A Mixed Methods Study of Endometriosis: Patient Experience and Provider Awareness

Endometriosis is a serious yet understudied medical condition impacting hundreds of millions of women around the world. We used a mixed methods approach to better understand provider’s perceptions of the disease, as well as patient’s experiences with the disease. The study consisted of two parts. The first was a quantitative analysis of providers, in which participants completed a brief survey to assess their perception of the prevalence of endometriosis. Fifty-three providers completed surveys. Analysis of the survey data included calculating means and frequencies of each item, as well as determining providers’ prevalence estimates of endometriosis and whether this estimate varied by sub-specialty, number of years in practice, and gender. All quantitative analyses were conducted using SPSS. Survey results indicated that only six of the 53 providers accurately identified the prevalence of endometriosis. The second part of the study involved in-depth, qualitative interviews with both providers and patients. Four providers and 12 patients participated in the interview process. For the provider and patient interviews, code books were created and used to analyze the responses to identify recurring themes. Emergent themes in the provider interviews included, limited training about endometriosis, the difficulty of making a diagnosis, referral process, patient-provider dynamic, and the importance of multidisciplinary collaboration. Emergent themes from patients included, the mental aspect of the disease, lack of confidence in the healthcare system, concerns about fertility, self-advocacy, quality of life, being adverse to hormonal therapies, feelings of dismissiveness by providers, the financial impact of the disease, limited treatment options, and lack of awareness. Findings of this study highlighted some of the major issues which currently contribute to its public health burden, and can allow clinicians to foster change in their current practice with the aim of increasing awareness, issuing more timely and accurate diagnoses, and a call to action for investment and funding for research that will move the field forward and ultimately improve patient outcomes

Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight.

Purpose: Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs). Design: Mixed methods, positive deviance study. Setting: Urban university-based family medicine practice. Participants: The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months. Measures: The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews. Analysis: Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory. Results: The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary. Conclusion: The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss

Bringing the Patient\u27s Voice into Teamwork Assessment Using the Jefferson Teamwork Observation Guide (JTOG)

Purpose: To test the feasibility of using the Jefferson Teamwork Observation Guide (JTOG) as a mobile application with diverse patients to gather perceptions of team-based care delivery. Background: A validated tool assessing IPE core competencies is a significant gap in the literature (IOM, 2015). Little research has demonstrated links between effective teamwork and improved patient outcomes. In 2015, a research team validated the JTOG tool to assess team function. This JTOG was then converted to a mobile application, and individual, patient, and caregiver versions were developed, allowing for 360° evaluation. Description of Intervention or Program: A research team piloted the Patient JTOG mobile application, asking patients to participate in a survey consisting of one open-ended and ten Likert scale questions. Items were tied to the domains of interprofessional collaborative practice – communication, values/ethics, teamwork, and roles/responsibilities (IPEC, 2011) – and one patient-centeredness (PC) domain. Results: Four hundred and forty three patients completed the JTOG, ranging in age from 18-90+. Of the diverse patient population, 52% were female and 39% male. Eighty-seven percent of patients responded “strongly agree” to a question about the importance of teamwork in healthcare. Teams received a mean score from 3.51 to 3.60 out of 4.0 for the eight IPE competency questions. Overall satisfaction with the teams evaluated was 3.83. Items were subjected to a principal axis factor analysis with varimax rotation and a screen plot inspection was used to determine the number of factors to extract. A Cronbach’s alpha was 0.93. Conclusion: Our study confirms the feasibility of using the Patient JTOG app to elicit patient perceptions of teams in inpatient and outpatient settings. By completing this survey, patients provided real-time feedback and summary reports were sent to care teams to improve team functioning. A full validation study of the Patient JTOG is now underway, and a multi-institutional study is planned to assess its use in other healthcare institutions. Relevance to interprofessional education or practice: Assessment strategies must incorporate the voice of the patient as we move forward in developing new tools to assess team function, identify behaviors consistent with effective teamwork, and demonstrate the impact of collaborative practice on patient outcomes. Learning Objectives: Two to three measurable learning objectives relevant to the conference goals. 1) Describe a new mobile tool for gathering patient feedback on patient-centered team based care 2) Apply lessons learned for 360° competency-based assessment of interprofessional education and collaborative practic

Women in Health Data Science and Statistics

Opportunities are expanding for women interested in health data science. This panel of leading professionals from academia and industry will highlight the accomplishments, perspectives and varied roles available for data professionals in the healthcare sector. Learn how to leverage your skills and talents into this expanding and dynamic field. Presentation: 58:4

Altered Expression of Human Mitochondrial Branched Chain Aminotransferase in Dementia with Lewy Bodies and Vascular Dementia

© 2016, The Author(s). Cytosolic and mitochondrial human branched chain aminotransferase (hBCATc and hBCATm, respectively) play an integral role in brain glutamate metabolism. Regional increased levels of hBCATc in the CA1 and CA4 region of Alzheimer’s disease (AD) brain together with increased levels of hBCATm in frontal and temporal cortex of AD brains, suggest a role for these proteins in glutamate excitotoxicity. Glutamate toxicity is a key pathogenic feature of several neurological disorders including epilepsy associated dementia, AD, vascular dementia (VaD) and dementia with Lewy bodies (DLB). To further understand if these increases are specific to AD, the expression profiles of hBCATc and hBCATm were examined in other forms of dementia including DLB and VaD. Similar to AD, levels of hBCATm were significantly increased in the frontal and temporal cortex of VaD cases and in frontal cortex of DLB cases compared to controls, however there were no observed differences in hBCATc between groups in these areas. Moreover, multiple forms of hBCATm were observed that were particular to the disease state relative to matched controls. Real-time PCR revealed similar expression of hBCATm mRNA in frontal and temporal cortex for all cohort comparisons, whereas hBCATc mRNA expression was significantly increased in VaD cases compared to controls. Collectively our results suggest that hBCATm protein expression is significantly increased in the brains of DLB and VaD cases, similar to those reported in AD brain. These findings indicate a more global response to altered glutamate metabolism and suggest common metabolic responses that might reflect shared neurodegenerative mechanisms across several forms of dementia

Learning From Past Mistakes – Opioids, Cannabis and the Treatment of Chronic Non-Cancer Pain Conditions

Background. Finding effective treatments for chronic pain is a major public health challenge. In the 1980s and 1990s, claims of opioid effectiveness without addiction for Chronic Non-Cancer Pain (CNCP) conditions were rooted in uncritical citation of faulty science by the pharmaceutical industry and physicians. The national public heath impact of the ‘opioid epidemic’ is well known. In the 2000s, Medical Cannabis has proliferated as a physician-prescribed treatment for CNCP conditions in the face of uncertain evidence. Some are questioning: has the medical community ‘repeated past mistakes’ in chronic pain management? We approach this question with a comparative analysis of quality of evidence for opioids and cannabis for CNCP conditions during their periods of liberalization. Method. We identified the ‘liberalization periods’ for Opioids as 1989-1999, and Medical Cannabis as 1998–2008 and conducted a literature search for Randomized Control Trials (RCTs) in these time periods. We then conducted modified GRADE criteria evaluations (Cochrane Collaborative tool for assessing Quality of Evidence) for each body of evidence, and contextualized our findings. Results. Opioids: Very Low quality evidence; concerns regarding publication bias, handling of dropouts and outcome data, vague method descriptions and indirectness of population and intervention. Cannabis: Low - Very Low quality evidence; concerns regarding publication bias, potential issues with blinding and indirectness of population. Conclusions & Discussion. It is important to consider several factors, including differences in scientific rigor in each time period and DEA schedule I classification of marijuana being a barrier to conducting studies. Still, there is a striking parallel of prescribing practices outpacing evidence quality. Policy Implications. Rescheduling Marijuana from Schedule I, reinforcing quality and rigor standards for clinical trials, and better integration of evidence interpretation and synthesis into medical school curricula are all warranted