Needs assessments have been successful in helping communities and congregations focus their health ministry efforts; however, most have used leader perceptions of congregational health needs. The ...purpose of this study was to examine and compare the self-reported needs of both church leaders and members to be addressed by their congregation. Church leaders (n = 369) and members (n = 459) from 92 congregations completed the 2019 Mid-South Congregational Health Survey. Frequencies and generalized linear mixed models (GLMM) were performed to examine the top 10 self-reported needs and associations by church role, respectively. Of the top 10 congregational needs, anxiety or depression, high blood pressure, stress, and healthy foods were ranked identically regardless of church role. Church leaders perceived obesity and diabetes to be important congregational health needs, whereas members perceived affordable health care and heart disease to be important congregational health needs. GLMM, controlling for within-church clustering and covariates, revealed church leaders were more likely than members to report obesity (odds ratio OR: 1.93, 95% confidence interval CI = 1.39, 2.67, p < .0001) and diabetes (OR: 1.73, 95% CI = 1.24, 2.41, p = .001) as congregational needs. Findings display similarities and differences in needs reported by church role. Including many perspectives when conducting congregational health needs assessments will assist the development of effective faith-based health promotion programs.
Le Bonheur Fetal Center opened in September 2009 to provide comprehensive care for women who had received a prenatal diagnosis of a congenital anomaly. After a generic request for child life staff to ...supervise the children of expectant mothers during their mother's ultrasound examinations, the child life team saw the need for more specialized psychosocial services for the expectant family. A certified child life specialist with prior experience in program development was assigned to the fetal center to assess the needs and initiate services.
To more closely examine the psychosocial care provided to this population and ways in which all the disciplines could be utilized to provide support as needed for each unique family.
We discuss collaboration that begins in the fetal center during obstetric visits, moves into labor and delivery at the nearby adult facility, and then follows with entry into the pediatric hospital. During this journey, families trust that all team members are working together to care for their child. To assist in the multiple transitions, child life specialists, in collaboration with nurses, aim to support the expectant family by providing preparation, emotional support, sibling preparation, parental coaching, and bereavement support when necessary. Success is totally reliant upon ongoing communication between all team members and the desire to always do what is best for that family in their unique situation.
The literature reveals that a prenatal diagnosis results in anxiety, grief, and uncertainty for the entire family. Whether a prenatal diagnosis is relatively minor or a lethal anomaly, ongoing multidisciplinary collaboration allows for individualized care and best practice to be provided for this population. Case studies will illustrate this collaboration.
Though nurses and child life specialists have worked closely to develop the communication and collaboration needed to successfully meet the psychosocial care of these patients, all specialties can gain further understanding and respect for the need for psychosocial care in the medical treatment of any population. It should be encouraged to consider if all the disciplines within an institution are being used to their best potential in collaborative efforts to provide patient‐ and family‐centered care. Though high‐risk obstetrics is not a population found in every healthcare setting and child life specialists are not staffed in every institution, the lessons learned from collaboration and communication in patient‐ and family‐centered care can be benefited by all healthcare providers.
The problem of selecting variables or features in a regression model in the presence of both additive (vertical) and leverage outliers is addressed. Since variable selection and the detection of ...anomalous data are not separable problems, the focus is on methods that select variables and outliers simultaneously. For selection, the fast forward selection algorithm, least angle regression (LARS), is used, but it is not robust. To achieve robustness to additive outliers, a dummy variable identity matrix is appended to the design matrix allowing both real variables and additive outliers to be in the selection set. For leverage outliers, these selection methods are used on samples of elemental sets in a manner similar to that used in high breakdown robust estimation. These results are compared to several other selection methods of varying computational complexity and robustness. The extension of these methods to situations where the number of variables exceeds the number of observations is discussed.
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Background: Pazopanib, an oral multikinase inhibitor, demonstrated noninferiority to sunitinib in patients with aRCC in COMPARZ (NCT00720941), a randomized, phase III trial (NEJM ...2013;369:722). The purpose of this study was to develop and validate prognostic nomograms based on outcome data from COMPARZ for predicting the probability of 12-month progression-free survival (PFS) and 30-month overall survival (OS) for aRCC patients who received pazopanib. Methods: Statistical modeling was performed on a dataset consisting of 557 patients from the pazopanib arm of COMPARZ. A Cox proportional hazards regression model was fit using predictors thought to be prognostic. These predictors included neutrophil count, platelet count, LDH, and alkaline phosphatase, all relative to ULN; calcium; albumin; hemoglobin; Karnofsky score; months from diagnosis to treatment; number of metastatic sites; and presence of lung, liver, and bone metastases. Data from patients on the sunitinib arm of COMPARZ and the pazopanib arm of the VEG105192 trial (NCT00334282; J Clin Oncol 2010;28:1061) were used for validation. Missing values were imputed using chained equations. For validation with the VEG105192 dataset, bootstrap-corrected estimates of discrimination and calibration were calculated following 1000 resamples. The Cox model was plotted as a nomogram. Results: Prognostic nomograms were developed and validated for predicting the probability of 12-month PFS and 30-month OS in aRCC patients based on a Cox regression model. Calibration plots suggested reasonable correspondence between predicted probabilities and actual proportions of PFS and OS. The concordance index for 12-month PFS was 0.636 with sunitinib patients and 0.635 for pazopanib patients; the concordance index was 0.692 for 30-month OS (sunitinib patients). When examining the PFS and OS nomograms, albumin, calcium, and LDH levels appeared to be the most influential predictors of outcome. Conclusions: The nomograms predict, with reasonable accuracy, treatment outcomes in patients with aRCC receiving pazopanib, based on their baseline clinical characteristics.
To develop and validate a prognostic nomogram for predicting the probability of 12-month progression-free survival (PFS) for patients receiving first-line pazopanib for advanced renal cell carcinoma ...(RCC).
Statistical modeling was performed with data from 557 pazopanib-treated patients in the phase 3 COMPARZ trial. A multivariable Cox model was fit using known prognostic indicators. Variables included neutrophil count, serum levels of albumin and alkaline phosphatase, time from diagnosis to treatment, and bone metastases. Data from the pazopanib arm of a placebo-controlled phase 3 trial were used for validation.
The model included ten prognostic variables and was plotted as a nomogram for predicting the probability of 12-month PFS. Calibration plots suggested reasonable correspondence between predicted probabilities and actual proportions of PFS. The concordance index for 12-month PFS was 0.625. Significant associations (p < 0.05) were observed between PFS and bone metastases, time from diagnosis to treatment, albumin, and alkaline phosphatase. Albumin and alkaline phosphatase appeared to be influential predictors.
The nomogram predicts, with reasonable accuracy, PFS in patients with advanced RCC receiving pazopanib, based on their baseline clinical characteristics.
Health needs assessments help congregations identify issues of importance to them and the communities they serve. Few tools exist, with little known about the processes needed to develop such tools.
...Develop a congregational health needs assessment tool and implementation protocol with community, health-care, and academic partners.
Meetings began in August 2018 to develop the Mid-South Congregational Health Needs Survey (MSCHS) and implementation protocol. Pilot testing occurred in December 2018 and feedback from 95 churches was used in modifications.
The MSCHS includes: demographics section, a 36-item health index, and the congregation's top five needs.The implementation protocol includes steps for working with congregation leadership to identify members to complete the survey.
Cross-disciplinary partnerships made the creation of the MSCHS and implementation protocol possible. Successes include long-term engagement across partnership sectors, organizational "buy-in," and development of a common language. These lessons can help others wanting to develop successful multi-sector partnerships.
Pazopanib versus Sunitinib in Renal Cancer Ramaekers, Ryan; Tharnish, Mark; Copur, M. Sitki ...
The New England journal of medicine,
11/2013, Letnik:
369, Številka:
20
Journal Article
Recenzirano
To the Editor:
Cancer treatments are expensive. The estimation of the total cost can be challenging because of several factors such as efficacy, toxicity, and the costs and duration of supportive ...care and end-of-life care. Motzer et al. (Aug. 22 issue)
1
report similar efficacy but a favorable safety and quality-of-life profile and less medical resource utilization with pazopanib as compared with sunitinib in first-line therapy for metastatic renal cancer. Since oncology is becoming an increasingly value-based specialty, we wanted to highlight another important aspect of this trial. Pazopanib appears to be favorable not only in terms of safety and quality . . .
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