Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery: Approaches From 3 Prospective Studies

Introduction: Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Implementation occurred in 2 study settings: PROs completed in the waiting room and reviewed during clinical visits to guide symptom management for multiple myeloma (visit-based PROs); and weekly PROs completed by cancer patients between chemotherapy visits to monitor symptoms at home (remote PROs). Methods: PRO implementation steps across studies included: (1) clinician and patient input on key symptoms, PRO measures, and identifying which PRO responses are clinically concerning to better target nursing actions; (2) developing PRO-based clinical decision support (CDS) for responding to concerning PROs; (3) training clinicians and clinical research assistants to interpret PROs and use software; and (4) describing implementation impact (frequency of concerning PRO responses and nursing actions). Discussion: Clinician and patient input was critical for identifying key symptoms, PRO measures, and clinically concerning response options. For the visit-based PRO observational study, all symptom scores appeared on a clinician dashboard, and those rated ≥1 by patients (on a 0–4 or 0–10 scale) had PRO-based CDS available for access. For the 2 remote PROs trials, stakeholders recommended that the 2 “worst” response options (eg, PRO responses of “often”/“always” or “severe”/“very severe”) would trigger an automated email alert to a nurse along with PRO-based CDS. In each study, PRO-based CDS was tailored based on clinician input. Across studies, the most common nursing response to concerning PROs was counseling patients on (or providing care plans for) self-management of symptoms. In the trials, the percentage of weekly remote PROs generating an alert to a nurse ranged from 13% at an academic center to 36% in community oncology practices. Key Points: Across 3 prospective studies, PROs implemented into cancer care enabled tailored care based on issues identified on PROs. Stakeholder engagement was critical for successful implementation. This paper assists in addressing important PRO implementation challenges by describing a stakeholder-driven approach

Comparative genomics of 16 Microbacterium spp. that tolerate multiple heavy metals and antibiotics

A total of 16 different strains of Microbacterium spp. were isolated from contaminated soil and enriched on the carcinogen, hexavalent chromium [Cr(VI)]. The majority of the isolates (11 of the 16) were able to tolerate concentrations (0.1 mM) of cobalt, cadmium, and nickel, in addition to Cr(VI) (0.5–20 mM). Interestingly, these bacteria were also able to tolerate three different antibiotics (ranges: ampicillin 0–16 μg ml−1, chloramphenicol 0–24 μg ml−1, and vancomycin 0–24 μg ml−1). To gain genetic insight into these tolerance pathways, the genomes of these isolates were assembled and annotated. The genomes of these isolates not only have some shared genes (core genome) but also have a large amount of variability. The genomes also contained an annotated Cr(VI) reductase (chrR) that could be related to Cr(VI) reduction. Further, various heavy metal tolerance (e.g., Co/Zn/Cd efflux system) and antibiotic resistance genes were identified, which provide insight into the isolates’ ability to tolerate metals and antibiotics. Overall, these isolates showed a wide range of tolerances to heavy metals and antibiotics and genetic diversity, which was likely required of this population to thrive in a contaminated environment

Promoting Positive Mother–Infant Relationships: A Randomized Trial of Community Doula Support For Young Mothers

Doulas, whose traditional role is to support women during labor and delivery, are being increasingly utilized within community‐based programs where a primary goal is supporting mother–infant relationships. The present study investigated the effect of doula services on parenting among young, low‐income mothers. A total of 248 pregnant women were randomly assigned to receive either doula services or routine medical and social services. The doulas provided prenatal home visitation, support during labor and delivery, and 3 months of postpartum home visitation. Parenting was assessed through video recordings of mother–infant interaction at 4, 12, and 24 months of child age and maternal report of parenting attitudes and stress. Intent‐to‐treat analyses showed that mothers who had received doula services endorsed more child‐centered parenting values, showed more positive engagement with their infants, and were more likely to respond to infant distress at 4 months. Their infants were less likely to show visible upset during observed interactions. Most effects of the program on parent and child behavior faded over time. Community doula intervention is a promising practice for supporting parenting and parent–infant interaction. Integration of doulas into longer term home‐visiting models might sustain the early impact of doula services and enhance parenting services offered by traditional home‐visiting programs. El servicio de “Doulas,” cuyo papel tradicional es apoyar a las mujeres durante el parto, está siendo utilizado con más frecuencia dentro de programas con base comunitaria donde una meta primordial es apoyar las relaciones madre‐infante. El presente estudio investigó el efecto que el servicio de “doula,” tiene en la crianza entre madres jóvenes de bajos recursos. 248 mujeres embarazadas fueron asignadas al azar para recibir bien el servicio de “doula,” bien los servicios médicos y sociales rutinarios. El servicio de “doula” proveyó visitas prenatales a casa, apoyo durante el parto, y tres meses de visitas a casa posteriormente al parto. La crianza fue evaluada por medio de grabaciones de vídeo de las interacciones madre‐infante a los 4, 12 y 24 meses de edad del niño, y por el reporte maternal de las actitudes y el estrés de la crianza. Los análisis basados en la “intención de tratamiento” mostraron que las madres que habían recibido el servicio de “doula” aprobaban valores de crianza más enfocados en el niño, mostraban un involucramiento más positivo con sus infantes, y estaban más propensas a responder a la angustia del infante a los 4 meses. Sus infantes estaban menos propensos a mostrar un disgusto visible durante las interacciones observadas. La mayoría de los efectos del programa sobre la crianza y la conducta del niño desaparecieron con el tiempo. La intervención del servicio comunitario de “doula” es una práctica para apoyar la crianza y la interacción madre‐infante. La integración del servicio de “doula” en modelos de visita a casa a más largos plazos pudiera mantener el impacto inicial de estos servicios y mejorar los servicios de crianza ofrecidos por programas tradicionales de visita a casa. Les doulas, dont le rôle traditionnel est de soutenir les femmes durant le travail et l’accouchement, sont de plus en plus utilisées au soin de programmes axés sur la communauté où le but principal est de soutenir les relations mères‐nourrisson. Cette étude s’est penchée sur l’effet des services de doulas sur le parentage chez de jeunes mères issues de milieux dévaforisés. 248 femmes enceintes ont été designées au hasard pour soit recevoir des services doula ou soit recevoir les services médicaux et sociaux de routine. La doula a offert des visites prénatales à domicile, un soutien durant le travail et l’accouchement, et trois mois de visites à domicile après l’accouchement. Le parentage a été évalué à travers des enregistrements vidéos de l’interaction mère‐nourrisson à 4, 12, et 24 moois pour l’enfant et des compte‐rendus maternels d’attitudes parentales et de stress. Les analyses Intention‐de‐traiter ont démontré que les mères ayant reçu les services doula faisaient preuves de plus de valeurs de parentage centrées sur l’enfant, d’un engagement plus positif avec leurs nourrissons, et étaient plus à même de réagir à la détresse du nourrisson à 4 mois. Les nourrissons étaient moins à même de faire preuve de contrariété visible durent les interactions observées. La plupart des effets du programme sur le comportement du parent et de l’enfant ont passés avec le temps. L’intervention d’une doula communautaire est une pratique pleine de promesse pour le soutien au parentage et à l’interaction parent‐nourrisson. L’intégration des doulas dans des modèles de visite à domicile à plus lolng terme pourrait soutenir l’impact précoce des services de doula et améliorer les services de parentage offerts par les programmes de visite à domicile traditionnels. Doulas, deren traditionelle Aufgabe es ist, Frauen während der Geburtswehen und der Geburt zu unterstützen, werden zunehmend in Community‐basierten Programmen eingesetzt, die als primäres Ziel das Unterstützen der Mutter‐Kind‐Beziehungen anstreben. Die vorliegende Studie untersuchte die Wirkung der Dienstleistungen von Doulas auf das Erziehungsverhalten junger Mütter mit niedrigem Einkommen. 248 schwangere Frauen wurden entweder den Doula‐Dienstleistungen oder medizinischen und sozialen Routinedienstleistungen randomisiert zugewiesen. Die Doulas führten pränatale Hausbesuche durch, unterstützen bei den Wehen und der Geburt und nahmen drei Monate nach der Geburt Hausbesuche vor. Das Erziehungsverhalten wurde anhand von Videoaufnahmen der Mutter‐Kind‐Interaktionen im Kindesalter von 4, 12 und 24 Monaten und über mütterliche Berichte bezüglich Erziehungseinstellungen und ‐belastungen untersucht. Intent‐to‐treat‐Analysen zeigten, dass Mütter, die Doula‐Dienstleistungen erhielten mehr kindzentrierte Erziehungswerte befürworteten, mehr positive Beschäftigungen mit ihren Kindern zeigten, und häufiger auf das viermonatige Kind, wenn es Kummer hatte, eingehen konnten. Ihre Kinder zeigten mit einer geringeren Wahrscheinlichkeit sichtbaren Ärger während der beobachteten Interaktionen. Die meisten Effekte des Programms auf das elterliche und kindliche Verhalten verschwanden im Laufe der Zeit. Die Doula‐Intervention ist ein vielversprechendes Verfahren zur Unterstützung des Erziehungsverhaltens und der Eltern‐Kind‐Interaktion. Die Integration von Doulas in längerfristige Hausbesuchsmodelle könnten die Effekte der frühen Doula‐Dienstleistungen aufrechterhalten und die Dienstleistungen für Erziehungsverhalten, die im Rahmen traditioneller Hausbesuchsprogramme angeboten werden, verbessern. 抄録：ドゥーラDoulaの伝統的な役割は陣痛と出産の時に女性を支援することだったが、母－乳幼児関係を支援することを主な目的とする地域社会を基盤とするプログラムcommunity‐based programsでますます利用されるようになっている。この研究では、若い低所得の母親達の間で、ドゥーラサービスが育児に与える影響を調査した。248人の妊婦が、ドゥーラサービスか、通常の医学的社会的サービスかに無作為に割り当てられた。ドゥーラは出産前の家庭訪問、陣痛と出産の間の支援、および出産３か月後の家庭訪問を提供した。育児は、乳児の月齢4、12、及び24か月時の母－乳児相互交流のビデオ記録および養育態度とストレスについての母親の報告から評価した。包括解析分析Intent‐to‐treat analysesから、ドゥーラサービスを受けた女性は、より子どもを中心とした育児に価値を置くことを認め、乳児とポジティブな関わりを見せ、そして、４か月時の乳児の不快により応答する傾向があることがわかった。乳児は、観察された相互交流の間に明らかなぐずりを示すことが少ない傾向があった。親と子どもに対するプログラムの効果の大部分は、時間が経つと消えていった。地域のドゥーラ介入は、育児と親－乳児相互交流を支援するための有望な実践である。ドゥーラを長期にわたる家庭訪問モデルと統合することにより、ドゥーラサービスの早期の影響を持続させ、伝統的な家庭訪問プログラムにより提供される育児サービスを増強するかもしれない。Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/100142/1/imhj21400.pd

Car Brake.

Patent for a new and improved car brake. This design "consists in a novel combination and arrangement of certain mechanical appliances by means of which the brakes of a railway-car are automatically operated by the pushing and pulling action of the draw-head, and which are applicable to any ordinary system of brake-levers and without interfering with the operation of the ordinary hand-brake" (lines 10-17)

Knowledge, attitudes and practices of community pharmacy professionals on poultry antimicrobial dispensing, use and resistance in Zambia : implications on antibiotic stewardship and WHO AWaRe classification of antibiotics

Globally, the inappropriate dispensing and use of antibiotics in animals has contributed to the development of bacterial antimicrobial resistance (AMR). In Zambia, there is insufficient infor-mation among community pharmacy professionals on antibiotic use (AMU) and AMR in food-producing animals. This study assessed community pharmacy professionals' knowledge, attitudes and practices regarding poultry antibiotic dispensing, use, and bacterial AMR the Lusaka district of Zambia. A cross-sectional study was conducted among 178 community pharmacy pro-fessionals between February and April 2022 using a semi-structured questionnaire. Data were analyzed using Stata version 17. Of the total participants (n=178), 51.1% (n=91) were pharmacists. The most dispensed antibiotic was oxytetracycline, a Watch antibiotic, mainly without prescrip-tions. Good knowledge of AMU and AMR was associated with work experience for more than one year (p=0.016), while good practices were associated with male gender (p=0.039) and work expe-rience of more than one year (p=0.011). The study found moderate knowledge, positive attitudes and moderate practices of pharmacy professionals on poultry AMU and AMR. There was high dispensing of poultry antibiotics without prescriptions, which calls for strict implementation of antimicrobial stewardship and surveillance programs in poultry production in Zambia to reduce AMR

A Petition for the Establishment of a Chapter of the Society of the Sigma Xi at the U.S. Naval Postgraduate School

A petition to the President of the Executive Committee and members of Sigma XI by NPS members organized as a Club to establish a Chapter at the U.S. Naval Postgraduate School.Approved for public release; distribution is unlimited