Cancer Care Coordination: a Systematic Review and Meta-Analysis of Over 30 Years of Empirical Studies

Background

According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of coordination is associated with poor symptom control, medical errors, and higher costs.

Purpose

The aims of this systematic review and meta-analysis were to (1) synthesize the findings of studies addressing cancer care coordination, (2) describe study outcomes across the cancer continuum, and (3) obtain a quantitative estimate of the effect of interventions in cancer care coordination on service system processes and patient health outcomes.

Methods

Of 1241 abstracts identified through MEDLINE, EMBASE, CINAHL, and the Cochrane Library, 52 studies met the inclusion criteria. Each study had US or Canadian participants, comparison or control groups, measures, times, samples, and/or interventions. Two researchers independently applied a standardized search strategy, coding scheme, and online coding program to each study. Eleven studies met the additional criteria for the meta-analysis; a random effects estimation model was used for data analysis.

Results

Cancer care coordination approaches led to improvements in 81 % of outcomes, including screening, measures of patient experience with care, and quality of end-of-life care. Across the continuum of cancer care, patient navigation was the most frequent care coordination intervention, followed by home telehealth; nurse case management was third in frequency. The meta-analysis of a subset of the reviewed studies showed that the odds of appropriate health care utilization in cancer care coordination interventions were almost twice (OR = 1.9, 95 % CI = 1.5–3.5) that of comparison interventions.

Conclusions

This review offers promising findings on the impact of cancer care coordination on increasing value and reducing healthcare costs in the USA.

     

Variation in Early Developmental Course in Autism and its Relation with Behavioral Outcome at 3–4 Years of Age

The aims of the present study were to describe variations in the early course of development in autism by utilizing an in-depth parent interview that incorporated techniques to improve accuracy of parent recall, and to examine the relation between variations in early developmental course in autism and behavioral outcome at 3–4 years of age. The Early Development Interview, which consisted of questions about child’s behavior in several domains from birth through 2 years of age, was created and administered to parents of 72 3–4-year-old children with autism spectrum disorder and 34 3–4-year-old children with developmental delay, who were matched on mental and chronological age, and 39 1–4-year-old typically developing children, who were matched to the clinical groups on mental age. At 3–4 years of age, children were administered standardized measures (some clinician administered and some parent report); these included verbal and nonverbal IQ, autism symptom severity, and adaptive and aberrant behavior. Based on the Early Development Interview, children with autism spectrum disorder (ASD) were reported to have elevated symptoms in the social and regulatory domains by 3–6 months. By 12–15 months, parents of children with ASD reported significantly higher levels of social symptoms than parents of children with developmental delay. At 3–4 years of age, children with autism with early vs. late onset of symptoms, and with vs. without a history of loss of skills (regression) were not found to differ on standardized tests of verbal and nonverbal IQ and observational measures of autism symptom severity.     

Prenatal and Postnatal Predictive Factors for Children’s Inattentive and Hyperactive Symptoms at 5 Years of Age: The Role of Early Family-related Factors

Child Psychiatry & Human Development - We examined several parent-reported prenatal and postnatal factors as potential risk factors for attention-deficit and hyperactivity disorder (ADHD)...     

The Very Early Identification of Autism: Outcome to Age 41/2–5

Forty-nine 2 years olds with social and language characteristics suggestive of autism were identified by community professionals and screening tools, then given a diagnostic assessment and reexamined at age 4 1/2. Agreement between autism clinic and screenings was high, with 88% receiving a diagnosis on the autism spectrum. The children were lower functioning relative to the autism population, thus more likely to be identified early. Reliability of diagnoses from 2 1/2 to 4 1/2 was high with 79% staying in the same diagnostic category, but more so for clear autism than for PDDNOS. About a third improved over 20 IQ points and similar number similarly declined. Changes were not related to amount or type of intervention but were related to the children's characteristics. Higher functioning children with milder autism were the most improved.     

150 Years of Freud-Kraepelin Dualism

The year 2006 marked the 150th Birthday of Emil Kraepelin and Sigmund Freud. Kraepelin and Freud were two very different yet very similar men. The comparison between their biographies shows many parallels in their lives and personalities. They were, in their time, the two most influential individuals in psychiatry. They wrote and thought about similar topics in the field yet came to quite different conclusions. Both did not show public respect for each other but wrote about the importance of integrating their respective approaches into the study of the mind/brain problem. Psychiatry today continues to struggle with the integration of the biological and psychodynamic approach.     

Age of onset of hypertension and risk of dementia in the oldest-old: The 90+ Study

Introduction

We investigated the association between age of onset of hypertension and dementia risk in an oldest-old cohort.

Time for Taste—A Review of the Early Cerebral Processing of Gustatory Perception

The first successfully recorded event-related potential (ERP) for taste, one of our basic senses, was published nearly half a century ago. Despite this large time span, surprisingly little is known about the early neural processing of taste perception. Here, we are providing a comprehensive and critical overview of over four decades of research, with a focus on the temporal dimension of cerebral taste processing in healthy humans. For this purpose, we review studies using techniques that permit a high temporal resolution, namely, electroencephalography and magnetoencephalography, ERP, and event-related magnetic fields (ERF). Our current knowledge of taste ERP is interpreted in the context of our understanding of other, nonchemical senses. Gaps in the existing literature are identified and discussed. Finally, we suggest directions for future investigations using gustatory ERP/ERF.     

Constructing Trauma’s Narratives in the Later Years: Aging and the Life Review

This article discusses contrasting patterns of familial communication to show that trauma can be either mitigated and transformed or instead transmitted among generations. The author describes her father-in-law’s storytelling as a means of processing and sharing his early traumas with his family, and contrasts it with her own experience in which family secrets and denials prevailed and traumas were evoked and enacted. When elders engage in life review and share their stories with younger generations, they can metabolize their traumas and promote healing throughout their lifespan. Thus, resilience and other strengths can be transmitted across generations. It is posited that some people are able to work through traumas when they are older adults. Ghosts that were frightening may seem less ominous when people are nearer to accepting life’s transience.     

Autism Spectrum Disorder as Early Neurodevelopmental Disorder: Evidence from the Brain Imaging Abnormalities in 2–3 Years Old Toddlers

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that occurs within the first 3 years of life, which is marked by social skills and communication deficits along with stereotyped repetitive behavior. Although great efforts have been made to clarify the underlying neuroanatomical abnormalities and brain-behavior relationships in adolescents and adults with ASD, literature is still limited in information about the neurobiology of ASD in the early age of life. Brain images of 50 toddlers with ASD and 28 age, gender, and developmental quotient matched toddlers with developmental delay (DD) (control group) between ages 2 and 3 years were captured using combined magnetic resonance-based structural imaging and diffusion tensor imaging (DTI). Structural magnetic resonance imaging was applied to assess overall gray matter (GM) and white matter (WM) volumes, and regional alterations were assessed by voxel-based morphometry. DTI was used to investigate the white matter tract integrity. Compared with DD, significant increases were observed in ASD, primarily in global GM and WM volumes and in right superior temporal gyrus regional GM and WM volumes. Higher fractional anisotropy value was also observed in the corpus callosum, posterior cingulate cortex, and limbic lobes of ASD. The converging findings of structural and white matter abnormalities in ASD suggest that alterations in neural-anatomy of different brain regions may be involved in behavioral and cognitive deficits associated with ASD, especially in an early age of 2–3 years old toddlers.     

Screening for Type 2 Diabetes in a High-Risk Population: Effects of a Negative Screening Test After 4 Years Follow-up

Background

A negative diabetes screening test may unintentionally provide reassurance, resulting in reduced incentive to follow a healthy lifestyle.

Purpose

The purpose of this study is to assess negative test result effects on lifestyle and risk perception at 4 years follow-up.

Methods

Risk perception and changes in smoking, physical activity, body mass index (BMI), and waist circumference were compared between 706 high-risk participants with a negative test result and 706 high-risk participants not offered screening (controls) in a randomized controlled trial of diabetes screening.

Results

Negative-screened individuals experienced a small but significant increase in BMI and waist circumference, but there was no significant difference with controls. The negative-screened group had significantly higher perception of risk of developing diabetes (p?=?0.009) than controls, but no differences were observed in perceived personal control, worry, and optimistic bias.

Conclusion

Screening negative for diabetes did not lead to overt long-term changes in lifestyle, despite a high perception of risk of developing diabetes. (ISRCTN75983009.)     

A Review of the Neural Mechanisms of Action and Clinical Efficiency of Riluzole in Treating Amyotrophic Lateral Sclerosis: What have we Learned in the Last Decade?

Amyotrophic lateral sclerosis (ALS) is a devastating and fatal neurodegenerative disease of adults which preferentially attacks the neuromotor system. Riluzole has been used as the only approved treatment for amyotrophic lateral sclerosis since 1995, but its mechanism(s) of action in slowing the progression of this disease remain obscure. Searching PubMed for “riluzole” found 705 articles published between January 1996 and June 2009. A systematic review of this literature found that riluzole had a wide range of effects on factors influencing neural activity in general, and the neuromotor system in particular. These effects occurred over a large dose range (<1 μM to >1 mM). Reported neural effects of riluzole included (in approximate ascending order of dose range): inhibition of persistent Na⁺ current = inhibition of repetitive firing < potentiation of calcium‐dependent K⁺ current < inhibition of neurotransmitter release < inhibition of fast Na⁺ current < inhibition of voltage‐gated Ca²⁺ current = promotion of neuronal survival or growth factors < inhibition of voltage‐gated K⁺ current = modulation of two‐pore K⁺ current = modulation of ligand‐gated neurotransmitter receptors = potentiation of glutamate transporters. Only the first four of these effects commonly occurred at clinically relevant concentrations of riluzole (plasma levels of 1–2 μM with three‐ to four‐fold higher concentrations in brain tissue). Treatment of human ALS patients or transgenic rodent models of ALS with riluzole most commonly produced a modest but significant extension of lifespan. Riluzole treatment was well tolerated in humans and animals. In animals, despite in vitro evidence that riluzole may inhibit rhythmic motor behaviors, in vivo administration of riluzole produced relatively minor effects on normal respiration parameters, but inhibited hypoxia‐induced gasping. This effect may have implications for the management of hypoventilation and sleep‐disordered breathing during end‐stage ALS in humans.     

Does Dynorphin Play a Role in the Onset of Puberty in Female Sheep?

Puberty onset involves increased gonadotrophin‐release (GnRH) release as a result of decreased sensitivity to oestrogen (E₂)‐negative feedback. Because GnRH neurones lack E₂ receptor α, this pathway must contain interneurones. One likely candidate is KNDy neurones (kisspeptin, neurokinin B, dynorphin). The overarching hypothesis of the present study was that the prepubertal hiatus in luteinising hormone (LH) release involves reduced kisspeptin and/or heightened dynorphin input. We first tested the specific hypothesis that E₂ would reduce kisspeptin‐immunopositive cell numbers and increase dynorphin‐immunopositive cell numbers. We found that kisspeptin cell numbers were higher in ovariectomised (OVX) lambs than OVX lambs treated with E₂ (OVX+ E₂) or those left ovary‐intact. Very few arcuate dynorphin cells were identified in any group. Next, we hypothesised that central blockade of κ‐opioid receptor (KOR) would increase LH secretion at a prepubertal (6 months) but not postpubertal (10 months) age. Luteinising hormone pulse frequency and mean LH increased during infusion of a KOR antagonist, norbinaltorphimine, in OVX + E₂ lambs at the prepubertal age but not in the same lambs at the postpubertal age. We next hypothesised that E₂ would increase KOR expression in GnRH neurones or alter synaptic input to KNDy neurones in prepubertal ewes. Oestrogen treatment decreased the percentage of GnRH neurones coexpressing KOR (approximately 68%) compared to OVX alone (approximately 78%). No significant differences in synaptic contacts per cell between OVX and OVX + E₂ groups were observed. Although these initial data are consistent with dynorphin inhibiting pulsatile LH release prepubertally, additional work will be necessary to define the source and mechanisms of this inhibition.