Search

Your search keyword '"Neuner, Joan M."' showing total 244 results
Start Over Author "Neuner, Joan M."
244 results on '"Neuner, Joan M."'

5. Developing a urinary incontinence primary care pathway: a mixed methods study.

Author

Luebke, Marie C, Neuner, Joan M, Balza, Joanna, Davidson, Emily R W, Hokanson, James A, Marowski, Sarah, O'Connor, Robert Corey, Schmitt, Emily, Winn, Aaron N, and Flynn, Kathryn E

Subjects
*KEGEL exercises, *PRIMARY care, *URINARY organs, *PELVIC floor, *HEALTH services accessibility, *URINARY incontinence in women
Abstract

Background While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment. Objective To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention. Methods Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway : Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months. Results While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n  = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n  = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms. Conclusion Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

6. No Increase in Fractures After Stopping Hormone Therapy: Results From the Women’s Health Initiative

Author

Watts, Nelson B, Cauley, Jane A, Jackson, Rebecca D, LaCroix, Andrea Z, Lewis, Cora E, Manson, JoAnn E, Neuner, Joan M, Phillips, Lawrence S, Stefanick, Marcia L, Wactawski-Wende, Jean, and Crandall, Carolyn

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Clinical Sciences, Cancer, Clinical Trials and Supportive Activities, Estrogen, Clinical Research, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Female, Follow-Up Studies, Hip Fractures, Hormone Replacement Therapy, Humans, Middle Aged, Osteoporosis, Postmenopausal, Postmenopause, Prognosis, Withholding Treatment, Women's Health, Women’s Health Initiative Investigators, Paediatrics and Reproductive Medicine, Endocrinology & Metabolism, Clinical sciences
Abstract

ContextThe Women's Health Initiative (WHI) hormone therapy (HT) trials showed protection against hip and total fractures, but a later observational report suggested loss of benefit and a rebound increased risk after cessation of HT.ObjectiveThe purpose of this study was to examine fractures after discontinuation of HT.Design and settingTwo placebo-controlled randomized trials served as the study setting.PatientsStudy patients included WHI participants (N = 15,187) who continued active HT or placebo through the intervention period and who did not take HT in the postintervention period.InterventionsTrial interventions included conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) in naturally menopausal women and CEE alone in women with prior hysterectomy.Main outcome measuresTotal fractures and hip fractures through 5 years after discontinuation of HT were recorded.ResultsHip fractures were infrequent (∼2.5 per 1000 person-years); this finding was similar between trials and in former HT and placebo groups. There was no difference in total fractures in the CEE + MPA trial for former HT vs former placebo users (28.9 per 1000 person-years and 29.9 per 1000 person-years, respectively; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.87 to 1.09; P = 0.63); however, in the CEE-alone trial, total fractures were higher in former placebo users (36.9 per 1000 person-years) compared with the former active group (31.1 per 1000 person-years), a finding that was suggestive of a residual benefit of CEE against total fractures (HR, 0.85; 95% CI, 0.73 to 0.98; P = 0.03).ConclusionsWe found no evidence for increased fracture risk, either sustained or transient, for former HT users compared with former placebo users after stopping HT. There was residual benefit for total fractures in former HT users from the CEE-alone study.

Published
2017

23. Pharmacy deserts and breast cancer patients’ receipt of influenza vaccines

Author

Neuner, Joan M., Zhou, Yuhong, Fergestrom, Nicole, Winn, Aaron, Pezzin, Liliana, Laud, Purushottam W., and Beyer, Kirsten

Subjects
Pharmacies, Influenza Vaccines, Influenza, Human, Vaccination, Humans, Breast Neoplasms, Female, Pharmacy, Census Tract, Medicare, Article, United States, Aged
Abstract

BACKGROUND: Yearly influenza vaccination is strongly recommended at age 65 and reimbursed by Medicare without copays or deductibles at pharmacies and clinical settings. Uptake is low among patients with high risk for influenza complications and good access to specialist care, such as recent cancer survivors. We hypothesized that more accessible pharmacies could be associated with higher immunization uptake in such patients. OBJECTIVES: To determine whether pharmacy access is associated with influenza vaccination in subjects recently diagnosed with breast cancer, and whether this association differs by additional risk factors for influenza complications. METHODS: We examined a cohort of Stage 0-III breast cancer patients diagnosed 2011–2015 from the Surveillance, End Results and Epidemiology (SEER)-Medicare cancer registry. All retail pharmacies in the US were identified and pharmacy access was measured by assessing supply and demand in each census tract using a 2-stage floating catchment area approach that accounted for pharmacy driving distances recommended by the Centers for Medicare and Medicaid Services. We examined the association of pharmacy access with influenza vaccination after breast cancer diagnosis in regression models. RESULTS: Over 11% of 45,722 breast cancer patients lived in census tracts where no pharmacies were within recommended driving distances from the population-weighted tract center. Vaccination in the year after diagnosis was less likely for patients in these very low-access tracts (Adjusted Odds Ratio 0.92, 95% Confidence Interval 0.86–0.96), Black (AOR 0.55, 95% CI 0.51–0.60) and Hispanic (AOR 0.76, 95% CI 0.70–0.83) women, and Medicaid recipients (AOR 0.74, 95% CI 0.69–0.79). Vaccination was inversely associated with per capita income in the subject’s census tract, but there was no difference in the pharmacy effect by race, ethnicity or census tract income. CONCLUSION: Very low pharmacy access is associated with modest reductions in vaccination that could be useful for policy and planning regarding vaccinator resources and outreach.

Published
2021

32. Response to Strassels and Durham

Author

Check, Devon K, primary, Winn, Aaron N, additional, Fergestrom, Nicole, additional, Reeder-Hayes, Katherine E, additional, Neuner, Joan M, additional, and Roberts, Andrew W, additional

Published
2020
Full Text
View/download PDF

47. Improving Communication in Breast Cancer Treatment Consultation: Use of a Computer Test of Health Numeracy

Author

Schapira, Marilyn M., primary, Fletcher, Kathlyn E., additional, Ganschow, Pamela S., additional, Jacobs, Elizabeth A., additional, Walker, Cindy M., additional, Smallwood, Alicia J., additional, Gil, Denisse, additional, Faghri, Arshia, additional, Kong, Amanda L., additional, Yen, Tina W., additional, McDunn, Susan, additional, Marcus, Elizabeth, additional, and Neuner, Joan M., additional

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results