Re-Validation of the COmprehensive Score for Financial Toxicity (COST): Assessing the Scale's Utility in Chronic Disease Populations.

OBJECTIVE: To report the psychometric properties of the COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure (PROM), an 11-item scale previously validated among patients diagnosed with cancer and receiving chemotherapy. METHODS: Data come from a cross-sectional survey (n = 2755 response rate of 87%) of participants in a remote digital health coaching intervention collected between January 2017 and February 2019. RESULTS: COST demonstrated very good internal consistency (Cronbach's alpha = .89) and good convergent validity. Lower financial toxicity was associated with improved physical and mental well-being HRQOL measures after controlling for covariates (b = 0.13, P < .0001; b = 0.28, P < .0001, respectively). Supplemental analyses indicated that the COST instrument loaded on 2 factors. CONCLUSIONS: The COST measure of financial toxicity has good internal consistency and predictive validity in a sample of patients with chronic conditions. However, contrary to previous research examining the psychometric properties of COST in a sample of individuals with cancer, which found COST to be unidimensional, our analyses indicated that the COST measure of financial toxicity is multidimensional in a sample of individuals with chronic conditions. In particular, the items that asked about "general financial wellbeing" loaded on the second factor while "illness-related financial wellbeing" loaded on the first.

Creating a healing environment: the importance of the service setting in the new consumer-oriented healthcare system.

Over the last ten years, the healthcare industry has recognized that the physical environment is a valuable resource that can and does affect all of its customers. Although most service organizations give some thought to setting, its importance to the service experience has been most thoroughly understood by those who view and treat their customers as guests, that is, the guest service industry. An excellent healing environment will reinforce excellent clinical quality, but an inferior environment can detract from fine clinical care. One of the most important principles learned by the guest service industry is to provide the setting customers expect. Another is to create an environment that meets or exceeds customer needs for safety, security, support, competence, physical comfort, and psychological comfort. This article provides a detailed discussion of how such an environment can be created in healthcare facilities drawing from the experience of the best guest service organizations.

Health departments' implementation of public health's core functions: an assessment of health impacts.

OBJECTIVES: The purpose of this article was to investigate the relationship between state health agencies' adherence to the recommendations of the United State's Institute of Medicine's (IOM) report, "The Future of Public Health", and changes in their populations' health. STUDY DESIGN: Data were abstracted from agencies' plans, budgets, annual reports, etc. spanning a 5-year period. A comprehensive change in population health measure over the same period was drawn from the UnitedHealth Group's annual survey. METHODS: Configurations, based on public health core functions, were established using linear regression and qualitative comparative analysis. The dependent variable was a holistic measure of change in a state population's health status. RESULTS: State agencies that most completely adopted a public health model emphasizing assessment, assurance and policy development also experienced significant improvements in their population health measures. CONCLUSIONS: State agencies that more completely adopted the IOM's public health core functions had a concomitant improvement in their populations' health statuses. Further research to explore if there is a causal link between adoption of the core functions and positive health impacts is warranted.

Methohexital anesthesia in the surgical treatment of uncontrollable epilepsy.

Twenty-five patients (aged 3 to 39 years) were anesthetized with methohexital for electrocorticographic mapping and resection of epileptogenic foci. These patients have been compared with 11 patients (aged 11 to 40 years) who had the same surgical procedure performed while they were awake because their epileptogenic foci were near the speech or motor areas. All patients received morphine and droperidol to produce analgesia and sedation, and a field block was established with local anesthetics. In the 25 patients, general anesthesia was induced with methohexital, 1.5 mg/kg. and maintained with a 0.1% infusion. After intubation, ventilation to a PaCO2 of 30 mm Hg was maintained with O2/air. A resectable abnormal electroencephalogram focus was localized in every case. All but two of the patients awoke promptly in the operating room, allowing extubation and participation in neurologic assessment. None remembered the procedure. The incidence of improvement of seizures in patients given methohexital was similar to that in patients who had surgery while awake. Unlike many general anesthetics that depress epileptogenic activity, methohexital activates seizure activity and can therefore be used for the dual purpose of producing general anesthesia and enhancing electrocorticographic delineation of epileptogenic foci.

Attitudes of organized labor officials toward health care issues: an exploratory survey of Alabama labor officials.

Delegates to the Alabama AFL-CIO Convention were surveyed concerning their attitudes toward their health benefits and various options for health care reform. Most are satisfied with their current health care coverage, but dissatisfied with its high costs. Participants attribute the high costs to providers' pricing policies and insurance companies' overhead.

A labor readiness index (Bishop score) for rhesus monkeys.

A scoring system is presented for quantitative evaluation of labor readiness in macaque monkeys. Cervical position, length, softness and dilation are rated along with fetal head position for a total score of 13. The system is based on experience in evaluating readiness of multiparous rhesus monkeys for labor induction. Guidelines for the examination for use of the score are described.

Host defense deficiency in newborn nonhuman primate lungs.

We have investigated two major aspects of the pulmonary host defense mechanism--alveolar macrophage function as a "first line of bacterial defense" and induced neutrophil migration into the lung as a "back-up defense." Chemotactic and phagocytic/killing assays revealed a functional deficiency in the alveolar macrophages of newborn primates. Serial bronchoalveolar lavage investigations revealed diminished neutrophil migration into the newborn primate lung. The overall pulmonary host defense capability in newborn primates was deficient. The results of this investigation may have direct clinical relevance to the susceptibility of newborns to infections and pneumonia.

The ontogeny of pulmonary defenses: alveolar macrophage function in neonatal and juvenile rhesus monkeys.

Using the technique of bronchoalveolar lavage, we isolated alveolar macrophages (AM) from the lower respiratory tract of newborn (1-4 days of age), infant (6-10 days of age), juvenile (3-6 months of age), and adult rhesus monkeys. The AM thus obtained were assayed in vitro to determine their chemotactic, phagocytic, and candidicidal capabilities. The predominant (greater than or equal to 89%) cell type in bronchoalveolar lavage effluent in all ages was the AM. Chemotaxis, phagocytosis, and killing of Candida albicans were markedly impaired in neonatal AM as compared with those from infants, juveniles, and adults. AM chemotactic activity achieved normal adult values by 6 days of age. Phagocytosis, and to a lesser extent candidicidal activity, were significantly improved in 6-day-old animals, but adult levels were still not achieved even by 6 months of age.