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Anwar E Ahmed,1,2 Donna K McClish,3 Thamer Alghamdi,4 Abdulmajeed Alshehri,4 Yasser Aljahdali,4 Khalid Aburayah,4 Abdulrahman Almaymoni,4 Monirah Albaijan,1 Hamdan Al-Jahdali,1,4–6 Abdul Rahman Jazieh4–6 1King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 2College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5King Abdulaziz Medical City, Riyadh, Saudi Arabia; 6Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia Background: Despite the continuing increase in the breast cancer incidence rate among Saudi Arabian women, no breast cancer risk-prediction model is available in this population. The aim of this research was to develop a risk-assessment tool to distinguish between high risk and low risk of breast cancer in a sample of Saudi women who were screened for breast cancer.Methods: A retrospective chart review was conducted on symptomatic women who underwent breast mass biopsies between September 8, 2015 and November 8, 2017 at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Results: A total of 404 (63.8%) malignant breast biopsies and 229 (36.2%) benign breast biopsies were analyzed. Women ≥40 years old (aOR: 6.202, CI 3.497–11.001, P=0.001), hormone-replacement therapy (aOR 24.365, 95% CI 8.606–68.987, P=0.001), postmenopausal (aOR 3.058, 95% CI 1.861–5.024, P=0.001), and with a family history of breast cancer (aOR 2.307, 95% CI 1.142–4.658, P=0.020) were independently associated with an increased risk of breast cancer. This model showed an acceptable fit and had area under the receiver-operating characteristic curve of 0.877 (95% CI 0.851–0.903), with optimism-corrected area under the curve of 0.865.Conclusion: The prediction model developed in this study has a high ability in predicting increased breast cancer risk in our facility. Combining information on age, use of hormone therapy, postmenopausal status, and family history of breast cancer improved the degree of discriminatory accuracy of breast cancer prediction. Our risk model may assist in initiating population-screening programs and prompt clinical decision making to manage cases and prevent unfavorable outcomes. Keywords: breast cancer management, risk assessment, modeling, patient stratification, predictive tool

Purpose: We conducted a randomized controlled clinical trial to test the effects of toothbrushing and chlorhexidine (CHX) on reducing dental plaque in mechanically ventilated adults in the ICU. Background/Significance: Because [...]

Anwar E Ahmed,1,2 Faris S Alzahrani,2 Ahmed M Gharawi,2 Salman A Alammary,2 Fahad H Almijmaj,2 Fahad M Alhusayni,2 Donna K McClish,3 Hamdan Al-Jahdali,1,2 Ashwaq A Al Olayan,4 Abdul Rahman Jazieh4 1King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 2King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; 4King Abdulaziz Medical City, National Guards Health Affairs, Riyadh, Saudi Arabia Background: Imaging tests used in our center are usually inadequate to confirm the high risk for pancreatic cancer. We aimed to use a combination of potential predictors including imaging tests to quantify the risk of pancreatic cancer and evaluate its utility. Methods: This was a retrospective cohort study of patients who were suspected as having pancreatic cancer and underwent biopsy examination of pancreatic mass at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 1, 2013, and December 31, 2016. We retrieved data on demographics, clinical history, imaging tests, and final pancreatic diagnosis from medical records. Results: Of the 206 who underwent pancreatic biopsies, the mean age was 63.6 years; 54.4% were male. Of all the biopsies, 57.8% were malignant and 42.2% were benign masses. Nine factors contributed significantly to the risk of pancreatic cancer and were noted: older age (adjusted odds ratio [aOR] =1.048; P=0.010), male gender (aOR =4.670; P=0.008), weight loss (aOR =14.810; P=0.001), abdominal pain (aOR =7.053; P=0.0.001), blood clots (aOR =20.787; P=0.014), pancreatitis (aOR =4.473; P=0.021), jaundice (aOR =7.446; P=0.003), persistent fatigue (aOR =22.015; P=0.015), and abnormal imaging tests (aOR =67.124; P=0.001). The model yielded powerful calibration (P=0.953), excellent predictive utility (area under the receiver operating characteristic curve 96.3%; 95% CI =94.1, 98.6), with optimism-corrected area under the curve bootstrap resampling of 94.9%. An optimal cut-off risk probability of 0.513 yielded a sensitivity of 94% and specificity of 84.7% for risk classification. Conclusion: The study developed and validated a risk model for quantifying the risk of pancreatic cancer. Nine characteristics were associated with increased risk of pancreatic cancer. This risk assessment model is feasible and highly sensitive and could be useful to improve screening performance and the decision-making process in clinical settings in Saudi Arabia. Keywords: pancreas, cancer, fatigue, weight loss, blood clots, jaundice, Saudi Arabia

Objective: As cancer diagnosis and treatment has moved to the outpatient healthcare setting, traditional cancer surveillance tools are less effective for complete and unbiased capture of incident cases. This study evaluates the potential for Medicare data to supplement cancer surveillance in a unique manner by using a standard that is independent of a central cancer registry.Design: State cancer registry records were matched with Medicare data. Case validation included inpatient record abstraction combined with a mail/telephone survey of treating physicians. The positive predictive value (PPV), sensitivity (capture rate), and potential additional cases were calculated for 6 Medicare claims-based case definitions.Results: The PPV varied according to cancer site and definition, ranging from 70%-97% (prostate) to 87%-98% (breast). Sensitivity varied inversely with PPV, ranging from 51%-94% (breast) to 10%-88% (lung). The most important factors that predicted being missed by the registry were having no admission to an ACOS-certified hospital and no surgical treatment.Conclusion: Medicare data represent a valid resource for supplementing state cancer registries in surveillance efforts. This potential is especially applicable to cancers predominantly diagnosed and treated outside the hospital setting. [ABSTRACT FROM AUTHOR]

Background: Cancer surveillance is essential for assessing patterns of cancer occurrence. State cancer registries do not capture all available cases potentially biasing results. Secondary data may be useful in identifying new cases and estimating the number of cases missed.Objective: We sought to create 2 distinct data sources from Medicare claims to use in combination with registry data as 3 sources for a capture-recapture analysis to estimate the capture rate and bias in capture of a statewide cancer registry.Methods: Data from the Virginia cancer registry (Registry) were merged with Medicare inpatient (Part A) as well as Medicare outpatient and physician claims (Part B) to provide 3 sources to estimate missing cases. A 3-source loglinear model was used to estimate the number of missing cancer cases for breast, lung, colorectal, and prostate cancer. Models included main effects and interactions. Additional analysis looked at the effect of demographic and comorbidity variables.Results: Loglinear models demonstrated mostly positive dependence between the 3 sources, implying that 2-source models would underestimate missing cases and overestimate capture rates. Using capture-recapture estimates of total number of cancer cases as the denominator, capture rates for Registry ranged from 59% (colorectal) to 74% (lung). When the aggregate of cases found by either Medicare or Registry were used the capture rates ranged from 74% (prostate) to 89% (breast). Further analysis indicated that capture rates differed by demographic characteristics.Conclusion: We conclude that Medicare claims are useful to supplement a Registry, estimate the number of missing cases, and assess bias in capture. [ABSTRACT FROM AUTHOR]

Anwar E Ahmed,1 Yosra Z Ali,2 Ahmad M Al-Suliman,3 Jafar M Albagshi,3 Majid Al Salamah,1 Mohieldin Elsayid,1 Wala R Alanazi,4 Rayan A Ahmed,5 Donna K McClish,6 Hamdan AL-Jahdali,1,2 1College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3King Fahad Hospital, Hofuf, Saudi Arabia; 4Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia; 5Dar Al Uloom University, Riyadh, Saudi Arabia; 6Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA Introduction: High white blood cell (WBC) count is an indicator of sickle cell disease (SCD) severity, however, there are limited studies on WBC counts in Saudi Arabian patients with SCD. The aim of this study was to estimate the prevalence of abnormal leukocyte count (either low or high) and identify factors associated with high WBC counts in a sample of Saudi patients with SCD. Methods: A cross-sectional and retrospective chart review study was carried out on 290 SCD patients who were routinely treated at King Fahad Hospital in Hofuf, Saudi Arabia. An interview was conducted to assess clinical presentations, and we reviewed patient charts to collect data on blood test parameters for the previous 6 months. Results: Almost half (131 [45.2%]) of the sample had abnormal leukocyte counts: low WBC counts 15 (5.2%) and high 116 (40%). High WBC counts were associated with shortness of breath (P=0.022), tiredness (P=0.039), swelling in hands/feet (P=0.020), and back pain (P=0.007). The mean hemoglobin was higher in patients with normal WBC counts (P=0.024), while the mean hemoglobin S was high in patients with high WBC counts (P=0.003). After adjustment for potential confounders, predictors of high WBC counts were male gender (adjusted odds ratio [aOR]=3.63) and patients with cough (aOR=2.18), low hemoglobin (aOR=0.76), and low heart rate (aOR=0.97). Conclusion: Abnormal leukocyte count was common: approximately five in ten Saudi SCD patients assessed in this sample. Male gender, cough, low hemoglobin, and low heart rate were associated with high WBC count. Strategies targeting high WBC count could prevent disease complication and thus could be beneficial for SCD patients. Keywords: white blood cell, leukocyte, SCD, Saudi, hemoglobin, low heart rate, Saudi Arabia

Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 +/- 8.2 days vs. 4.0 +/- 6.6) and third surveys (5.5 +/- 6.9 days vs. 3.8 +/- 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care. [ABSTRACT FROM AUTHOR]

Background: The validity of outcome report cards may depend on the ways in which they are adjusted for risk.Objectives: To compare the predictive ability of generic and disease-specific survival prediction models appropriate for use in patients with heart failure, to simulate outcome report cards by comparing survival across hospitals and adjusting for severity of illness using these models, and to assess the ways in which the results of these comparisons depend on the adjustment method.Design: Analysis of data from a prospective cohort study.Setting: A university hospital, a Veterans Affairs (VA) medical center, and a community hospital.Patients: Sequential patients presenting in the emergency department with acute congestive heart failure.Measurements: Unadjusted 30-day and 1-year mortality across hospitals and 30-day and 1-year mortality adjusted by using disease-specific survival prediction models (two sickness-at-admission models, the Cleveland Health Quality Choice model, the Congestive Heart Failure Mortality Time-Independent Predictive Instrument) and generic models (Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III, the mortality prediction model, and the Chadson comorbidity index).Results: The community hospital's unadjusted 30-day survival rate (85.0%) and the VA medical center's unadjusted 1-year survival rate (60.9%) were significantly lower than corresponding rates at the university hospital (92.7% and 67.5%, respectively). No severity model had excellent ability to discriminate patients by survival rates (all areas under the receiver-operating characteristic curve < 0.73). Whether the VA medical center, the community hospital, both, or neither had worse survival rates on simulated report cards than the university hospital depended on the prediction model used for adjustment.Conclusions: Results of simulated outcome report cards for survival in patients with congestive heart failure depend on the method used to adjust for severity. [ABSTRACT FROM AUTHOR]

Objective: We compared the efficacy of bladder training, pelvic muscle exercise with biofeedback-assisted instruction, and combination therapy, on urinary incontinence in women. The primary hypothesis was that combination therapy would be the most effective in reducing incontinent episodes.Study Design: A randomized clinical trial with three treatment groups was conducted in gynecologic practices at two university medical centers. Two hundred and four women diagnosed with genuine stress incontinence (n = 145) and/or detrusor instability (n = 59) received a 12-week intervention program (6 weekly office visits and 6 weeks of mail/telephone contact) with immediate and 3-month follow-up. Outcome variables included number of incontinent episodes, quality of life, perceived improvement, and satisfaction. Data analyses consisted of analysis of covariance using baseline values as covariates and chi2 tests.Results: The combination therapy group had significantly fewer incontinent episodes, better quality of life, and greater treatment satisfaction immediately after treatment. No differences among groups were observed 3 months later. Women with genuine stress incontinence had greater improvement in life impact, and those with detrusor instability had less symptom distress at the immediate follow-up; otherwise, no differences were noted by diagnosis, incontinence severity, or treatment site.Conclusions: Combination therapy had the greatest immediate efficacy in the management of female urinary incontinence regardless of urodynamic diagnosis. However, each of the 3 interventions had similar effects 3 months after treatment. Results suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling, and frequent patient contact. [ABSTRACT FROM AUTHOR]

Discusses the abstract of the study 'Brief Breast Cancer Risk Assessment Can Reduce Distress,' presented at the 21st Annual Education Conference of the National Society of Genetic Counselors held in Phoenix, Arizona in November 2002.

Abstract Background Sickle cell disease (SCD) is a chronic disease associated with high degrees of morbidity and increased mortality. Health-related quality of life (HRQOL) among adults with sickle cell disease has not been widely reported. Methods We administered the Medical Outcomes Study 36-item Short-Form to 308 patients in the Pain in Sickle Cell Epidemiology Study (PiSCES) to assess HRQOL. Scales included physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health. We compared scores with national norms using t-tests, and with three chronic disease cohorts: asthma, cystic fibrosis and hemodialysis patients using analysis of variance and Dunnett's test for comparison with a control. We also assessed whether SCD specific variables (genotype, pain, crisis and utilization) were independently predictive of SF-36 subscales, controlling for socio-demographic variables using regression. Results Patients with SCD scored significantly worse than national norms on all subscales except mental health. Patients with SCD had lower HRQOL than cystic fibrosis patients except for mental health. Scores were similar for physical function, role function and mental health as compared to asthma patients, but worse for bodily pain, vitality, social function and general health subscales. Compared to dialysis patients, sickle cell disease patients scored similarly on physical role and emotional role function, social functioning and mental health, worse on bodily pain, general health and vitality and better on physical functioning. Surprisingly, genotype did not influence HRQOL except for vitality. However, scores significantly decreased as pain levels increased. Conclusion SCD patients experience health related quality of life worse than the general population, and in general, their scores were most similar to patients undergoing hemodialysis. Practitioners should regard their HRQOL as severely compromised. Interventions in SCD should consider improvements in health related quality of life as important outcomes.

OBJECTIVE: We implemented a theory-based randomized controlled trial (Living Free of Tobacco, Plus (LIFT+) in ten rural middle schools and assessed impact on tobacco use and fruit/vegetable (F/V) intake in 2008-2010. Data on F/V intake at baseline, immediate post intervention, and 1-year follow-up are presented. METHODS: Schools were randomized to intervention or control groups. Goal setting, peer leaders, and class workshops with parent involvement, were intervention features; community partners were supportive. Seventh graders filled out surveys on health behaviors, psycho-social variables, and demographic characteristics. Adjusted models comparing intervention and control conditions were analyzed. RESULTS: Sample (n=1119) was 48.5% female, 50% White, with a mean age of 12.7years. Mean F/V servings were significantly higher in intervention schools at immediate post (3.19 servings) and at 1-year (3.02 servings) compared to controls (2.90, 2.69 respectively). Knowledge of 5-a-day recommendation was significantly higher in intervention schools at immediate post test (75.0%) versus controls (53.8%) but not at 1-year follow-up. CONCLUSIONS: Intervention schools reported significantly higher mean F/V servings at post intervention and 1-year, and for knowledge of F/V recommendations at immediate post compared to controls. Higher levels of parent and community involvement may further increase F/V intake in future interventions. ClinicalTrials.gov Identifier: NCT01412697.Copyright © 2012 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Abstract: The US National Pain Strategy recommends identifying individuals with chronic pain (CP) who experience substantial restriction in work, social, or self-care activities as having high-impact chronic pain (HICP). High-impact chronic pain has not been examined among individuals with CP and sickle cell disease (SCD). We analyzed data from 63 individuals with SCD and CP who completed at least 5 months of pain diaries in the Pain in Sickle Cell Epidemiology Study (PiSCES). Forty-eight individuals met the definition for HICP, which was operationalized in this study as reporting pain interference on more than half of diary days. Compared with individuals without HICP, individuals with HICP experienced higher mean daily pain intensity, particularly on days without crises. They also experienced a greater proportion of days with pain, days with healthcare utilization, and days with home opioid use and higher levels of stress. They did not have a statistically significantly higher proportion of days with crises or experience higher mean daily pain intensity on days with crises. Individuals with HICP experienced worse physical functioning and worse physical health compared with those without HICP, controlling for mean pain intensity, age, sex, and education. The results of this study support that HICP is a severely affected subgroup of those with CP in SCD and is associated with greater pain burden and worse health outcomes. The findings from this study should be confirmed prospectively in a contemporary cohort of individuals with SCD., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Abstract: In a cross-sectional analysis of baseline data from a randomized clinical trial, we studied 198 adolescents and adults aged 15+ with sickle cell disease. Interest was in assessing the relative strengths of the relationship of vaso-occlusive crisis (VOC) pain domains of intensity, frequency, and duration, with health-related quality of life (HRQOL). Variation in psychosocial, physical function, and pain expression domains of HRQOL was partially explained by frequency, intensity, and duration of VOC pain, separately and together, over and above differences in age, sex, genotype, and organ system damage. However, no single domain measure accounted for more than an additional partial R2 of 12.5% alone. Vaso-occlusive crisis pain frequency explained the most variation, when simultaneously considering VOC intensity and duration, except for stiffness , where duration was most predictive. Yet VOC pain intensity, and even VOC duration, also contributed to variability in HRQOL. We recommend that for most purposes, because all 3 VOC pain domains contribute to variability in HRQOL, all 3 domains should be assessed and interventions should be targeted to improve all 3 domains to maximize HRQOL outcomes (Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02197845 )., (Copyright © 2023 International Association for the Study of Pain.)

Objective: We performed a matched cohort study among individuals with and without nonalcoholic fatty liver disease (NAFLD) to determine: 1) the incidence of cancers (extrahepatic and liver) and their spectrum and 2) if NAFLD increases the risk of extrahepatic cancers., Methods: The NAFLD and non-NAFLD (control) cohorts were identified from electronic medical records via International Classification of Diseases (ICD) codes from a single center and followed from 2010 to 2019. Cohorts were matched 1:2 for age, sex, race, body mass index (BMI), and type 2 diabetes., Results: A total of 1,412 subjects were included in the analyses. There were 477 individuals with NAFLD and 935 controls (median age, 52 years; women, 54%; white vs. black: 59% vs. 38%; median BMI, 30.4 kg/m 2 ; type 2 diabetes, 34%). The cancer incidence (per 100,000 person-years) was 535 vs. 1,513 (NAFLD vs. control). Liver cancer incidence (per 100,000 person-years) was 89 in the NAFLD group vs. 0 in the control group, whereas the incidence of malignancy was higher across other types of cancer in the control group vs. in the NAFLD group., Conclusions: The overall extrahepatic cancer risk in NAFLD is not increased above and beyond the risk from background risk factors such as age, race, sex, BMI, and type 2 diabetes., Competing Interests: AJS is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect, Exhalenz and Hemoshear. He has served as a consultant to Astra Zeneca, Nitto Denko, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Fibrogen, Jannsen, Gilead, Lilly, Poxel, Artham, Cymabay, Boehringer Ingelhiem, Novo Nordisk, Birdrock, Novartis, Pfizer, Jannsen and Genfit. He has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Nordic Bioscience and Bristol Myers Squibb. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland and Novartis. He receives royalties from Elsevier and UptoDate. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Albhaisi, McClish, Kang, Gal and Sanyal.)

Abstract: Mean pain intensity alone is insufficient to describe pain phenotypes in sickle cell disease (SCD). The objective of this study was to determine impact of day-to-day intraindividual pain variability on patient outcomes in SCD. We calculated metrics of pain variability and pain intensity for 139 participants with <10% missing data in the first 28 days of the Pain in Sickle Cell Epidemiology Study. We performed Spearman rank correlations between measures of intraindividual pain variability and outcomes. We then used k-means clustering to identify phenotypes of pain in SCD. We found that pain variability was inversely correlated with health-related quality of life, except in those with daily or near-daily pain. Pain variability was positively correlated with affective coping, catastrophizing, somatic symptom burden, sickle cell stress, health care utilization, and opioid use. We found 3 subgroups or clusters of pain phenotypes in SCD. Cluster 1 included individuals with the lowest mean pain, lowest temporal instability and dependency, lowest proportion of days with pain and opioid use, and highest physical function. Cluster 2 included individuals with the highest mean pain, highest temporal dependency, highest proportion of days with pain and opioid use, and lowest physical function. Cluster 3 included individuals with high levels of mean pain, highest temporal instability, but with lower temporal dependency, proportion of days with pain and opioid use, and physical function compared with cluster 2. We conclude that intraindividual pain variability is associated with patient outcomes and psychological characteristics in SCD and is useful in delineating phenotypes of pain in SCD., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.)

Background: Filipino Americans (FAs) are the third-largest Asian American subgroup in the United States (US). Some studies showed that FAs experience more cardiometabolic diseases (CMDs) than other Asian subgroups and non-Hispanic Whites. The increased prevalence of CMD observed in FAs could be due to genetics and social/dietary lifestyles. While FAs are ascribed as an Asian group, they have higher burdens of CMD, and adverse social determinants of health compared to other Asian subgroups. Therefore, studies to elucidate how FAs might develop CMD and respond to medications used to manage CMD are warranted. The ultimate goals of this study are to identify potential mechanisms for reducing CMD burden in FAs and to optimize therapeutic drug selection. Collectively, these investigations could reduce the cardiovascular health disparities among FAs., Rationale and Design: This is a cross-sectional epidemiological design to enroll 300 self-identified Filipino age 18 yrs. or older without a history of cancer and/or organ transplant from Virginia, Washington DC, and Maryland. Once consented, a health questionnaire and disease checklist are administered to participants, and anthropometric data and other vital signs are collected. When accessible, we collect blood samples to measure basic blood biochemistry, lipids, kidney, and liver functions. We also extract DNA from the blood or saliva for genetic and pharmacogenetic analyses. CMD prevalence in FAs will be compared to the US population. Finally, we will conduct multivariate analyses to ascertain the role of genetic and non-genetic factors in developing CMD in FAs. Virginia Commonwealth University IRB approved all study materials (Protocol HM20018500)., Summary: This is the first community-based study to involve FAs in genomics research. The study is actively recruiting participants. Participant enrollment is ongoing. At the time of this publication, the study has enrolled 97 participants. This ongoing study is expected to inform future research to reduce cardiovascular health disparities among FAs.

Universal screening for colorectal cancer (CRC) is recommended for individuals 50-75 years of age, but screening uptake is suboptimal and African Americans have suffered persistent racial disparities in CRC incidence and deaths. We compared a culturally tailored fictional narrative and an engaging expert interview on the ability to increase intentions to be screened for CRC among African American women. In a post-only experiment, women (N = 442) in face-to-face listening groups in African American churches heard audio recordings of either a narrative or an expert interview. Questionnaires were completed immediately afterward and 30 days later. Women who heard narratives reported stronger intentions to be screened with a home stool blood test than women who heard the interview; the effect lasted at least 30 days. Culturally tailored, fictional narratives appear to be an effective persuasive strategy for reducing racial disparities in CRC outcomes., (© 2018 Wiley Periodicals, Inc.)

Sickle cell disease (SCD) pain is often acute-on-chronic, likening it to other chronic acute-on-chronic pain conditions. Pain treatment of SCD was already reported as inadequate prior to the current opioid epidemic, but attitudes underlying treatment were understudied. Understanding these attitudes prior to the current epidemic would be revealing. Therefore in 1997, before the current opioid epidemic, we surveyed physicians' attitudes toward pain management and treatment preferences for acute pain exacerbations in the Emergency Department in SCD versus those of chronic pancreatitis and chronic low back pain, two other acute-on-chronic pain diseases. Thirty-nine residency trainees were surveyed in a level one triage hospital. Resident estimates of the rate of opioid addiction in SCD were higher than estimates in both chronic pancreatitis and chronic low back pain. Most residents relied on their personal clinical experience rather than external sources of data or knowledge as the most important driver when they managed chronic pain. This survey research shows that, predating the current opioid epidemic, there was both a backdrop of opioid-phobia and a bias against treating SCD pain compared to other chronic pain conditions among our sample. Repeating this survey research among current training physicians, along with surveys of other attitudes, would provide useful comparisons.

Background: A case control study to better characterize the clinical features, laboratory, and radiological abnormalities associated with MERS-CoV infection in order to help with early identification of this syndrome from other respiratory infections., Methods: Eighty patients admitted to a hospital in Riyadh, diagnosed with MERS-CoV infection based on RT-PCR were matched on age, sex, and the presence of a co-morbid condition on a basis of 1:2 to other patients admitted with respiratory symptoms and tested negative for MERS-CoV on RT-PCR., Results: None of the reported MERS-CoV presenting symptoms was significantly associated with being infected with MERS-CoV. On the other hand, WBC count was significantly lower in patients with confirmed MERS-CoV infection (median 5.7 vs 9.3, P: 0.0004). Neutrophil count was as well significantly lower in MERS-CoV patients (median 3.7 vs 6.7, P: 0.0001). Both AST, and ALT values were significantly higher in MERS-CoV infected group (AST median 42 vs 36, P: 0.03, and ALT median 33 vs 28, P: 0.003). Overall our MERS-CoV mortality rate was (10%) below the national figure of (40%)., Conclusions: None of the presenting symptoms are specific for MERS-CoV infection. And out of all the investigations WBC, neutrophil counts, AST and ALT values have some predictive utility., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Knowing family history is important for understanding cancer risk, yet communication within families is suboptimal. Providing strategies to enhance communication may be useful., Methods: Four hundred ninety women were recruited from urban, safety-net, hospital-based primary care women's health clinics. Participants were randomized to receive the KinFact intervention or the control handout on lowering risks for breast/colon cancer and screening recommendations. Cancer family history was reviewed with all participants. The 20-minute KinFact intervention, based in communication and behavior theory, included reviewing individualized breast/colon cancer risks and an interactive presentation about cancer and communication. Study outcomes included whether participants reported collecting family history, shared cancer risk information with relatives, and the frequency of communication with relatives. Data were collected at baseline, 1, 6, and 14 months., Results: Overall, intervention participants were significantly more likely to gather family cancer information at follow-up (odds ratio [OR]: 2.73; 95% confidence interval [CI]: 2.01, 3.71) and to share familial cancer information with relatives (OR: 1.85; 95% CI: 1.37, 2.48). Communication frequency (1=not at all; 4=a lot) was significantly increased at follow-up (1.67 vs. 1.54). Differences were not modified by age, race, education, or family history. However, effects were modified by pregnancy status and genetic literacy. Intervention effects for information gathering and frequency were observed for nonpregnant women but not for pregnant women. Additionally, intervention effects were observed for information gathering in women with high genetic literacy, but not in women with low genetic literacy., Conclusions: The KinFact intervention successfully promoted family communication about cancer risk. Educating women to enhance their communication skills surrounding family history may allow them to partner more effectively with their families and ultimately their providers in discussing risks and prevention.

Objective: To determine whether response to a dietary intervention is greater among people with family history of colorectal cancer (CRC) compared with a general population., Design: Cohort study examining participants from 2 related studies., Setting: Rural Virginia., Participants: Seventy people with first-degree relatives with CRC and 113 participants from the intervention arm of a trial in the general population., Intervention: Both studies implemented a low-intensity intervention delivered via telephone and mail, including low-literacy self-help booklets and personalized dietary feedback., Main Outcome Measures: Fat, fiber, and fruit and vegetable behavior., Analysis: Propensity score matching controlled for confounders. Mixed-model ANOVAs compared samples; mediation by perceived cancer risk was assessed., Results: Participants in both groups significantly improved fat, fiber, and fruit and vegetable behavior at 1-month follow-up; there was significantly greater improvement in the general population sample. Cancer risk perception did not mediate the relationship between study sample and dietary change., Conclusions and Implications: Contrary to expectations, first-degree relatives of CRC patients did not respond better to a dietary intervention than the general population, nor was risk perception related to dietary change. Given the role of diet in CRC risk, additional research should investigate targeted strategies to improve dietary intakes of people at higher cancer risk., (Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Cancer treatment information is often underreported in cancer registries due to the shift in cancer care to ambulatory settings. Incomplete treatment information for central registries limits the usefulness of these data for understanding disparities in outcomes. The objective of this study was to evaluate the added value and validity of medical billing data to supplement treatment for incident cases within a central cancer registry., Methods: Billing data using standardized structure and nomenclature as submitted by all practices was evaluated using an automated software (MDoffice, MDO) process that captures and processes these data and submits the information in a standardized format. A validation of the billing reported treatment was performed using data from 3 community oncology practices., Results: The accuracy of treatment data captured was 100 percent for both chemotherapy and radiation therapy among the 313 cases validated. Chemotherapy (36 percent and 5 percent respectively for solid tumors and hematologic cancers) and radiation therapy (46 percent and 20 percent respectively for solid tumors and hematologic cancers) information was added to 738 known incident cases using billing data., Conclusion: Automated reporting based on billing data from community specialty providers is likely to markedly enhance the completeness of treatment data among known cancer cases as these community providers render significant amounts of treatment for cancer patients.

Background: The hallmark of sickle cell disease (SCD) is pain from a vaso-occlusive crisis. Although ambulatory pain accounts for most days in pain, pain is also the most common cause of hospitalization and is typically treated with parenteral opioids. The evidence base is lacking for most analgesic practice in SCD, particularly for the optimal opioid dosing for patient-controlled analgesia (PCA), in part because of the challenges of the trial design and conduct for this rare disease., Purpose: The purpose of this report is to describe our Network's experiences with protocol development, implementation, and analysis, including overall study design, the value of pain assessments rather than 'crisis' resolution as trial endpoints, and alternative statistical analysis strategies., Methods: The Improving Pain Management and Outcomes with Various Strategies (IMPROVE) PCA trial was a multisite inpatient randomized controlled trial comparing two PCA-dosing strategies in adults and children with SCD and acute pain conducted by the SCD Clinical Research Network. The specified primary endpoint was a 25-mm change in a daily average pain intensity using a Visual Analogue Scale, and a number of related pain intensity and pain interference measures were selected as secondary efficacy outcomes. A time-to-event analysis strategy was planned for the primary endpoint., Results: Of 1116 individuals admitted for pain at 31 participating sites over a 6-month period, 38 were randomized and 4 withdrawn. The trial was closed early due to poor accrual, reflecting a substantial number of challenges encountered during trial implementation., Limitations: While some of the design issues were unique to SCD or analgesic studies, many of the trial implementation challenges reflected the increasing complexity of conducting clinical trials in the inpatient setting with multiple care providers and evolving electronic medical record systems, particularly in the context of large urban academic medical centers., Lessons Learned: Complicated clinical organization of many sites likely slowed study initiation. More extensive involvement of research staff and site principal investigator in the clinical care operations improved site performance. During the subsequent data analysis, alternative statistical approaches were considered, the results of which should inform future efficacy assessments and increase future trial recruitment success by allowing substantial reductions in target sample size., Conclusions: A complex randomized analgesic trial was initiated within a multisite disease network seeking to provide an evidence base for clinical care. A number of design considerations were shown to be feasible in this setting, and several pain intensity and pain interference measures were shown to be sensitive to time- and treatment-related improvements. While the premature closure and small sample size precluded definitive conclusions regarding treatment efficacy, this trial furnishes a template for design and implementation considerations that should improve future SCD analgesic trials.

One unit's staff developed and evaluated an intervention to relocate shift-to-shift nursing report to the patient's bedside. Despite challenges related to privacy, distractions, and integration of nursing technicians to the change, bedside shift report reduced shift report times and improved nursing satisfaction.

Background: Reporting of hematologic malignancies is an increasingly important focus for cancer surveillance. As trends in cancer care are shifting to the outpatient setting, hospital-based data collection methods used for cancer surveillance will result in under-reporting of these cancers. This study describes the testing and validation of an automated system for capturing and reporting cancers from community oncology providers., Methods: The system was evaluated in 5 oncology practices in two states processing claims data for a 4- or 8-month interval. Resulting cancers were matched with the state registries. A random sample of nonmatched cases was reabstracted to measure the accuracy of the claims data for reporting of hematologic malignancies., Results: The overall match rate for the 1,935 hematologic malignancies reported during the study period was 58.2 % (range, 37.4 % for CLL to 71.2 % for Hodgkin's Lymphoma). The overall accuracy rate for billing-reported hematologic malignancies was 95 %. Accuracy among cases that did not match with the cancer registry was 88 %. The estimated number of missed cases for the five participating practices ranged from 0.8 leukemia cases/oncologist/year to 3.4 CLL cases/oncologist/year. The estimated total number of missed cases in the five participating practices was 292 with an interquartile range of 263-323., Conclusion: As cancer diagnosis and treatment continue migration into ambulatory physician practice settings unreported hematopoietic cases will become increasingly problematic. Leveraging the standardized electronic billing data for automated reporting of cancer cases from physician practices may be an efficient method to reduce this gap in cancer surveillance reporting.

Hospitals strive to provide all their patients with quality care that is safe, timely, efficient, equitable, effective, and patient centered. Although hospitals have developed technology- and industry-based quality improvement models, there remains a need to better engage the frontline health care workers at the site of care to enhance communication and coordination of care. To foster the work environment and relationships in the general acute care units, the authors describe a leadership model that partners a nurse manager with a physician director to build a local clinical care environment that seeks to enhance the whole patient care experience.

Background: Studies show that daughters of mothers with breast cancer may be at increased risk for developing the disease. However, daughters' adherence to health behavior and screening recommendations, compared to the general population, is unknown., Methods: Telephone interviews explored characteristics of adult daughters (n=147), including primary and secondary preventive behaviors, body mass index (BMI, kg/m(2)), physical activity, fruit/vegetable intake, alcohol intake, smoking, and mammography. Daughters of mothers with breast cancer were recruited from the community and were compared with Virginia women (n=2528) from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. Differences were examined using logistic regression, adjusting for demographic covariates., Results: Daughters were younger (p<0.001), more highly educated (p<0.001), and more likely to never have been married (p<0.001) than BRFSS participants, but groups were similar by race. In adjusted analyses, daughters were significantly more likely to have ever had a mammogram (p<0.001) and to have had one recently (p=0.001). Daughters also were significantly less likely to consume>3 fruit/vegetable servings daily (p=0.032) compared to BRFSS results. There were no differences in BMI, smoking rates, alcohol consumption, or level of physical activity at work., Conclusions: Daughters with familial breast cancer risk were more likely to receive mammography screening than BRFSS participants, but they were no different in BMI, physical activity at work, exercise, or smoking than BRFSS participants and were less likely to consume more fruits and vegetables. More research is needed to explore group differences in screening practices compared to modifiable health behaviors in daughters of mothers with breast cancer.

This study explored relationships between worry, perceived risk for breast cancer, consulting a genetic counselor, having genetic testing, and genetic risk for women whose mothers had breast cancer. Analyses involved data from a community-based phone survey of women whose mothers had breast cancer. Participants were categorized as having low, intermediate, or high genetic risk based on their reported family history, in accordance with an accepted classification scheme. The Lerman Breast Cancer Worry Scale measured worry, and participants reported their perceived lifetime likelihood of breast cancer, risk compared to others, and chance from 1 to 100. ANOVA, chi-square, and multiple regression analyses were conducted as appropriate. One hundred-fifty women participated. Mean age was 38 years, and 81% were Caucasian. Fifty-two women had low, 74 had intermediate, and 24 had high genetic risk for breast cancer. There were no significant differences in worry or perceived risk by hereditary risk category. Most high-risk women (91%) had not spoken with a genetic counselor, and no one had previous genetic testing. These findings suggest perceived risk, worry about breast cancer, and use of expert consultation do not match the genetic contribution to risk. There is a need for effectively stratifying and communicating risk in the community and providing tailored reassurance or referral for high-risk assessment.

Background: Urologic cancers represent a substantial proportion of the total cancer burden, yet the true burden of these cancers is unknown due to gaps in current cancer surveillance systems. Prostate and bladder cancers in particular may be underreported due to increased availability of outpatient care. Thus, there is a critical need to develop systems to completely and accurately capture longitudinal data to understand the true patterns of care and outcomes for these cancers., Methods: We determined the accuracy and impact of automated software to capture and process billing data to supplement reporting of cancers diagnosed and treated in a large community urology practice. From these data, we estimated numbers of unreported cancers for an actively reporting and for a non-reporting practice and the associated impact for a central cancer registry., Results: The software automatically processed billing data representing 26,133 visits for 15,495 patients in the 3.5-month study period. Of these, 2,275 patients had a cancer diagnosis and 87.2% of these matched with a central registry case. The estimated annual number of prostate and bladder cancers remaining unreported from this practice was 158. If the practice were not actively reporting, the unreported cases were estimated at 1,111, representing an increase of 12% to the registry. Treatments added from billing varied by treatment type with the largest proportion of added treatments for biologic response modifiers (BRMs) (127%-166%) and chemotherapy (22%)., Conclusion: Automated processing of billing data from community urology practices offers an opportunity to enhance capture of missing prostate and bladder cancer surveillance data with minimal effort to a urology practice., Impact: Broader implementation of automated reporting could have a major impact nationally considering the more than 12,000 practicing urologists listed as members of the American Urological Association.

Objective: Breast cancer mortality has declined, yet disease outcomes have not improved equally across populations. Disparities may initiate early in the continuum of care, in health behavior patterns, and screening practices. We examined variations in mammography, exercise, fruit and vegetable intake, alcohol consumption, and body mass index (BMI, kg/m2) by age and race in a diverse sample of clinic patients., Methods: We analyzed survey data collected at baseline from 855 women (>40 years old) in women's health clinics, who were recruited for a risk-tailored intervention. Screening practices, health behaviors, and demographics were surveyed. Statistical analyses were performed using bivariate difference tests and multiple logistic regression., Results: Overall, 47% of the women were African American, with a mean age of 50 years. Older women were twice as likely as younger women to have had mammography within the previous year and significantly more likely than women 10 years younger to exercise at least 3 times weekly. African American women were significantly less likely than white women to exercise at least 3 times weekly, eat more than 2 servings daily of fruit and vegetables, or report a BMI of less than <25 kg/m2. Mammography rates were comparable by race except among lesser-educated African American women, who showed higher rates versus comparable white women., Conclusions: New intervention models that link health behavior information with screening messages in clinical settings may be important in reducing breast cancer risk and mortality.