A Randomized Controlled Trial Evaluating Electronic Outpatient Symptom Monitoring After Ambulatory Cancer Surgery.

OBJECTIVE: We implemented routine daily electronic monitoring of patient-reported outcomes (PROs) for 10 days after discharge after ambulatory cancer surgery, with alerts to clinical staff for worrying symptoms. We sought to determine whether enhancing this monitoring by adding immediate automated normative feedback to patients regarding expected symptoms would further improve the patient experience. SUMMARY OF BACKGROUND DATA: PRO monitoring reduces symptom severity in cancer patients. In ambulatory cancer surgery, it reduces potentially avoidable urgent care center (UCC) visits, defined as those UCC visits without readmission. METHODS: Patients undergoing ambulatory cancer surgery (n = 2624) were randomized to receive standard PRO monitoring or enhanced feedback. The primary study outcome was UCC visits without readmission within 30 days; secondary outcomes included patient anxiety and nursing utilization. RESULTS: There was no significant difference in the risk of a potentially avoidable UCC visit [1.0% higher in enhanced feedback, 95% confidence interval (CI) -0.2-3.1%; P = 0.12]. There were similarly no significant differences in UCC visits with readmission or readmission overall (P = 0.4 for both). Patients randomized to enhanced feedback demonstrated a quicker reduction in anxiety (P < 0.001) and required 14% (95% CI 8-19%; P < 0.001) and 10% (95% CI 5-16%, P < 0.001) fewer nursing calls over 10 and 30 days postoperatively. CONCLUSIONS: Providing patients with feedback about symptom severity during recovery from ambulatory cancer surgery reduces anxiety and nursing workload without affecting UCC visits or readmissions. These results support wider incorporation of normative feedback in systems for routine PRO monitoring.

You don't need to talk to throw a ball! Children's inclusion of language-outgroup members in behavioral and hypothetical scenarios.

To investigate children's inclusion of language-outgroup members, English-speaking children (8-9 years and 10-11 years of age, N = 57) made inclusion decisions while playing a simulated ball-tossing game, Cyberball, and while evaluating hypothetical scenarios involving language-outgroup members who wanted to play with their group. In the Cyberball game, the group norm was to exclude non-English-speaking peers, and participant tosses to a language-outgroup member (i.e., Spanish, Chinese, or Arabic speaking) were coded as a measure of behavioral inclusion. In the hypothetical scenarios, participants made prescriptive and descriptive judgments about their expectations regarding the inclusion of a language-outgroup member. They also evaluated their own and their group's inclusion likelihood. Results revealed that participants' evaluations of how acceptable exclusion was predicted their behavioral inclusion in the Cyberball game. Further, participants were more likely to think that the language-outgroup member should be included and less likely to think that the outgroup member would be included. They also differentiated between their own and their group's likelihood of including a language-outgroup member and reasoned about this decision by focusing on group functioning and language. In addition, there were age-related differences, with participants demonstrating greater inclusivity with age. The findings suggest the complexity of children's social cognition and the importance of providing them with a rich array of opportunities to play with language-outgroup members. (PsycINFO Database Record

Educational and Psychosocial Support Needs in Lynch Syndrome: Implementation and Assessment of an Educational Workshop and Support Group.

Few reports of educational and counseling support resources exist for Lynch syndrome (LS), a disorder requiring multi-organ cancer screening and specialized medical care throughout adult life. Here we describe the development and efficacy of two resources designed to address this need, the Memorial Sloan Kettering Cancer Center Clinical Genetics Service annual Lynch Syndrome Educational Workshop (LSEW), and a quarterly Lynch Syndrome Patient Advocacy Network (LSPAN) support group. The LSEW and LSPAN were implemented beginning in 2012. Participant survey data evaluating satisfaction, clarity, and unmet needs for each event were retrospectively analyzed and summarized using descriptive statistics. Annual LSEW attendance ranged from 53 to 75 total participants. LSEW year 1 participants indicated a need for a support group, and preferred in-person meetings at a frequency of every 3-6 months. For LSEW year 2-5 participants, >96 % reported satisfaction with the LSEW, and >82 % expressed interest in secure online support. Common themes for improvement included increased time for question and answer sessions and additional introductory genetics education. Responding LSPAN participants (n = 57 total survey responses in 11 meetings) found the meetings helpful (100 %), information clear (91 %), and presence of a genetic counselor useful (67 %). Desired discussion topics included coping with stress and anxiety, development of a support network, family communication about LS, genetic testing decisions, and bereavement. Following genetic counseling, a need exists for ongoing educational and emotional support in LS. Implementation of resources such as the LSEW and LSPAN is feasible and perceived as helpful by participants.

Temperament in early childhood and peer interactions in third grade: the role of teacher-child relationships in early elementary grades.

Children's interactions with peers in early childhood have been consistently linked to their academic and social outcomes. Although both child and classroom characteristics have been implicated as contributors to children's success, there has been scant research linking child temperament, teacher-child relationship quality, and peer interactions in the same study. The purpose of this study is to examine children's early temperament, rated at preschool age, as a predictor of interactions with peers (i.e., aggression, relational aggression, victimization, and prosociality) in third grade while considering teacher-child relationship quality in kindergarten through second grades as a moderator and mediator of this association. The sample (N=1364) was drawn from the NICHD Study of Early Child Care and Youth Development. Results from structural equation models indicated that teacher-child conflict in early elementary grades mediated links between children's temperament and later peer interactions. Findings underscore the importance of considering children's temperament traits and teacher-child relationship quality when examining the mechanisms of the development of peer interactions.

A longitudinal study of school connectedness and academic outcomes across sixth grade.

The current longitudinal study examines the extent to which school connectedness (i.e., students' perceptions of school support and the number of adults with whom they have a positive relationship) is associated with academic outcomes across sixth grade for students from high poverty neighborhoods. Data were collected from 330 sixth-grade students attending two middle schools in a large public school district. Specifically, students completed a survey to assess their perceived connection to the school environment, and academic information regarding students' grades, attendance, and discipline referrals was obtained from school records. Results from latent growth curve modeling showed that, on average, students' perceptions of school support declined significantly across the sixth-grade year. However, students who reported less decline, or growth, in school support across sixth grade had higher academic achievement at the end of the year than students who reported more decline in school support. Sixth-grade boys were at a greater risk for negative outcomes (i.e., lower school support, lower GPAs, and more discipline referrals) across the school year than girls. Results point to the importance of perceived connectedness to school in helping economically disadvantaged students experience a safe and successful transition to middle school.