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Lichter KE, Baniel CC, Do I, Medhat Y, Avula V, Nogueira LM, Bates JE, Paulsson A, Malik N, Hiatt RA, Yom SS, Mohamad O. Effects of Wildfire Events on California Radiation Oncology Clinics and Patients. Adv Radiat Oncol 2024; 9:101395. [PMID: 38304108 PMCID: PMC10831805 DOI: 10.1016/j.adro.2023.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose The effect of climate-driven events, such as wildfires, on health care delivery and cancer care is a growing concern. Patients with cancer undergoing radiation therapy are particularly vulnerable to treatment interruptions, which have a direct effect on survival. We report the results of a study characterizing the effect of wildfires on radiation oncology clinics and their patients. Methods and Materials A survey of California radiation oncologists was used to evaluate emergency preparedness and the effect of wildfires on the delivery of radiation therapy services between 2017 and 2022. Descriptive statistics and Pearson's χ2 tests were performed to investigate potential relationships between provider characteristics, practice settings, and perceptions of the effect of wildfire events. California Department of Forestry and Fire Protection data were employed to map the geographic distribution of wildfires to clinic locations. Results Response rate was 12.3% (51/415 radiation oncologists), representing 25% of clinics (43/176) in 41% (24/58) of California counties. Sixty-one percent (31/51) of respondents reported being affected by a wildfire, 2 of which are rural clinics (100%, 2/2) and 29 are (59%, 29/49) metropolitan practices. Of these, 18% (9/51) reported a clinic closure, and 29% (15/51) reported staffing shortages. Respondents reported effects on patients, including having to evacuate (55%, 28/51), cancel/reschedule treatments (53%, 27/51), and experiencing physical, mental, or financial hardship due to wildfires (45%, 23/51). Respondents described effects on clinical operations, including being forced to transfer patients (24%, 12/51), transportation interruptions (37%, 19/51), regional/community evacuations (35%, 18/51), and physical/mental health effects (27%, 14/51) on clinic personnel. Less than half of the respondents (47%, 24/51) reported their workplace had a wildfire emergency preparedness plan. Additionally, geographic analysis revealed that 100% (176/176) of clinics were located within 25 miles of a wildfire. Conclusions This study highlights the effects of wildfires on radiation oncology clinics and patients and underscores the need for emergency preparedness planning to minimize the consequences of such disasters.
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Affiliation(s)
- Katie E. Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
- The Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Claire C. Baniel
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Isabelle Do
- University of California, Berkeley, Berkeley, California
| | - Yasmeen Medhat
- University of California, Berkeley, Berkeley, California
| | - Vennela Avula
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - James E. Bates
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Nauman Malik
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Robert A. Hiatt
- The Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Sue S. Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Osama Mohamad
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Ghosh AK, Azan A, Basu G, Bernstein J, Gillespie E, Gordon LB, Krishnamurthy S, LeFrancois D, Marcus EN, Tejani M, Townley T, Rimler E, Whelan H. Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement. J Gen Intern Med 2024:10.1007/s11606-024-08690-1. [PMID: 38424345 DOI: 10.1007/s11606-024-08690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.
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Affiliation(s)
- Arnab K Ghosh
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th St, New York, NY, 10065, USA.
| | - Alexander Azan
- Division of General Internal Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 1ST Ave, New York, NY, 10016, USA
| | - Gaurab Basu
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street25 Shattuck Street, CambridgeBoston, MAMA, 0213902115, USA
| | - Joanna Bernstein
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Elizabeth Gillespie
- School of Medicine, University of Colorado Anschutz Medical Campus, Leprino Building, 4th Floor, 12401 East 17th Avenue, Aurora, CO, 80045, USA
| | - Lesley B Gordon
- Department of Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Sudarshan Krishnamurthy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Darlene LeFrancois
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Erin N Marcus
- Division of General Internal Medicine, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Mehul Tejani
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - Theresa Townley
- Division of General Internal Medicine, Creighton University School of Medicine Omaha, 7500 Mercy Road, Omaha, NE, 68124, USA
| | - Eva Rimler
- Division of General Interval Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Heather Whelan
- Division of Hospital Medicine, Department of Medicine, San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA, 94121, USA
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Henneman A, Thornby KA, Rosario N, Latif J. Evaluation of pharmacy resident perceived impact of natural disaster on stress during pharmacy residency training. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:147-155. [PMID: 32147156 DOI: 10.1016/j.cptl.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/23/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Natural disasters present unique challenges for healthcare training programs. Limited literature has been published regarding the impact of natural disasters on pharmacy residency training. The objective of this study was to determine the degree of perceived impact natural disasters have on pharmacy resident stress and which factors contribute to any perceived change in stress. METHODS A cross-sectional study was conducted via a survey distributed to pharmacy residents whose program was located in an area potentially affected by natural disaster in the first six months of the 2017-2018 resident year. A modified Likert scale utilizing a 10-point scale was used to assess resident stress. Potential sources of stress were assessed via multiple-choice questions. The primary outcome was the degree of change in resident perceived stress compared to baseline during and after the natural disaster. RESULTS One hundred twenty-nine pharmacy residents completed the survey. Stress increased from baseline during the natural disaster and remained elevated after compared to baseline. Main sources of stress were increased residency workload, natural disaster preparation and recovery, and concerns regarding friends and family. Half of residents reported their residency program did not have an established natural disaster policy in place. CONCLUSIONS Improved planning and communication regarding workload expectations may minimize stress among residents balancing increased personal responsibilities during times of natural disaster.
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Affiliation(s)
- Amy Henneman
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, 901 S. Flagler Dr., West Palm Beach, FL 33416, United States.
| | - Krisy-Ann Thornby
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, 901 S. Flagler Dr., West Palm Beach, FL 33416, United States.
| | - Natalie Rosario
- Texas A&M University, 1010 W Ave B, Kingsville, TX 78363, United States.
| | - Justine Latif
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, 901 S. Flagler Dr., West Palm Beach, FL 33416, United States.
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Man RXG, Lack DA, Wyatt CE, Murray V. The effect of natural disasters on cancer care: a systematic review. Lancet Oncol 2019; 19:e482-e499. [PMID: 30191852 DOI: 10.1016/s1470-2045(18)30412-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022]
Abstract
As the incidence of cancer and the frequency of extreme weather events rise, disaster mitigation is becoming increasingly relevant to oncology care. In this systematic Review, we aimed to investigate the effect of natural disasters on cancer care and the associated health effects on patients with cancer. We searched MEDLINE, Embase, Scopus, CINAHL, PsycINFO, Web of Science, and ScienceDirect for articles published between database inception and November 12, 2016. Articles identifying the effect of natural disasters on oncology services or the associated health implications for patients with cancer were included. Only articles published in English were included. Data extraction was done by two authors independently and then verified by all authors. The effects of disaster events on oncology services, survival outcomes, and psychological issues were assessed. Of the 4593 studies identified, only 85 articles met all the eligibility criteria. Damage to infrastructure, communication systems and medication, and medical record losses substantially disrupt oncology care. The effect of extreme weather events on survival outcomes is limited to only a small number of studies, often with inadequate follow-up periods. Natural disasters cause substantial interruption to the provision of oncology care. To the best of our knowledge, this is the first systematic Review to assess the existing evidence base on the health effects of natural disaster events on cancer care. We advocate for the consideration of patients with cancer during disaster planning.
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Affiliation(s)
- Ralph Xiu-Gee Man
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
| | - David A Lack
- Emergency Department, Hervey Bay Hospital, Pialba, QLD, Australia
| | - Charlotte E Wyatt
- Dermatology Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Virginia Murray
- Global Disaster Risk Reduction, Public Health England, London, UK
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Stephens CT, Ortiz J, Pivalizza EG. The Anesthesiologist's Response to Hurricane Natural Disaster Incidents: Hurricane Harvey. Anesthesiol Clin 2019; 37:151-160. [PMID: 30711228 DOI: 10.1016/j.anclin.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
From personal experience and available resources, such as the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness templates from the manual for department procedures, the authors describe the primarily flooding impact of Hurricane Harvey in their area of Texas. They review the necessary analysis, development, and implementation of logistics; staffing and relief models; coordination with hospital partners; and dissemination of the planned procedures. The authors emphasize the commitment of anesthesiologists to patient care and rescue efforts outside of the operating room.
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Affiliation(s)
- Christopher T Stephens
- Department of Anesthesiology, University of Texas McGovern Medical School, MSB 5.020, 6431 Fannin Street, Houston, TX 77030, USA
| | - Jaime Ortiz
- Department of Anesthesiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM 120, Houston, TX 77030, USA
| | - Evan G Pivalizza
- Department of Anesthesiology, University of Texas McGovern Medical School, MSB 5.020, 6431 Fannin Street, Houston, TX 77030, USA.
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Searle NS. Baylor College of Medicine's support of Tulane University School of Medicine following Hurricane Katrina. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:733-44. [PMID: 17762246 DOI: 10.1097/acm.0b013e3180d0964f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The authors describe how Baylor College of Medicine (BCM), with three other Texas medical schools, "adopted" virtually all the 620 medical students and 526 house officers of Tulane University School of Medicine and continued their education for eight months after most of New Orleans, including Tulane, was flooded on August 29, 2005, after Hurricane Katrina. Soon after, BCM's president asked all senior staff to take whatever actions were necessary to sustain Tulane, and on September 7, leaders from BCM and three other Texas medical schools met to plan the relocation of Tulane's students and programs. The authors explain how problems were overcome (e.g., locating the scattered Tulane students and staff, finding them lodging, obtaining their records, and providing financial aid and counseling), and how high-quality educational experiences were maintained for both Tulane's and BCM's students and residents while assisting Tulane's faculty in numerous ways, helping Tulane plan the enrollment of its following year's students, and undergoing Liaison Committee for Medical Education and Accreditation Council on Graduate Medical Education site visits to BCM. After the BCM-Tulane experience, BCM developed a disaster-management plan (available online) that could help other schools as they plan for disasters. The authors also offer lessons learned in the areas of communication, cooperation, curriculum, collaboration, contact with accrediting bodies, and compassion. They close by stating that when BCM faculty are asked "how could you take Tulane's medical school in?" their response is, "how could we not?" They continue: "In medical education, a frequent discussion is how to teach humanism and professionalism; we teach it best by modeling it."
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Affiliation(s)
- Nancy S Searle
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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