Fwd: Implementing breast cancer decision aids in community sites: barriers and resources.

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From: HubMed - breast cancer <rssfwd@rssfwd.com>
Date: Sat, Feb 16, 2008 at 7:08 PM
Subject: Implementing breast cancer decision aids in community sites: barriers and resources.
To: mesothelioma77@gmail.com


[1]Health Expect. 2008 Mar; 11(1): 46-53
Silvia KA, Ozanne EM, Sepucha KR

Objective To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. Background There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. Design Structured individual interviews. Setting and participants Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. Main outcome measures Usage data, barriers to and resources for implementing the PtDAs. Results Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign-out system. The keys to successful implementation included nurses' and social workers' interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses' perceptions about patients' attitude towards participation in decision making. Conclusions It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available.



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Source: http://www.hubmed.org/display.cgi?uids=18275401
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Fwd: Prevalence of Abdominal and Pelvic Surgeries in Patients With Irritable Bowel Syndrome: Comparison Between Caucasian and African Americans.

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From: HubMed - cancer <rssfwd@rssfwd.com>
Date: Sat, Feb 16, 2008 at 7:08 PM
Subject: Prevalence of Abdominal and Pelvic Surgeries in Patients With Irritable Bowel Syndrome: Comparison Between Caucasian and African Americans.
To: mesothelioma77@gmail.com


[1]Am J Med Sci. 2008 Feb; 335(2): 82-88
Minocha A, Johnson WD, Wigington WC

BACKGROUND:: Although controversial, studies suggest that irritable bowel syndrome (IBS) is associated with an increased risk of abdominal and pelvic surgeries. However, the role of race in this interaction has not been defined. We studied the prevalence of appendectomy, cholecystectomy, and hysterectomy among African American patients with IBS among the population at large and compared it with the Caucasians residing in same area. METHODS:: A total of 990 adults from 9 different sites in the Jackson, Mississippi, metropolitan area (670 African Americans and 320 Caucasians), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS, based on ROME II criteria. We recorded the patient's name, age, sex, race, history of smoking, and history of surgeries. Subjects with a history of IBD and gastrointestinal cancer were excluded. The prevalence of appendectomy and hysterectomy was compared between IBS patients and non-IBS control subjects. RESULTS:: One thousand ninety-nine, or 84%, of those distributed were returned. On checking the exclusion and inclusion criteria, we eliminated 109 subjects. The reasons for elimination of 109 subjects included incomplete questionnaires and incorrect marking of questionnaires that resulted in invalid data. Overall, there was significantly higher prevalence of appendectomy (15.3% vs 5.1%) and cholecystectomy (6.6% vs 3.4%) but not hysterectomy (21.1% vs 17.6%; P = NS) among Caucasian Americans as compared with African Americans. The prevalence of appendectomy among IBS patients (n = 95) versus non-IBS subjects (n = 895) was not statistically significant (10.5% vs 8.2%; OR, 1.3; 95% CI, 0.7 to 2.7; P = 0.43). The prevalence of cholecystectomy in the 2 groups was also similar (5.3% vs 4.4%). Likewise, there was no statistically significant difference for the prevalence of hysterectomy among females IBS patients versus non-IBS females (23.3% vs 18.2%; OR, 1.4; 95% CI, 0.8 to 2.4; P = 0.29). Comparing the prevalence of these surgeries in with IBS patients (African Americans versus Caucasian Americans), we found significant difference in the prevalence of appendectomy to be 1.9% vs 21.4% (P

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Source: http://www.hubmed.org/display.cgi?uids=18277113
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