Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer.

BACKGROUND: The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES: This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS: NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS: Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Patterns of DNA methylation as an indicator of biological aging: State of the science and future directions in precision health promotion.

BACKGROUND: A rapidly expanding literature suggests that individuals of the same chronological age show significant variation in biological age. PURPOSE: The purpose of this article is to review the literature surrounding epigenetic age as estimated by DNA methylation, involving the addition or removal of methyl groups to DNA that can alter gene expression without changing the DNA sequence. METHODS: This state of the science literature review summarizes current approaches in epigenetic age determination and applications of aging algorithms. FINDINGS: A number of algorithms estimate epigenetic age using DNA methylation markers, primarily among adults. Algorithm application has focused on determining predictive value for risk of disease and death and identifying antecedents to age acceleration. Several studies have incorporated epigenetic age to evaluate intervention effectiveness. DISCUSSION: As the research community continues to refine aging algorithms, there may be opportunity to promote health from a precision health perspective.

The Complexities of "Struggling to Live Life".

Purpose The purpose of the study was to explore and describe perceptions and experiences of young adults with type 1 diabetes mellitus (T1DM) living in Appalachia, Tennessee. Methods Qualitative descriptive analysis of in-depth interviews of 9 young adults (male = 3, female = 6) 18 to 30 years of age living in Appalachian counties in Tennessee provided the basis of identifying the salient concerns from the perspective of this diverse group related to living daily with T1DM. Data analysis was facilitated by using NVivo 11 Pro and consisted of iterative review of the accounts in 3 phases: immersion, reduction, and interpretation. Results Findings revealed that young Appalachian adults had some common, consistent experiences living with T1DM. Major themes included the struggle toward adulthood, the daily struggle of living with diabetes, the strong desire to live life, the supportive environment, the development of one's identity by diabetes, the disruptiveness of diabetes' demands, and the pros and cons of technological development in diabetes management. Conclusion Health vulnerabilities are multiplied for young adults living with T1DM in Appalachian Tennessee. Participants pointed to living in communities with social stigma, lack of T1DM knowledge, and lack of access to health care that compares with the quality of care they experienced when in pediatric care. They also expressed fear about pregnancy, diabetes complications, and the dangers of hypoglycemia. Individual and community-based empowerment programs focusing on T1DM accompanied by insurance reimbursement and T1DM policy reinforcement are necessary to reduce health disparities and improve quality of life in this underserved population of young adults in Appalachia.