59 research outputs found
Splashers Promote Sales
No full textPhotograph used for a story in the Oklahoma Times newspaper. Caption: "Two 13-year-old saleswomen, Andrea Porter and Shellie Ellis, both of Shawnee, demonstrate the obvious advantages of hot tubs during a trade exposition in Shawnee.
The War on Heroin: A Prospective Analysis of Safe Injection Sites in King County, Washington
No full textThe rise in heroin overdose-related deaths among individuals with previous low rates of heroin use is unprecedented to such an extent it incites relatives of victims to petition for new approaches to reduce the death rates. In King County, Washington, officials, inspired by the impact of Insite, a safe injection site (SIS), on heroin crisis, in Vancouver, Canada, are considering implementing similar sites to provide a safe environment for heroin injection in King County. If implemented, these controversial sites will be the first to officially operate in United States. We attempt a better understanding of the proposed initiative by reviewing the scope of the heroin crisis in U.S., the effectiveness and efficiency of safe injection sites in Europe, Australia, and Canada where they are in effect. We also reviewed policies alternatives to SIS that address the heroin crisis in King County. This paper seeks to determine whether safe injection sites will fulfill its purpose, and whether they are better at reducing overdose death rates than other policies already implemented in King County.Master of Public Healt
Ashley Stake Relief Society Closing Social
No full textThe Ashley Stake Relief Society held a closing social at the Glines Chapel. At the Fashion Show, models: Connie Cook, Shellie Cook, Sandra Ellis, and Ilene McConkie modeled clothes that were sewn at home. These outfits were a mix and match variety
Declining Overuse of Hormone Therapy for Localized Prostate Cancer: Predictors of Reimbursement Responsiveness and Emerging Patterns of Care
No full textThis research examines the effects of reimbursement policy as a strategy to improve quality of care. We estimated the degree to which physician characteristics are associated with declining androgen deprivation therapy (ADT) overuse; identified the effect of reimbursement changes on ADT overuse; and, evaluated the impact of changing patterns of ADT overuse on quality of care in localized prostate cancer. We used SEER-linked Medicare claims and American Medical Association data to create three distinct longitudinal cohorts of individuals diagnosed with incident prostate cancer in the 2000s and their physicians. Multilevel logistic regression modeling controlled for patient and physician characteristics associated with overuse of medical care and prostate cancer treatment selection, and clustering of patients within physicians. In the first study, time in practice was not associated with ADT overuse, but three patterns of ADT overuse were observed. We could not distinguish urologists who increased ADT overuse from those who decreased ADT overuse after MMA based on physician characteristics. Our findings suggest that: 1) new types of interventions will be needed to address persistent overuse; 2) guidelines should underscore treatment strategies for vulnerable patients; and 3) economic theory may need to consider clinic explanations for the volume response. The second study suggests that, among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of ADT during a period of guideline stability. There was a small but significant negative association between ADT overuse and excess reimbursement relative to all treatments: urologists in favorable reimbursement climates had lower odds of ADT overuse. Multi-specialty group practice type was associated with lower odds of ADT overuse. Reimbursement cuts may not be effective strategy to reduce overuse in all clinical scenarios. Finally, physicians' pre-MMA ADT overuse was negatively associated with delivering guideline-concordant care post-MMA. High users of ADT pre-MMA were also more likely to overuse ADT and provide guideline-discordant care post-MMA. Reducing reimbursement for inappropriate therapy will not necessarily improve quality of care. Physicians unable to provide guideline-concordant care may need additional resources to align with guidelines or to adopt guideline-concordant technologies.Doctor of Philosoph
Examining Enrollment Barriers to Adult Cancer Clinical Trials
No full textAdvancing knowledge in cancer treatment can only be achieved with the conduct of clinical trials. Barriers to adult cancer clinical trial participation have been extensively examined, yet nearly 20% of trials fail due to low patient enrollment. This dissertation considers the gaps in knowledge related to health policy, healthcare industry changes, and variation in oncology service provider behavior in the conduct of cancer clinical trials. In the first study, we used data collected from an internet-based survey of cancer clinical trial sites across the nation and found that sites continued to receive insurance coverage denials for patients seeking treatment through participation in a cancer clinical trial after the 2010 Affordable Care Act’s mandate requiring most private health insurers to cover routine patient care costs for trial participation. Organizational characteristics of being National Cancer Institute designated and having previous state legislation related to coverage for clinical trial participation were not associated with receiving denials, while being an academic medical center and using a precertification process were significantly associated with receiving insurance denials. These results suggest that insurance denials and delays continue to be formidable barriers to the research community in achieving adequate and timely trial enrollment, thus negatively affecting the pace of cancer discovery. The second study used previously collected qualitative data and a validated theoretical framework to understand the substantial decrease in clinical trial enrollment related to changes in community cancer site personnel behavior after being acquired by a large, tertiary health system. These staff perceived many barriers to enrollment being present after the acquisition, particularly related to the opportunity and their capability to conduct clinical trials. The lack of support to conduct clinical trials by having adequate staff and available trials within which to enroll were perceived to be the primary barriers. Use of a theoretical model to understand changes in behavior adds to the empirically-based clinical trial enrollment barrier literature, and may be more helpful in matching future interventions to behavior determinants to address remaining barriers. There is demonstrated variation in providers following treatment guidelines. The final study was a retrospective analysis of data from a large health system’s electronic health record and clinical trial management systems to assess radiation oncologist variation in the completion of a field for recording patient assessment for trial participation. Completion of this field may serve as a proxy for radiation oncologist awareness of available clinical trials. We found radiation oncologist characteristics are not significantly correlated with recording patient assessment for clinical trial participation. This field was completed just over 40% of the time, identifying the need for additional evaluation of the factors motivating radiation oncologists to complete this field. Overall, there are organization and provider factors that negatively affect cancer research centers efforts to identify and enroll adult cancer patients into clinical trials
- …
