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Paskett ED, Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Gray DM, Pennell ML, Huang B, Young GS, Fickle D, Cromo M, Katz ML, Reiter PL, Rogers M, Gross DA, Fairchild V, Xu W, Carman A, Walunis JM, McAlearney AS, Huerta TR, Rahurkar S, Biederman E, Dignan M. Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial. Transl Behav Med 2023; 13:748-756. [PMID: 37202831 PMCID: PMC10538475 DOI: 10.1093/tbm/ibad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA
| | | | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
| | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA
| | - David A Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Vickie Fairchild
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Wendy Xu
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
| | - Angela Carman
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jean M Walunis
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | | | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
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Gibson A, Henley L, Fairchild V, Goss D, Baum C, Jicha G, Rhodus E. INCREASING DEMENTIA CARE MASTERY FOR RURAL CAREGIVERS: LESSONS FROM ADAPTING THE HARMONY @ HOME INTERVENTION. Innov Aging 2022. [PMCID: PMC9766313 DOI: 10.1093/geroni/igac059.1548] [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: 12/24/2022] Open
Abstract
Providing care support to rural Alzheimer’s disease and related dementia (ADRD) caregivers has always been challenging, but particularly with the COVID-19 pandemic, new barriers have emerged for families in accessing care support. Delivered via telehealth, Harmony at HOME (H@H) provides dementia care mastery for caregivers of persons with ADRD in the skills of assessing and modifying the home environment to promote "person-environment fit," whereby increasing functional activity engagement and minimizing maladaptive behaviors. To enhance care supports specific to the needs of rural communities, this study reports the findings of two focus groups with rural caregivers who participated in the H@H intervention. Focus groups were aimed to identify the needs of caregivers in rural communities to guide adaptation approaches for future implementation of the H@H intervention in these underserved areas. Additional studies to assess real-world efficacy of the adaptations to H@H are needed as a next step toward implementing this intervention in clinical, home care settings.
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Affiliation(s)
- Allison Gibson
- University of Kentucky, Lexington, Kentucky, United States
| | - Laura Henley
- HealthPRO Heritage, Louisville, Kentucky, United States
| | - Vickie Fairchild
- Northeast AHEC, St. Clair Healthcare, Morehead, Kentucky, United States
| | - David Goss
- Northeast AHEC, St. Clair Healthcare, Morehead, Kentucky, United States
| | - Carolyn Baum
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States
| | - Gregory Jicha
- University of Kentucky, Lexington, Kentucky, United States
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Babad S, Zwilling A, Carson K, Fairchild V, Nikulina V. Childhood Environmental Instability and Social-Emotional Outcomes in Emerging Adults. J Interpers Violence 2022; 37:NP3875-NP3904. [PMID: 32854580 PMCID: PMC8041097 DOI: 10.1177/0886260520948147] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/21/2023]
Abstract
Adverse childhood experiences (ACEs) can negatively affect social-emotional functioning. The association between individual and cumulative ACEs and social-emotional domains of self-esteem, loneliness, and negotiation in intimate partner relationships has not been explored in low-risk emerging adults, a gap this study aims to fill. An online survey was administered to undergraduate emerging adults, ages 18 to 25 years (Mage = 19.73, SD = 1.83; N = 436; 20.60% Hispanic; 63.80% female). The ACEs Survey, Child Abuse Potential Inventory, and Conflict Tactics Scale-2nd Edition were used. Three multivariate ordinary least squares regressions were run, each including predictors significant in bivariate analyses and outcomes of self-esteem, loneliness, and negotiation for each regression. Emotional abuse, B = -.20, p < .01; emotional neglect, B = -.21, p < .001; and substance using family member, B = -.12, p < .05, were negatively associated with self-esteem; emotional neglect, B = .11, p < .01, and cumulative ACEs, B = .16, p < .01, were positively associated with loneliness; and incarcerated family member was positively associated with negotiation, B = .12, p < .05. Overall, these findings suggest that individual ACEs associated with environmental instability (e.g., emotional abuse) are strong predictors of social-emotional outcomes, relative to ACEs associated with more direct physical harm (e.g., sexual abuse).
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Affiliation(s)
- S. Babad
- Queens College, City University of New York
- The Graduate Center, City University of New York
- Corresponding Author: Sara Babad, M.A., Doctoral Candidate, The Graduate Center & Queens College, City University of New York, Psychology Department, 65-30 Kissena Blvd, Science Building A344, Queens, NY 11367-1597, Phone: 516-578-5698,
| | - A. Zwilling
- Queens College, City University of New York
- The Graduate Center, City University of New York
| | - K.W. Carson
- Queens College, City University of New York
- The Graduate Center, City University of New York
| | - V. Fairchild
- Queens College, City University of New York
- The Graduate Center, City University of New York
| | - V. Nikulina
- Queens College, City University of New York
- The Graduate Center, City University of New York
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Kruse-Diehr AJ, Cromo M, Rogers M, Carman A, Huang B, Gross D, Russell S, Fairchild V, Dignan M. Abstract P12: Colorectal cancer screening in Appalachian Kentucky primary care clinics during COVID-19. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-p12] [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
Background: Colorectal cancer (CRC) mortality is disproportionately higher in Appalachian counties of Kentucky than in non-Appalachian regions. Part of the mortality gap can be explained by lower screening rates in Appalachian counties. Researchers at Markey Cancer Center partnered with primary care clinics in eastern Kentucky to address this disparity by identifying strategies to implement evidence-based interventions (EBIs) to improve CRC screening and follow-up in Appalachian Kentucky. Methods: Members of the research team conducted formative research activities to identify multilevel barriers to CRC screening. A menu of EBIs was then created to address these barriers, and clinic champions selected EBIs that were feasible in their respective practices. However, because of restrictions during COVID-19, clinics experienced multiple changes to workflow and operations, necessitating modifications to program activities. Over a series of virtual meetings, clinic champions selected adaptations that could allow clinics to continue promoting CRC screening in their practices despite COVID-related limitations. Results: Changes in clinic staffing and workflow resulting from COVID-19 included provider furloughs, a state-mandated pause in elective procedures, mandatory parking lot visits for many in-person visits, and an increase in telehealth. Among our clinic partners, total in-person visits were reduced by nearly half from first to second quarter of 2020, whereas telehealth visits were 23 times higher, though telehealth visits were cut in half by third quarter. To match these changing modes of practice, clinics adapted creative strategies for communicating CRC screening recommendations to patients, including shifting from paper to digital educational tools, promoting screening via telehealth visits, and prioritizing recommendations for stool-based tests over colonoscopy for average-risk patients. As a result, orders for FIT and FIT-DNA were 2 and 3 times higher, respectively, from second to third quarter of 2020. Conclusion: Rural primary care clinics in Appalachia continue to promote CRC screening despite the multiple challenges related to COVID-19. One relevant reference for clinicians is the National Colorectal Cancer Roundtable’s playbook for reigniting CRC screening during COVID-19, a document that promotes stool-based screening for average-risk patients. While elective procedures remain backlogged in rural areas due to state regulations, research partners should emphasize the need to prioritize stool-based CRC screening for average-risk populations and reserve scheduling colonoscopies for high-risk individuals or those with abnormal stool-based test results. While our clinical partners had previously focused on a “colonoscopy first” approach to screening, our findings suggest that our clinic partners increased orders for stool-based CRC tests. Nevertheless, continued outreach is needed to ensure CRC screening rates remain optimal.
Citation Format: Aaron J. Kruse-Diehr, Mark Cromo, Melinda Rogers, Angela Carman, Bin Huang, David Gross, Sue Russell, Vickie Fairchild, Mark Dignan. Colorectal cancer screening in Appalachian Kentucky primary care clinics during COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P12.
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Affiliation(s)
| | | | - Melinda Rogers
- 2University of Kentucky Markey Cancer Center, Lexington, KY,
| | | | - Bin Huang
- 1University of Kentucky, Lexington, KY,
| | - David Gross
- 3Northeast Kentucky Area Health Education Center, Morehead, KY
| | - Sue Russell
- 3Northeast Kentucky Area Health Education Center, Morehead, KY
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Fluck S, McKane W, Cairns T, Fairchild V, Lawrence A, Lee J, Murray D, Polpitiye M, Palmer A, Taube D. Chloramine-induced haemolysis presenting as erythropoietin resistance. Nephrol Dial Transplant 1999; 14:1687-91. [PMID: 10435877 DOI: 10.1093/ndt/14.7.1687] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In December 1996 we identified an outbreak of erythropoietin (rHuEpo) resistance requiring a substantial increase in rHuEpo dosage in one of our four haemodialysis (HD) units. The dialysate chloramine levels in this unit had risen from <0.1 p.p.m. in 1996 to 0.25-0.3 p.p.m. in 1997. In the other three HD units levels remained <0.1 p.p.m. Other parameters of water quality were within accepted standards. METHODS Monthly records of haemoglobin level and rHuEpo dose were available for 148 patients between January 1996 and May 1998. Seventy-two patients, with no recognized cause of rHuEpo resistance, were analysed in detail (August 1997 to April 1998). A subgroup of 15 patients was examined for evidence of haemolysis during HD (methaemoglobin and haptoglobin levels, reticulocyte counts and Heinz bodies). Larger carbon columns were installed in December 1997 to effect chloramine removal. RESULTS There was an increase in mean methaemoglobinaemia of 23% (P<0.01) and a 21% fall in mean haptoglobin (P<0.01) across HD, although no patient had a reticulocytosis and only one patient with G6PD deficiency had Heinz bodies. Following installation of larger carbon columns there was an 18.6% rise (P<0.001) in mean haemoglobin level and a subsequent 25.0% reduction (P<0.001) in mean rHuEpo dose. Intradialytic changes in methaemoglobin and haptoglobin were abolished. The dialysate chloramine levels fell to < 0.1 p.p.m. Water company records subsequently revealed a sustained twofold increase in mains water chloramine from November 1996. CONCLUSIONS This is the first report linking chloramine exposure and rHuEpo resistance, with only subtle signs of haemolysis. Unheralded changes in mains water constituents can directly affect dialysate water quality and clinical outcomes.
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Affiliation(s)
- S Fluck
- The Brent Laboratory, St. Mary's Hospital, London, UK
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