The Comprehensive Female Soldier Support Model

Women represent a small minority in the U.S. military and an even smaller minority in the military chaplaincy. Prior to this study, the U.S. Army chaplaincy did not have a gender-specific model for providing support to women soldiers. In this Delphi research project, wounded women soldiers and female military chaplains provided expert opinions to develop the comprehensive female soldier support model (CFS2). Ten military women and 11 female chaplains who had been deployed overseas contributed to the body of knowledge related to the understanding of the emotional and spiritual support needs of wounded female soldiers. Five key findings appeared in the study: (a) many women did not get the chaplain support they needed; (b) the gender of the chaplain was not significant; (c) the attitude of the chaplain was critical; (d) chaplain skills not found in literature were identified; and (e) the comprehensive female soldier support model was developed.     

Association Between Potentially Inappropriate Medications and Frailty in the Early Old Age: A Longitudinal Study in the GAZEL Cohort

Objectives

High-risk prescribing can have deleterious effects on the health of older people. This study aimed to assess the role of inappropriate prescribing on changes in frailty status over 3 years of follow-up.

Adherence to surveillance guidelines after radical cystectomy: A population-based analysis

ObjectivesSurveillance after radical cystectomy is recommended to detect tumor recurrence and treatment complications. We evaluated adherence to National Comprehensive Cancer Network (NCCN) guidelines using a large population-based database.Methods and materialsThe Surveillance, Epidemiology, and End Results–Medicare database was used to identify patients aged ≥66 years diagnosed with nonmetastatic bladder cancer who had undergone radical cystectomy between 2000 and 2007. Medicare claims information identified recommended surveillance tests for 2 years after cystectomy as outlined in the NCCN guidelines. Adherence was defined as receipt of urine cytology and imaging of the chest, abdomen, and pelvis in each year. We evaluated the effect of patient and provider characteristics on adherence, controlling for demographic and disease characteristics.ResultsOf 3,757 patients who had undergone radical cystectomy, 2,990 (80%) were alive after 2 years. Adherence to all recommended investigations was 17% for the first and the second years following surgery. Among patients surviving 2 years, only 9% had complete surveillance in both years. In either year, adherence was less likely in patients with advanced pathologic stage (III/IV) (adjusted odds ratio [AOR] = 0.74, 95% CI: 0.60–0.91) and unmarried patients (AOR = 0.82, 95% CI: 0.68–0.99). Adherence was more likely in patients treated by high-volume surgeons (AOR = 2.00, 95% CI: 1.70–2.36) and those who saw a medical oncologist (AOR = 1.52, 95% CI: 1.27–1.82). We also observed significant geographic variability in adherence.ConclusionPatterns of surveillance after radical cystectomy deviate considerably from NCCN recommendations. Despite increased utilization of radiographic imaging investigations, the omission of urine cytology significantly contributed to the low rate of overall adherence to surveillance guidelines. Uniform adherence to surveillance guidelines was observed in patients treated by high-volume surgeons. This suggests an important opportunity for quality improvement in bladder cancer care.