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Background Routine assessment and clinical utilisation of patient-reported outcome (PRO) measures can lead to improved patient outcomes. The PROMPT-Care eHealth system facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions, patient self-management, and shared care. Pilot testing demonstrated acceptability and feasibility of PROMPT-Care Version 1.0. This study aims to implement PROMPT-Care Version 2.0 and determine its efficacy in reducing emergency department (ED) presentations, and improving chemotherapy delivery and health service referrals, compared to usual care. Methods Groups eligible to participate in the intervention arm of this controlled trial are patients receiving cancer care (including follow-up). PROMPT-Care patients will complete monthly assessments (distress, symptoms, unmet needs) until voluntary withdrawal or death. In Version 1.0, the care team accessed patients’ clinical feedback reports in ‘real time’ to guide their care, and patients received links to support their self-management, tailored to their PRO responses. Version 2.0 was extended to include: i) an additional alert system notifying the care team of ongoing unresolved clinical issues, ii) patient self-management resources, and iii) an auto-populated Treatment Summary and Survivorship Care Plan (SCP). The control population will be patients extracted from hospital databases of the general cancer patient population who were seen at the participating cancer therapy centres during the study period, with a ratio of 1:4 of intervention to control patients. A minimum sample size of 1760 (352 intervention and 1408 control) patients will detect a 14% reduction in the number of ED presentations (primary outcome) in the PROMPT-Care group compared with the control group. Intervention patients will provide feedback on system usability and value of the self-management materials; oncology staff will provide feedback on usefulness of PROMPT-Care reports, response to clinical alerts, impact on routine care, and usefulness of the SCPs; and GPs will provide feedback on the usefulness of the SCPs and attitudes towards shared-care models of survivorship care planning. Discussion This study will inform the PROMPT-Care system’s impact on healthcare utilisation and utility as an alternative model for ongoing supportive care. Trial registration Australian New Zealand Clinical Trials Registry ( ACTRN12616000615482 ) on 12th May 2016 ( www.anzctr.org.au ).

Patient-reported outcome (PRO) measures have been used widely to screen for depression, anxiety, and symptoms in cancer patients. Computer-based applications that collect patients' responses and transfer them to the treating health professional in real time have the potential to improve patient well-being and cancer outcomes. This study will test the feasibility and acceptability of a newly developed eHealth system which facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. The eHealth system is being developed in consultation with 3 overarching content-specific expert advisory groups convened for this project: the clinical advisory group, technical advisory group, and evaluation advisory group. The following work has already been completed during this phase of the study: the Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) eHealth system was developed, patient-reported outcomes were selected (distress, symptoms, unmet needs), algorithms to inform intervention thresholds for clinical and self-management were determined, clinician PRO feedback summary and longitudinal reports were designed, and patient self-management resources were collated. PROsaiq, a custom information technology system, will transfer PRO data in real time into the hospital-based oncology information system to support clinical decision making. The PROMPT-Care system feasibility and acceptability will be assessed through patients completing PROMPT-Care assessments, participating in face-to-face cognitive interviews, and completing evaluation surveys and telephone interviews and oncology staff participating in telephone interviews. Over the course of 3 months, the system will be pilot-tested with up to 50 patients receiving treatment or follow-up care and 6 oncology staff at 2 hospitals in New South Wales, Australia. Data will be collected to determine the accuracy and completeness of data transfer procedures, extent of missing data from participants' assessments, acceptability of the eHealth system and usefulness of the self-management resources (via patient evaluation surveys and interviews), and acceptability and perceived usefulness of real-time PRO reporting (via oncology staff interviews) at the completion of the pilot phase. This research investigates implementation of evidence into real world clinical practice through development of an efficient and user-friendly eHealth system. This study of feasibility and acceptability of the newly developed eHealth system will inform the next stage of larger scale testing and future implementation of the system as part of routine care. Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0).

The cost basis in the policy (essentially how much premium has been paid to date into the policy); The current cash value and cash surrender value; The current policy loan amount if any; The current dividend options; and Forward looking illustrations that show how the policy performs at different dividend rate assumptions and utilizing different policy options. Variable life insurance products are long-term investments and may not be suitable for all investors. Private Placement Life Insurance is an unregistered securities product and is not subject to the same regulatory requirements as registered variable products.

In addition to accomplishing charitable goals, charitable lead annuity trusts (CLAT) can be powerful income tax deduction tools for clients ranging from former executives receiving large one-time income payments from deferred compensation plans or nonqualified retirement plans to professional athletes receiving up-front contract or roster bonuses. Hedge fund managers who hold offshore investments in their own funds are also looking at CLATs as a way to ease the tax burden incurred as they meet the Emergency Economic Stability Act of 2008 provision to repatriate this money by 2017. In its simplest form, a CLAT is the inverse of its brother, the charitable remainder trust (CRT). In a CRT, the primary beneficiary is the donor or a named individual, and then the charitable organization is the beneficiary of the remainder. Given the current tax rules and favorable market dynamics, advisors to ultra-high net worth individuals should consider reviewing grantor CLATs and their potential advantages when implemented with private placement insurance.

Most investment managers have a well articulated methodology for why they recommend a particular stock, bond, or fund out of the universe of offerings. Insurance brokers, however, have traditionally not had their own formal methodology to explain their carrier selection to clients. This needs to change, and there is a way to do that. Congress is currently considering whether the current model of having the insurers pay the rating services for their ratings creates a conflict of interest. Carrier selection becomes objective. This contrasts with the practices at some firms where carrier selection is done according to subjective factors and business relationships.

Editor: As a veteran Democratic legislator representing southwestern Baltimore County and a longtime reader of Sun editorials. I suppose I should have expected as twisted an editorial as appeared on Oct. 28. \"Baltimore County's Flawed Maps.\"

If we don't approve the 2 percent cap, is there any hope of otherwise controlling ever-increasing property taxes? I believe there is an alternative which at least should be given a chance. The alternative is the \"spending affordability\" mechanism recently established by the County Council. This approach is patterned after the generally effective plan adopted some years ago by the General Assembly to control the growth of the state budget. While certainly not a perfect solution, it represents a middle ground which restrains spending on the one hand while providing some flexibility on the other. Some ask, \"Isn't there fat that can be cut in the county budget?\" The simple and honest answer is yes, of course there is. But there simply isn't enough fat to avoid real and significant cuts in services if the 2 percent cap is approved. Moreover, cutting fat is a one-time exercise, while the cap locks revenues below the rate of inflation year after year after year.