20966 research outputs found
Sort by
U.S. Vietnamese Parents\u27 Perceptions of Different Approaches for Confirming Adolescent HPV Vaccination Records in Research Studies
No full textBACKGROUND: The United States (U.S.) Vietnamese communities face a high burden of HPV-related cancer rates; they also have low HPV vaccination coverage. HPV vaccination is a safe, effective tool to prevent HPV-related cancers, particularly when administered during adolescence. Understanding Vietnamese parents\u27 perspectives on the acceptability of different HPV vaccination status verification methods can improve the implementation of community-based research interventions to improve HPV vaccine coverage in this population.
OBJECTIVE: We assessed their perceptions of three HPV vaccination status confirmation methods: medical records, vaccination card photographs, and self-reported surveys.
DESIGN: We conducted interviews with Vietnamese parents of adolescents ages 9-18, healthcare providers, and community leaders (n = 34). We used an inductive thematic analysis approach with four qualitative coders.
RESULTS: Preferences for confirming vaccination status were split almost equally among each method. Key drivers of these preferences included privacy concerns, autonomy, efforts required from parents, digital literacy, and data accuracy.
DISCUSSION: These findings suggest offering multiple confirmation options to accommodate diverse preferences and enhance the effectiveness of HPV vaccination promotion strategies in this population.
PUBLIC CONTRIBUTION: Community involvement was integral to the design, implementation of this project, and writing of the manuscript. The study team partnered with a community organization that works closely with the U.S. Vietnamese population and Vietnamese healthcare providers. The group met regularly to discuss participant recruitment strategies and study instruments. Lived experiences from parents of adolescents, community leaders, and healthcare providers were included in the production of this manuscript to guide the interpretation of preferences for vaccination confirmation methods
Androgen Deprivation Therapy Practice Patterns in High-Risk Prostate Cancer Treated With Definitive Radiotherapy: Prospective Results From a Statewide Quality Consortium
No full textPURPOSE: The 2022 AUA/ASTRO guidelines recommend 18-36 months of androgen deprivation therapy (ADT) with definitive radiotherapy for localized, high-risk prostate cancer. The STAMPEDE M0 trial supports intensification with androgen receptor pathway inhibitors (ARPIs) for patients with ≤ 2 cT3/T4, Grade Group [GG] 4-5, prostate-specific antigen (PSA) ≤ 40 ng/mL, or cN1. Given advances in imaging, risk stratification, and treatment delivery, we characterized contemporary practice patterns using prospective data from the Michigan Radiation Oncology Quality Consortium (MROQC).
METHODS: Patients enrolled in MROQC with intact, high-risk M0/N0-1 prostate cancer were included. Clinical information, including intended ADT duration and ARPI use, was prospectively collected. The primary outcome was intended guideline-concordant ADT (GC-ADT, ≤ 18 months). Multivariable analyses (MVA) assessed associations between clinical factors and GC-ADT recommendations. We compared the adoption of ARPI with standard therapies before and after the publication of STAMPEDE M0. Facility-level variability was evaluated using a mixed-effects model, with the treatment site as a random intercept.
RESULTS: Between June 2020 and November 2024, 553 patients across 26 centers were included: cT3/4 (13.3%), cN1 (19.9%), GG 4-5 (75.0%), and PSA ≤ 20 ng/mL (40.0%). Overall, 91.3% were recommended ADT, with 67.0% being guideline-concordant. On MVA, GC-ADT was significantly associated with cN1 (odds ratio [OR], 2.94 [95% CI, 1.44 to 5.99]), GG (GG4 OR, 6.23 [95% CI, 2.85 to 13.62]; GG5 OR, 9.45 [95% CI, 4.46 to 20.06]), and PSA ≤ 40 (OR, 3.64 [95% CI, 1.22-10.87]). Facility-level variability persisted in the MVA (P \u3c .0001). Among the 27.9% who met meeting STAMPEDE criteria, ARPI recommendations increased from 0% prepublication to 23.2% afterward.
CONCLUSION: Within a statewide quality consortium, guideline-concordant ADT recommendations occurred in two thirds of patients, with ARPI intensification in under 25% among STAMPEDE-eligible patients. These findings highlight the need for individualized ADT strategies and collaborative efforts to standardize high-quality care
Association of area of deprivation index with magnetic resonance imaging (MRI) utilization for prostate cancer detection: results from a contemporary North American population
No full textPURPOSE: Since the use of Magnetic Resonance Imaging (MRI) in the initial diagnostic evaluation for prostate cancer (PCa) has considerable costs, there is concern that socioeconomic barriers may result in MRI underutilization. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and MRI utilization in PCa diagnostic setting using a contemporary North American population.
METHODS: We included all the patients aged \u3e 40 years with a confirmed PSA \u3e 3 ng/mL at Henry Ford Health (HFH) between 2018 and 2022. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socio-economic disadvantage. MRI and biopsy status were defined as undergoing these procedures within 6 and 9 months, respectively, from their first PSA \u3e 3 ng/mL in the time period. Univariable (UVA) and multivariable (MVA) Logistic regression models tested the impact of ADI on prostate MRI or biopsy utilization.
RESULTS: We included 18,827 patients who had a PSA \u3e 3 ng/mL, 3759 (20%) of whom were Non-Hispanic Black. Overall, 679 (3.6%) and 1672 (8.8%) of these individuals underwent prostatic MRI and prostate biopsy, respectively. Median (IQR) age and ADI percentile were 68 (62-74) years and 58 (38-79), respectively. Patients who received MRI were more likely to be younger (66 vs. 68, p = 0.006), Non-Hispanic Black [28.0% (95%CI: 24.7%-31.5%) vs. 19.7% (95% CI 19.1%-20.3%), p \u3c 0.0001] and to undergo PSA test in more recent median years (2021 vs. 2019, p \u3c 0.0001), compared to those who did not undergo MRI. When stratifying the population by ADI quintiles, men in the fifth (most deprived) quintile were less likely to receive MRI (3.1% vs. 5.9%, p \u3c 0.001), compared to those in the first (most affluent) quintile. At logistic MVA, patients living in more deprived neighborhoods (higher ADI percentile) were less likely to receive MRI before PCa diagnosis (OR: 0.90, p \u3c 0.001). Specifically, for an increase in ADI percentile of 10 units, the relative odds of receiving MRI decreased by 10%.
CONCLUSIONS: Although the overall utilization of prostate MRI remains low in this real-world study, men living in more socioeconomically deprived areas were significantly less likely to undergo MRI before PCa diagnosis. Our findings underscore the need for targeted interventions to ensure a more equitable access to advanced diagnostic tools
Comparison of Single- and Multiport Robot-assisted Approaches in Prostate and Renal Surgery: A Systematic Review and Meta-analysis
No full textBACKGROUND AND OBJECTIVE: The aim of this systematic review with meta-analysis was to assess the perioperative, functional, and oncological outcomes of single-port (SP) robotic procedures in the surgical management of prostate and renal diseases.
METHODS: A systematic review was conducted using the MEDLINE and Scopus databases, covering literature published up to December 2024. Studies were included if these compared SP versus multiport (MP) approaches in robot-assisted procedures, specifically radical prostatectomy (RARP), simple prostatectomy (RASP), partial nephrectomy (RAPN), radical nephrectomy (RARN), and pyeloplasty (RAP; PROSPERO registration number: CRD42025616519). Perioperative outcomes were assessed across all procedures. Functional and oncological outcomes were analysed specifically in patients undergoing RARP, while warm ischaemia time (WIT), off-clamp rates, and positive surgical margin rates were evaluated in those undergoing RAPN.
KEY FINDINGS AND LIMITATIONS: A total of 26, three, nine, one, and two studies evaluated RARP, RASP, RAPN, RARN, and RAP, respectively. Compared with MP-RARP, SP-RARP was associated with lower estimated blood loss (standardised mean difference [SMD] = 0.51; 95% confidence interval [CI]: 0.16-0.87), shorter length of stay (SMD = 1.12; 95% CI: 0.63-1.62), and reduced postoperative pain (SMD = 0.12; 95% CI: 0.04-0.35). The only difference between SP- and MP-RASP was represented by the use of a higher morphine milligram equivalent in the MP group (SMD = 0.59; 95% CI: 0.01-1.16). In patients undergoing RAPN, SP was associated with a significantly higher WIT than MP (SMD = -0.32; 95% CI: -0.58 to -0.06). However, the length of hospital stay (SMD = 0.31; 95% CI: 0.03-0.59) and pain score on postoperative day 1 (SMD = 0.22; 95% CI: 0.01-0.43) were significantly in favour of SP-RAPN. Limitations were the lack of randomised trials, and the across-study heterogeneity in surgical techniques and outcome definitions.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Compared with the MP approach, SP robotic surgery offers advantages in terms of reduced postoperative pain and hospital stay. In patients undergoing RARP, functional and oncological outcomes were comparable between the two approaches. In patients undergoing RAPN, the SP approach was associated with a longer WIT
Uncovering the role of microbiota and fecal microbiota transplantation in Crohn\u27s disease: Current advances and future hurdles
No full textCrohn\u27s disease (CD) is an idiopathic, chronic, and recurrent inflammatory condition of the gastrointestinal tract. Recent studies suggest a potential role of gut microbiota in CD, particularly dysbiosis-an imbalance in gut bacteria. While dysbiosis is consistently observed in CD, it remains uncertain whether it is a cause or a consequence of the disease. Given its association with CD, the therapeutic potential of fecal microbiota transplantation (FMT) has been explored. This review examines the role of gut microbiota in CD, evaluates the therapeutic potential of probiotics and FMT, and highlights current research findings and limitations. Key studies on the relationship between gut dysbiosis, probiotics, and FMT in CD were analyzed, with a focus on randomized trials, meta-analyses, and clinical observations. Dysbiosis is a consistent feature of CD, but its causative role remains unclear. Probiotics, prebiotics, and synbiotics have shown no efficacy in inducing or maintaining remission in CD. FMT shows potential as a therapeutic option for CD, but its efficacy remains inconsistent and inconclusive. The variability in outcomes, including diminished effects over time despite repeated FMT, underscores the need for larger, well-controlled trials. Only one randomized controlled trial (RCT) has compared FMT with sham transplantation, but the sample size was very small. Other studies are limited by factors such as small sample sizes, lack of control groups, short follow-up periods, and inconsistent methodologies, making it challenging to draw definitive conclusions. While gut dysbiosis likely plays a role in CD pathogenesis, its causative role remains uncertain. Current evidence does not support FMT as a reliable treatment for inducing or maintaining remission in CD, though it appears generally safe. Larger, standardized, RCTs are necessary to clarify the therapeutic role of FMT in CD management
Bridging the Gap with Innovation: Clinical Nurse Specialists (CNS) Transforming Discharge Planning and Patient Education in Diabetes Care
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1002/thumbnail.jp
Exploring Evolving Nurse Perceptions of Virtual Support: Bridging ICU Care with Virtual Technology
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1041/thumbnail.jp
Driving Change: Nursing Quality Improvement Process During a Community-Based Mobile Kidney Health Screening Initiative
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1043/thumbnail.jp
Enhancing Nurse Leader Well-Being: Implementing Jean Watson\u27s Caritas Processes to Promote Human Caring
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1048/thumbnail.jp
Advancing pain and symptom management in cancer: A data-driven analysis of care delivery, psychosocial support, and communication strategies
No full textBackground: Effective pain and symptom management is critical in cancer care, yet gaps exist in addressing psychosocial needs and communication strategies. Non-pharmacological interventions, psychosocial support, and innovative care models have shown promise, but comprehensive, data-driven analysis is lacking, especially regarding underrepresented demographics. Methods: A systematic analysis was conducted using data from ClinicalTrials.gov and PubMed to identify studies published from 2020 to 2025 focused on pain management, psychosocial support, and communication strategies in cancer care. Outcomes analyzed include pain severity, emotional well-being, adherence, and patient satisfaction. The study also examined demographic representation, with a focus on age and ethnicity. Results: From 180 relevant studies, 40% incorporated non-pharmacological interventions (e.g., CBT, mindfulness). Psychosocial support (peer support, therapy) appeared in 30%, and 25% explored communication strategies (decision-making, symptom communication). Key findings include: Non-pharmacological interventions reduced pain severity by 35% (p \u3c 0.01) and improved emotional well-being by 30% (p\u3c0.05). Psychosocial support reduced perceived stress by40% (p \u3c 0.001) and depressive symptoms by 25% (p \u3c 0.05). Innovative care models, particularly telehealth, improved adherence by 50% (p \u3c 0.001) and patient-care team communication by 45%(p\u3c0.01). Demographic analysis revealed underrepresentation: only 15% of trials included participants over 65 years, and 20% focused on racial/ethnic minorities. Conclusions: Psychosocial support, communication strategies, and non-pharmacological interventions enhance pain management and emotional well-being in cancer patients. Innovative care models like telehealth improve adherence and communication. However, underrepresentation of older adults and minorities in research limits the generalizability of these findings. Future research should prioritize inclusive recruitment strategies, explore the synergistic effects of combined interventions, and evaluate long-term outcomes to ensure equitable and effective care for all cancer patients