Inclusion in morning meetings

This thesis explores the extent to which teachers implement best practice of inclusion during their daily Morning Meetings. Morning Meetings are a standard practice at the beginning of the school day where student and teachers greet one another, share personal stories and information, participate in a group activity, and read a morning message written by the teachers. Preschool through third grade teachers in local school districts were given a self-reflection survey. The survey was a standardized checklist that was informed by research on inclusive practices and The Morning Meeting Book (Kriete & Davis, 2014). It was modeled after the Division for Early Childhood (DEC) and the National Association for the Education of Young Children (NAEYC) joint early childhood inclusion policy, which states the defining features of inclusion as access, participation, and supports (2009). The survey lists specific practices that teachers may or may not be implementing that promote inclusion. My hypothesis before the research began was that teachers would struggle to implement the practices that take more time and preparation outside of their normal routine. The analysis of the data showed that my hypothesis was correct to some extent, teachers were more successful when implementing accommodations that they could plan into the whole group, and less successful with one-on-one accommodations that required them to work individually with a student outside of the Morning Meeting

Systemic anticancer treatment in the Netherlands: Few hospitals treat many patients, many hospitals treat few patients

Introduction: The correlation between patient volume and clinical outcomes is well known for various oncological treatments, especially in the surgical field. The current level of centralisation of systemic treatment of (hemato-)oncology indications in Dutch hospitals is unknown. Objectives: The aim of this study was to gain insight in patient volumes per hospital of patients treated with systemic anticancer treatment in the Netherlands. Methods: National claims data (Vektis) of all 73 Dutch hospitals that provide systemic anticancer medication in the Netherlands for the time period 2019 were used. The distribution of volumes of patients treated with anticancer medication for 38 different haematological or oncological indications was analysed. Hospitals were categorized into academic/specialised, general, and top clinical. Two volume cut off points (10 and 30 patients) were used to identify hospitals treating relatively few patients with anticancer medication. Four indications were investigated in more detail. Results: A wide distribution in patient volumes within hospitals was observed. Top clinical hospitals generally treated the most patients per hospital, followed by general and academic/specialised oncology hospitals. The volume cut off points showed that in 19 indications (50%) the majority (>50%) of all hospitals treated less than 10 patients and in 25 indications (66%) the majority of all hospitals treated less than 30 patients with anticancer medication. Four case studies demonstrated that relatively few hospitals treat many patients while many hospitals treat few patients with anticancer medication. Conclusion: In the majority of oncology indications, a large proportion of Dutch hospitals treat small numbers of unique patients with anticancer medication. The high level of fragmentation gives ground for further exploration and discussion on how the organisation of care can support optimization of the efficiency and quality of care. Professional groups, policy makers, patients, and healthcare insurers should consider per indication whether centralisation is warranted

Health-related quality of life in cancer immunotherapy: a systematic perspective, using causal loop diagrams.

PURPOSE: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the health-related quality of life (HRQoL) of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for HRQoL of cancer immunotherapy patients. METHODS: We first applied a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively reviewed and enhanced the CLD through interviews with subject matter experts. RESULTS: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients' HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams' perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients' HRQoL. CONCLUSION: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains