Consensus recommendations for improving the cancer clinical trial matching environment.

Enrollment in cancer clinical trials cannot occur without first successfully identifying trials for which patients are a match based on their clinical characteristics. A lack of onsite matching trials has been identified as the single largest barrier preventing patients from participating in clinical trials. The site-agnostic cancer clinical trial matching environment is a mix of public and private tools and infrastructure that are not designed to work together to facilitate trial matching in an efficient manner. To identify policy and infrastructure solutions that could enable more effective and more frequent use of third-party site-agnostic matching, the American Cancer Society Cancer Action Network held a summit to examine challenges and propose consensus recommendations that could address those challenges. At this 2019 summit, stakeholders in this field examined these barriers and challenges and made a number of policy and infrastructure recommendations to improve the ability of this environment to work in a more coordinated and efficient manner.

Provider motivations and barriers to cancer clinical trial screening, referral, and operations: Findings from a survey.

BACKGROUND: Provider and institutional practices have been shown to have a large impact on cancer clinical trial enrollment. Understanding provider perspectives on screening for trial eligibility is necessary to improve enrollment. METHODS: A questionnaire about incentives, barriers, process tools, and infrastructure related to opening trials and referring patients to onsite and offsite trials was administered to diverse stakeholders, including professional societies, advocacy organizations, and industry networks. Descriptive statistics were used to summarize findings. RESULTS: Overall, 693 responses were received, primarily from physicians (42.7%) and nurses (35.6%) employed at hospital health systems (43.7%) and academic centers (36.5%). Approximately half (49.2%) screened all patients for onsite clinical trials with screening typically done by manual chart review (81.9%). The greatest incentive reported for offering trials was providing the best treatment options for patients (67.7%). Contracting and paperwork (48.5%) were the greatest barriers to opening more onsite trials. Offsite referrals were rare. CONCLUSIONS: Screening for trial eligibility is a largely manual and ad hoc process, with screening and referral to offsite trials occurring infrequently. Administrative and infrastructure barriers commonly prevent sites from opening more onsite trials. These findings suggest that automated trial screening tools built into workflows that screen in a site-agnostic manner could result in more frequent trial eligibility screening, especially for offsite trials. With recent momentum, in part in response to the COVID-19 pandemic, to improve clinical trial efficiencies and broaden access and participant diversity, implementing tools to improve screening and referral processes is timely and essential. PLAIN LANGUAGE SUMMARY: There are many factors that contribute to low adult enrollment in cancer clinical trials, but previous research has indicated that provider and institutional barriers are the largest contributors to low cancer clinical trial enrollment. In this survey, we sought to gain insight into cancer clinical trial enrollment practices from the perspective of health care providers such as physicians and nurses. We found that only approximately half of respondents indicated their institution systematically screens their patients for clinical trials and this process is manual and time consuming. Furthermore, we found that providers infrequently search for and refer patients to clinical trials at other sites. Creating better screening methods could improve enrollment in clinical trials.

"The kids get haggled over": how institutional practices contribute to segregation in elementary schools.

School segregation is a key topic in urban, educational and inequality research. While previous studies have mainly focused on the effects of both parental school choice and residential segregation patterns on the composition of schools, we draw attention to institutional players steering access to elementary schools as one important dimension of institutional discrimination. Combining expert interviews with school principals and the local schools department with a quantitative survey among parents, we scrutinize the interplay between institutional structures and practices and parental school choice strategies. We identify three dimensions of institutional discrimination as being particularly relevant for school access, and thus for school segregation and inequality: a school's guidelines and strategic objectives in dealing with segregation, the enrollment process, and a school's profiling and information policies. These factors prove to be rather subtle, yet crucial facets of institutional discrimination, co-producing and perpetuating spatial inequalities.

Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study.

BACKGROUND: In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS: A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS: Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS: This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.

Explorando el sistema de protección de la niñez en El Salvador

(analítico) Se exploran las prácticas institucionales que facilitan u obstaculizan la protección de los derechos de niños, niñas y adolescentes en el sistema de protección de la niñez en El Salvador. Partiendo de un diseño de etnografía institucional, se realizaron 61 entrevistas a trabajadores pertenecientes al sistema de protección. Como resultado, se identificó la ausencia de manuales que establezcan prácticas concretas en la aplicación de la Ley de Protección Integral de la Niñez y Adolescencia, obstruyendo su óptimo funcionamiento. A través del uso de la teoría del interaccionismo simbólico, se explora cómo la interpretación discrecional o no entendimiento de la ley forma instituciones aisladas del sistema; también se analiza el grado en que las dinámicas socioeconómicas del país ponen en desventaja a los sectores rurales para acceder a estos servicios.

(analytical) This study explores the institutional practices that support or hinder the rights of children and young people in the child protection system in El Salvador. Using an institutional ethnography approach, 61 individuals who worked directly or indirectly in the child protection system were interviewed. The findings highlight a lack of manuals that establish concrete practices in accordance with the application of the Law of Comprehensive Protection for Children and Youth, which reduces the effectiveness of the country's child protection system. Through an analytical approach based on symbolic interactionism, this study explored how the individual interpretations of the law, or lack thereof, combine with socioeconomic disadvantages to create difficulties for rural child protection institutions in terms of accessing operational resources.

(analítico) O presente estudo explora as práticas institucionais que apoiam ou dificultam os direitos de crianças e jovens no sistema de proteção infantil em El Salvador. Utilizando um desenho de etnografia institucional, foram entrevistados 61 indivíduos que trabalhavam ou trabalham no sistema de proteção à criança. Os achados indicam que faltam manuais que estabeleçam práticas concretas em consonância com a aplicação da Lei de Proteção Integral da Infância e Juventude o que dificulta a efetividade do sistema de proteção. Por meio de um entendimento baseado no interacionismo simbólico, este estudo explorou como as interpretações individuais da lei, ou a falta dela, e a desvantagem socio-econômica das instituições colocam os setores rurais em desvantagem no acesso aos recursos.

Bridges or Barriers? How Interactions between Individuals and Institutions Condition Community College Transfer.

Institutional practices and conditions at community colleges can improve rates of transfer, as can access to transfer student capital. However, we know little about how institutions attempt to build students' transfer capital, or about students' experiences within community colleges as they accumulate transfer capital. In this paper, we examine how students' institutional experiences, particularly their engagement with student supports at community colleges and transfer destinations, influence their understanding of, and ability to navigate, the transfer process. We view the accumulation of transfer student capital as an interactionist model between the students and their institution, where students' transfer knowledge and success is conditioned by an interaction between their background and institutional conditions. We draw on longitudinal qualitative interview data with transfer-intending community college students over the course of 3 years to understand how students access, receive, and accumulate transfer capital as they work toward their educational goals. By leveraging student experiences, our study can inform community colleges and transfer destinations about practices and policies interpreted as most effective from the perspective of students. Our work also connects to broader conversations about how institutions reproduce, ameliorate, or exacerbate inequalities based on student background.

"No One Really Likes Crying in School": The Influences of Classroom and Institutional Dynamics Upon Student Absenteeism During COVID-19.

The COVID-19 pandemic has worsened the already problematic issue of student absenteeism. This study uniquely employs an ecological agency approach to better understand student absenteeism during COVID-19. Using a case study methodology, the study captures the experiences of two absentee students within a United States suburban high school during the 2020-2021 school year to better understand the institutional structures motivating their daily decision to attend or miss school. In the remote learning environment, rigorous curricular expectations, minimal social interactions, teacher-led instruction as a response to student disengagement from student-led instruction, and lower teacher expectations contributed to the participants' daily decision to miss school. In the remote, hybrid, and full-time in-person learning spaces, staff apathy toward bullying, minimal space to escape feelings of anxiety, and fewer tutoring outlets motivated student absenteeism. Therefore, the school environment can better promote attendance during COVID-19 by establishing an in-school space to escape heightened anxiety, academic supports to reduce grade-induced anxiety, shifting from nonintervention to prosocial instructional interventions in all learning environments, teacher voices in policy design, reducing teacher-led instruction, and shifting teacher beliefs to an asset mindset. Recommendations for future research are included.

Exploring Ethical Issues Related to Patient Engagement in Healthcare: Patient, Clinician and Researcher's Perspectives.

Patient engagement in healthcare is increasingly discussed in the literature, and initiatives engaging patients in quality improvement activities, organizational design, governance, and research are becoming more and more common and have even become mandatory for certain health institutions. Here we discuss a number of ethical challenges raised by this engagement from patients from the perspectives of research, organizational/quality improvement practices, and patient experiences, while offering preliminary recommendations as to how to address them. We identified three broad categories of ethical issues that intersect between the different types of patient engagement: (1) establishing a shared vision about goals of patient engagement and respective roles; (2) the process and method of engaging with patients; and (3) practical aspects of patient engagement. To explain these issues, we build from our personal, professional, and academic experiences, as well as traditions such as pragmatism and hermeneutics that stress the importance of participation, empowerment, and engagement.  Patient engagement can be highly valuable at numerous levels, but particular attention should be paid to the process of engaging with patients and related ethical issues. Some lessons from the literature on the ethics of participatory research can be translated to organizational and quality improvement practices.

Qualitative study to develop processes and tools for the assessment and tracking of African institutions' capacity for operational health research.

OBJECTIVES: Research is key to achieving global development goals. Our objectives were to develop and test an evidence-informed process for assessing health research management and support systems (RMSS) in four African universities and for tracking interventions to address capacity gaps. SETTING: Four African universities. PARTICIPANTS: 83 university staff and students from 11 cadres. INTERVENTION/METHODS: A literature-informed 'benchmark' was developed and used to itemise all components of a university's health RMSS. Data on all components were collected during site visits to four African universities using interview guides, document reviews and facilities observation guides. Gaps in RMSS capacity were identified against the benchmark and institutional action plans developed to remedy gaps. Progress against indicators was tracked over 15 months and common challenges and successes identified. RESULTS: Common gaps in operational health research capacity included no accessible research strategy, a lack of research e-tracking capability and inadequate quality checks for proposal submissions and contracts. Feedback indicated that the capacity assessment was comprehensive and generated practical actions, several of which were no-cost. Regular follow-up helped to maintain focus on activities to strengthen health research capacity in the face of challenges. CONCLUSIONS: Identification of each institutions' strengths and weaknesses against an evidence-informed benchmark enabled them to identify gaps in in their operational health research systems, to develop prioritised action plans, to justify resource requests to fulfil the plans and to track progress in strengthening RMSS. Use of a standard benchmark, approach and tools enabled comparisons across institutions which has accelerated production of evidence about the science of research capacity strengthening. The tools could be used by institutions seeking to understand their strengths and to address gaps in research capacity. Research capacity gaps that were common to several institutions could be a 'smart' investment for governments and health research funders.

The Impact of Hospital Resources and Availability of Professional Lactation Support on Maternity Care: Results of Breastfeeding Surveys 2009-2014.

BACKGROUND: Breastfeeding provides maternal and infant health benefits. Maternity care practices encompassed in the 10 Steps to Successful Breastfeeding are positively associated with improved breastfeeding outcomes. This study assessed changes in maternity care practices and lactation support. MATERIALS AND METHODS: In 2009, 2011, and 2014, New York (NY) hospitals providing maternity care services were surveyed to assess the implementation of 9 of the 10 Steps to Successful Breastfeeding, professional lactation support, distribution of formula and discharge packs, and patient and hospital barriers to breastfeeding success. Generalized estimating equations were used to evaluate changes over time. RESULTS: Surveys were completed by 138/138 (2009), 128/129 (2011), and 125/125 (2014) NY hospitals. During this time period, the percent of hospitals reporting implementation of Steps 2, 4, 6, or 9 increased, and the mean number of 9 steps implemented increased from 4.3 to 5.3. Hospitals distributing formula samples at discharge to breastfeeding mothers decreased significantly from 39 (32%) to 3 (2%). Professional lactation staffing ratios (N/1,000 births) of both International Board Certified Lactation Consultants and Certified Lactation Counselors increased between 2009 and 2011, but then decreased between 2011 and 2014. Reported barriers to breastfeeding support changed, with reductions in mixed messages from staff, but increases in lack of financial resources for breastfeeding support, inadequate prenatal education, mothers not being prepared, and family not being receptive to breastfeeding. CONCLUSIONS: Between 2009 and 2014, NY hospitals reported increased barriers and a reduction in professional lactation support, which may have contributed to the limited improvements in breastfeeding support.

Social justice in education: how the function of selection in educational institutions predicts support for (non)egalitarian assessment practices.

Educational institutions are considered a keystone for the establishment of a meritocratic society. They supposedly serve two functions: an educational function that promotes learning for all, and a selection function that sorts individuals into different programs, and ultimately social positions, based on individual merit. We study how the function of selection relates to support for assessment practices known to harm vs. benefit lower status students, through the perceived justice principles underlying these practices. We study two assessment practices: normative assessment-focused on ranking and social comparison, known to hinder the success of lower status students-and formative assessment-focused on learning and improvement, known to benefit lower status students. Normative assessment is usually perceived as relying on an equity principle, with rewards being allocated based on merit and should thus appear as positively associated with the function of selection. Formative assessment is usually perceived as relying on corrective justice that aims to ensure equality of outcomes by considering students' needs, which makes it less suitable for the function of selection. A questionnaire measuring these constructs was administered to university students. Results showed that believing that education is intended to select the best students positively predicts support for normative assessment, through increased perception of its reliance on equity, and negatively predicts support for formative assessment, through reduced perception of its ability to establish corrective justice. This study suggests that the belief in the function of selection as inherent to educational institutions can contribute to the reproduction of social inequalities by preventing change from assessment practices known to disadvantage lower-status student, namely normative assessment, to more favorable practices, namely formative assessment, and by promoting matching beliefs in justice principles.

Variations in institutional staffing and clinical practice are predictive of center-specific 1-year survival post-transplant.

BACKGROUND: The accuracy of various risk models to predict early post-transplant mortality is limited by the type, quality, and era of the data collected. Most models incorporate a large number of recipient-derived and donor-derived variables; however, other factors related to specific institutional practices likely influence early mortality. The goal of this study was to determine if the addition of institutional practice variables would improve the predictive accuracy of a recipient/donor risk model in a modern cohort of heart transplant recipients. METHODS: Between 1999 and 2007, 3,591 primary heart transplants were performed at the 26 institutions participating in the Cardiac Transplant Research Database. Multivariable regression analysis in the hazard domain was used to identify recipient, donor, and institutional practice variables that were predictive of 1-year mortality. The derived model was used to predict institutional outcomes and compare them with observed outcomes first without and then with the inclusion of the institutional practice variables. RESULTS: Eleven individual plus 2 interaction recipient variables and 2 individual plus 2 interaction donor variables were predictive of increased mortality. The addition of institutional practice variables to the model identified 4 variables associated with decreased mortality: greater number of transplant cardiologists, a thoracic surgery fellowship, a surgery or cardiology attending taking donor call, and routine surveillance for antibody-mediated rejection. By using a p-value > 0.10 as a robust measure of similarity, the addition of institutional practice variables increased the number of institutions with similar predicted vs. observed mortality from 18 of 26 institutions (69%) to 26 of 26 (100%), demonstrating improved predictive accuracy of the model. CONCLUSIONS: Multiple recipient and donor variables influence early survival but do not fully explain the difference in predicted and observed outcomes at the institutional level. Variations in staffing and clinical practice contribute to risk, and the addition of these variables to our risk model improved predictive accuracy.

Entre instituições e encontros: a juventude dissolvendo a violência / Between institutions and encounters: youth putting an end to violence

Este artigo pretende refletir sobre as diferentes facetas da violência e como estas se manifestam na sociedade contemporânea, especialmente no que tange às políticas públicas e práticas institucionais voltadas para jovens. Partindo da crença moreniana de que todo sujeito encontra-se em constante desenvolvimento e transformação, este trabalho traz dois encontros sociodramáticos com adolescentes de uma instituição de apoio socioeducacional, apresentando ambas experiências como um convite a novos olhares na compreensão de trabalhos em instituições, onde o adolescente faz parte de uma cultura na qual a interação é um vetor constante. A partir das reflexões apresentadas neste artigo, é possível observar o quanto o trabalho baseado na abordagem psicodramática em instituições para jovens pode promover a transformação nos modos de ser adolescente, bem como instigar o potencial criador do sujeito jovem contemporâneo.(AU)

This article intends to reflect on the different facets of violence and the way violence manifests itself in our contemporary society, especially with regards to public policies and institutional practices directed at youth. Anchored in the Morenian belief that every individual is in constant development and transformation, this paper describes two sociodramatic encounters of youths from an institution offering socio-educational support, seeing both these experiences as a call to change our view and understanding of institutional work, adolescents being part of a culture where interaction is a constant vector. Based on these reflections it becomes notable how psychodramatic work in such institutions can promote changes in how to be an adolescent, and also instigate the creative potential of contemporary youths.(AU)

La atención de los varones en el espacio público de la salud en México Distrito Federal desde la mirada género sensible y sociosanitaria / Male attention in the public health space in México Federal District from a gender sensible and socio-sanitary perspective / Atenção dos homens no espaço público de saúde no México Distrito Federal desde um olhar gênero sensível e sócio-sanitário

El trabajo aborda las prácticas institucionales del personal de salud del sistema público de atención en la Secretaría de Salud del Gobierno del Distrito Federal (SSGDF) en varios hospitales de la red, forma parte de un trabajo más amplio, que constituye una tesis doctoral que se llevó a cabo entre 2003 y 2008 en la Ciudad de México. En esta ocasión se hace particular énfasis en el análisis y discusión de los hallazgos encontrados alrededor de la atención en salud a varones hetero y homosexuales, tanto en la población atendida como en la situación laboral del personal de salud identificada como homosexual prestando el servicio. Desde una mirada género sensible se puede concluir que ser hombre es un factor de riesgo para la atención y el cuidado de la salud y la prevención de la enfermedad; que, con población masculina hetero y homosexual, prevalecen los prejuicios sociales más que la preparación, desarrollo de habilidades y capacidades de atención de la problemática específicamente masculina dentro de los servicios. La exclusión, la discriminación, la desinformación muestran que el bagaje anatomofisiológico y la técnica quirúrgica o el conocimiento farmacéutico no son suficientes para brindar atención de calidad que hagan verdaderamente integrales las prácticas institucionales de salud llevadas a cabo por hombres y mujeres en el Sistema Público de atención de la Secretaría de Salud del Gobierno del Distrito Federal en México.

This article discusses the institutional practices of the health personnel from the public attention system from the Department of Health of the Federal District Government (SSGDF) in varioushospitals. The article is also part of a broader study, which constitutes a doctoral dissertation carried out between 2003 and 2008 in the city of Mexico. The study emphasizes analysis and discussions about the findings regarding health care to hetero and homosexual males, in both the population served, as well as people identified as homosexual within the personnel offering the health services. Concluding, from a gender sensitive perspective, being a male is a risk factorin health care and attention, as well as in disease prevention. Social prejudice still prevails with the hetero and homosexual male population, more than preparation and development ofattention skills specific to the male problem within health services. Exclusion, discrimination, and lack of information illustrate that the anatomy-physiologic burden and surgical technique or pharmaceutical knowledge are not enough to provide quality care. Care that could make the institutional health practices of the Department of Health of the Federal District Government in Mexico, truly comprehensive.

La violencia de género en las prácticas institucionales de salud: afectaciones del derecho a la salud y a las condiciones de trabajo en salud / Precautionary principle: perspectives involving human health aspects and environmental pollution

Este artículo tiene como objetivo analizar la violencia de género presente en las prácticas institucionales de salud ejercida al interior de los servicios ofrecidos por la Red Pública de Atención Hospitalaria de la Secretaría de Salud del Gobierno del Distrito Federal -SSGDF-. El abordaje se realizará desde la perspectiva de género, la salud colectiva y la medicina social. La problematización de las prácticas institucionales se hace a partir de la observación directa de diez de los veintiocho hospitales públicos de la red y el abordaje a profundidad de uno de ellos; por supuesto sus conclusiones no pretenden ser generalizables al sistema público de atención del Distrito Federal. Alientan este trabajo la reflexión en tres planos: la formación del recurso humano en salud, las relaciones de poder-subordinación, la relación médico-paciente y las posibilidades de concretar en el contexto institucional los derechos de las personas que son atendidas allí como de las personas que trabajan en la red.

This article has objective analyzed the gender violence in the health institutional practices in to the services offered by Public Network of hospitalary attention of the Health Secretary of Federal District Government of Mexico City. The approach has been made by gender perspective, collective health and social medicine. The problemize of institutional practices its made since direct observation exercise by ten to the twenty-eight public hospitals of the network and the deeply approach by one of them; of course, their conclusions don’t pretend be generalized to all public health systems by Federal District of Mexico City. Inspired this work the three lines of reflection: the human resources in health, formation, subordination-power relationship,medical-patient relationships and the possibilities of concrete in the institutional context the rights persons attended, like the rights of the persons that work there.