scholarly journals Delivering Equitable Care to Underserved Neuro-oncology Populations

2021 ◽  
pp. 1-9
Author(s):  
Alyx B. Porter ◽  
Ugonma N. Chukwueke ◽  
Aaron G. Mammoser ◽  
Bret Friday ◽  
Shawn Hervey-Jumper
Keyword(s):  
Clinical Trials ◽  
Multidisciplinary Care ◽  
The United States ◽  
Limited Attention ◽  
Provider Education ◽  
Supportive Services ◽  
Marginalized Communities ◽  
Underserved Groups ◽  
Oncologic Diseases

It is widely recognized that subspecialized multidisciplinary care improves neuro-oncology outcomes. Optimizing patient outcomes relies on the expertise of the treating physicians, neuroradiology and neuropathology, and supportive services familiar with common neurologic syndromes that occur after brain tumor diagnosis and treatment. Despite an increasing number of providers, patient access to specialized multidisciplinary care and clinical trials remains limited. Barriers to equitable health care exist across the United States, with marginalized communities being impacted disproportionately. Such disparity causes increased morbidity and mortality for patients from backgrounds with various elements of diversity. Limited attention to this inequity has resulted in an incomplete understanding of the spectrum of experiences that patients with neuro-oncologic diseases encounter. Clinical trials represent the highest standard and quality of care in medicine, but inclusion of under-represented and underserved groups consistently lags behind counterpart participants from majority racial and ethnic groups. Through provider education as it pertains to issues from bias and health literacy to increasing clinical trial enrollment and offering opportunities through telemedicine, opportunities for improving access to high-quality neuro-oncologic care are explored.

scholarly journals Planning for the First and Last Mile: A Review of Practices at Selected Transit Agencies in the United States

2021 ◽  
Vol 13 (4) ◽  
pp. 2222
Author(s):  
Hossain Mohiuddin
Keyword(s):  
Los Angeles ◽  
Gap Analysis ◽  
The United States ◽  
Design Guidelines ◽  
Plan Implementation ◽  
Marginalized Communities ◽  
Transit Ridership ◽  
Last Mile ◽  
Transit Agencies

A transit trip involves travel to and from transit stops or stations. The quality of what are commonly known as first and last mile connections (regardless of their length) can have an important impact on transit ridership. Transit agencies throughout the world are developing innovative approaches to improving first and last mile connections, for example, by partnering with ride-hailing and other emerging mobility services. A small but growing number of transit agencies in the U.S. have adopted first and last mile (FLM) plans with the goal of increasing ridership. As this is a relatively new practice by transit agencies, a review of these plans can inform other transit agencies and assist them in preparing their own. Four FLM plans were selected from diverse geographic contexts for review: Los Angeles County Metropolitan Transportation Authority (LA Metro), Riverside (CA) Transit Agency (RTA), and Denver Regional Transit District (RTD), and City of Richmond, CA. Based on the literature, we developed a framework with an emphasis on transportation equity to examine these plans. We identified five common approaches to addressing the FLM issue: spatial gap analysis with a focus on socio-demographics and locational characteristics, incorporation of emerging mobility services, innovative funding approaches for plan implementation, equity and transportation remedies for marginalized communities, and development of pedestrian and bicycle infrastructures surrounding transit stations. Strategies in three of the plans are aligned with regional goals for emissions reductions. LA Metro and Riverside Transit incorporate detailed design guidelines for the improvement of transit stations. As these plans are still relatively new, it will take time to evaluate their impact on ridership and their communities’ overall transit experience.

Quality of systemic cancer therapy in routine care: What are we measuring?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 249-249
Author(s):  
Shixin (Cindy) Shen ◽  
Monika K. Krzyzanowska
Keyword(s):  
Clinical Trials ◽  
Cancer Therapy ◽  
The United States ◽  
Cytotoxic Chemotherapy ◽  
System Level ◽  
Patient Specific ◽  
Routine Practice ◽  
Treatment Delivery ◽  
Early Stage Disease

249 Background: While clinical trials provide efficacy and early safety information regarding systemic cancer therapy (ST), most cancer patients who receive ST are treated outside clinical trials. We performed a systematic review of studies that have evaluated the quality of ST in routine practice to summarize the literature and define knowledge gaps across five quality domains – access, treatment delivery, toxicity, safety and outcome. Methods: We searched MEDLINE using a combination of terms pertaining to ST, such as “chemotherapy” with keywords related to healthcare quality for articles published in English from January 1, 2000 to December 31, 2010. Articles were included if they were based on original studies that examined quality of ST among adult patients from a population perspective (defined as multiple institutions). Study information was abstracted using a standardized form. Summary statistics were used to describe the results. Results: Our search identified 179 articles. The number of studies published each year increased over time from nine studies in 2000 to 30 in 2010. Most studies were conducted in the United States (58%) in either colorectal (31%) or breast cancers (27%) and focused on adjuvant intent cytotoxic chemotherapy (81%). Majority of the studies retrospectively (92%) identified patients from cancer registries (83%) and used either billing data (64%) or information in the registry itself (27%) for treatment identification. 66% of the studies evaluated a single quality domain, whereas the remaining articles assessed two or more domains. No study was found that examined safety from a population perspective. Access was the most frequently evaluated domain (77%) whereas treatment delivery was the least examined (12%). Treatment toxicity and outcome were evaluated in 21% and 31% of studies, respectively. Among studies that assessed outcome of ST, most evaluated patient specific outcomes such as survival (93%) although a few (13%) examined system level outcomes such as cost. Conclusions: Majority of studies evaluating quality of ST have focused on access to cytotoxic chemotherapy in early stage disease. Further studies focusing on other aspects of quality and in different clinical settings are needed.

Evolution of multidisciplinary care: Experience of the National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 67-67 ◽  
Author(s):  
Eliot Lawrence Friedman ◽  
Paul Morris ◽  
Margaret Currens ◽  
Kathleen M. Castro ◽  
Steven B. Clauser ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Organizational Support ◽  
Patient Navigation ◽  
Assessment Tool ◽  
Multidisciplinary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Integration Of Care

67 Background: A key aim of the NCCCP is to develop and improve the quality of multidisciplinary care (MDC). An assessment tool with nine key elements relevant to MDC structure and operations was developed to assess MDC maturity and set goals for continued quality improvement at individual sites and across the network. Methods: 14 NCCCP sites self-reported MDC assessments for lung, breast, and colorectal cancer in June 2010, 2011, and 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no MDC, level 5 = highly integrated MDC) in nine elements integral to the MDC process. Qualitative review of sites’ responses was also conducted. Results: MDC improvement was most evident in four of nine elements; case planning (CP), physician engagement (PE), integration of care coordination (ICC), and quality improvement (QI). The number of sites at level 3 or greater is reported in the table below. Integration of primary care providers and increased organizational support contributed to improved CP. PE was related to conditions of participation, insuring involvement of appropriate physicians in the MDC. The network focus on patient navigation was demonstrated by increase of ICC. Improvement in QI was related to increased participation of sites in physician and hospital quality initiatives (i.e., QOPI and RQRS), and an NCCCP project aimed at increasing referrals to genetics for patient with breast and colon cancer. Conclusions: The maturity of MDC reflected focused work of the Quality of Care sub-committee of the NCCCP. The efforts of working groups in patient navigation, genetics and physician conditions of participation was made evident in the improved performance in MDC’s for three of the four most common malignancies seen in the United States. We hope that this work will provide a blueprint for other health systems that wish to incorporate multidisciplinary care into their cancer programs. [Table: see text]

scholarly journals A new paradigm of screening and early diagnosis: assessment of benefits and harms

2020 ◽  
Vol 66 (6) ◽  
pp. 589-602
Author(s):  
Давид Заридзе ◽  
Dmitry Maksimovich ◽  
Ivan Stilidi
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Prostate Cancer ◽  
Clinical Trials ◽  
Early Diagnosis ◽  
The United States ◽  
Diagnostic Methods ◽  
New Paradigm

Abstract The article presents scientific evidence that confirms the new paradigm that  “early” diagnosis is not always beneficial, and that screening and early diagnosis can do more harm than good. As a result, of screening, in a number of cases, lesions are diagnosed that, although have histological patterns of cancer, are often clinically insignificant, indolent i.e. overdiagnosis takes place. Such lesions primarily include latent cancers of the prostate and thyroid gland. An increase in the incidence of certain types of cancers in the United States and other developed countries, as a result, of the introduction of PSA screening, mammography, ultrasound examination of the neck and other highly sensitive diagnostic methods, with stable or decreasing mortality, is a sign of overdiagnosis. In Russia, there is also a marked increase in the incidence of cancer of the prostate, breast, thyroid, kidney and melanoma, while mortality from these forms of cancer is stable or decreasing. The increase in the incidence of all malignant formations in Russian, as in American men, is determined by the increase in the incidence of prostate cancer. In randomized clinical trials of the efficacy of screening for prostate and breast cancer, an excess of the detected cases of cancer in the screening group compared with the control group indicates overdiagnosis. With an increase in follow-up (10-15 years), the number of excess cases in the screening group decreases. However, in some studies even after 10-15 years of follow-up, the excess of cancer cases in the screening group persisted, i.e. overdiagnosis was confirmed. Thus, the problem of overdiagnosis is also relevant to controlled clinical trials, despite a well-verified protocol and strict adherence to it. The danger of overdiagnosis in real life, daily practice, and especially with opportunistic screening, which, by definition, is carried out without quality control, is much higher. Overdiagnosis often leads to unnecessary, sometimes excessive treatment and a deterioration in the quality of life of patients who are not cancer patients. Refusal of aggressive therapy and active follow-up should be the method of choice for the management of patients with asymptomatic neoplasms identified at the screening. Such tactics will avoid unnecessary and excessive interventions, which, in turn, will prevent a deterioration in the quality of life of patients and, in addition, will reduce the cost of treatment. Key words: overdiagnosis, screening, early diagnosis, trends in incidence and mortality, prostate cancer, breast cancer, thyroid cancer

Nanomedicines for enhanced permeability and retention (EPR)-stratified patients have the potential to improve treatment outcomes

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Clinical Trials ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Survival Rates ◽  
The United States ◽  
Improve Treatment ◽  
Enhanced Permeability And Retention ◽  
Wide Range ◽  
The Cost

Nanomedicines are being tasked with boosting the efficacy of existing immunotherapies. Understanding the pathophysiology of the targeted tumors is critical for devising the optimum strategy. The corticosteroid dexamethasone has recently been discovered to promote tumor perfusion and nanomedicine accumulation. Only a limited percentage of patients, however, respond to immune checkpoint blockage (ICB). In the United States, for example, it is believed that ICB therapy is ineffective for about 87 percent of cancer patients. The care of enhanced permeability and retention (EPR)-stratified patients has the potential to improve treatment outcomes. Treating patients with several metastatic foci with varying amounts of EPR impact could increase nanomedicine impact in cancer patients, but only losartan has yet to reach clinical trials. Other medication repurposing techniques have been proposed for the increased efficacy of small medicines and antibodies, but they are still in clinical trials and need to be tested in human patients. The treatment of these patients could improve the effectiveness of nanomedi-based immunotherapy and reduce the toxicity of chemotherapy and radiation therapy. This could have a positive effect on cancer patients' survival rates and quality of life, as well as on the cost of treatment. The potential of nanomedicines to deliver a wide range of immunomodulating drugs and modulate their action in space

scholarly journals Dietary Sodium Intake: Scientific Basis for Public Policy

2015 ◽  
Vol 39 (1-3) ◽  
pp. 16-20 ◽  
Author(s):  
Paul K. Whelton
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Observational Studies ◽  
Direct Relationship ◽  
Sodium Intake ◽  
Large Body ◽  
The United States ◽  
Dietary Sodium

Background/Aims: National and international agencies recommend a reduction in dietary sodium intake. However, some have questioned the wisdom of these policies. The goal of this report was to assess the findings and quality of studies that have examined the relationship between dietary sodium and both blood pressure and cardiovascular disease. Methods: Literature review of the available observational studies and randomized controlled trials, including systematic reviews and meta-analyses. Results: A large body of evidence from observational studies and clinical trials documents a direct relationship between dietary sodium intake and the level of blood pressure, especially in persons with a higher level of blood pressure, African-Americans, and those who are older or have comorbidity, including chronic kidney disease. A majority of the available observational reports support the presence of a direct relationship between dietary sodium intake and cardiovascular disease but the quality of the evidence according to most studies is poor. The limited information available from clinical trials is consistent with a beneficial effect of reduced sodium intake on incidence of cardiovascular disease. Conclusions: The scientific underpinning for policies to reduce the usual intake of dietary sodium is strong. In the United States and many other countries, addition of sodium during food processing has led to a very high average intake of dietary sodium, with almost everyone exceeding the recommended goals. National programs utilizing voluntary and mandatory approaches have resulted in a successful reduction in sodium intake. Even a small reduction in sodium consumption is likely to yield sizable improvement in population health. Video Journal Club ‘Cappuccino with Claudio Ronco' at www.karger.com/?doi=368975.

scholarly journals Use of Herbal Medications for Treatment of Osteoarthritis and Rheumatoid Arthritis

Medicines ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 67
Author(s):  
Breanna N. Lindler ◽  
Katelyn E. Long ◽  
Nancy A. Taylor ◽  
Wei Lei
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
The United States ◽  
Pharmacological Therapy ◽  
Effective Management ◽  
Pharmacological Interventions ◽  
Safety And Efficacy ◽  
Herbal Medications ◽  
Anti Oxidant

Arthritis is a chronic condition that affects nearly a quarter of the United States population. Osteoarthritis (OA) and rheumatoid arthritis (RA) are two major forms of arthritis associated with severe joint pain and reduced quality of life. Various pharmacological interventions may be utilized for arthritis treatment when non-pharmacological therapy is insufficient. However, pharmacological therapy can be associated with serious side effects and high costs. Therefore, alternative therapies have been under investigation. Herbal medications have shown the potential for safe and effective management of arthritis. For this review, we attempt to summarize the mechanisms, safety, and efficacy of herbal treatments for OA and RA. After searching electronic databases, we identified nine herbs among 23 clinical trials used for the treatment of OA or RA patients. Improvement of OA and RA symptoms, pain, and inflammation was demonstrated. The herbs exhibited strong anti-inflammatory and anti-oxidant activities, contributing to a reduction in inflammation and tissue damage. Several herbs elucidated new mechanisms for OA and RA treatment as well. Though these herbs have shown promise for OA and RA treatment, more studies and clinical trials are required for determining safety and efficacy, bioactivity, and optimal bioavailability.

scholarly journals Clinical trial visits in the age of COVID-19: implementation of research participant safety measures

2021 ◽  
Vol 8 (2) ◽  
pp. 167
Author(s):  
Kathryn J. Krueger ◽  
Faith Rahman ◽  
Qiuhua Shen ◽  
John B. Hiebert ◽  
Janet D. Pierce
Keyword(s):  
Clinical Trials ◽  
Research Participant ◽  
The United States ◽  
National Institutes Of Health ◽  
Safety Measures ◽  
Personal Protection Equipment ◽  
Research Personnel ◽  
Control And Prevention ◽  
Collection Data

<p>The COVID-19 pandemic is having a major impact on how current clinical trials are being conducted in the United States. Researchers have experienced the effects of COVID-19 through the halting and delaying of clinical trials, the lack of personal protection equipment (PPE), the closing of clinical sites, and a decrease in participant recruitment. Many clinical trials will have more missing data because of a participant’s inability to attend in-person visits, discontinuation of trial activities, or interruption of time-sensitive study collection data due to COVID-19. All of these events affect the data quality of trials. Government agencies such as the Food and Drug Administration (FDA), centers for disease control and prevention (CDC), and National Institutes Of Health (NIH) have issued recommendations for investigators conducting clinical trials to combat the spread of COVID-19 and to maintain data integrity. Institutions sponsoring clinical trials have also provided guidelines to continue, modify, or pause research studies that are essential to ensure participant and research team safety. Key recommendations include implementing telehealth appointments, wearing a protective mask and face shield, quarantining for 14 days if exposed to COVID-19 or having travelled, and, if possible, maintaining a 6-foot distance. It is also recommended that investigators implement COVID-19 screening questionnaires prior to and during on-site visits. This includes participants and research personnel completing a temperature check and questionnaire screen before in-person data collection. This article will discuss the challenges encountered by researchers conducting clinical trials and provide resources and examples to assist investigators during the COVID-19 pandemic.</p>

Clinical Outcomes of the Cochlear™ Nucleus® 5 Cochlear Implant System and SmartSound™ 2 Signal Processing

2016 ◽  
Vol 27 (06) ◽  
pp. 425-440 ◽  
Author(s):  
Christina L. Runge ◽  
Kathryn Henion ◽  
Sergey Tarima ◽  
Anne Beiter ◽  
Teresa A. Zwolan
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Clinical Trials ◽  
Signal Processing ◽  
Speech Perception ◽  
The United States ◽  
Hearing In Noise ◽  
Noise Test ◽  
Listening In Noise

Background: While published data exist regarding cochlear implant (CI) outcomes from large academic programs, evidence of benefit based on national, multicenter clinical trials is needed for information regarding typical patient outcomes of devices implanted by U.S. centers representing larger academic to smaller hospital-based programs. Purpose: This nationwide trial evaluated outcomes in a group of newly implanted adult recipients of the Cochlear™ Nucleus® 5 CI system and SmartSound™ 2 signal processing. Unlike previous clinical trials, the AzBio sentence test was used and represents recent transition in our field to use of more challenging test materials. It was hypothesized that (1) speech perception scores in quiet with SmartSound™ 2 signal processing would not be statistically different from previous-generation devices; (2) speech perception scores in noise with SmartSound™ 2 signal processing would be better with enhanced microphone directionality; (3) speech perception scores in noise will be better with the preferred SmartSound™ 2 program for listening in noise; and (4) cochlear implantation would improve quality of life as assessed by the updated Health Utility Index Mark 3 (HUI3). A secondary purpose was to examine the relationships among the current and previously used speech perception tests of the Minimum Speech Test Battery (MSTB). It was hypothesized that speech perception scores within the same test interval would show predictive relationships. Research Design: Prospective, single-arm, repeated-measures study across 13 CI centers in the United States between February 2010 and June 2012. The participating centers ranged from larger academic to smaller hospital-based programs to accurately represent the diversity of programs in the United States. Study Sample: Participants were 38 postlingually deafened adult CI candidates. Data Collection and Analysis: Primary measures were Consonant-Nucleus-Consonant (CNC) words in quiet and the AzBio Sentence Test in Quiet (AzBioQ) and in Noise (AzBioN) tested at preoperative, and 3-, 6-, and 12-mo postactivation intervals. Quality of life was measured with the HUI3. For the secondary objective, statistical analyses were performed to investigate the predictive properties between current and previously used MSTB tests. Results: Mean CNC scores were significantly higher compared to the Nucleus® 24 Contour™ at 3 mo (p < 0.05) postactivation and showed no difference compared to the Nucleus® Freedom™ at 6 mo postactivation. Both SmartSound™ 2 FOCUS and NOISE programs provided significant improvements in performance in noise over the EVERYDAY program (p < 0.001), and performance with the FOCUS program was significantly better compared to the NOISE program (p < 0.001). Speech perception in noise was not related to patients’ subjective program preferences. Quality-of-life outcomes showed significant improvements from the preoperative to 6-mo postactivation interval (p < 0.05–0.001). Strong and significant correlations were found between preoperative CNC and AzBioQ and preoperative Hearing-in-Noise Test sentences in Quiet (HINTQ) and AzBioQ. At 12-mo postactivation, there were strong and highly significant correlations between CNC and AzBioQ, HINTQ and AzBioQ, and Hearing-in-Noise Test sentences in Noise and AzBioN (all p < 0.001). Conclusions: Results of this national clinical trial showed significant improvements in speech perception and quality of life following cochlear implantation. SmartSound™ 2 signal processing features showed a significant benefit of FOCUS when listening in noise, although preference of signal processing feature did not correlate with performance. Significant correlations were observed between speech perception tests. The findings of this study can be applied in clinical assessment, programming, and follow-up for CI candidates and recipients.

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