RESUMO
INTRODUCTION: Children, adolescent, and young adult cancer survivors experience overall increased risks of infertility that are preventable through effective fertility preservation services prior to starting cancer treatment. Oncofertility care is the evidence-based practice of informing newly diagnosed cancer patients about their reproductive risks and supporting shared decision-making on fertility preservation services. Despite longstanding clinical guidelines, oncofertility care delivery continues to be limited and highly variable across adult and pediatric oncology settings. MATERIALS AND METHODS: We describe the design of a stepped wedge cluster randomized clinical trial to evaluate the effectiveness of the multi-component Telehealth Oncofertility Care (TOC) intervention conducted in 20 adult and pediatric oncology clinics across three health systems in Southern California. Intervention components are: 1) electronic health record-based oncofertility needs screen and referral pathway to a virtual oncofertility hub; 2) telehealth oncofertility counseling through the hub; and 3) telehealth oncofertility financial navigation through the hub. We hypothesize the intervention condition will be associated with increased proportions of patients who engage in goal-concordant oncofertility care (i.e., engagement in reproductive risk counseling and fertility preservation services that meet the patient's fertility goals) and improved patient-reported outcomes, compared to the usual care control condition. We will also evaluate intervention implementation in a mixed-methods study guided by implementation science frameworks. DISCUSSION: Our overall goal is to speed implementation of a scalable oncofertility care intervention at cancer diagnosis for children, adolescent and young adult cancer patients to improve their future fertility and quality of life. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT05443737.
Assuntos
Sobreviventes de Câncer , Preservação da Fertilidade , Telemedicina , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Adulto Jovem , Aconselhamento/métodos , Preservação da Fertilidade/métodos , Neoplasias/terapiaRESUMO
OBJETIVOS: Determinar que el valor creatinina es útil como un método de diagnóstico para la Rotura Prematura de Membranas en el Hospital Nacional Arzobispo Loayza durante Agosto 2012 - Febrero 2013. METODOLOGIA: Estudio Observacional, de tipo analítico-comparativo prospectivo. Se trabajó con un total de 90 pacientes que se atendieron en los consultorios de Obstetricia que acuden al Hospital Nacional Arzobispo Loayza durante Agosto 2012 - Febrero 2013. Para ello se dividieron en dos grupos: 26 pacientes con diagnóstico de RPM y 64 pacientes sin diagnóstico de RPM a las cuales se midió el valor de la creatinina. Se estimaron las frecuencias absolutas y relativas y medidas de tendencia central y de dispersión. Se utilizó la prueba Chi cuadrado y t-Student, toda interpretación estadística se realizó con un nivel de significancia del 95 por ciento. RESULTADOS: La edad de las pacientes estuvo entre los rangos: 19 a 34 años (70 por ciento) y en menor porcentaje las menores de 19 años (4.4 por ciento). El 57.8 por ciento eran Solteras y el 1.1 por ciento Separadas. El nivel de instrucción de las participantes fue en el 60 por ciento nivel Secundario y el 12.2 por ciento Técnica. La edad materna en el grupo caso más frecuente fue 19 a 34 años (42.3 por ciento) y las mayores de 35 años (42.3 por ciento) muy diferente al grupo control donde priorizó los rangos de edad entre 19-34 años (81.2 por ciento), encontrándose diferencias significativas en ambas variables (p<0.001). El estado civil Soltera en ambos grupos fue similar (p=0.101), siendo en el grupo de pacientes sin RPM 69.2 por ciento y en el grupo sin RPM 53.1 por ciento. El 96.2 por ciento de los pacientes del grupo caso tuvo nivel de instrucción primaria y el 45.3 por ciento del grupo control tuvo nivel de instrucción Secundario, encontrándose estadísticas porcentuales significativas (p<0.001). En gran parte de gestantes del grupo caso (53.8 por ciento) tuvo una edad gestacional entre 37 a 40 semanas muy similar...
OBJECTIVE: Determine the creatinine value is useful as a diagnostic method for Premature Rupture of Membranes at National Hospital Arzobispo Loayza during August 2012 - February 2013. METHODOLOGY: Observational study of prospective comparative-analytical type. We worked with a total of 90 patients seen in the clinics of Obstetrics attending at National Hospital Arzobispo Loayza during August 2012 - February 2013. For this purpose, the groups were divided into two groups: 26 patients diagnosed with RPM and 64 patients without RPM which a value was measured by creatinine. We estimated absolute and relative frequencies and measures of central tendency and dispersion. We used the chi-square test and t-Student, all statistical interpretation was performed with a significance level of 95 per cent. RESULTS: The age of patients was found between the ranges: 19-34 years (70 per cent) and minority women less than 19 years (4.4 per cent). The singles were 57.8 per cent and separate were 1.1 per cent. The education level of the participants was: 60 per cent Secondary and 12.2 per cent Technical. Maternal age in the group case with the most frequent is between 19-34 years (42.3 per cent) and those older than 35 years (42.3 per cent) very different to the control group where prioritized age ranges between 19-34 years (81.2 per cent), with differences significant in both variables (p<0.001). Marital status was similar in both groups (p=0.101), being in the group of patients without RPM: 69.2 per cent and 53.1 per cent group without RPM. The 96.2 per cent of patients in the case group had primary level of education and 45.3 per cent of the control group had Secondary education level, being statistical significant both percentages (p<0.001). In much of pregnant women in the case group (53.8 per cent) had a gestational age from 37 to 40 weeks very similar to the control group (57.8 per cent) being statistically similar (p=0.731). With respect to parity: The 69.2 per cent...