Evaluating a Low-Cost Disaster Preparedness Simulation for Prelicensure Nursing Students.

OBJECTIVE: This innovation in simulation evaluated the effectiveness of a time sensible, low-cost simulation on prelicensure nursing students' knowledge and confidence in responding to public health emergencies. METHOD: One hundred eighty-two nursing students, in groups of 5, participated in a 75-min emergency preparedness disaster simulation. A mixed methods design was used to evaluate students' knowledge and confidence in disaster preparedness, and satisfaction with the simulation. RESULTS: Students reported an increase in knowledge and confidence following the disaster simulation and satisfaction with the experience. CONCLUSIONS: Prelicensure nursing programs can replicate this low cost, time sensible disaster simulation to effectively educate students in emergency preparedness.

The Vaginal Microbiome in U.S. Black Women: A Systematic Review.

Background: Advancements in next-generation sequencing have allowed for a more complete understanding of the vaginal microbiome and its role in health and disease. The role of race/ethnicity in the composition of the vaginal microbiome and what is deemed normal/healthy microbiome is conflicting. Thus, the purpose of this review is to synthesize research that investigated the vaginal microbiome in Black women in the United States by using advanced 16S analysis. Methods: Searches of Pubmed, Google Scholar, and relevant journals for publications between January 2008 and July 2018 were conducted. Eligibility criteria were that the study: (1) used a molecular technique for sequencing of the vaginal microbiome, (2) reported the microbiome by race/ethnicity that included Black women, and (3) was conducted in the United States. Results: Our review selected 18 manuscripts that met the inclusion criteria for full review. Three themes emerged: the vaginal microbiome in healthy women versus women with bacterial vaginosis (BV); vaginal microbiome considerations in HIV; and vaginal microbiome considerations in preterm labor/birth. Overall, our review found that a majority of Black women (including HIV-positive women) have a Lactobacillus dominant group. Specifically, Lactobacillus iners was the most frequently reported Lactobacillus species. Non-Lactobacillus dominant groups were also reported to be found in healthy asymptomatic Black women. The vaginal microbiome's influence on preterm labor and/or birth among Black women was inconclusive and warrants further investigation. Conclusions: The role that the microbiome plays in health and disease among Black women warrants further research to better elucidate the definition of a healthy versus pathogenic microbiome. The wide variability in methods for BV diagnostics and defining preterm labor/birth are significant limitations that should be considered when conducting comparative studies.

Knowledge of Anal Cancer, Anal Cancer Screening, and HPV in HIV-Positive and High-Risk HIV-Negative Women.

The incidence of anal cancer in HIV-positive women is a growing public health concern where they have a 7.8-fold increased risk for anal cancer than women in the general population. We examined knowledge of anal cancer, anal cancer screening, and HPV in HIV-positive women and high-risk HIV-negative women. Women were recruited from the Women's Interagency HIV Study and completed an adapted Knowledge of Anal Cancer and HPV Scale. Correlations among anal cancer knowledge and sociodemographic and risk factors were assessed using Pearson's or Spearman's rho r test. Student's t test or chi-square tests identified significant differences between groups by HIV status or risk factors. Among 155 women, 72% (n = 113) correctly identified the purpose of an anal Pap test. However, only 42% (n = 65) identified HIV as a risk factor for anal cancer. HIV-positive women were more knowledgeable about anal cancer than high risk HIV-negative women (t = 2.104, p = .037). Women with a history of an abnormal cervical Pap test (t = 2.137, p = .034), younger age (t = 3.716, p = .000), reported history of anal sex (t = 3.284, p = .001), some college education or higher (t = -2.005, p = .047), and non-smokers (t = 2.425, p = .016) were significantly more knowledgeable about HPV. Although most women were knowledgeable about anal cancer, many women could not identify important risk factors for anal cancer, such as HIV infection. Patient educational interventions tailored to HIV-positive women are warranted to improve knowledge and awareness of risk for anal cancer.

Sociodemographic Predictors of Anal Cancer Screening and Follow-up in Human Immunodeficiency Virus-Infected Individuals.

BACKGROUND: Anal cancer in the United States is generally rare; however, human immunodeficiency virus (HIV)-infected individuals are 28 times more likely to be given a diagnosis of anal cancer than the general population. OBJECTIVE: The aim of this study was to examine the rates and sociodemographic predictors of anal cancer screening and follow-up anoscopy in a sample of HIV-infected individuals. METHODS: Data for this study (n = 200) were derived from a retrospective chart review of randomly selected HIV-infected individuals. Data analyses included Pearson's correlation coefficient statistic to examine bivariate associations and logistic regression modeling for prediction of anal Papanicolaou test screening and follow-up anoscopy. RESULTS: Screening rates and follow-up after an abnormal anal Pap test were low. Women were less likely to be screened for anal cancer (odds ratio [OR], 0.244; P = .007). Men who have sex with men were almost 4 times more likely to be screened for anal cancer (OR, 3.7; P = .02). Men who have sex with men were 6 times more likely to have follow-up after an abnormal anal Pap test compared with heterosexual men or women of any sexual orientation (OR, 6.88; P = .002). CONCLUSIONS: High-risk groups for anal cancer should be targeted for preventative measures as part of a cancer prevention plan to decrease the personal and clinical burden associated with anal cancer. IMPLICATIONS FOR PRACTICE: Cancer prevention is a multistep process that requires screening and follow-up efforts, where healthcare providers play a vital role in these efforts. Findings from this study can inform strategies to improve screening and follow-up rates in HIV-infected individuals.

Making sense of loss through spirituality: Perspectives of African American family members who have experienced the death of a close family member to cancer.

OBJECTIVE: Among African Americans, spirituality is meaning or purpose in life and a faith in God who is in control of health and there to provide support and guidance in illness situations. Using qualitative methods, we explored the use of spirituality to make sense of the end-of-life and bereavement experiences among family members of a deceased cancer patient. METHOD: Data in this report come from 19 African Americans who experienced the loss of a family member to cancer. A qualitative descriptive design was used with criterion sampling, open-ended semistructured interviews, and qualitative content analysis. RESULTS: Participants made sense of the death of their loved one using the following five themes: Ready for life after death; I was there; I live to honor their memory; God's wisdom is infinite; and God prepares you and brings you through. These five themes are grounded in conceptualizations of spirituality as connectedness to God, self, and others.Significance of resultsOur findings support the results that even during bereavement, spirituality is important in the lives of African Americans. African American family members might struggle with issues related to life after death, their ability to be physically present during end-of-life care, and disentangling beliefs around God's control over the beginning and ending of life. The findings in this report can be used to inform healthcare providers to better support and address the needs for support of African American family members during end-of-life and bereavement experiences.

Cultural Competency Training to Increase Minority Enrollment into Radiation Therapy Clinical Trials-an NRG Oncology RTOG Study.

Despite initiatives to increase the enrollment of racial and ethnic minorities into cancer clinical trials in the National Cancer Institute National Cancer Clinical Trials Network (NCCTN), participation by Latino and African American populations remain low. The primary aims of this pilot study are (1) to develop a Cultural Competency and Recruitment Training Program (CCRTP) for physician investigators and clinical research associates (CRAs), (2) to determine if the CCRTP increases cultural competency scores among physician investigators and CRAs, and (3) to determine the impact of the CCRTP on minority patient recruitment into NRG Oncology Radiation Therapy Oncology Group (RTOG) clinical trials. Sixty-seven CRAs and physicians participated in an in-person or online 4-h CRRTP training. Five knowledge and attitude items showed significant improvements from pre- to post-training. A comparison between enrolling sites that did and did not participate in the CCRTP demonstrated a pre to 1-year post-incremental increase in minority accrual to clinical trials of 1.2 % among participating sites. While not statistically significant, this increase translated into an additional 300 minority patients accrued to NCCTN clinical trials in the year following the training from those sites who participated in the training.

Adherence to intravenous chemotherapy in African American and white women with early-stage breast cancer.

BACKGROUND: Adherence to intravenous chemotherapy offers survival and recurrence-free benefits for women diagnosed with early-stage breast cancer. However, previous studies have found that African American women are more likely to discontinue intravenous chemotherapy early, thus shortening their survival. Yet the existence of racial differences and predictors of adherence to chemotherapy treatment between African American and white women are largely understudied or inconsistent. OBJECTIVE: The purposes of this study were to examine factors that influence the decision to adhere to chemotherapy in African American and white women diagnosed with early-stage breast cancer and to test for racial differences that may exist in this sample. INTERVENTIONS/METHODS: The study recruited a convenience sample of 99 African American and white women. Factors examined were sociodemographic variables (age, race, access to healthcare), social support, religious coping, chemotherapy adverse effects, depression, breast cancer knowledge, health beliefs, cancer fatalism, and days from diagnosis to treatment. Data analyses included logistic regression modeling. RESULTS: No racial differences in adherence to intravenous chemotherapy between African American and white women were found (χ = 2.627, P = .10). Days to treatment (odds ratio [OR], 0.982, P = .058), health insurance (OR, 0.121; P = .016), change in depression (OR, 0.935; P = .118), and symptom severity (OR, 0.950; P = .038) were independently associated with nonadherence to chemotherapy. CONCLUSIONS: This study provides emerging evidence of factors that may be potentially modified with interventions at the clinical setting. IMPLICATIONS FOR PRACTICE: The findings can be used to spearhead future intervention studies that improve treatment decision making to chemotherapy adherence.

An integrative review of guidelines for anal cancer screening in HIV-infected persons.

HIV-infected individuals are 28 times more likely than the general population to be diagnosed with anal cancer. An integrative review of recommendations and guidelines for anal cancer screening was performed to provide a succinct guide to inform healthcare clinicians. The review excluded studies that were of non-HIV populations, redundant articles or publications, non-English manuscripts, or nonclinical trials. The review found no formal national or international guidelines exist for routine screening of anal cancer for HIV-infected individuals. To date, no randomized control trial provides strong evidence supporting efficaciousness and effectiveness of an anal cancer screening program. The screening recommendations from seven international-, national-, and state-based reports were reviewed and synthesized in this review. These guidelines suggest anal cancer screening, albeit unproven, may be beneficial at decreasing the incidence of anal cancer. This review highlights the paucity of screening-related research and is an area of need to provide clear direction and to define standard of care for anal cancer screening in HIV-infected persons.