REDCap-Based Operational Tool to Guide Care Coordination in a Multidisciplinary Cutaneous Oncology Clinic

2021 ◽  
pp. OP.20.00673
Author(s):  
Farees Saqlain ◽  
Sophia Z. Shalhout ◽  
Keith T. Flaherty ◽  
Kevin S. Emerick ◽  
David M. Miller
Keyword(s):  
Massachusetts General Hospital ◽  
The United States ◽  
Medical Decision ◽  
Multidisciplinary Teams ◽  
Web Based ◽  
Multidisciplinary Clinic ◽  
Primary Means ◽  
New Perspective ◽  
Operational Tool ◽  
Cutaneous Oncology

The multidisciplinary team is the primary means for delivery of complex cancer care in the United States. Considerable variability exists in how multidisciplinary teams operate across the landscape of oncology, including variation in represented specialties and specifics of the shared medical decision-making process. Here, we describe operations of a multidisciplinary clinic focused on the management of nonmelanoma skin cancer, formed as a joint effort between departments at the Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary. We describe deployment of a flexible Web-based operational tool created on the Research Electronic Data Capture platform to facilitate provider coordination and tracking and visualization of the patient census, offering a new perspective on optimization of the multidisciplinary workflow. To help promote further discussion, we have made the data dictionary for the operational tool and R code for the accompanying data visualization dashboard freely available online for download and customization.

Patient Autonomy, Capacity, and Consent

2020 ◽  
Author(s):  
Jessica Berg ◽  
Emma Cave
Keyword(s):  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Best Interests ◽  
Medical Decision ◽  
Human Rights Law ◽  
Federal Law ◽  
Medical Decisions ◽  
General Overview ◽  
Best Interests Standard

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.

scholarly journals Genome-Wide Analysis of Survival in Early-Stage Non–Small-Cell Lung Cancer

2009 ◽  
Vol 27 (16) ◽  
pp. 2660-2667 ◽  
Author(s):  
Yen-Tsung Huang ◽  
Rebecca S. Heist ◽  
Lucian R. Chirieac ◽  
Xihong Lin ◽  
Vidar Skaug ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Massachusetts General Hospital ◽  
Early Stage ◽  
The United States ◽  
Small Cell ◽  
Genome Wide Analysis ◽  
Early Stage Nsclc ◽  
Genome Wide ◽  
Nsclc Patients

Purpose Lung cancer, of which 85% is non–small-cell (NSCLC), is the leading cause of cancer-related death in the United States. We used genome-wide analysis of tumor tissue to investigate whether single nucleotide polymorphisms (SNPs) in tumors are prognostic factors in early-stage NSCLC. Patients and Methods One hundred early-stage NSCLC patients from Massachusetts General Hospital (MGH) were used as a discovery set and 89 NSCLC patients collected by the National Institute of Occupational Health, Norway, were used as a validation set. DNA was extracted from flash-frozen lung tissue with at least 70% tumor cellularity. Genome-wide genotyping was done using the high-density SNP chip. Copy numbers were inferred using median smoothing after intensity normalization. Cox models were used to screen and validate significant SNPs associated with the overall survival. Results Copy number gains in chromosomes 3q, 5p, and 8q were observed in both MGH and Norwegian cohorts. The top 50 SNPs associated with overall survival in the MGH cohort (P ≤ 2.5 × 10−4) were selected and examined using the Norwegian cohort. Five of the top 50 SNPs were validated in the Norwegian cohort with false discovery rate lower than 0.05 (P < .016) and all five were located in known genes: STK39, PCDH7, A2BP1, and EYA2. The numbers of risk alleles of the five SNPs showed a cumulative effect on overall survival (Ptrend = 3.80 × 10−12 and 2.48 × 10−7 for MGH and Norwegian cohorts, respectively). Conclusion Five SNPs were identified that may be prognostic of overall survival in early-stage NSCLC.

Abstract P297: Reduced Fat Mass and Improved Insulin Sensitivity in Overweight Black Women after Completion of 6-month Worksite Weight Loss Program

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Benjamin M Leon ◽  
Bernard V Miller ◽  
Gloria Zalos ◽  
Kong Y Chen ◽  
Anne E Sumner ◽  
...  
Keyword(s):  
Weight Loss ◽  
Black Women ◽  
Insulin Sensitivity ◽  
Fat Mass ◽  
Caloric Intake ◽  
Mass Gain ◽  
The United States ◽  
Sensitivity Index ◽  
Web Based ◽  
Total Fat

Background: As the epidemic of obesity in the United States steadily worsens, black women are disproportionately affected. Diminished insulin sensitivity has been linked with obesity and heightened risk of subsequent type 2 diabetes (T2D) and cardiovascular disease (CVD). Hypothesis: We propose that a decrease in fat mass achievable by weight loss intervention at the worksite improves insulin sensitivity in overweight black women. Methods: Fifty-four overweight black women [age 45±10 years (mean±SD), BMI range 25.9 to 54.7 kg/m 2 ] completed a 6-month program that included web-based nutrition information and/or dietitian counseling and access to exercise rooms near their work areas. All participants were advised to reduce daily caloric intake by 500 kcal and instructed to increase daily activity by 5,000 steps, measured by pedometer, above baseline readings. The following measurements were performed: weight, total fat mass by dual-energy X-ray absorptiometry, and insulin sensitivity index (S I ) calculated from the minimal model. Repeat of all measurements was performed at 6 months. Results: Baseline S I (median 3.0 liter/mU -1 •min -1 , range 0.74 to 7.58 liter/mU -1 •min -1 , with lower values signifying insulin resistance) was negatively associated with fat mass (r= -0.584, P<0.001) independent of age. Significant reductions in weight (92.6±18.1 to 91.1±18.9 kg, P<0.01) and fat mass (40.8±12.4 to 39.4±12.6 kg, P<0.01) were determined for subjects completing the program. Reduction in fat mass following completion of the program was associated with an increase in S I (r= -0.293, P=0.032). When analyzed by tertiles of fat mass change (Figure), compared to the tertile with net fat mass gain (far left bar), the two tertiles with net fat mass loss had significantly improved insulin sensitivity (higher S I ). Conclusions: Even modest fat mass reduction in overweight non-diabetic black women with a combination of diet and exercise can improve insulin sensitivity, which has the potential to reduce or delay the onset of T2D and CVD.

STUDY OF AMINO ACID MODIFIERS IN GUAYULE NATURAL RUBBER

2015 ◽  
Vol 88 (2) ◽  
pp. 310-323 ◽  
Author(s):  
Colleen McMahan ◽  
Dhondup Lhamo
Keyword(s):  
Amino Acids ◽  
Natural Rubber ◽  
Oxidative Stability ◽  
Chemical Properties ◽  
The United States ◽  
Thermal Oxidative Stability ◽  
Green Strength ◽  
Strain Induced Crystallization ◽  
New Perspective ◽  
Physical And Chemical

ABSTRACT Guayule, a desert shrub indigenous to the United States, is under development as a source of natural rubber that can be used in place of petroleum-based rubber or Hevea rubber. In natural rubbers, physical and chemical properties can be strongly affected by nonrubber constituents, typically proteins and lipids, present in the material, depending on the plant species and postharvest processing. Hevea natural rubber typically contains high levels of nonrubber constituents that contribute to thermal-oxidative stability, cure acceleration, and especially strain-induced crystallization. The latter has been attributed to compound properties that render Hevea natural rubber uniquely suited for the most demanding rubber applications (e.g., aircraft tires). Hevea proteins are susceptible to hydrolysis, releasing free amino acids into the latex, which can affect rubber and compound properties. Here, low-protein guayule latex was blended with a series of amino acids varying in chemical structure. Bulk viscosity was reduced, thermal-oxidative stability was improved, and cure rate was influenced by the addition of amino acids. Generally, gel formation, green strength, and tensile strength were not affected. The results introduce a new perspective for amino acids as biobased rubber compound additives and provide insights into naturally occurring nonrubber constituents' interaction with natural rubber polymers.

Differences in Career Satisfaction, Work–life Balance, and Stress by Gender in a National Survey of Pharmacy Faculty

2018 ◽  
Vol 33 (4) ◽  
pp. 415-419 ◽  
Author(s):  
Eric J. Ip ◽  
Tristan A. Lindfelt ◽  
Annie L. Tran ◽  
Amanda P. Do ◽  
Mitchell J. Barnett
Keyword(s):  
Career Satisfaction ◽  
Pharmacy Practice ◽  
The United States ◽  
Work Life ◽  
School Level ◽  
Work Life Balance ◽  
Academic Rank ◽  
Life Balance ◽  
Web Based ◽  
The Impact

Introduction The percentage of women pharmacy students and pharmacy faculty has greatly increased over the last 40 years. However, it is not known whether gender differences exist in terms of career satisfaction, work–life balance, and stress in the pharmacy academia workplace. Methods Results from a national web-based survey administered to American Association of Colleges of Pharmacy (AACP) members were utilized. Bivariate analyses were conducted to compare differences among faculty according to gender (men vs women). A series of multivariate models controlling for demographic and other faculty and school-level factors were created to explore the impact of gender on satisfaction with current position, satisfaction with work–life balance, and perceived stress. Results Among the 802 survey respondents, 457 (57.0%) women were more likely to be younger, hold a lower academic rank, and be in a pharmacy practice department, relative to 345 (43.0%) men. In adjusted results, men pharmacy faculty were more likely to report being extremely satisfied with their current job, more likely to report being extremely satisfied with their work–life balance, and score lower on a standardized stress measure relative to women. Conclusion While primarily descriptive, the results suggest women pharmacy faculty in the United States are less satisfied with their current academic position, less satisfied with their current work–life balance, and have higher stress levels compared to men even after controlling for age, academic rank, and department (along with other factors). Further research is needed to explore and address causes of the observed gender-related differences among pharmacy faculty.

scholarly journals The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

2021 ◽  
Author(s):  
Chandani Patel Chavez ◽  
Kenneth Cusi ◽  
Sushma Kadiyala
Keyword(s):  
Evidence Synthesis ◽  
Clinical Care ◽  
Treatment Options ◽  
Critical Role ◽  
Risk Groups ◽  
The United States ◽  
Multidisciplinary Teams ◽  
Consensus Statements ◽  
Meta Analyses

Abstract Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

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