Human Papillomavirus Vaccine Uptake in Texas Pediatric Care Settings: A Statewide Survey of Healthcare Professionals.

The purpose of this study was to identify barriers to and facilitators of human papillomavirus (HPV) vaccination in children aged 9-17 years across Texas. A literature review informed the development of a web-based survey designed for people whose work involves HPV vaccination in settings serving pediatric patients. The survey was used to examine current HPV vaccine recommendation practices among healthcare providers, barriers to HPV vaccination, reasons for parent/caregiver vaccine refusal, staff and family education practices, utilization of reminder and recall systems and status of vaccine administration (payment, ordering and stocking). 1132 responses were received representing healthcare providers, administrative and managerial staff. Respondents identified perceived barriers to HPV vaccination as parental beliefs about lack of necessity of vaccination prior to sexual debut, parental concerns regarding safety and/or side effects, parental perceptions that their child is at low risk for HPV-related disease, and parental lack of knowledge that the vaccine is a series of three shots. Of responding healthcare providers, 94 % (n = 582) reported they recommend the vaccine for 9-12 year olds; however, same-day acceptance of the vaccine is low with only 5 % (n = 31) of providers reporting the HPV vaccine is "always" accepted the same day the recommendation is made. Healthcare providers and multidisciplinary care teams in pediatric care settings must work to identify gaps between recommendation and uptake to maximize clinical opportunities. Training in methods to communicate an effective HPV recommendation and patient education tailored to address identified barriers may be helpful to reduce missed opportunities and increase on-time HPV vaccinations.

Barriers of Pediatric Residents to Speaking Up About Patient Safety.

BACKGROUND AND OBJECTIVES: Medical errors are a leading cause of death in the United States. Effective communication and speaking up are crucial factors in patient safety initiatives. We examined the reasons reported by pediatric residents for not speaking up about safety events when they are observed in practice. We also tested a priori hypotheses of associations between categories of barriers to speaking up with perceptions of safety and teamwork culture. METHODS: Pediatric residents completed an anonymous electronic survey measuring safety and teamwork culture along with an open-ended question asking them to list the top 3 barriers to speaking up about patient safety concerns. Researchers independently coded the open-ended responses to identify themes, which were then categorized into a published framework. Data were collected in 2013 (response rate = 46%) and 2014 (response rate = 62%). RESULTS: The most common reported barriers to speaking up were as follows: perceived personal safety of speaking up (consequences, intimidation, and hierarchy concerns), individual barriers (communication skills and confidence), perceived efficacy of speaking up (feeling powerless), and contextual factors (high workload). Residents who reported barriers relating to efficacy of speaking up reported lower safety culture scores in 2013 and 2014. Residents who reported barriers related to safety reported lower teamwork culture scores in 2013. CONCLUSIONS: Pediatric residents reported individual barriers, personal safety concerns, lack of efficacy, and contextual factors as reasons to not speak up about patient safety. Concerns about the safety of speaking up and the efficacy of speaking up were correlated with teamwork and safety culture, respectively.

Acceptability of self-sample human papillomavirus testing among medically underserved women visiting the emergency department.

OBJECTIVE: Self-sample human papillomavirus (HPV) testing in public emergency departments (EDs) may be a viable strategy to opportunistically screen women who otherwise do not attend for regular Papanicolaou test-based cervical cancer screening. We describe the acceptability of self-sample HPV testing among women presenting to two high-volume, urban EDs that primarily care for the medically underserved. METHODS: In 2014, a total of 210 women 21 years of age and older were recruited from two public ED waiting areas following a two-stage cluster sampling design. Questionnaire items inquired about demographics, healthcare access and utilization, history of cervical cancer screening, and acceptability of self-sample HPV testing. Descriptive analyses were performed. RESULTS: Overall, 34.8% of participants were considered screening non-attendees based on their adherence to the current guidelines for Pap testing every three years. Acceptability of self-sample HPV testing was high, with over 85% of participants reporting that they would be willing to use the test if available. A smaller proportion (58%) was deemed likely to accept self-sample HPV testing in a public ED restroom setting. Primary concerns expressed by women were that the sampling may not be done correctly (64%) and that they may not know how to perform the sampling (39%). CONCLUSIONS: Opportunistic self-sample HPV testing is acceptable to women seeking care at a high-volume, urban emergency care center. The use of this intervention potentially offers a unique strategy to improve cervical cancer screening among high-risk women who otherwise do not attend for regular screening.

Designed ankyrin repeat proteins as scaffolds for multivalent recognition.

Ankyrin repeat (AR) proteins are composed of tandem repeats of a basic structural motif of ca. 33 amino acid residues that form a ß-turn followed by two antiparallel α-helices. Multiple repeats stack together in a modular fashion to form a scaffold that is ideally suited for the presentation of multiple functional groups and/or recognition elements. Here we describe a biosynthetic strategy that takes advantage of the modular nature of these proteins to generate multivalent ligands that are both chemically homogeneous and structurally well-defined. Glycosylated AR proteins cluster the tetrameric lectin concanavalin A (Con A) at a rate that is comparable to the rate of Con A aggregation mediated by globular protein conjugates and variable density linear polymers. Thus, AR proteins define a new class of multivalent ligand scaffolds that have significant potential application in the study and control of a variety of multivalent interactions.