Community Engagement Practices at Research Centers in U.S. Minority Institutions: Priority Populations and Innovative Approaches to Advancing Health Disparities Research.

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.

DESCRIPTION AND PHYLOGENETIC AFFINITIES OF A NEW SPECIES OF NEOPSILOTREMA (DIGENEA: PSILOSTOMIDAE) FROM LESSER SCAUP, AYTHYA AFFINIS (ANSERIFORMES: ANATIDAE).

Neopsilotrema is a small genus of psilostomid digeneans parasitic in the intestine of birds in the Palearctic and Nearctic. At present, the genus includes 4 species: Neopsilotrema lisitsynae from the Palearctic and Neopsilotrema affine, Neopsilotrema lakotae, and Neopsilotrema marilae from the Nearctic. Herein, we describe a new species, Neopsilotrema itascae n. sp., from lesser scaup Aythya affinis collected in Minnesota. The species can be distinguished from congeners on the basis of the ventral sucker:oral sucker width ratio, body width:length ratio, and cirrus sac size, along with other characters. We generated new 28S ribosomal deoxyribonucleic acid (DNA) and NADH dehydrogenase (ND1) mitochondrial DNA sequence data of a variety of psilostomids from the Palearctic and Nearctic along with sequences of the ribosomal internal transcribed spacer (ITS) region (ITS1 + 5.8S + ITS2) from 3 Neopsilotrema species. The molecular phylogenetic affinities of a variety of psilostomid taxa were studied using 28S sequence data. The 28S sequences of psilostomids demonstrated 1-7.9% intergeneric divergence, whereas the sequences of ND1 had 17.7-34.1% intergeneric divergence. The interspecific divergence among members of Neopsilotrema was somewhat lower (0.2-0.5% in 28S; 0.3-0.4% in ITS; 12-15.7% in ND1). Our comparison of DNA sequences along with morphologic study suggests Holarctic distribution of N. lisitsynae.

Perception Versus Reality: The Use of Teach Back by Medical Residents.

BACKGROUND: Health care providers (HCPs) may ask patients if they understand their diagnosis or instructions during clinic visits; patients often simply say yes. However, many patients leave with little idea of their medication and discharge instructions. Teach Back (TB) is a patient-centered health-literate technique that allows HCPs to confirm patient understanding during clinic visits. OBJECTIVE: The purpose of this pilot study was to determine a relationship between perception and actual use of TB by medical residents in primary care outpatient clinics (providers, N = 16; clinic visits, N = 80) and, if the observed rate of TB was discordant with perception, did a TB skills training intervention have any impact on use of TB (clinic visit, N = 78). We were also interested in language used during TB and if use of TB was related to patient demographics or health literacy level. METHODS: Medical residents' perception was measured using the "Always Use Teach-Back Confidence and Conviction Scale" (N = 16). Clinic visits were audiotaped and scored for use of TB (pre-intervention, N = 80; post-intervention, N =78). The intervention was a 1-hour TB skills training course. Content analysis was performed to understand the use of TB language. KEY RESULTS: Despite the high level of confidence/conviction about TB (r[16] = .669, p <. 05) TB was only used twice out of 80 visits during pre-intervention clinic visits. During post-intervention, use of TB increased to 41 times by 10 residents (c2[1, N = 16] = 6.533, p <. 05). TB language after the intervention was more collaborative; there was a relationship between gender and use of TB. CONCLUSION: Results from our pilot study identified three important observations that may be critical to improving health-literate physician communication: residents believe they are using TB in the clinic for many patients; use of TB was discordantly low at 2.5%; and a single 1-hour skills training intervention dramatically increased TB use to 53%. Residents used patient-centered TB language after the training intervention. [HLRP: Health Literacy Research and Practice. 2019;3(2):e117-e126.]. PLAIN LANGUAGE SUMMARY: Medical residents believe they are using Teach Back to confirm patient understanding in the clinic 60% of the time when they actually used Teach Back only 2.5% of the time. After an educational intervention, they used Teach Back 53% of the time; Teach-Back language was collaborative and patient-centered, and all but two patients confirmed their medication and discharge plan.

Malignancy rate of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid nodules undergoing FNA in a suburban endocrinology practice: A retrospective cohort analysis.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was created to establish a standard terminology regarding thyroid nodules that can be shared between endocrinologists, pathologists, radiologists, and surgeons. Since its inception and use in 2009, multiple large hospitals and academic institutions have performed retrospective studies to compare their classification rates, specifically those of atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS), with the recommended rates created by the National Cancer Institute. The current study compared AUS/FLUS rates at a private suburban endocrine practice with those of previous publications from large institutions and the rates established by the National Cancer Institute. METHODS: Charts from 893 patients with fine-needle aspiration (FNA) performed in 2015 were reviewed. Data specific to thyroid aspirates classified as AUS/FLUS were organized into whether patients underwent surgery, underwent subsequent repeat FNA, or required continued observation. These results then were calculated to reveal the rate of malignancy in the AUS/FLUS category with surgical pathology in the study institution. RESULTS: A total of 893 patients underwent FNA, with 43 patients (4.82%) shown to have AUS/FLUS. A total of 21 patients proceeded to undergo thyroidectomy or lobectomy, with 7 patients (33.3%) found to have papillary or follicular thyroid carcinoma. CONCLUSIONS: The rate of use of the AUS/FLUS category for thyroid nodules examined at the study institution was found to be within the recommended range set forth by TBSRTC. However, the malignancy rates on histopathology in the study institution were found to be higher than the new proposed malignancy rates from TBSRTC published in 2017. This finding is comparable to those of multiple other community and academic institutions performed prior to and after institution of the new guidelines.

Managing and sustaining an ageing nursing workforce: identifying opportunities and best practices within collective agreements in Canada.

AIM: This paper seeks to identify gaps within nursing collective agreements for opportunities to implement practices to sustain the nursing workforce. BACKGROUND: Since the majority of nurses in Canada are unionised, some of the strategies recommended in the literature to cope with nursing shortage may not apply to unionised nurses, making collective agreements a potential source for designing practices that can mitigate the impact of ageing nurses. METHOD: Nine major collective agreements for registered nurses in each province governing the nursing employment relationship were analysed to see if different practices were already addressed in the collective agreements. RESULTS: Five such practices were identified, including: providing more mentorship opportunities; encouraging nurses who are eligible to retire to remain in the nursing workforce; attracting internationally trained nurses; implementing operational changes that include process improvements or new technologies; and empowering nurses through flexibility in work schedules. CONCLUSION: If collective agreements are silent in any of the strategies identified in the literature, health-care organisations can adopt these practices without violating the collective agreements. IMPLICATIONS FOR NURSING MANAGEMENT: Non-unionised health-care organisations can also benefit from learning about these policies and practices to assist in managing and sustaining an ageing nursing workforce.

Epilepsy: current evidence-based paradigms for diagnosis and treatment.

Although epilepsy has a prevalence of 5 to 7 per 1000 persons in the United States, it continues to be a poorly understood condition. Given the number of patients in the United States with epilepsy, it is very likely that primary care physicians will continue to provide care for these patients. This article refreshes some of the knowledge around the diagnosis of epilepsy, discusses special populations that may require additional management considerations, highlights the association of epilepsy with multiple comorbidities, and discusses antiepileptic drug (AED) treatment, including issues surrounding adherence and safety of AED therapy.

As the child with chronic disease grows up: transitioning adolescents with special health care needs to adult-centered health care.

The purpose of this article is to inform readers of the Delaware Medical Journal about the concept of transitional care for adolescents and young adults with chronic health care needs. This is a topic that has recently received national attention and was the subject of a supplement to Pediatrics in December 2002. The concept of transitional care bears special importance in Delaware as every year hundreds of children with chronic disease turn 18 and leave their pediatric providers. It is uncertain that these children resume their care with an adult health care provider, and there is almost always some lag in time as patients attempt to find an adult provider who is knowledgeable about their condition and willing to assume them as a patient. An even greater uncertainty is whether or not adult providers are prepared to take care of this new generation of adults with cyanotic congenital heart disease, spina bifida, cerebral palsy, and other conditions. This article explores some of these ideas and discusses what is available in the transition literature and where to go from here.