Perioperative genetic testing and time to surgery in patients with breast cancer.

BACKGROUND: Time to treatment has been identified as a quality metric, with longer time to treatment associated with poorer outcomes. Genetic evaluation is an integral part of treatment counseling for patients with breast cancer. With expanding indications for genetic testing and consideration of expansion of genetic testing to all patients with a personal history of breast cancer, this study aims to evaluate the effect of genetic evaluation on the time interval from initial surgical visit to surgery. METHODS: A retrospective review of patients undergoing upfront surgery for stage 0-3 breast cancer from June 2022 to December 2022. Patient demographics, treatment characteristics, National Comprehensive Cancer Network criteria for genetic testing, and results were obtained. RESULTS: The study included 492 patients (489 females). Eighty-one (16.2%) were ≤50 years of age at diagnosis. In total, 281 patients (57.1%) met National Comprehensive Cancer Network criteria for genetic testing and 199 consulted with a genetic counselor (72.4%). Seventy-six patients (27.6%) not meeting National Comprehensive Cancer Network criteria pursued genetic counseling. In total, 218 patients (79.3%) referred for genetic counseling completed testing. Mean turnaround time to genetic testing result was 11 days (range, 6-66 days). Twenty-six patients (11.9%) had a pathogenic or likely pathogenic variant. Twenty-four of these patients met National Comprehensive Cancer Network testing criteria (92.3%) and 2 did not (7.7%). The time to treatment for patients undergoing genetic testing was 33 vs 34 days in those without testing (P = .45). Three patients (11.5%) with pathogenic or likely pathogenic variants altered their initial surgical plan due to their genetic testing results. Seven patients with pathogenic or likely pathogenic variant results returning postoperatively did not undergo additional surgery. CONCLUSION: Hereditary breast cancer evaluation and genetic testing did not appear to delay time to treatment for patients with breast cancer in our study cohort.

Developing BSN Students' Quality Improvement Skills Through Addressing Real-World Problems.

ABSTRACT: To create a preferred future for nursing, our prelicensure program teaches students to think critically, communicate effectively, and be leaders and change agents in health care. As seniors, students apply the Institute for Healthcare Improvement Model for Improvement to search the literature for research evidence about a problem, collect and analyze data, and perform a root cause analysis to develop solutions and plans for implementation. At the semester's end, formal presentations are provided to academic and practice partners.

Report of the 2020 British Nuclear Medicine Society survey of nuclear medicine equipment, workforce and workload.

The British Nuclear Medicine Society (BNMS) survey represents the only resource that brings together detailed information on equipment, workforce and workload from the practice of nuclear medicine in the UK. This article is a report of the most recent BNMS survey which was collected during 2019 and 2020. The survey used two methods to collect data: for equipment and workforce, participants created or updated existing online records; for workload information, respondees were asked to submit 12 months of data from local radiology information systems. Following the survey, the BNMS database contained a total of 191 sites (63% of known sites) having either equipment or workforce data or both. In total 39 centres provided workload data which included over 175 000 examinations. A combination of automated tools and visual inspection were used to clean, sort and validate submitted data into formats that allowed further analysis and extraction of useful parameters. Results are presented that the authors believe may be useful for nuclear medicine professionals and other stakeholders. Potential applications include benchmarking for service review and equipment replacement/updating. The survey represents a valuable resource that might be used by the BNMS secretariat to respond to specific queries from BNMS members.

Experiences of Caregivers Caring for a Family Member Who Is Using Hemodialysis.

In this qualitative phenomenological study using a purposive sample, six caregivers of patients on hemodialysis were interviewed about their experiences of caring for a family member who uses hemodialysis. Six major themes and 12 subthemes were identified. Perceptions of caregivers are that caregiving is hard work and stressful; however, caregivers found the experience to be meaningful, even though the stress may interfere with their own health status. Study limitations include a small sample that may not represent the entirety of caregivers' perspectives. Implications for practice include developing informal and formal support systems and exercise programs that help this population manage the stress associated with caregiving for family members using hemodialysis.

A value-based insurance design program at a large company boosted medication adherence for employees with chronic illnesses.

This paper contributes to a small but growing body of evidence regarding the efficacy of value-based insurance design. In a retrospective, observational study of employees of a large global pharmaceutical firm, we evaluated how reduced patient cost sharing for prescription drugs for asthma, hypertension, and diabetes affected the use of these drugs and related medical services. We estimate that prescription medication use rose 5 percent per enrollee across the entire enrolled population. Increased use was most evident for patients taking cardiovascular medication. By the third year, adherence to cardiovascular medications was 9.4 percent higher, and patients realized cost savings over time. Overall, the program was mostly cost-neutral to the company, and there was no aggregate change in spending. However, we raise the prospect that this program may have saved the company money by reducing other medical costs.

Longitudinal continuity of care is associated with high patient satisfaction with physical therapy.

BACKGROUND AND PURPOSE: Recent literature has suggested that longitudinal continuity (ie, the patient is seen by the same practitioner for the entire course of treatment) may be linked to high degrees of patient satisfaction with medical care. The purpose of this study was to provide preliminary information regarding the association between longitudinal continuity and reports of patient satisfaction with physical therapy outpatient care. SUBJECTS AND METHODS: A sample of 1,502 adult subjects completed the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care at the time of discharge from outpatient physical therapy. Relationships between satisfaction measures and the presence or absence of longitudinal continuity were assessed by use of binary logistic regression. RESULTS: Overall, 36.8% of the subjects reported complete satisfaction on the internal subscale (patient-therapist), and 47.9% of the subjects reported complete satisfaction on the external subscale (patient-support staff). Higher percentages of women (40.2% and 51.1% for internal and external subscales, respectively) than of men (31.9% and 43.3% for internal and external subscales, respectively) were completely satisfied with care. Of subjects who reported complete satisfaction on the internal subscale, 71.2% had longitudinal continuity of care, and 28.8% did not. A similar trend was noted for the external subscale (patient-support staff); 66.8% of subjects who reported complete satisfaction had longitudinal continuity, and 33.2% did not. Odds ratios describing the probability of complete satisfaction with care for subjects who had longitudinal continuity and for those who did not were significant and ranged from 2.7 to 3.5. DISCUSSION AND CONCLUSION: Subjects who received their entire course of outpatient physical therapy from only 1 provider were approximately 3 times more likely to report complete satisfaction with care than those who received care from more than 1 provider. These findings suggest that clinicians and managers should make efforts to preserve longitudinal continuity of care as a means of improving patient satisfaction with care.

Use of a patient assistant to facilitate medical visits for Latino patients with low health literacy.

In the face of limited resources, evidence-based prioritization is needed to maximize the reach of health services for the underserved. A medical referral project that referred low income uninsured individuals to discounted appointments with office-based doctors found that some Latino patients had difficulty in taking advantage of these appointments. These individuals appeared to face barriers beyond the cultural and linguistic barriers faced by most patients in the project. One additional bilingual staff person, a Patient Assistant, was hired to facilitate doctor visits by these patients. The Patient Assistant performed the duties of a navigator, trouble shooter, and interpreter--and assisted with communications. The project staff derived a screening question to encourage patients to identify themselves as those who would need the help of the Patient Assistant. These patients were subsequently questioned in a waiting room survey designed to characterize them. The characteristics of these patients were compared with a comparison group of project patients. The target group and the comparison group differed in their levels of education. Sixty percent of the target group had less than 4 years of schooling compared to 13% of the comparison group. The target group was comprised entirely of immigrants from South and Central America. This report underscores the conclusions of the recent report of the Institute of Medicine on the problem of health literacy--patients' ability to understand and act in their own interest--and highlights the needs of Latin American immigrants who are burdened by cultural and linguistic barriers, low health literacy, and minimal education.

The MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care: a psychometric analysis.

STUDY DESIGN: Psychometric evaluation of a cross-sectional survey. OBJECTIVES: To determine the validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) to differentiate between patient satisfaction with internal and external factors. BACKGROUND: Self-report measures that sample a variety of items provide clinicians with an array of information that may assist in assessing patient satisfaction. An important measurement characteristic of these instruments is the ability to discriminate between different factors that may influence patient reports of satisfaction with care, ie, discriminant validity. In previous work, exploratory factor analysis suggested that the MRPS questionnaire has a 2-factor structure: "internal," relating to the patient-therapist interaction, and "external," describing nontherapist issues such as admissions and clinic environment. METHODS AND MEASURES: One thousand four hundred forty-nine adult patients completed the MRPS questionnaire upon finishing their course of outpatient physical therapy treatment. Discriminant validity of the 2-factor model was assessed using confirmatory factor analysis. The measures from the 2 factors were then evaluated for reliability by calculating the standard error of measurement (SEM), and for concurrent validity by correlating the mean score of the factors and individual items to global measures of satisfaction. RESULTS: Confirmatory factor analysis supported a good to excellent model fit for the internal factor (7 items) and external factor (3 items). The SEM for the 2 factors was 0.19 and 0.24, indicating a low degree of measurement error. Both factors had high significant correlation with global measures of satisfaction (internal, r = 0.83 and 0.80; external, r = 0.71 and 0.71). All individual items within the 2 factors had significant correlations with global measures ranging from r = 0.33 to 0.80. CONCLUSIONS: Our findings provide evidence of discriminant and concurrent validity of the 2-factor solution for the MRPS questionnaire for the sample that was tested. This 2-factor solution yields measures that are relatively free of error and may discriminate between internal and external factors influencing patient satisfaction. Patients who complete their course of physical therapy report that the professional interaction between the therapist and patient, especially the meaningful exchange of relevant information, is critical for patient satisfaction with care. The generalizability of our data to patients who do not complete their physical therapy care or who are receiving care in other health care environments is unknown.