A design thinking approach to primary ovarian insufficiency.

Most clinicians are not prepared to provide integrated personal care to address all the clinical needs of women with primary ovarian insufficiency. Design thinking is an engineering methodology used to develop and evaluate novel concepts for systems operation. Here we articulate the need for a seamlessly integrated mobile health system to support genomic research as well as patient care. We also review the pathophysiology and management of primary ovarian insufficiency. Molecular understanding regarding the pathogenesis is essential to developing strategies for prevention, earlier diagnosis, and appropriate management of the disorder. The syndrome is a chronic disorder characterized by oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. There may be significant morbidity due to: 1) depression and anxiety related to the loss of reproductive hormones and infertility; 2) associated autoimmune adrenal insufficiency or hypothyroidism; and 3) reduced bone mineral density and increased risk of cardiovascular disease related to estrogen deficiency. Approximately 5% to 10% of women with primary ovarian insufficiency conceive and have a child. Women who develop primary ovarian insufficiency related to a premutation in FMR1 are at risk of having a child with fragile X syndrome, the most common cause of inherited intellectual disability. In most cases of spontaneous primary ovarian insufficiency no environmental exposure or genetic mechanism can be identified. As a rare disease, the diagnosis of primary ovarian insufficiency presents special challenges. Connecting patients and community health providers in real time with investigators who have the requisite knowledge and expertise would help solve this dilemma.

Physician counseling on colorectal cancer screening and receipt of screening among Latino patients.

BACKGROUND: Latinos have lower rates of colorectal cancer (CRC) screening and later stage diagnosis than Whites, which may be partially explained by physician communication factors. OBJECTIVE: We assessed associations between patient-reported physician counseling regarding CRC screening and receipt of CRC screening among Latino primary care patients. DESIGN: This was a cross-sectional telephone survey. PARTICIPANTS: The participants of this study were Latino primary care patients 50 years of age or older, with one or more visits during the preceding year. MAIN MEASURES: We developed patient-reported measures to assess whether physicians provided explanations of CRC risks and tests, elicited patients' barriers to CRC screening, were responsive to patients' concerns about screening, and encouraged patients to be screened. Outcomes were patient reports of receipt of endoscopy (sigmoidoscopy or colonoscopy) and fecal occult blood test (FOBT) within recommended guidelines. KEY RESULTS: Of 817 eligible patients contacted, 505 (62 %) completed the survey; mean age was 61 years (SD 8.4), 69 % were women, and 53 % had less than high school education. Forty-six percent reported obtaining endoscopy (with or without FOBT), 13 % reported FOBT only, and 41 % reported no CRC screening. In bivariate analyses, physician explanations, elicitation of barriers, responsiveness to concerns, and greater encouragement for screening were associated with receipt of endoscopy (p < 0.001), and explanations (p < 0.05) and encouragement (p < 0.001) were associated with FOBT. Adjusting for covariates, physician explanations (OR = 1.27; 95 % CI 1.03, 1.58) and greater physician encouragement (OR = 6.74; 95 % CI 3.57, 12.72) were associated with endoscopy; patients reporting quite a bit/a lot of physician encouragement had six times higher odds of obtaining the FOBT as those reporting none/a little encouragement (OR = 6.54; 95 % CI 2.76, 15.48). CONCLUSIONS: Among primarily lower-socioeconomic status Latino patients, the degree to which patients perceived that physicians encouraged CRC screening was more strongly associated with screening than with providing risk information, eliciting barriers, and responding to their concerns about screening.

The patient-reported Clinicians' Cultural Sensitivity Survey: a field test among older Latino primary care patients.

BACKGROUND: Patient-reported measures of clinicians' cultural sensitivity are important to assess comprehensively quality of care among ethnically diverse patients and may help address persistent health inequities. OBJECTIVE: Create a patient-reported, multidimensional survey of clinicians' cultural sensitivity to cultural factors affecting quality of care. DESIGN: Using a comprehensive conceptual framework, items were written and field-tested in a cross-sectional telephone survey. Multitrait scaling and factor analyses were used to develop measures. SETTING AND PARTICIPANTS: Latino patients age ≥50 from primary care practices in California. MAIN VARIABLES STUDIED: Thirty-five items hypothesized to assess clinicians' sensitivity. MAIN OUTCOMES MEASURES: Validity and reliability of cultural sensitivity measures. RESULTS: Twenty-nine of 35 items measuring 14 constructs were retained. Eleven measures assessed sensitivity issues relevant to all participants: complementary and alternative medicine, mind-body connections, causal attributions, preventive care, family involvement, modesty, prescription medications, spirituality, physician discrimination due to education, physician discrimination due to race/ethnicity and staff discrimination due to race/ethnicity. Three measures were group specific: two to limited English proficient patients (sensitivity to language needs and discrimination due to language) and one to immigrants (sensitivity to immigrant status). Twelve multi-item scales demonstrated adequate reliability (alpha ≥0.68 except for Spanish discrimination due to education) and evidence of construct validity (item-scale correlations for all scales >0.40 except for sensitivity to immigrant status). Two single-item measures demonstrated sufficient construct validity to retain for further development. DISCUSSION AND CONCLUSIONS: The Clinicians' Cultural Sensitivity Survey can be used to assess the quality of care of older Latino patients.

Oral 5-aminosalicylic acid therapy for mild-to-moderate ulcerative colitis.

PURPOSE: 5-aminosalicylic acid (5-ASA) is the recommended first-line treatment for patients with ulcerative colitis (UC). These patients frequently fail to receive the full benefit from this treatment, often as a result of nonadherence to complex dosing regimens. The purpose of this review is to update nurse practitioners (NPs) on the available 5-ASA formulations for patients with UC and to explore the role of NPs in the effective use of these drugs in disease management. DATA SOURCES: Pubmed and recent conference abstracts were searched for studies that examined either 5-ASA therapy in UC or the role of NPs in their treatment. CONCLUSIONS: Patients frequently fail to adhere to their 5-ASA treatment regimens, perhaps owing to a lack of understanding about their disease, or a lack of awareness of their medical management options. The unique relationship between patients and NPs allow barriers to treatment success to be identified and overcome. IMPLICATIONS FOR PRACTICE: For patients with UC, NPs are often a primary point of contact, and are therefore ideally placed to take steps to positively influence and change patient behavior.