Quality Care in Survivorship: Lessons Learned From the ASCO Quality Oncology Practice Initiative

PURPOSE: The ASCO Quality Oncology Practice Initiative (QOPI) project was established to evaluate the influence of guideline recommendations on routine clinical practice. METHODS: QOPI provided summary data from 839 unique practices in which data were collected every six months from the Fall of 2015 to the Spring of 2019. From these data, six items were chosen based on their relationship to domains of survivorship. A zero-inflated negative binomial regression model was used to test for trends in QOPI measures adherence rates over time. The models were adjusted for the time period, region, practice-ownership, multispecialty site, fellowship program, and hospital type. RESULTS: Smoking cessation counseling recommended and smoking cessation counseling administered or referred both increased over time, 50%-61% (adjusted incidence rate ratios (IRR), 1.028; 95% CI, 1.016 to 1.040; P < .001) and 34%-49% (adjusted IRR, 1.052; 95% CI, 1.035 to 1.070; P < .001), respectively. Infertility risks discussed before chemotherapy increased from 36% to 53% (adjusted IRR, 1.056; 95% CI, 1.035 to 1.078; P < .001) and fertility options discussed or referred to specialists increased from 23% to 38% (adjusted IRR, 1.074; 95% CI, 1.046 to 1.102; P < .001). Twenty-nine percent documented a positron emission tomography, computed tomography, or bone scan within the first 12 months for women diagnosed with early breast cancer treated for curative intent (adjusted IRR, 1.000; 95% CI, 0.977 to 1.024; P = .971). Tumor marker surveillance within 12 months increased from 78% to 87% (adjusted IRR, 1.018; 95% CI, 1.002 to 1.033; P = .023). CONCLUSION: As scientific evidence to guide cancer survivorship care grows, the role of guideline recommendations permeating clinical practice using quality metrics will become increasingly important.

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Polytobacco use among young adult smokers: prospective association with cigarette consumption

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054625 ◽

2018 ◽

Vol 29 (1) ◽

pp. 43-48 ◽

Cited By ~ 7

Author(s):

Angela Petersen ◽

Mark G Myers ◽

Lyric Tully ◽

Kristin Brikmanis ◽

Neal Doran

Keyword(s):

Cigarette Smoking ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Tobacco Product ◽

Negative Binomial Regression Model ◽

Use Patterns ◽

Product Use ◽

Smoking Quantity ◽

Prospective Association ◽

Over Time

Background. The risks of polytobacco use among young adults are unclear because we know relatively little about the consistency of multiproduct patterns over time and how these patterns impact cigarette smoking. The purpose of this study was to examine changes in multiple tobacco product use over time and associations with cigarette smoking quantity.Methods. Participants (n=335; 55% male) were 18–24 years old non-daily cigarette smokers living in California. Polytobacco use patterns were assessed quarterly for 2 years.Results. Transition analyses showed that while the number of products that had been used recently was volatile, the most common pattern was stability between timepoints. A longitudinal negative binomial regression model indicated that those who used more non-cigarette products also reported greater cigarette quantity. The strength of this relationship increased over time.Conclusions. Findings suggest that individuals who use more tobacco products are at greater risk for increased cigarette smoking and maintaining a multiple product use pattern.

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Learning by Connecting: How Rule Networks Evolve Through Discovery of Relevance

Organization Science ◽

10.1287/orsc.2021.1524 ◽

2021 ◽

Author(s):

Martin Schulz ◽

Kejia Zhu

Keyword(s):

Clinical Practice ◽

Theoretical Model ◽

Lessons Learned ◽

Learning Theories ◽

Common Phenomenon ◽

Rule Based ◽

Empirical Context ◽

Organizational Rules ◽

Dynamic Interplay ◽

Over Time

Learning-by-connecting, the formation of connections between lessons, is a fairly common phenomenon, but how does it evolve? We argue that learning-by-connecting unfolds as the relevance of lessons to other lessons is gradually discovered over time. The process of “relevance discovery” unfolds through a dynamic interplay between lessons and their context that provides opportunities to discover the relevance of lessons to other lessons. We develop a theoretical model in which the availability of these opportunities and their sorting in time drive the formation of connections. We explore and test our model in the context of organizational rules that we conceptualize, following rule-based learning theories, as repositories of lessons learned. Our empirical context is the formation of citation ties between clinical practice guidelines (CPGs), a type of organizational rules in healthcare, in a Canadian regional healthcare organization. We find that citation tie formation intensifies when opportunities to discover relevance become available. We also find that learning-by-connecting creates rule networks in which the formation of new ties slows down due to the sorting of opportunities in time. Our findings support our assumption that learning-by-connecting is shaped by relevance discovery. Our study extends models of rule-based learning and contributes to discussions on the formation of connections in contexts of dispersed learning and knowledge.

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Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study

10.1101/2022.01.15.22269326 ◽

2022 ◽

Author(s):

Jing Lian Suah ◽

Masliyana Husin ◽

Peter Seah Keng Tok ◽

Boon Hwa Tng ◽

Thevesh Thevananthan ◽

...

Keyword(s):

Observational Study ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Vaccine Effectiveness ◽

Negative Binomial Regression Model ◽

Early Group ◽

Icu Admission ◽

Nationally Representative ◽

Late Group ◽

Over Time

Evaluation of vaccine effectiveness over time against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) is important. Evidence on effectiveness over time for the CoronaVac vaccine is lacking despite its widespread use globally. In Malaysia, a diverse set-up of COVID-19 vaccines was rolled out nationwide, and the waning of vaccine protection is a concern. We aimed to investigate and compare waning vaccine effectiveness against COVID-19 infections, COVID-19 related ICU admission and COVID-19 related deaths for BNT162b2 and CoronaVac vaccines. In this observational study, we consolidated nationally representative data on COVID-19 vaccination and patients′ outcomes. Data on all confirmed COVID-19 cases from 1 to 30 September 2021 were used to compare vaccine effectiveness between the ′early′ group (fully vaccinated in April to June 2021) and the ′late′ group (fully vaccinated in Jul to Aug 2021). We used a negative binomial regression model to estimate vaccine effectiveness against COVID-19 infections for both ′early′ and ′late′ groups, by comparing the rates of infection for individuals vaccinated in the two different periods relative to the unvaccinated. Among confirmed COVID-19 cases, we used logistic regression to estimate and compare vaccine effectiveness against ICU admission and deaths between the two different periods. For BNT162b2, vaccine effectiveness against COVID-19 infections declined from 90.8% (95% CI 89.4, 92.0) in the late group to 79.1% (95% CI 75.8, 81.9) in the late group. Vaccine effectiveness for BNT162b2 against ICU admission and deaths were comparable between the two different periods. For CoronaVac, vaccine effectiveness waned against COVID-19 infections from 74.4% in the late group (95% CI 209 70.4, 77.8) to 30.0% (95% CI 18.4, 39.9) in the early group. It also declined significantly against ICU admission, dropping from 56.1% (95% CI 51.4, 60.2) to 29.9% (95% CI 13.9, 43.0). For deaths, however, CoronaVac′s effectiveness did not wane after three to five months of full vaccination. Vaccine effectiveness against COVID-19 infections waned after three to five months of full vaccination for both BNT162b2 and CoronaVac in Malaysia. Additionally, for CoronaVac, protection against ICU admission declined as well. Evidence on vaccine effectiveness over time informs evolving policy decisions on vaccination.

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Patterns in cancer management changes for patients with COVID-19 in northern California.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1535 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1535-1535

Author(s):

Michael Glover ◽

Julie Wu ◽

Daniel H Kwon ◽

Sylvia Zhang ◽

Solomon Henry ◽

...

Keyword(s):

Clinical Status ◽

Northern California ◽

Curative Intent ◽

Palliative Intent ◽

Cancer Management ◽

Chi Squared ◽

Oncology Practice ◽

Management Changes ◽

Over Time ◽

Active Cancer

1535 Background: The COVID-19 pandemic affected oncology practice in ways that are still evolving. In particular, COVID-19 has led to changes in cancer treatment for patients (pts) infected with COVID, which may have long-term implications for both COVID and cancer-related outcomes. In this retrospective analysis, we describe changes in cancer management over time for cancer pts diagnosed with COVID-19 at two academic institutions in Northern California. Methods: Adult and pediatric pts diagnosed with COVID-19 receiving active cancer management, defined as therapy/surgery/diagnostics within 3 weeks of COVID diagnosis, were identified through the EMR. Patients whose care was affected by COVID-19 were identified and analyzed for significant intra-group differences with regards to management type, treatment intent, and the time of COVID-19 diagnosis (“early” was defined as March to June 2020 and “late” as July 2020 to January 2021). The duration and characteristics of such changes were compared across subgroups. Chi-squared test was used to compare the incidence of delays between subgroups. Results: Among 134 COVID-positive pts on active cancer management, 83 (62%) had significant changes in management that consisted primarily of treatment delays. More delays were identified in patients treated with curative intent earlier in the course of the pandemic compared to later (OR 4.1, p=0.022). This difference was not seen among pts treated with palliative intent. In addition, pts on oral (PO) therapy were significantly less likely to have treatment changes than those on IV/IM therapy (OR 0.32, p=0.005). This difference was driven by a decrease in management changes for those on PO therapy in the later time period (OR 0.27, p=0.026). Pts diagnosed later were more likely to have delays due to clinical reasons rather than institutional policy (OR 6.2, P<.005). The median delay in both time frames was 21 days. Comparison of subgroups is shown in the table. Conclusions: We found significant changes in management of cancer pts with COVID-19 that evolved over time. Oncologists have become increasingly willing to continue therapy for cancer pts treated with curative intent and pts on oral therapy. Changes in cancer therapy have become more frequently related to patient clinical status, and less so due to institutional policies. It will be important to analyze how these changes in management are ultimately reflected in cancer outcomes in order to equip patients and oncologists to react to the next pandemic.[Table: see text]

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Impact of expedited partner therapy (EPT) implementation on chlamydia incidence in the USA

Sexually Transmitted Infections ◽

10.1136/sextrans-2016-052887 ◽

2017 ◽

Vol 94 (7) ◽

pp. 545-547 ◽

Cited By ~ 8

Author(s):

Okeoma Mmeje ◽

Sarah Wallett ◽

Giselle Kolenic ◽

Jason Bell

Keyword(s):

Incidence Rate ◽

Repeated Measures ◽

Fixed Effects ◽

Legal Status ◽

Negative Binomial ◽

Incidence Rates ◽

Negative Binomial Regression Model ◽

Expedited Partner Therapy ◽

The Impact ◽

Over Time

ObjectivesThe diagnosis and treatment of Chlamydia trachomatis infection is important in preventing persistent or recurrent infection. Expedited partner therapy (EPT) is the favoured and supported method for STI treatment of the Centers for Disease Control and Prevention when the provider cannot be assured that all recent sexual partner(s) will seek therapy. EPT is legally permissible in 38 states and is endorsed by healthcare organisations to decrease the rates of chlamydia and gonorrhoea infection. Our study investigated the impact of EPT legal status (permissible, potentially allowable or prohibited) on C. trachomatis infection rates for each state.MethodsOur ecological study modelled the number of reported chlamydia cases from 2000 to 2013 as a function of year, legal status and the interaction between year and legality. We used a negative binomial regression model that included state fixed effects (including the District of Columbia) to account for both the repeated measures per state and state-specific characteristics that could not be measured for inclusion in this study. The lagged number of C. trachomatis cases was included as a covariate and each state's total population for a given year was included in the model as an exposure parameter. States were designated Y (EPT permissible), N (EPT prohibited) and M (EPT potentially allowable), and the legal status of each state could vary over time.ResultsEach legal category saw an increase in the incidence rate of C. trachomatis infection, but on average, the incidence rate for states with prohibitive EPT legislation grew significantly faster over time compared with the rate for the states where EPT was permissible. The average increase in predicted incidence rates per year for states with Y, N and M legal status were 14.1 (95% CI (12.0 to 16.2)), 17.5 (95% CI (15.9 to 19.2)) and 16.8 (95% CI (15.0 to 18.6)) cases per 100 000 persons per year, respectively, when controlling for state-specific effects.ConclusionsOur model suggests that a lack of EPT legislation is associated with an increase in STI rates. States with potentially allowable EPT legislation as of 2013 (n=8) should consider permitting EPT as a component of a multipronged strategy for treatment of sexual partners to prevent C. trachomatis infection.

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Reducing Pulmonary Disease: The Pharmacist’s Role in Smoking Cessation

Journal of Pharmacy Practice ◽

10.1106/j00t-w7m9-c18c-q6y6 ◽

2001 ◽

Vol 14 (2) ◽

pp. 143-159 ◽

Cited By ~ 7

Author(s):

Karen Suchanek Hudmon ◽

Robin L. Corelli ◽

Lisa A. Kroon ◽

Marilyn Standifer Shreve ◽

Alexander V. Prokhorov

Keyword(s):

Public Health ◽

Smoking Cessation ◽

Clinical Practice ◽

Health Service ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Public Health Service ◽

Smoking Cessation Counseling ◽

Quitting Smoking ◽

The U.S

As an important interface with the healthcare system for many patients, pharmacists are in a unique position to assist patients with quitting smoking, thereby improving patients’ pulmonary health. Because nicotine replacement therapy products and bupropion are available to patients largely via pharmacies, the pharmacist has become a logical candidate for providing smoking cessation assistance. Furthermore, research has shown that when pharmacists counsel patients on medications for quitting smoking, their intervention positively impacts smoking cessation rates. This article provides a review of methods for cessation and provides pharmacists with feasible and effective smoking cessation counseling strategies for implementation into everyday practice. The intervention approach draws heavily upon the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence.

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Surgery as a Teachable Moment for Smoking Cessation

Anesthesiology ◽

10.1097/aln.0b013e3181c61cf9 ◽

2010 ◽

Vol 112 (1) ◽

pp. 102-107 ◽

Cited By ~ 105

Author(s):

Yu Shi ◽

David O. Warner

Keyword(s):

Smoking Cessation ◽

Surgical Procedures ◽

Negative Binomial ◽

Outpatient Surgery ◽

Negative Binomial Regression ◽

The United States ◽

Major Surgery ◽

Negative Binomial Regression Model ◽

Teachable Moment ◽

Nationally Representative

Background A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery. Methods Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery. Results Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8% of all quit events in the United States annually can be attributed to the surgical procedures analyzed. Conclusions Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

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Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00092 ◽

2020 ◽

Vol 5 (1) ◽

pp. 88-96

Author(s):

Mary R. T. Kennedy

Keyword(s):

College Students ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Sense Of Self ◽

Scientific Evidence ◽

Sudden Onset ◽

Lessons Learned ◽

Speech Language Pathologists ◽

The Brain ◽

Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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