Following NCCN guidelines within one hospital system in the United States: Comparison between cancer centers and genetic counselor utilization

2021 ◽  
Author(s):  
Karen Powell ◽  
Jonathan Rakestraw ◽  
Sat Gupta ◽  
Wenhao Shou ◽  
Kyung Lee ◽  
...  
Keyword(s):  
United States ◽  
Genetic Counselor ◽  
The United States ◽  
Hospital System ◽  
Cancer Centers ◽  
Nccn Guidelines

Professional values, job satisfaction, career development, and intent to stay

2016 ◽  
Vol 24 (6) ◽  
pp. 675-685 ◽  
Author(s):  
Susan Yarbrough ◽  
Pam Martin ◽  
Danita Alfred ◽  
Charleen McNeill
Keyword(s):  
United States ◽  
Job Satisfaction ◽  
Career Development ◽  
Intent To Stay ◽  
The United States ◽  
Early Career ◽  
Professional Values ◽  
Convenience Sample ◽  
Hospital System ◽  
The Future

Background: Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse—an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. Research objective: The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. Research design: A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. Findings: Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. Discussion: Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. Conclusion: Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.

Clinical genetic counselor experience in the adoption of telehealth in the United States and Canada during the COVID‐19 pandemic

2021 ◽  
Author(s):  
Daria Ma ◽  
Priyanka R. Ahimaz ◽  
James M. Mirocha ◽  
Lola Cook ◽  
Jessica L. Giordano ◽  
...  
Keyword(s):  
United States ◽  
Genetic Counselor ◽  
The United States ◽  
Clinical Genetic

scholarly journals AIDS-Related Kaposi Sarcoma, Version 2.2019

2019 ◽  
Vol 17 (2) ◽  
pp. 171-189 ◽  
Author(s):  
Erin Reid ◽  
Gita Suneja ◽  
Richard F. Ambinder ◽  
Kevin Ard ◽  
Robert Baiocchi ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
Clinical Practice ◽  
General Population ◽  
Kaposi Sarcoma ◽  
The United States ◽  
People Living With Hiv ◽  
Nodal Disease ◽  
Nccn Guidelines ◽  
Living With Hiv

As treatment of HIV has improved, people living with HIV (PLWH) have experienced a decreased risk of AIDS and AIDS-defining cancers (non-Hodgkin’s lymphoma, Kaposi sarcoma, and cervical cancer), but the risk of Kaposi sarcoma in PLWH is still elevated about 500-fold compared with the general population in the United States. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AIDS-Related Kaposi Sarcoma provide diagnosis, treatment, and surveillance recommendations for PLWH who develop limited cutaneous Kaposi sarcoma and for those with advanced cutaneous, oral, visceral, or nodal disease.

scholarly journals Reflex Immunohistochemistry and Microsatellite Instability Testing of Colorectal Tumors for Lynch Syndrome Among US Cancer Programs and Follow-Up of Abnormal Results

2012 ◽  
Vol 30 (10) ◽  
pp. 1058-1063 ◽  
Author(s):  
Laura C. Beamer ◽  
Marcia L. Grant ◽  
Carin R. Espenschied ◽  
Kathleen R. Blazer ◽  
Heather L. Hampel ◽  
...  
Keyword(s):  
United States ◽  
Lynch Syndrome ◽  
Microsatellite Instability ◽  
Community Hospital ◽  
Response Rate ◽  
Standard Of Care ◽  
The United States ◽  
Cancer Centers ◽  
Abnormal Results

Purpose Immunohistochemistry (IHC) for MLH1, MSH2, MSH6, and PMS2 protein expression and microsatellite instability (MSI) are well-established tools to screen for Lynch syndrome (LS). Although many cancer centers have adopted these tools as reflex LS screening after a colorectal cancer diagnosis, the standard of care has not been established, and no formal studies have described this practice in the United States. The purpose of this study was to describe prevalent practices regarding IHC/MSI reflex testing for LS in the United States and the subsequent follow-up of abnormal results. Materials and Methods A 12-item survey was developed after interdisciplinary expert input. A letter of invitation, survey, and online-survey option were sent to a contact at each cancer program. A modified Dillman strategy was used to maximize the response rate. The sample included 39 National Cancer Institute–designated Comprehensive Cancer Centers (NCI-CCCs), 50 randomly selected American College of Surgeons–accredited Community Hospital Comprehensive Cancer Programs (COMPs), and 50 Community Hospital Cancer Programs (CHCPs). Results The overall response rate was 50%. Seventy-one percent of NCI-CCCs, 36% of COMPs, and 15% of CHCPs were conducting reflex IHC/MSI for LS; 48% of the programs used IHC, 14% of the programs used MSI, and 38% of the programs used both IHC and MSI. One program used a presurgical information packet, four programs offered an opt-out option, and none of the programs required written consent. Conclusion Although most NCI-CCCs use reflex IHC/MSI to screen for LS, this practice is not well-adopted by community hospitals. These findings may indicate an emerging standard of care and diffusion from NCI-CCC to community cancer programs. Our findings also described an important trend away from requiring written patient consent for screening.

scholarly journals Heterogeneity of Minimal/Measurable Residual Disease (MRD) Practices in Adult B-Cell Precursor Acute Lymphoblastic Leukemia (BCP-ALL) in the United States

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4478-4478
Author(s):  
Juliana E. Hidalgo-Lopez ◽  
Gail J. Roboz ◽  
Brent Wood ◽  
Michael Borowitz ◽  
Elias J. Jabbour ◽  
...  
Keyword(s):  
United States ◽  
Bone Marrow ◽  
Best Practices ◽  
Stock Options ◽  
Research Funding ◽  
The United States ◽  
Bone Marrow Sample ◽  
Sample Collection ◽  
Nccn Guidelines ◽  
Privately Held

Abstract Background: MRD testing in BCP-ALL is critical for appropriate patient management, but little is known regarding sample acquisition and testing heterogeneity across clinical practice settings. These factors may impact the quality and reliability of MRD assessment. Methods: Thirty-minute online surveys were conducted in May 2021 with hematologists/oncologists (HEME/ONCs) in the United States in both academic (acad) and community (comm) settings. Respondents were licensed physicians board certified in oncology and/or hematology who treated ≥2 BCP-ALL patients/year or ≥10 patients in the past 5 years, with over 25% of time spent in the clinical setting; pediatric HEME/ONCs were excluded. Survey enrollment is ongoing, with interim results presented here; a related survey for pathologists (PATHs) is underway. Results: HEME/ONC respondents (acad n=40, comm n=57, from 29 states) had been practicing as specialists for a median of between 11-15 years (choices were ranges, eg 6-10, 11-15, min-max was 1-34 years), and typically spent over 75% of their time in the clinic; 94% of respondents had ≥5 BCP-ALL patients/year and 92% ordered MRD tests for ≥5 patients/year. Typical timepoints for MRD testing included the end of induction/suspected complete remission, the end of consolidation, and at suspected disease progression; testing after the end of consolidation was infrequent in both groups (Table). Testing for MRD at the end of consolidation was notably more frequent in the academic setting. In both settings, the HEME/ONC ordering the MRD test generally also performed the bone marrow collection procedure (acad: 78%, comm: 56%). Resources consulted on bone marrow collection best practices included UpToDate (21%), ASH and ASCO (13%), NCCN guidelines (13%), and hematology/oncology journals. About half of practices had defined institutional protocols for bone marrow collection (acad: 55%, comm: 47%), nearly all of which were developed internally. The amount of bone marrow sample collected showed high variability, ranging from 1-10 draws (median=3) and 1-30 mL sample per draw (median=5 mL). While 49% of HEME/ONCs performed <5 draws and extracted ≤6 mL per draw, 22% collected 10 mL/draw, and 10% collected 20 mL/draw; the remaining 18% reported >5 draws and/or >6 mL per draw. In both settings, the first pull was identified and labeled in 35% of procedures; in those cases, the first-pull samples were used primarily for MRD testing in 60% of cases as recommended by NCCN guidelines (vs for morphology assessment and cytogenetic studies). HEME/ONCs typically relied on the expertise of pathologists to choose MRD testing methodology.Survey results indicate that external labs (both national clinical reference labs and commercial labs) were most commonly used for MRD assessments (63%); comm HEME/ONCs were more likely to use external reference labs and acad HEME/ONCs were more likely to use in-house labs. When asked to estimate the frequency with which different MRD methods were used, mean responses were 54% flow cytometry and 40% next-generation sequencing. While all HEME/ONCs indicated that MRD results were presented clearly in lab reports, there was a desire to include more guideline information about MRD interpretation and BCP-ALL treatment. Conclusion: Interim results identified broad heterogeneity in clinical practices affecting sample collection for MRD assessment in Ph- BCP-ALL in the US, indicating several opportunities for harmonization of routine MRD assessment in BCP-ALL. These opportunities include optimization of bone marrow sample collection techniques (volume/draw and identification/use of first pull for MRD), timing/frequency of specimen collection, serial MRD surveillance after consolidation, MRD method chosen, and standardizing reports to include guideline information. There were gaps in awareness of FDA-approved methods of MRD testing for BCP-ALL. Initiatives supporting provider education and harmonization of best practices from professional guideline committees/organizations are needed to optimize outcomes of BCP-ALL patients. Figure 1 Figure 1. Disclosures Hidalgo-Lopez: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Roboz: Janssen: Research Funding; Daiichi Sankyo: Consultancy; MEI Pharma - IDMC Chair: Consultancy; Actinium: Consultancy; AbbVie: Consultancy; Mesoblast: Consultancy; Bayer: Consultancy; Blueprint Medicines: Consultancy; Jazz: Consultancy; Janssen: Consultancy; Astex: Consultancy; Celgene: Consultancy; Bristol Myers Squibb: Consultancy; Agios: Consultancy; Astellas: Consultancy; Jasper Therapeutics: Consultancy; Helsinn: Consultancy; Glaxo SmithKline: Consultancy; Novartis: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy; Otsuka: Consultancy; Pfizer: Consultancy; Roche/Genentech: Consultancy. Wood: Pfizer, Amgen, Seattle Genetics: Honoraria; Juno, Pfizer, Amgen, Seattle Genetics: Other: Laboratory Services Agreement. Borowitz: Amgen, Blueprint Medicines: Honoraria. Jabbour: Amgen, AbbVie, Spectrum, BMS, Takeda, Pfizer, Adaptive, Genentech: Research Funding. Velasco: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Elkhouly: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Adedokun: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Zaman: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Iskander: Amgen Inc.: Current Employment, Current holder of stock options in a privately-held company. Logan: Amgen, Pfizer, AbbVie: Consultancy; Pharmacyclics, Astellas, Jazz, Kite, Kadmon, Autolus, Amphivena: Research Funding.

Continuous Quality Improvement in a Hospital System: Implications for Hospital Epidemiology

1992 ◽  
Vol 13 (5) ◽  
pp. 288-292 ◽  
Author(s):  
Michael D. Decker ◽  
William E. Scheckler
Keyword(s):  
United States ◽  
Quality Improvement ◽  
Infection Control ◽  
Continuous Quality Improvement ◽  
The United States ◽  
Teaching Hospitals ◽  
Hospital Epidemiology ◽  
Hospital System ◽  
Continuous Quality ◽  
Key Steps

The purpose of this report is to describe the “Continuous Quality Improvement” (CQI) paradigm as adopted by one of the 30 largest hospital systems in the United States and to explore the implications for hospital epidemiology and infection control. Hospital epidemiology has its roots in the application of epidemiologic tools and principles to the problems of nosocomial infections. Key steps in the development of hospital epidemiology came from physicians in Great Britain and the United States who were part of the public health systems of those countries. In the United States, physicians trained in infectious diseases as a subspecialty occupy the position of hospital epidemiologist in most university, Veterans Affairs, and larger community teaching hospitals. Some of these individuals argue that hospital epidemiologists should continue to focus principally on infection control. Others are just as convinced that the premises and knowledge of epidemiology honed by experiences in infection control are very well suited to many other problems facing hospitals in the 1990s.

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