Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Finding a Balance: Reconciling the Needs of the Institution,Patient, and Genetic Counselor for Optimal Resource Utilization

The current practice of cancer genetic counseling is undergoing widespread change and scrutiny. While there are clinical resources for genetic counselors (GCs) regarding the delivery of cancer genetic services, there is limited literature regarding effective management of a genetic counseling clinical program. We have developed administrative tools to manage a large team of GCs at a single academic medical center over a period of increasing demand for genetics services, with the initial aim of decreasing wait time for urgent genetic counseling visits. Here, we describe the three main elements of the clinical operations: Balancing patient volume between GCs, scheduling tracks for both routine and urgent appointments, and a team of triaging GCs to ensure appropriate patient referrals. For each of these elements, we describe how they have been modified over time and present data to support the utility of these strategies. The preliminary evidence offered here suggests that these tools allow for an equitable distribution of patient volume between team members, as well as the timely and accurate scheduling of urgent patients. As a result of the experiences presented here, other genetic counseling programs grappling with similar issues should be aware that it is possible to shift clinical operations to serve certain patient populations in a more timely fashion while keeping both providers and GC staff satisfied.     

Perception of objects oriented downward from a vertical position

In the present work we investigated people’s perceptions of orientation for surfaces that are conceived of as being sloped downward from vertical against a vertical reference frame. In the three conditions of Experiment 1, participants either (1) placed a ladder against a wall at what they thought was the most stable position, and then estimated its orientation; (2) gave a verbal (conceptual) estimate of what the most stable position of a ladder leaned against a wall would be; or (3) drew a line representing the most stable position of a ladder to be placed against a wall, and then gave a verbal estimate of the ladder’s orientation. Ladder placement was shallower than the most stable position, as were the verbal estimations of both the positioned and drawn orientations and the verbal (conceptual) estimates of the most stable position for a ladder to be leaned against a wall, relative to the actual orientations. In Experiment 2, participants verbally estimated various ladder orientations. The estimates were again shallower than the actual orientations. For orientations between 60° and 90°, the estimates showed a scale compression effect from horizontal. This perceived exaggeration of the orientation of an object typically oriented down from vertical is similar to the perceived exaggeration of the orientation of hills and ramps, typically thought of as oriented up from horizontal. This may point to a generic perceived exaggeration of slant whose direction depends on the conceptual or actual reference frame being used.     

Overgeneral memory extends to pictorial retrieval cues and correlates with cognitive features in posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) show overgeneral memory (OGM) when retrieving autobiographical memories to word cues. We investigated whether OGM extends to picture cues and whether it is related to PTSD symptoms and cognitions. Trauma survivors with (n = 29) and without (n = 26) PTSD completed the standard Autobiographical Memory Test (AMT) and a novel picture version. Compared to the no-PTSD group, the PTSD group showed OGM in both test versions. Pictures facilitated specific memory retrieval, but this effect was no longer significant when verbal intelligence or depressive symptoms were controlled. OGM correlated with PTSD symptoms and perceived self-change; with intrusive memories, their perceived "nowness," responses to intrusions (thought suppression, rumination, dissociation), and negative interpretations of symptoms.     

Using dynamic field theory to rethink infant habituation

Much of what psychologists know about infant perception and cognition is based on habituation, but the process itself is still poorly understood. Here the authors offer a dynamic field model of infant visual habituation, which simulates the known features of habituation, including familiarity and novelty effects, stimulus intensity effects, and age and individual differences. The model is based on a general class of dynamic (time-based) models that integrate environmental input in varying metric dimensions to reach a single decision. Here the authors provide simulated visual input of varying strengths, distances, and durations to 2 coupled and interacting fields. The 1st represents the activation that drives "looking," and the 2nd, the inhibition that leads to "looking away," or habituation. By varying the parameters of the field, the authors simulate the time course of habituation trials and show how these dynamics can lead to different depths of habituation, which then determine how the system dishabituates. The authors use the model to simulate a set of influential experiments by R. Baillargeon (1986, 1987a, 1987b) using the well-known "drawbridge" paradigm. The dynamic field model provides a coherent explanation without invoking infant object knowledge. The authors show that small changes in model parameters can lead to qualitatively different outcomes. Because in typical infant cognition experiments, critical parameters are unknown, effects attributed to conceptual knowledge may be explained by the dynamics of habituation.