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We explored perspectives of patients with metastatic non-small cell lung cancer (mNSCLC) on symptom screening and population-level patient-reported outcome (PRO) data regarding common symptom trajectories in the year after diagnosis. A qualitative study of patients with mNSCLC was conducted at a Canadian tertiary cancer centre. English-speaking patients diagnosed ≥ 6 months prior to study invitation were recruited, and semi-structured one-on-one interviews were conducted. Patient and treatment characteristics were obtained via chart review. Anonymized interview transcripts underwent deductive-inductive coding and thematic content analysis. Among ten participants (5 (50%) females; median (range) age, 68 (56-77) years; median (range) time since diagnosis, 28.5 (6-72) months; 6 (60%) with smoking histories), six themes were identified in total. Two themes were identified regarding symptom screening: (1) screening is useful for symptom self-monitoring and disclosure to the healthcare team, (2) screening of additional quality-of-life (QOL) domains (smoking-related stigma, sexual dysfunction, and financial toxicity) is desired. Four themes were identified regarding population-level symptom trajectory PRO data: (1) data provide reassurance and motivation to engage in symptom self-management, (2) data should be disclosed after an oncologic treatment plan is developed, (3) data should be communicated via in-person discussion with accompanying patient-education resources, and (4) communication of data should include reassurance about symptom stabilization, acknowledgement of variability in patient experience, and strategies for symptom self-management. The themes and recommendations derived from the patient experience with mNSCLC provide guidance for enhanced symptom screening and utilization of population-level symptom trajectory data for patient education.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Anciano , Femenino , Humanos , Masculino , Canadá , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Detección Precoz del Cáncer , Neoplasias Pulmonares/diagnóstico , Educación del Paciente como Asunto , Investigación Cualitativa , Calidad de Vida , Persona de Mediana EdadRESUMEN
INTRODUCTION: Pediatric asthma home visiting programs have improved clinical outcomes, but little is known about how providers perceive these programs. The purpose of this study was to understand how primary care providers and their colleagues in a medical home perceive an asthma home visiting program that is available at no cost to their patients. METHODS: After several years of running an asthma home visiting program using community health workers (CHW) in 10 pediatric primary care offices in the South Coast of Massachusetts, we surveyed the providers of patients who had enrolled in the program. An anonymous online survey was developed by the program leaders, the program analytics team, and the CHWs for quality improvement purposes. Survey domains included the perceived utility of various aspects of the program, impact on patients, and interaction with CHWs, as well as demographic information about the providers. RESULTS: Of the 24 providers asked to complete the survey from eight primary care practices, 21 completed the survey (88%). Respondents perceived that the most beneficial aspects were environmental assessment (95%), asthma education (91%), and addressing environmental issues (86%). In addition to numerous positive free-text responses, suggestions for improvement were in the areas of referral completion, post-visit communication, and patient identification in the medical record. All respondents would continue to refer to the program. CONCLUSIONS: Primary care providers and medical home staff perceived an asthma home visiting program to have high utility, particularly the environmental assessment, asthma education, and mitigation of environmental issues. Additional opportunities for improvement were identified.
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OBJECTIVE: To provide a 10-year follow-up of asthma cost-savings for patients served by the Community Asthma Initiative (CAI) group compared to a coarsely cost-matched comparison group from similar neighborhoods (comparison group). METHODS: CAI provided home visits and case management services for patients identified through emergency department (ED) visits and hospitalizations. Asthma costs for the two groups were extracted from the hospital administrative database for ED visits and hospitalizations for one year before and 10 years of follow-up. To eliminate cost differences at intake, a coarse cost-matching was implemented by randomly selecting comparison patients with similar costs to CAI patients (N = 208 pairs). The difference in cost-reduction between CAI and comparison patients was used to compute the adjusted Return on Investment (aROI). RESULTS: There were no significant differences between CAI and comparison groups, including baseline age (5.9 years [SD 2.9] v. 4.4 [SD 3.1]); Hispanic (46.2% v. 35.1%) and Black (43.9% v. 53.0%) race/ethnicity; and public insurance (71.2% v. 68.8%). The cost reduction difference for CAI was significant at one year (P = 0.0001) and two years (P = 0.03), but did not reach the level of significance for years 3-10. The CAI group had a greater cumulative cost reduction of $5,321 (P = 0.08, not significant). Average program cost per patient was $2,636. CAI broke-even after 3 years (aROI = 1.04) and yielded an adjusted ROI of 1.99 at 10 years. CONCLUSIONS: The greater reduction in cumulative cost for CAI patients suggested a shift in trajectory at 10 years of follow-up, resulting in a positive aROI after three years.
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Asma , Niño , Preescolar , Ahorro de Costo , Servicio de Urgencia en Hospital , Hospitalización , Hospitales Pediátricos , HumanosRESUMEN
Dog feces are a known source of nutrient, pathogen, and plastic pollution that can harm human and ecosystem health. Home composting may be a more environmentally sustainable method of managing dog feces and reducing this pollution. While composting is an established method for recycling animal manures into low-risk soil conditioners for food production, few studies have investigated whether household-scale compost methods can safely and effectively process dog feces for use in backyard edible gardens. A broad range of literature on in situ composting of dog feces is evaluated and compared according to scale, parameters tested, and compost methods used. Studies are analyzed based on key identified knowledge gaps: appropriate compost technologies to produce quality soil conditioner on small scales, potential for fecal pathogen disinfection in mesophilic compost conditions, and biodegradation of compostable plastic dog waste bags in home compost systems. This review also discusses how existing methods and quality standards for commercial compost can be adapted to dog fecal home composting. Priorities for future research are investigation of household-scale aerobic compost methods and potential compost amendments needed to effectively decompose dog feces and compostable plastic dog waste bags to produce a good-quality, sanitized, beneficial soil conditioner for use in home gardens. Integr Environ Assess Manag 2024;00:1-16. © 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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The range of cranial morphology seen in domestic dogs (Canis lupus familiaris) is a direct result of thousands of years of selective breeding. This article is the first to investigate how selection for reduced faces in brachycephalic dogs impacted the neuroanatomy of the canine brain through the analysis of endocasts. Previous research has demonstrated global effects on the shape of the bony cranium as the result of these breeding practices; however, these studies have largely focused on the bony structures of the skull and failed to consider the influence of facial reduction on the soft tissues of the brain. We generated endocasts from an existing set of clinically-obtained CT scans representing a variety of dogs with various cranial morphologies. These dogs represented four breeds as well as a comparative sample of dogs of unknown breed. We recorded three-dimensional coordinate data for 31 landmarks representing various gyri, sulci, and other neuroanatomical landmarks that allowed us to analyze differences in shape of the endocasts. Through geometric morphometric analyses, we determined that the endocast shape variance in this sample is correlated with cephalic index, and thus the selection for facial reduction has caused a perceivable effect on canine neuroanatomy. Additionally, we found the majority of the shape variance in the sample to be associated with olfactory anatomy; however, the rest of the morphology also correlates with cephalic index. The results of this article indicate that modern breeding practices and the selection for dogs with short faces have significantly influenced canine neuroanatomy.