Breast and cervical cancer programs' success in maintaining screening during periods of high COVID-19: A qualitative multi-case study analysis

Objective

During the first year of the COVID-19 pandemic, most of the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs (recipients) experienced significant declines in breast and cervical cancer screening volume. However, 6 recipients maintained breast and/or cervical cancer screening volume during July-December 2020 despite their states' high COVID-19 test percent positivity. We led a qualitative multi-case study to explore these recipients' actions that may have contributed to screening volume maintenance.

Methods

We conducted 22 key informant interviews with recipients, screening provider sites, and partner organizations. Interviews explored organizational and operational changes; screening barriers; actions taken to help maintain screening volume; and support for provider sites to continue screening. We documented contextual factors that may have influenced these actions, including program structures; clinic capacity; and state COVID-19 policies.

Results

Thematic analysis revealed crosscutting themes at the recipient, provider site, and partner levels. Recipients made changes to administrative processes to reduce burden on provider sites and delivered tailored technical assistance to support safe screening. Provider sites modified clinic protocols to increase patient safety, enhanced patient reminders for upcoming appointments, and increased patient education on the importance of timely screening during the pandemic. Partners worked with provider sites to identify and reduce patients' structural barriers to screening.

Conclusion

Study findings provide lessons learned to inform emergency preparedness-focused planning and operations, as well as routine operations for NBCCEDP recipient programs, other cancer screening initiatives, primary care clinics, and chronic disease prevention programs.

Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control

Background

Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes.

Methods

The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life.

Results

The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan.

Conclusions

This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.

Implementation studio: implementation support program to build the capacity of rural community health educators serving immigrant communities to implement evidence-based cancer prevention and control interventions

PURPOSE

Rural community-based organizations (CBOs) serving immigrant communities are critical settings for implementing evidence-based interventions (EBIs). The Implementation Studio is a training and consultation program focused on facilitating the selection, adaptation, and implementation of cancer prevention and control EBIs. This paper describes implementation and evaluation of the Implementation Studio on CBO's capacity to implement EBIs and their clients' knowledge of colorectal cancer (CRC) screening and intention to screen.

METHODS

Thirteen community health educators (CHEs) from two CBOs participated in the Implementation Studio. Both CBOs selected CRC EBIs during the Studio. The evaluation included two steps. The first step assessed the CHEs' capacity to select, adapt, and implement an EBI. The second step assessed the effect of the CHEs-delivered EBIs on clients' knowledge of CRC and intention to screen (n = 44).

RESULTS

All CHEs were Hispanic and women. Pre/post-evaluation of the Studio showed an increase on CHEs knowledge about EBIs (pre: 23% to post: 75%; p < 0.001). CHEs' ability to select, adapt, and implement EBIs also increased, respectively: select EBI (pre: 21% to post: 92%; p < 0.001), adapt EBI (pre: 21% to post: 92%; p < 0.001), and implement EBI (pre: 29% to post: 75%; p = 0.003). Pre/post-evaluation of the CHE-delivered EBI showed an increase on CRC screening knowledge (p < 0.5) and intention to screen for CRC by their clients.

CONCLUSION

Implementation Studio can address unique needs of low resource rural CBOs. An implementation support program with training and consultation has potential to build the capacity of rural CBOs serving immigrant communities to implementation of cancer prevention and control EBIs.

CLINICAL TRIALS REGISTRATION NUMBER

NCT04208724 registered.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Toward a more comprehensive understanding of organizational influences on implementation: the organization theory for implementation science framework

Introduction

Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.

Methods

The process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions.

Results

Twenty-four experts participated in concept mapping. Based on resulting construct groupings' coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7-13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence).

Discussion

Organizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Predicting Difficult Intubation by using Modified Mallampati (MMT) with or without Thyromental Height Test (TMHT)

Failed Tracheal Intubation with Subsequent inability to maintain an open airway and adequate oxygenation is the most frequent cause of brain damage or death during anesthesia. Recognizing before anesthesia the potential for difficult intubation allows time for optimal preparation. Proper Selection of equipment and techniques is needed to avoid unwanted situation. To find out difficulties associated with endotracheal intubation using Modified Mallampati Test (MMT) combined with Thyromental Height Test (TMHT) and MMT without TMHT. This prospective observational study was conducted at the Department of Anesthesia in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2018 to September 2018. Two hundred two patients with different surgical procedures under general anaesthesia in different operation theaters of BSMMU, Dhaka were selected as study population. After taking written consents from each patient or his/her attendant elaborate history of illness, meticulous clinical examinations were performed and relevant laboratory investigations were done. All information was recorded in a preformed data sheet and statistical analysis was done by SPSS-22.0. Mean age ±SD of the study subjects was 42.49±14.29 years in MMT with TMHT group and 43.40±15.39 years in MMT without TMHT group. Females were enrolled more than males in both the groups. BMI was 28.75±3.59kg/m² in MMT with TMHT group and 29.44±8.64kg/m² in MMT without TMHT group. There were no significant differences in age, gender and BMI between the groups. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT with TMHT in predicting intubation difficulty. Sensitivity, specificity, PPV, NPV and accuracy were 100.0%, 96.0%, 96.2%, 100.0% and 98.0% respectively of MMT only in predicting intubation difficulty. MMT combined with TMHT is a better predictor of intubation difficulty than MMT alone.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Epidemiology of drug driving: protocol from a national Canadian study measuring levels of cannabis, alcohol and other substances in injured drivers

Background

Drug driving is an emerging global road safety problem. As the prevalence of alcohol-impaired driving decreases, and as more jurisdictions decriminalize or legalize cannabis, it is increasingly important for policy makers to have accurate information on the prevalence and pattern of drug driving. Unfortunately, this data is not widely available and the World Health Organization identifies lack of accurate data on the prevalence of drug driving as an important knowledge gap.

Methods

In this paper, we discuss the limitations of current methods of monitoring drug use in drivers. We then present a novel methodology from a multi-centre study that monitors the prevalence and pattern of drug use in injured drivers across Canada. This study uses “left-over” blood taken as part of routine medical care to quantify cannabis and other drugs in non-fatally injured drivers who present to participating emergency departments after a collision. Toxicology testing is done with waiver of consent as we have procedures that prevent results from being linked to any individual. These methods minimize non-response bias and have the advantages of measuring drug concentrations in blood obtained shortly after a collision.

Discussion

Our methods can be applied in other jurisdictions and provide a consistent approach to collect data on drug driving. Consistent methods allow comparison of drug driving prevalence from different regions. Data from this research can be used to inform policies designed to prevent driving under the influence of cannabis and other impairing drugs.

Role of Oral Clonidine Premedication on Intra-operative Haemodynamics and PONV in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is a gold standard surgical procedure for gallbladder operation. It causes altered haemodynamic responses due to pneumoperitoneum and surgical procedure also causes high incidence of postoperative nausea &vomiting. Clonidine has been shown to reduce intraoperative haemodynamic instability. This randomized prospective single blind clinical study was designed to evaluate the efficacy of oral clonidine premedication for attenuation of haemodynamic responses associated with pneumoperitoneum & also reduce the incidence of postoperative nausea & vomiting and carried out in the department of Anaesthesia Analgesia and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to June 2010. Sixty adult patients of ASA physical status I & II scheduled for elective laparoscopic cholecystecomy were recruited for a prospective randomized single blind study. They were selected randomized into two equal groups, thirty in each group. Group A received no premedication & Group B (Clonidine) received clonidine (100μgm) orally 60 minutes before induction of anaesthesia. Pulse rate, mean arterial pressure were recorded prior to induction, 2 minutes after endotracheal intubation, before pneumoperitoneum, 10 minutes & 20 minutes after pneumoperitoneum, 10 minutes after release of carbon dioxide & 10 minutes after extubation. Patients in Group B (Clonidine) maintained greater haemodynamic stability intraoperatively compare to Group A after intubation, during pneumoperitoneum and also extubation. Pulse rate & mean arterial pressure significantly varies in Group A compare with Group B (Clonidine) at different times of intraoperative period (p<0.05). Postoperative nausea & vomiting was significantly less in Group B (Clonidine). Premedication with oral clonidine attenuates the haemodynamic responses produced by pneumoperitoneum during laparoscopic cholecystectomy and also significantly nausea and vomiting, results better patient satisfaction and cost effective.

Application of positron emission tomography in physical medicine

Positron emission tomography (PET) is widely used in the fields of clinical and basic medicine. The PET device utilizes coincidence logic to detect annihilation photons emitted from positrons and estimates physiological functions of human organs in vivo. Radiopharmaceutical 18F- fluorodeoxyglucose (FDG), an analogue of glucose, is trapped metabolically in cells after being administered into the body, and can be substantially used for evaluating physiological and biochemical functions in vivo. Here, we attempted to describe the basics of PET as well as to apply the technique together with 18F-FDG as a tracer for evaluating organ glucose metabolism induced by exercise. Three-dimensional (3D) FDG-PET was applied to normal volunteers who performed exercise to evaluate whole-body glucose metabolism. Regions of interest analysis were drawn on visually defined regions (i.e., lower limbs, thigh, liver, intestine, brain, heart, etc.) to determine radioactivity distribution. FDG-PET clearly showed the recruitment of energy resources from abdominal organs to lower limb skeletal muscles to balance energy expenditures. The results suggested that 3D FDG-PET can be applied as an imaging tool to physical medicine.

Effects of aerobic exercise training on brain structure and psychological well-being in young adults

AIM

There is convergent evidence that exercise increases psychological well-being; however, the mechanism of this psychological effect of exercise is not yet completely understood. The purpose of this study was to examine the effects of aerobic exercise training on brain structure and psychological well-being in young adults.

METHODS

University students who had not regularly exercised were divided into training group (N.=15) and control group (N.=15). The training group performed a total 30 periods of aerobic exercise training, while the control group never performed. Whole-brain magnetic resonance imaging scans and mental health questionnaire examinations were performed before and after the exercise training period for all of the participants. A voxel-based morphometry (VBM) analysis was used to compare the changes in gray-matter volumes in the two groups. VBM is an objective whole-brain technique for characterization of regional cerebral volume and tissue concentration differences in structural magnetic resonance images.

RESULTS

The results of VBM analysis revealed no change in gray-matter volume in the training group, although the gray-matter volume of the left insula was significantly decreased in the control group after the exercise training period. The training group exhibited significant improvement in some scores on the mental health questionnaire after the exercise training period, compared with the control group.

CONCLUSIONS

These findings suggest that aerobic exercise training may inhibit gray-matter volume loss in the insula, and that a relationship may exist between preservation of insula gray-matter and improvement of psychological well-being by aerobic exercise training.

Regional cerebral glucose metabolism of patients with malignant diseases in different clinical phases

BACKGROUND

Psychological and psychiatric aspects of cancer patients have not been studied well in terms of functional neuroimaging. The aim of this pilot study was to investigate the relationship between regional cerebral metabolism and different clinical phases.

MATERIAL AND METHODS

Relative cerebral glucose metabolism of 77 Japanese patients with various types of malignant diseases was studied by positron emission tomography with 18F-fluorodeoxyglucose. They were subgrouped into the 1) pre-treatment, 2) post-treatment, 3) recurrence and 4) terminal patient groups. These subgroups were compared to the control group of 17 in-patients with benign diseases, using voxel-based Statistic Parametrical Mapping software (SPM).

RESULTS

Relative reduction in the regional cerebral metabolism was detected in the prefrontal and basolateral (inferolateral) prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate gyrus, insula, basal ganglia, hippocampus and thalamus in the pre-treatment group. The anterior and posterior cingulate gyri were hypometabolic only in the pre-treatment group. Hypometabolic areas were detected only in the basolateral prefrontal cortex, orbitofrontal cortex, ventral part of cingulate gyrus and insula in the post-treatment group. In the terminal group, the hypometabolic pattern seemed very close to that in the pre-treatment group. The results seemed to suggest that hypometabolic findings before treatments could reverse after treatments but became prominent again in terminal stages. These results do not contradict with previous epidemiological findings that high incidence of adjustment disorders was seen in earlier stages and more brain organic syndromes were seen in terminal stages.

CONCLUSION

It could be speculated that decreased metabolism in early stages reflects state-dependent changes and that decreased metabolism in the terminal stages reflects organic brain damages. brain of cancer patients show a fluctuation in the regional metabolism. This finding might give a suggestion that functional imaging could be used as a supplementary method for psychological evaluation of patients with severe diseases.

Evaluation of resting brain conditions measured by two different methods (i.v. and oral administration) with18F-FDG-PET

Our aim was to evaluate regional differences between brain activity in two resting control conditions measured by 3D PET after administration of FDG through either the intravenous (i.v.) or the oral route. Ten healthy male volunteers engaged in the study as the i.v. group (mean age, 26 +/- 9.3 years, +/- S.D.) who received FDG intravenously and another 10 volunteers as the oral group (mean age, 27.9 +/- 11.3 years, +/- S.D.) who received FDG per os. A set of 3D-PET scans (emission and transmission scans) were performed in both groups. To explore possible functional differences between the brains of the two groups, the SPM-96 software was used for statistical analysis. The results revealed that glucose metabolism was significantly higher in the superior frontal gyrus, superior parietal lobule, lingual gyrus and left cerebellar hemisphere in the i.v. group than in the oral group. Metabolically active areas were found in the superior, middle and inferior temporal gyrus, parahippocampal gyrus, amygdaloid nucleus, pons and cerebellum in the oral group when compared with the i.v. group. These differences were presumably induced by differences between FDG kinetics and/or time-weighted behavioral effects in the two studies. This study suggests the need for extreme caution when selecting a pooled control population for designated activation studies.

[Simplified oral hygiene with subgingival pulsating jet irrigation with and without a dilute metronidazole solution as an adjunct for control of chronic periodontal disease]

This study compared the clinical effects of 0.05% metronidazole solution (MD) applied subgingivally using pulsated monojet irrigation following a single episode of scaling and root planing and simplified oral hygiene instruction, with the same system using a placebo solution (MDP). Twelve patients with 129 approximal units (pocket depth greater than or equal to 4 mm) in the MD group and 170 in the MDP group took part in the study. Within procedure comparisons revealed statistically highly significant reductions in Plaque Index, gingival oedema, Sulcus Bleeding Index, and probeable pocket depth in both groups. However between procedure comparisons indicated that the MD group showed more reduction in PI1, SBI and gingival oedema. Improvements in PPD were not significant except at day 56. The differences between groups were small clinically.