Acceptance of a Risk Estimation Tool for Colorectal Cancer Screening

poster abstractAbstract: While colonoscopy is the most prevalent screening test for colorectal cancer (CRC), it is often too expensive, too uncomfortable, or too time-consuming for patients. Non-compliance is common. Recently, fecal immunochemical testing (FIT) has become a guideline-recommended alternative. The FIT is a non-invasive, inexpensive method that requires no uncomfortable preparation by patients. The decision to recommend the colonoscopy or the FIT is based on the patient’s estimated risk for CRC. Several countries have created risk prediction tools to help identify patients at high risk for advanced colorectal neoplasia (the combination of CRC and advanced, precancerous polyps). A U.S.-based prediction tool was recently published1 that uses five easily and reliably measured factors (age, sex, a first degree relative with CRC, waist circumference, and cigarette smoking history) to quantify risk. We aimed to learn the impressions of clinicians and patients to this risk estimation tool. In the first phase of this study, we used a semi-structured format to interview clinicians at a VA medical center and a non-VA hospital. Using a paper prototype of the risk estimation tool, we asked about its usefulness to estimate risk and to aid their selection of a CRC screening tool. Using a grounded theory approach, we analyzed the interview transcripts and identified major themes. We found that clinicians thought the tool was clear and easy to use. However, they are unlikely to use it as a decision aid until FIT is more widely-endorsed as an acceptable alternative screening test. In phase two of the study, we will interview patients to assess their responses to the tool

Leadership Perspectives on Implementing Health Information Exchange: Qualitative Study in a Tertiary Veterans Affairs Medical Center

Background: The US Department of Veterans Affairs (VA) seeks to achieve interoperability with other organizations, including non-VA community and regional health information exchanges (HIEs). Objective: This study aims to understand the perspectives of leaders involved in implementing information exchange between VA and non-VA providers via a community HIE. Methods: We interviewed operational, clinical, and information technology leaders at one VA facility and its community HIE partner. Respondents discussed their experiences with VA-HIE, including barriers and facilitators to implementation, and the associated impact on health care providers. Transcribed interviews were coded and analyzed using immersion-crystallization methods. Results: VA and community HIE leaders found training to be a key factor when implementing VA-HIE and worked cooperatively to provide several styles and locations of training. During recruitment, a high-touch approach was successfully used to enroll patients and overcome their resistance to opting in. Discussion with leaders revealed the high levels of complexity navigated by VA providers and staff to send and retrieve information. Part of the complexity stemmed from the interconnected web of information systems and human teams necessary to implement VA-HIE information sharing. These interrelationships must be effectively managed to guide organizational decision making. Conclusions: Organizational leaders perceived information sharing to be of essential value in delivering high-quality, coordinated health care. The VA continues to increase access to outside care through the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Along with this increase in non-VA medical care, there is a need for greater information sharing between VA and non-VA health care organizations. Insights by leaders into barriers and facilitators to VA-HIE can be applied by other national and regional networks that seek to achieve interoperability across health care delivery systems

Prime movers: Advanced practice professionals in the role of stroke coordinator

Background and purpose Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Methods Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Conclusion Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. Implications for practice The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities

Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration

Objective: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). Methods: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Results: Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. Conclusions: The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care

Book Review: The Disabled Body in Contemporary Art

Title: The Disabled Body in Contemporary Art Author: Ann Millett-Gallant Reviewer: Cherie Luckhurst Publisher:New York: Palgrave MacMillan, 2010 ISBN: (hard cover) 978-0-230-10406-8, 177 pages with 10 embedded images Cost: $75.00. Amazon price$60.1

Book Review: Thinking About Suicide: Contemplating and Comprehending the Urge to Die

Reviewer: Cherie Luckhurst Author: David Webb Publisher: Ross-on-Wye, Herefordshire, UK: PCCS BOOKS, Ltd., 2010 ISBN: 978-1-906254-28-5 Cost: £13.00 (about $20.67), 184 page

Investigation of emotional contagion experienced by people with psychopathic personalities

Ph.D. University of Hawaii at Manoa 2014.Includes bibliographical references.This dissertation project explored the experience of emotional contagion (EC) by individuals with psychopathic personalities. EC is a three-step process that allows an observer to experience the feelings of another and thereby converge emotionally. Recent findings regarding mirror neurons provide complementary evidence for primitive contagion and support the three-step model proposed by Hatfield and her colleagues. This study informs scientific understanding of the construct of emotional contagion, the abilities necessary for the EC response, and the circumstances under which EC occurs or fails. We know that contagion helps us to establish solidarity with the people in our own tribe as well as outsiders. Many scholars assert that psychopaths are unable to deeply or genuinely connect with others. They probably feel no sense of camaraderie and therefore no sense of acceptance. By studying their emotional contagion process, we might better understand their thinking, their feelings, their instincts, and ultimately their behavior. The study recruited participants using an online work platform hosted by Amazon called Mechanical Turk (MTurk). In addition to a psychopathy screener and a demographic profile, each participant completed two short surveys, one that measured propensity for emotional contagion and another that measured capacity for empathy. Resulting data showed that level of psychopathy correlated strongly and negatively with self-assessed capacities for both emotional contagion and empathy. Participants also experienced the three steps of emotional contagion: mimicry, afferent response, and emotional convergence. All participants, when instructed, successfully completed each step. However, participants with psychopathy scores higher than one standard deviation above the mean did not naturally experience emotional contagion; when watching film clips of people in emotional situations, high-psychopathy participants did not share the feelings of the people in the films at the same rate as their low-psychopathy peers. Possible explanations for these findings are discussed, and questions for further research are considered

Capacity for Empathy and Emotional Contagion in Those With Psychopathic Personalities

People with psychopathic traits are sometimes adept at recognizing the emotions of others and using this knowledge in anti-social ways. However, data from incarcerated psychopaths suggest that they are incapable of true empathy. In this paper, we describe three studies that link psychopathic personality to emotional contagion and empathy, and we offer suggestions for reconciling the seemingly conflicting data. While most studies of psychopathic personality assess incarcerated respondents, the resulting data may not be generalizable to non-criminals; participants in these studies were recruited from the general population. The research confirms that empathy and emotional contagion are positively correlated and that each is negatively correlated with psychopathy, as expected. Unique to these studies is the finding that, when instructed, those with psychopathic traits can easily “catch” the emotions of others via the steps of the emotional contagion pathway, thus implying their capacity for empathy. However, without instruction, those with psychopathic traits did not automatically catch others’ emotions

A Brief History of Attempts to Measure Sexual Motives

Artists, creative writers, and musicians have long been interested in the complex motives that spark passionate love, sexual desire, and sexual behavior. Recently, scholars from a variety of disciplines have begun to investigate two questions: “Why do men and women choose to engage in sexual liaisons?” “Why do they avoid such encounters?” Theories abound. Many theorists have complained that there exists a paucity of scales designed to measure the plethora of motives that prompt people to seek out or to avoid sexual activities. In fact, this observation is incorrect. Many such scales of documented reliability and validity do exist. The reason that few scholars are familiar with these scales is that they were developed by psychometricians from a variety of disciplines and are scattered about in an assortment of journals, college libraries, and researchers’ desk drawers, thus making them difficult to identify and locate. This paper will attempt to provide a compendium of all known sexual motives scales, hoping that this will encourage scholars to take a multidisciplinary approach in developing typologies of sexual motives and/or in conducting their own research into the nature of sexual motives

Sexual Motives: The Impact of Gender, Personality, and Social Context on Sexual Motives and Sexual Behavior - Especially Risky Sexual Behavior

Recently, scholars from a variety of disciplines have begun to investigate passionate love, sexual desire, and sexual behavior. Specifically, they have begun to investigate questions profound questions as: “Why do men and women engage in sexual liaisons?”  “Why do they avoid such liaisons?”  In this paper, we will review what theorists have learned about the motives that encourage people to engage in (or to avoid) sexual encounters, focusing specifically about what is know about the influence of gender, personality, and social context on sexual motives.  We will close by speculating about the impact of such differing motives on sexual functioning and the prevalence of STIs and AIDs