Swabs by emergency responders (SWABBER): Enhancing care beyond the cancer center during the COVID-19 pandemic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 97-97
Author(s):  
Olivia S. Allen ◽  
Mark Liu ◽  
Kevin Munjal ◽  
Rex Lomboy ◽  
Aarti Sonia Bhardwaj ◽  
...  
Keyword(s):  
New York ◽  
Patient Experience ◽  
Healthcare Delivery ◽  
Cancer Center ◽  
Coordinated Care ◽  
Chi Square ◽  
Limited Mobility ◽  
Emergency Responders ◽  
Significant Difference ◽  
Patient Use

97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly selected patients completed a brief survey about their experiences with the program, with questions on a seven-point Likert scale. Sociodemographic data was collected from the EMR, and we used a chi-square test to identify differences in patient use of SWABBER by race. Results: From September 8, 2020–April 1, 2021, we saw 7,204 patients for infusion, of whom 993 (14%) participated in SWABBER. The cohort of all patients receiving treatment was 45% White, 19% Black, 6% Asian, 29% Other, and 1% Unknown race. The SWABBER cohort was 36% White, 21% Black, 12% Asian, 29% Other, and 1% Unknown race. There was a significant difference in patient race between these two groups (P < 0.00001), with more Black and Asian patients in SWABBER compared to all patients receiving treatment. A total of 406 (41%) SWABBER patients completed the patient experience survey. The mean scores for overall experience and likelihood of recommending the program were 6.9, with standard deviations of 0.56 and 0.44, respectively. Conclusions: SWABBER enabled us to deliver care directly to patients’ homes, mitigating COVID-19 exposure while promoting accessible care and providing an increased benefit for minority patients. Through SWABBER, we achieved near-perfect patient experience ratings, reduced the burden of testing, created a safer environment for patients and staff, and kept cancer care on track. Future work will evaluate ways to maintain elevated patient experience and continue striving for inclusive care beyond the pandemic.[Table: see text]

Does Gender Influence How Patients Rate Their Patient Experience after Total Knee Arthroplasty?

2017 ◽  
Vol 30 (07) ◽  
pp. 634-638 ◽  
Author(s):  
Marcelo Siqueira ◽  
Morad Chughtai ◽  
Anton Khlopas ◽  
Chukwuweike Gwam ◽  
Jaydev Mistry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Experience ◽  
Knee Arthroplasty ◽  
Pay For Performance ◽  
Continuous Variables ◽  
Chi Square ◽  
Men And Women ◽  
Significant Difference ◽  
Total Knee ◽  
Chi Square Analysis

AbstractThe Centers for Medicare and Medicaid Services has implemented the Value-Based Purchasing (VBP) score as a pay-for-performance reimbursement model. Patient experience, as measured by the Press Ganey (PG) survey, currently comprises 20% of total VBP score. It is therefore beneficial for the orthopaedist to become familiar with these changes to maximize profits. Currently, a paucity of data exists that elucidates which factors influence PG scores between men and women following total knee arthroplasty (TKA). Therefore, we asked: (1) which PG survey factors most influences hospital ratings among men and women patients post-TKA and (2) is there a significant difference in overall hospital ratings among men and women cohorts post-TKA? We queried the PG database for patients who received a TKA between November 2009 and January 2015, yielding 224 men (mean age 64 years, range: 39–88) and 519 women (mean age 65 years; range, 25–92). A multiple regression analysis was performed for each cohort with overall hospital satisfaction as the dependent variable to assess the influence (β-weight) each PG domain imparted on overall hospital rating. A chi-square analysis and t-test were performed to assess categorical and continuous variables, respectively. For men, communication with nurses (β = 0.408, p = 0.016), followed by communication about medications (β = 0.261, p = 0.032), most influenced overall hospital rating. For women, communication with nurses (β = 0.479, p < 0.001) most influenced overall hospital rating. This was followed by staff responsiveness (β = 0.201, p = 0.046), pain management (β = 0.263, p = 0.015), and communication about medications (β = − 0.152, p = 0.029). It is of great advantage for the orthopaedist to focus on the PG domains most pertinent to each patient gender post-TKA. For both genders, overall hospital rating was significantly influenced by communication with nurses and information about medication. However, staff responsiveness and pain control were of significant importance in determining overall hospital rating for women. Therefore, orthopaedists should consider focusing on these factors depending on the gender of the patient to optimize satisfaction.

Disparities in the use of telehealth during the COVID-19 pandemic.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 87-87
Author(s):  
Cardinale B. Smith ◽  
Aarti Sonia Bhardwaj
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Cancer Center ◽  
Third Wave ◽  
Chi Square ◽  
Asian Patients

87 Background: New York City was the epicenter of the COVID-19 pandemic. Public concern about exposure and policies to “flatten the curve” led to abrupt curtailment of health care service use, including cancer. Innovative strategies to mitigate the disruption, including telemedicine, was utilized. However, this may be less accessible to minority populations. We evaluated the differences in telehealth use among minorities and non-minorities with cancer. Methods: Our health system includes an NCI designated cancer center and 8 ambulatory sites across New York City. Utilizing the electronic medical record (EMR) we collected data on all cancer patients with an in-person or telehealth visit during the peak of the pandemic from March 1, 2020 to June 1, 2020. Race/ethnicity and visit type data was collected from the EMR. Telehealth includes video visits and telephone encounters. We used ANOVA and-chi square where appropriate to identify differences between the racial and ethnic groups in terms of use and type of telehealth and compared any differences to baseline cancer center demographics. Results: There were a total of 7,681 telehealth visits during 3/1/2020-6/1/2020; 76% were video visits. At baseline in 2019, < 1% of all patient visits were conducted via telehealth. Within our cancer center our demographic breakdown for patients seen in 2019 includes 42% patients were white, 23% Black, 14% Hispanic and 7% Asian. Among those patients utilizing video visits, 50% patients were white, 17% Black, 8% Asian, and 5% Hispanic. Among those patients utilizing phone encounters, 43% patients were white, 23% Black, 7% Hispanic and 6% Asian. Conclusions: During the COVID-19 pandemic our utilization of telehealth increased exponentially. There were significant disparities observed in the use of telehealth with Black, Hispanic and Asian patients having less utilization. These findings are important as telehealth use will now become more integrated into standard oncologic care, and it is likely that we will have a second or third wave of COVID-19 infections. Future work to understand the determinants of these disparities and interventions are needed. [Table: see text]

Impact of language on distress screening in cancer patients at an NCI-Designated Comprehensive Cancer Center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18070-e18070
Author(s):  
Veronica Jones ◽  
Karen L. Clark ◽  
Susanne Warner ◽  
Jenny Rodriguez ◽  
Joanne E. Mortimer ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Treatment Options ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Chi Square ◽  
Spanish Speaking ◽  
Significant Difference ◽  
Poor Outcomes

e18070 Background: Psychological distress has been linked to poor outcomes among cancer patients. In 2007, the Institute of Medicine reported that distress is often unrecognized. While much is known about distress screening in English speaking populations, little is known about the provision of screening in Spanish. Methods: From 2009-2016, over 9000 solid tumor and lymphoma patients treated at an NCI CCC were prospectively administered a validated biopsychosocial distress questionnaire in their preferred language. The data was retrospectively stratified by language and Chi-square and ANOVA tests were performed to detect differences. Results: Spanish-speaking patients had the highest levels of reported distress in every category when compared to any other group. Of the 629 patients that reported Spanish as their preferred language, 400 (63.6%) took the questionnaire in Spanish (SS) with the rest taking it in English (SE). There was no difference in reported gender, marital status, education level or income between the two groups. The SS patients were younger (mean age 56 vs 60.5, P = 0.00) and reported significantly higher distress than the SE patients in every biopsychosocial domain except functional. The greatest difference was seen in “understanding treatment options” (40.1% SS vs 19% SE, p = 0.00) with a significant difference seen also in “fear of medical procedures” (38.2% SS vs 29.9% SE, p = 0.037), “finances” (66.5% SS vs 55.4% SE, p = 0.01), “finding community resources” (34.8% SS vs 26% SE, p = 0.03), “managing emotions” (40.3% SS vs 31.5% SE, p = 0.032), “needing help to coordinate care” (41% SS vs 23.4% SE, p = 0.00) and “transportation” (35.2% SS vs 21.9% SE, p = 0.001). The distress of the SE patients was more similar to that seen in the English-English patients, but was still significantly higher. Conclusions: These provocative data demonstrate distress levels are stratified by preferred language among cancer patients. Spanish speaking patients had the highest levels of reported distress but this difference was more pronounced when they were administered the questionnaire in Spanish. More studies are needed to determine culturally effective ways to identify distress in Spanish speaking populations.

Effect of New Institutional Algorithm for Chemotherapy Induced Anemia (CIA) on Erythropoiesis-Stimulating Agent Treatment Patterns and Costs in Lymphoma Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1299-1299
Author(s):  
Aditya D. Raju ◽  
Lal S. Lal ◽  
Lesley-Ann Miller ◽  
Hua Chen ◽  
Sujit S Sansgiry
Keyword(s):  
Treatment Patterns ◽  
Cancer Center ◽  
Control Group ◽  
Chi Square ◽  
University Of Texas ◽  
Institutional Practice ◽  
Significant Difference ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Recently there has been accumulating data regarding the increased risks of mortality, thrombosis, cardiovascular events, and of possible tumor promotion when administering erythropoiesis-stimulating agents (ESAs) to a target hemoglobin (Hgb) level of 12 g/dL. In response to this evidence, the FDA mandated a Black Box warning and the CMS mandated changes in coverage for ESAs. Subsequently, in December, 2007, the University of Texas M.D. Anderson Cancer Center (M. D. Anderson) developed and implemented an institutional practice algorithm to advise physicians regarding treatment of CIA, which included recommendations for the initiation and continued use of ESAs. The objective of this study was to assess the impact of the new institutional practice algorithm on the treatment patterns and costs of CIA in lymphoma patients. The study design was a retrospective study with a historical control group. The historical controls (pre-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2007–April 30, 2007 and the cases (post-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2008–April 30, 2008, who were all followed for a period of up to 16 weeks. Patient demographics, chemotherapy type, ESA type and dosage, transfusions received, Hgb values at the time of ESA usage and transfusions (for all doses and transfusions received at the institution during the study period), and costs for ESA treatment and transfusions were extracted from patient medical charts and institutional databases at M. D. Anderson. Descriptive statistics, t-tests, Mann- Whitney U, and chi-square analyses were conducted to evaluate the study objectives. The study population consisted of 154 patients; 90 patients in the pre-group and 64 patients in the post-group. Both groups had similar demographic and baseline clinical characteristics. In the post period, though there was a significant decrease in the overall amount of ESA units dispensed per patient (p=0.0125), there was an increase in the amount of ESA units dispensed in the first eight weeks of treatment (p=0.03), indicating potentially less use of outside pharmacies. There was a significant decrease in the mean Hgb at the time of ESA usage, from 9.59g/dL to 8.98g/dL (p&lt;0.0001). The proportion of patients who received an ESA at a Hgb level &gt; 10 g/dL decreased significantly, from 66% to 17% (p&lt;0.0001). There was no significant difference in the mean Hgb level at week 4 of therapy, which may indicate that patients were not clinically affected by the change in practice. There was also no significant difference in the number of transfusions administered, or the costs associated with the treatment of CIA in the study population. The results indicate that the new institutional algorithm was effective in altering the treatment patterns of CIA with respect to the ESA units prescribed and dispensed and the hemoglobin levels at the time of ESA usage in lymphoma patients.

Impact of geography and travel distance on outcomes in epithelial ovarian cancer: a national cancer database analysis

2020 ◽  
pp. ijgc-2020-001807
Author(s):  
Ava Daruvala ◽  
F Lee Lucas ◽  
Jesse Sammon ◽  
Christopher Darus ◽  
Leslie Bradford
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Healthcare Delivery ◽  
High Volume ◽  
Cox Proportional Hazards ◽  
Travel Distance ◽  
Cancer Center ◽  
National Cancer Database ◽  
Significant Difference ◽  
The Impact

BackgroundAs ovarian cancer treatment shifts to provide more complex aspects of care at high-volume centers, almost a quarter of patients, many of whom reside in rural counties, will not have access to those centers or receive guideline-based care.ObjectiveTo explore the association between proximity of residential zip code to a high-volume cancer center with mortality and survival for patients with ovarian cancer.MethodsThe National Cancer Database was queried for cases of newly diagnosed ovarian cancer between January 2004 and December 2015. Our predictor of interest was distance traveled for treatment. Our primary outcomes were 30-day mortality, 90-day mortality, and overall survival. The effect of treatment on survival was analyzed with the Kaplan-Meier method. Multiple logistic regression for binary outcomes and Cox proportional hazards regression for overall survival were used to assess the effect of distance on outcome, controlling for potential confounding variables.ResultsA total of 115 540 patients were included. There was no statistically significant difference in 30- or 90-day mortality among any of the travel distance categories. A statistically significant decrease in 30-day re-admission was found among patients who lived further away from the treating facility. A total of 105 529 patients were available for survival analysis, and survival curves significantly differed between distance strata (p<0.0001). The adjusted regression models demonstrated increased long-term mortality in patients who lived farther away from the treating facility after controlling for potential confounding.ConclusionAlthough 30- and 90-day mortality do not differ by travel distance, worse survival is observed among women living >50 miles from a high-volume treatment facility. With a national policy shift toward centralization of complex care, a better understanding of the impact of distance on survival in patients with ovarian cancer is crucial. Our findings inform the practice of healthcare delivery, especially in rural settings.

Perception and barriers to virtual medicine in Hispanics and underrepresented populations.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 169-169
Author(s):  
Alvaro G. Menendez ◽  
Katarina Bade ◽  
Emily Hsu ◽  
Jyoti Chhabra
Keyword(s):  
Behavioral Interventions ◽  
Multivariable Analysis ◽  
Healthcare Delivery ◽  
Perceived Barriers ◽  
Healthcare Outcomes ◽  
Chi Square ◽  
Oncological Care ◽  
Home Based ◽  
Significant Difference ◽  
Virtual Medicine

169 Background: Perceptions and barriers to virtual medicine (VM) in Hispanics and underrepresented population (H/UP) are unknown. We investigated these parameters in a multicenter oncology trial in hopes of improving quality of care and minimizing potentially negative healthcare outcomes related to this increasingly popular healthcare delivery (HD) technique. Methods: An IRB-approved, 14-item questionnaire was offered in English and Spanish to all pts. receiving care at participating cancer centers over a 6-month period. Examined variables included demographic information, preferences and perceived barriers regarding VM. Multivariable analysis was performed using Chi Square test to determine association between demographic variables and participants preferences and perceived barriers. Results: A total of 180 pts were enrolled. H/UP rely more on social media to receive health information (32.6% vs 23.9%) as opposed to face-to-face. Fewer H/UP have received oncological care through VM (27.9% vs 32.9%) despite comparable preferences regarding incorporation or exclusive use of VM in HD (23.2 % vs 24.6%). Similar levels of satisfaction with current HD methods were reported (83.7% vs 86%). No significant difference by age, level of education, marital status or Hispanic ethnicity was noted although Spanish as primary language was statistically significant (p = 0.001) in patient satisfaction and preferences regarding use of VM. H/UP involve family members more frequently through VM (48.8% vs 29.1). H/UP have more technical barriers to VM as they were up to 2.6 times more likely to not have a phone/ipad/similar or have access to broadband connectivity (23.3% vs 9%; and 16.3% vs 8.2% respectively). Conclusions: H/UP are equally interested and satisfied in receiving oncological care through VM. Given the shift towards outpatient and home-based care, an aging population, and cultural appropriations, VM excitedly allows re-incorporation of family/caregiver in medical engagement. However, fewer H/UP are currently utilizing VM which could be secondary to H/UP’s specific barriers or healthcare bias. Although behavioral interventions may be explored, H/UP barriers are predominantly technical and targetable with appropriate policies that take into consideration institutional and reimbursement programs.

scholarly journals Department location: Factor for Airbnb user’s valuation perception

2019 ◽  
pp. 23-42
Author(s):  
Saúl Alfonso Esparza Rodríguez ◽  
Jaime Apolinar Martínez Arroyo
Keyword(s):  
New York ◽  
Mexico City ◽  
Average Cost ◽  
Chi Square ◽  
Location Factor ◽  
Quality Perception ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
The Impact

The objective is to analyze the impact of the location in the quality perception of customers. Data was obtained from the stars-based valuation of Airbnb website, considering a standardized option of accommodation just apartments of one room up to two guest maximum, with an average cost of USD 50 per night and located in four cities: New York and Miami in USA, and Mexico City and Cancun in Mexico, using a chi-square analysis to identify if there is a difference in quality perception considering if the destination place have beach or not. The results showed than departments located in New York had the most significant difference in valuation of quality of hosts.

Personal Audio System: Hearing Symptoms, Habits, and Sound Pressure Levels Measured in Real Ear and a Manikin

2020 ◽  
Vol 63 (6) ◽  
pp. 2016-2026
Author(s):  
Tamara R. Almeida ◽  
Clayton H. Rocha ◽  
Camila M. Rabelo ◽  
Raquel F. Gomes ◽  
Ivone F. Neves-Lobo ◽  
...  
Keyword(s):  
Sound Pressure ◽  
Daily Basis ◽  
Cross Sectional Study ◽  
Normal Hearing ◽  
Chi Square ◽  
Cross Sectional ◽  
The Real ◽  
Significant Difference ◽  
Sound Pressure Levels ◽  
Audio System

Purpose The aims of this study were to characterize hearing symptoms, habits, and sound pressure levels (SPLs) of personal audio system (PAS) used by young adults; estimate the risk of developing hearing loss and assess whether instructions given to users led to behavioral changes; and propose recommendations for PAS users. Method A cross-sectional study was performed in 50 subjects with normal hearing. Procedures included questionnaire and measurement of PAS SPLs (real ear and manikin) through the users' own headphones and devices while they listened to four songs. After 1 year, 30 subjects answered questions about their usage habits. For the statistical analysis, one-way analysis of variance, Tukey's post hoc test, Lin and Spearman coefficients, the chi-square test, and logistic regression were used. Results Most subjects listened to music every day, usually in noisy environments. Sixty percent of the subjects reported hearing symptoms after using a PAS. Substantial variability in the equivalent music listening level (Leq) was noted ( M = 84.7 dBA; min = 65.1 dBA, max = 97.5 dBA). A significant difference was found only in the 4-kHz band when comparing the real-ear and manikin techniques. Based on the Leq, 38% of the individuals exceeded the maximum daily time allowance. Comparison of the subjects according to the maximum allowed daily exposure time revealed a higher number of hearing complaints from people with greater exposure. After 1 year, 43% of the subjects reduced their usage time, and 70% reduced the volume. A volume not exceeding 80% was recommended, and at this volume, the maximum usage time should be 160 min. Conclusions The habit of listening to music at high intensities on a daily basis seems to cause hearing symptoms, even in individuals with normal hearing. The real-ear and manikin techniques produced similar results. Providing instructions on this topic combined with measuring PAS SPLs may be an appropriate strategy for raising the awareness of people who are at risk. Supplemental Material https://doi.org/10.23641/asha.12431435

The Influence of Age and Gender on Mandibular Indices among the Libyan Population

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Negative Correlation ◽  
Bone Mineralization ◽  
Age Groups ◽  
T Test ◽  
Chi Square ◽  
Age And Gender ◽  
Significant Difference ◽  
Chi Square Test ◽  
And Gender ◽  
Libyan Population

Radiographic Mandibular Indices serve as easy and relatively cheap tools for evaluating bone mineralization. Objectives: To examine the effect of age and gender on three mandibular indices: the panoramic mandibular index (PMI), the mandibular ratio (MR) and the mandibular cortical index (MCI), among Libyan population. Methods: The three indices were measured on 317 digital (OPGs) of adult humans (155 males, 162 females). The sample was divided into six age groups (from 18-25 years through 56-65 years). The measurements were analyzed for interactions with age and sex, using SPSS (Statistical Package for Social Studies) software version no. 22. The tests employed were two way ANOVA, the unpaired T-test and chi-square test. Results: The mean PMI fluctuated between 0.37 s.d. 0.012 and 0.38 s.d. 0.012. among the sixth age groups. One-way ANOVA statistical test revealed no significant of age on PMI. On the other hand gender variation has effect on PMI, since independent sample t-test disclosed that the difference between the male and female PMI means statistically significant. ANOVA test showed that the means of MR among age groups showed a negative correlation i.e. MR mean declined from 3.01 in 18-25 age groups to 2.7 in 55-65 age groups. In contrary, the gender showed no effect on MR according two sample t-test at p> 0.05. In regards with MCI, statistical analysis showed that it affected by age that is C1 was decreasing by age while C2 and C3 were increased by age. Using chi square test the result indicated that there is a significant difference among the different age group and the two genders in MCI readings. Conclusion: PMI was influenced significantly by age but minimally by the gender. MR is not affected by gender but has a negative correlation with age. MCI is affected by both age and gender

Nomophobia: An emerging fear

2020 ◽  
Vol 11 (01) ◽  
Author(s):  
Madhu Bala ◽  
Neetu Chaudhary
Keyword(s):  
Cell Phones ◽  
Administrative Authority ◽  
Chi Square ◽  
Current Time ◽  
Gender And Age ◽  
Significant Difference ◽  
Minimum Age ◽  
Multiple Cell ◽  
Negative Face ◽  
Agra City

In the current time, the use of technologies has become propensity more than necessity. Nobody has gotten away from them nor left youth or old. It's totally relying upon us How to utilize it? One such live innovation is a Smartphone. At only one touch we approach any data about the entire world. It is very easy to carry in our pocket so everyone can use it anytime whenever. Smartphone has some constructive as well as some cynical aspects too. Nomophobia is a negative face of the smartphone. Nomophobia is the irrational dread of being without cell phones or being not able to utilize phones (situational phobia) for some reason such as some signal or battery issues. Theprimary point of the current research is to find out the proportion of Nomophobia among understudies with regardof gender and age in Agra city. For this purpose, a total number of 300 students were selected by randomization (150 males and 150 females) from the age scope of 15-20 years. The data was taken by using a self-administered questionnaire NMP-Q developed by Yilidirim and Correia. The obtained data were analyzed using descriptive statistics, Mean and Chi-square. Results revealed that there is a significant difference between male and female score on nomophobia. The other result indicates that early adolescents positively related to Nomophobia as compare to late adolescents. In India, one person can use multiple cell phones. There is no minimum age to use mobile phones. It is adding fuel to the pre-existing problem of Nomophobia. Telecom Administrative Authority of India (TRAI) should assume a functioning job by making an arrangement/law that "setting based methodology" on cell phone limitations among individuals ought to be followed. A demonstration will be detailed, under this demonstration. There ought to choose the least age for portable use. It will assist a great deal with curbing the circumstance.

Sign in / Sign up

Export Citation Format

Share Document