MyBirthControl: Developing a tablet-based contraceptive counseling decision-support tool
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Evidence shows that clinicians are less likely to engage young women in shared decision-making about contraception, compared to older women. A more patient-centered approach to contraceptive counseling for youth could improve birth control satisfaction and continuation. In collaboration with Bedsider.org, we developed 'MyBirthControl', a tablet-based decision-support tool. MyBirthControl begins with interactive education about all contraception options in an engaging visual format and moves into a values-clarification quiz, producing personalized feedback. It ends with a printout detailing the user's questions and preferences, which can be used during clinical visits facilitating shared decision-making. MyBirthControl was developed iteratively, with feedback from diverse young women patient stakeholders. Our partner, Bedsider.org, plans to make MyBirthControl freely available to clinics across the country. The potential value of the tool encouraged us to conduct a randomized control trial to test its effect on patient-centered outcomes such as contraceptive continuation and contraceptive counseling experiences.
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The document discusses various methods of contraception and birth control. It notes that over 1 million teens became pregnant in 2000 in the US, with 512,000 giving birth. The effectiveness of different contraceptive methods is reviewed, including hormonal methods like birth control pills and implants, barrier methods like condoms and diaphragms, and long-acting reversible contraceptives like IUDs. Risks of STDs are also addressed.
Family planning....ppt
This document discusses various methods of family planning. It describes natural family planning methods like withdrawal and calendar-based methods. It then discusses barrier methods like condoms, diaphragms, and spermicides. Intrauterine devices that contain copper or hormones are explained next. The document also covers hormonal contraceptives like oral contraceptive pills containing estrogen and progestin, and progestin-only pills, implants, and injectables. Advantages and disadvantages are provided for many of the methods.
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Preventing Unintended Pregnancy Among Adolescents: Using mHealth to Promote a...
Health-E You/Salud iTu is an mHealth contraceptive decision support tool for adolescent girls. Through an interactive, youth-centered approach, the App provides accurate information (that can be updated in real-time), individually tailored feedback/messages, and a user-driven experience. Based on the youth’s preferences, and experiences, the App provides contraceptive recommendation(s) while also presenting the youth with all of the possible options including videos of providers and youth. Youth can then share information from the App with their provider to help them communicate their needs, interests and questions. In turn, the provider is better prepared for the face-to-face encounter. Pilot testing shows it is feasible to implement, acceptable to adolescents and providers; improves health knowledge; and visit quality. It is being evaluated at 14 school-based health centers using a longitudinal, cluster randomized control trial research design.
2017 CAEP Academic Symposium Slides
This document summarizes recommendations from a panel discussion on engaging patients in emergency medicine (EM) research. The panel reviewed literature on patient engagement and conducted interviews with EM researchers. They recommend that EM researchers adopt patient engagement to improve research relevance and impact. Specifically, they recommend that the Canadian Association of Emergency Physicians (CAEP) create resources and guidelines to support patient engagement at all stages of research. This includes establishing a national patient council, training materials, and making patient engagement eligible for funding. The panel also provides best practices for the preparatory, execution and translation phases of research that engages patients.
Leveraging Patient Support Programs in Biologic-Biosimilar Competitive Landscape
Biologics are facing intense competition from biosimilars. In this competitive landscape, strategic levers for both branded biologics and biosimilars typically include payor strategy, promotion and new formulation. As patients become more engaged and patient-centricity is on the rise, there is an increased opportunity to leverage patient support programs as additional strategic lever. This presentation will cover five key learnings that we have uncovered while conducting multi-phase patient support program research for both branded biologics and biosimilars.
Evidence based medicine
The document discusses evidence based healthcare and the process of evidence based medicine. It describes the 5 step process as asking questions, acquiring information, appraising the quality of evidence, applying the results, and assessing performance. Simple skills can help focus questions and basic rules can improve ability to critique literature. Simple math, not complex statistics, can help clearly describe study results.
Ganser_prenatal care capacity assessment poster
1) Philadelphia's infant mortality rate is higher than the national average, which may be due to high rates of preterm births and low birthweight. The closure of 13 obstetrics units has increased demand on the remaining 6 units.
2) The study assessed prenatal care capacity in Philadelphia by surveying providers on appointment availability, wait times, and other access factors. On average, newly pregnant women waited over 10 days for an initial appointment.
3) Recommendations include expanding prenatal care hours, increasing the provider workforce, standardizing scheduling policies, and addressing socioeconomic barriers through partnerships between medical centers and public health.
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This document describes several family history tools developed to assist primary care providers. It discusses the Pregnancy & Health Profile tool, which was implemented in four clinical settings and evaluated with positive feedback from patients and providers. It also describes the development of a pediatric family history tool in partnership with the AAP to launch in September 2013. Both tools integrate family history data with clinical decision support to help identify genetic risks and improve patient care.
PreNatal Module, HughesRiskApps
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history. A set of screenshots and an overview of the module can be reviewed via this downloadable ppt.
Improving children and their families experience of the cancer care pathway
The document summarizes the work of the Patient Experience Sub Group, which aims to improve the experience of cancer care for children and their families in North Thames. It discusses the membership of the sub-group and their goals of unifying patient information, conducting surveys of patient experience, and developing tools to better understand the perspectives of children. The document also provides updates on initial developments, including an information survey that identified gaps, the formation of a Parent's Council, and a pilot of a Holistic Needs Assessment for patients. It outlines next steps such as standardizing information, repeating surveys, analyzing experience data, and developing a tool to hear children's voices.
Support for healthy breastfeeding mothers with healthy term babies: What's th...
Health Evidence hosted a 60 minute webinar examining breastfeeding support interventions for healthy breastfeeding mothers with healthy term babies. Click here for access to the audio recording for this webinar: https://youtu.be/fxDY-Q87xaY
Alison McFadden, Senior Research Fellow, Director, Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee and Anna Gavine, Research Fellow School of Nursing and Health Sciences, University of Dundee will be leading the session and presenting findings from their recent Cochrane review:
McFadden A, Gavine A, Renfrew M, Wade A, Buchanan P, Taylor J, et al. (2017). Support for healthy breastfeeding mothers with healthy term babies . Cochrane Database of Systematic Reviews, 2017(2), CD001141.
Evidence suggests that not breastfeeding negatively impacts the health of both infants and mothers. Additionally, data demonstrates an inadequate uptake of the World Health Organization’s recommendations regarding type and duration of breastfeeding in many countries. This review examines the impact of breastfeeding support interventions on breastfeeding duration and exclusivity in healthy breastfeeding mothers with healthy term babies, compared to usual care. One-hundred trials with over 83,246 mother-infant pairs were included in this review. Seventy-three of the one-hundred trials were involved in the data analyses. Findings suggest that breastfeeding support interventions reduce cessation of ‘any breastfeeding’ before 4 to 6 weeks and 6 months, and cessation of ‘exclusive breastfeeding’ at 4 to 6 weeks and at 6 months. This webinar will provide an overview of the impact of support on breastfeeding duration and exclusivity in healthy breastfeeding mothers with healthy term babies.
2.8.4 louise browne
This document summarizes a gender-informed program called "What Were We Thinking" that aims to prevent postnatal mental health problems in women. It discusses the partnership between Monash University and Jean Hailes for Women's Health that generates and translates knowledge on this topic. It also provides information on prevalence of postnatal mental disorders, risk factors, existing prevention approaches, and describes the psychoeducational program components and evaluation through a randomized controlled trial. Translations for health professionals and consumers are discussed, along with strategies for sustainability.
Day 1: Newborn Screening: Pranesh Chakraborty, University of Ottawa
Day 1: Newborn Screening: Pranesh Chakraborty, University of OttawaCanadian Organization for Rare Disorders
CORD Rare Drug Conference: June 8-9, 2022
Diagnosis for All
Newborn Screening: Pranesh Chakraborty, University of Ottawa
Fetal_Medicine_Presentation Introduction
This document discusses the role of fetal medicine in prenatal care. It explores how fetal medicine specialists utilize advanced tools like ultrasounds and biophysical profiles to detect fetal conditions early and provide intervention. The collaboration between fetal medicine and genetics is also addressed, including genetic testing and counseling. Specific services offered like screenings and therapies are detailed. Case studies demonstrate the synergistic approach between fetal medicine and genetics and the improved outcomes this interdisciplinary care provides.
Does patient engagement in patient safety and quality committees advance safe...
Does patient engagement in patient safety and quality committees advance safe...Canadian Patient Safety Institute
At the end of the session patient/family champions as well as health authorities will understand different approaches to patient engagement in patient safety and quality committees (e.g. dealing with incident reporting, root cause analysis, developing policies and procedures) and how patient engagement impacted patient safety and quality outcomes. The participants and presenters are invited to present examples, tools, and leading practices so the participants will leave with at least one practical idea to implement. New York State Drug Court Program
New York State Drug Court Program: The
participant will be able to: Demonstrate the efficacy of
patient navigation in order to improve maternal/child
health outcomes and parenting skills for the court
involved population.
WhyIUD: A Peer-Led Social Communication Intervention
Friends and family are a trusted source of contraceptive information for young people. However, when it comes to IUDs, negative and incorrect information is prevalent in social communication. We developed a multi-technology, peer-led intervention to encourage fact-based communication about the IUD among women. Our intervention, WhyIUD, includes text messages for IUD users and a webpage and pamphlets for IUD users and their friends. WhyIUD is delivered by clinicians to IUD users during their IUD insertion or other clinic visit, and then by IUD users to their friends. WhyIUD aims to accelerate awareness, acceptance and uptake of IUDs among women for whom this method may be a good fit, thus decreasing the rate of unintended pregnancy. WhyIUD's development and evaluation may serve as a model to other behavior change initiatives seeking to harness social influence and spread evidence-based health information by partnering technology and clinical care.
FDA 2013 Clinical Investigator Training Course: A Patient Advocate’s Perspect...
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Jane Reese-Coulbourne, Reagan-Udall Foundation
DFCM Pearls: What is New
This document summarizes six research studies that will impact family medicine practice. The studies include: 1) decreased STI screening rates in young women after changes to cervical cancer guidelines, 2) reduced cervical dysplasia in adolescent girls receiving the HPV vaccine, 3) potential cost savings of a universal public drug plan in Canada, 4) using an online smoking cessation program to increase medication use, 5) unintended effects of wait time policies on medical education, and 6) increasing potentially inappropriate bupropion prescriptions suggesting misuse. The document provides an overview of each study's question, methods, findings, and implications for academic and clinical practice.
Strengthening Community Health Systems_Henry Perry_5.8.14
This document summarizes a review of community-based approaches to improving reproductive, maternal, neonatal and child health. The review found evidence that community health workers can effectively deliver interventions like immunizations, vitamin A supplementation, and treatment of childhood illnesses. Participatory women's groups and home visits were also found to improve health outcomes. Large community health worker programs in countries like Bangladesh and Ethiopia demonstrated improved coverage and reductions in mortality. The review calls for more integrated community-based programming, strengthening of health systems, and viewing communities as partners rather than just recipients of services.
School-based interventions to prevent HIV, STIs & adolescent pregnancy: What'...
Health Evidence hosted a 60 minute webinar examining the effectiveness of school-based interventions for preventing HIV, sexually transmitted infections and pregnancy in adolescents. Click here for access to the audio recording for this webinar: https://youtu.be/yCeIEQ4OTCc
Amanda Mason-Jones, Senior Lecturer in Global Public Health, Faculty of Science, University of York led the session and presented findings from her recent Cochrane review:
Mason-Jones A, Sinclair D, Mathews C, Kagee A, Hillman A, & Lombard C. (2016). School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents.Cochrane Database of Systematic Reviews, 2016(11), CD006417
http://healthevidence.org/view-article.aspx?a=school-based-interventions-preventing-hiv-sexually-transmitted-infections-29881
Sexually active adolescents are at risk of contracting HIV and STIs. Unintended pregnancy can have detrimental impact on young people’s lives. This review examines the impact of school sexual education programs on number of young people that contract STIs and number of adolescent pregnancies. Eight cluster randomized control trials, including 55,157 participants are included in this review. Findings suggest there is little evidence that school programs alone are effective in improving sexual and reproductive health outcomes for adolescents. This webinar examined the effectiveness and components of interventions that prevent HIV, STIs and adolescent pregnancy.
UROP Symposium 2017 Poster
The Undergraduate Research Opportunity Program’s Annual Spring Research Symposium is the culminating event for all students participating in UROP for the 2016-2017 academic year. The symposium will take place Wednesday, April 19th, 2017 from 9am - 5pm, at the Michigan Union
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Preventing Unintended Pregnancy Among Adolescents: Using mHealth to Promote a...
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Leveraging Patient Support Programs in Biologic-Biosimilar Competitive Landscape
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Improving children and their families experience of the cancer care pathway
Improving children and their families experience of the cancer care pathway
Support for healthy breastfeeding mothers with healthy term babies: What's th...
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Day 1: Newborn Screening: Pranesh Chakraborty, University of Ottawa
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WhyIUD: A Peer-Led Social Communication Intervention
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Strengthening Community Health Systems_Henry Perry_5.8.14
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Sexual Health is Just Health: Findings from a CDC National STD Prevention Tra...
Think about the last time you thought you had an STD. How did you feel? Who did you tell? What did you do? Awkward, right? Maybe this hasn't happened to you personally, but each year over 20 million Americans contract a Sexually Transmitted Disease. Over 50% are youth and most go undetected and untreated. Just Health is a risk screen app being used in over 100 School-Based Health Centers and is the flagship tool of a National CDC Center for Technology Innovation that is focused on adolescent sexual health. Just Health works to improve patient-provider communication and reduce stigma around a range of topics from safety, substance use, mental health, and sexual health including the intersectionality of needs and gender identity and sexual orientation. Just Health is an example of ongoing evaluation in real-word conditions. Population-level data are improving understanding of these needs and risks from a system perspective.
Utilizing HIV at-home testing and Telehealth Techonology
Through the use of telehealth technology, at-home HIV testing is brought to research participants in the comfort of their own home. This presentation explains the significance and impact of two active research studies of using telehealth for remote counseling sessions and at-home HIV testing from the University of Michigan.
Zines as a Means: Using Alternative Publishing as a Health Resource and Empow...
Zines (mini, independently created magazines) have been used throughout history as a tool to explore social and political issues. In this workshop, participants will be introduced to the history of zines. After a short presentation of the presenter's use of zines with Planned Parenthood's PG-13 Players, Vanderbilt LGBTQI Life, Students of Stonewall LGBTQI youth activism team, and Advocates for Youth, we will brainstorm together ways in which zines can be used in organizing and similar work, identify at least one practical way each of us can use zines in our life and work, and learn how to create a zine out of a single sheet of paper. Online resources and tools that can be used to amplify resources will be presented. Examples of zines in youth, health, and technology fields will be provided.
The Tangential Impacts of Design
As we release products and services into the world they have the potential to reshape and transform. Good, bad, or both this impact is something that we need to understand. It is no longer good enough to have a good idea. How does thinking about our work in context of the interwoven communities it impacts affect the way we approach the design process, and how does it shape the way we evaluate success?
In the Know: Comprehensive sexual health education with wraparound digital te...
DIY is an innovative intervention based on positive youth development and youth-centered design. This presentation will describe how to involve youth in the program design, share strategies on how to engage vulnerable populations, and highlight preliminary findings.
Porn Literacy
This document provides guidance for teachers and parents on discussing pornography with students and children. It emphasizes that porn depicts an unrealistic scripted version of sex, and that real sex involves communication, consent, and intimacy rather than the performances often shown. It encourages starting an open and ongoing dialogue by assuming children have seen porn and taking a curious approach without shaming, in order to have honest conversations. Parents are advised to discuss the differences between real sex and porn, and to inform children about potential addictive aspects of pornography. Resources for further information are also included.
PlushCare Access to PrEP in a Digital World
Telemedicine is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies. With more than 95% of adults, and 100% of young adults between the age of 18-29 owning a cell phone in the United States, a technology-based health intervention can be available to hard-to-reach populations or underserved areas.
Panelists will engage a rich dialogue and showcase innovative and effective ways to create prevention programs for HIV and STDs using the potential telehealth can offer, specifically with linking young people to HIV pre-exposure prophylaxis, or PrEP. This plenary brings together leaders in the field of HIV prevention, research and policy along with private organizations and companies that are currently active on the field of biomedical prevention.
Positive Connections: Digital Support for Adolescents Living with HIV
Adolescents living with HIV need accurate information about their diagnosis, care, and treatment; as well as long-term counseling and support. In-person support groups are a promising approach to meeting these needs, however some ALHIV face distinct challenges to attending regular in-person meetings. Virtual support groups may help to overcome challenges such as transportation costs, living away from home because of school or work, fear of stigma, or perceived danger associated with disclosure to household members. In this session attendees will learn how FHI 360, on behalf of YouthPower Action, is currently adapting the evidence based “Positive Connections: Leading Information and Support Groups for Adolescents Living with HIV, for delivery via Facebook.
Healthy Youth On-line Meet-Up
Youth health integrating mHealth is an amazing approach for youth who are interested in working in mhealth program, it gives youth a chance to promote and improve their skills, networking and access to information on health and related issues through mobile phone which provides reliable, safe and confidential information
Iowa TelePrEP: Delivering PrEP through Telemedicine and Public Health Partner...
Telemedicine is a collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies. With more than 95% of adults, and 100% of young adults between the age of 18-29 owning a cell phone in the United States, a technology-based health intervention can be available to hard-to-reach populations or underserved areas.
Panelists will engage a rich dialogue and showcase innovative and effective ways to create prevention programs for HIV and STDs using the potential telehealth can offer, specifically with linking young people to HIV pre-exposure prophylaxis, or PrEP. This plenary brings together leaders in the field of HIV prevention, research and policy along with private organizations and companies that are currently active on the field of biomedical prevention.
"It's Just a Preference": Dating Apps, Discrimination, and LGBTQ Health
It seems like there's a mobile app for just about everything nowadays even ones that can help you find that special someone. Although dating apps are great for finding new partners, they can also provide a platform for discriminatory language and behaviors, which can eventually lead to negative health outcomes. In this presentation, I'm going to combine data from qualitative interviews with gay men and actual language used on dating app profiles to shed light on how discrimination on these dating apps translates to negative health outcomes. Many LGBTQ folks rely on various technologies to connect with one another including LGBTQ youth but then face discrimination from those within their own community. Join me as I try to brainstorm solutions and reimagine the future of inclusive dating apps.
Youth-serving providers don't need another message board: digital alternative...
Youth-serving providers have a wealth of knowledge about what works in youth HIV prevention and treatment in a real world context. Digital storytelling is an effective way to foster peer-to-peer sharing between youth-serving providers throughout the United States. Come learn about two models of digital peer-to-peer sharing and discuss ways to incorporate digital peer-to-peer sharing in your work with youth.
Inst them and they will come...or will they?: The secrets of recruiting youth...
Are your social media ads flopping? Still using a flyer to recruit youth for research studies? Learn the to-do's and to-don'ts of using social media to recruit youth for research studies and programs. We recruited over 2,500 young women into two national randomized controlled trials to test two sexual health digital tools. We will show you our process for selecting the appropriate social media format to reach youth, developing relevant materials that makes youth click, and monitoring the campaigns to assess their effectiveness. We will share examples of our own materials, graphics, messages, recruitment videos, and tag lines used to entice youth. See how some flopped and how others exceeded our expectations. We will also present concrete data on recruitment cost, relevance, clicks, and reach, and how to tweak your campaigns to stay within budget and be more effective.
Parents for Prevention: Raising a sexually healthy generation
Do you work with parents and caregivers of young people from birth to high school and beyond? Are you interested in helping them discover how to raise the generation that will help get us closer to ending sexual violence for good? Come join us as we talk about Parents for Prevention, an online space and accompanying mentoring curriculum, and learn how we took the project from initial idea, through focus group testing, to website creation, and recruiting and training parent partners. We will share our successes and spectacular failures, where we're heading next, and how you can use this tool in your own communities.
Stick To It: Pilot study results of an intervention using gamification to inc...
Can games improve the delivery of health services? We think so that's why our team has set out to explore whether gamification, the use of game elements in non-game contexts, can enhance services to prevent HIV and other sexually transmitted infections. We hypothesize that the foundational elements of games competition, collaboration, skill acquisition, and fun can motivate young men to engage in positive health behaviors to protect themselves and their communities. We are a team of epidemiologists, economists, clinicians, and game experts working together to understand whether games can be useful additions to the clinical setting.
Smart Connect: Bringing Contraceptive Services Closer to Adolescent Girls thr...
A360 revolutionizes the way adolescent girls access contraceptives by flipping the model and starting with what matters to her. In Tanzania, A360 has co-designed with girls a program called Kuwa Mjanja, where girls can "be smart" (Swahili translation) and learn about themselves both their bodies and their dreams. Kuwa Mjanja inspires and opens possibilities, empowering girls to take action by considering contraception as "the first step to taking control of your future now." Connecting with Sara (CwS) is a DHIS2-powered, open-source platform to track, link, and engage with Sara (our client) through use of mobile phones to facilitate engagement with community mobilizers, service providers, and follow-up efforts. CwS enables a new way to engage with and bring service delivery closer to Sara. The platform powers program teams to engage more dynamically with Sara and to actively use data to inform pathways to method adoption.
Innovating, Adapting, Learning, Expanding and Excelling: Using Mobiles to Imp...
Over the course of the past four years, the Johns Hopkins Center for Communication Programs (CCP) repeatedly adapted the OppiaMobile platform an open-source, Android-based application for use in diverse country contexts. Each subsequent OppiaMobile app is developed as part of an evolving global system that supports thoughtful creation, curation, packaging and distribution of health-related content for health workers. With each subsequent adaptation of the OppiaMobile platform, CCP expands its ability to design and develop, sustainable context-specific job aids and BCC tools for frontline health workers and their clients.
Learning from real people through conversations at scale
During this presentation we will join in live conversation with 18-24 year olds in Kenya using mSurvey. We will develop a mobile conversation to answer any burning questions from the audience while also demonstrating best practices for mobile (e.g, concise content limited to 10 questions and 160 characters per question). Conversational responses from actual Kenyans will be viewed in real time allowing for a dynamic and iterative conversation about the most pressing issues impacting Kenyan youth today. Following the live conversation, we'll engage in a guided discussion about the advantages and disadvantages of mobile as a channel for connecting with global youth such as costs, ethical considerations, and content limitations.
Project PARTNER (Partnering with Adolescents to Ready The Newest Engaged Rese...
The intersection of community engagement, research, and interactive technology is an innovative way for youth to develop leadership and 21st century skills. The California Adolescent Health Collaborative and community health clinic partners, Livingston Community Health and Asian Health Services, developed Project PARTNER, where youth in rural and urban communities learn critical thinking, problem solving, and collaborative processes through researching community health issues. \n\nYouth and adult allies from the health clinics were recruited to be members of a cross-generational and cross-regional community advisory board and were trained in research methodology. The online educational technology platform Kahoot!, and the mobile app Kahoot!, were utilized in training members on research fundamentals. The advisory boards then developed community surveys through Google Forms and utilized its mobile app feature to canvas neighborhoods to obtain community data. With data collected, they will develop research questions and participate in collaborative cross-site activities to support their research.
Alcohol use, gender based violence and HIV risk among female sex workers in T...
Female sex workers (FSWs) are disproportionately affected by HIV and gender-based violence (GBV). Substance use has been shown to overlap with these co-occurring epidemics to further increase FSWs' risk for negative health outcomes. However, limited research has explored how aspects of the sex work environment shapes this risk. In this session, we will discuss findings from a mixed methods study that examined how aspects of the sex work environment facilitate alcohol use and increase FSWs' risk for GBV and HIV. We will then discuss the implications these results have for future interventions, with a special focus on the role technology can play in addressing aspects of the sex work environment to limit alcohol use and reduce FSWs' risk for GBV and HIV.
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Sexual Health is Just Health: Findings from a CDC National STD Prevention Tra...
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Zines as a Means: Using Alternative Publishing as a Health Resource and Empow...
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In the Know: Comprehensive sexual health education with wraparound digital te...
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"It's Just a Preference": Dating Apps, Discrimination, and LGBTQ Health
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Youth-serving providers don't need another message board: digital alternative...
Youth-serving providers don't need another message board: digital alternative...
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Parents for Prevention: Raising a sexually healthy generation
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Innovating, Adapting, Learning, Expanding and Excelling: Using Mobiles to Imp...
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Learning from real people through conversations at scale
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Project PARTNER (Partnering with Adolescents to Ready The Newest Engaged Rese...
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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MyBirthControl: Developing a tablet-based contraceptive counseling decision-support tool
- 1. MyBirthControl: Developing a tablet-based contraceptive counseling decision support tool Reiley Reed, MPH and Judy Fitzpatrick Program in Woman-Centered Contraception Department of Family and Community Medicine UCSF
- 2. Why develop a Birth Control DST? • Counseling can influence contraceptive use, but patients are often dissatisfied with contraceptive counseling • Contraception is a preference sensitive decision • Shared Decision Making approach is optimal, particularly for young people • Decision support tools are a patient- centered, time-saving approach to improving contraceptive counseling
- 3. Development Process • Collaborators • Christine Dehlendorf MD, MAS and research team at UCSF • The National Campaign to Prevent Teen and Unplanned Pregnancy • Initial needs assessment • Development of prototype by UCSF family planning experts and design team • Pilot testing at family planning clinic • Input from patient and provider stakeholders • Subsequent cognitive testing of English and Spanish language versions
- 4. Structure of the tool • Educational modules relevant to choice of contraceptive method • Interactive component where patient indicates preferences • Health history checklist evaluating eligibility for methods • Interactive “method chooser” with a method comparison feature • Questions page where patients can enter their own • Final printout with methods the patient is interested in, preferences, medical history, and questions for provider
- 19. Future dissemination • Currently conducting a randomized trial of the tool’s effectiveness at 4 clinics in SF • Working with the National Campaign to plan nationwide dissemination to clinics after study period ends • Easily incorporated into a range of clinical settings
- 20. Contact information Reiley Reed, MPH Assistant Clinical Research Coordinator Program in Woman-Centered Contraception Department of Family and Community Medicine UCSF Reiley.reed@ucsf.edu Judy Fitzpatrick Clinical Trial Coordinator Program in Woman-Centered Contraception Department of Family and Community Medicine UCSF Judith.fitzpatrick@ucsf.edu