A tool to enhance medical care, communication, and patients' understanding of high-resolution anoscopy.
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ABSTRACT:
SUBMITTER: Cachay ER
PROVIDER: S-EPMC3988425 | biostudies-literature | 2014 Mar
REPOSITORIES: biostudies-literature
Publications
A tool to enhance medical care, communication, and patients' understanding of high-resolution anoscopy.
Cachay Edward R ER Mathews Wm C WC
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20131219 6
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Project description: Not available
| S-EPMC10907917 | biostudies-literature
Project description:BackgroundPeople with HIV at highest risk of anal cancer include gay, bisexual, and other men who have sex with men and transgender women aged 35 years or older as well as other people with HIV aged 45 years or older. Identifying and treating precancerous lesions can reduce anal cancer incidence in these groups. We assessed the prevalence of anal cytology and access to high-resolution anoscopy among people with HIV overall and in those individuals at highest risk.MethodsData were obtained from the Centers for Disease Control and Prevention's Medical Monitoring Project, a population-based survey of people with HIV aged 18 years and older, and a supplemental Medical Monitoring Project facility survey. We report weighted percentages of people with HIV receiving anal cytology during the past 12 months, access to high-resolution anoscopy, and characteristics of HIV care facilities by availability of high-resolution anoscopy.ResultsOverall, 4.8% (95% confidence interval [CI] = 3.4% to 6.1%) of people with HIV had undergone anal cytology in the prior 12 months. Only 7.7% (95% CI = 5.1% to 10.6%) of gay, bisexual, and other men who have sex with men as well as transgender women 35 years of age or older and 1.9% (95% CI = 0.9% to 2.9%) of all other people with HIV aged 45 years and older had anal cytology. Prevalence was statistically significantly low among people with HIV with the following characteristics: non-Hispanic or Latino, Black or African American, high school education or less, heterosexual orientation, and living in southern Medical Monitoring Project states. Among people with HIV, 32.8% (95% CI = 28.0% to 37.7%) had no access to high-resolution anoscopy on-site or through referral at their care facility; 22.2% (95% CI = 19.5% to 24.9%) had on-site access; 45.0% (95% CI = 41.5% to 48.5%) had high-resolution anoscopy available through referral. Most facilities that received Ryan White HIV/AIDS Program funding, cared for more than 1000 people with HIV, or provided on-site colposcopy also provided high-resolution anoscopy on-site or through referral.ConclusionsRates of anal cytology and access to high-resolution anoscopy were low among people with HIV, including those individuals at highest risk of anal cancer. Our data may inform large-scale implementation of anal cancer prevention efforts.
| S-EPMC11323029 | biostudies-literature
Project description:ObjectiveThe objective of the study was to compare the medical prescription forms in European Union (EU) countries, evaluating their convergence toward the implementation of cross-border care, as proposed by the existing EU health-care directives. It also aims to assess how the existing EU prescription models fulfill higher standards of medication prescribing quality and patient safety.MethodsPrescription forms from all EU countries were purposively collected. The prescription fields and other content elements were qualitatively and quantitatively analyzed. Forms were statistically compared with each other and a theoretical EU cross-border prescription form, using hierarchical cluster analysis and nonparametric testing.FindingsNone of the EU countries' prescriptions include all the elements required by the cross-border legislation (CBL), with most countries having seven or less mandatory elements. Cluster analysis revealed that countries with similar prescription forms are geographically nearer. Important elements from the EU directive to assure patient safety are also absent such as the International Classification of Diseases, the patient's ID according to the European Health Insurance Card, and the patient's contact. However, Western and Nordic countries showed higher standardization when compared to the CBL and model.ConclusionPolitical action is still needed to harmonize medical prescription forms between countries, serving the common goal of trans-European health care and to increase EU patients' safety using medications and other prescribed treatments.
| S-EPMC5934983 | biostudies-literature
Project description:OBJECTIVE:To determine the required learning time for high-resolution anoscopy (HRA)-guided biopsy to detect histological high-risk squamous intraepithelial lesions (hHSIL) and to identify factors that impact on the training process. METHODS:All HIV-infected, screening-naïve men-who-have-sex-with-men who underwent HRA conducted by one single observer from 2010 to 2017 in a Spanish HIV-outpatient clinic were analysed. RESULTS:Eighty-five (14.7%) of the 581 patients included presented hHSIL. The factors associated with the capacity to detect hHSIL [adjusted odds ratio (aOR), 95% confidence interval (95%CI)] were the presence of cytological HSIL (3.04, 1.78-5.21; p < 0.001), infection with high-risk human papilloma virus (HR-HPV) (2.89, 1.38-6.05; p = 0.005), the number of biopsies taken/HRA (aOR: 1.28, 1.07-1.52; p = 0.006) and tobacco smoking (1.75; 1.12-2.73; p = 0.014). Two events independently augmented the detection rate of hHSIL: one single experienced pathologist interpreted biopsies after 409 HRA (2.80, 1.74-4.48; p = 0.035) and the anoscopist underwent an additional training after 536 HRA (2.57, 1.07-6.16; p = 0.035). A learning process could be observed throughout the whole study with stable HR-HPV prevalence. CONCLUSION:The data support the growing evidence that the proposed training volume of 50-200 performances is underestimated. Extensive training of both anoscopist and pathologist is warranted and the development of tools to support the diagnostic performance may be considered.
| S-EPMC6374501 | biostudies-literature
Project description:IntroductionThis technology report introduces an innovative risk communication tool developed to support providers in communicating diabetes-related risks more intuitively to people with type 2 diabetes mellitus (T2DM).MethodsThe development process involved three main steps: (1) selecting the content and format of the risk message; (2) developing a digital interface; and (3) assessing the usability and usefulness of the tool with clinicians through validated questionnaires.ResultsThe tool calculates personalized risk information based on a validated simulation model (United Kingdom Prospective Diabetes Study Outcomes Model 2) and delivers it using more intuitive risk formats, such as "effective heart age" to convey cardiovascular risks. Clinicians reported high scores for the usability and usefulness of the tool, making its adoption in routine care promising.ConclusionsDespite increased use of risk calculators in clinical care, this is the first time that such a tool has been developed in the diabetes area. Further studies are needed to confirm the benefits of using this tool on behavioral and health outcomes in T2DM populations.
| S-EPMC9264433 | biostudies-literature
Project description:BackgroundTwitter is a free social networking and microblogging service on the Internet. Medical professionals and patients have started to use Twitter in medicine. Twitter use by medical institutions can interactively and efficiently provide public health information and education for laypeople.ObjectiveThis study examined Twitter usage by medical institutions.MethodsWe reviewed all Japanese user accounts in which the names of medical institutions were described in the user's Twitter profile. We then classified medical institutions' tweets by content.ResultsWe extracted 168 accounts for medical institutions with ≥500 followers. The medical specialties of those accounts were dentistry and oral surgery (n=73), dermatology (n=12), cosmetic surgery (n=10), internal medicine (n=10), ophthalmology (n=6), obstetrics and gynecology (n=5), plastic surgery (n=2), and others (n=50). Of these, 21 accounts tweeted medical knowledge and 45 accounts tweeted guidance about medical practice and consultation hours, including advertisements. In the dentistry and oral surgery accounts, individual behavior or thinking was the most frequent (22/71, 31%) content. On the other hand, consultation including advertisements was the most frequent (14/23, 61%) in cosmetic surgery, plastic surgery, and dermatology.ConclusionsSome medical specialties used Twitter for disseminating medical knowledge or guidance including advertisements. This indicates that Twitter potentially can be used for various purposes by different medical specialties.
| S-EPMC4869231 | biostudies-literature
Project description:Background Anal cancer disproportionately affects sexual and gender minority individuals living with HIV. High-resolution anoscopy (HRA) is an in-clinic procedure to detect precancerous anal lesions and cancer, yet prospective data on factors associated with HRA attendance are lacking. We examined whether anal HPV sampling at home versus in a clinic impacts HRA uptake and assessed HRA acceptability. Methods Sexual and gender minority individuals were randomised to home-based self-sampling or clinical sampling. All were asked to attend in-clinic HRA 1year later. We regressed HRA attendance on study arm using multivariable Poisson regression and assessed HRA acceptability using χ 2 tests. Results A total of 62.8% of 196 participants who engaged in screening attended HRA. Although not significant (P =0.13), a higher proportion of participants who engaged in clinic-based screening attended HRA (68.5%) compared to home-based participants (57.9%). Overall, HRA uptake was higher among participants with anal cytology history (aRR 1.40, 95% CI 1.07-1.82), and lower among participants preferring a versatile anal sex position versus insertive (aRR 0.70, 95% CI 0.53-0.91), but did not differ by race or HIV serostatus. In the clinic arm, persons living with HIV had lower HRA attendance (42.9%) versus HIV-negative participants (73.3%) (P =0.02) and Black non-Hispanic participants had lower HRA attendance (41.7%) than White non-Hispanic participants (73.1%), (P =0.04). No differences in attendance by race or HIV status were observed in the home arm. Conclusions HRA uptake differed significantly by race and HIV status in the clinic arm but not the home arm.
| S-EPMC11752474 | biostudies-literature
Project description:ObjectivesTo determine if the Consecutive Interpreting Approach enhances medical English communication skills of students in a Japanese medical university and to assess this method based on performance and student evaluations.Methods This is a three-phase study using a mixed-methods design, which starts with four language reproduction activities for 30 medical and 95 nursing students, followed by a quantitative analysis of perfect-match reproduction rates to assess changes over the duration of the study and qualitative error analysis of participants' language reproduction. The final stage included a scored course evaluation and free-form comments to evaluate this approach and to identify effective educational strategies to enhance medical English communication skills.ResultsMean perfect-match reproduction rates of all participants over four reproduction activities differed statistically significantly (repeated measures ANOVA, p<0.0005). The overall perfect-match reproduction rates improved from 75.3 % to 90.1 % for nursing and 89.5 % to 91.6% for medical students. The final achievement levels of nursing and medical students were equivalent (test of equivalence, p<0.05). Details of lexical- and syntactic-level errors were identified. The course evaluation scores were 3.74 (n=30, SD = 0.59) and 3.77 (n=90, SD=0.54) for medical and nursing students respectively.ConclusionsParticipants' medical English communication skills are enhanced using this approach. Participants expressed positive feedback regarding this instruction method. This approach may be effective to enhance the language skills of non-native English-speaking students seeking to practice medicine in English speaking countries.
| S-EPMC5969989 | biostudies-literature
Project description:Although other methods exist for monitoring gastrointestinal motility and contractility, this study exclusively provides direct and quantitative measurements of the forces experienced by an orally ingested pill. We report motive forces and torques calculated from real-time, in vivo measurements of the movement of a magnetic pill in the stomachs of fasted and fed humans. Three-dimensional net force and two-dimensional net torque vectors as a function of time data during gastric residence are evaluated using instantaneous translational and rotational position data. Additionally, the net force calculations described can be applied to high-resolution pill tracking acquired by any modality. The fraction of time pills experience ranges of forces and torques are analyzed and correlate with the physiological phases of gastric digestion. We also report the maximum forces and torques experienced in vivo by pills as a quantitative measure of the amount of force pills experience during the muscular contractions leading to gastric emptying. Results calculated from human data are compared with small and large animal models with a translational research focus. The reported magnitude and direction of gastric forces experienced by pills in healthy stomachs serves as a baseline for comparison with pathophysiological states. Of clinical significance, the directionality associated with force vector data may be useful in determining the muscle groups associated with gastrointestinal dysmotility. Additionally, the quantitative comparison between human and animal models improves insight into comparative gastric contractility that will aid rational pill design and provide a quantitative framework for interpreting gastroretentive oral formulation test results.
| S-EPMC2889561 | biostudies-literature
Project description:BackgroundEngaging patients in quality improvement and innovation projects is increasingly important, yet challenges persist with involving patients who speak languages other than English. This article presents design activities our team used to engage Spanish-speaking patients and cultural brokers.ObjectiveTo develop a clinician communication tool to enhance patient trust in pregnancy care clinicians, especially among minoritized populations who face language and cultural barriers, using human-centered design (HCD).Patient involvement and innovationWe centered end-user experiences, including clinicians, Spanish-speaking patients, and Spanish-speaking cultural brokers, in our design process through multiple feedback sessions and modalities.MethodsWe used a HCD process to understand the problem, co-design a tool, and prepare for testing of a clinician tool. Design activities included a critical literature review, user interviews, design principles, solution sketching, rapid cycle feedback with subject matter experts, and field experience with pregnancy clinicians.ResultsWe innovated on a widely used clinical communication tool, the Four Habits Model, and developed the Five Habits for Pregnancy Care to support pregnancy care clinicians in building trust by bridging cultural and language differences. We added an equity-focused habit "Pause and Reflect" to bookend the Four Habits. We refined the tool to meet different needs across pregnancy care visits based on feedback from 7 clinicians.DiscussionWe applied equity principles in a HCD process to understand a problem, co-design a tool, and prepare for testing by engaging with patients and cultural brokers in Spanish. Balancing the differing approaches for designers and researchers yielded important insights for enhancing equitable processes and outcomes in healthcare improvement.Practical valueCommunication tools designed with and for minoritized populations are critical for improving trust in all patient-clinician dyads during pregnancy care.
| S-EPMC11750560 | biostudies-literature