Research Interests: Primary Care, Research Design, Primary Health Care, Medicine, Applied Economics, and 15 moreColorectal cancer, Prospective studies, Humans, Female, Male, Michigan, Patient Compliance, Medical Care, Aged, Middle Aged, Public health systems and services research, Colorectal Neoplasms, quality assurance in health care, mass Screening, and Reminder systems
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Family Medicine, Health Care, Medical Education, Family Practice, Medicine, and 14 moreCurriculum, Continuing Medical Education, Medical Students, Humans, Internal Medicine, United States, Health Care System, Patient Care, Clinical Competence, Family Physician, Specialty, Medical and Health Sciences, Referral, and Schools Medical
BACKGROUND Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that... more
BACKGROUND Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. OBJECTIVE The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. METHODS This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic–virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. RESULTS Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. CONCLUSIONS The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/46601
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Information Technology, Primary Care, Medical Informatics, Primary Health Care, Cancer Prevention, and 15 moreMedicine, Information Services, CA, Humans, Face to Face, Audit, Cancer Screening, Psychological Intervention, Selection Criteria, Clinical Sciences, Public health systems and services research, Neoplasms, Intervention study, Medical Audit, and Reminder systems
Research Interests: Endocrinology, Medicine, Internal Medicine, Kidney, Hypertension, and 14 moreNitric oxide, Female, Animals, Denervation, Clinical Sciences, Blood Flow, Arginine, Nervous System, Sympathetic Nervous System, Rabbits, Citrulline, Blood Vessel, Vascular Smooth Muscle, and Cardiovascular medicine and haematology
Research Interests: Health Sciences, Decision Making, Medicine, CA, Humans, and 15 moreFemale, Male, Clinical Sciences, Public health systems and services research, Neoplasms, Hematology and Oncology, Patient Participation, Risk Assessment, Decision Aids, Colorectal Neoplasms, Decision Support Techniques, Breast Neoplasms, Early detection of cancer, Prostatic neoplasms, and mass Screening
Background and objectives: Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification... more
Background and objectives: Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patterns of morbidity in Emilia Romagna, a large Italian region; and to compare estimated prevalence rates using pharmacy data with those available from a 2000 Emilia Romagna disease surveillance study. Methods: Using the Chronic Disease Score, a list of chronic conditions related to the consumption of drugs under the Italian pharmaceutical dispensing system was created. Clinical review identified medication classes within the Italian National Therapeutic Formulary that were linked to the management of each chronic condition. Algorithms were then tested on pharmaceutical claims data from Emilia Romagna for 2001 to verify the applicability of the classification scheme. Results: Thirty-one chronic condition drug groups (CCDGs) were identified. Applying the model to the pharmacy data, approximately 1.5 million individuals (37.1%) of the population were identified as having one or more of the 31 CCDGs. The 31 CCDGs accounted for 77% (E556 million) of 2001 pharmaceutical expenditures. Cardiovascular diseases, rheumatological conditions, chronic respiratory illness, gastrointestinal diseases and psychiatric diseases were the most frequent chronic conditions. External validation comparing rates of the diseases found through using pharmacy data with those of a 2000 Emilia Romagna disease surveillance study showed similar prevalence of illness. Conclusions: Using Italian automated pharmacy data, a measure of population-based chronic disease status was developed. Applying the model to pharmaceutical claims from Emilia Romagna 2001, a large proportion of the population was identified as having chronic conditions. Pharmacy data may be a valuable alternative to survey data to assess the extent to which large populations are affected by chronic conditions.
Research Interests:
Background:Using screen counts, women 50–64 years old have lower cancer screening rates for cervical and colorectal cancers (CRC) than all other age ranges. This paper aims to present woman-centric cervical cancer and CRC screenings to... more
Background:Using screen counts, women 50–64 years old have lower cancer screening rates for cervical and colorectal cancers (CRC) than all other age ranges. This paper aims to present woman-centric cervical cancer and CRC screenings to determine the predictor of being up-to-date for both.Methods:We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual survey to guide health policy in the United States, to explore the up-to-date status of dual cervical cancer and CRC screening for women 50–64 years old. We categorized women into four mutually exclusive categories: up-to-date for dual-screening, each single screen, or neither screen. We used multinomial multivariate regression modeling to evaluate the predictors of each category.Results:Among women ages 50–64 years old, dual-screening was reported for 58.2% (57.1–59.4), cervical cancer screening alone (27.1% (26.0–28.2)), CRC screening alone (5.4% (4.9–5.9)), and neither screen (9.3% (8.7–9.9)). Age, race, education, ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Health Communication, Medicine, Humans, Female, Male, and 14 moreMichigan, Patient Compliance, Patient Preference, African Americans, Aged, Middle Aged, Teaching Materials, Guidance and Counseling Intervention Programs, Preference, Colorectal Neoplasms, Psychology and Cognitive Sciences, Early detection of cancer, mass Screening, and Medical and Health Sciences
It is well known that people with chronic conditions represent the bulk of all health care needs and associated costs. To set appropriate health care strategies, a crucial issue for policy makers and health care researchers worldwide is... more
It is well known that people with chronic conditions represent the bulk of all health care needs and associated costs. To set appropriate health care strategies, a crucial issue for policy makers and health care researchers worldwide is therefore to find proper methodologies to assess the number of individuals affected by specific chronic illnesses. Thus far, surveillance studies have been largely used to estimate the health status of a population because they are fairly inexpensive and data are easy to collect. Recently, the analyses of automated pharmacy data have been proposed as an effective means to measure chronic disease within investigated populations. Pharmacy data offer several advantages. Prescription data are easily accessible, inexpensive, precise, and well coded. In addition, drugs prescribed may be associated, to some extent, with specific chronic conditions. However, few studies have validated the accuracy of chronic diseases prevalence rates obtained by this methodo...
Research Interests:
Introduction In evaluating a patient with haematuria, the primary care physician must answer the following three questions: 1. Is it really haematuria? 2. Should this patient with haematuria, be further evaluated, and if so, how? 3.... more
Introduction In evaluating a patient with haematuria, the primary care physician must answer the following three questions: 1. Is it really haematuria? 2. Should this patient with haematuria, be further evaluated, and if so, how? 3. Should this patient with haematuria, be referred to a specialty, and if so, to which specialty? The aim of this critical review is to discuss whether family physicians should evaluate and manage haematuria. Discussion Haematuria must be confirmed by a microscopic examination. Complete urological work-up entails assessment of renal function, urine culture, upper urinary tract imaging usually with computer tomography urogram and a referral to urology for cystoscopy. If a renal disease is suspected, suitable laboratory studies followed by a referral to nephrology, is appropriate. Conclusion While most patients with haematuria will undergo urological work-up to some degree, it is important to efficiently recognise those patients, who are at a minimal risk of...
Research Interests:
IntroductionUsing screen counts, women 50-64 yo have lower cancer screening rates for cervical and colorectal cancers compared to all other age ranges. The primary aim of this paper is to present cervical cancer and CRC screenings per... more
IntroductionUsing screen counts, women 50-64 yo have lower cancer screening rates for cervical and colorectal cancers compared to all other age ranges. The primary aim of this paper is to present cervical cancer and CRC screenings per woman and determine the predictors of being up-to-date for both.MethodsWe used the Behavioral Risk Factor Surveillance System (BRFSS), an annual survey to guide health policy in the US, to explore the up-to-date status of dual cervical and colorectal cancer screening for women 50-64 yo. We categorized women into four mutually exclusive categories: up-to-date for dual screening, each single-screen, or neither screen. Multinomial multivariate regression modeling was used to evaluate the predictors of each category.ResultsAmong women ages 50-64 yo, dual screening was reported for 58.7% (57.6-59.9), cervical cancer screening alone (27.0% (25.9-28.1), CRC screening alone (5.3% (4.8-5.8), and neither screen (9% (8.4-9.6). Age, race, education, income, and ch...
Research Interests:
INTRODUCTION Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings. STUDY DESIGN RCT.... more
INTRODUCTION Colorectal cancer screening has been shown to prevent or detect early colorectal cancer and reduce mortality; yet, adherence to screening recommendations remains low, particularly in rural settings. STUDY DESIGN RCT. SETTING/PARTICIPANTS Adults (n=7,812) aged 50-75 years and due for colorectal cancer screening in a largely rural health system were randomly assigned to either the intervention (n=3,906) or the control (n=3,906) group in September 2016, with analysis following through 2018. INTERVENTION A mailed motivational messaging screening reminder letter with an option to call and request a free at-home fecal immunochemical screening test (intervention) or the standard invitation letter detailing that the individual was due for screening (control). Multifaceted motivational messaging emphasized colorectal cancer preventability and the ease and affordability of screening, and communicated a limited supply of test kits. MAIN OUTCOME MEASURES Colorectal cancer screening participation within 6 months after mailed invitation was ascertained from the electronic medical record. RESULTS Colorectal cancer screening participation was significantly improved in the intervention (30.1%) vs the usual care control group (22.5%; p<0.001). Individuals randomized to the intervention group had 49% higher odds of being screened over follow-up than those randomized to the control group (OR=1.49, 95% CI=1.34, 1.65). A total of 13.2 screening invitations were needed to accomplish 1 additional screening over the usual care. Of the 233 fecal immunochemical test kits mailed to participants, 154 (66.1%) were returned, and 18 (11.7%) tested positive. CONCLUSIONS A mailed motivational messaging letter with a low-cost screening alternative increased colorectal cancer screening in this largely rural community with generally poor adherence to screening recommendations. Mailed colorectal cancer screening reminders using motivational messaging may be an effective method for increasing screening and reducing rural colorectal cancer disparities.
Research Interests:
Increasing patients' participation in health care is a commonly cited goal. While patient decision aids can promote participation, they remain underutilized. Theory-based models that assess barriers and facilitators to sustained... more
Increasing patients' participation in health care is a commonly cited goal. While patient decision aids can promote participation, they remain underutilized. Theory-based models that assess barriers and facilitators to sustained decision aid use are needed. The ready, willing, and able model specifies three preconditions for behavioral change. We present a descriptive analysis of the uptake of patient decision aids in the primary care setting and show how the ready, willing, and able model can be used to identify potential barriers and facilitators. An Ovid Medline literature search from January 2004 to November 2014 was used; additional sources were identified from reference lists and through peer consultations. Barriers and facilitators to decision aid use were identified and grouped into salient themes. The ready, willing, and able model provided a simple yet practical framework for identifying the mechanisms that facilitate (or work against) the adoption of patient decision ...
Research Interests:
Research Interests:
Research Interests: Health Care, Preventive medicine, Colorectal cancer, Software, Prospective studies, and 15 moreHumans, Female, Male, Michigan, Aged, Middle Aged, Early Detection, Public health systems and services research, Time Factors, Randomized Controlled Trial, Curriculum and Pedagogy, Internet, Colorectal Neoplasms, attitude to health, and mass Screening
Research Interests: Decision Making, Primary Health Care, Focus Groups, Telemedicine, Medicine, and 13 moreHumans, Female, Male, Aged, Middle Aged, Patient Participation, Internet, Community Health Centers, Colorectal Neoplasms, Decision Support Techniques, Psychology and Cognitive Sciences, mass Screening, and Medical and Health Sciences
Research Interests: Decision Making, Focus Groups, Community Health, Community, Ethnicity, and 15 moreColorectal cancer, Knowledge, Humans, African American, Female, Focus Group, Data Collection, Ethnic Groups, African Americans, Aged, Early Detection, Flexible Sigmoidoscopy, European Continental Ancestry Group, Choice Behavior, and Colorectal Neoplasms
To investigate whether changes in renal blood flow induced by nondepressor doses of L-arginine, the precursor of nitric oxide, are mediated by a sympathetic neural mechanism, we examined the following in conscious rabbits: (1) the effects... more
To investigate whether changes in renal blood flow induced by nondepressor doses of L-arginine, the precursor of nitric oxide, are mediated by a sympathetic neural mechanism, we examined the following in conscious rabbits: (1) the effects of intravenous infusion of L- or D-arginine (15 to 200 mumol/kg per minute) on renal blood flow and renal sympathetic nerve activity with or without intravenous infusion of a nonpressor dose of NG-monomethyl-L-arginine (L-NMMA), a nitric oxide synthase inhibitor, and (2) the effects of L-arginine on renal blood flow after renal denervation with or without L-NMMA pretreatment. In renal innervated rabbits, L-arginine (100 and 200 mumol/kg per minute) increased renal blood flow by 9 +/- 2 and 16 +/- 3 mL/min (P < .05, respectively) and decreased renal sympathetic nerve activity by 12 +/- 4% and 19 +/- 3% of control (P < .05, respectively). In contrast, no changes occurred in any variable during D-arginine infusion. L-NMMA attenuated the renal bl...
Research Interests:
Research Interests: Research Design, Primary Health Care, Medicine, Humans, Female, and 15 moreMale, Michigan, Patient Preference, Clinical Sciences, Aged, Middle Aged, Questionnaires, Community Based Mental Health Services, Predictive value of tests, Colorectal Neoplasms, Decision Support Techniques, Early detection of cancer, Community health services, mass Screening, and Cardiovascular medicine and haematology
... mortality. Santhi Swaroop Vege, MD Larry R. Bergstrom, MD Division of Area General Internal Medicine Mayo Clinic Rochester, Minn 1. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002; 287:487-494. ...
Research Interests:
Research Interests:
Research Interests:
What is the theoretical rationale for including this dimension? Patients choosing among various screening / diagnostic / treatment options need this information in order to arrive at an informed choice. Ethical and legal obligations along... more
What is the theoretical rationale for including this dimension? Patients choosing among various screening / diagnostic / treatment options need this information in order to arrive at an informed choice. Ethical and legal obligations along with decisionmaking theory make clear that patients require information in order to ensure that the decision made is consistent with their values and preferences.
During the coronavirus disease 2019 (COVID‐19) pandemic, cancer screening decreased precipitously; home screening for colorectal cancer diminished less than that for colonoscopy and breast and cervical cancer screening. The authors have... more
During the coronavirus disease 2019 (COVID‐19) pandemic, cancer screening decreased precipitously; home screening for colorectal cancer diminished less than that for colonoscopy and breast and cervical cancer screening. The authors have highlighted approaches for home cancer screening in addition to telemedicine.
Research Interests:
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non–muscle-invasive urothelial bladder... more
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non–muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non–muscle-invasive bladder cancer in the event of a bacillus Calmette-Guérin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonb...
Research Interests:
Background: Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study... more
Background: Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study is to describe the predictors of cervical cancer screening in older women as reported by three national surveys. Methods: The Behavioral Risk Factor Surveillance System (BRFSS 2016), the Health Information National Trends Survey (HINTS 2017), and the Health Center Patient Survey (HCPS 2014) were analyzed with univariate and multivariate analyses. We defined the cohort as women, without hysterectomy, who were 45–65 years old. The primary outcome was cytology within the last 3 years. Results: Overall, Pap screening rates were 71% (BRFSS), 79% (HINTS) and 66% (HCPS), among 41,657, 740 and 1571 women, respectively. BRFSS showed that women 60–64 years old (aPR = 0.88, 95% CI: 0.85, 0.91), and in rural locations (aPR = 0.95, 95% CI: 0.92, 0.98) were significantly less likely to report cervical cancer screening than women 45–49-years old or in urban locations. Compared to less than high school, women with more education reported more screening (aPR = 1.20, 95% CI: 1.13, 1.28), and those with insurance had higher screening rates than the uninsured (aPR = 1.47, 95% CI: 1.33, 1.62). HINTS and HCPS also showed these trends. Conclusions: All three surveys show that cervical cancer screening rates in women 45–65 years are insufficient to reduce cervical cancer incidence. Insurance is the major positive predictor of screening, followed by younger age and more education. Race/ethnicity are variable predictors depending on the survey.
Research Interests:
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on systemic therapy for muscle-invasive urothelial bladder cancer, as substantial revisions were made in the 2017 updates,... more
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on systemic therapy for muscle-invasive urothelial bladder cancer, as substantial revisions were made in the 2017 updates, such as new recommendations for nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab. The complete version of the NCCN Guidelines for Bladder Cancer addresses additional aspects of the management of bladder cancer, including non-muscle-invasive urothelial bladder cancer and nonurothelial histologies, as well as staging, evaluation, and follow-up.
Research Interests:
These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the... more
These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the recommendation of intravesical bacillus Calmette-Guérin, (2) strengthening the recommendations for perioperative systemic chemotherapy, and (3) incorporating immunotherapy into second-line therapy for locally advanced or metastatic disease. These NCCN Guidelines Insights further discuss factors that affect integration of these recommendations into clinical practice.
Research Interests:
Despite an increasing number of prostate cancer survivors in Japan, the current delivery of prostate cancer survivorship care is insufficient and lacks a multidisciplinary approach. We carried out a study to characterize prostate cancer... more
Despite an increasing number of prostate cancer survivors in Japan, the current delivery of prostate cancer survivorship care is insufficient and lacks a multidisciplinary approach. We carried out a study to characterize prostate cancer survivorship care in Japan, examine the Japanese workforce available to deliver survivorship care, introduce a conceptual framework for survivorship and identify opportunities to improve Japanese survivorship care. We systematically searched PubMed for prostate cancer survivorship care studies, including those from Japan. We also searched the internet for prostate cancer guidelines relevant to survivorship care. We found 392 articles, of which 71 were relevant, read in detail and reported here. In Japan, survivorship care is mostly provided by urologists. Primary care as a specialty does not exist in Japan, and there are no independent nurse practitioners or physician assistants to assist with survivorship care. Japanese quality of life studies chara...