Issue on Teaching and Training Future Health Informaticians:Partnering with Students to Develop a Capstone for a Graduate Health Informatics Program.

OBJECTIVE: To assess the desirability, feasibility, and sustainability of integrating a project-based capstone course with the course-based curriculum of an interdisciplinary MSc health informatics program guided with a student-partnered steering committee and student-centered approach. METHODS: We conducted an online cross-sectional survey (n=87) and three semi-structured focus groups (n=18) of health informatics students and alumni. Survey data was analyzed descriptively. Focus groups were audio-recorded and transcribed verbatim and then analyzed using a general inductive and classic analysis approach. RESULTS: Most students were supportive of including a capstone project but desired an option to work independently or within a group. Students perceived several benefits to capstone courses while concerned over perceived challenges to capstone implementation, evaluation, and managing group processes. Themes identified were: 1) professional development, identity, and career advancement; 2) emulating the real world and learning beyond the classroom, 3) embracing new, full circle learning, 4) anticipated course structure, delivery, and preparation, 5) balancing student choice, interests, and priorities, and 6) concerns over group dynamics, limitations, and support. CONCLUSIONS: This study demonstrates the value of having students as partners at each stage in the process from methods conception to course curriculum design. With the steering committee and the curriculum developer, we codeveloped a student-centered course that integrates foundational digital health-related project knowledge acquisition with an inquiry-based project which can be completed independently or in small groups. This study demonstrates the potential benefits and challenges that health informatics educators may consider when (re)-designing capstone courses.

Do family dinners reduce the risk for early adolescent substance use? A propensity score analysis.

The risks of early adolescent substance use on health and well-being are well documented. In recent years, several experts have claimed that a simple preventive measure for these behaviors is for families to share evening meals. In this study, we use data from the 1997 National Longitudinal Study of Youth (n = 5,419) to estimate propensity score models designed to match on a set of covariates and predict early adolescent substance use frequency and initiation. The results indicate that family dinners are not generally associated with alcohol or cigarette use or with drug use initiation. However, a continuous measure of family dinners is modestly associated with marijuana frequency, thus suggesting a potential causal impact. These results show that family dinners may help prevent one form of substance use in the short term but do not generally affect substance use initiation or alcohol and cigarette use.

Management of patients with primary central nervous system lymphoma treated with high-dose methotrexate.

Primary central nervous system lymphoma (PCNSL) is a rare, extranodal form of non-Hodgkin lymphoma that most commonly presents with neurologic changes. Comprehensive workup to diagnose PCNSL and rule out nodal non-Hodgkin lymphoma is critical to the development of an appropriate plan for therapy. Past PCNSL treatments have included whole-brain radiation or steroids, but high-dose methotrexate (MTX) has emerged as initial therapy. Although high-dose MTX is well tolerated, special considerations must be taken to administer the drug safely. Specific interventions include aggressive IV hydration with sodium bicarbonate fluids, monitoring blood chemistries, and the administration of leucovorin rescue. Nurses should evaluate and monitor patients closely during treatment to ensure safety and decrease drug toxicity.

Phase I study of a MUC1 vaccine composed of different doses of MUC1 peptide with SB-AS2 adjuvant in resected and locally advanced pancreatic cancer.

MUC1 is a glycoprotein overexpressed in tumors as a hypoglycosylated form. A vaccine composed of a 100-amino acid peptide corresponding to five 20-amino acid long repeats, and SB-AS2 adjuvant, was tested in a phase I study for safety, toxicity, and ability to elicit or boost MUC1-specific immune responses. Patients with resected or locally advanced pancreatic cancer without prior chemotherapy or radiotherapy were eligible. Escalating doses of the peptide (100, 300, 1,000, and 3,000 mug) were admixed with SB-AS2 and administered intramuscularly every 3 weeks for three doses, in cohorts of four patients. Sixteen patients were enrolled. Common adverse effects were grade 1 flu-like symptoms, tenderness, and erythema at the injection site. Delayed-type hypersensitivity (DTH) sites showed few or no T cells prevaccination (Pre V), but increased T-cell infiltration postvaccination (Post V). There was an increase in the percentage of CD8(+) T cells in the peripheral blood Post V. An increase in total MUC1-specific antibody was seen in some patients, and several patients developed IgG antibody. Two of 15 resected pancreatic cancer patients are alive and disease free at follow-up of 32 and 61 months. MUC1 100mer peptide with SB-AS2 adjuvant is a safe vaccine that induces low but detectable mucin-specific humoral and T-cell responses in some patients. No difference was seen between different peptide doses. Further evaluation is warranted to examine the effect on disease-free survival and overall survival, especially in early disease and in the absence of immunosuppressive standard therapy.

Social marketing improved the use of multivitamin and mineral supplements among resource-poor women in Bolivia.

OBJECTIVE: To test the hypothesis that social marketing improves women's awareness and consumption of multivitamin and mineral supplements. DESIGN: Formative research and baseline and final surveys using a multistaged stratified cluster sample. SETTING: Department of Santa Cruz, Bolivia. PARTICIPANTS: Women 15 to 49 years old (n=1709 at baseline and n=1735 at final survey). INTERVENTION: Social marketing campaign using radio and television spots. MAIN OUTCOME MEASURES: Awareness and use of multivitamins, including VitalDía, the brand promoted as part of this social marketing campaign. ANALYSIS: Cross-tabulations to assess changes over time in awareness and use of multivitamins. Logistic regression analyses to identify determinants of multivitamin use. RESULTS: The campaign increased women's awareness and use of multiple supplements, including VitalDía. Awareness of multiple supplements nearly doubled among women with 6 to 8 years of schooling, tripled among women with 4 to 5 years of education, and more than quadrupled among women with less than 4 years of schooling. After 9 months of social marketing, 11% of women had taken VitalDía one or more times, 7% had taken it at least once in the last 3 months, and 4% had used it one or more times in the last month. Improvements in the use of VitalDía were evident for women of all socioeconomic and educational levels, with the greatest increases occurring in the least advantaged groups. Additionally, women who had a positive perception of the benefits of multivitamins were 1.7 times (95% confidence interval 1.2-2.3; P <.01) more likely than women who did not have a positive perception to ever use VitalDía, once the effects of social class were adjusted. CONCLUSIONS AND IMPLICATIONS: Social marketing of multiple supplements reached resource-poor women and can be used to bridge gaps in access, improve awareness of supplementation as an option, and increase the likelihood that women will try supplements.