The computer program Adjuvant! can play practical and educational roles in clinical settings.

OBJECTIVES. This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low-income, inner-city housing developments. METHODS. Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. RESULTS. Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. CONCLUSIONS. HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances.

Reasons to donate or not are complex. Altruism, although important, does not seem to be sufficient to motivate organ donation. Knowing patient's preferences was a stronger influence overall. Moreover, certain reasons were highly correlated with each other. Supportive emotional care for the family and reassurance and information about the donation process are indicated as important issues to address to encourage donation.

Most families (96%) were told their family member was brain dead, but only 28.3% were able to provide a completely correct definition of brain death. No association between the definition of brain death and willingness to donate was found. Those who donated were less likely to agree with the statement that someone is dead only when the heart stops than those who did not donate. Respondents who accepted that their loved one was dead when informed the patient was brain dead were more likely to donate than those who did not consider the patient dead until mechanical support was turned off and the heart stopped.

2225) for general payments, respectively. Receipt of research payments was associated with increased prescribing for mRCC but not CML. Similarly, when treating payments as a continuous variable, increasing amounts of general payments were associated with increased prescribing. Considering individual drugs, we found increased prescribing when receiving vs not receiving general payments for sunitinib (50.5% vs 34.4%, P = .01), dasatinib (13.8% vs 11.4%, P = .02), and nilotinib (15.4% vs 12.5%, P = .01) (Figure) but found decreased prescribing of imatinib (72.4% vs 75.5%, P = .02). Differences for sorafenib and pazopanib were not statistically significant. Research payments were not associated with statistically significant differences in prescribing for any individual drug. Results were similar when including payments specifically attributed to the drug of interest rather than all payments from the corresponding manufacturer and when changing the exposure to receipt of payments in both 2013 and 2014 (vs 2013 without respect to 2014). Our study had some limitations. These include the observational design precluding causal assessment, potential inaccuracies with Open Payments data, 5 lack of generalizability to other cancers, absence of information about the indications for the drugs, and small sample sizes for comparisons in the research payments analysis, notably for physicians receiving CML research payments. Conclusions | For 3 of the 6 cancer drugs studied, physicians who received general payments were more likely to prescribe the drug marketed by the company that made the payments. Imatinib was a notable exception; this may reflect a strategy by the manufacturer of imatinib (which also produces nilotinib) to promote switching to nilotinib before the patent expiration of imatinib in 2015.

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Noninvasive prenatal testing (NIPT) offers pregnant women a new risk assessment tool for fetal aneuploidy that is superior to conventional screening tests. We conducted focus groups with women who were currently pregnant or had recently delivered in the past year to characterize their perspectives about NIPT and to explore factors they would consider during decision making about its use. Women identified accuracy, early timing, testing ease, and determination of fetal sex as advantages of NIPT over other screens, and the noninvasive method of NIPT as an advantage over diagnostic tests. False positive and false negative results, anxiety, cost and insurance coverage were seen as disadvantages of NIPT. Women who do not want fetal aneuploidy information most likely will not undergo NIPT, despite its advantages over other screening tests. However, given its advantages, the decision to have NIPT is straightforward for women who want genetic information about the fetus. Women emphasized the need to make autonomous, private, and informed choices about NIPT, as they would with any prenatal genetic testing option. These perspectives may guide clinicians to conduct effective and clinically relevant counseling with pregnant women who consider utilizing this new genetic technology.

BackgroundThe recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes.DiscussionOur ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required.SummaryThe deep understanding of the ‘how’ and ‘why’ behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0607-0) contains supplementary material, which is available to authorized users.