Systematic analysis of chemotherapy agents for home-based administration.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14012-e14012
Author(s):  
George Xiangyun Ye ◽  
Adam Binder ◽  
Nathan Handley ◽  
Maria Piddoubny ◽  
Gloria Espinosa ◽  
...  
Keyword(s):  
Large Scale ◽  
Room Temperature ◽  
The United States ◽  
Chemotherapeutic Agents ◽  
Inpatient Setting ◽  
Systematic Analysis ◽  
Home Setting ◽  
Home Based ◽  
Chemotherapy Infusion ◽  
Dramatic Shift

e14012 Background: Improvement in supportive care medications, feasibility of outpatient management, and regulatory changes have led to a dramatic shift in the primary location of chemotherapy delivery from the inpatient setting to outpatient infusion centers. Over the last decade, centers in Europe and Canada have taken the next logical step – home based chemotherapy infusion. To our knowledge there is no systematic large scale initiative that has transitioned chemotherapy to the home in the United States. In order to implement a home based chemotherapy infusion program, we systematically scored anti-neoplastic agents for ease of administration. Methods: We reviewed all anti-neoplastic agents administered at our infusion center. Characteristics of each medication that could be a barrier to home infusion were identified. These included route and duration of administration, vesicant status, emetogenic potential, and duration of stability at room temperature. Scoring was determined by a multi-disciplinary team of pharmacists and oncologists (see Table). Higher scores indicated greater potential for home administration. Results: We reviewed 100 medications. The highest possible score was 8; the lowest possible score was -4. Agents ranged with scores from 8 (fulvestrant) to -1 (dactinomycin), with a median score of 4. The mode score was 3 (24 medications). The largest factor lowering the ease of administration score was stability at room temperature; score of -2 and -1 in 19 and 18 medications respectively. Conclusions: It is feasible to administer the majority of our chemotherapeutic agents in the home setting. The biggest barrier to administration at home is stability of medications at room temperature. This issue can be addressed by transporting and storing the medication in a refrigerated container. Expectedly, injectable drugs and medications with short infusion times that are stable at room temperature would be the easiest to administer in the home. Further analysis in ongoing to assess the financial feasibility and establishment of our home based program. [Table: see text]

scholarly journals Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Katherine O’Brien ◽  
Sara Bradley ◽  
Vanessa Ramirez-Zohfeld ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Home Setting ◽  
Caregiver Support ◽  
Qualitative Survey ◽  
Home Based Primary Care ◽  
Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

scholarly journals Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review (Preprint)

2017 ◽  
Author(s):  
Annie Banbury ◽  
Susan Nancarrow ◽  
Jared Dart ◽  
Leonard Gray ◽  
Lynne Parkinson
Keyword(s):  
Social Support ◽  
Rural Areas ◽  
Large Scale ◽  
Health Knowledge ◽  
Group Processes ◽  
Future Research ◽  
Home Setting ◽  
Limited Mobility ◽  
Face To Face ◽  
Home Based

BACKGROUND Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. OBJECTIVE The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional–led group videoconferencing to provide education or social support or both, into the home setting. METHODS Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. RESULTS Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to replicate group processes such as bonding and cohesiveness. Similar outcomes were reported for those comparing face-to-face groups and videoconference groups. CONCLUSIONS Groups delivered by videoconference are feasible and potentially can improve the accessibility of group interventions. This may be particularly useful for those who live in rural areas, have limited mobility, are socially isolated, or fear meeting new people. Outcomes are similar to in-person groups, but future research on facilitation process in videoconferencing-mediated groups and large-scale studies are required to develop the evidence base.

Caregiver stress: Clinical evaluation and intervention strategies for caregiver burden prevention.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 22-22 ◽  
Author(s):  
Laura Velutti ◽  
Carlotta Pavesi ◽  
Chiara Poggio ◽  
Beatrice Carettoni ◽  
Annalisa Saetta ◽  
...  
Keyword(s):  
Caregiver Burden ◽  
Care Pathway ◽  
Structured Interview ◽  
Qualitative Assessment ◽  
Published Data ◽  
Inpatient Setting ◽  
Home Setting ◽  
Basic Care ◽  
Home Based ◽  
Weekly Meeting

22 Background: Caregivers (CGs) of advanced cancer patients (pts/ACPs) experience a higher incidence of medical and psychological conditions compared to general population. Methods: We conducted a prospective assessment of the caregiver burden (CGB) - a term describing the physical, psychological, emotional, social, and financial problems often experienced by CGs - to identify potential risk management strategies. We used the Caregiver Burden Inventory (CBI), a multi-dimensional questionnaire with 5 subscales: Time Dependent, Developmental, Physical, Social, Emotional CGB, as a quantitative tool to investigate the level of stress of our pts CGs. Also, we used a semi-structured interview with 5 questions as a qualitative tool. Results: From Dec 2016 to Feb 2017 we administered the CBI and the interview to 37 CGs (F/M 31/6) of ACPs in 3 different settings: inpatient (9 CGs), outpatient (15 CGs), home-based (13 CGs). The quantitative data analysis showed that CGs had a variable emotional load, mostly of moderate level. In particular, the level of stress of our pts CGs of outpatients and inpatients was higher in the physical dimension, while was higher in the time dimension for CGs of home-based pts. Semi-structured interviews showed that CGs of home-based pts did not feel adequate to provide assistance to their relatives, and had partial or poor knowledge of basic care, especially of in-bed mobilization and hygiene techniques. In the other 2 settings, CGs showed a higher level of stress due to the lack of a professional contact person throughout the care pathway, and experienced the need of psychological support. Overall, the qualitative assessment showed that CGs lives were strongly affected by caregiving. Conclusions: Our results confirm published data showing that assisting ACPs is a particularly difficult task for the CGs. Therefore, we implemented potential improvement strategies: in the home setting, specific attention to the educational aspects of basic care; in the inpatient setting, a weekly meeting for physicians, nurses, and psychologists, to discuss the most difficult cases; in the outpatient setting, a 25% increase in the number of visits for pain and supportive therapy to offer a better continuity of care.

scholarly journals Transformed

2015 ◽  
Vol 137 (03) ◽  
pp. 36-41
Author(s):  
Jack Thornton
Keyword(s):  
United States ◽  
Large Scale ◽  
Low Frequency ◽  
The United States ◽  
Government Officials ◽  
Transport Time ◽  
Delivery Times ◽  
Home Based ◽  
September 11 Attacks ◽  
Speed Up

This article describes the shift in manufacturing of transformers in the United States and its benefits. In the wake of the September 11 attacks, the grid’s heavy reliance on imported equipment was seen as vulnerability. The RecX project focused on transportation and speedy installation of a modularized grid transformer rather than grid standardization. Home-based manufacturing of transformers can have major implications for the security and robustness of the grid. Building big transformers in the United States, closer by thousands of miles to installation sites, can simplify and speed up the development of transformers. Shorter distances can also reduce transport time. Large-scale loss of grid transformers is considered a high-impact, low-frequency event. The distant manufacturing sites and long delivery times that so worried government officials in the past have been seen in a new light. They represent an annual replacement market of several hundred massive machines, sufficient to support a major manufacturing expansion in North America.

Quality Control of Data in a Large-Scale Cancer Register Program

1966 ◽  
Vol 05 (02) ◽  
pp. 67-74 ◽  
Author(s):  
W. I. Lourie ◽  
W. Haenszeland
Keyword(s):  
United States ◽  
Quality Control ◽  
Cancer Patients ◽  
Large Scale ◽  
The United States ◽  
Newly Diagnosed ◽  
Related Data ◽  
Cancer Register ◽  
Independent Review ◽  
End Results

Quality control of data collected in the United States by the Cancer End Results Program utilizing punchcards prepared by participating registries in accordance with a Uniform Punchcard Code is discussed. Existing arrangements decentralize responsibility for editing and related data processing to the local registries with centralization of tabulating and statistical services in the End Results Section, National Cancer Institute. The most recent deck of punchcards represented over 600,000 cancer patients; approximately 50,000 newly diagnosed cases are added annually.Mechanical editing and inspection of punchcards and field audits are the principal tools for quality control. Mechanical editing of the punchcards includes testing for blank entries and detection of in-admissable or inconsistent codes. Highly improbable codes are subjected to special scrutiny. Field audits include the drawing of a 1-10 percent random sample of punchcards submitted by a registry; the charts are .then reabstracted and recoded by a NCI staff member and differences between the punchcard and the results of independent review are noted.

Utopias of One

2019 ◽  
Author(s):  
Joshua Kotin
Keyword(s):  
United States ◽  
Soviet Union ◽  
World War I ◽  
Large Scale ◽  
Jim Crow ◽  
Personal Autonomy ◽  
The United States ◽  
Soviet Period ◽  
Original Research ◽  
The Soviet Union

This book is a new account of utopian writing. It examines how eight writers—Henry David Thoreau, W. E. B. Du Bois, Osip and Nadezhda Mandel'shtam, Anna Akhmatova, Wallace Stevens, Ezra Pound, and J. H. Prynne—construct utopias of one within and against modernity's two large-scale attempts to harmonize individual and collective interests: liberalism and communism. The book begins in the United States between the buildup to the Civil War and the end of Jim Crow; continues in the Soviet Union between Stalinism and the late Soviet period; and concludes in England and the United States between World War I and the end of the Cold War. In this way it captures how writers from disparate geopolitical contexts resist state and normative power to construct perfect worlds—for themselves alone. The book contributes to debates about literature and politics, presenting innovative arguments about aesthetic difficulty, personal autonomy, and complicity and dissent. It models a new approach to transnational and comparative scholarship, combining original research in English and Russian to illuminate more than a century and a half of literary and political history.

The Obesity Epidemic in Chinese American Youth?: A Literature Review and Pilot Study

2008 ◽  
Vol 6 (1) ◽  
pp. 31-42 ◽  
Author(s):  
Robyn Matloff ◽  
Angela Lee ◽  
Roland Tang ◽  
Doug Brugge
Keyword(s):  
Asian Americans ◽  
Ethnic Diversity ◽  
Large Scale ◽  
Community Health Center ◽  
Chinese American ◽  
The United States ◽  
Overweight And Obesity ◽  
Waiting Room ◽  
Obesity Epidemic ◽  
American Children

Despite nearly 12 million Asian Americans living in the United States and continued immigration, this increasingly substantial subpopulation has consistently been left out of national obesity studies. When included in national studies, Chinese-American children have been grouped together with other Asian Americans, Pacific Islanders or simply as “other,” yielding significantly lower rates of overweight and obesity compared to non-Asians. There is a failure to recognize the ethnic diversity of Asian Americans as well as the effect of acculturation. Results from smaller studies of Chinese American youth suggest that they are adopting lifestyles less Chinese and more Americans and that their share of disease burden is growing. We screened 142 children from the waiting room of a community health center that serves primarily recent Chinese immigrants for height, weight and demographic profile. Body Mass Index was calculated and evaluated using CDC growth charts. Overall, 30.1 percent of children were above the 85th we found being male and being born in the U .S. to be statistically significant for BMI > 85th percentile (p=0.039, p=0.001, respectively). Our results suggest that being overweight in this Chinese American immigrant population is associated with being born in the U.S. A change in public policy and framework for research are required to accurately assess the extent of overweight and obesity in Chinese American children. In particular, large scale data should be stratified by age, sex, birthplace and measure of acculturation to identify those at risk and construct tailored interventions.

Situational Breakdowns

2019 ◽  
Author(s):  
Anne Nassauer
Keyword(s):  
United States ◽  
Large Scale ◽  
Contextual Factors ◽  
The United States ◽  
Social Outcomes ◽  
Dynamic Processes ◽  
Collective Decisions ◽  
Different Types ◽  
The Impact

This book provides an account of how and why routine interactions break down and how such situational breakdowns lead to protest violence and other types of surprising social outcomes. It takes a close-up look at the dynamic processes of how situations unfold and compares their role to that of motivations, strategies, and other contextual factors. The book discusses factors that can draw us into violent situations and describes how and why we make uncommon individual and collective decisions. Covering different types of surprise outcomes from protest marches and uprisings turning violent to robbers failing to rob a store at gunpoint, it shows how unfolding situations can override our motivations and strategies and how emotions and culture, as well as rational thinking, still play a part in these events. The first chapters study protest violence in Germany and the United States from 1960 until 2010, taking a detailed look at what happens between the start of a protest and the eruption of violence or its peaceful conclusion. They compare the impact of such dynamics to the role of police strategies and culture, protesters’ claims and violent motivations, the black bloc and agents provocateurs. The analysis shows how violence is triggered, what determines its intensity, and which measures can avoid its outbreak. The book explores whether we find similar situational patterns leading to surprising outcomes in other types of small- and large-scale events: uprisings turning violent, such as Ferguson in 2014 and Baltimore in 2015, and failed armed store robberies.

Accidental Sustainability

2017 ◽  
Author(s):  
Geoffrey Jones
Keyword(s):  
Large Scale ◽  
Negative Impact ◽  
Positive Impact ◽  
Organic Food ◽  
The United States ◽  
Air Travel ◽  
Business Leaders ◽  
Natural Beauty ◽  
And Diffusion ◽  
Whole Foods

This chapter examines the scaling and diffusion of green entrepreneurship between 1980 and the present. It explores how entrepreneurs and business leaders promoted the idea that business and sustainability were compatible. It then examines the rapid growth of organic foods, natural beauty, ecological architecture, and eco-tourism. Green firms sometimes grew to a large scale, such as the retailer Whole Foods Market in the United States. The chapter explores how greater mainstreaming of these businesses resulted in a new set of challenges arising from scaling. Organic food was now transported across large distances causing a negative impact on carbon emissions. More eco-tourism resulted in more air travel and bigger airports. In other industries scaling had a more positive impact. Towns were major polluters, so more ecological buildings had a positive impact.

Ban Ki-moon, 2007–2016

2018 ◽  
Author(s):  
Richard Gowan
Keyword(s):  
United States ◽  
Decision Making ◽  
Security Council ◽  
Large Scale ◽  
Central African Republic ◽  
The United States ◽  
Cautious Approach ◽  
Peacekeeping Operations ◽  
Council Decision ◽  
The Face

During Ban Ki-moon’s tenure, the Security Council was shaken by P5 divisions over Kosovo, Georgia, Libya, Syria, and Ukraine. Yet it also continued to mandate and sustain large-scale peacekeeping operations in Africa, placing major burdens on the UN Secretariat. The chapter will argue that Ban initially took a cautious approach to controversies with the Council, and earned a reputation for excessive passivity in the face of crisis and deference to the United States. The second half of the chapter suggests that Ban shifted to a more activist pressure as his tenure went on, pressing the Council to act in cases including Côte d’Ivoire, Libya, and Syria. The chapter will argue that Ban had only a marginal impact on Council decision-making, even though he made a creditable effort to speak truth to power over cases such as the Central African Republic (CAR), challenging Council members to live up to their responsibilities.

Sign in / Sign up

Export Citation Format

Share Document