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Histologic Subtyping of Gastric Intestinal Metaplasia: Overview and Considerations for Clinical Practice.
Shah SC, Gawron AJ, Mustafa RA, Piazuelo MB
(2020) Gastroenterology 158: 745-750
MeSH Terms: Biopsy, Endoscopy, Gastrointestinal, Gastric Mucosa, Health Knowledge, Attitudes, Practice, Humans, Metaplasia, Population Surveillance, Precancerous Conditions, Stomach Neoplasms
Added March 3, 2020
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9 MeSH Terms
Low Awareness of Nonalcoholic Fatty Liver Disease in a Population-Based Cohort Sample: the CARDIA Study.
Cleveland ER, Ning H, Vos MB, Lewis CE, Rinella ME, Carr JJ, Lloyd-Jones DM, VanWagner LB
(2019) J Gen Intern Med 34: 2772-2778
MeSH Terms: Adolescent, Adult, Awareness, Cohort Studies, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Longitudinal Studies, Male, Middle Aged, Non-alcoholic Fatty Liver Disease, Population Surveillance, Prospective Studies, United States, Young Adult
Show Abstract · Added January 10, 2020
BACKGROUND - Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, yet little is known about NAFLD awareness in individuals with incidental fatty liver on imaging.
OBJECTIVE - To assess the level of awareness of imaging-defined NAFLD among individuals with and without metabolic risk factors.
DESIGN - Cross-sectional analysis within a prospective longitudinal population-based cohort study conducted in four U.S. cities.
PARTICIPANTS - Adults age 43 to 55 years enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study who underwent computed tomography and a personal health questionnaire at the year 25 exam (2010-2011, n = 2788).
MAIN MEASURES - NAFLD was defined as liver attenuation ≤ 51 Hounsfield units after exclusion of other causes of liver fat. Participants were considered "NAFLD aware" if they reported being told previously by a doctor or nurse that they had "fatty liver."
KEY RESULTS - NAFLD prevalence was 23.9%. Only 16 of 667 (2.4%) participants with CT-defined NAFLD were aware of a NAFLD diagnosis. NAFLD aware participants were more likely to be white (81.3% vs. 53.5%, p = 0.03) and have the metabolic syndrome (87.5% vs. 59.3%, p = 0.02) and/or hypertension (75.0% vs. 50.2%, p = 0.05). In multivariable analyses adjusted for demographics, metabolic syndrome and hypertension remained predictive of NAFLD awareness.
CONCLUSION - There is low awareness of NAFLD among individuals with hepatic steatosis on imaging, even among those with metabolic risk factors. These findings highlight an opportunity to raise public and practitioner awareness of NAFLD with the goal of increasing diagnosis and implementing early treatment strategies.
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16 MeSH Terms
Human papillomavirus vaccination completion rates among gynecological providers: an institutional retrospective review.
Elsamadicy EA, Schneiter MK, Hull PC, Khabele D
(2019) Hum Vaccin Immunother 15: 1851-1855
MeSH Terms: Adult, Female, Gynecology, Health Knowledge, Attitudes, Practice, Humans, Papillomavirus Infections, Papillomavirus Vaccines, Patient Acceptance of Health Care, Physicians, Practice Patterns, Physicians', Retrospective Studies, Vaccination, Young Adult
Show Abstract · Added July 11, 2019
: The primary aim of this study is to assess and characterize correlates of human papillomavirus (HPV) vaccine series completion among young adult women evaluated by gynecological (GYN) providers at a single institution and to measure changes over 4-y period. : At a major academic center, the medical records of 845 women administered the HPV vaccine series by a GYN provider were retrospectively reviewed from 2006 to 2010 and 2014 to 2015. Patients were grouped based on the date of vaccine initiation into "earlier" (2006-2010) and "later" (2014-2015) cohorts. Patient demographics, dates of vaccine administration, and practice locations where vaccines were administered were collected. Patients who received all 3 vaccines within 6 months were deemed "complete". Patients seen by a provider but did not receive the vaccination were deemed "missed opportunities". The primary outcome was completion of HPV vaccination according to the ACIP guidelines. : The 845 patients were divided into earlier (n = 399) and later (n = 446) cohorts. There was no statistically significant difference in completion rates between the earlier-cohort compared to the later-cohort (). Age at initiation were similar (), with the complete cohort having a significantly lower body mass index (BMI) than the incomplete cohort (). There was a significant difference between the completion rates among race/ethnic groups ( = .036). African-American and Hispanic ( patient-populations had the lowest completion rates and higher missed opportunities. : Our study found an overall low completion rate in both earlier and later cohorts. Additionally, higher BMI and African-American and Hispanic race/ethnicity were associated with low vaccine completion.
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13 MeSH Terms
Smashing the strict hierarchy: three cases of clinical decision support malfunctions involving carvedilol.
Wright A, Wright AP, Aaron S, Sittig DF
(2018) J Am Med Inform Assoc 25: 1552-1555
MeSH Terms: Adrenergic alpha-1 Receptor Antagonists, Adrenergic beta-Antagonists, Carvedilol, Decision Support Systems, Clinical, Electronic Health Records, Humans, Knowledge Management, Medication Errors, Terminology as Topic, Vocabulary, Controlled
Show Abstract · Added November 7, 2019
Clinical vocabularies allow for standard representation of clinical concepts, and can also contain knowledge structures, such as hierarchy, that facilitate the creation of maintainable and accurate clinical decision support (CDS). A key architectural feature of clinical hierarchies is how they handle parent-child relationships - specifically whether hierarchies are strict hierarchies (allowing a single parent per concept) or polyhierarchies (allowing multiple parents per concept). These structures handle subsumption relationships (ie, ancestor and descendant relationships) differently. In this paper, we describe three real-world malfunctions of clinical decision support related to incorrect assumptions about subsumption checking for β-blocker, specifically carvedilol, a non-selective β-blocker that also has α-blocker activity. We recommend that 1) CDS implementers should learn about the limitations of terminologies, hierarchies, and classification, 2) CDS implementers should thoroughly test CDS, with a focus on special or unusual cases, 3) CDS implementers should monitor feedback from users, and 4) electronic health record (EHR) and clinical content developers should offer and support polyhierarchical clinical terminologies, especially for medications.
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10 MeSH Terms
Black Americans' Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease.
Umeukeje EM, Wild MG, Maripuri S, Davidson T, Rutherford M, Abdel-Kader K, Lewis J, Wilkins CH, Cavanaugh K
(2018) Clin J Am Soc Nephrol 13: 551-559
MeSH Terms: Adult, Advertising, African Americans, Aged, Community Health Services, Cultural Competency, Emotions, Female, Focus Groups, Health Education, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Humans, Kidney Diseases, Male, Middle Aged, Motivation, Religion, Trust, Young Adult
Show Abstract · Added November 29, 2018
BACKGROUND AND OBJECTIVES - Incidence of ESKD is three times higher in black Americans than in whites, and CKD prevalence continues to rise among black Americans. Community-based kidney disease screening may increase early identification and awareness of black Americans at risk, but it is challenging to implement. This study aimed to identify participants' perspectives of community kidney disease screening. The Health Belief Model provides a theoretic framework for conceptualization of these perspectives and optimization of community kidney disease screening activities.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - Researchers in collaboration with the Tennessee Kidney Foundation conducted three focus groups of adults in black American churches in Nashville, Tennessee. Questions examined views on CKD information, access to care, and priorities of kidney disease health. Content analysis was used. Guided by the Health Belief Model, themes were generated, and additional themes were derived from the data using an inductive approach.
RESULTS - Thirty-two black Americans completed the study in 2014. Participants were mostly women (79%) with a mean age of 56 years old (range, 24-78). Two major categories of barriers to kidney disease screening were identified: () participant factors, including limited kidney disease knowledge, spiritual/religious beliefs, emotions, and culture of the individual; and () logistic factors, including lack of convenience and incentives and poor advertisement. Potential facilitators of CKD screening included provision of CKD education, convenience of screening activities, and use of culturally sensitive and enhanced communication strategies. Program recommendations included partnering with trusted community members, selecting convenient locations, tailored advertising, and provision of compensation.
CONCLUSIONS - Findings of this study suggest that provider-delivered culturally sensitive education and stakeholder engagement are critical to increase trust, decrease fear, and maximize participation and early identification of kidney disease among black Americans considering community screening.
Copyright © 2018 by the American Society of Nephrology.
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20 MeSH Terms
Adolescent Participation in HPV Vaccine Clinical Trials: Are Parents Willing?
Erves JC, Mayo-Gamble TL, Hull PC, Duke L, Miller ST
(2017) J Community Health 42: 894-901
MeSH Terms: Adolescent, Clinical Trials as Topic, Health Knowledge, Attitudes, Practice, Humans, Papillomavirus Vaccines, Parents, Patient Acceptance of Health Care, Vaccination
Show Abstract · Added March 27, 2017
Approximately one-quarter of human papillomavirus (HPV) infections are acquired by adolescents, with a higher burden among racial/ethnic minorities. However, racial/ethnic minorities have been underrepresented in previous HPV vaccine trials. Ongoing and future HPV vaccine optimization trials would benefit from racially- and ethnically-diverse sample of adolescent trial participants. This study examined factors influencing parental willingness to consent to their adolescents' participation in HPV vaccine clinical trials and tested for possible racial differences. A convenience sample of parents of adolescents (N = 256) completed a cross-sectional survey. Chi square analyses were used to assess racial differences in parental HPV vaccine awareness and intentions and willingness to consent to their child participating in an HPV vaccine clinical trial. Ordinal logistic regression was used to identify factors associated with willingness. Approximately 47% of parents were willing to allow their adolescent to participate in HPV vaccine clinical trials (30.7% African American and 48.3% Caucasian, p = .081). African Americans had lower HPV vaccine awareness (p = .006) but not lower intentions to vaccinate (p = .086). Parental willingness was positively associated with the following variables: Child's age (p < .039), Perceived Advantages of HPV Vaccination for Adolescents (p = .002), Parental Trust in Medical Researchers (p < .001), and Level of Ease in Understanding Clinical Trial Information (p = .010). Educating parents about the advantages of HPV vaccines for younger adolescents using low-literacy educational materials and building trust between parents and researchers may increase parental willingness to consent to adolescent participation in HPV vaccine clinical trials.
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8 MeSH Terms
'It means everyone should know their status': exploring lay conceptions of sickle cell trait and sickle cell trait screening among African Americans within middle reproductive age.
Mayo-Gamble TL, Barnes PA, Cunningham Erves J, Middlestadt SE, Lin HC
(2018) Ethn Health 23: 813-829
MeSH Terms: Adult, African Americans, Anemia, Sickle Cell, Decision Making, Female, Health Knowledge, Attitudes, Practice, Humans, Indiana, Male, Mass Screening, Reproductive Health, Sickle Cell Trait, Surveys and Questionnaires
Show Abstract · Added March 18, 2017
OBJECTIVE - This study examined the meaning of sickle cell trait and sickle cell trait screening from the lay perspective of African Americans.
DESIGN AND METHODS - African Americans (N = 300), ages 18-35 and unaware of their sickle cell trait status, completed two open-ended questions from a larger survey. One question asked for their understanding of sickle cell trait; the other asked for their understanding of sickle cell trait screening. Content analysis occurred in two phases: (1) In vivo and holistic coding; and (2) focused coding.
RESULTS - Four categories emerged illustrating lay conceptions of sickle cell trait; (1) Perceived as an illness; (2) Perceived recognition of the inheritance pattern of sickle cell trait; (3) Perceived lack of knowledge of sickle cell trait; and (4) Perceived importance of sickle cell trait. Five categories emerged illustrating lay conceptions for sickle cell trait screening: (1) Perceived recognition that screening means getting tested for sickle cell trait; (2) Perceived lack of knowledge of sickle cell trait screening; (3) Perceived health benefit of sickle cell trait screening; (4) Perceived importance of sickle cell trait screening; and (5) Perceived barriers to sickle cell trait screening.
CONCLUSIONS - Sickle cell trait and sickle cell trait screening are concepts that are both regarded as important among this high-risk population. However, there is still misunderstanding concerning the hereditary nature and reproductive implications of sickle cell trait. Interventions seeking to improve communication on the need for sickle cell trait screening should begin by identifying what the population at large understands, knows and/or believes to improve their ability to make informed health decisions.
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13 MeSH Terms
A Community-Driven Intervention for Improving Biospecimen Donation in African American Communities.
Patel K, Inman W, Gishe J, Johnson O, Brown E, Kanu M, Theriot R, Sanderson M, Hull P, Hargreaves M
(2018) J Racial Ethn Health Disparities 5: 15-23
MeSH Terms: Adult, African Americans, Biological Specimen Banks, Community-Based Participatory Research, Female, Health Education, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged
Show Abstract · Added August 22, 2017
INTRODUCTION - Human biospecimens are an invaluable resource for addressing cancers and other chronic diseases. The purpose of this study was to assess the impact of an educational intervention on biospecimen knowledge and attitudes.
METHODS - The participants consisted of 112 African Americans, 18 years and older, and who had not provided biospecimens for any health-related research in the past. A total of 55 participants received the educational brochure, and 57 received the educational video. The main outcomes of the study were knowledge and attitudes for biospecimen donation. This information was collected pre- and post-intervention.
RESULTS - The average knowledge scores increased (p < 0.0001) and the average attitude scores for biospecimen donation improved (p < 0.0001) post-intervention for both the video and brochure conditions. There was an interaction between the intervention condition and knowledge where the participants who received the educational video showed a greater increase in knowledge pre-to-post compared to those who received the educational brochure (p = 0.0061). There were no significant interactions between the two intervention conditions for attitudes toward biospecimen donation.
DISCUSSION - The results of this study demonstrated the feasibility and efficacy of an academic institution collaborating with the African American community in developing educational tools for biospecimen donation.
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10 MeSH Terms
Using an Implementation Research Framework to Identify Potential Facilitators and Barriers of an Intervention to Increase HPV Vaccine Uptake.
Selove R, Foster M, Mack R, Sanderson M, Hull PC
(2017) J Public Health Manag Pract 23: e1-e9
MeSH Terms: Adult, Continental Population Groups, Female, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Incidence, Male, Middle Aged, Papillomavirus Infections, Papillomavirus Vaccines, Patient Acceptance of Health Care, Qualitative Research, Tennessee, United States, Uterine Cervical Neoplasms, Vaccination
Show Abstract · Added February 21, 2017
BACKGROUND - Although the incidence of cervical cancer has been decreasing in the United States over the last decade, Hispanic and African American women have substantially higher rates than Caucasian women. The human papillomavirus (HPV) is a necessary, although insufficient, cause of cervical cancer. In the United States in 2013, only 37.6% of girls 13 to 17 years of age received the recommended 3 doses of a vaccine that is almost 100% efficacious for preventing infection with viruses that are responsible for 70% of cervical cancers. Implementation research has been underutilized in interventions for increasing vaccine uptake. The Consolidated Framework for Implementation Research (CFIR), an approach for designing effective implementation strategies, integrates 5 domains that may include barriers and facilitators of HPV vaccination. These include the innovative practice (Intervention), communities where youth and parents live (Outer Setting), agencies offering vaccination (Inner Setting), health care staff (Providers), and planned execution and evaluation of intervention delivery (Implementation Process).
METHODS - Secondary qualitative analysis of transcripts of interviews with 30 community health care providers was conducted using the CFIR to code potential barriers and facilitators of HPV vaccination implementation.
RESULTS - All CFIR domains except Implementation Process were well represented in providers' statements about challenges and supports for HPV vaccination.
CONCLUSION - A comprehensive implementation framework for promoting HPV vaccination may increase vaccination rates in ethnically diverse communities. This study suggests that the CFIR can be used to guide clinicians in planning implementation of new approaches to increasing HPV vaccine uptake in their settings. Further research is needed to determine whether identifying implementation barriers and facilitators in all 5 CFIR domains as part of developing an intervention contributes to improved HPV vaccination rates.
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17 MeSH Terms
Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.
Casey C, Chung CP, Crofford LJ, Barnado A
(2017) Clin Rheumatol 36: 97-102
MeSH Terms: Adult, Attitude of Health Personnel, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Internet, Lupus Erythematosus, Systemic, Male, Middle Aged, Quality Improvement, Quality Indicators, Health Care, Rheumatologists, Rheumatology, Southeastern United States, Surveys and Questionnaires
Show Abstract · Added March 25, 2020
Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.
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MeSH Terms