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

Raves, Clubs, and Ecstacy: The Impact of Peer Pressure

47 pages, 1 article*Raves, Clubs, and Ecstacy: The Impact of Peer Pressure* (Castillo-Garsow, Melissa; Henson, Leilani; Mejran, Marcin; Rios-Soto, Karen R.) 47 page

Physical Activity Predicts Population-Level Age-Related Differences in Frontal White Matter.

Physical activity has positive effects on brain health and cognitive function throughout the life span. Thus far, few studies have examined the effects of physical activity on white matter microstructure and psychomotor speed within the same, population-based sample (critical if conclusions are to extend to the wider population). Here, using diffusion tensor imaging and a simple reaction time task within a relatively large population-derived sample (N = 399; 18-87 years) from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN), we demonstrate that physical activity mediates the effect of age on white matter integrity, measured with fractional anisotropy. Higher self-reported daily physical activity was associated with greater preservation of white matter in several frontal tracts, including the genu of corpus callosum, uncinate fasciculus, external capsule, and anterior limb of the internal capsule. We also show that the age-related slowing is mediated by white matter integrity in the genu. Our findings contribute to a growing body of work, suggesting that a physically active lifestyle may protect against age-related structural disconnection and slowing

Wealth Building in Rural America: Programs, Policies, Research

Wealth Building in Rural America: Programs, Policies, Researc

Analyzing food value chains for nutrition goals

First proposed in 2010, the use of ‘value chain analysis’ to identify opportunities for targeted nutrition interventions in food systems is still an emerging method. This review explores and summarizes the application of value chain analysis to nutrition and from this provides five insights into how to more effectively conduct value chain analysis for nutrition: 1) use a consumer perspective to inform selection of foods and chains; 2) consider the research question, available resources, and the type of chain; 3) situate consumer research at the center of the analysis; 4) assess economic trade-offs; and 5) pay attention to governance and stakeholders’ capacity for and incentives to change

A national survey of managed honey bee 2010-11 winter colony losses in the USA: results from the Bee Informed Partnership

This study records the fifth consecutive year that winter losses of managed honey bee (Apis mellifera) colonies in the USA have been around 30%. In April 2011, a total of 5,441 US beekeepers (an estimated 11% of total US beekeepers) responded to a survey conducted by the Bee Informed Partnership. Survey respondents reported that they had lost an average of 38.4% of their colonies, for a total US colony loss of 29.9% over the winter of 2010-11. One-third of respondents (all classified as backyard beekeepers, i.e. keeping fewer than 50 colonies) reported no winter loss. There was considerable variation in both the average and total loss by state. On average, beekeepers consider acceptable losses to be 13.2%, but 68% of all responding beekeepers suffered actual losses in excess of what they considered acceptable. Of beekeepers who reported losing at least one colony, manageable conditions, such as starvation and a weak condition in the fall, were the leading self-identified causes of mortality. Respondents who indicated that varroa mites (Varroa destructor), small hive beetles (Aethina tumida), poor wintering conditions, and/or Colony Collapse Disorder (CCD) conditions were a leading cause of mortality in their operations suffered a higher average loss than beekeepers who did not list any of these as potential causes. In a separate question, beekeepers who reported the symptom "no dead bees in hive or apiary" had significantly higher losses than those who did not report this symptom. In addition, commercial beekeepers were significantly more likely to indicate that colonies died with this symptom than either backyard or sideliner beekeepers.Keywords: 2010-11, USA, Mortality, Honey bee, OverwinterKeywords: 2010-11, USA, Mortality, Honey bee, Overwinte

A comparison of five surface mixed layer models with a year of observations in the North Atlantic

Five upper ocean mixed layer models driven by ERA-Interim surface forcing are compared with a year of hydrographic observations of the upper 1000 m, taken at the Porcupine Abyssal Plain observatory site using profiling gliders. All the models reproduce sea surface temperature (SST) fairly well, with annual mean warm biases of 0.11  ° C (PWP model), 0.24  ° C (GLS), 0.31  ° C (TKE), 0.91  ° C (KPP) and 0.36  ° C (OSMOSIS). The main exception is that the KPP model has summer SSTs which are higher than the observations by nearly 3 ° . Mixed layer salinity (MLS) is not reproduced well by the models and the biases are large enough to produce a non-trivial density bias in the Eastern North Atlantic Central Water which forms in this region in winter. All the models develop mixed layers which are too deep in winter, with average winter mixed layer depth (MLD) biases between 160 and 228 m. The high variability in winter MLD is reproduced more successfully by model estimates of the depth of active mixing and/or boundary layer depth than by model MLD based on water column properties. After the spring restratification event, biases in MLD are small and do not appear to be related to the preceding winter biases. There is a very clear relationship between MLD and local wind stress in all models and in the observations during spring and summer, with increased wind speeds leading to deepening mixed layers, but this relationship is not present during autumn and winter. We hypothesize that the deepening of the MLD in autumn is so strongly driven by the annual cycle in surface heat flux that the winds are less significant in the autumn. The surface heat flux drives a diurnal cycle in MLD and SST from March onwards, though this effect is much more significant in the models than in the observations. We are unable to identify one model as definitely better than the others. The only clear differences between the models are KPP’s inability to accurately reproduce summer SSTs, and the OSMOSIS model’s more accurate reproduction of MLS

Social and clinical determinants of preferences and their achievement at the end of life: Prospective cohort study of older adults receiving palliative care in three countries

© 2017 The Author(s). Background: Achieving choice is proposed as a quality marker. But little is known about what influences preferences especially among older adults. We aimed to determine and compare, across three countries, factors associated with preferences for place of death and treatment, and actual site of death. Methods: We recruited adults aged ≥65-years from hospital-based multiprofessional palliative care services in London, Dublin, New York, and followed them for >17 months. All services offered consultation on hospital wards, support for existing clinical teams, outpatient services and received funding from their National Health Service and/or relevant Insurance reimbursements. The New York service additionally had 10 inpatient beds. All worked with and referred patients to local hospices. Face-to-face interviews recorded most and least preferred place of death, treatment goal priorities, demographic and clinical information using validated questionnaires. Multivariable and multilevel analyses assessed associated factors. Results: One hundred and thirty eight older adults (64 London, 59 Dublin, 15 New York) were recruited, 110 died during follow-up. Home was the most preferred place of death (77/138, 56%) followed by inpatient palliative care/hospice units (22%). Hospital was least preferred (35/138, 25%), followed by nursing home (20%) and home (16%); hospice/palliative care unit was rarely least preferred (4%). Most respondents prioritised improving quality of life, either alone (54%), or equal with life extension (39%); few (3%) chose only life extension. There were no significant differences between countries. Main associates with home preference were: cancer diagnosis (OR 3.72, 95% CI 1.40-9.90) and living with someone (OR 2.19, 1.33-3.62). Adults with non-cancer diagnoses were more likely to prefer palliative care units (OR 2.39, 1.14-5.03). Conversely, functional independence (OR 1.05, 1.04-1.06) and valuing quality of life (OR 3.11, 2.89-3.36) were associated with dying at home. There was a mismatch between preferences and achievements - of 85 people who preferred home or a palliative care unit, 19 (25%) achieved their first preference. Conclusion: Although home is the most common first preference, it is polarising and for 16% it is the least preferred. Inpatient palliative care unit emerges as the second most preferred place, is rarely least preferred, and yet was often not achieved for those who wanted to die there. Factors affecting stated preferences and met preferences differ. Available services, notably community support and palliative care units, require expansion. Contrasting actual place of death with capacity for meeting patient and family needs may be a better quality indicator than simply 'achieved preferences'

A national survey of managed honey bee 2011-12 winter colony losses in the United States: results from the Bee Informed Partnership

Estimates of winter loss for managed honey bee (Apis mellifera) colonies are an important measure of honey bee health and productivity. We used data from 5,500 US beekeepers (5,244 backyard, 189 sideline and 67 commercial beekeepers) who responded to the April 2012 Bee Informed Partnership Winter Colony Loss Survey and calculated loss as the difference in the number of colonies between October 1, 2011 and April 1, 2012, adjusting for increases and decreases over that period. In the US, the total colony loss was 22.5% for the 2011-12 winter; 45.1% (n = 2,482) of respondents reported no colony loss. Total loss during 2011-12 was substantially lower than loss during 2010-11 (29.9%). Of the 4,484 respondents who kept bees in 2010-11 and 2011-12, 72.0% reported that the loss during 2011-12 was smaller or similar to the loss during 2010-11. There was substantial variation in total loss by state (range 6.2% to 47.7%). The average loss per beekeeping operation was 25.4%, but the average loss was not significantly different by operation type (backyard, sideline, commercial). The average self-reported acceptable loss per respondent was 13.7%; 46.8% (n = 2,259) of respondents experienced winter colony losses in excess of the average acceptable loss. Of beekeepers who reported losing at least one colony during 2011-12, the leading self-identified causes of mortality were weak condition in the fall and queen failure. Respondents who indicated poor wintering conditions, CCD, or pesticides as a leading cause of mortality suffered a higher average loss when compared to beekeepers who did not list these as potential causes.Keywords: Mortality, Colony losses, USA, Honey bee, Overwinter, 2011-1