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1.  Validity of self-reported colorectal cancer test use in different racial/ethnic groups 
Family Practice  2011;28(6):683-688.
Objective. Prevalence of colorectal cancer (CRC) screening is ascertained by self-reported screening, yet little is known about the accuracy of this method across different racial/ethnic groups, particularly Hispanics. The purpose of this study was to compare the accuracy of CRC self-report measures across three racial/ethnic groups.
Methods. During 2004 and 2005, 271 white, African-American and Hispanic participants were recruited from a primary care clinic in Southeast Texas, and their CRC testing history based on self-report and medical record (the ‘gold standard’) were compared.
Results. Over-reporting was prevalent. Overall, up-to-date CRC test use was 57.6% by self-report and 43.9% by medical record. Racial/ethnic group differences were most pronounced for Hispanics in whom sensitivity was significantly lower for any up-to-date testing, fecal occult blood testing, flexible sigmoidoscopy and double contrast barium enema. There were no statistically significant differences across groups for over-reporting, specificity or concordance.
Conclusions. Self-report prevalence data are overestimating CRC test use in all groups; current measures are less sensitive in Hispanics.
PMCID: PMC3215921  PMID: 21566004
Colorectal carcinoma; cancer screening; primary care; African Americans; Hispanic Americans; reliability and validity
3.  Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians 
Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians.
A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians’ general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online.
Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient’s preferred role in making the decision (62.5% very confident) and exploring a patient’s values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future.
A comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients’ desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.
Electronic supplementary material
The online version of this article (doi:10.1186/1472-6947-14-95) contains supplementary material, which is available to authorized users.
PMCID: PMC4283132  PMID: 25361614
Decision making; Medical education; Primary health care
4.  The Impact of Race/Ethnicity on Preoperative Time to Hip Stabilization Procedure after Hip Fracture 
Southern medical journal  2010;103(5):414-418.
We sought to examine the preoperative time for hip stabilization procedure among Hispanics, non-Hispanic blacks (blacks) and non-Hispanic whites (whites).
This was a secondary data analysis using Medicare claims data. Our analysis included 40,321 patients admitted for hip fracture hospitalization from 2001-2005. Our primary analysis was generalized linear modeling, and our dependent variable was preoperative time. Our independent variable was race/ethnicity (Hispanics, blacks versus whites), and covariates were age, gender, income, type of hip fracture and comorbidities.
Bivariate analyses showed that both Hispanics and blacks experienced a longer preoperative time (P<0.01). The average (mean) of days to surgery was 1.2 for whites, 1.6 for blacks and 1.7 for Hispanics. The delayed preoperative time among Hispanics and blacks persisted after adjusting for covariates.
The delayed preoperative time among minorities suggests the need to closely monitor care among minorities with hip fracture to determine how to best address their developing needs.
PMCID: PMC2879872  PMID: 20375948
preoperative time; hip fractures; Medicare; disparities; Hispanic
5.  Behind Closed Doors: Physician-Patient Discussions About Colorectal Cancer Screening 
Journal of General Internal Medicine  2009;24(11):1228-1235.
Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings.
Describe physician-patient CRCS discussions during a wellness visit.
Cross-sectional; patients audio-recorded with physicians.
A subset of patients (N = 64) participating in a behavioral intervention trial designed to increase CRCS who completed a wellness visit during the trial with a participating physician (N = 8).
Transcripts were analyzed using qualitative methods.
Physicians in this sample consistently recommended CRCS, but focused on colonoscopy. Physicians did not offer a fecal occult blood test alone as a screening choice, which may have created missed opportunities for some patients to get screened. In this single visit, physicians’ communication processes generally precluded discussion of patients’ test preferences and did not facilitate shared decision-making. Patients’ questions indicated their interest in different CRCS test types and appeared to elicit more information from physicians. Some patients remained resistant to CRCS after discussing it with a physician.
If a preference for colonoscopy is widespread among primary-care physicians, the implications for intervention are either to prepare patients for this preference or to train physicians to offer options when recommending screening to patients.
PMCID: PMC2771240  PMID: 19763699
colorectal cancer screening; physician-patient communication; shared decision-making; qualitative research; interventions
6.  Cervical Cancer Screening Among College Students in Ghana: Knowledge and Health Beliefs 
Cervical cancer is the most incident cancer and the leading cause of cancer mortality in women in Ghana. Currently little is known about Ghanaian women's knowledge and beliefs about cervical cancer screening, yet this information is essential to the success of cervical cancer screening programs. The purpose of this study, therefore, was to describe the knowledge and beliefs of women university college students in Ghana.
A cross sectional survey among college women in a university in Ghana elicited information about sociodemographics, knowledge and beliefs and acceptability of cervical cancer screening, screening history, and sexual history. Bivariate analyses were conducted to identify factors associated with screening.
140 females were recruited; the age range was 20-35 years. The prior pap screening rate was 12.0%; Women were unaware of local screening initiatives and only 7.9% were aware of the link between HPV and cervical cancer. The most prevalent barriers were lack of awareness that the purpose of pap screening is to diagnose cancer, concerns about what others may think, and lack of information about how to obtain screening services. Although women perceived the benefits of screening, only about half perceived themselves to be at risk. Women received few screening cues. Three barriers were negatively associated with screening in bivariate analyses: lack of belief that cervical screening diagnoses cancer, belief that pap test is painful and belief that the test will take away virginity.
New screening programs in Ghana should address these barriers and increase screening cues to the public.
PMCID: PMC2826278  PMID: 19407569
cervical cancer screening; health beliefs; Ghanaian women
7.  Roseomonas gilardii Infection: Case Report and Review 
Journal of Clinical Microbiology  2002;40(12):4789-4791.
Roseomonas gilardii is a bacterium that has been indicated as a rare cause of human infections. The case of a patient presenting with cellulitis and bacteremia secondary to R. gilardii is described together with the clinical characteristics of infection with this organism obtained from a review of cases previously reported.
PMCID: PMC154581  PMID: 12454198

Results 1-7 (7)