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Background and purpose: Conventional measures of withdrawal in newborns with prenatal opioid exposure (POE) rely on nursing assessments, including the subjective judgment of infant irritability. This study investigated limb movement actigraphy as a tool for providing an objective, quantifiable measure of underlying distress. Methods: Correlational analyses compared continuous physiological-detected movement actigraphy and clinical intervallic-scored symptomology (modified Finnegan system) obtained from a control cohort of 37 term neonates with POE studied in their crib in the newborn unit (1–8 days). Results: Infants spent 15% crib time in high movement activity (>100 movements/minute; index irritability) and 38% crib time in low activity (0–5 movements/minute; index calm). There was a significant positive association between actigraphy and Finnegan composite score (r =.28, p =.001) and between actigraphy and subcomponent scores (i.e., central nervous system, gastrointestinal, and metabolic-vasomotor-respiratory). Conclusion: Movement activity via actigraphy captures underlying distress and calm not measured by conventional assessments. Such objective, quantifiable measures can serve to promote equitable assessment and treatment of hospitalized newborns with POE. [ABSTRACT FROM AUTHOR]

The Polaris Oncology Survivorship Transition (POST) system is a computer-based program that integrates information from the electronic health record, oncology team, and the patient to produce a personalized Survivorship Care Plan. The purpose of this study was to compare the POST to treatment as usual on confidence, quality of life, and interest in mental health referrals in women ending treatment for breast cancer. Two hundred women (100 POST, 100 treatment as usual) ending treatment for breast cancer were enrolled in a randomized controlled trial. Women randomized to the POST condition received a personalized care plan during a baseline/intervention appointment. At enrollment and baseline/intervention, a number of outcomes were examined in this study, including confidence to enter survivorship measured by the Confidence in Survivorship Index (CSI) and Quality of Life (QOL). One, three, and six month follow up assessments were also conducted. Treatment groups did not differ in terms of QOL scores at any time points. Mean CSI scores were statistically different between POST and treatment as usual at baseline for the total CSI score and both subscales, but only for confidence in knowledge about prevention and treatment at the 1-month follow-up. All significant differences were in favor of the POST intervention as mean CSI scores were higher for participants who received the POST intervention as opposed to treatment as usual. These findings disappeared at the 3 and 6 month follow up assessments. Finally, patients who received the POST intervention were twice as likely to request mental health/social services referrals compared to women who received treatment as usual. Oncologists may use the POST to build personalized care plans for women ending treatment for cancer, which may enhance patients' confidence in the short term as well as encourage use of mental health resources. [ABSTRACT FROM AUTHOR]

Background: In 2006, the Institute of Medicine (IOM) issued a report recommending that all cancer survivors receive a customized survivorship care plan (SCP) to increase survivors' understanding of diagnoses, long-term treatment effects, and ideas for improving overall health. Therefore, the purpose of this study was to compare a tailored SCP program (POST) to treatment as usual (TAU) on patient ratings of quality and content of discussion with providers at the end of their breast cancer treatment. Methods: Two hundred participants were randomized to receive either the POST treatment (n=100) or TAU (n=100) at their last treatment visit. Women were presented with a checklist of 29 survivorship topics and indicated whether their healthcare provider discussed it at their last visit. They were also asked to rate overall quality of discussion (QOD) with their providers and across several QOD subscales. Results: Analyses indicated that on average, POST women endorsed 20 out of the 29 topics compared to 14 topics endorsed by TAU. Additionally, POST women reported a better QOD overall and across all subscales. Conclusion: POST women remembered discussing more survivorship topics and reported better discussions with their providers. As a practical implication, cancer survivors should receive an individualized SCP to ensure that patients feel well informed of their road to survivorship. [ABSTRACT FROM AUTHOR]

The author comments on the study by Clark et al that analyzed the relationship between homelessness and infant health outcomes in the U.S. He raises issue about Clark's use of bivariable analysis considering the limitation of this model. Based on this shortcomings, he shows interest in analyzing the intersection between homelessness and infant health outcomes using multivariable analysis which he believes could improve the current findings.