Director Benard graduated from the University of New Hampshire in 2006 with a dual major in Psychology and Justice Studies. He was hired as a Corrections Officer on. GOVERNOR AND EXECUTIVE COUNCIL AGENDA State House, Concord, New Hampshire June 1, 2016, 10:00 a.m. CONSENT CALENDAR AGENDA #1 MOP 150, I, B (1. Patient Outcomes in the ENABLE III Randomized Controlled. Trial. Tosteson. Zhigang Li. Kathleen D. Lyons. Jay G. Hull. Zhongze Li. 8/4/2016 New Hampshire Family-Centered Early Supports and Services Program Directory August 2016. New Hampshire Drug Abuse Treatment Programs New Hampshire Inpatient and Outpatient Programs; Choose Group Therapy or Private Addiction Counseling in New Hampshire. GOVERNOR AND EXECUTIVE COUNCIL AGENDA Colby-Sawyer College, New London, New Hampshire August 24, 2016, 10:00 a.m. CONSENT CALENDAR AGENDA. To search for a resource listing in a different state, return to the state pages. Search Tip: So you don't have to scroll through pages of addresses on your state. J. Nicholas Dionne- Odom. Jennifer Frost. Konstantin H. Dragnev. Mark T. Hegel. Andres Azuero and. Early Supports & Services. Family Centered Early Supports & Services (FCESS) provide services to children who are experiencing developmental delays from birth to.Head Start is a program that helps eligible young children between the ages of three and five grow up ready to succeed in school and in life. Welcome Mission Statement. The mission of the Board of Registration in Podiatry is to ensure that only fully qualified podiatrists are permitted to provide podiatric. Tim A. Nicholas Dionne- Odom, and Andres Azuero, University of Alabama at Birmingham, Birmingham, AL; Marie A. Dragnev, Dartmouth- Hitchcock Medical Center; Zhongze Li, Norris Cotton Cancer Center. Lebanon; Tor D. Hegel, Geisel School of Medicine at Dartmouth; Zhigang Li and Jay. G. Hull, Dartmouth College, Hanover, NH; and Tim A. Ahles, Memorial Sloan- Kettering Cancer Center, New York, NY. Bakitas, DNSc, CRNP, School of Nursing/Department of Medicine, University of Alabama at Birmingham. Ave South, Birmingham, AL 3. We investigated the effect of early versus delayed PC on quality of life (QOL), symptom impact, mood, 1- year. Outcomes were QOL, symptom impact, mood, 1- year survival, and resource use (hospital/intensive care unit. Kaplan- Meier 1- year survival rates were 6. P = . 0. 38). Relative rates of early to delayed decedents' resource use were similar for hospital days (0. CI, 0. 4. 1 to. 1. P = . 2. 6), intensive care unit days (0. CI, 0. 2. 3 to 2. P = . 4. 9), emergency room visits (0. CI, 0. 4. 5 to 1. P = . 2. 1), chemotherapy in last 1. CI, 0. 3. 7 to 6. P = . 2. 7), and home death (2. Understanding the complex mechanisms whereby. PC may improve survival remains an important research priority. In the ENABLE II RCT. QOL), reduced depression, and trends in improved symptom intensity and survival. On the basis of interviews with surviving intervention (n = 2. RCT with three modifications: first, we added a three- session life review component; second, we designed. This design would allow us to address the question of optimal timing of initiating PC. As in our prior RCT,4 we defined early as initiating PC within 3. PC for 3 months. The rationale for choosing a 3- month delay was based on feedback from some surviving patients who felt. In our prior study, symptom intensity increased at 3 months. Therefore, the main research objective of this study was to compare the effect of early versus delayed intervention timing. Family caregiver outcomes are reported elsewhere. PATIENTS AND METHODSStudy Design. Using a fast- track RCT design. Appendix Fig A1, online only), patients were randomly assigned to receive the ENABLE telehealth concurrent PC model with standard oncology. Random. assignment was on a one- to- one basis using computer- generated randomly permuted treatment assignments with randomly assigned. Data collectors were. The study protocol and data and safety monitoring plan were approved by the Norris Cotton Cancer. Center/Dartmouth College (Lebanon, NH) and the Veterans Affairs Medical Center (White River Junction, VT) institutional review. Exclusions included impaired cognition (Callahan score . There were no formal caregiver exclusion criteria. Sessions one to three. Sessions four to six comprised Outlook, a life- review approach. After the six Charting. Your Course sessions, monthly follow- up calls reinforced prior content and identified new challenges or care coordination. Sessions generally lasted 3. The study. principal investigator (M. A. B.) was blinded to group assignment, reviewed all PC consultation notes, and digitally recorded. She met with the nurse coaches weekly to review and provide feedback on difficult. Baseline demographics included age, sex. Overall median survival was calculated based on time from enrollment to death or study closure (September 5, 2. Decedents' data for the period between the last patient- reported. We calculated a target sample size. FACIT- Pal and 2. CES- D based on. a t test comparing the 3- month group differences with a two- sided . However at the planned study completion date (March 1. On the basis of the final sample size, the 3- month detectable. FACIT- Pal, 7. 7 points; CES- D, 3. The advantage of this approach is that it models the trend. QOL backward from time of death rather than prospectively from time of enrollment; thus, it controls the association between. QOL and survival and therefore incorporates the survival effect on QOL. Terminal decline and survival distributions are estimated. On the basis of the fitted models, comparisons were made at specified. All intent- to- treat analyses. The method of estimation (maximum likelihood) results in valid and efficient estimates. We computed effects sizes as standardized mean differences (Cohen's d); effect sizes of at least 0. We chose 1- year survival as our primary survival outcome because the intervention targets (ie, communication, understanding. Using Kaplan- Meier curves, we compared early and delayed group. Overall survival was also compared via a log- rank test incorporating data for patients. Patients who were alive at the last follow- up (September 5, 2. We compared. relative rates for both groups of decedents of hospital, ICU, and ED days or visits using a Poisson generalized linear model. The early group had significantly less education, higher weekly alcoholic. Table 1). Patient- reported outcome scores were not statistically different at baseline (Appendix Table A1, online only). Participants (n = 2. PCT, palliative care treatment; psych, psychiatric disorder. Table 1. Baseline Demographic and Clinical Characteristics of Patient Participants. Relative to intervention participation, in- person PC consults were completed for 6. Eighty- eight percent of early and 6. Decedents' median participation ranged from 2. Similarly, there were no significant differences in analyses of decedents' outcomes looking backward from death at. Figure 2 Kaplan- Meier curves illustrate a 1. P = . 0. 38). Overall median survival was 1. However, the overall log- rank test was not significant (P = . Early decedents' relative rates of hospital, ICU days, and ED visits were lower compared with the delayed group but not. The estimated relative rate of chemotherapy use in the last 2 weeks of life was not statistically. CI, 0. 3. 7 to 6. P = . 5. 4). Just more than half of early (5. P = . 6. 0) of delayed entry decedents died at home; 8. Appendix Table A2, online only). We found no statistical differences in patient- reported. P = . 0. 38). These consistent findings suggest that concurrent PC provided soon after diagnosis confers a survival benefit by. Those findings, together with improved QOL and mood, served as the basis for the recommendation. PC for all patients with cancer with metastatic disease and/or high symptom burden. Unlike that by Temel et al. QOL or mood related to early PC. If QOL and. mood are presumed to be the mechanisms of improved survival, our results raise the question of how survival improvement occurred. First, in retrospect, we predicted an overly ambitious recruitment rate for a 3- year. A reduced sample size and power could have prevented us from detecting differences (type II error) in patient- reported. Second, it is possible that a 3- month delay was not long enough. PC benefits. In our prior study. RCT,3. 6 symptom distress levels were low at 3 months, and intervention effects on patient- reported outcomes were not apparent until. Third, it is possible that survival benefits occurred from unmeasured PC effects. For example, delaying exposure. Although chemotherapy use at baseline and use before death were similar in the current study, intermediate treatment choices. Less aggressive treatment choices or earlier hospice use—purported mechanisms of longer survival in advanced. PC survival advantage in the early- entry group. In those analyses, delayed decedents' mean scores in the year before death varied by < 1 point within a possible 1. Whether this represents measurement insensitivity, a ceiling effect, or a stabilizing effect from the intervention. In 2. 01. 2, PC via hospice had a duration of 1. The average time from PC referral to death ranged from 4. In our study, decedents' median participation was 2. As a result, we had ample time, in a convenient home setting. PC2. 1 and high- quality cancer care,4. First, although we did not detect differences in disease or sex between participants and. Second, racial and ethnic homogeneity. New England population. Third, clinicians were at liberty to refer patients to the clinical PC team. PC consults did so earlier than prescribed. Fourth, outcomes of intent- to- treat analyses included participants. Future analyses will explore intervention dose impact on study outcomes. Sixth, we did not choose a single primary outcome, resulting in the potential implication of. I error rate. Finally, regional PC quality improvement efforts,2 publication of early PC advantages,1,4,6 and growing acceptance of early PC as a care standard. The challenge now is to determine the optimal timing, essential elements. Our study supports the association between early PC and improved survival. PC mechanisms remain elusive. Tosteson, Zhigang Li, Kathleen D. Hegel, Tim. A. Ahles. Administrative support: Marie A. Bakitas, Jennifer Frost. Provision of study materials or patients: Marie A. Bakitas, Konstantin H. Dragnev. Collection and assembly of data: Marie A. Nicholas Dionne- Odom. Data analysis and interpretation: All authors. Manuscript writing: All authors. Final approval of manuscript: All authors. Acknowledgment. We thank members of Dartmouth- Hitchcock Section of Palliative Medicine (Ira Byock, MD, Sharona Sachs, MD, and Sandra Knowlton- Soho. RN) and the nurse practitioners, physicians, and staff of the Section of Hematology/Oncology (James Rigas, MD, and Marc Pipas. MD); Veterans Affairs Medical Center (VAMC; White River Junction, VT; Stefan Balan, MD, Luann Graves, Lisa Lambert, MD, Nancy. Kuemmerle, DO, Ph. D, and Sarah Colson, APRN); Mountainview Medical Center (Berlin, VT; John Valentine, MD, and Elaine Owen. APRN); the Dartmouth- Hitchcock Norris Cotton Cancer Center South staff; St Joseph Medical Center, (Nashua, NH); VAMC (Providence. RI; Katherine Farisy- Anderson, MD); the nurse interventionists (Peggy Bishop, MS, APRN, Peggy Plunkett, MSN, APRN, Lynn Devlin.
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