70 results on '"Rhyne RL"'
Search Results
2. A prospective study of blood donations in healthy elderly persons
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Garry, PJ, primary, VanderJagt, DJ, additional, Wayne, SJ, additional, Koehler, KH, additional, Rhyne, RL, additional, and Simon, TL, additional
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- 1991
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3. Field action report. Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.
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Rhyne RL and Hertzman PA
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The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a 'train the trainers' strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications. [ABSTRACT FROM AUTHOR]
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- 2002
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4. Barriers to colorectal cancer screening: physician and general population perspectives, New Mexico, 2006.
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Hoffman RM, Rhyne RL, Helitzer DL, Stone SN, Sussman AL, Bruggeman EE, Viera R, Warner TD, Hoffman, Richard M, Rhyne, Robert L, Helitzer, Deborah L, Stone, S Noell, Sussman, Andrew L, Bruggeman, Elizabeth E, Viera, Robyn, and Warner, Teddy D
- Published
- 2011
5. Concurrent Validity Between Potential Screening Tests for Early Mobility Decline in Independent Community Dwellers.
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Yoshida Y, Zeni JA, Zhu Y, and Rhyne RL
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- Humans, Aged, Prospective Studies, Cross-Sectional Studies, Syndrome, Locomotion, Exercise Test
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Background and Purpose: Standardized screening tests that detect early mobility decline, regardless of etiology, are needed for healthy aging. The locomotive syndrome (LS) tests are designed to identify stages of mobility decline and inform appropriate levels of intervention. The long-term goal of this research is to develop standardized mobility screening tests that can be used across health care settings and throughout a patient's lifespan to guide appropriate medical care. As the first step in this process, this study examines the concurrent validity between the reference and the LS tests., Methods: This cross-sectional study examined correlations between the LS functional tests and a set of reference tests and the ability to differentiate the 3 stages of mobility decline. The reference tests included the stair-climbing test, the 30-second chair rise test, the 6-minute walk test, the Global Physical Health (GPH) portion of the PROMIS, and the Lower Extremity Functional Scale (LEFS). The LS tests included the Stand-Up Test, the 2-Step Test, and the 25-question Geriatric Locomotive Function Scale (25-GLFS). A total of 115 community dwellers of 61.2 years old on average (±10.0 years), with n = 71 (61%) older than 60 years, voluntary participated in this prospective study. Nonparametric analyses of variance and correlations were used to examine the concurrent validity., Results and Discussion: Performance-based tests were significantly correlated (| r | = 0.38-0.61, P < .001) with LS tests. The LEFS was correlated with all LS tests, but the GPH was only correlated with the 25-GLFS. Also, significant differences were found in reference test scores between the 3 LS stages ( P < .05)., Conclusions: The LS tests and reference tests demonstrated significant correlations, and participants performed significantly worse on reference tests as LS severity increased. Given these results, it is possible that the LS standardized tests may play an important role in mobility screening. Future research should investigate feasibility, sensitivity, and specificity of these tests., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 APTA Geriatrics, An Academy of the American Physical Therapy Association.)
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- 2022
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6. Pilot Study of an Overdose First Aid Program in Juvenile Detention.
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Chambers S, Baca M, Navrotskaya E, Madaras A, Rhyne RL, Hettema J, and Phillips C
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- Adolescent, Health Knowledge, Attitudes, Practice, Humans, Narcotic Antagonists therapeutic use, Pilot Projects, Drug Overdose prevention & control, First Aid
- Abstract
Objectives: The purpose of this study was to evaluate the feasibility and short-term impact of a brief opioid overdose prevention and mitigation training administered to detained youth at risk for witnessing an overdose., Methods: Adolescents seen in the medical clinic in a youth detention center were screened to determine risk for witnessing an overdose. Eligible adolescents completed a pretraining assessment that included opioid witnessing experiences and knowledge of and attitudes toward opioid overdose prevention. Participants completed a one-on-one overdose first aid training, received a naloxone (Narcan) kit at release, and completed a posttraining assessment of knowledge and attitudes. At 1 month and 3 months postrelease, participants completed telephone interviews to report satisfaction and application of training concepts., Results: A total of 39 adolescent residents participated in this pilot study. Rates of recruitment and retention, as well as high rates of witnessing opioid use and overdose, indicate that opioid overdose prevention interventions are warranted with this population. There were significant changes in knowledge, confidence, and readiness to intervene in an opioid overdose from pre- to posttraining. At follow-up, the majority of participants still possessed their naloxone, and all reported sharing information from the training with others and having a plan if they witnessed an overdose. One participant reported completion of an overdose reversal., Implications: Opioid overdose prevention training with detained youth is feasible and shows promising impacts on knowledge and application, meriting the need for future research.
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- 2021
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7. Exemplary Practices in Cardiovascular Care: Results on Clinical Quality Measures from the EvidenceNOW Southwest Cooperative.
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Fernald DH, Mullen R, Hall T, Bienstock A, Kirchner S, Knierim K, de la Cerda D, Callan D, Rhyne RL, Dickinson LM, and Dickinson WP
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- Adult, Colorado, Humans, Longitudinal Studies, Primary Health Care, Quality Improvement, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Quality Indicators, Health Care
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Background: Identifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies., Objective: To identify practice characteristics associated with high performance on four cardiovascular disease CQMs., Design: Longitudinal cohort study among 211 primary care practices in Colorado and New Mexico. Quarterly CQM reports were obtained from 178 (84.4%) practices. There was 100% response rate for baseline practice characteristics and implementation tracking surveys. Follow-up implementation tracking surveys were completed for 80.6% of practices., Participants: Adult patients, staff, and clinicians in family medicine, general internal medicine, and mixed-specialty practices., Intervention: Practices received 9 months of practice facilitation and health information technology support, plus biannual collaborative learning sessions., Main Measures: This study identified practice characteristics associated with overall highest performance using area under the curve (AUC) analysis on aspirin therapy, blood pressure management, and smoking cessation CQMs., Results: Among 178 practices, 39 were exemplars. Exemplars were more likely to be a Federally Qualified Health Center (69.2% vs 35.3%, p = 0.0006), have an underserved designation (69.2% vs 45.3%, p = 0.0083), and have higher percentage of patients with Medicaid (p < 0.0001). Exemplars reported greater use of cardiovascular disease registries (61.5% vs 29.5%,), standing orders (38.5 vs 22.3%) or electronic health record prompts (84.6% vs 49.6%) (all p < 0.05), were more likely to have medical home recognition (74.4% vs 43.2%, p = 0.0006), and reported greater implementation of building blocks of high-performing primary care: regular quality improvement team meetings (3.0 vs 2.2), patient experience survey (3.1 vs 2.2), and resources for patients to manage their health (3.0 vs 2.3). High improvers (n = 45) showed greater improvement implementing team-based care (32.8 vs 11.7, p = 0.0004) and population management (37.4 vs 20.5, p = 0.0057)., Conclusions: Multiple strategies-registries, prompts and protocols, patient self-management support, and patient-team partnership activities-were associated with delivering high-quality cardiovascular care over time, measured by CQMs., Trial Registration: ClinicalTrials.gov registration: NCT02515578.
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- 2020
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8. Practice Transformation Support and Patient Engagement to Improve Cardiovascular Care: From EvidenceNOW Southwest (ENSW).
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Dickinson WP, Nease DE Jr, Rhyne RL, Knierim KE, Fernald DH, de la Cerda DR, and Dickinson LM
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- Aged, Evidence-Based Practice, Female, Guideline Adherence, Humans, Male, Practice Guidelines as Topic, Cardiovascular Diseases therapy, Patient Participation, Primary Health Care organization & administration, Quality Improvement organization & administration
- Abstract
Purpose: To improve cardiovascular care through supporting primary care practices' adoption of evidence-based guidelines., Study Design: A cluster randomized trial compared two approaches: (1) standard practice support (practice facilitation, practice assessment with feedback, health information technology assistance, and collaborative learning sessions) and (2) standard support plus patient engagement support., Methods: Primary outcomes were cardiovascular clinical quality measures (CQMs) collected at baseline, 9 months, and 15 months. Implementation of the first 6 "Building Blocks of High-Performing Primary Care" was assessed by practice facilitators at baseline and 3, 6, and 9 months. CQMs from practices not involved in the study served as an external comparison., Results: A total of 211 practices completed baseline surveys. There were no differences by study arm (odds ratio [95% confidence interval]) for aspirin use (1.03 [0.99, 1.06]), blood pressure (0.98 [0.95, 1.01]), cholesterol (0.96 [0.92, 1.00]), and smoking (1.01 [0.96, 1.07]); however, there were significant improvements over time in aspirin use (1.04 [1.01, 1.07]), cholesterol (1.05 [1.03, 1.08]), and smoking (1.03 [1.01, 1.06]), but not blood pressure (1.01 [0.998, 1.03]). Improvement in enrolled practices was greater than external comparison practices across all 4 measures (all P < .05). Implementation improved in both arms for Team-Based Care, Patient-Team Partnership, and Population Management, and improvement was greater in enhanced intervention practices (all P < .05). Leadership and Data-Driven Improvement ( P < .05) improved significantly, with no difference by arm. A greater improvement in Building Block implementation was associated with a greater improvement in blood pressure measures ( P < .05)., Conclusions: Practice transformation support can assist practices with improving quality of care. Patient engagement in practice transformation can further enhance practices' implementation of aspects of new models of care., Competing Interests: Conflicting and competing interests: All authors state that they have no competing interests., (© Copyright 2020 by the American Board of Family Medicine.)
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- 2020
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9. A non-randomized pilot study to test the feasibility of treating chronic pain and opioid prescription use in rural areas with acceptance and commitment therapy (T-PACT).
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Rhyne RL, Rishel Brakey H, Halladay JR, Mottus K, Greiner KA, Salt E, Myers O, Sutton K, Fuentes J, and Vowles KE
- Abstract
Chronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials., Competing Interests: The authors have no conflicts of interest with any industry or financial agencies within the last 3 years., (© The Association for Clinical and Translational Science 2020.)
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- 2020
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10. Characterizing health researcher barriers to sharing results with study participants.
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McElfish PA, Long CR, James LP, Scott AJ, Flood-Grady E, Kimminau KS, Rhyne RL, Burge MR, and Purvis RS
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Introduction: Research participants want to receive results from studies in which they participate. However, health researchers rarely share the results of their studies beyond scientific publication. Little is known about the barriers researchers face in returning study results to participants., Methods: Using a mixed-methods design, health researchers ( N = 414) from more than 40 US universities were asked about barriers to providing results to participants. Respondents were recruited from universities with Clinical and Translational Science Award programs and Prevention Research Centers., Results: Respondents reported the percent of their research where they experienced each of the four barriers to disseminating results to participants: logistical/methodological, financial, systems, and regulatory. A fifth barrier, investigator capacity, emerged from data analysis. Training for research faculty and staff, promotion and tenure incentives, and funding agencies supporting dissemination of results to participants were solutions offered to overcoming barriers., Conclusions: Study findings add to literature on research dissemination by documenting health researchers' perceived barriers to sharing study results with participants. Implications for policy and practice suggest that additional resources and training could help reduce dissemination barriers and increase the return of results to participants., (© The Association for Clinical and Translational Science 2019.)
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- 2019
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11. The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies.
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Kaufman A, Dickinson WP, Fagnan LJ, Duffy FD, Parchman ML, and Rhyne RL
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- Colorado, Delivery of Health Care organization & administration, Efficiency, Organizational, Humans, New Mexico, Oklahoma, Oregon, Organizational Case Studies, Patient Protection and Affordable Care Act economics, United States, Washington, Community Health Planning economics, Primary Health Care organization & administration, State Health Plans standards, Total Quality Management methods
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Passage of the Patient Protection and Affordable Care Act triggered 2 successive grant initiatives from the Agency for Healthcare Research and Quality, allowing for the evolution of health extension models among 20 states, not limited to support for in-clinic primary care practice transformation, but also including a broader concept incorporating technical assistance for practices and their communities to address social determinants of health. Five states stand out in stretching the boundaries of health extension: New Mexico, Oklahoma, Oregon, Colorado, and Washington. Their stories reveal lessons learned regarding the successes and challenges, including the importance of building sustained relationships with practices and community coalitions; of documenting success in broad terms as well as achieving diverse outcomes of meaning to different stakeholders; of understanding that health extension is a function that can be carried out by an individual or group depending on resources; and of being prepared for political struggles over "turf" and ownership of extension. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems., (© 2019 Annals of Family Medicine, Inc.)
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- 2019
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12. Primary Care Practices' Ability to Report Electronic Clinical Quality Measures in the EvidenceNOW Southwest Initiative to Improve Heart Health.
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Knierim KE, Hall TL, Dickinson LM, Nease DE Jr, de la Cerda DR, Fernald D, Bleecker MJ, Rhyne RL, and Dickinson WP
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- Adult, Aged, Aged, 80 and over, Colorado, Delivery of Health Care statistics & numerical data, Female, Humans, Male, Middle Aged, New Mexico, Primary Health Care statistics & numerical data, Proportional Hazards Models, Quality Improvement statistics & numerical data, Quality Indicators, Health Care statistics & numerical data, Cardiovascular Diseases therapy, Delivery of Health Care organization & administration, Electronic Health Records, Primary Health Care organization & administration, Quality Improvement organization & administration, Quality Indicators, Health Care organization & administration
- Abstract
Importance: The capability and capacity of primary care practices to report electronic clinical quality measures (eCQMs) are questionable., Objective: To determine how quickly primary care practices can report eCQMs and the practice characteristics associated with faster reporting., Design, Setting, and Participants: This quality improvement study examined an initiative (EvidenceNOW Southwest) to enhance primary care practices' ability to adopt evidence-based cardiovascular care approaches: aspirin prescribing, blood pressure control, cholesterol management, and smoking cessation (ABCS). A total of 211 primary care practices in Colorado and New Mexico participating in EvidenceNOW Southwest between February 2015 and December 2017 were included., Interventions: Practices were instructed on eCQM specifications that could be produced by an electronic health record, a registry, or a third-party platform. Practices received 9 months of support from a practice facilitator, a clinical health information technology advisor, and the research team. Practices were instructed to report their baseline ABCS eCQMs as soon as possible., Main Outcomes and Measures: The main outcome was time to report the ABCS eCQMs. Cox proportional hazards models were used to examine practice characteristics associated with time to reporting., Results: Practices were predominantly clinician owned (48%) and in urban or suburban areas (71%). Practices required a median (interquartile range) of 8.2 (4.6-11.9) months to report any ABCS eCQM. Time to report differed by eCQM: practices reported blood pressure management the fastest (median [interquartile range], 7.8 [3.5-10.4] months) and cholesterol management the slowest (median [interquartile range], 10.5 [6.6 to >12] months) (log-rank P < .001). In multivariable models, the blood pressure eCQM was reported more quickly by practices that participated in accountable care organizations (hazard ratio [HR], 1.88; 95% CI, 1.40-2.53; P < .001) or participated in a quality demonstration program (HR, 1.58; 95% CI, 1.14-2.18; P = .006). The cholesterol eCQM was reported more quickly by practices that used clinical guidelines for cardiovascular disease management (HR, 1.35; 95% CI, 1.18-1.53; P < .001). Compared with Federally Qualified Health Centers, hospital-owned practices had greater ability to report blood pressure eCQMs (HR, 2.66; 95% CI, 95% CI, 1.73-4.09; P < .001), and clinician-owned practices had less ability to report cholesterol eCQMs (HR, 0.52; 95% CI, 0.35-0.76; P < .001)., Conclusions and Relevance: In this study, time to report eCQMs varied by measure and practice type, with very few practices reporting quickly. Practices took longer to report a new cholesterol measure than other measures. Programs that require eCQM reporting should consider the time and effort practices must exert to produce reports. Practices may benefit from additional support to succeed in new programs that require eCQM reporting.
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- 2019
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13. Primary Care Practices' Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest.
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Hall TL, Knierim KE, Nease DE Jr, Staton EW, Nkouaga C, Miriam Dickinson L, Rhyne RL, and Perry Dickinson W
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- Colorado, Cross-Sectional Studies, Guideline Adherence organization & administration, Guideline Adherence statistics & numerical data, Health Plan Implementation organization & administration, Health Plan Implementation statistics & numerical data, Health Services Research statistics & numerical data, Humans, Medically Underserved Area, New Mexico, Practice Guidelines as Topic, Primary Health Care standards, Primary Health Care statistics & numerical data, Quality Improvement, Registries statistics & numerical data, Self-Management, Surveys and Questionnaires statistics & numerical data, Cardiovascular Diseases therapy, Decision Making, Shared, Patient Care Team organization & administration, Patient Participation, Primary Health Care organization & administration
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Introduction: Care teams partnering with patients are integral to quality primary care. Effective patient-team partnership recognizes patients' contributions in decision-making and respecting patients' goals and social context. We report practice characteristics associated with greater patient-team partnership scores., Methods: EvidenceNOW Southwest was a multistate initiative to improve cardiovascular care in primary care practices through guideline-concordant aspirin use, blood pressure control, cholesterol management, and smoking cessation. EvidenceNOW Southwest provided 9 months of practice facilitation and information technology support through regular meetings and training to 211 Colorado and New Mexico primary care practices from 2015 to 2017. We analyzed surveys from 97% of participating practices regarding patient-team partnership activities of self-management support, social need assessment, resource linkages, and patient input. We used linear and mixed effects regression modeling to examine relationships between patient-team partnership and practice characteristics., Results: Practice characteristics significantly associated with greater patient-team partnership were using patient registries, medically underserved area designation, multispecialty mix, and using clinical cardiovascular disease management guidelines. Our findings suggest that patient-team partnership implementation in small primary care practices is moderate, with mean practice- and member-level scores of 52 of 100 (range, 0-100) and 71 of 100 (range, 10-100), respectively., Conclusion: Practices can improve efforts to partner with patients to assess social needs, gather meaningful input on practice improvement and patient experience, and offer resource connections. Our findings supplement recent evidence that patient registries and evidence-based guidelines may effectively prevent and manage cardiovascular disease. These strategies may also promote primary care patient-team partnership., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)
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- 2019
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14. Health researchers' experiences, perceptions and barriers related to sharing study results with participants.
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Long CR, Purvis RS, Flood-Grady E, Kimminau KS, Rhyne RL, Burge MR, Stewart MK, Jenkins AJ, James LP, and McElfish PA
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- Communication, Humans, Surveys and Questionnaires, United States, Attitude, Biomedical Research, Disclosure, Information Dissemination, Research Personnel, Research Subjects
- Abstract
Background: Although research participants are generally interested in receiving results from studies in which they participate, health researchers rarely communicate study findings to participants. The present study was designed to provide opportunity for a broad group of health researchers to describe their experiences and concerns related to sharing results (i.e. aggregate study findings) with research participants., Methods: We used a mixed-methods concurrent triangulation design, relying on an online survey to capture health researchers' experiences, perceptions and barriers related to sharing study results with participants. Respondents were health researchers who conduct research that includes the consent of human subjects and hold a current appointment at an accredited academic medical institution within the United States. For quantitative data, the analytic strategy focused on item-level descriptive analyses. For the qualitative data, analyses focused on a priori themes and emergent subthemes., Results: Respondents were 414 researchers from 44 academic medical institutions; 64.5% reported that results should always be shared with participants, yet 60.8% of respondents could identify studies in which they had a leadership role where results were not shared. Emergent subthemes from researchers' reasons why results should be shared included participant ownership of findings and benefits of results sharing to science. Reasons for not sharing included concerns related to participants' health literacy and participants' lack of desire for results. Across all respondents who described barriers to results sharing, the majority described logistical barriers., Conclusions: Study findings contribute to the literature by documenting researchers' perspectives and experiences about sharing results with research participants, which can inform efforts to improve results sharing. Most respondents indicated that health research results should always be shared with participants, although the extent to which many respondents described barriers to results sharing as well as reported reasons not to share results suggests difficulties with a one-size-fits-all approach to improving results sharing.
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- 2019
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15. Practice-based Research Network (PBRN) Engagement: 20+ Years and Counting.
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Rhyne RL and Fagnan LJ
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- Community Networks economics, Health Services Research economics, History, 20th Century, History, 21st Century, Primary Health Care economics, United States, United States Agency for Healthcare Research and Quality economics, United States Agency for Healthcare Research and Quality history, Community Networks history, Health Services Research history, Primary Health Care history
- Abstract
Competing Interests: Conflict of interest: none declared.
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- 2018
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16. A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health.
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English AF, Dickinson LM, Zittleman L, Nease DE Jr, Herrick A, Westfall JM, Simpson MJ, Fernald DH, Rhyne RL, and Dickinson WP
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- Cardiovascular Diseases therapy, Cluster Analysis, Colorado, Humans, New Mexico, Patient Education as Topic, Community Participation methods, Patient Participation methods, Primary Health Care organization & administration, Quality Improvement organization & administration
- Abstract
Purpose: EvidenceNOW Southwest is a cluster-randomized trial evaluating the differential impact on cardiovascular disease (CVD) care of engaging patients and communities in practice transformation in addition to standard practice facilitation support. The trial included development of locally tailored CVD patient engagement materials through Boot Camp Translation (BCT), a community engagement process that occurred before practice recruitment but after cluster randomization., Methods: We introduce a cluster randomization method performed before recruitment of small to medium-size primary care practices in Colorado and New Mexico, which allowed for balanced study arms while minimizing contamination. Engagement materials for the enhanced study arm were developed by means of BCT, which included community members, practice members, and public health professionals from (1) metropolitan Denver, (2) rural northeast Colorado, (3) Albuquerque, and (4) rural southeast New Mexico. Outcome measures were messages and materials from BCTs and population characteristics of study arms after using geographic-based covariate constrained randomization., Results: The 4 BCTs' messages and materials developed by the BCT groups uniquely reflected each community and ranged from family or spiritual values to early prevention or adding relevance to CVD risk. The geographic-based covariate of a cluster randomization method constrained randomization-assigned regions to study arms, allowing BCTs to precede practice recruitment, reduce contamination, and balance populations., Conclusions: Cluster-randomized trials with community-based interventions present study design and implementation challenges. The BCTs elicited unique contextual messages and materials, suggesting that interventions designed to help primary care practices decrease CVD risk may not be one size fits all., Competing Interests: Conflicts of interest: authors report none., (© 2018 Annals of Family Medicine, Inc.)
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- 2018
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17. Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population: A Randomized Clinical Trial.
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Reuland DS, Brenner AT, Hoffman R, McWilliams A, Rhyne RL, Getrich C, Tapp H, Weaver MA, Callan D, Cubillos L, Urquieta de Hernandez B, and Pignone MP
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- Black or African American, Aged, Colonoscopy methods, Colonoscopy psychology, Decision Making, Female, Hispanic or Latino, Humans, Male, Medical Records, Problem-Oriented statistics & numerical data, Middle Aged, New Mexico epidemiology, North Carolina epidemiology, Occult Blood, Primary Health Care methods, Primary Health Care statistics & numerical data, Vulnerable Populations ethnology, Vulnerable Populations statistics & numerical data, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms psychology, Decision Support Techniques, Early Detection of Cancer methods, Early Detection of Cancer psychology, Patient Navigation methods
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Importance: Colorectal cancer (CRC) screening is underused, especially among vulnerable populations. Decision aids and patient navigation are potentially complementary interventions for improving CRC screening rates, but their combined effect on screening completion is unknown., Objective: To determine the combined effect of a CRC screening decision aid and patient navigation compared with usual care on CRC screening completion., Design, Setting, and Participants: In this randomized clinical trial, data were collected from January 2014 to March 2016 at 2 community health center practices, 1 in North Carolina and 1 in New Mexico, serving vulnerable populations. Patients ages 50 to 75 years who had average CRC risk, spoke English or Spanish, were not current with recommended CRC screening, and were attending primary care visits were recruited and randomized 1:1 to intervention or control arms., Interventions: Intervention participants viewed a CRC screening decision aid in English or Spanish immediately before their clinician encounter. The decision aid promoted screening and presented colonoscopy and fecal occult blood testing as screening options. After the clinician encounter, intervention patients received support for screening completion from a bilingual patient navigator. Control participants viewed a food safety video before the encounter and otherwise received usual care., Main Outcomes and Measures: The primary outcome was CRC screening completion within 6 months of the index study visit assessed by blinded medical record review., Results: Characteristics of the 265 participants were as follows: their mean age was 58 years; 173 (65%) were female, 164 (62%) were Latino; 40 (15%) were white non-Latino; 61 (23%) were black or of mixed race; 191 (78%) had a household income of less than $20 000; 101 (38%) had low literacy; 75 (28%) were on Medicaid; and 91 (34%) were uninsured. Intervention participants were more likely to complete CRC screening within 6 months (68% vs 27%); adjusted-difference, 40 percentage points (95% CI, 29-51 percentage points). The intervention was more effective in women than in men (50 vs 21 percentage point increase, interaction P = .02). No effect modification was observed across other subgroups., Conclusions and Relevance: A patient decision aid plus patient navigation increased the rate of CRC screening completion in compared with usual care invulnerable primary care patients., Trial Registration: clinicaltrials.gov Identifier: NCT02054598.
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- 2017
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18. Health Extension and Clinical and Translational Science: An Innovative Strategy for Community Engagement.
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Kaufman A, Rhyne RL, Anastasoff J, Ronquillo F, Nixon M, Mishra S, Poola C, Page-Reeves J, Nkouaga C, Cordova C, and Larson RS
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- Awards and Prizes, Biomedical Research methods, Financial Management methods, Humans, New Mexico, Universities economics, Biomedical Research economics, Community-Based Participatory Research economics, Community-Institutional Relations economics, Health Priorities economics, Health Services Needs and Demand, Research Personnel economics
- Abstract
Health Extension Regional Officers (HEROs) through the University of New Mexico Health Sciences Center (UNMHSC) help to facilitate university-community engagement throughout New Mexico. HEROs, based in communities across the state, link priority community health needs with university resources in education, service, and research. Researchers' studies are usually aligned with federal funding priorities rather than with health priorities expressed by communities. To help overcome this misalignment, the UNM Clinical and Translational Science Center (CTSC) provides partial funding for HEROs to bridge the divide between research priorities of UNMHSC and health priorities of the state's communities. A bidirectional partnership between HEROs and CTSC researchers was established, which led to: 1) increased community engaged studies through the CTSC, 2) the HERO model itself as a subject of research, 3) a HERO-driven increase in local capacity in scholarship and grant writing, and 4) development of training modules for investigators and community stakeholders on community-engaged research. As a result, 5 grants were submitted, 4 of which were funded, totaling $7,409,002.00, and 3 research articles were published. Health extension can serve as a university-funded, community-based bridge between community health needs and Clinical and Translational Science Award (CTSA) research capacity, opening avenues for translational research., (© Copyright 2017 by the American Board of Family Medicine.)
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- 2017
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19. Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions.
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Brenner AT, Hoffman R, McWilliams A, Pignone MP, Rhyne RL, Tapp H, Weaver MA, Callan D, de Hernandez BU, Harbi K, and Reuland DS
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- Aged, Female, Humans, Male, Middle Aged, Vulnerable Populations ethnology, Colorectal Neoplasms diagnosis, Decision Making, Decision Support Techniques, Mass Screening psychology, Vulnerable Populations psychology
- Abstract
Introduction: Low-income, low-literacy, limited English-proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient-provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits., Study Design: RCT with data collected from patients at baseline and immediately after the provider encounter., Setting/participants: Patients aged 50-75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014-September 2015; analysis, 2015)., Intervention: Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter., Main Outcome Measures: CRC screening-related knowledge, discussion, intent, test preferences, and test ordering., Results: The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%)., Conclusions: Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population., Trial Registration: This study is registered at www.clinicaltrials.gov NCT02054598., (Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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20. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography.
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Hoffman RM, Sussman AL, Getrich CM, Rhyne RL, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Murrietta AM, Saeed AI, and Mishra SI
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- Directive Counseling statistics & numerical data, Early Detection of Cancer methods, Early Detection of Cancer psychology, Female, Guideline Adherence standards, Health Plan Implementation, Humans, Interviews as Topic, Lung Neoplasms prevention & control, Male, Mass Screening standards, Medically Underserved Area, New Mexico, Physician Assistants psychology, Preventive Health Services statistics & numerical data, Professional-Patient Relations, Qualitative Research, Radiation Dosage, Risk Factors, Smoking adverse effects, Smoking Cessation methods, Health Knowledge, Attitudes, Practice, Lung Neoplasms diagnostic imaging, Mass Screening methods, Physicians, Primary Care psychology, Tomography, X-Ray Computed methods
- Abstract
Introduction: On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening., Methods: We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure., Results: We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population., Conclusion: Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
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- 2015
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21. Increasing the relative weight of noncognitive admission criteria improves underrepresented minority admission rates to medical school.
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Ballejos MP, Rhyne RL, and Parkes J
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- Adult, Cognition, College Admission Test, Communication, Cultural Diversity, Female, Humans, Male, New Mexico, Problem Solving, United States, Minority Groups education, School Admission Criteria
- Abstract
Unlabelled: CONSTRUCT: The objective of this study was to evaluate the impact of varying the relative weights of cognitive versus noncognitive admission criteria on the proportion of underrepresented minorities admitted to medical school. It answers the question, "Can medical schools increase the admission rates of underrepresented minority (URM) students by balancing cognitive criteria with the experiences, attributes, and metrics of noncognitive data in the admission process?", Background: U.S. demographics are shifting, and by 2042 ethnic minority groups will make up approximately 50% of the population. Increasing diversity of the U.S. population foreshadows the need to increase the number of physicians from underrepresented minorities to help address healthcare disparities that are on the rise., Approach: A cohort of three medical school applicant classes (2007-2009) was used to model the impact on URM admission rates as the relative weights of cognitive and noncognitive admission criteria were varied. This study used the minimum admission standards established for the actual incoming classes. The URM rate of admission to medical school was the outcome. Cognitive criteria included Medical College Admission Test scores and grade point averages. Noncognitive criteria included four categories: background and diversity, interest and suitability for a career in medicine, problem-solving and communication skills, and letters of recommendation., Results: A cohort of 480 applicants from the three applicant classes were enrolled in the study. As the weighting scheme was varied from 50% cognitive/50% noncognitive weights to 35%/65%, the proportion of URM students accepted to medical school increased from 24% (42/177) to 30% (57/193; p < .001). Hispanic and Native American acceptance rates increased by 5.1% and 0.7%, respectively., Conclusions: Admission rates of URM students can be increased by weighting noncognitive higher relative to cognitive criteria without compromising admission standards. Challenging conventional practice in the admissions process may improve health disparities and diversify the physician workforce.
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- 2015
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22. Underinsurance before the implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net).
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Cardinali G, Rhyne RL, Fleg A, Corum BN, Tsewang D, Jo A, Leiderman J, and North C
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- Adolescent, Adult, Aged, Humans, Middle Aged, Young Adult, Medically Uninsured statistics & numerical data, Patient Protection and Affordable Care Act, Safety-net Providers statistics & numerical data
- Abstract
Background: As the Affordable Care Act (ACA) is implemented and many uninsured become insured, rates of underinsurance may persist or increase. This study was designed to estimate the rate of underinsurance in primary care safety net clinics serving low income, multiethnic populations in New Mexico., Methods: Data were collected from 2 primary care clinics in an urban setting during a 2-week period in 2011 and 2012. Voluntary, anonymous, self-administered surveys were distributed to adult patients waiting to be seen by their doctor. Surveys were available in English and Spanish., Results: Of those insured, 44% were underinsured. The underinsured comprised higher proportions of patients who were Hispanic, young, and poor; 39% reported fair or poor health, 23% reported that their health suffered from an inability to seek care because of cost, and 53% had either Medicaid or state coverage insurance. Patients with an income of ≤$25,000 were 8 times more likely to be underinsured., Conclusion: A high level of underinsurance was found in these safety net clinics. Because millions of Americans gain health care insurance benefits, monitoring whether the current reform provides adequate health care coverage or whether those with new and existing health care insurance are underinsured is critical., (© Copyright 2014 by the American Board of Family Medicine.)
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- 2014
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23. Along the way to developing a theory of the program: a re-examination of the conceptual framework as an organizing strategy.
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Helitzer DL, Sussman AL, Hoffman RM, Getrich CM, Warner TD, and Rhyne RL
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- Colorectal Neoplasms diagnosis, Colorectal Neoplasms ethnology, Communication, Early Detection of Cancer, Health Knowledge, Attitudes, Practice, Humans, Minority Groups, Patient Care Team organization & administration, Professional-Patient Relations, Research Design
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Purpose: Conceptual frameworks (CF) have historically been used to develop program theory. We re-examine the literature about the role of CF in this context, specifically how they can be used to create descriptive and prescriptive theories, as building blocks for a program theory. Using a case example of colorectal cancer screening intervention development, we describe the process of developing our initial CF, the methods used to explore the constructs in the framework and revise the framework for intervention development., Methods: We present seven steps that guided the development of our CF: (1) assemble the "right" research team, (2) incorporate existing literature into the emerging CF, (3) construct the conceptual framework, (4) diagram the framework, (5) operationalize the framework: develop the research design and measures, (6) conduct the research, and (7) revise the framework., Results: A revised conceptual framework depicted more complicated inter-relationships of the different predisposing, enabling, reinforcing, and system-based factors. The updated framework led us to generate program theory and serves as the basis for designing future intervention studies and outcome evaluations., Conclusions: A CF can build a foundation for program theory. We provide a set of concrete steps and lessons learned to assist practitioners in developing a CF., (Copyright © 2014 Elsevier Ltd. All rights reserved.)
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- 2014
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24. Comparing the effect of a decision aid plus patient navigation with usual care on colorectal cancer screening completion in vulnerable populations: study protocol for a randomized controlled trial.
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Brenner AT, Getrich CM, Pignone M, Rhyne RL, Hoffman RM, McWilliams A, de Hernandez BU, Weaver MA, Tapp H, Harbi K, and Reuland D
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- Acculturation, Aged, Clinical Protocols, Colonoscopy, Colorectal Neoplasms ethnology, Colorectal Neoplasms pathology, Colorectal Neoplasms psychology, Early Detection of Cancer methods, Female, Health Knowledge, Attitudes, Practice ethnology, Hispanic or Latino psychology, Humans, Insurance Coverage, Insurance, Health, Language, Male, Middle Aged, New Mexico epidemiology, North Carolina epidemiology, Occult Blood, Patient Education as Topic, Predictive Value of Tests, Video Recording, Vulnerable Populations ethnology, Colorectal Neoplasms diagnosis, Decision Support Techniques, Early Detection of Cancer psychology, Patient Navigation, Research Design, Vulnerable Populations psychology
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Background: Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients., Methods/design: We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on CRC screening., Discussion: This pragmatic randomized controlled trial will test a combined decision aid and patient navigator intervention targeting CRC screening completion. Findings from this trial may inform future interventions and implementation policies designed to promote CRC screening in vulnerable patient populations and to reduce screening disparities., Clinical Trial Registration: ClinicalTrials.gov NCT02054598.
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- 2014
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25. Colorectal cancer incidence and mortality disparities in new Mexico.
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Hoffman RM, Espey DK, Rhyne RL, Gonzales M, Rajput A, Mishra SI, Stone SN, and Wiggins CL
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Background. Previous analyses indicated that New Mexican Hispanics and American Indians (AI) did not experience the declining colorectal cancer (CRC) incidence and mortality rates observed among non-Hispanic whites (NHW). We evaluated more recent data to determine whether racial/ethnic differences persisted. Methods. We used New Mexico Surveillance Epidemiology and End Results data from 1995 to 2009 to calculate age-specific incidence rates and age-adjusted incidence rates overall and by tumor stage. We calculated mortality rates using National Center for Health Statistics' data. We used joinpoint regression to determine annual percentage change (APC) in age-adjusted incidence rates. Analyses were stratified by race/ethnicity and gender. Results. Incidence rates continued declining in NHW (APC -1.45% men, -1.06% women), while nonsignificantly increasing for AI (1.67% men, 1.26% women) and Hispanic women (0.24%). The APC initially increased in Hispanic men through 2001 (3.33%, P = 0.06), before declining (-3.10%, P = 0.003). Incidence rates declined in NHW and Hispanics aged 75 and older. Incidence rates for distant-stage cancer remained stable for all groups. Mortality rates declined significantly in NHW and Hispanics. Conclusions. Racial/ethnic disparities in CRC persist in New Mexico. Incidence differences could be related to risk factors or access to screening; mortality differences could be due to patterns of care for screening or treatment.
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- 2014
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26. Surveillance of colorectal cancer screening in new Mexico hispanics and non-Hispanic whites.
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Gonzales M, Nelson H, Rhyne RL, Stone SN, and Hoffman RM
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- Aged, Behavioral Risk Factor Surveillance System, Female, Healthcare Disparities ethnology, Humans, Male, Middle Aged, New Mexico epidemiology, Risk Factors, Socioeconomic Factors, Colorectal Neoplasms ethnology, Early Detection of Cancer statistics & numerical data, Hispanic or Latino statistics & numerical data, White People statistics & numerical data
- Abstract
The incidence of colorectal cancer (CRC) among Hispanics in the state of New Mexico has increased in the past decade while that among whites has declined significantly. Using the 2006 New Mexico Behavioral Risk Factor Surveillance System (BRFSS) survey, we compared CRC screening among Hispanics and whites by gender to examine the influence of demographic, socioeconomic, preventive health, and clinical measures on the utilization of CRC screening. Although we found no ethnic differences in the prevalence of current breast, cervical and cancer screening, Hispanics were less likely to be current with CRC screening than whites. These differences were observed across a range of socioeconomic and other explanatory measures and in both genders. Hispanics also had a higher prevalence of CRC-related risk factors than whites, including inactivity, obesity, and diabetes, and ranked lower for most socioeconomic measures. Adjusting for healthcare coverage, education, and income in logistic regression models eliminated the Hispanic-white differences in CRC screening among men, and substantially reduced but did not eliminate screening differences among women. Innovative methods are needed to reach Hispanics to raise awareness of and participation in CRC screening. Because many CRC risk factors are potentially modifiable, appropriate cultural and linguistic interventions tailored to specific Hispanic subgroups and aimed at promoting CRC screening and reducing CRC risk factors may decrease ethnic disparities in CRC incidence.
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- 2012
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27. Primary care providers' needs and preferences for information about colorectal cancer survivorship care.
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Salz T, Oeffinger KC, Lewis PR, Williams RL, Rhyne RL, and Yeazel MW
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- Adult, Cross-Sectional Studies, Female, Health Care Surveys, Humans, Male, Middle Aged, United States, Colorectal Neoplasms rehabilitation, Health Personnel, Needs Assessment, Primary Health Care, Survivors
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Background: The Institute of Medicine (IOM) proposed that cancer survivors and their primary care providers (PCPs) should receive survivorship care plans to inform ongoing care. We aimed to determine PCPs' preferences for the content of survivorship care plans for colorectal cancer (CRC) survivors., Methods: PCPs in 3 practice-based research networks completed a survey regarding 45 topics of CRC information based on the IOM's survivorship care plan framework., Results: One hundred fifty-six PCPs completed the survey. For 35 topics (78%), at least half of respondents felt the topic was very important. Most PCPs reported receiving too little information about problems with chemotherapy (68%) or radiation (60%) and whether the oncologist intended to monitor for other cancers (71%). PCPs widely agreed that they do not have enough information about increased risk of second CRCs, other cancers, and other diseases (78%); long-term effects of chemotherapy (73%) and radiation (67%); and genetic counseling (83%)., Conclusions: PCPs endorse the IOM's survivorship care plan framework as relevant and often report needing more information. Survivorship care plans may provide important information to PCPs by communicating patients' cancer histories and making recommendations regarding which aspects of care should be provided by the oncologist or the PCP.
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- 2012
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28. Expressions of machismo in colorectal cancer screening among New Mexico Hispanic subpopulations.
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Getrich CM, Sussman AL, Helitzer DL, Hoffman RM, Warner TD, Sánchez V, Solares A, and Rhyne RL
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- Aged, Aged, 80 and over, Colorectal Neoplasms epidemiology, Colorectal Neoplasms prevention & control, Culture, Early Detection of Cancer statistics & numerical data, Emigrants and Immigrants psychology, Emigrants and Immigrants statistics & numerical data, Female, Health Knowledge, Attitudes, Practice, Health Promotion, Hispanic or Latino psychology, Humans, Incidence, Male, Middle Aged, New Mexico epidemiology, Patient Satisfaction, Qualitative Research, Rural Population, Socioeconomic Factors, Colorectal Neoplasms psychology, Early Detection of Cancer psychology, Hispanic or Latino statistics & numerical data, Masculinity, Men's Health
- Abstract
Although national colorectal cancer (CRC) incidence rates have steadily decreased, the rate for New Mexico Hispanics has been increasing, and screening rates are low. We conducted an exploratory qualitative study to determine barriers to CRC screening for New Mexico Hispanics. We found that machismo served as a dynamic influence on men's health-seeking behaviors; however, it was conceptualized differently by two distinct Hispanic subpopulations, and therefore appeared to play a different role in shaping their screening attitudes and behaviors. Machismo emerged as more of an influence for Mexican men, who expressed concern over colonoscopies being potentially transformative and/or stigmatizing, but was not as salient for Hispanos, who viewed the colonoscopy as "strictly medical," and were more concerned with discomfort and pain. Findings from the study highlight the importance of identifying varying characteristics among subpopulations to better understand screening barriers and provide optimal CRC screening counseling in primary care settings.
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- 2012
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29. Chronic non-cancer pain: a siren for primary care--a report from the PRImary Care MultiEthnic Network (PRIME Net).
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Leverence RR, Williams RL, Potter M, Fernald D, Unverzagt M, Pace W, Parnes B, Daniels E, Skipper B, Volk RJ, Brown AE, and Rhyne RL
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- Adult, Analgesics, Opioid therapeutic use, Chronic Pain drug therapy, Chronic Pain ethnology, Chronic Pain psychology, Community Health Services organization & administration, Cross-Sectional Studies, Health Care Surveys, Health Services Research organization & administration, Humans, Practice Guidelines as Topic, Primary Health Care, Surveys and Questionnaires, Chronic Pain therapy, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Introduction: Patients with chronic non-cancer pain (CNCP) are common and have a high degree of morbidity. Previous studies document clinician frustration and variability in CNCP management. We conducted this study to gather in-depth clinicians' views about factors that affect management of CNCP., Methods: We conducted a survey in the Primary Care MultiEthnic Network, a consortium of PBRNs of primary care clinicians practicing in low-income, medically underserved communities, and in a network of private primary care offices., Results: Of 792 clinicians surveyed, 497 (63%) participated. Responses and accompanying narrative comments clustered around 5 themes: (1) barriers to and uncertainties in optimal management; (2) the complex biopsychosocial nature of CNCP; (3) seriousness of prescription opioid abuse; (4) effort and burden required to properly manage CNCP; and (5) clinician commitment to provide care for CNCP patients and benefits of expanded care model for CNCP. One-third reported a severe outcome (death or life-threatening event) in a CNCP patient for whom they had prescribed opioids. Roughly one-third do not initiate prescribing of opioids., Conclusions: Guidelines and increased continuing medical education alone are unlikely to be the solutions to the challenges of CNCP management. Increased evidence for recommendations and resources for more comprehensive care management are needed.
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- 2011
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30. No longer simply a Practice-based Research Network (PBRN) health improvement networks.
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Williams RL and Rhyne RL
- Subjects
- Ambulatory Care organization & administration, Community Health Services organization & administration, Community Networks organization & administration, Education, Medical, Continuing, Family Practice education, Family Practice organization & administration, Humans, Medically Underserved Area, Primary Health Care standards, Community-Based Participatory Research organization & administration, Primary Health Care organization & administration, Quality Improvement organization & administration
- Abstract
While primary care Practice-based Research Networks are best known for their original, research purpose, evidence accumulating over the last several years is demonstrating broader values of these collaborations. Studies have demonstrated their role in quality improvement and practice change, in continuing professional education, in clinician retention in medically underserved areas, and in facilitating transition of primary care organization. A role in informing and facilitating health policy development is also suggested. Taking into account this more robust potential, we propose a new title, the Health Improvement Network, and a new vision for Practice-based Research Networks.
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- 2011
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31. A public-health perspective on screening colonoscopy.
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Hoffman RM, Espey D, and Rhyne RL
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- Colonic Polyps diagnosis, Colonic Polyps surgery, Colonoscopy economics, Colorectal Neoplasms economics, Colorectal Neoplasms prevention & control, Humans, Randomized Controlled Trials as Topic, Colonoscopy standards, Colorectal Neoplasms diagnosis
- Abstract
Colorectal cancer is an important global health problem. Randomized trials have shown that screening programs can reduce both colorectal cancer incidence and mortality, and guidelines strongly support screening. Nevertheless, screening rates are relatively low and concerted efforts are being made to increase screening uptake. Many guidelines and practitioners have come to view colonoscopy as the optimal screening strategy. Colonoscopy provides both a gold-standard diagnostic test and, with polypectomy, a therapeutic intervention that can prevent cancer. However, from a public-health perspective, emphasizing colonoscopy is problematic. The efficacy of colonoscopy has not been supported with randomized trial data, accuracy is imperfect, procedural quality is variable, complications are not uncommon, endoscopic capacity is limited, procedure costs are high, and many patients prefer alternative tests. Successful screening programs will need to provide a range of screening modalities and ensure that endoscopic resources are used efficiently.
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- 2011
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32. Combining web-based and mail surveys improves response rates: a PBRN study from PRIME Net.
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Kroth PJ, McPherson L, Leverence R, Pace W, Daniels E, Rhyne RL, and Williams RL
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- Attitude of Health Personnel, Hepatitis C diagnosis, Hepatitis C psychology, Hepatitis C therapy, Humans, Internet economics, Postal Service economics, Primary Health Care, Surveys and Questionnaires, United States, Data Collection methods, Health Surveys, Internet statistics & numerical data, Postal Service statistics & numerical data
- Abstract
Purpose: The advent of Web-based survey tools has provided the investigator with an alternative to paper-based survey methods that in many instances may be less expensive to implement than traditional paper-based surveys. Newer technology, however, does not diminish the importance of obtaining an adequate response rate., Methods: We analyzed response rate data obtained from a survey implemented across 3 practice-based research networks (PBRNs) in which the survey was first implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and then by 2 rounds of a paper-based version mailed only to nonresponders., Results: Overall, 24% of the total survey responses received were in the paper mode despite intense promotion of the survey in the electronic phase., Conclusions: Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates in PBRNs.
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- 2009
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33. Practice-based research network membership is associated with retention of clinicians in underserved communities: a Research Involving Outpatient Settings Network (RIOS Net) study.
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Sinclair-Lian N, Rhyne RL, Alexander SH, and Williams RL
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- Cross-Sectional Studies, Humans, New Mexico, Ambulatory Care organization & administration, Biomedical Research methods, Community Health Services methods, Medically Underserved Area, Practice Patterns, Physicians' standards, Primary Health Care standards, Rural Health Services standards
- Abstract
Background: Professional isolation is a barrier to practicing in rural and underserved communities. The purpose of this study was to investigate the association between membership in a practice-based research network and the length of employment in members' and nonmembers' current clinic sites., Methods: This was a cross sectional study of 7 group practices (2 urban and 5 rural groups comprising 22 clinic sites) throughout New Mexico that had RIOS Net member and nonmember practicing clinicians., Results: The 22 clinics employed 95 clinicians, of which 43% were RIOS Net members (21 of 59 MDs, 8 of 18 Nurse Practitioners, 9 of 15 Physician Assistants and 3 of 3 others). RIOS Net members had a significantly longer mean employment time (7.0 years; SD, 6.8 years; median, 5.0 years), compared with non-RIOS Net members (4.0 years; SD, 5.0 years; median, 2.3 years; P = .003). Similar results were found when analyzed by length of time in practice with cutoffs of 2 and 5 years., Discussion: Being a member of a practice-based research network may be a determinate of staying in rural practice longer. This is a hypothesis-generating study and needs confirmation from larger studies whose analysis stratifies clinician demographics and practice type.
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- 2008
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34. Factors in recruiting and retaining health professionals for rural practice.
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Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, and Rhyne RL
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- Adult, Employee Incentive Plans, Female, Health Care Surveys, Humans, Interprofessional Relations, Male, Medically Underserved Area, Middle Aged, Multivariate Analysis, New Mexico, Surveys and Questionnaires, Workforce, Attitude of Health Personnel, Career Choice, Internship and Residency, Personnel Selection, Professional Practice Location statistics & numerical data, Rural Health Services economics, Students, Health Occupations psychology
- Abstract
Context: Rural communities, often with complex health care issues, have difficulty creating and sustaining an adequate health professional workforce., Purpose: To identify factors associated with rural recruitment and retention of graduates from a variety of health professional programs in the southwestern United States., Methods: A survey collecting longitudinal data was mailed to graduates from 12 health professional programs in New Mexico. First rural and any rural employment since graduation were outcomes for univariate analyses. Multivariate analysis that controlled for extraneous variables explored factors important to those who took a first rural position, stayed rural, or changed practice locations., Findings: Of 1,396 surveys delivered, response rate was 59%. Size of childhood town, rural practicum completion, discipline, and age at graduation were associated with rural practice choice (P < .05). Those who first practiced in rural versus urban areas were more likely to view the following factors as important to their practice decision: community need, financial aid, community size, return to hometown, and rural training program participation (P < .05). Those remaining rural versus moving away were more likely to consider community size and return to hometown as important (P < .05). Having enough work available, income potential, professional opportunity, and serving community health needs were important to all groups., Conclusion: Rural background and preference for smaller sized communities are associated with both recruitment and retention. Loan forgiveness and rural training programs appear to support recruitment. Retention efforts must focus on financial incentives, professional opportunity, and desirability of rural locations.
- Published
- 2007
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35. Acanthosis nigricans and diabetes risk factors: prevalence in young persons seen in southwestern US primary care practices.
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Kong AS, Williams RL, Smith M, Sussman AL, Skipper B, Hsi AC, and Rhyne RL
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- Acanthosis Nigricans complications, Adolescent, Adult, Child, Cross-Sectional Studies, Humans, Hyperlipidemias complications, Hypertension complications, Obesity complications, Prevalence, Risk Factors, Southwestern United States, Acanthosis Nigricans epidemiology, Diabetes Mellitus, Type 2 etiology, Hyperlipidemias epidemiology, Hypertension epidemiology, Obesity epidemiology, Primary Health Care
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Purpose: Evidence shows acanthosis nigricans is often associated with hyperinsulinemia and may indicate increased risk of type 2 diabetes mellitus. The purpose of this study was to determine the association of acanthosis nigricans with type 2 diabetes risk factors and disease in young persons., Methods: We conducted a cross-sectional study in the Research in Outpatient Settings Network, a practice-based research network in southwestern US communities. Participating clinicians (N = 96) collected data on children and young adults aged 7 to 39 years seen during a 2-week sampling period. The main outcomes were the prevalence of acanthosis nigricans, type 2 diabetes risk factors (ethnicity, family history of type 2 diabetes, hypertension, overweight/obesity), type 2 diabetes, and the relationships among these., Results: Among 1,133 patients sampled, risk factors for type 2 diabetes were common: 69% had a family history of the disease; 3% of children (aged 7 to 19 years) and 12% of adults had hypertension; 43% of children and 73% of adults were overweight or obese; and 80% were members of ethnic minorities. Acanthosis nigricans was found in 17% of children and 21% of adults. Among children and adults alike, the more type 2 diabetes risk factors that were present, the higher the prevalence of acanthosis nigricans (P <.001). The prevalence ratio for type 2 diabetes in patients with acanthosis nigricans was 1.97 (95% confidence interval, 1.18-3.27; P = .01) after controlling for age, body mass index, and the number of type 2 diabetes risk factors. Clinicians reported that the identification of acanthosis nigricans frequently led to discussions about lifestyle modification for decreasing the risk of type 2 diabetes., Conclusions: Patients with acanthosis nigricans are likely to have multiple risk factors for type 2 diabetes. Acanthosis nigricans may be an independent risk factor for this disease. Detection of acanthosis nigricans may help clinicians more rapidly identify high-risk individuals for diabetes counseling.
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- 2007
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36. Interdisciplinary health education and career choice in rural and underserved areas.
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Rhyne RL, Daniels ZM, Skipper BJ, Sanders ML, and VanLeit BJ
- Subjects
- Adult, Aged, Cohort Studies, Female, Health Personnel, Humans, Longitudinal Studies, Male, Medically Underserved Area, Middle Aged, Career Choice, Education, Medical, Undergraduate methods, Health Education methods, Interprofessional Relations, Rural Health
- Abstract
Purpose: To assess the association between an educational rural health interdisciplinary programme (RHIP) and subsequent practice in US rural and underserved locations., Methods: We carried out a longitudinal cohort study of RHIP students and randomly selected classmate controls for the years 1990-2001, using a mailed survey., Outcomes: Main outcome measures were first rural, any rural, first underserved and any underserved practice locations. Multivariate statistical methods were used to calculate prevalence ratios (PRs) by discipline while controlling for possible extraneous variables., Results: Of 1396 surveys delivered, 820 were returned, giving a response rate of 59%. After exclusions, results from 255 RHIP and 534 control students were analysed for outcomes. Pharmacy students on the RHIP chose first and any rural practice locations more often than reference controls (PRs = 2.59 and 1.97, respectively; P < 0.05). Therapies (occupational, physical and speech therapy) RHIP students were associated with all 4 practice outcomes more often (PRs = 2.07, 1.85, 1.68 and 1.65, respectively; P < 0.05). Pharmacy and Therapies control students with rural training chose first rural and any rural practices more often (PRs = 2.58 and 1.62, respectively; P < 0.05 for both). Medicine and Nursing students did not choose outcome practice locations more often, but had small sample sizes and large numbers of controls with rural training. Rural health interdisciplinary students rated participation in rural training more highly as a factor in choosing first rural practices than did the controls who chose similar practices., Conclusions: Participation in RHIP and other rural training experiences may stimulate subsequent career choices in rural and underserved locations for Pharmacy and Therapies students. Other studies are needed to confirm these findings and answer questions raised by these data.
- Published
- 2006
- Full Text
- View/download PDF
37. Required research by medical students and their choice of a women's health care residency.
- Author
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Chongsiriwatana KM, Phelan ST, Skipper BJ, Rhyne RL, and Rayburn WF
- Subjects
- Female, Gynecology education, Humans, Male, Obstetrics education, Choice Behavior, Delivery of Health Care, Internship and Residency statistics & numerical data, Research statistics & numerical data, Students, Medical statistics & numerical data, Women's Health
- Abstract
Objective: This study searches for association between the subject of medical students' required research projects and subsequent choices of residency, focusing specifically on women's health fields., Study Design: Students at our school graduating between 1997 and 2004 (n = 535) were required to undertake a research project beginning in the preclinical years. The subject of their required research project was related to their subsequent choice of residency., Results: Ninety-nine of the 535 projects (18.5%) were women's health related. Although overall there was no significant relationship between the research project and residency choice, students who completed a women's health care project were nearly twice (1.8, 95% CI, 1.4-2.3) as likely to enter a women's health (obstetrics and gynecology or family medicine) residency than those who did not., Conclusion: An association exists between student participation in women's health research beginning during preclinical years and the subsequent choice of a women's health residency.
- Published
- 2005
- Full Text
- View/download PDF
38. Emotional responses to APO E genotype disclosure for Alzheimer disease.
- Author
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Romero LJ, Garry PJ, Schuyler M, Bennahum DA, Qualls C, Ballinger L, Kelly V, Schmitt C, Skipper B, Ortiz IE, and Rhyne RL
- Subjects
- Aged, Aged, 80 and over, Alleles, Cohort Studies, Female, Follow-Up Studies, Genetic Counseling, Humans, Male, Middle Aged, Affect, Alzheimer Disease genetics, Apolipoproteins E genetics, Disclosure, Genotype
- Abstract
The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.
- Published
- 2005
- Full Text
- View/download PDF
39. Use of herbal medicine by elderly Hispanic and non-Hispanic white patients.
- Author
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Zeilmann CA, Dole EJ, Skipper BJ, McCabe M, Low Dog T, and Rhyne RL
- Subjects
- Aged, Aged, 80 and over, Chi-Square Distribution, Complementary Therapies statistics & numerical data, Cross-Sectional Studies, Female, Humans, Interviews as Topic methods, Logistic Models, Male, Multivariate Analysis, Herbal Medicine statistics & numerical data, Hispanic or Latino statistics & numerical data, Plant Preparations therapeutic use, White People statistics & numerical data
- Abstract
Study Objectives: To determine the types and prevalence of herbal medicines used by Hispanic and non-Hispanic white individuals aged 65 years and older. Secondary objectives were to compare herbal medicine use according to ethnicity, sex, age, socioeconomic status, and education level, and to determine patients' beliefs about herbal medicines. Use of nonphysician health care providers such as acupuncturists and chiropractors also was assessed., Methods: Data for a cross-sectional, interviewer-administered survey were collected at the University of New Mexico Senior Health Center, an ambulatory health care clinic, in Albuquerque, New Mexico, from February 1996-January 1997. To participate in the study, patients had to be at least 65 years of age, established patients at the clinic, and live independently in a community dwelling. They were excluded if they had dementia, lived in an institution, or belonged to any ethnic group other than Hispanic or non-Hispanic white. Ethnicity was determined by asking the patients in which ethnic group they identified themselves., Results: A total of 186 patients were surveyed: 84 Hispanic (34 men, 50 women) and 102 non-Hispanic white (47 men, 55 women). Of the 186 patients, 91 (49%) admitted to having taken herbal medicines in the previous year. The most common were spearmint, chamomile, aloe vera, garlic, brook-mint, osha, lavender, ginger, ginseng, and camphor. Most of the patients who used herbal medicines were 65-74 years of age and took them primarily for health care maintenance or self-perceived problems., Conclusion: As approximately half of the elderly patients stated that they used herbal medicines, health care providers should be knowledgeable about herbal remedies and provide reliable information to their patients about them in a nonjudgmental manner.
- Published
- 2003
- Full Text
- View/download PDF
40. Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.
- Author
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Rhyne RL and Hertzman PA
- Subjects
- Adolescent, Adult, Asthma prevention & control, Breast Feeding, Child, Cooperative Behavior, Diabetes Mellitus prevention & control, Humans, New Mexico, Oral Hygiene, Program Development, Russia, Self Care, Sexually Transmitted Diseases prevention & control, Substance-Related Disorders prevention & control, Community Health Planning organization & administration, International Cooperation, Primary Health Care organization & administration, Public Health education, Social Medicine organization & administration, Urban Health
- Abstract
The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.
- Published
- 2002
- Full Text
- View/download PDF
41. Validity of home blood glucose reporting by geriatric patients.
- Author
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Herndon CM, Dole EJ, Rhyne RL, and Fike DS
- Subjects
- Aged, Data Collection, Female, Humans, Male, Middle Aged, Patient Compliance, Reproducibility of Results, Blood Glucose Self-Monitoring standards
- Published
- 2001
- Full Text
- View/download PDF
42. The influence of ethnicity on use of herbal remedies in elderly Hispanics and non-Hispanic whites.
- Author
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Dole EJ, Rhyne RL, Zeilmann CA, Skipper BJ, McCabe ML, and Low Dog T
- Subjects
- Aged, Cross-Sectional Studies, Data Collection, Female, Humans, Male, United States, Hispanic or Latino statistics & numerical data, Magnoliopsida, Phytotherapy, White People statistics & numerical data
- Abstract
Objective: To compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW)., Design: Cross-sectional, interviewer-administered survey., Patients/setting: 186 patients, 65 years and older, at a university-based, ambulatory, senior health center., Interventions: Not applicable., Main Outcome Measures: Differences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education., Results: Overall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, poleo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia., Conclusion: Ethnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.
- Published
- 2000
- Full Text
- View/download PDF
43. A scholarly research requirement for medical students: the ultimate problem-based learning experience.
- Author
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Rhyne RL
- Subjects
- New Mexico, Research, Education, Medical, Undergraduate methods, Problem-Based Learning methods
- Published
- 2000
- Full Text
- View/download PDF
44. Primary care and the community.
- Author
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Garr DR and Rhyne RL
- Subjects
- Humans, United States, Community Medicine, Family Practice, Physician's Role, Primary Health Care organization & administration
- Published
- 1998
45. Formal geriatric assessment, An imperative for the older person with cancer.
- Author
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Roche RJ, Forman WB, and Rhyne RL
- Subjects
- Activities of Daily Living, Aged, Aged, 80 and over, Depression psychology, Female, Humans, Male, Neoplasm Staging, Neoplasms therapy, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Geriatric Assessment, Neoplasms nursing
- Abstract
Purpose: The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices., Description: Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination. An extensive chart review established the type of cancer, stage at diagnosis, and treatment modalities used. The Karnofsky performance status scale score also was determined at this initial evaluation., Results: The group had a mean age of 74.9 years; 60% were women and 40% were men. The most common cancers were breast (28%) and prostate (16%). Fifty-two percent of the patients had localized disease and 48% had distant disease. Seventy-four percent had received treatment by the time of the initial assessment, with 62% undergoing combination therapy. The most common noncancer diagnoses were cardiovascular disease, hypertension, and osteoarthritis. Scores on standardized measures indicated that the majority of patients were independent. Those who did not receive treatment were more functionally impaired than those who received treatment. Twenty-seven percent of the sample were impaired cognitively and 24% were depressed. There were no statistical differences in functional, cognitive, or affective status between stages of disease for specific malignancies., Clinical Implications: Age alone is a poor predictor of outcome in cancer treatment and is an inappropriate factor by which to exclude persons with cancer from clinical trials. Treatment decisions based on age alone may lead to inadequate treatment. In this report, functional dependence was more prevalent in nontreated patients and was unrelated to the stage of disease. These results support the need for formal geriatric assessment, including measures of cognitive, functional, and affective status, in elderly persons with cancer. Further studies on the role of functional, cognitive, and affective status at the time of cancer diagnosis, as well as how these parameters might alter treatment decisions, are warranted. In addition, further investigation to identify which of these multiple variables influence treatment outcome are needed.
- Published
- 1997
46. Impact of environmental patient education on preventive medicine practices.
- Author
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Mead VP, Rhyne RL, Wiese WH, Lambert L, and Skipper B
- Subjects
- Adult, Cholesterol blood, Cooperative Behavior, Family Practice, Female, Humans, Immunization, Secondary, Mammography statistics & numerical data, Middle Aged, Papanicolaou Test, Physicians, Family psychology, Tetanus Toxoid, Vaginal Smears statistics & numerical data, Patient Education as Topic methods, Preventive Health Services statistics & numerical data, Primary Prevention
- Abstract
Background: Studies show that provider-oriented reminders alone are less effective at increasing physician compliance with prevention guidelines than are combinations of patient- and provider-oriented physician reminders. The effectiveness of environmental patient education (ie, office-based videos, pamphlets, and posters) without individual staff or educator involvement has not been well established. The objective of this study was to evaluate the effectiveness of environmental patient education in increasing the amount of preventive services patients receive., Methods: A nonrandomized controlled trial using historical controls was conducted in a model family practice clinic at the University of New Mexico School of Medicine in Albuquerque. The study group (n = 389) included adult women who had been seen at the clinic at a time when educational materials were present in the waiting area. The control group (n = 381) were similarly selected patients seen during the same period of the previous year, when no such materials were available. During the intervention, patients in the waiting area were exposed to educational materials that encouraged them to ask their physicians about cholesterol testing, Papanicolaou (Pap) smears, tetanus boosters, and mammograms. For both the control and study groups, physician orders for preventive services were monitored over a 4-month follow-up period by reviewing medical records., Results: There were no statistically significant changes in the number of cholesterol tests, Pap smears, tetanus boosters, or mammograms ordered after the environmental patient education intervention, despite adequate statistical power., Conclusions: Environmental patient education materials were not effective in increasing the amount of preventive services performed by physicians in this study. Although such interventions are inexpensive, easily comprehended, and well intended, they may be ineffective in increasing the performance of patient preventive services.
- Published
- 1995
47. Imaging techniques and anatomical body composition in aging.
- Author
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Baumgartner RN, Rhyne RL, Garry PJ, and Heymsfield SB
- Subjects
- Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Aging physiology, Body Composition physiology
- Published
- 1993
- Full Text
- View/download PDF
48. Body composition in the elderly from magnetic resonance imaging: associations with cardiovascular disease risk factors.
- Author
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Baumgartner RN, Rhyne RL, Garry PJ, and Chumlea WC
- Subjects
- Adipose Tissue anatomy & histology, Aged, Aged, 80 and over, Anthropometry, Body Constitution, Body Mass Index, Cholesterol blood, Cholesterol, HDL blood, Cholesterol, LDL blood, Female, Humans, Male, Risk Factors, Sex Characteristics, Triglycerides blood, Body Composition, Cardiovascular Diseases etiology, Magnetic Resonance Imaging
- Published
- 1993
- Full Text
- View/download PDF
49. Appendicular skeletal muscle areas assessed by magnetic resonance imaging in older persons.
- Author
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Baumgartner RN, Rhyne RL, Troup C, Wayne S, and Garry PJ
- Subjects
- Adipose Tissue anatomy & histology, Aged, Aged, 80 and over, Anthropometry, Arm, Humans, Middle Aged, Reference Values, Thigh, Magnetic Resonance Imaging, Muscles anatomy & histology
- Abstract
Measurements of cross-sectional muscle areas of the upper-arm and mid-thigh from MRI images were compared to corresponding estimates from anthropometric measurements of limb circumferences and skinfold thicknesses in 25 normal, healthy, elderly persons. The anthropometric method significantly overestimated actual muscle areas, and the amount of error increased systematically with level of adiposity. These results agree with those from other, similar studies using CT in younger adults, but indicate that the degree of error is 2 to 3 times greater for elderly persons. At present, there does not appear to be any simple way to "correct" the anthropometric method. Prediction methods may be developed, but these will still produce large errors for some individuals. Alternative approaches are discussed.
- Published
- 1992
- Full Text
- View/download PDF
50. Fat distribution and blood lipids in a sample of healthy elderly people.
- Author
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Chumlea WC, Baumgartner RN, Garry PJ, Rhyne RL, Nicholson C, and Wayne S
- Subjects
- Aged, Aged, 80 and over, Aging blood, Aging physiology, Analysis of Variance, Blood Pressure, Body Composition, Body Height, Body Weight, Cholesterol, HDL blood, Cross-Sectional Studies, Female, Humans, Male, Prospective Studies, Regression Analysis, Risk Factors, Skinfold Thickness, Triglycerides blood, Adipose Tissue anatomy & histology, Aging metabolism, Lipids blood
- Abstract
The cross-sectional sample consisted of data for 41 white men and 63 white women, 67-92 years of age who were healthy volunteer participants in the Aging Process Study at the University of New Mexico School of Medicine in Albuquerque, New Mexico. The variables consisted of anthropometric measures of body fatness, blood lipids and blood pressures. Correlations were computed between principal component scores, ratios of body circumferences, W/S2, blood lipid values and blood pressures for each sex. In the men, the significant correlations were of the abdomen/hip and abdomen/thigh ratios with W/S2, and the principal component scores with HDL cholesterol, triglyceride and systolic blood pressure. In the women, the abdomen/hip ratio had a low negative correlation with HDL cholesterol but a low positive correlation with triglyceride levels. The principal component scores also had low correlations with blood pressure and triglycerides. Multiple regressions were used to determine further associations between risk factors and fat distribution indices. In the men, the relationships of age and levels of body fatness with HDL cholesterol were much stronger and more complex than those with triglyceride or systolic blood pressure. In the women, only HDL cholesterol and triglyceride were associated with abdomen/hip ratio after removing the effects of overall fatness. The present findings indicate that a large abdominal circumference, implying a correspondingly large internal adipose tissue deposit, produces negative health alterations in blood lipid levels in this sample of elderly individuals. In younger adults, these changes are considered to increase the risk for cardiovascular disease.
- Published
- 1992
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