Depression and Anxiety Disorders among Hospitalized Women with Breast Cancer

PubMed Central

Vin-Raviv, Neomi; Akinyemiju, Tomi F.; Galea, Sandro; Bovbjerg, Dana H.

2015-01-01

Purpose To document the prevalence of depression and anxiety disorders, and their associations with mortality among hospitalized breast cancer patients. Methods We examined the associations between breast cancer diagnosis and the diagnoses of anxiety or depression among 4,164 hospitalized breast cancer cases matched with 4,164 non-breast cancer controls using 2006-2009 inpatient data obtained from the Nationwide Inpatient Sample database. Conditional logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CI) for the associations between breast cancer diagnosis and diagnoses of anxiety or depression. We also used binary logistic regression models to examine the association between diagnoses of depression or anxiety, and in-hospital mortality among breast cancer patients. Results We observed that breast cancer cases were less likely to have a diagnosis of depression (OR=0.63, 95% CI: 0.52-0.77), and less likely to have a diagnosis of anxiety (OR=0.68, 95% CI: 0.52-0.90) compared with controls. This association remained after controlling for race/ethnicity, residential income, insurance and residential region. Breast cancer patients with a depression diagnosis also had lower mortality (OR=0.69, 95% CI: 0.52-0.89) compared with those without a depression diagnosis, but there was no significant difference in mortality among those with and without anxiety diagnoses. Conclusion Diagnoses of depression and anxiety in breast cancer patients were less prevalent than expected based on our analysis of hospitalized breast cancer patients and matched non-breast cancer controls identified in the NIS dataset using ICD-9 diagnostic codes. Results suggest that under-diagnosis of mental health problems may be common among hospitalized women with a primary diagnosis of breast cancer. Future work may fruitfully explore reasons for, and consequences of, inappropriate identification of the mental health needs of breast cancer patients. PMID

Hospital variation in sphincter preservation for elderly rectal cancer patients.

PubMed

Dodgion, Christopher M; Neville, Bridget A; Lipsitz, Stuart R; Schrag, Deborah; Breen, Elizabeth; Zinner, Michael J; Greenberg, Caprice C

2014-09-01

The primary goal of an operation for rectal cancer is to cure cancer and, where possible, preserve continence. A wide range of sphincter preservation rates have been reported. This study evaluated hospital variation in the use of low anterior resection (LAR), local excision (LE), and abdominoperineal resection (APR) in the treatment of elderly rectal cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare linked data, we identified 4959 patients older than 65 y with stage I-III rectal cancer diagnosed from 2000-2005 who underwent operative intervention at one of 370 hospitals. We evaluated the distribution of hospital-specific procedure rates and used generalized mixed models with random hospital effects to examine the influence of patient characteristics and hospital on operation type, using APR as a reference. The median hospital performed APR on 33% of elderly patients with rectal cancer. Hospital was a stronger predictor of LAR receipt than any patient characteristic, explaining 32% of procedure choice, but not a strong predictor of LE, explaining only 3.8%. Receipt of LE was primarily related to tumor size and tumor stage, which combined explained 31% of procedure variation. Receipt of LE is primarily determined by patient characteristics. In contrast, the hospital where surgery is performed significantly influences whether a patient undergoes an LAR or APR. Understanding the factors that cause this institutional variation is crucial to ensuring equitable availability of sphincter preservation. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter?

PubMed

Casazza, Franco; Becattini, Cecilia; Rulli, Eliana; Pacchetti, Ilaria; Floriani, Irene; Biancardi, Marco; Scardovi, Angela Beatrice; Enea, Iolanda; Bongarzoni, Amedeo; Pignataro, Luigi; Agnelli, Giancarlo

2016-09-01

Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.

Memories of Montpelier: Home of James and Dolley Madison. Teaching with Historic Places.

ERIC Educational Resources Information Center

Boyer, Candace

The paternal estate of U.S. President James Madison is nestled at the foot of Virginia's Blue Ridge Mountains. The estate, Montpelier, features a large mansion designed for hospitality, a fine garden, and a widespread lawn. In the early 19th century, countless visitors expressed a great sense of pleasure in the place and the people who lived…

Patient experience and quality of urologic cancer surgery in US hospitals.

PubMed

Shirk, Joseph D; Tan, Hung-Jui; Hu, Jim C; Saigal, Christopher S; Litwin, Mark S

2016-08-15

Care interactions as perceived by patients and families are increasingly viewed as both an indicator and lever for high-value care. To promote patient-centeredness and motivate quality improvement, payers have begun tying reimbursement with related measures of patient experience. Accordingly, the authors sought to determine whether such data correlate with outcomes among patients undergoing surgery for genitourinary cancer. The authors used the Nationwide Inpatient Sample and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from 2009 through 2011. They identified hospital admissions for cancer-directed prostatectomy, nephrectomy, and cystectomy, and measured mortality, hospitalization length, discharge disposition, and complications. Mixed effects models were used to compare the likelihood of selected outcomes between the top and bottom tercile hospitals adjusting for patient and hospital characteristics. Among a sample of 46,988 encounters, the authors found small differences in patient age, race, income, comorbidity, cancer type, receipt of minimally invasive surgery, and procedure acuity according to HCAHPS tercile (P<.001). Hospital characteristics also varied with respect to ownership, teaching status, size, and location (P<.001). Compared with patients treated in low-performing hospitals, patients treated in high-performing hospitals less often faced prolonged hospitalization (odds ratio, 0.77; 95% confidence interval, 0.64-0.92) or nursing-sensitive complications (odds ratio, 0.85; 95% confidence interval, 0.72-0.99). No difference was found with regard to inpatient mortality, other complications, and discharge disposition (P>.05). Using Nationwide Inpatient Sample and HCAHPS data, the authors found a limited association between patient experience and surgical outcomes. For urologic cancer surgery, patient experience may be optimally viewed as an independent quality domain rather than a mechanism with which to improve surgical

Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study.

PubMed

Yen, Tina W F; Pezzin, Liliana E; Li, Jianing; Sparapani, Rodney; Laud, Purushuttom W; Nattinger, Ann B

2017-05-15

The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation. Women who were diagnosed with stage I-III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy). Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high-, medium-, and low-volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05-1.25; high volume: OR = 1.30, 95% CI = 1.14-1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06-1.24; high volume: OR = 1.28, 95% CI = 1.13-1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07-1.17; high volume: OR = 1.16, 95% CI = 1.09-1.24). Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume-survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957-66. © 2016 American Cancer Society. © 2016 American Cancer Society.

Implementation of a hospital-based quality assessment program for rectal cancer.

PubMed

Hendren, Samantha; McKeown, Ellen; Morris, Arden M; Wong, Sandra L; Oerline, Mary; Poe, Lyndia; Campbell, Darrell A; Birkmeyer, Nancy J

2014-05-01

Quality improvement programs in Europe have had a markedly beneficial effect on the processes and outcomes of rectal cancer care. The quality of rectal cancer care in the United States is not as well understood, and scalable quality improvement programs have not been developed. The purpose of this article is to describe the implementation of a hospital-based quality assessment program for rectal cancer, targeting both community and academic hospitals. We recruited 10 hospitals from a surgical quality improvement organization. Nurse reviewers were trained to abstract rectal cancer data from hospital medical records, and abstracts were assessed for accuracy. We conducted two surveys to assess the training program and limitations of the data abstraction. We validated data completeness and accuracy by comparing hospital medical record and tumor registry data. Nine of 10 hospitals successfully performed abstractions with ≥ 90% accuracy. Experienced nurse reviewers were challenged by the technical details in operative and pathology reports. Although most variables had less than 10% missing data, outpatient testing information was lacking from some hospitals' inpatient records. This implementation project yielded a final quality assessment program consisting of 20 medical records variables and 11 tumor registry variables. An innovative program linking tumor registry data to quality-improvement data for rectal cancer quality assessment was successfully implemented in 10 hospitals. This data platform and training program can serve as a template for other organizations that are interested in assessing and improving the quality of rectal cancer care. Copyright © 2014 by American Society of Clinical Oncology.

Determinants of Hospital Death for Taiwanese Pediatric Cancer Decedents, 2001-2010.

PubMed

Hung, Yen-Ni; Liu, Tsang-Wu; Tang, Siew Tzuh

2015-11-01

Factors influencing pediatric cancer patients' place of death may have evolved with advances in medical and hospice care since earlier studies were done. To comprehensively analyze factors associated with hospital death in an unbiased population of pediatric cancer patients in Taiwan. This was a retrospective cohort study using administrative data for 1603 Taiwanese pediatric cancer patients who died in 2001-2010. Place of death was hypothesized to be associated with 1) patient sociodemographics and disease characteristics, 2) primary physician's specialty, 3) characteristics and health care resources at both the hospital and regional levels, and 4) historical trends. Most Taiwanese pediatric cancer patients (87.4%) died in an acute care hospital. The probability of dying in hospital increased slightly over time, reaching significance only in 2009 (adjusted odds ratio [AOR], 95% CI: 2.84 [1.32-6.11]). Children were more likely to die in an acute care hospital if they resided in the most urbanized area, were diagnosed with leukemia or lymphoma (2.32 [1.39-3.87]), and received care from a pediatrician (1.58 [1.01-2.47]) in a nonprofit proprietary hospital (1.50 [1.01-2.24]) or large hospital, reaching significance for the third quartile (2.57 [1.28-5.18]) of acute care hospital beds. Taiwanese pediatric cancer patients predominantly died in an acute care hospital with a slightly increasing trend of shifting place of death from home to hospital. Propensity for hospital death was determined by residential urbanization level, diagnosis, primary physician's specialty, and the primary hospital's characteristics and health care resources. Clinical interventions and health policies should ensure that resources are allocated to allow pediatric cancer patients to die in the place they and their parents prefer to achieve a good death and promote their parents' bereavement adjustment. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier

Disparities in breast cancer tumor characteristics, treatment, time to treatment, and survival probability among African American and white women.

PubMed

Foy, Kevin Chu; Fisher, James L; Lustberg, Maryam B; Gray, Darrell M; DeGraffinreid, Cecilia R; Paskett, Electra D

2018-01-01

African American (AA) women have a 42% higher breast cancer death rate compared to white women despite recent advancements in management of the disease. We examined racial differences in clinical and tumor characteristics, treatment and survival in patients diagnosed with breast cancer between 2005 and 2014 at a single institution, the James Cancer Hospital, and who were included in the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute Cancer Registry in Columbus OH. Statistical analyses included likelihood ratio chi-square tests for differences in proportions, as well as univariate and multivariate Cox proportional hazards regressions to examine associations between race and overall and progression-free survival probabilities. AA women made up 10.2% (469 of 4593) the sample. Average time to onset of treatment after diagnosis was almost two times longer in AA women compared to white women (62.0 days vs 35.5 days, p  < 0.0001). AA women were more likely to report past or current tobacco use, experience delays in treatment, have triple negative and late stage breast cancer, and were less likely to receive surgery, especially mastectomy and reconstruction following mastectomy. After adjustment for confounding factors (age, grade, and surgery), overall survival probability was significantly associated with race (HR = 1.33; 95% CI 1.03-1.72). These findings highlight the need for efforts focused on screening and receipt of prompt treatment among AA women diagnosed with breast cancer.

Toni Wolff-James Kirsch correspondence.

PubMed

Kirsch, Thomas B

2003-09-01

This paper draws on the letters between Toni Wolff and James Kirsch from 1929-1933 and from 1949-1953 to highlight some aspects of Toni Wolff's relationship with her superviser and former analysand, James Kirsch. Her personality, her approach to her work as analyst, and her relationship with Jung and with colleagues are illustrated with selected quotes from the correspondence.

Re-Presenting James Britton: A Symposium.

ERIC Educational Resources Information Center

Tirrell, Mary Kay; And Others

1990-01-01

Presents revised versions of four symposium papers examining the work of linguist, teacher, and educator of teachers James Britton. Includes "James Britton: An Impressionistic Sketch" (Mary Kay Tirrell); "Collaborating with Jimmy Britton" (Gordon M. Pradl); "Rejoicing in the Margins" (John Warnock); and "A…

Characteristics Associated with In-Hospital Death among Commercially Insured Decedents with Cancer.

PubMed

Brooks, Gabriel A; Stuver, Sherri O; Zhang, Yichen; Gottsch, Stephanie; Fraile, Belen; McNiff, Kristen; Dodek, Anton; Jacobson, Joseph O

2017-01-01

A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common. We sought to identify characteristics associated with in-hospital death. Case series. Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life. Patient characteristics, healthcare utilization, and in-hospital death (primary outcome) were ascertained from institutional records and healthcare claims. Bivariate and multivariable analyses were used to evaluate the association of in-hospital death with patient characteristics and end-of-life outcome measures. We identified 904 decedents, with a median age of 59 years at death. In-hospital death was observed in 254 patients (28%), including 110 (12%) who died in an intensive care unit. Hematologic malignancy was associated with a 2.57 times increased risk of in-hospital death (95% confidence interval [CI] 1.91-3.45, p < 0.001), and nonenrollment in hospice was associated with a 14.5 times increased risk of in-hospital death (95% CI 9.81-21.4, p < 0.001). Time from cancer diagnosis to death was also associated with in-hospital death (p = 0.003), with the greatest risk among patients dying within six months of cancer diagnosis. All significant associations persisted in multivariable analyses that were adjusted for baseline characteristics. In-hospital deaths are common among commercially insured cancer patients. Patients with hematologic malignancy and patients who die without receiving hospice services have a substantially higher incidence of in-hospital death.

Processes of code status transitions in hospitalized patients with advanced cancer.

PubMed

El-Jawahri, Areej; Lau-Min, Kelsey; Nipp, Ryan D; Greer, Joseph A; Traeger, Lara N; Moran, Samantha M; D'Arpino, Sara M; Hochberg, Ephraim P; Jackson, Vicki A; Cashavelly, Barbara J; Martinson, Holly S; Ryan, David P; Temel, Jennifer S

2017-12-15

Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR. In total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P < .001), and a greater likelihood of inpatient death (P = .005). One-half of code status order changes among hospitalized patients with advanced cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society. © 2017 American Cancer Society.

HOSPITAL VARIATION IN SPHINCTER PRESERVATION FOR ELDERLY RECTAL CANCER PATIENTS

PubMed Central

Dodgion, Christopher M.; Neville, Bridget A; Lipsitz, Stuart R.; Schrag, Deborah; Breen, Elizabeth; Zinner, Michael J.; Greenberg, Caprice C.

2014-01-01

Purpose To evaluate hospital variation in the use of low anterior resection (LAR), local excision (LE) and abdominoperineal resection (APR) in the treatment of rectal cancer in elderly patients. Methods Using SEER-Medicare linked data, we identified 4,959 stage I–III rectal cancer patients over age 65 diagnosed from 2000–2005 who underwent operative intervention at one of 370 hospitals. We evaluated the distribution of hospital-specific procedure rates and used generalized mixed models with random hospital effects to examine the influence of patient characteristics and hospital on operation type, using APR as a reference. Results The median hospital performed APR on 33% of elderly rectal cancer patients. Hospital was a stronger predictor of LAR receipt than any patient characteristic, explaining 32% of procedure choice, but not a strong predictor of LE, explaining only 3.8%. Receipt of LE was primarily related to tumor size and tumor stage, which, combined, explained 31% of procedure variation. Conclusions Receipt of local excision is primarily determined by patient characteristics. In contrast, the hospital where surgery is performed significantly influences whether a patient undergoes an LAR or APR. Understanding the factors that cause this institutional variation is crucial to ensuring equitable availability of sphincter preservation. PMID:24750983

Characteristic Trend Analysis of Cancer Patients Hospitalized in Shanxi Tumor Hospital for the First Time during 2001 and 2010.

PubMed

Zhang, Wen-Li; Wang, Yan; Han, Cun-Zhi

2015-01-01

To observe and analyze the characteristic trend of cancer patients hospitalized for the first time in Shanxi Tumor Hospital from 2001 to 2010, clinical data including case number, age, gender, and frequency of different tumor occurrences were collected and statistically analyzed. (i) From 2001 to 2010, the number of cancer patients hospitalized for the first time increased by 1.3-fold; (ii) The patient overall average age also increased from 51.8 to 54.4, for males from 55.5 to 58.7 and females from 48.4 to 51.1, respectively. (iii) Male patients accounted for 43-48% and females accounted for 52-57% of the total. The percentage of female patients was higher than that of male patients in every year and showed an upward trend over the years, while that of the males showed a downward trend (χ2 =7.031, p=0.008); (iv) Among the top 6 most common cancers, lung, cervical, esophageal, colorectal and breast cancers tended to increase over the years (p<0.05), but not gastric cancer (p=0.423). (i) The number of cancer patients hospitalized for the first time during the past 10 years increased year by year, and was higher for female than male; (ii) the average age of patients increased year after year and was greater for male than female; (iii) the number of patients with lung cancer, cervical cancer, esophageal cancer, colorectal cancer and breast cancer increased over years.

Maniac Talk - Dr. James Garvin

NASA Image and Video Library

2014-05-28

James Garvin Maniac Lecture, 28 May 2014 Dr. James Garvin, Chief Scientist, NASA Goddard Space Flight Center, presented a Maniac Talk entitled "From Brownian Motion to Mars, by way of hockey on the rocks." Jim shared how his passion for rocks and landscapes drove him to promote new remote sensing approaches for measuring their topologies and led to founding of the Mars Science Laboratory and its Curiosity Rover.

James Bay

Atmospheric Science Data Center

2013-04-17

article title:  Hudson Bay and James Bay, Canada   ... which scatters more light in the backward direction. This example illustrates how multi-angle viewing can distinguish physical structures ... MD. The MISR data were obtained from the NASA Langley Research Center Atmospheric Science Data Center in Hampton, VA. Image ...

Poor and Rich in James: A Relevance Theory Approach to James's Use of the Old Testament

ERIC Educational Resources Information Center

Morales, Nelson R.

2015-01-01

The epistle of James was for years a forgotten book in academic circles. In recent decades, however, a renewed focus on early Judaism has generated interest in looking at James with new eyes. Poverty and wealth in the epistle continues to be a point of interest. Other topics, however, are still to be explored. One of these topics is the rhetorical…

Home versus hospital mortality from cancer in Mexico (1999-2009).

PubMed

Castillo-Guzmán, Sandra; Palacios-Ríos, Dionicio; Nava-Obregón, Teresa Adriana; Torres-Pérez, Juan Francisco; González-Santiago, Omar

2013-05-01

To analyze the place of death from cancer in México from 1999 to 2009 and find the associated factors. We collected data on mortality by cancer from the national database including age, gender, area of residence, level of education, place of death, and type of cancer. The proportion of deaths at home and hospital was 55.67% and 39%, respectively. Factors associated with home deaths were old age, female gender, rural area of residence, and lack of formal education. There was a short but significant decrease in home deaths for cervical cancer and leukemia. In México, mortality in home is greater than in hospital for patients with cancer. Our results have important implications for palliative care professionals and health services of México.

Space perception and William James's metaphysical presuppositions.

PubMed

Farrell, Martin J

2011-05-01

William James's overtly philosophical work may be more continuous with his psychological work than is sometimes thought. His Essays in Radical Empiricism can be understood as an explicit statement of the absolute presupposition that formed the basis of Jamesian psychology: that direct experience is primary and has to be taken at face value. An examination of James's theory of space perception suggests that, even in his early work, he presupposed the primacy of direct experience, and that later changes in his account of space perception can be understood as making his view more consistent with this presupposition. In his earlier view of space perception, James argued that sensations were directly experienced as spatial, though he accepted that spatial relations between sensations may be constructed by higher order thought. In his later view, however, James argued that spatial relations were just as directly experienced as sensations. The work of T. H. Green may have prompted James to recognize the full consequence of his ideas and to realize that taking experience at face value required that spatial relations be thought of as intrinsic to experience rather than the result of intellectual construction.

Disease Specific Productivity of American Cancer Hospitals

PubMed Central

Goldstein, Jeffery A.; Prasad, Vinay

2015-01-01

Context Research-oriented cancer hospitals in the United States treat and study patients with a range of diseases. Measures of disease specific research productivity, and comparison to overall productivity, are currently lacking. Hypothesis Different institutions are specialized in research of particular diseases. Objective To report disease specific productivity of American cancer hospitals, and propose a summary measure. Method We conducted a retrospective observational survey of the 50 highest ranked cancer hospitals in the 2013 US News and World Report rankings. We performed an automated search of PubMed and Clinicaltrials.gov for published reports and registrations of clinical trials (respectively) addressing specific cancers between 2008 and 2013. We calculated the summed impact factor for the publications. We generated a summary measure of productivity based on the number of Phase II clinical trials registered and the impact factor of Phase II clinical trials published for each institution and disease pair. We generated rankings based on this summary measure. Results We identified 6076 registered trials and 6516 published trials with a combined impact factor of 44280.4, involving 32 different diseases over the 50 institutions. Using a summary measure based on registered and published clinical trails, we ranked institutions in specific diseases. As expected, different institutions were highly ranked in disease-specific productivity for different diseases. 43 institutions appeared in the top 10 ranks for at least 1 disease (vs 10 in the overall list), while 6 different institutions were ranked number 1 in at least 1 disease (vs 1 in the overall list). Conclusion Research productivity varies considerably among the sample. Overall cancer productivity conceals great variation between diseases. Disease specific rankings identify sites of high academic productivity, which may be of interest to physicians, patients and researchers. PMID:25781329

Disease specific productivity of american cancer hospitals.

PubMed

Goldstein, Jeffery A; Prasad, Vinay

2015-01-01

Research-oriented cancer hospitals in the United States treat and study patients with a range of diseases. Measures of disease specific research productivity, and comparison to overall productivity, are currently lacking. Different institutions are specialized in research of particular diseases. To report disease specific productivity of American cancer hospitals, and propose a summary measure. We conducted a retrospective observational survey of the 50 highest ranked cancer hospitals in the 2013 US News and World Report rankings. We performed an automated search of PubMed and Clinicaltrials.gov for published reports and registrations of clinical trials (respectively) addressing specific cancers between 2008 and 2013. We calculated the summed impact factor for the publications. We generated a summary measure of productivity based on the number of Phase II clinical trials registered and the impact factor of Phase II clinical trials published for each institution and disease pair. We generated rankings based on this summary measure. We identified 6076 registered trials and 6516 published trials with a combined impact factor of 44280.4, involving 32 different diseases over the 50 institutions. Using a summary measure based on registered and published clinical trails, we ranked institutions in specific diseases. As expected, different institutions were highly ranked in disease-specific productivity for different diseases. 43 institutions appeared in the top 10 ranks for at least 1 disease (vs 10 in the overall list), while 6 different institutions were ranked number 1 in at least 1 disease (vs 1 in the overall list). Research productivity varies considerably among the sample. Overall cancer productivity conceals great variation between diseases. Disease specific rankings identify sites of high academic productivity, which may be of interest to physicians, patients and researchers.

Hospital of diagnosis and probability of having surgical treatment for resectable gastric cancer.

PubMed

van Putten, M; Verhoeven, R H A; van Sandick, J W; Plukker, J T M; Lemmens, V E P P; Wijnhoven, B P L; Nieuwenhuijzen, G A P

2016-02-01

Gastric cancer surgery is increasingly being centralized in the Netherlands, whereas the diagnosis is often made in hospitals where gastric cancer surgery is not performed. The aim of this study was to assess whether hospital of diagnosis affects the probability of undergoing surgery and its impact on overall survival. All patients with potentially curable gastric cancer according to stage (cT1/1b-4a, cN0-2, cM0) diagnosed between 2005 and 2013 were selected from The Netherlands Cancer Registry. Multilevel logistic regression was used to examine the probability of undergoing surgery according to hospital of diagnosis. The effect of variation in probability of undergoing surgery among hospitals of diagnosis on overall survival during the intervals 2005-2009 and 2010-2013 was examined by using Cox regression analysis. A total of 5620 patients with potentially curable gastric cancer, diagnosed in 91 hospitals, were included. The proportion of patients who underwent surgery ranged from 53.1 to 83.9 per cent according to hospital of diagnosis (P < 0.001); after multivariable adjustment for patient and tumour characteristics it ranged from 57.0 to 78.2 per cent (P < 0.001). Multivariable Cox regression showed that patients diagnosed between 2010 and 2013 in hospitals with a low probability of patients undergoing curative treatment had worse overall survival (hazard ratio 1.21; P < 0.001). The large variation in probability of receiving surgery for gastric cancer between hospitals of diagnosis and its impact on overall survival indicates that gastric cancer decision-making is suboptimal. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Environmental market factors associated with electronic health record adoption among cancer hospitals.

PubMed

Tarver, Will L; Menachemi, Nir

2017-02-22

Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care. The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals. Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited. In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals. A greater understanding of the environment's relationship to health information technology adoption in

The Darwinian Center to the Vision of William James.

ERIC Educational Resources Information Center

Bredo, Eric

The essence of William James's vision can sometimes be hard to discover due to emotional volatility and exploratory impulsiveness. On the other hand, beneath James's apparent inconsistency was a constancy of purpose that can be easily underestimated. This paper argues that the center of James's vision lay in an interpretation of Darwinism. By…

Hospital volume, complications, and cost of cancer surgery in the elderly.

PubMed

Nathan, Hari; Atoria, Coral L; Bach, Peter B; Elkin, Elena B

2015-01-01

Hospital surgical volume has been shown to correlate with short-term outcomes after cancer surgery, but the relationship between volume and cost of care is unclear. We sought to characterize variation in payments for cancer surgery and assess the relationship between hospital volume and payments. Using 2000 to 2007 Surveillance, Epidemiology, and End Results-Medicare data, we assessed risk-adjusted 30-day episode Medicare payments for elderly patients undergoing one of six procedures for resection of cancer. Payments for the index hospitalization, readmissions, physician services, emergency room visits, and postdischarge ancillary care were analyzed, as were data on 30-day mortality and complications. The analysis included 31,191 colectomies, 2,670 cystectomies, 1,514 pancreatectomies, 2,607 proctectomies, 12,228 prostatectomies, and 10,151 pulmonary lobectomies. There was substantial variation in cost; differences between the first and third terciles of cost varied from 27% for cystectomy to 40% for colectomy. The majority of variation (66% to 82%) was attributable to payments for the index admission rather than readmissions or physician services. There were no meaningful associations between total risk-adjusted payments and hospital volume. Surgical mortality was low, but complication rates ranged from 10% (prostatectomy) to 56% (lobectomy). Complication rates were not correlated with hospital volume, but occurrence of complications was associated with 47% to 70% higher costs. We found substantial variation in Medicare payments for these six cancer procedures. Cost was strongly associated with postoperative complications and primarily driven by differences in the cost of the index hospitalization. Efforts to prevent and cost-effectively manage complications are more likely to reduce costs than volume-based referral of cancer surgery alone. © 2014 by American Society of Clinical Oncology.

Henry James on the Art of Acting.

ERIC Educational Resources Information Center

Thompson, David W.

Henry James, the nineteenth-century American novelist, also served on occasion as a theatre critic. Between 1875 and 1890 he reviewed several productions in Boston, New York, London, and Paris for "Atlantic Monthly" and other periodicals. The reviews are of interest because of James' high standards regarding acting and his often…

Performance of activities of daily living among hospitalized cancer patients.

PubMed

Lindahl-Jacobsen, Line; Hansen, Dorte Gilså; Wæhrens, Eva Ejlersen; la Cour, Karen; Søndergaard, Jens

2015-03-01

Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. RESULTS from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments. Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.

An audit of the laboratory service provided to the Health Service Executive Orthodontic Department, St James Hospital, Dublin.

PubMed

Al-Awadhi, E A; Wolstencroft, S J; Blake, M

2006-01-01

To evaluate the service purchased from contracted orthodontic laboratories used by HSE (SWA) regional orthodontic unit, St. James's Hospital, Dublin and identify deficiencies in the current service. A data collection questionnaire was designed and distributed to the departmental orthodontists for a period of three months (October-December 2004). Gold standards, drawn up based on the authors' ideal requirements and published guidelines, were supplied to grade the work returned. During the study period 363 items of laboratory work were requested. 20% of the laboratory work arrived late and most of the delayed work was delayed for more than 24 hours. Most laboratory delays occurred with functional appliances, retainers and study models. Prior to fit, 20% of the appliances required adjustments for more than 30 seconds. 65% of laboratory work returned to the department met all of the gold standards. 10% of appliances were considered unsatisfactory. Functional appliances were most often ill fitting accounting for almost half of the unsatisfactory laboratory work. The majority of the laboratory work returned to the department met our gold standards and arrived on time. Forty six percent of the appliances required adjustments. Functional appliances required the most adjustments; one in five of all functional appliances ordered were considered unsatisfactory.

The Cancer Pattern in Africans at Bargwanath Hospital, Johannesburg†

PubMed Central

Robertson, M. A.; Harington, J. S.; Bradshaw, Evelyn

1971-01-01

Material on African cancer cases admitted to Baragwanath Hospital, Johannesburg, over the years 1948-64 has been analysed, and it has been possible to obtain a useful incidence rate, a ratio study and a tribal analysis for purposes of comparison. The incidence rate, when compared to an earlier Johannesburg survey, showed a rise in oesophageal cancers for males and females. Both lung and prostate cancers showed rising rates in the men, while the female breast and cervix cancer rates remained relatively constant. Liver cancers had decreased in both sexes. PMID:5144511

Organizational Factors Affect Safety-Net Hospitals' Breast Cancer Treatment Rates.

PubMed

Bickell, Nina A; Moss, Alexandra DeNardis; Castaldi, Maria; Shah, Ajay; Sickles, Alan; Pappas, Peter; Lewis, Theophilus; Kemeny, Margaret; Arora, Shalini; Schleicher, Lori; Fei, Kezhen; Franco, Rebeca; McAlearney, Ann Scheck

2017-12-01

To identify key organizational approaches associated with underuse of breast cancer care. Nine New York City area safety-net hospitals. Mixed qualitative-quantitative, cross-sectional cohort. We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions," calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm. We used hierarchical models to assess organizational and patient factors' impact on underuse. Underuse varied by hospital (8-29 percent). QCA found lower underuse sites designated individuals to track and follow-up no-shows; shared clinical information during handoffs; had fully integrated electronic medical records enabling transfer of responsibility across specialties; had strong system support; allocated resources to cancer clinics; had a patient-centered culture paying close organizational attention to clinic patients. High underuse sites lacked these characteristics. Multivariate modeling found that hospitals with strong approaches to follow-up had low underuse rates (RR = 0.28; 0.08-0.95); individual patient characteristics were not significant. At safety-net hospitals, underuse of needed cancer therapies is associated with organizational approaches to track and follow-up treatment. Findings provide varying approaches to safety nets to improve cancer care delivery. © Health Research and Educational Trust.

Developing an effective lung cancer program in a community hospital setting.

PubMed

Fischel, Richard J; Dillman, Robert O

2009-07-01

Lung cancer remains the number one cause of cancer-based mortality in men and women. The importance of proper lung cancer care outside of major academic centers cannot be overemphasized because the vast majority of lung cancer care occurs in community hospital settings. We have had the opportunity to develop a highly successful community hospital-based lung cancer program. Utilizing a multidisciplinary approach, we have achieved steadily improving survival rates that are much higher than those observed nationally for patients diagnosed with lung cancer. Key components of this successful program include: (1) a weekly multidisciplinary lung cancer case conference with medical doctor representatives from medical oncology, thoracic surgery, pulmonary medicine, radiology, radiation oncology, and nuclear medicine who discuss patient presentation, test results, treatment history, and plans for therapy; (2) thoracic surgeons skilled in minimally invasive video-assisted thoracoscopic surgery; (3) nurse navigator/coordinators to help patients through the process from detection to recovery and provide a personal bond that greatly improves patient satisfaction; (4) utilization of treatment guidelines for patient-specific treatment strategies; (5) formal continuing medical education; (6) an emphasis on early detection that includes consideration of computed tomography screening of former smokers; (6) a cancer center that allows for many services to be offered at a single location for patient convenience and to promote interdisciplinary care; and (7) access to research protocols. These components have helped us provide a quality lung cancer program in a community hospital setting that is associated with excellent clinical outcomes.

Validation of Predictors of Fall Events in Hospitalized Patients With Cancer.

PubMed

Weed-Pfaff, Samantha H; Nutter, Benjamin; Bena, James F; Forney, Jennifer; Field, Rosemary; Szoka, Lynn; Karius, Diana; Akins, Patti; Colvin, Christina M; Albert, Nancy M

2016-10-01

A seven-item cancer-specific fall risk tool (Cleveland Clinic Capone-Albert [CC-CA] Fall Risk Score) was shown to have a strong concordance index for predicting falls; however, validation of the model is needed. The aims of this study were to validate that the CC-CA Fall Risk Score, made up of six factors, predicts falls in patients with cancer and to determine if the CC-CA Fall Risk Score performs better than the Morse Fall Tool. Using a prospective, comparative methodology, data were collected from electronic health records of patients hospitalized for cancer care in four hospitals. Risk factors from each tool were recorded, when applicable. Multivariable models were created to predict the probability of a fall. A concordance index for each fall tool was calculated. The CC-CA Fall Risk Score provided higher discrimination than the Morse Fall Tool in predicting fall events in patients hospitalized for cancer management.

Fever and neutropenia hospital discharges in children with cancer: A 2012 update.

PubMed

Mueller, Emily L; Croop, James; Carroll, Aaron E

2016-02-01

Fever and neutropenia (FN) is a common precipitant for hospitalization among children with cancer, but hospital utilization trends are not well described. This study describes national trends for hospital discharges for FN among children with cancer for the year 2012, compared with the authors' previous analysis from 2009. Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2012. Pediatric patients with cancer who had a discharge for FN were identified using age ≤19 years, urgent or emergent admit type, nontransferred, and a combination of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for fever and neutropenia. The authors evaluated factors associated with a "short length of stay" (SLOS). Sampling weights were used to permit national inferences. In 2012, children with cancer accounted for 1.8% of pediatric hospital discharges (n = 120,675), with 12.2% (n = 13,456) of cancer-related discharges meeting FN criteria. Two fifths of FN discharges had a SLOS, which accounted for $91 million (2015 US$) in hospital charges. The majority had no serious infections; most common infections were viral infection (9.6%) or upper respiratory infection (9.6%). Factors significantly associated with SLOS included having a diagnosis of ear infection (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.03), soft tissue sarcoma (OR = 1.47, CI: 1.10-1.95), and Hodgkin lymphoma (OR = 1.51, CI: 1.09-2.10), as compared with not having those diagnoses. SLOS admissions continue to be rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN. Implementation of risk stratification schemas to identify patients who meet low-risk criteria may decrease financial burden.

Patients' expectations of information provided at cancer hospitals in Japan.

PubMed

Hamajima, N; Tajima, K; Morishita, M; Hyodo, C; Sakakibara, N; Kawai, C; Moritaka, S

1996-10-01

In order to survey patients' views on disease and treatment information that should be provided at hospitals, an anonymous self-administered questionnaire was distributed to patients at Aichi Cancer Center Hospital in 1995. All eligible first-visit outpatients (97 persons), randomly selected revisit outpatients (99 persons; about one in ten refused), and all except six eligible inpatients in good condition at discharge (97 persons) responded. Out of 293 patients (115 males, 174 females and 4 unspecified), 74% answered that they wanted to be informed of their diagnosis irrespective of circumstances, 20% answered that they would want to be informed only in certain circumstances, and 2% did not want to be informed at all. There were no significant differences in response among the three sources of patients. Inpatients wanted more (81%) to be explained about recommended therapy than either first-visit outpatients (67%) or revisit outpatients (67%). The majority considered that about a 30-minute explanation was needed using pamphlet-like written materials or video. When asked what information was needed when choosing a cancer hospital, 71% specified information on the specialty of the hospital, 57% the content of the care provided, 23% the name and specialty of the doctors, 20% the waiting period before scheduled admission, 13% the average admission period, 11% the number of patients with the same disease, 10% the waiting time at the outpatient clinic, 6% the meal menu, and 4% the number of private wards. Forty-three percent wanted an information service covering all hospitals in the region through an information center. The results revealed that patients at this cancer hospital required information on their disease, treatment, and hospital specialty.

James Ferguson remembered

NASA Astrophysics Data System (ADS)

Davenhall, Clive

2012-03-01

The year 2010 marked the three hundredth anniversary of the birth of the astronomer, author and lecturer James Ferguson (1710-1776). Subsequently I visited the site of the churchyard where Ferguson is buried. He is mentioned in a plaque on the site and I thought that the details might be of interest.

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis.

PubMed

Whitney, Robin L; Bell, Janice F; Tancredi, Daniel J; Romano, Patrick S; Bold, Richard J; Joseph, Jill G

2017-11-01

Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might

Establishing a general medical outpatient clinic for cancer survivors in a public city hospital setting.

PubMed

Goytia, Elliott J; Lounsbury, David W; McCabe, Mary S; Weiss, Elisa; Newcomer, Meghan; Nelson, Deena J; Brennessel, Debra; Rapkin, Bruce D; Kemeny, M Margaret

2009-11-01

Many cancer centers and community hospitals are developing novel models of survivorship care. However, few are specifically focused on services for socio-economically disadvantaged cancer survivors. To describe a new model of survivorship care serving culturally diverse, urban adult cancer patients and to present findings from a feasibility evaluation. Adult cancer patients treated at a public city hospital cancer center. The clinic provides comprehensive medical and psychosocial services for patients within a public hospital cancer center where they receive their oncology care. Longitudinal data collected over a 3-year period were used to describe patient demographics, patient needs, and services delivered. Since inception, 410 cancer patients have been served. Demand for services has grown steadily. Hypertension was the most frequent comorbid condition treated. Pain, depression, cardiovascular disease, hyperlipidemia, and bowel dysfunction were the most common post-treatment problems experienced by the patients. Financial counseling was an important patient resource. This new clinical service has been well-integrated into its public urban hospital setting and constitutes an innovative model of health-care delivery for socio-economically challenged, culturally diverse adult cancer survivors.

Factors that influence minority use of high-volume hospitals for colorectal cancer care.

PubMed

Huang, Lyen C; Tran, Thuy B; Ma, Yifei; Ngo, Justine V; Rhoads, Kim F

2015-05-01

Previous studies suggest that minorities cluster in low-quality hospitals despite living close to better performing hospitals. This may contribute to persistent disparities in cancer outcomes. The purpose of this work was to examine how travel distance, insurance status, and neighborhood socioeconomic factors influenced minority underuse of high-volume hospitals for colorectal cancer. The study was a retrospective, cross-sectional, population-based study. All hospitals in California from 1996 to 2006 were included. Patients with colorectal cancer diagnosed and treated in California between 1996 and 2006 were identified using California Cancer Registry data. Multivariable logistic regression models predicting high-volume hospital use were adjusted for age, sex, race, stage, comorbidities, insurance status, and neighborhood socioeconomic factors. A total of 79,231 patients treated in 417 hospitals were included in the study. High-volume hospitals were independently associated with an 8% decrease in the hazard of death compared with other settings. A lower proportion of minorities used high-volume hospitals despite a higher proportion living nearby. Although insurance status and socioeconomic factors were independently associated with high-volume hospital use, only socioeconomic factors attenuated differences in high-volume hospital use of black and Hispanic patients compared with white patients. The use of cross-sectional data and racial and ethnic misclassifications were limitations in this study. Minority patients do not use high-volume hospitals despite improved outcomes and geographic access. Low socioeconomic status predicts low use of high-volume settings in select minority groups. Our results provide a roadmap for developing interventions to increase the use of and access to higher quality care and outcomes. Increasing minority use of high-volume hospitals may require community outreach programs and changes in physician referral practices.

Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

PubMed

Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

2017-04-01

To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

[Predictive value and sensibility of hospital discharge system (PMSI) compared to cancer registries for thyroïd cancer (1999-2000)].

PubMed

Carré, N; Uhry, Z; Velten, M; Trétarre, B; Schvartz, C; Molinié, F; Maarouf, N; Langlois, C; Grosclaude, P; Colonna, M

2006-09-01

Cancer registries have a complete recording of new cancer cases occurring among residents of a specific geographic area. In France, they cover only 13% of the population. For thyroid cancer, where incidence rate is highly variable according to the district conversely to mortality, national incidence estimates are not accurate. A nationwide database, such as hospital discharge system, could improve this estimate but its positive predictive value and sensibility should be evaluated. The positive predictive value and the sensitivity for thyroid cancer case ascertainment (ICD-10) of the national hospital discharge system in 1999 and 2000 were estimated using the cancer registries database of 10 French districts as gold standard. The linkage of the two databases required transmission of nominative information from the health facilities of the study. From the registries database, a logistic regression analysis was carried out to identify factors related to being missed by the hospital discharge system. Among the 973 standardized discharge charts selected from the hospital discharge system, 866 were considered as true positive cases, and 107 as false positive. Forty five of the latter group were prevalent cases. The predictive positive value was 89% (95% confidence interval (CI): 87-91%) and did not differ according to the district (p=0,80). According to the cancer registries, 322 thyroid cancer cases diagnosed in 1999 or 2000 were missed by the hospital discharge system. Thus, the sensitivity of this latter system was 73% (70-76%) and varied significantly from 62% to 85% across districts (p<0.001) and according to the type of health facility (p<0.01). Predictive positive value of the French hospital discharge system for ascertainment of thyroid cancer cases is high and stable across districts. Sensitivity is lower and varies significantly according to the type of health facility and across districts, which limits the interest of this database for a national estimate of

Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.

PubMed

Grenda, Tyler R; Revels, Sha'Shonda L; Yin, Huiying; Birkmeyer, John D; Wong, Sandra L

2015-11-01

Wide variations in mortality rates exist across hospitals following lung cancer resection; however, the factors underlying these differences remain unclear. To evaluate perioperative outcomes in patients who underwent lung cancer resection at hospitals with very high and very low mortality rates (high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) to better understand the factors related to differences in mortality rates after lung cancer resection. In this retrospective cohort study, 1279 hospitals that were accredited by the Commission on Cancer were ranked on a composite measure of risk-adjusted mortality following major cancer resections performed from January 1, 2005, through December 31, 2006. We collected data from January 1, 2006, through December 31, 2007, on 645 lung resections in 18 LMHs and 25 HMHs. After adjusting for patient characteristics, we used hierarchical logistic regression to examine differences in the incidence of complications and "failure-to-rescue" rates (defined as death following a complication). Rates of adherence to processes of care, incidence of complications, and failure to rescue following complications. Among 645 patients who received lung resections (441 in LMHs and 204 in HMHs), the overall unadjusted mortality rates were 1.6% (n = 7) vs 10.8% (n = 22; P < .001) for LMHs and HMHs, respectively. Following risk adjustment, the difference in mortality rates was attenuated (1.8% vs 8.1%; P < .001) but remained significant. Overall, complication rates were higher in HMHs (23.3% vs 15.6%; adjusted odds ratio [aOR], 1.79; 95% CI, 0.99-3.21), but this difference was not significant. The likelihood of any surgical (aOR, 0.73; 95% CI, 0.26-2.00) or cardiopulmonary (aOR, 1.23; 95% CI, 0.70-2.16) complications was similar between LMHs and HMHs. However, failure-to-rescue rates were significantly higher in HMHs (25.9% vs 8.7%; aOR, 6.55; 95% CI, 1.44-29.88). Failure-to-rescue rates are higher at HMHs, which may

Not just bricks and mortar: planning hospital cancer services for Aboriginal people

PubMed Central

2011-01-01

Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i) being alone and lost in a big, alien and inflexible system; (ii) failure of open communication, delays and inefficiency in the system; (iii) practicalities: costs, transportation, community and family responsibilities; (iv) the need for Aboriginal support persons; and (v) connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes. PMID:21401923

Equivalent Treatment and Survival after Resection of Pancreatic Cancer at Safety-Net Hospitals.

PubMed

Dhar, Vikrom K; Hoehn, Richard S; Kim, Young; Xia, Brent T; Jung, Andrew D; Hanseman, Dennis J; Ahmad, Syed A; Shah, Shimul A

2018-01-01

Due to disparities in access to care, patients with Medicaid or no health insurance are at risk of not receiving appropriate adjuvant treatment following resection of pancreatic cancer. We have previously shown inferior short-term outcomes following surgery at safety-net hospitals. Subsequently, we hypothesized that safety-net hospitals caring for these vulnerable populations utilize less adjuvant chemoradiation, resulting in inferior long-term outcomes. The American College of Surgeons National Cancer Data Base was queried for patients diagnosed with pancreatic adenocarcinoma (n = 32,296) from 1998 to 2010. Hospitals were grouped according to safety-net burden, defined as the proportion of patients with Medicaid or no insurance. The highest quartile, representing safety-net hospitals, was compared to lower-burden hospitals with regard to patient demographics, disease characteristics, surgical management, delivery of multimodal systemic therapy, and survival. Patients at safety-net hospitals were less often white, had lower income, and were less educated. Safety-net hospital patients were just as likely to undergo surgical resection (OR 1.03, p = 0.73), achieving similar rates of negative surgical margins when compared to patients at medium and low burden hospitals (70% vs. 73% vs. 66%). Thirty-day mortality rates were 5.6% for high burden hospitals, 5.2% for medium burden hospitals, and 4.3% for low burden hospitals. No clinically significant differences were noted in the proportion of surgical patients receiving either chemotherapy (48% vs. 52% vs. 52%) or radiation therapy (26% vs. 30% vs. 29%) or the time between diagnosis and start of systemic therapy (58 days vs. 61 days vs. 53 days). Across safety-net burden groups, no difference was noted in stage-specific median survival (all p > 0.05) or receipt of adjuvant as opposed to neoadjuvant systemic therapy (82% vs. 85% vs. 85%). Multivariate analysis adjusting for cancer stage revealed no difference in

Coping strategies used by hospitalized children with cancer undergoing chemotherapy.

PubMed

Sposito, Amanda Mota Pacciulio; Silva-Rodrigues, Fernanda Machado; Sparapani, Valéria de Cássia; Pfeifer, Luzia Iara; de Lima, Regina Aparecida Garcia; Nascimento, Lucila Castanheira

2015-03-01

To analyze coping strategies used by children with cancer undergoing chemotherapy during hospitalization. This was an exploratory study to analyze qualitative data using an inductive thematic analysis. Semistructured interviews using puppets were conducted with 10 children with cancer, between 7 and 12 years old, who were hospitalized and undergoing chemotherapy. The coping strategies to deal with chemotherapy were: understanding the need for chemotherapy; finding relief for the chemotherapy's side effects and pain; seeking pleasure in nourishment; engaging in entertaining activities and having fun; keeping the hope of cure alive; and finding support in religion. Children with cancer undergoing chemotherapy need to cope with hospitalizations, pain, medication side effects, idle time, and uncertainty regarding the success of treatment. These challenges motivated children to develop their own coping strategies, which were effective while undergoing chemotherapy. By gaining knowledge and further understanding about valid coping strategies during chemotherapy treatment, health professionals can mobilize personal and material resources from the children, health teams, and institutions aiming to potentiate the use of these strategies to make treatments the least traumatic. © 2015 Sigma Theta Tau International.

Improving cancer patients' pain: the impact of the hospital specialist palliative care team.

PubMed

Jack, B; Hillier, V; Williams, A; Oldham, J

2006-12-01

Pain is reported to occur in the majority of patients with advanced cancer and is one of the main reasons for referral to a hospital specialist palliative care team. Yet despite this, there is a paucity of research into the impact the hospital specialist palliative care team has on pain control in patients. A non-equivalent control group design using a quota sample investigated 100 cancer patients who had been admitted to hospital for symptom control. Fifty patients received specialist hospital palliative care team intervention compared with 50 patients receiving traditional care. Outcome was assessed using the Palliative Care Assessment (PACA) tool on three occasions. There was no difference between the groups on the initial assessment and the results indicated that all cancer patients admitted to hospital had a significant improvement in their pain control. However, the patients who had the additional input of the palliative care team demonstrated a statistically significant greater improvement than the control group (P<0.001). Potential explanations are made for the results including the enhanced knowledge and skills of the hospital specialist palliative care team.

Surgery for oesophageal cancer at Galway University Hospital 1993-2008.

PubMed

Chang, K H; McAnena, O J; Smith, M J; Salman, R R; Khan, M F; Lowe, D

2010-12-01

Surgical volume and outcome remain controversial in the management of oesophageal cancer. To assess the outcome of oesophagectomy for cancer at Galway University Hospital (GUH). Between 1994 and 2008, patients who underwent oesophagectomy were analysed. During the study period, 126 oesophagectomies were performed for cancer. The average surgeon volume was 9 cases per year. The 30-day and overall in-hospital mortality rates were 6.3 and 7.9%, respectively. Restructuring of our critical care services has led to a reduction in 30-day mortality from 8.2 to 5.1%. The use of neoadjuvant chemoradiotherapy has increased from 17 to 35% during the study period. In patients who underwent resection, the 3 and 5-year overall survival rates were 45 and 29%, respectively. Operative morbidity and mortality at GUH are comparable with worldwide outcomes. Improved resources and national restructuring of cancer services have significantly improved the quality of care and outcomes of patients.

Speculation on Curriculum from the Perspective of William James.

ERIC Educational Resources Information Center

Shubert, William H; Zissis, Georgiana

1988-01-01

This article discusses the implications for curriculum theory, research, and practice of William James' thought. Also considered is the question of what curriculum theory and research might be like if James had garnered greater influence than Thorndike. (IAH)

Early hospital discharge versus continued hospitalization in febrile pediatric cancer patients with prolonged neutropenia: A randomized, prospective study.

PubMed

Ahmed, Nabil; El-Mahallawy, Hadir A; Ahmed, Ibrahim A; Nassif, Shimaa; El-Beshlawy, Aamal; El-Haddad, Alaa

2007-11-01

Hospitalization with single or multi-agent antibiotic therapy has been the standard of care for treatment of febrile neutropenia in cancer patients. We hypothesized that an empiric antibiotic regimen that is effective and that can be administered once-daily will allow for improved hospital utilization by early transition to outpatient care. Febrile pediatric cancer patients with anticipated prolonged neutropenia were randomized between a regimen of once-daily ceftriaxone plus amikacin (C + A) and imipenem monotherapy (control). Afebrile patients on C + A satisfying "Early Discharge Criteria" at 72 hr continued treatment as outpatients. We compared the outcome, adverse events, duration of hospitalization, and cost between both groups. A prospective randomized controlled clinical trial was conducted on 129 febrile episodes in pediatric cancer patients with prolonged neutropenia. No adverse events were seen in 32 children (84% of study arm) treated on an outpatient basis. We found a statistically significant difference between the duration of hospitalization of the C + A group [median 5 days] and control [median 9 days](P < 0.001), per episode antibiotic cost (P < 0.001) and total episode cost (P < 0.001). There was no statistically significant difference in the response to treatment at 72 hr or after necessary antimicrobial modifications. We conclude that pediatric febrile cancer patients initially considered at risk for sepsis due to prolonged neutropenia can be re-evaluated at 72 hr for outpatient therapy. The convenience, low incidence of adverse effects, and cost benefit of the once-daily regimen of C + A may be particularly useful to reduce the overall treatment costs and duration of hospitalization. (c) 2007 Wiley-Liss, Inc.

Managing hospital supplies: process reengineering at Gujarat Cancer Research Institute, India.

PubMed

Ramani, K V

2006-01-01

Aims to give an overview of the re-engineering of processes and structures at Gujarat Cancer Research Institute (GCRI), Ahmedabad. A general review of the design, development and implementation of reengineered systems in order to address concerns about the existing systems. Findings GCRI is a comprehensive cancer care center with 550 beds and well equipped with modern diagnostic and treatment facilities. It serves about 200,000 outpatients and 16,000 inpatients annually. The approach to a better management of hospital supplies led to the design, development, and implementation of an IT-based reengineered and integrated purchase and inventory management system. The new system has given GCRI a saving of about 8 percent of its annual costs of purchases, and improved the availability of materials to the user departments. Shows that the savings obtained are used not only for buying more hospital supplies, but also to buy better quality of hospital supplies, and thereby satisfactorily address the GCRI responsibility towards meeting its social obligations for cancer care.

William James, Nitrous Oxide, and the Anaesthetic Revelation.

PubMed

Moon, Jane S; Kuza, Catherine M; Desai, Manisha S

2018-01-01

William James greatly influenced the fields of psychology, philosophy, and religion during the late 19 th and early 20 th centuries. This was the era of Modernism, a time when many writers rejected the certainty of Enlightenment ideals. Positivism, which rose to prominence in the early 19th century, had emphasized physical phenomena, empirical evidence, and the scientific method. Darwin's On the Origin of Species (1859), with its theory of natural selection, provided an explanation for the evolution of species apart from a divine Creator. Within this context, William James served as a "mediator between scientific agnosticism and the religious view of the world." James' own experience inhaling nitrous oxide played an important role in shaping his views. For James, the use of nitrous oxide served a key role in elucidating some of his most central ideas: 1) the value of religion, and the emphasis on mysticism and revelation (as opposed to theology and doctrine) as religion's foundation; 2) the universe as pluralistic (as opposed to absolutist, constant, eternal), driven by chance, experience, and change. Copyright © 2017 Elsevier Inc. All rights reserved.

NASA Sponsors Cancer Research at Children's Hospital

NASA Technical Reports Server (NTRS)

1998-01-01

NASA Administrator Dan Goldin (left), during a visit at Children's Hospital of Wisconsin in Milwaukee, Wisconsin, discussed how NASA's special lighting technology may soon treat cancer. Goldin talked with Dr.Harry Whelan (right) and Dr. Kerneth Reichert (center left), both pediatric neurologists with the Hospital and professors at the Medical College of Wisconsin in Milwaukee. Accompanied by Astronaut Mary Ellen Weber, Goldin was shown this innovative treatment, called Photodynamic Therapy, a method used to destroy the tumor without damaging the delicate brain tissue around it. The treatment uses tiny pinhead-size Light Emitting Diodes (LEDs) developed for Space Product Development plant growth experiments.

Preferences for photographic art among hospitalized patients with cancer.

PubMed

Hanson, Hazel; Schroeter, Kathryn; Hanson, Andrew; Asmus, Kathryn; Grossman, Azure

2013-07-01

To determine the preferences of patients with cancer for viewing photographic art in an inpatient hospital setting and to evaluate the impact of viewing photographic art. Quantitative, exploratory, single-group, post-test descriptive design incorporating qualitative survey questions. An academic medical center in the midwestern United States. 80 men (n = 44) and women (n = 36) aged 19-85 years (X = 49) and hospitalized for cancer treatment. Participants viewed photographs via computers and then completed a five-instrument electronic survey. Fatigue, quality of life, performance status, perceptions of distraction and restoration, and content categories of photographs. Ninety-six percent of participants enjoyed looking at the study photographs. The photographs they preferred most often were lake sunset (76%), rocky river (66%), and autumn waterfall (66%). The most rejected photographs were amusement park (54%), farmer's market vegetable table (51%), and kayakers (49%). The qualitative categories selected were landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Some discrepancy between the quantitative and qualitative sections may be related to participants considering water to be a landscape. The hypothesis that patients' preferences for a category of photographic art are affected by the psychophysical and psychological qualities of the photographs, as well as the patients' moods and characteristics, was supported. Nurses can play an active role in helping patients deal with the challenges of long hospital stays and life-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. Nurses can use photographic imagery to provide a restorative intervention during the hospital experience. Photographic art can be used as a distraction from the hospital stay and the uncertainty of a cancer diagnosis. Having patients view

Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality.

PubMed

Clarke, Christina A; Asch, Steven M; Baker, Laurence; Bilimoria, Karl; Dudley, R Adams; Fong, Niya; Holliday-Hanson, Merry L; Hopkins, David S P; Imholz, Elizabeth M; Malin, Jennifer; Moy, Lisa; O'Sullivan, Maryann; Parker, Joseph P; Saigal, Christopher S; Spurlock, Bruce; Teleki, Stephanie; Zingmond, David; Lang, Lance

2016-10-01

Most patients, providers, and payers make decisions about cancer hospitals without any objective data regarding quality or outcomes. We developed two online resources allowing users to search and compare timely data regarding hospital cancer surgery volumes. Hospital cancer surgery volumes for all California hospitals were calculated using ICD-9 coded hospital discharge summary data. Cancer surgeries included (bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach) were selected on the basis of a rigorous literature review to confirm sufficient evidence of a positive association between volume and mortality. The literature could not identify threshold numbers of surgeries associated with better or worse outcomes. A multidisciplinary working group oversaw the project and ensured sound methodology. In California in 2014, about 60% of surgeries were performed at top-quintile-volume hospitals, but the per-hospital median numbers of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries were four or fewer. At least 670 patients received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer type; 72% of those patients lived within 50 miles of a top-quintile-volume hospital. There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.

Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care

PubMed Central

Williams, Mark D; Braun, Lee Ann; Cooper, Liesl M; Johnston, Joseph; Weiss, Richard V; Qualy, Rebecca L; Linde-Zwirble, Walter

2004-01-01

Introduction Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. Methods Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. Results There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of $3.4 billion per year. Conclusion Severe sepsis is a common, deadly, and costly complication in cancer patients. PMID:15469571

Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care.

PubMed

Williams, Mark D; Braun, Lee Ann; Cooper, Liesl M; Johnston, Joseph; Weiss, Richard V; Qualy, Rebecca L; Linde-Zwirble, Walter

2004-10-01

Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140-208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77-2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94-3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of 3.4 billion dollars per year. Severe sepsis is a common, deadly, and costly complication in cancer patients.

Quality of colon cancer outcomes in hospitals with a high percentage of Medicaid patients.

PubMed

Rhoads, Kim F; Ackerson, Leland K; Jha, Ashish K; Dudley, R Adams

2008-08-01

There is evidence that patients with Medicaid insurance suffer worse outcomes from surgical conditions; but there is little research about whether this reflects clustering of such patients at hospitals with worse outcomes. We assess the outcomes of patients with colon and rectal cancers at hospitals with a high proportion of Medicaid patients. California Cancer Registry patient-level records were linked to discharge abstracts from California's Office of Statewide Health Planning and Development. All operative California Cancer Registry patients from 1998 and 1999 were included. Hospitals with > 40% Medicaid patients were labeled high Medicaid hospitals (HMH). We analyzed the odds of mortality at 30 days, 1, and 5 years for colon cancer and rectal cancer separately. Multilevel logistic regression models were constructed, using MLwiN 2.0, to include patient and hospital-level characteristics. Thirty-day mortality after colon operation was worse in HMH (1% versus 0.6%; p = 0.04); as was 1-year mortality (3.4% versus 2.4%; p = 0.001). There was no substantial difference in rates of 5-year mortality. Individuals who were insured by Medicaid had worse outcomes at 5 years. Adjustment for surgical volume eliminated the effect of HMH at 30 days (1% versus 0.7%; p = 0.45) but not at 1 year (3.4% versus 2.5%; p = 0.01). Adjustment for academic affiliation did not alter these results. There were an insufficient number of rectal cancer patients to detect any differences by hospital type. HMH have higher postoperative colon cancer mortality rates at 30 days and 1 year but not at 5 years. The early effect can be explained by surgical volume, but additional research is needed to determine which factors contribute to differences in intermediate outcomes after operations in HMH settings.

Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions.

PubMed

Sultan, Dawood H; Gishe, Jemal; Hanciles, Angella; Comins, Meg M; Norris, Claire M

2015-09-01

To examine cancer treatment disparities at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC) and non-specialty hospitals. Florida hospital discharge datasets were used. ICD9-CM codes were used to define patients with female reproductive organ cancers (FROC), male reproductive organ cancers (MROC), and OTHER cancer diagnoses. A total of 7462 NCI-CCC patients and 21,875 non-specialty hospital patients were included in the statistical analysis. Data analysis was conducted in SAS 9.2. Increases in age reduced the odds of receiving treatment at the NCI-CCC. Male patients were more likely than female patients to be treated at the NCI-CCC. Age-adjusted odds of African American and Hispanic out/inpatients being treated at the NCI-CCC were significantly lower than those of White out/inpatients. Only patients with workers' compensation, charity, or other insurance had higher odds of being treated at the NCI-CCC. The odds of minority patients receiving outpatient treatment at the NCI-CCC declined after 2005. The odds of receiving inpatient treatment at the NCI-CCC significantly increased after 2006. More targeted outreach by the NCI-CCC is required. However, we expect the creation of local Accountable Care Organizations (ACOs) to reduce the numbers of minority and older patients at the NCI-CCC. Coordinated quality care at ACOs implies a potential for retaining the patient market share held by non-specialty hospitals and a potential for increased demand for ACO care by minority and older patients.

Creating a "culture of research" in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program.

PubMed

Dimond, Eileen P; St Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

2015-06-01

The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to

Famous optician: James Clerk Maxwell

NASA Astrophysics Data System (ADS)

Haidar, Riad

2018-04-01

Mainly known for his unifying theory of electricity, magnetism and induction, James Clerk Maxwell also concluded that light was an electromagnetic wave, and was responsible for the first true colour photograph.

Racial differences in colorectal cancer survival at a safety net hospital.

PubMed

Tapan, Umit; Lee, Shin Yin; Weinberg, Janice; Kolachalama, Vijaya B; Francis, Jean; Charlot, Marjory; Hartshorn, Kevan; Chitalia, Vipul

2017-08-01

While racial disparity in colorectal cancer survival have previously been studied, whether this disparity exists in patients with metastatic colorectal cancer receiving care at safety net hospitals (and therefore of similar socioeconomic status) is poorly understood. We examined racial differences in survival in a cohort of patients with stage IV colorectal cancer treated at the largest safety net hospital in the New England region, which serves a population with a majority (65%) of non-Caucasian patients. Data was extracted from the hospital's electronic medical record. Survival differences among different racial and ethnic groups were examined graphically using Kaplan-Meier analysis. A univariate cox proportional hazards model and a multivariable adjusted model were generated. Black patients had significantly lower overall survival compared to White patients, with median overall survival of 1.9 years and 2.5 years respectively. In a multivariate analysis, Black race posed a significant hazard (HR 1.70, CI 1.01-2.90, p=0.0467) for death. Though response to therapy emerged as a strong predictor of survival (HR=0.4, CI=0.2-0.7, p=0.0021), it was comparable between Blacks and Whites. Despite presumed equal access to healthcare and socioeconomic status within a safety-net hospital system, our results reinforce findings from previous studies showing lower colorectal cancer survival in Black patients, and also point to the importance of investigating other factors such as genetic and pathologic differences. Copyright © 2017 Elsevier Ltd. All rights reserved.

77 FR 58773 - Drawbridge Operation Regulations; James River, Newport News, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-24

... Operation Regulations; James River, Newport News, VA AGENCY: Coast Guard, DHS. ACTION: Notice of temporary... schedule that governs the US 17/258 Bridge across the James River, mile 5.0, at Newport News, VA. The... 17/258 Bridge over the James River, mile 5.0, at Newport News, VA opens on signal as required by 33...

[Estimation of the excess of lung cancer mortality risk associated to environmental tobacco smoke exposure of hospitality workers].

PubMed

López, M José; Nebot, Manel; Juárez, Olga; Ariza, Carles; Salles, Joan; Serrahima, Eulàlia

2006-01-14

To estimate the excess lung cancer mortality risk associated with environmental tobacco (ETS) smoke exposure among hospitality workers. The estimation was done using objective measures in several hospitality settings in Barcelona. Vapour phase nicotine was measured in several hospitality settings. These measurements were used to estimate the excess lung cancer mortality risk associated with ETS exposure for a 40 year working life, using the formula developed by Repace and Lowrey. Excess lung cancer mortality risk associated with ETS exposure was higher than 145 deaths per 100,000 workers in all places studied, except for cafeterias in hospitals, where excess lung cancer mortality risk was 22 per 100,000. In discoteques, for comparison, excess lung cancer mortality risk is 1,733 deaths per 100,000 workers. Hospitality workers are exposed to ETS levels related to a very high excess lung cancer mortality risk. These data confirm that ETS control measures are needed to protect hospital workers.

Cervical cancer screening in hospitals: the efficacy of legislation in Maryland.

PubMed Central

Klassen, A C; Celentano, D D; Weisman, C S

1993-01-01

OBJECTIVES. The purpose of the study was to examine the efficacy of a Maryland law requiring Pap testing to be offered during hospital admissions. "In-reach" strategies emphasize cancer screening within existing health care contacts (such as inpatient stays) rather than additional visits solely for screening. METHODS. Data from a 1986 telephone survey of Maryland women were used to examine the effect of hospitalization on self-reported Pap testing in a 3-year period. The effect of hospitalization on screening was examined by age and income to assess whether inpatient screening was more prevalent among certain subgroups of women. RESULTS. For the group as a whole, the odds of Pap screening did not vary with hospitalization. However, among women aged 45 to 54 years with annual household incomes over $20,000, hospitalized women were more likely than nonhospitalized women to report recent Pap tests. For low-income women aged 75 years and older, hospitalization actually decreased the likelihood of reporting Pap tests. CONCLUSIONS. Despite legislation, inpatient cervical cancer screening appears to mirror outpatient patterns, leaving elderly and low-income women unscreened. Methods for increasing inpatient Pap testing for underscreened women are discussed. PMID:8363009

Vulvar and vaginal cancers and dysplasia in France--an analysis of the hospital medical information system (PMSI) database.

PubMed

Rémy, Vanessa; Mathevet, Patrice; Vainchtock, Alexandre

2009-12-01

Literature on the epidemiology of vulvar and vaginal cancers is scarce. The incidence of these diseases seems to be increasing. It has been reported that about 40% of vulvar and 70% of vaginal cancers may be linked to human papillomavirus (HPV). This study aimed to assess the medical burden associated with hospitalizations and management of vulvar and vaginal cancers and dysplasia (VIN and VaIN) in France. A retrospective analysis using the French national hospital database (PMSI) was performed to assess the annual number of patients hospitalized for vulvar and vaginal cancers and VIN/VaIN, based on hospital admissions in 2006. Data for all stays and chemotherapy/radiotherapy sessions were extracted. SAE database (Statistiques annuelles des établissements de santé) was used to take into account patients who had radiotherapy sessions performed in the private sector which are not reported in the PMSI. In 2006, 1237 and 623 patients were hospitalized for vulvar cancer and VIN, respectively. There were also 728 and 244 patients hospitalized for vaginal cancer and VaIN, respectively. Overall, about 35% of all patients were hospitalized in the private setting. For all lesions except vaginal cancer, surgery was the most common type of management. For vaginal cancer, medical care was the most prevalent (52%), followed by surgery (31%). The burden of hospitalizations due to vulvar and vaginal cancers is substantial. Further research is needed to assess the outpatient burden due to these diseases especially for precancerous dysplasia which may be mostly managed in an outpatient setting.

The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients.

PubMed

Eyigor, S; Karapolat, H; Korkmaz, O K; Eyigor, C; Durmaz, B; Uslu, R; Uyar, M

2009-03-01

To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.

Meeting patients' health information needs in breast cancer center hospitals - a multilevel analysis.

PubMed

Kowalski, Christoph; Lee, Shoou-Yih D; Ansmann, Lena; Wesselmann, Simone; Pfaff, Holger

2014-11-25

Breast cancer patients are confronted with a serious diagnosis that requires them to make important decisions throughout the journey of the disease. For these decisions to be made it is critical that the patients be well informed. Previous studies have been consistent in their findings that breast cancer patients have a high need for information on a wide range of topics. This paper investigates (1) how many patients feel they have unmet information needs after initial surgery, (2) whether the proportion of patients with unmet information needs varies between hospitals where they were treated and (3) whether differences between the hospitals account for some of these variation. Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analyzed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix. Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs. We found differences in proportions of patients with unmet information needs between hospitals and that hospitals' structure and process-related attributes of the hospitals were associated with these differences to some extent. Hospitals may contribute to reducing the patients' information needs by means that are not necessarily resource-intensive.

Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

PubMed Central

2001-01-01

Background Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. Objectives This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals' Web sites and to gather some preliminary data on patients' use of the Internet. Methods In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. Results Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) ( P= 0.007). Conclusions The hospitals' Web sites offer cancer patients and relatives useful information, but the Web sites were not

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

PubMed

Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K

2013-01-01

Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Examination of unplanned 30-day readmissions to a comprehensive cancer hospital.

PubMed

Saunders, Neil David; Nichols, Shawnn D; Antiporda, Michael Alfredo; Johnson, Kristen; Walker, Kerri; Nilsson, Rhonda; Graham, Lisa; Old, Matt; Klisovic, Rebecca B; Penza, Sam; Schmidt, Carl R

2015-03-01

The Centers for Medicare and Medicaid Services (CMS), under the Hospitals Readmissions Reductions Program, may withhold regular reimbursements for excessive 30-day readmissions for select diagnoses. Such penalties imply that some readmissions reflect poor clinical decision making or care during the initial hospitalization. We examined factors related to potentially preventable readmissions in CMS patients at a tertiary cancer hospital. The medical records of all CMS patients with unplanned readmissions within 30 days of index admission were reviewed over 6 months (October 15, 2011-April 15, 2012). Each readmission was classified as not preventable or potentially preventable. Factors associated with potentially preventable readmissions were sought. Of 2,531 inpatient admissions in CMS patients over 6 months, 185 patients experienced at least one readmission for 282 total readmissions (11%). Median time to readmission was 9 days (range, 0 to 30 days). The most common causes for first readmission were new diagnoses not present at first admission (n = 43, 23%), new or worsening symptoms due to cancer progression (n = 40, 21%) and complications of procedures (n = 25, 13%). There were 38 (21%) initial readmissions classified as potentially preventable. Use of total parenteral nutrition at the time of discharge was associated with potentially preventable readmission (P = .028). Most unplanned readmissions to a tertiary cancer hospital are related to progression of disease, new diagnoses, and procedure complications. Minimizing readmissions in complex cancer patients is challenging. Larger multi-institutional datasets are needed to determine a reasonable standard for expected readmission rates. Copyright © 2015 by American Society of Clinical Oncology.

Factors Associated with Hospital Length of Stay among Cancer Patients with Febrile Neutropenia

PubMed Central

Rosa, Regis G.; Goldani, Luciano Z.

2014-01-01

Purpose This study sought to evaluate factors associated with hospital length of stay in cancer patients with febrile neutropenia. Methods A prospective cohort study was performed at a single tertiary referral hospital in southern Brazil from October 2009 to August 2011. All adult cancer patients with febrile neutropenia admitted to the hematology ward were evaluated. Stepwise random-effects negative binomial regression was performed to identify risk factors for prolonged length of hospital stay. Results In total, 307 cases of febrile neutropenia were evaluated. The overall median length of hospital stay was 16 days (interquartile range 18 days). According to multiple negative binomial regression analysis, hematologic neoplasms (P = 0.003), high-dose chemotherapy regimens (P<0.001), duration of neutropenia (P<0.001), and bloodstream infection involving Gram-negative multi-drug-resistant bacteria (P = 0.003) were positively associated with prolonged hospital length of stay in patients with febrile neutropenia. The condition index showed no evidence of multi-collinearity effect among the independent variables. Conclusions Hematologic neoplasms, high-dose chemotherapy regimens, prolonged periods of neutropenia, and bloodstream infection with Gram-negative multi-drug-resistant bacteria are predictors of prolonged length hospital of stay among adult cancer patients with febrile neutropenia. PMID:25285790

Creating a “culture of research” in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program

PubMed Central

St. Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

2015-01-01

Background The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute’s Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. Methods To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. Limitations The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important

The medical science fiction of James White: Inside and Outside Sector General.

PubMed

Howard, Richard

2016-12-01

James White was a Northern Irish science fiction author working in the subgenre of medical science fiction from the mid-1950s to the end of the twentieth century. The aim of this article is to introduce White to scholars working in the medical humanities, pointing to features of interest and critiquing the more excessive utopian impulses of the author. The article covers White's Sector General series, set on a vast intergalactic hospital, as well as the author's standalone fictions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

James Madison High School. A Curriculum for American Students.

ERIC Educational Resources Information Center

Bennett, William J.

This document presents the Secretary of Education's personal concept of a sound secondary school core curriculum. It is called "James Madison High School" in honor of President James Madison and his strong views that the people, in order to govern properly, must arm themselves with knowledge. The theoretical curriculum consists of four…

Delivering breast cancer care in urban India: Heterotopia, hospital ethnography and voluntarism.

PubMed

Macdonald, Alison

2016-05-01

Despite substantial strides to improve cancer control in India, challenges to deliver oncology services persist. One major challenge is the provision and accessibility of adequate infrastructure. This paper offers ethnographic insight on the conceptual and material conditions that are currently shaping the delivery of oncology in Mumbai, focusing specifically on the way India's socio-economic context necessitates non-biomedical acts of voluntarism or 'seva' (selfless service). Developing the premise that hospitals are not identical clones of a biomedical model, detailed attention is paid to the way 'care' emerges through 'praxis of place' (Casey, 2003) within the cancer hospital as a multi-scalar 'heterotopic' (Street and Coleman, 2012) site. Such a perspective enables global/local tensions to come into view, together with the heterogeneous confluence of juxtaposing materialities, imaginations, social practices and values that both propels and constrains the everyday delivery of care. The paper reflects on the theoretical implications of hospital seva in Mumbai in light of social science studies of hospital ethnography and health activism and contributes important ethnographic insight into the current global health debates regarding effective implementation of cancer services in India. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012.

PubMed

Kim, Sun Jung; Han, Kyu-Tae; Kim, Tae Hyun; Park, Eun-Cheol

2015-10-01

Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available. © The Author(s) 2015.

1. Historic American Buildings Survey James F. and Jean B. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Historic American Buildings Survey James F. and Jean B. O'Gorman, Photographers October 1963 EXTERIOR FROM THE SOUTHEAST Gift of James F. and Jean B. O'Gorman - Stephen Higginson Jr. House, 7 Kirkland Street, Cambridge, Middlesex County, MA

2. Historic American Buildings Survey James F. and Jean B. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Historic American Buildings Survey James F. and Jean B. O'Gorman, Photographers October 1963 EXTERIOR FROM THE SOUTHWEST Gift of James F. and Jean B. O'Gorman - Stephen Higginson Jr. House, 7 Kirkland Street, Cambridge, Middlesex County, MA

Aerial photographic water color variations from pollution in the James River

NASA Technical Reports Server (NTRS)

Bressette, W. E.

1978-01-01

A photographic flight was made over the James River on May 17, 1977. The data show that, in general, James River water has very high sunlight reflectance. In the Bailey Bay area this reflectance is drastically reduced. Also shown is a technique for normalizing off-axis variations in radiance film exposure from camera falloff and uneven sunlight conditions to the nadir value. After data normalization, a spectral analysis is performed that identifies Bailey Creek water in James River water. The spectral results when compared with laboratory spectrometer data indicate that reflectance from James River water is dominated by suspended matter, while the substance most likely responsible for reduced reflectance in Bailey Creek water is dissolved organic carbon.

Reply to James Muir

ERIC Educational Resources Information Center

White, John

2004-01-01

In "EPAT", vol. 36, no. 1, 2004, James Muir takes the author and fellow philosophers of education to task for their ignorance of the history of philosophy of education. "[T]oo many currently influential educationists, Professor White in particular, are literally unaware that educational philosophy has a history more than three hundred years in…

Winter Naming: James Welch

ERIC Educational Resources Information Center

Lincoln, Kenneth

2005-01-01

In the early 1970s James Welch enters American literature as an Indian postmodernist, a fractured classicist of the West, drawing fragments from both sides of the Buckskin Curtain. Reading the likes of Cesar Vallejo and early modernists from Ezra Pound to Theodore Roethke and decreationists such as Ray Carver (through Richard Hugo's tutelage at…

Racial/Ethnic Differences in Patients' Selection of Surgeons and Hospitals for Breast Cancer Surgery.

PubMed

Freedman, Rachel A; Kouri, Elena M; West, Dee W; Keating, Nancy L

2015-05-01

Racial differences in breast cancer treatment may result in part from differences in the surgeons and hospitals from whom patients receive their care. However, little is known about differences in patients' selection of surgeons and hospitals. To examine racial/ethnic differences in how women selected their surgeons and hospitals for breast cancer surgery. We surveyed 500 women (222 non-Hispanic white, 142 non-Hispanic black, 89 English-speaking Hispanic, and 47 Spanish-speaking Hispanic) from northern California cancer registries with stage 0 to III breast cancer diagnosed during 2010 through 2011. We used multivariable logistic regression to assess the reasons for surgeon and hospital selection by race/ethnicity, adjusting for other patient characteristics. We also assessed the association between reasons for physician selection and patients' ratings of their surgeon and hospital. Reasons for surgeon and hospital selection and ratings of surgeon and hospital. The 500 participants represented a response rate of 47.8% and a participation rate of 69%. The most frequently reported reason for surgeon selection was referral by another physician (78%); the most frequently reported reason for hospital selection was because it was a part of a patient's health plan (58%). After adjustment, 79% to 87% of black and Spanish-speaking Hispanic women reported selecting their surgeon based on a physician's referral vs 76% of white women (P = .007). Black and Hispanic patients were less likely than white patients to report selecting their surgeon based on reputation (adjusted rates, 18% and 22% of black and Hispanic women, respectively, vs 32% of white women; P = .02). Black and Hispanic women were also less likely than white women to select their hospital based on reputation (adjusted rates, 7% and 15% vs 23%, respectively; P = .003). Women who selected their surgeon based on reputation more often rated the care from their surgeon as excellent (adjusted odds ratio, 2

Compliance with National Comprehensive Cancer Network anti-emesis guidelines in a Community Hospital Cancer Center.

PubMed

Daniel, Divya; Waddell, Aubrey

2016-02-01

Nausea and vomiting are common adverse events exhibited by patients receiving chemotherapy. Prophylactic use of anti-emetic agents has been shown to reduce chemotherapy-induced nausea and vomiting. Compliance with the National Comprehensive Cancer Network anti-emesis guidelines (Version 1.2013) by practitioners in a community out-patient hospital (Blount Memorial Hospital) has been reviewed and the results are presented herein. Retrospective study of patients receiving their first cycle of chemotherapy. A total of 487 patients were reviewed from January 2005 to July 2012. In total, 70 patients were categorized in the high-risk category, 292 patients were categorized in the moderate-risk category, 60 patients were categorized in the low-risk category, and 65 patients were categorized in the minimal-risk category as per the National Comprehensive Cancer Network guidelines. Included patients were being administered the first cycle of their first treatment at Blount Memorial Hospital. Data were collected retrospectively from patient chemotherapy dispensing folders. In all, 63% of the patients received appropriate anti-emetic prophylaxis medications as per the National Comprehensive Cancer Network guidelines. Post-comparison between outcomes based on the risk category showed that patients in the moderate-risk category were most likely (91%) and patients in the low-risk category were least likely (6.67%) to receive appropriate anti-emetic prophylaxis as per the National Comprehensive Cancer Network guidelines. Overall compliance with guidelines is acceptable. Patients in the moderate risk category are most likely to receive appropriate anti-emetic prophylaxis. © The Author(s) 2014.

3. Historic American Buildings Survey James F. and Jean B. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. Historic American Buildings Survey James F. and Jean B. O'Gorman, Photographers October 1963 ORIGINAL MANTELPIECE AND WINDOW SHUTTERS, FIRST FLOOR Gift of James F. and Jean B. O'Gorman - Stephen Higginson Jr. House, 7 Kirkland Street, Cambridge, Middlesex County, MA

Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations.

PubMed

Loehrer, Andrew P; Chang, David C; Song, Zirui; Chang, George J

2018-01-01

Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.

[Development and validation of an algorithm to identify cancer recurrences from hospital data bases].

PubMed

Manzanares-Laya, S; Burón, A; Murta-Nascimento, C; Servitja, S; Castells, X; Macià, F

2014-01-01

Hospital cancer registries and hospital databases are valuable and efficient sources of information for research into cancer recurrences. The aim of this study was to develop and validate algorithms for the detection of breast cancer recurrence. A retrospective observational study was conducted on breast cancer cases from the cancer registry of a third level university hospital diagnosed between 2003 and 2009. Different probable cancer recurrence algorithms were obtained by linking the hospital databases and the construction of several operational definitions, with their corresponding sensitivity, specificity, positive predictive value and negative predictive value. A total of 1,523 patients were diagnosed of breast cancer between 2003 and 2009. A request for bone gammagraphy after 6 months from the first oncological treatment showed the highest sensitivity (53.8%) and negative predictive value (93.8%), and a pathology test after 6 months after the diagnosis showed the highest specificity (93.8%) and negative predictive value (92.6%). The combination of different definitions increased the specificity and the positive predictive value, but decreased the sensitivity. Several diagnostic algorithms were obtained, and the different definitions could be useful depending on the interest and resources of the researcher. A higher positive predictive value could be interesting for a quick estimation of the number of cases, and a higher negative predictive value for a more exact estimation if more resources are available. It is a versatile and adaptable tool for other types of tumors, as well as for the needs of the researcher. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Building cancer nursing skills in a resource-constrained government hospital.

PubMed

Strother, R M; Fitch, Margaret; Kamau, Peter; Beattie, Kathy; Boudreau, Angela; Busakhalla, N; Loehrer, P J

2012-09-01

Cancer is a rising cause of morbidity and mortality in resource-constrained settings. Few places in the developing world have cancer care experts and infrastructure for caring for cancer patients; therefore, it is imperative to develop this infrastructure and expertise. A critical component of cancer care, rarely addressed in the published literature, is cancer nursing. This report describes an effort to develop cancer nursing subspecialty knowledge and skills in support of a growing resource-constrained comprehensive cancer care program in Western Kenya. This report highlights the context of cancer care delivery in a resource-constrained setting, and describes one targeted intervention to further develop the skill set and knowledge of cancer care providers, as part of collaboration between developed world academic institutions and a medical school and governmental hospital in Western Kenya. Based on observations of current practice, practice setting, and resource limitations, a pragmatic curriculum for cancer care nursing was developed and implemented.

National Quality Forum Colon Cancer Quality Metric Performance: How Are Hospitals Measuring Up?

PubMed

Mason, Meredith C; Chang, George J; Petersen, Laura A; Sada, Yvonne H; Tran Cao, Hop S; Chai, Christy; Berger, David H; Massarweh, Nader N

2017-12-01

To evaluate the impact of care at high-performing hospitals on the National Quality Forum (NQF) colon cancer metrics. The NQF endorses evaluating ≥12 lymph nodes (LNs), adjuvant chemotherapy (AC) for stage III patients, and AC within 4 months of diagnosis as colon cancer quality indicators. Data on hospital-level metric performance and the association with survival are unclear. Retrospective cohort study of 218,186 patients with resected stage I to III colon cancer in the National Cancer Data Base (2004-2012). High-performing hospitals (>75% achievement) were identified by the proportion of patients achieving each measure. The association between hospital performance and survival was evaluated using Cox shared frailty modeling. Only hospital LN performance improved (15.8% in 2004 vs 80.7% in 2012; trend test, P < 0.001), with 45.9% of hospitals performing well on all 3 measures concurrently in the most recent study year. Overall, 5-year survival was 75.0%, 72.3%, 72.5%, and 69.5% for those treated at hospitals with high performance on 3, 2, 1, and 0 metrics, respectively (log-rank, P < 0.001). Care at hospitals with high metric performance was associated with lower risk of death in a dose-response fashion [0 metrics, reference; 1, hazard ratio (HR) 0.96 (0.89-1.03); 2, HR 0.92 (0.87-0.98); 3, HR 0.85 (0.80-0.90); 2 vs 1, HR 0.96 (0.91-1.01); 3 vs 1, HR 0.89 (0.84-0.93); 3 vs 2, HR 0.95 (0.89-0.95)]. Performance on metrics in combination was associated with lower risk of death [LN + AC, HR 0.86 (0.78-0.95); AC + timely AC, HR 0.92 (0.87-0.98); LN + AC + timely AC, HR 0.85 (0.80-0.90)], whereas individual measures were not [LN, HR 0.95 (0.88-1.04); AC, HR 0.95 (0.87-1.05)]. Less than half of hospitals perform well on these NQF colon cancer metrics concurrently, and high performance on individual measures is not associated with improved survival. Quality improvement efforts should shift focus from individual measures to defining composite measures

Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics.

PubMed

Rococo, E; Mazouni, C; Or, Z; Mobillion, V; Koon Sun Pat, M; Bonastre, J

2016-01-01

Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. We used Hospital Episode Statistics for all women having undergone breast conserving surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures considered as better treatment options were analyzed: BCS, immediate breast reconstruction (IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation according to the hospital profile and volume. Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas one third of the hospitals no longer performed this type of surgery. In 2012, the mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely, IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals (RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average]; the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall, whatever the surgical procedure considered, inter-hospital variation in rates declined substantially in CC and RTH. We identified considerable variation in IBR and SLNB rates between French hospitals. Although more complex and less standardized than BCS, most clinical guidelines recommended these procedures. This apparent heterogeneity suggests unequal access to high-quality procedures for women with breast cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.

How James Wood Works

ERIC Educational Resources Information Center

Goldstein, Evan R., Comp.

2008-01-01

Reading through news-media clippings about James Wood, one might reasonably conclude that "pre-eminent critic" is his official job title. In fact, Wood is a staff writer for "The New Yorker" and a professor of the practice of literary criticism at Harvard University. But at a time when there is much hand-wringing about the death of the…

Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009.

PubMed

Mueller, Emily L; Walkovich, Kelly J; Mody, Rajen; Gebremariam, Achamyeleh; Davis, Matthew M

2015-05-10

Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described. Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences. Pediatric cancer patients accounted for 1.5 % of pediatric hospital discharges in 2009 (n = 110,967), with 10.1 % of cancer-related discharges meeting FN criteria (n = 11,261). Two-fifths of FN discharges had a "short length of stay" (SLOS) of ≤3 days, which accounted for approximately $65.5 million in hospital charges. Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS. Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses. FN represents a common precipitant for hospitalizations among pediatric cancer patients. SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

The state of cancer survivorship programming in Commission on Cancer-accredited hospitals in Georgia.

PubMed

Kirsch, Logan J; Patterson, Angela; Lipscomb, Joseph

2015-03-01

In Georgia, there are more than 356,000 cancer survivors. Although many encounter challenges as a result of treatment, there is limited data on the availability of survivorship programming. This paper highlights findings from two surveys assessing survivorship care in Commission on Cancer (CoC)-accredited hospitals in Georgia. In 2010, 38 CoC-accredited hospitals were approached to complete a 36-item survey exploring knowledge of national standards and use of survivorship care plans (SCPs), treatment summaries (TSs), and psychosocial assessment tools. In 2012, 37 CoC-accredited hospitals were asked to complete a similar 21-item survey. Seventy-nine percent (n = 30) of cancer centers completed the 2010 survey. Sixty percent (n = 18) reported having a cancer survivorship program in place or in development. Forty-three percent (n = 13) provided survivors with a SCP and 40% (n = 12) a TS. Sixty percent (n = 18) reported either never or rarely using a psychosocial assessment tool. Sixty-two percent (n = 23) completed the 2012 survey. Ninety-six percent (n = 22) were aware of the new CoC guideline 3.3. Thirty-nine percent (n = 9) provided a SCP and/or TS. Eighty-seven percent (n = 20) stated they were very confident or somewhat confident their organization could implement a SCP and/or TS by 2015. The data indicated the importance of collaboration and shared responsibility for survivorship care. Broad implementation of SCPs and TSs can help address the late and long-term effects of treatment. Increasing knowledge on survivorship care is imperative as the Georgia oncology community engages oncologists and primary care providers to achieve higher quality of life for all survivors.

4. Historic American Buildings Survey James F. and Jean B. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. Historic American Buildings Survey James F. and Jean B. O'Gorman, Photographers October 1963 LATE 19th-CENTURY MANTELPIECE IN FIRST FLOOR ROOM Gift of James F. and Jean B. O'Gorman - Stephen Higginson Jr. House, 7 Kirkland Street, Cambridge, Middlesex County, MA

The eponymous Dr James Marion Sims MD, LLD (1813-1883).

PubMed

West, M J; Irvine, L M

2015-02-01

Dr James Marion Sims was born in 1813 in Lancaster County, South Carolina. It was while pioneering numerous surgical procedures in Alabama that in 1849 he achieved the outstanding landmark in medical history of successfully, and consistently, repairing vesicovaginal fistulae. Sims soon developed a reputation as a fine surgeon, with new operations and techniques, using novel surgical instruments and his innovative approaches frequently published. Moving to New York City in 1853, he further established hospitals devoted entirely to women's health. Sims was controversial, with flamboyant descriptions of self-confident success, yet they were tempered with sober reflection of failure and loss. Today we remain with the Sims speculum and Sims position, eponymous tributes to his accomplishments as the 'Father of Gynaecology'. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer.

PubMed

Nipp, Ryan D; El-Jawahri, Areej; Moran, Samantha M; D'Arpino, Sara M; Johnson, P Connor; Lage, Daniel E; Wong, Risa L; Pirl, William F; Traeger, Lara; Lennes, Inga T; Cashavelly, Barbara J; Jackson, Vicki A; Greer, Joseph A; Ryan, David P; Hochberg, Ephraim P; Temel, Jennifer S

2017-12-01

Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization. We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P < .001), psychological distress (PHQ-4 total: B, 0.11; P = .040), and depression symptoms (PHQ-4 depression: B, 0.22; P = .017) were associated with longer hospital LOS. Physical (ESAS: hazard ratio, 1.01; P < .001), and anxiety symptoms (PHQ-4 anxiety: hazard ratio, 1.06; P = .045) were associated with a higher likelihood for readmission. Hospitalized patients with advanced cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American

The financial burden of cancer: estimates from patients undergoing cancer care in a tertiary care hospital.

PubMed

Zaidi, Adnan A; Ansari, Tayyaba Z; Khan, Aziz

2012-10-15

The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH) Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%). The financial burden of cancer was perceived as significant by 28 (42%) patients and unmanageable by 18 (27%) patients. This perceived level of burden was associated significantly with average monthly income (p = <0.001). Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.

Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System.

PubMed

Perlow, Haley K; Ramey, Stephen J; Silver, Ben; Kwon, Deukwoo; Chinea, Felix M; Samuels, Stuart E; Samuels, Michael A; Elsayyad, Nagy; Yechieli, Raphael

2018-04-01

Objective To examine the impact of treatment setting and demographic factors on oropharyngeal and laryngeal cancer time to treatment initiation (TTI). Study Design Retrospective case series. Setting Safety net hospital and adjacent private academic hospital. Subjects and Methods Demographic, staging, and treatment details were retrospectively collected for 239 patients treated from January 1, 2014, to June 30, 2016. TTI was defined as days between diagnostic biopsy and initiation of curative treatment (defined as first day of radiotherapy [RT], surgery, or chemotherapy). Results On multivariable analysis, safety net hospital treatment (vs private academic hospital treatment), initial diagnosis at outside hospital, and oropharyngeal cancer (vs laryngeal cancer) were all associated with increased TTI. Surgical treatment, severe comorbidity, and both N1 and N2 status were associated with decreased TTI. Conclusion Safety net hospital treatment was associated with increased TTI. No differences in TTI were found when language spoken and socioeconomic status were examined in the overall cohort.

Access to Accredited Cancer Hospitals Within Federal Exchange Plans Under the Affordable Care Act

PubMed Central

Liao, Kai-Ping; Krause, Trudy M.; Giordano, Sharon H.

2017-01-01

Purpose The Affordable Care Act expanded access to health insurance in the United States, but concerns have arisen about access to specialized cancer care within narrow provider networks. To characterize the scope and potential impact of this problem, we assessed rates of inclusion of Commission on Cancer (CoC) –accredited hospitals and National Cancer Institute (NCI) –designated cancer centers within federal exchange networks. Methods We downloaded publicly available machine-readable network data and public use files for individual federal exchange plans from the Centers for Medicare and Medicaid Services for the 2016 enrollment year. We linked this information to National Provider Identifier data, identified a set of distinct provider networks, and assessed the rates of inclusion of CoC-accredited hospitals and NCI-designated centers. We measured variation in these rates according to geography, plan type, and metal level. Results Of 4,058 unique individual plans, network data were available for 3,637 (90%); hospital information was available for 3,531 (87%). Provider lists for these plans reduced into 295 unique networks for analysis. Ninety-five percent of networks included at least one CoC-accredited hospital, but just 41% of networks included NCI-designated centers. States and counties each varied substantially in the proportion of networks listed that included NCI-designated centers (range, 0% to 100%). The proportion of networks that included NCI-designated centers also varied by plan type (range, 31% for health maintenance organizations to 49% for preferred provider organizations; P = .04) but not by metal level. Conclusion A large majority of federal exchange networks contain CoC-accredited hospitals, but most do not contain NCI-designated cancer centers. These results will inform policy regarding access to cancer care, and they reinforce the importance of promoting access to clinical trials and specialized care through community sites. PMID:28068172

Health status after cancer: does it matter which hospital you belong to?

PubMed

Fiva, Jon H; Haegeland, Torbjørn; Rønning, Marte

2010-07-13

Survival rates are widely used to compare the quality of cancer care. However, the extent to which cancer survivors regain full physical or cognitive functioning is not captured by this statistic. To address this concern we introduce post-diagnosis employment as a supplemental measure of the quality of cancer care. This study is based on individual level data from the Norwegian Cancer Registry (n = 46,720) linked with data on labor market outcomes and socioeconomic status from Statistics Norway. We study variation across Norwegian hospital catchment areas (n = 55) with respect to survival and employment five years after cancer diagnosis. To handle the selection problem, we exploit the fact that cancer patients in Norway (until 2001) have been allocated to local hospitals based on their place of residence. We document substantial differences across catchment areas with respect to patients' post-diagnosis employment rates. Conventional quality indicators based on survival rates indicate smaller differences. The two sets of indicators are only moderately correlated. This analysis shows that indicators based on survival and post-diagnosis employment may capture different parts of the health status distribution, and that using only one of them to capture quality of care may be insufficient.

William James and the Heidelberg fiasco.

PubMed

Gundlach, Horst

2018-02-01

Urged on by his father to become a physician instead of a painter, William James pursued 3 evasion stratagems. First, to avoid becoming a practitioner, he declared that he wanted to specialize in physiology. Based upon this premise, he left for Germany in the spring of 1867. The second step was giving up general physiology and announcing that he would specialize in the nervous system and psychology. Based upon this premise, he declared that he would go to Heidelberg and study with Helmholtz and Wundt. However, he then deferred going there. When, at last, he was urged by an influential friend of his father's to accompany him to Heidelberg, he employed his default stratagem: He simply fled. He returned home after 3 terms in Europe without enrolling at a single university. There is no evidence that he had learned anything there about psychology or experimental psychology, except, possibly, by reading books. James's "Heidelberg fiasco" was the apogee of his evasion of his father's directive. A dense fog of misinformation surrounds his stay in Heidelberg to this day. By analyzing circumstances and context, this article examines the fiasco and places it in the pattern of his behavior during his stay in Europe. Nevertheless, experiencing this fiasco potentially shaped James's ambivalent attitude toward experimental psychology on a long-term basis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

8. John and James Dobson Carpet Mill, East and West ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. John and James Dobson Carpet Mill, East and West Parcels, site plan, and survey lower left, 1865. Hexamer, Ernest and Son. Hexamer General Surveys, 1867-1895, Philadelphia, Pennsylvania: E. Hexamer and Son, 1865, p. 279. - John & James Dobson Carpet Mill (West Parcel), 4041-4055 Ridge Avenue, Philadelphia, Philadelphia County, PA

Arash: A social robot buddy to support children with cancer in a hospital environment.

PubMed

Meghdari, Ali; Shariati, Azadeh; Alemi, Minoo; Vossoughi, Gholamreza R; Eydi, Abdollah; Ahmadi, Ehsan; Mozafari, Behrad; Amoozandeh Nobaveh, Ali; Tahami, Reza

2018-06-01

This article presents the thorough design procedure, specifications, and performance of a mobile social robot friend Arash for educational and therapeutic involvement of children with cancer based on their interests and needs. Our research focuses on employing Arash in a pediatric hospital environment to entertain, assist, and educate children with cancer who suffer from physical pain caused by both the disease and its treatment process. Since cancer treatment causes emotional distress, which can reduce the efficiency of medications, using social robots to interact with children with cancer in a hospital environment could decrease this distress, thereby improving the effectiveness of their treatment. Arash is a 15 degree-of-freedom low-cost humanoid mobile robot buddy, carefully designed with appropriate measures and developed to interact with children ages 5-12 years old. The robot has five physical subsystems: the head, arms, torso, waist, and mobile-platform. The robot's final appearance is a significant novel concept; since it was selected based on a survey taken from 50 children with chronic diseases at three pediatric hospitals in Tehran, Iran. Founded on these measures and desires, Arash was designed, built, improved, and enhanced to operate successfully in pediatric cancer hospitals. Two experiments were devised to evaluate the children's level of acceptance and involvement with the robot, assess their feelings about it, and measure how much the robot was similar to the favored conceptual sketch. Both experiments were conducted in the form of storytelling and appearance/performance evaluations. The obtained results confirm high engagement and interest of pediatric cancer patients with the constructed robot.

Application of whole-body FDG-PET for cancer screening in a cohort of hospital employees.

PubMed

Hu, Chin; Liu, Chun-Peng; Cheng, Jin-Shiung; Chiu, Yu-Li; Chan, Hung-Pin; Peng, Nan-Jing

2016-11-01

Whole-body positron emission tomography/computed tomography with the glucose analog 2-[F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) has been extensively used to screen for underlying malignancies in asymptomatic individuals. We were able to survey a cohort of hospital employees using FDG-PET/CT and to report the results herein.A total of 116 hospital employees older than 55 years old were offered whole-body FDG-PET in our hospital. Ninety-seven employees (83.6%) completed the assessment from February 2014 to August 2014 in our PET center. The final confirmation of cancer was based on pathologic examination and follow-up after more than 1 year.Among the 97 participants, 92 were asymptomatic and 5 presented with previously diagnosed cancers. Six of the 92 asymptomatic participants (6.6%) with significant nodular lesions were referred for histological or cytological evaluation of the possibility of malignancy, and 1 case was considered clinically important and required surgical resection. The cancer discovery rate was 3.3% (3/92) with positive predictive value of 50% (3/6). In the 5 participants with previously identified cancers, no recurrence or metastasis was detected.The offer of whole-body FDG-PET for cancer screening was welcomed with enthusiasm by most of the hospital employees. PET/CT combines the merits of PET and CT and can be administered to and provide benefits to a select group of hospital employees.

Cancer patients and positive sensory impressions in the hospital environment--a qualitative interview study.

PubMed

Timmermann, C; Uhrenfeldt, L; Birkelund, R

2013-01-01

This study explores how cancer patients experience the meaning of positive sensory impressions in the hospital environment such as architecture, decoration and the interior. Data were obtained at a general hospital in Denmark by interviewing six cancer patients at two different wards. The analysis process was guided by the hermeneutical-phenomenological theory of interpretation as presented by the French philosopher Paul Ricoeur. Two main themes were identified: to preserve identity and positive thoughts and feelings. The participants experienced that positive sensory impressions in the hospital environment had a significant impact on their mood, generating positive thoughts and feelings. A view to nature also helped them to forget their negative thoughts for a while. The possibility of having a view helped some cancer patients to connect with good memories and personal life stories that enabled them to recall some of their feelings of identity. This paper adds knowledge about how cancer patients experience sensory impressions in the hospital environment. An environment that provides homeliness and offers a view to nature seems to help some patients to preserve their identity. Furthermore, positive sensory impressions and the opportunity for recreation through environmental facilities strengthen the patient's positive thoughts and feelings. © 2012 Blackwell Publishing Ltd.

Conference James F.Buckli

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2008-02-07

L'association du personnel a le plaisir d'accueillir Mons. James F.Buckli, astronaute, né en 1947. Il a participé à la mission Space Lab D1 qui pour la première fois mettait 8 personnes sur orbite.L'ass.du pers. remercie aussi Gordon White(s) de la mission américaine d'avoir permis d'organiser cette conférence

James Webb Space Telescope

NASA Image and Video Library

2017-12-08

When the James Webb Space Telescope (JWST) reaches its orbit about a million miles (1.5 kilometers) from Earth and begins studying the distant reaches of the universe, the event will mark an unprecedented triumph on several technological fronts. Photo Credit: Chris Gunn For more information go to the Goddard Tech Trends Archive: Spring 2007 (http://gsfctechnology.gsfc.nasa.gov/TechTrendsArchive.html)

Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments.

PubMed

Hsu, Po-Kuei; Chen, Hui-Shan; Wang, Bing-Yen; Wu, Shiao-Chi; Liu, Chao-Yu; Shih, Chih-Hsun; Liu, Chia-Chuan

2015-01-28

To study the "hospital type-outcome" and "volume-outcome" relationships in patients with esophageal cancer who receive non-surgical treatments. A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, >56 cases) or an upper quartile (>75%) volume of 377 cases (annual volume>94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival. A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, >94 vs ≤94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P=0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ≤94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of >94 (31.1% and 9.4%, respectively; P=0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume>94 vs ≤94) were independent prognostic factors. Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.

78 FR 48609 - Safety Zone; James River; Newport News, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...-AA00 Safety Zone; James River; Newport News, VA AGENCY: Coast Guard, DHS. ACTION: Temporary final rule...-0670 to read as follows: Sec. 165.T05-0670 Safety Zone, James River, Newport News, VA. (a) Definitions...'11'' N longitude 076[deg]38'40'' W, located near Fort Eustis in Newport News, VA. (c) Regulations. (1...

Cancer and HIV infection in referral hospitals from four West African countries.

PubMed

Jaquet, Antoine; Odutola, Michael; Ekouevi, Didier K; Tanon, Aristophane; Oga, Emmanuel; Akakpo, Jocelyn; Charurat, Manhattan; Zannou, Marcel D; Eholie, Serge P; Sasco, Annie J; Bissagnene, Emmanuel; Adebamowo, Clement; Dabis, Francois

2015-12-01

The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among the 1644 cancer patients enrolled, 184 (11.2%) were identified as HIV-infected. The HIV prevalence in the referent group (n=792) was 4.4% [CI 3.0-5.8]. HIV infection was associated with Kaposi sarcoma (aOR 34.6 [CI: 17.3-69.0]), non-Hodgkin lymphoma (aOR 3.6 [CI 1.9-6.8]), cervical cancer (aOR 4.3 [CI 2.2-8.3]), anogenital cancer (aOR 17.7 [CI 6.9-45.2]) and squamous cell skin carcinoma (aOR 5.2 [CI 2.0-14.4]). A strong association is now reported between HIV infection and Human Papillomavirus (HPV)-related cancers including cervical cancer and anogenital cancer. As these cancers are amenable to prevention strategies, screening of HPV-related cancers among HIV-infected persons is of paramount importance in this African context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Analyzing quality of colorectal cancer care through registry statistics: a small community hospital example.

PubMed

Hopewood, Ian

2011-01-01

As the quantity of elderly Americans requiring oncologic care grows, and as cancer treatment and medicine become more advanced, assessing quality of cancer care becomes a necessary and advantageous practice for any facility.' Such analysis is especially practical in small community hospitals, which may not have the resources of their larger academic counterparts to ensure that the care being provided is current and competitive in terms of both technique and outcome. This study is a comparison of the colorectal cancer care at one such center, Falmouth Community Hospital (FCH)--located in Falmouth, Massachusetts, about an hour and a half away from the nearest metropolitan center--to the care provided at a major nearby Boston Tertiary Center (BTC) and at teaching and research facilities across New England and the United States. The metrics used to measure performance encompass both outcome (survival rate data) as well as technique, including quality of surgery (number of lymph nodes removed) and the administration of adjuvant treatments, chemotherapy, and radiation therapy, as per national guidelines. All data for comparison between FCH and BTC were culled from those hospitals' tumor registries. Data for the comparison between FCH and national tertiary/referral centers were taken from the American College of Surgeons' Commission on Cancer, namely National Cancer Data Base (NCDB) statistics, Hospital Benchmark Reports and Practice Profile Reports. The results showed that, while patients at FCH were diagnosed at both a higher age and at a more advanced stage of colorectal cancer than their BTC counterparts, FCH stands up favorably to BTC and other large centers in terms of the metrics referenced above. Quality assessment such as the analysis conducted here can be used at other community facilities to spotlight, and ultimately eliminate, deficiencies in cancer programs.

Community Hospitals Indianapolis creates breast cancer awareness. The hospital joins a partnership with local ABC affiliate.

PubMed

Herreria, J

1999-01-01

Community Hospitals Indianapolis raises the public's awareness of the importance of breast self-examination and mammography as the best tools for early detection of breast cancer. The health system has designed a program called Buddy Check 6 to partner with a local television station.

Influence of hospital and clinician workload on survival from colorectal cancer: cohort study.

PubMed

Kee, F; Wilson, R H; Harper, C; Patterson, C C; McCallion, K; Houston, R F; Moorehead, R J; Sloan, J M; Rowlands, B J

1999-05-22

To determine whether clinician or hospital caseload affects mortality from colorectal cancer. Cohort study of cases ascertained between 1990 and 1994 by a region-wide colorectal cancer register. Mortality within a median follow up period of 54 months after diagnosis. Of the 3217 new patients registered over the period, 1512 (48%) died before 31 December 1996. Strong predictors of survival both in a logistic regression (fixed follow up) and in a Cox's proportional hazards model (variable follow up) were Duke's stage, the degree of tumour differentiation, whether the liver was deemed clear of cancer by the surgeon at operation, and the type of intervention (elective or emergency and curative or palliative intent). In a multilevel model, surgeon's caseload had no significant effect on mortality at 2 years. Hospital workload, however, had a significant impact on survival. The odds ratio for death within 2 years for cases managed in a hospital with a caseload of between 33 and 46 cases per year, 47 and 54 cases per year, and >/=55 cases per year (compared to one with cancer, but survival of patients treated in hospitals with caseloads above 33 cases per year was slightly worse than for those treated in hospitals with fewer caseloads. Imprecise measurement of clinician specific "events rates" and the lack of routinely collected case mix data present major challenges for clinical audit and governance in the years ahead.

Disparities in hospitalization outcomes among African-American and White prostate cancer patients.

PubMed

Naik, Gurudatta; Akinyemiju, Tomi

2017-02-01

This paper aims to determine whether racial disparities exist in hospitalization outcomes among African-American and White hospitalized prostate cancer patients in the United States. We evaluated racial differences among matched groups of patients in post-operative complications, hospital length of stay and in-hospital mortality. We identified a total of 183,856 men aged 40 years and older with a primary diagnosis of prostate cancer, of which 58,701 underwent prostatectomy, through the Nationwide Inpatient Sample, and matched all African-American patients with White patients on: 1) Demographics, 2) Demographics+Clinical presentation and 3) Demographics+Clinical presentation+Treatment. Multivariable regression analyses were conducted in SAS and estimates were reported with 95% confidence intervals. African-American patients were more likely to be admitted with metastatic disease (24.8%) compared with White patients matched on demographics (17.9%), and demographics+presentation (23.6%). However, 23.9% of African-American patients received surgery compared with 38.2% and 34.2% of Whites matched on demographics and demographics+presentation, respectively. White patients had lower in-hospital mortality compared with African-American patients matched on demographics (OR: 0.72, 95% CI: 0.66-0.79), demographics+presentation (OR: 0.88, 95% CI: 0.81-0.96), but was no longer significantly lower when matched on demographics, presentation and treatment (OR: 0.92, 95% CI: 0.85-1.00). There were significant racial differences in outcomes among prostate cancer patients within the inpatient setting, even after accounting for demographic and presentation differences. Copyright © 2016 Elsevier Ltd. All rights reserved.

Author! Author!: James E. Ransome.

ERIC Educational Resources Information Center

School Library Media Activities Monthly, 1996

1996-01-01

Presents a profile of James E. Ransome, a children's book illustrator. Highlights include his background, the influence of filmmaking in his storyboards, illustration as storytelling, manuscript selection, the use of models and realistic themes, awards, future work, and advice for librarians and teachers about how to use his books. (AEF)

The James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Mather, John

2003-01-01

The James Webb Space Telescope (JWST) will extend the discoveries of the Hubble Space Telescope by deploying a large cooled infrared telescope at the Sun-Earth Lagrange point L2. It will have a 6 m aperture and three instruments covering the wavelength range from 0.6 to 28 microns.

11. John and James Dobson Carpet Mill, East and West ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. John and James Dobson Carpet Mill, East and West parcels, site plan-upper left, elevation-lower left, and survey-right, 1877. Hexamer, Ernest and Son. Hexamer General Surveys, 1867-1895, Philadelphia, Pennsylvania: E. Hexamer and Son, 1877, pp. 1095-1096. - John & James Dobson Carpet Mill (West Parcel), 4041-4055 Ridge Avenue, Philadelphia, Philadelphia County, PA

13. John and James Dobson Carpet Mill, East and West ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. John and James Dobson Carpet Mill, East and West parcels, site plan-upper left, elevation-upper right, and survey-below, 1885. Hexamer, Ernest and Son. Hexamer General Surveys, 1867-1895, Philadelphia, Pennsylvania: E. Hexamer and Son, 1885, pp. 1890-1891. - John & James Dobson Carpet Mill (West Parcel), 4041-4055 Ridge Avenue, Philadelphia, Philadelphia County, PA

9. John and James Dobson Carpet Mill, portion of West ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. John and James Dobson Carpet Mill, portion of West parcel, site plan-left, elevation-upper right, and survey-lower right, 1873. Hexamer, Ernest and Son. Hexamer General Surveys 1867-1895, Philadelphia, Pennsylvania: E. Hexamer and Son, 1873, pp. 670-671. - John & James Dobson Carpet Mill (West Parcel), 4041-4055 Ridge Avenue, Philadelphia, Philadelphia County, PA

Health Status After Cancer: Does It Matter Which Hospital You Belong To?

PubMed Central

2010-01-01

Background Survival rates are widely used to compare the quality of cancer care. However, the extent to which cancer survivors regain full physical or cognitive functioning is not captured by this statistic. To address this concern we introduce post-diagnosis employment as a supplemental measure of the quality of cancer care. Methods This study is based on individual level data from the Norwegian Cancer Registry (n = 46,720) linked with data on labor market outcomes and socioeconomic status from Statistics Norway. We study variation across Norwegian hospital catchment areas (n = 55) with respect to survival and employment five years after cancer diagnosis. To handle the selection problem, we exploit the fact that cancer patients in Norway (until 2001) have been allocated to local hospitals based on their place of residence. Results We document substantial differences across catchment areas with respect to patients' post-diagnosis employment rates. Conventional quality indicators based on survival rates indicate smaller differences. The two sets of indicators are only moderately correlated. Conclusions This analysis shows that indicators based on survival and post-diagnosis employment may capture different parts of the health status distribution, and that using only one of them to capture quality of care may be insufficient. PMID:20626866

National Comparison of Hospital Performances in Lung Cancer Surgery: The Role Of Casemix Adjustment.

PubMed

Beck, Naomi; Hoeijmakers, Fieke; van der Willik, Esmee M; Heineman, David J; Braun, Jerry; Tollenaar, Rob A E M; Schreurs, Wilhelmina H; Wouters, Michel W J M

2018-04-03

When comparing hospitals on outcome indicators, proper adjustment for casemix (a combination of patient- and disease characteristics) is indispensable. This study examines the need for casemix adjustment in evaluating hospital outcomes for Non-Small Cell Lung Cancer (NSCLC) surgery. Data from the Dutch Lung Cancer Audit for Surgery was used to validate factors associated with postoperative 30-day mortality and complicated course with multivariable logistic regression models. Between-hospital variation in casemix was studied by calculating medians and interquartile ranges for separate factors on hospital level and the 'expected' outcomes per hospital as a composite measure. 8040 patients, distributed over 51 Dutch hospitals were included for analysis. Mean observed postoperative mortality and complicated course were 2.2% and 13.6% respectively. Age, ASA-classification, ECOG performance score, lung function, extent of resection, tumor stage and postoperative histopathology were individual significant predictors for both outcomes of postoperative mortality and complicated course. A considerable variation of these casemix factors between hospital-populations was observed, with the expected mortality and complicated course per hospital ranging from 1.4 to 3.2% and 11.5 to 17.1%. The between-hospital variation in casemix of patients undergoing surgery for NSCLC emphasizes the importance of proper adjustment when comparing hospitals on outcome indicators. Copyright © 2018. Published by Elsevier Inc.

Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials.

PubMed

Shih, Sophy T F; Carter, Rob; Heward, Sue; Sinclair, Craig

2017-08-01

While skin cancer is still the most common cancer in Australia, important information gaps remain. This paper addresses two gaps: i) the cost impact on public hospitals; and ii) an up-to-date assessment of economic credentials for prevention. A prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using State service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Combining inpatient and outpatient costs, total annual costs for Victoria were $48 million to $56 million. The SunSmart program is estimated to have prevented more than 43,000 skin cancers between 1988 and 2010, a net cost saving of $92 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). At about $50 million per year for hospitals in Victoria alone, the cost burden of a largely preventable disease is substantial. Skin cancer prevention remains highly cost-effective, yet underfunded. Implications for public health: Increased funding for skin cancer prevention must be kept high on the public health agenda. Hospitals would also benefit from being able to redirect resources to non-preventable conditions. © 2017 The Authors.

Conference James F.Buckli

ScienceCinema

None

2017-12-09

L'association du personnel a le plaisir d'accueillir Mons. James F.Buckli, astronaute, né en 1947. Il a participé à la mission Space Lab D1 qui pour la première fois mettait 8 personnes sur orbite.L'ass.du pers. remercie aussi Gordon White(s) de la mission américaine d'avoir permis d'organiser cette conférence

Hospitalization costs of lung cancer diagnosis in Turkey: Is there a difference between histological types and stages?

PubMed

Türk, Murat; Yıldırım, Fatma; Yurdakul, Ahmet Selim; Öztürk, Can

2016-12-01

To establish the direct costs of diagnosing lung cancer in hospitalized patients. Hospital data of patients who were hospitalized and diagnosed as lung cancer between September 2013 and August 2014 were retrospectively analyzed. Patients who underwent surgery for diagnosis and who were initiated with cancer treatment during the same hospital stay were excluded from study. Histological types and stages of lung cancer were determined. Expenses were grouped as laboratory costs, pathology costs, diagnostic imaging costs, overnight room charges, medication costs, blood center costs, consumable expenditures' costs and inpatient service charges (including consultants' service, electrocardiogram, follow-up, nursing services, diagnostic interventions). Of the 68 patients, 55 (81%) had non-small cell lung cancer (NSCLC), 13 (19%) had small cell lung cancer (SCLC). 47% of patients with NSCLC had stage 4 disease and 86% of patients with SCLC had extensive stage disease. Median total cost per patient was 910 (95% CI= 832-1291) Euros (€). Of all costs, 37% were due to inpatient service charges and 22% were medication costs. Median total cost per patient was 912 (95% CI= 783-1213) € in NSCLC patients and 908 (95% CI= 456-2203) € in SCLC patients (p> 0.05). In NSCLC group, total cost per patient was 873 (95% CI= 591-1143) € in stage 1-2-3 diseases and 975 (95% CI= 847-1536) € in stage 4 disease (p> 0.05). In SCLC group total cost per patient was 937 € in limited stage and 502 (95% CI= 452-2508) € in extensive stage (p> 0.05). There is no significant difference between costs related to diagnosis of different lung cancer types and stages in patients hospitalized in a university hospital.

Epidemiology of pancreatic cancer in France: descriptive study from the French national hospital database.

PubMed

Maire, Frédérique; Cibot, Jean-Olivier; Compagne, Catherine; Hentic, Olivia; Hammel, Pascal; Muller, Nelly; Ponsot, Philippe; Levy, Philippe; Ruszniewski, Philippe

2017-08-01

Although indirect evidence suggests that the incidence of pancreatic adenocarcinoma has increased in the last decade, few data are available in European countries. The aim of the present study was to update the epidemiology of pancreatic cancer in France in 2014 from the French national hospital database (Programme de Médicalisation des Systèmes d'Information). All patients hospitalized for pancreatic cancer in France in 2014 in public or private institutions were included. Patient and stays (length, type of support, institutions) characteristics were studied. The results were compared with those observed in 2010. A total of 13 346 (52% men, median age 71 years) new patients were treated for pancreatic cancer in 2014, accounting for a 12.5% increase compared with 2010. Overall, 22% of patients were operated on. Liver metastases were present in 60% of cases. The disease accounted for 146 680 hospital stays (+24.8% compared with 2010), 76% of which were related to chemotherapy (+32%). The average annual number and length of stay were 7 and 2.6 days, respectively. In 2014, 11 052 deaths were reported (+15.8%). Approximately 13 350 new cases of pancreatic cancer were observed in France in 2014. The increase in incidence was associated with a marked increase in hospital stays for chemotherapy.

Symptom Frequencies and Intensities in Hospitalized Patients With Advanced Cancer Having Depressive Disorder.

PubMed

Liu, Yong; Liu, Fei; Yu, Yang; Li, Qing; Jin, Xin; Li, Jin

2017-06-01

To explore the frequencies and intensities of depressive symptoms associated with hospitalized patients with advanced cancer. A total of 196 hospitalized patients with advanced cancer were surveyed with the Edmonton Symptom Assessment System and Self-Rating Depression Scale (SDS). The χ 2 test and Wilcoxon rank-sum test were used to compare the frequency and intensity of symptoms between patients with and without depressive disorders. Spearman rank correlation was used to test the correlation between depression and symptoms. Of the 196 enrolled patients, 115 (59%) were males. The median age of the patients was 58 (19-80) years. Seventy-six (39%) patients were diagnosed with depression (SDS ≥ 53). Patients with depressive disorders exhibited pain, drowsiness, and nausea along with a higher frequency and intensity of poor self-perception, appetite loss, anxiety, dyspnea, and fatigue. Depressive symptoms were positively correlated with the symptoms. Depressive disorders are very common and severe in hospitalized patients with advanced cancer. Identifying the frequencies and intensities of the symptoms enables early intervention to improve patients' quality of life.

Comparison between types of cancer chemotherapies used in a private and a government-based hospital in Mexico.

PubMed

Calderón Guzmán, David; Juarez Olguín, Hugo; Guevara Zempoalteca, Angeles; Juárez Jacobo, Arturo; Segura Abarca, Lourdes; Barragán Mejía, Gerardo; Hernández García, Ernestina

2009-01-01

We have compared the frequency and types of cancer chemotherapies used in a private hospital and in a government-based hospital in Mexico City. A retrospective study was conducted from January 2005 to December 2007, and therapeutic management determined in 415 cases reviewed by the attending physicians of the oncology service. In the government-based hospital, 60 different types of cancer were found among 273 patients diagnosed. Acute lymphoblastic leukemia (ALL) had the greatest incidence (30%), followed by Hodgkin's lymphoma (9%), retinoblastoma (7%), neuroblastoma (6%), and osteosarcoma (6%). The entire number of chemotherapy sessions was 7575. Drugs most frequently employed included etoposide (577), followed by methotrexate (575), vincristine (483), cyclophosphamide (312), and cytarabine (277). The economic status among these patients was mainly of limited resources and represented 80% of the total number of patients. The types of cancer found in the private hospital were similar, however the drugs used were predominantly cyclophosphamide (416), doxorubicin (382), 5-fluorouracil (368), paclitaxel (237) and cisplatin (128). The types of cancer were similar in both hospitals and reflected the incidence among the entire population in Mexico, since acute lymphoblastic leukemia, Hodgkin's lymphoma and retinoblastoma, were the types most represented. However, the treatment schemes differed; the chemotherapeutic agents used in the private hospital were rather more specific but significantly more expensive than those employed in the government hospital.

Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

ERIC Educational Resources Information Center

Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

2016-01-01

Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

Reproductive Cancer Treatment Hospitalizations of U.S. Women with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Parish, Susan L.; Son, Esther; Powell, Robyn M.; Igdalsky, Leah

2018-01-01

There is a dearth of existing research on the treatment of reproductive cancers among women with intellectual and developmental disabilities (IDD). This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared the prevalence of reproductive cancer treatment hospitalization discharges among women with…

A qualitative analysis of communication between members of a hospital-based multidisciplinary lung cancer team.

PubMed

Rowlands, S; Callen, J

2013-01-01

The aim of the study was to explore how patient information is communicated between health professionals within a multidisciplinary hospital-based lung cancer team and to identify mechanisms to improve these communications. A qualitative method was employed using semi-structured in-depth interviews with a representative sample (n = 22) of members of a multidisciplinary hospital-based lung cancer team including medical, nursing and allied health professionals. Analysis was undertaken using a thematic grounded theory approach to derive key themes to describe communication patterns within the team and how communication could be improved. Two themes with sub-themes were identified: (1) characteristics of communication between team members including the impact of role on direction of communications, and doctors' dominance in communications; and (2) channels of communication including, preference for face-to-face and the suboptimal roles of the Multidisciplinary Team Meeting and the hospital medical record as mediums for communication. Traditional influences of role delineation and the dominance of doctors were found to impact on communication within the multidisciplinary hospital-based lung cancer team. Existing guidelines on implementation of multidisciplinary cancer care fail to address barriers to effective team communication. The paper-based medical record does not support team communications and alternative electronic solutions need to be used. © 2012 Blackwell Publishing Ltd.

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors.

PubMed

Mathoulin-Pélissier, Simone; Bécouarn, Yves; Belleannée, Geneviève; Pinon, Elodie; Jaffré, Anne; Coureau, Gaëlle; Auby, Dominique; Renaud-Salis, Jean-Louis; Rullier, Eric

2012-07-19

Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥ 12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥ 12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some

[Occupational and environmental cancer in southern Sardinia: a survey on ten years of hospitalizations].

PubMed

Argiolas, F; Marras, V; Porcu, S; Senis, G; Saderi, L; Spada, L; Santus, S; Coppola, R C; Cocco, P; Campagna, M; Steri, G

2012-01-01

Based on hospital discharges in 1001-2010, we calculated risk of tumours with an elevated occupational and environmental etiological fraction by health district of residence within the Local Health Unit (LHU) N. 8 of Sardinia. With reference to the age and gender-specific hospitalization rates of the whole LHU, residents in the urban Cagliari health district showed an excess risk of haemolymphopoietic cancer (RR = 1.07; 95% CI 1.03-1.12) and bladder cancer (RR = 1.10; 95% CI 1.05-1.16); in both instances, risks were higher among female residents. The highest excess risk for lung cancer was observed among residents in the Quartu-Parteolla health district (RR = 1.13; 95% CI 1.05-1.21), and it was slightly higher among male residents. The results appear to confirm the role of urban factors in increasing cancer risk.

NCI Expands Repository of Cancer Research Models

Cancer.gov

NCI is expanding its Patient-Derived Models Repository (PDMR), which generates and distributes models like patient-derived xenografts and organoids. In this Cancer Currents Q&A with Drs. Yvonne Evrard and James Doroshow, learn how the expansion can help cancer researchers make more rapid progress.

"Restructuring" Stirs Outcry at James Madison.

ERIC Educational Resources Information Center

Magner, Denise K.

1995-01-01

An administration plan to discontinue the physics major at James Madison University (Virginia) has raised concerns about the president's leadership and management style, and the role of faculty in institutional decision making. Faculty were notified of the plan only after student leaders were told. (MSE)

Pre-menopausal triple-negative breast cancer at HAM hospital medan

NASA Astrophysics Data System (ADS)

Betty; Laksmi, L. I.; Siregar, K. B.

2018-03-01

Triple-negative breast cancers (TNBC) are a type of breast cancer that does not have any or lack expression of the three receptors of estrogen (ER), progesterone (PR), and human epidermal growth factor receptor 2 (HER-2). This cross-sectional study was performed on patients TNBC in HAM hospital Medan from 2013 to 2016 by immunohistochemistry stained. A total 60 invasive breast cancer samples with TNBC. The more frequent in TNBC group were 51-60 years (19 cases, 31.66%) and pre-menopause (34 cases, 57%). Tumor size T3 and T4 with staging IIIA and IIIB, histology sub-type IC-NOS and ILC with grade 2 and grade 3 of histologic was more common in TNBC.

The contribution of William James to the origins of "scientific" psychology.

PubMed

Ferreri, Antonio M

2006-01-01

This paper illustrates the specific nature of the contribution made by the psychology of William James to the construction of modern scientific psychology. Universally recognized as the father of American scientific psychology, William James still remains a much-debated scientist, mainly for two reasons. First, he was interested in subjects that were often very far from the narrow and traditional approaches taken by the greater part of his contemporary colleagues. Secondly, in order to enlighten psychological issues, he continued to adopt multidisciplinary contributions, rather than selecting only those that stemmed from experimental and specifically laboratory contexts. James has been recently inserted in the more complex international consortium of psychologists, psychiatrists, physicians, psychotherapists, and philosophers that has been called "the French-Swiss-English-and-American psychotherapeutic alliance." This does in reality seem a more appropriate framework for understanding the specificity of James's psychology. In order to illustrate the peculiar Jamesian way of thinking about psychological issues, this paper undertakes an examination of his classical concept of the "stream of thought." Here, in fact, many different contributions converge in defining and outlining "the primary fact of consciousness"--personal, subjective, and introspective observation; philosophical arguments; "mental experiments," and psychopathological experiences; but, most of all, neurological data derived specifically from brain physiology. This last contribution has been too often underestimated, as has also the background of James's training in the development of experimental psychology, neurology, and physiology at Harvard before 1890. The paper concludes with the assertion that James represents the prototype of a new way of defining the scientific quality of modern psychology, far from the narrow definition given by the laboratory experimentalists fresh from the German

Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer.

PubMed

Jonna, Sushma; Chiang, Leslie; Liu, Jingxia; Carroll, Maria B; Flood, Kellie; Wildes, Tanya M

2016-11-01

Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital's Oncology Acute Care of Elders (OACE) unit from 2000 to 2008. Data collected included geriatric assessments from OACE screening questionnaires as well as demographic and medical history data from chart review. The primary end point was time from index admission to death. The Cox proportional hazard modeling was performed. The median age was 72.5 years old. Geriatric syndromes and functional impairment were common. Half of the patients (50.4 %) were dependent in one or more activities of daily living (ADLs), and 74 % were dependent in at least one instrumental activity of daily living (IADLs). On multivariate analysis, the following factors were significantly associated with worse overall survival: male gender; a total score <20 on Lawton's IADL assessment; reason for admission being cardiac, pulmonary, neurologic, inadequate pain control, or failure to thrive; cancer type being thoracic, hepatobiliary, or genitourinary; readmission within 30 days; receiving cancer treatment with palliative rather than curative intent; cognitive impairment; and discharge with hospice services. In older adults with cancer, certain geriatric parameters are associated with shorter survival after hospitalization. Assessment of functional status, necessity for readmission, and cognitive impairment may provide prognostic information so that oncologists and their patients make more informed, individualized decisions.

Circulating tumoral cells lack circadian-rhythm in hospitalized metastasic breast cancer patients.

PubMed

García-Sáenz, José Angel; Martín, Miguel; Maestro, Marisa; Vidaurreta, Marta; Veganzones, Silvia; Villalobos, Laura; Rodríguez-Lajusticia, Laura; Rafael, Sara; Sanz-Casla, María Teresa; Casado, Antonio; Sastre, Javier; Arroyo, Manuel; Díaz-Rubio, Eduardo

2006-11-01

The relationship between breast cancer and circadian rhythm variation has been extensively studied. Increased breast tumorigenesis has been reported in melatonin-suppressed experimental models and in observational studies. Circulating Tumor Cells (CTC) circadian- rhythm may optimize the timing of therapies. This is a prospective experimental study to ascertain the day-time and night-time CTC levels in hospitalized metastasic breast cancer (MBC) patients. CTC are isolated and enumerated from a 08:00 AM and 08:00 PM blood collections. 23 MBC and 23 healthy volunteers entered the study. 69 samples were collected (23 samples at 08:00 AM and 23 samples at 08:00 PM from MBC; 23 samples from healthy volunteers). Results from two patients were rejected due to sample processing errors. No CTC were isolated from healthy-volunteers. No-differences between daytime and night-time CTC were observed. Therefore, we could not ascertain CTC circadian-rhythm in hospitalized metastasic breast cancer patients.

High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage

PubMed Central

Sieswerda, Elske; Font-Gonzalez, Anna; Reitsma, Johannes B.; Dijkgraaf, Marcel G. W.; Heinen, Richard C.; Jaspers, Monique W.; van der Pal, Helena J.; van Leeuwen, Flora E.; Caron, Huib N.

2016-01-01

Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources. PMID:27433937

High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage.

PubMed

Sieswerda, Elske; Font-Gonzalez, Anna; Reitsma, Johannes B; Dijkgraaf, Marcel G W; Heinen, Richard C; Jaspers, Monique W; van der Pal, Helena J; van Leeuwen, Flora E; Caron, Huib N; Geskus, Ronald B; Kremer, Leontien C

2016-01-01

Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9-2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5-10 and 20-30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1-16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6-11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources.

John James Audubon & the Turkey

ERIC Educational Resources Information Center

Hinshaw, Craig

2012-01-01

In the first half of the 1800s, John James Audubon roamed the wilds of America attempting to draw all the birds in their natural habitat. He published his life-sized paintings in a huge book entitled "Birds of America." Audubon developed a unique system of depicting the birds in natural poses, such as flying. After shooting the bird, he would wire…

A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines.

PubMed

Symonds, Erin L; Simpson, Kalindra; Coats, Michelle; Chaplin, Angela; Saxty, Karen; Sandford, Jayne; Young Am, Graeme P; Cock, Charles; Fraser, Robert; Bampton, Peter A

2018-06-18

To examine the compliance of colorectal cancer surveillance decisions for individuals at greater risk with current evidence-based guidelines and to determine whether compliance differs between surveillance models. Prospective auditing of compliance of surveillance decisions with evidence-based guidelines (NHMRC) in two decision-making models: nurse coordinator-led decision making in public academic hospitals and physician-led decision making in private non-academic hospitals. Selected South Australian hospitals participating in the Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP). Proportions of recall recommendations that matched NHMRC guideline recommendations (March-May 2015); numbers of surveillance colonoscopies undertaken more than 6 months ahead of schedule (January-December 2015); proportions of significant neoplasia findings during the 15 years of SCOOP operation (2000-2015). For the nurse-led/public academic hospital model, the recall interval recommendation following 398 of 410 colonoscopies (97%) with findings covered by NHMRC guidelines corresponded to the guideline recommendations; for the physician-led/private non-academic hospital model, this applied to 257 of 310 colonoscopies (83%) (P < 0.001). During 2015, 27% of colonoscopies in public academic hospitals (mean, 27 months; SD, 13 months) and 20% of those in private non-academic hospitals (mean, 23 months; SD, 12 months) were performed more than 6 months earlier than scheduled, in most cases because of patient-related factors (symptoms, faecal occult blood test results). The ratio of the numbers of high risk adenomas to cancers increased from 6.6:1 during 2001-2005 to 16:1 during 2011-2015. The nurse-led/public academic hospital model for decisions about colorectal cancer surveillance intervals achieves a high degree of compliance with guideline recommendations, which should relieve burdening of colonoscopy resources.

[Febrile neutropenia at the emergency department of a cancer hospital].

PubMed

Debey, C; Meert, A-P; Berghmans, T; Thomas, J M; Sculier, J P

2011-01-01

Febrile neutropenia is an important cause of fever in the cancer patient. When he/she is undergoing chemotherapy, the priority is to exclude that complication because it requires rapid administration of empiric broad-spectrum antibiotics. We have studied the rate and characteristics of febrile neutropenia in cancer patients consulting in a emergency department. We have conducted a retrospective study in the emergency department of a cancer hospital over the year 2008. Every patient with cancer and fever > or = 38 degrees C was included. Over 2.130 consultations, 408 were selected (313 patients) including 21.6% (88) for febrile neutropenia. A focal symptom or physical sign was present in the majority of the cases. 88% were assessed as low risk for severe complications and about half of them received oral antibiotics. There were only a few patients with a nude fever for which it was difficult to make a hypothetical diagnosis in order to administer a probabilistic treatment. The majority of the consultations lead to hospital admission. Over the 80 hospitalisations, 6 deaths occurred. There was no death among the patients who remained ambulatory. In conclusion, our study shows that febrile neutropenia is frequent in ambulatory cancer patients presenting with fever and that in the majority of the cases, it is associated with a low risk. In such a situation, ambulatory management is more and more often considered or, at least, a rapid discharge after a short admission in case of low risk febrile neutropenia. In that context, the role of the general practioner has to be emphasised and to facilitate the outpatient management, we propose an algorithm that requires validation.

Determinants of hospital death in haematological cancers: findings from a qualitative study

PubMed Central

McCaughan, Dorothy; Roman, Eve; Smith, Alexandra G; Garry, Anne; Johnson, Miriam; Patmore, Russell; Howard, Martin

2018-01-01

Objectives Current UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases. Methods The study was set within the Haematological Malignancy Research Network (HMRN—www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data. Results Five themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred. Conclusions Hospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death. PMID:28663341

Trend and forecasting rate of cancer deaths at a public university hospital using univariate modeling

NASA Astrophysics Data System (ADS)

Ismail, A.; Hassan, Noor I.

2013-09-01

Cancer is one of the principal causes of death in Malaysia. This study was performed to determine the pattern of rate of cancer deaths at a public hospital in Malaysia over an 11 year period from year 2001 to 2011, to determine the best fitted model of forecasting the rate of cancer deaths using Univariate Modeling and to forecast the rates for the next two years (2012 to 2013). The medical records of the death of patients with cancer admitted at this Hospital over 11 year's period were reviewed, with a total of 663 cases. The cancers were classified according to 10th Revision International Classification of Diseases (ICD-10). Data collected include socio-demographic background of patients such as registration number, age, gender, ethnicity, ward and diagnosis. Data entry and analysis was accomplished using SPSS 19.0 and Minitab 16.0. The five Univariate Models used were Naïve with Trend Model, Average Percent Change Model (ACPM), Single Exponential Smoothing, Double Exponential Smoothing and Holt's Method. The overall 11 years rate of cancer deaths showed that at this hospital, Malay patients have the highest percentage (88.10%) compared to other ethnic groups with males (51.30%) higher than females. Lung and breast cancer have the most number of cancer deaths among gender. About 29.60% of the patients who died due to cancer were aged 61 years old and above. The best Univariate Model used for forecasting the rate of cancer deaths is Single Exponential Smoothing Technique with alpha of 0.10. The forecast for the rate of cancer deaths shows a horizontally or flat value. The forecasted mortality trend remains at 6.84% from January 2012 to December 2013. All the government and private sectors and non-governmental organizations need to highlight issues on cancer especially lung and breast cancers to the public through campaigns using mass media, media electronics, posters and pamphlets in the attempt to decrease the rate of cancer deaths in Malaysia.

Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project.

PubMed

Ortiz, Héctor; Codina, Antonio; Ciga, Miguel Á; Biondo, Sebastiano; Enríquez-Navascués, José M; Espín, Eloy; García-Granero, Eduardo; Roig, José V

2016-10-01

INTRODUCCIóN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons. Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥36 procedures per year). After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI95% 5.6-7.6), 20.3 (CI95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI95% 1.071-1,333]), local recurrence (MHR 1.308 [CI95% 1.010-1.668]) and metastases (MHR 1.300 [CI95% 1.181; 1.476]) between all hospitals. Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients. However, local recurrence was not influenced by caseload. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Care and Outcomes of Patients With Cancer Admitted to the Hospital on Weekends and Holidays: A Retrospective Cohort Study.

PubMed

Lapointe-Shaw, Lauren; Abushomar, Hani; Chen, Xi-Kuan; Gapanenko, Katerina; Taylor, Chelsea; Krzyzanowska, Monika K; Bell, Chaim M

2016-07-01

Patients admitted to the hospital on weekends experience worse outcomes than those admitted on weekdays. Patients with cancer may be especially vulnerable to the effects of weekend care. Our objective was to compare the care and outcomes of patients with cancer admitted urgently to the hospital on weekends and holidays versus those of patients with cancer admitted at other times. This was a retrospective study of all adult patients with cancer having an urgent hospitalization in Canada from 2010 to 2013. Patients admitted to hospital on weekends/holidays were compared with those admitted on weekdays. The primary outcome was 7-day in-hospital mortality. We also compared performance of procedures in the first 2 days of hospital admission and admission to critical care after the first 24 hours. 290,471 hospital admissions were included. Patients admitted to hospital on weekends/holidays had an increased risk of 7-day in-hospital mortality (4.8% vs 4.3%; adjusted odds ratio [OR], 1.13; 95% CI, 1.08-1.17), corresponding to 137 excess deaths per year compared with the weekday group. This risk persisted after restricting the analysis to patients arriving by ambulance (7.1% vs 6.4%; adjusted OR, 1.11; 95% CI, 1.04-1.18). Among those who had procedures in the first 4 days of admission, fewer weekend/holiday-admitted patients had them performed in the first 2 days, for 8 of 9 common procedure groups. There was no difference in critical care admission risk after the first 24 hours. Patients with cancer admitted to the hospital on weekends/holidays experience higher mortality relative to patients admitted on weekdays. This may result from different care processes for weekend/holiday patients, including delayed procedures. Future research is needed to identify key outcome-driving procedures, and ensure timely access to these on all days of the week. Copyright © 2016 by the National Comprehensive Cancer Network.

Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

PubMed Central

Zwicker, Jeffrey I.; Rojan, Adam; Campigotto, Federico; Rehman, Nadia; Funches, Renee; Connolly, Gregory; Webster, Jonathan; Aggarwal, Anita; Mobarek, Dalia; Faselis, Charles; Neuberg, Donna; Rickles, Frederick R.; Wun, Ted; Streiff, Michael B.; Khorana, Alok A.

2014-01-01

Purpose Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in

75 FR 9904 - James A. Holland; Denial of Hearing; Final Debarment Order

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-N-0205] James A. Holland; Denial of Hearing; Final Debarment Order AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is denying James A. Holland's request for...

Increased risk of alteration of nutritional status in hospitalized elderly patients with advanced cancer.

PubMed

Paillaud, E; Caillet, P; Campillo, B; Bories, P N

2006-01-01

Malnutrition is common in patients with advanced cancer and is associated with worse prognosis. The aim of this study was to follow-up the nutritional status of elderly patients with advanced cancer in comparison with that of younger ones, in the course of hospitalization. Eighty-eight (44 males and 44 females) patients with advanced cancer entered the study. Two groups were defined according to age : superior 70 y (n = 45) and < 70 y (n = 43). Nutritional status by means of anthropometric variables and daily intake were assessed on Day 0, Day 30 and Day 60. A blood sample was collected on Day 0 for determination of serum proteins. The two groups of patients did not differ in terms of anthropometry and biological variables on admission to our department ; only bicipital skinfold thickness and energy intake were lower in the elderly patients. After one month hospitalization, tricipital skinfold thickness and fat mass decreased in these patients. After two months, mid-arm circumference also decreased. Unlike the older group, the younger patients increased their daily energy and protein intakes. During hospitalization, older persons with advanced cancer cannot improve their energy intake and therefore, are at particular risk of aggravating their nutritional status.

Hospital costs of colorectal cancer surgery for the oldest old: A Dutch population-based study.

PubMed

Govaert, Johannes A; Govaert, Marc J P M; Fiocco, Marta; van Dijk, Wouter A; Tollenaar, Rob A E M; Wouters, Michel W J M

2016-12-01

Background Due to increasing healthcare costs, discussions regarding increased hospital costs when operating on high-risk patients is rising. Therefore, the aim of this study was to analyze if oldest-old colorectal cancer patients have a greater impact on hospital costs than their younger counterparts. All colorectal cancer procedures performed in 29 Dutch hospitals between 2010 and 2012 and listed in the Dutch Surgical Colorectal Audit were analyzed. Oldest-old patients (≥85 years) were compared to patients <85 years. Ninety-day hospital costs were measured uniformly in all hospitals based on time-driven activity-based costs. Compared to <85-year-old patients (n = 9130), the oldest old (n = 783) had longer hospital stays (LOS) (11.3 vs. 13.2, P < 0.001), more severe complications (21.8% vs. 29.0%, P < 0.001), more failure to rescue (13.9% vs. 37.0%, P < 0.001) and higher mortality (3.0% vs. 10.7%, P < 0.001). Deceased oldest-old patients had significantly less LOS and less LOS ICU. Total hospital costs were 3% lower for oldest-old patients (€13,168) than for <85-year-old patients (€13,644, P < 0.001). In cases of severe complications or death, hospital costs for the oldest old were 25% and 31% lower than those of <85-year-old patients (both P < 0.001). Although frequently assumed to be more expensive, operating on oldest-old patients with colorectal cancer does not increase hospital costs compared to younger patients. This was most likely due to faster deterioration or less aggressive treatment of oldest-old patients when (severe) complications occurred. J. Surg. Oncol. 2016;114:1009-1015. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Economic burden of cancer among patients with surgical resections of the lung, rectum, liver and uterus: results from a US hospital database claims analysis.

PubMed

Kalsekar, Iftekhar; Hsiao, Chia-Wen; Cheng, Hang; Yadalam, Sashi; Chen, Brian Po-Han; Goldstein, Laura; Yoo, Andrew

2017-12-01

To determine hospital resource utilization, associated costs and the risk of complications during hospitalization for four types of surgical resections and to estimate the incremental burden among patients with cancer compared to those without cancer. Patients (≥18 years old) were identified from the Premier Research Database of US hospitals if they had any of the following types of elective surgical resections between 1/2008 and 12/2014: lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection, or total hysterectomy. Cancer status was determined based on ICD-9-CM diagnosis codes. Operating room time (ORT), length of stay (LOS), and total hospital costs, as well as frequency of bleeding and infections during hospitalization were evaluated. The impact of cancer status on outcomes (from a hospital perspective) was evaluated using multivariable generalized estimating equation models; analyses were conducted separately for each resection type. Among the identified patients who underwent surgical resection, 23 858 (87.9% with cancer) underwent lung lobectomy, 13 522 (63.8% with cancer) underwent LAR, 2916 (30.0% with cancer) underwent liver wedge resection and 225 075 (11.3% with cancer) underwent total hysterectomy. After adjusting for patient, procedural, and hospital characteristics, mean ORT, LOS, and hospital cost were statistically higher by 3.2%, 8.2%, and 9.2%, respectively for patients with cancer vs. no cancer who underwent lung lobectomy; statistically higher by 6.9%, 9.4%, and 9.6%, respectively for patients with cancer vs. no cancer who underwent LAR; statistically higher by 4.9%, 14.8%, and 15.7%, respectively for patients with cancer vs. no cancer who underwent liver wedge resection; and statistically higher by 16.0%, 27.4%, and 31.3%, respectively for patients with cancer vs. no cancer who underwent total hysterectomy. Among patients who underwent each type of resection, risks for bleeding and infection were generally higher

Family Caregiver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults With Cancer.

PubMed

Geddie, Patricia I; Wochna Loerzel, Victoria; Norris, Anne E

2016-07-01

To explore factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions for older adults with cancer.
. A prospective longitudinal design and a retrospective chart review.
. Adult oncology outpatient infusion centers and inpatient units at Orlando Regional Medical Center in Florida.
. A convenience sample of 129 dyads of older adults with cancer and their family caregivers. 
. Family caregiver demographic and side effect knowledge data were collected prospectively during interviews with family caregivers using a newly developed tool, the Nurse Assessment of Family Caregiver Knowledge and Action Tool. Patient demographic and clinical data were obtained through a retrospective chart review. Descriptive statistics and logistic regression analyses were used to evaluate data and examine relationships among variables.
. Patient illness characteristics; impaired function; side effects, such as infection, fever, vomiting, and diarrhea; family caregiver knowledge; and unplanned hospital admissions.
. Unplanned hospital admissions were more likely to occur when older adults had impaired function and side effects, such as infection, fever, vomiting, and diarrhea. Impaired function and family caregiver knowledge did not moderate the effects of these side effects on unplanned hospital admissions. 
. Findings suggest that the presence of impaired function and side effects, such as infection, fever, vomiting, and diarrhea, predict unplanned hospital admissions in older adults with cancer during the active treatment phase. Side effects may or may not be related to chemotherapy and may be related to preexisting comorbidities. 
. Nurses can conduct targeted assessments to identify older adults and their family caregivers who will need additional follow-up and support during the cancer treatment trajectory. Information gained from these assessments will assist nurses to provide practical and

Association of Hospital Volume With Racial and Ethnic Disparities in Locally Advanced Cervical Cancer Treatment.

PubMed

Uppal, Shitanshu; Chapman, Christina; Spencer, Ryan J; Jolly, Shruti; Maturen, Kate; Rauh-Hain, J Alejandro; delCarmen, Marcela G; Rice, Laurel W

2017-02-01

To evaluate racial-ethnic disparities in guideline-based care in locally advanced cervical cancer and their relationship to hospital case volume. Using the National Cancer Database, we performed a retrospective cohort study of women diagnosed between 2004 and 2012 with locally advanced squamous or adenocarcinoma of the cervix undergoing definitive primary radiation therapy. The primary outcome was the race-ethnicity-based rates of adherence to the National Comprehensive Cancer Network guideline-based care. The secondary outcome was the effect of guideline-based care on overall survival. Multivariable models and propensity matching were used to compare the hospital risk-adjusted rates of guideline-based adherence and overall survival based on hospital case volume. The final cohort consisted of 16,195 patients. The rate of guideline-based care was 58.4% (95% confidence interval [CI] 57.4-59.4%) for non-Hispanic white, 53% (95% CI 51.4-54.9%) for non-Hispanic black, and 51.5% (95% CI 49.4-53.7%) for Hispanic women (P<.001). From 2004 to 2012, the rate of guideline-based care increased from 49.5% (95% CI 47.1-51.9%) to 59.1% (95% CI 56.9-61.2%) (Ptrend<.001). Based on a propensity score-matched analysis, patients receiving guideline-based care had a lower risk of mortality (adjusted hazard ratio 0.65, 95% CI 0.62-0.68). Compared with low-volume hospitals, the increase in adherence to guideline-based care in high-volume hospitals was 48-63% for non-Hispanic white, 47-53% for non-Hispanic black, and 41-54% for Hispanic women. Racial and ethnic disparities in the delivery of guideline-based care are the highest in high-volume hospitals. Guideline-based care in locally advanced cervical cancer is associated with improved survival.

Joint use of epidemiological and hospital medico-administrative data to estimate prevalence. Application to French data on breast cancer.

PubMed

Colonna, Marc; Mitton, Nicolas; Schott, Anne-Marie; Remontet, Laurent; Olive, Frédéric; Gomez, Frédéric; Iwaz, Jean; Polazzi, Stéphanie; Bossard, Nadine; Trombert, Béatrice

2012-04-01

Estimate complete, limited-duration, and hospital prevalence of breast cancer in a French Département covered by a population-based cancer registry and in whole France using complementary information sources. Incidence data from a cancer registry, national incidence estimations for France, mortality data, and hospital medico-administrative data were used to estimate the three prevalence indices. The methods included a modelling of epidemiological data and a specific process of data extraction from medico-administrative databases. Limited-duration prevalence at 33 years was a proxy for complete prevalence only in patients aged less than 70 years. In 2007 and in women older than 15 years, the limited-duration prevalence at 33 years rate per 100,000 women was estimated at 2372 for Département Isère and 2354 for whole France. The latter rate corresponded to 613,000 women. The highest rate corresponded to women aged 65-74 years (6161 per 100,000 in whole France). About one third of the 33-year limited-duration prevalence cases were diagnosed five years before and about one fourth were hospitalized for breast-cancer-related care (i.e., hospital prevalence). In 2007, the rate of hospitalized women was 557 per 100,000 in whole France. Among the 120,310 women hospitalized for breast-cancer-related care in 2007, about 13% were diagnosed before 2004. Limited-duration prevalence (long- and short-term), and hospital prevalence are complementary indices of cancer prevalence. Their efficient direct or indirect estimations are essential to reflect the burden of the disease and forecast median- and long-term medical, economic, and social patient needs, especially after the initial treatment. Copyright © 2011 Elsevier Ltd. All rights reserved.

James Bernard Russell: Scholar, collaborator, mentor

USDA-ARS?s Scientific Manuscript database

At the time of his untimely death in 2009, ARS scientist Dr. James B. Russell had established himself as the premier rumen microbiologist of his generation. Dr. Russell’s many contributions to the field, including much of the early work on the Cornell Net Carbohydrate System model, were the product ...

James Madison and "The Federalist Papers."

ERIC Educational Resources Information Center

Patrick, John J.; And Others

A collection of resources for high school history and government teachers and their students, this volume treats core ideas on constitutional government in the United States. James Madison's ideas as found in "The Federalist Papers" are examined in conjunction with their counterpoints in essays of the Anti-Federalists. This volume…

Salvaging the self in a world without soul: William James's The Principles of psychology.

PubMed

Coon, D J

2000-05-01

This article explores William James's transformation of the religious soul into the secular self in The Principles of Psychology. Although James's views on the self are familiar to many historians of psychology, the article places his treatment of the self within the broader social and cultural context of a secularizing, industrializing society. There were palpable tensions and anxieties that accompanied the cultural shift, and these are particularly transparent in James's Principles. James attempted the project of secularizing the soul in order to promote a natural science of the mind but with marked ambivalence for the project, because it left out some of the moral and metaphysical questions of great interest to him.

James Madison and a Shift in Precipitation Seasonality

NASA Astrophysics Data System (ADS)

Druckenbrod, D. L.; Mann, M. E.; Stahle, D. W.; Cleaveland, M. K.; Therrell, M. D.; Shugart, H. H.

2001-12-01

An eighteen-year meteorological diary and tree ring data from James Madison's Montpelier plantation provide a consistent reconstruction of early summer and prior fall rainfall for the 18th Century Virginia piedmont. The Madison meteorological diary suggests a seasonal shift in monthly rainfall towards an earlier wet season relative to 20th Century norms. Furthermore, dendroclimatic reconstructions of early summer and prior fall rainfall reflect this shift in the seasonality of summer rainfall. The most pronounced early summer drought during the Madison diary period is presented as a case study. This 1792 drought occurs during one of the strongest El Niño events on record and is highlighted in the correspondence of James Madison.

Work settings of the first seven cohorts of James Cook University Bachelor of Medicine, Bachelor of Surgery graduates: Meeting a social accountability mandate through contribution to the public sector and Indigenous health services.

PubMed

Woolley, Torres; Sen Gupta, Tarun; Larkins, Sarah

2018-05-25

The James Cook University medical school's mission is to produce a workforce appropriate for the health needs of northern Australia. James Cook University medical graduate data were obtained via cross-sectional survey of 180 early-career James Cook University medical graduates from 2005-2011 (response rate of 180/298 contactable graduates = 60%). Australian medical practitioner data for 2005-2009 graduates were obtained via the 2015 'Medicine in Australia: Balancing Employment and Life' wave 8 dataset. Comparison of the range of work settings and hours worked by James Cook University medical graduates to Australian medical graduates. Compared to a similar group of Australian medical graduates, James Cook University Bachelor of Medicine, Bachelor of Surgery graduates are significantly more likely to work in government-funded 'public' organisations (hospitals, community health centres, Aboriginal Community Controlled Health Services, government departments, agencies or defence forces). In particular, James Cook University medical graduates were more likely to work in Aboriginal Community Controlled Health Services and community health centres and other state-run primary health care organisations than other Australian medical graduates. James Cook University medical graduates appear to work in a higher proportion of public settings; in particular, primary care settings, than Australian medical graduates. This is an appropriate mix for the predominantly rural and remote geography of Queensland and its associated medical workforce priorities. Reporting medical graduate outcomes by their nature of practice could be an important adjunct to other measures, such as geographic location and choice of specialty. © 2018 National Rural Health Alliance Ltd.

Unmet home healthcare needs and quality of life in cancer patients: a hospital-based Turkish sample.

PubMed

Ataman, Gülsen; Erbaydar, Tugrul

2017-07-01

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37-item, study-specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease-related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital-integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital-based healthcare services. © 2017 John Wiley & Sons Ltd.

Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer.

PubMed

Jacobs, Shana; Mowbray, Catriona; Cates, Lauren Muser; Baylor, Allison; Gable, Christopher; Skora, Elizabeth; Estrada, Monica; Cheng, Yao; Wang, Jichuan; Lewin, Daniel; Hinds, Pamela

2016-05-01

Adolescents with cancer experience many troubling symptoms, including sleep disruptions that can affect mood and quality of life. Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer. This study aimed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients. Adolescents ages 12-21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children's National Health System and randomized to either massage intervention or a waitlist control. Patients in the intervention group received one massage per night, for two or three nights. Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue, mood, and anxiety. The majority (78%) of patients approached for the study consented, and almost all patients in the intervention group (94%) received at least one massage, 69% received two, and rates of completion of instruments among adolescents were high demonstrating feasibility. There were trends toward increased night time and overall sleep in the intervention group compared with standard of care, but no differences between groups in the patient reported outcome measures. Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital. Massage for hospitalized adolescents with cancer is feasible, well received, and can potentially improve patients' sleep. A randomized multicenter efficacy study is warranted. © 2016 Wiley Periodicals, Inc.

The delusion of the Master: the last days of Henry James.

PubMed

Bartolomeo, Paolo

2013-11-01

The novelist Henry James shared with his brother William, the author of the Principles of Psychology, a deep interest in the ways in which personal identity is built through one's history and experiences. At the end of his life, Henry James suffered a vascular stroke in the right hemisphere and developed a striking identity delusion. He dictated in a perfectly clear and coherent manner two letters as if they were written by Napoleon Bonaparte. He also showed signs of reduplicative paramnesia. Negative symptoms resulting from right hemisphere damage may disrupt the feelings of "warmth and intimacy and immediacy" and the "resemblance among the parts of a continuum of feelings (especially bodily feelings)", which are the foundation of personal identity according to William James. On the other hand, a left hemisphere receiving inadequate input from the damaged right hemisphere may produce positive symptoms such as delusional, confabulatory narratives. Other fragments dictated during Henry James's final disease reveal some form of insight, if partial and disintegrated, into his condition. Thus, even when consciousness is impaired by brain damage, something of its deep nature may persist, as attested by the literary characteristics of the last fragments of the Master.

James Homer Wright: a biography of the enigmatic creator of the Wright stain on the occasion of its centennial.

PubMed

Lee, Robert E; Young, Robert H; Castleman, Benjamin

2002-01-01

James Homer Wright (1869-1928), the eldest son of a Pittsburgh glass merchant, was educated in Baltimore and practiced pathology in Boston from 1893 until his death in 1928. In 1896, when not quite 27 years old, he assumed directorship of the newly founded Pathology Laboratory at the Massachusetts General Hospital, a post he held for the next 30 years. He is remembered eponymously by the blood cell stain that bears his name and the Homer Wright pseudorosettes of neuroblastoma, but he made many additional contributions to pathology. These include the following: determination of the cellular lineage of multiple myeloma, identification of the megakaryocyte as the cell of origin of blood platelets, recognition of the cell of origin of the neuroblastoma, demonstration of spirochetes in syphilitic aneurysms of the aorta, and clarification of misconceptions about actinomycosis. Additionally, Wright coauthored, with Dr. Frank B. Mallory, the book Pathological Technique, which was a staple of laboratories for >40 years and exemplifies Wright's wide-ranging interests in, and contributions to, practical aspects of pathology including staining, culture and frozen section techniques, photography, and development of the rotary microtome. He received Honorary Doctor of Science Degrees from Harvard University, the University of Maryland (his alma mater), and the University of Missouri. He was the recipient of the Gross prize in 1905 for his publication on actinomycosis and the Boylston Medical Prize in 1908 for his discovery of the origin of platelets, and he was inducted into the American Academy of Arts and Sciences in 1915. Although shy and somewhat austere in the workplace, a different side was shown by his anonymously sending flowers to a young Norwegian opera singer whom he subsequently married. The pathology laboratories of the Massachusetts General Hospital were named the "James Homer Wright Pathology Laboratories" in 1956. Today James Homer Wright is remembered and

Geriatric Assessment of Older Adults With Cancer During Unplanned Hospitalizations: An Opportunity in Disguise.

PubMed

Mariano, Caroline; Williams, Grant; Deal, Allison; Alston, Shani; Bryant, Ashley Leak; Jolly, Trevor; Muss, Hyman B

2015-07-01

Geriatric assessment (GA) is an important tool for management of older cancer patients; however, GA research has been performed primarily in the outpatient setting. The primary objective of this study was to determine feasibility of GA during an unplanned hospital stay. Secondary objectives were to describe deficits found with GA, to assess whether clinicians recognized and addressed deficits, and to determine 30-day readmission rates. The study was designed as an extension of an existing registry, "Carolina Senior: Registry for Older Patients." Inclusion criteria were age 70 and older and biopsy-proven solid tumor, myeloma, or lymphoma. Patients had to complete the GA within 7 days of nonelective admission to University of North Carolina Hospital. A total of 142 patients were approached, and 90 (63%) consented to participation. All sections of GA had at least an 83% completion rate. Overall, 53% of patients reported problems with physical function, 63% had deficits in instrumental activities of daily living, 34% reported falls, 12% reported depression, 31% had ≥10% weight loss, and 12% had abnormalities in cognition. Physician documentation of each deficit ranged from 20% to 46%. Rates of referrals to allied health professionals were not significantly different between patients with and without deficits. The 30-day readmission rate was 29%. GA was feasible in this population. Hospitalized older cancer patients have high levels of functional and psychosocial deficits; however, clinician recognition and management of deficits were poor. The use of GA instruments to guide referrals to appropriate services is a way to potentially improve outcomes in this vulnerable population. Geriatric assessment (GA) is an important tool in the management of older cancer patients; however, its primary clinical use has been in the outpatient setting. During an unplanned hospitalization, patients are extremely frail and are most likely to benefit from GA. This study demonstrates

Two decades of external peer review of cancer care in general hospitals; the Dutch experience.

PubMed

Kilsdonk, Melvin J; Siesling, Sabine; Otter, Rene; van Harten, Wim H

2016-03-01

External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

[The impacts of the multidisciplinary team model on the length of stay and hospital expenses of patients with lung cancer].

PubMed

Zou, Jing; Xu, Xingxiang; Wang, Daxin; Xu, Jin; Gu, Wenju

2015-05-01

To explore the impacts of the multidisciplinary team model on the average length of stay and hospital expenses of patients with lung cancer. After the multidisciplinary team discussion, 97 patients with lung cancer were selected as the lung cancer group according to the enrollment and elimination criteria the control group was 97 patients with lung cancer managed without team discussion during the same period. All the patients were firstly diagnosed to have lung cancer from December 2011 to December 2013 in Subei People's Hospital. The length of stay, hospital expenses, stages of tumor, types of tumor, Zubrod-ECOG-WHO score, the form of payment, smoking history, sex and age of all the patients were collected. The difference in the average length of stay and hospital expenses between the 2 groups and the associated factors were analyzed by using χ² test, t test and multi-factor stepwise regression analysis. There were 68 males and 29 females with a mean age of (61 ± 9) years in the lung cancer group, while there were 73 males and 24 females with a mean age of (63 ± 10) years in the control group. There were no differences between the 2 groups in tumor staging, tumor types, Zubrod-ECOG-WHO score, the form of payment, smoking history, sex and age (χ² = 4.854, P = 0.563, χ² = 4.248, P = 0.097; χ² = 0.395, P = 0.821; χ² = 1.191, P = 0.554; χ² = 0.108, P = 0.977; χ² = 1.011, P = 0.389; χ² = 0.649, P = 0.519; P = 0.474, P = 0.845, respectively). The average hospital expenses (13 303 vs 16 553, Yuan) were lower and the length of stay (10.33 vs 12.49, days) was shorter in the lung cancer group as compared to the control group (t = 2.616, P = 0.010; t = 2.730, P = 0.007), especially so for the first clinical hospitalization (15 953 vs 19 485 yuan, t = 2.315, P = 0.022; 12.71 vs 14.75 days, t = 1.979, P = 0.049). The average length of stay and the tumor stages were the main factors associated with the average hospital expenses. Except for patients with the

Healthy cooking classes at a children's cancer hospital and patient/survivor summer camps: initial reactions and feasibility.

PubMed

Raber, Margaret; Crawford, Karla; Chandra, Joya

2017-06-01

Childhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour. A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. One paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes. One hundred and eighty-nine CCS of varying ages and thirteen parents of CCS. Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.

[Frequency of cancer in a specialty hospital in Mexico City. Implications for the development of early detection methods].

PubMed

Herrera-Torre, Analy; García-Rodríguez, Francisco Mario; García, Rebeca Gil; Jiménez-Villanueva, Xicoténcatl; Hernández-Rubio, Angela; Aboharp-Hasan, Ziad

2014-01-01

Cancer is the second cause of death in Mexico. The Juarez Hospital of Mexico is a highly specialized general hospital in which the frequency of cancer treated at the Oncology Unit is a representative sample of the frequency of cancer in the country. To learn about the frequency of presentation of tumors diagnosed in a third level hospital. We reviewed all the biopsies and surgical specimens diagnosed as cancer or malignant tumors registered in the pathology unit during the years 2006 to 2010. We grouped the cases by age, sex, and anatomic site. We identified the 10 most common cancers for both sexes, age groups and sex affected, raising the chances of early detection campaigns reinforce for the most common cancers and try to increase control and cure rates and improve coverage of the economically weak, for their integration into health systems. Information obtained reflects the reality of the country to the general population without entitlements. That in our country women suffer more than men of cancer that breast neoplasms and genital tract are the most frequent, and timely detection systems exist and should be strengthened to achieve greater eligible for early identification of cases in our population.

Breast cancer in a multi-ethnic Asian setting: results from the Singapore-Malaysia hospital-based breast cancer registry.

PubMed

Pathy, Nirmala Bhoo; Yip, Cheng Har; Taib, Nur Aishah; Hartman, Mikael; Saxena, Nakul; Iau, Philip; Bulgiba, Awang M; Lee, Soo Chin; Lim, Siew Eng; Wong, John E L; Verkooijen, Helena M

2011-04-01

Two hospital-based breast cancer databases (University Malaya Medical Center, Malaysia [n = 1513] and National University Hospital, Singapore [n = 2545]) were merged into a regional registry of breast cancer patients diagnosed between 1990 and 2007. A review of the data found 51% of patients diagnosed before the age of 50 years. and 72% percent of the women were Chinese followed by Malays (16%), Indians (8%), and other races (4%). Median tumor size at presentation was 26 mm and about 25% of patients presented with TNM stage III or IV disease. Most tumors were of ductal histology (87%). Fifty-seven percent of tumors were estrogen receptor positive and 40% were poorly differentiated. Of those patients who had surgery, 70% had mastectomy while 30% had breast conserving surgery. Overall, chemotherapy was administered to 56% of patients and hormonal treatment to 60%. Five-year overall survival was 82.5% in patients with TNM stage 0 to stage II cancer, and 30.2% in those with later stages. Copyright © 2011 Elsevier Ltd. All rights reserved.

Oral Health Related Quality of Life in Patients of Head and Neck Cancer Attending Cancer Hospital of Bhopal City, India.

PubMed

Shavi, Girish R; Thakur, Bhanupriya; Bhambal, Ajay; Jain, Swapnil; Singh, Vani; Shukla, Ankita

2015-08-01

To assess the oral health related quality of life (OHRQoL) of head and neck cancer patients and to find association between QoL, demographic and disease variables. This cross-sectional study was conducted on 153 patients diagnosed and being treated for head and neck cancer in Jawaharlal Nehru Cancer Hospital, India. Data collected from the survey included demographic details and OHRQoL, which was measured by European Organization of Research for Treatment of Cancer QoL questionnaire head & neck-35. Cancer measurements (location of tumor, stages of cancer, treatment type) were collected from the patient's hospital records. The majority of the population 84 (54.9%) belonged to 41-60 years age group and most of them were male (78.4%). The most frequent site of the primary tumor was the oral cavity (71.3%) and the majority of patients had Stage II and III cancer. Main factors affecting QoL were loss of weight, use of painkillers, sticky saliva, reduced mouth opening and problems in social eating. Significant association found between pain (P = 0.044), swallowing (P = 0.018), sense (P = 0.001), Social eating (P = 0.003), social contact (P = 0.008), reduced mouth opening (P = 0.008) with respect to type of treatment. We conclude that there was a significant reduction in the QoL in cancer patients resulting from myriad forms of cancers. An assessment of the QoL and symptoms can help the dentist to direct attention to most important symptoms and provide counseling for appropriate interventions towards improving QoL outcomes and the response to the treatment.

Inpatient cancer treatment: an analysis of financial and nonfinancial performance measures by hospital-ownership type.

PubMed

Newton, Ashley N; Ewer, Sid R

2010-01-01

This study uses longitudinal data of inpatient treatment from the Agency for Healthcare Research and Quality's (AHRQ's) Healthcare Cost and Utilization Project (HCUP) to examine the differences in historical trends and build future projections of charges, costs, and lengths of stay (LOS) for inpatient treatment of four of the most prevalent cancer types: breast, colon, lung, and prostate. We stratify our data by hospital ownership type and for the aforementioned four major cancer types. We use the Kruskal Wallis (nonparametric ANOVA) Test and time series models to analyze variance and build projections, respectively, for mean charges per discharge, mean costs per discharge, mean LOS per discharge, mean charges per day, and mean costs per day. We find that significant differences exist in both the mean charges per discharge and mean charges per day for breast, colon, lung, and prostate cancers and in the mean LOS per discharge for breast cancer. Additionally, we find that both mean charges and mean costs are forecast to continue increasing while mean LOS are forecast to continue decreasing over the forecast period 2008 to 2012. The methodologies we employ may be used by individual hospital systems, and by health care policy-makers, for various financial planning purposes. Future studies could examine additional financial and nonfinancial variables for these and other cancer types, test for geographic disparities, or focus on procedural-level hospital measures.

James Madison and the Constitutional Convention.

ERIC Educational Resources Information Center

Scanlon, Thomas M.

1987-01-01

Part 1 of this three-part article traces James Madison's life and focuses primarily on those events that prepared him for leadership in the U.S. Constitutional Convention of 1787. It describes his early love of learning, education, and public service efforts. Part 2 chronicles Madison's devotion to study and preparation prior to the Constitutional…

Landscapes of Removal and Resistance: Edwin James's Nineteenth-Century Cross-Cultural Collaborations

ERIC Educational Resources Information Center

Lyndgaard, Kyhl

2010-01-01

The life of Edwin James (1797-1861) is bookended by the Lewis and Clark expedition (1803-6) and the Civil War (1861-65). James's work engaged key national concerns of western exploration, natural history, Native American relocation, and slavery. His principled stands for preservation of lands and animals in the Trans-Mississippi West and his…

Efficacy Beliefs and the Learning Experiences of Children with Cancer in the Hospital Setting.

ERIC Educational Resources Information Center

Crossland, Andrea

2002-01-01

A study examined how self-efficacy beliefs influenced motivation, affect, and adjustment in five students aged 9-13 with cancer, receiving educational services in a hospital setting. Education was an effective vehicle through which children with cancer could experience control and autonomy and also achieve many necessary developmental outcomes for…

The Case of James Leininger: An American Case of the Reincarnation Type.

PubMed

Tucker, Jim B

2016-01-01

Numerous cases of young children who report memories of previous lives have been studied over the last 50 years. Though such cases are more easily found in cultures that have a general belief in reincarnation, they occur in the West as well. This article describes the case of James Leininger, an American child who at age two began having intense nightmares of a plane crash. He then described being an American pilot who was killed when his plane was shot down by the Japanese. He gave details that included the name of an American aircraft carrier, the first and last name of a friend who was on the ship with him, and a location and other specifics about the fatal crash. His parents eventually discovered a close correspondence between James׳s statements and the death of a World War II pilot named James Huston. Documentation of James׳s statements that was made before Huston was identified includes a television interview with his parents that never aired but which the author has been able to review. Copyright © 2016 Elsevier Inc. All rights reserved.

Physiology as the antechamber to metaphysics: the young William James's hope for a philosophical psychology.

PubMed

Croce, P J

1999-11-01

In the 5 years before 1878, when his career in psychology was becoming established, William James wrote a series of notes and reviews assessing the work of many of the pioneers in the new field. Adopting a public and confident voice, even while he was privately still uncertain and searching, James criticized the dogmatism of positivist and idealist claims to the study of the human brain and mind. In his short writings of 1873-1877, James started to formulate his own middle path. His first steps on that path show that he did not reject either scientific or philosophic inquiry; instead, he viewed scientific knowledge as a way to understand philosophical questions more deeply. Saving his sharpest critiques for positivism, James endorsed scientific investigation without materialist assmptions. While his career in psychology was still only a hope, James treated science as a means toward humanist insight.

From Father to Son: Generative Care and Gradual Conversion in William James's Writing of "The Varieties"

ERIC Educational Resources Information Center

Bridgers, Lynn; Snarey, John R.

2003-01-01

Using a historical and biographical, then developmental, approach, this article examines William James's spiritual family history by reviewing key events in the life of his father, Henry James, Sr. It pays particular attention to Henry Sr's tumultuous relationship with his own father, William James of Albany, and Henry Sr's subsequent conversion…

Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.

PubMed

Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

2017-06-01

To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Variation in Neoadjuvant Chemotherapy Utilization for Epithelial Ovarian Cancer at High Volume Hospitals in the United States and Associated Survival

PubMed Central

Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

2017-01-01

Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006–2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/yr) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95%CI 0.83–0.97 and HR 0.85 95%CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. PMID:28366545

Utility of two cancer organization websites for a multiethnic, public hospital oncology population: comparative cross-sectional survey.

PubMed

Nguyen, Katherine D; Hara, Belinda; Chlebowski, Rowan T

2005-07-01

While information websites have been developed by major cancer organizations, their appropriateness for patients in multiethnic, multilingual public hospital settings has received limited attention. The objective of the study was to determine the utility of cancer information websites for a public hospital patient population. A 70-item questionnaire was developed to evaluate cancer information seeking behavior, Internet access and use, and content appropriateness of two cancer information websites: People Living with Cancer from the American Society of Clinical Oncology (ASCO) and Breast Cancer Info from the Susan Komen Breast Cancer Foundation (SKF). Interviews were conducted with consecutive consenting oncology patients seen in a public hospital oncology clinic. Fifty-nine persons participated in the survey. The response rate was 80%. Participants were Caucasian (25%), African American (19%), Hispanic (42%), and Asian/Pacific Islander (11%). English was the primary language in 53% of participants, 56% had a high school education or less, and 74% had an annual income less than US 35000 dollars. With respect to computer and Internet use, 71% had computer access, and 44% searched for cancer information online, with more being interested in obtaining online information in the future (63%). Participants who had computer access were likely to be English speaking (P = .04). Those less likely to have previously used a computer tended to have a lower annual income (P = .02) or to be males aged 55 years or older (P < .05). When shown sample content from the two websites, almost all participants stated that it was "easy to understand" (ASCO 96%, SKF 96%) and had "easy to understand terms" (ASCO 94%, SKF 92%). Somewhat fewer respondents agreed that the websites provided "information they could use" (ASCO 88%, SKF 80%) or that they would return to these websites (ASCO 73%, SKF 68%). The majority planned to "discuss website information with their oncologists" (ASCO 82%, SKF 70

Breast Cancer Training Program

DTIC Science & Technology

2005-08-01

trainee support in year 05 Dr. Matulka studies the biology and stem cell features of parity- induced mammary epithelial cells (PI- MECs). In particular...cancer- from discovery to application February 10, 2005 Dr. James Trosko Michigan State University Role of Human Adult Stem Cells and Cell - Cell ...cancer epidemiology September 6, 2001 Dr. Gilbert Smith NCI Mammary stem cells May 24, 2001 Dr. V. Craig Jordan Northwestern University School Henry

James John Harpell: An Adult Education Pioneer.

ERIC Educational Resources Information Center

Quarter, Jack

2000-01-01

In early 20th-century Canada, James John Harpell began correspondence courses and study clubs and was instrumental in the cooperatives movement. He used small businesses to promote social and educational innovations and was an advocate for self-study and lifelong learning. (SK)

Using the numerical method in 1836, James Jackson bridged French therapeutic epistemology and American medical pragmatism.

PubMed

Kahn, Linda G; Morabia, Alfredo

2015-04-01

To review James Jackson's analysis of bloodletting among pneumonitis patients at the newly founded Massachusetts General Hospital, in which he implemented the numerical method advocated by Pierre-Charles-Alexandre Louis. The study sample included 34 cases of clinically diagnosed pneumonitis admitted to Massachusetts General Hospital between April 19, 1825, and May 10, 1835, and discharged alive. Patient data were extracted from meticulously kept case books. Jackson calculated mean number of venesections, ounces of blood taken, and days of convalescence within groups stratified by day of the disease when first bloodletting occurred. He also calculated average convalescence within groups stratified by age, sex, prior health, vesication, and day of the disease when the patients were admitted to the hospital. To Jackson's surprise, it "seemed to be of less importance, whether our patients were bled or not, than whether they entered the hospital early or late" after the onset of the pneumonitis. Bloodletting was ineffective. Our multivariate reanalysis of his data confirms his conclusion. Outstandingly for his time, Jackson ruled out unwarranted effects of covariates by tabulating their numerical relations to the duration of pneumonia. Using novel gathering of patient clinical data from hospital records and quantitative analytical methods, Jackson contributed results that challenged conventional wisdom and bridged French therapeutic epistemology and American medical pragmatism. Copyright © 2015 Elsevier Inc. All rights reserved.

The life and work of the Dumfries surgeon James Hill (1703-1776): his contributions to the management of cancer and of head injury.

PubMed

Macintyre, Iain

2016-11-01

James Hill was apprenticed to the formidable Edinburgh surgeon, physician and philosopher George Young from whom he learned the value of careful observation and scepticism in medicine. As a surgeon in Dumfries he was able to take advantage of newly established medical journals to publish case reports. His book Cases in Surgery summarised three aspects of his life's work as a surgeon. In it he provides a classical description of the features and transmission of sibbens (endemic syphilis) and suggests from careful clinical observation that sibbens and venereal syphilis were the same disease. His success with treatment of cancer led him to advocate curative rather than palliative excision, a view that ran counter to accepted contemporary practice. Hill's ability to diagnose cerebral compression caused by bleeding following head injury enabled him to treat this successfully by directed trephine and drainage. His results on the treatment of head injury were the best to be published in their day and an important addition to the increasing understanding of the basis of the management of head injury. © The Author(s) 2014.

Hospital of Diagnosis Influences the Probability of Receiving Curative Treatment for Esophageal Cancer.

PubMed

van Putten, Margreet; Koëter, Marijn; van Laarhoven, Hanneke W M; Lemmens, Valery E P P; Siersema, Peter D; Hulshof, Maarten C C M; Verhoeven, Rob H A; Nieuwenhuijzen, Grard A P

2018-02-01

The aim of this article was to study the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among patients with esophageal cancer (EC). Although EC surgery is centralized in the Netherlands, the disease is often diagnosed in hospitals that do not perform this procedure. Patients with potentially curable esophageal or gastroesophageal junction tumors diagnosed between 2005 and 2013 who were potentially curable (cT1-3,X, any N, M0,X) were selected from the Netherlands Cancer Registry. Multilevel logistic regression was performed to examine the probability to undergo curative treatment (resection with or without neoadjuvant treatment, definitive chemoradiotherapy, or local tumor excision) according to hospital of diagnosis. Effects of variation in probability of undergoing curative treatment among these hospitals on survival were investigated by Cox regression. All 13,017 patients with potentially curable EC, diagnosed in 91 hospitals, were included. The proportion of patients receiving curative treatment ranged from 37% to 83% and from 45% to 86% in the periods 2005-2009 and 2010-2013, respectively, depending on hospital of diagnosis. After adjustment for patient- and hospital-related characteristics these proportions ranged from 41% to 77% and from 50% to 82%, respectively (both P < 0.001). Multivariable survival analyses showed that patients diagnosed in hospitals with a low probability of undergoing curative treatment had a worse overall survival (hazard ratio = 1.13, 95% confidence interval 1.06-1.20; hazard ratio = 1.15, 95% confidence interval 1.07-1.24). The variation in probability of undergoing potentially curative treatment for EC between hospitals of diagnosis and its impact on survival indicates that treatment decision making in EC may be improved.

[Anxiety and depression of cancer patients hospitalized and at home].

PubMed

Vellone, Ercole; Sinapi, Nadia; Piria, Paola; Bernardi, Francesca M; Dario, Lucia; Brunetti, Annarita

2004-01-01

The aim of this study was to investigate the anxiety and depression of cancer patients hospitalized and at home. Using a descriptive, correlational and comparative design and the Roy Adaptation Model, a sample of 80 oncologic patients was studied. Several instruments were used to measure anxiety and depression (HADS), quality of life and symptoms (RSCL), sociodemographic factors, variables connected to the hospitalization, quality of the relationship with health practitioners, family members and friends and the degree of satisfaction for the received information and support. The examined variables were measured on the same patients at hospital and at home. About the 30% of the patients were anxious and depressed. Statistical analysis showed that while anxiety did not change from the hospital to home, depression increased soon after the discharge and decreased over time and after the increasing of the number of hospital access. Anxiety and depression were positively correlated to boredom during the hospitalization, physical symptoms, number of the patients children, and previous anxious and depressive problems. Anxiety and depression were negatively correlated to the ward comfort, the support of health practitioners, family members and friends and the satisfaction for the received information. Differences between this study and the international literature are discussed. Recommendations for the future research and nursing practice are given.

James Wardrop and equine recurrent uveitis.

PubMed

Paglia, Danielle T; Miller, Paul E; Dubielzig, Richard R

2004-08-01

James Wardrop should be remembered not only as one of the founders of ocular pathology but also for his contributions to the field of comparative ophthalmology. He described a "specific inflammation" that veterinarians today know as equine recurrent uveitis. As described by Wardrop in the 19th century, this condition is known today to eventually lead to blindness.

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

PubMed Central

Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

Objective In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Design Data for patients diagnosed with CRC in England in 2001–2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Results Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer ‘centres of excellence’, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%–5%, p<2.2×10−6) and an improvement in survival (p<10−19; 5-year difference: 3.8% (41.0%–44.8%)) comparing high participation for ≥4 years with 0 years. Conclusions There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. PMID:27797935

Determinants of hospital death in haematological cancers: findings from a qualitative study.

PubMed

McCaughan, Dorothy; Roman, Eve; Smith, Alexandra G; Garry, Anne; Johnson, Miriam; Patmore, Russell; Howard, Martin; Howell, Debra A

2018-03-01

Current UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases. The study was set within the Haematological Malignancy Research Network (HMRN-www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data. Five themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred. Hospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

James Dunlop's historical catalogue of southern nebulae and clusters

NASA Astrophysics Data System (ADS)

Cozens, Glen; Walsh, Andrew; Orchiston, Wayne

2010-03-01

In 1826 James Dunlop compiled the second ever catalogue of southern star clusters, nebulae and galaxies from Parramatta (NSW, Australia) using a 23-cm reflecting telescope. Initially acclaimed, the catalogue and author were later criticised and condemned by others - including Sir John Herschel and both the catalogue and author are now largely unknown. The criticism of the catalogue centred on the large number of fictitious or ‘missing’ objects, yet detailed analysis reveals the remarkable completeness of the catalogue, despite its inherent errors. We believe that James Dunlop was an important early Australian astronomer, and his catalogue should be esteemed as the southern equivalent of Messier's famous northern catalogue.

[An Analysis of Perforated Gastric Cancer with Acute Peritonitis in Our Hospital].

PubMed

Adachi, Shinichi; Endo, Shunji; Chinen, Yoshinao; Itakura, Hiroaki; Takayama, Hirotoshi; Tsuda, Yujiro; Ueda, Masami; Nakashima, Shinsuke; Ohta, Katsuya; Ikenaga, Masakazu; Yamada, Terumasa

2018-01-01

Perforated gastric cancer is relatively rare and the incidence is reported about 1% of all the cases of gastric cancer. We retrospectively analyzed the clinical data of the consecutive 12 patients with perforated gastric cancer who underwent operation in our hospital between January 2005 and December 2016. There were 5 men and 7 women, with an average age of 65.8 years old(34-87). Perforated gastric cancer occurred in the region U(1 cases), M(6 cases), L(5 cases). There were 11 cases with distant metastasis. We could successfully diagnosed as perforated gastric cancer in 8 cases before emergency operation. Gastrectomy was performed in 5 cases. However, the curative resection was performed only 1 case. Prognosis of perforated gastric cancer is poor. We considered as an appropriate two-step surgical strategy that the first step of surgery is an acute peritonitis treatment followed by radical gastrectomy with lymphadenectomy.

Astronaut James Buchli wearing extravehicular mobility unit

NASA Technical Reports Server (NTRS)

1985-01-01

Astronaut James F. Buchli, wearing an extravehicular mobility unit (EMU), is about to be submerged in the weightless environment training facility (WETF) to simulate a contingency extravehicular activity (EVA) for STS 61-A. In this portrait view, Buchli is wearing a communications carrier assembly (CCA).

Biological Basis for Chemoprevention of Ovarian Cancer

DTIC Science & Technology

2006-10-01

2005;16:955-63. 11) Kelemen L, James M, Spurdle A, Campbell I, Chang-Claude J, Peel D, Anton-Culver H, Berchuck A, Schildkraut J, Whittemore A...X., Abbazadegan, M., et al. CYP17 promotor polymorphism and ovarian cancer risk. Intl J Cancer. 2000; 86: 436-9. 23.Menin, C., Banna , G. L., De

Awareness of Breast Cancer among Female Care Givers in Tertiary Cancer Hospital, China

PubMed Central

Dinegde, Negalign Getahun; Xuying, Li

2017-01-01

Objective: Breast cancer is a worldwide public health issue and most common cancer diagnosed among women including China, where advanced stages at diagnosis appears to be increasing and an ever-rising incidence twice as fast as global rates. The study was conducted to describe the awareness of breast cancer and associated factors among care giver women in tertiary Cancer Hospital, China. Methods: Institutional based cross-sectional study was conducted among 261 women selected by systematic random sampling. Information provided by the participants was converted into awareness scores for analysis using SPSS version 23. Awareness scores were dichotomized in to ‘good awareness and ‘poor awareness’ taking median score=11 as the cut-off point. Data analysis was performed using the binary logistic regression. A p-value of <0.05 was considered statistically significant. Result: The study showed that 46.7% of the respondents had good awareness. Breast lump was the most commonly known symptom of cancer by 61.7% of the respondents. Slightly more than half of the study participants acknowledged having a past history of breast cancer, drinking alcohol and having close relative with breast cancer as potential risk factors for breast cancer (63.6%, 58.6%, and 55.6% respectively). Nevertheless, a vast majority of the study participants were unable to appreciate modifiable risk factors of the disease. More than half of the participants had never/rarely checked their breasts and all of the participants wrongly answered breast cancer knowledge age related risk. Awareness level was significantly associated with entertainment preference (OR=3.57; 95%CI=1.71, 7.44) and residence setting areas (OR=2.4; 95%CI=1.04, 5.69). Conclusion: The study indicated suboptimal awareness while entertainment preference and residence setting were significantly associated with awareness level. Public awareness campaigns should be made by dissemination of information about breast cancer through

The James Bay Project: Reaction or Action?

ERIC Educational Resources Information Center

Mackwood, Gae

1991-01-01

Discusses the plan to restructure northern Quebec's landscape through the James Bay hydroelectric project. Suggests that the project offers opportunities to study development versus preservation, federal versus provincial powers, and the conflict between business and Native communities. Explores the need to teach students to care about social…

Exploring William James's Radical Empiricism and Relational Ontologies for Alternative Possibilities in Education

ERIC Educational Resources Information Center

Thayer-Bacon, Barbara J.

2017-01-01

In "A Pluralistic Universe," James argues that the world we experience is more than we can describe. Our theories are incomplete, open, and imperfect. Concepts function to try to shape, organize, and describe this open, flowing universe, while the universe continually escapes beyond our artificial boundaries. For James and myself, the…

James Ferguson: A Commemoration

NASA Astrophysics Data System (ADS)

Davenhall, Clive

2010-11-01

James Ferguson (1710-1776) was a renowned author and lecturer on scientific subjects and maker of scientific instruments. His Astronomy Explained upon Sir Isaac Newton's Principles of 1756 was an extremely popular non-mathematical exposition of Newton's ideas in English. He wrote numerous other books, some of which remained in print until the mid-nineteenth century. Ferguson rose from humble beginnings as a shepherd in northeast Scotland to become a wealthy lecturer, author and Fellow of the Royal Society, enjoying an international reputation. April 2010 marked the three hundredth anniversary of Ferguson's birth, and the present short communication briefly commemorates this event.

Young James Madison: His Character and Civic Values.

ERIC Educational Resources Information Center

Bennett, William J.

1987-01-01

Examines the life of James Madison, Founding Father and "theoretic statesman." Focuses specifically on Madison's education and character, his friendship with Thomas Jefferson, and his civic legacy: a selfless devotion to republican government and union. (JDH)

Aerial photographic water color variations from the James River

NASA Technical Reports Server (NTRS)

Bressette, W. E.

1979-01-01

Photographic flights from 305 meters altitude were made throughout the day of May 17, 1977, over seven water data stations in the James River. The flights resulted in wide-angle, broadband, spectral radiance film exposure data between the wavelengths of 500 to 900 nanometers for sun elevation angles ranging from 37 to 64 deg and variable atmospheric haze conditions. It is shown from densitometer data that: (1) the dominant observed color from James River waters is determined by the optical properties of the total suspended solid load, (2) variability in observed color is produced by a changing solar elevation angle; and (3) the rate at which observed color changes is influenced by both solar elevation angle and atmospheric conditions.

Attitudes towards pain management in hospitalized cancer patients and their influencing factors

PubMed Central

Lou, Fangli; Shang, Shaomei

2017-01-01

Objective To investigate patients’ attitudes towards cancer pain management and analyze the factors influencing these attitudes. Methods The self-developed Demographic and Disease-Related Information Questionnaires, Pain Management Barriers Questionnaire-Taiwan form (BQT), and Pain Knowledge Questionnaire were administered to 363 pairs of hospitalized cancer patients and their caregivers from the oncology departments of 7 hospitals in Beijing, China. Results The average patient score for attitudes towards pain management was 2.96±0.49. The dimension scores indicated good attitudes in three areas (scores <2.5), “Desire to be good” (2.22±1.04), “Fatalism” (2.08±0.81) and “Religious fatalism” (1.86±1.00), and poor attitudes in six areas (scores ≥2.5), “Tolerance” (3.83±0.96), “Use of analgesics as needed (p.r.n.)” (3.73±1.01), “Addiction” (3.44±1.05), “Disease progression” (3.28±1.26), “Distraction of physicians” (3.16±1.07) and “Side effects” (2.99±0.68). Two factors were entered into the regression equation: the caregivers’ attitudes towards cancer pain management and the patients’ pain knowledge. These two factors explained 23.2% of the total variance in the patients’ average scores for their attitudes towards cancer pain management. Conclusions The patients’ attitudes towards cancer pain management were poor and could be influenced by the caregivers’ attitudes and the patients’ pain knowledge, and thus need to be improved. PMID:28373756

Building Data-Driven Pathways From Routinely Collected Hospital Data: A Case Study on Prostate Cancer

PubMed Central

Clark, Jeremy; Cooper, Colin S; Mills, Robert; Rayward-Smith, Victor J; de la Iglesia, Beatriz

2015-01-01

Background Routinely collected data in hospitals is complex, typically heterogeneous, and scattered across multiple Hospital Information Systems (HIS). This big data, created as a byproduct of health care activities, has the potential to provide a better understanding of diseases, unearth hidden patterns, and improve services and cost. The extent and uses of such data rely on its quality, which is not consistently checked, nor fully understood. Nevertheless, using routine data for the construction of data-driven clinical pathways, describing processes and trends, is a key topic receiving increasing attention in the literature. Traditional algorithms do not cope well with unstructured processes or data, and do not produce clinically meaningful visualizations. Supporting systems that provide additional information, context, and quality assurance inspection are needed. Objective The objective of the study is to explore how routine hospital data can be used to develop data-driven pathways that describe the journeys that patients take through care, and their potential uses in biomedical research; it proposes a framework for the construction, quality assessment, and visualization of patient pathways for clinical studies and decision support using a case study on prostate cancer. Methods Data pertaining to prostate cancer patients were extracted from a large UK hospital from eight different HIS, validated, and complemented with information from the local cancer registry. Data-driven pathways were built for each of the 1904 patients and an expert knowledge base, containing rules on the prostate cancer biomarker, was used to assess the completeness and utility of the pathways for a specific clinical study. Software components were built to provide meaningful visualizations for the constructed pathways. Results The proposed framework and pathway formalism enable the summarization, visualization, and querying of complex patient-centric clinical information, as well as the

Dealing with symptoms and issues of hospitalized patients with cancer in indonesia: the role of families, nurses, and physicians.

PubMed

Effendy, Christantie; Vissers, Kris; Tejawinata, Sunaryadi; Vernooij-Dassen, Myrra; Engels, Yvonne

2015-06-01

Patients with cancer often face physical, psychological, social, spiritual, and emotional symptoms. Our aim was to study symptoms and issues of hospitalized patients with cancer in Indonesia, a country with strong family ties, and how family members, nurses, and physicians deal with them. In 2011, 150 hospitalized cancer patients in 3 general hospitals in Indonesia were invited to fill in a questionnaire, which was based on the validated Problems and Needs of Palliative Care (short version) questionnaire. Descriptive statistics were performed. Of 119 patients (79%) who completed the questionnaire, 85% stated that their symptoms and issues were addressed. According to these patients, financial (56%), autonomy (36%), and psychosocial (34%) issues were most often addressed by the family alone. Physical symptoms (52%) and spiritual issues (33%) were addressed mainly by a combination of family, nurses, and physicians. Hospitalized patients with cancer in Indonesia felt that most of their symptoms and issues had been addressed, and the family was highly involved. The strong family ties in Indonesian culture may have contributed to this family role. More research is needed to clarify how this influences patient outcome, quality of care, and quality of life of both the patients and their families, along with the degree of partnership between families and professionals. This information might help answer the question what advantages and disadvantages the family role in caring for a hospitalized patient with cancer generates for the patient, the family, and professional caregivers. © 2014 World Institute of Pain.

Obscurity and Gender Resistance in Patricia Duncker's James Miranda Barry

PubMed Central

Funke, Jana

2012-01-01

Since his death in 1865, military surgeon James Barry has alternately been classified as a cross-dressing woman or as an intersexed individual. Patricia Duncker's novel James Miranda Barry (1999) poses an important challenge to such readings, as it does not reveal any foundational truth about Barry's sex. Resting on obscurity rather than revelation, the text frustrates the desire to know the past in terms of gender binaries and stable sexual identity categories. Drawing on feminist and queer theorisations of the relation between gender and time, this essay demonstrates that Duncker's use of obscurity opens up alternative strategies of gender resistance. PMID:25400502

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals.

PubMed

Govaert, J A; Fiocco, M; van Dijk, W A; Scheffer, A C; de Graaf, E J R; Tollenaar, R A E M; Wouters, M W J M

2015-08-01

Healthcare providers worldwide are struggling with rising costs while hospitals budgets are under stress. Colorectal cancer surgery is commonly performed, however it is associated with a disproportionate share of adverse events in general surgery. Since adverse events are associated with extra hospital costs it seems important to explicitly discuss the costs of complications and the risk factors for high-costs after colorectal surgery. Retrospective analysis of clinical and financial outcomes after colorectal cancer surgery in 29 Dutch hospitals (6768 patients). Detailed clinical data was derived from the 2011-2012 population-based Dutch Surgical Colorectal Audit database. Costs were measured uniform in all participating hospitals and based on Time-Driven Activity-Based Costing. Of total hospital costs in this study, 31% was spent on complications and the top 5% most expensive patients were accountable for 23% of hospitals budgets. Minor and severe complications were respectively associated with a 26% and 196% increase in costs as compared to patients without complications. Independent from other risk factors, ASA IV, double tumor, ASA III, short course preoperative radiotherapy and TNM-4 stadium disease were the top-5 attributors to high costs. This article shows that complications after colorectal cancer surgery are associated with a substantial increase in costs. Although not all surgical complications can be prevented, reducing complications will result in considerable cost savings. By providing a business case we show that investments made to develop targeted quality improvement programs will pay off eventually. Results based on this study should encourage healthcare providers to endorse quality improvement efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

James Madison University Survey of Faculty Activities.

ERIC Educational Resources Information Center

James Madison Univ., Harrisonburg, VA.

The activities of the faculty at James Madison University during the fall term of the academic year 1978-79 are described. Full-time instructional faculty, part-time faculty involved in resident instruction, administrators and classified employees who taught at least one course, and graduate teaching assistants were surveyed. Information was…

Patient navigation for breast and colorectal cancer in 3 community hospital settings: an economic evaluation.

PubMed

Donaldson, Elisabeth A; Holtgrave, David R; Duffin, Renea A; Feltner, Frances; Funderburk, William; Freeman, Harold P

2012-10-01

The Ralph Lauren Cancer Center implemented patient navigation programs in sites across the United States building on the model pioneered by Harold P. Freeman, MD. Patient navigation targets medically underserved with the objective of reducing the time interval between an abnormal cancer finding, diagnostic resolution, and treatment initiation. In this study, the authors assessed the incremental cost effectiveness of adding patient navigation to standard cancer care in 3 community hospitals in the United States. A decision-analytic model was used to assess the cost effectiveness of a colorectal and breast cancer patient navigation program over the period of 1 year compared with standard care. Data sources included published estimates in the literature and primary costs, aggregate patient demographics, and outcome data from 3 patient navigation programs. After 1 year, compared with standard care alone, it was estimated that offering patient navigation with standard care would allow an additional 78 of 959 individuals with an abnormal breast cancer screening and an additional 21 of 411 individuals with abnormal colonoscopies to reach timely diagnostic resolution. Without including medical treatment costs saved, the cost-effectiveness ratio ranged from $511 to $2080 per breast cancer diagnostic resolution achieved and from $1192 to $9708 per colorectal cancer diagnostic resolution achieved. The current results indicated that implementing breast or colorectal cancer patient navigation in community hospital settings in which low-income populations are served may be a cost-effective addition to standard cancer care in the United States. Copyright © 2012 American Cancer Society.

Grandparents of children with cancer: Quality of life, medication and hospitalizations.

PubMed

Wakefield, C E; Fardell, J E; Doolan, E L; Drew, D; De Abreu Lourenco, R; Young, A L; Cohn, R J

2017-01-01

Grandparents can play a crucial role of providing emotional and practical support for families facing childhood cancer. Yet, many have their own healthcare needs. This controlled study systematically assesses the impact of childhood cancer on grandparents' quality of life (QOL). Our objective was to compare QOL in grandparents of children with and without cancer and to identify factors associated with grandparents' QOL. Grandparents (N = 222) completed two patient-reported outcome (PRO) measures assessing QOL: EQ-5D-5L and WHOQOL-BREF. Secondary endpoints included sleep, medications and hospitalizations. We used independent samples t-tests and multivariate linear regression to assess between-group differences and identify predictors. Grandparents of children with cancer (n = 89) reported significantly worse QOL than controls (n = 133) [mean WHOQOL-BREF score: 75.6 (SD = 17.6) vs. 81.5 (15.6), P = 0.007; mean EQ-5D-5L index value: 0.777 (0.20) vs. 0.874 (0.14), P < 0.001)]. They also reported more problems with anxiety and depression (47.2 vs. 21.8%, P < 0.001) and pain (64.8 vs. 49.6%, P = 0.031). Grandparents of children with cancer reported taking longer to fall asleep [mean: 30.4 min (55.6) vs. 18.2 (20.2), P = 0.011] and taking more medications in the last 4 weeks [mean: 2.9 (SD = 3.8) vs. 1.8 (SD = 2.3), P = 0.012]. Hospitalizations were comparable across groups. Grandmothers, those living in urban locations, and retired/unemployed grandparents experienced reduced QOL. Grandparents are significantly affected by childhood cancer. The impact appears across many domains of life and results in meaningful QOL differences. Given that four or more individuals may be affected per child, and that grandparent well-being can influence the whole family, interventions targeting at-risk grandparents are needed. © 2016 Wiley Periodicals, Inc.

Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

PubMed

Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

2016-10-01

The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods. Copyright © 2016 Elsevier Inc. All rights reserved.

James Galway: Music as a Way of Life.

ERIC Educational Resources Information Center

Spaeth, Jeanne

1999-01-01

Presents an interview with the flutist, James Galway, in which he discusses issues such as the musical culture of Ireland, his technical mastery as a musician, and the importance of music education in the lives of young people. (CMK)

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

PubMed Central

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Diabetes Management and Self-Care Education for Hospitalized Patients With Cancer

PubMed Central

Leak, Ashley; Davis, Ellen D.; Houchin, Laura B.; Mabrey, Melanie

2009-01-01

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

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres.

PubMed

van Lent, Wineke A M; de Beer, Relinde D; van Harten, Wim H

2010-08-31

Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations.Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. The improved benchmarking process and the success

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

PubMed Central

2010-01-01

Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. Conclusions The improved

Knowledge about breast cancer and hereditary breast cancer among nurses in a public hospital 1

PubMed Central

Prolla, Carmen Maria Dornelles; da Silva, Patrícia Santos; Netto, Cristina Brinckmann Oliveira; Goldim, José Roberto; Ashton-Prolla, Patricia

2015-01-01

OBJECTIVE: To assess the knowledge of nurses involved in the care of oncology patients in a public university hospital, regarding breast cancer and hereditary breast cancer, and to verify the use of such knowledge in their daily practice. METHODS: This is a descriptive cross-sectional study. Data were obtained through a structured, self-administered questionnaire. Out of 154 nurses, 137 (88.9%) agreed to participate in the study. Two questionnaires were excluded such that 135 questionnaires were analyzed. RESULTS: The global percentage of correct answers was not associated with age (p=0.173) or degree/specialization (p=0.815). Questions were classified into categories. In categories involving knowledge of established breast cancer risk factors and indicators of hereditary breast cancer, the rate of correct answers was 65.8% and 66.4%, respectively. On the practice of genetic counseling, 40.7% of those interviewed were not sure about the definition of genetic counseling and 78.5% reported never having identified or referred a patient at genetic risk for specialized risk assessment. Practice of educational actions regarding this subject was reported by 48.5% of those interviewed. CONCLUSION: This study reinforces the need to develop qualifying actions for nurses, so that strategies to control breast cancer become effective in their health care practice. PMID:25806636

James Abbot McNeill Whistler: "At the Piano."

ERIC Educational Resources Information Center

Hallenberg, Heather

1987-01-01

"At the Piano," an oil-on-canvas painting completed in 1859 by James Abbot McNeill Whistler, is used as the basis of a lesson designed to help junior high school students analyze the painting's mood, subject matter, and composition. (JDH)

Healthy cooking classes at a children’s cancer hospital and patient/survivor summer camp: initial reactions and feasibility

PubMed Central

Raber, Margaret; Crawford, Karla; Chandra, Joya

2018-01-01

Objective Childhood cancer survivors (CCS) have been shown to practice sub-optimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviors in community-based programming and academic research, however, literature on teaching cooking classes in CCS is limited. The purpose of this study is to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behavior. Design A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. Setting One pediatric cancer hospital inpatient unit, one pediatric cancer in-hospital camp program and two off-site pediatric cancer summer camp programs. Subjects One hundred and eighty nine CCS of varying ages and thirteen parents of CCS. Results Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. Conclusions Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS. PMID:28463101

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study.

PubMed

Downing, Amy; Morris, Eva Ja; Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, p<2.2×10 -6 ) and an improvement in survival (p<10 -19 ; 5-year difference: 3.8% (41.0%-44.8%)) comparing high participation for ≥4 years with 0 years. There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Feasibility of integrated home/hospital physiotherapeutic support for children with cancer.

PubMed

Savio, Christian; Garaventa, Alberto; Gremmo, Marina; Camoriano, Riccardo; Manfredini, Luca; Fieramosca, Sara; Dini, Giorgio; Miano, Maurizio

2007-01-01

Children suffering from cancer often have to undergo physiotherapy that either extends the duration of in-patient hospitalisation or requires more frequent visits to the outpatient clinic. To improve care and to decrease the length of hospitalisation of children being treated at the Dept. of Haematoloy/Oncology of the Gaslini Children's Hospital, a programme of Home Care was set up in April 2000. In June 2003, rehabilitation was added to the procedures that were feasible at home and included i.v. therapy administration, blood examinations, transfusion and/or psychological support, as well as palliative care for terminally ill children. The physiotherapy sessions were done in the ward, in the Rehabilitation Unit Gym, or at home, depending on the clinical conditions and the needs of the child and the family. Between June 2003 and May 2005, 46 children, whose median age was 7 years (range 6 months-21 years) suffering from CNS tumours (13), leukaemia (13), neuroblastoma (7), bone tumours (6), sarcoma (4) and lymphoma (3), underwent 1,398 physiotherapy sessions for neuro-motor re-education (534), motor rehabilitation (485), strain re-education and training (250), respiratory care (79), or to improve comfort during the terminal phase of the disease (50). To maintain continuity of care, the treatments were performed at home (931), in the hospital ward (282), or in the gymnasium of our Physiotherapy Service (185). The physiotherapist was able to start or to continue assistance at home or in the hospital, and to keep up the programme based on the child's needs. Integrated home/hospital physiotherapy for children suffering from cancer is feasible and is useful for maintaining continuity of treatment without lengthening hospitalisation.

JAMES RIVER FACE WILDERNESS, VIRGINIA.

USGS Publications Warehouse

Brown, C. Ervin; Gazdik, Gertrude C.

1984-01-01

A mineral survey concluded that the James River Face Wilderness, Virginia, had little promise for the occurrence of metallic mineral resources. Two major rock units in the area do contain large nonmetallic mineral resources of quartzite and shale that have been mined for silica products and for brick and expanded aggregate, respectively. Because large deposits of the same material are more easily available in nearby areas, demand for the deposits within the wilderness is highly unlikely. No energy resources were identified in the course of this study.

Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

PubMed

Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

2015-01-01

Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Making James Joyce Contemporary: Recreating Classical Fiction

ERIC Educational Resources Information Center

Clay, Rebecca

2015-01-01

Can you make James Joyce's short story "Eveline" contemporary and create a modern short story based on Joyce's work? The purpose of this study was to provide a context to Joyce's short story "Eveline," illustrate the journey of my fiction writing, and expand the conversation on using classical fiction as a guide to modern short…

Practice Patterns in Hepatitis B Virus Screening Before Cancer Chemotherapy in a Major US Hospital Network.

PubMed

Kwak, Ye Eun; Stein, Stacy M; Lim, Joseph K

2018-01-01

Cancer patients receiving chemotherapy face an increased risk of reactivation of chronic hepatitis B virus infection. To determine the HBV screening rate in patients receiving cancer chemotherapy in various clinical settings. We identified 11,959 adult cancer patients (age ≥ 18 years) receiving parenteral chemotherapy between 2012 and 2015 within a major US hospital network, including a large university hospital, community teaching hospitals, and community oncology clinics. Two thousand and forty-five patients (17.1%) were screened for either HBV surface antigen (HBsAg) or HBV core antibody (HBcAb) before chemotherapy, and 1850 patients (15.5%) had both HBsAg and HBcAb tested before chemotherapy. 8.4% were exposed to HBV, and 0.9% had chronic HBV infection (both HBsAg/HBcAb positive). Patients with hematologic tumor were more often screened than with solid tumor (55.6 vs. 8.3%, p < 0.001). Patients receiving chemotherapy with higher HBV reactivation risk had higher yet suboptimal HBV screening rate (41.1% B-depleting agents, 21.5% anthracycline, 14.9% steroid, 64.7% anti-TNF alpha and 18.6% other chemotherapy, p < 0.001). Patients with age ≥ 50 years (old 16.2% vs. young 23.9%, p < 0.001) and Asian ethnicity (Asian 13.6 vs. Caucasian 16.6%, p < 0.001) were screened less for HBV despite higher prevalence of HBV exposure (old 9.3% vs. young 4.3%, p < 0.001 and Asian 27.8% vs. Caucasian 6.4%, p < 0.001). Patients receiving chemotherapy in community oncology clinics were less screened versus community teaching hospitals or university hospital (12.7 vs. 19.1 vs. 19.7%, p < 0.001), despite similar prevalence of HBV infection. On multivariate analysis, receiving chemotherapy at a community oncology clinic [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.45-0.72, p < 0.001] was independently associated with less HBV screening compared to receiving chemotherapy at a university or community teaching hospital. HBV screening among patients

Epidemiological Trends of GI Cancers in Patients Visiting a Tertiary Care Hospital in Chandigarh, North India.

PubMed

Sharma, Munesh K; Singh, Tarundeep; Pandey, Avdesh K; Kankaria, Ankita

2015-01-01

Cancer has become an epidemic disease. Nearly ten million new cancer cases are diagnosed annually in the world and out of these about half are from the developing world. To appropriately plan for treatment, management and prevention of the disease, it becomes necessary to study the trends about morbidity caused by cancers. Data for patients diagnosed with any form of gastrointestinal (GI) cancers was extracted from records maintained in the outpatient department registers of the Oncology Department of Government Medical College and Hospital in Chandigarh from 1999 to 2012. Trends were analysed for different categories of GI cancers for the period of 12 years. In present study GI cancers accounted for 23 % of all registered cases (n-9603) of carcinomas. Males predominated for all GI cancers except in the gall bladder. Gastrointestinal cancers as a proportion of total cancers increased from 21% in 1999 to 25.9% in 2012 with a significant increasing trend in our series (χ2 for linear trend=9.36, p<0.003). Cancers of the tonsil, oral cavity and pharynx taken together showed an increasing trend over the years (χ2 for trend=55.2, p<0.001) whereas cancers of the lower GI (χ2=19.6, p<0.0001) and gall bladder (χ2=19.5, p<0.0001) showed a declining trend in our series. GI cancers form a significant proportion of all cancers reporting to our data. In depth studies to ascertain the reasons for the changing trends are required to design intervention programs. Further information is necessary from cancer registries and from the hospital records of oncology departments.

James Ross Island captured by NASA photographer James Ross, from NASA's DC-8 aircraft during an AirSAR 2004 mission over the Antarctic Peninsula

NASA Image and Video Library

2004-03-16

James Ross Island captured by NASA photographer James Ross(no relation), from NASA's DC-8 aircraft during an AirSAR 2004 mission over the Antarctic Peninsula. James Ross Island, named for 19th century British polar explorer Sir James Clark Ross, is located at the northern tip of the Antarctic Peninsula. The island is about 1500 m high and 40-60 km wide. In recent decades, the area has experienced significant atmospheric warming (about 2 degrees C since 1950), which has triggered a vast and spectacular retreat of its floating ice shelves, glacier reduction, a decrease in permanent snow cover and a lengthening of the melt season. AirSAR 2004 is a three-week expedition in Central and South America by an international team of scientists that is using an all-weather imaging tool, called the Airborne Synthetic Aperture Radar (AirSAR), located onboard NASA's DC-8 airborne laboratory. Scientists from many parts of the world are combining ground research with NASA's AirSAR technology to improve and expand on the quality of research they are able to conduct. These photos are from the DC-8 aircraft while flying an AirSAR mission over Antarctica. The Antarctic Peninsula is more similar to Alaska and Patagonia than to the rest of the Antarctic continent. It is drained by fast glaciers, receives abundant precipitation, and melts significantly in the summer months. This region is being studied by NASA using a DC-8 equipped with the Airborne Synthetic Aperture Radar developed by scientists from NASA’s Jet Propulsion Laboratory. AirSAR will provide a baseline model and unprecedented mapping of the region. This data will make it possible to determine whether the warming trend is slowing, continuing or accelerating. AirSAR will also provide reliable information on ice shelf thickness to measure the contribution of the glaciers to sea level.

Caution Ahead: Research Challenges of a Randomized Controlled Trial Implemented to Improve Breast Cancer Treatment at Safety-Net Hospitals.

PubMed

Bickell, Nina A; Shah, Ajay; Castaldi, Maria; Lewis, Theophilus; Sickles, Alan; Arora, Shalini; Clarke, Kevin; Kemeny, Margaret; Srinivasan, Anitha; Fei, Kezhen; Franco, Rebeca; Parides, Michael; Pappas, Peter; McAlearney, Ann Scheck

2018-03-01

To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs). We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool's usefulness. We conducted intention-to-treat and pre- and poststudy analyses to assess the T&F tool and implementation effectiveness, respectively. Between the study start and intervention implementation, several hospitals reorganized care delivery and 49% of patients scheduled to undergo breast cancer surgery were ineligible because they already were in contact with an oncologist. One high-volume hospital closed. Despite randomization of hospitals, intervention (INT) hospitals had fewer white patients (5% v 16%; P = .0005), and more underuse (28% v 15%; P = .002) compared with usual care (UC) hospitals. Over time, INT hospitals with poorer follow-up significantly reduced underuse compared with UC hospitals (INT hospitals, from 33% to 9%, P = .001 v UC hospitals, from 15% to 11%, P = .5). There was no difference in underuse (9% at INT hospitals, 11% at UC hospitals; P = .8). Hospitals with better follow-up (odds ratio, 0.85; 95% CI, 0.73 to 0.98) had less underuse. In settings with poor follow-up and tracking approaches, key informants found the tool useful. The rapidly changing delivery landscape posed significant challenges to this implementation research. A T&F tool did not significantly reduce adjuvant underuse but may help reduce underuse in SNHs with poor follow-up capabilities. Inability to discern T&F effectiveness is likely due to encountered challenges that inform lessons for future implementation research.

The Thoc1 Ribonucleoprotein as a Novel Biomarker for Prostate Cancer Treatment Assignment

DTIC Science & Technology

2015-10-01

REPORT NUMBER Health Research Inc. and Roswell Park Cancer Institute Elm & Carlton Streets Buffalo, NY 14263-0001 9. SPONSORING / MONITORING AGENCY...Synergistic Idea Development Award in collaboration with Dr. James Mohler (Partnering PI, Roswell Park Cancer Institute). Dr. Mohler will be

Organochlorine pesticides accumulation and breast cancer: A hospital-based case-control study.

PubMed

He, Ting-Ting; Zuo, An-Jun; Wang, Ji-Gang; Zhao, Peng

2017-05-01

The aim of this study is to detect the accumulation status of organochlorine pesticides in breast cancer patients and to explore the relationship between organochlorine pesticides contamination and breast cancer development. We conducted a hospital-based case-control study in 56 patients with breast cancer and 46 patients with benign breast disease. We detected the accumulation level of several organochlorine pesticides products (β-hexachlorocyclohexane, γ-hexachlorocyclohexane, polychlorinated biphenyls-28, polychlorinated biphenyls-52, pentachlorothioanisole, and pp'-dichlorodiphenyldichloroethane) in breast adipose tissues of all 102 patients using gas chromatography. Thereafter, we examined the expression status of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER2), and Ki-67 in 56 breast cancer cases by immunohistochemistry. In addition, we analyzed the risk of breast cancer in those patients with organochlorine pesticides contamination using a logistic regression model. Our data showed that breast cancer patients suffered high accumulation levels of pp'-dichlorodiphenyldichloroethane and polychlorinated biphenyls-52. However, the concentrations of pp'-dichlorodiphenyldichloroethane and polychlorinated biphenyls-52 were not related to clinicopathologic parameters of breast cancer. Further logistic regression analysis showed polychlorinated biphenyls-52 and pp'-dichlorodiphenyldichloroethane were risk factors for breast cancer. Our results provide new evidence on etiology of breast cancer.

Introspecting in the Spirit of William James: Comment on Fox, Ericsson, and Best (2011)

ERIC Educational Resources Information Center

Schooler, Jonathan W.

2011-01-01

Fox, Ericsson, and Best's (2011) thoughtful justification of the use of think-aloud protocols for revealing the stream of consciousness comes on the centennial of the death of William James, history's greatest practitioner and advocate of introspection. This confluence naturally invites speculation about how James might have responded to the…

Quality of water in James Creek, Monroe County, Mississippi

USGS Publications Warehouse

Bednar, G.A.

1981-01-01

A short-term quality-of-water study of James Creek near Aberdeen , Mississippi was conducted on November 14-16, 1978, during a period of low streamflow. During the study, the water in the 2.6-mile stream reach was undesireable for many uses. Wastewater inflow immediately upstream of the study area contributed to the dissolved-solids load in James Creek. The specific conductance of the water ranged from 775 to 890 micromhos at the head of the study reach and from 650 to 750 micromhos at the end of the study reach. A substantial biochemical oxygen-demand was evident in James Creek. Five-day biochemical oxygen demand values downstream of a sewage disposal pond outfall ranged from 8.3 to 11 milligrams per liter and dissolved-oxygen concentrations ranged from 0.4 to 4.5 milligrams per liter. Nitrogen and phosphorus compounds and fecal bacteria densities were highest downstream. Total ammonia nitrogen and phosphorus concentrations in the water leaving the study area ranged from 0.29 to 1.4 milligrams per liter and from 0.65 to 1.7 milligrams per liter, respectively. Fecal coliform densities exceeding 50,000 colonies per 100 milliliters of sample were observed in the study area. The median fecal coliform density of the water leaving the study area was 2,800 colonies per 100 milliliters. (USGS)

Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?

PubMed

Hamano, Jun; Yamaguchi, Takashi; Maeda, Isseki; Suga, Akihiko; Hisanaga, Takayuki; Ishihara, Tatsuhiko; Iwashita, Tomoyuki; Kaneishi, Keisuke; Kawagoe, Shohei; Kuriyama, Toshiyuki; Maeda, Takashi; Mori, Ichiro; Nakajima, Nobuhisa; Nishi, Tomohiro; Sakurai, Hiroki; Shimoyama, Satofumi; Shinjo, Takuya; Shirayama, Hiroto; Yamada, Takeshi; Morita, Tatsuya

2016-05-01

Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital. This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services. Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01). In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2016;122:1453-1460. © 2016 American Cancer Society. © 2015 American Cancer Society.

Initial surgical experience following implementation of lung cancer screening at an urban safety net hospital.

PubMed

Muñoz-Largacha, Juan A; Steiling, Katrina A; Kathuria, Hasmeena; Charlot, Marjory; Fitzgerald, Carmel; Suzuki, Kei; Litle, Virginia R

2018-06-01

Safety net hospitals provide care mostly to low-income, uninsured, and vulnerable populations, in whom delays in cancer screening are established barriers. Socioeconomic barriers might pose important challenges to the success of a lung cancer screening program at a safety net hospital. We aimed to determine screening follow-up compliance, rates of diagnostic and treatment procedures, and the rate of cancer diagnosis in patients classified as category 4 by the Lung CT Screening Reporting and Data System (Lung-RADS 4). We conducted a retrospective review of all patients enrolled in our multidisciplinary lung cancer screening program between March 2015 and July 2016. Demographics, smoking status, Lung-RADS score, and number of diagnostic and therapeutic interventions and cancer diagnoses were captured. A total of 554 patients were screened over a 16-month period. The mean patient age was 63 years (range, 47-85 years), and 60% were male. The majority (92%; 512 of 554) were classified as Lung-RADS 1 to 3, and 8% (42 of 554) were classified as Lung-RADS 4. Among the Lung-RADS 4 patients, 98% (41 of 42) completed their recommended follow-up; 29% (12 of 42) underwent a diagnostic procedure, for an overall diagnostic intervention rate of 2% (12 of 554). Eleven of these 12 patients had cancer, and 1 patient had sarcoidosis. The overall rate of surgical resection was 0.9% (5 of 554), and the rate of diagnostic intervention for noncancer diagnosis was 0.1% (1 of 554). Implementation of a multidisciplinary lung cancer screening program at a safety net hospital is feasible. Compliance with follow-up and interventional recommendations in Lung-RADS 4 patients was high despite anticipated social challenges. Overall diagnostic and surgical resection rates and interventions for noncancer diagnosis were low in our initial experience. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Cultural Resources Survey of the Angelina Revetment Item, St. James Parish, Louisiana.

DTIC Science & Technology

1986-10-22

Corps G) of Engineers O New Oreans Dist 0 N In CULTURAL RESOURCES SURVEY OF THE ANGELINA REVETMENT ITEM, ST. JAMES . PARISH, LOUISIANA. FINAL REPORT...PD-86/0 3 AF Go 4. TITLE (ad S-belde) S. TYPE OF REPORT & PENIOO COVERED Cultural Resources Survey of the Final Angelina Revetment Item, St. James...the Angelina Revetment Item, adjacent to the Mississippi River channel, during August and September, 1985. b-The area was settled during the Spanish

Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California

PubMed Central

Gomez, Scarlett Lin; Press, David J.; Lichtensztajn, Daphne; Keegan, Theresa H. M.; Shema, Sarah J.; Le, Gem M.; Kurian, Allison W.

2012-01-01

Background Clinical guidelines recommend breast conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans (AA) are more likely than other groups to have mastectomy or omit radiation after BCS. Methods We applied polytomous logistic regression and recursive partitioning (RP) to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California AAs diagnosed with stage 0–II breast cancer from 1990–2007. Results The percentage receiving mastectomy ranged from 40% among US-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some AA ethnicities, and additional factors including hospital (smaller hospital size, not NCI cancer center, low socioeconomic status (SES) patient composition, and high hospital AA patient composition) and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through RP, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity. Conclusions Tumor characteristics and, secondarily, patient, hospital and neighborhood factors, are predictors of mastectomy and omission of radiation following BCS among AAs. Impact By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study, and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options. PMID:22402290

Surgery Branch recruiting patients to study new treatment for cancers with RAS mutations | Center for Cancer Research

Cancer.gov

RAS is a family of proteins that send signals to genes involved in cell growth and is mutated in approximately a quarter of all human cancers. James Yang, M.D., of the Surgery Branch is leading a team of investigators who have generated a special T-cell receptor from mouse cells that can recognize a mutation of RAS that is found in many human cancer cells. The goal is to

78 FR 50458 - Entergy Nuclear Operations, Inc., James A. Fitzpatrick Nuclear Power Plant, Vermont Yankee...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-19

... Nuclear Operations, Inc., James A. Fitzpatrick Nuclear Power Plant, Vermont Yankee Nuclear Power Station, Pilgrim Nuclear Power Station, Request for Action AGENCY: Nuclear Regulatory Commission. ACTION: Request... that the NRC take action with regard to James A. Fitzpatrick Nuclear Power Plant, Vermont Yankee...

The Thoc1 Ribonucleoprotein as a Novel Biomarker for Prostate Cancer Treatment Assignment

DTIC Science & Technology

2015-10-01

INVESTIGATOR: James L. Mohler, MD CONTRACTING ORGANIZATION: Health Research, Inc., Roswell Park Division Buffalo,NY 14263 REPORT DATE: October...Comprehensive Cancer and Roswell Park Cancer Institute. Administration Core A will have direct responsibility for organization and facilitation of...project’s goals: Roswell Park Cancer Institute’s Cancer Center Support Grant (CCSG) includes six programs and 13 cores resources. Support is

The value of a comprehensive geriatric assessment for patient care in acutely hospitalized older patients with cancer.

PubMed

Hamaker, Marije E; Buurman, Bianca M; van Munster, Barbara C; Kuper, Ingeborg M J A; Smorenburg, Carolien H; de Rooij, Sophia E

2011-01-01

A comprehensive geriatric assessment systematically collects information on geriatric conditions and is propagated in oncology as a useful tool when assessing older cancer patients. The objectives were: (a) to study the prevalence of geriatric conditions in cancer patients aged ≥ 65 years, acutely admitted to a general medicine ward; (b) to determine functional decline and mortality within 12 months after admission; and (c) to assess which geriatric conditions and cancer-related variables are associated with 12-month mortality. This was an observational cohort study of 292 cancer patients aged ≥ 65 years, acutely admitted to the general medicine and oncology wards of two university hospitals and one secondary teaching hospital. Baseline assessments included patient characteristics, reason for admission, comorbidity, and geriatric conditions. Follow-up at 3 and 12 months was aimed at functional decline (loss of one or more activities of daily living [ADL]) and mortality. The median patient age was 74.9 years, and 95% lived independently; 126 patients (43%) had metastatic disease. A high prevalence of geriatric conditions was found for instrumental ADL impairment (78%), depressive symptoms (65%), pain (65%), impaired mobility (48%), malnutrition (46%), and ADL impairment (38%). Functional decline was observed in 8% and 33% of patients at 3 and 12 months, respectively. Mortality rates were 38% at 3 months and 64% at 12 months. Mortality was associated with cancer-related factors only. In these acutely hospitalized older cancer patients, mortality was only associated with cancer-related factors. The prevalence of geriatric conditions in this population was high. Future research is needed to elucidate if addressing these conditions can improve quality of life.

The Value of a Comprehensive Geriatric Assessment for Patient Care in Acutely Hospitalized Older Patients with Cancer

PubMed Central

Buurman, Bianca M.; van Munster, Barbara C.; Kuper, Ingeborg M.J.A.; Smorenburg, Carolien H.; de Rooij, Sophia E.

2011-01-01

Introduction. A comprehensive geriatric assessment systematically collects information on geriatric conditions and is propagated in oncology as a useful tool when assessing older cancer patients. Objectives. The objectives were: (a) to study the prevalence of geriatric conditions in cancer patients aged ≥65 years, acutely admitted to a general medicine ward; (b) to determine functional decline and mortality within 12 months after admission; and (c) to assess which geriatric conditions and cancer-related variables are associated with 12-month mortality. Methods. This was an observational cohort study of 292 cancer patients aged ≥65 years, acutely admitted to the general medicine and oncology wards of two university hospitals and one secondary teaching hospital. Baseline assessments included patient characteristics, reason for admission, comorbidity, and geriatric conditions. Follow-up at 3 and 12 months was aimed at functional decline (loss of one or more activities of daily living [ADL]) and mortality. Results. The median patient age was 74.9 years, and 95% lived independently; 126 patients (43%) had metastatic disease. A high prevalence of geriatric conditions was found for instrumental ADL impairment (78%), depressive symptoms (65%), pain (65%), impaired mobility (48%), malnutrition (46%), and ADL impairment (38%). Functional decline was observed in 8% and 33% of patients at 3 and 12 months, respectively. Mortality rates were 38% at 3 months and 64% at 12 months. Mortality was associated with cancer-related factors only. Conclusion. In these acutely hospitalized older cancer patients, mortality was only associated with cancer-related factors. The prevalence of geriatric conditions in this population was high. Future research is needed to elucidate if addressing these conditions can improve quality of life. PMID:21914699

Lonely Courage, Commemorative Confrontation, and Communal Therapy: William James Remembers the Massachusetts 54th

ERIC Educational Resources Information Center

Stob, Paul

2012-01-01

On May 31, 1897, William James, one of America's most influential philosophers and psychologists, delivered the first civic oration of his career. The principal orator at the dedication of the Robert Gould Shaw memorial in Boston, James did what commemorative speakers are not supposed to do. He chose to be confrontational and divisive in a…

Discovering and Developing Successful Cardiovascular Therapeutics: A Conversation With James N. Topper, MD, PhD.

PubMed

Topper, James N; Rutherford, John D

2016-11-15

Dr James (also known as Jamie) N. Topper, MD, PhD, serves as Managing General Partner at Frazier Healthcare Partners, where he leads the Life Science Venture practice. In 2011, and 2016, he was named to the Midas List of leading venture capitalists, and, in 2013, he was recognized by Forbes as one of the top 10 healthcare investors. He has >25 years of experience working with entrepreneurs to found and build successful therapeutics-focused companies. Dr Topper holds a BS from the University of Michigan. He received an MD and PhD (in biophysics) from Stanford University School of Medicine. He completed postgraduate training in internal medicine and cardiovascular disease at the Brigham and Women's Hospital in Boston and is board certified in both disciplines. © 2016 American Heart Association, Inc.

1. Historic American Buildings Survey James Butters, Photographer. Mar, 28, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Historic American Buildings Survey James Butters, Photographer. Mar, 28, 1936. GENERAL FRONT VIEW (SOUTHWEST ELEVATION) - Marschalk Printing Office, Wall & Franklin Streets, Natchez, Adams County, MS

Depth Acuity Methodology for Electronic 3D Displays: eJames (eJ)

DTIC Science & Technology

2016-07-01

AFRL-RH-WP-TR-2016-0060 Depth Acuity Methodology for Electronic 3D Displays: eJames (eJ) Eric L. Heft, John McIntire...AND SUBTITLE Depth Acuity Methodology for Electronic 3D Displays: eJames (eJ) 5a. CONTRACT NUMBER FA8650-08-D-6801-0050 5b. GRANT NUMBER...of 3D electronic displays: one active-eyewear Stereo 3D (S3D) and two non-eyewear full parallax Field-of-Light Display (FoLD) systems. The two FoLD

What Is Important to Young Children Who Have Cancer while in Hospital?

ERIC Educational Resources Information Center

Aldiss, Susie; Horstman, Maire; O'Leary, Chris; Richardson, Alison; Gibson, Faith

2009-01-01

This paper reports on a participatory research project exploring children's experiences and views of cancer care services. It focusses on findings from interviews conducted with 10 children aged four and five years old. Play and puppets were used to help children express their views. The themes elicited reveal important aspects of hospital care…

Astronaut James Newman with latch hook for tether device

NASA Technical Reports Server (NTRS)

1993-01-01

Astronaut James H. Newman, mission specialist, shows off a latch hook for a tether device used during the STS-51 extravehicular activity (EVA) on September 16, 1993. Newman, on Discovery's middeck, appears surrounded by sleep restraints.

Analysis of differences in exercise recognition by constraints on physical activity of hospitalized cancer patients based on their medical history.

PubMed

Choi, Mi-Ri; Jeon, Sang-Wan; Yi, Eun-Surk

2018-04-01

The purpose of this study is to analyze the differences among the hospitalized cancer patients on their perception of exercise and physical activity constraints based on their medical history. The study used questionnaire survey as measurement tool for 194 cancer patients (male or female, aged 20 or older) living in Seoul metropolitan area (Seoul, Gyeonggi, Incheon). The collected data were analyzed using frequency analysis, exploratory factor analysis, reliability analysis t -test, and one-way distribution using statistical program SPSS 18.0. The following results were obtained. First, there was no statistically significant difference between cancer stage and exercise recognition/physical activity constraint. Second, there was a significant difference between cancer stage and sociocultural constraint/facility constraint/program constraint. Third, there was a significant difference between cancer operation history and physical/socio-cultural/facility/program constraint. Fourth, there was a significant difference between cancer operation history and negative perception/facility/program constraint. Fifth, there was a significant difference between ancillary cancer treatment method and negative perception/facility/program constraint. Sixth, there was a significant difference between hospitalization period and positive perception/negative perception/physical constraint/cognitive constraint. In conclusion, this study will provide information necessary to create patient-centered healthcare service system by analyzing exercise recognition of hospitalized cancer patients based on their medical history and to investigate the constraint factors that prevents patients from actually making efforts to exercise.

How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials.

PubMed

Sateren, Warren B; Trimble, Edward L; Abrams, Jeffrey; Brawley, Otis; Breen, Nancy; Ford, Leslie; McCabe, Mary; Kaplan, Richard; Smith, Malcolm; Ungerleider, Richard; Christian, Michaele C

2002-04-15

We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials. We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program. Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials. We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.

Subsequent Oophorectomy and Ovarian Cancer after Hysterectomy for Benign Gynecologic Conditions at Chiang Mai University Hospital.

PubMed

Jitkunnatumkul, Aurapin; Tantipalakorn, Charuwan; Charoenkwan, Kittipat; Srisomboon, Jatupol

2016-01-01

This study was undertaken to determine the incidence of subsequent oophorectomy due to ovarian pathology or ovarian cancer in women with prior hysterectomy for benign gynecologic conditions at Chiang Mai University Hospital. Medical records of women who underwent hysterectomy for benign gynecologic diseases and pre-cancerous lesions between January 1, 2004 and December 31, 2013 at Chiang Mai University Hospital were retrospectively reviewed. The incidence and indications of oophorectomy following hysterectomy were analyzed. During the study period, 1,035 women had hysterectomy for benign gynecologic conditions. Of these, 590 women underwent hysterectomy with bilateral salpingo-oophorectomy and 445 hysterectomy with bilateral ovarian preservation or unilateral salpingo-oophorectomy. The median age was 47 years (range, 11-75 years). Ten women (2.45 %) had subsequent oophorectomy for benign ovarian cysts. No case of ovarian cancer was found. The mean time interval between hysterectomy and subsequent oophorectomy was 43.1 months (range, 2-97 months) and the mean follow-up time for this patient cohort was 51 months (range, 1.3-124.9 months). According to our hospital-based data, the incidence of subsequent oophorectomy in women with prior hysterectomy for benign gynecologic conditions is low and all present with benign conditions.

Spending on Hospital Care and Pediatric Psychology Service Use Among Adolescents and Young Adults With Cancer.

PubMed

McGrady, Meghan E; Peugh, James L; Brown, Gabriella A; Pai, Ahna L H

2017-10-01

To examine the relationship between need-based pediatric psychology service use and spending on hospital care among adolescents and young adults (AYAs) with cancer. Billing data were obtained from 48 AYAs with cancer receiving need-based pediatric psychology services and a comparison cohort of 48 AYAs with cancer not receiving services. A factorial analysis of covariance examined group differences in spending for hospital care. Pending significant findings, a multivariate analysis of covariance was planned to examine the relationship between need-based pediatric psychology service use and spending for inpatient admissions, emergency department (ED) visits, and outpatient visits. Spending for hospital care was higher among AYAs receiving need-based pediatric psychology services than in the comparison cohort (p < .001, ωPartial2 = .11). Group differences were driven by significantly higher spending for inpatient admissions and ED visits among AYAs receiving need-based pediatric psychology services. The behavioral and psychosocial difficulties warranting need-based pediatric psychology services may predict higher health care spending. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Variability in the quality of rectal cancer care in public hospitals in Catalonia (Spain): clinical audit as a basis for action.

PubMed

Manchon-Walsh, P; Borras, J M; Espinas, J A; Aliste, L

2011-04-01

Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aimed at promoting equity of access to therapy and quality of cancer care. The colorectal cancer (CRC) guideline was first published in 2003 and subsequently updated in 2008. This study examined the quality of therapy administered to patients with rectal cancer in public hospitals in Catalonia (Spain) in 2005 and 2007, according to CRC guideline recommendations. We conducted a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Data were drawn from clinical records. The study covered 1831 patients with rectal cancer. Performance of total mesorectal excision (TME) was poorly reported by surgeons (46.4%) and pathologists (36.2%). Pre-operative radiotherapy was performed on 52% of stage-II and -III patients. Compared to high-caseload hospitals, those with a low caseload (≤11 cases/year) registered more Hartman's procedures, worse TME quality, a higher rate of post-operative complications and lower adherence to recommended pre-operative radio-chemotherapy. Reporting quality of care is essential for ascertaining current performance status and opportunities for improvement. In our case, there is a need for the quality of the information included in clinical records to be improved, and variability in adherence to guideline recommendations to be reduced. In view of the fact that heterogeneity in the quality of the health care process was linked to hospital caseload, the health authorities have decided to reorganise the provision of rectal cancer care. Copyright © 2011 Elsevier Ltd. All rights reserved.

Swyer-James syndrome associated with Noonan syndrome: report of a case.

PubMed

Lin, Y M; Huang, W L; Hwang, J J; Ko, Y L; Lien, W P

1995-12-01

A 28-year-old man with Noonan syndrome associated with unilateral hyperlucent lung is reported. He had the typical craniofacial appearance and short stature of Noonan syndrome; he had mild mental retardation, atrophic testis, mild funnel chest and kyphosis. cardiovascular abnormalities included asymmetric hypertrophic cardiomyopathy and a significantly different caliber of the left and right pulmonary arteries. The unilateral hyperlucent lung was shown to result from acquired nondestructive emphysema caused by nonvalvular obstruction of the bronchi (Swyer-James syndrome or Macleod's syndrome). To the authors' knowledge, this is the first reported case of Noonan syndrome associated with Swyer-James syndrome.

Low skeletal muscle mass is associated with increased hospital expenditure in patients undergoing cancer surgery of the alimentary tract.

PubMed

van Vugt, Jeroen L A; Buettner, Stefan; Levolger, Stef; Coebergh van den Braak, Robert R J; Suker, Mustafa; Gaspersz, Marcia P; de Bruin, Ron W F; Verhoef, Cornelis; van Eijck, Casper H C; Bossche, Niek; Groot Koerkamp, Bas; IJzermans, Jan N M

2017-01-01

Low skeletal muscle mass is associated with poor postoperative outcomes in cancer patients. Furthermore, it is associated with increased healthcare costs in the United States. We investigated its effect on hospital expenditure in a Western-European healthcare system, with universal access. Skeletal muscle mass (assessed on CT) and costs were obtained for patients who underwent curative-intent abdominal cancer surgery. Low skeletal muscle mass was defined based on pre-established cut-offs. The relationship between low skeletal muscle mass and hospital costs was assessed using linear regression analysis and Mann-Whitney U-tests. 452 patients were included (median age 65, 61.5% males). Patients underwent surgery for colorectal cancer (38.9%), colorectal liver metastases (27.4%), primary liver tumours (23.2%), and pancreatic/periampullary cancer (10.4%). In total, 45.6% had sarcopenia. Median costs were €2,183 higher in patients with low compared with patients with high skeletal muscle mass (€17,144 versus €14,961; P<0.001). Hospital costs incrementally increased with lower sex-specific skeletal muscle mass quartiles (P = 0.029). After adjustment for confounders, low skeletal muscle mass was associated with a cost increase of €4,061 (P = 0.015). Low skeletal muscle mass was independently associated with increased hospital costs of about €4,000 per patient. Strategies to reduce skeletal muscle wasting could reduce hospital costs in an era of incremental healthcare costs and an increasingly ageing population.

The Hospital for the Ruptured and Crippled: Knight to Gibney, 1870-1887.

PubMed

Levine, David B

2006-02-01

In 1870, R&C moved to its second site on the corner of Lexington Avenue and 42nd Street. A newly constructed building designed by a specialist in ecclesiastical architecture became the home of a 200-bed children's hospital planned entirely by Dr. James Knight, founder of the hospital and its first Surgeon-in-Chief. Expansion of the facilities and of the professional staff, although needed and welcomed, brought new challenges, changes, and conflicts. The root of these was to lie in the complex character of James Knight with his dogmatic approach to patient care vs the open nature of his newly appointed assistant, Virgil Gibney, who was to become his successor and eventually the second Surgeon-in-Chief. How these two personalities worked together for 13 years, abruptly parted, and then after Knight's death, the reappearance of Gibney, is a fascinating story of the early development of the first orthopedic hospital in this country. It was a period after the Civil War described as the "Gilded Age," where not only the country, but the city, was going through its own challenges, changes and conflicts. Emerging was a new era for R&C introducing surgery, postgraduate medical education, and eventually, clinical and basic research.

2. Historic American Buildings Survey James Butters, Photographer April 8, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

2. Historic American Buildings Survey James Butters, Photographer April 8, 1936 GENERAL REAR VIEW (SOUTHWEST ELEVATION) - Hope Farm (Villa), Auburn Avenue & Homochitto Street, Natchez, Adams County, MS

Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective.

PubMed

Conner, J Michael; Aviles-Robles, Martha J; Asdahl, Peter H; Zhang, Fang Fang; Ojha, Rohit P

2016-09-01

The prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence of malnourishment among paediatric cancer patients in Mexico City, and assess the association between malnourishment and length of hospital stay. Individuals eligible for this study were paediatric cancer patients (aged <18 years) admitted to Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-score<-2 (ie, 2 SDs below the expected mean of the WHO reference population). We estimated time ratios (TRs) and 95% confidence limits (CLs) for the association between malnourishment and length of hospital stay. Our study population comprised 111 paediatric cancer patients with febrile neutropaenia, of whom 71% were aged <10 years and 52% were males. The prevalence of malnourishment was 14%, equal to a 530% (standardised morbidity ratio=6.3; 95% CL 3.7, 10) excess of malnourishment compared with the world reference population. The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had the shortest length of stay. Future studies should explore potential interventions for malnourishment to reduce the length of hospital stay or other established adverse consequences of malnourishment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Lung cancer risk and pollution in an industrial region of Northern Spain: a hospital-based case-control study.

PubMed

López-Cima, María Felicitas; García-Pérez, Javier; Pérez-Gómez, Beatriz; Aragonés, Nuria; López-Abente, Gonzalo; Tardón, Adonina; Pollán, Marina

2011-01-25

Asturias, an Autonomous Region in Northern Spain with a large industrial area, registers high lung cancer incidence and mortality. While this excess risk of lung cancer might be partially attributable to smoking habit and occupational exposure, the role of industrial and urban pollution also needs to be assessed. The objective was to ascertain the possible effect of air pollution, both urban and industrial, on lung cancer risk in Asturias. This was a hospital-based case-control study covering 626 lung cancer patients and 626 controls recruited in Asturias and matched by ethnicity, hospital, age, and sex. Distances from the respective participants' residential locations to industrial facilities and city centers were computed. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to urban and industrial pollution sources were calculated, with adjustment for sex, age, hospital area, tobacco consumption, family history of cancer, and occupation. Whereas individuals living near industries displayed an excess risk of lung cancer (OR = 1.49; 95%CI = 0.93-2.39), which attained statistical significance for small cell carcinomas (OR = 2.23; 95%CI = 1.01-4.92), residents in urban areas showed a statistically significant increased risk for adenocarcinoma (OR = 1.92; 95%CI = 1.09-3.38). In the Gijon health area, residents in the urban area registered a statistically significant increased risk of lung cancer (OR = 2.17; 95%CI = 1.25-3.76), whereas in the Aviles health area, no differences in risk were found by area of exposure. This study provides further evidence that air pollution is a moderate risk factor for lung cancer.

Lung cancer risk and pollution in an industrial region of Northern Spain: a hospital-based case-control study

PubMed Central

2011-01-01

Background Asturias, an Autonomous Region in Northern Spain with a large industrial area, registers high lung cancer incidence and mortality. While this excess risk of lung cancer might be partially attributable to smoking habit and occupational exposure, the role of industrial and urban pollution also needs to be assessed. The objective was to ascertain the possible effect of air pollution, both urban and industrial, on lung cancer risk in Asturias. Methods This was a hospital-based case-control study covering 626 lung cancer patients and 626 controls recruited in Asturias and matched by ethnicity, hospital, age, and sex. Distances from the respective participants' residential locations to industrial facilities and city centers were computed. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to urban and industrial pollution sources were calculated, with adjustment for sex, age, hospital area, tobacco consumption, family history of cancer, and occupation. Results Whereas individuals living near industries displayed an excess risk of lung cancer (OR = 1.49; 95%CI = 0.93-2.39), which attained statistical significance for small cell carcinomas (OR = 2.23; 95%CI = 1.01-4.92), residents in urban areas showed a statistically significant increased risk for adenocarcinoma (OR = 1.92; 95%CI = 1.09-3.38). In the Gijon health area, residents in the urban area registered a statistically significant increased risk of lung cancer (OR = 2.17; 95%CI = 1.25-3.76), whereas in the Aviles health area, no differences in risk were found by area of exposure. Conclusions This study provides further evidence that air pollution is a moderate risk factor for lung cancer. PMID:21266041

Robert Green's "James IV:" Love, Power, and Justice.

ERIC Educational Resources Information Center

Hayashi, Tetsumaro

1984-01-01

How events of the late medieval period of Great Britain are depicted in Robert Greene's play, "The Scottish History of James the Fourth," is discussed. The play reflects the spirit of a time in which some began to claim that women were the intellectual equals of men. (RM)

The James Madison College Student Handbook, 1970-71.

ERIC Educational Resources Information Center

Michigan State Univ., East Lansing. James Madison Coll.

James Madison College of Michigan State University provides a 4-year, residentially-based program devoted to the study of major social, economic, and political policy problems. It offers 5 fields of concentration: (1) Ethnic and Religious Intergroup Relations Policy Problems; (2) International Relations Policy Problems; (3) Justice, Morality and…

2002 Annual Report of the Korea Central Cancer Registry: Based on Registered Data from 139 Hospitals

PubMed Central

Shin, Hai-Rim; Jung, Kyu-Won; Won, Young-Joo

2004-01-01

Purpose To estimate the number of cancer cases during 2002 in Korea through a nationwide hospital based cancer registration by the Korea Central Cancer Registry (KCCR). Materials and Methods One hundred and thirty nine hospitals participated in the KCCR program in 2002. Cancer cases were coded and classified according to the International Classification of Diseases for Oncology 2nd edition (ICD-O-2). The software program "IARC Check" was used to evaluate the quality of registered cancer cases. Of the 122,770 malignancies registered, 11,732 (9.6%) duplicated malignancies were excluded. Among the remaining 102,677 malignancies, 3,652 (3.6%) cases with carcinoma in situ (Morphology code/2) were separated. Finally, 99,025 malignancies were analyzed. Results Of the total of 99,025 malignancies, 55,398 (55.9%) cases were males and 43,627 (44.1%) were females. More than one third of cases were from the elderly (65 years old and more). The six leading primary cancer sites in the order of their relative frequency, were stomach (24.0%), followed by the lung (16.0%), the liver (15.4%), the colorectum (11.6%), the bladder (3.2%), and the prostate (3.0%) among males. In females, the breast (16.8%) was the common cancer site, followed by the stomach (15.3%), the colorectum (10.7%), the thyroid gland (9.5%), the cervix uteri (9.1%), and the lung (6.6%). Conclusion With the continued increase in cancer cases especially prostate cancer among males and thyroid cancer among females, the total number of registered cancer cases in Korea continues to rapidly increase. PMID:20396549

Family history of venous thromboembolism and risk of hospitalized thromboembolism in cancer patients: A nationwide family study.

PubMed

Zöller, Bengt; Palmer, Karolina; Li, Xinjun; Sundquist, Jan; Sundquist, Kristina

2015-09-01

The importance of family history of venous thromboembolism (VTE) in cancer patients is unclear. We conducted a nationwide study to determine whether family history of VTE is a risk factor for hospitalized VTE in cancer patients. The Swedish Multi-Generation Register was linked to the Swedish Hospital Discharge Register and the Swedish Cancer Registry. Familial (sibling/parent history of VTE) hazard ratios (HRs) for VTE in 20 cancer types were determined by cause-specific Cox regression for 258877 cancer patients in 1987-2010 without previous VTE. Familial HRs were also determined in 7644203 individuals without cancer or VTE before 1987, with follow-up in 1987-2010. Significant familial HRs for VTE in cancer patients were observed for the following cancer types: cancers of the breast (HR=1.79), lung (HR=1.21), colon (HR=1.30), prostate (HR=1.46), testis (HR=2.02), nervous system (HR=1.31), stomach (HR=1.73), and rectum (HR=1.77), as well as melanoma (HR=1.71), non-Hodgkin lymphoma (HR=1.32), myeloma (HR=1.69), and leukemia (HR=1.44). In a time-dependent analysis the familial HRs for VTE were significant before diagnosis of cancer (p-values <0.0001). After diagnosis of cancer the familial HRs VTE were weaker, with significant HRs for 12 cancer types. On an additive scale, the joint effect of cancer and family history was significantly increased compared to separate effects in four cancer types. However, for certain cancers the familial VTE cases were limited. Family history of VTE is a risk factor for VTE in several cancer types. However, familial factors are relatively more important in non-cancer than in cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Nephrology in A Medicinal Dictionary of Robert James (1703-1776).

PubMed

Bisaccia, Carmela; De Santo, Natale G; Cirillo, Massimo; Perna, Alessandra; De Santo, Rosalba; Richet, Gabriel

2011-01-01

Robert James was a member of the College of Physicians at Cambridge and a practitioner. He was considered one of the "three best known characters in London--perhaps in Europe. The other two being the lexycographer Samuel Johnson and the Shakespearean actor David Garrick." James became famous for his powerful ability to write and publish, which produced many books, including the ponderous A Medicinal Dictionary, With a History of Drugs, in 3 volumes in folio, published in London in the years 1743-1745, and dedicated to the famous professor and royal physician John Mead. The Dictionary was translated into French by Denis Diderot, François-Vincent Toussaint and Marc Antoine Eidous, and was revised by Juliene T. Busson, president of the University of Paris. During the translation, Diderot learned much biology and medicine, which he used subsequently in developing his Encyclopédie. Interesting chapters are devoted to urine, predictions from urine, bloody urine, good urine, bad urine, urine portending death, diabetes, dropsy, nephritis, stone, ischury, dysury and urine incontinence. In general their strength resides in their accurate clinical descriptions. The paragraphs on urine are concise and clinically sound, and the description of procedures for urine analysis and the utilization of results (quantity, quantity, colors, sediments and consistency) in diagnosis and prognosis of bloody urine is accurate. The section on diabetes is excellent and is comparable to that of Desault written decades later in the Encyclopédie of Diderot. In the chapter on dropsy (he does not use the word oedema), patients are well described and their remedies are appropriate for the time. The contributions of kidney and liver are clear. The plants for renal treatment can be traced to Dioscorides. Concerning dosage, he is precise and helpful to his readers. The chapter on stones is a real masterpiece, clinically well centered and giving all the pertinent information to localize them, their

8. Historic American Buildings Survey, James C. Massey, Photographer November, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. Historic American Buildings Survey, James C. Massey, Photographer November, 1959 INTERIOR LOOKING TO REAR. - Provident Life & Trust Company Bank, 407-409 Chestnut Street, Philadelphia, Philadelphia County, PA

7. Historic American Buildings Survey James Butters, Photographer, April 14, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. Historic American Buildings Survey James Butters, Photographer, April 14, 1936. FRONT VIEW OF SERVANTS HOME (WEST ELEVATION) - Auburn, Auburn Boulevard, Duncan Memorial Park, Natchez, Adams County, MS

3. Historic American Buildings Survey James Butters, Photographer April 8, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. Historic American Buildings Survey James Butters, Photographer April 8, 1936 FRONT VIEW REAR WING (NORTH ELEVATION) - Hope Farm (Villa), Auburn Avenue & Homochitto Street, Natchez, Adams County, MS

4. James L. Dillon and Company, Inc., photographer January, 1967 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. James L. Dillon and Company, Inc., photographer January, 1967 INTERESTING OVAL STAIRWELL, LOOKING STRAIGHT UP FROM SECOND FLOOR - 626 South Front Street (House), Philadelphia, Philadelphia County, PA

Factors affecting hospital costs in lung cancer patients in the United Kingdom.

PubMed

Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J

2016-07-01

Rising healthcare costs and financial constraints are increasing pressure on healthcare budgets. There is little published data on the healthcare costs of lung cancer in the UK, with international studies mostly small and limited by data collection methods. Accurate assessment of healthcare costs is essential for effective service planning. We conducted a retrospective, descriptive cohort study linking clinical data from a local electronic database of lung cancer patients at a large UK teaching hospital with recorded hospital income. Costs were adjusted to 2013-2014 prices. The study analysed secondary care costs of 3274 patients. Mean cumulative costs were £5852 (95% CI, £5694 to £6027) at 90 days and £10,009 (95% CI, £9717 to £10,278) at one year. The majority of costs (58.5%) were accumulated within the first 90 days, with acute inpatient costs the largest contributor at one year (42.1%). The strongest predictor of costs was active treatment, especially surgery. Costs were also affected by age, route to diagnosis, clinical stage and cell type. Successful early diagnosis initiatives that increase radical treatment rates and improve outcomes may significantly increase the secondary care costs of lung cancer management. The use of routine NHS clinical and financial data can enable efficient and effective analyses of large cohort health economic data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cancer patients' respect experiences in relation to perceived communication behaviours from hospital staff: analysis of the 2012-2013 National Cancer Patient Experience Survey.

PubMed

Clucas, Claudine

2016-04-01

Respect experiences are poorly understood despite respect being central to professionalism in health care and patient well-being, and needed for optimal patient care. This study explores which patient-perceived communication behaviours from hospital staff contribute most to cancer patients' respect experiences and account for variation in their experience by socio-demographic and clinical characteristics. We present a secondary analysis of data from the 2012-2013 National Cancer Patient Experience Survey of 45,191 patients with a primary cancer diagnosis treated in English National Health Service trusts providing adult acute cancer services who provided data on experienced respect and dignity. Both autonomy-supportive and caring/emotionally sensitive behaviours were associated with reported respect, although the latter showed stronger associations and accounted for most differences in reports of respect between patient groups. Differences in respect were found by gender, race/ethnicity, age, the presence of long-standing conditions, treatment response, time since first treated for cancer (p < .001), employment and type of cancer (p < .05). The study questions the tendency to conceptualise respect primarily in terms of autonomy-supportive behaviours and shows the relative contribution of autonomy-supportive and caring/emotionally sensitive behaviours in explaining disparities in respect experiences. More attention should be paid to affective communication behaviours from hospital staff to reduce disparities in respect experiences.

2001 Annual Report of the Korea Central Cancer Registry: Based on Registered Data from 134 Hospitals

PubMed Central

Shin, Hai-Rim; Won, Young-Joo; Jung, Kyu-Won

2004-01-01

Purpose To estimate the number of cancer cases during 2001, in Korea, through a nationwide hospital based cancer registration by the Korea Central Cancer Registry (KCCR). Materials and Methods One hundred and thirty four hospitals participated in the KCCR program in 2001. Cancer cases were coded and classified according to the International Classification of Diseases for Oncology 2nd edition (ICD-O-2). The software program "IARC Check" was used to evaluate the quality of the registered cancer cases. Of the 111,816 malignancies registered, 10,106 (9.0%) duplicated malignancies were excluded. Among the remaining 95,542 malignancies, 3,598 (3.8%) cases with carcinoma in situ (Morphology code/2) were separated. Finally, 91,944 malignancies were analyzed. Results Of the total 91,944 malignancies, 51,753 (56.3%) cases were males and 40,191 (43.7%) were females. More than one third of cases were from the elderly (65 years old and more). The six leading primary cancer sites, in the order of their relative frequency, were stomach (24.1%), followed by the lung (16.0%), the liver (16.0%), the colorectum (10.5%), the bladder (3.4%), and the prostate (2.8%) among males. In females, the breast (16.1%) was the common cancer site, followed by the stomach (15.3%), the colorectum (10.5%), the cervix uteri (10.1%), the thyroid gland (8.3%) and the lung (6.6%). Conclusion With the continued increase in cancer cases, the total number of registered cancer cases in Korea continues to rapidly increase. PMID:20396562

Die Another Day, James Bond's smoking over six decades.

PubMed

Wilson, Nick; Tucker, Anne

2016-09-01

We aimed to examine smoking-related content in all 24 James Bond movies in the Eon Productions series from 1962 to 2015. There were favourable downward trends for any smoking by James Bond (p=0.015 for trend), and for tobacco-related spy-gadgetry (p=0.009). Around 20% of Bond's 60 sexual partners smoked in each decade, and most recently in 2012. There were regular mentions of smoking risks to health (starting from 1967) and product placement of branded packs was present in two movies. Overall, the persisting smoking content remains problematic from a public health perspective, especially given the popularity of this movie series. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Association Between Hospital Case Volume and the Use of Bronchoscopy and Esophagoscopy During Head and Neck Cancer Diagnostic Evaluation

PubMed Central

Sun, Gordon H.; Aliu, Oluseyi; Moloci, Nicholas M.; Mondschein, Joshua K.; Burke, James F.; Hayward, Rodney A.

2013-01-01

Background There are no clinical guidelines on best practices for the use of bronchoscopy and esophagoscopy in diagnosing head and neck cancer. This retrospective cohort study examined variation in the use of bronchoscopy and esophagoscopy across hospitals in Michigan. Patients and Methods We identified 17,828 head and neck cancer patients in the 2006–2010 Michigan State Ambulatory Surgery Databases. We used hierarchical, mixed-effect logistic regression to examine whether a hospital’s risk-adjusted rate of concurrent bronchoscopy or esophagoscopy was associated with its case volume (<100, 100–999, or ≥1000 cases/hospital) for those undergoing diagnostic laryngoscopy. Results Of 9,218 patients undergoing diagnostic laryngoscopy, 1,191 (12.9%) received concurrent bronchoscopy and 1,675 (18.2%) underwent concurrent esophagoscopy. The median hospital rate of bronchoscopy was 2.7% (range 0–61.1%), and low-volume (OR 27.1 [95% CI 1.9, 390.7]) and medium-volume (OR 28.1 [95% CI 2.0, 399.0]) hospitals were more likely to perform concurrent bronchoscopy compared to high-volume hospitals. The median hospital rate of esophagoscopy was 5.1% (range 0–47.1%), and low-volume (OR 9.8 [95% CI 1.5, 63.7]) and medium-volume (OR 8.5 [95% CI 1.3, 55.0]) hospitals were significantly more likely to perform concurrent esophagoscopy relative to high-volume hospitals. Conclusions Head and neck cancer patients undergoing diagnostic laryngoscopy are much more likely to undergo concurrent bronchoscopy and esophagoscopy at low- and medium-volume hospitals than at high-volume hospitals. Whether this represents over-use of concurrent procedures or appropriate care that leads to earlier diagnosis and better outcomes merits further investigation. PMID:24114146

9. Historic American Buildings Survey, James C. Massey, Photographer November, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. Historic American Buildings Survey, James C. Massey, Photographer November, 1959 DETAIL OF EXPOSED ROOF TRUSS. - Provident Life & Trust Company Bank, 407-409 Chestnut Street, Philadelphia, Philadelphia County, PA

7. Historic American Buildings Survey, James C. Massey, Photographer November, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. Historic American Buildings Survey, James C. Massey, Photographer November, 1959 REAR FACADE ON RANSTEAD STREET. - Provident Life & Trust Company Bank, 407-409 Chestnut Street, Philadelphia, Philadelphia County, PA

James Webb Space Telescope (JWST) Town Hall - Panel question and

NASA Image and Video Library

2016-11-02

James Webb Space Telescope (JWST) Town Hall - Panel question and answer - Bill Ochs; Dr. John Mather; Dr. Eric Smith; Thomas Zurbuchen; Center Director Chris Scolese; NASA Administrator Charlie Bolden.

Population versus hospital controls in the assessment of dietary intake of isoflavone for case-control studies on cancers in China.

PubMed

Li, Lin; Zhang, Min; Holman, C D'Arcy J

2013-01-01

To assess dietary isoflavone intake between population and hospital outpatient controls and examine if cancer risks estimated for isoflavone using hospital outpatient controls would be different from those using population controls. Three parallel case-control studies on leukemia, breast, and colorectal cancers in China in 2009-2010 were conducted, using population and hospital outpatient controls to separately match 560 incident cases at a 1:1 ratio. A validated food frequency questionnaire was administered by face-to-face interview. Conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The 2 control groups had closely similar distributions of dietary isoflavone intake. Risk estimates for breast cancers were adjusted ORs (95% CI) of 0.39 (0.23-0.66) and 0.31 (0.18-0.55) for daidzein, 0.35 (0.20-0.61) and 0.28 (0.16-0.52) for genistein, 0.66 (0.41-1.08) and 0.53 (0.32-0.88) for glycitein, and 0.53 (0.33-0.85) and 0.43 (0.26-0.71) for total isoflavone using hospital outpatient and population controls respectively. The study found that hospital outpatient controls were comparable to population controls in measured dietary intake of isoflavone in the Chinese hospital setting.

James Madison's "Public" As Interpreter of the Constitution.

ERIC Educational Resources Information Center

Dewey, Donald O.

James Madison's thoughts on various interpretations of the Constitution maintain that public opinion is the ultimate method of legitimizing the document. The Constitution must prevail against mere public opinion, but public opinion may be used to establish the meaning of the Constitution when conflicting interpretations exist. The public good and…

Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.

PubMed

Purmonen, Timo T; Auvinen, Päivi K; Martikainen, Janne A

2010-04-01

Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint. The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results. Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease. Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

Medical expenses of urban Chinese patients with stomach cancer during 2002-2011: a hospital-based multicenter retrospective study.

PubMed

Sun, Xiao-Jie; Shi, Ju-Fang; Guo, Lan-Wei; Huang, Hui-Yao; Yao, Neng-Liang; Gong, Ji-Yong; Sun, Ya-Wen; Liu, Guo-Xiang; Mao, A-Yan; Liao, Xian-Zhen; Bai, Ya-Na; Ren, Jian-Song; Zhu, Xin-Yu; Zhou, Jin-Yi; Mai, Ling; Song, Bing-Bing; Liu, Yu-Qin; Zhu, Lin; Du, Ling-Bin; Zhou, Qi; Xing, Xiao-Jing; Lou, Pei-An; Sun, Xiao-Hua; Qi, Xiao; Wang, Yuanzheng; Cao, Rong; Ren, Ying; Lan, Li; Zhang, Kai; He, Jie; Wang, Jia-Lin; Dai, Min

2018-04-17

In China, stomach cancer is the third most common cancer and the third leading cause of cancer death. Few studies have examined Chinese stomach cancer patients' medical expenses and their associated trends. The Cancer Screening Program in Urban China (CanSPUC) is a Major Public Health Project funded by the central government. Through this project, we have extracted patients' medical expenses from hospital billing data to examine the costs of the first course treatments (which refers to 2 months before and 10 months after the date of cancer diagnosis) in Chinese patients with stomach cancer and the associated trends. The expense data of 14,692 urban Chinese patients with stomach cancer were collected from 40 hospitals in 13 provinces. We estimated the inflation-adjusted medical expenses per patient during 2002-2011. We described the time trends of medical expenses at the country-level, and those trends by subgroup, and analyzed the compositions of medical expenses. We constructed the Generalized Linear Mixed (GLM) regression model with Poisson distribution to examine the factors that were associated with medical expenses per patient. The average medical expenses of the first course treatments were about 43,249 CNY (6851 USD) in 2011, more than twice of that in 2002. The expenses increased by an average annual rate of 7.4%. Longer stay during hospitalization and an increased number of episodes of care are the two main contributors to the expense increase. The upward trend of medical expenses was observed in almost all patient subgroups. Drug expenses accounted for over half of the medical expenses. The average medical expenses of the first course (2 months before and 10 months after the date of cancer diagnosis) treatments per stomach cancer patient in urban China in 2011 were doubled during the previous 10 years, and about twice as high as the per capita disposable income of urban households in the same year. Such high expenses indicate that it makes economic

Hospital variation and the impact of postoperative complications on the use of perioperative chemo(radio)therapy in resectable gastric cancer. Results from the Dutch Upper GI Cancer Audit.

PubMed

Schouwenburg, M G; Busweiler, L A D; Beck, N; Henneman, D; Amodio, S; van Berge Henegouwen, M I; Cats, A; van Hillegersberg, R; van Sandick, J W; Wijnhoven, B P L; Wouters, M W J; Nieuwenhuijzen, G A P

2018-04-01

Dutch national guidelines on the diagnosis and treatment of gastric cancer recommend the use of perioperative chemotherapy in patients with resectable gastric cancer. However, adjuvant chemotherapy is often not administered. The aim of this study was to evaluate hospital variation on the probability to receive adjuvant chemotherapy and to identify associated factors with special attention to postoperative complications. All patients who received neoadjuvant chemotherapy and underwent an elective surgical resection for stage IB-IVa (M0) gastric adenocarcinoma between 2011 and 2015 were identified from a national database (Dutch Upper GI Cancer Audit). A multivariable linear mixed model was used to evaluate case-mix adjusted hospital variation and to identify factors associated with adjuvant therapy. Of all surgically treated gastric cancer patients who received neoadjuvant chemotherapy (n = 882), 68% received adjuvant chemo(radio)therapy. After adjusting for case-mix and random variation, a large hospital variation in the administration rates for adjuvant was observed (OR range 0.31-7.1). In multivariable analysis, weight loss, a poor health status and failure of neoadjuvant chemotherapy completion were strongly associated with an increased likelihood of adjuvant therapy omission. Patients with severe postoperative complications had a threefold increased likelihood of adjuvant therapy omission (OR 3.07 95% CI 2.04-4.65). Despite national guidelines, considerable hospital variation was observed in the probability of receiving adjuvant chemo(radio)therapy. Postoperative complications were strongly associated with adjuvant chemo(radio)therapy omission, underlining the need to further reduce perioperative morbidity in gastric cancer surgery. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

10. Historic American Buildings Survey, James C. Massey, Photographer November, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. Historic American Buildings Survey, James C. Massey, Photographer November, 1959 DETAIL OF COLUMN CAPITAL, FRONT ALCOVE. - Provident Life & Trust Company Bank, 407-409 Chestnut Street, Philadelphia, Philadelphia County, PA

5. William Beardsley standing along canal section. Photographer James Dix ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. William Beardsley standing along canal section. Photographer James Dix Schuyler, 1903. Source: Schuyler report. - Waddell Dam, On Agua Fria River, 35 miles northwest of Phoenix, Phoenix, Maricopa County, AZ

James Webb Space Telescope Optical Telescope Element Mirror Development History and Results

NASA Technical Reports Server (NTRS)

Feinber, Lee D.; Clampin, Mark; Keski-Kuha, Ritva; Atkinson, Charlie; Texter, Scott; Bergeland, Mark; Gallagher, Benjamin B.

2012-01-01

In a little under a decade, the James Webb Space Telescope (JWST) program has designed, manufactured, assembled and tested 21 flight beryllium mirrors for the James Webb Space Telescope Optical Telescope Element. This paper will summarize the mirror development history starting with the selection of beryllium as the mirror material and ending with the final test results. It will provide an overview of the technological roadmap and schedules and the key challenges that were overcome. It will also provide a summary or the key tests that were performed and the results of these tests.

Classification of hospital pathways in the management of cancer: application to lung cancer in the region of burgundy.

PubMed

Nuemi, G; Afonso, F; Roussot, A; Billard, L; Cottenet, J; Combier, E; Diday, E; Quantin, C

2013-10-01

The evaluation of national cancer plans is an important aspect of their implementation. For this evaluation, the principal actors in the field (doctors, nurses, etc.) as well as decision-makers must have access to information that is reliable, synthetic and easy to interpret, and which reflects the implementation process in the field. We propose here a methodology to make this type of information available in the context of reducing inequalities with regard to access to healthcare for patients with lung cancer in the region of Burgundy. We used the national medico-administrative DRG-type database, which gathers together all hospital stays. By using this database, it was possible to identify and reconstruct the care management history of these patients. That is, by linking together all attended hospitals, sorted chronologically. Eligible patients were at least 18 years old, whatever the gender and had undergone surgery for their lung cancer. They had to be residents of Burgundy at the time of the first operation between 2006 and 2008. Patient's pathway was defined as the sequence of all attended hospitals (hospital stays) during the year of follow up linked together using an anonymised patient identifier. We then constructed a pathway typology of pathway using an unsupervised clustering method, and conducted a spatial analysis of this typology. Between 2006 and 2008, we selected 495 patients in the 4 administrative departments of the Burgundy region. They accounted for a total of 3821 stays during the year of follow-up. There were 393 men (79%) and the mean age was 64 (95% confidence interval: 63-65) years. We reconstructed 94 pathways (about five per patient). Here, neighbourhood's cares accounted for 41% of them, while 44% included a surgical intervention outside the region of Burgundy. We constructed a pathway typology with five classes. Spatial analysis showed that the vast majority of initial surgeries took place in the major regional centres. The construction

A Conversation with James E. Gilliam on Autism.

ERIC Educational Resources Information Center

Gilliam, James E.; Smith, Burt Kruger

James E. Gilliam is the author of a book entitled "Autism," published in 1981 by Charles C. Thomas Company. This brochure records an interview with Mr. Gilliam conducted by Burt Smith and later converted to narrative form for publication by Charlene Warren. Adapted from a series of radio broadcasts entitled "The Human…

Looking Backward: James Madison University's General Education Reform.

ERIC Educational Resources Information Center

Reynolds, Charles W.; Allain, Violet Anselmini; Erwin, T. Dary; Halpern, Linda Cabe; McNallie, Robin; Ross, Martha K.

1998-01-01

Describes the new general education program at James Madison University (Virginia) and the process by which it was developed. Indicates that the program is organized by five broad areas of knowledge that are defined by interdisciplinary clusters of learning objectives, which in turn were developed using input from every academic department on…

James Williamson d/b/a Golden Triangle Builders Information Sheet

EPA Pesticide Factsheets

James Williamson d/b/a Golden Triangle Builders (the Company) is located in Pittsburgh, Pennsylvania. The settlement involves renovation activities conducted at property constructed prior to 1978, located in Pittsburgh, Pennsylvania.

6. Watchman Robert 'Jerry' Jones at Camp Dyer. Photographer James ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. Watchman Robert 'Jerry' Jones at Camp Dyer. Photographer James Dix Schuyler, 1903. Source: Schuyler report. - Waddell Dam, On Agua Fria River, 35 miles northwest of Phoenix, Phoenix, Maricopa County, AZ

The Hospital for the Ruptured and Crippled: Knight to Gibney, 1870–1887

PubMed Central

2006-01-01

In 1870, R&C moved to its second site on the corner of Lexington Avenue and 42nd Street. A newly constructed building designed by a specialist in ecclesiastical architecture became the home of a 200-bed children's hospital planned entirely by Dr. James Knight, founder of the hospital and its first Surgeon-in-Chief. Expansion of the facilities and of the professional staff, although needed and welcomed, brought new challenges, changes, and conflicts. The root of these was to lie in the complex character of James Knight with his dogmatic approach to patient care vs the open nature of his newly appointed assistant, Virgil Gibney, who was to become his successor and eventually the second Surgeon-in-Chief. How these two personalities worked together for 13 years, abruptly parted, and then after Knight's death, the reappearance of Gibney, is a fascinating story of the early development of the first orthopedic hospital in this country. It was a period after the Civil War described as the “Gilded Age,” where not only the country, but the city, was going through its own challenges, changes and conflicts. Emerging was a new era for R&C introducing surgery, postgraduate medical education, and eventually, clinical and basic research. PMID:18751838

5. Historic American Buildings Survey James Rainey, Photographer May 10, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. Historic American Buildings Survey James Rainey, Photographer May 10, 1936 GRINDING PLATFORM, VIEW OF INTERIOR LOOKING WEST - Old Town Mill, Mill Brook, near Mill Street, New London, New London County, CT

The James Webb Space Telescope Integrated Science Instrument Module

NASA Technical Reports Server (NTRS)

Greenhouse, Matthew A.; Sullivan, Pamela C.; Boyce, Leslye A.; Glazer, Stuart D.; Johnson, Eric L.; McCloskey, John C.; Voyton, Mark F.

2004-01-01

The Integrated Science Instrument Module of the James Webb Space Telescope is described from a systems perspective with emphasis on unique and advanced technology aspects. The major subsystems of this flight element are described including: structure, thermal, command and data handling, and software.

Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya

PubMed Central

Kipsang, Susan; Gramelspacher, Gregory; Choi, Eunyoung; Brown, Colleen; Hill, Adam B.; Loehrer, Patrick J.; Busakhala, Naftali; Chite Asirwa, F.

2015-01-01

Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. Methods This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement. Results This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services. Conclusion Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program. PMID:28804768

Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya.

PubMed

Cornetta, Kenneth; Kipsang, Susan; Gramelspacher, Gregory; Choi, Eunyoung; Brown, Colleen; Hill, Adam B; Loehrer, Patrick J; Busakhala, Naftali; Chite Asirwa, F

2015-10-01

The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement. This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services. Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.

The King James Bible and the Politics of Religious Education: Secular State and Sacred Scripture

ERIC Educational Resources Information Center

Gearon, Liam

2013-01-01

This article provides an outline historical-educational analysis of the King James Bible from its 1611 publication through to its four-hundredth anniversary commemoration in 2011. With particular focus on England, the article traces the educational impact of the King James Bible and charts, in the country of its origin, its progressive decline in…

Translating New Lung Cancer Screening Guidelines into Practice: The Experience of One Community Hospital.

PubMed

Ledford, Christy J W; Gawrys, Breanna L; Wall, Jessica L; Saas, Patrick D; Seehusen, Dean A

2016-01-01

In December 2013 the US Preventive Services Task Force issued a recommendation for lung cancer screening with annual low-dose computed tomography (LDCT). As screening guidelines emerge and change, this creates an environment for studying the translation of these guidelines into practice. This study assessed how these guidelines were implemented in a community hospital setting and the resulting radiologic findings. This observational study examined the radiologic outcomes of LDCT lung cancer screening guidelines and the resulting notification. During the first year after publication of the guidelines, 94 screening LDCT scans were ordered. Of these, 21 (22.3%) did not meet the criteria outlined by the US Preventive Services Task Force. Among the 72 cases that did met published criteria, 65.3% of scans detected nodules, and among the remaining 35.6%, half had another clinically significant finding. This study shows that new lung cancer screening guidelines, as implemented at a community hospital, resulted in radiologic findings that required follow-up in more than half of patients. Clinicians must be aware of these potential incidental findings when talking to patients about the decision to order screenings. © Copyright 2016 by the American Board of Family Medicine.

Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

PubMed

Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

2017-11-01

Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P < .001). However, both the star rating and surgical volume were correlated with 4 short-term cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting

Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.

PubMed

Mor, V; Stalker, M Z; Gralla, R; Scher, H I; Cimma, C; Park, D; Flaherty, A M; Kiss, M; Nelson, P; Laliberte, L

1988-01-01

A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

Sir James Mouat, VC KCB FRCS (1815-1899): winner of the first medical Victoria Cross.

PubMed

Lawrenson, Ross

2004-11-01

Sir James Mouat was the first of 36 doctors to win the Victoria Cross. Born in Kent in 1815, he was educated at University College London before joining the army. After service in India and Ireland he joined the 6th Dragoon Guards as regimental surgeon and served with them throughout the Crimean War. He won his VC at the Battle of Balaclava. After the Crimean War he was appointed principal medical officer to the British troops in the New Zealand Wars. After serving in New Zealand he returned to England and became Inspector General of Hospitals. Surgeon General Mouat retired on 28 April 1876. He was appointed an honorary surgeon to the Queen in 1888, and a Knight Commander of the Order of the Bath in 1894. He died of a stroke on 4 January 1899 at the age of 83.

"To Mediate Relevantly": A Response to James Simpson

ERIC Educational Resources Information Center

Waters, Alan

2009-01-01

In Waters (2009), it was contended that, because of its ideological orientation, a good deal of applied linguistics for language teaching (ALLT) fails to "mediate relevantly" between academic and practitioner perspectives. James Simpson's rejoinder to my article (Simpson 2009) attempts to refute its claims. However, in my view, it fails to do so,…

Engineering new medicine: an interview with James Collins.

PubMed

Collins, James

2010-01-01

At first glance, the commonality among synthetic gene networks, nerve cell response times and the emergence of antibiotic resistance is obscure. Yet, when speaking with James (Jim) Collins, the relationship becomes clear: all are applications-oriented problems, and all inspire unique approaches from this unusual engineer who is empowered by his freedom to fail.

James Van Allen and His Namesake NASA Mission

NASA Astrophysics Data System (ADS)

Baker, D. N.; Hoxie, V. C.; Jaynes, A.; Kale, A.; Kanekal, S. G.; Li, X.; Reeves, G. D.; Spence, H. E.

2013-12-01

In many ways, James A. Van Allen defined and "invented" modern space research. His example showed the way for government-university partners to pursue basic research that also served important national and international goals. He was a tireless advocate for space exploration and for the role of space science in the spectrum of national priorities.

James Madison's Practical Ideals for the 1990s.

ERIC Educational Resources Information Center

Delattre, Edwin J.

This paper examines recent behavior of public officials at various levels of government in the United States, finds a systemic failure to meet ethical standards, and concludes that the wisdom of James Madison has much applicability to current times. Given his keen perception of human nature, Madison would not be too surprised at today's poor…

Effects of Smoking on Cost of Hospitalization and Length of Stay among Patients with Lung Cancer in Iran: a Hospital-Based Study.

PubMed

Sari, Ali Akbari; Rezaei, Satar; Arab, Mohammad; Majdzadeh, Reza; Matin, Behzad Karami; Zandian, Hamed

2016-01-01

Smoking is recognized as a main leading preventable cause of mortality and morbidity worldwide. It is responsible for a considerable nancial burden both on the health system and in society. This study aimed to examine the effect of smoking on cost of hospitalization and length of stay (LoS) among patients with lung cancer in Iran in 2014. A total of 415 patients were included in the study. Data on age, sex, insurance status, type of hospitals, type of insurance, geographic local, length of stay and cost of hospitalization was extracted by medical records and smoking status was obtained from a telephone survey. To compare cost of hospitalization and LoS for different smoking groups, current smokers, former smokers, and never smokers, a gamma regression model and zero-truncated poisson regression were used, respectively. Compared with never smokers, current and former smokers showed a 48% and 35% increase in hospitalization costs, respectively. Also, hospital LoS for current and former smokers was 72% and 31% higher than for never smokers, respectively. Our study indicated that cigarette smoking imposes a signi cant nancial burden on hospitals in Iran. It is, however, recommended that more research should be done to implement and evaluate hospital based smoking cessation interventions to better increase cessation rates in these settings.

[Estimation of hospital costs of colorectal cancer in Catalonia (Spain)].

PubMed

Corral, Julieta; Borràs, Josep Maria; Chiarello, Pietro; García-Alzorriz, Enric; Macià, Francesc; Reig, Anna; Mateu de Antonio, Javier; Castells, Xavier; Cots, Francesc

2015-01-01

To assess the hospital cost associated with colorectal cancer (CRC) treatment by stage at diagnosis, type of cost and disease phase in a public hospital. A retrospective analysis was conducted of the hospital costs associated with a cohort of 699 patients diagnosed with CRC and treated for this disease between 2000 and 2006 in a teaching hospital and who had a 5-year follow-up from the time of diagnosis. Data were collected from clinical-administrative databases. Mean costs per patient were analysed by stage at diagnosis, cost type and disease phase. The mean cost per patient ranged from 6,573 Euros for patients with a diagnosis of CRC in situ to 36,894 € in those diagnosed in stage III. The main cost components were surgery-inpatient care (59.2%) and chemotherapy (19.4%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs and an increase in chemotherapy costs. This study provides the costs of CRC treatment based on clinical practice, with chemotherapy and surgery accounting for the major cost components. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

6. Historic American Buildings Survey James Rainey, Photographer May 7, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. Historic American Buildings Survey James Rainey, Photographer May 7, 1936 STAIRS FROM ROOM OF SECRETARY OF STATE SECOND FLOOR (Looking North) - Old State House, Main Street & Central Row, Hartford, Hartford County, CT

The impact of pharmaceutical innovation on premature mortality, cancer mortality, and hospitalization in Slovenia, 1997-2010.

PubMed

Lichtenberg, Frank R

2015-04-01

In Slovenia during the period 2000-2010, the number of years of potential life lost before the age of 70 years per 100,000 population under 70 years of age declined 25 %. The aim of this study was to test the hypothesis that pharmaceutical innovation played a key role in reducing premature mortality from all diseases in Slovenia, and to examine the effects of pharmaceutical innovation on the age-standardized number of cancer deaths and on hospitalization from all diseases. Estimates and other data were used to calculate the incremental cost effectiveness of pharmaceutical innovation in Slovenia. Longitudinal disease-level data was analyzed to determine whether diseases for which there was greater pharmaceutical innovation-a larger increase in the number of new chemical entities (NCEs) previously launched-had larger declines in premature mortality, the age-standardized number of cancer deaths, and the number of hospital discharges. My methodology controls for the effects of macroeconomic trends and overall changes in the healthcare system. Premature mortality from a disease is inversely related to the number of NCEs launched more than 5 years earlier. On average, the introduction of an additional NCE for a disease reduced premature mortality from the disease by 2.4 % 7 years later. The age-standardized number of cancer deaths is inversely related to the number of NCEs launched 1-6 years earlier, conditional on the age-standardized number of new cancer cases diagnosed 0-2 years earlier. On average, the launch of an NCE reduced the number of hospital discharges 1 year later by approximately 1.5 %. The estimates imply that approximately two-thirds of the 2000-2010 decline in premature mortality was due to pharmaceutical innovation. If no NCEs had been launched in Slovenia during 1992-2003, the age-standardized number of cancer deaths in 2008 would have been 12.2 % higher. The NCEs launched in Slovenia during 2003-2009 are estimated to have reduced the number of

Effect of Play-based Occupational Therapy on Symptoms of Hospitalized Children with Cancer: A Single-subject Study.

PubMed

Mohammadi, Ahmad; Mehraban, Afsoon Hassani; Damavandi, Shahla A

2017-01-01

Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy. Two hospitalized children with acute lymphoblastic leukemia at least 4 months after diagnoses who received two courses of chemotherapy participated in this pilot study. Takata Play History and Iranian Children Participation Assessment Scale were used to develop intervention protocol. Nine, 30-45 min play-based occupational therapy sessions took place for each child. Children filled out the Faces Pain Scale, Visual Fatigue Scale, and Faces Anxiety Scale before and after each intervention session. Pain, anxiety, and fatigue levels decreased in both participants. Furthermore, the results showed a relationship between pain, anxiety, and fatigue variables in these children. Play-based occupational therapy can be effective in improving pain, anxiety, and fatigue levels in hospitalized children with cancer receiving chemotherapy.

Effect of Play-based Occupational Therapy on Symptoms of Hospitalized Children with Cancer: A Single-subject Study

PubMed Central

Mohammadi, Ahmad; Mehraban, Afsoon Hassani; Damavandi, Shahla A.

2017-01-01

Objective: Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy. Methods: Two hospitalized children with acute lymphoblastic leukemia at least 4 months after diagnoses who received two courses of chemotherapy participated in this pilot study. Takata Play History and Iranian Children Participation Assessment Scale were used to develop intervention protocol. Nine, 30–45 min play-based occupational therapy sessions took place for each child. Children filled out the Faces Pain Scale, Visual Fatigue Scale, and Faces Anxiety Scale before and after each intervention session. Results: Pain, anxiety, and fatigue levels decreased in both participants. Furthermore, the results showed a relationship between pain, anxiety, and fatigue variables in these children. Conclusions: Play-based occupational therapy can be effective in improving pain, anxiety, and fatigue levels in hospitalized children with cancer receiving chemotherapy. PMID:28503651

The James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Gardner, Jonathan P.

2011-01-01

The James Webb Space Telescope is the scientific successor to the Hubble and Spitzer Space Telescopes, and is currently the largest scientific project under construction in the United States. It will be a large (6.6m) cold (50K) telescope launched in about 5 years into orbit around the second Earth-Sun Lagrange point. It is a partnership of NASA with the European and Canadian Space Agencies. Science with the James Webb Space Telescope falls into four themes. The End of the Dark Ages: First Light and Reionization theme seeks to identify the first luminous sources to form and to determine the ionization history of the universe. The Assembly of Galaxies theme seeks to determine how galaxies and the dark matter, gas, stars, metals, morphological structures, and black holes within them evolved from the epoch of reionization to the present. The Birth of Stars and Proto planetary Systems theme seeks to unravel the birth and early evolution of stars, from infall onto dust-enshrouded protostars, to the genesis of planetary systems. The Planetary Systems and the Origins of Life theme seeks to determine the physical and chemical properties of planetary systems around nearby stars and of our own, and investigate the potential for life in those systems. Webb will have four instruments: The Near-Infrared Camera, the Near-Infrared multi-object Spectrograph, and the Tunable Filter Imager will cover the wavelength range 0.6 to 5 microns, while the Mid-Infrared Instrument will do both imaging and spectroscopy from 5 to 28.5 microns. I will conclude the talk with a description of recent technical progress in the construction of the observatory.

The James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Gardner, Jonathan P.

2011-01-01

The James Webb Space Telescope is the scientific successor to the Hubble and Spitzer Space Telescopes, and is currently the largest scientific project under construction in the United States. It will be a large (6.6m) cold (50K) telescope launched into orbit around the second Earth-Sun Lagrange point. It is a partnership of NASA with the European and Canadian Space Agencies. Science with the James Webb Space Telescope falls into four themes. The End of the Dark Ages: First Light and Reionization theme seeks to identify the first luminous sources to form and to determine the ionization history of the universe. The Assembly of Galaxies theme seeks to determine how galaxies and the dark matter, gas, stars, metals, morphological structures, and black holes within them evolved from the epoch of reionization to the present. The Birth of Stars and Protoplanetary Systems theme seeks to unravel the birth and early evolution of stars, from infall onto dust-enshrouded protostars, to the genesis of planetary systems. The Planetary Systems and the Origins of Life theme seeks to determine the physical and chemical properties of planetary systems around nearby stars and of our own, and investigate the potential for life in those systems. Webb will have four instruments: The Near-Infrared Camera, the Near-Infrared multi-object Spectrograph, and the Tunable Filter Imager will cover the wavelength range 0.6 to 5 microns, while the Mid-Infrared Instrument will do both imaging and spectroscopy from 5 to 28.5 microns. I will conclude the talk with a description of recent technical progress in the construction of the observatory.

The James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Gardner, Jonathan P.

2011-01-01

The James Webb Space Telescope is the scientific successor to the Hubble and Spitzer Space Telescopes, and is currently the largest scientific project under construction in the United States. It will be a large (6.6m) cold (50K) telescope launched in about 5 years into orbit around the second Earth-Sun Lagrange point. It is a partnership of NASA with the European and Canadian Space Agencies. Science with the James Webb Space Telescope falls into four themes. The End of the Dark Ages: First Light and Reionization theme seeks to identify the first luminous sources to form and to determine the ionization history of the universe. The Assembly of Galaxies theme seeks to determine how galaxies and the dark matter, gas, stars, metals, morphological structures, and black holes within them evolved from the epoch of reionization to the present. The Birth of Stars and Protoplanetary Systems theme seeks to unravel the birth and early evolution of stars, from infall onto dust-enshrouded protostars, to the genesis of planetary systems. The Planetary Systems and the Origins of Life theme seeks to determine the physical and chemical properties of planetary systems around nearby stars and of our own, and investigate the potential for life in those systems. Webb will have four instruments: The Near-Infrared Camera, the Near-Infrared multi-object Spectrograph, and the Tunable Filter Imager will cover the wavelength range 0.6 to 5 microns, while the Mid-Infrared Instrument will do both imaging and spectroscopy from 5 to 28.5 microns. I will conclude the talk with a description of recent technical progress in the construction of the observatory.

Hospital organizational factors affect the use of immediate breast reconstruction after mastectomy for breast cancer in the Netherlands.

PubMed

Schreuder, K; van Bommel, A C M; de Ligt, K M; Maduro, J H; Vrancken Peeters, M T F D; Mureau, M A M; Siesling, S

2017-08-01

Significant hospital variation in the use of immediate breast reconstruction (IBR) after mastectomy exists in the Netherlands. Aims of this study were to identify hospital organizational factors affecting the use of IBR after mastectomy for ductal carcinoma in situ (DCIS) or invasive breast cancer (BC) and to analyze whether these factors explain the variation. Patients with DCIS or primary invasive BC treated with mastectomy between 2011 and 2013 were selected from the national NABON Breast Cancer Audit. Hospital and organizational factors were collected with an online web-based survey. Regression analyses were performed to determine whether these factors accounted for the hospital variation. In total, 78% (n = 72) of all Dutch hospitals participated in the survey. In these hospitals 16,471 female patients underwent a mastectomy for DCIS (n = 1,980) or invasive BC (n = 14,491) between 2011 and 2014. IBR was performed in 41% of patients with DCIS (hospital range 0-80%) and in 17% of patients with invasive BC (hospital range 0-62%). Hospital type, number of plastic surgeons available and attendance of a plastic surgeon at the MDT meeting increased IBR rates. For invasive BC, higher percentage of mastectomies and more weekly MDT meetings also significantly increased IBR rates. Adjusted data demonstrated decreased IBR rates for DCIS (average 35%, hospital range 0-49%) and invasive BC (average 15%, hospital range 0-18%). Hospital organizational factors affect the use of IBR in the Netherlands. Although only partly explaining hospital variation, optimization of these factors could lead to less variation in IBR rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

Patterns of Resuscitation Care and Survival After In-Hospital Cardiac Arrest in Patients With Advanced Cancer.

PubMed

Bruckel, Jeffrey T; Wong, Sandra L; Chan, Paul S; Bradley, Steven M; Nallamothu, Brahmajee K

2017-10-01

Little is known regarding patterns of resuscitation care in patients with advanced cancer who suffer in-hospital cardiac arrest (IHCA). In the Get With The Guidelines - Resuscitation registry, 47,157 adults with IHCA with and without advanced cancer (defined as the presence of metastatic or hematologic malignancy) were identified at 369 hospitals from April 2006 through June 2010. We compared rates of return of spontaneous circulation (ROSC) and survival to discharge between groups using multivariable models. We also compared duration of resuscitation effort and resuscitation quality measures. Overall, 6,585 patients with IHCA (14.0%) had advanced cancer. Patients with advanced cancer had lower multivariable-adjusted rates of ROSC (52.3% [95% CI, 49.5% to 55.3%] v 56.6% [95% CI, 53.8% to 59.5%]; P < .001) and survival to discharge (7.4% [95% CI, 6.6% to 8.4%] v 13.4% [95% CI, 12.1% to 14.8%]; P < .001). Among nonsurvivors who died during resuscitation, patients with advanced cancer had better performance on most resuscitation quality measures. Among patients with ROSC, patients with advanced cancer were made Do Not Attempt Resuscitation (DNAR) more frequently within 48 hours (adjusted relative risk, 1.30 [95% CI, 1.24 to 1.37]; P < .001). Adjustment for DNAR status explained some of the immediate effect of advanced cancer on survival; however, survival remained significantly lower in patients with cancer. Patients with advanced cancer can expect lower survival rates after IHCA compared with those without advanced cancer, and they are more frequently made DNAR within 48 hours of ROSC. These findings have important implications for discussions of resuscitation care wishes with patients and can better inform end-of-life discussions.

Astronaut James Lovell hoisted from water by recovery helicopter

NASA Technical Reports Server (NTRS)

1965-01-01

Astronaut James A. Lovell Jr., pilot of the Gemini 7 space flight, is hoisted from the water by a recovery helicopter from the Aircraft Carrier U.S.S. Wasp. Astronaut Frank Borman, command pilot, waits in the raft to be hoisted aboard the helicopter.

Astronaut James Newman with latch hook for tether device

NASA Image and Video Library

1993-09-19

STS051-26-002 (12-22 Sept 1993) --- Astronaut James H. Newman, mission specialist, shows off a latch hook for a tether device used during the STS-51 extravehicular activity (EVA) on September 16, 1993. Newman, on Discovery's middeck, appears surrounded by sleep restraints.

Picking up Galen: James Joyce in Cecilia Street.

PubMed

Lyons, J B

1997-07-01

James Joyce (1882-1941) registered as a student of the Catholic University Medical School, Cecilia Street, in 1902. His attendance in November was brief; by early December, Joyce was in Paris. A recently-acquired Guide for Medical Students, a booklet compiled by Ambrose Birmingham, dean of the Cecilia Street school, sheds light on this hitherto obscure episode.

James Madison High: A School at the Crossroads

ERIC Educational Resources Information Center

Stroup, John T.; Salmonowicz, Michael J.; Broom, Christopher C.

2007-01-01

This case tells the story of James Madison High School, which became the epicenter of a debate over the future reorganization and control of large secondary schools in the Los Angeles Unified School District (LAUSD). The LAUSD, recently taken over by the newly elected mayor, was fighting for control of this 3,000-student high school with a charter…

The James Webb Space Telescope

NASA Technical Reports Server (NTRS)

Mather, John C.

2003-01-01

The James Webb Space Telescope (JWST) will extend the discoveries of the Hubble Space Telescope by deploying a large cooled infrared telescope at the Sun-Earth Lagrange point L2. With a 6 m aperture and three instruments covering the wavelength range from 0.6 to 28 pm, it will provide sensitivities orders of magnitude better than any other facilities. It is intended to observe the light from the first galaxies and the first supernovae, the assembly of galaxies, and the formation and evolution of stars and planetary systems. In this talk I will review the scientific objectives, the hardware concepts and technology, and the predicted system performance.

The James Webb Space Telscope

NASA Technical Reports Server (NTRS)

Mather, John C.

2003-01-01

The James Webb Space Telescope (JWST) will extend the discoveries of the Hubble Space Telescope by deploying a large cooled infrared telescope at the Sun-Earth Lagrange point L2. With a 6 m aperture and three instruments covering the wavelength range from 0.6 to 28 microns, it will provide sensitivities orders of magnitude better than any other facilities. It is intended to observe the light from the first galaxies and the first supernovae, the assembly of galaxies, and the formation and evolution of stars and planetary systems. In this talk I will review the scientific objectives, the hardware concepts and technology, and the predicted system performance.

Risk factors and costs of oral cancer in a tertiary care hospital in Delhi.

PubMed

Goyal, Sandeep; Tiwari, Vijay Kumar; Nair, Kesavan Sreekantan; Raj, Sherin

2014-01-01

The present study conducted with 100 oral cancer patients at a private tertiary care hospital in Delhi demonstrated that stage III cancer was associated with longer use of tobacco and poor oral hygiene. There was also statistically significant association (p<.05) between consumption of tobacco and alcohol. More than 60% treatment expenditure was on surgery followed by accommodation (9%) and investigations (8%). The effect of tobacco was well known among patients as 76% of the patients knew that common cancer in tobacco chewer is 'oral cancer', 22% of the patients however responded that they did not know which cancer is common in tobacco chewers. 58% said that they learnt about ill effects of tobacco from media while 24% said they learnt from family and friends. Out of 78 tobacco users, 60 (77%) said that they never received help to quit tobacco while 18(23%) have received help to quit.

77 FR 27118 - Safety Zone; Rocketts Red Glare Fireworks, Ancarrows Landing Park, James River, Richmond, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-09

... DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Part 165 [Docket No. USCG-2012-0114] RIN 1625-AA00 Safety Zone; Rocketts Red Glare Fireworks, Ancarrows Landing Park, James River, Richmond, VA... Glare Fireworks, Ancarrows Landing Park, James River, Richmond, VA in the Federal Register (76 FR 13525...

Descriptive analysis of breast cancer in African-American women at Howard University Hospital, 1960-1987.

PubMed

Williams, R; Laing, A E; Demenais, F; Kissling, G; Gause, B L; Chen, V; Bonney, G

1993-11-01

This article describes breast cancer cases seen at the Howard University Hospital from 1960 through 1987 using information from the database of the Tumor Registry, established in 1960. Clinical information at presentation is presented as well as a description of reproductive and demographic characteristics. Pre- and postmenopausal women are compared, revealing differences in reproductive experience. This may contribute to the increasing incidence of breast cancer seen among younger women in recent years. This is of particular interest because the classic excess of nulliparous women among breast cancer cases is not seen among the population described here.

Descriptive analysis of breast cancer in African-American women at Howard University Hospital, 1960-1987.

PubMed Central

Williams, R.; Laing, A. E.; Demenais, F.; Kissling, G.; Gause, B. L.; Chen, V.; Bonney, G.

1993-01-01

This article describes breast cancer cases seen at the Howard University Hospital from 1960 through 1987 using information from the database of the Tumor Registry, established in 1960. Clinical information at presentation is presented as well as a description of reproductive and demographic characteristics. Pre- and postmenopausal women are compared, revealing differences in reproductive experience. This may contribute to the increasing incidence of breast cancer seen among younger women in recent years. This is of particular interest because the classic excess of nulliparous women among breast cancer cases is not seen among the population described here. PMID:8107157

President Nixon at Hickam AFB congratulates Astronaut James Lovell

NASA Technical Reports Server (NTRS)

1970-01-01

President Richard M. Nixon and Astronaut James A. Lovell Jr., Apollo 13 commander, shake hands at special ceremonies at Hickam Air Force Base, Hawaii. President Nixon was in Hawaii to present the Apollo 13 crew with the Presidential Medal of Freedom, the nation's highest civilian honor.

STS-69 Mission Specialist James H. Newman in white room

NASA Technical Reports Server (NTRS)

1995-01-01

At Launch Pad 39A, STS-69 Mission Specialist James H. Newman chats with white room closeout crew members Rene Arriens (far left), Travis Thompson and Bob Saulnier (right) prior to entering the Space Shuttle Endeavour.

Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission.

PubMed

Wild, Sarah H; Walker, Jeremy J; Morling, Joanne R; McAllister, David A; Colhoun, Helen M; Farran, Bassam; McGurnaghan, Stuart; McCrimmon, Rory; Read, Stephanie H; Sattar, Naveed; Byrne, Christopher D

2018-02-01

To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM. © 2017 by the American Diabetes Association.

[Endoscopic and pathological characteristics of gastric cancer in a Peruvian public hospital].

PubMed

Parillo Durand, Lilian Brenda

2017-01-01

The endoscopic and pathological characteristics of gastric cancer in Luis N. Sáenz National Hospital between 2008 and 2013. retrospective cross-sectional observational study. We reviewed the endoscopic reports of patients older than 30 years, we studied the histological diagnosis of gastric adenocarcinoma, pathological variables such as histological type, presence of H. pylori and complete and incomplete intestinal metaplasia. 92 cases of gastric adenocarcinoma were identified. Average prevalence 0.6%, 0.34% in 2009 and 0.82% in 2013; 62% male, 38% female, age less than 55 years 16%, greater than 76 years 42%; endoscopic presentation Borrmann III 57%, II 16.3%, IV 15%, V 7.6%, I 3.3%; 8 times most frequent presentations distal the proximal v, 75% histologic intestinal type, H. pylori in 50% cases, intestinal metaplasia in 40% of cases of gastric cancer. We found high prevalence of gastric cancer. Common in males, and in people over 76, more frequent endoscopic presentation was Borrmann III, the presence of H. pylori and incomplete intestinal metaplasia associated with intestinal cancer type.

NASA Invites Artists to Visit James Webb Space Telescope

NASA Image and Video Library

2017-12-08

Witness History: Be inspired by giant, golden, fully-assembled James Webb Space Telescope mirror on display at NASA Goddard. Read more: go.nasa.gov/2dUOmSX Are you an artist? If so, we have a unique opportunity to view the amazing and aesthetic scientific marvel that is the James Webb Space Telescope. Because of Webb’s visually striking appearance, we are hosting a special viewing event on Wednesday, Nov. 2, 2016, at NASA’s Goddard Space Flight Center in Greenbelt, Maryland. Artists are invited to apply to attend. Credit: NASA/Goddard/Chris Gunn NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014.

PubMed

Dasch, Burkhard; Kalies, Helen; Feddersen, Berend; Ruderer, Caecilie; Hiddemann, Wolfgang; Bausewein, Claudia

2017-01-01

Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care. To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital. Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life. Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient's life. Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of

"Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital".

PubMed

de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo

2018-02-17

The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.

Traveltime, reaeration, and water-quality characteristics during low-flow conditions in Wilsons Creek and the James River near Springfield, Missouri

USGS Publications Warehouse

Berkas, W.R.

1987-01-01

Before upgrading the Southwest Wastewater-Treatment Plant near Springfield, Missouri, to tertiary treatment, adverse water quality conditions resulting from discharge of wastewater effluent to Wilson Creek were documented in the creek and in the James River. About 7 years after the upgrading of the treatment plant, traveltime, reaeration, and water quality characteristics were determined in Wilsons Creek and the James River. Traveltime was measured once in Wilsons Creek and twice in the James River during low-flow conditions. Traveltimes in the James River were estimated for discharge between 55 and 200 cu ft/sec at a site near Boaz. Reaeration coefficients were calculated for five reaches in Wilsons Creek and the James River using the modified-tracer technique. Calculated reaeration coefficients were compared with coefficients predicted by twelve empirical equations and one equation was chosen that best fit the data. Water quality data were collected during two 44-hr periods, August 14 to 16, 1984, and July 23 to 25, 1985. Samples were collected at the outflow of the Southwest Wastewater Treatment Plant at seven sites along Wilsons Creek and the James River. Dissolved-oxygen concentrations in Wilsons Creek and the James River were all larger than Missouri 's water quality standard of 5.0 mg/l. Ammonia concentrations and 5-day carbonaceous biochemical oxygen demands were small, which indicated that the oxygen consumption by oxidizing ammonia and carbonaceous organic materials would be insignificant. Measured streambed oxygen demand in the James River was largest directly downstream from Wilsons Creek. (USGS)

4. Historic American Buildings Survey James C. Massey, Photographer 1964 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. Historic American Buildings Survey James C. Massey, Photographer 1964 MAIN (SOUTH) ENTRANCE (4x5' b&w film copy neg. from 35mm slide) - Albert F. Madlener House, 4 West Burton Place, Chicago, Cook County, IL

James Franck and the “Franck Report”

Science.gov Websites

, The University of Chicago "James Franck was one of Germany's leading experimental physicists in Spectroscopy and Franck Condon Factors (video) Top Some links on this page may take you to non-federal websites

Pestalozzi and James Pierrepont Greaves: A Shared Educational Philosophy.

ERIC Educational Resources Information Center

Latham, Jackie E. M.

2002-01-01

Focuses on Johann H. Pestalozzi, James Pierrepont Greaves, and Reverend Charles Mayo. States that Greaves and Mayo disseminated Pestalozzi's ideas and techniques in England. Explains that Pestalozzi and Greaves trained elementary teachers to view students' talents and personal growth as a whole person concept. Argues less effort would limit…

78 FR 11094 - Drawbridge Operation Regulation; James River, Between Isle of Wight and Newport News, VA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-15

... Operation Regulation; James River, Between Isle of Wight and Newport News, VA AGENCY: Coast Guard, DHS... River, mile 5.0, between Isle of Wight and Newport News, VA. This deviation is necessary to facilitate... Isle of Isle and Newport News, VA opens on signal. The James River Bridge has vertical clearances in...

Clinical trial tests combinations of immunotherapy drugs for prostate cancer | Center for Cancer Research

Cancer.gov

Metastatic castration-resistant prostate cancer (mCRPC) is a disease that has spread beyond the prostate and no longer responds to hormone therapy. James Gulley, M.D., Ph.D., of the Genitourinary Malignancies Branch is leading a study of combination immunotherapy where patients will be treated with two, three or four drugs that affect the immune system in different ways to

James J. Gallagher: Man in the White Hat

ERIC Educational Resources Information Center

Jolly, Jennifer L.; Robinson, Ann

2014-01-01

In classic Western movies, the good guy could be frequently identified by his trademark white Stetson hat, whereas the bad guy always wore black. James J. Gallagher wore many hats during his career that spanned over six decades; he too would be known as the "man in the white hat,"--trusted to do the right thing. From 1967 to 1970,…

5. Historic American Buildings Survey James C. Massey, Photographer 1964 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. Historic American Buildings Survey James C. Massey, Photographer 1964 MAIN (SOUTH) ENTRANCE DETAIL (4x5' b&w film copy neg. from 35mm slide) - Albert F. Madlener House, 4 West Burton Place, Chicago, Cook County, IL

Safety and tolerability of combination therapy vs. standard treatment alone for patients with previously treated non-small cell lung cancer | Center for Cancer Research

Cancer.gov

Dr. James Gulley is leading a team to test the safety and tolerability of the combination of nivolumab and CV301 to see if it can improve the survival for patientis with metastatic non-small cell lung cancer.  Learn more...

Sir James Reid and the Death of Queen Victoria: An Early Model for End-of-Life Care.

PubMed

Abrams, Robert C

2015-12-01

An appraisal of the last ten days of Queen Victoria's life, viewed primarily from the perspective of her personal physician, Sir James Reid, is presented. Sir James' clinical encounters with his patient and the Royal Family are examined to reveal his strategic and medical thinking and gauge his level of success in basic palliative aims. It was found that the lack of effective medical interventions, tensions within the Royal Family, the importance of his post to Sir James' professional career, and the political ramifications unavoidably connected with the illness of a head of state, all presented challenges to Reid's efforts to ease the physical and emotional pain of Queen Victoria's dying. Key features of Sir James' approach included reliance on physician-patient and physician-family relationships, emphasis on emotional support for the patient, and the careful selection of interventions for the family. In the first years of the 20th century, an era when the contemporary concepts of palliative care, hospice, and family dynamics did not exist, Sir James' management of the Queen's final illness suggested an early model for end-of-life care. By the end of Queen Victoria's life, Sir James was seen to have preserved his patient's comfort and dignity, at the same time advancing family and societal acceptance of the death of this matriarchal figure. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Predictors of hospital stay and home care services use: a population-based, retrospective cohort study in stage IV gastric cancer.

PubMed

Mahar, Alyson L; Coburn, Natalie G; Viola, Raymond; Johnson, Ana P

2015-02-01

Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis. To examine disease, patient and healthcare system predictors of hospital stay, and home care services use in metastatic gastric cancer patients. This is a population-based, retrospective cohort study. Chart review and administrative data were linked, using a 26-month time horizon to collect health services data. All patients diagnosed with metastatic gastric cancer in the province of Ontario between 2005 and 2008 were included in the study (n = 1433). Age, comorbidity, tumor location, and burden of metastatic disease were identified as predictors of hospital stay and receipt of home care services. Individuals who received home care services spent fewer days in hospital than individuals who did not (relative risk: 0.44; 95% confidence interval: 0.38-0.51). Patients who interacted with a high-volume oncology specialist had shorter cumulative hospital stay (relative risk: 0.62; 95% confidence interval: 0.54-0.71) and were less likely to receive home care services (relative risk: 0.80; 95% confidence interval: 0.72-0.88) than those who did not. Examining how differences in hospital stay and home care services use impact clinical outcomes and how policies may reduce costs to the healthcare system is necessary. © The Author(s) 2014.

Astronaut James D. van Hoften examines student experiment on Challenger

NASA Technical Reports Server (NTRS)

1984-01-01

Astronaut James D. van Hoften, 41-C mission specialist, holds an aluminum box full of honeybees. The experiment in earth orbit is duplicated with another colony of the bees on earth. This is an experiment submitted by student researchers.

ASTRONAUT JAMES A. LOVELL, JR. - MISC. - GT-7 RECOVERY

NASA Image and Video Library

1965-12-18

S65-61828 (18 Dec. 1965) --- Astronaut James A. Lovell Jr., pilot of the Gemini-7 spaceflight, is hoisted from the water by a recovery helicopter from the Aircraft Carrier USS Wasp. Astronaut Frank Borman, command pilot, waits in the raft to be hoisted aboard the helicopter. Photo credit: NASA

THE JAMES MADISON WOOD QUADRANGLE, STEPHENS COLLEGE, COLUMBIA, MISSOURI.

ERIC Educational Resources Information Center

MCBRIDE, WILMA

THE JAMES MADISON WOOD QUADRANGLE AT STEPHENS COLLEGE IS A COMPLEX OF BUILDINGS DESIGNED TO MAKE POSSIBLE A FLEXIBLE EDUCATIONAL ENVIRONMENT. A LIBRARY HOUSES A GREAT VARIETY OF AUDIO-VISUAL RESOURCES AND BOOKS. A COMMUNICATION CENTER INCORPORATES TELEVISION AND RADIO FACILITIES, A FILM PRODUCTION STUDIO, AND AUDIO-VISUAL FACILITIES. THE LEARNING…

[Delocalizing the mind. Peirce, James, Wittgenstein, Descombes].

PubMed

Chauviré, Christiane

2010-01-01

The cognitive sciences have breathed fresh air into the old problem of localizing mental functions, which was often laughed off. Regarding the most philosophical form of the question on the localization of the mind, authors such as Peirce, James, Wittgenstein, and most recently Descombes have imagined delocalizing the mind in order to spread the conviction that the idea itself of a location of the mental is meaningless and to criticize the localisationism of today's cognitive scientists.

End-of-life care in lung cancer patients in Ontario: aggressiveness of care in the population and a description of hospital admissions.

PubMed

Barbera, Lisa; Paszat, Lawrence; Qiu, Feng

2008-03-01

The purpose of this study was to describe (1) the aggressiveness of care in a population of patients who die of lung cancer and (2) differences in care between a sample of lung cancer patients who died in an acute care hospital (DH) and a sample of lung cancer patients who were admitted to hospital during the last six months of life but were discharged and died elsewhere (DO). All lung cancer deaths in 2002 were identified in the provincial registry. Cases were linked to administrative sources of health care data to describe the population as a whole and the aggressiveness of the care that they received. Primary data were collected from a province-wide sample of patients' hospital charts focusing on reasons for admission, care in hospital, advanced planning, pain, and disposition. In total, 5,855 patients who died of lung cancer in 2002 were eligible for inclusion in the cohort. Rates of in-hospital death, emergency room visits, intensive care unit admissions, and chemotherapy use near the end of life were 59.5%, 32.2%, 5.5%, and 4.6%, respectively. The records of 491 patients were abstracted for this study. The DH and DO groups were similar with respect to age, gender, neighborhood income level, and extent of metastatic disease. The most common chief complaints were shortness of breath, pain, inability to cope at home, and altered level of consciousness. Compared to patients in the DO group, those in the DH group presented with pain more often (19% vs. 10%, P<0.005) and were more likely to be admitted with progressive chest malignancy (30% vs. 21%, P<0.05). Regardless of reason for admission, pain was commonly documented as a problem during admission: 73.5% in the DH group and 62.4% in the DO group (P<0.05). Lung cancer patients are heavy users of acute care beds and the emergency room at the end of life. Those who do or do not die in hospital are similar in many respects but our results suggest those dying in hospital have more problems with pain and burden from

Incidence of Hydronephrosis in Cervical Cancer Patients in A Tertiary Hospital Lagog, Nigeria.

PubMed

Sowunmi, A C; Ajekigbe, A T; Alabi, A O; Popoola, A O; Fatiregun, O A; Akinyanju, A M

2015-01-01

Cervical cancer is still a global health challenge that affects women of reproductive age group and consequently causes a drawback on the social and economic stability of nations. Developing countries suffer a greater burden of the disease because of several factors such as poverty, multiple sexual partners, unbalanced diet, poor knowledge and attitude to prevention of diseases and late-presentation. The aim of this study is to evaluate the incidence of hydronephrosis in cervical cancer patients in Lagos University Teaching Hospital (LUTH), Lagos, Nigeria for the period of 3 years (2010-2012). This study is a cross sectional study carried out among cervical cancer patients seeking treatment in the Radiotherapy department of the Lagos University Teaching Hospital (LUTH), between the year 2010 and 2012, to find out the incidence of hydronephrosis using abdominopelvic ultrasonography. The incidence of hydronephrosis during the 3years period studied was 43.7%. A rise in the incidence of hydronephrosis of 5.4% in 2011 and 13.3% in 2012 was noted. The mean age of the patients was 55.5 years. 122 (56.7%) were grand multiparous and 123 (57.2%) had multiple sexual partners. An increase of 8.3% in 2011 and 9.3% in 2012 was noted in the incidence of cervical cancer cases studied. 107 (49.8%) presented at stages III and IV. Late presentation of patients is still a major challenge affecting treatment outcomes. The presence of hydronephrosis was noticed at staging, during or after treatment, resulting in the need to separate this population from current Stage IIIB classification. The presence of hydronephrosis may or may not be related to the disease and so adequate staging is important.

Reaching beyond Uncle William: a century of William James in theory and in life.

PubMed

Croce, Paul J

2010-11-01

During the hundred years since his death, James's works have developed a reputation for literary flair and personal appeal, but also for inconsistency and lack of rigor; this has contributed to more admiration than influence. He had a talent rare among intellectuals for popularization of complex ideas. Meanwhile, his difficult coming of age and his compelling personality have contributed to an iconic status as a kind of uncle figure in philosophy, psychology, religious studies, and more fields that he influenced, and in American intellectual life in general, rather than as a major philosopher and scholar. Often reflecting these ways of depicting James, his biographies have gone through three phases: in the early-to-middle twentieth century, emphasis on his development of theories as solutions to personal problems; since the 1960s, increased scrutiny of deep troubles in his private life; and recently renewed attention to intellectual factors especially as amplified by greater appreciation of James's theories in the last generation. Now, with so much knowledge and insight achieved for understanding his personal life and his contributions to many fields, a next frontier for biographical work will be in synthesis of these strands of the life of William James. Recent and prospective work offers the promise of finding deeper meaning and implications in his work beyond, and even through, his informal style, and with integration of his apparent inconsistencies.

History through Red Eyes: A Conversation with James Loewen

ERIC Educational Resources Information Center

Jetty, Mike

2006-01-01

This article presents a conversation with James Loewen. Loewen is an author, historian, and professor. In a recent conversation with the author, he shared his views on how American Indian topics and events are traditionally taught and offered his insights into what teachers can do to accommodate multiple perspectives in their examination of…

Beyond Walls: A Strategic Plan for James White Library.

ERIC Educational Resources Information Center

Andrews Univ., Berrien Springs, MI. James White Library.

The strategic plan for the James White Library of Andrews University uses the phrase "beyond walls," rather than the catchphrase "library without walls," to acknowledge that printed matter is here to stay but that the paradigm in which it operates is open to innovation and exploration. The fundamental changes taking place in…

A Shattering Epiphany in James Joyce's "Araby"

ERIC Educational Resources Information Center

Rokeya, Ms.; Ahammed, A.K. Zunayet

2017-01-01

This article attempts to show an adolescent boy's continuing process of self-realisation through his disillusionment with the bleak reality of Dublin in the early twentieth century in the short story "Araby" by James Joyce. Brought up in the drab and deadening surroundings with his uncle and aunt in conservative Catholic cultures, the…

Clinical profiles and trend analysis of newly diagnosed lung cancer in a tertiary care hospital of East China during 2011-2015.

PubMed

Wang, Pingli; Zou, Jixia; Wu, Jingni; Zhang, Chengyan; Ma, Chengxi; Yu, Juan; Zhou, You; Li, Baizhou; Wang, Kai

2017-07-01

More than one-third of lung cancer worldwide occurring in China. However, the clinical profiles of lung cancer patients in the mainland of China are rarely reported and largely unknown. The objective of this study is to analyze the characteristics and time trends of newly diagnosed lung cancer cases during the past 5 years in East China. The data came from an academic tertiary care hospital of East China. Patients who were newly diagnosed as lung cancer from 2011 to 2015 were enrolled. All new cases got pathological supports by lung biopsy or surgery. Tumor staging was performed according to the seventh edition of the tumor node metastasis (TNM) classification of malignant tumors. The patients' disease information was collected from the database of the hospital information system (HIS). From 2011 to 2015, aggregately 5,779 patients, including 3,719 males and 2,060 females, were diagnosed as lung cancer. The major histologic subtypes of lung cancer were adenocarcinoma (ADC, 60.0%), squamous cell carcinoma (SCC, 25.6%), small cell lung cancer (SCLC, 8.5%), large cell carcinoma (0.6%), adenosquamous carcinoma (1%), other non-small cell carcinoma (1.6%) and unclassified or rare carcinoma (2.8%). ADC proportion of female was much higher than that of male. A higher proportion of advanced stage (stage IIIB, IV) of lung cancer existed in patients who were admitted to hospital due to respiratory or cancer related symptoms (RCRS) than those without RCRS. Smoking rate in male patients reached 80.2%, while it was only 2.7% in females. EGFR mutation existed in 66% of female and 37% of male patients with ADC. This study demonstrates the clinicopathologic characteristics of lung cancer patients from East China, including histologic composition, staging proportion, smoking prevalence and gene mutation status. During the past 5 years, the proportion of ADC has increased gradually whereas SCC decreased.

Studies demonstrate modified T cells effective in treating blood-borne cancers

Cancer.gov

At the 2013 American Society of Hematology meeting in Dec. 2013, James Kochenderfer, M.D., NCI, presented findings from two clinical trials evaluating the use of genetically modified immune system T cells as cancer therapy. These reports represent import

Public performance reporting and hospital choice: a cross-sectional study of patients undergoing cancer surgery in the Australian private healthcare sector

PubMed Central

Bismark, Marie; Dunt, David; Miller, Julie A.; Kelaher, Margaret

2018-01-01

Objectives National mandatory public performance reporting (PPR) for Australian public hospitals, including measures of cancer surgery waiting times, was introduced in 2011. PPR is voluntary for private hospitals. The aims of this study were to assess whether PPR of hospital data is used by patients with breast, bowel or lung cancer when selecting a hospital for elective surgery and how PPR could be improved to meet their information needs. Design A national cross-sectional postal questionnaire. Setting Australian private healthcare sector. Participants Private patients with breast, bowel or lung cancer who attended a public or private hospital for elective surgery (n=243) in 2016. Outcome measures Patients’ choice of hospital, use of PPR information and preferred areas of PPR information. Descriptive and conventional qualitative content analyses were conducted. Results Two hundred and twenty-eight respondents (94%) attended a private hospital. Almost half could choose a hospital. Choice of hospital was not influenced by PPR data (92% unaware) but by their specialist (90%). Respondents considered PPR to be important (71%) but they did not want to see the information, preferring their general practitioners (GPs) to tell them about it (40%). Respondents considered surgery costs (59%), complications (58%) and recovery success rates (57%) to be important areas of information that should be publicly reported. Almost half suggested that quality indicators should be reported at the individual clinician level. Analysis of the open-ended questions identified four themes: (1) decision-making factors; (2) data credibility; (3) unmet information needs and (4) unintended consequences. Conclusions PPR of hospital data had no substantial impact on patients’ choice of hospital. Nonetheless, many respondents expressed interest in using it in future. To increase PPR awareness and usability, personalised and integrated information on cost and quality of hospitals is required

33 CFR 165.504 - Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va. 165.504 Section 165.504 Navigation and Navigable... Coast Guard District § 165.504 Newport News Shipbuilding and Dry Dock Company Shipyard, James River...

33 CFR 165.504 - Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va. 165.504 Section 165.504 Navigation and Navigable... Coast Guard District § 165.504 Newport News Shipbuilding and Dry Dock Company Shipyard, James River...

33 CFR 165.504 - Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va. 165.504 Section 165.504 Navigation and Navigable... Coast Guard District § 165.504 Newport News Shipbuilding and Dry Dock Company Shipyard, James River...

33 CFR 165.504 - Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va. 165.504 Section 165.504 Navigation and Navigable... Coast Guard District § 165.504 Newport News Shipbuilding and Dry Dock Company Shipyard, James River...

33 CFR 165.504 - Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Newport News Shipbuilding and Dry Dock Company Shipyard, James River, Newport News, Va. 165.504 Section 165.504 Navigation and Navigable... Coast Guard District § 165.504 Newport News Shipbuilding and Dry Dock Company Shipyard, James River...

77 FR 64718 - Safety Zone; Steam Ship Col. James M. Schoonmaker Relocation Project, Maumee River, Toledo, OH

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

... DEPARTMENT OF HOMELAND SECURITY Coast Guard 33 CFR Part 165 [Docket No. USCG-2012-0939] RIN 1625-AA00 Safety Zone; Steam Ship Col. James M. Schoonmaker Relocation Project, Maumee River, Toledo, OH...-0939 as follows: Sec. 165.T09-0939 Safety Zone; Steam Ship Col. James M. Schoonmaker relocation project...

Reflections on Policy in Gifted Education: James J. Gallagher

ERIC Educational Resources Information Center

Brown, Elissa F.; Garland, Rebecca B.

2015-01-01

In this article, Brown and Garland, reflect on issues raised by James J. Gallagher, such as educational policies helping to create and support an infrastructure within which the needs of students can be addressed. Gallagher felt that a strong federal policy, such as IDEA, was critical to building and maintaining a solid infrastructure. Gallagher…

Dr. John Mather and the James Webb Space Telescope

NASA Image and Video Library

2017-12-08

Nobel Laureate and James Webb Space Telescope project scientist Dr. John Mather takes a selfie with the telescope. May 4, 2016 was a rare day for JWST, as it briefly faced the cleanroom observation window. The telescope was eventually rotated face-down in prep for the installation of the flight instruments. Credit: Meredith Gibb

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

PubMed Central

Dasch, Burkhard; Kalies, Helen; Feddersen, Berend; Ruderer, Caecilie; Hiddemann, Wolfgang; Bausewein, Claudia

2017-01-01

Background Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care. Aim To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital. Methods Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life. Results Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient’s life. Conclusions Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts

Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics.

PubMed

Raine, Rosalind; Wong, Wun; Scholes, Shaun; Ashton, Charlotte; Obichere, Austin; Ambler, Gareth

2010-01-14

To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer. Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006. Hospital episode statistics (HES) dataset. 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer. Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment. Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0

42 CFR 412.23 - Excluded hospitals: Classifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... diagnosis and treatment of mentally ill persons; and (3) Meet the conditions of participation for hospitals... hospital satellite facility as of October 1, 2011. (f) Cancer hospitals—(1) General rule. Except as... as a cancer hospital and is excluded from the prospective payment systems beginning with its first...

42 CFR 412.23 - Excluded hospitals: Classifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... diagnosis and treatment of mentally ill persons; and (3) Meet the conditions of participation for hospitals... hospital satellite facility as of October 1, 2011. (f) Cancer hospitals—(1) General rule. Except as... as a cancer hospital and is excluded from the prospective payment systems beginning with its first...

Astronaut James Newman works with computers and GPS

NASA Image and Video Library

1993-09-20

STS051-16-028 (12-22 Sept 1993) --- On Discovery's middeck, astronaut James H. Newman, mission specialist, works with an array of computers, including one devoted to Global Positioning System (GPS) operations, a general portable onboard computer displaying a tracking map, a portable audio data modem and another payload and general support computer. Newman was joined by four other NASA astronauts for almost ten full days in space.

A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital.

PubMed

Castaldi, Maria; Safadjou, Saman; Elrafei, Tarek; McNelis, John

Cancer health disparities affecting low-income and minority patients have been well documented to lead to poor outcomes. This report examines the impact of patient navigation on adherence to prescribed adjuvant breast cancer treatment. A multidisciplinary patient navigation program was initiated at a public safety net hospital to improve compliance with 3 National Quality Forum measures: (1) administration of combination chemotherapy for women with Stage (defined by the American Joint Committee on Cancer [AJCC]) T1c, II, or III hormone receptor-negative breast cancer within 120 days; (2) administration of endocrine therapy for women with AJCC Stage T1c, II, or III hormone receptor-positive breast cancer within 365 days; and (3) radiation therapy for women receiving breast-conserving surgery within one year. Implementation of a multidisciplinary patient navigation program reduced time to treatment and improved compliance with adjuvant therapy for breast cancer in an underserved minority community.

Keening Woman and Today: James Welch's Early Unpublished Novel

ERIC Educational Resources Information Center

Orton, Thomas

2006-01-01

It was most likely in the spring of 1966 that the late American Indian novelist James Welch wrote his first novel, predating his first published fiction by eight years. The titleless, hand-corrected typescript, stored in his Missoula home for many years, is 114 pages long and unfinished. The book is playful and experimental the way warm-ups…

Alternative Fuels Data Center: James Madison University Teaches Alternative

Science.gov Websites

TransportationA> James Madison University Teaches Alternative Transportation to someone by E-mail public. For information about this project, contact Virginia Clean Cities. Download QuickTime Video Videos Photo of a car Electric Vehicles Charge up at State Parks in West Virginia Dec. 9, 2017 Photo of a

Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

PubMed

Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

2015-08-01

When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exposure to ACEI/ARB and β-Blockers Is Associated with Improved Survival and Decreased Tumor Progression and Hospitalizations in Patients with Advanced Colon Cancer1

PubMed Central

Engineer, Diana R; Burney, Basil O; Hayes, Teresa G; Garcia, Jose M

2013-01-01

BACKGROUND: Advanced colon cancer is associated with weight loss and decreased survival. Studies suggest that angiotensin and β-adrenergic blockade decrease colon cancer progression and ameliorate weight loss. This study aims to determine whether exposure to β-adrenoceptor blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) is associated with decreased mortality, tumor progression, number of hospitalizations, or weight loss in colorectal cancer. METHODS: Retrospective chart review included patients with advanced colorectal cancer. Survival, stage, hospitalization, cancer progression, cancer treatment, and body weight history were collected. RESULTS: Two hundred sixty-two of 425 new stage III to IV colorectal cancer cases reviewed met the study criteria. Those exposed to ACEI/ARB, BB, or both were more likely to have diabetes, hypertension, and stage III colorectal cancer. Adjusting for age, presence of hypertension and diabetes, and stage, ACEI/ARB + BB exposure was associated with decreased mortality compared to unexposed individuals [hazard ratio (HR) = 0.5, confidence interval (CI) = 0.29–0.85; Cox regression, P = .01]. Fewer total and cancer-related hospitalizations and decreased cancer progression in the ACEI/ARB + BB group versus the unexposed group (HR = 0.59, CI = 0.36–0.99, P = .047) were seen. Exposure did not affect weight changes; furthermore, body weight changes from both prediagnosis and at diagnosis to 6, 12, 18, and 24 months postdiagnosis predicted survival. CONCLUSIONS: We have observed an association between exposure to a combination of ACEI/ARB + BB and increased survival, decreased hospitalizations, and decreased tumor progression in advanced colorectal cancer. Future studies will be needed to replicate these results and generalize them to broader populations. Determination of causality will require a randomized controlled trial. PMID:24151534

Surgery Branch recruiting patients to study new treatment for cancers with RAS mutations | Center for Cancer Research

Cancer.gov

RAS is a family of proteins that send signals to genes involved in cell growth and is mutated in approximately a quarter of all human cancers. James Yang, M.D., of the Surgery Branch is leading a team of investigators who have generated a special T-cell receptor from mouse cells that can recognize a mutation of RAS that is found in many human cancer cells. The goal is to determine if a new therapy is safe and can help shrink tumors that have the G12V RAS mutation. Read more...

APOLLO 13 CREW JOHN SWIGERT, JAMES LOVELL, AND FRED HAISE

NASA Technical Reports Server (NTRS)

1970-01-01

John L. Swigert, Jr., left, the Apollo 13 backup crewman being considered as command module pilot in place of Thomas K. Mattingly II because of the latter's exposure to measles, has been training with the prime crew -- James A. Lovell, Jr., center and Fred W. Haise, Jr.

75 FR 16520 - James A. Fitzpatrick Nuclear Power Plant; Exemption

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-01

... date for all operating nuclear power plants, but noted that the Commission's regulations provide... Power Plant; Exemption 1.0 Background Entergy Nuclear Operations, Inc. (the licensee) is the holder of Facility Operating License No. DPR-59, which authorizes operation of the James A. FitzPatrick Nuclear Power...

[Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume].

PubMed

Ortiz, Héctor; Biondo, Sebastiano; Codina, Antonio; Ciga, Miguel Á; Enríquez-Navascués, José; Espín, Eloy; García-Granero, Eduardo; Roig, José Vicente

2016-04-01

This multicentre observational study aimed to determine the anastomotic leak rate in the hospitals included in the Rectal Cancer Project of the Spanish Society of Surgeons and examine whether hospital volume may contribute to any variation between hospitals. Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all adenocarcinomas of the rectum operated by an anterior resection at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, use of defunctioning stoma, tumour location and stage, administration of neoadjuvant treatment, and annual volume of elective surgical procedures. A total of 7231 consecutive patients were included. The rate of anastomotic leak was 10.0%. Stratified by annual surgical volume hospitals varied from 9.9 to 11.3%. In multilevel regression analysis, the risk of anastomotic leak increased in male patients, in patients with tumours located below 12 cm from the anal verge, and advanced tumour stages. However, a defunctioning stoma seemed to prevent this complication. Hospital surgical volume was not associated with anastomotic leak (OR: 0.852, [0.487-1.518]; P=.577). Furthermore, there was a statistically significant variation in anastomotic leak between all departments (MOR: 1.475; [1.321-1.681]; P<0.001). Anastomotic leak varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Escalation of Oncologic Services at the End of Life Among Patients With Gynecologic Cancer at an Urban, Public Hospital

PubMed Central

Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G.

2015-01-01

Purpose: Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Methods: Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Results: Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P < .001), with the most dramatic changes occurring during the last 2 months. Patients with longer duration of continuity of care used significantly fewer resources toward the end of life. Conclusion: To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. PMID:25604595

Escalation of oncologic services at the end of life among patients with gynecologic cancer at an urban, public hospital.

PubMed

Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G

2015-03-01

Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P < .001), with the most dramatic changes occurring during the last 2 months. Patients with longer duration of continuity of care used significantly fewer resources toward the end of life. To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. Copyright © 2015 by American Society of Clinical Oncology.

Cancer patient experience with navigation service in an urban hospital setting: a qualitative study.

PubMed

Gotlib Conn, L; Hammond Mobilio, M; Rotstein, O D; Blacker, S

2016-01-01

Cancer patient navigators are increasingly present on the oncology health care team. The positive impact of navigation on cancer care is recognised, yet a clear understanding of what the patient navigator does and how he/she executes the role continues to emerge. This study aimed to understand cancer patients' perceptions of, and experiences with patient navigation, exploring how navigation may enhance the patient experience in an urban hospital setting where patients with varying needs are treated. A qualitative study using a constructionist approach was conducted. Fifteen colorectal cancer patients participated in semi-structured telephone interviews. Data were analyzed inductively and iteratively. Findings provide insight into two central aspects of cancer navigation: navigation as patient-centred coordination and explanation of clinical care, and navigation as individualised, holistic support. Within these themes, the key benefits of navigation from the patients' perspective were demystifying the system; ensuring comprehension, managing expectations; and, delivering patient-centred care. The navigator provided individualised and extended family support; a holistic approach; and, addressed emotional and psychological needs. These findings provide a means to operationalise and validate an emerging role description and competency framework for the cancer navigator who must identify and adapt to patients' varying needs throughout the cancer care continuum. © 2014 John Wiley & Sons Ltd.

75 FR 59237 - TRICARE Co-Pay Waiver at Captain James A. Lovell Federal Health Care Center Demonstration Project

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

... Federal Health Care Center Demonstration Project AGENCY: Office of the Secretary, Department of Defense. ACTION: Notice of TRICARE Co-Pay waiver at Captain James A. Lovell Federal Health Care Center... ``TRICARE Co-Pay Waiver at Captain James A. Lovell Federal Health Care (FHCC) Demonstration Project.'' Under...

Trends in head and neck cancers in Peru between 1987 and 2008: Experience from a large public cancer hospital in Lima

PubMed Central

Walter, Leora; Vidaurre, Tatiana; Gilman, Robert H.; Poquioma, Ebert; Olaechea, Carlos; Gravitt, Patti E.; Marks, Morgan A.

2017-01-01

Background Few studies have evaluated the trends in head and neck cancer in developing countries. The purpose of this study was to estimate trends in incidence of human papillomavirus–related (HPV-R) and HPV-unrelated (HPV-U) head and neck cancer in Lima, Peru, from 1987 to 2008. Methods Registry data from a single public cancer hospital were used to estimate age and sex-specific incidence rates. Annualized percent change was estimated using Poisson regression. Results The rate of total head and neck cancers, HPV-U, and HPV-R was 11.9, 10.9, and 0.8, respectively, per 100,000 person-years. Significant increases in HPV-U head and neck cancer were observed in men aged 30 to 44 (2.5%/year) and women 15 to 29 (4.2%/year), 30 to 44 (3.4%/ year), and 60 to 74 (2.0%/year). Significant increases in HPV-R head and neck cancer were observed only among men aged 45 to 59 (9.6%/year). Conclusion Although increased exposure to tobacco, occupational carcinogens, and changing sexual behaviors could be influencing these trends, additional analyses to assess generalizability of these findings to other regions of Peru are needed. PMID:23616366

Occupational risk factors of lung cancer: a hospital based case-control study

PubMed Central

Droste, J. H.; Weyler, J. J.; Van Meerbeeck, J. P.; Vermeire, P. A.; van Sprundel, M. P.

1999-01-01

OBJECTIVES: To investigate the relation between lung cancer and exposure to occupational carcinogens in a highly industrialised region in western Europe. METHODS: In a case-control study 478 cases and 536 controls, recruited from 10 hospitals in the Antwerp region, were interviewed. Cases were male patients with histologically confirmed lung cancer; controls were male patients without cancer or primary lung diseases. Data were collected by questionnaires to obtain information on occupations, exposures, and smoking history. Job titles were coded with the Office of Populations, Censuses and Surveys industrial classification. Exposure was assessed by self report and by job-task exposure matrix. Exposure odds ratios were calculated with logistic regression analysis adjusted for age, smoking history, and marital and socio-economic status. RESULTS: A job history in the categories manufacturing of transport equipment other than automobiles (for example, shipyard workers), transport support services (for example, dockers), and manufacturing of metal goods (for example, welders) was significantly associated with lung cancer (odds ratios (ORs) 2.3, 1.6, and 1.6 respectively). These associations were independent of smoking, education, civil, and economic status. Self reported exposure to potential carcinogens did not show significant associations with lung cancer, probably due to nondifferential misclassification. When assessed by job-task exposure matrix, exposure to molybdenum, mineral oils, and chromium were significantly associated with lung cancer. A strong association existed between smoking and lung cancer: OR of ex- smokers 4.2, OR of current smokers 14.5 v non-smokers. However, smoking did not confound the relation between occupational exposure and lung cancer. CONCLUSIONS: The study has shown a significant excess risk of lung cancer among workers in manufacturing of metal goods, manufacturing of transport equipment (other than automobiles), and transport support

Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

ERIC Educational Resources Information Center

Viney, Linda L.; And Others

1994-01-01

Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

The Thoc1 Ribonucleoprotein as a Novel Biomarker for Prostate Cancer Treatment Assignment

DTIC Science & Technology

2017-10-01

INVESTIGATOR: James L. Mohler, MD CONTRACTING ORGANIZATION: Health Research, Inc., Roswell Park Division Buffalo, NY 14263-0001 REPORT DATE...ORGANIZATION REPORT NUMBER Health Research, Inc. Buffalo,NY 14263 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM...support for cancer clinical trials. Specific Aims: 1. Facilities: Physical facilities dedicated to the conduct of cancer focused research, and to

Hacking the hospital environment: young adults designing youth-friendly hospital rooms together with young people with cancer experiences.

PubMed

Boisen, Kirsten A; Boisen, Anne; Thomsen, Stine Legarth; Matthiesen, Simon Meggers; Hjerming, Maiken; Hertz, Pernille Grarup

2015-12-09

There is a need for youth-friendly hospital environments as the ward environment may affect both patient satisfaction and health outcomes. To involve young people in designing youth-friendly ward environment. We arranged a design competition lasting 42 h (Hackathon). Students in architecture, design, engineering, communication and anthropology participated (27 young adults) - forming eight groups. Adolescents and young adults (AYA) with current or former cancer experience participated as sparring partners. We provided workspace and food during the weekend. The groups presented their products to a jury and relevant stakeholders. The groups created eight unique design concepts. The young designers were extremely flexible listening to ideas and experiences from the young patients, which led to common features including individual and flexible design, privacy in two-bed wardrooms and social contact with other hospitalized AYA. The winning project included an integrated concept for both wardrooms and the AYA day room, including logos and names for the rooms and an 'energy wall' in the day room. A hackathon event was an effective mode of youth participation. The design concepts and ideas were in line with current evidence regarding pleasing hospital environment and youth-friendly inpatient facilities and may be applicable to other young patients.

Prevalence of oral cancer and pre-cancerous lesions and the association with numerous risk factors in North India: A hospital based study

PubMed Central

Gupta, Shalini; Singh, Rajender; Gupta, O. P.; Tripathi, Anurag

2014-01-01

Background: Oral cancer is one of the most common life-threatening diseases all over the world. Developing countries face several challenges to identify and remove potential risk factors. Chewing tobacco/pan masala is considered to be the most potent risk factor for oral precancerous lesions and oral cancer. Objectives: To investigate the relative occurrence of different oral pre-cancerous lesions and oral cancer in North India and to identify the associated risk factors. Materials and Methods: A hospital-based study was conducted and 471 subjects were recruited in the study. The subjects comprised patients with squamous cell carcinoma (n = 85), oral submucous fibrosis (n = 240), leukoplakia (n = 32), lichen planus (n = 15), and controls (n = 99). Statistical analysis of the data was done using Chi-square and regression analysis. Results: A strong correlation was observed between the presence of the chewing habit in all the oral precancerous lesions and oral cancer. Duration of the habit and intensity of habit ware also strongly correlated with the risk of oral precancerous lesions and oral cancer. Other factors such as alcohol and smoking were found to be less important in concern with oral cancer and precancerous lesions. PMID:25937723

7. VARIABLEANGLE LAUNCHER DEDICATION PLAQUE SHOWING JAMES H. JENNISON (LEFT), ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. VARIABLE-ANGLE LAUNCHER DEDICATION PLAQUE SHOWING JAMES H. JENNISON (LEFT), AND W.H. SAYLOR (RIGHT), AT THE DEDICATION CEREMONY, May 7, 1948. (Original photograph in possession of Dave Willis, San Diego, California.) - Variable Angle Launcher Complex, CA State Highway 39 at Morris Reservior, Azusa, Los Angeles County, CA

James Moffett's Mistake: Ignoring the Rational Capacities of the Other

ERIC Educational Resources Information Center

Donehower, Kim

2013-01-01

Using Alasdair MacIntyre's theory of tradition-bound rationalities, this essay analyses James Moffett's depiction of the censors who opposed his "Interactions" textbook series in the Kanawha County, West Virginia, schools. Many reviewers have found Moffett's analysis of the censors in "Storm in the Mountains" even-handed and…

Acute Hospital Care Is The Chief Driver of Regional Spending Variation in Medicare Patients with Advanced Cancer

PubMed Central

Brooks, Gabriel A.; Li, Ling; Uno, Hajime; Hassett, Michael J.; Landon, Bruce E.; Schrag, Deborah

2014-01-01

The root causes of regional variation in medical spending are poorly understood and vary by clinical condition. To identify drivers of regional spending variation for Medicare patients with advanced cancer, we used linked Surveillance, Epidemiology, and End Results (SEER) program–Medicare data from 2004–10. We broke down Medicare spending into thirteen cancer-relevant service categories. We then calculated the contribution of each category to spending and regional spending variation. Acute hospital care was the largest component of spending and the chief driver of regional spending variation, accounting for 48 percent of spending and 67 percent of variation. In contrast, chemotherapy accounted for 16 percent of spending and 10 percent of variation. Hospice care comprised 5 percent of spending; however variation in hospice spending was fully offset by opposing variation in other categories. Our analysis suggests that the strategy with the greatest potential to improve the value of care for patients with advanced cancer is to reduce reliance on acute hospital care for this patient population. PMID:25288424

Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act.

PubMed

Hong, Young; Zheng, Chaoyi; Hechenbleikner, Elizabeth; Johnson, Lynt B; Shara, Nawar; Al-Refaie, Waddah B

2016-07-01

Penalties from the Hospital Readmission Reduction Program can push financially strained, vulnerable patient-serving hospitals into additional hardship. In this study, we quantified the association between vulnerable hospitals and readmissions and examined the respective contributions of patient- and hospital-related factors. A total of 110,857 patients who underwent major cancer operations were identified from the 2004-2011 State Inpatient Database of California. Vulnerable hospitals were defined as either self-identified safety net hospitals (SNHs) or hospitals with a high percentage of Medicaid patients (high Medicaid hospitals [HMHs]). We used multivariable logistic regression to determine the association between vulnerable hospitals and readmission. Patient and hospital contributions to the elevation in odds of readmission were assessed by comparing estimates from models with different subsets of predictors. Of the 355 hospitals, 13 were SNHs and 31 were HMHs. After adjusting for Hospital Readmission Reduction Program variables, SNHs had higher 30-day (odds ratio [OR] = 1.32; 95% CI, 1.18-1.47), 90-day (OR = 1.28; 95% CI, 1.18-1.38), and repeated readmissions (OR = 1.33; 95% CI, 1.18-1.49); HMHs also had higher 30-day (OR = 1.18; 95% CI, 1.05-1.32), 90-day (OR = 1.28; 95% CI, 1.16-1.42), and repeated readmissions (OR = 1.24; 95% CI, 1.01-1.54). Compared with patient characteristics, hospital factors accounted for a larger proportion of the increase in odds of readmission among SNHs (60% to 93% vs 24% to 39%), but a smaller proportion among HMHs (9% to 15% vs 60% to 115%). Vulnerable status of hospitals is associated with higher readmission rates after major cancer surgery. These findings reinforce the call to account for socioeconomic variables in risk adjustments for hospitals who serve a disproportionate share of disadvantaged patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.