7,339 research outputs found

    Incidence and drug treatment of emotional distress after cancer diagnosis : a matched primary care case-control study

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    Notes This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License.Peer reviewedPublisher PD

    Dissemination of Clinical Practice Guidelines : A Content Analysis of Patient Versions

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    Financial support for this study was provided to Nancy Santesso from a Canadian Institutes of Health Research Fellowship in Knowledge Translation. Financial support for this study was provided by the Canadian Institutes of Health Research Fellowship in Knowledge Translation and for the DECIDE project from the European Union’s Seventh Framework Programme under grant agreement number 258583. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.Peer reviewedPostprin

    Dissemination of clinical practice guidelines: A content analysis of patient versions

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    Background. Clinical practice guidelines (CPGs) are typically written for health care professionals but are meant to assist patients with health care decisions. A number of guideline producers have started to develop patient versions of CPGs to reach this audience. Objective. To describe the content and purpose of patient versions of CPGs and compare with patient and public views of CPGs. Design. A descriptive qualitative study with a directed content analysis of a sample of patient versions of CPGs published and freely available in English from 2012 to 2014. Results. We included 34 patient versions of CPGs from 17 guideline producers. Over half of the patient versions were in dedicated patient sections of national/professional agency websites. There was essentially no information about how to manage care in the health care system. The most common purpose was to equip people with information about disease, tests or treatments, and recommendations, but few provided quantitative data about benefits and harms of treatments. Information about beliefs, values and preferences, accessibility, costs, or feasibility of the interventions was rarely addressed. Few provided personal stories or scenarios to personalize the information. Three versions described the strength of the recommendation or the level of evidence. Limitations. Our search for key institutions that produce patient versions of guidelines was comprehensive, but we only included English and freely available versions. Future work will include other languages. Conclusions. This review describes the current landscape of patient versions of CPGs and suggests that these versions may not address the needs of their targeted audience. Research is needed about how to personalize information, provide information about factors contributing to the recommendations, and provide access

    Factors Associated with Colorectal Cancer Screening among Younger African American Men: A Systematic Review

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    Of cancers affecting both men and women, colorectal cancer (CRC) is the second leading cancer killer among African Americans in the U.S. Compared to White men, African American men have incidence and mortality rates 25% and 50% higher from CRC. Despite the benefits of early detection and the availability of effective screening, most adults over age 50 have not undergone testing, and disparities in colorectal cancer screening (CRCS) persist. Owing to CRC’s high incidence and younger age at presentation among African American men, CRCS is warranted at age 45 rather than 50. However, the factors influencing young adult (i.e., age \u3c 50) African American men’s intention to screen and/or their CRCS behaviors has not been systematically assessed. To assess whether the factors influencing young adult African American men’s screening intentions and behaviors are changeable through structured health education interventions, we conducted a systematic review, with the two-fold purpose of: (1) synthesizing studies examining African American men\u27s knowledge, beliefs, and behaviors regarding CRCS; and (2) assessing these studies’ methodological quality. Utilizing Garrard’s Matrix Method, a total of 28 manuscripts met our inclusion/exclusion criteria: 20 studies followed a non-experimental research design, 4 comprised a quasi-experimental design, and 4, an experimental design. Studies were published between 2002 and 2012; the majority, between 2007 and 2011. The factors most frequently assessed were behaviors (79%), beliefs (68%), and knowledge (61%) of CRC and CRCS. Six factors associated with CRC and CRCS emerged: previous CRCS, CRC test preference, perceived benefits, perceived barriers, CRC/CRCS knowledge, and physician support/recommendation. Studies were assigned a methodological quality score (MQS – ranging from 0 to 21). The mean MQS of 10.9 indicated these studies were, overall, of medium quality and suffered from specific flaws. Alongside a call for more rigorous research, this review provides important suggestions for practice and culturally relevant interventions

    Multimodal assessment of estrogen receptor mRNA profiles to quantify estrogen pathway activity in breast tumors

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    Background Molecular markers have transformed our understanding of the heterogeneity of breast cancer and have allowed the identification of genomic profiles of estrogen receptor (ER)-α signaling. However, our understanding of the transcriptional profiles of ER signaling remains inadequate. Therefore, we sought to identify the genomic indicators of ER pathway activity that could supplement traditional immunohistochemical (IHC) assessments of ER status to better understand ER signaling in the breast tumors of individual patients. Materials and Methods We reduced ESR1 (gene encoding the ER-α protein) mRNA levels using small interfering RNA in ER+ MCF7 breast cancer cells and assayed for transcriptional changes using Affymetrix HG U133 Plus 2.0 arrays. We also compared 1034 ER+ and ER− breast tumors from publicly available microarray data. The principal components of ER activity generated from these analyses and from other published estrogen signatures were compared with ESR1 expression, ER-α IHC, and patient survival. Results Genes differentially expressed in both analyses were associated with ER-α IHC and ESR1 mRNA expression. They were also significantly enriched for estrogen-driven molecular pathways associated with ESR1, cyclin D1 (CCND1), MYC (v-myc avian myelocytomatosis viral oncogene homolog), and NFKB (nuclear factor kappa B). Despite their differing constituent genes, the principal components generated from these new analyses and from previously published ER-associated gene lists were all associated with each other and with the survival of patients with breast cancer treated with endocrine therapies. Conclusion A biomarker of ER-α pathway activity, generated using ESR1-responsive mRNAs in MCF7 cells, when used alongside ER-α IHC and ESR1 mRNA expression, could provide a method for further stratification of patients and add insight into ER pathway activity in these patients

    A review of mammographic positioning image quality criteria for the craniocaudal projection

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    Detection of breast cancer is reliant on optimal breast positioning and the production of quality images. Two projections, the mediolateral (MLO) and craniocaudal (CC), are routinely performed. Determination of successful positioning and inclusion of all breast tissue is achieved through meeting stated image quality criteria. For the CC view, current image quality criteria are inconsistent. Absence of reliable anatomical markers, other than the nipple, further contribute to difficulties in assessing the quality of CC views. The aim of this paper was to explore published international quality standards to identify and find the origin of any CC positioning criteria which might provide for quantitative assessment. The pectoralis major (pectoral) muscle was identified as a key posterior anatomical structure to establish optimum breast tissue inclusion on mammographic projections. It forms the first two of the three main CC metrics that are frequently reported 1. visualisation of the pectoral muscle, 2. measurement of the posterior nipple line (PNL) and 3. depiction of retroglandular fat. This literature review explores the origin of the three metrics, and discusses three key publications, spanning 1992 to 1994, on which subsequent image quality standards have been based. The evidence base to support published CC metrics is sometimes not specified and more often the same set of publications are cited, most often without critical evaluation. To conclude, there remains uncertainty if the metrics explored for the CC view support objective evaluation and reproducibility to confirm optimal breast positioning and quality images

    Addressing the Psychosocial State of High-Risk Individuals Undergoing Hereditary Cancer Screening by Advanced Practice Registered Nurses (APRNs) in the Community Oncology Setting

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    Abstract Neoteric advances in genetics make it possible to define genetic risk in cancer, and there should be methods in place to provide comprehensive genomic care with oncology advanced practice registered nurses bridging this gap. The current scope of nursing practice stipulates genetic and genomic literacy; however, there remains a deficit among advanced practice registered nurses in identifying and addressing psychosocial distress during the genetic cancer risk assessment process. Oncology advanced practice registered nurses must be equipped with the knowledge that the genetic cancer risk assessment also involves protecting patients from the psychosocial repercussions of carrying a hereditary cancer gene beyond medical assessment. The goals of this study were to identify psychosocial risk factors in individuals with heightened cancer risk, improve psychosocial management plans, increase shared decision-making referrals based on individual risk factors, and determine the appropriate psychosocial risk tool to utilize in clinical practice. The Genetic Psychosocial Risk Instrument and Supportive Care Screening Questionnaire were implemented in utilizing best practice guidelines at an outpatient community oncology practice in San Antonio, Texas. This three-month project used a quantitative comparative design with a randomized convenience sample who received the Genetic Psychosocial Risk Instrument or Supportive Care Screening Questionnaire. The reconceptualized uncertainty of illness theory was the theoretical framework used to guide this project. Discovering the antecedents of uncertainty provided the advanced practice registered nurses with salient clues about the patient’s uncertainty related to the genetic cancer risk assessment process and helped prompt psychosocial referrals. Results revealed that in patients undergoing genetic cancer risk assessment assessments, a certain percentage experienced psychosocial distress, and there is demand for a standardized psychosocial needs identification in this patient population. Keywords: advanced practice registered nurses, Genetic Psychosocial Risk Instrument, hereditary cancer syndromes, genetic cancer risk assessment, psychosocial distress, previvor

    What is the Evidence that Increasing the Length of Breastfeeding has on Risk Reduction of Breast Cancer

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    The focus of this study was to review the literature to determine if breast cancer incidence was reduced by breastfeeding duration. It is important for health care providers to present the benefits of breastfeeding to women of childbearing age and especially to those who are pregnant. This literature review will result in a pamphlet that will be available to health care providers to present to prenatal patients. Informing women about the benefits of breastfeeding and breast cancer risk reduction will promote their ability to make an informed decision on breastfeeding. The Health Belief Model is the framework that was used for this study. We know that a health behavior is an action shown by people perceiving the susceptibility of a health problem. It is important for women to understand that the benefits of breastfeeding outweigh the barriers of not breastfeeding to reduce and hopefully prevent breast cancer. A comprehensive review of the literature to identify the evidence related to duration of breastfeeding and reduced breast cancer risk. While studies reviewed different data and aspects of increased duration of lactation and the effects on reducing breast cancer risk there is not enough strong evidence to promote longer duration of breastfeeding to reduce the risk of breast cancer. While the literature is still out on risk reduction of breast cancer and breastfeeding there are many clinical guidelines that promote breastfeeding and breast cancer risk reduction. The American Academy of Pediatrics, American Dietetic Association and the Academy of Family Physicians all promote breastfeeding for the benefits to women and their babie
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