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1

Educating Health Care Professionals to Provide Institutional Changes in Cancer Survivorship Care  

PubMed Central

The Institute of Medicine (IOM) 2006 report, From Cancer Patient to Cancer Survivor: Lost in Transition (In M. Hewitt, S. Greenfield and E. Stovall (Eds.), (pp. 9–186). Washington DC: The National Academies Press, 2006) identifies the key components of care that contribute to quality of life for the cancer survivor. As cancer survivorship care becomes an important part of quality cancer care oncology professionals need education to prepare themselves to provide this care. Survivorship care requires a varied approach depending on the survivor population, treatment regimens and care settings. The goal of this program was to encourage institutional changes that would integrate survivorship care into participating centers. An NCI-funded educational program: Survivorship Education for Quality Cancer Care provided multidiscipline two-person teams an opportunity to gain this important knowledge using a goal-directed, team approach. Educational programs were funded for yearly courses from 2006 to 2009. Survivorship care curriculum was developed using the Quality of Life Model as the core around the IOM recommendations. Baseline data was collected for all participants. Teams were followed-up at 6, 12 and 18 months postcourse for goal achievement and institutional evaluations. Comparison data from baseline to 18 months provided information on the 204 multidiscipline teams that participated over 4 years. Teams attended including administrators, social workers, nurse practitioners, registered nurses, physicians and others. Participating centers included primarily community cancer centers and academic centers followed by pediatric centers, ambulatory/physician offices and free standing cancer centers. Statistically significant changes at p=<0.05 levels were seen by 12 months postcourse related to the effectiveness, receptiveness and comfort of survivorship care in participant settings. Institutional assessments found improvement in seven domains of care that related to institutional change. This course provided education to participants that led to significant changes in survivorship care in their settings. PMID:22271583

Economou, Denice; Ferrell, Betty; Uman, Gwen

2013-01-01

2

Music and healing in cancer care: A survey of supportive care providers  

Microsoft Academic Search

This paper explores the role of music activity and music therapy in health care drawing on a survey of UK cancer care providers offering music interventions and music therapy. The survey examined the extent and type of music provision and explored providers’ views about the role and contribution of music and music therapy in healing. As well as music, the

Norma Daykin; Leslie Bunt; Stuart McClean

2006-01-01

3

The economics of cancer care: longitudinal changes in provider efficiency.  

PubMed

Renewed debate over competition in healthcare suggests that greater specialization is good for the health economy. In essence, greater specialization is hypothesized to lead to lower average costs, due to learning curve effects, scale, or other operating efficiencies. This hypothesis was tested in oncology care, since this disease group is one of the few with existing specialized cancer centers already in place. Data envelopment analysis (DEA), and specifically a longitudinal Malmquist index over a 5-year period was applied to the major, specialized inpatient cancer centers to determine if these specialized centers achieve higher productivity over time, and if scale leads to higher operating efficiency. Results suggest policy and payer implications since these DRG-exempt hospitals may not be improving their technical efficiency over time. Despite advancements in technology and greater scale, the average efficiency of cancer care has marginally declined. Similarly, when compared to other hospitals with greater numbers of other service offerings, oncology care has not benefited from increasing returns to scale. PMID:19469458

Langabeer, James R; Ozcan, Yasar A

2009-06-01

4

Caring for Alaska Native prostate cancer survivors in primary care: a survey of Alaska Tribal Health System providers  

PubMed Central

Background Little is known about the constraints of optimizing health care for prostate cancer survivors in Alaska primary care. Objective To describe the experiences and attitudes of primary care providers within the Alaska Tribal Health System (ATHS) regarding the care of prostate cancer survivors. Design In late October 2011, we emailed a 22-item electronic survey to 268 ATHS primary care providers regarding the frequency of Prostate Specific Antigen (PSA) monitoring for a hypothetical prostate cancer survivor; who should be responsible for the patient's life-long prostate cancer surveillance; who should support the patient's emotional and medical needs as a survivor; and providers’ level of comfort addressing recurrence monitoring, erectile dysfunction, urinary incontinence, androgen deprivation therapy, and emotional needs. We used simple logistic regression to examine the association between provider characteristics and their responses to the survivorship survey items. Results Of 221 individuals who were successfully contacted, a total of 114 responded (52% response rate). Most ATHS providers indicated they would order a PSA test every 12 months (69%) and believed that, ideally, the hypothetical patient's primary care provider should be responsible for his life-long prostate cancer surveillance (60%). Most providers reported feeling either “moderately” or “very” comfortable addressing topics such as prostate cancer recurrence (59%), erectile dysfunction (64%), urinary incontinence (63%), and emotional needs (61%) with prostate cancer survivors. These results varied somewhat by provider characteristics including female sex, years in practice, and the number of prostate cancer survivors seen in their practice. Conclusions These data suggest that most primary care providers in Alaska are poised to assume the care of prostate cancer survivors locally. However, we also found that large minorities of providers do not feel confident in their ability to manage common issues in prostate cancer survivorship, implying that continued access to specialists with more expert knowledge would be beneficial. PMID:24596707

Tilburt, Jon C.; Kelley, Stacy; DeCourtney, Christine A.; Humeniuk, Katherine M.; Latini, Jerilyn; Kim, Simon P.

2014-01-01

5

Pancreatic Cancer Center: Providing the Research Tools Necessary to Advance Pancreatic Cancer Patient Care  

E-print Network

Pancreatic Cancer Center: Providing the Research Tools Necessary to Advance Pancreatic Cancer the fourth leading cause of cancer deaths, and PDAC patients have a dismal 5-year survival rate of 6 number of NCI-designated cancer centers have a specialized pancreatic cancer program. The creation

Zhou, Yaoqi

6

Effectively Communicating Colorectal Cancer Screening Information to Primary Care Providers: Application for State, Tribe or Territory Comprehensive Cancer Control Coalitions  

ERIC Educational Resources Information Center

Background: Patients are more likely to be screened for colorectal cancer if it is recommended by a health care provider. Therefore, it is imperative that providers have access to the latest screening guidelines. Purpose: This practice-based project sought to identify Kentucky primary care providers' preferred sources and methods of receiving…

Redmond, Jennifer; Vanderpool, Robin; McClung, Rebecca

2012-01-01

7

Health care providers underestimate symptom intensities of cancer patients: A multicenter European study  

Microsoft Academic Search

BACKGROUND: Many patients with advanced cancer depend upon health care providers for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined. METHODS: This cross-sectional study included 1933 patient-health care provider dyads, from 11 European countries. Patients reported symptoms by using the four-point scales of the

Eivor A Laugsand; Mirjam AG Sprangers; Kristin Bjordal; Frank Skorpen; Stein Kaasa; Pål Klepstad

2010-01-01

8

The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients  

PubMed Central

Facing a cancer diagnosis at any age is devastating. However, young cancer patients have the added burden that life-preserving cancer treatments, including surgery, chemotherapy, and radiotherapy, may compromise their future fertility. The possibility of reproductive dysfunction as a consequence of cancer treatment has a negative impact on the quality of life of cancer survivors. The field of oncofertility, which merges the clinical specialties of oncology and reproductive endocrinology, was developed to explore and expand fertility preservation options and to better manage the reproductive status of cancer patients. Fertility preservation for females has proved to be a particular challenge because mature female gametes are rare and difficult to acquire. The purpose of this article is to provide the gynecologist with a comprehensive overview of how cancer treatments affect the female reproductive axis, delineate the diverse fertility preservation options that are currently available or being developed for young women, and describe current measures of ovarian reserve that can be used pre- and post-cancer treatment. As a primary care provider, the gynecologist will likely interact with patients throughout the cancer care continuum. Thus, the gynecologist is in a unique position to join the oncofertility team in providing young cancer patients with up-to-date fertility preservation information and referrals to specialists. PMID:21927621

Duncan, Francesca E; Jozefik, Jennifer K; Kim, Alison M; Hirshfeld-Cytron, Jennifer; Woodruff, Teresa K

2011-01-01

9

Predicting cancer prognosis using interactive online tools: A systematic review and implications for cancer care providers  

PubMed Central

Cancer prognosis is of keen interest for cancer patients, their caregivers and providers. Prognostic tools have been developed to guide patient-physician communication and decision-making. Given the proliferation of prognostic tools, it is timely to review existing online cancer prognostic tools and discuss implications for their use in clinical settings. Using a systematic approach, we searched the Internet, Medline, and consulted with experts to identify existing online prognostic tools. Each was reviewed for content and format. Twenty-two prognostic tools addressing 89 different cancers were identified. Tools primarily focused on prostate (n=11), colorectal (n=10), breast (n=8), and melanoma (n=6), though at least one tool was identified for most malignancies. The input variables for the tools included cancer characteristics (n=22), patient characteristics (n=18), and comorbidities (n=9). Effect of therapy on prognosis was included in 15 tools. The most common predicted outcome was cancer specific survival/mortality (n=17). Only a few tools (n=4) suggested patients as potential target users. A comprehensive repository of online prognostic tools was created to understand the state-of-the-art in prognostic tool availability and characteristics. Use of these tools may support communication and understanding about cancer prognosis. Dissemination, testing, refinement of existing, and development of new tools under different conditions are needed. PMID:23956026

Rabin, Borsika A.; Gaglio, Bridget; Sanders, Tristan; Nekhlyudov, Larissa; Dearing, James W.; Bull, Sheana; Glasgow, Russell E.; Marcus, Alfred

2013-01-01

10

Rural Primary Care Providers' Perceptions of Their Role in the Breast Cancer Care Continuum  

ERIC Educational Resources Information Center

Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and…

Rayman, Kathleen M.; Edwards, Joellen

2010-01-01

11

Knowledge and Attitudes of Hispanic Women and Their Health Care Providers about Breast Cancer Risk Factors and Screening  

Microsoft Academic Search

Objectives: The purpose of our study was to develop and evaluate an educational program for health care providers and patients on the topics of general breast cancer risk factors, breast cancer genetics, and breast cancer screening recommendations. The program was designed with specific emphasis on addressing the needs of medically underserved Hispanic women in Southern Texas. We also identified and

Michelle N. Strecker; Aimee J. Williams; Melissa Bondy; Dennis A. Johnston; Hope Northrup

2002-01-01

12

Implementation of cancer clinical care pathways: a successful model of collaboration between payers and providers.  

PubMed

Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. PMID:22942833

Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Philip; Scott, Jeffrey A

2012-05-01

13

Predictors of Colorectal Cancer Screening Variation Among Primary Care Providers and Clinics  

PubMed Central

Objectives Colorectal cancer (CRC) screening is underutilized. To effect change, we must understand reasons for underuse at multiple levels of the healthcare system. We evaluated patient, provider, and clinic factors that predict variation in CRC screening among primary care clinics and primary care providers (PCPs). Methods We analyzed electronic medical record (EMR) data for 34,319 adults eligible for CRC screening, 19 clinics, and 97 PCPs in a large, academic physician group. Detailed data on potential patient, provider, and clinic predictors of CRC screening were obtained from the EMR. PCP perceptions of CRC screening barriers were measured via survey. The outcome was completion of CRC screening at the patient level. Multivariate logistic regression with clustering on clinics obtained adjusted odds ratios and 95% confidence intervals for potential predictors of CRC screening at each level. Results Seventy-one percent of patients completed CRC screening. Variation in screening rates was seen among clinics (51–80%) and among PCPs (51–82%). Significant predictors of completing CRC screening were identified at all levels: patient (older age, white race, being married, primarily English-speaking, having commercial insurance plans versus Medicare or Medicaid, and higher healthcare resource utilization), provider (larger panel size of patients eligible for CRC screening), and clinic (hospital-owned, shorter distance to nearest optical colonoscopy center). Conclusions Variation in CRC screening exists among primary care clinics and providers within a single clinic. Predictors of variation can be identified at patient, provider, and clinic levels. Quality improvement interventions addressing CRC screening need to be directed at multiple levels of the healthcare system. PMID:23670114

Weiss, Jennifer M.; Smith, Maureen A.; Pickhardt, Perry J.; Kraft, Sally A.; Flood, Grace E.; Kim, David H.; Strutz, Elizabeth; Pfau, Patrick R.

2013-01-01

14

Health care providers' perspectives about working with parents of children with cancer: a qualitative study.  

PubMed

Research to understand the sources of stress and job satisfaction in pediatric oncology staff is limited. The aim of the authors' qualitative study was to describe the key work-related demands and rewards in relation to working closely with parents from the perspective of health care providers (HCPs). Semistructured interviews were conducted with 13 doctors, 9 nurses, 5 social workers, and 6 child life specialists. Line-by-line, focused, and theoretical coding was used to establish categories and themes. Constant comparisons were used to examine the relationships within and across codes and categories. Interviewing continued until no new themes emerged. HCPs found it rewarding when they established close or long-term relationships with parents and to helped families through the entire cancer journey, including palliative care. HCPs found it challenging to work with complex families; with parents who are demanding, rude, or angry; with parents who have differing views about the treatments and palliative care; and with having to relay bad news to parents. Future research could explore the relationship between the factors that the authors have identified and burnout syndrome. PMID:22415857

Klassen, Anne; Gulati, Sonia; Dix, David

2012-01-01

15

Implementation of cancer clinical care pathways: s successful model of collaboration between payers and providers.  

PubMed

Despite rising medical costs within the US healthcare system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of healthcare in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the healthcare cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology healthcare consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. PMID:22694114

Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Phillip; Scott, Jeffrey A

2012-05-01

16

Palliative Care in Cancer  

MedlinePLUS

... cancer.gov/cancertopics/factsheet/Support/hospice on the Internet. 6. Where do cancer patients receive palliative care? ... at http://www.getpalliativecare.org/providers on the Internet. The National Hospice and Palliative Care Organization’s Web ...

17

Is Distance to Provider a Barrier to Care for Medicaid Patients with Breast, Colorectal, or Lung Cancer?  

ERIC Educational Resources Information Center

Purpose: Distance to provider might be an important barrier to timely diagnosis and treatment for cancer patients who qualify for Medicaid coverage. Whether driving time or driving distance is a better indicator of travel burden is also of interest. Methods: Driving distances and times from patient residence to primary care provider were…

Scoggins, John F.; Fedorenko, Catherine R.; Donahue, Sara M. A.; Buchwald, Dedra; Blough, David K.; Ramsey, Scott D.

2012-01-01

18

Patient-Health Care Provider Communication among Patients with Newly Diagnosed Prostate Cancer: Findings from A Population-based Survey  

PubMed Central

Objective To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences. Methods The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling. Results Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCP’s contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient- HCP communication and prostate cancer communication. Conclusion Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer. Practice Implications: HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer. PMID:23332967

Song, Lixin; Bensen, Jeannette T.; Zimmer, Catherine; Sleath, Betsy; Blackard, Bonny; Fontham, Elizabeth; Su, L. Joseph; Brennan, Christine S.; Mohler, James L.; Mishel, Merle

2014-01-01

19

Compassion FatigueA Review of the Research to Date and Relevance to Cancer-care Providers  

Microsoft Academic Search

Fifty-seven studies were reviewed to identify the prevalence of compassion fatigue among cancer-care providers, instruments used to detect it and means of prevention and treatment. Conclusions were limited by an ambiguous definition of compassion fatigue that fails to adequately differentiate it from related constructs (e.g. burnout, secondary traumatic stress) and the modest number of cancer-related studies found. However, evidence suggests

Nadine Najjar; Louanne W. Davis; Kathleen Beck-Coon; Caroline Carney Doebbeling

2009-01-01

20

Health Care Providers' and Cancer Patients' Preferences Regarding Disclosure of Information About Advance Directives  

Microsoft Academic Search

The Patient Self-Determination Act (PSDA) of 1990 requires hospitals to tell patients when they are admitted to the hospital about their right to complete an advance directive. The purpose of the study was to learn how providers and patients believe information about advance directive should be presented. When focus groups of providers and patients from a regional cancer center were

Andrew D. Shore; Haya R. Rubin; Mary Ellen Haisfield; Deborah B. McGuire; James R. Zabora; Sharon Krumm

1994-01-01

21

'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers  

PubMed Central

Background Palliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. Methods A qualitative design was used as we were looking for the personal views of 'very ill' cancer patients with a Turkish or Moroccan background, their family members and their Dutch care providers. We interviewed 83 people, involved in 33 cases to obtain information about their views, values and norms on 'good care'. Results The main concerns about 'good care' expressed by Turkish and Moroccan families were: maximum treatment and curative care until the end of their lives, never having hope taken away, devoted care by their families, avoiding shameful situations, dying with a clear mind and being buried in their own country. Their views conflict, to some extent, with the dominant principles in palliative care, for example, the emphasis on quality of life and advanced care planning, which includes discussing diagnosis and prognosis with the patient. Conclusions Patients and their families with a Turkish or Moroccan background often have different ideas about 'good care' than their Dutch care providers. As many of them are aiming at cure until the end of life, they find 'good palliative care' a contradiction in terms. PMID:20831777

2010-01-01

22

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK.  

PubMed

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1-10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this. PMID:24246444

Leary, Alison; White, John; Yarnell, Laura

2014-02-01

23

Adherence to Survivorship Care Guidelines in Health Care Providers for Non-Small Cell Lung Cancer and Colorectal Cancer Survivor Care  

ClinicalTrials.gov

Adenocarcinoma of the Lung; Mucinous Adenocarcinoma of the Colon; Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Colon; Signet Ring Adenocarcinoma of the Rectum; Squamous Cell Lung Cancer; Stage I Colon Cancer; Stage I Rectal Cancer; Stage IA Non-small Cell Lung Cancer; Stage IB Non-small Cell Lung Cancer; Stage IIA Colon Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIA Rectal Cancer; Stage IIB Colon Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIB Rectal Cancer; Stage IIC Colon Cancer; Stage IIC Rectal Cancer; Stage IIIA Colon Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIA Rectal Cancer; Stage IIIB Colon Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIB Rectal Cancer; Stage IIIC Colon Cancer; Stage IIIC Rectal Cancer

2014-01-31

24

Rural health professionals' perspectives on providing grief and loss support in cancer care.  

PubMed

Research demonstrates considerable inequalities in service delivery and health outcomes for people with cancer living outside large metropolitan cities. Semi-structured interviews with 11 professionals providing grief and loss support for people with cancer and their families in rural, regional, and remote areas Western Australia revealed the challenges they faced in delivering such support. The data are presented in four themes - Inequity of regional versus metropolitan services, Strain of the 'Jack of all trades' role, Constraints to accessing professional development, and Challenges in delivering post-bereavement services. These challenges are likely to be of growing concern given that populations are declining in rural areas as Australia becomes increasingly urban. The findings have implications in enhancing the loss and grief support services available in rural, regional, and remote Western Australia, including those grieving the death of a loved one through cancer. PMID:23834431

Breen, L J; O'Connor, M

2013-11-01

25

Provider Training in ENACCT’s Pilot Education Program: Enhancing the Role of Primary Care Providers and Cancer Clinical Trials Staff | accrualnet.cancer.gov  

Cancer.gov

An advocacy group developed training programs targeting primary care providers (PCPs) and clinical trials staff. PCPs were reached using an innovative, action-oriented train-the-trainer curriculum which included discussion of trials and how they work, patient protections, strategies for discussing trials, and their role in referring recently diagnosed patients to trials. Research staff attended interactive workshops focused on optimizing recruitment and retention practices, including ways to incorporate Cultural and Linguistically Appropriate Service (CLAS) standards in the clinical research setting.

26

Spine Care Provider Search  

MedlinePLUS

... a spine care professional. As a multidisciplinary spine organization, NASS members are MDs, DOs and PhDs in 22 spine-related specialties, including orthopedics, neurosurgery, physiatry, pain management and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, ...

27

Family Day Care Provider Handbook  

ERIC Educational Resources Information Center

Family day care providers are responsible for creating a high-quality program where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care

New York State Office of Children and Family Services, 2006

2006-01-01

28

Quality of Cancer Care  

Cancer.gov

Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.

29

'Palliative care': a contradiction in terms? A qualitative study of cancer patients with a Turkish or Moroccan background, their relatives and care providers  

Microsoft Academic Search

BACKGROUND: Palliative cancer care aims to improve quality of life and ultimately quality of dying, while prolonging life is not an objective anymore when death nears. The question is, however, whether these perspectives on palliative care are congruent with the perspectives of immigrant families with a Turkish or Moroccan background. METHODS: A qualitative design was used as we were looking

Fuusje M de Graaff; Anneke L Francke; Maria ETC van den Muijsenbergh; Sjaak van der Geest

2010-01-01

30

Providing general practice needs-based care for carers of people with advanced cancer: a randomised controlled trial  

PubMed Central

Background Carers of patients with advanced cancer often have health and psychosocial needs, which are frequently overlooked. Aim To meet the needs of carers through a GP consultation directed by a self-completed carer needs checklist. Design and setting Randomised controlled trial in general practice with recruitment through specialist oncology clinics, in Brisbane, Australia. Method Intervention was (a) carer–GP consultations directed by a self-completed checklist of needs at baseline and 3 months; and (b) a GP-Toolkit to assist GPs to address carer-identified needs. Control group received usual care. Outcome measures were intensity of needs, anxiety and depression, and quality of life. Results Total recruitment 392. Overall, no significant differences were detected in the number or intensity of need between groups. Compared to controls, intervention participants with baseline clinical anxiety showed improvements in mental wellbeing (P = 0.027), and those with baseline clinical depression had slower development of anxiety (P = 0.044) at 6 months. For those not anxious, physical wellbeing improved at 1 month (P = 0.040). Carers looking after patients with poor functional status had more physical needs (P = 0.037) at 1 month and more psychological and emotional needs at 3 months (P = 0.034). Those caring for less unwell patients showed improved mental wellbeing at 3 months (P = 0.022). Conclusion The intervention did not influence the number or intensity of needs reported by carers of people with advanced cancer. There was limited impact in people with pre-existing clinical anxiety and depression. For the carer of those most severely affected by advanced cancer, it drew attention to the needs arising from the caregiving role. PMID:24152483

Mitchell, Geoffrey K; Girgis, Afaf; Jiwa, Moyez; Sibbritt, David; Burridge, Letitia H; Senior, Hugh E

2013-01-01

31

Perceptions of Patient-Provider Communication in Breast and Cervical Cancer-Related Care: A Qualitative Study of Low-Income English- and Spanish-Speaking Women  

PubMed Central

To explore patient perceptions of patient-provider communication in breast and cervical cancer-related care among low-income English- and Spanish- speaking women, we examined communication barriers and facilitators reported by patients receiving care at safety net clinics. Participants were interviewed in English or Spanish after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Following an inductive approach, interviews were coded and analyzed by the language spoken with providers and patient-provider language concordance status. Of 78 participants, 53% (n = 41) were English-speakers and 47% (n = 37) were Spanish-speakers. All English-speakers were language-concordant with providers. Of Spanish-speakers, 27% (n = 10) were Spanish-concordant; 38% (n = 14) were Spanish-discordant, requiring an interpreter; and 35% (n = 13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. English-speakers focused on communication barriers, and difficulty understanding jargon arose as a theme. Spanish-speakers emphasized communication facilitators related to Spanish language use. Themes among all Spanish-speaking sub-groups included appreciation for language support resources and preference for Spanish-speaking providers. Mixed-concordant participants accounted for the majority of Spanish-speakers who reported communication barriers. Our data suggest that, although perception of patient-provider communication may depend on the language spoken throughout the care continuum, jargon is lost when health information is communicated in Spanish. Further, the respective consistency of language concordance or interpretation may play a role in patient perception of patient-provider communication. PMID:23553683

Simon, Melissa A.; Ragas, Daiva M.; Nonzee, Narissa J.; Phisuthikul, Ava M.; Luu, Thanh Ha; Dong, XinQi

2013-01-01

32

Group Family Day Care Provider Handbook  

ERIC Educational Resources Information Center

Group family day care providers need to create high-quality programs where children have opportunities to grow, learn and thrive. Part of providing high-quality child care includes complying with the group family day care regulations from the New York State Office of Children and Family Services (OCFS). This Handbook will help day care providers:…

New York State Office of Children and Family Services, 2006

2006-01-01

33

Providing Child Care At East Carolina University  

E-print Network

Providing Child Care At East Carolina University Preliminary Report October 9, 2006 #12;Providing Child Care At East Carolina University Preliminary Report October 9, 2006 1 Overview In April 2006 to child care for university employees and exploring child care options for the campus community

34

Find a Hospice or Palliative Care Provider  

MedlinePLUS

... Name: Organization Type: Hospice Multi-Location Hospice Provider Palliative Care Provider or Sitemap Contact Us Privacy Informacion en Español Copyright National Hospice and Palliative Care Organization 1731 King Street, Suite 100 Alexandria, Virginia ...

35

Family Day Care Provider Support Services Directory.  

ERIC Educational Resources Information Center

This directory profiles numerous organizational support services for family day care providers in the Kansas City metropolitan area. The first chapter, on operating a family day care home, concerns licensing and registration, the processes of starting and marketing a day care business, zoning and municipal regulation, and substitute providers. The…

Galblum, Trudi W.; Boyer-Shesol, Cathy

36

Integrating acupuncture into cancer care.  

PubMed

Oncology acupuncture has become a new and promising field of research because more and more cancer patients have sought non-pharmacological alternatives for symptom management. While different mechanisms have been proposed to explain its efficacy, including theories of the neural system, endocrine cytokine or immunological regulation, its eventual role has become that of alleviating the side effects induced by chemotherapy or radiotherapy. In this paper, we have reviewed the related articles focusing on acupuncture mechanisms and applications in cancer care to provide a quick sketch of acupuncture in cancer care. A detailed search was performed to identify the randomized controlled trials (RCTs) and systematic reviews on acupuncture in oncology, using PUBMED and Cochrane. The search terms included: Acupuncture, acupressure, and cancer. Additional terms were used to target specific symptoms (i.e., breast cancer, hot flash, xerostomia, nausea, vomiting, cancer pain, insomnia, fatigue). Two authors independently extracted data for analysis and review. Ultimately, 25 articles underwent full-text review. Recent trials made efforts in studying (a) hot flashes in breast cancer, (b) xerostomia induced by radiotherapy in head and neck cancer, (c) nausea and vomiting post-chemotherapy, (d) cancer pain, and (e) fatigue and insomnia in cancer patients. Controversial results for acupuncture application in cancer care appeared in different categories, but a trend emerged that acupuncture can palliate cancer-related symptoms. The research to date certainly offers us a valid complementary therapy in treating cancer-related symptoms. Meanwhile, practical strategies with safe measures for enhancing the efficacy are needed in further interventions, as well as continuing research with a validated methodology. PMID:24716183

Chien, Tsai-Ju; Liu, Chia-Yu; Hsu, Chung-Hua

2013-10-01

37

Integrating Acupuncture into Cancer Care  

PubMed Central

Oncology acupuncture has become a new and promising field of research because more and more cancer patients have sought non-pharmacological alternatives for symptom management. While different mechanisms have been proposed to explain its efficacy, including theories of the neural system, endocrine cytokine or immunological regulation, its eventual role has become that of alleviating the side effects induced by chemotherapy or radiotherapy. In this paper, we have reviewed the related articles focusing on acupuncture mechanisms and applications in cancer care to provide a quick sketch of acupuncture in cancer care. A detailed search was performed to identify the randomized controlled trials (RCTs) and systematic reviews on acupuncture in oncology, using PUBMED and Cochrane. The search terms included: Acupuncture, acupressure, and cancer. Additional terms were used to target specific symptoms (i.e., breast cancer, hot flash, xerostomia, nausea, vomiting, cancer pain, insomnia, fatigue). Two authors independently extracted data for analysis and review. Ultimately, 25 articles underwent full-text review. Recent trials made efforts in studying (a) hot flashes in breast cancer, (b) xerostomia induced by radiotherapy in head and neck cancer, (c) nausea and vomiting post-chemotherapy, (d) cancer pain, and (e) fatigue and insomnia in cancer patients. Controversial results for acupuncture application in cancer care appeared in different categories, but a trend emerged that acupuncture can palliate cancer-related symptoms. The research to date certainly offers us a valid complementary therapy in treating cancer-related symptoms. Meanwhile, practical strategies with safe measures for enhancing the efficacy are needed in further interventions, as well as continuing research with a validated methodology. PMID:24716183

Chien, Tsai-Ju; Liu, Chia-Yu; Hsu, Chung-Hua

2013-01-01

38

Improving modern cancer care through information technology.  

PubMed

The cancer care system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a "medical home" (the ideal accountable care provider) for cancer patients. Patients and families often cite such difficulties as information deficits, uncoordinated care, and insufficient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancer care in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancer care. PMID:21521595

Clauser, Steven B; Wagner, Edward H; Aiello Bowles, Erin J; Tuzzio, Leah; Greene, Sarah M

2011-05-01

39

Health Care Provider Physical Activity Prescription Intervention  

ERIC Educational Resources Information Center

Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…

Josyula, Lakshmi; Lyle, Roseann

2013-01-01

40

Primary care providers' perception of care coordination needs and strategies in adult primary care practice.  

E-print Network

?? Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute… (more)

Florini, Marita A.

2014-01-01

41

Primary care perspectives on prostate cancer screening.  

PubMed

Although the effectiveness of prostate cancer screening is controversial, screening rates have risen dramatically among primary care providers in the United States. The authors' findings suggest more collaboration among primary care and specialty organizations, especially with respect to decision aid endorsement, is needed to achieve more discriminatory and patient-centered prostate cancer screening. PMID:21572298

Skolarus, Ted A; Holmes-Rovner, Margaret; Northouse, Laurel L; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond Y; Rovner, David R; Darwish-Yassine, May; Wei, John T

2011-06-01

42

The Family Day Care Providers' Legal Handbook.  

ERIC Educational Resources Information Center

Designed specifically for family day care providers in Alameda County, California, this handbook provides legal and business advice thought to be useful as well to providers throughout the United States. A wide range of legal and business issues is covered in 15 brief chapters. Advice is offered on provider-parent contracts, planning for accidents…

Treadwell, Lujuana Wolfe

43

Vaccine perceptions among Oregon health care providers.  

PubMed

Health care providers exert a significant influence on parental pediatric vaccination decisions. We conducted hour-long interviews with traditional and alternative health care providers in which we explored a range of associations between vaccination perceptions and practice. A key finding was that the Health Belief Model constructs of perceived susceptibility to and severity of either an illness or an adverse vaccine event partially explained health care provider (HCP) beliefs about the risks or benefits of vaccination, especially among alternative care providers. Low or high perceived susceptibility to a vaccine-preventable disease (VPD) or of the severity of a given VPD affects whether an HCP will promote or oppose pediatric vaccination recommendations. Beyond these perceptions, health and vaccination beliefs are affected by the contextual factors of personal experience, group norms, immunology beliefs, and beliefs about industry and government. Building powerful affective heuristics might be critical to balancing the forces that defeat good public health practices. PMID:23964059

Bean, Sandra J; Catania, Joseph A

2013-09-01

44

Primary care perspectives on prostate cancer survivorship: Implications for improving quality of care  

Microsoft Academic Search

ObjectivesPrimary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care.

Ted A. Skolarus; Margaret Holmes-Rovner; Laurel L. Northouse; Angela Fagerlin; Carol Garlinghouse; Raymond Y. Demers; David R. Rovner; May Darwish-Yassine; John T. Wei

45

Head & Neck Cancer Care Program  

E-print Network

OROPHARYNGEAL CANCER PROGRAM THYROID AND PARATHYROID PROGRAM · Alexander Colevas, MD · Vasu Divi, MD · ChrisHead & Neck Cancer Care Program NONPROFITORG. U.S.POSTAGE PAID PALOALTO,CA PERMITNO.188900BlakeWilburDrive PaloAlto,CA94304 Starting February 24, 2014, the Head & Neck Cancer Care Program is moving to a new

Bogyo, Matthew

46

Talking about Complementary and Alternative Medicine with Your Health Care Providers: A Workbook and Tips  

MedlinePLUS

... Health Talking about Complementary and Alternative Medicine with Health Care Providers: A Workbook and Tips Office of Cancer ... your needs and interests. If you are a health care provider… this workbook contains several documents which can ...

47

Providing Pediatric Subspecialty Care: A Workforce Analysis  

Microsoft Academic Search

Objective. To provide a snapshot of pe- diatric subspecialty practice, examine issues pertaining to the subspecialty workforce, and analyze subspecial- ists' perspective on the health care market. Background. Before the effort of the Future of Pedi- atric Education II (FOPE II) Project, very little informa- tion existed regarding the characteristics of the pediatric subspecialty workforce. This need was addressed through

Jeffrey J. Stoddard; William L. Cull; Ethan A. B. Jewett; Sarah E. Brotherton; Holly J. Mulvey; Errol R. Alden

48

Biomarkers, Bundled Payments, and Colorectal Cancer Care  

PubMed Central

Changes in the management of cancers such as colorectal cancer (CRC) are urgently needed, as such cancers continue to be one of the most commonly diagnosed cancers; CRC accounts for 21% of all cancers and is responsible for mortalities second only to lung cancer in the United States. A comprehensive science-driven approach towards markedly improved early detection/screening to efficacious targeted therapeutics with clear diagnostic and prognostic markers is essential. In addition, further changes addressing rising costs, stemming from recent health care reform measures, will be brought about in part by changes in how care is reimbursed. For oncology, the advances in genomics and biomarkers have the potential to define subsets of patients who have a prognosis or response to a particular type of therapy that differs from the mean. Better definition of a cancer’s behavior will facilitate developing care plans tailored to the patient. One method under study is episode-based payment or bundling, where one payment is made to a provider organization to cover all expenses associated with a discrete illness episode. Payments will be based on the average cost of care, with providers taking on a risk for overutilization and outliers. For providers to thrive in this environment, they will need to know what care a patient will require and the costs of that care. A science-driven “personalized approach” to cancer care has the potential to produce better outcomes with reductions in the use of ineffectual therapies and costs. This promising scenario is still in the future, but progress is being made, and the shape of things to come for cancer care in the age of genomics is becoming clearer. PMID:22893787

Lynch, Patrick; Raju, Gottumukkala; Rodriguez, Alma; Burke, Thomas; Hafemeister, Lisa; Hawk, Ernest; Wu, Xifeng; DuBois, Raymond N.

2012-01-01

49

Sick Child Care Book for Parents and Child Care Providers.  

ERIC Educational Resources Information Center

Intended for use by parents and child care providers, this short booklet offers practical information about many common childhood illnesses, providing suggestions for making decisions which concern the sick child. Information is given relating to how parents (especially working parents) can be prepared for their child's illnesses, specific…

Bananas, Inc., Oakland, CA.

50

Caring: Information for Family Day-Care Providers.  

ERIC Educational Resources Information Center

This series of leaflets provides information for family day care providers on nine topics. Age differences and developmental stages are emphasized. The first topic concerns ways to help young children get along with others. Self-esteem is emphasized, and methods for helping children develop self-esteem are listed. The second leaflet discusses…

California Univ., Berkeley. Cooperative Extension Service.

51

Review of Pesticide Education Materials for Health Care Providers Providing Care to Agricultural Workers  

ERIC Educational Resources Information Center

Context: Pesticide exposure is an important environmental and occupational health risk for agricultural workers and their families, but health care providers receive little training in it. Objective: To evaluate the medical resources available to providers caring for patients, particularly farmworkers, exposed to pesticides and to recommend a…

Hiott, Ann E.; Quandt, Sara A.; Early, Julie; Jackson, David S.; Arcury, Thomas A.

2006-01-01

52

Frontiers of cancer care in Asia-Pacific region: cancer care in Australia  

PubMed Central

Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included. Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancer care practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancer care, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancer care in Australia. PMID:21611000

Koh, ES; Do, VT; Barton, MB

2008-01-01

53

Providing high-quality care in primary care settings  

PubMed Central

Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Rejean; Goudreau, Johanne; Hogg, William

2014-01-01

54

Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results  

ERIC Educational Resources Information Center

Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

2014-01-01

55

Child Care Provider Training Helping Early Childhood Educators  

E-print Network

to child care. Children who receive high-quality care develop better language, math, and social skillsChild Care Provider Training Helping Early Childhood Educators Provide Quality Care for Today of child care on a regular basis from persons other than their parents (Child Care Aware, 2012). The Texas

56

Health care policy and cancer survivorship.  

PubMed

The United States and the European Union (EU) vary widely in approaches to ensuring affordable health care coverage for our respective populations. Such variations stem from differences in the political systems and beliefs regarding social welfare. These variations are also reflected in past and future initiatives to provide high quality cancer survivorship care. The United States spends considerably more on health care compared to most European countries, often with no proven benefit. In the United States, individuals with chronic illnesses, such as cancer survivors, often experience difficulties affording insurance and maintaining coverage, a problem unknown to EU countries with national health insurance. This article reviews health policy development over time for the United States and EU and the impact for cancer survivors. For the United States, the impact of the Affordable Care Act on improving access to affordable care for cancer survivors is highlighted. For the EU, the importance of multiple-morbidity disease management, cancer plan development, and pan-European data collection for monitoring cancer outcomes is addressed. Given predicted workforce shortages and ever-increasing numbers of aging cancer survivors on both sides of the Atlantic, sharing lessons learned will be critical. PMID:23695931

Virgo, Katherine S; Bromberek, Julia L; Glaser, Adam; Horgan, Denis; Maher, Jane; Brawley, Otis W

2013-06-01

57

Total Cancer Care  

Cancer.gov

Skip to Main Content at the National Institutes of Health | www.cancer.gov Epidemiology and Genomics Research In NCI's Division of Cancer Control and Population Sciences Menu Search EGRP Site: EGRP Home About the Program Mission & Vision Organizational

58

Primary care perspectives on prostate cancer survivorship: Implications for improving quality of care  

PubMed Central

OBJECTIVES Primary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care. METHODS The 2006 Early Detection and Screening for Prostate Cancer Knowledge, Attitudes and Practice Survey conducted by the Michigan Public Health Institute investigated the beliefs and practice patterns of primary care providers in Michigan. We evaluated responses from 902 primary care providers regarding the timing and content of their prostate cancer survivorship care and relationships with specialty care. RESULTS Two-thirds (67.6%) of providers cared for men during and after prostate cancer treatment. Providers routinely inquired about incontinence, impotence and bowel problems (83.3%), with a few (14.2%) using surveys to measure symptoms. However, only a minority felt ‘very comfortable’ managing the side effects of prostate cancer treatment. Clear plans (76.1%) and details regarding management of treatment complications (65.2%) from treating specialists were suboptimal. Nearly one-half (45.1%) of providers felt it was equally appropriate for them and treating specialists to provide prostate cancer survivorship care. CONCLUSIONS Primary care providers reported that prostate cancer survivorship care is prevalent in their practice, yet few felt very comfortable managing side effects of prostate cancer treatment. To improve quality of care, implementing prostate cancer survivorship care plans across specialties, or transferring primary responsibility to primary care providers through survivorship guidelines, should be considered. PMID:21775171

Skolarus, Ted; Holmes-Rovner, Margaret; Northouse, Laurel; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond; Rovner, David; Darwish-Yassine, May; Wei, John

2011-01-01

59

The "specter" of cancer: exploring secondary trauma for health professionals providing cancer support and counseling.  

PubMed

Health professionals are vulnerable to occupational stress and tend to report high levels of secondary trauma and burnout; this is especially so for those working in "high-death" contexts such as cancer support and palliative care. In this study, 38 health professionals (psychologists, social workers, pastoral carers/chaplains, nurses, group facilitators, and a medical practitioner) who provide grief support and counseling in cancer and palliative care each participated in a semistructured interview. Qualitatively, a grounded theory analysis revealed four themes: (a) the role of health professionals in supporting people who are experiencing grief and loss issues in the context of cancer, (b) ways of working with patients with cancer and their families, (c) the unique qualities of cancer-related loss and grief experiences, and (d) the emotional demands of the work and associated self-care. The provision of psychological services in the context of cancer is colored by the specter of cancer, an unseen yet real phenomenon that contributes to secondary trauma and burnout. The participants' reported secondary trauma has serious repercussions for their well-being and may compromise the care they provide. The findings have implications for the retention and well-being of personnel who provide psychosocial care in cancer and the quality and delivery of services for people with cancer and their families. PMID:24079353

Breen, Lauren J; O'Connor, Moira; Hewitt, Lauren Y; Lobb, Elizabeth A

2014-02-01

60

42 CFR 438.804 - Primary care provider payment increases.  

...2014-10-01 2014-10-01 false Primary care provider payment increases. 438...MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Conditions for Federal Financial Participation § 438.804 Primary care provider payment increases....

2014-10-01

61

42 CFR 438.804 - Primary care provider payment increases.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Primary care provider payment increases. ...Financial Participation § 438.804 Primary care provider payment increases. ...MCO, PIHP or PAHP for specified primary care services furnished as of...

2013-10-01

62

Assessing breast cancer risk in a primary care setting.  

PubMed

Individuals who are given a preventive exam by a primary care provider are more likely to agree to cancer screening. The provider recommendation has been identified as the strongest factor associated with screening utilization. This article provides a framework for breast cancer risk assessment for an advanced practice registered nurse working in primary care practice. PMID:25225979

Kiely, Deirdre; Schwartz, Shira

2014-10-15

63

What to Ask Dialysis Care Providers  

MedlinePLUS

... fast appeal Your Medicare rights Authorization to Disclose Personal Health Information Manage Your Health Login to MyMedicare.gov Get Medicare forms Advance directives & long-term care Electronic prescribing Electronic Health Records (EHRs) Medicare's Blue Button Coordinating your care Forms, ...

64

Child Care Provider's Guide to Safe Sleep  

MedlinePLUS

... safe sleep practices please contact Healthy Child Care America at the American Academy of Pediatrics at childcare@aap.org or 888/227-5409. Remember, if you have a question about the health and safety of an infant in your care, ask the baby’s parents if you ...

65

Lactose Intolerance: Information for Health Care Providers  

E-print Network

't traditionally include dairy products in their diets.3 There are three main types of lactose intolerance patients with lactose intolerance may believe they are allergic to milk or milk products. A milk allergy Lactose Intolerance: Information for Health Care

Rau, Don C.

66

Root Doctors as Providers of Primary Care  

PubMed Central

Physicians in primary care recognize that as many as 65 percent of the patients seen in their offices are there for psychological reasons. In any southern town with a moderate population of blacks, there are at least two “root doctors.” These root doctors have mastered the power of autosuggestion and are treating these patients with various forms of medication and psychological counseling. This paper updates the practicing physician on root doctors who practice primary care. PMID:6887277

Stitt, Van J.

1983-01-01

67

Providing Safe Health Care: The Role of Educational Support Personnel.  

ERIC Educational Resources Information Center

This handbook is written for the educational support person (ESP) who may or may not be a trained or licensed health care provider, but whose job has come to include caring for students with disabilities with special health care needs. Section 1, "The Laws Governing the ESP and the Care of the Student with Special Health Care Needs," discusses the…

Weiss, Julie

68

Cancer Supportive Care Program  

E-print Network

of a cancer diagnosis, followed by weekly web-based writing exercises and dialogue facilitated by the leader ­ 5 years of diagnosis or recurrence, followed by weekly web-based writing exercises and dialogue and deep relaxation. Healing Partners A community service program that pairs women diagnosed with breast

Bogyo, Matthew

69

Ten Things Lesbians Should Discuss with Their Health Care Provider  

MedlinePLUS

... for high blood pressure, cholesterol problems, and diabetes. Health care providers can also offer tips on quitting smoking, ... lesbians experience violence in their intimate relationships. However, health care providers do not ask lesbians about intimate partner ...

70

How Do Health Care Providers Diagnose Polycystic Ovary Syndrome (PCOS)?  

MedlinePLUS

... En Español How do health care providers diagnose PCOS? Skip sharing on social media links Share this: Page Content Your health care provider may suspect PCOS if you have eight or fewer periods per ...

71

How Do Health Care Providers Diagnose Adrenal Gland Disorders?  

MedlinePLUS

... Trials Resources and Publications En Español How do health care providers diagnose adrenal gland disorders? Skip sharing on ... and urine tests. 1 Cushing’s Syndrome If a health care provider suspects Cushing’s syndrome, he or she may ...

72

Successful Reentry: The Perspective of Private Correctional Health Care Providers  

PubMed Central

Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process. PMID:17131191

Greifinger, Robert B.

2006-01-01

73

Music therapy in supportive cancer care  

Microsoft Academic Search

The purpose of this paper is to show some aspects of music therapy application in cancer care and to present the integration of music therapy program into a continuous supportive cancer care for inpatients. A cancer diagnosis is one of the most feared and serious life events that causes stress in individuals and families. Cancer disrupts social, physical and emotional

Malgorzata Monika Stanczyk

2011-01-01

74

Chater 4 Roles of Child Health-Care Providers Roles of Child Health-Care  

E-print Network

screening, as recommended. 4. Provide family lead education. 5. Provide diagnostic and follow-up testing-up care, child health-care providers should per- form blood lead testing when children have unexplained-Care Providers 2. Give anticiator gbidance. During prenatal care and during preventive care at 3-6 months

75

Preparing for an epidemic: cancer care in an aging population.  

PubMed

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer. PMID:24857069

Shih, Ya-Chen Tina; Hurria, Arti

2014-01-01

76

Palliative care for children with cancer.  

PubMed

Over the past two decades, paediatric palliative care has emerged as both a primary approach and as its own medical subspecialty, the overall aim of which is to ease suffering for children with life-threatening illness and their families through a concurrent model of care. However, most discussions have been focused on the transition to palliative care when no realistic hope for cure exists. We believe that, because the course of cancer is so unpredictable, this idea is misleading. Indeed, palliative care is increasingly being recognized as being about not just how to cope with the process of dying, but also about how to engage in living when faced with a life-threatening illness. This article will examine our current understanding of several areas of palliative care, with the ultimate message that palliative care is simply a novel term for the total care of a child and family, an approach that should be applied consistently and concurrently regardless of disease status. By improving familiarity with palliative care and building relationships with palliative care specialists, the paediatric oncology clinician will ensure that the best care possible for children and families is provided, regardless of outcome. PMID:23337915

Waldman, Elisha; Wolfe, Joanne

2013-02-01

77

Child Care Providers' Experiences Caring for Sick Children: Implications for Public Policy.  

ERIC Educational Resources Information Center

Examined the experiences of preschool and school-age child care providers regarding sick child care. Found that providers repeatedly described sick children whose health problems made it impossible to provide adequate care for sick and well children in their care. Findings pose international public health policy implications for child care and…

Heymann, S. Jody; Vo, Phuong Hong; Bergstrom, Cara A.

2002-01-01

78

Collaborative communication between psychologists and primary care providers.  

PubMed

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient's primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient's confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan. PMID:19234866

Knowles, Philip

2009-03-01

79

The Role of Child Care Providers in Child Abuse Prevention  

ERIC Educational Resources Information Center

Child care providers are likely to be the professionals who most frequently interact with families with young children. Thus, infant and toddler child care providers are uniquely positioned to recognize and respond to families' needs for information and support. This article describes knowledge, skills, and strategies that support child care

Seibel, Nancy L.; Gillespie, Linda G.; Temple, Tabitha

2008-01-01

80

Iowa intermediate care facilities: an evaluation of care providers'attitudes toward oral hygiene care.  

PubMed

This study investigated the oral hygiene care (OHC) activities and attitudes of care providers in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) in the state of Iowa. Questionnaires were distributed to care providers employed at three ICF/MRs. About 98% of the staff ranked OHC as important to extremely important for residents. Twenty-three percent disliked OHC occasionally or more frequently. Lack of time and lack of staff were the main reasons preventing care providers from assisting residents with OHC. Residents' behaviors resulted in inadequate OHC for 64.9%, and 49% of residents required complete assistance with OHC. Most common OHC difficulties reported were residents biting the toothbrush, refusing OHC, or not opening their mouths. Subjects reported spending 3.0 minutes brushing a resident's teeth and 3.0 minutes cleaning dentures. Care providers experienced significant behavioral and physical difficulties while providing OHC, but still found OHC important. Training programs for care providers are needed to address these difficulties. PMID:20500704

Thole, Karla; Chalmers, Jane; Ettinger, Ronald L; Warren, John

2010-01-01

81

Consumers Learning To Recognize High-Value Health Care Providers  

MedlinePLUS

... salud para tà Newsletters Events Newsroom Navigating the Health Care System Advice Columns from Dr. Carolyn Clancy Former ... 3 2012 Consumers Learning To Recognize High-Value Health Care Providers By Carolyn M. Clancy, M.D. As ...

82

Questions to Ask a Veteran's Health Care Providers  

MedlinePLUS

... caregiver.va.gov Questions to Ask a Veteran’s Health Care Providers . The list of questions below can help ... you accept? . Planning for Discharge from the Hospital/Health Care Facility . As part of the process of planning ...

83

Proteomic Contributions to Personalized Cancer Care*  

PubMed Central

Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients. PMID:18664563

Koomen, John M.; Haura, Eric B.; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R.; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A.; Yeatman, Timothy J.; Hildreth, Lynne T.; Sellers, Thomas A.; Jacobsen, Paul B.; Fenstermacher, David A.; Dalton, William S.

2008-01-01

84

Proteomic contributions to personalized cancer care.  

PubMed

Cancer impacts each patient and family differently. Our current understanding of the disease is primarily limited to clinical hallmarks of cancer, but many specific molecular mechanisms remain elusive. Genetic markers can be used to determine predisposition to tumor development, but molecularly targeted treatment strategies that improve patient prognosis are not widely available for most cancers. Individualized care plans, also described as personalized medicine, still must be developed by understanding and implementing basic science research into clinical treatment. Proteomics holds great promise in contributing to the prevention and cure of cancer because it provides unique tools for discovery of biomarkers and therapeutic targets. As such, proteomics can help translate basic science discoveries into the clinical practice of personalized medicine. Here we describe how biological mass spectrometry and proteome analysis interact with other major patient care and research initiatives and present vignettes illustrating efforts in discovery of diagnostic biomarkers for ovarian cancer, development of treatment strategies in lung cancer, and monitoring prognosis and relapse in multiple myeloma patients. PMID:18664563

Koomen, John M; Haura, Eric B; Bepler, Gerold; Sutphen, Rebecca; Remily-Wood, Elizabeth R; Benson, Kaaron; Hussein, Mohamad; Hazlehurst, Lori A; Yeatman, Timothy J; Hildreth, Lynne T; Sellers, Thomas A; Jacobsen, Paul B; Fenstermacher, David A; Dalton, William S

2008-10-01

85

Logic Regression for Provider Effects on Kidney Cancer Treatment Delivery  

PubMed Central

In the delivery of medical and surgical care, often times complex interactions between patient, physician, and hospital factors influence practice patterns. This paper presents a novel application of logic regression in the context of kidney cancer treatment delivery. Using linked data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program and Medicare we identified patients diagnosed with kidney cancer from 1995 to 2005. The primary endpoints in the study were use of innovative treatment modalities, namely, partial nephrectomy and laparoscopy. Logic regression allowed us to uncover the interplay between patient, provider, and practice environment variables, which would not be possible using standard regression approaches. We found that surgeons who graduated in or prior to 1980 despite having some academic affiliation, low volume surgeons in a non-NCI hospital, or surgeons in rural environment were significantly less likely to use laparoscopy. Surgeons with major academic affiliation and practising in HMO, hospital, or medical school based setting were significantly more likely to use partial nephrectomy. Results from our study can show efforts towards dismantling the barriers to adoption of innovative treatment modalities, ultimately improving the quality of care provided to patients with kidney cancer. PMID:24795774

Banerjee, Mousumi; Filson, Christopher; Xia, Rong; Miller, David C.

2014-01-01

86

Opportunities to reduce cancer barriers: community town halls and provider focus groups.  

PubMed

This paper presents the findings from town hall meetings held with community residents and focus groups with health care providers. A total of five town halls (N?=?139) were conducted. Four were conducted in English and a fifth was conducted in Spanish to obtain the input of the local Hispanic community. Surveys were provided to town hall participants to assess their perceptions of cancer and screening as well as their cancer screening behaviors. Participants were asked questions designed to determine local gaps and needs in health and cancer care, and their attitudes regarding breast cancer resources, education, treatment, and clinical trials. Additionally, four focus groups (N?=?45) were held with a wide range of providers to obtain their perspectives on barriers to breast cancer screening, local cancer prevention and care, and clinical trials. Results indicate gaps in local resources and support services, particularly in terms of education and integrated care. PMID:23055135

Mosavel, Maghboeba; Rafie, Carlin; Cadet, Debbie L; Ayers, Antoinette

2012-12-01

87

Breast cancer: Multidisciplinary care and clinical outcomes  

Microsoft Academic Search

A multidisciplinary approach to the management of breast cancer is the standard of care in developed health systems. We performed a systematic review to assess the extent and quality of evidence on whether multidisciplinary care (MDC), or related aspects of care contribute to clinical outcomes in breast cancer, and in particular whether these influence survival. Only two primary studies have

Nehmat Houssami; Richard Sainsbury

2006-01-01

88

Factors Used by Parents in Selecting Child Care Providers  

Microsoft Academic Search

Regardless of the type of small business, marketing research shows that understanding how consumers\\/clients select a particular product or service is useful when formulating a promotional program. Traditionally, marketing research results have seldom been applied to the world of child care, but child care providers have a valuable “product” to market. Child care research indicates that the most important three

Kathy R. Thornburg; Steve Corbin

1998-01-01

89

Health Care Transition: Youth, Family, and Provider Perspectives  

Microsoft Academic Search

ABSTRACT. Objective. This study examined the pro- cess of health care transition (HCT) posing the following questions: What are the transition experiences of youths and young adults with disabilities and special health care needs, family members, and health care providers? What are promising practices that facilitate successful HCT? What are obstacles that inhibit HCT? Methods. A qualitative approach was used

John G. Reiss; Robert W. Gibson; Leslie R. Walker

2010-01-01

90

Difficult Children and Difficult Parents: Constructions by Child Care Providers  

ERIC Educational Resources Information Center

As more mothers of young children work, concerns about child care have gained prominence. Analyses of this topic typically address availability, safety, and costs of care, or the impact of care on children's "outcomes." When providers' input is included, it is generally used as an assessment tool to reinforce the researcher's conceptual framework.…

Owens, Erica; Ring, Gail

2007-01-01

91

Health Care Provider Value Chain Lukasz Kawczynski, Marco Taisch  

E-print Network

Health Care Provider Value Chain Lukasz Kawczynski, Marco Taisch Department of Management health care system. This paper aims to propose a value definition and a value chain model within the health care. In order to define value patients and experts were surveyed. The proposed definition offers

Boyer, Edmond

92

Asthma Information Handbook for Early Care and Education Providers  

ERIC Educational Resources Information Center

With proper care, most children with asthma can lead normal, active lives and can enter school with the same abilities as other children. For this purpose, the Asthma Information Packet for Early Care and Education Providers was designed to cover the following topics: (1) Basic information; (2) How to improve early care and education environments…

California Childcare Health Program, 2004

2004-01-01

93

Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children  

Microsoft Academic Search

IntroductionUnexpressed grief in health care providers who care for chronically ill children may lead to the development of some symptoms of compassion fatigue. The purpose of this study was to describe the scope of compassion fatigue in health care providers working on critical care units with children. A secondary aim was to evaluate the effectiveness of providing educational seminars on

Patrick Meadors; Angela Lamson

2008-01-01

94

Provider Characteristics Desired by African American Women in Prenatal Care  

PubMed Central

Purpose The purpose of this study was to describe provider characteristics African American pregnant women identified as important when interacting with their prenatal care providers in an outpatient office setting. Study Design and Method A descriptive qualitative design was used to explore provider characteristics desired by African American women receiving prenatal care at two inner-city hospital–based obstetric clinics. A total of 22 African American women between the ages of 19 and 28 years participated in the study. Findings Four major provider characteristic themes emerged from the data: (a) demonstrating quality patient–provider communication, (b) providing continuity of care, (c) treating the women with respect, and (d) delivering compassionate care. Discussion and Conclusion An overarching theme revealed by the data analysis was the desire by African American women in this study to have their prenatal providers know and remember them. They wanted their providers to understand the context of their lives from their prenatal interactions. Incorporating findings from this study to improve patient–provider interactions during prenatal care could provide an increased understanding of the many complex variables affecting African American women’s lives. Implications for Practice and Research Prenatal care provides an opportunity for African American women to develop a trusting relationship with a provider. Developing models of prenatal care congruent with the realities of African American women’s lives has the potential to improve patient–provider interactions and potentially affect birth outcomes. PMID:21191039

Lori, Jody R.; Yi, Chin Hwa; Martyn, Kristy K.

2012-01-01

95

Patients' Experiences with Navigation for Cancer Care  

PubMed Central

Objective We examined how navigation, defined as the assessment and alleviation of barriers to adequate health care, influences patients' perspectives on the quality of their cancer care. Methods We conducted post-study patient interviews from a randomized controlled trial (usual care vs. patient navigation services) from cancer diagnosis through treatment completion. Patients were recruited from 11 primary care, hospital and community oncology practices in New York. We interviewed patients about their expectations and experience of patient navigation or, for non-navigated patients, other sources of assistance. Results Thirty-five patients newly diagnosed with breast or colorectal cancer. Valued aspects of navigation included emotional support, assistance with information needs and problem-solving, and logistical coordination of cancer care. Unmet cancer care needs expressed by patients randomized to usual care consisted of lack of assistance or support with childcare, household responsibilities, coordination of care, and emotional support. Conclusion Cancer patients value navigation. Instrumental benefits were the most important expectations for navigation from navigated and non-navigated patients. Navigated patients received emotional support and assistance with information needs, problem-solving, and logistical aspects of cancer care coordination. Practice Implications Navigation services may help improve cancer care outcomes important to patients by addressing fragmented, confusing, uncoordinated, or inefficient care. PMID:20006459

Carroll, Jennifer K.; Humiston, Sharon G.; Meldrum, Sean C.; Salamone, Charcy M.; Jean-Pierre, Pascal; Epstein, Ronald M.; Fiscella, Kevin

2010-01-01

96

Integrating yoga into cancer care.  

PubMed

Although yoga has been practiced in Eastern culture for thousands of years as part of life philosophy, classes in the United States only recently have been offered to people with cancer. The word yoga is derived from the Sanskrit root yuj, meaning to bind, join, and yoke. This reflection of the union of the body, mind, and spirit is what differentiates yoga from general exercise programs. Yoga classes in the United States generally consist of asanas (postures), which are designed to exercise every muscle, nerve, and gland in the body. The postures are combined with pranayama, or rhythmic control of the breath. As a complementary therapy, yoga integrates awareness of breath, relaxation, exercise, and social support--elements that are key to enhancing quality of life in patients with cancer. Yoga practice may assist cancer survivors in managing symptoms such as depression, anxiety, insomnia, pain, and fatigue. As with all exercise programs, participants need to be aware of potential risks and their own limitations. The purpose of this article is to familiarize nurses with yoga as a complementary therapy, including current research findings, types of yoga, potential benefits, safety concerns, teacher training, and ways to integrate yoga into cancer care. PMID:18258582

DiStasio, Susan A

2008-02-01

97

The military health care provider in litigation: an overview.  

PubMed

Nowhere is the importance of readiness more critical than in the context of the health care provider preparing for an appearance in court. Accordingly, it is necessary to maintain a general working knowledge of both the general principles associated with the rendering of health care services in the military and the basic tactics that lawyers may employ toward health care providers during litigation. PMID:8479628

Addicott, J F

1993-04-01

98

Community health centers as primary providers of health care  

Microsoft Academic Search

In their essay, Shelly Raymer Duncan and Cinthia L. Deye examine the experience of community health centers as primary providers\\u000a of health care. These centers provide quality health care for their clientele and operate in an efficient manner. The authors\\u000a argue that community health centers are a viable mechanism for the provision of comprehensive quality primary care for underserved\\u000a persons.

Shelly Raymer Duncan; Cinthia L. Deye

2006-01-01

99

Caregivers' Level of Trust in Their Children's Health Care Providers  

ERIC Educational Resources Information Center

Trust in healthcare providers is associated with clinical outcomes among adult patients. Children with disabilities have complex health needs that place stress on caregivers. Consequently, they are increasingly likely to rely on their children's health care providers to ensure children's health care needs are met. However, no studies have explored…

Chen, Huey Jen; Boothroyd, Roger A.

2006-01-01

100

Collaborative practice and provider styles of delivering health care  

Microsoft Academic Search

The delivery of primary health care involves complex interactive communication between the provider and patient. Describing the manner or style of this communication is important to more completely understand the delivery of primary health care. The purpose of this study was to examine provider's style of interaction with the patient and to compare the styles of nurse practitioners and physicians

James D. Campbell; Hans O. Mauksch; Helen J. Neikirk; Michael C. Hosokawa

1990-01-01

101

ABC conceptual model of effective multidisciplinary cancer care  

Microsoft Academic Search

The treatment of cancer requires that health care providers and caregivers from many disciplines work together on the intertwined physical, psychological, social and spiritual needs of oncology patients. Providing a conceptual framework explaining how the members of multidisciplinary oncology treatment teams may best interact with each other and the patient helps drive patient-centered care and clarifies the roles of specific

T. David Ito; R. Kevin Grigsby; Melanie V. Black; Janis Apted; Naoto T. Ueno

2010-01-01

102

Delivering High-Quality and Affordable Care Throughout the Cancer Care Continuum  

PubMed Central

The national cost of cancer care is projected to reach $173 billion by 2020, increasing from $125 billion in 2010. This steep upward cost trajectory has placed enormous an financial burden on patients, their families, and society as a whole and raised major concern about the ability of the health care system to provide and sustain high-quality cancer care. To better understand the cost drivers of cancer care and explore approaches that will mitigate the problem, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “Delivering Affordable Cancer Care in the 21st Century” in October 2012. Workshop participants included bioethicists, health economists, primary care physicians, and medical, surgical, and radiation oncologists, from both academic and community settings. All speakers expressed a sense of urgency about the affordability of cancer care resulting from the future demographic trend as well as the high cost of emerging cancer therapies and rapid diffusion of new technologies in the absence to evidence indicating improved outcomes for patients. This article is our summary of presentations at the workshop that highlighted the overuse and underuse of screening, treatments, and technologies throughout the cancer care continuum in oncology practice in the United States. PMID:24127450

Shih, Ya-Chen Tina; Ganz, Patricia A.; Aberle, Denise; Abernethy, Amy; Bekelman, Justin; Brawley, Otis; Goodwin, James S.; Hu, Jim C.; Schrag, Deborah; Temel, Jennifer S.; Schnipper, Lowell

2013-01-01

103

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients  

PubMed Central

Background To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. Methods We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. Results The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. Conclusions The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. PMID:23617741

2013-01-01

104

Uncompensated care provided by emergency physicians in Florida emergency departments.  

PubMed

Uncompensated emergency department (ED) visits can negatively affect patients, clinicians, and hospitals, particularly as overcrowding occurs. Florida provides a unique market to analyze uncompensated ED care due to the high percent of for-profit hospitals, which typically provide significantly less uncompensated care, coupled with the older population that is more likely to be insured through Medicare. A survey of 188 Florida hospital emergency physician groups was conducted to estimate the level of uncompensated care provided by each ED physician group in 1998. The response rate was 44 percent (eighty-three ED physician groups). All ED physician groups provided substantial uncompensated care regardless of hospital ownership type. Uncompensated care averaged 46.8 percent and ranged from 25.8 to 79.4 percent. A model was developed to predict the amount of uncompensated care using ED volume and payer mix. A rise in the percent of self-pay patients causes a disproportionate increase in uncompensated care, such that EDs with high levels of self-pay visits have markedly higher uncompensated care rates. The results suggest the need for a uniform reporting method of ED physician uncompensated care cost. PMID:16292008

Langland-Orban, Barbara; Pracht, Etienne; Salyani, Seena

2005-01-01

105

Cancer care scenario in Bangladesh  

PubMed Central

Bangladesh is a developing country that is facing many challenges, especially in the health sector. Cancer management is a priority due to the current trend of increased incidence in this region. In this article, the current scenario of cancer in Bangladesh and its management with brief history is outlined. The combined effort of government and private sector is highlighted with the gradual progress in cancer management. Recent introduction of the state-of-the-art facilities and the training facilities for human resource development are also outlined. The existing challenges and cooperation from local NGOs and other overseas sources are also highlighted to provide an insight regarding possible ways to tackle these challenges to ensure a better future. PMID:24455570

Uddin, A. F. M. Kamal; Khan, Zohora Jameela; Islam, Johirul; Mahmud, AM

2013-01-01

106

Standardizing treatment: a crisis in cancer care.  

PubMed

The Institute of Medicine has emphasized the roles of multidisciplinary treatment planning, evidence-based clinical practice guidelines, and regionalization of healthcare in optimizing the quality of cancer care. We discuss these critical elements as they pertain to head and neck cancer care. PMID:23910477

Lewis, Carol M; Weber, Randal S

2013-08-01

107

Rhinosinusitis treatment protocol: Changing provider habits in primary care  

Microsoft Academic Search

Objective: Sinus infections are common and represent a high cost to the health care industry. Clinical protocols can be used to develop cost-effective treatment strategies. Our objective was to show that a protocol for rhinosinusitis can change provider practice patterns in primary care. Study Design and Setting: We used a literature search, survey of primary caregivers, and chart review from

William C. Kinney

2002-01-01

108

Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers  

ERIC Educational Resources Information Center

These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

Roberts, James R.; McCurdy, Leyla Erk

2005-01-01

109

Understanding physicians’ skills at providing end-of-life care  

Microsoft Academic Search

BACKGROUND: A framework for understanding and evaluating physicians’ skills at providing end-of-life care from the perspectives of patients,\\u000a families, and health care workers will promote better quality of care at the end of life.\\u000a \\u000a \\u000a OBJECTIVE: To develop a comprehensive understanding of the factors contributing to the quality of physicians’ care for dying patients.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN: Qualitative study using focus groups and

J. Randall Curtis; Marjorie D. Wenrich; Jan D. Carline; Sarah E. Shannon; Donna M. Ambrozy; Paul G. Ramsey

2001-01-01

110

Providers' Perceptions of Challenges in Obstetrical Care for Somali Women  

PubMed Central

Background. This pilot study explored health care providers' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement. PMID:24223041

Lazar, Jalana N.; Johnson-Agbakwu, Crista E.; Davis, Olga I.; Shipp, Michele P.-L.

2013-01-01

111

29 CFR 825.125 - Definition of health care provider.  

Code of Federal Regulations, 2011 CFR

...providing health care services” include only: (1) Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by...

2011-07-01

112

29 CFR 825.125 - Definition of health care provider.  

Code of Federal Regulations, 2010 CFR

...providing health care services” include only: (1) Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by...

2010-07-01

113

29 CFR 825.125 - Definition of health care provider.  

Code of Federal Regulations, 2012 CFR

...providing health care services” include only: (1) Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by...

2012-07-01

114

29 CFR 825.125 - Definition of health care provider.  

...care provider as: (1) A doctor of medicine or osteopathy who is authorized to practice medicine...appropriate) by the State in which the doctor practices; or (2) Any...workers and physician assistants who are authorized to practice...

2014-07-01

115

Talk with Your Health Care Provider about High Cholesterol  

MedlinePLUS

... Talk With Your Health Care Provider About High Cholesterol Partnership for HEALTH Here are some questions to ... prevention.va.gov and April 2009 If your cholesterol is in the desirable range and you are ...

116

Talk with Your Health Care Provider about High Blood Pressure  

MedlinePLUS

... nurse. Talk With Your Health Care Provider About High Blood Pressure Partnership for HEALTH Here are some questions to ... What can you do to prevent or control high blood pressure? 1. Quit smoking and/or chewing tobacco. Ask ...

117

33 CFR 55.13 - Family child care providers.  

Code of Federal Regulations, 2012 CFR

...DEPARTMENT OF HOMELAND SECURITY PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...to the cost of services at Coast Guard child development centers. 33 CFR Ch. I...

2012-07-01

118

33 CFR 55.13 - Family child care providers.  

Code of Federal Regulations, 2010 CFR

...DEPARTMENT OF HOMELAND SECURITY PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...to the cost of services at Coast Guard child development centers. 33 CFR Ch. I...

2010-07-01

119

33 CFR 55.13 - Family child care providers.  

Code of Federal Regulations, 2011 CFR

...DEPARTMENT OF HOMELAND SECURITY PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...to the cost of services at Coast Guard child development centers. 33 CFR Ch. I...

2011-07-01

120

33 CFR 55.13 - Family child care providers.  

Code of Federal Regulations, 2013 CFR

...DEPARTMENT OF HOMELAND SECURITY PERSONNEL CHILD DEVELOPMENT SERVICES General § 55.13 Family child care providers. When appropriated...to the cost of services at Coast Guard child development centers. 33 CFR Ch. I...

2013-07-01

121

Check With Your Health Care Provider About Breast Changes  

Cancer.gov

Check with your health care provider if you notice that your breast looks or feels different. No change is too small to ask about. In fact, the best time to call is when you first notice a breast change.

122

Coordinating care and treatment for cancer patients.  

PubMed

Survival following a diagnosis of cancer is contingent upon an interplay of factors, some non-modifiable (e.g., age, sex, genetics) and some modifiable (e.g., volitional choices) but the majority determined by circumstance (personal, social, health system context and capacity, and health policy). Accordingly, mortality and survival rates vary considerably as a function of geography, opportunity, wealth and development. Quality of life is impacted similarly, such that aspects of care related to coordination and integration of care across primary, community and specialist environments; symptom control, palliative and end-of-life care for those who will die of cancer; and survivorship challenges for those who will survive cancer, differs greatly across low, middle and high-income resource settings. Session 3 of the 4th International Cancer Control Congress (ICCC-4) focused on cancer care and treatment through three plenary presentations and five interactive workshop discussions: 1) establishing, implementing, operating and sustaining the capacity for quality cancer care; 2) the role of primary, community, and specialist care in cancer care and treatment; 3) the economics of affordable and sustainable cancer care; 4) issues around symptom control, support, and palliative/end-of-life care; and 5) issues around survivorship. A number of recommendations were proposed relating to capacity-building (standards and guidelines, protocols, new technologies and training and deployment) for safe, appropriate evidence-informed care; mapping and analysis of variations in primary, community and specialist care across countries with identification of models for effective, integrated clinical practice; the importance of considering the introduction, or expansion, of evidence-supported clinical practices from the perspectives of health economic impact, the value for health resources expended, and sustainability; capacity-building for palliative, end-of-life care and symptom control and integration of these services into national cancer control plans; the need for public education to reduce the fear and stigma associated with cancer so that patients are better able to make informed decisions regarding follow-up care and treatment; and the need to recognize the challenges and needs of survivors, their increasing number, the necessity to integrate survivorship into cancer control plans and the economic and societal value of functional survival after cancer. Discussions highlighted that coordinated care and treatment for cancer patients is both a ' systems'challenge and solution, requiring the consideration of patient and family circumstances, societal values and priorities, the functioning of the health system (access, capacity, resources, etc.) and the importance assigned to health and illness management within public policy. PMID:22631594

Yip, Cheng Har; Samiei, Massoud; Cazap, Eduardo; Rosenblatt, Eduardo; Datta, Niloy Ranjan; Camacho, Rolando; Weller, David; Pannarunothai, Supasit; Goh, Cynthia; Black, Fraser; Kaur, Ranjit; Fitch, Margaret; Sutcliffe, Catherine; Sutcliffe, Simon

2012-01-01

123

How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists  

PubMed Central

Background Internet mailing lists are an important and increasingly common way for cancer survivors to find information and support. Most studies of these mailing lists have investigated lists dedicated to one type of cancer, most often breast cancer. Little is known about whether the lessons learned from experiences with breast cancer lists apply to other cancers. Objectives The aim of the study was to compare the structural characteristics of 10 Internet cancer-related mailing lists and identify the processes by which cancer survivors provide support. Methods We studied a systematic 9% sample of email messages sent over five months to 10 cancer mailing lists hosted by the Association of Cancer Online Resources (ACOR). Content analyses were used to compare the structural characteristics of the lists, including participation rates and members’ identities as survivors or caregivers. We used thematic analyses to examine the types of support that list members provided through their message texts. Results Content analyses showed that characteristics of list members and subscriber participation rates varied across the lists. Thematic analyses revealed very little “off topic” discussion. Feedback from listowners indicated that they actively modeled appropriate communication on their lists and worked to keep discussions civil and focused. In all lists, members offered support much more frequently than they requested it; survivors were somewhat more likely than caregivers to offer rather than to ask for support. The most common topics in survivors’ messages were about treatment information and how to communicate with health care providers. Although expressions of emotional support were less common than informational support, they appeared in all lists. Many messages that contained narratives of illness or treatment did not specifically ask for help but provided emotional support by reassuring listmates that they were not alone in their struggles with cancer. Survivors’ explicit expressions of emotional support tended to be messages that encouraged active coping. Such messages also provided senders with opportunities to assume personally empowering “helper” roles that supported self-esteem. Conclusions Many cancer survivors use the Internet to seek informational and emotional support. Across 10 lists for different cancers, informational support was the main communication style. Our finding of an emphasis on informational support is in contrast to most prior literature, which has focused on emotional support. We found the most common expressions of support were offers of technical information and explicit advice about how to communicate with health care providers. Topics and proportions of informational and emotional support differed across the lists. Our previous surveys of ACOR subscribers showed that they join the lists primarily to seek information; this qualitative study shows that they can and do find what they seek. They also find opportunities to play rewarding roles as support givers. PMID:17513283

Lyons, Elizabeth J; Frydman, Gilles; Forlenza, Michael; Rimer, Barbara K

2007-01-01

124

Quality of Cancer Care - Applied Research  

Cancer.gov

The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.

125

Managed Care and Provider Satisfaction in Mental Health Settings  

Microsoft Academic Search

We assess the satisfaction of mental health providers using four dimensions from the medical practice literature—degree of\\u000a autonomy, relationship with patients, compensation, and administrative burden—and extend current work on professional satisfaction\\u000a to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported\\u000a for primary care settings, we find that the impact of managed care

Kimberley R. Isett; Alan R. Ellis; Sharon Topping; Joseph P. Morrissey

2009-01-01

126

Defining Value in Cancer Care: AVBCC 2012 Steering Committee Report  

PubMed Central

Approximately 200 oncologists, payers, employers, managed care executives, pharmacy benefit managers, and other healthcare stakeholders convened in Houston, TX, on March 28–31, 2012, for the Second Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The mission of the conference was to align the various perspectives around the growing need of defining value in cancer care and developing strategies to enhance patient outcomes. The AVBCC conference presented a forum for the various viewpoints from all the stakeholders across the cancer care continuum, featuring more than 20 sessions and symposia led by nearly 30 oncology leaders. The discussions focused on current trends and challenges in optimizing value in oncology by reducing or controlling cost while improving care quality and patient outcomes, introducing emerging approaches to management and tools that providers and payers are using to enhance cancer care collaboratively. The AVBCC Second Annual Conference was opened by a Steering Committee discussion of 11 panel members who attempted to define value in cancer care and articulated action steps that can help to implement value into cancer care delivery. The following summary represents highlights from the Steering Committee discussion, which was moderated by Gene Beed, MD, and Gary M. Owens, MD. PMID:24991320

Beed, Gene; Owens, Gary M.; Benson, Al B.; Klein, Ira M.; Silver, Samuel M.; Beveridge, Roy A.; Malin, Jennifer; Sprandio, John D.; Deligdish, Craig K.; Mitchell, Matthew; Vogenberg, F. Randy; Fox, John; Newcomer, Lee N.

2012-01-01

127

Developing a service model that integrates palliative care throughout cancer care: the time is now.  

PubMed

Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal. PMID:25199756

Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

2014-10-10

128

[Update on current care guidelines: oral cancer].  

PubMed

Most oral malignancies are squamous cell carcinomas (OSCC). Incidence of OSCC is increasing in both genders, and survival rates remain poor. OSCC is frequently preceded by potentially malignant disorders (OPMD), which include leukoplakia, erythroplakia and lichen planus. OSCC is preventable because the risk factors are known: smoking and alcohol consumption, snuff and human papillomavirus infections. Fresh vegetables, fruit and fish provide protection from OSCC. Regular systematic examination is essential to the early detection of OSCC and OPMD. Treatment of oral cancers comprises either surgery alone, or combined with radiotherapy and chemotherapy. Management of patients with OPMD and treated OSCC include careful life-long follow-up. PMID:22612027

2012-01-01

129

Working Together in the Neonatal Intensive Care Unit: Provider Perspectives  

Microsoft Academic Search

OBJECTIVES: To elicit healthcare provider perceptions of working together in a neonatal intensive care unit (NICU).STUDY DESIGN: We conducted focus groups to elicit descriptions of how providers work together. The groups included one each of transport nurses, staff nurses, residents, fellows, attending physicians and two multiple provider groups. To identify themes and their descriptive elements we performed qualitative data analysis.RESULTS:

Eric J Thomas; Gwen D Sherwood; Jennipher L Mulhollem; J Bryan Sexton; Robert L Helmreich

2004-01-01

130

Surrogate pregnancy: a guide for Canadian prenatal health care providers  

PubMed Central

Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks ofsurrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support. PMID:17296962

Reilly, Dan R.

2007-01-01

131

Achieving provider engagement: providers' perceptions of implementing and delivering integrated care.  

PubMed

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. PMID:25212855

Ignatowicz, Agnieszka; Greenfield, Geva; Pappas, Yannis; Car, Josip; Majeed, Azeem; Harris, Matthew

2014-12-01

132

Human Trafficking: The Role of the Health Care Provider  

PubMed Central

Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health care provider is outlined through a case study and clinical practice tools are provided. Suggestions for future research are also briefly addressed. PMID:20732668

Dovydaitis, Tiffany

2011-01-01

133

Reducing Isolation of Family Child Care Providers by Participation in a Provider-Initiated Support Network.  

ERIC Educational Resources Information Center

Because of the difficulty of finding time for professional and personal development, many family child care (FCC) providers are isolated in their work environment. This practicum study developed a provider-initiated support network to reduce this isolation. The local FCC association provided advertising about the formation of the network. A group…

Wetherington, Patricia Reish

134

Chiropractors as Primary Spine Care Providers: precedents and essential measures  

PubMed Central

Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine care provider’ may be a worthwhile niche position to create for society’s needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada. PMID:24302774

Erwin, W. Mark; Korpela, A. Pauliina; Jones, Robert C.

2013-01-01

135

Chiropractors as Primary Spine Care Providers: precedents and essential measures.  

PubMed

Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a 'primary spine care provider' may be a worthwhile niche position to create for society's needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada. PMID:24302774

Erwin, W Mark; Korpela, A Pauliina; Jones, Robert C

2013-12-01

136

PALLIATIVE CARE FOR PATIENTS WITH ADVANCED CANCER  

PubMed Central

The increasing life expectancy in Saudi Arabia will be accompanied by an alteration of the patterns of disease similar to that in Western countries. One of these will be cancer, the second leading cause of death in the west at present, where 1:3 people develop cancer during their lifetime and 1:4 die of it. Cancer deaths are rarely easy. The distress particularly the pain it can cause is legendary. Palliative care is the care and study of patients with active progressive far advanced disease, where cure is impossible, the prognosis predictably short, and the focus of care is the patient's quality of life. A Palliative Care Program has been developed at KFSH&RC, since 1991. This has broadened the spectrum of health services available to cancer patients. Palliative care needs to be more widely available in the kingdom to relieve an important cause of human suffering. PMID:23008572

Gray, Alan; Ezzat, Adnan

1997-01-01

137

Providing Obstetric Care to a Remote Native Population  

PubMed Central

A family-practice residency program has been involved in providing direct patient care to a number of Native communities in a remote area of Manitoba. The residents and preceptors have provided care on site in the communities, as well as being the primary referral services in the tertiary-care setting. During the 12 years of the program's evolution much experience was gained in dealing with a generally high-risk obstetric population whose care was complicated by such factors as language barriers, distance, and economic and social circumstances. The author of this article reviews the nature of the program and the issues, medical and other, that it deals with, making some reference to experience of similar populations elsewhere. PMID:21253222

Thorsteinson, V.J.

1988-01-01

138

Western voodoo: providing mental health care to Haitian refugees.  

PubMed

This article described certain aspects of Haitian life, voodoo and its role in Haitian society, the quality and quantity of psychiatric and mental health care for Haitians in Haiti, and suggestions for providing appropriate mental health care to Haitian refugees in the United States. Conway and Buchanan (1985) described what has helped Haitian refugees adapt in the transition to life in the United States: the strengths from their cultural heritage, such as fortitude; perseverance in the most arduous circumstances; deep religious faith; high self-respect; reliance on the extended family; and the tradition of sharing. Building on these assets may assist Western mental health-care providers in offering culturally sensitive mental health care to Haitians. PMID:2607490

Gustafson, M B

1989-12-01

139

The role of primary care providers in managing falls.  

PubMed

Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. PMID:25237872

Demons, Jamehl L; Duncan, Pamela W

2014-01-01

140

University of Wisconsin-Milwaukee Certification of Health Care Provider  

E-print Network

University of Wisconsin-Milwaukee Certification of Health Care Provider (Family and Medical Leave the Family and Medical Leave Act. Does the patient's condition1 qualify under any of the categories described by another provider of health services (e.g., physical therapist), please state the nature of the treatments

Saldin, Dilano

141

Patient-centred care: making cancer treatment centres accountable.  

PubMed

Patient-centred care is argued to be an essential component in the delivery of quality health and cancer care. This manuscript discusses the need to generate credible data which indicates the quality of patient-centred care provided by cancer treatment centres. Patient-centred care covers six domains including physical comfort; emotional support; respect for patients' preferences and values; integration and coordination; involvement of family and friends; and the provision of information, communication and education to enable patients to understand and make informed decisions about their care. First, we identify priority areas within each domain. Next, we propose three questions that should be asked of every patient across the six domains of patient-centred care. The first question explores whether patients were specifically asked by a healthcare provider at the cancer treatment centre about their concerns, values and preferences. Research indicates that it cannot be assumed that clinicians are aware of patient's needs or preferences in these six areas. Second, if the answer from the patient suggests that they would like assistance, then it would be expected that this would be offered. Thirdly, if the patient indicates that they would like such assistance and it is provided, then it might be expected that the patient would report that the provided assistance did relieve their suffering, or the assistance provided was consistent with their preferences, needs and values. Regular measurement and reporting of these aspects of patient-centred cancer care has the potential to identify deficits and inequities in care delivery, allow for comparisons across treatment centres and stimulate an improvement in the patient-centred care provided to cancer patients. PMID:24696084

Zucca, Alison; Sanson-Fisher, Rob; Waller, Amy; Carey, Mariko

2014-07-01

142

Integrated networks and health care provider cooperatives: new models for rural health care delivery and financing.  

PubMed

Minnesota's 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. Four CISNs are licensed, and three organizations are incorporated as health care provider cooperatives. Many of the policy issues Minnesota has faced regarding the development of CISNs and health care provider cooperatives in rural areas are similar to those raised by current Medicare reform proposals. PMID:9143900

Casey, M M

1997-01-01

143

Cancer Core Europe: A consortium to address the cancer care - Cancer research continuum challenge.  

PubMed

European cancer research for a transformative initiative by creating a consortium of six leading excellent comprehensive cancer centres that will work together to address the cancer care-cancer research continuum. Prerequisites for joint translational and clinical research programs are very demanding. These require the creation of a virtual single 'e-hospital' and a powerful translational platform, inter-compatible clinical molecular profiling laboratories with a robust underlying computational biology pipeline, standardised functional and molecular imaging, commonly agreed Standard Operating Procedures (SOPs) for liquid and tissue biopsy procurement, storage and processing, for molecular diagnostics, 'omics', functional genetics, immune-monitoring and other assessments. Importantly also it requires a culture of data collection and data storage that provides complete longitudinal data sets to allow for: effective data sharing and common database building, and to achieve a level of completeness of data that is required for conducting outcome research, taking into account our current understanding of cancers as communities of evolving clones. Cutting edge basic research and technology development serve as an important driving force for innovative translational and clinical studies. Given the excellent track records of the six participants in these areas, Cancer Core Europe will be able to support the full spectrum of research required to address the cancer research- cancer care continuum. Cancer Core Europe also constitutes a unique environment to train the next generation of talents in innovative translational and clinical oncology. PMID:25263570

Eggermont, Alexander M M; Caldas, Carlos; Ringborg, Ulrik; Medema, René; Tabernero, Josep; Wiestler, Otmar

2014-11-01

144

Patient-Healthcare Provider Communication: Perspectives of African American Cancer Patients  

Microsoft Academic Search

Objective: African Americans are often viewed as ineffective communicators during medical encounters. However, most previous studies have been conducted among noncancer populations and based on the perceptions of health care providers (HCP) and researchers. This study aimed to explore African American cancer patients' perspectives of HCPs' communication behaviors and how these communication patterns facilitate or hinder their cancer management and

Lixin Song; Jill B. Hamilton; Angelo D. Moore

2012-01-01

145

Care providers' needs and perspectives on suffering and care in Bosnia and Herzegovina and Cambodia.  

PubMed

This exploratory study aimed to obtain insight into field-level care providers' views on suffering and healing as well as existing obstacles and needs related to providing care to their clients. This research provides a "snapshot" for a better understanding of existing care systems in two post-conflict settings. By identifying existing approaches to care and the needs of the care provider community, this research might be useful in guiding psychosocial assistance programming in post-conflict settings. Utilizing a semi-structured questionnaire, 45 care providers were interviewed, including local health care practitioners, traditional/ spiritual healers, and humanitarian relief workers, in Bosnia and Herzegovina and Cambodia. This study found that the majority of care providers in both settings perceived poverty and violence as significant causes and consequences of human suffering and, at the same time, felt ill-equipped in addressing these issues and related problems. Other issues that hindered these healers in providing care included: limited government/institutional support; lack of training; material resources and funding. Study findings point to a new framework for developing effective interventions and the need for further emphasis on supporting care providers in their work, and most specifically, in identifying and responding to poverty and violence. PMID:23331393

McDonald, Laura; Mollica, Richard F; Douglas Kelley, Susan; Tor, Svang; Halilovic, Majda

2012-01-01

146

African-American elders. Implications for health care providers.  

PubMed

With the demographic projections that are expected in the next century, health care professionals of all disciplines will be caring for a large group of older African Americans. Most will be women with multiple chronic illnesses that are, and will continue to be, influenced by a number of factors, including race, gender, and socioeconomic status. Although the data we have on older African Americans have increased significantly over the past several years, a great need for studies that examine the complexities of race, health risks, and disease course still exists. Health-care providers will begin to avoid stereotypes as they begin to appreciate the diversity of this group, which will become especially important as the characteristics of the current cohort of elders changes in the coming years. It is clear that more and more African Americans are living longer and are in better health. An examination of those determinants of successful aging that might be applied to elders of all racial and ethnic backgrounds must occur. It will be imperative that all facets of the established medical system begin to provide and plan for culturally sensitive health care and services, which will require data, both quantitative and qualitative, that defines the characteristics of older African Americans along with their health-service needs. Health professional schools will have to adapt curricula to include issues of ethnogeriatrics to ensure that all providers are prepared to meet the challenge of providing culturally sensitive health care.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7720018

Brangman, S A

1995-02-01

147

The Journey from Babysitter to Child Care Professional: Military Family Child Care Providers.  

ERIC Educational Resources Information Center

Describes the transformation of women from babysitters to child care professionals as a result of becoming a family child care provider in the U.S. military Family Child Care (FCC) program. Discusses application process, orientation training, the use of peer mentors, initial setup, inspections, enrollment, caregiver training, and accreditation.…

Nielsen, Dianne Miller

2002-01-01

148

Continuum of care: Military health care providers and the traumatic brain injured service members.  

PubMed

This article will address and describe the military continuum of care and its implications for the health care providers intimately involved in the treatment of service members who sustain traumatic brain injuries (TBI). Clinical Practice Guidelines have been created and distributed for treatment of TBI sustained by service members in both the deployed setting and in the continental United States (CONUS). The military has established specific levels of care each with specific purpose in the treatment continuum that extends from the battlefield to the most advanced military treatment facility (MTF). The health care providers who care for this particular patient population can also face unique opportunities, challenges and rewards. PMID:20448318

Doncevic, Selina; Boerman, Heidi L

2010-01-01

149

Maternity care providers' perceptions of women's autonomy and the law  

PubMed Central

Background Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman’s decision may lead to increased risk of harm to the fetus. Little is known about care providers’ perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth. This paper examined maternity care providers’ attitudes and beliefs towards women’s right to make autonomous decisions during pregnancy and birth, and the legal responsibility of professionals for maternal and fetal outcomes. Methods Attitudes and beliefs around women’s autonomy and health professionals’ legal accountability were measured in a sample of 336 midwives and doctors from both public and private health sectors in Queensland, Australia, using a questionnaire available online and in paper format. Student’s t-test was used to compare midwives’ and doctors’ responses. Results Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions. Interprofessional differences were evident, with midwives and doctors significantly differing in their responses on five of the six items. Conclusions Maternity care professionals inconsistently supported women’s right to autonomous decision making during pregnancy and birth. This finding is further complicated by care providers’ poor understanding of legal accountability for outcomes experienced in pregnancy and birth. The findings of this study support the need for guidelines on decision making in pregnancy and birth for maternity care professionals, and for recognition of interprofessional differences in beliefs around the rights of the woman, her fetus and health professionals in order to facilitate collaborative practice. PMID:23557134

2013-01-01

150

Multilevel factors affecting quality: examples from the cancer care continuum.  

PubMed

The complex environmental context must be considered as we move forward to improve cancer care and, ultimately, patient and population outcomes. The cancer care continuum represents several care types, each of which includes multiple technical and communication steps and interfaces among patients, providers, and organizations. We use two case scenarios to 1) illustrate the variability, diversity, and interaction of factors from multiple levels that affect care quality and 2) discuss research implications and provide hypothetical examples of multilevel interventions. Each scenario includes a targeted literature review to illustrate contextual influences upon care and sets the stage for theory-informed interventions. The screening case highlights access issues in older women, and the survivorship case illustrates the multiple transition challenges faced by patients, families, and organizations. Example interventions show the potential gains of implementing intervention strategies that work synergistically at multiple levels. While research examining multilevel intervention is a priority, it presents numerous study design, measurement, and analytic challenges. PMID:22623591

Zapka, Jane; Taplin, Stephen H; Ganz, Patricia; Grunfeld, Eva; Sterba, Katherine

2012-05-01

151

Communication in Cancer Care (PDQ®)  

Cancer.gov

Expert-reviewed information summary about communicating with the cancer patient and his or her family, including unique aspects of communication with cancer patients, factors affecting communication, and training in communication skills.

152

Role of support groups in cancer care  

Microsoft Academic Search

Support groups have been introduced in medicine since a number of years and several studies indicate that these groups can be beneficial for cancer patients. This article reviews the concept and types of support groups in cancer care. The demands on facilitators and patients in these groups are discussed and potential problems are emphasized. Ground rules for the establishment of

J. Johnson

1993-01-01

153

Examining Racial Disparities in Colorectal Cancer Care  

Microsoft Academic Search

African Americans are disproportionately burdened with colorectal cancer. Although incidence and mortality rates have declined in the past two decades, the disparity in health outcomes has progressively increased. This comprehensive review examines the existing literature regarding racial disparities in colorectal cancer screening, stage at diagnosis, and treatment to determine if differences exist in the quality of care delivered to African

Jamillah Berry; Kevin Bumpers; Vickie Ogunlade; Roni Glover; Sharon Davis; Margaret Counts-Spriggs; John Kauh; Christopher Flowers

2009-01-01

154

Primary Care Providers' Views regarding Assessing and Treating Suicidal Patients  

ERIC Educational Resources Information Center

Primary care providers (PCPs) usually do not explore patient suicidality during routine visits. Factors that predict PCP attitudes toward the assessment and treatment of suicidality were examined via an online survey of 195 practicing PCPs affiliated with medical schools in the United States. PCPs who perceived themselves as competent to work with…

Graham, Ryan D.; Rudd, M. David; Bryan, Craig J.

2011-01-01

155

Promoting Mental Health: A Parent/Child Care Provider Partnership.  

ERIC Educational Resources Information Center

This document provides descriptions of simple intervention techniques that day care center staff can use to help working parents and support young children's mental health. Discussion begins with the proposition that when children let adults know through their behavior that they are troubled, the children deserve a joint effort of parents and…

Sale, June Solnit

156

Are primary care providers aware of varicella vaccination guidelines?  

Microsoft Academic Search

PURPOSE To determine whether physicians providing primary care in Ontario were aware of guidelines published by Health Canada's National Advisory Committee on Immunization (NACI), their opinions about the varicella vaccine, and factors that influence use of the vaccine. METHODS A questionnaire examining awareness, knowledge, and perceived barriers to using varicella vaccine was developed and mailed to a random sample of

Darshini Persaude; Lorna Teape-Humphrey; Raquel Adelstein; CCFP Sharon Domb; CCFP Liisa Jaakkimainen

157

Chinese health care providers’ attitudes about HIV: a review  

Microsoft Academic Search

China has one of the fastest growing HIV epidemics in the world with an increase in reported cases of about 30% yearly (UNAIDS, 2004). As the epidemic has grown, there have been several studies of health care provider attitudes towards HIV in China over the last 15 years. While attitudes have evolved, misconceptions about transmission of HIV, low levels of

G. C. Webber

2007-01-01

158

Intimate partner violence: a guide for primary care providers.  

PubMed

Women, men, children, and adolescents who self-disclose exposures to or at risk for exposures to intimate partner violence or domestic violence may exhibit moderate-to-severe psycho-social-emotional, mental, and physical healthcare problems. Healthcare providers have a unique opportunity to assist this population in the primary care office. PMID:24253530

Shavers, Clarissa Agee

2013-12-10

159

RESPONDING TO WOMAN ABUSE: A PROTOCOL FOR HEALTH CARE PROVIDERS  

Microsoft Academic Search

relationships. While each health care provider and practice setting has its own specific needs and requirements that need to be considered, this document is a resource for those involved to develop protocols for identifying and responding effectively to women who experience abuse in their intimate relationships. Development of effective woman abuse protocols helps to give women the opportunity to disclose

Christine Reynolds RN

160

Health Care Providers On the Frontline of Recognizing  

E-print Network

there is no cure for autism, early detection, assessment, and intervention are keys to promoting positive outcomesHealth Care Providers­ On the Frontline of Recognizing Signs of Risk for Autism Parents rely on you of their children. One in about 150 children will be diagnosed with an autism spectrum disorder (ASD). Although

Sarkar, Nilanjan

161

Family caregiving: who provides the care, and at what cost?  

PubMed

Today, there are an estimated 1.6 million people over 65 years of age who require assistance with two or more daily activities. This number is projected to rise to 2.1 million by 2001, with fewer family caregivers expected to be available to provide this informal care. Seventy-two percent of unpaid family caregivers are women, the majority of whom are mid-life daughters or daughters in law. Uncompensated care to the frail elderly requires an average of 28 to 39.9 hours per week of custodial care. The financial impact on informal caregivers includes: 9% of family caregivers who leave the labor force to provide care, 29.4% who adjust their work schedules, and 18.1% who take time off without pay. The estimated annual value of uncompensated kin care in 1990 was $18 billion. Thirty-two percent of all family caregivers are categorized as poor or near-poor at incomes that are less than 125% of the federal poverty level. PMID:9362866

Robinson, K M

1997-01-01

162

Cultural Aspects of Communication in Cancer Care  

Microsoft Academic Search

Cancer is increasing in incidence and prevalence worldwide, and the WHO has recently included cancer and its treatments as\\u000a a health priority in developed and developing countries. The cultural diversity of oncology patients is bound to increase,\\u000a and cultural sensitivity and competence are now required of all oncology professionals. A culturally competent cancer care\\u000a leads to improved therapeutic outcome and

A. Surbone

163

Provider workload and quality of care in primary care settings: moderating role of relational climate.  

PubMed

Primary care providers are increasingly under pressure to do more with fewer resources. We examined the effect of workload on patients' experiences of quality of care, measured through approximately 44,000 patient experience surveys in a sample of 222 primary care clinics in the Veterans Health Administration. We tested the extent to which relational climate, a measure of teamwork, moderated the relationship between workload and patient ratings of quality of care. Our outcome measures included patient complaints, time spent with provider, and overall visit quality. Workload was negatively associated with patients' quality of care ratings and relational climate moderated the relation between workload and quality of care ratings. Patients seen in clinics with higher workload and greater relational climate reported better care compared with patients in clinics with higher workload but lower relational climate. Findings highlight the importance of relational climate as an important teamwork factor when managing and developing clinic policies, practices, and procedures in resource-constrained settings. PMID:23222471

Mohr, David C; Benzer, Justin K; Young, Gary J

2013-01-01

164

Health Care Providers and Dying Patients: Critical Issues in Terminal Care.  

ERIC Educational Resources Information Center

Identifies three major areas of concern in relationship between health care providers and dying patients: (1) nature of difficulties and stresses associated with terminal care; (2) education of providers for work; and (3) influence of organizational structure and institutionalized values on services for dying patients and families. Reviews…

Benoliel, Jeanne Quint

1988-01-01

165

The ABCs of Safe and Healthy Child Care: A Handbook for Child Care Providers.  

ERIC Educational Resources Information Center

Recognizing the importance of maintaining a safe and healthy child care setting, this manual for home or center child care providers contains information and guidelines to help providers maintain child health and reduce sickness and injuries. Part 1, "Introduction," describes how diseases are spread and how to prevent and prepare for unintentional…

Hale, Cynthia M.; Polder, Jacquelyn A.

166

Models of helping and coping in cancer care.  

PubMed

This paper provides a theoretical analysis of four models of helping and coping as they relate to cancer care. The four conceptual models focus on the issue of whether or not patients should be viewed as responsible for the cause or the treatment of their cancer. The moral model, characterized by the holistic health movement, holds patients responsible for both causing and resolving health problems. The compensatory model, exemplified by cancer education programs, attributes low responsibility to patients for causing health problems but high responsibility for resolving them. The medical model views patients as neither responsible for causing nor for resolving health problems. The enlightenment model, typified by the healing movement, holds people responsible for causing their health problems, but not for resolving them. An attempt is made to examine existing programs in cancer care in light of these models. The present analysis addresses the following questions. Why is each of these models appealing? Why are they sometimes embraced by patients or health care providers? What are the benefits and disadvantages of using each of these models with cancer patients? What happens when the health care provider and patient hold different models regarding the patient's responsibility or participation in the cause of the disease or its treatment? Further research is needed to determine the conditions under which a particular model results in better health outcomes for patients, and to assess how factors such as extent of disease or type of cancer influence the patient's choice of a model. PMID:2290741

Northouse, L L; Wortman, C B

1990-02-01

167

Clinical Cancer Care Full screening services and diagnostics  

E-print Network

Clinical Cancer Care · Full screening services and diagnostics · Advanced treatments for all forms of cancer · Most frequent cancers at the Cancer Center: Breast 15% Gastrointestinal 13% Skin 17% Lung 13 treatment protocols that link the latest Cancer Center research to clinical care · Familial Cancer Program

Myers, Lawrence C.

168

Enhancing the Primary Care Team to Provide Redesigned Care: The Roles of Practice Facilitators and Care Managers  

PubMed Central

ABSTRACT Efforts to redesign primary care require multiple supports. Two potential members of the primary care team—practice facilitator and care manager—can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities—reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care. PMID:23319510

Taylor, Erin Fries; Machta, Rachel M.; Meyers, David S.; Genevro, Janice; Peikes, Deborah N.

2013-01-01

169

Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.  

PubMed

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care. PMID:23319510

Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

2013-01-01

170

Barriers to prenatal care among Medicaid managed care enrollees: patient and provider perceptions.  

PubMed

To identify what patients and providers perceive as barriers to prenatal care among women enrolled in a Medicaid managed care plan, focus group discussions of: 1) women, 13 to 45 years of age, enrolled in a Medicaid managed care plan and 2) providers (physicians, nurse practitioners, nurses, and medical assistants) that serve this population were conducted at a location in the community by professional facilitators. Forty-two enrolled women and 22 providers participated. Based on an interpretive analysis of comments regarding perceived barriers towards receiving prenatal care by patients and providers, we found some perceived barriers that were similar for both groups. Both groups of respondents thought that problems with transportation, knowledge of TennCare, and substance abuse were barriers to receiving prenatal care. Providers mentioned lack of enrollee's education, need for child care, and limited hours of operation; and patients mentioned treatment by office personnel, lack of rapport with health providers and lack of recognition of pregnancy as additional barriers. Understanding both patient and provider perspectives of the barriers to receiving care is the first step towards meeting the needs of the target population. Health plans that serve the historically underserved population must take a specialized approach that adapts to the population's distinct needs. PMID:10172940

Gazmararian, J A; Schwarz, K S; Amacker, L B; Powell, C L

1997-03-01

171

Inequalities in breast cancer care and outcome.  

PubMed Central

Comparisons across Europe suggest that survival from breast cancer is less good in the United Kingdom than in many countries. The care given in some UK breast cancer units is exemplary. However, it is difficult to escape the conclusion that a substantial number of women who present with breast cancer receive suboptimal care. Cancer registry-based studies have clearly demonstrated variations between surgeons and between hospitals in the management of early breast cancer. Although variations in surgical practice per se may have little impact on survival, there is evidence that differences in the use of systemic adjuvant therapy influence outcome. Five-year survival seems to be greater in women treated by surgeons seeing more than 30-50 new cases of breast cancer each year. This may be because such patients are more likely to be treated by a multidisciplinary team and to receive adjuvant therapy. Proposals that would increase the overall quality of breast cancer care and remove current inequalities must be carefully considered and should then be implemented. PMID:9303363

Richards, M.; Sainsbury, R.; Kerr, D.

1997-01-01

172

Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers  

PubMed Central

Background Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians’ perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers’ (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs’ views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). Methods A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006 - September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. Results CSPs’ lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients’ limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient–provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people’s distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs, cancer education for Aboriginal stakeholders, continuity of care, avoiding use of medical jargon, accommodating patients’ psychosocial and logistical needs, and in-service coordination. Conclusion Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes. PMID:24188503

2013-01-01

173

Integrating mental health into primary health care in Zambia: a care provider's perspective  

PubMed Central

Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia. PMID:20653981

2010-01-01

174

Providing primary health care with non-physicians.  

PubMed

The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined. PMID:6497324

Chen, P C

1984-04-01

175

Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers  

PubMed Central

Background Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process. Methods We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n?=?13) and nurses (n?=?3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model. Results Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters. Conclusions This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of. PMID:22551452

2012-01-01

176

Prostate cancer screening and health care system distrust in Philadelphia  

PubMed Central

Objective We aim to examine whether distrust of health care system (hereafter distrust) is associated with prostate cancer screening and whether different dimensions of distrust demonstrate similar relationships with prostate cancer screening. Method With data on 1,784 men aged 45–75 from the Philadelphia metropolitan area, we first applied factor analysis to generate factor scores capturing two distrust sub-scales: competence and values. We then implemented logistic regressions to estimate the relationships between distrust and prostate cancer screening, controlling for covariates related to demographics (e.g., race and age), socioeconomic status (e.g., poverty status and education), health care resources (e.g., insurance status), and health status (i.e., self-rated health). Results Without considering any other covariates, both competence and values distrust were negatively associated to the receipt of prostate cancer screening. After accounting for other covariates shown above, values distrust remained negatively associated with the odds of receiving prostate cancer screening (OR=0.89, 95% CI=[0.81, 0.98]) but competence distrust was not a significant predictor. Conclusions Values distrust was independently associated with prostate cancer screening. Macro-level change in the health care system may influence men’s health behaviors. Our findings suggested that efforts to make the health care system more transparent and enhanced communications between men and health providers may facilitate prostate cancer screening. PMID:23775208

Yang, Tse-Chuan; Matthews, Stephen A.; Anderson, Roger T.

2013-01-01

177

Understanding & Influencing Multilevel Factors Across the Cancer Care Continuum  

Cancer.gov

The National Cancer Institute (NCI) Division of Cancer Control and Population Sciences is pleased to announce the May 2012 Journal of the National Cancer Institute (JNCI) Special Issue, Understanding and Influencing Multilevel Factors Across the Cancer Care Continuum.

178

Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives  

PubMed Central

Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884

Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

2013-01-01

179

Providing health care for older persons in Singapore.  

PubMed

Health care social policy in Singapore has passed the burden of care to the individual and the family on the rationale that it would enable the state to contain the costs of long-term care by channelling some of its funds to community services and to providing essential health services to all Singaporeans and not just the older group. While a wide array of services has come into existence, there is a lack of integration between the available resources and needs of the individual/family and what has been availed at the community and state levels. Part of the problem lies in the stringent criteria to which the state allows subsidies to be used; the lack of understanding with regard to the profile of users of services; and the case manager approach in offering services. Mapping health care has proven more difficult than anticipated because ageing is a diverse experience, varying by gender, race, income, religion and intergenerational relationships. A social policy does not apply to a 'universal citizen' and services that exist in the public sphere should not exist as merely commodified services which require a great deal of institutional processing. PMID:12745176

Teo, Peggy; Chan, Angelique; Straughan, Paulin

2003-06-01

180

Provider's Constraints and Difficulties in Primary Health Care System  

PubMed Central

Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i) physical infrastructure, (ii) organization's working environment, (iii) privileges of staff, (iv) discontentment, (v) human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization's culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel's in health facilities. PMID:25161964

Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Anu

2014-01-01

181

Family Child Care Health and Safety Checklist: A Packet for Family Child Care Providers [with Videotape].  

ERIC Educational Resources Information Center

This checklist and accompanying video are designed to help family child care providers assess the health and safety of the child care home. The checklist includes suggestions for conducting the self-evaluation and for creating a safer, healthier home environment. The areas of the checklist are: your home, out of bounds areas, gates and guards,…

Kendrick, Abby Shapiro; Gravell, Joanne

182

Interactions between patients and dental care providers: does gender matter?  

PubMed

Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental care provider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. PMID:23570810

Inglehart, Marita R

2013-04-01

183

Challenges in providing culturally-competent care to patients with metastatic brain tumours and their families.  

PubMed

Being diagnosed with a metastatic brain tumour can be devastating as it is characterized by very low cure rates, as well as significant morbidity and mortality. Given the poor life expectancy and progressive disability that ensues, patients and family members experience much turmoil, which includes losses that bring about changes to family roles, routines and relationships. Crisis and conflict are common during such major disruptions to a family system, as individual members attempt to make sense of the illness experience based on cultural and spiritual beliefs, past experiences and personal philosophies. It is imperative health care providers strive towards increased awareness and knowledge of how culture affects the overall experience of illness and death in order to help create a mutually satisfactory care plan. Providing culturally-competent care entails the use of proper communication skills to facilitate the exploration of patient and family perspectives and allows for mutual decision making. A case study will illustrate the challenges encountered in providing culturally-competent care to a woman with brain cancer and her family. As the patient's health declined, the family entered into a state of crisis where communication between family members and health care professionals was strained; leading to conflict and sub-optimal outcomes. This paper will address the ethical dilemma of providing culturally-competent care when a patient's safety is at risk, and the nursing implications of upholding best practices in the context of differing beliefs and priorities. PMID:25265763

Longo, Lianne; Slater, Serena

2014-01-01

184

76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers  

Federal Register 2010, 2011, 2012, 2013

...governing payment for other non-VA health care providers. Because the newly applicable...methodology for in- and outpatient health care professional services provided...FR 78901. We explained: Home Health Care and Hospice Care [T]he...

2011-11-21

185

Cancer spheres from gastric cancer patients provide an ideal model system for cancer stem cell research.  

PubMed

Cancer stem cells have been hypothesized to drive the growth and metastasis of tumors. Because they need to be targeted for cancer treatment, they have been isolated from many solid cancers. However, cancer stem cells from primary human gastric cancer tissues have not been isolated as yet. For the isolation, we used two cell surface markers: the epithelial cell adhesion molecule (EpCAM) and CD44. When analyzed by flow cytometry, the EpCAM(+)/CD44(+) population accounts for 4.5% of tumor cells. EpCAM(+)/CD44(+) gastric cancer cells formed tumors in immunocompromised mice; however, EpCAM(-)/CD44(-), EpCAM(+)/CD44(-) and EpCAM(-)/CD44(+) cells failed to do so. Xenografts of EpCAM(+)/CD44(+) gastric cancer cells maintained a differentiated phenotype and reproduced the morphological and phenotypical heterogeneity of the original gastric tumor tissues. The tumorigenic subpopulation was serially passaged for several generations without significant phenotypic alterations. Moreover, EpCAM(+)/CD44(+), but not EpCAM(-)/CD44(-), EpCAM(+)/CD44(-) or EpCAM(-)/CD44(+) cells grew exponentially in vitro as cancer spheres in serum-free medium, maintaining the tumorigenicity. Interestingly, a single cancer stem cell generated a cancer sphere that contained various differentiated cells, supporting multi-potency and self-renewal of a cancer stem cell. EpCAM(+)/CD44(+) cells had greater resistance to anti-cancer drugs than other subpopulation cells. The above in vivo and in vitro results suggest that cancer stem cells, which are enriched in the EpCAM(+)/CD44(+) subpopulation of gastric cancer cells, provide an ideal model system for cancer stem cell research. PMID:21448722

Han, Myoung-Eun; Jeon, Tae-Yong; Hwang, Sun-Hwi; Lee, Young-Suk; Kim, Hyun-Jung; Shim, Hye-Eun; Yoon, Sik; Baek, Sun-Yong; Kim, Bong-Seon; Kang, Chi-Dug; Oh, Sae-Ock

2011-11-01

186

Spirituality in Cancer Care (PDQ)  

MedlinePLUS

... important to patients coping with cancer. Spirituality and religion may have different meanings. Serious illness, such as ... information on end-of-life issues.) Spirituality and religion may have different meanings. The terms spirituality and ...

187

Provider-client interactions and quantity of health care use.  

PubMed

This paper considers three types of provider-client interactions that influence quantity of health care use: rationing, effort, and persuasion. By rationing, we refer to a quantity limit set by a provider; effort, the productive inputs supplied by a provider to increase a client's demand; persuasion, the unproductive inputs used by a provider to induce a client's demand. We construct a theoretical model incorporating all three mechanisms as special cases. When the general model is specialized into one of three mechanisms, a set of empirical implications emerges. We test for the presence of each mechanism using data of patients receiving outpatient treatment for alcohol abuse in the Maine Addiction Treatment System. We find evidence for rationing and persuasion, but not effort. PMID:15556245

Lien, Hsien-Ming; Albert Ma, Ching-To; McGuire, Thomas G

2004-11-01

188

Cancer care in Nepal: variables that affect diagnosis, treatment, and prognosis: a case study.  

PubMed

This manuscript presents a case study of a Nepalese woman experiencing breast cancer. Six themes were identified to have an impact on the diagnosis, treatment, and prognosis. They include: cultural impact on women's roles, socioeconomic status and education, surgical oncologist-patient relationship, surgical oncologist-nurse relationship, nurses' lack of oncology knowledge, and lack of a cancer screening and prevention program in Nepal. Cancer care is on the rise in Nepal. However, many of the variables identified above are not considered in the cancer care provided. Nepal has just opened its first national cancer center with the intent to improve cancer care throughout the country. PMID:11318261

Braun, C M; Itano, J K

2001-04-01

189

A Framework for Fibromyalgia Management for Primary Care Providers  

PubMed Central

Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. PMID:22560527

Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.

2012-01-01

190

The challenges of providing palliative care for people with intellectual disabilities: a literature review.  

PubMed

People with intellectual disabilities are often marginalised from mainstream health-care services because of the complexities of their disability. They are under-referred to specialist palliative care owing to a limited understanding of its role and little collaborative working. Furthermore, professionals caring for people with intellectual disabilities and palliative care services often lack knowledge about and confidence in their ability to meet the needs of people with an intellectual disability who require palliative care. This literature review explores the challenges of providing palliative care for people with intellectual disability. It highlights that training requirements need to be effectively identified, referrals between professional groups made, and the perspectives of patients understood to overcome the marginalisation of people with intellectual disability. There is a need for ongoing staff development focusing on staff confidence, collaborative working between professionals, and the empowerment of people with intellectual disability to be involved in decisions about their end-of-life care. Further research is needed to examine the most effective way of capturing the perspectives of those with intellectual disability and of enabling people with intellectual disability to access and engage with health surveillance, cancer screening, and palliative care services. PMID:25040863

Dunkley, Susie; Sales, Rachel

2014-06-01

191

Model program to improve care for a unique cancer population: young women with breast cancer.  

PubMed

Young women with breast cancer face a variety of problems unique to or accentuated by their age. Attention to these concerns is warranted, yet research has revealed inadequacies in care and that the needs of these patients are not being met. To address these critical issues, we have developed a comprehensive program to provide additional support and education for young women with breast cancer and their providers. On the basis of the preliminary success of the program, we have developed and pilot tested an exportable version that may serve as a national model for care of this unique population. We believe this work will not only improve care for young women with breast cancer, but also may serve as a paradigm to overcome barriers to delivering optimal care for unique groups of patients in other settings. PMID:23277772

Partridge, Ann H; Ruddy, Kathryn J; Kennedy, Jamie; Winer, Eric P

2012-09-01

192

Supportive Care of the Older Cancer Patient  

Microsoft Academic Search

Cancer mainly affects individuals aged 65 and over, so that supportive care for cancer treatment concerns mostly elderly patients.\\u000a Age is a risk factor for increased incidence and severity of chemotherapy-related toxicity and also for the emergence of different\\u000a forms of toxicity including delirium and malnutrition; in addition age may modulate the perception of pain and the response\\u000a to analgesics,

Lodovico Balducci

193

Providing surgical care in Somalia: A model of task shifting  

PubMed Central

Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves in Somalia, on-site training by expatriate surgeons and anesthesiologists will be re-established. Until then, the best way MSF has found to support surgical care in Somalia is continue to support in a "remote" manner. PMID:21762491

2011-01-01

194

Provider and Clinic Cultural Competence in a Primary Care Setting  

PubMed Central

A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

2008-01-01

195

Stakeholder preferences for cancer care performance indicators  

Microsoft Academic Search

Purpose – The purpose of this paper is to show that performance data use could be promoted with a better understanding of the type of indicators that are important to different stakeholders. This study explored patient, nurse, physician and manager preferences for cancer care quality indicators. Design\\/methodology\\/approach – Interviews were held with 30 stakeholders between March and June 2004. They

Anna Gagliardi; Louise Lemieux-Charles; Adalsteinn Brown; Terry Sullivan; Vivek Goel

2008-01-01

196

Provider perceptions of colorectal cancer screening clinical decision support at three benchmark institutions.  

PubMed

Implementation of computerized clinical decision support (CDS), and its integration into workflow has not reached its potential. To better understand the use of CDS for colorectal cancer (CRC) screening at benchmark institutions for health information technology (HIT), we conducted direct observation, including opportunistic interviews of primary care providers, as well as key informant interviews and focus groups, to document current challenges to CRC screening and follow-up at clinics affiliated with the Veterans Heath Administration, Regenstrief Institute, and Partners HealthCare System. Analysis revealed six common barriers across institutions from the primary care providers' perspective: receiving and documenting "outside" exam results, inaccuracy of the CDS, compliance issues, poor usability, lack of coordination between primary care and gastroenterology, and the need to attend to more urgent patient issues. Strategies should be developed to enhance current HIT to address these challenges and better support primary care providers and staff. PMID:20351917

Saleem, Jason J; Militello, Laura G; Arbuckle, Nicole; Flanagan, Mindy; Haggstrom, David A; Linder, Jeffrey A; Doebbeling, Bradley N

2009-01-01

197

Psychosocial Rehabilitation in Cancer Care  

Microsoft Academic Search

Prevalence data on psychosocial morbidity indicate that from 30% to 50% of cancer patients may experience distress significant\\u000a enough to warrant professional intervention at some time during survivorship. These patients may require professional attention\\u000a to manage the debilitating effects of diagnosis, treatment, and morbidity that can wax and wane over time depending upon a\\u000a host of other variables. It is

Richard P. McQuellon; Suzanne C. Danhauer

198

Perspectives of Foster-Care Providers, Service Provicers, and Judges Regarding Privtized Foster-Care Services  

E-print Network

beginning to im- plement managed-care principles in their child welfare services or exploring this option. Fifty-eight interviews with 33participants (youth in out-of-home placements, theirparents,foster-careproviders, service providers, and judges) were... is instruc- tive. A Child Welfare League of America study found that 29 of the 49 states that responded were implementing managed care or privatization principles, and another 12 were planning to do so (McCullough & Schmitt, 1999, 2000). Other states...

Humphrey, Kristen R.; Turnbull, Ann P.; Turnbull, H. Rutherford

2006-01-01

199

An action plan for translating cancer survivorship research into care.  

PubMed

To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG: Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: "Biennial Cancer Survivorship Research Conference: Translating Science to Care." Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research-improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process. PMID:25249551

Alfano, Catherine M; Smith, Tenbroeck; de Moor, Janet S; Glasgow, Russell E; Khoury, Muin J; Hawkins, Nikki A; Stein, Kevin D; Rechis, Ruth; Parry, Carla; Leach, Corinne R; Padgett, Lynne; Rowland, Julia H

2014-11-01

200

NIH scientists provide new insight into rare kidney cancer:  

Cancer.gov

NIH scientists have discovered a unique feature of a rare, hereditary form of kidney cancer that may provide a better understanding of its progression and metastasis, possibly laying the foundation for the development of new targeted therapies.

201

Overhead lift systems reduce back injuries among burn care providers.  

PubMed

Extensive patient handling in burn care provides ample opportunities for staff injury. The objective of this retrospective study was to evaluate frequency of work-related back injury pre- and postinstallation of overhead lifting systems (OLS) in a burn intensive care unit. After receiving institutional review board approval, the Workers Compensation Fund of Utah released deidentified back injury claims filed from the authors' burn center between January 1, 2001 and December 31, 2012. Number of back injuries, cost to workers' compensation, and missed workdays were examined. Three distinct time periods were analyzed based on the timing of installation of OLS in the burn center. Forty-five workers were injured in the burn unit; most were female (76%) nurses (73%), with the majority having lower-back injury (71%). Thirty claims (67%) involved staff with a previous back injury. Median age was 32 years (interquartile range, 22-40) and median term of employment at the burn center before injury was 3.7 years (interquartile range, 1.6-7.7). During the intervention period, rate of staff injuries, number of missed workdays, and total number of paid claims decreased significantly. In the period since installation, only one claim has been filed, which is the lowest number of claims that any individual intensive care unit has reported in the facility. The burn unit installed five OLS at a cost of $7000 per unit. This retrospective review indicated that the installation of OLS on the burn unit was an effective tool for reducing staff injury and associated costs. Back injury was essentially eliminated when five OLS were installed. PMID:24217002

Anyan, Walter; Faraklas, Iris; Morris, Stephen; Cochran, Amalia

2013-01-01

202

Addressing sexual dysfunction in colorectal cancer survivorship care  

PubMed Central

Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction. PMID:25276411

Averyt, Jennifer C.

2014-01-01

203

Assessing and enhancing health care providers' response to domestic violence.  

PubMed

This study aimed to examine possible changes from 2008 to 2012 in the skills of health care staff in identifying and intervening in domestic violence (DV). A longitudinal descriptive study design with volunteer samples (baseline; n = 68, follow-up; n = 100) was used to acquire information regarding the present state and needs of the staff in practices related to DV. The results of the baseline survey were used as a basis for planning two interventions: staff training and drafting practical guidelines. Information was collected by questionnaires from nurses, physicians, and social workers and supplemented by responses from the interviews. The data were analysed using both quantitative and qualitative methods. A chi-square test was used to test the statistical significance of the data sets. In addition, participants' quotes are used to describe specific phenomena or issues. The comparison showed that overall a small positive change had taken place between the study periods. However, the participants were aware of their own shortcomings in identifying and intervening in DV. Changes happen slowly, and administrative support is needed to sustain such changes. Therefore, this paper offers recommendations to improve health care providers' response to DV. Moreover, there is a great need for evaluating the training programme used. PMID:24864205

Leppäkoski, Tuija; Flinck, Aune; Paavilainen, Eija

2014-01-01

204

The Future of Cancer Survivorship Care for Veterans  

PubMed Central

Veterans have unique risk factors for cancer and comorbidities that may complicate cancer survivorship care. These population-specific characteristics compel research into the needs of veteran cancer survivors to inform best practice. PMID:21318051

Moye, Jennifer; Schuster, Jennifer L.; Latini, David M.; Naik, Aanand D.

2011-01-01

205

Cost-accounting techniques for health care providers.  

PubMed

The author reviews cost-accounting techniques and systems used by manufacturing companies. Some of the concepts and techniques used by for-profit companies can be implemented for health care institutions. Nurse executives can learn many lessons in product cost accounting from these for-profit companies. Understanding the various cost-accounting methodologies and techniques that are available can help nurse executives design, implement, and use a cost accounting system that will identify the costs associated with products and services provided. The author also reviews and explains standard costing systems. These systems can serve as valuable tools for budgeting, evaluating, and controlling departmental costs. When used in these instances, they can prove useful, and they furnish important information that is necessary for pricing products, determining alternatives or substitute services, and controlling costs. PMID:10153619

Pelfrey, S

1995-12-01

206

Opinion & Special Articles: neurologist: specialized primary care provider vs consultant.  

PubMed

As per the Centers for Medicare and Medicaid Services (CMS) current proposal, many specialties including neurology are not eligible for the increase in Medicare reimbursements that will be allocated to other cognitive specialties, such as the 7% increase for family physicians, 5% for internists, and 4% for geriatric specialists.(1,2) Other specialties such as anesthesiology, radiology, and cardiology are scheduled for a 3%-4% decrease in reimbursement in order to pay for the increases outlined above. Current estimates show that neurologists provide a significant amount of primary care for complex patients and yet these services are not eligible for increased payments. It is estimated that up to 60% of neurologists' services to these complex patients are ineligible for increased payments.(3.) PMID:23817521

Lakhan, Shaheen E; Schwindt, Mitchel; Alshareef, Bashar N; Tepper, Deborah; Mays, Maryann

2013-07-01

207

Cancer patient supportive care and pain management. Special listing  

SciTech Connect

This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Infectious disease in cancer patients; Immunological aspects of supportive care of cancer patients; Nutritional evaluation and support of cancer patients; Pain management of cancer patients.

Not Available

1981-04-01

208

Training mid-level providers on palliative care: bringing advanced directives and symptom assessment and management to community oncology practices.  

PubMed

Palliative care services are not available in most outpatient oncology practices. A program training 11 mid-level providers from oncology practices on advanced directive discussions and supportive symptom assessment and management performed by palliative care specialists was completed. A follow-up session 9 months later identified barriers to implementation. Of the 11 mid-level providers, 8 participated in the follow-up session, and 9 of the 11 providers implemented advanced directive's discussions and symptom assessment and management for patients with metastatic cancer. Main barriers included uncertainties about reimbursement, patients' lack of knowledge about palliative care, and lack of access to supportive services. This program successfully promoted advanced directive discussions and supportive/palliative care symptom assessment and management to community oncology practices, which will hopefully translate into improved quality of life for patients with metastatic cancer. PMID:23616274

Lesperance, Mary; Shannon, Robert; Pumphrey, Phyllis K; Dunbar, Erin; Genther, Renee; Coleman, C Lynn; Tabano, Margaret; Maurer, Jennifer; Vazquez, Adrienne; Capp, Elizabeth; McMillan, Jessica; Wilkerson, Katie; Robbins, Gerald; Phillips, Dorothy Green; Howick, Priscilla; Solaun, Catherine; Sloan, Jeff; Colón-Otero, Gerardo

2014-05-01

209

lColon Cancer Patterns of Care in Chicagoof Care in Chicago  

E-print Network

lColon Cancer Patterns of Care in Chicagoof Care in Chicago Progress, preliminary results Disparities in Stage-Specific Colorectal Cancer Mortality: 1960-2005. Am J Public Health. 2010 October 1, 2010;100(10):1912-6. 2 #12;Colon Cancer Patterns of Care in Chicago · XXXXX · Goals 1. Examine how prior screening

Illinois at Chicago, University of

210

Measuring stigma among health care and social service providers: The HIV/AIDS Provider Stigma Inventory.  

PubMed

Initial validation of the HIV/AIDS Provider Stigma Inventory (HAPSI), piloted on a sample of 174 nursing students, supported the psychometric qualities of a suite of measures capturing tendencies to stigmatize and discriminate against people living with HIV/AIDS (PLHA). Derived from social psychology and mindfulness theories, separate scales addressing awareness, acceptance, and action were designed to include notions of labeling, stereotyping, outgrouping, and discriminating. These were enhanced to capture differences associated with personal characteristics of PLHA that trigger secondary stigma (e.g., sexual orientation, injection drug use, multiple sex partners) and fears regarding instrumental and symbolic stigma. Reliabilities were strong (coefficients ? for 16 of 19 resulting measures ranged from 0.80 to 0.98) and confirmatory factor analyses indicated good model fit for two multidimensional (Awareness and Acceptance) and one unidimensional (Action) measure. Evidence of convergent construct validity supported accuracy of primary constructs. Implications for training and professional socialization in health care are discussed. PMID:21967495

Rutledge, Scott Edward; Whyte, James; Abell, Neil; Brown, Kristin M; Cesnales, Nicole I

2011-11-01

211

Not Babysitting: Work Stress and Well-Being for Family Child Care Providers  

ERIC Educational Resources Information Center

Family child care providers contend with a number of work stressors related to the dual roles of operating a small business and providing child care in their home. Research has documented many sources of work related stress for family child care providers; however, research examining family child care providers' experiences outside of the…

Gerstenblatt, Paula; Faulkner, Monica; Lee, Ahyoung; Doan, Linh Thy; Travis, Dnika

2014-01-01

212

Robotic surgery in cancer care: opportunities and challenges.  

PubMed

Malignancy-associated mortality, decreased productivity, and spiritual, social and physical burden in cancer patients and their families impose heavy costs on communities. Therefore cancer prevention, early detection, rapid diagnosis and timely treatment are very important. Use of modern methods based on information technology in cancer can improve patient survival and increase patient and health care provider satisfaction. Robot technology is used in different areas of health care and applications in surgery have emerged affecting the cancer treatment domain. Computerized and robotic devices can offer enhanced dexterity by tremor abolition, motion scaling, high quality 3D vision for surgeons and decreased blood loss, significant reduction in narcotic use, and reduced hospital stay for patients. However, there are many challenges like lack of surgical community support, large size, high costs and absence of tactile and haptic feedback. A comprehensive view to identify all factors in different aspects such as technical, legal and ethical items that prevent robotic surgery adoption is thus very necessary. Also evidence must be presented to surgeons to achieve appropriate support from physicians. The aim of this review article is to survey applications, opportunities and barriers to this advanced technology in patients and surgeons as an approach to improve cancer care. PMID:24606422

Mohammadzadeh, Niloofar; Safdari, Reza

2014-01-01

213

Evaluating the impact of palliative or hospice care provided in nursing homes.  

PubMed

Palliative and hospice care are increasingly being provided in nursing home settings. The current article reviews the existing evidence relevant to nursing homes to provide practitioners with a greater understanding of the impact of palliative and hospice care on clinical care outcomes (e.g., pain, symptom management), processes of care outcomes (e.g., hospitalizations, cost of care), and family member or health care proxy perceptions of care. Overall, the provision of hospice or palliative care in nursing facilities can improve the clinical care residents receive, reduce hospitalizations, and improve family members' perception of care. [Journal of Gerontological Nursing, 40(10), 10-14.]. PMID:25275780

Cimino, Nina M; McPherson, Mary Lynn

2014-10-01

214

Cultural aspects of communication in cancer care  

Microsoft Academic Search

Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate\\u000a effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased\\u000a disparities in cancer care. Cultural competence in oncology entails a basic knowledge of different cultural attitudes and\\u000a practices of communication of the truth and of decision-making styles throughout the

Antonella Surbone

2008-01-01

215

Narrative analysis of the ethics in providing advance care planning.  

PubMed

Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity. PMID:23702895

Baughman, Kristin R; Aultman, Julie M; Ludwick, Ruth; O'Neill, Anne

2014-02-01

216

Palliative care in patients with lung cancer.  

PubMed

Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508

Farbicka, Paulina; Nowicki, Andrzej

2013-01-01

217

Palliative care in patients with lung cancer  

PubMed Central

Lung cancer accounts for 12% of all cancers and has the highest annual rate of mortality in men and women. The overall aim is cure or prolongation of life without evidence of disease. Almost 60% of patients at the moment of diagnosis are not eligible for radical treatment. Therefore soothing and supportive treatment is the only treatment of choice. Patients with lung cancer who have symptoms of dyspnea, chronic cough, severe pain, exhaustion and cachexia syndrome, fear and depression and significantly reduced physical and intellectual activities are qualified for inpatient or home palliative care. Knowledge about various methods used in palliative treatment allows one to alleviate symptoms that occur in an advanced stage of disease with an expected short survival period. Methods of oncological treatment that are often used in patients with advanced lung cancer include radiotherapy and chemotherapy. Drawing attention to the earlier implementation of palliative care is an objective of research carried out during recent years. Advances in surgical and conservative treatment of these patients have contributed to better outcomes and longer survival time. PMID:24596508

Farbicka, Paulina

2013-01-01

218

Providing accessible health care for adolescents with sexually transmitted disease  

Microsoft Academic Search

Provision of sexually transmitted disease (STD) care for sexually active adolescents has been neglected in developing countries, although this is changing. Available evidence indicates that STDs are a serious problem among adolescents (10–19 years), especially in rural areas where services are limited for any age group. Curative care is hampered by the inadequacy of the syndromic approach for identifying adolescents

Loretta Brabin

1996-01-01

219

Providing Perinatal Mental Health Services in Pediatric Primary Care  

ERIC Educational Resources Information Center

After birth, newborns and their caregivers are seen routinely and frequently in pediatric primary care settings. The close succession of visits in the first few months of life puts pediatric primary care professionals in a unique position to enhance infant mental health by developing strong relationships with caregivers, supporting babies and…

Talmi, Ayelet; Stafford, Brian; Buchholz, Melissa

2009-01-01

220

Electronic health records (EHRs): supporting ASCO's vision of cancer care.  

PubMed

ASCO's vision for cancer care in 2030 is built on the expanding importance of panomics and big data, and envisions enabling better health for patients with cancer by the rapid transformation of systems biology knowledge into cancer care advances. This vision will be heavily dependent on the use of health information technology for computational biology and clinical decision support systems (CDSS). Computational biology will allow us to construct models of cancer biology that encompass the complexity of cancer panomics data and provide us with better understanding of the mechanisms governing cancer behavior. The Agency for Healthcare Research and Quality promotes CDSS based on clinical practice guidelines, which are knowledge bases that grow too slowly to match the rate of panomic-derived knowledge. CDSS that are based on systems biology models will be more easily adaptable to rapid advancements and translational medicine. We describe the characteristics of health data representation, a model for representing molecular data that supports data extraction and use for panomic-based clinical research, and argue for CDSS that are based on systems biology and are algorithm-based. PMID:24857080

Yu, Peter; Artz, David; Warner, Jeremy

2014-01-01

221

Barriers and Facilitators to Providing Common Preventive Screening Services in Managed Care Settings  

Microsoft Academic Search

Despite increasing emphasis on disease prevention and health promotion, and ample evidence demonstrating the effectiveness of preventive services, such services are underutilized in the United States. The current trend of health care toward health maintenance organizations and other managed care systems opens the door, perhaps to more effective control of heart disease, cancers and other chronic diseases through preventive care.

Mayur M. Amonkar; Suresh Madhavan; Sidney A. Rosenbluth; Kenneth J. Simon

1999-01-01

222

Disenrollment From Medicare Managed Care Among Beneficiaries With and Without a Cancer Diagnosis  

PubMed Central

Background Medicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis. Methods We identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28?331), colorectal (n = 26?494), prostate (n = 29?046), or lung (n = 31?243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient’s diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression. Results In the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage. Conclusion A new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare. PMID:18612131

Ishill, Nicole; Riley, Gerald F.; Bach, Peter B.; Gonen, Mithat; Begg, Colin B.; Schrag, Deborah

2008-01-01

223

Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial  

E-print Network

Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial and forward movement in stage of adoption at 6 months post-intervention. African American primary care to their scheduled visit with their primary care provider. Hypotheses were that differences between groups would

Zhou, Yaoqi

224

The global cancer genomics consortium's third annual symposium: from oncogenomics to cancer care  

PubMed Central

The Global Cancer Genomics Consortium (GCGC) is a cohesive network of oncologists, cancer biologists and structural and genomic experts residing in six institutions from Portugal, United Kingdom, Japan, India, and United States. The team is using its combined resources and infrastructures to address carefully selected, shared, burning questions in cancer medicine. The Third Annual Symposium was organized by the Institute of Molecular Medicine, Lisbon Medical School, Lisbon, Portugal, from September 18 to 20, 2013. To highlight the benefits and limitations of recent advances in cancer genomics, the meeting focused on how to better translate our gains in oncogenomics to cancer patients while engaging our younger colleagues in cancer medicine at-large. Over two hundreds participants actively discussed some of the most recent advances in the areas cancer genomics, transcriptomics and cancer system biology and how to best apply such knowledge to cancer therapeutics, biomarkers discovery and drug development, and an essential role played by bio-banking throughout the process. In brief, the GCGC symposium provided a platform for students and translational cancer researchers to share their excitement and worries as we are beginning to translate the gains in oncogenomics to a better cancer patient treatment.

Costa, Luis; Casimiro, Sandra; Gupta, Sudeep; Knapp, Stefan; Pillai, M.Radhakrishna; Toi, Masakazu; Badwe, Rajendra; Carmo-Fonseca, Maria; Kumar, Rakesh

2014-01-01

225

LONG TERM CARE PLAN 01-01-2012 The Long Term Care ("LTC") Plan provides benefits for specific types of medical care and  

E-print Network

range of personal care, health care, and social services for people who suffer a chronic disease or long1 LONG TERM CARE PLAN 01-01-2012 The Long Term Care ("LTC") Plan provides benefits for specific types of medical care and assistance not covered by the medical plan. Long term care refers to a wide

Johnson, Peter D.

226

Antenatal and obstetric care in Afghanistan - a qualitative study among health care receivers and health care providers  

PubMed Central

Background Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled “the worst country in which to be a mom” in Save the Children’s World’s Mothers’ Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Methods Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi’s phenomenological analysis. Results Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. Conclusion This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care, especially by poorly educated rural women. Patients frequently complained of being treated disrespectfully, and health care providers correspondingly complained about poor working conditions leading to exhaustion and a lack of compassion. Widespread corruption, including the necessity of personal contacts inside hospitals, was also emphasized as an obstacle to equitable antenatal and obstetric health care. PMID:23642217

2013-01-01

227

42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.  

Code of Federal Regulations, 2010 CFR

...provide inpatient care directly. 418...418.110 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...PROGRAM HOSPICE CARE Conditions of...rub dispensers in health care facilities;...

2010-10-01

228

42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.  

Code of Federal Regulations, 2011 CFR

...provide inpatient care directly. 418...418.110 Public Health CENTERS FOR MEDICARE...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...PROGRAM HOSPICE CARE Conditions of...rub dispensers in health care facilities;...

2011-10-01

229

75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...  

Federal Register 2010, 2011, 2012, 2013

...Publication of Model Notices for Health Care Continuation Coverage Provided...Reconciliation Act (COBRA) and Other Health Care Continuation Coverage, as Required...of the availability of the Model Health Care Continuation Coverage Notices...

2010-03-22

230

75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...  

Federal Register 2010, 2011, 2012, 2013

...Publication of Model Notices for Health Care Continuation Coverage Provided...Reconciliation Act (COBRA) and Other Health Care Continuation Coverage, as Required...of the Availability of the Model Health Care Continuation Coverage Notices...

2010-05-11

231

75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...  

Federal Register 2010, 2011, 2012, 2013

...Publication of Model Notices for Health Care Continuation Coverage Provided...Reconciliation Act (COBRA) and Other Health Care Continuation Coverage, as Required...of the Availability of the Model Health Care Continuation Coverage Notices...

2010-01-15

232

Animal Cancer Care and Research Program Summer 2011  

E-print Network

Synergy Animal Cancer Care and Research Program Summer 2011 Michael G. Conzemius, D.V.M., Ph Cancer Care and Research Program 2 · Synergy Summer 2011 COTC016: A pilot study to assess feasibility Clinical Sciences, College of Veterinary Medicine and Masonic Cancer Center T he University of Minnesota

Minnesota, University of

233

Grantee Research Highlight: Taking Account of the Patient's Perspective when Examining the Quality of Cancer Care  

Cancer.gov

Optimizing patient experiences with care is especially important in cancer because cancer care is often complex and involves communication with and coordination across providers of multiple specialties and across multiple institutional settings. Unsatisfactory interactions with the health care system pose an additional burden on patients when they are already ill and vulnerable. More importantly, less-than-optimal patient experiences can have a significant negative impact on patients’ health-related quality of life.

234

Voices of multi-ethnic providers in NYC: health care for viral hepatitis to prevent hepatocellular carcinoma.  

PubMed

Worldwide, hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths and the ninth in the US. Hepatitis B and C make up almost 80% of HCC cases. Based on our Hepatitis Outreach Network screening program data, approximately 40% of at-risk foreign-born community members who tested positive for viral hepatitis B and/or C did not follow up for additional care. Our aim was to use theory-driven qualitative research to identify barriers and facilitators to follow-up after viral hepatitis diagnosis among these community members from the viewpoint of primary care providers (PCPs). As viral hepatitis is a precursor of liver cancer, timely treatment of the virus has the potential to reduce the incidence and burden of liver cancer. We performed semi-structured key informant interviews with 20 primary care physicians who predominantly serve Korean, Chinese, Egyptian, and Russian communities. Barriers detected included cultural factors commonly seen amongst immigrant populations such as busy work schedules and non-English language. Common facilitators include increased primary care physician involvement and linkages to care within communities in which patients reside. Providers perceived that they are gatekeepers to specialty care for their patients and therefore key persons to engage in viral hepatitis evaluation and management by specialists. This initial study suggests that re-focusing energy into primary care physicians might offer promise for improved care for individuals from immigrant communities who have viral hepatitis to help them engage in care and thereby reduce the burden of liver cancer. PMID:24189830

Han, Hyosun; Perumalswami, Ponni V; Kleinman, Lawrence C; Jandorf, Lina H

2014-06-01

235

Challenges in multidisciplinary cancer care among general surgeons in Canada  

Microsoft Academic Search

BACKGROUND: While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care

Anna R Gagliardi; Frances C Wright; Dave Davis; Robin S McLeod; David R Urbach

2008-01-01

236

Benefit finding through caring: The cancer caregiver experience  

Microsoft Academic Search

Objectives: The aim of this study was to explore benefit finding in cancer carers taking account of timeline and care recipient, in relation to burden of care, perceived stress, optimism, resilience, self efficacy, perceived support and psychological distress.Methods: A cohort sequential survey was conducted with a group of 842 female cancer carers who were caring for a spouse, a parent

Tony Cassidy

2012-01-01

237

Implementation of a Performance Improvement Initiative in Colorectal Cancer Care  

PubMed Central

Purpose: In the United States, colorectal cancer (CRC) is the third leading cause of cancer after breast and prostate cancer. Numerous improvement programs have been implemented to increase CRC screening rates, but few have focused on improving the care and management of patients with a diagnosis of this malignancy. As national medical organizations focus on quality of care, efforts are necessary to provide clinicians the opportunity for self-assessment and methods for practice improvement. With this goal in mind, a national continuing medical education–certified performance improvement initiative was conceived. Methods: The initiative consisted of three stages: First, participants self-assessed their performance of predetermined topic measures through a review of patient charts. The topic areas included patient safety and supportive care, evidence-based surveillance, and evidenced-based treatment and were derived from current guidelines and other successful quality-improvement initiatives. Second, an actionable plan for practice improvement was developed in at least one of the three topic areas. Third, after a period of self-improvement, participants reassessed their performance of the same topic measures to determine tangible changes in patient care. Results: A total of 540 patient charts were reviewed by 27 clinicians. Notable results showed large gains in areas of supportive care, such as quantitative pain assessments and emotional well-being evaluations, which traditionally have been a minor focus of other quality-improvement initiatives. Participants also showed tangible improvements in the performance of leading measures of quality care. Conclusion: These findings support the need for continued efforts toward performance improvement in both established and emerging areas of CRC patient care. PMID:23277769

Marshall, John L.; Cartwright, Thomas H.; Berry, Carolyn A.; Stowell, Stephanie A.; Miller, Sara C.

2012-01-01

238

77 FR 64340 - Announcement of Requirements and Registration for Cancer Care Video Challenge  

Federal Register 2010, 2011, 2012, 2013

...Requirements and Registration for Cancer Care Video Challenge AGENCY: Office of the National...SUMMARY: The Cancer Care Video Challenge is an opportunity for members...their ability manage care. The Cancer Care Video Challenge is an [[Page 64341

2012-10-19

239

Palliative cancer care in Middle Eastern countries: accomplishments and challenges †  

PubMed Central

Background In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinics of Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family. PMID:22628412

Silbermann, M.; Arnaout, M.; Daher, M.; Nestoros, S.; Pitsillides, B.; Charalambous, H.; Gultekin, M.; Fahmi, R.; Mostafa, K.A.H.; Khleif, A.D.; Manasrah, N.; Oberman, A.

2012-01-01

240

Can We Talk? Priorities for Patient Care Differed Among Health Care Providers  

Microsoft Academic Search

Objective: Poor communication and collaboration between members of a patient's health care team can result in medical errors and poor quality of care. The purpose of this study was to assess communication and consensus regarding patient care goals between members of the health care team (physicians, registered nurses (RNs), and patient care technicians (PCTs)) caring for the same patient on

Bradley Evanoff; Patricia Potter; Laurie Wolf; Deborah Grayson; Clay Dunagan; Stuart Boxerman

241

Views of breast and colorectal cancer survivors on their routine follow-up care  

PubMed Central

Objective Our understanding of optimum health care delivery for cancer survivors is limited by the lack of a patient-centred perspective. The objectives of the present study were to explore the views of breast and colorectal cancer survivors on their routine follow-up care, with respect to needs, preferences, and quality of follow-up, and their views on cancer specialist– compared with family physician (fp)–led follow-up care. Methods In Nova Scotia, Canada, 23 cancer survivors (13 breast, 10 colorectal) participated in either a focus group or a one-on-one interview. Participants were asked to reflect upon their lives as cancer survivors and on the type and quality of care and support they received during the follow-up period. Each focus group or interview was transcribed verbatim, and the transcripts were audited and subjected to a thematic analysis. Results Six themes were identified: My care is my responsibilityHow I receive information on follow-up careI have many care needsI want to be prepared and informedThe role of my fp in my cancer experience and follow-up careThe role of media Survivors often characterized the post–primary treatment experience as lacking in information and preparation for follow-up and providing inadequate support to address many of the care needs prevalent in survivor populations. Despite valuing fp participation in follow-up care, many survivors continued to receive comfort and reassurance from specialist care. Conclusions Our findings point to the need to implement strategies that better prepare breast cancer and colorectal cancer survivors for post-treatment care and that reassure survivors of the ability of their fp to provide quality care during this period. PMID:23300354

Urquhart, R.; Folkes, A.; Babineau, J.; Grunfeld, E.

2012-01-01

242

Integrating genetic and genomic information into effective cancer care in diverse populations  

PubMed Central

This paper provides an overview of issues in the integration of genetic (related to hereditary DNA) and genomic (related to genes and their functions) information in cancer care for individuals and families who are part of health care systems worldwide, from low to high resourced. National and regional cancer plans have the potential to integrate genetic and genomic information with a goal of identifying and helping individuals and families with and at risk of cancer. Healthcare professionals and the public have the opportunity to increase their genetic literacy and communication about cancer family history to enhance cancer control, prevention, and tailored therapies. PMID:24001763

Fashoyin-Aje, L.; Sanghavi, K.; Bjornard, K.; Bodurtha, J.

2013-01-01

243

Decision Support for Post-Operative Breast Cancer Care David England, Taleb-Bendiab Azzelarabe, Paulo Lisboa, Karen Murphy, Ian  

E-print Network

cancer care raises a number of interdisciplinary questions in a complex and emotive area. The project, including multi-criteria, will provide breast cancer clinicians and patients with a flexible decisionDecision Support for Post-Operative Breast Cancer Care David England, Taleb-Bendiab Azzelarabe

Taleb-Bendiab, A.

244

Effects of Guided Care on Providers' Satisfaction with Care: A Three-Year Matched-Pair Cluster-Randomized Trial  

PubMed Central

Abstract It is important to understand the effects of a new care model on health professionals' satisfaction, which may help inform organizations' decisions regarding the adoption of the model. This study evaluates the effect of the Guided Care model of primary care on physicians', Guided Care Nurses' and practice staff satisfaction with processes of care for chronically ill older patients. In Guided Care, a specially educated registered nurse works with 2–5 primary care physicians, performing 8 clinical activities for 50–60 chronically ill older patients. This model was tested in a 3-year matched-pair cluster-randomized controlled trial with 14 pods (teams of physicians and staff) randomly assigned, within pairs, to provide Guided Care or usual care. Physicians and Guided Care Nurses were surveyed at baseline and annually for 3 years. Staff were surveyed at baseline and 2 years later. Physicians' satisfaction with chronic care processes, knowledge of patients, and care coordination were measured, as well as Guided Care Nurses' satisfaction with chronic care processes and staff perceptions of quality of care. Findings suggest that Guided Care improved physician satisfaction with patient/family communication and management of chronic care, and it may bolster staff beliefs that care is patient oriented. Differences in other aspects of care were not statistically significant. (Population Health Management 2013;16:317–325) PMID:23560515

Hsu, Yea-Jen; Wen, Mei; Wolff, Jennifer; Frick, Kevin; Reider, Lisa; Scharfstein, Daniel; Boyd, Cynthia; Leff, Bruce; Schwartz, Lindsay; Karm, Lya; Boult, Chad

2013-01-01

245

Training Programs for Family Child Care Providers: An Analysis of Ten Curricula. Second Edition.  

ERIC Educational Resources Information Center

This report analyzes the following 10 curricula for training programs for family child care providers: (1) Child Care, a family day home care provider program developed by Texas A&M's Agricultural Extension Service; (2) the Family Day Care Education Series, a coordinated resource manual and independent study course, the Active Learning Series, and…

Modigliani, Kathy

246

PROSTATE CANCER SURVIVORSHIP: LESSONS FROM CARING FOR THE UNINSURED  

PubMed Central

Since 2001, UCLA has operated IMPACT: Improving Access, Counseling and Treatment for Californians with prostate cancer. Funded by the California Department of Public Health, with a cumulative budget of over $80 million, the program provides comprehensive care for low-income, uninsured Californian men with biopsy-proven prostate cancer. Health services research conducted with program enrollees, through the UCLA Men’s Health Study, yields an opportunity to perform qualitative and quantitative assessments of patient-reported outcomes in these men, all members of historically underserved, primarily minority populations. This review summarizes data from several studies in which validated instruments were administered longitudinally in 727 participants, prospectively measuring health-related quality of life (HRQOL), self-efficacy in interactions with physician interactions, social and emotional health, symptom distress, satisfaction with care, and other patient-reported outcomes. PMID:22127017

Chamie, Karim; Connor, Sarah E.; Maliski, Sally L.; Fink, Arlene; Kwan, Lorna; Litwin, Mark S.

2011-01-01

247

Caring for and about cancer patients: identifying the meaning of the phenomenon "caring" through narratives.  

PubMed

For several decades nurses have been using the terms "caring" and "nursing." Caring, considered to be a universal phenomenon, has been seen as a nursing term, including all aspects of delivering nursing care to patients. Ten registered nurses selected from hematologic, oncologic, and lung medicine wards were asked to narrate one situation in which they had been able to supply good caring and one situation wherein they had not been able to provide good caring for the patient. To identify the meaning of the caring phenomenon as experienced and expressed by nurses working with patients who have cancer, a qualitative analysis using phenomenologic hermeneutics was used. The narrated interviews, tape-recorded and transcribed verbatim, were analyzed, and a theme was interpreted: developing and maintaining a helping-trusting interpersonal relationship. Five subthemes also were identified: creating an interaction with the patient and the next of kin, acting to satisfy the needs of the patient and next of kin, feeling frustration in the role of caring, being affected by time aspects, and developing self and acquiring insight. It is in caring that nurses and patients connect with one another, are fulfilled, and experience growth. If they work actively with this perspective, nurses will feel fulfilled, not frustrated. PMID:10603688

Berterö, C

1999-12-01

248

Human Relationships in Palliative Care of Cancer Patient: Lived Experiences of Iranian Nurses  

PubMed Central

Background: cancer patients require palliative care. Aim: the purpose of this study was to explore the experiences of nurses, who provide palliative care for cancer patients, within the context of Iranian culture. Methods: we conducted a hermeneutic phenomenological study. Semi structured in-depth interviews with 10 nurses were audio taped and transcribed. The transcriptions were then analyzed by Van Manen’s method. Results: one of the most important themes that emerged was “human relationships”, which also contained the subthemes of “comprehensive acceptance” and “psychological support”. Conclusions: the results provide deep understanding of human relationships in palliative care of cancer patients in Iran. PMID:24757399

Borimnejad, Leili; Mardani Hamooleh, Marjan; Seyedfatemi, Naimeh; Tahmasebi, Mamak

2014-01-01

249

Pancreatic cancer-improved care achievable  

PubMed Central

Pancreatic adenocarcinoma is one of the most aggressive cancers, and the decline in mortality observed in most other cancer diseases, has so far not taken place in pancreatic cancer. Complete tumor resection is a requirement for potential cure, and the reorganization of care in the direction of high patient-volume centers, offering multimodal treatment, has improved survival and Quality of Life. Also the rates and severity grade of complications are improving in high-volume pancreatic centers. One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer. Suboptimal investigation, follow up and oncological treatment outside specialized centers are additional key problems. New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease, and different adjuvant treatment options result in well documented survival benefit. Neoadjuvant treatment is highly relevant, but needs further evaluation. Also adjuvant immunotherapy, in the form of vaccination with synthetic K-Ras-peptides, has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors. Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention. PMID:25132756

Buanes, Trond A

2014-01-01

250

Assessment of growth by primary health care providers  

Microsoft Academic Search

Introduction: Precise measurements of children are critical for accurate growth assessment. Many children are referred to endocrine practices in error becauseheights are obtained but plotted onlength growth charts, giving the appearance that growth has decelerated. Method: In an attempt to evaluate growth assessment in primary care practices (PCPs), we instituted a telephone survey to gather the following data: (a) how

Terri H. Lipman; Karen Hench; Jeanne D. Logan; Diane A. DiFazio; Paula M. Hale; Carol Singer-Granick

2000-01-01

251

Obstacles in Providing Neonatal Care in Kurdistan, Iraq  

Microsoft Academic Search

Our world is shrinking because of computerized linkages and the mobility of society. Information is shared rapidly around the world. Issues surrounding newborn and infant nursing are global. In efforts to acknowledge the international community, each Newborn and Infant Nursing Review issue will feature a column that highlights care-related issues from a featured country or region of the world. This

Atiya K. Mohammed; Evelyn Acheson; Carole Kenner

2009-01-01

252

Perspectives from the frontlines: palliative care providers' expectations of Canada's compassionate care benefit programme.  

PubMed

Recognising their valuable role as key informants, this study examines the perspectives of front-line palliative care providers (FLPCP) regarding a social benefit programme in Canada designed to support family caregivers at end-of-life, namely the Compassionate Care Benefit (CCB). The CCB's purpose is to provide income assistance and job security to family caregivers who take temporary leave from employment to care for a dying family member. Contributing to an evaluative study that aims to provide policy-relevant recommendations about the CCB, this analysis draws on semi-structured interviews undertaken in 2007/2008 with FLPCPs (n = 50) from across Canada. Although participants were not explicitly asked during interviews about their expectations of the CCB, thematic content analysis revealed 'expectations' as a key finding. Through participants' discussions of their knowledge of and familiarity with the CCB, specific expectations were identified and grouped into four categories: (1) temporal; (2) financial; (3) informational; and (4) administrative. Findings demonstrate that participants expect the CCB to provide: (1) an adequate length of leave time from work, which is reflective of the uncertain nature of caregiving at end-of-life; (2) adequate financial support; (3) information on the programme to be disseminated to FLPCPs so that they may share it with others; and (4) a simple, clear, and quick application process. FLPCPs hold unique expertise, and ultimately the power to shape uptake of the CCB. As such, their expectations of the CCB contribute valuable knowledge from which relevant policy recommendations can be made to better meet the needs of family caregivers and FLPCPs alike. PMID:20584086

Giesbrecht, Melissa; Crooks, Valorie A; Williams, Allison

2010-11-01

253

Providing nutritional support for patients with cancer cachexia.  

PubMed

Malnutrition is the single most common secondary diagnosis for patients with advanced cancer, and can affect up to 85% of patients. Anorexia and weight loss affect up to 80% of patients and are responsible for death in up to 20% of cases. Cancer cachexia is a feature of advanced cancer characterised by anorexia and a progressive loss of body weight, reduced immune response, poor treatment response, and poor quality of life. Providing effective nutritional support for patients who experience cancer cachexia at the end of life is very challenging and requires a multidisciplinary team approach to consider the implications beyond the patient's dietary needs being met. Evidence suggests that health professionals have limited understanding of cachexia and are often at a loss as to how to manage patients who experience this severe form of weight loss. The purpose of this article is to examine the quality of life of patients with advanced cancer who experience cachexia. The article covers the aetiology and management of the condition as well as current treatment methods and management strategies. In particular, it emphasises the advantages of the Macmillan approach to weight and eating. This approach focuses on the social aspects of eating and weight gain, indicating the importance of considering the effects of malnutrition on both the patient and the carer. PMID:23354431

McCreery, Elizabeth; Costello, John

2013-01-01

254

Transition Planning for Adolescents with Special Health Care Needs and Disabilities: A Guide for Health Care Providers.  

ERIC Educational Resources Information Center

Designed for Massachusetts health care providers, this booklet provides information on transition planning for adolescents with special health care needs and disabilities. It includes resources and strategies to guide interventions with families and to focus their attention on four key facets of adulthood: health care, education, employment, and…

Porter, Stephanie; Freeman, Linda; Griffin, Lynne Reeves

255

Family Child Care Providers' Perspectives regarding Effective Professional Development and Their Role in the Child Care System: A Qualitative Study  

ERIC Educational Resources Information Center

This study examines family child care providers' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child care providers. Supportive social relationships emerged as an important dimension of…

Lanigan, Jane D.

2011-01-01

256

Health Sciences Center Department of Internal Medicine Employee Health Promotion Program Health Care Provider Report  

E-print Network

Health Sciences Center Department of Internal Medicine Employee Health Promotion Program Health Care Provider Report Dear Health Care Provider: Your patient, ______________________________, has applied for enrollment in a fitness program sponsored by the University of New Mexico, Employee Health

New Mexico, University of

257

Cancer care--A stress for health professionals  

Microsoft Academic Search

Literature related to health care professionals dealing with stress of cancer care is still in its infancy. The authors distinguish papers of general interest (the most frequent), papers identifying stressors, and papers about stress consequences. Most of them recognize death of the patients as a major stressor for health care professionals. There are also additional stressors specific to health care

Nicole Delvaux; Darius Razavi; Christine Farvacques

1988-01-01

258

Neonatal nurse practitioners provide quality, cost-effective care.  

PubMed

Loretta Ford, the pioneer of nurse practitioners, was the recipient of the Crystal Trailblazer Award from the American College of Nurse Practitioners in February 2003. In her acceptance speech, the stated that "in some ways, the profession had expanded beyond my wildest dreams," but cautioned against the medicalization of the NP role: "The profession is rooted in nursing ... and we enhance, advance, and influence through nursing." She added: "Medical and nursing interdependency sets the stage for the highest level of care. No one profession can deliver comprehensive health care themselves." NNPs, functioning collaboratively with neonatologists as part of a multidisciplinary team, illustrate the truth of Ford's words. They have clearly and unequivocally made significant strides during the past 20 years. Their achievements and contributions have been many but their potential has yet to be reached. PMID:14508891

Geiss, Donna M; Cavaliere, Terri A

2003-09-01

259

Research Initiatives | CanCORS: Research Gaps Identified in Cancer Care Quality and Outcomes  

Cancer.gov

CanCORS has prospectively studied the quality of care and health outcomes of approximately 5,000 lung cancer patients and approximately 5,000 colorectal cancer patients. The study design, which blends patient, provider, and caregiver surveys with detailed clinical data from medical records, provides a rich and comprehensive data resource, allowing the investigators to examine care processes and outcomes during initial treatment as well as long-term survivorship in greater detail than previously possible.

260

PROVIDING END-OF-LIFE CARE TO PATIENTS: CRITICAL CARE NURSES' PERCEIVED OBSTACLES AND SUPPORTIVE BEHAVIORS  

Microsoft Academic Search

• BACKGROUND Critical care nurses care for dying patients daily. The process of dying in an intensive care unit is complicated, and research on specific obstacles that impede delivery of end-of-life care and\\/or supportive behaviors that help in delivery of end-of-life care is limited. • OBJECTIVE To measure critical care nurses' perceptions of the intensity and frequency of occurrence of

Renea L. Beckstrand; Karin T. Kirchhoff

261

Foster Care Providers: Helping Youth at Risk for Suicide  

E-print Network

This information sheet addresses suicide prevention among youth in foster care. It is written for professionals and volunteers who interact with foster children or work with their caregivers. Every year in the United States, more than 4,800 children, teens, and young adults ages 0–24 die by suicide (CDC, 2010). Approximately 175,800 others are treated in emergency departments for injuries from self-harm (CDC, 2012). Although suicide can occur in any family, youth in foster care are at higher risk for attempting or seriously considering suicide (Pilowsky & Wu, 2006). Fortunately, there are steps that foster caregivers can take to identify and get help for youth who are at risk. Many young people who are thinking of killing themselves show warning signs. Knowing the warning signs and risk factors can help foster caregivers intervene and get the young person connected with assistance. Foster caregivers can also help address underlying mental health issues and strengthen the factors that protect against suicide. Suicidal Behavior and Youth in Foster Care Most youth who die by suicide have a mental disorder, such as depression, or a substance use disorder.

unknown authors

262

Health Care Provider Attitudes and Beliefs About People Living with HIV: Initial Validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS).  

PubMed

HIV stigma is a pressing concern for people living with HIV, and particularly when it is perpetuated by health care providers, as it may affect quality of life and access to health care services. The current study describes the development and initial validation of a contextually appropriate HIV stigma scale for health care providers in North America. A ground-up qualitative approach was used to develop the scale, and it was assessed psychometrically with health care trainees across Canada. The measure demonstrates excellent internal consistency reliability and test-retest reliability, as well as convergent and divergent validity. The study supports a tripartite model of HIV stigma consisting of stereotyping, prejudice and discrimination. The scale provides a new tool to assess HIV stigma in health care providers and can be used to inform training, intervention and self-evaluation of stigmatizing attitudes, beliefs and behaviors among providers. PMID:24965675

Wagner, Anne C; Hart, Trevor A; McShane, Kelly E; Margolese, Shari; Girard, Todd A

2014-12-01

263

"Not the 'Grim Reaper Service'": An Assessment of Provider Knowledge, Attitudes, and Perceptions Regarding Palliative Care Referral Barriers in Heart Failure  

PubMed Central

Background Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. Methods and Results We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF?related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. Conclusions Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease?related burden. PMID:24385453

Kavalieratos, Dio; Mitchell, Emma M.; Carey, Timothy S.; Dev, Sandesh; Biddle, Andrea K.; Reeve, Bryce B.; Abernethy, Amy P.; Weinberger, Morris

2014-01-01

264

Care.com BackupCareSM is a service provided by Parents in a Pinch, Inc., a Care.com company.  

E-print Network

enough help to offset the burden of full-time caregiving. Kathy told her mother about the backup care teenage sons. When Mrs. G. had knee replacement surgery, Dr. G. took time off of work to help care for herCare.com® BackupCareSM is a service provided by Parents in a Pinch, Inc., a Care.com company. Real

Reuter, Martin

265

Developing communication competency in the context of cancer: a critical interpretive analysis of provider training programs.  

PubMed

We conducted a critical interpretive analysis of 47 studies from the Cochrane Review of the communications training literature to capture the empirical indicators used to judge provider communication competency and to describe how the indicators were characterized in the context of a cancer care system. Of the 47 studies reviewed, few showed any resemblance to recommendations from two international consensus conferences of experts in the communication research field. Some of the challenges in moving forward with cancer-related communication skills involve deciding what we want people to learn, providing learning across various experiences, identifying learning models, and finding alternate ways of motivating people to learn. Once core competencies are clearly articulated, we can determine the best approaches for developing cancer-specific training programs. PMID:16200525

Butler, Lorna; Degner, Lesley; Baile, Walter; Landry, M

2005-10-01

266

Primary Care Providers' Perceptions of and Experiences with an Integrated Healthcare Model  

ERIC Educational Resources Information Center

Objective and Participants: The authors examined the experiences of primary care providers participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary care providers in the treatment of students. Participants…

Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris

2008-01-01

267

The Structural Landscape of the Health Care System for Breast Cancer Care: Results from The Los Angeles Women's Health Study  

PubMed Central

The structure of health care has been rapidly evolving in response to financial pressures and demands to improve quality. Little work has documented the structure of care and its impact in the context of breast cancer care. We conducted a survey to characterize Los Angeles physicians caring for breast cancer patients and the structural landscape of the healthcare system in which they practice. Cross-sectional survey of physicians who treated a population-based cohort of breast cancer patients. We surveyed 477 physicians, targeting all Los Angeles County medical oncologists, radiation oncologists, and surgeons reported by patients participating in the Los Angeles Women’s Health Study (77% response rate). Specialty-specific questionnaires were developed. Items were based on the structure and quality of care literature, cognitive interviews with cancer care specialists, and existing physician survey instruments. Breast cancer care providers in Los Angeles are diverse, with one-third non-white and 46% speaking a non-English language. Group practice is most common, (37% single specialty, 16% group-model HMO, 8% multi-specialty group). Minimal teaching involvement predominates. Mean new breast cancer patient volumes are relatively high (8 per month overall; six for surgeons), representing 46% of new cancer patients. Physicians reported high career satisfaction levels (83–92%). Physicians were least satisfied with the amount of time spent with patients (82%). Data from this study represent important building blocks for further analyses to determine the impact of structural characteristics on the quality of care that breast cancer patient’s experience. PMID:19120382

Tisnado, Diana M.; Malin, Jennifer L.; Tao, May L.; Ganz, Patricia; Rose-Ash, Danielle; Hu, Ashlee F.; Adams, John; Kahn, Katherine L.

2010-01-01

268

The implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on cancer care delivery.  

PubMed

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. This legislation attempts to address cost control and improve the quality of healthcare in the United States. Cancer is a major health problem in the United States and the leading cause of death for Americans under the age of 80. Therefore, cancer care providers need to be fully engaged in ongoing discussions regarding quality measurement and care delivery. With the optimum level of collaboration and support, the proposals in the legislation can be properly structured to deliver improved access to care via better delivery systems, as well as more appropriate reimbursement to advance the prevention and treatment of cancer. PMID:21472704

Albright, Heidi W; Moreno, Mark; Feeley, Thomas W; Walters, Ronald; Samuels, Marc; Pereira, Alissa; Burke, Thomas W

2011-04-15

269

Type of Plan and Provider Network (Affordable Care Act)  

MedlinePLUS

... choose Marketplace insurance Type of plan and provider network Comparing health plans Marketplace insurance categories Monthly premiums ... of-pocket costs Type of plan and provider network Benefits How to keep your doctor How to ...

270

Assessing Gynecologic and Breast Cancer Survivors' Sexual Health Care Needs (Sexual Care Needs of Cancer Survivors)  

PubMed Central

Objectives To identify patterns of female cancer survivors’ interest in receiving care for sexual concerns. Methods Survey and medical record data were collected June 2008 to March 2009 from 261 gynecologic and breast cancer patients. Logistic regression was used to estimate the effect of age and months since treatment on interest in receiving sexual health care. Results Participants’ mean age was 55 years (range 21–88). Only 7% had recently sought medical help for sexual issues, yet 41.6% were interested in receiving care. More than 30% responded that they would be likely to see a physician to address sexual matters and 35% of all women were willing to be contacted if a formal program was offered. When compared to older women (>65 years), younger women (18–47 years) were significantly more likely to report interest in receiving care to address sexual issues (OR 2.94, 95% CI 1.14–7.54), to see a physician to address sexual matters (OR 4.51, 95% CI 1.51–13.43) and more willing to be contacted for a formal program (AOR 5.00, 95% CI 1.63–15.28). Compared to those currently in treatment, women who last received treatment more than 12 months prior were significantly more interested in receiving care (AOR 2.02, 95% CI 1.02–4.01) and more willing to be contacted (AOR 2.49, 95% CI 1.18–5.26). Conclusions More than 40% of survivors expressed interest in receiving sexual health care, but few had ever sought such care. There is an unmet need for attention to sexual concerns among women with gynecologic and breast cancer. PMID:21656742

Hill, Emily K.; Sandbo, Stacey; Abramsohn, Emily; Makelarski, Jennifer; Wroblewski, Kristen; Wenrich, Emily Rose; McCoy, Stacy; Temkin, Sarah M.; Yamada, S. Diane; Lindau, Stacy Tessler

2010-01-01

271

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)  

PubMed Central

Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care. PMID:25005598

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-01-01

272

Ethical issues arising from the requirement to provide written information in palliative care  

E-print Network

1 Ethical issues arising from the requirement to provide written information in palliative care Plu by improving cooperation, coordination and the continuity of care. When applied to palliative care in the home and the gap between the legislation and the nature of the physician-patient relationship in palliative care

Paris-Sud XI, Université de

273

Providing Health Care to Latino Immigrants: Community-Based Efforts in the Rural Midwest  

Microsoft Academic Search

We examined case studies of 3 rural Midwestern communities to as- sess local health care systems' re- sponse to rapidly growing Latino pop- ulations. Currently, clinics provide free or low-cost care, and schools, public health, social services, and re- ligious organizations connect Latinos to the health care system. However, many unmet health care needs result from lack of health insurance,

Michelle M. Casey; Lynn A. Blewett; Kathleen T. Call

274

Child Care for Children with and without Disabilities: The Provider, Observer, and Parent Perspectives  

ERIC Educational Resources Information Center

This three-phase study, part of a larger study conducted by the Midwest Child Care Research Consortium (MCCRC), investigated the characteristics of child care providers in inclusive and non-inclusive center-based classrooms and family child care homes, the observed quality of care in a subset of these programs, and families' perceptions of quality…

Knoche, Lisa; Peterson, Carla A.; Edwards, Carolyn Pope; Jeon, Hyun-Joo

2006-01-01

275

78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers  

Federal Register 2010, 2011, 2012, 2013

...governing payments for certain non-VA health care, 38 CFR 17.56, applicable to...rule, we estimate that each home health care and hospice provider that does...negotiated contracts offer home health care or hospice care to veterans...

2013-05-06

276

Lessons Learned from Home Visiting with Home-Based Child Care Providers  

ERIC Educational Resources Information Center

Caring for Quality and Partners in Family Child Care are home visiting programs designed to improve the quality of home-based child care. This article describes the experiences of two different home visitors to demonstrate how programs such as these can help providers improve the overall quality of care, increase children's development, and lead…

McCabe, Lisa A.; Peterson, Shira M.; Baker, Amy C.; Dumka, Marsha; Brach, Mary Jo; Webb, Diana

2011-01-01

277

Centralisation of End of Life Care Coordination: Impact on the Role of Community Providers  

Microsoft Academic Search

Background The recently published End of Life Care Strategy 1 and emerging service improvements have raised the profile of end of life care (EOLC) across health and social care sectors. Policy emphasises providing patients with more choice over where they are cared for at the end of life. Surveys and anecdotal evidence suggest that the majority of people would prefer

Rachael Addicott

2009-01-01

278

Can we select health professionals who provide safer care  

PubMed Central

In order to improve patient safety, health services are looking to other industries' experiences and as a result are adopting a systems approach to learning from error, rather than simply focusing the blame on the individual. However, in health care the individual will remain an important contributor to safety and this paper looks at other literatures besides health to consider a number of individual characteristics and the role they might play in terms of work practices that affect patient safety. It considers the effects of a variety of personality profiles including sensation seeking, Type A, and those with high self esteem; looks at our ability to select for psychological wellbeing; and discusses the ways that psychometrics have been used in medicine to predict performance. It concludes that although rarely used, psychometrics has been shown to be useful in predicting some aspects of performance in medicine and suggests that this is an area well worth further study for the benefit of patient care. Nevertheless, we are a long way away from being able to select safer staff and should instead be developing this knowledge to enable us to recognise and address potential difficulties. PMID:14645743

Firth-Cozens, J; Cording, H; Ginsburg, R

2003-01-01

279

Caveats for doctors providing care for themselves, family, friends, and colleagues.  

PubMed

Physicians are almost always asked by a family member, friend, other healthcare provider, or an employee to provide him or her with medical care. Often this request for medical care is made over the phone, at a social gathering, or in the hallway of hospital. This article will discuss the ethics involved with providing medical care to family, friends, and colleagues and suggest guidelines for caring for these special people/patients. PMID:24873131

Kepper, Paul; Baum, Neil

2014-01-01

280

Vascular Endothelial Growth Factor Inhibitor-Induced Hypertension: Basics for Primary Care Providers  

PubMed Central

Frequently, primary care providers continue to manage the overall medical care of cancer patients. With newer and often more potent antitumor agents, patients may present to their local physicians with drug-induced toxicities such as hypertension induced by vascular endothelial growth factor (VEGF) inhibitors. It is imperative that these healthcare providers are aware of basic aspects of this drug class, as its use has increased significantly in the last several years. Uncontrolled or malignant hypertension due to these agents should be recognized readily and treated early to prevent more severe outcomes. This overview provides a brief background on the role of VEGF and angiogenesis in tumor metabolism as well as theories of the mechanism of VEGF inhibitors and hypertension. Helpful clinical practice aspects including the types of inhibitors used in the United States and their pharmacologic characteristics will be discussed. Also, diagnosis and treatment of hypertension induced by vascular endothelial growth factors are reviewed. A summary of key aspects of this drug class and hypertension is included. PMID:21629798

Escalante, Carmen P.; Zalpour, Ali

2011-01-01

281

Psychosocial distress among young breast cancer survivors: implications for healthcare providers.  

PubMed

Breast cancer (BC) experiences foster serious psychosocial problems among young survivors. Previous studies have repeatedly discussed younger age as a factor that puts women with BC at higher risk of psychosocial distress. Although most BC survivors receive the necessary information from healthcare providers on treatment options and procedures at diagnosis, they often fail to receive support and guidance after acute treatment has completed in dealing with the possible physical, emotional, social, and psychological effects of cancer. This article discusses common psychosocial problems experienced by young BC survivors, such as issues related to interpersonal relationships, sexuality, fertility, and employment. In particular, it examines influences of the Japanese sociocultural background on young survivors' distress and considers the clinical implications for Japanese healthcare. The importance of integrating psychosocial care with routine oncology care cannot be overemphasized. PMID:24318377

Takahashi, Miyako

2014-11-01

282

Care managers' views on death and caring for older cancer patients in Japan.  

PubMed

Care managers (CMs) have an important role in coordinating care for cancer patients who are in the end-of-life stage; however, little is known about their views of death and their experiences while caring for older cancer patients. This study was conducted to examine CMs' views of death and caring for older cancer patients in a home care setting in Japan. Convenience sampling was undertaken, and 35 offices from 43 approached services agreed to participate. The final valid sample included responses from 136 CMs (90.7%). Most CMs, including nurses, care workers, home helpers, and social workers in home care settings, experienced difficulty in managing the care of cancer patients in the end-of-life stage. Respondents reported a wide array of experiences with end-of-life care, care management, and seminar attendance, and their ages and Frommelt Attitude Toward Care of the Dying (FATCOD) scores were associated factors. Moreover, multiple regression analysis indicated that better attitudes toward caring for the dying were positively associated with seminar attendance. These results suggest that CMs need education about palliative and end-of-life care in order to promote good home care for cancer patients. PMID:24356505

Matsui, Miho; Kanai, Emi; Kitagawa, Akiko; Hattori, Keiko

2013-12-01

283

Health reforms as examples of multilevel interventions in cancer care.  

PubMed

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

Flood, Ann B; Fennell, Mary L; Devers, Kelly J

2012-05-01

284

Patient choice, mobility and competition among health care providers.  

PubMed

Policymakers are increasingly designing policies that encourage patient choice and therefore mobility across providers. Since prices are regulated (fixed) in most countries, providers need to compete on quality to attract patients. This chapter reviews the current theoretical and empirical literature on patient choice and quality competition in health markets. The theoretical literature identifies key factors affecting incentives to provide quality. These include: altruistic motives, cost structure, number of providers, demand responsiveness, GP gatekeeping, degree of specialization, profit constraints and soft budgets. We also review the theoretical literature on choice across different countries (e.g. within the EU) or regions within the same countries. The chapter reviews selected empirical studies that investigate whether demand responds to quality and waiting times, the role of patient's mobility and the effect of competition on quality. PMID:24864380

Brekke, Kurt R; Gravelle, Hugh; Siciliani, Luigi; Straume, Odd Rune

2014-01-01

285

Family Members Providing Home-Based Palliative Care to Older Adults: The Enactment of Multiple Roles  

ERIC Educational Resources Information Center

Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis…

Clemmer, Sarah J.; Ward-Griffin, Catherine; Forbes, Dorothy

2008-01-01

286

Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach  

Microsoft Academic Search

Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the strategies they perceive to encourage healthy eating in child care settings.

Meghan Lynch; Malek Batal

2012-01-01

287

Providing Palliative Care to People with Intellectual Disabilities: Services, Staff Knowledge, and Challenges  

Microsoft Academic Search

People with intellectual disabilities require access to compassionate, quality, and effective palliative and end- of-life care when facing serious, life-limiting illness. This study was designed to document the degree to which hospice and palliative care services were provided to New Jersey residents with intellectual disabilities, and the challenges in providing this care. Surveys were designed to assess the provision of

Gary L. Stein

2008-01-01

288

Child care for children with and without disabilities: The provider, observer, and parent perspectives  

Microsoft Academic Search

This three-phase study, part of a larger study conducted by the Midwest Child Care Research Consortium (MCCRC), investigated the characteristics of child care providers in inclusive and non-inclusive center-based classrooms and family child care homes, the observed quality of care in a subset of these programs, and families’ perceptions of quality and satisfaction with child care services. A telephone survey

Lisa Knoche; Carla A. Peterson; Carolyn Pope Edwards; Hyun-Joo Jeon

2006-01-01

289

Lung Cancer Assistant: a hybrid clinical decision support application for lung cancer care  

PubMed Central

Multidisciplinary team (MDT) meetings are becoming the model of care for cancer patients worldwide. While MDTs have improved the quality of cancer care, the meetings impose substantial time pressure on the members, who generally attend several such MDTs. We describe Lung Cancer Assistant (LCA), a clinical decision support (CDS) prototype designed to assist the experts in the treatment selection decisions in the lung cancer MDTs. A novel feature of LCA is its ability to provide rule-based and probabilistic decision support within a single platform. The guideline-based CDS is based on clinical guideline rules, while the probabilistic CDS is based on a Bayesian network trained on the English Lung Cancer Audit Database (LUCADA). We assess rule-based and probabilistic recommendations based on their concordances with the treatments recorded in LUCADA. Our results reveal that the guideline rule-based recommendations perform well in simulating the recorded treatments with exact and partial concordance rates of 0.57 and 0.79, respectively. On the other hand, the exact and partial concordance rates achieved with probabilistic results are relatively poorer with 0.27 and 0.76. However, probabilistic decision support fulfils a complementary role in providing accurate survival estimations. Compared to recorded treatments, both CDS approaches promote higher resection rates and multimodality treatments. PMID:24990290

Sesen, M. Berkan; Peake, Michael D.; Banares-Alcantara, Rene; Tse, Donald; Kadir, Timor; Stanley, Roz; Gleeson, Fergus; Brady, Michael

2014-01-01

290

Taking care of care providers: a wellness program for pediatric nurses.  

PubMed

The cumulative effect of professional stress and compassion fatigue within the health care profession has been receiving increasing attention. The impact can be especially worrisome for nurses who work with chronic illness populations, such as oncology. While interventions targeted at reducing nurses stress and promoting wellness are cited as necessary, they are often lacking in busy medical environments. In this article, the authors describe a newly developed 10-session wellness program that was offered on 2 occasions to both inpatient and outpatient nursing staff. The nursing staff chose the content areas, and each session used a combined approach of hands on and didactic learning. A description of the activity offered during each session along with the core competency and objectives measured are provided. Overall, staff found the wellness series very helpful to themselves and to their ability to positively change their job performance. PMID:22907685

Zadeh, Sima; Gamba, Nicole; Hudson, Caroline; Wiener, Lori

2012-01-01

291

Diet and Nutrition in Cancer Survivorship and Palliative Care  

PubMed Central

The primary goal of palliative cancer care is typically to relieve suffering and improve quality of life. Most approaches to diet in this setting have focused only on eating as many calories as possible to avoid cachexia. However, as the concept of palliative care has evolved to include all aspects of cancer survivorship and not just end of life care, there is an increasing need to thoughtfully consider diet and nutrition approaches that can impact not only quality of life but overall health outcomes and perhaps even positively affect cancer recurrence and progression. In this regard, there has been a recent emphasis in the literature on nutrition and cancer as an important factor in both quality of life and in the pathophysiology of cancer. Hence, the primary purpose of this paper is to review the current data on diet and nutrition as it pertains to a wide range of cancer patients in the palliative care setting. PMID:24288570

Bazzan, Anthony J.; Newberg, Andrew B.; Cho, William C.; Monti, Daniel A.

2013-01-01

292

Survival Strategies for Michigan's Health Care Safety Net Providers  

PubMed Central

Objective To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. Data Sources/Study Setting Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. Research Design In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. Principal Findings Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. Conclusions Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity. PMID:15960698

Jacobson, Peter D; Dalton, Vanessa K; Berson-Grand, Julie; Weisman, Carol S

2005-01-01

293

Ontology-based Modeling of Clinical Practice Guidelines: A Clinical Decision Support System for Breast Cancer Follow-up Interventions at Primary Care Settings  

E-print Network

for Breast Cancer Follow-up Interventions at Primary Care Settings Samina R. Abidi, Syed SR. Abidi, Sajjad, Canada Abstract Breast cancer follow-up care can be provided by family phy- sicians after specialists complete the primary treatment. Can- cer Care Nova Scotia has developed a breast cancer follow- up Clinical

Abidi, Syed Sibte Raza

294

Time To Talk with Your Health Care Providers: 4 Tips to Start the Conversation  

MedlinePLUS

... to Talk Tips Time To Talk With Your Health Care Providers: 4 Tips To Start the Conversation When ... fully informed and can help patients make wise health care decisions. Here are 4 tips to help you ...

295

Hepatitis B and Health Care Providers: What You Need to Know  

MedlinePLUS

... 489-4900 · info@hepb.org Hepatitis B and Health Care Providers What You Need To Know What is ... virus. How can I protect myself as a health care worker? The Centers for Disease Control and Prevention ( ...

296

Cultural perceptions in cancer care among African-American and Caucasian patients.  

PubMed Central

PURPOSE: This exploratory study examined perceptions and beliefs of African Americans and Caucasians related to cancer care. Understanding belief systems and cultures optimizes cancer treatment and care delivery to ethnic minority individuals. PATIENTS AND METHODS: Focus groups were conducted with 39 African-American and Caucasian cancer patients. Data analysis included whole group analysis with a team of five researchers. RESULTS: Regardless of ethnicity, cancer patients share many of the same emotions and experiences, and want complete information and quality care. Differences were also apparent. African-American participants were more likely to report increased religious behaviors, believe that healthcare providers demonstrate care with simple actions and provision of practical assistance, and use church and community information sources. Caucasian participants were more likely to report spiritual but not overtly religious changes, and depend on healthcare providers for information. CONCLUSION: Understanding how culture colors perceptions, communication and information requirements is critical to providing effective care to ethnically diverse cancer patients. Findings have implications for professionals understanding ways patients seek information, the role of spirituality and religion in care, and ways healthcare providers demonstrate care. PMID:17987914

Matsuyama, Robin K.; Grange, Christina; Lyckholm, Laurie J.; Utsey, Shawn O.; Smith, Thomas J.

2007-01-01

297

Cancer Care in the United States: What's Right, What's Wrong? - September 16, 1999  

Cancer.gov

CANCER CARE IN THE UNITED STATES: WHAT'S RIGHT, WHAT'S WRONG? ENSURING THE QUALITY OF CANCER CARE Robert Hiatt, M.D., Ph.D., Deputy Director of the Division of Cancer Control and Population Sciences National Cancer Institute National Institutes

298

CERTIFICATION OF HEALTH CARE PROVIDER FOR EMPLOYEE'S PREGNANCY DISABILITY  

E-print Network

. THE GENETIC INFORMATION NONDISCRIMINATION ACT OF 2008 (GINA): The Genetic Information Nondiscrimination Act or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information

Gleeson, Joseph G.

299

The Need for a Multidisciplinary Approach to Cancer Care  

Microsoft Academic Search

Background. Treatment of the cancer patient is multifaceted. In addition to treating the cancer itself, there are additional important, “noncancer” issues to consider concomitantly, such as the patient's coexistent diseases, their health behaviors, and preventive care measures. While the need for coordination among surgeons, oncologists, and radiation oncologists has been well documented for treatment of the cancer, little attention has

Clifford Ko; Saima Chaudhry

2002-01-01

300

The Work-Family Support Roles of Child Care Providers across Settings  

ERIC Educational Resources Information Center

This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…

Bromer, Juliet; Henly, Julia R.

2009-01-01

301

Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide "focused antenatal care"  

PubMed Central

Background Maternal mortality remains high in developing countries and data to monitor indicators of progress in maternal care is needed. We examined the status of maternal care before and after health care worker (HCW) training in WHO recommended Focused Antenatal Care. Methods An initial cross-sectional survey was conducted in 2002 in Asembo and Gem in western Kenya among a representative sample of women with a recent birth. HCW training was performed in 2003 in Asembo, and a repeat survey was conducted in 2005 in both areas. Results Antenatal clinic (ANC) attendance was similar in both areas (86%) in 2005 and not significantly different from 2002 (90%). There was no difference in place of delivery between the areas or over time. However, in 2005, more women in Asembo were delivered by a skilled assistant compared to Gem (30% vs.23%, P = 0.04), and this proportion increased compared to 2002 (17.6% and 16.1%, respectively). Provision of iron (82.4%), folic acid (72.0%), sulfadoxine-pyrimethamine (61.7%), and anthelminths (12.7%) had increased in Asembo compared to 2002 (2002: 53.3%, 52.8%, 20.3%, and 4.6%, respectively), and was significantly higher than in Gem in 2005 (Gem 2005: 69.7%, 47.8%, 19.8%, and 4.1%, respectively) (P < 0.05 for all). Offering of tests for sexually transmitted diseases and providing information related to maternal health was overall low (<20%) and did not differ by area. In 2005, more women rated the quality of the antenatal service in Asembo as very satisfactory compared to Gem (17% vs. 6.5%, P < 0.05). Conclusions We observed improvements in some ANC services in the area where HCWs were trained. However, since our evaluation was carried out 2 years after three-day training, we consider any significant, sustained improvement to be remarkable. PMID:20429906

2010-01-01

302

Obstacles To Enhancing the Learning Environments of Infants in Day Care: An Evaluation of Problems Perceived by Day Care Providers.  

ERIC Educational Resources Information Center

This study focused on creating a liaison between day care providers and college developmental psychology researchers with the intent that day care providers would be able to share discoveries and develop expertise in challenging infants appropriately to encourage development. The project was collaborated on by college students and faculty; the day…

Chambliss, Catherine

303

Cancer as a problem to be solved: internet use and provider communication by men with cancer.  

PubMed

Increasingly, cancer-related Web sites have been developed to provide information for patients. More needs to be done to understand the experience of men with cancer using the Internet. Heideggerian hermeneutics is the interpretive approach used to guide this study. Fifteen men with cancer who used the Internet were recruited through a prostate cancer support group and snowball sampling. Participants were individually interviewed and asked to tell stories of Internet use and practices. Transcribed interviews provided data for interpretive analysis. The overall constitutive pattern describing the men's experience is "cancer diagnosis as a problem to be solved." Five related themes included (1) seeking disease and treatments information from the Internet for decision making, to become comfortable with treatment plan; (2) organizing information to facilitate provider encounters and to monitor for reoccurrence; (3) evaluating Web information by credibility and usability with trust in the physician influencing the end decision point; (4) symptom management by knowing possibilities by hearing patient stories; and (5) navigating through the healthcare system politics and power. Men with cancer are incorporating Internet use into their cancer journey. They perceive changing provider-patient relationships when they participate in treatment decisions and monitor for reoccurrence. PMID:20975535

Dickerson, Suzanne S; Reinhart, Amber; Boemhke, Marcia; Akhu-Zaheya, Laila

2011-07-01

304

Nursing management of nutrition in cancer and palliative care.  

PubMed

Malnutrition is prevalent in patients with cancer. This can have deleterious effects including reduced response to treatment, diminished quality of life, increased length of hospital stay and decreased survival. It is, therefore, imperative that thorough nutritional screening is carried out by nurses on patients' admission and during their hospital stay to detect those who are malnourished or at risk of malnutrition in order to plan their nutritional care effectively. Cancer cachexia is the progressive weight loss and emaciation seen in cancer patients, particularly in advanced disease, which can have a devastating effect on the physical, psychological, social and spiritual aspects of the patient's life. Therefore, the aims of nutritional care are identified depending on the stage of the patient's illness and recommendations made for nursing, pharmacological and nutritional intervention. These include nursing comfort strategies, the use of recommended pharmacological agents and dietary interventions such as experimenting with different foods, textures, portion sizes and nutritional supplements. The use of fish oil-enhanced nutritional supplements and artificial nutritional support is also discussed. Consideration is also given to the legal and ethical aspects of providing nutrition and nutritional support. PMID:12829966

Holder, Helen

305

[Anemia caused by cancer in the context of palliative care].  

PubMed

Tumor anemia is very common in patients with cancer. The causes are very diverse and the parameter value depends on several factors. If this however develops to be symptomatic it may adversely impact health related quality of life. Erythropoietin or blood transfusion provides options for treatment. However, these are not always uneventful. There could also be a lack of response to Erythropoietin. This case report describes the complexity of tumor anemia. It also includes a more detailed discussion on the Fatigue Syndrome, which is one of the most common symptoms of patients with cancer. In the context of palliative care there is often the question of alternatives for improving the quality of patients life. Some kinds of treatment may also cause the opposite effect. A multidimensional assessment should help to approach this difficult issue and to find ways for a meaningful treatment of the symptoms of anemia. PMID:22328049

Altinger, Marion; Strasser, Florian

2012-01-01

306

The intelligent clinical laboratory as a tool to increase cancer care management productivity.  

PubMed

Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity. PMID:24761839

Mohammadzadeh, Niloofar; Safdari, Reza

2014-01-01

307

Primary care utilization patterns before and after lung cancer diagnosis.  

PubMed

The objective of this study was to evaluate change in primary care utilization rates after lung cancer diagnosis in the Veterans Health Administration. We used electronic medical record data (1997-2005) to identify male veterans (n = 323) with incident lung cancers. Primary care utilization rates were assessed in the 12-month period before and after cancer diagnosis. Statistical analysis included paired t-tests. Rates of primary care utilization decreased by 0.02 visits per person-month (VPPM) in the 12-month period after cancer diagnosis (P > 0.05). Utilization for acute conditions decreased by 20% (P < 0.01) in the 12-month period after diagnosis, from 0.32 VPPM before diagnosis to 0.12 VPPM after diagnosis. Utilization for chronic conditions remained stable after diagnosis (0.29 VPPM vs. 0.29 VPPM, P > 0.05). Indications for primary care utilization after diagnosis were similar to indications for utilization prior to diagnosis. Common indications for utilization included hypertension and lower respiratory infections. We speculate that primary care utilization for acute conditions was lower after cancer diagnosis because several of the acute conditions (e.g. upper respiratory infection) treated prior to the cancer may have been harbingers of the cancer diagnosis. Additional research is required to illuminate how primary care can best be delivered during the initial phase of cancer treatment. PMID:19267732

Jones, L E; Carney Doebbeling, C

2009-03-01

308

Professional caregivers' perceptions of providing information to parents of children with cancer.  

PubMed

Information has been described as a critical part of the care for parents of children with cancer, but not much is known about how caregivers makes decisions about informing parents. This study aims to illuminate professional caregivers' perceptions of providing information to parents of children with cancer. Twenty caregivers at a Swedish pediatric oncology ward participated in four focus group interviews. The interviews were transcribed verbatim and subjected to qualitative content analysis. Two themes were found: Matching the amount of information to the parents' needs concerned situations where the amount of information provided according to the caregivers' assessment is deemed too small, appropriate, or too large. Navigating through a vague structure dealt with a disrupted setting, unclear responsibilities within the team, difficult timing, unintelligible information, and underused tools for communication. Implications for intervention development are discussed. PMID:20841445

Ringnér, Anders; Jansson, Lilian; Graneheim, Ulla H

2011-01-01

309

Child-Rearing Beliefs Within Diverse Social Structures: Mothers and Day-Care Providers in Mexico  

Microsoft Academic Search

The child-rearing beliefs of 32 mothen and 36 day-care providers in Mexico were compared. Day-care providers expected children to master developmental skills at an earlier age than did mothers. Day-care providers more strongly valued the development of independent and cooperative behavior. and placed less importance on obedience. The y also reported employing more flexible and nonauthoritarian discipline strategies than did

Susan D. Holloway; Kathleen S. Gorman; Bruce Fuller

1988-01-01

310

Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers  

ERIC Educational Resources Information Center

The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…

Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

2011-01-01

311

Primary Care Providers' Knowledge, Practices, and Perceived Barriers to the Treatment and Prevention of Childhood Obesity  

Microsoft Academic Search

This study evaluated primary care providers' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year well-child care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics

Jordan G. Spivack; Maggie Swietlik; Evaline Alessandrini; Myles S. Faith

2010-01-01

312

Factors Related to the Recruitment, Training, and Retention of Family Child Care Providers.  

ERIC Educational Resources Information Center

Identified factors related to the recruitment, training, and retention of family child care (FCC) providers in two rural communities who participated in an FCC training program. Findings point to the relative success of efforts to recruit and train high quality family child care providers and the relative difficulty of retaining these providers

Mueller, Charles W.; Orimoto, Lisa

1995-01-01

313

Lesbian Experiences and Needs During Childbirth: Guidance for Health Care Providers  

Microsoft Academic Search

JOGNN 13 Objective: To provide an overview of the litera- ture regarding lesbian experiences of childbirth and to offer health care providers guidance in supporting the childbearing lesbian couple. Data Sources: A search of the literature from 1980 through 2004 was conducted using PsycINFO, Ovid, PubMed, Ebscohost, and CINAHL, and the key words, lesbian, childbirth, parenting health care provid- ers,

Alison J. McManus; Lauren P. Hunter; Hope Renn

2006-01-01

314

Second Helping: An Advanced Enrichment Course for Family Child Care Providers. Program Information Package. [Revised.  

ERIC Educational Resources Information Center

Second Helping is a 32-hour, 4-module course designed by and for family child care providers to address issues of concern to the provider, such as individual well-being, business skills, family relations, and child development. This booklet discusses the Second Helping family child care provider training course and outlines the qualifications…

Windflower Enterprises, Colorado Springs, CO.

315

Promoting Wellness: A Nutrition, Health and Safety Manual for Family Child Care Providers.  

ERIC Educational Resources Information Center

This manual provides a reference source for use by sponsor organizations of the Child and Adult Care Food Program (CACFP) in training family child care providers. The manual begins with separate introductory sections for trainers and for providers. The trainer's section includes materials on: how adults learn, strengths and limitations of various…

Tatum, Pam S.

316

Health Care Providers: A Missing Link in Understanding Acceptability of the Female Condom  

ERIC Educational Resources Information Center

Health care providers can play a key role in influencing clients to initiate and maintain use of the female condom, an underused method for HIV/STI and pregnancy prevention. In 2001-2002, based on semistructured interviews with 78 health care providers from four types of settings in New York City, we found that most providers had seen the female…

Mantell, Joanne E.; West, Brooke S.; Sue, Kimberly; Hoffman, Susie; Exner, Theresa M.; Kelvin, Elizabeth; Stein, Zena A.

2011-01-01

317

Massachusetts General Hospital Cancer Center Advancing cancer care through groundbreaking research  

E-print Network

of basic cancer research in fields from genetics and genomics to computational biology and stem cell advances are allowing researchers to gain a deeper understanding of the genetic makeup of cancers, whichMassachusetts General Hospital Cancer Center Advancing cancer care through groundbreaking research

de Bakker, Paul

318

Applying justice and commitment constructs to patient-health care provider relationships  

PubMed Central

Abstract Objective To examine patients’ experiences of fairness and commitment in the health care context with an emphasis on primary care providers. Design Qualitative, semistructured, individual interviews were used to gather evidence for the justice and commitment frameworks across a variety of settings with an emphasis on primary care relationships. Setting Rural, urban, and semiurban communities in Nova Scotia. Participants Patients (ages ranged from 19 to 80 years) with varying health care needs and views on their health care providers. Methods Participants were recruited through a variety of means, including posters in practice settings and communication with administrative staff in clinics. Individual interviews were conducted and were audiotaped and transcribed verbatim. A modified grounded theory approach was used to interpret the data. Main findings Current conceptualizations of justice (distributive, procedural, interpersonal, informational) and commitment (affective, normative, continuance) capture important elements of patient–health care provider interactions and relationships. Conclusion Justice and commitment frameworks developed in other contexts encompass important dimensions of the patient–health care provider relationship with some exceptions. For example, commonly understood subcomponents of justice (eg, procedural consistency) might require modification to apply fully to patient–health care provider relationships. Moreover, the results suggest that factors outside the patient–health care provider dyad (eg, familial connections) might also influence the patient’s commitment to his or her health care provider. PMID:22423030

Holmvall, Camilla; Twohig, Peter; Francis, Lori; Kelloway, E. Kevin

2012-01-01

319

Training Providers and Patients to Talk about End-of-Life Care  

Cancer.gov

Failing to discuss the transition from active cancer treatment to end-of-life care can leave doctors unsure of what a patient truly wants. Failing to receive end-of-life care in line with their values and wishes can cause patients and their families great distress. Researchers have developed innovative, evidence-based programs to help doctors and patients improve their communication skills and grow comfortable with these discussions.

320

California Early Care and Education Workforce Study: Licensed Family Child Care Providers Statewide, 2006  

ERIC Educational Resources Information Center

This report presents the results of First 5 California's 2004 statewide and regional study of the early care and education (ECE) workforce in licensed family child care. The goal of the study was to collect information on the characteristics of this workforce (i.e., educational background and potential need and demand for professional…

Whitebook, Marcy; Sakai, Laura; Kipnis, Fran; Lee, Yuna; Bellm, Dan; Speiglman, Richard; Almaraz, Mirella; Stubbs, LaToya; Tran, Paulina

2006-01-01

321

Approach to primary care follow-up of patients with prostate cancer  

PubMed Central

OBJECTIVE To review resources available to aid family physicians in their care of prostate cancer patients and develop an algorithm to summarize these findings. SOURCES OF INFORMATION MEDLINE, EMBASE, and relevant website search. All relevant guidelines were level III evidence. MAIN MESSAGE Improved screening and treatment of patients with prostate cancer is resulting in an increasing number of survivors. These men require ongoing monitoring, a responsibility that is largely falling to family physicians. We review the expected prostate-specific antigen (PSA) responses to different prostate cancer treatment modalities and provide an appropriate schedule of follow-up and monitoring techniques for prostate cancer patients. CONCLUSION In light of the paucity of resources for family physicians in their ongoing care of prostate cancer patients, we present an algorithm, primarily based on PSA kinetics, for practical use in the continuing care of these patients. PMID:18272636

Wilkinson, Anna N.; Brundage, Michael D.; Siemens, Robert

2008-01-01

322

Patient and Provider Preferences for Colorectal Cancer Screening: How Does CT Colonography Compare to Other Modalities?  

PubMed Central

Objectives Patient and provider preferences toward CT colonography (CTC) remain unclear. The primary goals of this study were 1) to investigate patient preferences for one of the currently recommended CRC screening modalities and 2) to evaluate provider preferences before and after review of updated guidelines. Methods Cross-sectional survey of ambulatory-care patients and providers in the primary care setting. Providers were surveyed before and after reviewing the 2008 guidelines by the American Cancer Society, US Multisociety Task Force on Colorectal Cancer and the American College of Radiology. Results Of 100 patients surveyed, 59% preferred colonoscopy, 17% fecal occult blood testing (FOBT), 14% stool DNA (sDNA) testing, and 10% CTC (P <0.001). The majority of those whose first choice was a stool-based test chose the alternate stool-based test as their second choice over CTC or colonoscopy (P<0.0001). Patients who preferred colonoscopy chose accuracy (76%) and frequency of testing (10%) as the most important test features, whereas patients who preferred a stool-based test chose discomfort (52%) and complications (23%). Of 170 providers surveyed, 96% chose colonoscopy, 2% FOBT, and 1% FOBT with flexible sigmoidoscopy (FS) (p < 0.0001). No providers chose CTC or sDNA as their preferred option before reviewing guidelines, and 89% kept their preference after review of guidelines. As a default option for patients who declined colonoscopy, 44% of providers chose FOBT, 12% FOBT+FS, 4% CTC, and 37% deferred to patient preference before review of guidelines. Of the 33% of providers who changed their preference after review of guidelines, 46% recommended CTC. Accuracy was the most influential reason for provider test choice. Conclusions Patients and providers prefer colonoscopy for CRC screening. Revised guidelines endorsing the use of CTC are unlikely to change provider preferences but may influence choice of default strategies for patients who decline colonoscopy.

Calderwood, Audrey H.; Wasan, Sharmeel K.; Heeren, Timothy C.; Schroy, Paul C.

2013-01-01

323

Ethical Issues in the End of Life Care for Cancer Patients in Iran  

PubMed Central

Background: In the recent years, advances in medical technologies for end stage cancer patients’ care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists’ viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process. Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data. Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system. Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians’ communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care. PMID:23515352

MOBASHER, Mina; NAKHAEE, Nouzar; TAHMASEBI, Mamak; ZAHEDI, Farzaneh; LARIJANI, Bagher

2013-01-01

324

Communication and Cultural Issues in Providing Reproductive Health Care to Immigrant Women: Health Care Providers’ Experiences in Meeting Somali Women Living in Finland  

Microsoft Academic Search

Communication problems due to language and cultural differences between health care professionals and patients are widely\\u000a recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as\\u000a more open in their communication. The aim of the study was to explore physicians-nurses\\/midwives’ communication when providing\\u000a reproductive and maternity health care to Somali women in

Filio Degni; Sakari Suominen; Birgitta Essén; Walid El Ansari; Katri Vehviläinen-Julkunen

325

Trust in health care providers: factors predicting trust among homeless veterans over time.  

PubMed

We examined whether a combination of predisposing, enabling, need, and primary care experience variables would predict trust in medical health care providers for homeless veterans over 18 months. Linear mixed model analysis indicated that, among these variables, race, social support, service-connected disability status, and satisfaction and continuity with providers predicted trust in provider over time. Trust in providers improved during the initial stages of the relationship between patient and provider and then declined to slightly below baseline levels over time. Further research is needed to determine generalizability and effects of provider trust on patient health care status over longer periods of time. PMID:25130239

van den Berk-Clark, Carissa; McGuire, James

2014-08-01

326

Racial and Ethnic Differences in Beliefs About Lung Cancer Care  

PubMed Central

Background: Disparities in lung cancer treatment and palliative care are well documented. However, the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer. Methods: Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients. Results: Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups (P > .05), whereas black patients were more likely to believe that surgery might cause lung cancer to spread (P = .008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups (P ? .02). No significant differences were found in attitudes toward clinician communication about cancer prognosis (P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care (P ? .02). Conclusions: Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes. PMID:22700777

Jonnalagadda, Sirisha; Lin, Jenny J.; Nelson, Judith E.; Powell, Charles A.; Salazar-Schicchi, John; Berman, Andrew R.; Keller, Steven M.; Smith, Cardinale B.; Lurslurchachai, Linda; Halm, Ethan A.; Leventhal, Howard

2012-01-01

327

75 FR 69449 - Draft Guidance for Industry and Food and Drug Administration Staff on Dear Health Care Provider...  

Federal Register 2010, 2011, 2012, 2013

...Drug Administration Staff on Dear Health Care Provider Letters: Improving Communication...and FDA staff entitled ``Dear Health Care Provider Letters: Improving Communication...Important Safety Information.'' Dear Health Care Provider (DHCP) Letters are...

2010-11-12

328

California Early Care and Education Workforce Study: Licensed Child Care Centers and Family Child Care Providers. Statewide Highlights  

ERIC Educational Resources Information Center

Recognizing the critical role that early childhood educators play in the lives of California's children and families, First 5 California commissioned in 2004 a statewide and regional study of the early care and education (ECE) workforce in licensed child care centers and licensed family child care homes. The overall goal of the study was to…

Center for the Study of Child Care Employment, University of California at Berkeley, 2006

2006-01-01

329

Examining the Preferences of Health Care Providers: An application to hospital consultants  

Microsoft Academic Search

The aim of this chapter is to show how discrete choice experiments (DCEs) can be applied to examine the preferences of health\\u000a care providers. Health care providers comprise health care organisations and health professionals employed within them. Health\\u000a professionals make decisions about their supply of labour in addition to clinical decisions. A key policy issue across many\\u000a developed and developing

Anthony Scott; Cristina Ubach; Fiona French; Gillian Needham

330

End-of-life caregiver interactions with health care providers: learning from the bad.  

PubMed

This qualitative study examined caregivers' perceptions of and stories about their interactions with nonhospice health care providers. The sample included 27 family caregivers who provided the majority of in-home physical care and emotional support to the elders for at least 6 months. Caregivers described some startling interactions that suggest the need to reevaluate health care professionals' abilities and attitudes concerning their treatment and communication with family caregivers and their elders dying from life-limiting illnesses. PMID:20375703

Guo, Guifang; Phillips, Linda R; Reed, Pamela G

2010-01-01

331

Implementing a care coordination program for children with special healthcare needs: partnering with families and providers.  

PubMed

Care coordination has been a key theme in national forums on healthcare quality, design, and improvement. This article describes the characteristics of a care coordination program aimed at supporting families in building care coordination competencies and providers in the coordination of care across multiple specialties. The program included implementation of a Care Coordination Counselor (CC Counselor) and several supporting tools-Care Binders, Complex Scheduling, Community Resources for Families Database, and a Care Coordination Network. Patients were referred by a healthcare provider to receive services from the CC Counselor or to receive a Care Binder organizational tool. To assess the impact of the counselor role, we compared patient experience survey results from patients receiving CC Counselor services to those receiving only the Care Binder. Our analysis found that patients supported by the CC Counselor reported greater agreement with accessing care coordination resources and identifying a key point person for coordination. Seventy-five percent of CC Counselor patients have graduated from the program. Our findings suggest that implementation of a CC Counselor role and supporting tools offers an integrative way to connect patients, families, and providers with services and resources to support coordinated, continuous care. PMID:22913270

Taylor, April; Lizzi, Michele; Marx, Alison; Chilkatowsky, Maryann; Trachtenberg, Symme W; Ogle, Sue

2013-01-01

332

Perspectives of College Students and Their Primary Health Care Providers on Substance Abuse Screening and Intervention  

ERIC Educational Resources Information Center

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care -provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires…

Baldwin, Julie A.; Johnson, Rhonda M.; Gotz, Nina K.; Wayment, Heidi A.; Elwell, Kristan

2006-01-01

333

How Health Care Providers Can Help Link Children to Medicaid and Other Child Health Insurance Programs.  

ERIC Educational Resources Information Center

This reports that health care providers, including those based in schools, can be instrumental in efforts to enroll eligible children in Medicaid or low-cost health insurance. There are 10 ways in which health care providers can help: (1) inform families about the availability of free and low-cost health insurance for children; (2) enlist all…

Ross, Donna Cohen

334

Collaborative Development of a Recipe and Menu Planning Guide for Child Care Providers  

Microsoft Academic Search

LEARNING OUTCOME: To identify the components in the development and evaluation of a recipe and menu planning guide for child care providers based on dietary guidelines.In an effort to introduce the basic concepts of the Dietary Guidelines to child care providers, a project was undertaken to create a recipe and menu planning guide. At the onset of the project (Phase

J. Haines; M. Sigman-Grant; L. Brown

1996-01-01

335

Choosing a Primary Health Care Provider (PCP): A Guide for Young Women  

MedlinePLUS

Choosing a Primary Health Care Provider (PCP): General Information Posted under Health Guides . Updated 12 June 2013. +Related Content Key Facts Having a PCP ... needs. How do I find the names of health care providers? You should first make a list of ...

336

Choosing a Primary Health Care Provider (PCP): A Guide for Young Men  

MedlinePLUS

C hoosing a Primary Health Care Provider (PCP) Choosing a PCP Check-Ups How to Find a PCP When to Visit Your PCP Health Plans If ... Qualifications of PCPs Confidentiality Going to a primary health care provider (PCP) is a very important part of ...

337

Child-Care Provider Survey Reveals Cost Constrains Quality. Research Brief. Volume 96, Number 5  

ERIC Educational Resources Information Center

A survey of 414 child care providers in southeastern Wisconsin reveals that cost as well as low wages and lack of benefits for workers can constrain providers from pursuing improvements to child-care quality. Of survey respondents, approximately half of whom are home-based and half center-based, 13% have at least three of five structural factors…

Public Policy Forum, 2008

2008-01-01

338

Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach  

ERIC Educational Resources Information Center

Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…

Lynch, Meghan; Batal, Malek

2012-01-01

339

Promoting Child Development and Behavioral Health: Family Child Care Providers' Perspectives  

Microsoft Academic Search

IntroductionGiven the significant proportion of children in nonparental child care and the importance of early life experiences on development, interventions to improve a child care provider's ability to enhance a young child's development and behavior are essential. Such interventions require understanding of and responsiveness to the provider's self-perceived roles, responsibilities, and willingness to engage in such interventions, yet prior research

Marjorie S. Rosenthal; Angela A. Crowley; Leslie Curry

2009-01-01

340

Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs  

ERIC Educational Resources Information Center

The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

2009-01-01

341

Computer Mediated Communication: Providing Pastoral Care to Youth in “A High Tech” World  

Microsoft Academic Search

This study used a hermeneutical methodology to explore how Computer Mediated Communication (CMC) can be used to provide pastoral care to youth in a high tech world. The research was motivated by the writers desire to find ways to be in communication with youth and provide pastoral care to them during their adolescent years. The thesis will explore computer mediated

Tanya L. Ramer

2008-01-01

342

License-Exempt Child Care Providers: A Needs Assessment for Designing an Implementation Model  

ERIC Educational Resources Information Center

Many children from low-income families appear to be not receiving quality child care from their license-exempt subsidized child-care providers. The purpose of this qualitative case study was to obtain data from a sample of license-exempt providers/caregivers and parents from a mailed self-administered survey and telephone interview. Four research…

Roseburr, Linda Joyce

2008-01-01

343

Bringing cancer care to the poor: experiences from Rwanda.  

PubMed

The knowledge and tools to cure many cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Bringing cancer care to the poor, particularly to low-income countries, is a great challenge, but it is one that we believe can be met through partnerships, careful planning and a set of guiding principles. Alongside vaccinations, screening and other cancer-prevention efforts, treatment must be a central component of any cancer programme from the start. It is also critical that these programmes include implementation research to determine programmatic efficacy, where gaps in care still exist and where improvements can be made. This article discusses these issues using the example of Rwanda's expanding national cancer programme. PMID:25355378

Shulman, Lawrence N; Mpunga, Tharcisse; Tapela, Neo; Wagner, Claire M; Fadelu, Temidayo; Binagwaho, Agnes

2014-12-01

344

Documenting the health insurance needs of cancer patients and providing scarce resolutions.  

PubMed

The American Cancer Society's Health Insurance Assistance Service provides callers to its National Cancer Information Center with detailed knowledge to help them access or maintain health insurance coverage for which they might be eligible. Demographic data from April 2009 to June 2011 show that 76 % were uninsured and between the ages of 40-60; 65 % were Caucasian, 17 % African American, and 12% Hispanic; and monthly incomes were $1,999 or less. Current trends indicate that callers are similar to those identified in various health care reform publications: callers are unable to afford co-pays; facilities are requesting cash upfront; callers report loss of coverage, less adequate or less affordable coverage from employers; large out-of-pocket expense or high deductibles are needed; and modification of the CDC's Breast and Cervical Screening Program's eligibility guidelines create challenges. Six lessons that have been learned while initiating and managing this program are presented. PMID:23371058

Wiatrek, Dawn Elise; Morra, Marion; Shaw, Beverly; Sharpe, Katherine; George, Roshini; Battaglia-Seiler, Mandi; Fellers, Melissa

2013-06-01

345

Watch for Cancer Care and Economics Research Blog!  

Cancer.gov

ARP's Health Services and Economics Branch (HSEB) will soon launch its Cancer Care and Economics Research blog. HSEB studies demographic, social, economic, and health system factors as they relate to screening, diagnostic, treatment, and survivorship care, and it develops and improves the methods and techniques of economic and health services research across the cancer control continuum. The blog is intended to facilitate dialogue about HSEB's research resources and research initiatives.

346

Promoting new approaches for cancer care in the Middle East  

PubMed Central

Cancer is now the fastest growing killing disease in the Middle East. Accordingly, there is an urgent need to train local health professionals: Oncologists, Palliative Care experts, Oncology Nurses, Psychologists, along with social workers, physiotherapists and spiritual counselors on strategies for early detection, curative therapies and palliation. Professionals in the region, along with the public, need to convince medical administrators, regulators and policymakers about investing in education and training of YOUNG professionals, As well as those with already proven experience in cancer care. Training is the basis for any future cancer care program, which aims at the integration of palliative care practices into standard oncology care across the trajectory of the illness. PMID:24001764

Silbermann, M.; Epner, D. E.; Charalambous, H.; Baider, L.; Puchalski, C. M.; Balducci, L.; Gultekin, M.; Abdalla, R. F.; Daher, M.; Al-Tarawneh, M. R.; Smith, T. J.

2013-01-01

347

Accountable care organizations: the case for flexible partnerships between health plans and providers.  

PubMed

Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare's cost growth in their communities. However, the dismal history of provider-led attempts to manage costs suggests that this program is unlikely to accomplish its objectives. What's more, if ACOs foster more market concentration among providers, they have the potential to shift costs onto private insurers. This paper proposes a more flexible payment model for providers and private insurers that would divide health care services into three categories: long-term, low-intensity primary care; unscheduled care, including unscheduled emergency services; and major clinical interventions that usually involve hospitalization or organized outpatient care. Each category of care would be paid for differently, with each containing different elements of financial risk for the providers. Health plans would then be encouraged to provide logistical and analytic support to providers in managing health costs in these categories. PMID:21209435

Goldsmith, Jeff

2011-01-01

348

Knowledge and attitudes of day care center parents and care providers regarding children infected with human immunodeficiency virus.  

PubMed

It was hypothesized that parents and child care providers are not prepared to accept children infected with human immunodeficiency virus (HIV), who are increasing in number, into the day care center setting. To determine their knowledge and attitudes toward HIV transmission, 219 parents in 4 day care centers and 176 care providers in 12 day care centers were given confidential questionnaires. More than 98% of respondents knew that sex and needle sharing can transmit HIV; 84% of parents and 77% of care providers knew that contact with blood can transmit HIV. There was, however, uncertainty about transmission via many common contacts in day care centers: human bites, urine, stool, tears, and vomit; kissing; sharing of food and eating utensils; and diaper changing areas. Only 43% of parents said they would allow their child to stay in the same room with a child who was infected with HIV. In a multiple logistic regression model, the unwillingness of parents to have their child stay in the same room with a child who was infected with HIV was significantly (P less than .0001) associated with black ethnicity, beliefs that such a child is likely to infect others (40%) and is dangerous to others (58%), and fear of their child being exposed to HIV (86%). Care providers' unwillingness to care for a child infected with HIV in the classroom (48%) was significantly (P less than .0001) associated with beliefs that such a child is likely to infect others (44%) and that common day care center contacts can transmit HIV (62%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2034493

Morrow, A L; Benton, M; Reves, R R; Pickering, L K

1991-06-01

349

Delivery of affordable and equitable cancer care in India.  

PubMed

The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. Public expenditure on cancer in India remains below US$10 per person (compared with more than US$100 per person in high-income countries), and overall public expenditure on health care is still only slightly above 1% of gross domestic product. Out-of-pocket payments, which account for more than three-quarters of cancer expenditures in India, are one of the greatest threats to patients and families, and a cancer diagnosis is increasingly responsible for catastrophic expenditures that negatively affect not only the patient but also the welfare and education of several generations of their family. We explore the complex nature of cancer care systems across India, from state to government levels, and address the crucial issues of infrastructure, manpower shortages, and the pressing need to develop cross-state solutions to prevention and early detection of cancer, in addition to governance of the largely unregulated private sector and the cost of new technologies and drugs. We discuss the role of public insurance schemes, the need to develop new political mandates and authority to set priorities, the necessity to greatly improve the quality of care, and the drive to understand and deliver cost-effective cancer care programmes. PMID:24731888

Pramesh, C S; Badwe, Rajendra A; Borthakur, Bibhuti B; Chandra, Madhu; Raj, Elluswami Hemanth; Kannan, T; Kalwar, Ashok; Kapoor, Sanjay; Malhotra, Hemant; Nayak, Sukdev; Rath, Goura K; Sagar, T G; Sebastian, Paul; Sarin, Rajiv; Shanta, V; Sharma, Suresh C; Shukla, Shilin; Vijayakumar, Manavalan; Vijaykumar, D K; Aggarwal, Ajay; Purushotham, Arnie; Sullivan, Richard

2014-05-01

350

Genetics and Common Disorders: Implications for Primary Care and Public Health Providers  

SciTech Connect

We developed this program for primary care providers (PCPs) and public health professionals (PHPs) who are interested in increasing their understanding of the genetics of common chronic diseases and of the implications of genetics and genomics for their fields. The program differs from virtually all previous educational efforts in genetics for health professionals in that it focuses on the genetics of common chronic disease and on the broad principles that emerge when one views disease from the perspectives of variation and individuality, which are at the heart of thinking genetically. The CD-ROM introduces users to content that will improve their understanding of topics such as: • A framework for genetics and common disease; • Basic information on genetics, genomics, genetic medicine, and public health genetics, all in the context of common chronic disease; • The status of research on genetic contributions to specific common diseases, including a review of research methods; • Genetic/environmental interaction as the new “central dogma” of public health genetics; • The importance of taking and analyzing a family history; • The likely impact of potential gene discovery and genetic testing on genetic counseling and risk assessment and on the practices of PCPs and PHPs; • Stratification of populations into low-, moderate-, and high-risk categories; • The potential role of PCPs and PHPs in identifying high-risk individuals and families, in providing limited genetics services, and in referring to clinical genetics specialists; the potential for standard referral algorithms; • Implications of genetic insights for diagnosis and treatment; • Ethical, legal, and social issues that arise from genetic testing for common chronic diseases; and • Specific prevention strategies based on understanding of genetics and genetic/ environmental interactions. The interactive content – developed by experts in genetics, primary care, and public health – is organized around two case studies designed to appeal to primary care providers (thrombophilia) and public health professionals (development of a screening grogram for colorectal cancer). NCHPEG has distributed more than 0000 copies of the CD-ROM to NCHPEG member organizations and to other organizations and individuals in response to requests. The program also is available at www.nchpeg.org.

McInerney, Joseph D.; Greendale, Karen; Peay, Holly L.

2005-06-01

351

WHEN DOES AN EPISODE OF CARE FOR CANCER BEGIN?  

PubMed Central

Background Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms prior to a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized that health care use increases prior to diagnosis of a new primary cancer. Methods We used a longitudinal case-control design to estimate incremental medical care utilization rates. Cases were 121,293 persons enrolled between January, 2000 and December, 2008 with one or more primary cancers. We selected 522,839 controls randomly from among all health plan members who had no tumor registry evidence of cancer prior to January, 2009, and we frequency matched controls to cancer cases on a five-to-one ratio by age group, gender, and having health plan eligibility in the year of diagnosis of the index cancer case. Utilization data were extracted for all cases and controls for the period 2000-2008 from standardized distributed data warehouses. To determine when and the extent to which patterns of medical care use change preceding a cancer diagnosis, we compute hospitalization rates, hospital days, emergency department visits, same-day surgical procedures, ambulatory medical office visits, imaging procedures, laboratory tests, and ambulatory prescription dispensings per 1,000 persons per month within integrated delivery systems. Results One- to three-fold increases in monthly utilization rates were observed during the three to five months prior to a cancer diagnosis, compared to matched non-cancer control groups. This pattern was consistent for both aged and non-aged cancer patients. Aged cancer patients had higher utilization rates than non-aged cancer patients throughout the year prior to a cancer diagnosis. Conclusion The pre-diagnosis phase is a resource-intensive component of cancer care episodes and should be included in cost of cancer estimates. More research is needed to determine whether reliable prognostic markers can be identified as the start of a cancer episode prior to a pathology-based diagnosis. PMID:23222500

Hornbrook, Mark C.; Fishman, Paul A.; Ritzwoller, Debra P.; Lafata, Jennifer Elston; O'Keeffe-Rosetti, Maureen C.; Salloum, Ramzi G.

2012-01-01

352

Is provider type associated with cancer screening and prevention: advanced practice registered nurses, physician assistants, and physicians  

PubMed Central

Background Physician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians’ ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations. Methods Data from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n?=?26,716). Results In adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p?provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p?provider type). Conclusions Seeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform. PMID:24685149

2014-01-01

353

Comparison of trust in public vs private health care providers in rural Cambodia.  

PubMed

How trust in providers affects health care-seeking behaviour is not well understood. Focus groups and household surveys were conducted in Cambodia to examine how villagers describe their trust in public and private providers, and to assess whether a difference exists in provider trust levels. Our findings suggest the reasons for trusting public and private providers differ, and that villagers' trust in and relationship with providers is one of the important considerations affecting where they seek care. People believed that public providers were 'honest' and 'sincere', did not 'bad mouth people' and explained the 'status of [the] disease'. Villagers trusted public providers for their skills and abilities, and for an effective referral system. In contrast, respondents noted that seeing private providers was 'comfortable and easy', that they 'come to our home' and patients can 'owe [them] some money'. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact. Among those who sought care in the past 30 days, trust in the health care provider was listed as the fifth and second most important consideration for choosing public or private providers, respectively. This study illustrates the importance of trust as a unique concept that can affect people's choice of health care providers in a low-income country. PMID:21729914

Ozawa, Sachiko; Walker, Damian G

2011-07-01

354

Nutrition and oral health considerations in children with special health care needs: implications for oral health care providers.  

PubMed

Children with special health care needs are at increased risk for oral diseases. The purpose of this article was to discuss: nutritional and oral health factors routinely observed in most chronic childhood disorders; dietary modifications associated with select systemic disorders and how they may impact oral health in children; and the following factors common to chronic disorders associated with diet modifications-decreased appetite and increased nutritional risk; frequency of food intake; parental overindulgence; long-term use of cariogenic medications; and xerostomia. Characteristics of childhood disorders that require dietary modifications (congenital heart disease, cystic fibrosis, cancer, AIDS/HIV, diabetes mellitus, and phenylketonuria) are summarized. In addition, healthy dietary modifications and oral health recommendations are suggested. Implementation of these recommendations can assist the dentist and dental team as they join physicians and nutritionists in delivering the best possible care to children with special health care needs. PMID:20836954

Moursi, Amr M; Fernandez, Jill B; Daronch, Marcia; Zee, Lena; Jones, Cassandra L

2010-01-01

355

Informational Flyer for the Patient-Centered Communication in Cancer Care monograph  

Cancer.gov

National Cancer Institute PATIENT-CENTERED COMMUNICATION IN CANCER CARE Promoting Healing and Reducing Suffering U.S. DEPARTMENT OF HEAL TH AND HUMAN SERVICES National Institutes of Health PATIENT-CENTERED COMMUNICATION IN CANCER CARE Promoting

356

Increasing Primary Care Physician Support for and Promotion of Cancer Clinical Trials  

PubMed Central

Only 2.5%–3% of adult cancer patients participate in cancer clinical trials, yet about 20% of cancer patients are medically eligible to participate. Research suggests that the primary care provider (PCP) can influence a patient's awareness of, and potentially, his or her decision to consider a clinical trial. To address low cancer clinical trial accrual rates, ‘Imi Hale Native Hawaiian Cancer Network partnered with The Queen's Cancer Center to provide and evaluate education on clinical trials to Hawai‘i PCPs. The educational materials were developed from a national curriculum and tailored to local audiences. Objectives of the curriculum were to educate PCPs about common myths (attitudinal barriers) around clinical trials and suggest ways that PCPs can introduce the concept of clinical trials to their patients with cancer or suspicion of cancer. The curriculum was tested on 128 PCPs in 2012. Knowledge of the PCP's role and their willingness to mention clinical trials were measured through a post-test immediately following the presentation, which 74 (58%) PCPs completed. The post-test results suggested an increase in awareness among PCPs of their potential role in cancer clinical trial accrual, and an increase in PCP willingness to mention clinical trials to their patients with suspicion of cancer or diagnosed with cancer. Although findings suggest that this intervention is useful in increasing PCP receptivity to promoting cancer clinical trials, more research is needed to test if increased willingness results in increased accrual of cancer patients into clinical trials in Hawai‘i. PMID:24660125

Tsark, JoAnn U; Braun, Kathryn L

2014-01-01

357

Cancer Care Outcomes Research & Surveillance Consortium (CanCORS)  

Cancer.gov

Although many studies have documented disparities in cancer care, few have explored the reasons for these disparities. Few data are available about relationships between quality of care and outcomes among patients who would not meet criteria for enrollment in many clinical trials; these include elderly patients and patients with substantial co-morbidity.

358

Understanding process-of-care delays in surgical treatment of breast cancer at a comprehensive cancer center.  

PubMed

Few studies have examined care processes within providers' and institutions' control that expedite or delay care. The authors investigated the timeliness of breast cancer care at a comprehensive cancer center, focusing on factors influencing the time from initial consultation to first definitive surgery (FDS). The care of 1,461 women with breast cancer who underwent surgery at Dana-Farber/Brigham and Women's Cancer Center from 2011 to 2013 was studied. The interval between consultation and FDS was calculated to identify variation in timeliness of care based on procedure, provider, and patients' sociodemographic characteristics. Targets of 14 days for lumpectomy and mastectomy and 28 days from mastectomy with immediate reconstruction were set and used to define delay. Mean days between consultation and FDS was 21.6 (range 1-175, sd 15.8) for lumpectomy, 36.7 (5-230, 29.1) for mastectomy, and 37.5 (7-111, 16) for mastectomy with reconstruction. Patients under 40 were less likely to be delayed (OR = 0.56, 95 % CI = 0.33-0.94, p = 0.03). Patients undergoing mastectomy alone (OR = 2.64, 95 % CI = 1.80-3.89, p < 0.0001) and mastectomy with immediate reconstruction (OR = 1.34 95 % CI = 1.00-1.79, p = 0.05) were more likely to be delayed when compared to lumpectomy. Substantial variation in surgical timeliness was identified. This study provides insight into targets for improvement including better coordination with plastic surgery and streamlining pre-operative testing. Cancer centers may consider investing in efforts to measure and improve the timeliness of cancer care. PMID:25270121

Golshan, Mehra; Losk, Katya; Kadish, Sarah; Lin, Nancy U; Hirshfield-Bartek, Judith; Cutone, Linda; Sagara, Yasuaki; Aydogan, Fatih; Camuso, Kristen; Weingart, Saul N; Bunnell, Craig

2014-11-01

359

Why do cancer patients smoke and what can providers do about it?  

PubMed Central

Despite the widespread dissemination of information about the health risks associated with smoking, many cancer patients continue to smoke, which results in a decreased quality of life, an increased probability of cancer recurrence, and a decreased survival time. Efficacious interventions are available to assist cancer patients to quit smoking, yet smoking cessation interventions are often not implemented. This review describes how clinicians, administrators, insurers, and purchasers can encourage a culture of health care in which tobacco cessation interventions are implemented consistent with evidenced-based standards of care. Implementing efficacious tobacco cessation interventions can reduce morbidity and mortality among cancer patients. PMID:23175636

Duffy, Sonia A.; Louzon, Samantha A.; Gritz, Ellen R.

2012-01-01

360

Bayesian Networks for Clinical Decision Support in Lung Cancer Care  

PubMed Central

Survival prediction and treatment selection in lung cancer care are characterised by high levels of uncertainty. Bayesian Networks (BNs), which naturally reason with uncertain domain knowledge, can be applied to aid lung cancer experts by providing personalised survival estimates and treatment selection recommendations. Based on the English Lung Cancer Database (LUCADA), we evaluate the feasibility of BNs for these two tasks, while comparing the performances of various causal discovery approaches to uncover the most feasible network structure from expert knowledge and data. We show first that the BN structure elicited from clinicians achieves a disappointing area under the ROC curve of 0.75 (± 0.03), whereas a structure learned by the CAMML hybrid causal discovery algorithm, which adheres with the temporal restrictions, achieves 0.81 (± 0.03). Second, our causal intervention results reveal that BN treatment recommendations, based on prescribing the treatment plan that maximises survival, can only predict the recorded treatment plan 29% of the time. However, this percentage rises to 76% when partial matches are included. PMID:24324773

Sesen, M. Berkan; Nicholson, Ann E.; Banares-Alcantara, Rene; Kadir, Timor; Brady, Michael

2013-01-01

361

Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic  

PubMed Central

Given the prevalence of human immunodeficiency virus (HIV) in veterans and that nearly 90% of veterans have not been HIV tested, the Veterans Affairs (VA) has recommended routine HIV testing of all veterans. The objective of this study carried out at an urban VA primary care clinic was to assess provider knowledge of recent U.S. Centers for Disease Control and Prevention (CDC) and VA HIV testing recommendations and policies. Fifty-six primary care providers completed a survey. Nearly 40% of providers were unaware of the CDC recommendation to test all persons ages 13 to 64 in health care settings or the VA policy to test veterans of all ages. Over 75% of providers were unaware of the latest requirements for pre- and posttest counseling, and many were unaware of the latest consent process requirements. Educating VA providers about recent HIV testing recommendations and policies may improve the low HIV testing prevalence in the VA. PMID:23707836

Arya, Monisha; Bush, Amber L.; Kallen, Michael A.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.

2014-01-01

362

Transitional Care Challenges of Rehospitalized Veterans: Listening to Patients and Providers  

PubMed Central

Abstract Readmissions to the hospital are common and costly, often resulting from poor care coordination. Despite increased attention given to improving the quality and safety of care transitions, little is known about patient and provider perspectives of the transitional care needs of rehospitalized Veterans. As part of a larger quality improvement initiative to reduce hospital readmissions, the authors conducted semi-structured interviews with 25 patients and 14 of their interdisciplinary health care providers to better understand their perspectives of the transitional care needs and challenges faced by rehospitalized Veterans. Patients identified 3 common themes that led to rehospitalization: (1) knowledge gaps and deferred power; (2) difficulties navigating the health care system; and (3) complex psychiatric and social needs. Providers identified different themes that led to rehospitalization: (1) substance abuse and mental illness; (2) lack of social or financial support and homelessness; (3) premature discharge and poor communication; and (4) nonadherence with follow-up. Results underscore that rehospitalized Veterans have a complex overlapping profile of real and perceived physical, mental, and social needs. A paradigm of disempowerment and deferred responsibility appears to exist between patients and providers that contributes to ineffective care transitions, resulting in readmissions. These results highlight the cultural constraints on systems of care and suggest that process improvements should focus on increasing the sense of partnership between patients and providers, while simultaneously creating a culture of empowerment, ownership, and engagement, to achieve success in reducing hospital readmissions. (Population Health Management 2013;16:326–331) PMID:23560514

Sackett, Nathan; Pierce, Read; Schopfer, David; Schmajuk, Gabriela; Moy, Nicholas; Bachhuber, Melissa; Wallhagen, Margaret I.; Lee, Sei J.

2013-01-01

363

Transitional care challenges of rehospitalized veterans: listening to patients and providers.  

PubMed

Readmissions to the hospital are common and costly, often resulting from poor care coordination. Despite increased attention given to improving the quality and safety of care transitions, little is known about patient and provider perspectives of the transitional care needs of rehospitalized Veterans. As part of a larger quality improvement initiative to reduce hospital readmissions, the authors conducted semi-structured interviews with 25 patients and 14 of their interdisciplinary health care providers to better understand their perspectives of the transitional care needs and challenges faced by rehospitalized Veterans. Patients identified 3 common themes that led to rehospitalization: (1) knowledge gaps and deferred power; (2) difficulties navigating the health care system; and (3) complex psychiatric and social needs. Providers identified different themes that led to rehospitalization: (1) substance abuse and mental illness; (2) lack of social or financial support and homelessness; (3) premature discharge and poor communication; and (4) nonadherence with follow-up. Results underscore that rehospitalized Veterans have a complex overlapping profile of real and perceived physical, mental, and social needs. A paradigm of disempowerment and deferred responsibility appears to exist between patients and providers that contributes to ineffective care transitions, resulting in readmissions. These results highlight the cultural constraints on systems of care and suggest that process improvements should focus on increasing the sense of partnership between patients and providers, while simultaneously creating a culture of empowerment, ownership, and engagement, to achieve success in reducing hospital readmissions. PMID:23560514

Stephens, Caroline; Sackett, Nathan; Pierce, Read; Schopfer, David; Schmajuk, Gabriela; Moy, Nicholas; Bachhuber, Melissa; Wallhagen, Margaret I; Lee, Sei J

2013-10-01

364

Cancer and Communication in the Health Care Setting: Experiences of Older Vietnamese Immigrants, A Qualitative Study  

PubMed Central

Background As patients grow older, accurate communication with health care providers about cancer becomes increasingly important. However, little is known about the cancer communication experiences of older Asian immigrants. Objective To learn about the cancer-related communication experiences of older Vietnamese immigrants from the insider perspective. Design Qualitative study (grounded theory, constant comparative method) using individual interviews with older Vietnamese immigrants with the purpose of discussing how they learn about cancer. Interviews were conducted in Vietnamese. Participants Vietnamese immigrants aged 50–70 years, recruited through community-based organizations. Most had low education and limited English proficiency. The sample size of 20 was sufficient to achieve theoretical saturation. Results We identified 3 categories of themes concerning informants’ experiences with cancer communication in the health care setting: (1) attitudes about addressing screening with providers, (2) issues/problems communicating with physicians about cancer, and (3) language/translation difficulties. There was substantial overlap between informants who mentioned each theme category, and 40% of the participants mentioned all 3 categories. Conclusion Clinicians should be aware of and act upon specific cancer communication needs/challenges of their older immigrant patients. Moreover, health care systems need to be prepared to address the needs of an increasingly multiethnic and linguistically diverse patient population. Finally, community-level interventions should address baseline knowledge deficits while encouraging immigrant patients to engage their doctors in discussions about cancer screening. PMID:18030538

Barg, Frances K.; Armstrong, Katrina; Holmes, John H.; Hornik, Robert C.

2007-01-01

365

Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan  

PubMed Central

Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care. PMID:19166559

Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

2011-01-01

366

Competence of health care providers on care of newborns at birth in a level-1 health facility in Yaound?, Cameroon  

PubMed Central

Introduction This is an observational study which was carried out at a level one health facility in Yaoundé from June to July 2009. The aim was to evaluate the competence of health care providers towards newborns’ care at birth Methods Ten health care providers took care of three hundred and thirty-five pregnant women who were enrolled for the study after informed verbal consent in the delivery room. Results Out of 340 offspring delivered and taken care of, 179 (52.6%) were male and 161 (47.4%) were female. Only two out of ten health workers had a WHO Essential Newborn Care (ENC) training. None of them had received any refresher course for the past two years. The mean gestational age of women was 39.5±3.5 weeks. Resuscitation was carried out on 21 (6.2%) of the newborns including 7 (33.3%) who had birth asphyxia. Health care providers scored 100% in performing the following tasks: warming up the baby, applying eye drops, injecting vitamin K, identifying the neonate, searching for any apparent life threatening congenital malformations, preventing for infection after procedures and initiating breastfeeding. The score was 24% at neonatal resuscitation tasks. Low level of education was associated with poor competence on applying ENC tasks (p<0.001). Lack of WHO ENC training was associated with poor competence on ENC tasks (p<0.001) and poor skills on resuscitation (p=0.03). Conclusion There is a need to reinforce the capacity of health care providers by training in WHO ENC course with emphasis on providing skills on resuscitation in order to reduce the burden of neonatal intrapartum-related deaths. PMID:22593781

Monebenimp, Francisca; Tenefopa, Makudjou; Mve Koh, Valere; Kago, Innocent

2012-01-01

367

Myths and realities in cancer care: another point of view.  

PubMed

Cancer care is advancing, and the cancer community is right to celebrate that progress. Simultaneously, however, the cost of cancer therapy is rising along with all medical costs. In a matter of just a few years, the cost of health coverage is projected to reach heights that are simply unsustainable for most American families, overshadowing every other daily expense. Such an overwhelming burden will continue to undermine the progress made in developing new, more effective treatment and care for cancer patients. There cannot be a celebration of discoveries if there is no way to pay for them. It is from that perspective that I react and respond here to the commentary of Dana Goldman and Tomas Philipson, who debunk five myths in cancer care. I concur with the authors' assessment of the value and impact of progress in cancer care. However, I also argue that researchers and policy makers must pay more attention to the impact of cost on patients' adherence and experience and the speed with which new treatment and care are being developed. PMID:25288426

Newcomer, Lee N

2014-10-01

368

HIV care providers emphasize the importance of the Ryan White Program for access to and quality of care.  

PubMed

With the implementation of the Affordable Care Act (ACA) under way, some policy makers have questioned the continued relevance of the Ryan White HIV/AIDS Program as a safety net for people living with HIV/AIDS. We surveyed HIV care providers to understand the role of the Ryan White Program and to identify concerns regarding the ACA implementation. We also addressed whether the program is still relevant after ACA implementation and, if so, what elements should be retained. We found that providers consider the Ryan White Program to be critical in facilitating high-quality care for people living with HIV/AIDS. Most of the providers highlighted the program's support for providing medical and nonmedical case management as especially valuable and important to the entire continuum of care and for all patient subpopulations. Whether care is supplied by the Ryan White Program, Medicaid, or other means, our findings suggest that case management services will remain critical in treating HIV/AIDS as the health care landscape continues to evolve. PMID:24590936

Sood, Neeraj; Juday, Timothy; Vanderpuye-Orgle, Jacqueline; Rosenblatt, Lisa; Romley, John A; Peneva, Desi; Goldman, Dana P

2014-03-01

369

Pattern of cancer deaths in a saudi tertiary care hospital.  

PubMed

The medical records of deceased patients were reviewed to describe the pattern of cancer deaths in a newly established Saudi tertiary care hospital. During eleven months, 87 patients died of cancer. The majority (80 patients, 92%) died of incurable cancer; among which 53% did not receive any systemic anti-cancer therapy (SAT) and 43% received SAT with palliative intent. Younger age (< 65 years), relatively chemosensitive tumours and initial presentation in a potentially curable stage were associated with higher prevalence of palliative SAT administration (p = 0.009, 0.019 and 0.001, respectively). The last palliative SAT was administered during the last two months of life in 66% and during the last two weeks in 14%. During the last admission, 54% of patients were admitted through emergency room, 50% stayed >14 days and 14% died in intensive care unit or emergency room. The results demonstrate that palliative care is a realistic treatment for the majority of patients in our setting and that a significant proportion of these patients receive aggressive care at the end-of-life. There is a need to establish an integrative palliative care program to improve the quality-of-life of dying cancer patients in our region and to minimize the aggressiveness of end-of-life care. PMID:22378940

Al-Zahrani, Abdullah S; El-Kashif, Amr T; Haggag, Rasha M; Alsirafy, Samy A

2013-02-01

370

Factors associated with the decision of family physicians to provide intrapartum care.  

PubMed Central

OBJECTIVE: To investigate which characteristics and beliefs of family physicians determine their decision to provide intrapartum care. DESIGN: Confidential survey questionnaire mailed in spring 1993. SETTING: Alberta and Ontario. SUBJECTS: Random selection of 207 physicians who had graduated from medical school between 1953 and 1990 and were thought to be in family or general practice. Of 178 eligible physicians, usable replies were received from 104 (58.4%). OUTCOME MEASURES: Beliefs (measured on a 7-point Likert scale) about the relevance of 16 primary factors to the type of obstetric care provided; demographic, training and practice characteristics. RESULTS: The respondents who provided intrapartum care differed from those who did not in their beliefs about the availability of a local hospital suitable for intrapartum care (p < 0.001), their practice partners' views on the role of family physicians in providing obstetric care (p < 0.002), their own concept of the role of family physicians in providing obstetric care (p < 0.001) and women's views on the type of obstetric care they want (p < 0.002). They also differed, although less significantly, in their beliefs about the adequacy of their obstetric training before entering family practice (p < 0.04), the expected effects of providing obstetric care on their free time (p < 0.006), their fear of malpractice litigation (p < 0.028) and their perceived competence in performing practical obstetric procedures (p < 0.05). Logistic regression analysis revealed that certain secondary factors were particularly relevant to the respondents' provision of intrapartum care at present. These included the physician's perceived competence at managing postpartum maternal hemorrhage (odds ratio [OR] 48.90, 90% confidence interval [CI] 4.70 to 509), the belief that medical insurance premiums should not be affected by the type of obstetric care provided (OR 3.55, 90% CI 1.67 to 7.57]) and the number of practice partners who provided intrapartum care (OR 10.08, 90% CI 2.31 to 44.10). CONCLUSION: Several factors appear to influence family physicians in their decision to provide intrapartum care. This information will help to focus efforts to provide appropriate obstetric training for family practice residents and to retain involvement of family physicians in intrapartum care. PMID:7773895

Smith, L F; Reynolds, J L

1995-01-01

371

Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa  

PubMed Central

Background Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning. In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. Methods Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Results Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. Conclusion This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered. PMID:19689791

Harries, Jane; Stinson, Kathryn; Orner, Phyllis

2009-01-01

372

Turning primary care providers' attention to child behavior: a review of the literature.  

PubMed

Twenty-five years ago, writers first drew the nation's attention to the "new morbidities"--problems that were biosocial or developmental in nature and were induced or complicated by social or environmental factors. The American Academy of Pediatrics responded by urging primary care providers to spend more time counseling parents on behavioral issues. Recent violent episodes in schools have renewed concern and prompted child health advocates to ask how well primary care providers are doing in attending to problematic childhood behavior. A review of the literature was conducted to examine the role the primary care provider plays in attending to childhood behavior. PMID:11353360

Hawkins-Walsh, E

2001-01-01

373

Teaching Child Care Providers to Reduce the Risk of SIDS (Sudden Infant Death Syndrome)  

ERIC Educational Resources Information Center

Keeping children safe and healthy is one of the main concerns of parents and child care providers. SIDS (Sudden Infant Death Syndrome) is the leading cause of death in infants 1 month to 12 months of age. Over 2,000 infants die from SIDS every year in the United States, and almost 15% of these deaths occur in child care settings. A targeted…

Byington, Teresa; Martin, Sally; Reilly, Jackie; Weigel, Dan

2011-01-01

374

Ethnicity and Health: Mexican Americans. A Guide for Health Care Providers.  

ERIC Educational Resources Information Center

Several characteristics and perspectives of how Mexican Americans regard health care are presented for health care providers. Following a brief discussion of culture and health, the guide describes the traditional and modern value orientations of Hispanics and the external forces that contribute to their adoption. Four key concepts to…

Roberts, Robert E.

375

Review of Child Care Services Provided Under Title IV, Social Security Act.  

ERIC Educational Resources Information Center

This report on child care services is based on: (1) a review of program administration at the central and regional offices of the Social and Rehabilitation Service and the Office of Child Development, and (2) a review of selected child care providers in nine states. The program and fiscal management at each administrative level were evaluated,…

Department of Health, Education, and Welfare, Washington, DC. HEW Audit Agency.

376

Teleost fish providing parental care: individual and intergenerational costs and consequences of nest  

E-print Network

of swimming performance, a proxy for parental care. Finally, I tested whether nest predation pressureTeleost fish providing parental care: individual and intergenerational costs and consequences of nest predation pressure By Marie-Ange Gravel B.Sc., University of Ottawa, 2006 A thesis submitted

Cooke, Steven J.

377

Broadening the Knowledge of the LPN Long-Term Care Provider: A Pilot Study  

ERIC Educational Resources Information Center

There are little data regarding Licensed Practical Nurse (LPN) roles in long-term care settings and how the roles might be expanded or changed to meet the unique needs of the elderly. The purpose of this quantitative descriptive study was to determine if an increase in knowledge occurred in LPN care providers after implementation of a 32-hour…

Faulk, Debbie; Parker, Francine; Lazenby, Ramona; Morris, Arlene

2008-01-01

378

Stress among Care Givers: The Impact of Nursing a Relative with Cancer  

PubMed Central

Aims: The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer. Setting and Design: An assessment of care givers’ stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis. Materials and Methods: A close-ended questionnaire that had seven sections on different aspects of caregivers’ stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed. Results: The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10); of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress. Conclusion: Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care. PMID:24600180

Kulkarni, Priyadarshini; Kulkarni, Pradeep; Ghooi, Ravindra; Bhatwadekar, Madhura; Thatte, Nandini; Anavkar, Vrushali

2014-01-01

379

How Biomedical Research Provides Fertility Hope to Cancer Survivors  

NSDL National Science Digital Library

A FASEB Horizons in Bioscience Publication. This publication discusses how biomedical research of in vitro fertilization (IVF) and cryopreservation (freezing) of embryos is helping female cancer survivors have children.

2010-08-04

380

Helping Family Day Care Providers Implement Developmentally Appropriate Child Care Practices in Their Homes with a Four Point Strategy.  

ERIC Educational Resources Information Center

This practicum was developed to increase the quality of child care offered by family daycare providers on a military base in the western United States. Providers were to improve their developmentally appropriate practices (DAP) by following a daily activity schedule, setting up enriched home environments, writing and implementing curricula, and…

Kirshenbaum, Karen

381

Association of Communication Between Hospital-based Physicians and Primary Care Providers with Patient Outcomes  

Microsoft Academic Search

BACKGROUND  Patients admitted to general medicine inpatient services are increasingly cared for by hospital-based physicians rather than\\u000a their primary care providers (PCPs). This separation of hospital and ambulatory care may result in important care discontinuities\\u000a after discharge. We sought to determine whether communication between hospital-based physicians and PCPs influences patient\\u000a outcomes.\\u000a \\u000a \\u000a \\u000a METHODS  We approached consecutive patients admitted to general medicine services at

Chaim M. Bell; Jeffrey L. Schnipper; Andrew D. Auerbach; Peter J. Kaboli; Tosha B. Wetterneck; David V. Gonzales; Vineet M. Arora; James X. Zhang; David O. Meltzer

2009-01-01

382

Communication and cultural issues in providing reproductive health care to immigrant women: health care providers' experiences in meeting the needs of [corrected] Somali women living in Finland.  

PubMed

Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives' communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics. PMID:21465142

Degni, Filio; Suominen, Sakari; Essén, Birgitta; El Ansari, Walid; Vehviläinen-Julkunen, Katri

2012-04-01

383

Leveraging primary care in the fight against lung cancer.  

PubMed

In recent years, the decline in youth smoking rates has stopped as the tobacco industry strives to successfully reclaim market areas where it has lost favor. The plateau in lung cancer incidence and stagnation in progress toward smoking abstinence illustrates the necessity for renewed efforts to fight tobacco use. Barriers to fighting tobacco use exist in both the clinical arena and within the general population, but can be overcome. Primary care physicians (PCPs) are uniquely poised to successfully treat nicotine dependence with strategic targeting of these barriers, improved training in smoking cessation techniques, and focused political efforts in tobacco control. Herein, this article describes the landscape of tobacco use in America and provides background, methodology, and resources for PCPs to help achieve the goals of Healthy People 2010 in reducing the illness, disability, and death that occur as a result of tobacco use and exposure to secondhand smoke. PMID:18172737

Sanders, Jason L; Colson, Yolonda L

2008-03-01

384

Cancers Covered by Patterns of Care/Quality of Care  

Cancer.gov

Skip to Main Content at the National Institutes of Health | www.cancer.gov Print Page E-mail Page Search: Please wait while this form is being loaded.... Home Browse by Resource Type Browse by Area of Research Research Networks Funding Information About

385

Providing quality skin and wound care for the bariatric patient: an overview of clinical challenges.  

PubMed

Obesity, (defined as body mass index [BMI] ?30), and especially morbid obesity (defined as BMI ?40), has a profound impact on the health and integrity of the patient's integumentary system and on the caregivers who strive to provide care for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices. PMID:24434162

Beitz, Janice M

2014-01-01

386

Talk With Your Health Care Provider About Taking Aspirin to Prevent Heart Attack  

MedlinePLUS

... Health Care Provider About Taking Aspirin to Prevent Heart Attacks Partnership for HEALTH For Men How much aspirin ... take aspirin to reduce the chances of a heart attack. Does aspirin also help women prevent heart attacks? ...

387

42 CFR 433.56 - Classes of health care services and providers defined.  

42 Public Health 4 2014-10-01 2014-10-01 false Classes of health care services and providers defined. 433.56 Section 433.56 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

2014-10-01

388

76 FR 9968 - Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws  

Federal Register 2010, 2011, 2012, 2013

...DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 88 RIN...Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws...SUMMARY: The Department of Health and Human Services issues this final...

2011-02-23

389

HIV health-care providers' burnout: can organizational culture make a difference?  

PubMed

One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p < .005, R(2) = .18). Further negative organizational culture (i.e., critical appraisal) was positively related to depersonalization (p < .005, R(2) = .18). These findings suggest that effective organizational communication interventions might protect HIV health-care providers from burnout. PMID:25025453

Ginossar, Tamar; Oetzel, John; Hill, Ricky; Avila, Magdalena; Archiopoli, Ashley; Wilcox, Bryan

2014-12-01

390

Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’  

PubMed Central

Background Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’. Methods Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. Results The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. Conclusion The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits. PMID:25409502

Majrooh, Muhammad Ashraf; Hasnain, Seema; Akram, Javaid; Siddiqui, Arif; Memon, Zahid Ali

2014-01-01

391

Cancer Survivorship: Moving the Science and Art of Research and Care Beyond Cure - March 31, 2003  

Cancer.gov

Cancer Survivorship: Moving the Science and Art of Research and Care Beyond Cure Statement of Julia H. Rowland, Ph.D. Director, Office of Cancer Survivorship Division of Cancer Control and Population Sciences National Cancer Institute National

392

Early experience of a safety net provider reorganizing into an accountable care organization.  

PubMed

Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. PMID:24842968

Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

2014-08-01

393

Improving Breast Cancer Care for Older Women  

Cancer.gov

Earlier diagnosis, improved treatment, and the overall increase in average lifespan continue to expand the number of breast cancer survivors who are aged 65 and older. This population is already estimated to be one million of the total 2.3 million breast cancer survivors.

394

Prevalence and determinants of violence against emergency medical care providers in Karachi, Pakistan  

Microsoft Academic Search

BackgroundViolence against healthcare workers is a growing problem. About 9% to 49.5% violence has been reported from different parts of the world. Healthcare providers in emergency departments throughout the world are exposed to workplace violence.ObjectiveTo determine the prevalence and determinants of workplace violence against emergency care providers in tertiary care hospitals of Karachi, Pakistan.MethodsThe study was conducted in emergency departments

E U Siddiqui; K Ejaz; J A Razzak; M U Shehzad; S Jamali

2010-01-01

395

Milwaukee County Child Care Providers Appear Ready for YoungStar: Local Providers Compare Favorably to State as a Whole. Research Brief. Volume 99, Number 4  

ERIC Educational Resources Information Center

In collaboration with the Wisconsin Early Childhood Association (WECA), the Public Policy Forum surveyed 1,425 child care center directors, center employees, and family child care providers statewide. The survey was designed to provide a picture of the status of Wisconsin's child care workforce in terms of educational attainment, experience,…

Kovach, Melissa

2011-01-01

396

Quality of Life Among Immigrant Latina Breast Cancer Survivors: Realities of Culture and Enhancing Cancer Care  

Microsoft Academic Search

Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors\\u000a that impact the quality of life and survivorship experiences of Latina immigrant breast cancer survivors. We interviewed Latina\\u000a breast cancer survivors (n?=?19) and, based on the interview findings, conducted two focus groups (n?=?9). Research staff translated transcripts from Spanish into English.

Monique Perret-Gentil; Barbara Kreling; Larisa Caicedo; Jeanne Mandelblatt; Kristi D. Graves

397

Bone health care for patients with prostate cancer receiving androgen deprivation therapy.  

PubMed

Patients with prostate cancer often receive androgen deprivation therapy (ADT) as part of their treatment regimen. However, treatment with ADT causes multiple side effects, including reduced bone mineral density (BMD), lower lean body mass, and a higher risk for fractures. Several organizations provide clinical practice guidelines for osteoporosis screening, prevention, and treatment in this population, but adherence to these guidelines remains low. Areas for improvement in provider adherence include baseline and follow-up BMD testing, as well as counseling regarding healthy bone behaviors such as calcium/vitamin D intake, lifestyle changes, and physical exercise. Comparison of osteoporosis care in breast cancer and non-oncology populations shows that suboptimal bone health care is not isolated to prostate cancer. A summary of the literature examining improvements in patient adherence and provider delivery of bone health care is included in this review, but high-quality studies are lacking. Patients may be the most receptive to written educational information delivered at or near the time of ADT initiation. Involvement of a primary care practitioner and oncologist in care delivery is associated with higher BMD test use. Institution-level programs that automatically initiate osteoporosis screening and management may be effective at reducing the incidence of hip fracture. Lastly, suggestions are provided for future approaches to knowledge translation and quality of care studies to improve bone health. PMID:24769788

Tsang, Derek S; Alibhai, Shabbir M

2014-04-01

398

Who provides walk-in services? Survey of primary care practice in Ontario.  

PubMed Central

OBJECTIVE: To compare walk-in clinics with other primary care settings on characteristics associated with best practices in primary care. DESIGN: A mailed self-administered questionnaire asked about organizational and clinical characteristics of primary care practices located in major urban and suburban areas in Ontario. SETTING: Four types of fee-for-service group practices: walk-in and urgent-care clinics (WICs), mixed practices (MPs), after-hours clinics (AHCs), and group family practices (GFPs). PARTICIPANTS: A physician or a staff member involved in practice administration. MAIN OUTCOME MEASURES: The four practice types were compared on organizational characteristics and measures of access, continuing care, comprehensiveness, coordination, and mechanisms for monitoring quality of care. RESULTS: Walk-in clinics, MPs, and AHCs were open more hours during evenings and weekends and were more likely to see patients without appointments; GFPs were more likely to have on-call arrangements. Group family practices saw a larger proportion of patients for whom they provided ongoing care; WICs and MPs reported that more than 60% of their visits were with "regular" patients. Walk-in clinics were less likely to provide preventive services and psychological counseling than were GFPs and MPs. A few WICs, MPs, and GFPs had procedures to support coordination of care or to monitor quality of care. CONCLUSION: Although WICs, MPs, and AHCs provided walk-in services to Ontario patients, WICs and MPs also provided a substantial amount of ongoing care and preventive services. Independent AHCs appeared to most closely fit the "walk-in clinic" stereotype. PMID:11935716

Barnsley, Jan; Williams, A. Paul; Kaczorowski, Janusz; Vayda, Eugene; Vingilis, Evelyn; Campbell, Alan; Atkin, Karen

2002-01-01

399

Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration  

PubMed Central

Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Cancer Center, the Oncology Evaluation and Treatment Center (OETC) and Infusion Center, to deliver urgent care and infusions after hours to oncology patients. Quality measures based on evidence-based care and cost-efficiency measures were implemented within these centers. Ability to meet predetermined goals for these measures will be a guide for implementing continuous quality and cost-efficiency interventions. During the first two quarters of operations, 2023 patients received care in the OETC (n = 423) and Infusion Center (n = 1600). The average time spent in the OETC was 48% less than the time spent in the BUMC emergency department (ED). Eighty-nine percent of the cancer center’ patients who received urgent care at BUMC were referred to the OETC for this care, instead of the BUMC ED. The hospital admission rate in the OETC was 59% lower than it was in the BUMC ED, a high-volume level I trauma center. The addition of the OETC and Infusion Center to the cancer center holds promise for providing continuous quality cancer care that is cost-efficient. PMID:23543960

Miller, Alan M.; Paulson, R. Steven

2013-01-01

400

Multi-agent systems: effective approach for cancer care information management.  

PubMed

Physicians, in order to study the causes of cancer, detect cancer earlier, prevent or determine the effectiveness of treatment, and specify the reasons for the treatment ineffectiveness, need to access accurate, comprehensive, and timely cancer data. The cancer care environment has become more complex because of the need for coordination and communication among health care professionals with different skills in a variety of roles and the existence of large amounts of data with various formats. The goals of health care systems in such a complex environment are correct health data management, providing appropriate information needs of users to enhance the integrity and quality of health care, timely access to accurate information and reducing medical errors. These roles in new systems with use of agents efficiently perform well. Because of the potential capability of agent systems to solve complex and dynamic health problems, health care system, in order to gain full advantage of E- health, steps must be taken to make use of this technology. Multi-agent systems have effective roles in health service quality improvement especially in telemedicine, emergency situations and management of chronic diseases such as cancer. In the design and implementation of agent based systems, planning items such as information confidentiality and privacy, architecture, communication standards, ethical and legal aspects, identification opportunities and barriers should be considered. It should be noted that usage of agent systems only with a technical view is associated with many problems such as lack of user acceptance. The aim of this commentary is to survey applications, opportunities and barriers of this new artificial intelligence tool for cancer care information as an approach to improve cancer care management. PMID:24460364

Mohammadzadeh, Niloofar; Safdari, Reza; Rahimi, Azin

2013-01-01

401

Nurse-led follow-up care for cancer patients: what is known and what is needed.  

PubMed

Traditionally, cancer patient follow-up has focused on disease surveillance and detecting recurrence. However, an increasing number of patients who have survived cancer acknowledge the importance of cancer rehabilitation issues and the need for more patient-oriented models of care by reporting their unmet physical, emotional, and social needs. Nurse-led follow-up care for cancer patients fulfills this need and has been developing gradually for various cancer diagnoses and prognoses. A growing body of evidence suggests that these services provide high-quality care that is both safe and efficient. Furthermore, patients benefit from the continuity of care and easy access to support for their multitude of needs, provided by such organized care. In this paper, we review the literature published in the past 5 years regarding nurse-led follow-up care for cancer patients in order to provide input and opinion for future research, clinical practice development, and nursing leadership. We pay special attention to head and neck cancer patients, a group that has been largely understudied and hence underreported in the literature. These patients have specific needs with respect to information and education regarding their cancer and potential treatment side-effects as well as a particular need for long-term psychosocial support and practical advice. PMID:23828397

de Leeuw, Jacqueline; Larsson, Maria

2013-09-01

402

Study: ED-based care coordination interventions need to fit unique needs of ED settings, providers.  

PubMed

Most health policy experts recognize that effective care coordination between the ED and other providers has the potential to improve health and reduce costs. However, researchers have found that ED-based interventions have differing rates of success, depending on the unique characteristics of the work environment, as well as the providers involved. With these caveats in mind, researchers combing through the literature on this topic have found that making care coordinators available to older patients, and having mechanisms in place to automatically set up follow-up appointments for ED patients, have demonstrated some success at improving follow-up care and reducing repeat ED utilization. Also, a new model that is just getting underway in Buffalo, NY, aims to improve care coordination through the use of community health workers who will be embedded in two metro-area EDs. The approach, which has just received federal grant funding, aims to save more than $6 million over a period of three years. In anticipation of new payment models that will reward effective care coordination, experts advise ED managers to begin forming links with outside providers and organizations. Recognize that outside organizations and providers need to be willing to connect with the ED in an effective way for care coordination efforts to succeed. Consider methods for connecting high-ED utilizers with primary care as well as social services that can help patients with socioeconomic, environmental, or mental health issues. PMID:22838050

2012-07-01

403

Defining Value in Cancer Care: AVBCC 2013 Steering Committee Report  

PubMed Central

The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2–5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group. PMID:24991360

Zweigenhaft, Burt; Bosserman, Linda; Kenney, James T.; Lawless, Grant D.; Marsland, Thomas A.; Deligdish, Craig K.; Burgoyne, Douglas S.; Knopf, Kevin B.; Long, Douglas M.; McKercher, Patrick; Owens, Gary M.; Hennessy, John E.; Lang, James R.; Malin, Jennifer; Natelson, Leonard; Palmgren, Matthew C.; Slotnik, Jayson; Shockney, Lillie D.; Vogenberg, F. Randy

2013-01-01

404

Defining Value in Cancer Care: AVBCC 2013 Steering Committee Report.  

PubMed

The AVBCC Annual Meeting experiences exponential growth in attendance and participation as oncologists, payers, employers, managed care executives, patient advocates, and drug manufacturers convened in Hollywood, FL, on May 2-5, 2013, for the Third Annual Conference of the Association for Value-Based Cancer Care (AVBCC). The conference presented an all-inclusive open forum for stakeholder dialogue and integration across the cancer care continuum, facilitating an open dialogue among the various healthcare stakeholders to align their perspectives around the urgent need to address value in cancer care, costs, patient education, safety, outcomes, and quality. The AVBCC 2013 Steering Committee was held on the first day of the conference to define value in cancer care. The committee was divided into 7 groups, each representing a key stakeholder in oncology. The goal of the Steering Committee was to define value from the particular point of view of each of the stakeholder groups and to suggest how that particular perspective can contribute to the value proposition in oncology, by balancing cost, quality, and access to care to improve overall patient outcomes. The following summary highlights the major points addressed by each group. PMID:24991360

Zweigenhaft, Burt; Bosserman, Linda; Kenney, James T; Lawless, Grant D; Marsland, Thomas A; Deligdish, Craig K; Burgoyne, Douglas S; Knopf, Kevin B; Long, Douglas M; McKercher, Patrick; Owens, Gary M; Hennessy, John E; Lang, James R; Malin, Jennifer; Natelson, Leonard; Palmgren, Matthew C; Slotnik, Jayson; Shockney, Lillie D; Vogenberg, F Randy

2013-07-01

405

Form 3501 FR.50B Certification of Health Care Provider for Employee's Serious Health Condition  

E-print Network

(Family and Medical Leave Act) SECTION I: For Completion by the EMPLOYER INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA to other health care provider(s) for evaluation or treatment (e.g., physical therapist)? ____No ____Yes

406

Burden Experienced by Informal Providers of Home Care for the Elderly.  

ERIC Educational Resources Information Center

Research has found that approximately 80 percent of the care received by elderly people living at home is provided by family members. Although assistance provided by informal supports can be important in sustaining the functionally disabled elderly at home, caregiving can have important negative effects on the informal providers. To examine the…

Caro, Francis G.; Blank, Arthur E.

407

Integrating mental health into primary health care in Zambia: a care provider's perspective  

Microsoft Academic Search

BACKGROUND: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative

Lonia Mwape; Alice Sikwese; Augustus Kapungwe; Jason Mwanza; Alan Flisher; Crick Lund; Sara Cooper

2010-01-01

408

[Novel drugs provide better therapy for prostate cancer].  

PubMed

Several effective drugs have become available for prostate cancer therapy, which are being used after the development of castration resistance and studied already at an earlier stage of prostate cancer therapy. Novel hormonally acting drugs include degarelix, enzalutamide and abiraterone. Cytotoxic agents that have proven effective in studies include the docetaxel derivative cabazitaxel, denosumab in the prevention of complications caused by bone metastases, and radium-233 chloride as treatment for bone metastases. The optimal sequence of administration of the novel drugs as well as combining them are subject to intensive research. PMID:23786104

Kellokumpu-Lehtinen, Pirkko; Tammela, Teuvo

2013-01-01

409

Quality palliative care for cancer and dementia in five European countries: some common challenges  

PubMed Central

Objectives There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. PMID:24131061

Davies, Nathan; Maio, Laura; van Riet Paap, Jasper; Mariani, Elena; Jaspers, Birgit; Sommerbakk, Ragni; Grammatico, Daniela; Manthorpe, Jill; Ahmedzai, Sam; Vernooij-Dassen, Myrra; Iliffe, Steve

2013-01-01

410

A survey of Alabama eye care providers in 2010-2011  

PubMed Central

Background State level information regarding eye care resources can provide policy makers with valuable information about availability of eye care services. The current study surveyed ophthalmologists, optometrists and vision rehabilitation providers practicing in Alabama. Methods Three mutually exclusive provider groups were identified, i.e., all ophthalmologists, optometrists, and vision rehabilitation providers working in Alabama in 2010. Eligible providers were contacted in 2010 and 2011 and information was requested regarding provider demographics and training, practice type and service characteristics, and patient characteristics. Descriptive statistics (e.g., means, proportions) were used to characterize provider groups by their demographic and training characteristics, practice characteristics, services provided and patients or clients served. In addition, county level figures demonstrate the numbers and per capita ophthalmologists and optometrists. Results Ophthalmologists were located in 24 of Alabama’s 67 counties, optometrists in 56, and 10 counties had neither an ophthalmologist nor an optometrist. Overall, 1,033 vision care professionals were identified as eligible to participate in the survey: 217 ophthalmologists, 638 optometrists, and 178 visual rehabilitation providers. Of those, 111 (51.2%) ophthalmologists, 246 (38.6%) optometrists, and 81 (45.5%) rehabilitation providers participated. Most participating ophthalmologists, optometrists, and vision rehabilitation providers identified themselves as non-Hispanic White. Ophthalmologists and optometrists estimated that 27% and 22%, respectively, of their patients had diabetes but that the proportion that adhered to eye care guidelines was 61% among ophthalmology patients and 53% among optometry patients. Conclusions A large number of Alabama communities are isolated from eye care services. Increased future demand for eye care is anticipated nationally given the aging of the population and decreasing numbers of providers; however, Alabama also has a high and growing prevalence of diabetes which will result in greater numbers at risk for diabetic retinopathy, glaucoma, and cataracts. PMID:24708636

2014-01-01

411

The Fiscal Impact of Colorado Child Care Assistance Program Payments on the Child Care Industry: An Assessment of How the Child Care Provider Underwrites Publicly Purchased Child Care, 2001.  

ERIC Educational Resources Information Center

The Colorado Child Care Assistance Program (CCCAP) purchases child care for low-income families to enable their participation in the workforce. This report describes CCCAP and its effect on child care centers and family child care providers. The report notes that each county in Colorado sets the daily purchase price of child care, with most…

Colorado Office of Resource and Referral Agencies, Inc., Englewood.

412

Providing care to military personnel and their families: how we can all contribute.  

PubMed

Providing medical care to members of the military and their families remains a societal duty carried out not only by military physicians but also, and in large part, by civilian providers. As many military families are geographically dispersed, it is probable that all physicians at some point in their training or careers will care for this unique patient population. Understanding the military culture can help physicians provide the best care possible to our military families, and inclusion of military cultural competency curricula in all medical schools is a first step in advancing this understanding. The authors review the knowledge, skills, and attitudes that all health professionals should acquire to be able to care for those who serve and offer recommendations for developing these among all students and trainees. PMID:24979291

Gleeson, Todd D; Hemmer, Paul A

2014-09-01

413

The eICU research institute - a collaboration between industry, health-care providers, and academia.  

PubMed

As the volume of data that is electronically available promliferates, the health-care industry is identifying better ways to use this data for patient care. Ideally, these data are collected in real time, can support point-of-care clinical decisions, and, by providing instantaneous quality metrics, can create the opportunities to improve clinical practice as the patient is being cared for. The business-world technology supporting these activities is referred to as business intelligence, which offers competitive advantage, increased quality, and operational efficiencies. The health-care industry is plagued by many challenges that have made it a latecomer to business intelligence and data-mining technology, including delayed adoption of electronic medical records, poor integration between information systems, a lack of uniform technical standards, poor interoperability between complex devices, and the mandate to rigorously protect patient privacy. Efforts at developing a health care equivalent of business intelligence (which we will refer to as clinical intelligence) remains in its infancy. Until basic technology infrastructure and mature clinical applications are developed and implemented throughout the health-care system, data aggregation and interpretation cannot effectively progress. The need for this approach in health care is undisputed. As regional and national health information networks emerge, we need to develop cost-effective systems that reduce time and effort spent documenting health-care data while increasing the application of knowledge derived from that data. PMID:20659837

McShea, Michael; Holl, Randy; Badawi, Omar; Riker, Richard R; Silfen, Eric

2010-01-01

414

Trust in Medical Technology by Patients and Health Care Providers in Obstetric Work Systems  

PubMed Central

Multiple types of users (i.e. patients and care providers) have experiences with the same technologies in health care environments and may have different processes for developing trust in those technologies. The objective of this study was to assess how patients and care providers make decisions about the trustworthiness of mutually used medical technology in an obstetric work system. Using a grounded theory methodology, we conducted semi-structured interviews with 25 patients who had recently given birth and 12 obstetric health care providers to examine the decision-making process for developing trust in technologies used in an obstetric work system. We expected the two user groups to have similar criteria for developing trust in the technologies, though we found patients and physicians differed in processes for developing trust. Trust in care providers, the technologies’ characteristics and how care providers used technology were all related to trust in medical technology for the patient participant group. Trustworthiness of the system and trust in self were related to trust in medical technology for the physician participant group. Our findings show that users with different perspectives of the system have different criteria for developing trust in medical technologies. PMID:20802836

Winchester, Woodrow W.; Kleiner, Brian M.

2010-01-01

415

The parents', hospitalized child's, and health care providers' perceptions and experiences of family centered care within a pediatric critical care setting: a metasynthesis of qualitative research.  

PubMed

The delivery of family centered care (FCC) occurs within varied pediatric care settings with a belief that this model of care meets the psychosocial, emotional, and physical needs of the hospitalized child and family. The aim of this review was to explore the attitudes, experiences, and implementation of FCC from many studies and to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, hospitalized children, and their health care providers within a pediatric critical care setting. A metasynthesis is an integration of qualitative research findings based on a systematic review of the literature. Thirty original research articles focusing on family-centered care experiences from the hospitalized child's, parents', and health care providers' perception published between 1998 and 2011 met the criteria for the review. Nine syntheses from 17 themes emerged from the synthesis of the literature: Prehospital, Entry into the Hospital, Journeying Through Unknown Waters, Information, Relationships, The hospital Environment, The Possibility of Death, Religion and Spirituality, and The Journey Home. The individual cultures of the critical care units helped create and reinforce the context of parental needs where satisfaction with communication, information, and relationships were interconnecting factors that helped maintain the positive or negative experiences for the parent, hospitalized child, and/or health care providers. PMID:23884697

Foster, Mandie Jane; Whitehead, Lisa; Maybee, Patricia; Cullens, Victoria

2013-11-01

416

An examination of advanced cancer caregivers' support provided by staff interventions at hospices in Argentina  

PubMed Central

The aim of the study was to describe the type of intervention provided by hospice staff in order to address the pragmatic, psycho-social, and spiritual needs of home-caregivers for patients in the last stage of cancer. The qualitative inquiry was carried out in real life contexts. The explicit demands that caregivers (n = 40) identified in the first interviews were: (1) helping to organize the care of the patient at home; (2) unspecific demands, with unclear or unrealistic purposes (e.g., curative treatment or a miracle expected to occur); (3) specific resources (such as formal caregivers to replace them), and (4) a place to leave the patient either for a temporary period (a respite for the family) or in a permanent way. The main issues discussed were the delays in the patients’ referral to the hospice and the lack of time for long-term interventions; explicit focus is placed on the care by addressing the spiritual and emotional needs of caregivers, unlike in hospital settings where professionals avoid discussions of spiritual needs due to a lack of time, inadequate training and poor understanding of spirituality; hospices’ interventions are based upon an ethos similar to the movement’s original Christian spirit with emphasis placed on qualities of care such as love, charity, and compassion besides expertise and end-of-life competence, all while tolerating a sense of abandonment by health and social security systems following the patient’s referral. PMID:23226163

Luxardo, Natalia; Brage, Eugenia; Alvarado, Cynthia

2012-01-01

417

Five myths about cancer care in america.  

PubMed

In this commentary we debunk a number of the most common misconceptions about cancer treatment, such as claims that the war on cancer has been a failure and that treatment costs are unsustainable. In addition, there is good evidence that patients value these treatments more highly than traditional cost-effectiveness analysis would indicate. We argue that coverage policies placing undue burden on patients are socially wasteful and will likely discourage further innovation. PMID:25288425

Goldman, Dana P; Philipson, Tomas

2014-10-01

418

Intensive care unit and lung cancer: when should we intubate?  

PubMed Central

Lung cancer still remains the leading cause of cancer death among males. Several new methodologies are being used in the everyday practise for diagnosis and staging. Novel targeted therapies are being used and others are being investigated. However; early diagnosis still remains the cornerstone for efficient treatment and disease management. Lung cancer patients requires in many situations intensive care unit (ICU) admission, either due to the necessity for supportive care until efficient disease symptom control (respiratory distress due to malignant pleural effusion) or disease adverse effect management (massive pulmonary embolism). In any case guidelines indicating the patient that has to be intubated have not yet been issued. In the current review we will present current data and finally present an algorithm based on the current published information for lung cancer patients that will probably benefit from admission to the ICU. PMID:24102014

Pataka, Athanasia; Terzi, Eirini; Hohenforst-Schmidt, Wolfgang; Machairiotis, Nikolaos; Huang, Haidong; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Mpakas, Andreas; Zarogoulidis, Kostas

2013-01-01

419

Resource allocation in health care: the allocation of lifestyles to providers.  

PubMed

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3112537

Reinhardt, U E

1987-01-01

420

Representation of expatriates among cancer patients in Kuwait and the need for culturally-competent care.  

PubMed

From 2000 to 2007, 11,793 cancer patients received treatment in Kuwait. Non-Kuwaitis accounted for 6,016 (51%) patients. They came from 68 countries, mainly from the World Health Organization Eastern Mediterranean (59%) and South-East Asian (20%) regions. The majority (69%) was from low- and low-middle income countries. Thirty-seven percent were from non-Arabic speaking countries. To provide culturally-competent care for expatriate patients, there is a need to explore the impact of their ethnic, sociocultural, economic, language diversity, and expatriation-related stressors on different aspects of cancer care. PMID:22571250

Alshemmari, Salem H; Refaat, Samar M; Elbasmi, Amani A; Alsirafy, Samy A

2012-01-01

421

Dehydration reduction in community-dwelling older adults: perspectives of community health care providers.  

PubMed

Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults. PMID:20077993

Abdallah, Lisa; Remington, Ruth; Houde, Susan; Zhan, Lin; Melillo, Karen Devereaux

2009-01-01

422

Diabetes management and self-care education for hospitalized patients with cancer.  

PubMed

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical. PMID:19349267

Leak, Ashley; Davis, Ellen D; Houchin, Laura B; Mabrey, Melanie

2009-04-01

423

Diabetes Management and Self-Care Education for Hospitalized Patients With Cancer  

PubMed Central

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older “compliance” model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical. PMID:19349267

Leak, Ashley; Davis, Ellen D.; Houchin, Laura B.; Mabrey, Melanie

2009-01-01

424

Symptom Control Issues and Supportive Care of Patients With Head and Neck Cancers  

Microsoft Academic Search

Combined-modality treatment of head and neck cancers, though linked to improved outcomes over earlier treatment methods, can be associated with acute and late adverse effects. These toxicities may lead to significant morbidity, increased mortality, and decreased quality of life. It is necessary to provide patients with adequate supportive-care measures in order to lessen suffering while maintaining the ability to deliver

Barbara A. Murphy; Jill Gilbert; Anthony Cmelak; Sheila H. Ridner

2007-01-01

425

Impact of providing care on the risk of leaving employment in Canada.  

PubMed

ABSTRACT Population aging is likely to lead to an increase in the number of people in need of assistance. It is well known that a large part of this assistance originates, and will continue to originate, from the network of relatives and friends. However, the effects of the provision of care on individuals' employment trajectories when this care is combined with employment of varying intensity or with childcare responsibilities have rarely been examined. The present study used proportional hazards models with the General Social Survey, Cycles 20 and 21, to assess the impact of providing care to a partner, a parent or parent-in-law, another relative, or a non-relative on the risk of leaving employment. The analyses show that providing care to a parent or parent-in-law increases the probability of leaving employment only among women employed full-time and among men and women who have no children or only adult children. PMID:25394780

Proulx, Christine; Le Bourdais, Céline

2014-12-01

426

Health care providers under pressure: making the most of challenging times.  

PubMed

Whether the slowing economic recovery, tight credit markets, increasing costs, or the uncertainty surrounding health care reform, the health care industry faces some sizeable challenges. These factors have put considerable strain on the industry's traditional financing options that the industry has relied on in the past--bonds, banks, finance companies, private equity, venture capital, real estate investment trusts, private philanthropy, and grants. At the same time, providers are dealing with rising costs, lower reimbursement rates, shrinking demand for elective procedures, higher levels of charitable care and bad debt, and increased scrutiny of tax-exempt hospitals. Providers face these challenges against a back ground of uncertainty created by health care reform. PMID:21294438

Davis, Scott B; Robinson, Phillip J

2010-01-01