Evaluation of an Electronic Health Record Intervention to Decrease Over-screening in Women Beyond the Screening Age Limits or Post-hysterectomy

University of Minnesota M.S. thesis. March 2018. Major: Clinical Research. Advisor: Shalini Kulasingam. 1 computer file (PDF); ix, 37 pages.Objectives: 1) To assess healthcare provider adherence to the 2012 cervical cancer screening guidelines beyond screening age limits and post-hysterectomy; 2) To evaluate effects of electronic health record clinical decision support to decrease non-indicated screening. Methods: A retrospective chart review determined cervical cancer screening practices from 2012-2014 in women 65 years of age or post-hysterectomy. Tests were designated as indicated/non-indicated per 2012 guidelines. To test the effect of clinical decision support, the proportion of non-indicated tests were compared before and after implementation of decision support. Results: Tests were indicated in 51%, 40%, and 29% of women 65 years, and post-hysterectomy, respectively. Implementation of clinical decision support did not change the proportion of non-indicated Pap tests (OR 1.08, 95% CI 0.77-1.52). Conclusions: 35% of Pap tests in women beyond the screening age limits or post-hysterectomy were not indicated. A clinical decision support alert did not change practices

Nearly 30 Years of Treatment for Recurrent Granulosa Cell Tumor of the Ovary: A Case Report and Review of the Literature

A 30-year-old woman was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary in 1979. Following removal of the adnexal mass and complete surgical staging, she remained disease-free for 12 years. In 1991 she underwent a resection of a retroperitoneal mass, confirmed to be a recurrent GCT. Despite adjuvant radiation treatment at the time of recurrence, the patient presented five years later with abdominal pain, and was found to have a second recurrence. Over the next 10 years the patient had multiple recurrences and progressive disease despite surgical resection, cytotoxic, hormonal and targeted chemotherapy treatments. In conclusion, there is no standard management for recurrent GCT of the ovary. We review this patient's treatment in the context of the current literature

Diagnosis and Management of Adenocarcinoma in Situ: A Society of Gynecologic Oncology Evidence-Based Review and Recommendations.

This publication represents an extensive literature review with the goal of providing guidelines for the evaluation and management of cervical adenocarcinoma in situ (AIS). The authors drafted the guidelines on behalf of the Society of Gynecologic Oncology, and the guidelines have been reviewed and endorsed by the ASCCP. These guidelines harmonize with the ASCCP Risk-Based Management Consensus Guidelines and provide more specific guidance beyond that provided by the ASCCP guidelines. Examples of updates include recommendations to optimize the diagnostic excisional specimen, AIS management in the setting of positive compared with negative margins on the excisional specimen, surveillance and definitive management after fertility-sparing treatment, and management of AIS in pregnancy. The increasing incidence of AIS, its association with human papillomavirus-18 infection, challenges in diagnosis owing to frequent origin within the endocervical canal, and the possibility of skip lesions all make AIS a unique diagnosis whose management needs to be differentiated from the management of the more prevalent squamous cell dysplasia

Diagnosis and Management of Adenocarcinoma in Situ: A Society of Gynecologic Oncology Evidence-Based Review and Recommendations.

This publication represents an extensive literature review with the goal of providing guidelines for the evaluation and management of cervical adenocarcinoma in situ (AIS). The authors drafted the guidelines on behalf of the Society of Gynecologic Oncology, and the guidelines have been reviewed and endorsed by the ASCCP. These guidelines harmonize with the ASCCP Risk-Based Management Consensus Guidelines and provide more specific guidance beyond that provided by the ASCCP guidelines. Examples of updates include recommendations to optimize the diagnostic excisional specimen, AIS management in the setting of positive compared with negative margins on the excisional specimen, surveillance and definitive management after fertility-sparing treatment, and management of AIS in pregnancy. The increasing incidence of AIS, its association with human papillomavirus-18 infection, challenges in diagnosis owing to frequent origin within the endocervical canal, and the possibility of skip lesions all make AIS a unique diagnosis whose management needs to be differentiated from the management of the more prevalent squamous cell dysplasia

Evaluation of graphic messages to promote human papillomavirus vaccination among young adults: A statewide cross-sectional survey

Young adults in the United States 18–26 years of age are eligible for human papillomavirus (HPV) vaccination, yet they rarely attend preventive healthcare visits. In contrast, they have a high prevalence of social media use, which could be leveraged to provide healthcare recommendations. Since graphics attract users, the study's primary objective was to determine the most appealing graphic to promote HPV vaccination to young adults. A cross-sectional survey was conducted at the Minnesota State Fair. Participants 18–26 years of age completed a 36-item survey including information on demographics, HPV vaccination status, eHealth literacy, and assessed the appeal of 8 Instagram graphic mock-ups promoting HPV vaccination to prevent cancer. The graphics represented 4 categories: 1) infographics; 2) disease photos; 3) young adult cancer patient photos; 4) humorous graphics. A total of 1037 eligible young adults participated in the study. Median age was 22 years. A majority were women (63%), white (82%), educated (79% post-secondary education or greater), or privately insured (85%). Although 61% reported receiving at least one dose of HPV vaccine, only 48% reported receiving all three recommended doses. Participants were slightly more drawn to posts with humorous graphics or infographics than disease or patient photos (pairwise p-values <0.0001). There were small but statistically significant differences in response to graphics by gender, race, HPV vaccination status, and eHealth literacy.In conclusion, graphic types tested in this study showed only small differences in response, suggesting that factors other than graphic type need to be explored to improve appeal of HPV vaccine promotional messaging. Keywords: HPV vaccination, Social media, Graphics, Health promotio

Online medical misinformation in cancer: Distinguishing fact from fiction

It is without question that the Internet has democratized access to medical information, with estimates that 70% of the American population use it as a resource, particularly for cancer-related information. Such unfettered access to information has led to an increase in health misinformation. Fortunately, the data indicate that health care professionals remain among the most trusted information resources. Therefore, understanding how the Internet has changed engagement with health information and facilitated the spread of misinformation is an important task and challenge for cancer clinicians. In this review, we perform a meta-synthesis of qualitative data and point toward empirical evidence that characterizes misinformation in medicine, specifically in oncology. We present this as a call to action for all clinicians to become more active in ongoing efforts to combat misinformation in oncology

COVID-19 Concerns among Physicians who treat cancer survey in the United States, Cross-sectional study March/April 2020

We have provided the survey instrument, data, and the SAS program(s) which generate the calculated variables and statistical analyses as described in the manuscript(s). A. Filename: COVID19_us_oncologist_survey_data3.csv Short description: Data set B. Filename: COVID19AndOncologistsSurvey_REDCapSurvey.pdf Short Description: PDF of survey as presented to participants in REDCap online C. Filename: Covid19_oncologist_analysis_emot_health_final_UPLOAD.sas Short Description: SAS code (9.4) to generate variables and statistical analysis for Thomaier et al., 2020. NOTE: Variables dem_1, dem_3, dem_4, dem_5, and dem_17 have been removed from this public version of the dataset to protect participant privacy. These correspond to age, transgender status, race, ethnicity, and state of residence/practice. To obtain a complete raw dataset, please contact the lead investigator to be vetted for access to that data.Cross-sectional anonymous online survey among physicians treating individuals with cancer in the United States during the initial phase of the COVID-19 pandemic (March 27, 2020 – April 10, 2020). Recruitment: Snowball convenience sampling through social media (Twitter, Facebook, LinkedIn). Eligibility criteria: ≥18 years, able to read/write in English, and being a physician (MD or DO) currently residing and providing cancer treatment in the United States. Data collected and stored in REDCap.This research was supported in part by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494 as well as the National Cancer Institute P30 Cancer Center Support Grant, grant CA77598. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences or the National Cancer Institute