bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Provider Survey
Authors: Gulitz Elizabeth , Bustillo‐Hernandez Marta , Kent Ellen B. 
Published: March 2003

PURPOSE
: Lack of physician recommendation is a major predictor of underutilization of breast and cervical cancer screening. The authors conducted a comprehensive two‐part study of Florida primary care providers to determine which providers were not screening their older patients and why. This article reports on the study's quantitative survey component.
DESCRIPTION OF STUDY
: After an initial mailing of surveys to 2052 randomly sampled, licensed medical and osteopathic physicians, nurse practitioners, and certified nurse midwives, a follow‐up mailing and phone calls resulted in 496 usable surveys. Outcome variables were whether or not primary care providers performed screening tests for their asymptomatic, women patients older than 50 years of age. Predictor variables included: age, race, gender, training, specialty, practice size, and location of the providers, and the percentage of older patients that they served.
RESULTS
: The best predictors of primary care providers not screening their asymptomatic women patients who were older than 50 years of age were providers also being older than 50, specializing in geriatrics or adult health, and working in a small or rural practice. An analysis of providers' responses to structured survey items related to their own and their patients' attitudes about screening indicated that providers often miss the opportunity to screen due to a combination of patient, provider, practice, and access barriers.
CLINICAL IMPLICATIONS
: The authors recommend that public health and primary care practitioners collaborate in developing strategies that address areas of potential change for overcoming these four barriers, while also considering the essential public health services of assessment, policy development, and assurance. These strategies should be designed to facilitate the breast and cervical cancer screening process for both providers and patients, so that providers feel more comfortable performing and recommending these important tests, particularly for underserved groups of older women.
An Evaluation of Advisors' Activities
Authors: Earp Jo Anne L. , Flax Valerie L. 
Published: March 2003

PURPOSE
: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities.
DESCRIPTION OF STUDY
: Between September 1994 and January 1996, 144 lay health advisors, associated with the North Carolina Breast Cancer Screening Program, were asked to complete, on a periodic basis, a standardized, self‐administered activity report that asked about group presentations in the past 3 months and one‐on‐one contacts in the past week. Eighty‐five advisors submitted one or more reports. The authors tabulated responses for lay health advisors overall, for those turning in one or more reports, and for those reporting a specific type of activity.
RESULTS
: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one‐on‐one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms.
CLINICAL IMPLICATIONS
: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in‐service training is necessary, and how to enhance the recruitment and training of additional lay health advisors.
Multidisciplinary Care of Hepatocellular Carcinoma
Authors: Van Cleave Janet , Devine Pamela , Odom‐Ball Pam 
Published: March 2003

objectives: Multidisciplinary care of cancer patients in varied settings is well described in the literature, but there is little specifically describing the multidisciplinary care of the patient with hepatocellular carcinoma (HCC). The purpose of this article is to describe HCC and the multidisciplinary approach at the Philadelphia Veterans Affairs Medical Center (PVAMC).materials and methods: HCC is one of the most common solid tumors in the world, but it is rare in North America. It is associated with environmental carcinogens identified in animal studies, hepatitis B and C, cirrhosis of any etiology, and various metabolic diseases. No reliable therapy has been established for HCC. Surgical resection is the best treatment, but it is possible only in the patient with adequate hepatic reserve and limited‐stage cancer. From January 1995 to May 1998, 22 patients at PVAMC received a diagnosis of primary HCC. One patient was a candidate for surgery, two patients received radiation therapy, and one patient underwent chemoembolization. Eighteen patients presented with an advanced‐stage disease and comorbidities.results: Therapy goals in these 18 patients were limited to supportive care and enhancement of quality of life. A multidisciplinary team provided care to this challenging patient population. The multidisciplinary team treating HCC at PVAMC consisted of physicians, nurses, pharmacists, social workers, and a chaplain. Most care occurred in the outpatient setting. Supportive therapy included the controlling of ascites and abdominal discomfort, hepatic encephalopathy, and pruritus. Opioids relieved abdominal pain. Psychiatric support and counseling helped patients and families cope with the poor prognosis.conclusions: A multidisciplinary team approach helped provide care for this challenging population. Through anecdotal reports, patients and family expressed satisfaction with their care. Research is needed to systematically test interventions designed to enhance quality of life in patients with HCC.
Colorectal Cancer Screening Beliefs
Authors: Rawl Susan M. , Menon Usha , Champion Victoria L. , Foster June L. , Skinner Celette Sugg 
Published: March 2003

Objectives: The purpose of this paper is to describe the perceived benefits and barriers to colorectal cancer screening reported by first‐degree relatives of colorectal cancer patients.Materials and methods: In this study, the authors used focus groups to identify perceived benefits and barriers to colorectal cancer screening among parents and children of colorectal cancer patients. Four focus groups were conducted with relatives of colorectal cancer patients seen at two university medical centers in the Midwest. The groups ranged in size from five to eight members each and were stratified by gender.Results: Four benefits of colorectal cancer screening were identified by participants: finding colorectal cancer early, decreasing the chances of dying from colorectal cancer, freedom from worry about colorectal cancer, and reassurance that one was cancer‐free. Four main barriers were identified that applied to all four types of colorectal cancer screening or to colorectal cancer screening in general. These included inadequate public awareness of colorectal cancer, inconsistent recommendations from healthcare providers, concerns about the efficacy of screening tests, and embarrassment. Barriers unique to each screening test also were identified.Conclusions: Understanding individual beliefs about the benefits and barriers to colorectal cancer screening will allow clinicians and researchers to develop effective interventions to increase screening. Results from the focus groups have been used to develop an instrument to measure benefits and barriers to colorectal cancer screening, which now needs to be tested with more culturally and socioeconomically diverse groups.
Family History of Breast Cancer
Authors: Petrisek Ann , Campbell Susan , Laliberte Linda 
Published: March 2003

Purpose: Family history is the most prominent risk factor, besides advanced age, for the incidence of breast cancer among women. This study investigates differences in the experiences of women in the detection, diagnosis, and treatment of early‐stage disease. The purpose of this research is to obtain a more comprehensive understanding of the impact of family history on the overall illness experience.Description of study: Self‐report retrospective data obtained from in‐depth interviews with a convenience sample of 179 women who had recently received a diagnosis of nonrecurrent stage 0 to IIIA breast cancer are used to compare the experiences of women with and without a family history of breast cancer (FHOBC). The authors examine differences in screening behavior, method of detection, diagnostic processes, treatment decision making, and therapy receipt, and they report the results of bivariate analyses.Results: The results suggest that women with FHOBC have a different disease experience than those without an affected relative. Women with FHOBC were more likely than their counterparts to comply with screening guidelines, to seek more timely care, to consult with specialists, to be influenced by the experiences of others, to feel comfortable with treatment decisions, and to receive adjuvant therapy.Clinical implications: Healthcare providers should be aware that compliance with mammography and therapy guidelines may vary with FHOBC. Because the better health‐related behavior reported by women with affected relatives suggests that they may have higher perceived risk, physicians should be sensitive to potentially elevated levels of anxiety, provide accurate information about relative risk, put patient concerns in the proper perspective, and include family members in treatment discussions. Alternatively, women without an FHOBC appear to have less favorable screening, detection, diagnosis, and treatment decision‐making behavior. Because family doctors play an important role in the care of these patients, they may need to provide special education and counseling regarding the importance of adherence to screening guidelines, recognition of relevant symptoms, initiation of timely examinations, consultation with cancer specialists, and compliance with treatment recommendations.
Fears about Breast Cancer Recurrence:
Authors: Johnson Vickberg Suzanne M. 
Published: March 2003

Purpose:Prior research shows that the majority of women diagnosed with breast cancer experience ongoing fears about recurrence. These studies primarily have used Likert scales to determine the extent to which women fear recurrence but have not presented details of women's experiences or addressed the nature of women's fears. This report describes a pilot study designed to capture women's diverse experiences related to the possibility of recurrence.Description of study:Sixteen women participated in semi‐structured interviews about their thoughts and feelings regarding the possibility of breast cancer recurrence. Thematic content coding was used to categorize women's responses.Results:Although some women indicated strong fears about recurrence, the majority expressed more moderate fears. Fears revolved around the possibility of death, further treatment (particularly chemotherapy), emotional difficulties, pain, advancement of the disease, suffering of family members, and loss of the breast. Many women spoke about life circumstances that were more salient than the possibility of recurrence. Women also described events/situations that triggered fears and strategies used for coping with fears.Clinical implications:Results suggest that more systematic investigation of women's fears about breast cancer recurrence is warranted and that clinicians should address the multidimensional nature of women's fears as they relate to other psychological processes and events in women's lives. Moreover, women's life circumstances should be considered when attempting to determine whether a social support intervention might be beneficial or detrimental.
Perceived Cancer Causes
Authors: Maskarinec Gertraud , Gotay Carolyn C. , Tatsumura Yvonne , Shumay Dianne M. , Kakai Hisako 
Published: March 2003

Purpose: The objectives of this report are to describe beliefs about general and personal cancer causes among patients with cancer who use and do not use complementary and alternative medicine (CAM), to compare these beliefs with current epidemiologic knowledge, and to explore associations between these beliefs and choice of CAMs.Description of interviews: The authors conducted a semistructured interview with 143 patients with cancer, who were identified via the Hawaii Tumor Registry and had participated in a survey on CAM use. By design, the majority of interviewees (85%) were CAM users. A qualitative data analysis was performed.Results: Genetics, environment, and diet were among the most common perceived general causes of cancer, whereas psychosocial factors were by far the most common perceived personal causes. CAM users were more likely than nonusers to name environment, immune system, and stress as cancer causes. Compared with the epidemiologic literature, study participants were less likely to mention tobacco use and more likely to consider environmental exposures, psychosocial factors, immunologic mechanisms, and physical injury as causes of cancer. Furthermore, the interviews suggest that causal thinking may be related to the type of CAM used.Clinical implications: Given the discrepancy between popular cancer theories and current scientific knowledge, the challenge for the healthcare provider is to listen and try to understand the patient's beliefs about cancer etiology. Understanding the patient's beliefs about their disease is important in providing the support and information they need to make effective decisions about their medical care.
Cancer Clinical Trial Patients in the Information Age
Authors: Ehrenberger Heidi E. 
Published: March 2003

Purpose:The purpose of this pilot study was to explore the cancer clinical trial patient's perception and use of electronic information and communication.Description of study:A total of 42 participants who self‐reported they had enrolled, or were enrolled, in a cancer clinical trial completed a Web‐based clinical trials survey questionnaire linked to a cancer‐specific Web site. The questionnaire was used to obtain written responses to open‐ended questions regarding the perception and use of electronic information and communication.Results:The pilot study findings document that more than one third of the respondents use the Internet to seek clinical trials information. Results also describe the impact of the Internet in helping these patients to identify what questions to ask their healthcare providers. The findings underscore the desire of patients to communicate not only with others on the same clinical trial, but also with their healthcare providers via the Internet.Clinical implications:When providing care to cancer clinical trial patients in the information age, online information seeking and the desire for electronic communication must increasingly be acknowledged, understood, and supported. A proactive and comprehensive approach to addressing patient information and support needs can facilitate patient empowerment and satisfaction.
Acetate Hemodialysis Does Not Increase the Frequency of Arrhythmia in Hemodialysis Patients
Authors: Kayatas Mansur , Ertürk Arif , Muderrisoglu Haldun , Emin Korkmaz  , Nurhan Özdemir  
Published: March 2003

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future.Arrhythmia is one of the most important causes of mortality in patients on hemodialysis and may develop due to cardiovascular diseases or fluid‐electrolyte or acid‐base abnormalities. Previous studies have shown that acetate hemodialysis (AHD) increased the frequency of arrythmia. To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean age of 45 ± 18 years) who were under AHD (4 h, 3 times/week, mean duration of HD of 38 ± 29 months) with the same Cuprophan membranes. All patients underwent a detailed echocardiographic evaluation during the interdialytic period. Twenty‐four hours of Holter monitoring was performed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn for serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD (from 2.3 ± 0.5 to 1.9 ± 0.3 mEq/L and from 5 ± 0.7 to 3.4 ± 0.4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbonate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433 ± 42 to 464 ± 43 ms, p < 0.001), which was thought to be related to the decrease in serum magnesium and potassium levels. The frequencies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8 ± 9.1 to 6.5 ± 11 contractions/h, p > 0.05). This was also true for supraventricular premature contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsustained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmia. In our ambulatory electrocardiographic study, the frequencies of VPCs and SVPCs observed during the interdialytic period were only positively correlated with age (r = 0.54, p = 0.013 and r = 0.50, p = 0.010, respectively). No relation was found between the frequency of arrhythmia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the frequency of arrhythmia in HD patients as had been shown in previous studies.
Biodiversity Value, Status, and Strategies for Conservation of Sacred Groves of Meghalaya, India
Authors: Tiwari B.K. , Barik S.K. , Tripathi R.S. 
Published: March 2003

ABSTRACTThe tribal communities of Meghalaya in northeast India—Khasis, Garos, and Jaintias—have a tradition of environmental conservation based on various religious beliefs which have been passed on from one generation to the other. Based on these beliefs, certain patches of forests are designated as sacred groves under customary law and are protected from any product extraction by the community. Such forests are very rich in biological diversity and harbor many endangered plant species including rare herbs and medicinal plants. Seventy‐nine sacred groves were located, denoted on a geographical map of Meghalaya, and studied for their biodiversity value, status, and vegetation characteristics. A baseline floristic survey revealed that at least 514 species representing 340 genera and 131 families were present in these sacred groves. The status of sacred groves was ascertained through canopy cover estimate. A little over 1.3% of total sacred grove area was undisturbed, 42.1% had relatively dense forest, 26.3% had sparse canopy cover, and 30.3% had open forest. The vegetation characteristics and species diversity of an undisturbed sacred grove were compared with that of an unprotected disturbed forest. The species diversity indices were higher for the sacred grove than for the disturbed forest. The species composition and community characteristics differed significantly between the two forests. Sociocultural aspects of sacred grove conservation were analyzed, and views of the local people were enlisted. Based on the findings, conservation strategies for sacred groves were suggested.
Beyond the Rhetoric of Premeditated Murder: Toward a Rational and Compassionate Environmentalist Perspective about the Ethics of Risk Assessment
Authors: Tal Alon 
Published: March 2003

ABSTRACTThe philosophical basis for opposition and support of risk assessment by environmentalists is considered. Opponents’ perspective is dominated by “empathy” for individual victims, theoretical and identifiable, who suffer morbidity or mortality due to environmental pollution. Proponents’ perceive optimization of aggregate public health as the ethical imperative. Taken to their extreme, these positions lead to angry rhetoric in their mutual efforts to discredit the opposing view, without considering whether it is possible to integrate the legitimated impulses that lie behind the two perspectives. This essay presents one such synthesis that both accepts the inevitability of risk assessment (and in many cases its importance) as a decision analytic tool but also integrates many of the noble convictions that lie behind the critique when victims are clearly identifiable. As ecological risk assessment becomes an increasingly developed tool for decision‐making about managing ecosystem health, many of the same arguments are certain to be wielded. A balanced philosophical approach to this new discipline has the potential to expedite a more rational and ultimately protective public policy while conveying an important societal message about compassion and respect for the sanctity of life.
Forest Health Monitoring in Australia: National and Regional Commitments and Operational Realities
Authors: Stone Christine , Old Ken , Kile Glen , Coopst Nicholas 
Published: March 2003

ABSTRACTThis review examines national and regional approaches and challenges to forest health monitoring in Australia. Divergent management priorities for forests and plantations within Australia have resulted in differing interpretations of what is meant by forest health. This in turn has influenced the approaches taken to monitoring forest health. The commercial forest sector has taken a simplistic approach, focusing on the surveillance of tree condition and the extent of damaging agents that directly affect tree productivity. Resources for this task are generally restricted to high‐value plantations. In order to fulfil their obligations to sustainable forest management most State forestry agencies are committed to developing regional Sustainable Forest Management monitoring programs. At the federal level there is a commitment to complying with several international conservation agreement including the Montreal Process. Forest health in these programs tends to be poorly defined. Some States have established, or are planning monitoring programs based on intensive measurements in permanent sites or plots. While current forest health monitoring programs in Australia are state‐based, the need for coordination and compatibility of assessment and reporting systems is recognized. Several national and state fora exist, for example, the national Forest Health Committee and the state‐based Forest Health Advisory Committees. These groups have the potential to develop and coordinate the linkage from the regional‐based forest health monitoring programs up to the national level. A major driver of this process, however, will be individual State's priorities and available resources and funding.