Talking about health: Community ambassadors as a health promotion strategy to increase breast and bowel cancer screening in regional Australia.

ISSUE ADDRESSED: In Australia, cancer is the leading contributor to disease burden, with breast and bowel cancer among the most commonly diagnosed cancers. Despite the presence of community-wide health promotion activities and screening programs, people living in regional and rural locations experience a number of factors that reduce breast and bowel cancer survival outcomes. This study investigates the ways that high-risk community members in a regional area of Australia interact with health messaging about breast and bowel cancer screening. METHODS: A qualitative research method was used to conduct 31 in-depth one-on-one interviews with community members, leaders and essential service providers. A thematic approach was used to analyse data. RESULTS: Findings provided insight to the ways that health is spoken about within the community, what prompts discussion of health, trustworthy sources of health information and the significance of peer-to-peer communication. CONCLUSIONS: Existing community communication lines can be used to assist in delivering public health messages among high-risk and vulnerable population groups. Utilising community ambassadors is identified as a health promotion method for hard-to-reach populations. SO WHAT?: Conversations about health and screening amongst community members, and led by community members, play a key role in shaping engagement with cancer screening programs and represent an important site for health promotion activities. These findings have implications for future public health initiatives amongst high-risk groups in regional locations.

Palliation or Prolongation? The Impact of a Peer-Review Intervention on Shortening Radiotherapy Schedules for Bone Metastases.

PURPOSE: Shorter fractionation radiation regimens for palliation of bone metastases result in lower financial and social costs for patients and their caregivers and have similar efficacy as longer fractionation schedules, although practice patterns in the United States show poor adoption. We investigated whether prospective peer review can increase use of shorter fractionation schedules. METHODS: In June 2016, our practice mandated peer review of total dose and fractionation for all patients receiving palliative treatment during our weekly chart rounds. We used descriptive statistics and Fisher's exact test to compare lengths of treatment of uncomplicated bone metastases before and after implementation of the peer review process. RESULTS: Between July 2015 and December 2016, a total of 242 palliative treatment courses were delivered, including 105 courses before the peer review intervention and 137 after the intervention. We observed greater adoption of shorter fractionation regimens after the intervention. The use of 8 Gy in one fraction increased from 2.8% to 13.9% of cases postadoption. Likewise, the use of 20 Gy in five fractions increased from 25.7% to 32.8%. The use of 30 Gy in 10 fractions decreased from 55.2% to 47.4% ( P = .002), and the use of ≥ 11 fractions decreased from 16.2% before the intervention to 5.8% after ( P = .006). CONCLUSION: Prospective peer review of palliative regimens for bone metastases can lead to greater adoption of shorter palliative fractionation schedules in daily practice, in accordance with national guidelines. This simple intervention may therefore benefit patients and their caregivers as well as provide value to the health care system.

Provider variability in intensity modulated radiation therapy utilization among Medicare beneficiaries in the United States.

BACKGROUND: In this study, we sought to examine the variation in intensity modulated radiation therapy (IMRT) use among radiation oncology providers. METHODS AND MATERIALS: The Medicare Physician and Other Supplier Public Use File was queried for radiation oncologists practicing during 2014. Healthcare Common Procedural Coding System code 77301 was designated as IMRT planning with metrics including number of total IMRT plans, rate of IMRT utilization, and number of IMRT plans per distinct beneficiary. RESULTS: Of 2759 radiation oncologists, the median number of total IMRT plans was 26 (mean, 33.4; standard deviation, 26.2; range, 11-321) with a median IMRT utilization rate of 36% (mean, 43%; standard deviation, 25%; range, 4% to 100%) and a median number of IMRT plans per beneficiary of 1.02 (mean, 1.07; range, 1.00-3.73). On multivariable analysis, increased IMRT utilization was associated with male sex, academic practice, technical fee billing, freestanding practice, practice in a county with 21 or more radiation oncologists, and practice in the southern United States (P < .05). The top 1% of users (28 providers) billed a mean 181 IMRT plans with an IMRT utilization rate of 66% and 1.52 IMRT plans per beneficiary. Of these 28 providers, 24 had billed technical fees, 25 practiced in freestanding clinics, and 20 practiced in the South. CONCLUSIONS: Technical fee billing, freestanding practice, male sex, and location in the South were associated with increased IMRT use. A small group of outliers shared several common demographic and practice-based characteristics.

A mobile platform for automated screening of asthma and chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) and asthma each represent a large proportion of the global disease burden; COPD is the third leading cause of death worldwide and asthma is one of the most prevalent chronic diseases, afflicting over 300 million people. Much of this burden is concentrated in the developing world, where patients lack access to physicians trained in the diagnosis of pulmonary disease. As a result, these patients experience high rates of underdiagnosis and misdiagnosis. To address this need, we present a mobile platform capable of screening for Asthma and COPD. Our solution is based on a mobile smart phone and consists of an electronic stethoscope, a peak flow meter application, and a patient questionnaire. This data is combined with a machine learning algorithm to identify patients with asthma and COPD. To test and validate the design, we collected data from 119 healthy and sick participants using our custom mobile application and ran the analysis on a PC computer. For comparison, all subjects were examined by an experienced pulmonologist using a full pulmonary testing laboratory. Employing a two-stage logistic regression model, our algorithms were first able to identify patients with either asthma or COPD from the general population, yielding an ROC curve with an AUC of 0.95. Then, after identifying these patients, our algorithm was able to distinguish between patients with asthma and patients with COPD, yielding an ROC curve with AUC of 0.97. This work represents an important milestone towards creating a self-contained mobile phone-based platform that can be used for screening and diagnosis of pulmonary disease in many parts of the world.

Clinical utility of the modified segmental boost technique for treatment of the pelvis and inguinal nodes.

PURPOSE: Low-lying pelvic malignancies often require simultaneous radiation to pelvis and inguinal nodes. We previously reported improved homogeneity with the modified segmental boost technique (MSBT) compared to that with traditional methods, using phantom models. Here we report our institutional clinical experience with MSBT. METHODS AND MATERIALS: MSBT patients from May 2001 to March 2007 were evaluated. Parameters analyzed included isocenter/multileaf collimation shifts, time per fraction (four fields), monitor units (MU)/fraction, femoral doses, maximal dose relative to body mass index, and inguinal node depth. In addition, a dosimetric comparison of the MSBT versus intensity modulated radiation therapy (IMRT) was conducted. RESULTS: Of the 37 MSBT patients identified, 32 were evaluable. Port film adjustments were required in 6% of films. Median values for each analyzed parameter were as follows: MU/fraction, 298 (range, 226-348); delivery time, 4 minutes; inguinal depth, 4.5 cm; volume receiving 45 Gy (V45), 7%; V27.5, 87%; body mass index, 25 (range, 16.0-33.8). Inguinal dose was 100% in all cases; in-field inhomogeneity ranged from 111% to 118%. IMRT resulted in significantly decreased dose to normal tissue but required more time for treatment planning and a higher number of MUs (1,184 vs. 313 MU). CONCLUSIONS: In our clinical experience, the mono-isocentric MSBT provides a high degree of accuracy, improved homogeneity compared with traditional techniques, ease of simulation, treatment planning, treatment delivery, and acceptable femoral doses for pelvic/inguinal radiation fields requiring 45 to 50.4 Gy. In addition, the MSBT delivers a relatively uniform dose distribution throughout the treatment volume, despite varying body habitus. Clinical scenarios for the use of MSBT vs. intensity-modulated radiation therapy are discussed. To our knowledge, this is the first study reporting the utility of MSBT in the clinical setting.