scholarly journals Challenges Associated With Living Remotely From a Pediatric Cancer Center: A Qualitative Study

2019 ◽  
Vol 15 (3) ◽  
pp. e219-e229
Author(s):  
Emily B. Walling ◽  
Mark Fiala ◽  
Andrea Connolly ◽  
Alyssa Drevenak ◽  
Sarah Gehlert
Keyword(s):  
Rural Communities ◽  
Pediatric Cancer ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Rural Setting ◽  
Cancer Center ◽  
Medical Visit ◽  
Patients With Cancer ◽  
And Coping ◽  
The Impact

PURPOSE: Pediatric patients with cancer who live in rural communities face disparate access to medical services compared with those in urban areas. Our objectives were to use qualitative methods to describe how living in a rural setting during receipt of treatment at an urban cancer center affects a patient’s clinical course and to identify feasible areas of intervention to enhance service to these families. MATERIALS AND METHODS: We conducted semistructured interviews of caregivers of pediatric patients with cancer who received treatment at an urban pediatric hospital in the Midwest. Questions focused on how distance between home residence and cancer-treating hospital affected cancer treatment. RESULTS: Eighteen caregiver interviews were conducted. Five multithemed domains were identified; two related to receipt of emergent care at local hospitals, one related to the impact that distance had on the family, and two related to managing and coping with a pediatric cancer diagnosis. CONCLUSION: Rural families of pediatric patients with cancer face unique challenges in addition to those previously identified for pediatric patients with cancer, most notably increased travel time to their cancer centers and increased time spent in community hospitals to receive emergent care. We recommend feasible steps to improve the care of rural children with cancer, including improved parental anticipatory guidance about unanticipated emergent visits to local hospitals, outreach to local hospitals, and medical visit coordination.

scholarly journals The Gendered Path for Girls in Rural Communities: The Impact of COVID-19 on Youth Presenting at Juvenile Detention Facilities

2021 ◽  
pp. 001112872110226
Author(s):  
April N. Terry ◽  
Ashley Lockwood ◽  
Morgan Steele ◽  
Megan Milner
Keyword(s):  
Criminal Justice ◽  
Rural Communities ◽  
Juvenile Justice ◽  
Urban Areas ◽  
Juvenile Detention ◽  
Rural And Urban ◽  
Criminal Justice Systems ◽  
Court Processing ◽  
The Impact ◽  
Detention Facilities

Prior to the COVID-19 pandemic, girls and women represented one of the fastest growing populations within the juvenile and criminal justice systems. Since the spread of COVID-19, suggestions were provided to juvenile justice bodies, encouraging a reduction of youth arrests, detainments, and quicker court processing. Yet, the research comparing peri-COVID-19 changes for girls and boys is lacking, with an oversight to gender trends and rural and urban differences. This study used Juvenile Intake and Assessment Center (JIAC) data from a rural Midwestern state to look at rural and urban location trends for both boys and girls. Results suggest rural communities are responding differently to girls’ behaviors, revealing a slower decline in intakes compared to boys and youth in urban areas.

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

scholarly journals Parental Perspectives on Whole-Exome Sequencing in Pediatric Cancer: A Typology of Perceived Utility

2017 ◽  
pp. 1-10 ◽  
Author(s):  
Janet Malek ◽  
Melody J. Slashinski ◽  
Jill O. Robinson ◽  
Amanda M. Gutierrez ◽  
D. Williams Parsons ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Pediatric Cancer ◽  
Pediatric Patients ◽  
Clinical Care ◽  
Current Treatment ◽  
Peace Of Mind ◽  
Patients With Cancer ◽  
Whole Exome ◽  
Parental Perspectives

Purpose To explore how parents of pediatric patients with cancer perceived the utility of clinical tumor and germline whole-exome sequencing (WES) results. Patients and Methods We conducted longitudinal interviews with parents of a diverse pediatric cancer population before disclosure of WES results (n = 64), then 1 to 8 months (n = 33) after disclosure. Interview transcripts were analyzed using a thematic qualitative approach. Results Parents identified a broad range of types of utility for their child’s WES results. Even when results did not affect their child’s current treatment, they expressed optimism about future clinical utility for their child, themselves, and other family members. Parents also reported experiencing psychological utility including peace of mind, relief of guilt, and satisfaction of curiosity. Pragmatic utility, such as the ability to plan for the future and make better reproductive decisions, was also described. Conclusion Parents of pediatric patients with cancer perceive WES to have broad utility, including psychological and pragmatic utility, even if there is no direct impact on clinical care. Additional research will need to consider how the value of genomic information should be characterized, how risks and benefits should be described, and how these results should inform recommendations and decisions about using WES.

scholarly journals Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

2018 ◽  
Vol 46 (8) ◽  
pp. 3172-3182 ◽  
Author(s):  
Vijay Agusala ◽  
Priyanka Vij ◽  
Veena Agusala ◽  
Vivekanand Dasari ◽  
Bhargavi Kola
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Parental Education ◽  
Pediatric Patients ◽  
Hospital Admissions ◽  
Care Utilization ◽  
Asthma Education ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Objective It is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state. Methods This prospective study investigated an interactive asthma education intervention in pediatric patients aged 2–18 years and their caregivers. Change in parental/caregiver knowledge about their child’s asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered. Results The study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control. Conclusion Asthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

Causes of urban-rural disparities in adjuvant chemotherapy (AC) for rectal cancer (RC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14603-e14603
Author(s):  
Khodadad Rasool Javaheri ◽  
Ali Moghaddamjou ◽  
Caroline Speers ◽  
Winson Y. Cheung
Keyword(s):  
Rural Communities ◽  
Urban Areas ◽  
Census Data ◽  
Distance Matrix ◽  
Cancer Center ◽  
Stepwise Logistic Regression ◽  
Community Size ◽  
Cancer Centers ◽  
Logistic Regression Models ◽  
Urban Rural

e14603 Background: While urban-rural differences in cancer care are well described, the etiology of these disparities is unclear. Our aims were to 1) characterize differences in AC use based on community size and 2) determine if such disparities are mediated through variations in driving distance (DD) and travel time (TT) to closest cancer center. Methods: Patients diagnosed with stage 2 and 3 RC from 1999 to 2009 and referred to any 1 of 5 regional cancer centers in British Columbia were reviewed. Communities were classified as rural, small urban, moderate urban and large urban based on census data. Using zip codes and a distance matrix application interface, DD and TT to the closest cancer center were determined and categorized into quartiles. Stepwise logistic regression models were constructed to explore AC use based on urban vs rural communities, adjusting for DD and TT. Results: A total of 3,017 patients were identified: median age was 67 years (IQR 58-75), 64% were men and 58% received AC. Patients were distributed across various communities: rural 36%; small urban 12%; moderate urban 13%; and large urban 39%. There were no differences in baseline patient and disease characteristics based on community size (all p>0.05). Compared to patients in large urban centers, those living in rural, small urban and moderate urban areas were less likely to be treated with AC (62 vs 49 vs 54 vs 58%, respectively, p<0.001). Likewise, DD and TT were shortest for large urban and longest for rural residents (both p<0.001). In multivariate analyses that controlled for confounders, urban-rural disparities in receipt of AC persisted, but these differences significantly diminished after adjusting for DD, TT, or both (Table). Conclusions: Urban-rural disparities in AC use is partly mediated by commute. Strategic distribution of cancer services that reduce DD and TT to cancer centers may improve access to AC for a number of RC patients who are living in smaller communities. [Table: see text]

Integrating clinical pharmacy services into patient care in an early-phase clinical trial clinic.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18228-e18228
Author(s):  
Dazhi Liu ◽  
Thu Oanh Dang ◽  
Stephen Harnicar ◽  
Katherine Kargus ◽  
Lauren A Evans ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Supportive Care ◽  
Clinical Pharmacist ◽  
Early Phase ◽  
Treatment Options ◽  
Cancer Center ◽  
Protocol Violation ◽  
Patients With Cancer ◽  
The Impact

e18228 Background: Early phase clinical trials have broadened treatment options for patients with cancer. Expert management of these new therapies is essential to positive patient outcomes. At Memorial Sloan Kettering Cancer Center, the Developmental Therapeutic Center (DTC) satisfies this need. Oncology clinical pharmacists collaborate with other healthcare professionals to maximize the benefits of drug therapy and minimize toxicities. The purpose of this project is to describe the interventions from a clinical pharmacist assigned to the DTC. Methods: A clinical pharmacist joined DTC to serve adult patients with cancer undergoing clinical trials. The clinical pharmacist acted as a liaison between pharmacy team and medical team, and sees patients during their trial eligibility screening and follow-up visits. The interventions were documented by the clinical pharmacist in patients’ medical charts and email communications. All interventions during 1 month were retrospectively collected and categorized into supportive care optimization, protocol violation prevention, and operational. Results: The oncology clinical pharmacist was involved in 115 patient visits for trial eligibility screening or protocol follow-up. A total of 769 interventions were addressed including supportive care optimization (40.2%), protocol violation prevention (24.7%), and operational (35.1%). Conclusions: The oncology clinical pharmacist is actively engaged in many aspects of cancer care at the early phase trial clinic. Our results demonstrate the vital role of an oncology clinical pharmacist. The impact of these categorized intervention areas would require a formal outcome and cost-saving analysis. [Table: see text]

scholarly journals Pengelolaan Dana Desa di Kecamatan Balong Kabupaten Ponorogo

2019 ◽  
Vol 7 (1) ◽  
pp. 63
Author(s):  
Maretha Berlianantiya Muhammad Ridwan Eka Wardani
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Poverty Reduction ◽  
Agricultural Sector ◽  
Rural Poverty ◽  
Infrastructure Development ◽  
The Impact ◽  
The Village

<p><em>Poverty often occurs in rural areas rather than urban areas, low education which results in low quality of human resources and lack of access is often the cause of rural poverty. In addition, most of the economies of rural communities rely solely on the traditional agricultural sector. Various poverty reduction policies have been implemented, including village fund policies. This study aims to examine the management of village funds in the Balong sub-district of Madiun Regency with a case study in the villages of Tatung and Karangmojo villages covering the management of village funds in Tatung village and Karangmojo village. Balong Subdistrict and the impact of empowerment in the villages of Tatung and Karangmojo, Balong District. This research was conducted in Balong Subdistrict, Ponorogo Regency with a Case study in Tatung Village and Karangmojo Village with qualitative methods. In the village of Tatung village funds are managed as tourist villages with a focus on Paragliding tourist rides. Whereas in Karangmojo village it is used for Bumdes in the form of Lovebird birds, providing Gapoktan assistance, and infrastructure development.</em></p>

scholarly journals Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

2017 ◽  
Vol 13 (3) ◽  
pp. e249-e258 ◽  
Author(s):  
Lauren M. Hamel ◽  
Louis A. Penner ◽  
Susan Eggly ◽  
Robert Chapman ◽  
Justin F. Klamerus ◽  
...  
Keyword(s):  
Social Support ◽  
African American ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Younger Patients ◽  
Patients With Cancer ◽  
The Cost ◽  
Clinical Interactions ◽  
The Impact

Purpose: Financial toxicity negatively affects patients with cancer, especially racial/ethnic minorities. Patient-oncologist discussions about treatment-related costs may reduce financial toxicity by factoring costs into treatment decisions. This study investigated the frequency and nature of cost discussions during clinical interactions between African American patients and oncologists and examined whether cost discussions were affected by patient sociodemographic characteristics and social support, a known buffer to perceived financial stress. Methods Video recorded patient-oncologist clinical interactions (n = 103) from outpatient clinics of two urban cancer hospitals (including a National Cancer Institute–designated comprehensive cancer center) were analyzed. Coders studied the videos for the presence and duration of cost discussions and then determined the initiator, topic, oncologist response to the patient’s concerns, and the patient’s reaction to the oncologist’s response. Results: Cost discussions occurred in 45% of clinical interactions. Patients initiated 63% of discussions; oncologists initiated 36%. The most frequent topics were concern about time off from work for treatment (initiated by patients) and insurance (initiated by oncologists). Younger patients and patients with more perceived social support satisfaction were more likely to discuss cost. Patient age interacted with amount of social support to affect frequency of cost discussions within interactions. Younger patients with more social support had more cost discussions; older patients with more social support had fewer cost discussions. Conclusion: Cost discussions occurred in fewer than one half of the interactions and most commonly focused on the impact of the diagnosis on patients’ opportunity costs rather than treatment costs. Implications for ASCO’s Value Framework and design of interventions to improve cost discussions are discussed.

Early versus delayed administration of granulocyte-colony stimulating factor following chemotherapy in pediatric patients with Ewing sarcoma

2019 ◽  
Vol 26 (2) ◽  
pp. 325-329
Author(s):  
Deema Al-Momani ◽  
Wiam Al-Qasem ◽  
Rawan Kasht ◽  
Iyad Sultan
Keyword(s):  
Febrile Neutropenia ◽  
Hospital Stay ◽  
Ewing Sarcoma ◽  
Pediatric Patients ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
The Impact ◽  
Stimulating Factor

BackgroundThe optimal timing of initiating granulocyte-colony stimulating factor following chemotherapy in pediatric patients has not been clearly defined. This study aimed to compare the administration of granulocyte-colony stimulating factor on day 1 versus day 3 postchemotherapy in pediatric patients with Ewing sarcoma.MethodA retrospective study of pediatric patients with Ewing sarcoma who received granulocyte-colony stimulating factor following chemotherapy between January 2016 and September 2018 at a comprehensive cancer center. The institution’s chemotherapy protocol for Ewing sarcoma was modified in April 2017 to include granulocyte-colony stimulating factor initiation on day 3 instead of day 1 post-chemotherapy. Febrile neutropenia requiring hospitalization, duration of hospital stay, and chemotherapy delay were compared for patients before and after the protocol change.ResultsOver the study period, 250 cycles were evaluated with day 1 granulocyte-colony stimulating factor and 221 cycles with day 3 granulocyte-colony stimulating factor. There were no differences between the day 1 and day 3 groups in the number of cycles associated with Febrile neutropenia requiring hospitalization (34 vs. 19, p = 0.086), and the length of Febrile neutropenia-related hospitalization (mean 4 ± 2.1 vs. 4.6 ± 1.8, p = 0.123). However, delay in chemotherapy due to neutropenia was reported in significantly more cycles in the day 1 group, compared to the day 3 group (37 vs. 16, p = 0.01).ConclusionsFebrile neutropenia resulting in hospital admission and the length of hospital stay was not different between pediatric patients with Ewing sarcoma who received granulocyte-colony stimulating factor on day 1 or day 3 post-chemotherapy. Chemotherapy delay due to neutropenia was higher in patients who received granulocyte-colony stimulating factor on day 1. Larger studies are required to fully determine the impact of delayed initiation of granulocyte-colony stimulating factor.

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