Pardee Hospital

BackgroundFinancial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations.MethodsWe conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality.ResultsResults from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources.ConclusionsStaff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices.

A 2.5-year-old female kea (Nestor notabilis) weighing 711 g was presented for acute lethargy, pelvic limb paraparesis, and decreased appetite. Results from a complete blood count revealed a leukocytosis (67540 cells/µL [reference interval 4200 - 37880 cells/µL]). Radiographic images revealed a mass effect within the mid coelom. The patient was provided supportive care that included antifungal medication (voriconazole 15 mg/kg PO q12h x 6 months and 10 days) and antibiotic therapy (enrofloxacin 20 mg/kg PO q12h x 27 days). A discrete 2.3 × 2.7 × 2.6 cm soft tissue mass adjacent to multiple organs was identified on contrast computed tomographic images (IsoVue 370 at 4 mL/kg IV over 2 minutes). The mass was medial and dorsal to the proventriculus, cranial to the ventriculus, caudal to the liver, and ventral to the cranial renal divisions. The mass had an irregular vascularized wall with a poorly vascularized center. Ten days after initial presentation, exploratory coeliotomy and mass removal via left lateral coeliotomy were performed. Bacterial (aerobic and anaerobic) and fungal cultures were negative. Fourteen days postsurgery, the leukocytosis was resolved. Microscopic review of the submitted tissue mass found multinucleated giant cells, macrophages, and brown fungal hyphae with irregular internal septations and some branching, leading to a diagnosis of phaeohyphomycosis. Panfungal polymerase chain reaction testing and sequencing were unsuccessful at speciation. Treatment with voriconazole was continued until behavioral, hematologic, and computed tomographic assessments indicated resolution of the problem 6 months postsurgery. No recurrence of disease has been reported 20 months following mass removal.

This data is provided as supporting and supplementary material to the article <em>Warming stimulates CO2 emission than precipitation variation in China's coastal wetlands</em>. The CO2 flux part of this data source is from 48 articles analyzed by Mate, and 1011 pairs of data are extracted.2from the China Meteorological Force Dataset (CMFD) with 0.1° spatial resolution (He et al.,.2020) and match.Specific Mate data screening principles are as follows: we searched for "CO2 emissions fluxes from coastal wetlands in China", with four typical vegetation species for coastal wetlands in China (T. chinensis, S. glauca, S. triqueter, and P. australis). The search criterion was ‘China AND (coastal wetland OR salt marsh OR tidal marsh OR brackish marsh OR estuarine marsh),’ in combination with ‘(CO2 OR carbon dioxide OR ecosystem respiration OR greenhouse gas OR carbon fluxes)’, published in the Web of Science (http://apps.webofknowledge.com/) or in the China National Knowledge Infrastructure (http://www.cnki.net/) between January 1, 2000, and September 12, 2021. In total, 246 papers were found in Chinese and English. To distinguish the vegetation ecosystems' roles in CO2 emission fluxes and ensure data consistency, we used the static opaque chamber method to select data for our meta-analysis. After this screening, 48 articles were selected, and 1011 pairs of data were extracted.

Patients with cancer are at heightened risk of experiencing financial hardship. Financial navigation (FN) is an evidence-based approach for identifying and addressing patient and caregiver financial needs. In preparation for the implementation of a multisite FN intervention, we describe existing processes (ie, events and actions) and mechanisms (ie, how events work together) connecting patients to financial assistance, comparing rural and nonrural practices. We conducted in-depth, semistructured interviews with stakeholders (ie, administrators, providers, and staff) at each of the 10 oncology care sites across a single state (five rural and five nonrural practices). We developed process maps for each site and analyzed stakeholder perspectives using thematic analysis. After reporting findings back to stakeholders, we synthesized themes and process maps across rural and nonrural sites separately. Eighty-three stakeholders were interviewed. We identified six core elements of existing financial assistance processes across all sites: distress screening (including financial concerns), referrals, resource connection points, and pharmaceutical, insurance, and community/foundation resources. Processes differed by rurality; however, facilitators and barriers to identifying and addressing patient financial needs were consistent. Open communication between staff, providers, patients, and caregivers was a primary facilitator. Barriers included insufficient staff resources, challenges in routinely identifying needs, inadequate preparation of patients for anticipated medical costs, and limited tracking of resource availability and eligibility. This study identified a clear need for systematic implementation of oncology FN to equitably address patient and caregiver financial hardship. Results have informed our current efforts to implement a multisite FN intervention, which involves comprehensive financial toxicity screening and systematization of intake and referrals.

Palliative care provides a holistic approach and care for patients with a terminal illness and their families. In palliative care physical complaints as well as emotional, social and spiritual aspects are considered. Nutritional care should be also considered within palliative support. For those working in the nutritional support field, to withhold or withdraw nutritional support may be an ethical dilemma in this scenario. The controversy starts when considering nutrition and hydration as basic care or a treatment. The goals of nutrition support in palliative care patients differ from common ones, aiming to improve quality of life, survival or both. The decision should be based on a consideration of prognosis (length of survival), quality of life, and risks-benefits ratio. Regarding oral nutrition (with or without oral supplements) the idea prevails of "comfort feeding", based on providing oral feeding till discomfort or avoidance develop. There is no evidence on the benefit of specific nutrients, despite the fact that omega-3 FAs may have some positive effects in patients with cancer. Regarding nutritional support (enteral or parenteral), no scientific evidence is present, so the decision needs to be agreed according to the desires and beliefs of the patient and their family, and based on a consensus with the interdisciplinary team on the aims of this support.

Many economists are accustomed to thinking about Federal Reserve policy in terms of the institution's “dual mandate,” which refers to price stability and high employment, and in which the exchange rate and other international variables matter only insofar as they influence inflation and the output gap—which is to say, not very much. In fact, this conventional view is heavily shaped by the distinctive and peculiar circumstances of the last three decades, when the influence of international considerations on Fed policy has been limited. In fact, the Federal Reserve paid significant attention to international considerations in its first two decades, followed by relative inattention to such factors in the two-plus decades that followed, then back to renewed attention to international aspects of monetary policy in the 1960s, before the recent period of benign neglect of the international dimension. I argue that in the next few decades, international aspects are likely to play a larger role in Federal Reserve policy making than at present.

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### OBJECTIVE: The objective of this study is to evaluate the role of radiological examination in the management of adenoidal hypertrophy. ### METHODS: A retrospective study was carried out in the North West Armed Forces Hospital, Tabuk, Kingdom of Saudia Arabia on pediatric patients who had x-ray of lateral naso pharynx to exclude adenoidal hypertrophy, January 2001 to December 2001. The study included; age of the patient, sex and reason for radiology examination and the management rendered. ### RESULTS: A total of two hundred and ninety-seven pediatric patients were involved. Two hundred and thirteen males (71.7%) and 84 (28.3%) females, age ranged between 2 months and 12 years. The reason given for radiological examination was one or more of the following symptoms, snoring, mouth breathing, recurrent tonsillitis, runny nose, deafness and obstructive sleep apnea. Small adenoids reported in 63 patients (21.2%) and were treated for their complaints by their primary physician. Two hundred and thirty-four patients (78.8%) with large adenoids were referred to the otolaryngology department of these 33 patients lost follow up. One hundred and nineteen referred (40.1%) patients were treated conservatively, while 82 patients (27.6%) who showed resistance to medical treatment under went adenoidectomy with or without other related surgical procedures. ### CONCLUSION: It was concluded that radiological examination in the management of adenoidal hypertrophy had a limited role, increased Radiological Department workload, wastage of resources in addition to unnecessary radiation exposure.