MRI as an Adjunct to Conventional Mamomography Screening for Cancer in Dense Breast Tissue

February, 2015  As Chair of the Walden University Faculty Dissertation Committee, I am pleased to present the Abstract prepared by Rachel S. Connett, Ph.D. in Health Services.  Dr. Marilyn Simon served as her Committee Member.

Abstract

 Diagnostic methods to effectively image dense breast tissue (DBT) can pose challenges. While conventional mammography is the gold standard for breast cancer screening, conventional mammography can miss about 78% of cancers in DBT and ultrasonography can miss 24% or produce false positive results. Magnetic resonance imaging (MRI) has a high sensitivity for imaging DBT and produces a smaller number of false positives, but MRI is used to image only women with an elevated threat of breast cancer; it is not routine for this population. The purpose of this study was to determine to what extent conventional mammograms can miss breast cancer in women with DBT and to determine if an adjunct method of imaging DBT might detect breast cancers that are missed by mammography alone. This mixed methods study was based on the theoretical framework of von Bertalanffy’s general systems theory, Miller’s living systems theory, and the theory of intelligent medical diagnosis. Key research inquiries were as follows: (a) Can MRI can be used for screening women with DBT as an adjunct to conventional mammography? (b) What were the lived experiences of women with breast cancer in DBT prior to and after the breast cancer diagnosis? Key results showed that (a) a significant number of women with DBT had breast cancer that was undetected by mammograms; (b) women with DBT can benefit from breast cancer screening by adding an adjunct screening method (MRI or ultrasonography). This study may contribute to social change by making the breast cancer screening community aware of the potential benefit of adding MRI as an adjunct to conventional screening so that more breast cancers are detected in the early stages of the disease.

Marketplace Clinics Complimenting Community-Based Diabetes Care for Urban Residing American Indians

May, 2015  I am pleased to share with you the Abstract of the doctoral dissertation completed by Robert Rick, Ph.D. in Health Services at Walden University. I served as Chair of his Faculty Dissertation Committee.  Dr. Raymond Thron served as Committee Member.

Abstract

Many inner-city populations experience disproportionately high disease rates. Among those adversely affected are the Minneapolis, Minnesota 20,000 American Indian residents who experience limited health care access and suffer threefold diabetes health disparity. This research project evaluated the extent to which marketplace clinics, such as those located in the pharmacy areas of CVS, Walmart, Target, or Supervalu stores extended their business model to be more culturally aware and inclusive of medically underserved and urban Indian persons with diabetes. The quantitative study was conducted within the Patient Activation Measure (PAM) analytical framework in assessing one’s knowledge, skills, and confidence for self-managing diabetes health and health care. The study’s main theoretical foundation is that complementary marketplace and community-based self-management education motivates self-determination, which in turn, actuates diabetes health improvement. A case-control study tested whether marketplace clinics and activated support group participants got better at managing their diabetes relative to the control group. The positive effects of marketplace clinics and community-based complementation were borne out with respect to significantly improved blood sugar control, weight loss, and healthful lifestyle adaptation. Implications for social change include sharing this complementary network with Minneapolis medically underserved and urban Indian neighbors. Social change progress could also be realized by incorporating patient activation methods with diabetes health prevention for 30 Urban Indian Health Organizations that are located in large cities throughout the country.

Prostate Cancer & Afro-Caribbean Men: Experiences, Perceptions and Beliefs

February, 2015  I am pleased to have Chaired the Walden University, Faculty Dissertation Committee for Harold E. Taitt, Ph.D in Health Services.  Dr. Jim Goes served as Committee Member.   Please read the Abstract of Dr. Taitt's research:  PROSTATE CANCER & AFRO-CARIBBEAN MEN: EXPERIENCES, PERCEPTIONS, & BELIEFS.

                                                                       Abstract

Despite the high incidence of prostate cancer (PC) amongst men of African descent, there is a paucity of qualitative data that explores how Afro-Caribbean men perceive their risk, susceptibility to, and management of this disease.  This phenomenological study sought to explore and analyze beliefs about PC in a sample of Afro-Caribbean men who reside in the United States (U.S.).  The research questions considered the perceptions, beliefs, and lived experiences of participants.  The conceptual framework is a synthesis of the health belief model (HBM) and the theory of reasoned action (TRA), primarily because the TRA allows for a culturally-based relevance and perspective that is lacking in the HBM.  Data were collected using in-depth interviews from a purposive sample of 13 U.S. participants from 7 Caribbean territories, who provided detailed descriptions of their perceptions.  Data management and inductive, iterative analysis were facilitated through the use of the NVivo 10 software program.  This study found that participants had a low level of awareness and education about PC, but they also believed that if PC were caught early, they have a good chance of a long life.  There was no indication that culture played a significant role in their attitudes, beliefs, and perceptions of the disease.  Education about PC should be targeted to this population as well as their significant others. In addition, qualitative research is needed to compare perspectives of Afro-Caribbean, African American, and African men who all reside in the United States.  This study may contribute to positive social change by providing practical strategies that may increase screening and early diagnosis among Afro-Caribbean men, thereby reducing the mortality from this disease.