1
|
Allen CG, Donahue C, Coen E, Meeder K, Wallace K, Melvin C, Neelon B, Hughes K. Implementation Mapping for Managing Patients at High Risk for Hereditary Cancer. Am J Prev Med 2024; 66:503-515. [PMID: 37806365 PMCID: PMC10922485 DOI: 10.1016/j.amepre.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Currently, no standard workflow exists for managing patients with pathogenic variants that put them at higher risk for hereditary cancers. Therefore, follow-up care for individuals with pathogenic variants is logistically challenging and results in poor guideline adherence. To address this challenge, authors created clinical management strategies for individuals identified at high risk for hereditary cancers. METHODS An implementation mapping approach was used to develop and evaluate the establishment of a Hereditary Cancer Clinic at the Medical University of South Carolina throughout in 2022. This approach consisted of 5 steps: conduct a needs assessment, identify objectives, select implementation strategies, produce implementation protocols, and develop an evaluation plan. The needs assessment consisted of qualitative interviews with patients (n=11), specialists (n=9), and members of the implementation team (n=4). Interviews were coded using the Consolidated Framework for Implementation Research to identify barriers and facilitators to establishment of the Hereditary Cancer Clinic. Objectives were identified, and then the team selected implementation strategies and produced implementation protocols to address concerns identified during the needs assessment. Authors conducted a second round of patient interviews to assess patient education materials. RESULTS The research team developed a long-term evaluation plan to guide future assessment of implementation, service, and clinical/patient outcomes. CONCLUSIONS This approach provides the opportunity for real-time enhancements and impact, with strategies for care specialists, patients, and implementation teams. Findings support ongoing efforts to improve patient management and outcomes while providing an opportunity for long-term evaluation of implementation strategies and guidelines for patients at high risk for hereditary cancers.
Collapse
Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Colleen Donahue
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Emma Coen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kiersten Meeder
- Division of Oncologic and Endocrine Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin Hughes
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
2
|
Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
Collapse
Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
| |
Collapse
|
3
|
Howell KE, Pugh N, Longoria J, Shah N, Kutlar A, Gordeuk VR, King AA, Glassberg J, Kayle M, Melvin C, Treadwell M, Hankins JS, Porter JS. Burden of Aging: Health Outcomes Among Adolescents and Young Adults With Sickle Cell Disease. Hemasphere 2023; 7:e930. [PMID: 37456969 PMCID: PMC10348722 DOI: 10.1097/hs9.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Kristen E. Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Norma Pugh
- RTI International, Research Triangle Park, NC, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - Abdullah Kutlar
- Department of Medicine, Augusta University, Augusta, GA, USA
| | | | - Allison A. King
- Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mariam Kayle
- Clinical Health Systems and Analytics Division, Duke University, Durham, NC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, San Francisco, CA, USA
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jerlym S. Porter
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
4
|
Allen CG, Jefferson M, Magwood G, Melvin C, Babatunde OA, Halbert CH. Understanding men's beliefs and concerns about linking health data in the context of precision medicine. J Clin Transl Sci 2023; 7:e150. [PMID: 37456269 PMCID: PMC10346034 DOI: 10.1017/cts.2023.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Background/Objective Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers' and clinicians' ability to deliver care. We have limited understanding of how individuals perceive linking data as it relates to precision medicine. The aim of this study was to identify how sociodemographics, comorbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among men. Methods We recruited 124 adult men from primary care practices at a large clinical research university to complete a cross-sectional survey that included questions about sociodemographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptive statistics, bivariate associations, and multivariable regression were conducted. Results Participants had positive beliefs about linking data for precision medicine (M = 4.05/5) and average concern about linking data (M = 2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (β = 0.41, p = 0.027). Races other than African American (β = -0.64, p = 0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (β = -0.75, p = 0.0006). Conclusion Our results advance the literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
Collapse
Affiliation(s)
- Caitlin G. Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Ibemere SO, Oyedeji CI, Preiss L, Van Althuis LE, Hankins JS, Azul M, Burns EN, Glassberg J, Hagar W, Hussain F, King A, Melvin C, Myers J, Snyder A, Shah N, Tanabe P. Characterising the prevalence of overweight and obese status among adults with sickle cell disease. Br J Haematol 2023; 200:633-642. [PMID: 36382420 PMCID: PMC9957798 DOI: 10.1111/bjh.18548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022]
Abstract
Individuals with sickle cell disease (SCD) have historically been considered underweight. Despite increasing body mass index (BMI) in the general population, the prevalence of overweight and obese status remains unclear in the adult SCD population. Our primary aim was to determine the prevalence of overweight and obese status and to identify associations between BMI, demographic, and clinical characteristics. We conducted an analysis of abstracted electronic health record data and patient-reported outcomes from the Sickle Cell Disease Implementation Consortium registry; individuals aged 20-45 years were included. The median (interquartile range) BMI for the 1664 adults in this analysis was 23.9 (21.1-28) kg/m2 . In this cohort, 42.9% had a BMI of >25 kg/m2 (Centers for Disease Control and Prevention definition of overweight/obese). In multivariable analysis, higher odds of being overweight or obese were associated with female gender, older age, college education, private insurance, and hypertension diagnosis. Higher odds of a BMI of >25 kg/m2 were observed in individuals with HbSC or HbSβ+ thalassaemia regardless of hydroxycarbamide (hydroxyurea) exposure (odds ratio [OR] 3.4, p < 0.0001) and HbSS or HbSβ0 thalassaemia exposed to hydroxycarbamide (OR 1.6, p = 0.0003) compared to those with HbSS or HbSβ0 thalassaemia with no hydroxycarbamide exposure. These data highlight the importance of early identification, prevention, and intervention for increasing BMI to reduce obesity-related complications that may impact SCD-related complications.
Collapse
Affiliation(s)
| | - Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Jane S Hankins
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa Azul
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ebony N Burns
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Ward Hagar
- University of California San Francisco, San Francisco, California, USA
| | - Faiz Hussain
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Allison King
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Myers
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Nirmish Shah
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University Hospital, Durham, North Carolina, USA
| | - Paula Tanabe
- Duke University School of Nursing and Medicine, Durham, North Carolina, USA
| |
Collapse
|
6
|
Hankins JS, Potter MB, Fernandez ME, Melvin C, DiMartino L, Jacobs SR, Bosworth HB, King AA, Simon J, Glassberg JA, Kutlar A, Gordeuk VR, Shah N, Baumann AA, Klesges LM. Evaluating the implementation of a multi-level mHealth study to improve hydroxyurea utilization in sickle cell disease. Front Health Serv 2023; 2:1024541. [PMID: 36925803 PMCID: PMC10012741 DOI: 10.3389/frhs.2022.1024541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/22/2023]
Abstract
Background Sickle Cell Disease (SCD) is a progressive genetic disease that causes organ damage and reduces longevity. Hydroxyurea is an underutilized evidence-based medication that reduces complications and improves survival in SCD. In a multi-site clinical trial, part of the NIH-funded Sickle Cell Disease Implementation Consortium (SCDIC), we evaluate the implementation of a multi-level and multi-component mobile health (mHealth) patient and provider intervention to target the determinants and context of low hydroxyurea use. Given the complexity of the intervention and contextual variability in its implementation, we combined different behavioral and implementation theories, models, and frameworks to facilitate the evaluation of the intervention implementation. In this report, we describe engagement with stakeholders, planning of the implementation process, and final analytical plan to evaluate the implementation outcomes. Methods During 19 meetings, a 16-member multidisciplinary SCDIC implementation team created, conceived, and implemented a project that utilized Intervention Mapping to guide designing an intervention and its evaluation plan. The process included five steps: (1) needs assessment of low hydroxyurea utilization, (2) conceptual framework development, (3) intervention design process, (4) selection of models and frameworks, and (5) designing evaluation of the intervention implementation. Results Behavioral theories guided the needs assessment and the design of the multi-level mHealth intervention. In designing the evaluation approach, we combined two implementation frameworks to best account for the contextual complexity at the organizational, provider, and patient levels: (1) the Consolidated Framework for Implementation Research (CFIR) that details barriers and facilitators to implementing the mHealth intervention at multiple levels (users, organization, intervention characteristics, broader community), and (2) the Technology Acceptance Model (TAM), a conceptual model specific for explaining the intent to use new information technology (including mHealth). The Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework was used to measure the outcomes. Discussion Our research project can serve as a case study of a potential approach to combining different models/frameworks to help organize and plan the evaluation of interventions to increase medication adherence. The description of our process may serve as a blueprint for future studies developing and testing new strategies to foster evidence-based treatments for individuals living with SCD.
Collapse
Affiliation(s)
- J. S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - M. B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, United States
- Clinical, Family, and Community Medicine, University of California San Francisco, CA, United States
| | - M. E Fernandez
- Health Promotion and Behavioral Sciences, University of Texas Health Science Center, School of Public Health at Houston, Houston, TX, United States
| | - C Melvin
- The Medical University of South Carolina, Charleston, SC, United States
| | - L DiMartino
- RTI International, Research triangle park, NC, United States
| | - S. R Jacobs
- RTI International, Research triangle park, NC, United States
| | - H. B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - A. A King
- Department of Pediatrics, Washington University, Saint louis, MO, United States
| | - J Simon
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - J. A Glassberg
- Department of Emergency Medicine, Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - A Kutlar
- Augusta University, Augusta, GA, United States
| | - V. R Gordeuk
- Department of Medicine, the University of Illinois at Chicago, Chicago, IL, United States
| | - N Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC, United States
| | - A. A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | - L. M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, Saint louis, MO, United States
| | | |
Collapse
|
7
|
Lamont AE, Hsu LL, Jacobs S, Gibson R, Treadwell M, Chen Y, Lottenberg R, Axelrod K, Varughese T, Melvin C, Smith S, Chukwudozie IB, Kanter J. What does it mean to be affiliated with care?: Delphi consensus on the definition of "unaffiliation" and "specialist" in sickle cell disease. PLoS One 2022; 17:e0272204. [PMID: 36367870 PMCID: PMC9651581 DOI: 10.1371/journal.pone.0272204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Accruing evidence reveals best practices for how to help individuals living with Sickle Cell Disease (SCD); yet, the implementation of these evidence-based practices in healthcare settings is lacking. The Sickle Cell Disease Implementation Consortium (SCDIC) is a national consortium that uses implementation science to identify and address barriers to care in SCD. The SCDIC seeks to understand how and why patients become unaffiliated from care and determine strategies to identify and connect patients to care. A challenge, however, is the lack of agreed-upon definition for what it means to be unaffiliated and what it means to be a "SCD expert provider". In this study, we conducted a Delphi process to obtain expert consensus on what it means to be an "unaffiliated patient" with SCD and to define an "SCD specialist," as no standard definition is available. Twenty-eight SCD experts participated in three rounds of questions. Consensus was defined as 80% or more of respondents agreeing. Experts reached consensus that an individual with SCD who is unaffiliated from care is "someone who has not been seen by a sickle cell specialist in at least a year." A sickle cell specialist was defined as someone with knowledge and experience in SCD. Having "knowledge" means: being knowledgeable of the 2014 NIH Guidelines, "Evidence-Based Management of SCD", trained in hydroxyurea management and transfusions, trained on screening for organ damage in SCD, trained in pain management and on SCD emergencies, and is aware of psychosocial and cognitive issues in SCD. Experiences that are expected of a SCD specialist include experience working with SCD patients, mentored by a SCD specialist, regular attendance at SCD conferences, and obtains continuing medical education on SCD every 2 years." The results have strong implications for future research, practice, and policy related to SCD by helping to lay a foundation for an new area of research (e.g., to identify subpopulations of unaffiliation and targeted interventions) and policies that support reaffiliation and increase accessibility to quality care.
Collapse
Affiliation(s)
| | - Lewis L. Hsu
- University of Illinois, Chicago, Illinois, United States of America
| | - Sara Jacobs
- RTI International, Research Triangle Park, NC, United States of America
| | - Robert Gibson
- Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Marsha Treadwell
- UCSF School of Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Yumei Chen
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | | | - Kathleen Axelrod
- RTI International, Research Triangle Park, NC, United States of America
| | - Taniya Varughese
- Washington University St Louis, St. Louis MO, United States of America
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Sharon Smith
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | | | - Julie Kanter
- University of Alabama, Birmingham, Birmingham, AL, United States of America
| | | |
Collapse
|
8
|
Allen CG, Judge DP, Levin E, Sterba K, Hunt K, Ramos PS, Melvin C, Wager K, Catchpole K, Clinton C, Ford M, McMahon LL, Lenert L. A pragmatic implementation research study for In Our DNA SC: a protocol to identify multi-level factors that support the implementation of a population-wide genomic screening initiative in diverse populations. Implement Sci Commun 2022; 3:48. [PMID: 35484601 PMCID: PMC9052691 DOI: 10.1186/s43058-022-00286-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2021, the Medical University of South Carolina (MUSC) partnered with Helix, a population genetic testing company, to offer population-wide genomic screening for Centers for Disease Control and Preventions' Tier 1 conditions of hereditary breast and ovarian cancer, Lynch syndrome, and familial hypercholesterolemia to 100,000 individuals in South Carolina. We developed an implementation science protocol to study the multi-level factors that influence the successful implementation of the In Our DNA SC initiative. METHODS We will use a convergent parallel mixed-methods study design to evaluate the implementation of planned strategies and associated outcomes for In Our DNA SC. Aims focus on monitoring participation to ensure engagement of diverse populations, assessing contextual factors that influence implementation in community and clinical settings, describing the implementation team's facilitators and barriers, and tracking program adaptations. We report details about each data collection tool and analyses planned, including surveys, interview guides, and tracking logs to capture and code work group meetings, adaptations, and technical assistance needs. DISCUSSION The goal of In Our DNA SC is to provide population-level screening for actionable genetic conditions and to foster ongoing translational research. The use of implementation science can help better understand how to support the success of In Our DNA SC, identify barriers and facilitators to program implementation, and can ensure the sustainability of population-level genetic testing. The model-based components of our implementation science protocol can support the identification of best practices to streamline the expansion of similar population genomics programs at other institutions.
Collapse
Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Daniel P Judge
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paula S Ramos
- Department of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Karen Wager
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth Catchpole
- Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Marvella Ford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Lori L McMahon
- Office of Vice President for Research, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
9
|
Kanter J, Phillips S, Schlenz A, Mueller M, Dooley M, Sirline L, Nickel R, Brown RC, Hilliard L, Melvin C, Adams R. Transcranial Doppler Screening in a Current Cohort of Children With Sickle Cell Anemia: Results From the DISPLACE Study. J Pediatr Hematol Oncol 2021; 43:e1062-e1068. [PMID: 33625093 PMCID: PMC8481351 DOI: 10.1097/mph.0000000000002103] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
Stroke prevention guidelines for sickle cell anemia (SCA) recommend transcranial Doppler (TCD) screening to identify children at stroke risk; however, TCD screening implementation remains poor. This report describes results from Part 1 of the 28-site DISPLACE (Dissemination and Implementation of Stroke Prevention Looking at the Care Environment) study, a baseline assessment of TCD implementation rates. This report describes TCD implementation by consortium site characteristics; characteristics of TCDs completed; and TCD results based on age. The cohort included 5247 children with SCA, of whom 5116 were eligible for TCD implementation assessment for at least 1 study year. The majority of children were African American or Black, non-Hispanic and received Medicaid. Mean age at first recorded TCD was 5.9 and 10.5 years at study end. Observed TCD screening rates were unsatisfactory across geographic regions (mean 49.9%; range: 30.9% to 74.7%) independent of size, institution type, or previous stroke prevention trial participation. The abnormal TCD rate was 2.9%, with a median age of 6.3 years for first abnormal TCD result. Findings highlight real-world TCD screening practices and results from the largest SCA cohort to date. Data informed the part 3 implementation study for improving stroke screening and findings may inform clinical practice improvements.
Collapse
Affiliation(s)
- Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham
| | | | - Alyssa Schlenz
- Department of Pediatrics, University of Colorado School of Medicine
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina
- Department of Public Health Sciences, Medical University of South Carolina
| | - Mary Dooley
- College of Nursing, Medical University of South Carolina
| | - Logan Sirline
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert Nickel
- Divison of Hematology-Oncology, Children’s National Medical Center
| | - R. Clark Brown
- Aflac Cancer and Blood Disorder Center, Emory University
| | | | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert Adams
- Department of Neurology and Neurosurgery, Medical University of South Carolina
| |
Collapse
|
10
|
Jefferson M, Magwood G, Melvin C, Babatunde O, Halbert CH, Allen CG. Abstract PO-074: Understanding men’s concerns about linking health data in the context of precision medicine. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background and Importance: Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers’ and clinicians’ ability to deliver care. To date, we have limited understanding of how racial and ethnic minorities perceive linking data as it relates to precision medicine. Objective: The aim of this study was to identify how demographics, co-morbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among minority men. Methods: Adult individuals were recruited from primary care practices at a large clinical research university. 375 individuals were invited to participate and 124 completed a cross-sectional survey that included questions about demographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptives, bivariate, and multivariable regression were conducted in SAS version 9.4. Results: Participants had positive perceptions about beliefs about linking data for precision medicine (M=4.05/5) and average concern about linking data (M=2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (B=0.41, p=0.027). Races other than Black or African American (B=-0.64, p=0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (B=-0.75, p=-.0006).
Conclusion and Relevance: Our results contribute to the lack of literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
Citation Format: Melanie Jefferson, Gayenell Magwood, Cathy Melvin, Oluwole Babatunde, Chanita Hughes Halbert, Caitlin G. Allen. Understanding men’s concerns about linking health data in the context of precision medicine [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-074.
Collapse
Affiliation(s)
| | | | - Cathy Melvin
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | | |
Collapse
|
11
|
Halbert CH, Allen CG, Jefferson M, Magwood GS, Melvin C, Babatunde OA, Baquet C, Delmoor E, Johnson J, Mathews D, Leach RJ, Ricks-Santi L. Lessons Learned from the Medical University of South Carolina Transdisciplinary Collaborative Center (TCC) in Precision Medicine and Minority Men's Health. Am J Mens Health 2020; 14:1557988320979236. [PMID: 33319609 PMCID: PMC7745579 DOI: 10.1177/1557988320979236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
The Transdisciplinary Collaborative Center (TCC) in Precision Medicine for Minority Men's Health was established at the Medical University of South Carolina (MUSC) in 2015 to address disparities in the translation of precision medicine approaches among racial minority groups. This regional consortium focuses on three primary areas: (1) the development of a consortium of regional and national partners, (2) conducting transdisciplinary research examining synergistic effects of biological, social, physiological, and clinical determinants of chronic disease risks and outcomes, and (3) dissemination and implementation of precision medicine approaches, with an emphasis on reducing disparities in health care and outcomes among minority men. Given consistent calls to better translate precision medicine approaches and the focus of this consortium on addressing disparities among minority men, we provide an overview of our experience in developing the MUSC TCC, including barriers and facilitators to conducting translational research on minority men's health issues in the context of precision medicine. Lessons learned and areas for improvement include providing enough time to create consistent partnerships and community engagement to improve recruitment and retention, identifying unique ways to engage diverse partners from across the region and nation, and better approaches to dissemination and communication for large partnerships focusing on precision medicine.
Collapse
Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin G. Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell S. Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyami Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Claudia Baquet
- Hope Institute LLC and UMB School of Pharmacy Pharmaceutical HSR, Baltimore, USA
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, Philadelphia, PA, USA
| | - Jerry Johnson
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robin J. Leach
- Department of Cell Systems and Anatomy, Mays Cancer Center, UT Health San Antonio, San Antonio, TX, USA
| | | |
Collapse
|
12
|
Phillips S, Schlenz AM, Mueller M, Melvin C, Adams RJ, Kanter J. Practice patterns for neuroimaging and transfusion therapy for management of neurologic complications in sickle cell anemia: DISPLACE consortium. Pediatr Blood Cancer 2020; 67:e28569. [PMID: 32894002 PMCID: PMC7722116 DOI: 10.1002/pbc.28569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Children with sickle cell anemia (SCA) are at risk for neurologic complications (stroke and silent cerebral infarct). The 2014 National Heart, Lung, and Blood Institute (NHLBI) guidelines for sickle cell disease include recommendations for initiation and maintenance of chronic red cell transfusion (CRCT) therapy for children with SCA at risk for or with ischemic stroke. The guidelines do not include well-delineated recommendations for cerebral imaging for stroke screening. The purpose of this study was to evaluate current stroke risk screening, prevention, and intervention practices amongst the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) study sites. PROCEDURE A survey was administered to DISPLACE site principal investigators to identify current stroke prevention practices relative to the Stroke Prevention Trial in Sickle Cell Anemia (STOP) study protocols and the 2014 NHLBI guidelines. Data were analyzed using descriptive statistics and line-by-line analysis of comments. RESULTS Sites consistently applied NHLBI recommendations to initiate CRCT for ischemic stroke and abnormal transcranial Doppler ultrasound (TCD) results. Similarly, nearly all sites reported obtaining an magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) following an abnormal TCD result. There was wide variation for other indications for MRI/MRA, frequency of MRI/MRA, and other neurological indications for initiating CRCT. CONCLUSIONS Guideline-based practices for preventing ischemic stroke through TCD and CRCT initiation were evident in nearly all sites. Wide variation in practices pertaining to MRI/MRA exists, potentially influenced by more recent stroke prevention trials. New guidelines from the American Society of Hematology were published in April 2020, which may reduce practice variation.
Collapse
Affiliation(s)
| | - Alyssa M. Schlenz
- Department of Pediatrics, Medical University of South Carolina,Department of Pediatrics, University of Colorado School of Medicine
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina,Department of Public Health Sciences, Medical University of South Carolina
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert J. Adams
- Department of Neurology, Medical University of South Carolina
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham
| | | |
Collapse
|
13
|
Masese RV, DeMartino T, Bonnabeau E, Burns EN, Preiss L, Varughese T, Nocek JM, Lasley P, Chen Y, Davila C, Nwosu C, Scott S, Bowman L, Gordon L, Clesca C, Peters-Lawrence M, Melvin C, Shah N, Tanabe P. Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC). J Immigr Minor Health 2020; 23:725-732. [PMID: 33034793 PMCID: PMC8032811 DOI: 10.1007/s10903-020-01102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/27/2022]
Abstract
Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15-45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
Collapse
Affiliation(s)
- Rita V Masese
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA.
| | - Terri DeMartino
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Emily Bonnabeau
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Ebony N Burns
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | | - Taniya Varughese
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Judith M Nocek
- Department of Medicine, Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Yumei Chen
- University of California, San Francisco, Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | | | | | - Samantha Scott
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Latanya Bowman
- Augusta University Center for Blood Disorders, Augusta, GA, USA
| | - Lauren Gordon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cindy Clesca
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marlene Peters-Lawrence
- Division of Blood Diseases and Resources, National Institute of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Cathy Melvin
- Medical University of South Carolina, Charleston, SC, USA
| | - Nirmish Shah
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | - Paula Tanabe
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC, 27710, USA
| | | |
Collapse
|
14
|
Hankins JS, Shah N, DiMartino L, Brambilla D, Fernandez ME, Gibson RW, Gordeuk VR, Lottenberg R, Kutlar A, Melvin C, Simon J, Wun T, Treadwell M, Calhoun C, Baumann A, Potter MB, Klesges L, Bosworth H. Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization: Protocol for an Efficacy and Implementation Study. JMIR Res Protoc 2020; 9:e16319. [PMID: 32442144 PMCID: PMC7388044 DOI: 10.2196/16319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hydroxyurea prevents disease complications among patients with sickle cell disease (SCD). Although its efficacy has been endorsed by the National Health Lung and Blood Institute evidence-based guidelines, its adoption is low, both by patients with SCD and providers. Mobile health (mHealth) apps provide benefits in improving medication adherence and self-efficacy among patients with chronic diseases and have facilitated prescription among medical providers. However, mHealth has not been systematically tested as a tool to increase hydroxyurea adherence nor has the combination of mHealth been assessed at both patient and provider levels to increase hydroxyurea utilization. OBJECTIVE This study aims to increase hydroxyurea utilization through a combined two-level mHealth intervention for both patients with SCD and their providers with the goals of increasing adherence to hydroxyurea among patients and improve hydroxyurea prescribing behavior among providers. METHODS We will test the efficacy of 2 mHealth interventions to increase both patient and provider utilization and knowledge of hydroxyurea in 8 clinical sites of the NHLBI-funded Sickle Cell Disease Implementation Consortium (SCDIC). The patient mHealth intervention, InCharge Health, includes multiple components that address memory, motivation, and knowledge barriers to hydroxyurea use. The provider mHealth intervention, Hydroxyurea Toolbox (HU Toolbox), addresses the clinical knowledge barriers in prescribing and monitoring hydroxyurea. The primary hypothesis is that among adolescents and adults with SCD, adherence to hydroxyurea, as measured by the proportion of days covered (the ratio of the number of days the patient is covered by the medication to the number of days in the treatment period), will increase by at least 20% after 24 weeks of receiving the InCharge Health app, compared with their adherence at baseline. As secondary objectives, we will (1) examine the change in health-related quality of life, acute disease complications, perceived health literacy, and perceived self-efficacy in taking hydroxyurea among patients who use InCharge Health and (2) examine potential increases in the awareness of hydroxyurea benefits and risks, appropriate prescribing, and perceived self-efficacy to correctly administer hydroxyurea therapy among SCD providers between baseline and 9 months of using the HU Toolbox app. We will measure the reach, adoption, implementation, and maintenance of both the InCharge Health and the HU Toolbox apps using the reach, effectiveness, adoption, implementation, and maintenance framework and qualitatively evaluate the implementation of both mHealth interventions. RESULTS The study is currently enrolling study participants. Recruitment is anticipated to be completed by mid-2021. CONCLUSIONS If this two-level intervention, that is, the combined use of InCharge Health and HU Toolbox apps, demonstrates efficacy in increasing adherence to hydroxyurea and prescribing behavior in patients with SCD and their providers, respectively, both apps will be offered to other institutions outside the SCDIC through a future large-scale implementation-effectiveness study. TRIAL REGISTRATION ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16319.
Collapse
Affiliation(s)
- Jane S Hankins
- St. Jude Childrens Research Hospital, Memphis, TN, United States
| | - Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, United States
| | - Lisa DiMartino
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Donald Brambilla
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Maria E Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Robert W Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Victor R Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Richard Lottenberg
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainsville, FL, United States
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jena Simon
- Ichan School of Medicine at Mount Sinai, New York, NY, United States
| | - Ted Wun
- Division of Hematology Oncology, UC Davis School of Medicine, Davis, CA, United States
| | - Marsha Treadwell
- University of California San Francisco Benioff Children Hospital Oakland, Oakland, CA, United States
| | - Cecelia Calhoun
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Ana Baumann
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Michael B Potter
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Lisa Klesges
- Division of Hematology Oncology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Hayden Bosworth
- Department of Medicine, Duke University, Durham, NC, United States
| | -
- Bethesda, MA, United States
| |
Collapse
|
15
|
Schlenz AM, Phillips S, Mueller M, Melvin C, Adams RJ, Kanter J. Practice patterns for stroke prevention using transcranial Doppler in sickle cell anemia: DISPLACE Consortium. Pediatr Blood Cancer 2020; 67:e28172. [PMID: 31925913 PMCID: PMC7036320 DOI: 10.1002/pbc.28172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/13/2019] [Accepted: 12/29/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Children with sickle cell anemia (SCA) are at increased risk for stroke. In 2014, the National Heart, Lung, and Blood Institute (NHLBI) developed guidelines for stroke prevention in SCA informed by the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP II) trials. The guidelines specify the use of transcranial Doppler (TCD) screening and intervention with chronic red cell transfusions (CRCT) in children with SCA who have TCD indication of high stroke risk. The purpose of this study was to describe real-world practice patterns of stroke risk screening and intervention in sites that participated in the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment (DISPLACE) Consortium. PROCEDURE Site investigators completed a survey during the formative stages of the study to evaluate their TCD practices relative to the STOP studies. Descriptive statistics and analysis of free-text comments for more complex practices were evaluated. RESULTS Results suggested universal acceptance of annual TCD screening and initiation of CRCT following an abnormal result among the DISPLACE Consortium, consistent with NHLBI recommendations. However, there was wide variation in methods for conducting TCD screenings (eg, dedicated Doppler vs TCD imaging), classifying TCD results, and actions taken for conditional and inadequate results. CONCLUSIONS Annual TCD screening and initiation of CRCT are critical stroke prevention practices that were universally embraced in the consortium. Additional research would be beneficial for informing clinical practices for areas in which guidelines are absent or unclear.
Collapse
Affiliation(s)
- Alyssa M. Schlenz
- Department of Pediatrics, Medical University of South Carolina,Department of Pediatrics, University of Colorado School of Medicine
| | | | - Martina Mueller
- College of Nursing, Medical University of South Carolina,Department of Public Health Sciences, Medical University of South Carolina
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina
| | - Robert J. Adams
- Department of Neurology and Neurosurgery, Medical University of South Carolina
| | - Julie Kanter
- Division of Hematology & Oncology, University of Alabama Birmingham
| | | |
Collapse
|
16
|
Bryant DC, Hill LM, Melvin C, Powell-Young YM, Ford ME. The Community Compass Project: A Community Engagement Model Targeting African-Americans in the Low Country of South Carolina. J Natl Black Nurses Assoc 2017; 28:38-42. [PMID: 29932566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite cutting edge progress in early detection, risk reduction, and prevention, unique contextual and sociocultural factors contribute to higher mortality rates for selected cancers in African-American men and women. Collaborative community engagement and outreach programming strategies that focus on sustainability and grass-roots organizing can inform health risk disparities, build trust, and allow communities to take ownership of their own health needs. This paper describes a successful evidence-based community engagement intervention woven into the social and interpersonal fabric of the African-American community in Charleston, South Carolina. Through the creation of a coalition of community partners that included the state's only National Cancer Institute designated cancer center, collaboratively developed platforms devoted to population-specific preventive interventions for cancer and obesity education, awareness, and research initiatives were implemented within the identified community.
Collapse
|
17
|
Witzig T, Sokol L, Jacobsen E, Advani R, Mondejar R, Piris M, Burrows F, Melvin C, Mishra V, Scholz C, Gualberto A. PRELIMINARY RESULTS FROM AN OPEN-LABEL, PHASE II STUDY OF TIPIFARNIB IN RELAPSED OR REFRACTORY PERIPHERAL T-CELL LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T. Witzig
- Laboratory Medicine and Pathology; Mayo Clinic; Rochester USA
| | - L. Sokol
- Medical Oncology; H. Lee Moffitt Cancer Center & Research Institute; Tampa USA
| | - E. Jacobsen
- Medical Oncology; Dana Farber Cancer Institute; Boston USA
| | - R. Advani
- Medicine - Med/Oncology; Stanford Cancer Institute; Palo Alto USA
| | - R. Mondejar
- Laboratorio de Genómica del Cáncer, IDIVAL-Instituto de Investigación Marqués de Valdecilla; Santander Spain
| | - M. Piris
- Pathology Service, Fundación Jiménez Díaz; Madrid Spain
| | - F. Burrows
- Research & Development; Kura Oncology; La Jolla USA
| | - C. Melvin
- Research & Development; Kura Oncology; La Jolla USA
| | - V. Mishra
- Research & Development; Kura Oncology; La Jolla USA
| | - C. Scholz
- Research & Development; Kura Oncology; La Jolla USA
| | - A. Gualberto
- Research & Development; Kura Oncology; La Jolla USA
| |
Collapse
|
18
|
Nemeth LS, Rice LJ, Potts M, Melvin C, Jefferson M, Hughes-Halbert C. Priorities and Preferences for Weight Management and Cardiovascular Risk Reduction in Primary Care. Fam Community Health 2017; 40:245-252. [PMID: 28525445 PMCID: PMC6027628 DOI: 10.1097/fch.0000000000000155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Implementing behavioral interventions for cardiovascular risk reduction and weight management is challenging in primary care. Primary care patients and providers were recruited for qualitative interviews to identify priorities and preferences for addressing weight management. Thematic analysis was used to identify relevant resources, barriers to lifestyle modification, health behavior change, and implementation of weight management strategies into care. Patients and providers prioritized increasing physical activity and healthy diets when managing chronic disease; and reported decreased patient motivation, knowledge, and limited organizational capacity and time among providers to deliver intensive interventions. Providers and patients disagreed regarding who owns accountability for weight management.
Collapse
Affiliation(s)
- Lynne S Nemeth
- College of Nursing (Drs Nemeth and Potts), Department of Public Health Sciences (Drs Nemeth and Melvin), Department of Psychiatry and Behavioral Sciences (Drs Rice, Jefferson, and Hughes-Halbert), Hollings Cancer Center (Drs Rice, Melvin, Jefferson, and Hughes-Halbert), Medical University of South Carolina, Charleston; and Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran's Administration Medical Center, Charleston, South Carolina (Dr Hughes-Halbert)
| | | | | | | | | | | |
Collapse
|
19
|
Halbert CH, Melvin C, Briggs V, Delmoor E, Rice LJ, Lynch C, Jefferson M, Johnson JC. Neighborhood Satisfaction and Colorectal Cancer Screening in a Community Sample of African Americans. J Community Health 2016; 41:38-45. [PMID: 26184107 DOI: 10.1007/s10900-015-0062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Social determinants are important to cancer screening among African Americans. To evaluate the association between social determinants (e.g., psychological characteristics, perceived social environment, cultural beliefs such as present temporal orientation) and colorectal cancer (CRC) screening among African Americans. African American adults (n = 262) ages 50-75 completed a telephone interview. Multivariate logistic regression analysis was used to identify factors having significant independent associations with CRC screening. Only 57% of respondents reported having CRC screening. The likelihood of screening increased with greater neighborhood satisfaction (OR = 1.38, 95% CI = 1.01, 1.90, p = 0.04), older age (OR = 1.75, 95% CI = 1.24, 2.48, p = 0.002), greater self-efficacy (OR = 2.73, 95% CI = 1.40, 5.35, p = 0.003), and health care provider communication (OR = 10.78, 95% CI = 4.85, 29.94, p = 0.0001). Community resources are important precursors to CRC screening and outcomes among African Americans. In addition to addressing psychological factors and patient-provider communication, efforts to ensure the availability of quality health care facilities that provide CRC screening in the neighborhoods where African Americans live are needed.
Collapse
Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA. .,Ralph H. Johnson Veterans Administration Medical Center, 68 President Street, Suite BE103, Charleston, SC, 29425, USA.
| | - Cathy Melvin
- Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA.,Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Vanessa Briggs
- Health Promotion Services, Public Health Management Corporation, Pennsylvania, 260 South Broad Street, Philadelphia, PA, 19102, USA
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, 1415 N. Broad Street, Suite 221B, Philadelphia, PA, 19122, USA
| | - LaShanta J Rice
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Cheryl Lynch
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.,Ralph H. Johnson Veterans Administration Medical Center, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Jerry C Johnson
- Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA, 19104-2676, USA
| |
Collapse
|
20
|
Downe S, Finlayson K, Melvin C, Spiby H, Ali S, Diggle P, Gyte G, Hinder S, Miller V, Slade P, Trepel D, Weeks A, Whorwell P, Williamson M. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG 2015; 122:1226-34. [PMID: 25958769 PMCID: PMC4690197 DOI: 10.1111/1471-0528.13433] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 01/19/2023]
Abstract
Objective (Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use. Design Multi-method randomised control trial (RCT). Setting Three NHS Trusts. Population Nulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness. Methods Randomisation at 28–32 weeks’ gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks’ gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal. Main outcome measures Primary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis. Results Six hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64–1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference −0.72, 95% CI −1.16 to −0.28, P = 0.001); fear (mean difference −0.62, 95% CI −1.08 to −0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: ‘Mean difference’ replaced ‘Odds ratio (OR)’ in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI −£257.93 to £267.59). Conclusions Allocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation. Tweetable abstract Going to 2 prenatal self-hypnosis groups didn't reduce labour epidural use but did reduce birth fear & anxiety postnatally at < £5 per woman.
Collapse
Affiliation(s)
- S Downe
- Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK
| | - K Finlayson
- Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK
| | - C Melvin
- Women & Children's Health Research Team, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - H Spiby
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - S Ali
- Department of Health Sciences, University of York, York, UK
| | - P Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - G Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women and Childrens' Health, Liverpool Women's NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - S Hinder
- RaFT Research, Clitheroe, Lancashire, UK
| | - V Miller
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - P Slade
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - D Trepel
- Department of Health Sciences, University of York, York, UK
| | - A Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - P Whorwell
- Centre for Gastrointestinal Sciences, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - M Williamson
- Women & Children's Health Research Team, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| |
Collapse
|
21
|
Halbert CH, Bellamy S, Briggs V, Bowman M, Delmoor E, Johnson JC, Kumanyika S, Melvin C, Purnell J, Rogers R, Weathers B. Intervention completion rates among African Americans in a randomized effectiveness trial for diet and physical activity changes. Cancer Epidemiol Biomarkers Prev 2014; 23:1306-13. [PMID: 24755713 DOI: 10.1158/1055-9965.epi-13-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The intervention completion rate is an important metric in behavioral and intervention research; trials with limited intervention completion rates may have reduced internal validity. We examined intervention completion rates among 530 African Americans who had been randomized to an integrated (INT) or disease-specific (DSE) risk education protocol as part of a comparative effectiveness trial from September 2009 to August 2012. METHODS The interventions were developed by an academic-community partnership using community-based participatory research. Intervention completion rates were determined based on attendance at all four intervention sessions. Intervention completers were participants who completed all four sessions and noncompleters were those who did not complete any session or only completed one to three sessions following randomization. RESULTS Seventy-three percent of participants were intervention completers and 27% were noncompleters. There were no differences in intervention completion based on randomization to INT (72%) or DSE (75%), sociodemographic factors, or body mass index (BMI) in the total sample. Different factors were associated significantly with intervention completion within study groups. Among participants randomized to INT, the odds of intervention completion were greater with higher levels of intrinsic motivation, less exposure to information about diet and cardiovascular disease, and greater BMI. Among participants randomized to DSE, the odds of completing the intervention were associated significantly with older age and greater dietary self-efficacy. CONCLUSIONS Many African Americans are likely to complete risk education interventions. IMPACT Psychologic characteristics should be considered when determining intervention completion rates following randomization in behavioral and intervention trials.
Collapse
Affiliation(s)
- Chanita Hughes Halbert
- Authors' Affiliations: Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center;
| | - Scarlett Bellamy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
| | | | - Marjorie Bowman
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Ernestine Delmoor
- National Black Leadership Initiative on Cancer, Philadelphia Chapter
| | | | - Shiriki Kumanyika
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics
| | - Cathy Melvin
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | | | - Rodney Rogers
- Christ of Calvary Community Development Corporation, Philadelphia, Pennsylvania; and
| | | |
Collapse
|
22
|
Stamatakis KA, Norton WE, Stirman SW, Melvin C, Brownson RC. Developing the next generation of dissemination and implementation researchers: insights from initial trainees. Implement Sci 2013; 8:29. [PMID: 23497462 PMCID: PMC3626831 DOI: 10.1186/1748-5908-8-29] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dissemination and implementation (D&I) research is a relatively young discipline, underscoring the importance of training and career development in building and sustaining the field. As such, D&I research faces several challenges in designing formal training programs and guidance for career development. A cohort of early-stage investigators (ESI) recently involved in an implementation research training program provided a resource for formative data in identifying needs and solutions around career development. RESULTS Responses outlined fellows' perspectives on the perceived usefulness and importance of, as well as barriers to, developing practice linkages, acquiring additional methods training, academic advancement, and identifying institutional supports. Mentorship was a cross-cutting issue and was further discussed in terms of ways it could foster career advancement in the context of D&I research. CONCLUSIONS Advancing an emerging field while simultaneously developing an academic career offers a unique challenge to ESIs in D&I research. This article summarizes findings from the formative data that outlines some directions for ESIs and provides linkages to the literature and other resources on key points.
Collapse
Affiliation(s)
- Katherine A Stamatakis
- Division of Public Health Sciences and Alvin J, Siteman Cancer Center, Washington University School of Medicine, Washington University in St, Louis, St, Louis, MO, USA.
| | | | | | | | | |
Collapse
|
23
|
Wheeler SB, Kohler RE, Goyal RK, Lich KH, Moore A, Smith T, Melvin C, Reeder-Hayes KE, Domino ME. Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
171 Background: Community Care of North Carolina (CCNC) initiated an innovative medical home (MH) program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes, but has not been evaluated in the context of cancer care. We sought to determine whether MH enrollment was associated with guideline-concordant surveillance and follow-up care among breast cancer survivors. Methods: Using state cancer registry records matched to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007 and tracked their CCNC enrollment. Using published American Society for Clinical Oncology breast cancer survivorship guidelines to define our outcomes, we employed multivariate logistic regressions to examine correlates of receipt of surveillance mammogram and at least two physical exams within 15 months post-diagnosis. Results: In total, 840 women were included in our sample. Approximately half were enrolled in a CCNC MH during the study period, 38% were enrolled for more than 7 months post-diagnosis. Enrollment in a MH for at least 7 months post-diagnosis was strongly associated with receiving guideline-recommended surveillance mammogram (p<0.01) and at least 2 physical exams (p<0.01) within 15 months post-diagnosis. Conclusions: Results suggest that MH enrollment is associated with higher quality breast cancer survivorship care among women insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on primary care MH, more research is needed to explore how medical homes can enhance and ensure the provision of guideline-recommended care during cancer survivorship.
Collapse
Affiliation(s)
| | | | - Ravi K. Goyal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Alexis Moore
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Timothy Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cathy Melvin
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | |
Collapse
|
24
|
Jones B, Lightfoot A, De Marco M, Isler MR, Ammerman A, Nelson D, Harrison L, Motsinger B, Melvin C, Corbie-Smith G. Community-responsive research priorities: health research infrastructure. Prog Community Health Partnersh 2012; 6:339-48. [PMID: 22982847 DOI: 10.1353/cpr.2012.0045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
THE PROBLEM A disconnect exists between research resources and the health and health care needs of people those resources are designed to serve. While a great deal of research is being produced at academic institutions across the country, the topics investigated are often driven by researchers' interests or by funding announcements focused on specific research areas of interest to the funder. PURPOSE OF THE ARTICLE: The purpose of this article is to describe a process that connects community identified health priorities with research funds as well as capacity building efforts. KEY POINTS The North Carolina Translational and Clinical Sciences Institute (NC TraCS) developed a process to identify the health priorities of North Carolina communities through a partnership with the network of county Healthy Carolinians partnerships. The priorities identified were obesity, youth issues, healthcare delivery/access, mental health/ substance abuse, specific chronic diseases, cancer/tobacco, and injury/ violence. NC TraCS then used these research priorities to guide pilot funding and facilitate research capacity building. CONCLUSIONS Tapping into an established community-based network and linking researchers to community-identified priorities ensures that NC TraCS addresses the most pressing health needs of North Carolina's residents.
Collapse
Affiliation(s)
- Bonnie Jones
- North Carolina Translational and Clinical Sciences Institute, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Kohler RE, Wheeler SB, Reeder-Hayes KE, Goyal RK, Lich KH, Smith T, Melvin C, Moore A, Muss HB. Endocrine therapy use among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.6017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6017 Background: Estrogen receptor positive (ER+) and progesterone receptor positive (PR+) cancers account for the majority of breast cancer diagnoses and deaths. Among women with ER+ or PR+ breast cancers, endocrine therapy (ET) is the cornerstone of adjuvant therapy and reduces 5-year risk of recurrence by as much as 40%. Observational studies in Medicare and privately-insured populations suggest that ET is underutilized. We sought to characterize ET use in a low-income Medicaid-insured population in North Carolina. Methods: We used Medicaid claims data matched to NC Central Cancer Registry records for women ages 18-64 diagnosed with in situ, stage I or II breast cancer from 2003-2007. We excluded dual eligibles and included only cases enrolled in Medicaid for at least 12 of the 15 months following the index diagnosis. We defined our outcome as receipt of any ET medication (tamoxifen, letrozole, exemestane, or anastroxole) in prescription claims during the 15-month period post-diagnosis, among women with ER+ or PR+ disease. In multivariate logistic regressions, independent variables included age, race, tumor characteristics, receipt of other breast cancer treatments, co-morbidity, rural/urban residence, reason for Medicaid eligibility, involvement in the Breast and Cervical Cancer Control Program (BCCCP), patient-centered medical home enrollment, and diagnosis year. Results: Of the 269 women who met inclusion/exclusion criteria and were ER+ or PR+, only 45% filled a prescription for ET during the study period. In multivariate analyses, being involved in the CDC-affiliated BCCCP was significantly associated with higher likelihood of receipt of guideline-recommended endocrine therapy (Marginal Effect: 0.299, p<0.01), but other independent variables were not significantly correlated with receipt of ET. Conclusions: Results suggest that ET is substantially underutilized in this low-income, vulnerable population and that intervention efforts to improve ET use may be important. Qualitative research is needed to understand the more nuanced, behavioral reasons for ET underuse, which may be related to symptom burden, cost, and patient-provider communication.
Collapse
Affiliation(s)
| | | | | | - Ravi K. Goyal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Timothy Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cathy Melvin
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alexis Moore
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hyman Bernard Muss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| |
Collapse
|
26
|
Wheeler SB, Kohler RE, Goyal RK, Reeder-Hayes KE, Lich KH, Smith T, Melvin C, Moore A, Domino ME. Patient-centered medical homes may improve breast cancer surveillance among survivors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.6029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6029 Background: Community Care of North Carolina (CCNC) initiated a medical home (MH) program in the early 1990s focused on improving care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular disease outcomes, but has not been examined in the context of cancer care. We sought to determine whether CCNC enrollment was associated with improved cancer surveillance among breast cancer survivors. Methods: Using state cancer registry records linked to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007. We included only cases insured by Medicaid for at least 12 of 15 months following the index cancer diagnosis. Reflecting ASCO guidelines for breast cancer surveillance for survivors (2006), we defined outcomes as time to first surveillance mammogram post-diagnosis and overall receipt of mammogram by 15-months post-diagnosis. Our primary independent variable was enrollment in CCNC, categorized as never enrolled, enrolled up to 6 months, and enrolled 7 months or more. We used multivariate Cox proportional hazards stratified by receipt of radiation therapy (RT) and logistic regressions. Results: 840 women were included in our sample. Approximately half were enrolled in CCNC for at least some time during the study period, 38% for more than 7 months post-diagnosis. Among women who received RT, being in a MH for at least 7 months corresponded to earlier follow-up mammogram (Hazard Ratio: 1.34; p=0.028), controlling for all other factors. Enrollment in a MH for at least 7 months post-diagnosis also was associated with overall receipt of mammogram by 15 months (p<0.01). Interaction terms indicated that women enrolled in MHs and living in a rural area had a statistically significant higher likelihood of receiving mammography. Conclusions: Results suggest that MH enrollment is associated with improved cancer surveillance among breast cancer survivors insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on MHs in the Affordable Care Act, more research is needed to explore how patient-centered medical homes can be enhanced to improve the transition from cancer patient to cancer survivor.
Collapse
Affiliation(s)
| | | | - Ravi K. Goyal
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Timothy Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cathy Melvin
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alexis Moore
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marisa E Domino
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
27
|
Bowen DJ, Sorensen G, Weiner BJ, Campbell M, Emmons K, Melvin C. Dissemination research in cancer control: where are we and where should we go? Cancer Causes Control 2009; 20:473-85. [PMID: 19224380 PMCID: PMC2915900 DOI: 10.1007/s10552-009-9308-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
Dissemination of evidence-based programs and policies is a critical final step in reducing the burden of cancer in the general public. Yet, we have not been fully successful to date in improving clinical or public health practice by disseminating programs found to be effective in research. Therefore, research is needed into the dissemination process and outcomes to enable better efforts in the future. This paper explores the definitions and models used for dissemination, the designs of dissemination studies, and possible research questions in dissemination research, all focused on cancer prevention and control. We hope that this paper will encourage dissemination research in our field.
Collapse
Affiliation(s)
- Deborah J Bowen
- Social and Behavioral Sciences Department, School of Public Health, Boston University, 715 Albany Street T2 W, Boston, MA 02118, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Adams K, Melvin C, Raskind-Hood C. Sociodemographic, insurance, and risk profiles of maternal smokers post the 1990s: How can we reach them? Nicotine Tob Res 2008; 10:1121-9. [DOI: 10.1080/14622200802123278] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Glanz K, Melvin C. How not to get lost in translation: implementing the recommendations and identifying research gaps. Am J Prev Med 2008; 35:S3-5. [PMID: 18541186 DOI: 10.1016/j.amepre.2008.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 04/14/2008] [Accepted: 04/16/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Glanz
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
| | | |
Collapse
|
30
|
Straub B, Melvin C, Labbok M. A descriptive study of Cambodian refugee infant feeding practices in the United States. Int Breastfeed J 2008; 3:2. [PMID: 18218121 PMCID: PMC2266734 DOI: 10.1186/1746-4358-3-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 01/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this exploratory study was to examine Cambodian refugee mothers' infant feeding beliefs, practices, and decision making regarding infant feeding in the U.S. and to explore if a culturally-specific breastfeeding program is appropriate for this community. Methods A self-administered questionnaire and a 30 minute in-person interview were used to collect information from nine women. The audio-taped interviews were transcribed, answers compiled, and themes from each question identified. Results All participants practiced either traditional Cambodian diet (pregnancy and postpartum diet including, tnam sraa, herbs mixed with either wine or tea), traditional Cambodian rituals (like spung, amodified sauna) or both, despite having lived in the U.S. for many years. All nine women initiated breastfeeding, however eight women introduced infant formula while in hospital. Perceived low milk supply and returning to work were the main reasons cited for partial breastfeeding and early cessation of breastfeeding. Conclusion While causes of initiation of other foods are similar to those found in the U.S. as a whole, a culturally-specific Cambodian breastfeeding support program may help overcome some breastfeeding problems reported by Cambodian refugee mothers who have immigrated to the United States.
Collapse
Affiliation(s)
- Becky Straub
- Department of Maternal and Child Health University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | | |
Collapse
|
31
|
Paz-Ares L, Pollak M, Eisenberg P, Blakely L, Haluska P, Cohen R, Kreisman H, Melvin C, Gualberto A, Karp D. 6508 ORAL CP-751, 871, an anti-IGF-IR antibody, in combination with paclitaxel and carboplatin or paclitaxel and carboplatin alone as first-line treatment for advanced non-small cell lung cancer (NSCLC): A phase Ib/randomized phase II, non-comparative, open label trial. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
32
|
Abstract
Advances in the number and type of medications for psychiatric illness have substantially aided physicians. However, as the number of available medications within a class increases, so does the complexity in decision making for provider and patient. Systematic review of a class of medications can assist providers in drug choice. The purpose and methods of such drug class reviews are described. Critical elements of a quality review include the choice of the question, explicit eligibility criteria, systematic search of the literature, article abstraction, and sometimes pooling of the data by using meta-analysis with direct or indirect comparison of study findings. Best practices are suggested for clinicians, administrators, and policy makers to consider when using drug class reviews in clinical organizations. The number of drug class reviews is increasing, and they have the potential to significantly assist providers, patients, and payers.
Collapse
Affiliation(s)
- Timothy S Carey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599, USA.
| | | | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND While smoking cessation interventions have been shown to work, questions remain about how to increase their efficacy. PURPOSE To examine strategies for effective tobacco treatment in adults and special populations. DATA SOURCES MEDLINE, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane Library, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts (1 January 1980 to 10 June 2005). STUDY SELECTION Systematic reviews; randomized, controlled trials; and observational studies. DATA EXTRACTION Two reviewers independently abstracted data on study design, population, sample size, treatment, outcomes, and quality. DATA SYNTHESIS Findings from systematic reviews were summarized and compared with findings from original research published beyond date ranges included in the reviews. Strength of evidence was used to assess the body of evidence. Our review included studies evaluating the efficacy of cessation strategies, such as self-help, counseling, single pharmaceutical agents, combined pharmacotherapies, and pharmacotherapies combined with psychological counseling. Research findings consistent with previous reviews show that self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve rates of success with quit attempts. Two studies of self-help materials reported discrepancies across effects. Five studies provided mixed results for counseling interventions. Fourteen studies provided sufficient evidence of the efficacy of single pharmacotherapy, combined pharmacotherapy, and psychological interventions either with or without pharmacotherapy. Few studies focused on ways to reach or treat special populations. Three studies with hospitalized patients had findings consistent with a previous review showing no strong evidence that clinical diagnosis affected the likelihood of quitting. New evidence was insufficient to address the effectiveness of interventions for persons with coexisting psychiatric conditions and substance abuse problems. LIMITATIONS Previous systematic reviews variably cover the range of issues we addressed. More recent studies do not fill all gaps, especially those for persons with coexisting disease. CONCLUSIONS Although self-help strategies alone marginally affect quit rates, individual and combined pharmacotherapies and counseling either alone or in combination can significantly increase cessation. Using effective smoking treatments is strongly encouraged for all populations, especially those with high and heavy rates of smoking, such as psychiatric and substance abuse populations.
Collapse
Affiliation(s)
- Leah Ranney
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | | | | | | | | |
Collapse
|
34
|
Ranney L, Melvin C, Lux L, McClain E, Morgan L, Lohr KN. Tobacco use: prevention, cessation, and control. Evid Rep Technol Assess (Full Rep) 2006:1-120. [PMID: 17764211 PMCID: PMC4781119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed the evidence on (a) the effectiveness of community- and population-based interventions to prevent tobacco use and to increase consumer demand for and implementation of effective cessation interventions; (b) the impacts of smokeless tobacco marketing on smoking, use of those products, and population harm; and (c) the directions for future research. DATA SOURCES We searched MEDLINE, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane libraries, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts from January 1980 through June 10, 2005. We included English-language randomized controlled trials, other trials, and observational studies, with sample size and follow-up restrictions. We used 13 Cochrane Collaboration systematic reviews, 5 prior systematic reviews, and 2 meta-analyses as the foundation for this report. REVIEW METHODS Trained reviewers abstracted detailed data from included articles into evidence tables and completed quality assessments; other senior reviewers confirmed accuracy and resolved disagreements. RESULTS We identified 1,288 unique abstracts; 642 did not meet inclusion criteria, 156 overlapped with prior reviews, and 2 were not published articles. Of 488 full-text articles retrieved and reviewed, we excluded 298 for several reasons, marked 88 as background, and retained 102. Evidence (consistent with previous reviews) showed that (a) school-based prevention interventions have short-term (but not long-term) effects on adolescents; (b) multicomponent approaches, including telephone counseling, increase the number of users who attempt to quit; (c) self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve success rates of quit attempts; and (d) provider training and academic detailing improve provider delivery of cessation treatments, but evidence is insufficient to show that these approaches yield higher quit rates. New evidence was insufficient to address the following: (a) effectiveness of population-based prevention interventions; (b) effectiveness of provider-based interventions to reduce tobacco initiation; (c) effectiveness of community- and provider-based interventions to increase use of proven cessation strategies; (d) effectiveness of marketing campaigns to switch tobacco users from smoking to smokeless tobacco products; and (e) effectiveness of interventions in populations with comorbidities and risk behaviors (e.g., depression, substance and alcohol abuse). No evidence was available on the way in which smokeless tobacco product marketing affects population harm. CONCLUSIONS The evidence base has notable gaps and numerous study deficiencies. We found little information to address some of the issues that previous authoritative reviews had not covered, some information to substantiate earlier conclusions and recommendations from those reviews, and no evidence that would overturn any previous recommendations.
Collapse
|
35
|
Gualberto A, Alsina M, Lacy M, Poutney S, Birgin A, Littman B, Melvin C, Petersen J. Inhibition of the insulin like growth factor 1 receptor by a specific monoclonal antibody in multiple myeloma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Gualberto
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - M. Alsina
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - M. Lacy
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - S. Poutney
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - A. Birgin
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - B. Littman
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - C. Melvin
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| | - J. Petersen
- Pfizer Global Rsrch & Dev, New London, CT; H Lee Moffitt Cancer Ctr & Rsrch Inst, Tampa, FL; Mayo Clinic, Rochester, MN
| |
Collapse
|
36
|
Melvin C, Bodley R, Booth A, Meagher T, Record C, Savage P. Managing errors in radiology: a working model. Clin Radiol 2004; 59:841-5. [PMID: 15351251 DOI: 10.1016/j.crad.2004.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 01/12/2004] [Accepted: 01/20/2004] [Indexed: 10/26/2022]
Abstract
AIM To develop a practical mechanism for reviewing reporting discrepancies as addressed in the Royal College of Radiologists publication "To err is human. The case for review of reporting discrepancies". MATERIALS AND METHODS A regular meeting was developed, and has evolved, within the department to review discrepancies. Standard forms were devised for submission of cases as well as recording and classification of discrepancies. This has resulted in availability of figures that can be audited annually. RESULTS Eighty-one cases involving error were reviewed over a 12-month period. Seven further cases flagged as discrepancies were not identified on peer review. Twenty-four reports were amended subsequent to the meeting. Nineteen additional cases were brought to the meeting as illustrative of teaching points or for discussion. CONCLUSION We have evolved a successful process of reviewing reporting errors, which enjoys the confidence and support of all clinical radiologists, and is perceived as a method of improving patient care through an increasing awareness of lapses in performance.
Collapse
Affiliation(s)
- C Melvin
- Department of Radiology, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK.
| | | | | | | | | | | |
Collapse
|
37
|
Orleans T, Melvin C, Marx J, Maibach E, Vose KK. National action plan to reduce smoking during pregnancy: the National Partnership to Help Pregnant Smokers Quit. Nicotine Tob Res 2004; 6 Suppl 2:S269-77. [PMID: 15203827 DOI: 10.1080/14622200410001669105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although there has been remarkable progress and momentum toward achieving smoke-free pregnancies in the United States since 1990, concerted action is needed to close the remaining gaps in treatment and prevention so that we can reach the Healthy People 2010 goal for pregnant smokers: a prevalence of 1% or less. This need for action led to the formation of the National Partnership to Help Pregnant Smokers Quit, a collaboration among more than 50 organizations and agencies, public and private, that have joined forces to help pregnant smokers quit by providing proven clinical and community-based interventions to every pregnant smoker. This article summarizes the action plan developed by the partnership, the strategies it outlines, and some of the actions taken by partners over the past year to put the plan into action. Action is planned and progress is being made in five strategic areas: offering help through the health care system; using the media effectively; harnessing community and worksite resources; promoting policies known to increase smoking cessation efforts and successes; and expanding national research, surveillance, and evaluation efforts.
Collapse
Affiliation(s)
- Tracy Orleans
- The Robert Wood Johnson Foundation, Princeton, NJ 08543, USA.
| | | | | | | | | |
Collapse
|
38
|
Abstract
A growing volume of research since 1975 has demonstrated that clinically proven, effective interventions exist to produce long-term or even permanent abstinence from tobacco for all smokers. Achieving cessation is important for all smokers but especially for pregnant and parenting smokers because their smoking poses risks not only for themselves but also for their pregnancies and children. Treatments for smokers in general apply to parenting smokers, but special considerations regarding treatment need to be made for pregnant women. Due to the harms associated with exposure to environmental tobacco smoke, or second-hand smoke (SHS), parents and caregivers of young children should receive treatment to achieve cessation or counseling on how to eliminate exposure of children to SHS. Despite the availability of these treatments, surveys show that fewer than half of all obstetricians caring for pregnant women in the United States actually provide such treatment. We review the recommendations made in 2000 regarding treatment for pregnant and parenting smokers, summarize recent findings that may affect treatment protocols, and make recommendations regarding further research in treatment approaches for pregnant and parenting smokers. We summarize recommended changes in treatment approaches for clinicians based on this review and describe the factors affecting clinician adoption and use of proven treatments and systems supports found to increase the likelihood of clinician use of these treatments.
Collapse
Affiliation(s)
- Cathy Melvin
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
| | | |
Collapse
|
39
|
Adams EK, Nishimura B, Merritt RK, Melvin C. Costs of poor birth outcomes among privately insured. J Health Care Finance 2003; 29:11-27. [PMID: 12635991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Despite expansions in the public insurance coverage of pregnant women, concerns over poor birth outcomes remain. Poor birth outcomes occur among publicly and privately insured women, however, thereby imposing excess costs on employers and their insurers. Data from a large sample of privately insured for 1996 are used to examine these outcomes and costs. Almost one-fourth (24.3 percent) of the infants in our matched sample of 12,020 deliveries was premature or had other problems at birth. Costs for these infants accounted for 82 percent of the total $56 million spent on sample infants. The incremental cost of infants with poor birth outcomes versus those with normal, full-terms was approximately $14,600. We found that these relative costs had increased over time due perhaps to the increased technology and intensity of services used to save infant lives. We also found that factors other than maternal and infant complications affected cost variations. For example, employers located in the Northeast, hiring older mothers, and in unionized sectors have higher prenatal, delivery, and infant costs.
Collapse
Affiliation(s)
- E Kathleen Adams
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | |
Collapse
|
40
|
Adams EK, Miller VP, Ernst C, Nishimura BK, Melvin C, Merritt R. Neonatal health care costs related to smoking during pregnancy. Health Econ 2002; 11:193-206. [PMID: 11921317 DOI: 10.1002/hec.660] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
RESEARCH OBJECTIVE Much of the work on estimating health care costs attributable to smoking has failed to capture the effects and related costs of smoking during pregnancy. The goal of this study is to use data on smoking behavior, birth outcomes and resource utilization to estimate neonatal costs attributable to maternal smoking during pregnancy. STUDY DESIGN We use 1995 data from the Center for Disease Control's (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) database. The PRAMS collects representative samples of births from 13 states (Alabama, Alaska, California, Florida, Georgia, Indiana, Maine, Michigan, New York (excluding New York City), Oklahoma, South Carolina, Washington, and West Virginia), and the District of Columbia. The 1995 PRAMS sample is approximately 25 000. Multivariate analysis is used to estimate the relationship of smoking to probability of admission to an NICU and, separately, the length of stay for those admitted or not admitted to an NICU. Neonatal costs are predicted for infants 'as is' and 'as if' their mother did not smoke. The difference between these constitutes smoking attributable neonatal costs; this divided by total neonatal costs constitutes the smoking attributable fraction (SAF). We use data from the MarketScantrade mark database of the MedStattrade mark Corporation to attach average dollar amounts to NICU and non-NICU nursery nights and data from the 1997 birth certificates to extrapolate the SAFs and attributable expenses to all states. PRINCIPAL FINDINGS The analysis showed that maternal smoking increased the relative risk of admission to an NICU by almost 20%. For infants admitted to the NICU, maternal smoking increased length of stay while for non- NICU infants it appeared to lower it. Over all births, however, smoking increased infant length of stay by 1.1%. NICU infants cost $2496 per night while in the NICU and $1796 while in a regular nursery compared to only $748 for non-NICU infants. The combination of the increased NICU use, longer stays and higher costs result in a positive smoking attributable fraction (SAF) for neonatal costs. The SAF across all states is 2.2%. Across the states, the SAF varied from a low of 1.3% in Texas to a high of 4.6% in Indiana. CONCLUSIONS These results further confirm the adverse effects of smoking. Among mothers who smoke, smoking adds over $700 in neonatal costs. The smoking attributable neonatal costs in the US represent almost $367 million in 1996 dollars; these costs vary from less than a million in smaller states to over $35 million in California. These costs are highly preventable since the adverse effects of maternal smoking occur in the short-run and can be avoided by even a temporary cessation of maternal smoking. These cost estimates can be used by managed care plans, state and local public health officials and others to evaluate alternative smoking cessation programs.
Collapse
Affiliation(s)
- E Kathleen Adams
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Ahluwalia IB, Johnson C, Rogers M, Melvin C. Pregnancy Risk Assessment Monitoring System (PRAMS): unintended pregnancy among women having a live birth. PRAMS Working Group. J Womens Health Gend Based Med 1999; 8:587-9. [PMID: 10839641 DOI: 10.1089/jwh.1.1999.8.587] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
42
|
Morel DR, Huttemeier PC, Skoskiewicz MJ, Nguyenduy T, Melvin C, Robinson DR, Zapol WM. Dose-dependent effects of a pyridoquinazoline thromboxane synthetase inhibitor on arachidonic acid metabolites and hemodynamics during E. coli endotoxemia in anesthetized sheep. Prostaglandins 1987; 33:879-902. [PMID: 3118413 DOI: 10.1016/0090-6980(87)90116-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We investigated the effects of a new pyridoquinazoline thromboxane synthetase inhibitor infused before administering Escherichia Coli endotoxin into 18 anesthetized sheep with lung lymph fistulas. In normal sheep increasing plasma Ro 23-3423 concentrations were associated with increased plasma levels of 6-keto-PGF1 alpha, a reduced systemic vascular resistance (SVR, r = -0.80) and systemic arterial pressure (SAP, r = -0.92), the mean SAP falling from 80 to 50 mm Hg at the 20 and 30 mg/kg doses. Endotoxin infused into normal sheep caused transient pulmonary vasoconstriction associated with increased TxB2 and 6-keto-PGF1 alpha levels while vasoconstriction and TxB2 increase were significantly inhibited by pretreatment with Ro 23-3423 in a dose-dependent manner. When compared to controls, plasma and lymph levels of 6-keto-PGF1 alpha, PGF2 alpha and PGE2 after endotoxin infusion were increased several-fold by administering Ro 23-3423 up to plasma levels of 10 micrograms/ml. Doses over 30 mg/kg with blood levels above 10 micrograms/ml reduced plasma and lymph levels of 6-keto-PGF1 alpha, PGF2 alpha and PGE2, suggesting cyclooxygenase blockade at this dose. The peak 6-keto-PGF1 alpha levels at 60 min after endotoxin infusion in sheep with Ro-23-3423 levels below 10 micrograms/ml were associated with the greatest systemic hypotension due to a reduced SVR (r = -0.86). After endotoxin infusion the leukotrienes B4, C4, D4 and E4 in lung lymph were assayed by radioimmunoassay and high pressure liquid chromatography and remained at baseline values.
Collapse
Affiliation(s)
- D R Morel
- Department of Anesthesia, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | |
Collapse
|
43
|
Robinson DR, Skoskiewicz M, Bloch KJ, Castorena G, Hayes E, Lowenstein E, Melvin C, Michelassi F, Zapol WM. Cyclooxygenase blockade elevates leukotriene E4 production during acute anaphylaxis in sheep. J Exp Med 1986; 163:1509-17. [PMID: 3011947 PMCID: PMC2188117 DOI: 10.1084/jem.163.6.1509] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We examined changes in the levels of eicosanoids in blood and pulmonary lymph of anesthetized sheep undergoing acute anaphylaxis. Within 1-3 min of intravenous antigenic challenge of previously sensitized sheep, there were approximately 7-30-fold elevations in mean arterial plasma levels of thromboxane B2 and 6-ketoprostaglandin F1 alpha, respectively, as measured by RIA. Negligible changes in levels of these cyclooxygenase products were found in both nonsensitized sheep and in sensitized sheep treated with indomethacin before antigenic challenge. In contrast, no changes in levels of sulfidopeptide leukotrienes (SPLT) in pulmonary lymph were detectable by RIA during anaphylaxis in sensitized or nonsensitized sheep, but levels of SPLT in indomethacin-treated sensitized sheep increased more than fivefold above levels in lymph from both other groups of animals. The immunoreactive SPLT in lymph from indomethacin-treated sheep was accounted for as LTE4, as demonstrated by mobility on HPLC and absorbance at 280 nm. These results support the possibility that certain undesirable effects of nonsteroidal antiinflammatory drugs, such as cardiopulmonary reactions in aspirin-sensitive individuals, and impaired renal and cardiac function during therapy with these drugs, may be related in part to augmented synthesis of the 5-lipoxygenase pathway products, especially those of the sulfidopeptide class. Increased LT production could also limit the antiinflammatory effectiveness of these drugs in many disease states.
Collapse
|
44
|
Liberman A, Melvin C, Bustamante M, Willey E. A community services approach to quality assurance in a mental retardation facility. Med Rec News 1978; 49:64, 66-7, 69 passim. [PMID: 10273094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|