Medicine and Health Sciences Commons^™

Representation Of Ehr Data For Predictive Modeling: A Comparison Between Umls And Other Terminologies, Laila Rasmy, Firat Tiryaki, Yujia Zhou, Yang Xiang, Cui Tao, Hua Xu, Degui Zhi

Faculty, Staff and Student Publications

OBJECTIVE: Predictive disease modeling using electronic health record data is a growing field. Although clinical data in their raw form can be used directly for predictive modeling, it is a common practice to map data to standard terminologies to facilitate data aggregation and reuse. There is, however, a lack of systematic investigation of how different representations could affect the performance of predictive models, especially in the context of machine learning and deep learning.

MATERIALS AND METHODS: We projected the input diagnoses data in the Cerner HealthFacts database to Unified Medical Language System (UMLS) and 5 other terminologies, including CCS, CCSR, …

Everything You Need To Know About Caregiving For Parkinson’S Disease, Lianna Marie

Purdue University Press Book Previews

Caregiving for those who suffer from Parkinson’s disease comes with many challenges, from how to deal with guilt and loneliness to avoiding burnout and figuring out what to expect from an unpredictable disease. When giving care, too often caregivers neglect their own well-being. Everything You Need to Know About Caregiving for Parkinson’s Disease is not just about caring for your loved one, but also about taking care of yourself. Lianna Marie served as her mother's caregiver for more than twenty years after she was diagnosed with Parkinson’s disease. Drawing on firsthand experience, her training as a nurse, and the many …

Instability Of Glucocorticoid Metabolites In Coyote Scats: Implications For Field Sampling, Erika T. Stevenson, Eric M. Gese, Lorin A. Neuman-Lee, Susannah S. French

United States Department of Agriculture Wildlife Services: Staff Publications

Studying physiologic stress responses can assist in understanding the welfare of animals. One method of measuring the physiologic stress response is evaluating concentrations of glucocorticoid metabolites in feces. Previously, using an adrenocorticotropic hormone challenge, we found fecal glucocorticoid metabolite levels were a reliable indicator of physiologic stress response in coyotes (Canis latrans). We determine whether glucocorticoid metabolite concentrations remain stable when collecting feces over a 2-week period, a timeframe commonly used in scat surveys for wild canids. We collected feces from 6 captive coyotes maintained at the U.S. Department of Agriculture, Wildlife Services, National Wildlife Research Center, Predator …

The Complete Guide For People With Parkinson’S Disease And Their Loved Ones, Lianna Marie

Purdue University Press Book Previews

A diagnosis of Parkinson’s disease is as disorienting as it is devastating. The Complete Guide for People With Parkinson’s Disease and Their Loved Ones helps make sense of what comes next and what can be done, not just for those suffering from the disease but for their family and friends as well. A trained nurse and primary caregiver for her mother, who was diagnosed with Parkinson’s disease in 1991, Lianna Marie draws upon over twenty years of education, research, and direct experience. Written in straightforward and easily accessible language, this essential guide aims to help patients better understand their role …

Strengthening Human And Physical Infrastructure Of Primary Healthcare Settings To Deliver Hypertension Care In Vietnam: A Mixed-Methods Comparison Of Two Provinces, Lana Meiqari, Thi-Phuong-Lan Nguyen, Dirk Essink, Pamela Wright Phd, Ms, Med, Rn, Cen, Fedde Scheele

Publications

In Vietnam, the overall prevalence of hypertension (HTN) was 21%, with lower estimates for the prevalence of HTN awareness and treatment. The health systems, like other low- and middle-income countries, were designed to provide acute care for episodic conditions, rather than a chronic condition where patients need long-term care across time and disciplines. This article describes the delivery and organization of HTN care at primary healthcare (PHC) settings in both urban and rural areas at Hue Province of Central Vietnam in comparison with Thai Nguyen province in Northern Vietnam based on the infrastructure capacity and patients' and providers' perspectives and …

Barriers To Psychosocial Support And Quality Of Life For Patients With Inflammatory Bowel Disease: A Survey Study, Rebecca Lawrence, Md, Cuckoo Choudhary, Md

Department of Medicine Faculty Papers

Background: Psychological comorbidities are common among people with inflammatory bowel disease (IBD) and are associated with worse disease outcomes. Evidence-based psychotherapy is an effective means to increase psychosocial support. This study aimed to identify the barriers to attending psychotherapy.

Methods: This electronic survey study included a demographic, quality of life, and barriers to psychotherapy questionnaire. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Barriers were assessed using the Perceived Barriers to Psychological Treatments scale (PBPT). Linear regression was used to identify participant characteristics associated with higher PBPT scores.

Results: One hundred eighty-seven …

Health Impact Assessment And City Council Policy: Identifying Opportunities To Address Local Social Determinants Of Health & Place-Health Relationships, 10 Years Later, Ryan J. Petteway, Shannon Cosgrove

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Health Impact Assessment (HIA) can be used to assess any type of policy/program related to social determinants (SDH). However, local public health departments (LHDs) have been slow to adopt formal use of HIA in efforts to address local SDH, even with growing evidence linking SDH and place-health relationships. Ten years ago we completed a review of Baltimore City Council policies to advance this conversation within the LHD. Our goal here is to revisit this review and, again, outline a process by which LHDs can: a) monitor local policies in regard to SDH and b) identify opportunities for potential HIA …

Predicting Vaginal Birth After Previous Cesareavn: Using Machine-Learning Models And A Population-Based Cohort In Sweden, Charlotte Wollmann, Kyle D. Hart, Can Liu, Aaron B. Caughey, Olof Stephansson, Jonathan M. Snowden

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Predicting a woman’s probability of vaginal birth after cesarean could facilitate the antenatal decision-making process. Having a previous vaginal birth strongly predicts vaginal birth after cesarean. Delivery outcome in women with only a cesarean delivery is more unpredictable. Therefore, to better predict vaginal birth in women with only one prior cesarean delivery and no vaginal deliveries would greatly benefit clinical practice and fill a key evidence gap in research. Our aim was to predict vaginal birth in women with one prior cesarean and no vaginal deliveries using machine-learning methods, and compare with a US prediction model and its further …

Healthy Birth Initiatives: The Road Toward Reproductive Justice, Roberta Hunte, Susanne Klawetter, Sherly Paul

School of Social Work Faculty Publications and Presentations

This study concerns racialized experiences of reproductive oppression among Black women and the efforts of one organization - Multnomah County’s Healthy Birth Initiatives (HBI) - to combat this oppression and move towards Reproductive Justice. This study explores how Black women experience and respond to racism-related stress and its impacts on their health during and after pregnancy and subsequent parenting. The project was informed by a pilot focus group conducted in 2016 by Drs. Jenna Ramaker and Roberta Hunte in partnership with HBI, which asked HBI clients about the role of toxic stress and racism-related stress in their lives. The current …

Integration Of Mechanistic Immunological Knowledge Into A Machine Learning Pipeline Improves Predictions, Anthony Culos, Amy S. Tsai, Natalie Stanley, Martin Becker, Mohammad S. Ghaemi, David R. Mcilwain, Ramin Fallahzadeh, Athena Tanada, Huda Nassar, Camilo Espinosa, Maria Xenochristou, Edward Ganio, Laura Peterson, Xiaoyuan Han, Ina A. Stelzer, Kazuo Ando, Dyani Gaudilliere, Thanaphong Phongpreecha, Ivana Marić, Alan L. Chang, Gary M. Shaw, David K. Stevenson, Sean Bendall, Kara L. Davis, Wendy Fantl, Garry P. Nolan, Trevor Hastie, Robert Tibshirani, Martin S. Angst

All Dugoni School of Dentistry Faculty Articles

The dense network of interconnected cellular signalling responses that are quantifiable in peripheral immune cells provides a wealth of actionable immunological insights. Although high-throughput single-cell profiling techniques, including polychromatic flow and mass cytometry, have matured to a point that enables detailed immune profiling of patients in numerous clinical settings, the limited cohort size and high dimensionality of data increase the possibility of false-positive discoveries and model overfitting. We introduce a generalizable machine learning platform, the immunological Elastic-Net (iEN), which incorporates immunological knowledge directly into the predictive models. Importantly, the algorithm maintains the exploratory nature of the high-dimensional dataset, allowing for …

2020 Fall Newsletter, Morehead State University. Nursing Department.

Nursing Department Publications Archive

2020 Fall Newsletter of the Department of Nursing at Morehead State University.

Characterization Of Genome-Wide Binding Of Nuclear-Factor I-X In Hematopoietic Progenitor Cells, Megan J. Walker

Theses and Dissertations (ETD)

We report that ectopic expression of Nfix in primary mouse HSPC extended their ex vivo culture from 20 to 40 days. HSPC overexpressing Nfix displayed hypersensitivity to supportive cytokines and reduced apoptosis when subjected to cytokine deprivation compared to controls. Ectopic Nfix resulted in elevated levels of c-Mpl transcripts and cell surface protein on primary murine HSPC as well as increased phosphorylation of STAT5, which is known to be activated down-stream of c-MPL signaling. Blocking c-MPL signaling by removal of its ligand, thrombopoietin (TPO), or addition of a c-MPL neutralizing antibody negated the anti-apoptotic effect of Nfix overexpression on cultured …

A Unique Cause Of Elbow Pain And Loss Of Range Of Motion In A 13-Year-Old, Thomas Munro, Brian S. Harvey

Posters

A 13-year-old right hand dominant young lady presented to a pediatric sports medicine clinic for evaluation of decreased ROM and pain in her left elbow with an associated locking sensation that had been occurring for over a year. Two weeks prior to presentation, these symptoms had been acutely worsening as she was practicing for over 10 hours per day for an upcoming dance competition. The patient’s pain is described as a “tightness” and is localized to her antecubital fossa medial to her biceps tendon. The feeling of tightness occurs most prominently with end extension and flexion of the elbow. She …

Announcing The Isev2020 Special Achievement Award Recipients: Andrew Hill And Edit Buzás; And The Recipient Of The Isev2020 Special Education Award: Carolina Soekmadji., Kenneth W Witwer, Lucia R Languino, Alissa M Weaver, Marca H Wauben

Kimmel Cancer Center Faculty Papers

No abstract provided.

Caregiver Experience And Perceived Acceptability Of A Novel Near Point-Of-Care Early Infant Hiv Diagnostic Test Among Caregivers Enrolled In The Pmtct Program, Myanmar: A Qualitative Study, Win Lei Yee, Kyu Kyu Than, Yasmin Mohamed, Hla Htay, Htay Htay Tin, Win Thein, Latt Latt Kyaw, Win Win Yee, Moe Myat Aye, Stanley Luchters

Population Health, East Africa

Background: The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4–6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low test- ing rates and delays in result communication and treatment initiation. Decentralized point- of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care.

Aim: This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled …

Clinical Performance And Utility Of A Comprehensive Next-Generation Sequencing Dna Panel For The Simultaneous Analysis Of Variants, Tmb And Msi For Myeloid Neoplasms, Nikhil Shri Sahajpal, Ashis K. Mondal, Sudha Ananth, Allan Njau, Pankaj Ahluwalia, Kimya Jones, Meenakshi Ahluwalia, Nwogbo Okechukwu, ,Natasha M. Savage, Vamsi Kota

Pathology, East Africa

The extensively employed limited-gene coverage NGS panels lead to clinically inadequate molecular profiling of myeloid neoplasms. The aim of the present investigation was to assess performance and clinical utility of a comprehensive DNA panel for myeloid neoplasms. Sixty-one previously well characterized samples were sequenced using TSO500 library preparation kit on NextSeq550 platform. Variants with a VAF ≥ 5% and a total read depth of >50X were filtered for analysis. The following results were recorded-for clinical samples: clinical sensitivity (97%), specificity (100%), precision (100%) and accuracy (99%) whereas reference control results were 100% for analytical sensitivity, specificity, precision and accuracy, with …

Maternal And Newborn Care During The Covid-19 Pandemic In Kenya: Re-Contextualising The Community Midwifery Model, Rachel Kimani, Rose Maina, Constance Shumba, Sheila Shaibu

School of Nursing & Midwifery, East Africa

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the …

Early Breastfeeding Practices Contribute To Exclusive Breastfeeding In Bangladesh, Vietnam And Ethiopia, Phuong Hong Nguyen, Sunny S. Kim, Lan Mai Tran, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

Limited evidence exists on the complex relationship among interventions, early initiation of breastfeeding (EIBF), prelacteal feeding and exclusive breastfeeding (EBF). We examined whether early breastfeeding practices are associated with EBF and how much improving EIBF and non-prelacteal feeding contributes to increased prevalence of EBF. Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia. Multivariable logistic regression analyses were used to examine effects of interventions and early breastfeeding practices on EBF. Structural equation modelling quantified the direct …

A Novel Technique For Extraction Of A Leadless Pacemaker That Embolized To The Pulmonary Artery In A Young Patient: A Case Report., Sanjaya Gupta, Ken Cho, John Papagiannis, Svjetlana Tisma-Dupanovic, John Borsa

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Covid-19 And The Case For Global Development, Johan A. Oldekop, Rory Horner, David Hulme, Roshan Adhikari, Bina Agarwal, Matthew Alford, Oliver Bakewell, Nicola Banks, Stephanie Barrientos, Tanja Bastia, Anthony J. Bebbington, Upasak Das, Ralitza Dimova, Richard Duncombe, Charis Enns, David Fielding, Christopher Foster, Timothy Foster, Tomas Frederiksen, Ping Gao, Tom Gillespie, Richard Heeks, Sam Hickey, Martin Hess, Nicholas Jepson, Ambarish Karamchedu, Uma Kothari, Aarti Krishnan, Tom Lavers, Aminu Mamman, Diana Mitlin, Negar Monazam Tabrizi

Geography

COVID-19 accentuates the case for a global, rather than an international, development paradigm. The novel disease is a prime example of a development challenge for all countries, through the failure of public health as a global public good. The COVID-19 pandemic has highlighted the falsity of any assumption that the global North has all the expertise and solutions to tackle global challenges, and has further highlighted the need for multi-directional learning and transformation in all countries towards a more sustainable and equitable world. We illustrate our argument for a global development paradigm by examining the implications of the COVID-19 pandemic …

Redefining Cardiac Biomarkers In Predicting Mortality Of Inpatients With Covid-19, Juan-Juan Qin, Xu Cheng, Feng Zhou, Fang Lei, Gauri Akolkar, Jingjing Cai, Xiao-Jing Zhang, Alice Blet, Jing Xie, Peng Zhang, Ye-Mao Liu, Zizhen Huang, Ling-Ping Zhao, Lijin Lin, Meng Xia, Ming-Ming Chen, Xiaohui Song, Liangjie Bai, Ze Chen, Xingyuan Zhang, Da Xiang, Jing Chen, Qingbo Xu, Xin-Liang Ma, Rhian M Touyz, Chen Gao, Haitao Wang, Liming Liu, Weiming Mao, Pengcheng Luo, Youqin Yan, Ping Ye, Manhua Chen, Guohua Chen, Lihua Zhu, Zhi-Gang She, Xiaodong Huang, Yufeng Yuan, Bing-Hong Zhang, Yibin Wang, Peter P Liu, Hongliang Li

Department of Emergency Medicine Faculty Papers

The prognostic power of circulating cardiac biomarkers, their utility, and pattern of release in coronavirus disease 2019 (COVID-19) patients have not been clearly defined. In this multicentered retrospective study, we enrolled 3219 patients with diagnosed COVID-19 admitted to 9 hospitals from December 31, 2019 to March 4, 2020, to estimate the associations and prognostic power of circulating cardiac injury markers with the poor outcomes of COVID-19. In the mixed-effects Cox model, after adjusting for age, sex, and comorbidities, the adjusted hazard ratio of 28-day mortality for hs-cTnI (high-sensitivity cardiac troponin I) was 7.12 ([95% CI, 4.60-11.03] P<0.001), (NT-pro)BNP (N-terminal pro-B-type natriuretic peptide or brain natriuretic peptide) was 5.11 ([95% CI, 3.50-7.47] P<0.001), CK (creatine phosphokinase)-MB was 4.86 ([95% CI, 3.33-7.09] P<0.001), MYO (myoglobin) was 4.50 ([95% CI, 3.18-6.36] P<0.001), and CK was 3.56 ([95% CI, 2.53-5.02] P<0.001). The cutoffs of those cardiac biomarkers for effective prognosis of 28-day mortality of COVID-19 were found to be much lower than for regular heart disease at about 19%-50% of the currently recommended thresholds. Patients with elevated cardiac injury markers above the newly established cutoffs were associated with significantly increased risk of COVID-19 death. In conclusion, cardiac biomarker elevations are significantly associated with 28-day death in patients with COVID-19. The prognostic cutoff values of these biomarkers might be much lower than the current reference standards. These findings can assist in better management of COVID-19 patients to improve outcomes. Importantly, the newly established cutoff levels of COVID-19-associated cardiac biomarkers may serve as useful criteria for the future prospective studies and clinical trials.

Sudden Shoulder Swelling In An Elderly Man After The Flu Shot., Joseph Jean, Md, Elizabeth M Lee, Xiao Chi Zhang

Department of Emergency Medicine Faculty Papers

A 99-year-old man presented to the emergency department (ED) with sudden left shoulder pain hours after receiving the influenza vaccine. DIAGNOSIS: Aseptic inflammatory arthritis secondary to influenza vaccination

Proposals For Upper Limits Of Safe Intake For Methionine, Histidine, And Lysine In Healthy Humans, Luc Cynober, Dennis M Bier, Patrick Stover, Motoni Kadowaki, Sidney M Morris, Rajavel Elango, Miro Smriga

Children’s Nutrition Research Center Staff Publications

Based on research presented during the 10th Amino Acid Assessment Workshop, no observed adverse effect levels (NOAELs) for supplemental methionine at 46 mg/(kg·d) (∼3.2 g/d), for supplemental histidine at 8.0 g/d, and for supplemental lysine at 6.0 g/d have been proposed. These NOAELs are relevant to healthy adults and are applicable only to high-purity amino acids administered in fortified foods or dietary supplements. Because individuals are exposed to the above supplemental amino acids in the context of complex combinations of essential amino acids or individually in dietary supplements for various physiologic benefits, such as body fat reduction, skin conditioning, mental …

The Central Melanocortin System And Human Obesity, Yongjie Yang, Yong Xu

Children’s Nutrition Research Center Staff Publications

The prevalence of obesity and the associated comorbidities highlight the importance of understanding the regulation of energy homeostasis. The central melanocortin system plays a critical role in controlling body weight balance. Melanocortin neurons sense and integrate the neuronal and hormonal signals, and then send regulatory projections, releasing anorexigenic or orexigenic melanocortin neuropeptides, to downstream neurons to regulate the food intake and energy expenditure. This review summarizes the latest progress in our understanding of the role of the melanocortin pathway in energy homeostasis. We also review the advances in the identification of human genetic variants that cause obesity via mechanisms that …

Evidence For Craniofacial Enhancer Variation Underlying Nonsyndromic Cleft Lip And Palate, Vershanna E Morris, S Shahrukh Hashmi, Lisha Zhu, Lorena Maili, Christian Urbina, Steven Blackwell, Matthew R Greives, Edward P Buchanan, John B Mulliken, Susan H Blanton, W Jim Zheng, Jacqueline T Hecht, Ariadne Letra

Faculty, Staff and Student Publications

Nonsyndromic cleft lip with or without cleft palate (NSCLP) is a common birth defect for which only ~ 20% of the underlying genetic variation has been identified. Variants in noncoding regions have been increasingly suggested to contribute to the missing heritability. In this study, we investigated whether variation in craniofacial enhancers contributes to NSCLP. Candidate enhancers were identified using VISTA Enhancer Browser and previous publications. Prioritization was based on patterning defects in knockout mice, deletion/duplication of craniofacial genes in animal models and results of whole exome/whole genome sequencing studies. This resulted in 20 craniofacial enhancers to be investigated. Custom amplicon-based …

Effect Of Female Sex Work-Targeted Community-Based Interventions Along The Hiv Treatment Cascade In Sub-Saharan Africa: A Systematic Review Protocol, Lydia Atuhaire, Olatunji Adetokunboh, Constance Shumba, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Introduction: Female sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs’ uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs’ continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of …

Changes In Preventive Care Utilisation And Its Influencing Factors Among Chinese Adults Before And After The Healthcare Reform: Cross-Sectional Evidence From The China Health And Nutrition Survey In 2004-2015, Tingting Wu, Wei Wei Liu, Mao Zou, Xun Lei, Qiang Yang, Manoj Sharma, Yong Zhao, Zu Min Shi

Environmental & Global Health Faculty Research

Objective China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform. Design A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004–2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used. Setting Data were derived from urban and rural communities of nine provinces in China. Participants Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 …

Positive Parenting Approaches And Their Association With Child Eating And Weight: A Narrative Review From Infancy To Adolescence, Katherine N. Balantekin, Stephanie Anzman-Frasca, Lori A. Francis, Alison K. Ventura, Jennifer O. Fisher, Susan L. Johnson

Kinesiology and Public Health

Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths-based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the …

Adult Secondary Hemophagocytic Lymphohistiocytosis, Antonina Obayo, Karishma Sharma, Caroline Mithi, Riyat Malkit, Anne Mwirigi

Internal Medicine, East Africa

Background: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation and tissue destruction due to abnormal immune activation. HLH carries a very high mortality, and while delays in patients’ presentation to hospital, time to suspicion of HLH, investigation, and initiation of therapy all play a part, mortality remains high even with timely diagnosis and treatment. Classical manifestations of HLH include persistent fever, cytopenias, and liver dysfunction.

Case presentation: We present four cases of secondary HLH, highlighting the demographic and clinical characteristics of these patients, underlying triggers (including systemic lupus erythematosus, lymphoproliferative disorders, and leishmaniasis), together with challenges associated with the …

Determining The Effectiveness Of System-Based Solutions To Improve Fragmented Care For Oncology Patients Living In Rural And Remote Regions: An Integrative Review, Andrea Nicole Fulmer

Doctoral Dissertations and Projects

The purpose of this integrative review is to review, critique, and synthesize the current literature to determine the state of the science related to the established systems approach for improving healthcare management and care coordination of the oncology patient population in rural and remote regions. The oncology patient population with co-existing chronic disease living in rural and remote regions experience fragmented health care. New cancer diagnoses take precedence over other existing comorbidities and require focused and specialized care for lengthy periods of time. Research is significantly limited for the current state of science for the identified patient population living in …