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Despite improvements in first‐line treatment of T‐cell acute lymphoblastic leukemia (T‐ALL), the outcome of relapsed T-ALL remains dismal with less than 7% achieving a long-term survival. Thus, there is an unmet need for new treatment strategies to improve outcomes in this setting. Suppression of apoptosis is one of the hallmarks of anticancer drug resistance. Hence, over the past few years, antiapoptotic proteins have become an attractive target for therapeutic intervention in several hematologic malignancies. Venetoclax (ABT-199) is a novel, orally bioavailable small-molecule inhibitor of B-cell lymphoma 2 (BCL-2), a key regulator of the intrinsic apoptotic pathway. Recent preclinical studies have suggested that inhibition of BCL-2 may be a novel therapeutic strategy for patients with T-ALL. Herein, we report a case of clinical response to venetoclax in combination with a hypomethylating agent in a patient with relapsed T-ALL after allogeneic stem cell transplant and review the existing literature.

Regular reflective practice group sessions, focusing on enhancing mindfulness, were piloted as part of a support programme for researchers in a clinical oncology setting. Methods: As a previous systematic review highlighted a wide variety of approaches and a lack of published evidence on the use of specific models for reflective practice in health care, a scoping review of existing literature describing reflective practice models preceded piloting the programme with the research team. The Mindful Attention Awareness Scale (MAAS) was used to assess the benefit for participants. Scores from the first and last session were analysed using a paired-sample t-test. Feedback from questionnaires was analysed using descriptive statistics (for Likert scales) and direct quotes from free text exemplified the experience. Results: Seven people participated. Six were female, all were research nurses except for one research allied health professional. The median age was 37 (range: 23–40 years). The average time since graduation was 10 years (range: 1.5–18 years). All researchers worked in a tertiary oncology setting. Although a total of 21 reflective practice sessions were facilitated, the median number of sessions attended was 9 (range: 2–21). The mean MAAS score improved from 57.83 to 62.83 (p=0.0146). The participants rated the experience and impact as positive. Conclusion: The results of the MAAS score indicate that mindfulness was enhanced by the sessions. The feedback from the participants highlighted the impact on their professional development. This is encouraging to support developing similar facilitated reflective practice programmes in different settings.

AbstractThis article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and address the academic, developmental, and behavioral needs frequently encountered in pediatric healthcare. Furthermore, school psychology training enhances their ability to effectively collaborate across health, education, and family systems to enhance the coordination of care. Case reviews provide data regarding frequency and types of services provided by the school psychologists, including conducting behavioral health screenings and assessments, implementing evidence-based interventions, and providing diagnostic psychoeducation. Physicians participating in this integrated health model provided program feedback, as well as caregivers of patients that received integrated care. Details regarding implementation, program evaluation, lessons learned, and future directions are discussed.

Several letters to the editor are presented in response to the article "The cruel sea" by Gareth Morgan published in "New Zealand Listeners".

This study’s purpose was to determine the impact of OASIS implementation on documented assessments, interventions, and client outcomes for oral medication management. The sample consisted of 100 clients with Type 2 diabetes: 50 clients who received services in 1997 and 50 clients who received services in 2000. Assessments and interventions for oral medication management were more frequently documented in the 2000 cohort versus the 1997 cohort, but there were no differences in clients’ oral medication management outcomes. Study findings supported the potential utility of the Outcome and Assessment Information Set for improving care processes and outcomes yet cautioned that outcome goals need to be individualized.

The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time.

The study's purpose was to compare characteristics, service utilization, and outcomes of home health patients enrolled in fee-for-service (FFS) versus health maintenance organization (HMO) health plans. Results documented that HMO patients were healthier and used fewer resources than FFS patients. Outcomes for HMO patients were superior to those of FFS patients. Phi correlation coefficients showed that purchaser type was not a substantial predictor of patient outcomes. Home health staff need to begin intense case management of FFS patients to identify when patient outcomes are maximized and continued services will not further improve or stabilize the patient's condition.

As home health reimbursement moves from fee-for-service to prospective payment, data describing the relationship between service utilization fand patient outcomes will be the basis for planning services. The investigators measured the relationship between service utilization and generic patient outcomes for 1,704 home health episodes of care. Few significant relationships were found. The average study patient received 17 visits, well below the average number for the state and nation. Investigators suggested the possibility that visit numbers were too low to stimulate improvement in outcomes and that when services are curtailed, home health staff may do well to focus quality improvement efforts on condition-specific patient outcomes rather that generic outcomes.

As home health administrators select performance evaluation systems to meet the benchmark requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a frequently asked question is: Does rural versus urban locale influence patient outcomes To answer the question, patient outcome data were collected from rural and urban home health agencies. Data analysis showed better outcomes for rural than for urban patients. Locale predicted less than 1 percent of the variance in each of the five outcomes studied. Factors that could account for rural-urban outcome differences were suggested.

Home health nurse visit and care coordination time were compared between Medicare patients enrolled in an health maintenance organization (HMO) and in the traditional Medicare fee-for-service program. In-home nurse visit time did not differ for the two groups. Coordination time per episode of care was approximately 40 minutes longer for an HMO patient. When home health administrators develop discounted visit rates for HMO contracts, they must include the extra coordination time in the rates.

Resource shortages have stimulated a change in focus among leaders of social service agencies, moving them away from a mission and toward a professional orientation more concerned with self-preservation. This is manifested both in a greater concern about resource mobilization than mission and professional issues and in an inward orientation among administrators rather than an orientation to the environment. This represents a dramatic change since the 1970s, when organizational theory first came to recognize the environment us an important factor in organizational behavior, and when successful organizational strategy was understood to require moving beyond organizational boundaries. This article reports on a national survey of executive directors and board presidents of family service agencies in major cities. It shows substantial consensus between these two groups that resource issues are more important than mission and professional issues, and that solving resource problems involves strategies that emphasize organizational autonomy.

Methods to improve the quality of care are a national issue for home healthcare agencies. In comparison with the traditional process-focused care plans, outcome-focused care plans (OCPs) resulted in significantly belter quality indicator scores for clients cared for by agency staff members. Although OCPs are a valuable tool for enhancing quality, tools are only as good as the individuals who use them. Before deciding to change to an OCP format, administrators must assess all resources needed to effect the change.

This article examines venturing, or the commercial sale of services and products, as a strategy employed by voluntary social agencies to bolster their faltering budgets. It reports the findings of a descriptive study of a population of 101 such agencies in greater Philadelphia. The authors suggest that the increase in commercial ventures by nonprofits is to some extent a by-product of the expansion of government contracting in the social welfare field. They conclude that even when successful, commercial ventures pose significant risks to nonprofit agencies.

While the twin problems of homelessness and squatting are usually associated with the cities of the Third World, this article examines them in the context of Western postindustrial metropolises. It argues that the growing numbers of homeless and squatters in the United States and Europe reflect not simply the current economic situation, but rather the longer-term changes in economic and demographic structure that have accompanied the transition of such cities from industrial to postindustrial centers. A critical factor contributing to the problem has been shrinkage in the private rental sector, which must be given priority by housing policymakers.

A commonly held belief is that patients enrolled in health maintenance organizations (HMOs) are authorized fewer home health services than patients enrolled in fee-for-service (FFS) plans. This study compared home health resource utilization patterns between patients enrolled in a cost HMO and in FFS plans. Although no significant differences were found, the cost HMO subscribers actually received more services. Despite these similarities, home health administrators need to carefully craft contracts with cost HMOs.

The purpose of this study was to compare nurses' knowledge of diabetes and nursing interventions in a home health care agency (HHCA) that employed a diabetes nurse educator (DNE) and an agency that did not employ a DNE. Nurse knowledge of diabetes mellitus was measured using the Ditibetes: Basic Knowledge Test (DBKT). Nursing care interventions for patients with diabetes were measured using a researcher-developed tool, the Nursing Care Intervention Tool (NCIT). The data analysis showed that the nurses in the agency with the diabetes nurse educator were significantly more knowledgeable about diabetes. The data also showed that the nurses in the HHCA with a diabetes nurse educator provided a significantly higher standard of patient care than the nurses in the agency without a diabetes nurse educator.

No abstract available for this article.

Dramatic changes in human services funding in the 1980s prompted a redefinition of leadership in family service agencies. In this study of family service executives, attention is focused on changes in the roles executives play within their agencies, the skills they need, and the problems they face in the current environment. Their involvement in advocacy activity is discussed. The authors conclude that the future viability of the voluntary social service sector is tied to the type of leadership provided by agency executives.

Since 1906, in the United States, the under-1-year and 15- to 24-year age groups have had an increasing number of deaths due to motor vehicle accident. The death rates for most other age groups have been declining since the late 1920's and 1930's. This decrease has been most marked for the elderly. The trends suggest that the 1960 cohort will experience its lowest death rates at ages 5 to 14 and its peak rates at ages 15 to 24. They also suggest several hypotheses, such as associations of mortality with inexperience and insufficient concern for self-preservation, that may have direct significance to prevention of deaths.

Several letters to the editor are presented in response to articles in previous issues including "Blessed are the cheesemakers" in the May 21, 2011 issue, "Art's bright star" in the May 14, 2011 issue, and an article on green politics in New Zealand by Ian Hood in the May 7, 2011 issue.

When home care providers contemplate the Balanced Budget Act of 1997 (BBA), most think about home health payment reforms. However, the BBA had other provisions that influence the way home health agencies conduct business. Are you using the BBA mandate that hospitals give patients a choice in choosing a home health agency?

Presents the poem, "The Color of Water," by Carolyn Adams.

Presents the poem "Death Row," by Carolyn Adams. First Line: He is a boy; Last Line: in the fullness of this world.

Presents the poem "Lilia," by Carolyn Adams. First Line: There is a flower that grows by a river; Last Line: of a bitter river.