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The actual "Worktivity" mHealth treatment to cut back non-active actions in the workplace: a new feasibility cluster randomised managed aviator examine.
No funding supported the writing of this commentary. The author has nothing to disclose.No funding supported the writing of this article. The author is an employee of AmerisourceBergen and leads its Good Neighbor Pharmacy program, which supports independent community pharmacy customers.No funding was received for the writing of this commentary. The author has nothing to disclose.Background Improving medication adherence can reduce health care spending, and studies have demonstrated community pharmacists can positively affect adherence through the provision of enhanced services. The North Carolina (NC) Community Pharmacy Enhanced Services Network (CPESN) was formed in early 2014 with the goal of enhancing the care provided through its network pharmacies. Objective To evaluate differences in medication adherence performance scores between pharmacies that participated in the NC-CPESN and control pharmacies in NC that did not. Methods Medication adherence performance data for statins, renin-angiotensin system antagonists, oral diabetes medications, and a custom multiple chronic medication measure were gathered from quarterly reports between December 2014 and September 2016. Data for these quarterly reports were derived from NC Medicaid claims. These data were combined with pharmacy demographics and service offerings data from the National Council on Prescription Drug Plans dataQ databaseced services pharmacy network, and CPESN USA, a for-profit company that developed out of the original grant-funded project. Farley has nothing to disclose.Background Non-small cell lung cancer (NSCLC) is the most common form of lung cancer in the United States. Immunotherapies and cytotoxic chemotherapies used to treat advanced NSCLC carry a substantial risk of adverse events (AEs), but real-world data on the incidence and costs associated with the unique AE profiles of these treatments are sparse. Objective To examine the AE incidence and costs among patients initiating non-driver mutation-targeted first-line therapy for metastatic NSCLC (mNSCLC) in clinical practice. Methods This was a retrospective administrative claims study conducted among commercial and Medicare Advantage health plan members who initiated first-line, nontargeted systemic anti-NSCLC therapy between January 1, 2008, and February 28, 2018. Patients were assigned to mutually exclusive treatment cohorts (cytotoxic chemotherapy [CHEM], immuno-oncology agents [IO], or immuno-oncology + cytotoxic chemotherapy [IO-CHEM]) and were observed from the index date (start of first-line therapy) through tn is an employee of AstraZeneca. Engel-Nitz, Johnson, and Bunner are employees of Optum, which was contracted by AstraZeneca to conduct this study, and shareholders in UnitedHealth Group. Engel-Nitz has also worked on cancer-related studies for which Optum received funding from Bayer AG, Clovis Oncology, Eli Lilly, EMD Serono, Exact Sciences, Janssen, and Novartis. Johnson worked on cancer-related studies for which Optum received funding from Eli Lilly, Medtronic, Sanofi, and UnitedHealthcare. Bunner has worked on cancer-related studies for which Optum received funding from Celgene and Incyte.No funding supported the writing of this commentary. The author has nothing to disclose.Many different enzymes in intermediate metabolism dynamically assemble filamentous polymers in cells, often in response to changes in physiological conditions. Most of the enzyme filaments known to date have only been observed in cells, but in a handful of cases structural and biochemical studies have revealed the mechanisms and consequences of assembly. In general, enzyme polymerization functions as a mechanism to allosterically tune enzyme kinetics, and it may play a physiological role in integrating metabolic signaling. Here, we highlight some principles of metabolic filaments by focusing on two well-studied examples in nucleotide biosynthesis pathways-inosine-5'-monophosphate (IMP) dehydrogenase and cytosine triphosphate (CTP) synthase.Purpose A telehealth oncology practice was created to care for patients in rural communities to improve access to health care, decrease financial burdens, and save time. Patients and methods Patients with cancer at Sevier Valley Hospital in Richfield, Utah, were treated with a real-time video-based telehealth program under the care of an oncologist at a tertiary medical center. Data on financial savings, travel hours, mileage avoided, carbon emissions reduced, and revenue retained by Sevier Valley Hospital were collected from 2015 to 2018. Results From 2015 to 2018, 119 patients with cancer in Richfield, Utah, were treated with telehealth for oncology visits, accounting for 1,025 patient encounters. On average, patients saved 4 hours and 40 minutes and 332 miles roundtrip per encounter. In total, patients' savings were estimated to be $333,074. Carbon emissions were reduced by approximately 150,000 kg. Of new patient referrals, 59% were for solid tumors (70 of 119 referrals; 42 metastatic and 28 nonmetastatic cancers), and 41% were hematology consultations (49 of 119 referrals; 28 classical and 21 malignant hematologic conditions). We estimate that Sevier Valley Hospital retained $3,605,500 in revenue over this 4-year period. Conclusion Using a telehealth program in rural Utah, patients with cancer benefited from substantial time and monetary savings. The local medical center was able to retain revenue it would have otherwise lost to outsourcing cancer care. Recent regulatory changes to address the COVID-19 pandemic should increase the number of patients with cancer treated via telehealth nationwide.Purpose The 21-gene recurrence score (RS) assay is used to guide breast cancer treatment decisions but can be poorly understood by patients. We examined the effects of a question prompt list (QPL) on knowledge, distress, and decisional conflict related to genomic testing and treatment in early-stage breast cancer. selleck products Methods We describe the feasibility and acceptability of the QPL and the impact of the QPL on knowledge, distress, and decisional conflict before and after the receipt of the QPL (MEND 2, N = 65). We also compared distress and decisional conflict between women who received the QPL (MEND 2, N = 65) and a comparable group of women who did not receive the QPL who participated in an earlier observational study within the same clinics (MEND 1, N = 136). Results MEND 2 participants indicated high acceptability and feasibility using the QPL. Knowledge increased post-QPL (P less then .01) but did not decrease distress. Decisional conflict was lower among women in MEND 2 compared with those in MEND 1 (P less then .01), with no statistically significant differences in distress. Conclusion The findings suggest that the QPL is feasible, acceptable, can improve knowledge and decrease decisional conflict in the large group of women deciding treatment while integrating RS test results.Purpose The Edmonton Symptom Assessment System (ESAS) is a validated instrument whose use has been standardized in the Ontario cancer system to measure symptoms among ambulatory patients with cancer. The objective was to examine the effect of ESAS exposure on visits to the emergency department (ED) and hospitalizations. Methods This was a retrospective matched cohort study conducted in Ontario, Canada. The study included patients ≥ 18 years of age diagnosed with cancer between 2007 and 2015. Patients were considered exposed if they were screened with ESAS at least once during the study period, and their first ESAS screening date was defined as the index date. Each exposed patient was matched randomly to a patient with cancer without ESAS assessment using a combination of hard matching (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type, and sex) and propensity score matching (14 variables, including cancer stage, treatments received, and comorbidities). A multivariable Andersen-Gill recurrent event model was used to evaluate the effect of ESAS on the rate of health care use. Results The analysis included 128,893 matched pairs that were well balanced on baseline measures. After adjusting for other variables, patients with ESAS had lower rates of both ED visits (relative rate [RR], 0.92; 95% CI, 0.91 to 0.93) and hospitalizations (RR, 0.86; 95% CI, 0.85 to 0.87) compared with patients without ESAS. Conclusion ESAS exposure is independently associated with decreased rates of ED visits and hospitalizations. This provides real-world evidence of one potential positive impact of standardized symptom assessment in cancer care.In 1900, 13% of infants in the United States died before their first birthday, most of dehydration from diarrhea. As part of a nationwide effort to "save the babies," pediatricians focused on several endeavors-experimenting with commercially made infant-food products; working with dairy farmers to clean up cows' milk; lobbying to pass municipal and state legislation regulating the dairy industry; and devising mathematical "formulas" that represented instructions to chemists on how to "humanize" cows' milk for the needs of a particular infant. Pediatricians dubbed the latter endeavor "percentage feeding" and, from the 1890s to the 1920s, they deemed percentage feeding a lifesaving scientific achievement. The complex, virtually infinite array of mathematical formulas that comprised this infant-feeding system is the origin of the word "formula" as used today to describe artificial baby milk.Psoriasis is a chronic, multisystem inflammatory disease, predominantly affecting the skin and joints, which is present in 2-3% of the world's population. Narrow band ultraviolet B (NB-UVB) and Psoralen + ultraviolet A (PUVA) are recognised, effective and, in the case of UVB, economical second-line treatments for psoriasis where topical therapies fail to control the disease or are an impracticable option due to the extent of skin involvement. This article examines the history of phototherapy and photochemotherapy and looks at current phototherapy treatments used for psoriasis. It discusses side effects of treatment and regimens that can be followed to increase effectiveness of treatment and minimise risks. The role of the nurse phototherapist is also discussed.Background Administration of doxorubicin via bolus injection may result in environmental contamination and a risk of nurses becoming exposed. Small spills are frequently observed by nurses when syringes are connected to, and disconnected from, infusion lines. Aims The effect of a closed-system drug transfer device (CSTD) on the release of doxorubicin was studied during administration via bolus injections. Methods 10 administrations with the currently used technique and 10 administrations using the CSTD were compared by analysis of doxorubicin contamination on gauze pads, tissues and gloves. Findings Using the current technique, contamination was found during nine administrations, which was mainly on the gauze pads and, to a lesser extent, on the tissues and gloves, indicating release of doxorubicin during administration. With use of the CSTD, contamination was found only on one pair of gloves. Conclusion Use of a CSTD significantly decreased the number of spills and level of contamination compared with the currently used technique and, consequently, the use of such devices offers a safer working environment for nurses.
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