Evaluation of Follow-up Colposcopy Procedures After Abnormal Cervical Screening Result Across a Statewide Study in Mississippi.

Purpose: Cervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result. Methods: The STRIDES (Studying Risk to Improve DisparitiES) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening. Results: Of the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Based on age, individuals 30 + were more likely to follow up with a colposcopy compared to individuals < 30 years (49% and 38.7%, respectively; p < .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up colposcopy guidelines (p < .001). Conclusion: Despite high cervical cancer screening rates among Mississippians, a substantial portion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.

Improving care practices of the patient with type 2 diabetes in community health centers.

BACKGROUND: Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. LOCAL PROBLEM: Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). METHODS: Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. INTERVENTION: Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. RESULTS: Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). CONCLUSIONS: Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.

Telehealth during the pandemic: Patient perceptions and policy implications.

INTRODUCTION: Telehealth's potential to improve access to specialty health care, increase favorable patient outcomes, and save money demands attention. Unfortunately, patients often fail to embrace telehealth. The COVID-19 pandemic fueled greater telehealth usage globally. Little is known about patient perceptions of telehealth in the context of a pandemic. Therefore, we sought to understand patient perceptions of telehealth during the COVID-19 pandemic and explore relevant policy implications. DESIGN: Researchers used a cross-sectional, non-experimental design to survey 366 patients across two telehealth programs at a Mississippi academic health sciences center between November 1, 2021 and November 15, 2021. METHODS: As part of a larger, psychometric study on patient acceptance of telehealth, participants rated the item, "The COVID-19 pandemic has made me more open to using telehealth" on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Means of the different groups were analyzed using independent t-test and one-way ANOVA with Bonferroni post-hoc multiple comparisons. RESULTS: Of the total participants, 73% (n = 366) either agreed or strongly agreed that the COVID-19 pandemic had made them more open to using telehealth. Significant differences existed by age (p = 0.016), race/ethnicity (p = 0.015), and sex (p < 0.001), however, groups did not differ by age during post-hoc analysis. A significant difference in the mean responses was observed between black participants (M = 4.29) and white participants (M = 3.91; p = 0.011). In addition, female participants (M = 4.11) rated the item higher than male participants (M = 3.65). CONCLUSION: As access to telehealth increased due to the COVID-19 pandemic, patients' perceptions to telehealth seem to have shifted in the positive direction as well. Findings may be used to support expansion of telehealth and advocacy for patients in a variety of settings. CLINICAL RELEVANCE: Study findings indicate that participants of telehealth are more open to using telehealth due to the COVID-19 pandemic. Implementing telehealth should be a priority to increase access to care for those who have limited access to specialty care, and policymakers should advocate to decrease barriers to telehealth within their institutions.

Exploring Parents' Intentions to Monitor and Mediate Adolescent Social Media Use and Implications for School Nurses.

Social media may promote health and social connectedness, but its misuse and frequency of use may pose risks. Social media use during adolescence requires parental monitoring and mediation to mitigate potentially harmful effects such as depression, anxiety, and risk-taking behaviors. While parents and health care professionals convey concern surrounding exposure to inappropriate content, prolonged screen time, and cyberbullying, appropriate social media monitoring remains challenging. The purpose of this study was to explore parental monitoring and mediation of social media use in adolescents. Online recruitment yielded a nationwide sample (n = 836) of parents of adolescents. The results of the online survey indicated that parents are concerned about adolescent social media use and endorse positive attitudes toward monitoring. Yet parents perceived little control over monitoring. Findings from this study support the school nurse in promoting healthy social media use, media literacy among parents and adolescents, and the use of screening tools.

Preparing for Next Generation NCLEX ® Through Team-Based Learning: Student Perspectives.

ABSTRACT: The Next Generation NCLEX ® requires higher levels of understanding for new registered nurses to practice safely. Team-based learning (TBL) offers a rigorous but pragmatic approach to achieve that aim. TBL employs collaborative strategies for structured problem-solving, a key focus of contemporary nurse educators. In this prospective study, a faculty team at a second-degree, accelerated baccalaureate nursing program within the southeast United States evaluated student perspectives of TBL. Overall findings revealed positive student experiences ( n = 30, with three students on an alternate plan of study) in all aspects of the method.

Dispersion of daily physical activity behaviors in school-age children: A novel approach to measure patterns of physical activity.

PURPOSE: The objectives of this paper are (1) to examine patterns of physical activity (PA) and sedentary behavior; (2) to describe development of a method to quantify movement dispersion; and (3) to determine the relationship between variables of movement (i.e., volume, intensity, and dispersion), volume of sedentary behavior, and estimated cardiorespiratory capacity in school-aged children. DESIGN AND METHODS: A secondary analysis of an existing data set with raw accelerometer data identified PA patterns of movement dispersion in school-aged children. Bar graphs visually depicted each participant's daily vector magnitude counts. The research team developed a dispersion variable-movement dispersion-and formula to provide a new quantification of daily PA patterns. Total movement dispersion represents both intensity and distribution of movement, whereas pure movement dispersion refers to the distribution of movement during the wear time, independent of intensity. Kendall's tau examined the relationship between several variables: body mass index percentile, average minutes of sedentary behavior, average minutes of light PA, average minutes of moderate-vigorous PA (MVPA), derived VO2 max, total movement dispersion, and pure movement dispersion. RESULTS: Three participants' activity graphs were presented as examples: (1) active, (2) inactive, and (3) mixed. The more active participant had the highest values for pure and total movement dispersion. The inactive participant had much lower pure and total movement dispersion values compared to the active participant. The mixed participant had high average minutes of MVPA yet lower pure and total movement dispersion values. Total movement dispersion had a significant correlation with average minutes of light PA (r = .406, p = .016) and average minutes of MVPA (r = .686, p < .001). Pure movement dispersion was significantly correlated with average minutes of light PA (r = .448, p = .008) and average minutes of MVPA (r = .599, p < .001). Average minutes of sedentary behavior (SB) were not significantly correlated with total (r = .041, p = .806) or pure movement dispersion (r = .165, p = .326). PRACTICE IMPLICATIONS: Movement dispersion may provide another tool to advance knowledge of PA, potentially leading to improved health outcomes. Raw accelerometer data, such as that gathered at the elementary school in this study, offer opportunities to identify school-aged children at risk for obesity, SB, and lack of PA.

Age-specific prevalence of human papillomavirus and abnormal cytology at baseline in a diverse statewide prospective cohort of individuals undergoing cervical cancer screening in Mississippi.

BACKGROUND: Mississippi (MS) has among the highest rates of cervical cancer incidence and mortality in the United States, with disproportionately higher rates among Blacks compared to Whites. Here, we evaluate the prevalence of high-risk human papillomavirus (HPV) and abnormal cytology in a representative baseline sample from a diverse statewide cohort of individuals attending cervical screening in MS from the STRIDES Study (STudying Risk to Improve DisparitiES in cervical cancer). METHODS: We included individuals aged 21-65 years undergoing screening at the University of Mississippi Medical Center (UMMC) and the Mississippi State Department of Health (MSDH) from May to November 2018. We calculated age-specific HPV prevalence, overall and by partial HPV16/18 genotyping, and abnormal cytology by race. RESULTS: A total of 6871 individuals (mean age 35.7 years) were included. HPV prevalence was 25.6% and higher in Blacks (28.0%) compared to Whites (22.4%). HPV prevalence was significantly higher in Blacks aged 21-24 years (50.2%) and 30-34 years (30.2%) compared to Whites in the same age groups (32.1% and 20.7%; p < 0.0001, respectively). The prevalence of high-grade cytologic abnormalities, a cytologic sign of cervical precancer, peaked earlier in Blacks (ages 25-29) compared to Whites (35-39). For comparison, we also analyzed HPV prevalence data from the National Health and Nutrition Examination Survey (NHANES, 2013-2016) and observed similar racial differences in HPV prevalence among women aged 21-24 years. CONCLUSIONS: Our findings suggest that Blacks undergoing cervical cancer screening in MS have higher prevalence of other high-risk 12 HPV types at younger ages and experience an earlier peak of high-grade cytologic abnormalities compared to Whites.

STRIDES - STudying Risk to Improve DisparitiES in Cervical Cancer in Mississippi - Design and baseline results of a Statewide Cohort Study.

Cervical cancer rates in Mississippi are disproportionately high, particularly among Black individuals; yet, research in this population is lacking. We designed a statewide, racially diverse cohort of individuals undergoing cervical screening in Mississippi. Here, we report the baseline findings from this study. We included individuals aged 21 years and older undergoing cervical screening with cytology or cytology-human papillomavirus (HPV) co-testing at the Mississippi State Health Department (MSDH) and the University of Mississippi Medical Center (UMMC) (December 2017-May 2020). We collected discarded cytology specimens for future biomarker testing. Demographics and clinical results were abstracted from electronic medical records and evaluated using descriptive statistics and chi-square tests. A total of 24,796 individuals were included, with a median age of 34.8 years. The distribution of race in our cohort was 60.2% Black, 26.4% White, 7.5% other, and 5.9% missing. Approximately 15% had abnormal cytology and, among those who underwent co-testing at MSDH (n = 6,377), HPV positivity was 17.4% and did not vary significantly by race. Among HPV positives, Black individuals were significantly less likely to be HPV16/18 positive and more likely to be positive for other high-risk 12 HPV types compared to White individuals (20.5% vs. 27.9%, and 79.5% and 72.1%, respectively, p = 0.011). Our statewide cohort represents one of the largest racially diverse studies of cervical screening in the U.S. We show a high burden of abnormal cytology and HPV positivity, with significant racial differences in HPV genotype prevalence. Future studies will evaluate cervical precancer risk, HPV genotyping, and novel biomarkers in this population.

Enteral nutrition for intubated adults in the intensive care unit prior to general anesthesia: a scoping review.

OBJECTIVE: The objective of this scoping review was to examine and map fasting times for intubated adult patients in the intensive care unit prior to general anesthesia, and patient outcomes following the cessation of enteral nutrition. BACKGROUND: Malnutrition in critically ill patients in the intensive care unit has been associated with increased infectious morbidity, increased length of intensive care unit and hospital stay, increased rate of infections, increased number of ventilator days, and impaired wound healing. One potential contributor to malnutrition is prolonged fasting times prior to general anesthesia. The American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine recommend minimizing fasting times prior to surgery; however, neither gives guidelines for intubated patients in the intensive care unit. By limiting fasting times with cuffed endotracheal tubes, nutritional goals could be improved without additional complications. INCLUSION CRITERIA: This scoping review considered studies that included patients in the intensive care unit who were 18 years and older possessing a cuffed endotracheal tube, requiring enteral nutrition, and undergoing surgery requiring general anesthesia. Specifically, fasting protocols, location of enteral nutrition being delivered, and patient outcomes were mapped for studies meeting these criteria. The review also looked at available protocols for preoperative fasting times for patients with cuffed endotracheal tubes prior to surgical procedures requiring anesthesia. METHODS: The JBI methodology was followed to complete this scoping review. The objectives, inclusion criteria, and methods of analysis for this review were previously established and documented in an a priori protocol. RESULTS: Three studies, one prospective observational study, and two retrospective chart reviews, with a total of 128 participants, were included in this review. Also, eight fasting protocols regarding adult intensive care unit patients with cuffed endotracheal tubes prior to general anesthesia were identified. CONCLUSIONS: The identified studies and protocols conclude that institutions apply different fasting times depending on procedure types and feeding access for patients with cuffed endotracheal tubes. Some protocols require fasting to begin at midnight on the day of the procedure, while others allow enteral nutrition to be continued throughout the procedure. All identified protocols exclude some procedures from a reduced fast, typically airway procedures and abdominal surgeries. Each institution has specific requirements for patients that qualify for a reduced fast - such as feeding tube location, type of procedure, and positioning during the procedure - as well as specific times for enteral nutrition to be held. Following review of the studies, no aspiration events were witnessed during any operative procedure where a reduced fast was used.

Racial differences in HPV type 16 prevalence in women with ASCUS of the uterine cervix.

BACKGROUND: Understanding racial influences on human papillomavirus (HPV) distribution in women with atypical squamous cells of undetermined significance (ASCUS) cytology via partial genotyping in a statewide population can inform HPV-based prevention efforts. METHODS: Women aged 21 to 65 years with any cytology result and partial HPV genotyping for ASCUS triage between January 1, 2014, and December 31, 2017, were included. All women attended a Mississippi State Department of Health clinic. Age, race, cytopathologic, and HPV data were extracted from the electronic health record and analyzed. Cytologic specimens were processed with ThinPrep and HPV testing with the Cobas 4800 assay. HPV genotypes were evaluated in hierarchical categories. Chi-square tests and multinomial logistic regression models evaluated associations between race and type prevalence. RESULTS: There were 43,106 women who underwent cervical cancer screening with cytology and ASCUS triage. Of these, 34,363 (80.2%) had normal cytology, 4672 (10.9%) had ASCUS, 2683 (6.3%) had a low-grade squamous intraepithelial lesion, and 633 (1.5%) had a high-grade squamous intraepithelial lesion. Blacks represented 69.3% of the sample and had a higher proportion of HPV-positive ASCUS (6.5%) in comparison with whites (5.6%). Blacks had significantly decreased odds of HPV-16 (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.6-0.9; P = .002) and significantly increased odds for 12 other types (OR, 1.37; 95% CI, 1.2-1.5; P < .0001) in comparison with whites. CONCLUSIONS: In a diverse population, significant differences in HPV genotypes are shown by race. Importantly, blacks with ASCUS are less likely to be positive for HPV-16 in comparison with whites. Ongoing work is evaluating the individual genotype prevalence and genotype-specific risk of precancer by race.

Adults' and children's perceptions of barriers and facilitators of school-aged children's physical activity in an inner-city urban area.

In the United States, obesity rates among children remain a pressing public health concern Compounding that, disparities exist with higher childhood obesity among minority and lower socioeconomic neighborhoods. Physical activity is associated with more favorable weight status in children and adolescents. PURPOSE: This study aimed to identify and explore factors that influence physical activity in children in a low-income neighborhood. DESIGN AND METHODS: An exploratory descriptive qualitative design was employed using Photovoice and focus group interviews to identify barriers and facilitators of physical activity. RESULTS: Eight adults and five children enrolled in the study. Photovoice was used to prompt discussions during the focus groups. Analysis of verbatim transcripts included constructed coding with categorization into themes. Four themes of (a) knowledge, (b) play, (c) opportunities and a changing environment, and (d) resources were identified. Among children, three themes from the children's focus group were identified as (a) knowledge, (b) play, and (c) environment. This study found both resource and knowledge challenges, as well as a strong commitment to providing physical activity opportunities. PRACTICE IMPLICATIONS: Continued efforts are needed to develop and implement physical activity interventions to reduce obesity and improve health among children in impoverished, urban areas.