Locally-tailored vs. centrally-administered strategies for implementation of primary human papillomavirus (HPV) screening in an integrated healthcare system: a qualitative research study.

Introduction: Primary human papillomavirus HPV testing is recommended for cervical cancer screening for women aged 30-65 years without a history of abnormal results. However, there is little clear guidance regarding effective strategies for implementing primary HPV screening. As part of an ongoing randomized trial comparing implementation strategies for primary HPV testing (a centrally administered + usual care strategy vs.

Automatic Abstraction of Computed Tomography Imaging Indication Using Natural Language Processing for Evaluation of Surveillance Patterns in Long-Term Lung Cancer Survivors.

Purpose: Despite its routine use to monitor patients with lung cancer (LC), real-world evaluations of the impact of computed tomography (CT) surveillance on overall survival (OS) have been inconsistent. A major confounder is the absence of imaging indications because patients undergo CT scans for purposes beyond surveillance, like symptom evaluations (eg, cough) linked to poor survival. We propose a novel natural language processing model to predict CT imaging indications (surveillance others).

Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System.

Background: While research on health-related social needs (HRSNs) has expanded, important gaps remain in understanding associations between HRSN and healthcare cost, especially across general populations of patients with broad-ranging medical and social needs.

Objective: To examine the association between HRSN and healthcare cost in a large, diverse, insured population.

Design: In this cross-sectional study, we evaluated cost differences between patients with different HRSN levels using survey-weighted multivariable generalized linear models.

Components Necessary for High-Quality Lung Cancer Screening: A 10-Year Update.

Lung cancer screening (LCS) has evolved over the past decade with research advances and clinical experience helping to define target populations for screening, to improve lung nodule detection and management, and to identify structural components of programs that improve the quality of screening delivery. The 2015 American College of Chest Physicians and American Thoracic Society Policy Statement, "Components Necessary for High-Quality Lung Cancer Screening," identified 9 essential components for high-quality LCS. Ten years later, optimizing the balance between the benefits and harms of LCS and ensuring equitable screening among all population groups remain fundamental objectives.

Baseline Characteristics of Participants and Pulmonary Nodules in the Watch the Spot Trial: A Pragmatic Trial of Less versus More Intensive Strategies for Active Surveillance of Patients With Small Pulmonary Nodules.

Background: Optimal surveillance strategies for patients with small pulmonary nodules are uncertain. The Watch the Spot Trial, a large, cluster-randomized, pragmatic clinical trial, compared less- versus more-intensive strategies for surveillance of patients with incidental or screening-detected nodules ≤15 mm.

Methods: We describe between-site variation in methods to identify and enroll patients with small nodules; we used standard measures to describe baseline characteristics of participants and nodules.

A pragmatic randomized trial to compare strategies for implementing primary HPV testing for routine cervical cancer screening in a large healthcare system.

Background: Recent updates to national guidelines recommend primary human papillomavirus (HPV) screening for routine cervical cancer screening alongside previously recommended screening options. However, limited guidance exists for implementation approaches that best facilitate cancer screening practice substitution and achieve optimal stakeholder-centered outcomes. We compared "centrally-administered + locally-tailored" (here after referred to as locally-tailored) vs.

Evaluating the trend of time to colposcopy follow-up among women with a positive primary human papillomavirus screening result at Kaiser Permanente Southern California.

Background: Timeliness of colposcopy follow-up after primary human papillomavirus screening has not been well examined.

Objective: We evaluated time to colposcopy follow-up among women with an abnormal primary human papillomavirus screening result overall and by human papillomavirus genotype, triage cytology results, race/ethnicity, and neighborhood deprivation index.

Study Design: Women aged 30 to 65 years who received primary human papillomavirus screening at Kaiser Permanente Southern California from July 15, 2020, to December 31, 2021 and had screening results that required colposcopy follow-up were identified.

Burden of Comorbid Conditions Among Individuals Screened for Lung Cancer.

Importance: Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality in trials that included relatively younger, healthier, and predominantly White populations. The comorbidity profiles among patients undergoing lung cancer screening in practice settings are poorly understood.

Objective: To evaluate the comorbidity profiles of patients in the Personalized Lung Cancer Screening (PLuS) cohort as a clinical setting vs the National Lung Screening Trial (NLST) participants in a clinical trial setting.

Neighborhood-Level Socioeconomic Disadvantage and Adherence to Guidelines for the Evaluation of Patients With Incidentally Detected Pulmonary Nodules.

Background: The management of incidental pulmonary nodules is guided by recommendations set forth by the Fleischner Society. Although most pulmonary nodules are benign, timely and evidence-based follow-up can reduce morbidity and mortality. There are known socioeconomic disparities for engagement with recommended cancer screenings; however, it is unclear whether disparities exist for follow-up of incidentally detected pulmonary lesions.

The American Cancer Society National Lung Cancer Roundtable strategic plan: Optimizing strategies for lung nodule evaluation and management.

Lung nodules are frequently detected on low-dose computed tomography scans performed for lung cancer screening and incidentally detected on imaging performed for other reasons. There is wide variability in how lung nodules are managed by general practitioners and subspecialists, with high rates of guideline-discordant care. This may be due in part to the level of evidence underlying current practice guideline recommendations (primarily based on findings from uncontrolled studies of diagnostic accuracy).

Primary Human Papillomavirus Screening: Women's Perceptions of New Cervical Cancer Screening Recommendations.

Current clinical guidelines recommended primary human papillomavirus (HPV) screening for cervical cancer testing. Previous studies reported patient-level barriers (e.g.

2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Introduction: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Methods: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice.

Results: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions.

Thrombocytopenia is Associated with Higher Fontan Pressure and Increased Morbidity in Patients with Fontan Circulation.

After the Fontan procedure, patients require lifelong follow-up due to significant late morbidity and mortality. Thrombocytopenia is seen frequently post-Fontan, likely due to secondary hypersplenism from elevated Fontan pressure. We investigated platelet counts in patients with a Fontan circulation and assessed associations with catheterization data and clinical outcomes.

Rhythm in sport: Adapted rhythmic training to optimize timing and enhance performance in athletes.

Precise timing, the ability to control exactly when something should be done, integrates physical characteristics like strength, power, and technique into highly skilled sporting actions. Despite timing's indispensability to peak athletic performance, there exist few timing-specific training methods. The authors present a new training approach which adapts exercises from drummers, the elite timing experts, to athletes.

Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening.

Background: Physician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population.

Methods: We analyzed data from the Health Information National Trends Survey from 2014 to 2020.

Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study.

Objectives: Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial.

Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules: Results From the Watch the Spot Trial.

Background: Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules.

Research Question: How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes?

Study Design And Methods: This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vs less intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8 weeks following nodule identification.

The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure.

Purpose: Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality.

Methods: Using data from Kaiser Permanente Northern/Southern California's 36 medical centers, we identified patients with COVID-19-related acute respiratory failure who reached ≥80% FiO2 on high flow nasal cannula or non-invasive ventilation.