An Empirical Chart Analysis of the Suitability of Telemedicine for Hospice Visits

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2005.11.90.Telehospice® (TH) utilizes telemedicine technology to provide care at the end of life. A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care. Videophones were deployed for telenursing visits and evaluations by social workers. In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology, we reviewed clinical records retrospectively for hospice nurse home visits. Clinical notes documenting home nursing visits were obtained from two large hospices, one based in Kansas, and the other in Michigan. Records were randomly selected for patients who received hospice nurse visits during the month of January 2000. The charts were reviewed for patient demographic information, patient assessments, teaching activities, and interventions. Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument. After careful review of the records, the coders also made a subjective observation regarding the suitability of each visit for telemedicine. As part of this analysis, we found that 64.5% of home hospice nursing visits could be performed by telemedicine. Using TH, it is possible to reduce the number of in-person visits, thereby significantly decreasing the cost of providing hospice care

Searching for cures: Inner-city and rural patients' awareness and perceptions of cancer clinical trials

Fewer than 5% of cancer patients participate in clinical trials, making it challenging to test new therapies or interventions for cancer. Even within that small number, patients living in inner-city and rural areas are underrepresented in clinical trials. This study explores cancer patients' awareness and perceptions of cancer clinical trials, as well as their perceptions of patient-provider interactions related to discussing cancer clinical trials in order to improve accrual in cancer clinical trials. Interviews with 66 former and current in inner-city and rural cancer patients revealed a lack of awareness and understanding about clinical trials, as well as misconceptions about what clinical trials entail. Findings also revealed that commercials and television shows play a prominent role in forming inner-city and rural patients' attitudes and/or misconceptions about clinical trials. However, rural patients were more likely to hold unfavorable views about clinical trials than inner-city patients. Patient-provider discussions emerged as being crucial for increasing awareness of clinical trials among patients and recruiting them to trials. Findings from this study will inform communication strategies to enhance recruitment to cancer clinical trials by increasing awareness and countering misconceptions about clinical trials

Midwest Cancer Alliance: Partnership to Support Quality Cancer Care

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionOver 85% of cancer patients nationwide receive care in the community setting (NCI, 2007). In 2008, the Midwest Cancer Alliance (MCA) launched with a vision of marshaling the exceptional cancer resources of the region to support the system of care provided to patients while keeping them “close to home”. With an emphasis on education and research, the MCA was developed to connect hospitals and physician groups across Kansas and western Missouri with the purpose of: Providing strong support to community cancer care professionals; Enhancing cancer care for patients across the region; Advancing access to innovative, investigator-initiated and cooperative group clinical trials; Advancing access to newly developed therapies and prevention strategies; Providing continuing professional and community education opportunities; Facilitating second opinion and consultation services; and Providing patient navigator technical assistance across the network. A membership-based organization, the MCA currently has 14 partners spanning the region including: Children's Mercy Hospital and Clinics; Goodland Regional Medical Center; Hays Medical Center; Kansas Bioscience Authority; Kansas State University; Mt. Carmel Regional Medical Center; Promise Regional Medical Center; Saint Luke's Health; Salina Regional Health Center; St. Francis Health Center; Stormont-Vail HealthCare; Stowers Institute for Medical Research; Truman Medical Center; The University of Kansas Hospital. Methods: In collaboration with members, the MCA facilitates a wide-array of cancer related services. Activities range from developing clinical trial infrastructure including, a centralized Institutional Review Board (IRB), online Velos clinical trials management software to facilitate enrollment and trial data management, and access to Southwest Oncology Group (SWOG), Clinical Trials Support Unit (CTSU) sponsored trials, and research initiated by The University of Kansas Cancer Center's Investigators. MCA provides professional and community education specific to the needs of the community. Members have access to The University of Kansas Cancer Center Tumor Boards as well as continuing education such as chemotherapy and oncology nurse certification curricula. Results: Numerous cancer-related activities have occurred since the inception of the MCA. Over 11,450 individuals attended MCA community education and screening events. 6,200 cancer screenings resulted in 470+ referrals back to local physicians for follow-up on abnormal results. Over 3,096 Continuing Nursing Education (CNE) credits and 296 Continuing Medical Education (CME) credits. Five members have capacity to enroll patients through MCA sponsored trials with access to SWOG and CTSU. 7 cases have been presented at tumor boards. 9 second opinion consultations occurred through the use of telemedicine technology. Discussion: Less than three percent of adult cancer patients participate in clinical trials (Christian & Trimble, 2003). The MCA was established, in part, to address disparities such as this, in an effort to enhance the excellent cancer care provided across the region. The MCA appears to hold great promise of achieving this vision, by leveraging region's collective cancer resources and cancer expertise

Telehealth Services to Improve Nonadherence: A Placebo-Controlled Study

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2006.12.289.The objective of this study was to test whether a telehealth intervention could improve the compliance with continuous positive airway pressure (CPAP) by patients with sleep apnea. These patients had been nonadherent for the initial 3 months of therapy even after receiving the initial standard and then supplemental audiotaped/videotaped patient education for adhering to CPAP nightly. The materials and methods included a randomized testing of experimental and placebo interventions. Interventions were delivered by nurses to two groups in their homes by telehealth over a 12-week period. The placebo intervention was used to control for Hawthorne effect, time and attention influences and the novelty of having telehealth in the home. Results following the telehealth interventions were that significantly more patients in the experimental group 1 (n = 10) than the placebo group 2 (n = 9) were adhering nightly to CPAP (χ2 = 4.55, p = 0.033). Group 1 patients reported greater satisfaction with their intervention. However, both groups rated telehealth delivery positively. The mean cost of each 20-minute telehealth visit was $30 while the total cost of the telehealth intervention for each patient was$420. These costs included telehealth equipment, initial installation, longdistance telephone charges, nurse salary, and intervention materials. Conclusions are that telehealth interventions are a potentially cost-effective service for increasing adherence to prescribed medical treatments. Replication studies with large samples and in other clinical groups are recommended

Mimesis stories: composing new nature music for the shakuhachi

Nature is a widespread theme in much new music for the shakuhachi (Japanese bamboo flute). This article explores the significance of such music within the contemporary shakuhachi scene, as the instrument travels internationally and so becomes rooted in landscapes outside Japan, taking on the voices of new creatures and natural phenomena. The article tells the stories of five compositions and one arrangement by non-Japanese composers, first to credit composers’ varied and personal responses to this common concern and, second, to discern broad, culturally syncretic traditions of nature mimesis and other, more abstract, ideas about the naturalness of sounds and creative processes (which I call musical naturalism). Setting these personal stories and longer histories side by side reveals that composition creates composers (as much as the other way around). Thus it hints at much broader terrain: the refashioning of human nature at the confluence between cosmopolitan cultural circulations and contemporary encounters with the more-than-human world

A Phase II Trial of Pyrazine Diazohydroxide in Patients with Disseminated Malignant Melanoma and no Prior Chemotherapy – Southwest Oncology Group Study

Malignant melanoma is rapidly increasing inthe United States. Metastatic diseaseresponds poorly to currently availablechemotherapy. Pyrazine diazohydroxide(PZDH) is a new agent inhibiting DNAsynthesis that is active in mouse tumormodels and human xenografts and lackscross resistance withmultiple standard agents. In this phase IItrial, patients with no prior chemotherapyor immunotherapyfor metastatic disease and performancestatus (SWOG) of 0–1, were treated withpyrazine diazohydroxide at a dose of 100 mg/m 2 /day by IV bolus injectionover 5–15 minutes for 5 consecutive daysevery 6 weeks. There were 23 eligiblepatients entered on this trial with 74%having PS of 0 and 91% having visceralmetastases. There were no confirmed anti-tumor responses. Theoverall response rate is 0% (95% CI 0%–15%). Median overall survival is sixmonths (95% CI 5-8months). The most common toxicities were hematologic and consisted of lymphopenia,thrombocytopenia, anemia, and leukopenia. Fatigue, and nausea and vomiting were thenext mostcommon toxicities. Pyrazine diazohydroxideby this dose and schedule has insufficientactivity in thetreatment of disseminated malignantmelanoma to warrant further investigation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45216/1/10637_2004_Article_390690.pd

Floodwater farming, discontinuous ephemeral streams, and Puebloan abandonment in southwestern Colorado

Geoarchaeological study on the southern piedmont of Sleeping Ute Mountain in southwestern Colorado indicates the presence of discontinuous ephemeral streams that were the foci of episodic Puebloan occupation between A.D. 600s and 1280. Characterized by arroyos, discontinuous ephemeral streams contain alternating aggrading and degrading reaches and are well suited for ak chin floodwater agriculture. Episodic Puebloan abandonment of the southern piedmont correlates with periods of drought but does not appear to be linked to stream entrenchment. We question a priori assumptions of droughts correlated to stream entrenchment and urge caution in the use of drought-arroyo models for settlement shifts in alluvial flood plains without supporting stratigraphic or geomorphic evidence

Session #2: Providing Oncology Care via Telemedicine

Telemedicine, the use of telecommunications technology to provide services to populations with limited access to care, can be beneficial for urban patients for chronic disease management and for medically underserved communities in rural locations where provider shortages exist. Oncologists from The University of Kansas Cancer Center started a ‘tele-oncology’ practice in 1994, initially to provide ongoing cancer care and second opinions for rural cancer patients throughout the state of Kansas. Over time, and at the request of communities in the state, additional telemedicine services were offered to support the care of the cancer patient including: psycho-oncology evaluations, symptom management and palliative care consultations, genetics consultations, survivorship services, cancer care support groups, hospice care, multidisciplinary case conferences, provider continuing education events, and most recently, access to cancer clinical trials. This discussion will review two services, tele-oncology and telehospice, with an emphasis on organizational aspects that must be addressed when launching and running a telemedicine practice