Catalyzing a Nursing Response to Healthcare Discrimination Against Transgender and Nonbinary Individuals

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163559/2/jnu12597.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163559/1/jnu12597_am.pd

A Cognitive Architecture Based on a Learning Classifier System with Spiking Classifiers

© 2015, Springer Science+Business Media New York. Learning classifier systems (LCS) are population-based reinforcement learners that were originally designed to model various cognitive phenomena. This paper presents an explicitly cognitive LCS by using spiking neural networks as classifiers, providing each classifier with a measure of temporal dynamism. We employ a constructivist model of growth of both neurons and synaptic connections, which permits a genetic algorithm to automatically evolve sufficiently-complex neural structures. The spiking classifiers are coupled with a temporally-sensitive reinforcement learning algorithm, which allows the system to perform temporal state decomposition by appropriately rewarding “macro-actions”, created by chaining together multiple atomic actions. The combination of temporal reinforcement learning and neural information processing is shown to outperform benchmark neural classifier systems, and successfully solve a robotic navigation task

A mixed method study of medical oncologists' perceived barriers and motivators to addressing long-term effects in breast cancer survivors.

PurposeThe purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.MethodsThis study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data.ResultsKey barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: "Competing priorities during brief appointments;" "Discussing long-term effects-Who? What? When?;" and "Beyond my expertise and comfort level." Two motivator categories emerged: "I owe it to them;" and "Giving people a life worth living."ConclusionOncologists' key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients' quality of life. Future efforts should leverage oncologists' professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer

Patient- reported outcomes collected in ambulatory oncology practices: Feasibility, patterns, and correlates

ObjectiveTo examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and describe the patterns and correlates of patient- reported toxicities.Data SourcesPatient survey data from 29 Michigan ambulatory oncology practices collected in 2017.Study DesignSecondary analysis of patient survey data. Descriptive statistics were generated at the patient and practice levels. Thematic analysis of open- text comments identified clusters of frequently reported toxicities.Data Collection MethodsPatients completed 11 items from the Patient- Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Using a 5- point Likert scale, patients rated the frequency of nausea, vomiting, diarrhea, and pain; the severity of nausea, vomiting, constipation, numbness/tingling, and pain; and how much numbness/tingling and pain interfered with usual or daily activities. Patients could also report two toxicities in open- text comments. Finally, patients reported unplanned health care service for toxicity or side effect management.Principal FindingsOf 3565 eligible patients, 2245 participated (63%) and 457 (20%) rated at least one toxicity as severe/very severe. Across practices, the proportion of patients who reported at least one severe/very severe toxicity ranged from 8% to 50%. Troubling toxicities included pain frequency (mean 2.3, SD 1.3), pain severity (2.1, 1.1), and diarrhea frequency (1.9, 1.0). From completed assessments, 1653 (74%) reported at least one toxicity in open- text comments; fatigue (n = 182), stomach discomfort (n = 53), and skin/nail changes (n = 41) were most frequently reported. Regarding consequences, 156 patients (7%) reported unplanned health care service use: 41 (26%) visited an emergency department and 32 (21%) were admitted to a hospital.ConclusionsQuerying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, which informed quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open- text questions enabled exploration with newer treatment regimens.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163565/3/hesr13574-sup-0001-Authormatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163565/2/hesr13574_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163565/1/hesr13574.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163565/4/hesr13574-sup-0002-AppendixS1.pd

Lessons Learned From a Practiceâ Based, Multisite Intervention Study With Nurse Participants

PurposeTo identify challenges and solutions to the efficient conduct of a multisite, practiceâ based randomized controlled trial to improve nursesâ adherence to personal protective equipment use in ambulatory oncology settings.DesignThe Drug Exposure Feedback and Education for Nursesâ Safety (DEFENS) study is a clustered, randomized, controlled trial. Participating sites are randomized to Webâ based feedback on hazardous drug exposures in the sites plus tailored messages to address barriers versus a control intervention of a Webâ based continuing education video.ApproachThe study principal investigator, the study coordinator, and two site leaders identified challenges to study implementation and potential solutions, plus potential methods to prevent logistical challenges in future studies.FindingsNoteworthy challenges included variation in human subjectsâ protection policies, grants and contracts budgeting, infrastructure for nursingâ led research, and information technology variation. Successful strategies included scheduled Web conferences, siteâ based study champions, site visits by the principal investigator, and centrally based document preparation. Strategies to improve efficiency in future studies include early and continued engagement with contract personnel in sites, and proposed changes to the common rule concerning human subjects. The DEFENS study successfully recruited 393 nurses across 12 sites. To date, 369 have completed surveys and 174 nurses have viewed educational materials.ConclusionsMultisite studies of nursing personnel are rare and challenging to the existing infrastructure. These barriers can be overcome with strong engagement and planning.Clinical RelevanceLeadership engagement, onsite staff support, and continuous communication can facilitate successful recruitment to a workplaceâ based randomized, controlled behavioral trial.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136422/1/jnu12279.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136422/2/jnu12279_am.pd

Sheaths for urinary incontinence: a randomized crossover trial

Objective: To evaluate the full range of self-adhesive continence sheaths for men available in the UK and thus provide clinicians and consumers with a basis for product selection. Subjects and methods: Fifty-eight volunteers (aged 30–89 years) tested each of six different self-adhesive sheaths available in the UK in September 1998 for 1 week each. Thirty subjects applied the sheaths themselves and 28 subjects relied on a carer to do so. During each week subjects completed a diary recording sheath changes and the result of skin inspection, to note any unscheduled sheath changes (because of sheath detachment) and any skin problems. At the end of each week an 11-item questionnaire was completed using a three-point rating scale ('good', 'acceptable', 'unacceptable') to assess the key aspects of product performance. Results: A significantly higher proportion of subjects scored the 'Aquadry Clear Advantage' sheath as 'good' than four of the other sheaths (P < 0.01) and a significantly higher proportion found the 'Incare' sheath to be 'unacceptable' than all of the other sheaths (P < 0.001) for the 'overall opinion' question. Sheath detachments (sheath falling off or blowing off) for the 'Incare' were significantly more common than for four of the other products (P < 0.01). Sheath detachments for the 'Aquadry Clear Advantage' were significantly less common than for two of the other products (P < 0.01). A significantly higher proportion of subjects found sheaths with an applicator to be 'unacceptable' than sheaths with no applicator (P < 0.001) for the 'ease of putting on' and 'overall opinion' questions (when adjusted for previous product use and person applying the sheath). Conclusions: There were substantial differences between products in their general performance and ergonomics, and for the frequency of detachment as recorded in the diary. The 'Aquadry Clear Advantage' was particularly successful and the 'Incare' particularly unsuccessful when compared with the other sheaths. Sheaths with no applicators were preferred to those with applicators. Applicators are mainly designed to make sheaths easier to put on, especially for carers, but there was no evidence that carers preferred applicators. This may have implications for manufacturers

Financial hardship and neighborhood socioeconomic disadvantage in long-term childhood cancer survivors

BackgroundLong-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships.MethodsWe performed a cross-sectional analysis of data from the Childhood Cancer Survivor Study between 1970 and 1999 and self-reported financial information from 2017 to 2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material and financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status.ResultsAnalysis was restricted to 3475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 years (interquartile range [IQR] = 33-46 years and 47 years (IQR = 39-59 years), respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings; P < .001). One quintile increases in deprivation were associated with small increases in behavioral (second quintile, P = .017) and psychological financial hardship (second quintile, P = .009; third quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income (≥$60 000 income, P < .001) and being single (P = .048).ConclusionsChildhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Neighborhood-level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships