 cancer survivors (41% short- and 59% long-term) completed the survey. On average, they were 62 years of age (SD=15.1), 94% Caucasian, 47% female, and 68% underwent local excision alone. Long- vs. short-term survivors were less likely to receive routine skin screening every 3-6 months (38% vs. 83%, p<0.001) or follow-up for their melanoma in the last 6 months (54% vs. 76% p=0.045). Sun protection practices were similar between groups; however, long-term survivors decreased their use of tanning beds (33% vs. 18%, p=0.03) and time seeking a tan relative to short-term survivors (72% vs. 48%, p=0.002). Overall, survivors rated anxiety as the most prevalent symptom (33%), followed by numbness of the scar site (31%), forgetfulness (26%), sleep problems and depression (23%), pain and fatigue (17%). Sixty-eight percent of all survivors reported their symptoms were not addressed by their health provider, and of those stating their provider addressed their symptoms (32%), the survivor initiated the conversation 71% of the time. In general, survivors desired education about the long-term effects of melanoma (41%), family risk of skin cancer (28%), and protecting their skin from further damage (20%). Twenty percent of all survivors requested treatment for the long term effects of melanoma, and 12% wanted emotional support. Conclusions: Melanoma survivors experience continuing symptoms long after treatment, namely anxiety, and express a need for information about long-term melanoma effects, psychosocial support, and prevention of further skin cancer. Clinicians should routinely assess survivorship needs to improve quality of life.

Quality Assurance Methods Applied For Exposed-Aggregate Concrete Pavement Construction

2021 ◽  
Author(s):  
Adam Glinicki ◽  
Michal Glinicki
Keyword(s):  
Quality Assurance ◽  
Early Stage ◽  
Traffic Noise ◽  
Cost Effective ◽  
Weather Conditions ◽  
Special Treatment ◽  
Aggregate Concrete ◽  
Adverse Weather ◽  
Pavement Construction

The exposed aggregate pavement technology for construction of concrete highways is used in European countries, including Poland, mostly for heavy trafficked roads. It is mainly a two-lift slip-form technology with a special treatment of the top surface after the final smoothing operation. This is a demanding technology that leaves a little margin for mistakes. When properly done the pavement layer with exposed aggregates ensures designed skid resistance for vehicle wheels even in adverse weather conditions without excessive traffic noise. The challenge is to provide its cost-effective long term performance including both the adequate roughness and the desired smoothness of the pavement. The paper presents tools and methods for construction quality assurance specific for exposed aggregate concrete pavements. Required monitoring of the stability of concrete mix properties is discussed. The importance of concrete curing is analyzed in respect to the long term durability in wet-freeze regions with heavy use of deicing salts. Macrotexture assessment at the early stage of pavement construction is seen as the key factor for assurance of the proper skidding resistance. Local evaluation of smoothness is also a useful approach to assure the target IRI. Examples of quality assurance efforts applied on concrete highways recently constructed in Poland are presented.

Long-Term Complications of Lymphoma and Its Treatment

2011 ◽  
Vol 29 (14) ◽  
pp. 1885-1892 ◽  
Author(s):  
Andrea K. Ng ◽  
Ann LaCasce ◽  
Lois B. Travis
Keyword(s):  
Late Effects ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Large Body ◽  
Hodgkin's Lymphoma ◽  
Long Term Effects ◽  
Early Stage Disease ◽  
Long Term Follow Up

As a result of therapeutic advances, there is a growing population of survivors of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). A thorough understanding of the late effects of cancer and its treatment, including the risk of developing a second malignancy and non-neoplastic complications, most notably cardiac disease, is essential for the proper long-term follow-up care of these patients. For HL survivors cured in the past 5 decades, a large body of literature describes a range of long-term effects, many of which are related to extent of treatment. These studies form the basis for many of the follow-up recommendations developed for HL survivors. As HL therapy continues to evolve, however, with an emphasis toward treatment reduction, in particular for early-stage disease, it will be important to rigorously observe this new generation of patients long term to document and quantify late effects associated with modern treatments. Although data on late effects after NHL therapy have recently emerged, the formulation of structured follow-up plans for this heterogeneous group of survivors is challenging, given the highly variable natural history, treatments, and overall prognosis. However, the chemotherapy and radiation therapy approaches for some types of NHL are similar to that for HL; thus, some of the follow-up guidelines for patients with HL may also be transferrable to selected survivors of NHL. Additional work focused on treatment-related complications after NHL will facilitate the development of follow-up programs, as well as treatment refinements to minimize late effects in patients with various types of NHL.

Who is receiving survivorship care plans? Findings from the 2012 Livestrong survey.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9608-9608
Author(s):  
Ruth Rechis ◽  
Carla Bann ◽  
Stephanie Nutt ◽  
Linda Squiers ◽  
Naveen Rao
Keyword(s):  
Medical Center ◽  
Care Plan ◽  
Cancer Center ◽  
Survivorship Care Plans ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Long Term Effects ◽  
Care Plans ◽  
Key Stakeholders

9608 Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions (Table). While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, Black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue. [Table: see text]

Long-term cancer survivorship care: On the radar screen?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20567-e20567
Author(s):  
Rutika Mehta ◽  
Rohit Jain ◽  
Lori Rhodes ◽  
Joseph Abraham ◽  
Kenneth David Miller
Keyword(s):  
Cancer Survivors ◽  
Cancer Treatment ◽  
Breast Cancer Survivors ◽  
Demographic Data ◽  
Cancer Center ◽  
Specific Information ◽  
Survivorship Care ◽  
Coordination Of Care ◽  
Long Term Effects

e20567 Background: Long-term cancer survivors require comprehensive care. The purpose of this study was to describe how survivorship care fits into oncologists’ clinical time, and characterize long-term cancer survivors’ problems and oncology follow-up care. Methods: We abstracted 18,882 medical records of unique cancer patient visits during 2010 at a major NCI-designated cancer center and then evaluated survivor care for one week in April, 2010 to characterize how oncologists spend their clinical time. Finally, we selected three subgroups from the survivor population (n≈100 each) of survivors at 1-5 years, 6-10 years, and >10 years after diagnosis. We collected demographic data, purpose of visit, cancer-specific information, late and long-term effects, and type of care delivered, including surveillance for recurrence, intervention, prevention, and coordination of care. Results: In the larger group of 18,882, only 14% of survivors were more than 10 years post-diagnosis. Approximately two-thirds of the survivors were women. Breast cancer survivors comprised 38%, and survivors of hematologic malignancies accounted for 21% of the population. During the one week studied, the majority of oncologists' patients (74%) were actively receiving treatment; only 5% of their patients were 5 or more years post-diagnosis. Second or secondary malignancies were noted in 8% of patients. Late and long-term effects were uncommon. Approximately 25% of survivors beyond five years were observed to have late effects due to cancer treatment, most common being fatigue, neurological endocrine, and cardiac. Of the 300 selected survivors, sixty-two percent received only surveillance care during their visit. Only 3% of these patients received an entire array of survivorship care that included surveillance, intervention, co-ordination and prevention. Conclusions: A small proportion of oncologists’ visits were with long-term cancer survivors (5-14%) of whom only 25% had late or long-term effects of cancer treatment so overall very few of office visits were with long-term survivors who had late and long-term complications. All visits involved surveillance for cancer recurrence but there was little focus on prevention, intervention, and coordination of care for cancer survivors.

scholarly journals Simple Soil Tests for On-Site Evaluation of Soil Health in Orchards

2019 ◽  
Vol 11 (21) ◽  
pp. 6009
Author(s):  
Esther O. Thomsen ◽  
Jennifer R. Reeve ◽  
Catherine M. Culumber ◽  
Diane G. Alston ◽  
Robert Newhall ◽  
...  
Keyword(s):  
Microbial Biomass ◽  
Soil Health ◽  
Soil Nutrient ◽  
Cost Effective ◽  
Nutrient Concentrations ◽  
Long Term Effects ◽  
Soil Tests ◽  
Site Evaluation ◽  
Positive Correlations

Standard commercial soil tests typically quantify nitrogen, phosphorus, potassium, pH, and salinity. These factors alone are not sufficient to predict the long-term effects of management on soil health. The goal of this study was to assess the effectiveness and use of simple physical, biological, and chemical soil health indicator tests that can be completed on-site. Analyses were conducted on soil samples collected from three experimental peach orchards located on the Utah State Horticultural Research Farm in Kaysville, Utah. All simple tests were correlated to comparable lab analyses using Pearson’s correlation. The highest positive correlations were found between Solvita® respiration, and microbial biomass (R = 0.88), followed by our modified slake test and microbial biomass (R = 0.83). Both Berlese funnel and pit count methods of estimating soil macro-organism diversity were fairly predictive of soil health. Overall, simple commercially available chemical tests were weak indicators of soil nutrient concentrations compared to laboratory tests. Modified slake tests, Solvita® respiration and soil organism biodiversity counts may be efficient and cost-effective tools for monitoring soil health on-site.

Long-term effects of warren ripping for rabbit control in semi-arid South Australia.

1991 ◽  
Vol 13 (2) ◽  
pp. 96 ◽  
Author(s):  
GJ Mutze
Keyword(s):  
South Australia ◽  
Cost Effective ◽  
Long Term Effects ◽  
Short Term ◽  
Long Term Effect ◽  
Perennial Shrubs ◽  
Control Work ◽  
Semi Arid

Warren ripping and poisoning were used to control rabbits on the flood-out plain of a major creek system on Manunda Station, a sheep-grazing property near Yunta in semi-arid South Australia. Rabbit numbers were initially reduced by >99 per cent, as indicated by the number of active entrances remaining in rabbit warrens. After nearly 10 years without follow-up control work, ripped warrens had only two per cent of the pre-control number of active entrances. Poisoning effectively reduced rabbit numbers in the short-term, but had no long-term effect on the number of active entrances, either in ripped or unripped warrens. Perennial shrubs regenerated on and around ripped warrens. Warren ripping on this part of Manunda is a cost-effective management option.

Cost-Effective Methods of Monitoring Pesticide Pollution in Water

2019 ◽  
pp. 236-256
Author(s):  
S. Kanagasubbulakshmi ◽  
Krishnasamy Lakshmi ◽  
K. Kadirvelu
Keyword(s):  
Multidisciplinary Approach ◽  
Cost Effective ◽  
Long Term Effects ◽  
Pesticide Monitoring ◽  
Pesticide Pollution ◽  
Lack Of Information ◽  
Pros And Cons ◽  
Labeling Requirements ◽  
Monitoring Technologies

Environmental protection efforts require numerous advanced technologies to prevent and monitor the health and ecological effects associated with abiotic and biotic systems. Development of innovative tools and methodologies with the help of multidisciplinary approach to assess the transport, accumulation, and impact of pesticides will avoid the long-term effects in the environment. The lack of information about the pesticides hampers the labeling requirements that lead to misuse and discharge of pesticide-contaminated effluents into the water resources. This chapter covers the information on major sources of pesticides, chronic impacts, labeling of pesticides, multidisciplinary approach for monitoring, current cost-effective technologies, pros and cons of current technologies, and future perspectives of the pesticide monitoring technologies.

Maternal dietary intake during pregnancy has longstanding consequences for the health of her offspring

2013 ◽  
Vol 91 (6) ◽  
pp. 412-420 ◽  
Author(s):  
Ryan James Wood-Bradley ◽  
Sarah Louise Henry ◽  
Amanda Vrselja ◽  
Victoria Newman ◽  
James Andrew Armitage
Keyword(s):  
Dietary Intake ◽  
Maternal Nutrition ◽  
Metabolic Diseases ◽  
Communicable Disease ◽  
Cost Effective ◽  
Noncommunicable Disease ◽  
Fat Intake ◽  
Long Term Effects ◽  
Beneficial Impact

Over the past 100 years, advances in pharmaceutical and medical technology have reduced the burden of communicable disease, and our appreciation of the mechanisms underlying the development of noncommunicable disease has broadened. During this time, a number of studies, both in humans and animal models, have highlighted the importance of maintaining an optimal diet during pregnancy. In particular, a number of studies support the hypothesis that suboptimal maternal protein and fat intake during pregnancy can have long-term effects on the growing fetus, and increase the likelihood of these offspring developing cardiovascular, renal, or metabolic diseases in adulthood. More recently, it has been shown that dietary intake of a number of micronutrients may offset or reverse the deleterious effects of macronutrient imbalance. Furthermore, maternal fat intake has also been identified as a major contributor to a healthy fetal environment, with a beneficial role for unsaturated fats during development as well as a beneficial impact on cell membrane physiology. Together these studies indicate that attempts to optimise maternal nutrition may prove to be an efficient and cost-effective strategy for preventing the development of cardiovascular, renal, or metabolic diseases.

Immunomodulatory therapies delay disease progression in multiple sclerosis

2016 ◽  
Vol 22 (13) ◽  
pp. 1732-1740 ◽  
Author(s):  
Roberto Bergamaschi ◽  
Silvana Quaglini ◽  
Eleonora Tavazzi ◽  
Maria Pia Amato ◽  
Damiano Paolicelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Early Stage ◽  
Long Term Evolution ◽  
Long Term Effects ◽  
Open Label ◽  
Disease Modifying Drugs ◽  
Neurodegenerative Process ◽  
Term Evolution ◽  
Methodological Problems

Background: Few studies have analysed long-term effects of immunomodulatory disease modifying drugs (DMDs). Objective: Assessment of the efficacy of DMDs on long-term evolution of multiple sclerosis, using a Bayesian approach to overcome methodological problems related to open-label studies. Methods: MS patients from three different Italian multiple sclerosis centres were divided into subgroups according to the presence of treatment in their disease history before the endpoint, which was represented by secondary progression. Patients were stratified on the basis of the risk score BREMS (Bayesian risk estimate for multiple sclerosis), which is able to predict the unfavourable long-term evolution of MS at an early stage. Results: We analysed data from 1178 patients with a relapsing form of multiple sclerosis at onset and at least 10 years of disease duration, treated (59%) or untreated with DMDs. The risk of secondary progression was significantly lower in patients treated with DMDs, regardless of the initial prognosis predicted by BREMS. Conclusions: DMDs significantly reduce the risk of multiple sclerosis progression both in patients with initial high-risk and patients with initial low-risk. These findings reinforce the role of DMDs in modifying the natural course of the disease, suggesting that they have a positive effect not only on the inflammatory but also on the neurodegenerative process. The study also confirms the capability of the BREMS score to predict MS evolution.

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