Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program

PRCIS

Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling.

PURPOSE

The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program.

MATERIAL AND METHODS

A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program.

RESULTS

Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P =0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return.

CONCLUSIONS

Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.

Tissue distribution of ethanol after intraprostatic injection using a porous needle

Purpose

To develop a safe and precise method for intraprostatic injection, and to establish correlation between the volume of ethanol injectate and the volume of subsequent infiltrated prostate tissue.

Materials and methods

We performed intraprostatic injection of 96% ethanol using a needle which has a segment of its wall made of capillary membrane with hundreds of pores in an acute and chronic canine experiment, in heart-beating cadaveric organ donors, and in a xenograft model of human prostate cancer. Whole mount tissue sections were used for three-dimensional reconstruction of the necrotic lesions and calculation of their volumes.

Results

The ethanol injection resulted in oval shaped lesions of well-delineated coagulative necrosis. In both healthy human and canine prostates, the prostatic pseudocapsule and neurovascular bundle remained intact without evidence of disruption. There was a linear correlation between administered volume of ethanol and the volume of necrotic lesion. Regression analysis showed strong correlation in the acute canine experiments and in experiments performed on xenografts of human prostate cancer. A formula was calculated for each experiment to estimate the relationship between the injected volume and the volume of infiltrated prostate tissue area.

Conclusions

Intraprostatic injection using a porous needle allows for effective and predictable tissue distribution of the injectate in the prostate. Through varying the volume of the agent injected and use of needles with a different length of the porous segment, the volume of infiltrated tissue could be adjusted allowing for targeted focal treatment.

Auditory habituation in young and older adults: the verbal transformation effect

In 3 experiments, auditory massed repetition was used to examine age-related differences in habituation by means of the verbal transformation paradigm. Participants heard 10 words (5 high frequency and 5 low frequency), each presented 180 times, and they reported perceived changes in the repeated words (verbal transformations). In these experiments, older adults reported fewer illusory percepts than young adults. Older adults' loss of auditory acuity and slowing of processing, stimulus degradation (in young adults), and instructions biasing the report of these illusory percepts did not account for the fewer illusory percepts reported by the older adults. These findings suggest that older adults' reduced susceptibility to habituation arises from centrally located declines in the transmission of information within the word-recognition pathway. The discussion focuses on the implications that these age-related declines may have on word identification during on-line speech perception.

Auditory habituation in young and older adults: the verbal transformation effect

In 3 experiments, auditory massed repetition was used to examine age-related differences in habituation by means of the verbal transformation paradigm. Participants heard 10 words (5 high frequency and 5 low frequency), each presented 180 times, and they reported perceived changes in the repeated words (verbal transformations). In these experiments, older adults reported fewer illusory percepts than young adults. Older adults' loss of auditory acuity and slowing of processing, stimulus degradation (in young adults), and instructions biasing the report of these illusory percepts did not account for the fewer illusory percepts reported by the older adults. These findings suggest that older adults' reduced susceptibility to habituation arises from centrally located declines in the transmission of information within the word-recognition pathway. The discussion focuses on the implications that these age-related declines may have on word identification during on-line speech perception.

Direct comparison of auditory implicit memory tests

In this experiment, we examined the degree to which four implicit tests and two explicit tests, all involving auditory presentation, were sensitive to the perceptual characteristics of the stimuli presented during study. Presenting stimuli visually decreased priming in all the implicit memory tests, relative to auditory presentation. However, changing voice between study and test decreased priming only in the implicit memory tests requiring identification of words degraded by noise or by low-pass filtering, but not in those tests requiring generation from word portions (stems and fragments). Modality effects without voice effects were observed in cued recall, but the opposite pattern of results (voice effects without modality effects) was obtained in recognition. The primary new finding is the demonstration that auditory memory tests, both explicit and implicit, differ in their sensitivity to the perceptual information encoded during study.

Sensitive topics and adolescents: making research about risk behaviors happen

This article discusses conducting research with adolescents as a positive experience, both from a clinical and scholarly perspective. However, topics involving risk-taking behaviors may be especially difficult for adolescents to discuss openly. To implement research protocols with the adolescent population, particularly when dealing with risk-taking behaviors, investigators need to be aware of developmental challenges that warrant specific methodological choices. In a pilot study that involved adolescents who had been hospitalized for traumatic injury, the researchers gained valuable experience in conducting a study on substance use. Experiences with the study provide direction for future research about investigating sensitive topics with adolescents.

Representing refugees: the role of elites in Burundi refugee society

Among Burundi refugees in Tanzania, men who have a university education and know English or French are most likely to represent their concerns to officials, particularly those from UNHCR. Officials consequently learn about the perspectives of refugees from these men. Based upon findings from two years of field research in Tanzania, the history of relations between ethnic Hutu elites and the peasantry in Burundi is outlined and it is explained why education has assumed such pronounced significance in Burundi refugee society. The use of ethnicity as a political tool for elite refugees is also described. It is concluded that elite refugees may not, as is often claimed, represent the refugee majority.