scholarly journals The State of Oncology Practice in America, 2018: Results of the ASCO Practice Census Survey

2018 ◽  
Vol 14 (7) ◽  
pp. e412-e420 ◽  
Author(s):  
M. Kelsey Kirkwood ◽  
Amy Hanley ◽  
Suanna S. Bruinooge ◽  
Elizabeth Garrett-Mayer ◽  
Laura A. Levit ◽  
...  
Keyword(s):  
The United States ◽  
Primary Sources ◽  
Health Care Environment ◽  
Care Environment ◽  
Practice Size ◽  
Size Number ◽  
The Us ◽  
Day To Day Operations ◽  
Oncology Practice ◽  
Survey Responses

[Media: see text] Purpose: To describe the US hematology and medical oncology practice landscape and to report findings of the sixth annual ASCO Oncology Practice Census survey. Participants and Methods: ASCO used Medicare Physician Compare data to characterize oncology practices in the United States. Practice size, number of care sites, and geographic distribution were determined. Trends in the number and size of practices from 2013 to 2017 were examined. All US oncology practices were targeted for the survey; survey responses were linked to the practices identified from Physician Compare to augment results and assess generalizability. Results: More than 2,200 hematology/oncology practices provided care to adult patients in 2017. We observed annual decreases in the number of practices and annual increases in practice size. Of the 2017 practices, 394 (18%) completed the survey and accounted for 58% of the US hematologist/oncologist workforce (n = 7,203). Respondents tended to be larger and encompass more sites of care than nonrespondents. Surveyed practices cited payers (58%), competition (38%), and staffing (37%) as primary sources of strain. Prior authorization was dominant among payer pressures (78%). Electronic health records remained a burden on practices, with only 15% reporting full interoperability. Conclusion: The results of ASCO’s 2017 survey indicate that oncology practices are challenged by day-to-day operations, often related to payment, reimbursement, and competition. Our findings likely represent conservative estimates of such burdens because they are driven by responses from midsized to large-sized organizations, which have lower relative administrative burden, greater market influence, and potentially better ability to adapt in a changing health care environment.

Building America

2019 ◽  
Author(s):  
Jean H. Baker
Keyword(s):  
United States ◽  
Early Republic ◽  
Critical Role ◽  
Water System ◽  
The United States ◽  
Primary Sources ◽  
Early American ◽  
Transatlantic Exchange ◽  
The Us ◽  
Private Homes

Building America: The Life of Benjamin Henry Latrobe is a biography of America’s first professionally trained architect and engineer. Born in 1764, Latrobe was raised in Moravian communities in England and Germany. His parents expected him to follow his father and brother into the ministry, but he rebelled against the church. Moved to London, he studied architecture and engineering. In 1795 he emigrated to the United States and became part of the period’s Transatlantic Exchange. Latrobe soon was famous for his neoclassical architecture, designing important buildings, including the US Capitol and Baltimore Basilica as well as private homes. Carpenters and millwrights who built structures more cheaply and less permanently than Latrobe challenged his efforts to establish architecture as a profession. Rarely during his twenty-five years in the United States was he financially secure, and when he was, he speculated on risky ventures that lost money. He declared bankruptcy in 1817 and moved to New Orleans, the sixth American city that he lived in, hoping to recoup his finances by installing a municipal water system. He died there of yellow fever in 1820. The themes that emerge in this biography are the critical role Latrobe played in the culture of the early republic through his buildings and his genius in neoclassical design. Like the nation’s political founders, Latrobe was committed to creating an exceptional nation, expressed in his case by buildings and internal improvements. Additionally, given the extensive primary sources available for this biography, an examination of his life reveals early American attitudes toward class, family, and religion.

Alliance Embeddedness: Rodrigo Duterte and the Resilience of the US–Philippine Alliance

2021 ◽  
Vol 17 (3) ◽  
Author(s):  
Gregory Winger
Keyword(s):  
United States ◽  
Foreign Policy ◽  
Detailed Analysis ◽  
The United States ◽  
Personal Relationship ◽  
Primary Sources ◽  
Government Officials ◽  
The Us ◽  
Philippine Government ◽  
Defense Cooperation

Abstract In 2016, Philippine President Rodrigo Duterte pledged to radically reorient Philippine foreign policy by separating from Manila's longtime ally the United States. Yet, this vaunted break with America has failed to manifest. Joint US–Philippine military activities have continued with President Duterte even singing the praises of his American partners. To understand how this about-face in Manila occurred, I conducted a detailed analysis of the first eighteen months of the Duterte administration. Drawing on primary sources and interviews with government officials from both countries, I argue that the continued vitality of the US–Philippine alliance stems not from disenchantment with China nor personal relationship between Duterte and Trump, but rather from an underlying institutional affinity engendered over decades of defense cooperation. Specifically, institutionalized cooperation within the alliance has cultivated a strong reservoir of support for the alliance within key institutions inside the Philippine government. This case not only highlights the development of the Duterte administration but also illustrates the wider ability of alliances to weather political discord by cultivating support within national bureaucracies.

scholarly journals Pharmacoeconomics of Cancer Therapy

1998 ◽  
Vol 5 (5) ◽  
pp. 415-424 ◽  
Author(s):  
Susan E. Beltz ◽  
Gary C. Yee
Keyword(s):  
Health Care ◽  
Treatment Decision ◽  
Health Care Expenditures ◽  
The United States ◽  
Health Care Environment ◽  
Design Data ◽  
Care Environment ◽  
Treatment Decision Making ◽  
Economic Analyses ◽  
The Cost

Background In 1990, annual costs of the diagnosis and treatment of cancer reached nearly $100 billion and currently constitutes approximately 10% of health care expenditures in the United States. As new and often more expensive therapies for cancer treatment become available, the health care decision- maker must consider the cost effectiveness of the therapy. Methods Key principles of economic analyses and the inherent differences among these analyses are reviewed. Results While pharmacoeconomic analyses are increasingly being used in treatment decision-making, several issues relating to study design, data collection, and research methods are controversial. Conclusions Pharmacoeconomics analyses are necessary in the current health care environment, but the assumptions used within the analyses warrant careful evaluation.

American Buddhism during World War II Imprisonment

2018 ◽  
Author(s):  
Michihiro Ama
Keyword(s):  
United States ◽  
World War Ii ◽  
Los Angeles ◽  
Political Ideology ◽  
The United States ◽  
Primary Sources ◽  
Japanese American ◽  
World War ◽  
The Us ◽  
American Buddhism

American Buddhism during World War II imprisonment refers to the Japanese American Buddhist experience between 1942 and 1945 when persons of Japanese ancestry, commonly known as Nikkei Amerikajin, were imprisoned. A discussion of the Nikkei Buddhist experience includes the experiences of Euro-American convert Buddhists who supported them during the imprisonment period. Immediately after the Imperial Japanese Navy attacked Pearl Harbor on December 7, 1941, the Federal Bureau of Investigation (FBI) arrested and interned Japanese Buddhist priests and other leaders of Japanese communities in the United States. In March 1942, the Western Defense Command designated the three West Coast states (Washington, Oregon, and California) and Arizona as Military Area No. 1, from which all persons of Japanese descent, and alien Germans and Italians, were forcefully removed. Following Executive Order 9066 signed by President Franklin D. Roosevelt, the US government removed approximately 120,000 Japanese Americans from the aforementioned military zone and incarcerated them in relocation centers built throughout the continental United States. During that time, the Nikkei community consisted primarily of the Issei, the first generation of Japanese immigrants, and the Nisei, their American-born children. As Tetsuden Kashima defines, the word “internment” refers to the imprisonment of enemy aliens, such as the Issei Japanese nationals, by the Department of Justice and the US Army, while the term “incarceration” refers to the confinement of the Nikkei, including a great number of the Nisei American citizens, by the War Relocation Authority. The word “imprisonment” designates the entire process consisting of internment and incarceration. The study of American Buddhism during World War II is still in its early stages. Finding records and documents related to this subject from the large collections on Japanese American imprisonment is not an easy task. While the National Archives in Washington, DC, maintains the majority of primary sources dealing with Japanese American relocation and incarceration, other institutions, such as the Japanese American National Museum, the University of California-Los Angeles, and museums built around the sites of internment camps, also preserve records. Some of the primary sources are written in Japanese and are located in Japan, which is another stumbling block for researchers who do not read Japanese. Duncan R. Williams’s forthcoming book, American Sutra: Buddhism and the World War II Japanese American Experience, however, will change the current state of scholarship on Japanese American Buddhism during World War II. The forceful relocation of Japanese American Buddhists served to weaken their long-standing efforts to make their ethno-religious practices accepted by America’s general public. Mass incarceration, however, forced the Japanese American Buddhists to further Americanize their religion, generated a set of new Buddhist practices, and gave them opportunities to reflect on their national identities. Buddhist faith and cultural practices associated with Japanese Buddhism contributed to ethnic solidarity, even though the Japanese American community was divided over the issue of US patriotism. During the postwar period, Japanese American Buddhists initiated a campaign to improve their image in the United States and to honor the Nisei Buddhist soldiers who fought during World War II. The formation of American Buddhism was closely connected to the development of US political ideology.

From silos to coalitions: The evolution of the US Hospital Preparedness Program

2020 ◽  
Vol 18 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Sharon Medcalf, PhD ◽  
Shreya Roy, MS, PhD Student ◽  
Sarbinaz Bekmuratova, PhD ◽  
Wael ElRayes, MBBCh, PhD, FACHE ◽  
Harlan Sayles, MS ◽  
...  
Keyword(s):  
Emergency Preparedness ◽  
Positive Impact ◽  
The United States ◽  
Emergency Plans ◽  
Daily Work ◽  
The Us ◽  
Hospital Preparedness ◽  
Day To Day Operations ◽  
Hospital Emergency Preparedness ◽  
Percent Decrease

Objective: The objective of this article is to trace the hospital emergency preparedness movement in the United States, strengthen the case for hospital investments in emergency preparedness, and make recommendations to ensure sustainability of the program.  Design/Approach: This article is a narrative review. Main themes from the literature about the US Hospital Preparedness Program (HPP) are discussed, beginning with the trends in funding levels of the HPP, the rise of regional healthcare coalitions, preparedness performance measures, and the challenges faced over the past 15 years of HPP activities. Finally, recommendations are made about ways to sustain the program.Findings: The HPP was established in 2002 and funding for the program has seen a 56 percent decrease over the last 16 years. Beyond the initial investment in supplies and equipment, hospitals have received very little of the healthcare preparedness funding.Disaster drills and exercises to test emergency plans in hospitals are perceived as a costly distraction from daily work. The biggest challenge is the lack of engagement and support from hospital leadership.Conclusions: To ensure the sustainability of the HPP, the positive impact of preparedness activities on the hospital’s day-to-day operations must be demonstrated.

scholarly journals Flea and tick treatment satisfaction, preference, and adherence of dog owners in the United States, United Kingdom, and Australia who treated their dog with fluralaner

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Robert Lavan ◽  
Rob Armstrong ◽  
Karen Lipworth ◽  
Dorothy Normile ◽  
Hannah Newbury
Keyword(s):  
United States ◽  
United Kingdom ◽  
The United States ◽  
Treatment Recommendation ◽  
The Us ◽  
Similar Survey ◽  
Extended Duration ◽  
Dog Owners ◽  
The Uk ◽  
Survey Responses

Background: An extended duration flea and tick medication of the isoxazoline class (fluralaner) was introduced in 2014 in the United States and other countries. A survey was developed in 2016 to gauge dog owner adherence with veterinary recommendations around the administration of preventive flea and tick medications. Current fluralanerusing dog owners were also asked to compare their experience with opinions on monthly flea and tick products. Aim: To survey dog owners who were current users of fluralaner on their opinions, experiences, and attitudes around the administration of flea and tick medications to their dogs in light of current veterinarian recommendations. Methods: Dog owners in the United States (US), United Kingdom (UK), and Australia that gave fluralaner oral chews to their dogs were asked to compare their experience using fluralaner (12-week dosing) and monthly flea and tick medications. The survey responses of dog owners in the UK and Australia were compared against responses to a similar survey conducted in the US in 2017. Surveys were completed by dog owners who were in the clinic for any reason other than a sickness visit. Additionally, veterinarians that prescribed fluralaner from all three countries provided their annual flea and tick treatment recommendation for dogs. Results: A sample of veterinarians from the US, UK, and Australia that prescribe fluralaner recommend that dog owners obtain approximately 12 months of flea protection per year and 9–12 months of tick protection per year. A variable proportion of owners (22%–90%) reported that their dog participates in outdoor and social activities associated with an increased flea and tick exposure risk. A similarly variable proportion of owners reported prior experience of finding fleas (24%–50%) or ticks (18%–35%) on their dogs. All participating owners treated their dogs currently withfluralaner and most (68%–77%) had previously treated their dog with monthly flea and tick products. The convenience of 12-week dosing and less frequent dosing were the most frequently identified product qualities associated with their choice of an extended effect flea and tick treatment.Conclusion: Most veterinarians surveyed in this survey recommended year-round use of a flea and tick medication for dogs in the US, UK, and Australia. Dog owners recalled the veterinary recommendation for flea and tick prevention as 8–10 months per year. Most dog owners from the clinics in the US, UK, and Australia had used shorter-acting (monthly) flea/tick medications previously. The majority of those who currently gave fluralaner doses to their dogs were “satisfied” or “very satisfied” with the extended duration flea and tick product. Preference for a 12-week  duration medication over monthly re-treatment was also high (82%–92%) in all three countries and was associated with convenience. Keywords: Dogs, Ectoparasites, Fluralaner, Preference, Satisfaction.

scholarly journals Resolving Lingering Problems or Continued Support for Pseudoscience? The ICER Value Assessment Update

2017 ◽  
Vol 8 (4) ◽  
pp. 7
Author(s):  
Paul C. Langley
Keyword(s):  
Evaluation Framework ◽  
Value Assessment ◽  
Assessment Framework ◽  
Health Care Environment ◽  
Care Environment ◽  
Scientific Methods ◽  
The Us ◽  
Evidence Analysis ◽  
The Uk ◽  
Therapy Intervention

The Institute for Clinical and Economic Review (ICER) released its updated value assessment framework in mid-2017. This included refinements to its conceptual structure and modifications to methods of collecting and assessing evidence. Consequent to this release, a number of authors have commented on the updated value framework, addressing the question of whether the latest framework represents a major revision or merely attempts to resolve lingering problems. The purpose of this commentary is twofold: (i) to revisit what are considered to be fundamental flaws in the ICER value assessment framework and (ii) to question whether or not post-release critiques of the value framework address the fundamental weaknesses in the ICER approach: the absence of credible, evaluable and replicable claims for the benefits and harms of a therapy intervention. The commentary argues that while ICER sees the purpose of its value assessment framework as forming ‘the backbone of rigorous, transparent evidence reports’ in placing ‘scientific methods of evidence analysis at the heart of a clearer and more transparent process’ it falls far short of these ideals. Rather, in attempting to replicate in the US health care environment the evaluation framework mandated by the National Institute for Health and Care Excellence (NICE) in the UK, the ICER falls into the trap of generating value claims for product impact that fail to meet the standards of normal science.   Type: Commentary

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