Overcoming Barriers to Enrolling Minorities in Medical Research: What Does the Evidence Say?

Background: Despite the pervasive underrepresentation of minorities in health research studies, little is known about strategies that aim to increase minority enrollment in research. Purpose: The purpose of this study was to identify whether elder African American and Latinos were more likely to refuse research participation, identify tangible and specific incentives to improve research participation in this population, and to review the successes and data reporting of recruitment interventions attempted on diverse populations at large, including the non-elderly. Methods: We conducted a review of Yale OAIC studies to determine minority vs. non-minority research enrollment rates, interviewed key informants about likely barriers and gateways to minority research participation, conducted focus groups and administered a quantitative survey on and to elderly African Americans and Latinos in the New Haven, CT area, and performed a systematic review of published studies attempting to recruit diverse populations. Results: Results from analyzing OAIC studies determined that elderly minorities were not more likely to refuse research participation. Main themes that emerged from the Key informant interviews and Focus groups were access, the benefits of research and trust in medicine and doctors as well as in researchers and research procedures. Enticements most often identified by survey participants as very important to enrolling in research studies included disclosure of study findings, free health care, 24-hr access to study personnel, explanation of study safety precautions, researchers showing respect, and presence of Spanish speaking research staff for Latinos. The systematic review of attempted recruitment interventions on diverse populations identified that most such studies published do not offer adequate qualitative and quantitative data, are recruiting for preventive studies, are performed more so on African Americans, and that social marketing and community outreach were more commonly attempted when compared to referrals and health system recruitment. Social marketing is successful in leading to the most subjects enrolled with the caveat that it requires a large sample to be screened. Discussion: Results suggest that minorities can be recruited to medical research, and that innovative methods such as interviewing key informants and conducting focus groups are also particularly helpful in assessing their opinions. Social marketing recruitment interviews appear promising, but better quantitative and qualitative data reporting must be carried out in the future in order to better inform researchers on the ideal ways to recruit diverse populations

Revisiting CT-guided percutaneous core needle biopsy of musculoskeletal lesions: contributors to biopsy success.

ObjectiveThe purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy.Materials and methodsFour hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm).ResultsOf 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions.ConclusionCT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms

Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period.

PurposeTo retrospectively assess percutaneous core needle biopsies performed by radiologists and the association with tumor seeding along the biopsy tract when anatomic compartment guidelines are not consistently observed.Materials and methodsRetrospective data from computerized patient records and digital images from 363 consecutive computed tomography-guided biopsies of the lower extremity (thigh and leg) performed by radiologists at a single institution from August 2002 to August 2008 were analyzed for breaches of biopsy guidelines.ResultsOf the 363 biopsies, 243 (67%) were of soft tissue lesions and 120 (33%) were of bony lesions. There were 188 (52%) malignant and 175 (48%) benign lesions. The following biopsy breaches were observed: 13 (3.6%) of anatomic compartment, 42 (11.6%) of "vital structures," and 82 (68.3%) of needle path for bony tumors. Vital structures as defined by the literature included, but were not limited to, the following: knee joint capsule, greater trochanteric bursa, rectus femoris and vastus intermedius muscles, tibial tubercle, peroneus brevis and peroneus longus distal tendons, and neurovascular bundles. No cases of tumor recurrences could be attributed to needle seeding along a biopsy tract for any of these biopsy guideline breaches.ConclusionsThe concern for needle tract seeding with musculoskeletal tumors is more widespread than the evidence supporting it as a significant or frequent complication. In this study, breaching anatomic compartment, vital structures (other than neurovascular structures), and suggested exact needle path guidelines were not associated with needle tract seeding in the lower extremity

Revisiting CT-Guided Percutaneous Core Needle Biopsy of Musculoskeletal Lesions: Contributors to Biopsy Success

ObjectiveThe purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy.Materials and methodsFour hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm).ResultsOf 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions.ConclusionCT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms

Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period.

PurposeTo retrospectively assess percutaneous core needle biopsies performed by radiologists and the association with tumor seeding along the biopsy tract when anatomic compartment guidelines are not consistently observed.Materials and methodsRetrospective data from computerized patient records and digital images from 363 consecutive computed tomography-guided biopsies of the lower extremity (thigh and leg) performed by radiologists at a single institution from August 2002 to August 2008 were analyzed for breaches of biopsy guidelines.ResultsOf the 363 biopsies, 243 (67%) were of soft tissue lesions and 120 (33%) were of bony lesions. There were 188 (52%) malignant and 175 (48%) benign lesions. The following biopsy breaches were observed: 13 (3.6%) of anatomic compartment, 42 (11.6%) of "vital structures," and 82 (68.3%) of needle path for bony tumors. Vital structures as defined by the literature included, but were not limited to, the following: knee joint capsule, greater trochanteric bursa, rectus femoris and vastus intermedius muscles, tibial tubercle, peroneus brevis and peroneus longus distal tendons, and neurovascular bundles. No cases of tumor recurrences could be attributed to needle seeding along a biopsy tract for any of these biopsy guideline breaches.ConclusionsThe concern for needle tract seeding with musculoskeletal tumors is more widespread than the evidence supporting it as a significant or frequent complication. In this study, breaching anatomic compartment, vital structures (other than neurovascular structures), and suggested exact needle path guidelines were not associated with needle tract seeding in the lower extremity