Improving Utilization and Quality of Survivorship Care for Patients with Gynecological Malignancies

After patients end their cancer treatmentand have no evidence of disease, theyenter survivorship portion of their care.Survivorship programs provide thefollowing services: psychosocial support,nutrition, medication side-effects, geneticcounseling, and fertility concerns throughthe use of treatment summaries andsurvivorship care plans. Patients continue to face difficulty in accessing services.Objectives: To increase enrollment insurvivorship program

Moving through a dappled world: the aesthetics of shade and shadow in place

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. In addressing geography’s neglect of shade and shadow, this paper explores how the dynamic play of shadow and light constitutes an integral part of everyday affective and sensory attunement to place and guides pedestrian movement. First, we identify how particular shadows are shaped by distinctive kinds of solar radiance, material forms, human visual perception and cultural representations. We then consider the different cultural ways in which shade and shadow have been interpreted across space and time and identify diverse shadowy effects in different geographical contexts. Thereafter, we focus on particular key elements of central Melbourne’s shadow aesthetics, discuss how patterns of shade guide urban choreographies, and explore how architects have imaginatively manipulated shadow

Effect of Mutation on Helper T-cells and Viral Population: A Computer Simulation Model for HIV

A Monte Carlo simulation is proposed to study the dynamics of helper T-cells (N H) and viral (N V) populations in an immune response model relevant to HIV. Cellular states are binary variables and the interactions are described by logical expressions. Viral population shows a nonmonotonic growth before reaching a constant value while helper T-cells grow to a constant after a relaxation/reaction time. Initially, the population of helper cells grows with time with a power-law, N H ∼t β, before reaching the steady-state; the growth exponent β increases systematically (β ≈ 1 – 2) with the mutation rate (P mut≈0.1–0.4). The critical recovery time (t c) increases exponentially with the viral mutation, t c≈Ae αP mut , with α=4.52±0.29 in low mutation regime and α=15.21±1.41 in high mutation regime. The equilibrium population of helper T-cell declines slowly with P mut and collapses at ∼ 0.40; the viral population exhibits a reverse trend, i.e., a slow increase before the burst around the same mutation regime

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care? Contraception

Abstract Background: The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception. Study Design: Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology. Results: Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice. Conclusions: The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies

A Monte Carlo Approach to Population Dynamics of Cells in a HIV Immune Response Model

Using a direct Monte Carlo simulation, population growth of helper T-cells (N H) and viral cells (N v) is studied for an immune response model with an enhanced spatial inter-cellular interaction relevant to HIV as a function of viral mutation. In the absence of cellular mobility (P mob=0), the helper T-cells grow nonmonotonically before reaching saturation and the viral population grows monotonically before reaching a constant equilibrium. Cellular mobility (P mob=1) enhances the viral growth and reduces the stimulative T-cell growth. Below a mutation threshold (P c), the steady-state density of helper T-cell (p H) is larger than that of the Virus (p v); the density difference Δp o(=pV−pH) remains a constant at P mob=1 while −Δp o→0 as P mut→P c at P mob=0. Above the mutation threshold, the difference Δp o in cell density, grows with ΔP=P mut−P c monotonically: ΔP o ∞ (ΔP)β ≃ with β≈0.574±0.016 in absence of mobility, while Δp o≈6(ΔP) with P mob=1

Management of ruptured ovarian teratoma mimicking advanced ovarian cancer.

•Chronic chemical peritonitis caused by spontaneous rupture of a mature cystic teratoma may result in prolonged hospitalization and respiratory decline and can mimic a gynecologic malignancy.•Earlier surgical intervention for mature teratoma may prevent morbidity.•Inclusion of a gynecologic oncologist is advised for management discussions and/or surgical back-up.•Complex benign gynecologic surgeries may have some benefit for gynecologic oncologic trainees, which can be used for later oncologic cases

Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer.

PurposeHealth-related quality of life (HRQOL) is an important prognostic factor in cancer patients. To date, no other studies have assessed the association between HRQOL measured before diagnosis and survival in older women with endometrial cancer.MethodsThe Surveillance, Epidemiology, and End Results - Medicare Health Outcomes Survey linked database was used to identify 995 women who were at least 65 years old and completed a survey before diagnosis with endometrial cancer. We obtained scores for 10 HRQOL scales, as measured by Medical Outcomes Study Short Form-36 and Veterans RAND 12-Item Survey, and data on activities of daily living (ADLs) impairments and depressive symptoms. Fine and Gray competing risks regression and Cox proportional hazards were used to estimate the association of HRQOL with endometrial cancer-specific and overall survival, respectively.ResultsWomen who died had worse pre-diagnosis HRQOL than women who were still alive at the end of the study period. For every five-point increase in HRQOL score, overall survival improved by 5-9%. The strongest associations were observed for vitality (HR = 0.91, 95% CI 0.86, 0.97, p = 0.0021) and physical functioning (HR = 0.92, 95% CI 0.87, 0.97, p = 0.0010). ADL impairments were generally not predictive of survival, though depressive symptoms were significantly associated with increased hazard of death from all causes (HR = 1.34, 95% CI 1.00, 1.79, p = 0.0466).ConclusionHRQOL measured before diagnosis with endometrial cancer has prognostic value. Having measures of HRQOL available at diagnosis may facilitate timely supportive care to improve survival

46 Beyond rounds: improving physician wellness on the gynoncology service through meaningful connection

Objectives: Burnout in medicine is a growing crisis, and SGO has identified combatting burnout as a priority. The estimated prevalence of burnout is almost 90% among Gyn-Oncology fellows and 50% among Ob/Gyn residents. Most wellness initiatives focus on helping trainees find fulfillment outside of the hospital, and little has been done to help trainees find wellness in their work. Our quality improvement project seeks to improve the wellness of physician trainees on the Gyn-Oncology service, by returning them to their patients’ bedsides to engage in meaningful activities and develop connections that go “Beyond Rounds.” Methods: Each week the team identifies a patient they think would benefit from engaging in a meaningful activity, and a trainee to pair with them. If the patient elects to participate, the patient and trainee select an activity to do together. Trainees are guaranteed 90 minutes of protected time during normal work hours for the activity. Outcomes are measured using the Physician Fulfillment Index (PFI), which measures both professional fulfillment and burnout. The pre and post-survey is self-administered via a QR code, and includes the PFI and short answer questions. Our project has a specific focus on equity and inclusion, and prioritizes patients who face barriers to care due to their gender/sexuality, race/ethnicity, insurance status, immigration status, or primary language. Funding was provided through a grant from the ACGME's “Back-to-Bedside” Initiative. Results: In the first 6 weeks of the project, 4 trainees completed a meaningful activity. The project has been met with enthusiasm and has been rapidly integrated into the workflow of the Gyn-Oncology service. We anticipate at least 16 meaningful activities to have been completed by June 2023. Activities chosen included: drinking coffee outside, manicures, working on a puzzle, and looking at family photographs. All trainees felt that their time was adequately protected and agreed that the experience changed their perspective on the care our team provides. The intervention had a large positive effect on professional fulfilment and a moderate positive effect on burnout (Cohen's D; medium = 0.4, large = 0.8). Common themes of the short answer questions included: developing a fulfilling connection, gaining a better understanding of how cancer impacts patients as people, and recognizing the trust and gratitude our patients have for our team. Conclusions: Our quality improvement project demonstrates that creating protected time for physician trainees to return to their patients’ bedsides, has an immediate, positive, and measurable effect on professional fulfillment and burnout. The causes of burnout are complex and multifactorial, but helping physicians find wellness in their work is essential to combatting it