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Adult immunization improvement in an underserved family medicine practice

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Family Medicine and Community Health 2015年第2期3卷 2-7页

作者： Mohamad Sidani jaden Harris Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:Vaccines prevent many cases of infectious disease,yet immunization campaigns are hindered by various *** work presents the results of a quality improvement project addressing barriers to vaccine compliance in an underserved teaching practice by reducing missed opportunities and increasing provider and patient compliance rates for pneumococcal,Tdap,influenza,and zoster vaccines in ***:The study intervention aimed to address patient knowledge,provider knowledge and skills,proactive care coordination,and outreach and counselling of high-risk ***-gate patient data from intervention at year-end were compared to the prior *** targets were as follows:improved vaccination rates by one-half of the difference between baseline and Healthy People 2020 goals;reduced patient refusals by 10%;and reduced missed opportunities by 50%.Results:All of the vaccination rates improved,but with mixed results regarding the target *** rates of vaccine refusal were mixed in terms of the direction of the change,the significance,and achieving *** opportunities all improved,but the significance was mixed and none reached ***:This project has helped to identify patient and provider knowledge of vacci-nation as a key to increasing compliance,and missed opportunities as the greatest challenge in achieving *** burden of documentation is significant on providers,and future work should focus on methods to improve the ease of *** outcomes and improvements were encouraging;however,it is clear that there remain challenges to reaching Healthy People 2020 goals within the study population and nationally.

关键词： Immunization vaccine practice improvement pneumococcal Tdap influenza zoster

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

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Family Medicine and Community Health 2015年第2期3卷 48-53页

作者： Sandra j.Gonzalez Maria C.Mejia de Grubb Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

The reciprocal relationship between mental and physical health is well ***,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of *** growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been *** objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

关键词： Patient-centered medical home integrated primary care health care service delivery mental health chronic disease management behavioral health integration

The global burden of preventable cancer mortality

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Family Medicine and Community Health 2017年第1期5卷 1-2页

作者： Roger j.zoorob Department of Family and Community Medicine 3701 Kirby DriveSuite 600HoustonTX 77098USA

I am pleased to present this special issue of Family Medicine and Community Health,entitled“The Global Burden of Preventable Cancer Mortality.”This issue was completed in collaboration with the Baylor College of Medicine(BCM)Department of Family and Community Medicine in Houston,Texas,*** mission of the department is to enhance population health and advance the primary care discipline through rigorous and evidence-based prevention and *** focus our research efforts on a broad range of research areas including,but not limited to,cancer con-trol,nutrition and health,medical education,and health disparities.

关键词： prevention rigorous education

Self-reported preferences for patient and provider roles in cancer treatment decision-making in the United States

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Family Medicine and Community Health 2017年第1期5卷 43-55页

作者： Kiara Spooner Charles Chima jason L.Salemi Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:To describe differences in preferred roles in cancer treatment decision-making and identify associated sociodemographic and health-related factors among adults in the United ***:We conducted a cross-sectional analysis of nationally representative data from the 2014 Health Information National Trends *** statistics were calculated and multi-variable logistic regression was conducted to examine ***:Half(48.3%)of respondents preferred a collaborative role in decision-making under the supposition of a moderate chance of survival;while 53.4%preferred a more active role when the chance of survival was *** 7%-8%indicated a preference for a passive role in decision-making,for both low and moderate chances of *** predictors of role prefer-ence for cancer treatment decision-making emerged,including age,sex,education,race/ethnicity,and having a regular health care *** both low and moderate chances of survival,the col-lege educated were less likely to prefer a passive role,whereas Hispanics were two to three times more likely than whites to indicate a preference for a passive ***:Adults’role preference for cancer treatment decision-making may be influenced by sociodemographic and health-related *** awareness of these factors,paired with enhanced patient-provider communication,may assist health care professionals in providing indi-vidualized and high-quality,patient-centered cancer care.

关键词： Cancer treatment decision-making decision-making role preference

Unplanned hospitalizations for metastatic cancers:The changing patterns of inpatient palliative care,discharge to hospice care,and in-hospital mortality in the United States

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Family Medicine and Community Health 2017年第1期5卷 13-28页

作者： jason L.Salemi Charles C.Chima Kiara K.Spooner Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:To describe the rates and temporal trends of inpatient end-of-life care among patients hospitalized with metastatic cancer in the United ***:We used data from the Nationwide Inpatient Sample to conduct a cross-sectional analysis of unplanned inpatient hospitalizations of patients aged 18 years or older with metastatic cancer from 2002 to *** logistic regression was used to assess patient-and hospital-level predictors of discharge to hospice care,palliative care,and in-hospital *** trends in outcomes were characterized with use of joinpoint ***:There were an estimated 350,241 unplanned hospitalizations per year of patients with a diagnosis of metastatic *** their inpatient stay,5.8%of patients received palliative care,and among those discharged alive,12.2%were referred to hospice *** rate of inpatient palliative care increased from 2.3%to 13.6%,the rate of discharge to hospice care increased from 4.1%to 15.6%,and the in-hospital mortality rate decreased from more than 14.0%to 9.8%.These patterns were consistent across cancer subtypes,and were most pronounced among patients with extreme risk of ***:Despite increases in the provision of comfort-oriented care to patients with meta-static cancer,few receive such *** recommend screening protocols in hospitals to identify patients who are good candidates for palliative care consultation and hospice referral.

关键词： End-of-life hospice care inpatient mortality metastatic cancer palliative care unplanned hospitalization

Exploring point-of-care transformation in diabetic care:A quality improvement approach

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Family Medicine and Community Health 2015年第2期3卷 20-26页

作者： Malvika juneja Maria C.Mejia de Grubb Haijun Wang Kiara Spooner Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)at a community health center in Houston,***:This was a before-and-after POC intervention among adult patients who received primary care services between 1 july 2014 and 31 December 2014(baseline visit)and who had at least one 3-month follow-up ***:Three hundred eighty-seven patients were included in the *** majority were9%)at baseline,with the highest average levels among Hispanic(10.9%)and black(10.7%)*** was a significant difference in the HbA1c level before(mean=10.65,SD=1.9291)and after(mean=9.25,SD=1.8187)*** absolute reduction in the level of HbA1c was 1.4%(t=12.834,p<0.001),corresponding to a 13%overall percentage decrease from ***:There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c,improving self-management,and reducing long-term costs.

关键词： Diabetes point of care stat HbA1c

Temporal trends in colorectal cancer incidence among Asian American populations in the United States, 1994-2013

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Family Medicine and Community Health 2017年第1期5卷 56-64页

作者： Haijun Wang Maria C.Mejia de Grubb Sandra j.Gonzalez Mohamad Sidani jianping Ma Roger j.zoorob Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Shenzhen Nanshan Center for Chronic Disease Control ShenzhenGuangdongChina

Objective:To investigate the incidence and trends in colorectal cancer(CRC)among Asian American populations in the United ***:CRC incidence data from 1994 through 2013 were obtained from 13 Surveillance,Epidemiology,and End Results ****Stat and IBM SPSS Statistics were ***:The age-adjusted incidence of CRC among Asian Americans decreased from 45.6 per 100,000 in 1994 to 33.0 per 100,000 in 2013,with the annual percent change being−1.8%(P<0.05).The incidences were higher for men,the elderly(aged 60 years or older),and several geographic *** those younger than 70 years,the rectal site was more affected compared with those aged 70 years or older,in whom the proximal site were more *** patients presented with localized and regional ***,80 years or older,in situ stage,and some geo-graphic areas such as Connecticut and California experienced significant incidence decreases in the 20-year observation ***:Although CRC incidence has declined among Asian American populations in the United States in the past 2 decades,there are persistent differences by age and geographic *** research is needed to guide the design and implementation of tailored strategies to reduce CRC outcome differences across Asian American populations.

关键词： Colorectal cancer proximal colon distal colon rectal cancer incidence trend

Mixing in Shallow Waters: Measurements, Processing, and Applications

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journal of Ocean University of China 2005年第4期4卷 293-305页

作者： Iossif Lozovatsky Elena roget H.j.S.Fernado Environmental Fluid Dynamics Program Arizona State UniversityTempe85287-6106U.S.A. P.P.Shirshov Institute of OceanologyRussian Academy of SciencesMoscow117851Russia University of Girona Girona E-17071CataloniaSpain Environmental Fluid Dynamics Program Arizona State UniversityTempe85287-6106U.S.A.

Microstructure profiling measurements taken on a shallow Black Sea shelf and in Lake Banyoles and Boadella reservoir (Both in Spain) are analyzed to investigate the influence of boundary-layer-induced turbulence of various sources on mixing in the water interior. The state of turbulence in shallow waters is examined and details of microstructure data processing and error analysis are discussed. The dependence between averaged activity parameter (-A)G and buoyancy Reynolds number (-Reb) for the shelf turbulence indicates that for (-Reb) ＜ 1 the state of turbulence can be described by the fossil turbulence model, which postulates AG ～ Re1/2 b. For (-Reb) ＞ 1, however, the influence of (-Reb) on (-A)G is weak, signifying that the buoyancy Reynolds number can no longer serve as the governing parameter for active turbulent mixing. The generation of turbulence by a one-minute long wind bursts (the Boadella reservoir) increases the averaged dissipation rate 〈ε〉 of the surface mixed layer by more than 5 times (up to 3 × 10-6 W kg-1). The influence of the wind bursts was also traced below the thermocline, where turbulent patches with 〈ε〉 = (10 7 - 10-6) W kg-1 were generated. It is shown that the geothermal convection in Lake Banyoles produces intermittent turbulent patches with characteristic dissipation rate 〈ε〉 = (2 × 10-8 -3 × 10-7)W kg-1, which influences the overall vertical mixing in the basin.

关键词：湍流海洋动力学微观结构扩散性气候系统

Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999-2009

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Family Medicine and Community Health 2017年第1期5卷 3-12页

作者： Maria C.Mejia de Grubb Barbara Kilbourne Katy Kilbourne Michael Langston Lisa Gittner Roger j.zoorob Robert Levine Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Sociology Department Tennessee State UniversityNashvilleTNUSA Department of Family and Community Medicine Meharry Medical CollegeNashvilleTNUSA Department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTNUSA Department of Political Science Texas Tech University College of Arts and SciencesLubbockTXUSA

Background:The American Cancer Society estimates that about 25%of all US cancer deaths will be due to lung cancer-more than from cancers of the colon,breast,and prostate ***:We ascertained county-level age-adjusted and age-specific death rates and 95%confidence intervals from the Centers for Disease Control and Prevention Compressed Mortality *** regression analyses were used to estimate the strength and direction of relationships between county poverty,smoking,fine particulate matter(PM2.5)air pollution,and US Census divisions and race-and sex-specific lung cancer ***:Poverty,smoking,and particulate matter air pollution were positively and signifi-cantly related to lung cancer deaths among white men,but of these,only poverty and smoking were significantly associated with lung cancer deaths among white *** in the South Atlantic,East South Central,and West South Central US Census divisions at the time of death was significantly associated with lung cancer deaths for both white men and white *** with white men,poverty and smoking were associated with lung cancer deaths among black men,but of these,only adult smoking had a statistically significant association among black ***:The results support the need for further research,particularly in high-risk areas,to better differentiate factors specific to race and sex and to understand the impact of local risk factors.

关键词： Lung cancer mortality geographic risk factors environmental hot spot