Prostate Cancer Ambassadors

Prostate cancer is a sizeable threat to the health and well-being of men living in the United States, and African American men suffer at a disproportionately higher rate compared with their Caucasian counterparts (American Cancer Society, 2014). Prostate cancer occurs most frequently in older men, but it occurs at an earlier age in African Americans; the differences in tumor type and disease aggressiveness or progression between Caucasian and African American men may drive the disparity (Powell, Bock, Ruterbusch, & Sakr, 2010; Roberts, 2014). Education is important in bringing people into the cancer care continuum, which begins with prevention and screening. Participatory approaches to educating individuals and communities about prostate cancer and informed decision making (IDM) about screening may be an important step in addressing cancer disparities

Linking Beauty and Health Among African- American Women: Using Focus Group Data to Build Culturally and Contextually Appropriate Interventions

African-American women suffer a disproportionate burden of morbidity and mortality compared to Caucasian women. Addressing racial/ethnic disparities in health requires the engagement of African-American women in the development of interventions that are culturally and contextually appropriate. Three age groups of African-American women who attend beauty salons (18-29; 30-49; 50+) were recruited into six focus groups. Participants reviewed a series of magazine pictures of African-American women and discussed their perceptions of beauty and health. In addition, we explored ideas for how to best intervene in beauty salons. Focus group discussions were recorded, transcribed, and analyzed with NVivo 2.0. After a thematic analysis of the substantive content of the transcripts, an iterative process based on grounded theory was used to summarize themes and make recommendations for intervening with contextually appropriate interventions. Beauty and health were each conceptualized as consisting of internal (confidence, attitude, disposition) and external/behavioral elements (hair, dress, eating healthy, exercise). Younger women perceived beauty and health as consisting more of outer dimensions, whereas older women emphasized inner dimensions. From the linkage between beauty and health emerged a consistent theme of beauty from the inside out, where inner aspects of beauty and health were connected with physical health and outer beauty. Participants shared ideas for specific strategies that would help the research team create culturally and contextually appropriate interventions for the beauty salon environment, including the stylist as role-model, materials that depict women with various sizes, shapes and weight loss goals, and graphics exhibiting diversity in terms of beauty and health. Engaging African-American women through focus groups is an important first step when building culturally and contextually appropriate interventions

African Americans’ Perceptions of Prostate-Specific Antigen Prostate Cancer Screening

In 2012, the US Preventive Services Task Force (USPSTF) released a hotly-debated recommendation against prostate-specific antigen (PSA) testing for all men. The present research examines African Americans’ beliefs about their susceptibility to prostate cancer (PCa) and the effectiveness of PSA testing in the context of the controversy surrounding this recommendation

Exploring systems that support good clinical care in Indigenous primary health-care services: a retrospective analysis of longitudinal systems assessment tool data from high-improving services

Background: Continuous quality improvement is a process for raising the quality of primary health care across Indigenous PHC services. In addition to clinical auditing using plan, do, study, act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous primary health care services in northern Australia to understand the systems used to support quality care. Methods: High improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the ABCD National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Pre-collected SAT data (from annual team SAT meetings) is presented longitudinally using radar plots for quantitative scores for each component and content analysis is used to describe strengths and weaknesses of performance in each systems component. Results: High improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports and engagement with other organisations and community while the weaknesses included lack of service infrastructure, recruitment, retention and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance and subsequent SAT data provided evidence of changes made to address concerns. Conclusion: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas

Respect is central: a critical review of implementation frameworks for continuous quality improvement in Aboriginal and Torres Strait Islander primary health care services

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context. Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia. Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect. Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context

A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services

Background: Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. Methods: A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. Results: A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). Conclusions: These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Sonosensitive Cavitation Nuclei—A Customisable Platform Technology for Enhanced Therapeutic Delivery

Ultrasound-mediated cavitation shows great promise for improving targeted drug delivery across a range of clinical applications. Cavitation nuclei—sound-sensitive constructs that enhance cavitation activity at lower pressures—have become a powerful adjuvant to ultrasound-based treatments, and more recently emerged as a drug delivery vehicle in their own right. The unique combination of physical, biological, and chemical effects that occur around these structures, as well as their varied compositions and morphologies, make cavitation nuclei an attractive platform for creating delivery systems tuned to particular therapeutics. In this review, we describe the structure and function of cavitation nuclei, approaches to their functionalization and customization, various clinical applications, progress toward real-world translation, and future directions for the field