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Chu CD, Smith CE, Gorski J, Smolkin M, Zhao H, Jones RA, Hollen P, Dengel LT. Implementation of a Novel Patient Decision Aid for Women with Elevated Breast Cancer Risk Who Are Considering MRI Screening: A Pilot Study. Ann Surg Oncol 2023; 30:6152-6158. [PMID: 37505352 DOI: 10.1245/s10434-023-13901-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening. METHODS This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability. RESULTS Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow. CONCLUSIONS This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.
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Affiliation(s)
- Crystal D Chu
- University of Virginia School of Nursing, Charlottesville, VA, USA.
| | - Caleigh E Smith
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Smolkin
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Hui Zhao
- James Madison University School of Nursing, Harrisonburg, VA, USA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Patricia Hollen
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Lynn T Dengel
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Statler MC, Wall BM, Richardson JW, Jones RA, Kools S. Illuminating the Contributions of African American Nurse Scientists Despite Structural Racism Barriers: A Qualitative Descriptive Study. ANS Adv Nurs Sci 2023; 46:381-398. [PMID: 36730844 DOI: 10.1097/ans.0000000000000463] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A qualitative descriptive approach examined African American nurse scientists' (AANSs') experiences with African American research participants despite obstacles of structural racism. Fourteen nurse scientists participated in semistructured interviews that provided data for the thematic analysis. Major themes included barriers to overcome as doctoral students, cultural experiences with structural racism, designers of culturally sensitive research, and humanitarian respect and relationship depth. This is the first research study to illuminate the contributions of AANSs who lead research in health disparities. Therefore, nursing leadership needs to illuminate AANSs' contributions, increase nurse diversification, and dismantle structural racism that creates obstacles that ultimately impact population health.
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Affiliation(s)
- Marie Campbell Statler
- Towson University Department of Nursing, Hagerstown, Maryland (Dr Statler); and University of Virginia School of Nursing (Drs Wall, Jones, and Kools), and Department of Public Health Sciences, University of Virginia School of Medicine (Dr Richardson), Charlottesville
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Hood V, Bandini L, Carter T, Schatz A, Sweetenham J, Smedley W, Fawzy Morales J, Nellis RV, Jones RA, Zonakis L, Carlson RW. NCCN Policy Summit: Cancer Care in the Workplace: Building a 21st Century Workplace for Patients, Survivors, and Caretakers. J Natl Compr Canc Netw 2023; 21:459-464. [PMID: 37156481 DOI: 10.6004/jnccn.2023.7007] [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] [Received: 12/06/2022] [Accepted: 02/01/2023] [Indexed: 05/10/2023]
Abstract
Survival rates for people with cancer and quality of life for survivors have increased significantly as a result of innovations in cancer treatment, improvements in early detection, and improved healthcare access. In the United States, 1 in 2 men and 1 in 3 women will be diagnosed with cancer in their lifetime. As more cancer survivors and patients remain in the workforce, employers must evaluate how they can adjust workplace policies to meet employee and business needs. Unfortunately, many people still encounter barriers to remaining in the workplace following a cancer diagnosis for themselves or a loved one. In an effort to explore the impacts of contemporary employment policies on patients with cancer, cancer survivors, and caregivers, NCCN hosted the Policy Summit "Cancer Care in the Workplace: Building a 21st Century Workplace for Cancer Patients, Survivors, and Caretakers" on June 17, 2022. This hybrid event, through keynotes and multistakeholder panel discussions, explored issues regarding employer benefit design, policy solutions, current best and promising practices for return to work, and how these issues impact treatment, survivorship, and caregiving in the cancer community.
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Affiliation(s)
- Victoria Hood
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Lindsey Bandini
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Taneal Carter
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Alyssa Schatz
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - John Sweetenham
- 2Southwestern Simmons Comprehensive Cancer Center, Dallas, Texas
| | | | | | | | - Randy A Jones
- 6University of Virginia School of Nursing, Charlottesville, Virginia
| | | | - Robert W Carlson
- 1National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
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Bennett R, DeGuzman PB, LeBaron V, Wilson D, Jones RA. Exploration of shared decision making in oncology within the United States: a scoping review. Support Care Cancer 2023; 31:94. [PMID: 36585510 PMCID: PMC9803891 DOI: 10.1007/s00520-022-07556-8] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions. METHODS We conducted a scoping review using the Arksey and O'Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016. RESULTS Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience. CONCLUSION Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.
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Affiliation(s)
- Rachel Bennett
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Pamela B. DeGuzman
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Virginia LeBaron
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Daniel Wilson
- University of Virginia Health Library, 1350 Jefferson Park Avenue, VA 22908 Charlottesville, USA
| | - Randy A. Jones
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
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5
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Affiliation(s)
- Randy A Jones
- University of Virginia School of Nursing, Charlottesville
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Jones RA, Hirschey R, Campbell G, Cooley ME, Lally R, Rueter EK, Gullatte MM. Update to 2019-2022 ONS Research Agenda: Rapid Review to Promote Equity in Oncology Healthcare Access and Workforce Development. Oncol Nurs Forum 2021; 48:604-612. [PMID: 34673761 DOI: 10.1188/21.onf.604-612] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The Oncology Nursing Society (ONS) tasked a rapid response research team (RRRT) to develop priorities to increase diversity, equity, and inclusivity in oncology clinical care and workforce development. METHODS An RRRT of experts in health disparities conducted a rapid review of the literature, consulted with oncology nurse leaders and disparities researchers, and reviewed priorities from funding agencies. RESULTS Significant gaps in the current oncology disparities literature were identified and used to inform priority areas for future research practice and workforce development in oncology nursing. SYNTHESIS This is the second article in a two-part series that presents findings on structural racism and health inequities in oncology nursing. In the first article, three priority areas for oncology nursing research were presented. In this article, strategies to improve diversity, equity, and inclusivity in clinical practice and the oncology workforce are described. IMPLICATIONS FOR RESEARCH Recommendations are presented to inform research, clinical, administrative, and academic oncology nursing settings on increasing diversity, equity, and inclusivity and deconstructing structural racism.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville
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Carhuapoma LR, Thayer WM, Elmore CE, Gildersleeve J, Singh T, Shaukat F, Uveges MK, Gray T, Chu C, Song D, Hollen PJ, Wenzel J, Jones RA. Employing a mobile health decision aid to improve decision-making for patients with advanced prostate cancer and their decision partners/proxies: the CHAMPION randomized controlled trial study design. Trials 2021; 22:631. [PMID: 34530868 PMCID: PMC8444368 DOI: 10.1186/s13063-021-05602-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with minimal inclusion of patients with advanced prostate cancer and their decision partners. The use of a community patient navigator (CPN) has been shown to have a positive supportive role in health care, particularly with individuals from minority populations. Research is needed to evaluate decision support interventions tailored to the needs of advanced prostate cancer patients and their decision partners in diverse populations. METHODS Guided by Janis and Mann's Conflict Model of Decision Making, the Cancer Health Aid to Manage Preferences and Improve Outcomes through Navigation (CHAMPION) is a randomized controlled trial to assess the feasibility and acceptability of a mobile health (mHealth), CPN-administered decision support intervention designed to facilitate communication between patients, their decision partners, and the healthcare team. Adult prostate cancer patients and their decision partners at three mid-Atlantic hospitals in the USA were randomized to receive enhanced usual care or the decision intervention. The CHAMPION intervention includes a theory-based decision-making process tutorial, immediate and health-related quality of life graphical summaries over time (using mHealth), values clarification via a balance sheet procedure with the CPN support during difficult decisions, and facilitated discussions with providers to enhance informed, shared decision-making. DISCUSSION The CHAMPION intervention is designed to leverage dynamic resources, such as CPN teams, mHealth technology, and theory-based information, to support decision-making for advanced prostate cancer patients and their decision partners. This intervention is intended to engage decision partners in addition to patients and represents a novel, sustainable, and scalable way to build on individual and community strengths. Patients from minority populations, in particular, may face unique challenges during clinical communication. CHAMPION emphasizes the inclusion of decision partners and CPNs as facilitators to help address these barriers to care. Thus, the CHAMPION intervention has the potential to positively impact patient and decision partner well-being by reducing decisional conflict and decision regret related to complex, treatment-based decisions, and to reduce cancer health disparities. Trial registration ClinicalTrials.gov NCT03327103 . Registered on 31 October 2017-retrospectively registered. World Health Organization Trial Registration Data Set included in Supplementary Materials.
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Affiliation(s)
- Lourdes R. Carhuapoma
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
- Division of Neurosciences Critical Care, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Winter M. Thayer
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Catherine E. Elmore
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
| | - Jane Gildersleeve
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
| | - Tanmay Singh
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 401 North Broadway, Baltimore, MD 21231 USA
| | - Farah Shaukat
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Melissa K. Uveges
- Boston College Connell School of Nursing, Maloney Hall 375, 140 Commonwealth Avenue, Chestnut Hill, MA USA
| | - Tamryn Gray
- Palliative Care, Dana Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215 USA
| | - Crystal Chu
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
| | - Daniel Song
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, 401 North Broadway, Baltimore, MD 21231 USA
| | - Patricia J. Hollen
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
| | - Jennifer Wenzel
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Randy A. Jones
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA 22908 USA
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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Beller HL, Corey T, Horton BJ, Lobo JM, Schenkman NS, Sims T, Jones RA, Krupski TL. Optimizing Telemedicine Technologic Infrastructure with Animal Models: A Case in Telecystoscopy. Telemed J E Health 2020; 27:568-574. [PMID: 32907508 DOI: 10.1089/tmj.2020.0188] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Rapid evolution of telemedicine technology requires procedures in telemedicine to adapt frequently. An example in urology, telecystoscopy, allows certified advanced practice providers to perform cystoscopy, endoscopic examination of the bladder, in rural areas with real-time interpretation and guidance by an off-site urologist. We have previously shown the technological infrastructure for optimized video quality. Introduction: Newer models of cystoscope and coder/decoder (codec) are available with anticipation that components used in our original model will become unavailable. Our objective is to assess the diagnostic ability of two cystoscopes (Storz, Wolf) with old (SX20) and new (DX70) codecs. Materials and Methods: A single urologist performed flexible cystoscopy on an ex vivo porcine bladder. Combinations of cystoscope (Storz vs. Wolf), codec (SX20 vs. DX70), and internet transmission speed were used to create eight distinct recordings. Deidentified videos were reviewed by expert urologist reviewers via electronic survey with questions on video quality and diagnostic ability. A logistic regression model was used to assess the ability to make a diagnosis. Results: Eight transmitted cystoscopy videos were reviewed by 16 urologists. Despite new technology, the Storz cystoscope combined with the SX20 codec (the original combination) provides the best diagnostic capacity. Discussion: Technical infrastructure must be routinely validated to assess the component impact on overall quality because newer is not always better. Should the SX20 become obsolete, ex vivo animal models are safe, inexpensive anatomic models for testing. Conclusions: As technology continues to evolve, procedures in telemedicine must critically scrutinize the impact of new technologic components to uphold quality.
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Affiliation(s)
- Haerin L Beller
- Department of Urology, and University of Virginia, Charlottesville, Virginia, USA
| | - Thomas Corey
- TeleMedicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Bethany J Horton
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer M Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Noah S Schenkman
- Department of Urology, and University of Virginia, Charlottesville, Virginia, USA
| | - Terran Sims
- Department of Urology, and University of Virginia, Charlottesville, Virginia, USA
| | - Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Tracey L Krupski
- Department of Urology, and University of Virginia, Charlottesville, Virginia, USA
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Jones RA, Barratt J, Brettell EA, Cockwell P, Dalton RN, Deeks JJ, Eaglestone G, Pellatt-Higgins T, Kalra PA, Khunti K, Morris FS, Ottridge RS, Sitch AJ, Stevens PE, Sharpe CC, Sutton AJ, Taal MW, Lamb EJ. Biological variation of cardiac troponins in chronic kidney disease. Ann Clin Biochem 2020; 57:162-169. [DOI: 10.1177/0004563220906431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Patients with chronic kidney disease often have increased plasma cardiac troponin concentration in the absence of myocardial infarction. Incidence of myocardial infarction is high in this population, and diagnosis, particularly of non ST-segment elevation myocardial infarction (NSTEMI), is challenging. Knowledge of biological variation aids understanding of serial cardiac troponin measurements and could improve interpretation in clinical practice. The National Academy of Clinical Biochemistry (NACB) recommended the use of a 20% reference change value in patients with kidney failure. The aim of this study was to calculate the biological variation of cardiac troponin I and cardiac troponin T in patients with moderate chronic kidney disease (glomerular filtration rate [GFR] 30–59 mL/min/1.73 m2). Methods and results Plasma samples were obtained from 20 patients (median GFR 43.0 mL/min/1.73 m2) once a week for four consecutive weeks. Cardiac troponin I (Abbott ARCHITECT® i2000SR, median 4.3 ng/L, upper 99th percentile of reference population 26.2 ng/L) and cardiac troponin T (Roche Cobas® e601, median 11.8 ng/L, upper 99th percentile of reference population 14 ng/L) were measured in duplicate using high-sensitivity assays. After outlier removal and log transformation, 18 patients’ data were subject to ANOVA, and within-subject (CVI), between-subject (CVG) and analytical (CVA) variation calculated. Variation for cardiac troponin I was 15.0%, 105.6%, 8.3%, respectively, and for cardiac troponin T 7.4%, 78.4%, 3.1%, respectively. Reference change values for increasing and decreasing troponin concentrations were +60%/–38% for cardiac troponin I and +25%/–20% for cardiac troponin T. Conclusions The observed reference change value for cardiac troponin T is broadly compatible with the NACB recommendation, but for cardiac troponin I, larger changes are required to define significant change. The incorporation of separate RCVs for cardiac troponin I and cardiac troponin T, and separate RCVs for rising and falling concentrations of cardiac troponin, should be considered when developing guidance for interpretation of sequential cardiac troponin measurements.
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Affiliation(s)
- RA Jones
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - J Barratt
- University Hospitals of Leicester, Leicester, UK
| | - EA Brettell
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - P Cockwell
- Renal Medicine, Queen Elizabeth Hospital Birmingham and Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - RN Dalton
- Evelina London Children’s Hospital, London, UK
| | - JJ Deeks
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Test Evaluation Research Group, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Eaglestone
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - T Pellatt-Higgins
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - PA Kalra
- Salford Royal NHS Foundation Trust, Salford, UK
| | - K Khunti
- University of Leicester, Leicester, UK
| | - FS Morris
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - RS Ottridge
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - AJ Sitch
- Test Evaluation Research Group, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - PE Stevens
- Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - CC Sharpe
- King’s College London & King’s College Hospital NHS Foundation Trust, London, UK
| | - AJ Sutton
- Institute of Health Economics (IHE), Edmonton, Canada
| | - MW Taal
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - EJ Lamb
- Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
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Beller H, Lobo JM, Horton BJ, Sims T, Corey T, Tyson T, Schenkman NS, Krupski TL, Jones RA. Adapting nurse-led cystoscopy experience to the United States: Tele-cystoscopy a possible compromise? Int J Urol Nurs 2019. [DOI: 10.1111/ijun.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haerin Beller
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Jennifer M. Lobo
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Bethany J. Horton
- Public Health Sciences; University of Virginia Healthcare System; Charlottesville Virginia
| | - Terran Sims
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Thomas Corey
- Center for Telehealth; University of Virginia; Charlottesville Virginia
| | | | - Noah S. Schenkman
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Tracey L. Krupski
- Department of Urology; University of Virginia Healthcare System; Charlottesville Virginia
| | - Randy A. Jones
- School of Nursing; University of Virginia; Charlottesville Virginia
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12
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Beller HL, Mills J, Mason J, Horton BJ, Jones RA, Corey T, Sims T, Schenkman NS, Krupski TL. Diagnostic utility of tele-cystoscopy for bladder cancer surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18335] [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
e18335 Background: Urology workforce shortage in rural areas limits access to surveillance cystoscopy for bladder cancer. Tele-cystoscopy is a novel solution whereby an advanced practice provider (APP) performs cystoscopy at a satellite location with real-time interpretation and guidance by an off-site urologist via transmitted video. We hypothesized that tele-cystoscopy videos would be comparable to traditional cystoscopy videos in diagnostic utility. Methods: Our IRB approved tele-cystoscopy protocol utilizes a dual-cystoscopy model. Two sequential cystoscopies are performed first by an APP with off-site urologist guidance (tele-cystoscopy) then by a urologist onsite (traditional cystoscopy) without removal of the cystoscope from the urethra. Both cystoscopies are video-captured. Twelve de-identified videos were reviewed via electronic survey (Qualtrics) by board-certified urologists who were blinded as to whom performed the cystoscopy. Survey questions centered on completeness of exam and diagnostic level of suspicion. A random effects logistic regression model was used to account for multiple reviews of the same video. Results: Diagnostic utility, defined as visibility sufficient for diagnosis, was 83% for both tele-cystoscopy and traditional cystoscopy. There were no statistically significant differences in completeness of exam between the two techniques (tele 83.3%, traditional 91.7%, p = 0.308). When asked about action taken based on cystoscopic findings, reviewers recommended action other than planned surveillance (i.e., biopsy, operative resection, etc.) for 58.3% of tele-cystoscopy videos vs. 66.7% for traditional cystoscopy videos (p = 0.300). Conclusions: Tele-cystoscopy provides high quality bladder surveillance with diagnostic capacity comparable to that of traditional cystoscopy. These results support continued expansion of the tele-cystoscopy platform as a means to amplify the care provided by a single urologist. [Table: see text]
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Affiliation(s)
| | | | | | - Bethany J. Horton
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA
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Wilson LS, Blonquist TM, Hong F, Halpenny B, Wolpin S, Chang P, Filson CP, Master VA, Sanda MG, Chien GW, Jones RA, Krupski TL, Berry DL. Assigning value to preparation for prostate cancer decision making: a willingness to pay analysis. BMC Med Inform Decis Mak 2019; 19:6. [PMID: 30626400 PMCID: PMC6327504 DOI: 10.1186/s12911-018-0725-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Personal Patient Profile-Prostate (P3P) is a web-based decision support system for men newly diagnosed with localized prostate cancer that has demonstrated efficacy in reducing decisional conflict. Our objective was to estimate willingness-to-pay (WTP) for men's decisional preparation activities. METHODS In a multicenter, randomized trial of P3P, usual care group participants received typical preparation for decision making plus referral to publicly-available, educational websites. Intervention group participants received the same, plus online P3P educational media specific to the user's personal preferences and values, and a communication coaching component tailored to race\ethnicity, age and language. WTP data were collected one week after physician consultation. An iterative bidding direct contingent valuation survey format was used, randomly assigning participants to high or low starting values (SV). Tobit models were used to explore associations between SV-adjusted WTP and age, education, marital and work-status, insurance, decision-control preference and decision-making stage. RESULTS Of 392 participants enrolled, 141 P3P and 107 usual care (UC) provided a WTP value. Men were willing to pay a median $25 (IQR $10-100) for P3P in addition to usual care preparation materials. In the final multivariable tobit regression model, SV, marital status, stage of decision making and income were significantly associated with WTP for P3P. Decision control preference was considered marginally significant (p = 0.11). Men were WTP a median $30 (IQR $10-$200) for usual care material alone. In the final multivariable model, SV, education, and stage of decision making were significantly associated with WTP in usual care. CONCLUSION WTP was similar for UC and for the addition of P3P to UC decision preparation. The WTP values were associated with demographic and preference variables. Findings can help focus decision support on future patients who would benefit most: those without strong support systems, at earlier stages of decision making, and open to a shared-decision style. TRIAL REGISTRATION NCT NCT01844999 . Registered May 3, 2013.
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Affiliation(s)
- Leslie S. Wilson
- University of California San Francisco, 2130 Fulton St, San Francisco, CA 94117 USA
| | - Traci M. Blonquist
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Seth Wolpin
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Christopher P. Filson
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Viraj A. Master
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Martin G. Sanda
- Emory University School of Medicine, 1365 Clifton Rd NE, Suite B1400, Atlanta, GA 30322 USA
| | - Gary W. Chien
- Kaiser Permanente Medical Center, 4867 Sunset Blvd, Los Angeles, CA 90027 USA
| | - Randy A. Jones
- University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA 22908 USA
| | - Tracey L. Krupski
- University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA 22908 USA
| | - Donna L. Berry
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
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Tomaz SA, Jones RA, Hinkley T, Bernstein SL, Twine R, Kahn K, Norris SA, Draper CE. Gross motor skills of South African preschool-aged children across different income settings. J Sci Med Sport 2018; 22:689-694. [PMID: 30606626 DOI: 10.1016/j.jsams.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/17/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES No studies have investigated gross motor skill (GMS) proficiency of preschool-aged children across different income settings in South Africa. Research from high-income countries suggests that children from low-income settings display poorer GMS proficiency compared to higher-income peers. This study aimed to (1) describe GMS proficiency of preschool-aged children in urban high-income (UH), urban low-income (UL) and rural low-income (RL) settings; and (2) explore differences in proficiency between income settings and sex. DESIGN Descriptive cross-sectional study. METHODS The Test of Gross Motor Development-Edition 2 (TGMD-2) was used to assess GMS. The TGMD-2 gross motor quotient, standardised scores and raw scores were used to describe proficiency. RESULTS GMS proficiency was assessed in n=259 3-6-year-old children (n=46 UH, n=91 UL, n=122 RL). Overall, 93% of the children were classified as having 'average' or better GMS. According to TGMD-2 standardised scores, the RL children performed significantly better than UH and UL children (p=0.028 and p=0.009, respectively). RL children were significantly more proficient than UH and UL children in the strike and horizontal jump when comparing raw scores. Overall, boys performed significantly better than girls in the strike, stationary dribble, kick and leap when comparing raw scores (all p<0.001). CONCLUSIONS This study reports high GMS proficiency in preschool-aged children across income settings in South Africa. The factors associated with higher GMS in low-income settings are not immediately obvious. Thus, future research should explore potential factors and identify opportunities to ensure that GMS proficiency is capitalised on as preschool-aged children enter formal schooling.
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Affiliation(s)
- S A Tomaz
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
| | - R A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Australia
| | - T Hinkley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - S L Bernstein
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa
| | - R Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - K Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Umeå Centre for Global Health Research, Umeå University, Sweden; INDEPTH Network, Ghana
| | - S A Norris
- South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - C E Draper
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, South Africa; South African MRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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Peden ME, Okely AD, Eady MJ, Jones RA. What is the impact of professional learning on physical activity interventions among preschool children? A systematic review. Clin Obes 2018; 8:285-299. [PMID: 29852538 DOI: 10.1111/cob.12253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/25/2018] [Accepted: 03/30/2018] [Indexed: 11/30/2022]
Abstract
The purpose of this systematic review was to investigate professional learning models (length, mode, content) offered as part of objectively measured physical childcare-based interventions. A systematic review of eight electronic databases was conducted to June 2017. Only English, peer-reviewed studies that evaluated childcare-based physical activity interventions, incorporated professional learning and reported objectively measured physical activity were included. Study designs included randomized controlled trails, cluster randomized trials, experimental or pilot studies. The search identified 11 studies. Ten studies objectively measured physical activity using accelerometers; five studies used both accelerometer and direct observation tools and one study measured physical activity using direct observation only. Seven of these studies reported statistically significant intervention effects. Only six studies described all components of professional learning, but only two studies reported specific professional learning outcomes and physical activity outcomes. No patterns were identified between the length, mode and content of professional learning and children's physical activity outcomes in childcare settings. Educators play a critical role in modifying children's levels of physical activity in childcare settings. The findings of this review suggest that professional learning offered as part of a physical activity intervention that potentially impacts on children's physical activity outcomes remains under-reported.
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Affiliation(s)
- M E Peden
- Early Start, School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - A D Okely
- Early Start, School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - M J Eady
- School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - R A Jones
- Early Start, School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Education, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Berry DL, Hong F, Blonquist TM, Halpenny B, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M, Somayaji P. Decision Support with the Personal Patient Profile-Prostate: A Multicenter Randomized Trial. J Urol 2017; 199:89-97. [PMID: 28754540 DOI: 10.1016/j.juro.2017.07.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE We evaluated the efficacy of the web based P3P (Personal Patient Profile-Prostate) decision aid vs usual care with regard to decisional conflict in men with localized prostate cancer. MATERIALS AND METHODS A randomized (1:1), controlled, parallel group, nonblinded trial was performed in 4 regions of the United States. Eligible men had clinically localized prostate cancer and an upcoming consultation, and they spoke and read English or Spanish. Participants answered questionnaires to report decision making stage, personal characteristics, concerns and preferences plus baseline symptoms and decisional conflict. A randomization algorithm allocated participants to receive tailored education and communication coaching, generic teaching sheets and external websites plus a 1-page summary to clinicians (intervention) or the links plus materials provided in clinic (usual care). Conflict outcomes and the number of consultations were measured at 1 month. Univariate and multivariable models were used to analyze outcomes. RESULTS A total of 392 men were randomized, including 198 to intervention and 194 to usual care, of whom 152 and 153, respectively, returned 1-month outcomes. The mean ± SD 1-month decisional conflict scale (score range 0 to 100) was 10.9 ± 16.7 for intervention and 9.9 ± 18.0 for usual care. The multivariable model revealed significantly reduced conflict in the intervention group (-5.00, 95% CI -9.40--0.59). Other predictors of conflict included income, marital or partner status, decision status, number of consultations, clinical site and D'Amico risk classification. CONCLUSIONS In this multicenter trial the decision aid significantly reduced decisional conflict. Other variables impacted conflict and modified the effect of the decision aid, notably risk classification, consultations and resources. P3P is an effective adjunct for shared decision making in men with localized prostate cancer.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts.
| | - Fangxin Hong
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Traci M Blonquist
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Barbara Halpenny
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | | | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia
| | - Peter Chang
- Department of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Randy A Jones
- University of Virginia Schools of Nursing, Charlottesville, Virginia
| | - Tracey L Krupski
- Department of Urology, School of Medicine, Charlottesville, Virginia
| | - Seth Wolpin
- University of Washington School of Nursing, Seattle, Washington
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California-San Francisco, San Francisco, California
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Memorial Healthcare, Worcester, Massachusetts
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Sun B, Brown RC, Burns TG, Murdaugh D, Palasis S, Jones RA. Differences in Activation and Deactivation in Children with Sickle Cell Disease Compared with Demographically Matched Controls. AJNR Am J Neuroradiol 2017; 38:1242-1247. [PMID: 28408626 DOI: 10.3174/ajnr.a5170] [Citation(s) in RCA: 3] [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] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Declines in both functional activation and functional connectivity have been reported in patients with sickle cell disease. In this study, we derived the functional and default mode responses to a word stem paradigm in age-, ethnicity-, and background-matched subjects with sickle cell disease and control groups, with the aim of testing whether both networks were similarly attenuated and whether the changes were related to physiologic parameters that characterize sickle cell disease. MATERIALS AND METHODS Both the functional and default mode responses were obtained from age- and background-matched controls and the sickle cell population by using a visually presented word stem paradigm on a 3T scanner. RESULTS We observed an attenuated response to both activation and deactivation in the sickle cell disease group. There were no significant differences in the activation response between the 2 groups for the contrast control > sickle cell disease; however, significant differences were observed in the medial parietal cortex, the auditory cortex, and the angular gyrus for the default mode. For the sickle cell group, a significant correlation between the activation z scores and the physiologic parameters was observed; for the deactivation, the results were not significant but the trend was similar. CONCLUSIONS The results indicate that the physiologic parameters modulate the activation in the expected fashion, but that the effect was weaker for deactivation. Given that significant differences between the 2 groups were only seen for deactivation, additional factors must modulate the deactivation in sickle cell disease.
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Affiliation(s)
- B Sun
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | | | - T G Burns
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - D Murdaugh
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S Palasis
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | - R A Jones
- From the Departments of Radiology (B.S., S.P., R.A.J.)
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Jones RA, Hanrahan NP. Impact of the Nurse Faculty Scholars program on Schools of Nursing. Nurs Outlook 2017; 65:336-337. [DOI: 10.1016/j.outlook.2017.01.001] [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] [Received: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 12/01/2022]
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Msaouel P, Gralla RJ, Jones RA, Hollen PJ. Key issues affecting quality of life and patient-reported outcomes in prostate cancer: an analysis conducted in 2128 patients with initial psychometric assessment of the prostate cancer symptom scale (PCSS). BMJ Support Palliat Care 2017; 7:308-315. [PMID: 28167656 DOI: 10.1136/bmjspcare-2016-001146] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 12/19/2016] [Accepted: 01/19/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evidence-based quality of life (QL) questionnaires require the identification of issues of importance to patients. The primary aim of this study was to inform providers on patient-expressed issues while enhancing the content validity of instruments assessing QL and patient-reported outcomes (PROs) in prostate cancer. The study provided additional psychometric properties for the new PRO and QL instrument, the Prostate Cancer Symptom Scale (PCSS). METHODS An anonymous web-based survey of 2128 patients with prostate cancer was conducted with patients rating 18 QL items on a five-point scale. RESULTS Most respondents (74%) were aged 55-74 years, had early stage disease at diagnosis (81%) and were diagnosed within 2 years of the survey (81%). The top five-rated issues were: overall QL, ability to perform normal activities, maintaining independence, ability to sleep and not being a burden. These items were ranked as either 'very important' or 'important' by at least 88% of patients. None of the most highly ranked issues were symptoms. Instead, the highest ranked items were global issues reflecting the impact of symptoms on patients. In addition to the enhanced content validity findings, good reliability results and initial support for construct validity are reported for the PCSS. CONCLUSIONS This is the largest survey providing patient-expressed background for content validity for QL and PRO measures. The findings of this study should aid development of newer practical questionnaires, such as the PCSS, which can be adapted to electronic platforms enhancing rapid and accurate PRO and QL evaluation.
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Affiliation(s)
- Pavlos Msaouel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York, USA
| | - Randy A Jones
- University of Virginia, Charlottesville, Virginia, USA
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Jones RA, Cohn WB, Wilkes AA, MacKenzie DS. Negative feedback regulation of thyrotropin subunits and pituitary deiodinases in red drum, Sciaenops ocellatus. Gen Comp Endocrinol 2017; 240:19-26. [PMID: 27597549 DOI: 10.1016/j.ygcen.2016.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022]
Abstract
Thyroxine (T4) undergoes dynamic daily cycles in the perciform fish the red drum, Sciaenops ocellatus, that are inversely timed to cycles of thyrotropin (TSH) subunit mRNA expression in the pituitary gland. We have proposed that these daily cycles are regulated by negative feedback of circulating T4 on expression of pituitary thyroid hormone deiodinase type 3 (Dio3), such that elevated circulating T4 results in diminished pituitary thyroid hormone catabolism and consequent increased negative feedback on expression of TSH subunits during the day. To determine whether thyroid hormones function to modulate expression of pituitary deiodinase enzymes we developed an immersion technique to administer physiological doses of T3 and T4in vivo. Immersion in T4 or T3 significantly inhibited the mRNA expression of the TSH α and β subunits from 4 to 66h of immersion. Pituitary Dio3 expression was significantly diminished by T3 and T4 at 22h. These results indicate that both T4 and T3 are capable of negative feedback regulation of TSH subunit expression in red drum at physiological concentrations and on a time scale consistent with the T4 daily cycle. Furthermore, thyroid hormones negatively regulate Dio3 expression in the pituitary in a manner suggesting that negative thyroxine feedback on Dio3 promotes the release of TSH subunits from TH inhibition and may be an important mechanism for generating daily thyroid hormone cycles. These results highlight a potentially important role for D3 in mediating thyroid hormone feedback on TSH expression, not previously described in other species.
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Affiliation(s)
- R A Jones
- Department of Biology, Texas A&M University, 3258 TAMUS, College Station, TX 77843-3258, USA.
| | - W B Cohn
- Department of Biology, Texas A&M University, 3258 TAMUS, College Station, TX 77843-3258, USA.
| | - A A Wilkes
- Department of Biology, Texas A&M University, 3258 TAMUS, College Station, TX 77843-3258, USA.
| | - D S MacKenzie
- Department of Biology, Texas A&M University, 3258 TAMUS, College Station, TX 77843-3258, USA.
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Johnson CC, Taylor AG, Anderson JG, Jones RA, Whaley DE. Feasibility and Acceptability of an Internet-Based, African Dance-Modified Yoga Program for African-American Women with or at Risk for Metabolic Syndrome. J Yoga Phys Ther 2015; 4:1000174. [PMID: 25593785 PMCID: PMC4292896 DOI: 10.4172/2157-7595.1000174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
African-American (AA) women are the segment of the population that experiences the highest mortality from metabolic syndrome (MetS). Yoga decreases risk of MetS, yet there have been no yoga studies of AA women with or at risk for MetS. The purpose of this 4-week study was to test the feasibility and acceptability of a culturally tailored, Internet-based intervention, yogic dance (YD), using digital videos in a sample of AA women (ages 35-64) at risk for or with MetS. The investigators examined the rates of accrual, attrition, and reasons for attrition; the feasibility of using the Internet to deliver the intervention; the acceptability of the intervention as structured; and any other benefits and/or limitations of YD. The study used a single-group, mixed-methods design underpinned by social constructivist theory and Pender's Health Promotion Model. Twenty-four women provided consent to enroll in the study. After completing in-person semi-structured interviews and Internet-based measures, including the Physical Activity Readiness Questionnaire, and the modified International Physical Activity Questionnaire, consented participants engaged in 4-weeks of the yogic dance intervention via daily video-based instructions located on the study Web site. After the intervention, four women participated in focus groups to voice their perceptions of barriers to and benefits from YD and the acceptability of using the YD intervention. The investigators analyzed focus group data using content/thematic analysis and validated themes with baseline semi-structured interviews. The majority of the women (79%) found YD acceptable. Themes that emerged from the descriptive data include: (1) Culture is an important aspect of yogic dance; and (2) Increased social support would enhance yogic dance participation. The integrated results from this feasibility study will inform research exploring the complex correlates that influence health behaviors in AA women.
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Hickey KT, Hodges EA, Thomas TL, Coffman MJ, Taylor-Piliae RE, Johnson-Mallard VM, Goodman JH, Jones RA, Kuntz S, Galik E, Gates MG, Casida JM. Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. Nurs Outlook 2014; 62:394-401. [PMID: 25085329 DOI: 10.1016/j.outlook.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.
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Affiliation(s)
| | - Eric A Hodges
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Tami L Thomas
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Maren J Coffman
- University of North Carolina at Charlotte School of Nursing, Charlotte, NC
| | | | | | | | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | - Sandra Kuntz
- Montana State University College of Nursing, Bozeman, MT
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Cerwinka WH, Grattan-Smith JD, Jones RA, Haber M, Little SB, Blews DE, Williams JP, Kirsch AJ. Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol 2014; 10:344-51. [PMID: 24128878 DOI: 10.1016/j.jpurol.2013.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 07/22/2012] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare the accuracy of dimercaptosuccinic acid (DMSA) renal scan to magnetic resonance urography (MRU) in the identification of renal parenchyma defects (RPD). MATERIALS AND METHODS Twenty-five children with history of acute pyelonephritis and vesicoureteral reflux underwent DMSA scan and MRU to determine the presence of RPD. DMSA scans and MRUs were each evaluated by two radiologists and agreement achieved by consensus. Discordant DMSA-MRU findings were re-evaluated in a side-by-side comparison and an ultimate consensus reached. RESULTS The ultimate consensus diagnosis was 18 kidneys with RPDs in 15 patients, of which five were classified as mild RPDs, six as moderate RPDs, and seven as severe RPDs. Although DMSA scan and MRU were similar in their ability to diagnose RPDs, MRU was considered to represent the true diagnosis in 11 of the 12 discordant cases in consensus review by four pediatric radiologists. MRU showed a much higher inter-observer agreement with a weighted kappa of 0.96 for both kidneys compared to 0.71 for the right kidney and 0.86 for the left kidney by DMSA scan. CONCLUSIONS Our results suggest that MRU is superior to DMSA scan in the identification of renal parenchyma defects.
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Affiliation(s)
- W H Cerwinka
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30342, USA.
| | - J D Grattan-Smith
- Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - R A Jones
- Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - M Haber
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - S B Little
- Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - D E Blews
- Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - J P Williams
- Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA
| | - A J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30342, USA
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Jones RA, Cohn WB, Miller TC, Jaques JT, Mackenzie DS. Cyclic mRNA expression of thyrotropin subunits and deiodinases in red drum, Sciaenops ocellatus. Gen Comp Endocrinol 2013; 194:248-56. [PMID: 24095808 DOI: 10.1016/j.ygcen.2013.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
The role of thyrotropin (thyroid-stimulating hormone, TSH) in driving peripheral thyroid function in non-mammalian species is still poorly understood. Thyroxine (T₄), the principal hormone released from the thyroid gland in response to TSH stimulation, circulates with a robust daily rhythm in the teleost fish the red drum. Previous research suggests that the red drum T₄ cycle is circadian in nature, driven by TSH secretion in the early photophase and inhibited by T₄ feedback in the early scotophase. To determine whether TSH is produced in a pattern consistent with feedback inhibition by this T₄ cycle, we used quantitative real time PCR (qPCR) to quantify the daily cycle of expression of the pituitary TSH subunits GSUα, and TSHβ. We found that TSH expression cycled inversely to, and 6-12 h out of phase with, the T₄ cycle, consistent with the hypothesis that TSH secretion drives the T₄ cycle. To examine the potential role of deiodinases in negative feedback regulation of this TSH cycle, we also utilized qPCR to assess the pituitary expression patterns of the TH activating enzyme outer-ring deiodinase (Dio2) and the TH deactivating enzyme inner-ring deiodinase (Dio3). Dio2 was not expressed with an obvious daily cycle, whereas Dio3 expression mirrored the expression of TSH. These results are consistent with circulating T₄ providing the negative feedback signal controlling both TSH production and Dio3 expression in the pituitary, and suggest that TH inactivation by inner ring deiodination is an important component of TSH negative feedback control.
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Affiliation(s)
- R A Jones
- Department of Biology, Texas A&M University, 3258 TAMU, College Station, TX 77843-3258, USA.
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Abstract
PURPOSE/OBJECTIVES To examine the feasibility and acceptability of using a decision aid with an interactive decision-making process in patients with solid tumors and their caregivers during cancer-related treatment. RESEARCH APPROACH A phenomenologic approach was used to analyze qualitative data, with a focus on the meaning of participants' lived experiences. Interviews were conducted by telephone or in person. SETTING Outpatient clinics at two regional cancer centers. PARTICIPANTS 160 total individuals; 80 patients with newly diagnosed breast (n = 22), advanced-stage prostate (n = 19), or advanced-stage lung (n = 39) cancer, and their caregivers (n = 80). METHODOLOGIC APPROACH Twenty-seven of the 80 pairs engaged in audio recorded interviews that were conducted using a semistructured interview guide. Continuous text immersion revealed themes. Validity of qualitative analysis was achieved by member checking. FINDINGS Significant findings included three themes: (a) the decision aid helped patients and caregivers understand treatment decisions better, (b) the decision aid helped patients and caregivers to be more involved in treatment decisions, and (c) frequent contact with the study nurse was valuable. CONCLUSIONS Decision making was more complex than participants expected. The decision aid helped patients and caregivers make satisfying treatment decisions and become integral in a shared treatment decision-making process. INTERPRETATION Decision aids can help patients and their caregivers make difficult treatment decisions affecting quantity and quality of life during cancer treatment. The findings provide valuable information for healthcare providers helping patients and their caregivers make treatment decisions through a shared, informed, decision-making process. KNOWLEDGE TRANSLATION Decision aids can be helpful with treatment choices. Caregivers' understanding about treatment is just as important in the decision-making process as the patients' understanding. Incorporating decision aids that are delivered by healthcare providers or trained personnel has the potential to improve patients' decision satisfaction.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, VA, USA.
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Jones RA, Liu JC, Zhe J, Schimmer AA, Eldad Z. Abstract P1-04-05: Role of the Rb and p53 Tumor Suppressor Pathways in Mammary Tumorigenesis. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-04-05] [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]
Abstract
Abstract
The retinoblastoma (Rb) and p53 tumor suppressor pathways are frequently altered in human malignancies including breast cancer. To investigate the role of these pathways in mammary tumorigenesis, we crossed mice expressing Cre recombinase in the mammary epithelium (MMTV-Cre) with mice harboring Rb and p53 floxed alleles to generate MMTV-Cre:Rbf/f:p53f/f mutant mice. Combined somatic loss of Rb and p53 led to the formation of aggressive triple-negative tumors (ER−, PR−, HER2−) that often displayed features of an epithelial to mesenchymal transition (EMT) including sarcomatoid differentiation and high expression of the mesenchymal marker N-Cadherin. Molecular profiling revealed Rb/p53 deficient tumors shared similar gene expression profiles with mouse and human claudin-low breast cancers. Interstingly, limiting dilution transplantation analysis also suggests that Rb/p53 deficient claudin-low tumors are enriched for tumor-initiating cells (TICs).
To investigate the cellular origin of claudin-low tumors, the Rbf/f and p53f/f alleles were deleted within the luminal and basal compartments of the mammary gland using a Cre-expressing adenovirus (Ad-Cre) and CD24-CD49f-based FACS analysis. The different cellular fractions were then transplanted into the cleared mammary fat pad of recipient mice which are currently being monitored for tumor development.
Finally, primary cell lines isolated from Rb/p53 deficient mammary tumors were used in conjunction with high-throughput chemical and genetic screens to identify new therapeutic targets. A primary screen of 260 kinase inhibitors and 312 FDA-approved off-patent drugs has identified novel candidates and a genome wide negative selection (‘drop-out’) screen is currently in progress.
Ultimately, the results of this research will provide important insight into the biology of triple-negative breast cancer and will lead to the identification of novel therapeutic targets for the treatment of patients living with this disease.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-04-05.
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Affiliation(s)
- RA Jones
- University Health Network, Toronto, ON, Canada
| | - JC Liu
- University Health Network, Toronto, ON, Canada
| | - J Zhe
- University Health Network, Toronto, ON, Canada
| | - AA Schimmer
- University Health Network, Toronto, ON, Canada
| | - Z Eldad
- University Health Network, Toronto, ON, Canada
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Hood KB, Hart A, Belgrave FZ, Tademy RH, Jones RA. The role of trust in health decision making among African American men recruited from urban barbershops. J Natl Med Assoc 2012; 104:351-9. [PMID: 23092050 DOI: 10.1016/s0027-9684(15)30176-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 11/17/2022]
Abstract
OBJECTIVE To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured interviews. At the completion of each interview, participants completed a brief self-administered demographic survey. The semistructured interviews were audiotaped and transcribed verbatim and then imported into a qualitative software program for organizing, sorting, and coding data. The principles of thematic analysis and template approach were used in this study. The survey data were analyzed using descriptive statistics. RESULTS Trust was a major theme that emerged from the semistructured interviews. The men listed trust in the health care provider as the primary reason for choosing a collaborative or active role in the decision-making process. Within the theme of trust, 4 subthemes emerged: expertise, information sharing, active listening, and relationship length. Thirty-five out of the 40 men interviewed preferred an active or collaborative role in the decision-making process; only 5 preferred passive decision making. CONCLUSIONS Trust emerged as an important factor that influenced role preference for African American men when making health care decisions in the context of the patient-provider relationship. Future studies that help identify which other factors influence health care decision-making roles among African American men may have implications for addressing health disparities among this population and improve the quality of their health care.
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Affiliation(s)
- Kristina B Hood
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond, VA 23284-2018, USA.
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Sun B, Brown RC, Hayes L, Burns TG, Huamani J, Bearden DJ, Jones RA. White matter damage in asymptomatic patients with sickle cell anemia: screening with diffusion tensor imaging. AJNR Am J Neuroradiol 2012; 33:2043-9. [PMID: 22595904 DOI: 10.3174/ajnr.a3135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic injury to the brain is a common complication of SCA. To better understand the neurologic impact of SCA, TBSS were applied to DTI data to investigate white matter injuries in pediatric patients with SCA. MATERIALS AND METHODS TBSS comparisons of a range of anisotropy and diffusion measures were carried out between age- and background-matched population groups: patients with SCA with no visible lesions, patients with SCA with mild gliosis, and normal controls. RESULTS TBSS analysis revealed that both SCA populations exhibited reduced anisotropy and increased diffusivity compared with normal controls in multiple brain regions, including the corpus callosum and centrum semiovale. Furthermore, the results suggest that the severity of SCA is positively correlated with the white matter changes in the corpus callosum. CONCLUSIONS The study demonstrates that TBSS is a viable technique in detecting subtle white matter damage in patients with SCA whose conventional anatomic MR imaging scans show no, or minimal, abnormalities and has the potential to evaluate the neurologic impact of the treatment of SCA.
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Affiliation(s)
- B Sun
- Departments of Radiology, Children’s Healthcare of Atlanta, Atlanta, GA 30342, USA
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29
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Hollen PJ, Gralla RJ, Jones RA, Thomas CY, Brenin DR, Weiss GR, Schroen AT, Petroni GR. A theory-based decision aid for patients with cancer: results of feasibility and acceptability testing of DecisionKEYS for cancer. Support Care Cancer 2012; 21:889-99. [PMID: 23052911 DOI: 10.1007/s00520-012-1603-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Appropriate utilization of treatment is a goal for all patients undergoing cancer treatment. Proper treatment maximizes benefit and limits exposure to unnecessary measures. This report describes findings of the feasibility and acceptability of implementing a short, clinic-based decision aid and presents an in-depth clinical profile of the participants. METHODS This descriptive study used a prospective, quantitative approach to obtain the feasibility and acceptability of a decision aid (DecisionKEYS for Balancing Choices) for use in clinical settings. It combined results of trials of patients with three different common malignancies. All groups used the same decision aid series. Participants included 80 patients with solid tumors (22 with newly diagnosed breast cancer, 19 with advanced prostate cancer, and 39 with advanced lung cancer) and their 80 supporters as well as their physicians and nurses, for a total of 160 participants and 10 health professionals. RESULTS The decision aid was highly acceptable to patient and supporter participants in all diagnostic groups. It was feasible for use in clinic settings; the overall value was rated highly. Of six physicians, all found the interactive format with the help of the nurse as feasible and acceptable. Nurses also rated the decision aid favorably. CONCLUSIONS This intervention provides the opportunity to enhance decision making about cancer treatment and warrants further study including larger and more diverse groups. Strengths of the study included a theoretical grounding, feasibility testing of a practical clinic-based intervention, and summative evaluation of acceptability of the intervention by patient and supporter pairs. Further research also is needed to test the effectiveness of the decision aid in diverse clinical settings and to determine if this intervention can decrease overall costs.
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30
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Wenzel J, Jones RA, Klimmek R, Krumm S, Darrell LP, Song D, Stearns V, Ford JG. Cancer support and resource needs among African American older adults. Clin J Oncol Nurs 2012; 16:372-7. [PMID: 22842688 PMCID: PMC4659371 DOI: 10.1188/12.cjon.372-377] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Indexed: 11/17/2022]
Abstract
Older African Americans face substantial barriers to state-of-the-art cancer care. Implementing culturally appropriate support throughout cancer therapy is critical to improving cancer outcomes and quality of life for this vulnerable population. The purpose of this study was to obtain experiential data regarding cancer diagnosis and treatment, and analyze survivors' recommendations regarding treatment-related needs, psychosocial support, and strategies and resources. Four main issues emerged from the study: (a) the need for more health-related and cancer-specific education, (b) the importance of faith and spirituality, (c) the availability of support, and (d) participants' difficulty identifying and articulating financial needs. Few participants reported requesting or receiving assistance (financial or otherwise) outside of the family during their cancer experience. However, treatment-related medication costs posed a significant hardship for many.
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Affiliation(s)
- Jennifer Wenzel
- Department of Acute and Chronic Care in the School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
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31
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Trebble T, Jones RA. Forming a consultant limited liability partnership. Assoc Med J 2011. [DOI: 10.1136/bmj.d961] [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: 11/03/2022]
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Abstract
Efforts to treat obesity in childhood and adolescence would benefit from a greater understanding of evidence-based strategies to modify physical activity behaviour. A systematic review was conducted to examine the impact of child and adolescent obesity treatment interventions on physical activity. Studies included were randomized controlled trials or controlled trials, with overweight and obese youth (aged < 18 years), which reported statistical analysis of free-living physical activity at pretreatment and post-treatment. Two independent reviewers assessed each study for methodological quality. Seventeen child and three adolescent studies were retrieved, half of which were conducted in the USA. Studies were characterized by small samples of limited cultural and economic diversity. Fifteen studies reported an increase in at least one physical activity outcome at post-test or follow-up. Overall, study quality was rated as low (child median score = 3/10, range = 0-9; adolescent median score = 3/10, range = 2-5) with three child studies classified as high quality (>or=6/10). Research evaluating the effect of child and adolescent obesity treatment trials on physical activity is limited in both quantity and quality. Studies testing innovative, theoretically driven treatment approaches that use robust methodologies are required to better understand generalizable approaches for promoting physical activity participation among obese youth.
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Affiliation(s)
- D P Cliff
- Child Obesity Research Centre, University of Wollongong, Wollongong, NSW, Australia.
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Abstract
Pollen grains were harvested from an interspecific F(1) hybrid between the cultivated tomato, Lycopersicon esculentum Mill., and its wild relative Lycopersicon hirsutum Humb. & Bonpl., a low temperature tolerant accession originating from an altitude of 3200 m in the Peruvian Andes. The two species differ for electrophoretically-detectable loci that mark six (possibly seven) of the 12 tomato chromosomes. Isozyme analysis of the BC(1) populations derived from controlled pollinations at normal and low temperatures indicates a significant skewing of allelic frequencies favoring two independent chromosome segments of L. hirsutum at low temperatures. The results demonstrate that gametophytic selection for low temperature tolerance of tomato pollen is determined, at least in part, by genes expressed in the haploid pollen.
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Affiliation(s)
- D Zamir
- Department of Vegetable Crops, University of California, Davis, CA95616
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Jones RA, Broder MW, Stotzky G. Effects of genetically engineered microorganisms on nitrogen transformations and nitrogen-transforming microbial populations in soil. Appl Environ Microbiol 2010; 57:3212-9. [PMID: 16348584 PMCID: PMC183950 DOI: 10.1128/aem.57.11.3212-3219.1991] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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
The principal concern about releasing genetically engineered microorganisms (GEMs) into the environment is their potential adverse effects on the environment, whether caused directly or indirectly by the GEMs. The effects of five GEMs on ammonification, nitrification, and denitrification in soil were studied. With the possible exception of a strain of Enterobacter cloacae carrying a plasmid, no consistent statistically or ecologically significant differences in effects on these processes or on the population dynamics of the microorganisms responsible for the processes were observed between soils inoculated with the GEMs or their homologous plasmidless hosts and those that were not inoculated. Increasing the concentration of montmorillonite in the soil enhanced the rate of nitrification, regardless of the inoculum, indicating that the perfusion technique used was sensitive enough to detect changes in nitrification rates when they occurred.
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Affiliation(s)
- R A Jones
- Laboratory of Microbial Ecology, Department of Biology, New York University, New York, New York 10003
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36
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Jones RA, Steeves R, Williams I. Family and friend interactions among African-American men deciding whether or not to have a prostate cancer screening. Urol Nurs 2010; 30:189-166. [PMID: 20648856 PMCID: PMC3616189] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Prostate cancer disproportionately affects African-American men. Family, friends, and trust in health care providers are factors that influence the decision making of African-American men when determining whether or not to get a prostate cancer screening done.
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Affiliation(s)
- Randy A Jones
- University of Virginia, School of Nursing, Charlottesville, VA, USA
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Abstract
Etodolac is a non-steroidal anti-inflammatory drug (NSAID) which has been shown to be effective in the treatment of rheumatoid arthritis and osteoarthritis and a selective COX-2 inhibitor in a wide range of clinically relevant assays in direct comparisons with other NSAIDs. Studies have shown etodolac to have no overall suppression of gastric or duodenal prostaglandins and endoscopic analysis with etodolac showed placebo level scores in comparison with ibuprofen, which showed inducement of gastro-intestinal (GI) side effects. This high degree of gastric tolerability was further demonstrated by microbleeding studies. The favourable GI tolerability profile of etodolac has been shown in long-term and large-scale trials and by routine clinical observation. In summary, etodolac is a well established selective COX-2 inhibitor that has been shown not to suppress gastric or duodenal prostaglandins, to have minimal hepatic or renal effects and to have favourable GI tolerability in comparison with ibuprofen.
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Affiliation(s)
- R A Jones
- Monmouth Pharmaceuticals, Guildford, Surrey.
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38
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Abstract
Giant coronary artery aneurysm is a rare manifestation of coronary artery disease. This patient presented at echocardiography and was successfully managed by surgical resection.
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Affiliation(s)
- P C Strike
- Wessex Cardiothoracic Centre, Southampton University Hospitals, Southampton, United Kingdom
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39
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Jones RA, Taylor AG, Bourguignon C, Steeves R, Fraser G, Lippert M, Theodorescu D, Mathews H, Kilbridge KL. Family interactions among African American prostate cancer survivors. Fam Community Health 2008; 31:213-20. [PMID: 18552602 PMCID: PMC2810541 DOI: 10.1097/01.fch.0000324478.55706.fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 05/15/2023]
Abstract
Prostate cancer affects African Americans at a higher rate than any other ethnic group in the United States. Prostate cancer does not only affect the man with the disease but also affects those individuals who are closest to him, such as his family and friends. Open communication is valuable in coping with stressors that are affiliated with chronic illnesses. This article focuses on family and friend social support of men with prostate cancer. Data analysis revealed that support from family members and friends plays an important role in how men cope with their treatment and recovery from prostate cancer.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, VA 22908, USA.
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40
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Abstract
This unit describes high-yield procedures for protection of purine ribonucleosides based on a reaction that allows concomitant highly regioselective 2'-silylation and 3'-phosphitylation to give, in one step, monomers that are ready for H-phosphonate synthesis. For preparation of phosphoramidites, the H-phosphonate monoester is cleaved without silyl migration to give intermediates ready for phosphitylation by standard methods.
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Affiliation(s)
- B L Gaffney
- Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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41
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Jones RA, Utz SW, Williams IC, Hinton I, Alexander G, Moore C, Blankenship J, Steeves R, Oliver N. Family interactions among African Americans diagnosed with type 2 diabetes. Diabetes Educ 2008; 34:318-26. [PMID: 18375781 PMCID: PMC3616190 DOI: 10.1177/0145721708314485] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes and their willingness to be involved in a culturally tailored program. METHODS This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual standard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes. Twenty-one participants were randomly assigned to an individual education group or a culturally tailored intervention group. Family members/peers (n = 6) attended invited group sessions to obtain information about diabetes and family/peer support. The facilitator of the invited group sessions used a guide to help with group discussions. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide, thus identifying recurring themes within the participants' responses. RESULTS The data revealed that family and friends made a difference in the diabetes management of individuals with diabetes. Although family and friends may have been helpful at times, they also created moments of problems and an environment that made it more difficult to care for diabetes. The data also revealed that diabetes is hard to manage and control. Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging. CONCLUSIONS These findings confirm that family and peers greatly influence diabetes management among rural African Americans. The study's results will help health care providers understand the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes, particularly within rural African American communities where resources are limited.
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Affiliation(s)
- Randy A Jones
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Sharon W Utz
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Ishan C Williams
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Ivora Hinton
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Gina Alexander
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Cynthia Moore
- University of Virginia Medical Center, Charlottesville, Virginia (CM, JB)
| | - Jean Blankenship
- University of Virginia Medical Center, Charlottesville, Virginia (CM, JB)
| | - Rick Steeves
- The University of Virginia School of Nursing, Charlottesville, Virginia (RAJ, SWU, ICW, IH, GA, RS)
| | - Norman Oliver
- University of Virginia School of Medicine, Charlottesville, Virginia (NO)
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Abstract
Prostate cancer is the most commonly diagnosed cancer in men in the United States. It disproportionately affects African American men when compared to other ethnic groups. African American men are two to three times more likely to die of prostate cancer than white men. The reasons for the disparity remain unclear, but several factors may be involved, such as age, race, nationality, nutrition, exercise, and family history of cancer. Detection of prostate cancer in high-risk African Americans is important but continues to be controversial. This article reviews the current issues and challenges regarding prostate cancer in African American men. Nurses play a vital role in the health care and education of patients; therefore, they must be aware of the issues.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, VA, USA.
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Jones RA, Taylor AG, Bourguignon C, Steeves R, Fraser G, Lippert M, Theodorescu D, Mathews H, Kilbridge KL. Complementary and alternative medicine modality use and beliefs among African American prostate cancer survivors. Oncol Nurs Forum 2007; 34:359-64. [PMID: 17573300 PMCID: PMC3616188 DOI: 10.1188/07.onf.359-364] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the cultural beliefs and attitudes of African American prostate cancer survivors regarding the use of complementary and alternative medicine (CAM) modalities. RESEARCH APPROACH Mixed methods with primary emphasis on a phenomenology approach. SETTING In-person interviews in participants' homes and rural community facilities. PARTICIPANTS 14 African American men diagnosed with and treated for prostate cancer. METHODOLOGIC APPROACH Personal interviews using a semistructured interview guide. MAIN RESEARCH VARIABLES Prostate cancer, CAM, African American men's health, culture, herbs, prayer, spirituality, and trust. FINDINGS All participants used prayer often; two men used meditation and herbal preparations. All men reported holding certain beliefs about different categories of CAM. Several men were skeptical of CAM modalities other than prayer. Four themes were revealed: importance of spiritual needs as a CAM modality to health, the value of education in relation to CAM, importance of trust in selected healthcare providers, and how men decide on what to believe about CAM modalities. CONCLUSIONS Prayer was a highly valued CAM modality among African American prostate cancer survivors as a way to cope with their disease. Medical treatment and trust in healthcare providers also were found to be important. INTERPRETATION Most participants were skeptical of CAM modalities other than prayer. Participants expressed a strong belief in spirituality and religiosity in relationship to health and their prostate cancer. Participants' trust in their healthcare providers was important. Healthcare providers must understand how African Americans decide what to believe about CAM modalities to improve their health. This research provided valuable information for future development of culturally sensitive communication and infrastructural improvements in the healthcare system.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, VA, USA.
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Jeremy JY, Jones RA, Koupparis AJ, Hotston M, Persad R, Angelini GD, Shukla N. Reactive oxygen species and erectile dysfunction: possible role of NADPH oxidase. Int J Impot Res 2006; 19:265-80. [PMID: 17053777 DOI: 10.1038/sj.ijir.3901523] [Citation(s) in RCA: 55] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Erectile dysfunction (ED) is a widespread condition, the incidence of which is increasing globally. ED is also indicative of underlying vasculopathy and represents a predictor of more serious cardiovascular disorders. Understanding the aetiology of ED may therefore provide invaluable pointers to the pathobiology of other cardiovascular diseases (CVDs) and syndromes. It follows, too, that therapeutic interventions that are successful in treating ED may, ipso facto, be effective in treating the early stages of conditions that include atherosclerosis, angina, plaque rupture and diabetic angiopathy. One common pathological denominator in both CVD and ED is oxidative stress, that is, the overproduction of reactive oxygen species (ROS), in particular, superoxide (O(2)(*-)) and hydrogen peroxide (H(2)O(2)). In this review, therefore, we consider the aetiology and pathobiology of O(2)(*-) in promoting ED and focus on NADPH oxidase as an inducible source of O(2)(*-) and H(2)O(2). Therapeutic strategies aimed at reducing oxidative stress to improve erectile function are also discussed.
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Affiliation(s)
- J Y Jeremy
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, The University of Bristol, Bristol, UK.
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Jones RA, Campbell CI, Gunther EJ, Chodosh LA, Petrik JJ, Khokha R, Moorehead RA. Transgenic overexpression of IGF-IR disrupts mammary ductal morphogenesis and induces tumor formation. Oncogene 2006; 26:1636-44. [PMID: 16953219 DOI: 10.1038/sj.onc.1209955] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Overexpression and hyperactivation of the type I insulin-like growth factor receptor (IGF-IR) has been observed in human breast tumor biopsies. In addition, in vitro studies indicate that overexpression of IGF-IR is sufficient to transform cells such as mouse embryo fibroblasts and this receptor promotes proliferation and survival in breast cancer cell lines. To fully understand the function of the IGF-IR in tumor initiation and progression, transgenic mice containing human IGF-IR under a doxycycline-inducible MMTV promoter system were generated. Administration of 2 mg/ml doxycycline in the animals' water supply beginning at 21 days of age resulted in elevated levels of IGF-IR in mammary epithelial cells as detected by Western blotting and immunohistochemistry. Whole mount analysis of 55-day-old mouse mammary glands revealed that IGF-IR overexpression significantly impaired ductal elongation. Moreover, histological analyses revealed multiple hyperplasic lesions in the mammary glands of these 55-day-old mice. The formation of palpable mammary tumors was evident at approximately 2 months of age and was associated with increased levels of IGF-IR signaling molecules including phosphorylated Akt, Erk1/Erk2 and STAT3. Therefore, these transgenic mice provide evidence that IGF-IR overexpression is sufficient to induce mammary epithelial hyperplasia and tumor formation in vivo and provide a model to further understand the function of IGF-IR in mammary epithelial transformation.
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Affiliation(s)
- R A Jones
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Jones RA, Utz S, Wenzel J, Steeves R, Hinton I, Andrews D, Murphy A, Oliver N. Use of complementary and alternative therapies by rural African Americans with type 2 diabetes. Altern Ther Health Med 2006; 12:34-8. [PMID: 17017753 PMCID: PMC3665110] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The prevalence of type 2 diabetes among non-Hispanic African American adults aged 20 years and older is 11.4%, compared to 8.4% non-Hispanic whites. Given the high rate of diabetes in this population, it is important to determine whether African Americans use complementary and alternative medicine (CAM), and if so, what kind. Such information is important to healthcare professionals who prescribe therapies and make self-care recommendations to those with diabetes. The use of CAM by African Americans with diabetes has not been well studied, however, particularly among those living in rural areas. This descriptive study was conducted in 2 rural communities in Central Virginia to explore the use of CAM therapies and the role of religion and spirituality in dealing with diabetes among adult African Americans with type 2 diabetes. Sixty-eight participants attended 1 of 8 focus group sessions in various community settings and described their use of alternative therapies. According to these sessions, the most common alternative therapies used are prayer, diet-based therapies, and natural products. The participants' descriptions enhance our understanding of CAM use among rural African Americans with diabetes.
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Affiliation(s)
- Randy A Jones
- University of Virginia School of Nursing, Charlottesville, USA
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Utz SW, Steeves RH, Wenzel J, Hinton I, Jones RA, Andrews D, Muphy A, Oliver MN. "Working hard with it": self-management of type 2 diabetes by rural African Americans. Fam Community Health 2006; 29:195-205. [PMID: 16775469 DOI: 10.1097/00003727-200607000-00006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The specific aims of this study were to describe the experience of self-managing type 2 diabetes among rural dwelling African Americans, to identify facilitators and barriers to self-management, to describe the use of prescribed and alternative therapies, and to elicit recommendations for programs of diabetes care. Ten focus groups were held in 3 rural communities. Men and women were in separate groups with facilitators matched by race and gender. Seventy-three participants attended the focus groups to discuss the management of diabetes. Group sessions were tape-recorded and transcribed; field notes were also taken. Data were analyzed using Folio Views software and were reviewed by the multidisciplinary team. Results indicate both unique and common themes from this population.
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Affiliation(s)
- Sharon W Utz
- University of Virginia School of Nursing, Charlottesville, VA 22908, USA.
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Abstract
Diabetes has a disproportionate impact on people of color, including Black Americans. An understanding of the perspectives of rural Blacks is needed to design effective programs of diabetes care. The purpose of this study was to examine the experience of being diagnosed with diabetes as described by rural Blacks. This descriptive, exploratory study conducted gender-separated focus groups in 3 rural communities to capture diagnosis perspectives. Findings may be useful to healthcare professionals providing diabetes care to rural Blacks. Participants could describe events surrounding diagnosis with clarity. For many, the diagnosis was not an emotional and/or surprising experience. Participants commonly used expressive or figurative language to relate their stories of diagnosis, and gender differences were noted. Descriptions of diagnosis revealed valuable infor-mation about participants' perceptions of their diabetes.
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Jones RA, Kotsakis P, Johnson TS, Chau DYS, Ali S, Melino G, Griffin M. Matrix changes induced by transglutaminase 2 lead to inhibition of angiogenesis and tumor growth. Cell Death Differ 2005; 13:1442-53. [PMID: 16294209 DOI: 10.1038/sj.cdd.4401816] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [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] [Indexed: 11/09/2022] Open
Abstract
Administration of active TG2 to two different in vitro angiogenesis assays resulted in the accumulation of a complex extracellular matrix (ECM) leading to the suppression of endothelial tube formation without causing cell death. Matrix accumulation was accompanied by a decreased rate of ECM turnover, with increased resistance to matrix metalloproteinase-1. Intratumor injection of TG2 into mice bearing CT26 colon carcinoma tumors demonstrated a reduction in tumor growth, and in some cases tumor regression. In TG2 knockout mice, tumor progression was increased and survival rate reduced compared to wild-type mice. In wild-type mice, an increased presence of TG2 was detectable in the host tissue around the tumor. Analysis of CT26 tumors injected with TG2 revealed fibrotic-like tissue containing increased collagen, TG2-mediated crosslink and reduced organized vasculature. TG2-mediated modulation of cell behavior via changes in the ECM may provide a new approach to solid tumor therapy.
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Affiliation(s)
- R A Jones
- School of Biomedical and Natural Sciences, Nottingham Trent University, Nottingham NG11 8NS, UK
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Jones RA, Wenzel J. Prostate cancer among African-American males: understanding the current issues. J Natl Black Nurses Assoc 2005; 16:55-62. [PMID: 16255315] [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: 05/05/2023]
Abstract
Prostate cancer affects African-American males within the United States in a disproportionate number compared to White males. African-American males are 1.7 times more likely to develop and 2-3 times more likely to die from prostate cancer than White males. Numerous reasons for this disparity exist, including low socioeconomic status, distrust, conflicting cultural beliefs, and past health-care experiences. Controversies surrounding this topic and perhaps contributing to the disparity include cancer-screening recommendations, cancer-related myths, and potential prevention modalities. Nursing research must focus on cancer-related issues among African-Americans to increase the awareness and knowledge of health-care professionals and the public to help decrease morbidity and mortality within African-Americans and other minority populations, and particularly among more vulnerable sections of at-risk minority populations. This article focuses on current issues related to African-American men and prostate health.
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Affiliation(s)
- Randy A Jones
- Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, VA, USA.
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