Journal articles: 'Journey pathways'

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Stanley, F. "One journey, many pathways." Internal Medicine Journal 33, no. 1-2 (January 2003): 59–61. http://dx.doi.org/10.1046/j.1445-5994.2002.00305.x.

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Cable, Stuart. "E-Pathways Computers and the Patient’s Journey Through CareE-Pathways Computers and the Patient’s Journey Through Care." Nursing Standard 18, no. 9 (November 12, 2003): 29. http://dx.doi.org/10.7748/ns2003.11.18.9.29.b226.

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Omar, Irfan A. "Pathways to dialogue: the journey of Mahmoud Ayoub." Islam and Christian–Muslim Relations 15, no. 1 (January 2004): 9–11. http://dx.doi.org/10.1080/09596410310001631777.

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Di Nunzio, C., P. Mordenti, D. L. Capuano, A. Soriani, L. Zanlari, R. Achilli, M. L. Galli, et al. "Redefining the pathways of care: the patient journey." Annals of Oncology 26 (October 2015): vi122. http://dx.doi.org/10.1093/annonc/mdv346.31.

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Yezierski, Robert P. "Interview: Pathways to discovery: reflections on an ongoing journey." Pain Management 1, no. 4 (July 2011): 307–9. http://dx.doi.org/10.2217/pmt.11.26.

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Bowers, David, Klemens Fheodoroff, Patricia Khan, Julian P. Harriss, Khashayar Dashtipour, Laxman Bahroo, Michael Lee, Denis Zakharov, Jovita Balcaitiene, and Virgilio Evidente. "Spastic Paresis and Rehabilitation – The Patient Journey." European Neurological Review 11, no. 2 (2016): 87. http://dx.doi.org/10.17925/enr.2016.11.02.87.

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Spastic paresis is a complex condition associated with damage to the upper motor neurons, typically caused by cerebral palsy, multiple sclerosis, stroke or trauma. Despite substantial impact on patients’ independence and burden on caregivers, there is a lack of consensus on optimal management of this condition and the patient journey remains unclear. A group of physicians, experienced in spasticity management, recently convened with the objective of analysing the patient journey from a care pathway perspective in different geographical regions and under different conditions from acute phase to long-term/chronic disease status. The experts reviewed results from recent patient and healthcare practitioner surveys on the subject and assessed how current patient pathways could be improved, using their own experiences to highlight the issues related to management deficiencies in their individual countries. The group divided the patient journey into steps, considering the evidence from the point of view of healthcare practitioners, patients, caregivers and funders/payors. This paper is a response to the lack of consensus on the optimal management of spastic paresis, and acts as a call to action to develop a consistent care pathway that could be applied across a broad range of illnesses, using an interdisciplinary approach.

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Marinova, Petya, and Rali Marinova. "Providing structured stoma care through established patient pathways." British Journal of Healthcare Management 29, no. 1 (January 2, 2023): 38–41. http://dx.doi.org/10.12968/bjhc.2022.0104.

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Marinova and Marinova outline the stoma patient pathway at St Mark's Hospital, London, highlighting how care provision throughout the stoma journey can improve patient outcomes and reduce costs to the NHS.

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Chan, Timothy C. Y., Maria Eberg, Katharina Forster, Claire Holloway, Luciano Ieraci, Yusuf Shalaby, and Nasrin Yousefi. "An Inverse Optimization Approach to Measuring Clinical Pathway Concordance." Management Science 68, no. 3 (March 2022): 1882–903. http://dx.doi.org/10.1287/mnsc.2021.4100.

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Clinical pathways outline standardized processes in the delivery of care for a specific disease. Patient journeys through the healthcare system, however, can deviate substantially from these pathways. Given the positive benefits of clinical pathways, it is important to measure the concordance of patient pathways so that variations in health system performance or bottlenecks in the delivery of care can be detected, monitored, and acted upon. This paper proposes the first data-driven inverse optimization approach to measuring pathway concordance in any problem context. Our specific application considers clinical pathway concordance for stage III colon cancer. We develop a novel concordance metric and demonstrate using real patient data from Ontario, Canada that it has a statistically significant association with survival. Our methodological approach considers a patient’s journey as a walk in a directed graph, where the costs on the arcs are derived by solving an inverse shortest path problem. The inverse optimization model uses two sources of information to find the arc costs: reference pathways developed by a provincial cancer agency (primary) and data from real-world patient-related activity from patients with both positive and negative clinical outcomes (secondary). Thus, our inverse optimization framework extends existing models by including data points of both varying “primacy” and “alignment.” Data primacy is addressed through a two-stage approach to imputing the cost vector, whereas data alignment is addressed by a hybrid objective function that aims to minimize and maximize suboptimality error for different subsets of input data. This paper was accepted by Chung Piaw Teo, Management Science Special Section on Data-Driven Prescriptive Analytics.

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Sonnenburg, Stephan, and Mark Runco. "Pathways to the Hero’s Journey: A Tribute to Joseph Campbell and the 30th Anniversary of His Death." Journal of Genius and Eminence 2, Volume 2, Issue 2: Winter 2017 (December 1, 2017): 1–8. http://dx.doi.org/10.18536/jge.2017.02.2.2.01.

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Joseph Campbell is the mythographer of the last century who has congenially opened the mythological universe to both scholars and to a wide range of people searching for pathways to enlighten their lives. His elixir of life was to help people “see myth as a reflection of the one sublime adventure of life, and then to breathe new life into it” (Campbell, 2003, p. xiv). The hero’s journey is his gift, his “ultimate boon” (Campbell, 2008, p. 29) for the human condition and social world. It represents a universal motif which runs through virtually all kinds of change, transformation, and growth. The main objective of this special issue of the Journal of Genius and Eminence is to explore the multi-faceted potential of the hero’s journey and perhaps shed new light on it. The introduction gives an overview of Campbell’s ultimate boon and a summary of each of the 12 articles that follow. Distinguished scientists and outstanding practitioners have joined this journey in tribute to Campbell and the 30th anniversary of his death. The contributors take us far and wide, exploring different ways to explore Campbell’s thoughts, allowing insights into the nuances and subtleties of his mythological world, and striking new ways to illuminate the Campbellian universe.

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Fouad, Nadya A. "Review of Pathways to Multicultural Counseling Competence: A Developmental Journey." Contemporary Psychology: A Journal of Reviews 41, no. 9 (September 1996): 945. http://dx.doi.org/10.1037/003160.

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Beards, Stephanie, and Helen L. Fisher. "The journey to psychosis: an exploration of specific psychological pathways." Social Psychiatry and Psychiatric Epidemiology 49, no. 10 (September 5, 2014): 1541–44. http://dx.doi.org/10.1007/s00127-014-0953-6.

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Brunton, Paul. "Care pathways: challenges and opportunities for restorative dentistry." Faculty Dental Journal 4, no. 3 (July 2013): 142–44. http://dx.doi.org/10.1308/204268513x13703528619121.

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In the future, dental care in England, both in the primary and secondary sectors, will be delivered increasingly via care pathways. A care pathway describes in detail a patient’s journey from referral to treatment, review and subsequent recall if required. It provides for the right person treating the right patients at the right time for the right condition in the right situation. It is the intention at a central National Health Service (NHS) level that these pathways will operate in managed clinical networks that will be consultant and/or specialist led. There are already several successful pilots running in England. A good example is the periodontic and endodontic service provided by three enhanced practitioners in the Bradford and Airedale primary care trust (PCT).

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Waller, Glenn, Ulrike Schmidt, Janet Treasure, Katie Murray, Joana Aleyna, Francesca Emanuelli, Jo Crockett, and Maria Yeomans. "Problems across care pathways in specialist adult eating disorder services." Psychiatric Bulletin 33, no. 1 (January 2009): 26–29. http://dx.doi.org/10.1192/pb.bp.107.018325.

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Aims and MethodDespite considerable knowledge of outcomes for patients who complete treatment for eating disorders, less is known about earlier stages in the treatment journey. This study aimed to map the efficiency of the anticipated patient journey along care pathways. Referrals to specialist eating disorder services (n=1887) were tracked through the process of referral, assessment, treatment and discharge.ResultsThe patient mortality rate was low. However, there were serious problems of attrition throughout the care pathways. of the original referrals where a meaningful conclusion could be reached, in approximately 35% the person was never seen, only half entered treatment and only a quarter reached the end of treatment.Clinical ImplicationsThis study demonstrates considerable inefficiency of resource utilisation. Suggestions are made for reducing this inefficiency, to allow more patients the opportunity of evidence-based care.

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Bellia, F., V. Lanza, S. García-Viñuales, I. M. M. Ahmed, A. Pietropaolo, C. Iacobucci, G. Malgieri, et al. "Ubiquitin binds the amyloid β peptide and interferes with its clearance pathways." Chemical Science 10, no. 9 (2019): 2732–42. http://dx.doi.org/10.1039/c8sc03394c.

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Jasti, M., F. Khan, and G. Jacob. "P01-301-Journey through an adolescent picu. three years on…" European Psychiatry 26, S2 (March 2011): 303. http://dx.doi.org/10.1016/s0924-9338(11)72012-0.

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IntroductionThe age of onset of mental health problems is becoming younger and the severity of illness presentation throws lots of challenges for health professionals and service providers. Currently there are only four recognised Psychiatric intensive care units in England.ObjectivesLittle data is available regarding the characteristics of patients referred and treated in adolescentPICU's. This presents a challenge for clinicians and service providers for delivery of care for this patient group and developing care pathways. The main objective of this study to get a better understanding of the young people referred to help optimise care whilst in hospital and develop appropriate care pathwaysAimsThe study aims at identifying demographic, diagnostic characteristics and care pathways for young people admitted to an adolescent PICU.MethodsA retrospective case note study was undertaken of all the patients admitted over three years since opening of the adolescent PICU at Cheadle Royal hospital.ResultsData was collected from all the young people admitted to the ward between April 2007 and April 2010.Information regarding demographics including age of presentation, gender characteristics, ethnicity and area of referral were looked. The authors looked at the care pathways including reasons for referral, where admitted from, risk issues on admission, diagnostic criteria and discharge pathways.ConclusionThis study has highlighted the widely held impression that there are still gaps in adolescent crisis provisions and the need for further acute interventions. The study highlights the challenges for service providers the current gaps in care pathways for young people with multiple diagnosis and lack of adequate crisis interventions in the community.

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Jovanovic, N. "Black and south asian women’s pathways to accessing community and inpatient perinatal mental health services: An analysis of local service data from the paam study." European Psychiatry 64, S1 (April 2021): S604. http://dx.doi.org/10.1192/j.eurpsy.2021.1611.

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IntroductionWomen from ethnic minorities who experience mental health problems during the perinatal period are disproportionately represented in involuntary care. They have poorer access to community care but have higher engagement with services once accessed. Their pathways to accessing perinatal mental health care remain underexplored.ObjectivesTo investigate the pathways to perinatal mental health services for women across different ethnic groups, including number of caregivers encountered and time elapsed between referrals.MethodsAnalysis of patient records and routine service data from community and inpatient perinatal mental health services in the United Kingdom. Use of an adaptation of the WHO’s pathway encounter form.ResultsWomen from ethnic minority groups experience increased levels of complexity on their journey to accessing perinatal mental health care. We will present a detailed analysis of patient and service characteristics.ConclusionsReferral pathways to perinatal mental health services need to be optimised for women from underrepresented groups.

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Sagan, Mark, Heather Hadjistavropoulos, and H. Jay Beim. "The Cost of Developing and Implementing a Pathway for Congestive Heart Failure: Not an Inexpensive Journey." Healthcare Management Forum 18, no. 3 (October 2005): 44–48. http://dx.doi.org/10.1016/s0840-4704(10)60369-9.

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This article describes the cost of developing and implementing an integrated care pathway (ICP) for Congestive Heart Failure. Costs were tracked prospectively and allocated to either development or implementation. The development took 1,980 hours of staff time at a salary cost of $67,800. The ICP implementation took 2,083 hours of personnel time at a salary cost of $66,900. Even though an available pathway was adapted for local use, a substantial amount of time and money was required. This article may be useful to others who are interested in monitoring costs of pathways.

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Olsen, Cecilie Fromholt, Astrid Bergland, Jonas Debesay, Asta Bye, and Anne Gudrun Langaas. "Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People." Qualitative Health Research 31, no. 9 (May 19, 2021): 1710–23. http://dx.doi.org/10.1177/10497323211003861.

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Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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Benavides, Linda E. "Spiritual Journey from Childhood to Adolescence: Pathways to Strength and Healing." Journal of Religion & Spirituality in Social Work: Social Thought 33, no. 3-4 (July 3, 2014): 201–17. http://dx.doi.org/10.1080/15426432.2014.930628.

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Hore, Soumyadip, and Ravi P. Singh. "Phosphorylation of arenes, heteroarenes, alkenes, carbonyls and imines by dehydrogenative cross-coupling of P(O)–H and P(R)–H." Organic & Biomolecular Chemistry 20, no. 3 (2022): 498–537. http://dx.doi.org/10.1039/d1ob02003j.

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Wells, Christine E., and Sarah J. Smith. "Diagnostic Care Pathways in Dementia." Journal of Primary Care & Community Health 8, no. 2 (November 22, 2016): 103–11. http://dx.doi.org/10.1177/2150131916678715.

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Objectives: Increasing diagnostic rates of dementia is a national health priority; to meet this priority, improvement needs to be made to diagnostic services. It has been increasingly recognized that primary can play a significant role in the diagnostic journey for people with dementia, with some diagnostic services entirely located in primary care. This article reviews the extent of the involvement of primary care in diagnostic care pathways for people presenting with memory complaints within England, and presents examples of innovative approaches, which may be of interest to practitioners. Method: A rapid review was undertaken to identify articles outlining diagnostic care pathways for dementia involving primary care in England. Results: Six articles relating to pathway evaluations and innovative approaches involving primary care were deemed suitable for inclusion in the review. Conclusions: The review found examples of diagnostic pathways and innovative practices being implemented in in primary care. These practices aligned to the strategic ambitions of the National Dementia Strategy. However, it was widely acknowledged that there is a need to improve postdiagnostic pathways; in particular, access to postdiagnostic support. This issue is being reflected in contemporary policy initiatives such as the Department of Health’s 2016 Joint Declaration on postdiagnostic dementia care and support.

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Seguin, Maureen L., Avanti Rangnekar, Alicia Renedo, Benjamin Palafox, Martin McKee, and Dina Balabanova. "Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases." BMJ Global Health 5, no. 9 (September 2020): e002464. http://dx.doi.org/10.1136/bmjgh-2020-002464.

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The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.

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Scheffold, Maike Iris Esther, and Inga Hense. "There and back again, a journey of many pathways: conceptualising the marine organic carbon cycle." Ocean Science 18, no. 2 (March 31, 2022): 437–54. http://dx.doi.org/10.5194/os-18-437-2022.

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Abstract. Understanding and determining the pathways that organic carbon (OC) takes in the ocean is one of the pressing tasks of our time, as the fate of OC in the ocean is linked to the climate system and the functionality of marine ecosystems. The multitude and complexity of these pathways are typically investigated with sophisticated, mainly quantitative, methods focused on individual pathways in order to resolve their interactions and processes as realistically as possible. In addition to these approaches towards understanding and recreating complexity, there is a need to identify commonalities and differences between individual OC pathways and define their overarching structures. Such structures can provide a framework for the growing number of partly overlapping concepts, which conceptualise selected OC pathways, and promote more systematic comparisons and consistent communication, especially between different disciplines. In response, we propose a (visual) concept in which we define such higher-level “structures” by comparing and condensing marine OC pathways based on their sequences of processes and the layers of the marine system in which they operate. The resulting structures comprise “closed loops”, three remineralisation and two recalcitrant dissolved organic carbon (rDOC) loops that close within marine systems, and “open loops”, condensing pathways leaving the marine system for the atmosphere or deeper sediment layers. In addition, we provide a synthesis of embedded processes, OC pools, and process-performing organisms (agents) embedded in these loops. By translating a definition of the biological carbon pump (BCP) into our concept, we show how the application and discussion of our defined structures facilitate a consistent visualisation, a systematic comparison of differently resolved concepts and studies, and integration of these into the larger picture of the marine OC cycle. As a complement to quantitative studies and descriptions of individual pathways, our concept decomposes the complexity of OC pathways by defining new universal structures. These structures provide a skeleton that can be adapted to different systems and filled with life by the users.

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Kulkarni, Vineet Vinay, and Sandra Maday. "Neuronal endosomes to lysosomes: A journey to the soma." Journal of Cell Biology 217, no. 9 (August 16, 2018): 2977–79. http://dx.doi.org/10.1083/jcb.201806139.

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How are lysosomal degradation pathways spatially organized in the complex landscape of a neuron? Cheng et al. (2018. J Cell Biol. https://doi.org/10.1083/jcb.201711083) and Yap et al. (2018. J. Cell Biol. https://doi.org/10.1083/jcb.201711039) characterize the distribution and function of endolysosomal organelles in neurons, providing insights into compartment-specific mechanisms regulating the neuronal proteome.

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Humphris, Rachel, Hannah Bradby, Beatriz Padilla, Jenny Phillimore, Simon Pemberton, and Silja Samerski. "After encounters: revealing patients’ unseen work through their pathways to care." International Journal of Migration, Health and Social Care 16, no. 2 (May 6, 2020): 173–87. http://dx.doi.org/10.1108/ijmhsc-07-2019-0066.

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Purpose Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next. Design/methodology/approach Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of “decision partners”; and reframes the medical encounter as a journey, where one encounter leads to and informs the next. Findings This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns. Originality/value De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey.

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Bosserman, Linda D., Mary Cianfrocca, Bertram Yuh, Christina Yeon, Helen Chen, Stephen Sentovich, Amy Polverini, et al. "Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience." Journal of Clinical Medicine 10, no. 2 (January 7, 2021): 188. http://dx.doi.org/10.3390/jcm10020188.

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As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.

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Bosserman, Linda D., Mary Cianfrocca, Bertram Yuh, Christina Yeon, Helen Chen, Stephen Sentovich, Amy Polverini, et al. "Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience." Journal of Clinical Medicine 10, no. 2 (January 7, 2021): 188. http://dx.doi.org/10.3390/jcm10020188.

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As the US transitions from volume- to value-based cancer care, many cancer centers and community groups have joined to share resources to deliver measurable, high-quality cancer care and clinical research with the associated high patient satisfaction, provider satisfaction, and practice health at optimal costs that are the hallmarks of value-based care. Multidisciplinary oncology care pathways are essential components of value-based care and their payment metrics. Oncology pathways are evidence-based, standardized but personalizable care plans to guide cancer care. Pathways have been developed and studied for the major medical, surgical, radiation, and supportive oncology disciplines to support decision-making, streamline care, and optimize outcomes. Implementing multidisciplinary oncology pathways can facilitate comprehensive care plans for each cancer patient throughout their cancer journey and across large multisite delivery systems. Outcomes from the delivered pathway-based care can then be evaluated against individual and population benchmarks. The complexity of adoption, implementation, and assessment of multidisciplinary oncology pathways, however, presents many challenges. We review the development and components of value-based cancer care and detail City of Hope’s (COH) academic and community-team-based approaches for implementing multidisciplinary pathways. We also describe supportive components with available results towards enterprise-wide value-based care delivery.

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Toulson, Rob, and Russ Hepworth-Sawyer. "Connected learning journeys in music production education." Journal of Music, Technology & Education 11, no. 3 (December 1, 2018): 269–86. http://dx.doi.org/10.1386/jmte.11.3.269_1.

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The field of music production education is a challenging one, exploring multiple creative, technical and entrepreneurial disciplines, including music composition, performance electronics, acoustics, musicology, project management and psychology. As a result, students take multiple ‘learning journeys’ on their pathway towards becoming autonomous learners. This article uniquely evaluates the journey of climbing Bloom’s cognitive domain in the field of music production and gives specific examples that validate teaching music production in higher education through multiple, connected ascents of the framework. Owing to the practical nature of music production, Kolb’s Experiential Learning Model is also considered as a recurring function that is necessary for climbing Bloom’s domain, in order to ensure that learners are equipped for employability and entrepreneurship on graduation. The authors’ own experiences of higher education course delivery, design and development are also reflected upon with reference to music production pathways at both the University of Westminster (London, United Kingdom) and York St John University (York, United Kingdom).

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Gray, Barbara. "The Pathways of My Research: A Journey of Personal Engagement and Change." Journal of Applied Behavioral Science 25, no. 4 (November 1989): 383–98. http://dx.doi.org/10.1177/002188638902500406.

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Research is a process of self-engagement, for researchers project their own identities and conflicts into their professional work. In this autobiographical account, the author describes her background as a middle-class Catholic in Cleveland, her education and work experience in chemistry, her community activism, and her experiences as a doctoral student, faculty member, and consultant in organizational behavior. From this personal history four key themes emerge that inform her work: developing meaningful relationships, dealing with diversity, commitment to social change, and empowerment. These themes are particularly evident in her work on multiparty collaboration to resolve business and social problems. The author suspects that her gravitation toward organizational transformation and collaboration reflects her own inner search for wholeness.

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Gray, Jane S., Judith R. Swan, Margaret A. Lynch, Tracey M. Tay, Marika-Jane Mackenzie, John H. Wiggers, Karen A. Harrison, et al. "Hunter and New England HealthPathways: a 4-year journey of integrated care." Australian Health Review 42, no. 1 (2018): 66. http://dx.doi.org/10.1071/ah16197.

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Objective This paper describes the 4-year journey of Hunter and New England HealthPathways – a password-protected web-based portal designed to provide localised evidence-informed clinical and referral information to support general practice at the point of care. Methods A process evaluation was conducted in 2013, with a case study comparison performed in 2014 to assess impact of HealthPathways on patient referral and access to specialist care, followed by a review in 2016 of utilisation of the online portal to assess whether healthcare providers continued to access HealthPathways. Results Increased utilisation was correlated with an increase in the number of pathways published online. Clinical leadership and the process of developing pathways built relationships between primary care and specialist teams. Case studies indicated that a comprehensive approach to pathway implementation accompanied by service redesign resulted in higher pathway use and improved access to specialist care. Senior management support and a formal partnership between major health care providers led to strong governance of HealthPathways and the delivery of other integrated care initiatives. There was significant growth in utilisation over the 4 years, increasing to an average of 6679 sessions per month in 2016 and more general practices reported use of HealthPathways. Conclusions HealthPathways is a vehicle for building strong foundations to support system change and integrated care. The critical elements for acceptability, growth and sustainability are the strong relationships between primary care and specialist clinicians, as well as formal partnerships that are built from the processes used to develop HealthPathways. What is known about the topic? HealthPathways and similar web-based evidence-informed guidelines aimed at improving system integration are increasing in Australia. There are few published papers that describe approaches to inform the ongoing implementation of such programs. What does this paper add? This paper describes iterative methodology for evaluating complex programs, such as HealthPathways, that identifies the critical factors required to build sustainable models of integrated care. What are the implications for practitioners? The 4-year experience of Hunter and New England HealthPathways provides an approach to improve the implementation, sustainability and spread of similar programs and associated integrated care initiatives.

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D'Amore, Claudio, Valentina Salizzato, Christian Borgo, Luca Cesaro, Lorenzo A. Pinna, and Mauro Salvi. "A Journey through the Cytoskeleton with Protein Kinase CK2." Current Protein & Peptide Science 20, no. 6 (May 20, 2019): 547–62. http://dx.doi.org/10.2174/1389203720666190119124846.

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Substrate pleiotropicity, a very acidic phosphorylation consensus sequence, and an apparent uncontrolled activity, are the main features of CK2, a Ser/Thr protein kinase that is required for a plethora of cell functions. Not surprisingly, CK2 appears to affect cytoskeletal structures and correlated functions such as cell shape, mechanical integrity, cell movement and division. This review outlines our current knowledge of how CK2 regulates cytoskeletal structures, and discusses involved pathways and molecular mechanisms.

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Roberto, Michela, Andrea Botticelli, Alessio Caggiati, Alberto Chiriatti, Carlo Della Rocca, Virginia Ferraresi, Felice Musicco, Giovanni Pellacani, and Paolo Marchetti. "A Regional Survey on Merkel Cell Carcinoma: A Plea for Uniform Patient Journey Modeling and Diagnostic–Therapeutic Pathway." Current Oncology 29, no. 10 (September 30, 2022): 7229–44. http://dx.doi.org/10.3390/curroncol29100570.

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Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neuroendocrine cancer that usually affects the elderly and immunosuppressed in sun-exposed areas. Due to its rarity, it is frequently unrecognized, and its management is not standardized across medical centers, despite the more recent availability of immunotherapy, with avelumab as first-line treatment improving the prognosis even in advanced stages of disease. We conducted a purpose-designed survey of a selected sample of physicians working in the Lazio region, in Italy, to assess their awareness and knowledge of MCC as well as their perspective on assisted diagnostic and therapeutic pathways. The Lazio region, and in particular Rome, is one of the most important academic and non- academic center in Italy dedicated to the diagnosis and treatment of skin cancer. A total of 368 doctors (including 100 general practitioners, 72 oncologists, 87 dermatologists, 59 surgeons, and 50 anatomopathologists) agreed to be part of this survey. Surgeons, oncologists, and dermatologists thought themselves significantly more updated on MCC than primary care physicians, but more than half of the interviewees are interested in CCM training courses and training with clearer and more standardized care pathways. Significant differences have been reported from survey participants in terms of multidisciplinary team set up for MCC management. The identification of specialized centers and the improvement of communication pathways among different specialties, as well as between patients and physicians, could be very beneficial in improving patients’ journey modeling and starting a uniform diagnostic and therapeutic pathway for MCC patients in the new era of immunotherapies.

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Passegue, Emmanuelle. "Surviving Change: The Metabolic Journey of Hematopoietic Stem Cells." Blood 128, no. 22 (December 2, 2016): SCI—32—SCI—32. http://dx.doi.org/10.1182/blood.v128.22.sci-32.sci-32.

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Hematopoietic stem cell (HSC) activation is accompanied by mitochondria activation and a shift in metabolic activity from glycolysis to OXPHOS, which provides energy and increases the production of ROS and other mitochondrial metabolites that can act both as signaling molecules and substrates/co-activators for epigenetic enzymes. Metabolically activated HSCs are poised to undergo lineage priming and produce different lineage-biased multipotent progenitors (MPP). However, activated HSCs must also return to quiescence to maintain the stem cell pool. In this context, autophagy plays an essential role by clearing activated mitochondria to allow OXPHOS-driven HSCs to efficiently revert to a mostly glycolysis-based quiescence metabolism. Without autophagy, HSCs display an overactive OXPHOS-driven metabolism that promotes myeloid-biased differentiation and loss of stemness, likely as a direct consequence of epigenetic reprogramming. At steady state, blood production reflects the differential generation by HSCs of a small number of myeloid-biased MPP2/3 and a large number of lymphoid-biased MPP4, which both contribute to myeloid output. In contrast, during blood regeneration, activated HSCs are induced to overproduce MPP2/3, and MPP4 are reprogrammed towards almost exclusive myeloid output in large part due to cytokine stimulations and the triggering of specific regulatory pathways. Altogether, the metabolic activation of HSCs and the remodeling of the MPP compartment represent emergency myelopoiesis pathways that are transiently activated during regeneration, and are continuously triggered in myeloid disease conditions. Disclosures No relevant conflicts of interest to declare.

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Wilson, Carol B. "Reflective Journaling and Self-Care: The Experience of MSN Students in a Course on Caring." International Journal of Human Caring 11, no. 1 (February 2007): 16–21. http://dx.doi.org/10.20467/1091-5710.11.1.16.

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The purpose of this phenomenological study was to discover the experience of MSN students’ participation in a reflective exercise designed to promote caring for self and to enhance the appreciation of self-care to caring in nursing practice. Two constitutive patterns emerged. Within The Nature of the Journey were stories of searching for directions and pathways to self-care that included struggles to reach self-care goals. With Reflections on the Journey, participants described coming to learn the importance of self-care and a desire to continue self-care activities in the future.

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Scalco, Renata C., Fernanda A. Correa, Naiara C. B. Dantas, Gabriela A. Vasques, and Alexander A. L. Jorge. "Hormone resistance and short stature: A journey through the pathways of hormone signaling." Molecular and Cellular Endocrinology 536 (October 2021): 111416. http://dx.doi.org/10.1016/j.mce.2021.111416.

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Hindle-Smith, Sue. "The Pathways Association of Central England (PACE) conference: The Journey to Better Health." International Journal of Care Pathways 14, no. 1 (March 2010): 42–44. http://dx.doi.org/10.1258/jicp.2010.010006.

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Liu, Zai-Qun. "Anti-Oxidant in China: A Thirty-Year Journey." American Journal of Chinese Medicine 47, no. 05 (January 2019): 1005–24. http://dx.doi.org/10.1142/s0192415x19500514.

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Anti-oxidant refers to such a kind of endogenous or exogenous compound that is able to retard or even prohibit in vivo or in vitro oxidation with only small amount being used. The study of anti-oxidants starts nearly 30 years ago, and the research on this topic in China almost begins simultaneously with that in the world. Gratifyingly, contributions on anti-oxidants from China researchers have rapidly increased in the recent decade as anti-oxidants have become a hot topic in biochemistry, pharmacology, food science, chemistry as well as other related disciplines. Anti-oxidants provide a specific viewpoint for clarifying pharmacological effects of Chinese medicinal herbs. For example, as a traditional Chinese medicinal herb, Panax ginseng C. A. Meyer is found to be a natural anti-oxidant resource. Meanwhile, some signaling pathways such as nuclear factor-[Formula: see text]B (NF-[Formula: see text]B), nuclear factor erythroid 2 related factor 2 (Nrf2), and Kelch-like ECH associated protein 1 (Keap1) are regarded to play an important role in anti-oxidant responses. These findings provide a substantial basis for understanding the pharmacological behaviors of Chinese medicinal herbs in view of regulating the aforementioned signaling pathways. Moreover, inhibition of reactive oxygen species (ROS) by supplementation of anti-oxidant becomes a popularly accepted idea in keeping health and treating diseases. Isolations of antio-xidative ingredients from medicinal herbs and foods lead to set up a large range of anti-oxidative compound libraries, and intake of anti-oxidants from foods may be the most efficient way for supplementing exogenous anti-oxidants. On the other hand, designing anti-oxidants with novel structures motivates organic and medicinal chemists to explore the structure–activity relationship, and then, to find novel structural features with anti-oxidative properties. Therefore, it is reasonable to believe that China researchers will donate more endeavors to obtain more achievements on anti-oxidants in the future.

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Sehgal, Amita. "The 2020 Pittendrigh/Aschoff Lecture: My Circadian Journey." Journal of Biological Rhythms 36, no. 1 (January 11, 2021): 84–96. http://dx.doi.org/10.1177/0748730420982398.

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The circadian field has come a long way since I started as a postdoctoral fellow ~30 years ago. At the time, the only known animal clock gene was period, so I had the privilege of witnessing, and participating in, the molecular revolution that took us from the discovery of the circadian clock mechanism to the identification of pathways that link clocks to behavior and physiology. This lecture highlights my role and perspective in these developments, and also demonstrates how the successful use of Drosophila for studies of circadian rhythms inspired us to develop a fly model for sleep. I also touch upon my experiences as a non-white immigrant woman navigating my way through the US science and education system, and hope my story will be of interest to some.

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Phadke, Shruti, Mattia Samory, and Tanushree Mitra. "Pathways through Conspiracy: The Evolution of Conspiracy Radicalization through Engagement in Online Conspiracy Discussions." Proceedings of the International AAAI Conference on Web and Social Media 16 (May 31, 2022): 770–81. http://dx.doi.org/10.1609/icwsm.v16i1.19333.

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The disruptive offline mobilization of participants in online conspiracy theory (CT) discussions has highlighted the importance of understanding how online users may form radicalized conspiracy beliefs. While prior work researched the factors leading up to joining online CT discussions and provided theories of how conspiracy beliefs form, we have little understanding of how conspiracy radicalization evolves after users join CT discussion communities. In this paper, we provide the empirical modeling of various radicalization phases in online CT discussion participants. To unpack how conspiracy engagement is related to radicalization, we first characterize the users' journey through CT discussions via conspiracy engagement pathways. Specifically, by studying 36K Reddit users through their 169M contributions, we uncover four distinct pathways of conspiracy engagement: steady high, increasing, decreasing, and steady low. We further model three successive stages of radicalization guided by prior theoretical works. Specific sub-populations of users, namely those on steady high and increasing conspiracy engagement pathways, progress successively through various radicalization stages. In contrast, users on the decreasing engagement pathway show distinct behavior: they limit their CT discussions to specialized topics, participate in diverse discussion groups, and show reduced conformity with conspiracy subreddits. By examining users who disengage from online CT discussions, this paper provides promising insights about conspiracy recovery process.

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Eisen, Andrea, Jasmin Soobrian, Ashley Tyrrell, Clement Li, Derek Muradali, Margaret F. Forbes, Angelika Gollnow, Jillian Ross, and Claire Holloway. "Using a disease pathway management approach to improve the quality of breast cancer care in Ontario." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 109. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.109.

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109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

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Martins, Tanimola, Samuel William David Merriel, and William Hamilton. "Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review." BMJ Open 10, no. 11 (November 2020): e038605. http://dx.doi.org/10.1136/bmjopen-2020-038605.

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BackgroundMost cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients’ journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA.Design and settingsA systematic review of available literature was performed.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject.Results18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi’s sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi’s sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region.ConclusionThe proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.

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Kane, Michele. "Enhanced Well-Being Through Mindfulness: Supporting the Gifted Adolescent Journey." Gifted Child Today 43, no. 2 (March 18, 2020): 116–23. http://dx.doi.org/10.1177/1076217519899146.

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Adolescence is a developmental journey that is both exhilarating and exhausting, especially for those gifted and talented youngsters who are sensitive, intense, and altruistic. This combines with four major changes in brain circuitry that lead to shifts in thinking, feeling, decision-making, and interacting in the teenage mind. In addition, physical maturation complicates the process with additional challenges. Mindfulness and other contemplative practices continue to find evidence-based, effective support for improving and fostering well-being in adolescents. For gifted teens, whose asynchony provides qualitatively different life experiences, beginning regular mindfulness practices can generate an enhanced sense of social and emotional mental health. Mindfulness practices that are pathways to calm and peace are discussed along with recommended apps for centering.

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Beldon, Georgina, Felicity Caryer, and Uzma Meraj. "MBT and older adults: A learning journey and some reflections." FPOP Bulletin: Psychology of Older People 1, no. 160 (October 2022): 26–30. http://dx.doi.org/10.53841/bpsfpop.2022.1.160.26.

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As group of psychologists across the UK who have found one another through our shared journey and struggles in training and using Mentalisation-Based Treatment (MBT) with Older Adults we hoped to share some of our thoughts, reflections and challenges at the Faculty of Psychology of Older People conference 2022 and within this summary. We hope that it may be of some help for clinicians interested in MBT and for those who may be considering integrating MBT into their treatment pathways. And if you are interested in any way – we also love you to join our special interest group! You can email us on the addresses provided at the end of article. Keywords: MBT; older people; complex emotional; relational needs.

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Apoorva, S. R. "From the mouth to gut: A microbial journey!" Journal of Academy of Dental Education 6 (December 29, 2020): 16–22. http://dx.doi.org/10.25259/jade_6_2020.

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The oral microbiome invades almost the whole of the body, resulting in “n” number of systemic diseases. The gut is no exception in falling short to them. Many studies both in the four legged animals and their two legged successors (presumed to be the humans) have concluded that the oral microbiome can translocate to the gut and change its microbiota and eventually the immune defense. This ectopic displacement of oral microbiome specifically occurs in severe systemic diseases. Most commonly it is seen having its rage in patients with chronic periodontitis. Dysbiosis in the subgingival microbiota and immune defense, sometimes dysregulation in the gut, turns out to be the threat posed by the oral microbes. Among the other tiny troublemakers, Porphyromonas gingivalis remains the most serious. A dysbiotic gut microbiota may further cause diseases elsewhere in the body. The fact that chronic periodontitis may affect the gut microbiota suggests that the future would foresee a coordinated approach to the treatment of periodontitis and gastrointestinal diseases. Although this specific area of investigation is still a bud, it may portray different pathways for the oral microbiome to cause systemic diseases thence deserving a detailed probe furthermore.

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Perrone, Francesco, Raimondo Di Liello, Piera Gargiulo, Laura Arenare, Lorenzo Guizzaro, Paolo Chiodini, Ciro Gallo, and Maria Carmela Piccirillo. "The opportunity of patient-journey studies for academic clinical research in oncology." BMJ Open 11, no. 9 (September 2021): e052871. http://dx.doi.org/10.1136/bmjopen-2021-052871.

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A wave of new treatments and treatment combinations are becoming available for solid tumours. Trials performed to obtain registration establish a positive benefit-risk but unavoidably leave many questions unanswered on place-in-therapy and the relative efficacy of different treatment sequences. Such limitations create problems in terms of strength of treatment guidelines and reimbursement (in countries where a public payer exists). Data on new drugs arriving during the last 10 years for the treatment of hepatocellular carcinoma and renal cancer are reported as an example of how the fortunate condition of having new effective treatments may translate into uncertainty regarding the optimal treatment plan. We suggest that academic research should react to such limitations and propose a model of patient-journey study (PJS), where patients are followed from the initial diagnosis across subsequent lines of treatment. A PJS master protocol might include at each node of clinical decision either the possibility of choosing treatment according to guidelines (generating prospective real-world evidence) or the possibility to randomise where uncertainty exists (generating comparative effectiveness data). PJS protocols might be adaptively modified every time a new drug arrives on the market. Overall, methodologically sound analyses of PJS will produce knowledge on the efficacy and the effectiveness of different treatment pathways and might significantly optimise treatment of patients in clinical practice. PJS would represent a jump from a few snapshots (trials performed to get regulatory approval) to a full movie (evidence on the relative value of treatment pathways).

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Evans, William K., Yee Ung, Carol Anne Sawka, and Nathalie Assouad. "Using a disease pathway management (DPM) approach to improve the quality of lung cancer care in Ontario." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 93. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.93.

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93 Background: Cancer Care Ontario (CCO) is mandated to oversee quality of cancer care in Ontario and began its Lung Cancer (LC) DPM initiative in 2009. DPM has 4 objectives: align provincial quality improvement (QI) initiatives by disease site; map the patient journey and identify gaps in evidence/quality in clinical practice that impact care or the patient experience; set and manage regional quality indicators across the pathway; and leverage tools to model the impact of policy decisions. Methods: The LC DPM drafted a disease pathway map and established 5 multidisciplinary working groups (WGs) each focussed on a phase of the LC patient journey: prevention, screening, and early diagnosis; diagnosis; treatment; palliative care; the patient experience. WGs held 25 two-hour meetings and developed ideas for 17 QI projects. 8 were selected for discussion at a provincial consensus conference and yielded a Priorities for Action Report. Regional “roadshows” were held in all 14 regions of the province at which region-specific data on incidence, stage at diagnosis, compliance of treatment with guidelines and wait times, amongst other metrics relevant to LC, were shared with the regional care providers. Funding was provided by CCO for regional QI based on the data and identified priorities. Results: Completed diagnostic and treatment pathways are posted on CCO’s website as are educational materials on dyspnea management, including a patient video and a document prepared by patients for patients “Understanding Lung Cancer.” Lung diagnostic assessment units/programs have been initiated in 14 regions. An audit is underway to better understand the barriers to the uniform uptake of evidence-based practices across the province. The percent of LC patients whose symptoms are assessed at least once a month using a standardized symptom assessment instrument (ESAS) has improved. Conclusions: Regional cancer programs are now aware of their performance on a range of LC specific quality metrics. Standardized diagnostic and treatment pathways have been developed and assessment units have been implemented across the province.

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Yancey, Nan Russell. "Technology and Teaching-Learning: Opportunities and Restrictions." Nursing Science Quarterly 31, no. 4 (September 17, 2018): 333–34. http://dx.doi.org/10.1177/0894318418792880.

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The author introduces a discussion by a nurse faculty of a teaching-learning strategy based on King’s theory of goal attainment. Considering technology merely as a tool to be used in extending the traditional time-space boundaries of the classroom, the author challenges faculty to seek innovative ways of honoring the unique person of the student and illuminating pathways of discovery in the teaching-learning journey.

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Singh, Om Prakash. "National Mental Health Policy of India - New Pathways New Hope — A Journey on Enchanted Path." Eastern Journal of Psychiatry 18, no. 2 (October 13, 2021): 1–2. http://dx.doi.org/10.5005/ejp-18-2-1.

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Singh, Om Prakash. "National Mental Health Policy of India - New Pathways New Hope — A Journey on Enchanted Path." Eastern Journal of Psychiatry 18, no. 2 (October 13, 2021): 1–2. http://dx.doi.org/10.5005/ejp-18-2-1.

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Watzlawik, Meike, and Katrin Kullasepp. "Career as Affective Journey: How Constant Flux Challenges the Search for Career Pathways and Counseling." Integrative Psychological and Behavioral Science 50, no. 3 (May 14, 2016): 492–506. http://dx.doi.org/10.1007/s12124-016-9349-3.

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Journal articles on the topic 'Journey pathways'

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