Medical Specialties Commons^™

Factors Influencing Medication Adherence Among Adults Living With Diabetes And Comorbidities: A Qualitative Systematic Review, Kendall Gow, Amineh Qin, Lisa Whitehead

Research outputs 2022 to 2026

Purpose of review: Medication adherence plays an important role in improving health outcomes related to diabetes and comorbidity. The potential factors influencing medication adherence and how they contribute to health behaviors have not been synthesized to date. This review synthesized qualitative studies that identified factors influencing medication adherence among adults living with diabetes and comorbidity. Recent findings: Twenty-eight findings were extracted and synthesized into four themes: perceived support, lack of knowledge, medication issues, and the importance of routine. The findings highlight the factors that support medication adherence and areas that can be targeted to support and promote medication adherence. The …

Educating Oncology Nurses On Identifying And Managing Cancer-Related Distress, Rosemary Vivella Irish

Walden Dissertations and Doctoral Studies

AbstractUp to 50% of patients diagnosed with cancer will experience significant levels of distress. Cancer is related to psychological distress and can negatively impact recovery from surgery, increase treatment side effects, and decrease overall quality of life. The National Comprehensive Cancer Network recommended screening for distress as part of comprehensive cancer care. In the practice setting, there was a need for better assessment of distress in cancer patients. The purpose of this staff education project was to address a gap in practice regarding the lack of knowledge of screening for distress by providing education to oncology nurses on how to …

Oncology Nurses, Compassion Fatigue And General Health: A Mixed-Methods Study, Michelle Rampersad

Walden Dissertations and Doctoral Studies

Current literature on compassion fatigue is expansive, but there is a lack on the relationship between compassion fatigue and general health complaints in oncology nurses; how they perceive compassion fatigue and its relation to their general health. Using Pender’s health promotion model, this mixed methods study addressed how oncology nurses perceive compassion fatigue and whether a correlation exists between compassion fatigue and general health complaints. Data were collected from a sample of 55 oncology nurses through two separate Survey Monkey links. All 55 participants completed quantitative data points including a demographic questionnaire, the Professional Quality of Life 5 tool, and …

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Health-Related Quality Of Life And Disease Severity Among Patients With Idiopathic Pulmonary Fibrosis, Rowida Mohamed

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Predicting the survival of patients with Idiopathic pulmonary fibrosis (IPF) remains challenging due to the remarkable heterogeneity of the disease prognosis. Therefore, developing reliable prognostic tools is of utmost importance in IPF management. Nomograms currently represent the most accurate and discriminatory tools for predicting outcomes, with superior performance compared to the commonly used integer score approach. Therefore, developing a valid local nomogram to predict mortality among patients with IPF is warranted. Additionally, IPF is characterized by a high symptom burden significantly impacting Health-related quality of life (HRQoL). Accurately measuring HRQoL in IPF is crucial as it guides treatment decisions …

Relationships Among Pregnancy, Substance Use, Social Determinants Of Health And Assessment, Referral, And Utilization Of Treatment: A Secondary Analysis Of Nsduh Data, Heather Lynn Coddington

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Relationships Among Pregnancy, Substance Use, Social Determinants of Health and Assessment, Referral, and Utilization of Treatment: A Secondary Analysis of NSDUH Data

Heather Coddington

Background: Assessment and referral for substance use disorder during pregnancy is crucial to improving outcomes for mothers and newborns during the antepartum and postpartum period. Healthcare professionals are essential during the entirety of the pregnancy during each trimester to provide effective communication when assessing for substance use early and throughout each trimester of pregnancy. The purpose of this study was to determine if there was a relationship between assessment, referral, and utilization of treatment …

Palliative And End-Of-Life Care Access For Immigrants Living In High-Income Countries: A Scoping Review, Gertrude G. Phiri, Joyce Muge-Sugutt, Davina Porock

Research outputs 2022 to 2026

This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients’ family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in …

Reduced Serum Concentrations Of Reactive Oxygen And Nitrogen Species Following Strenuous Exercise In The Heat Are Not Associ-Ated With An Upregulation In Serum Antioxidative Capacity, Sebastian Keller, Hannah Lisa Notbohm, Wilhelm Bloch, Moritz Schumann

Baltic Journal of Health and Physical Activity

Introduction: Reactive oxygen and nitrogen species (RONS) are produced as a response to exercise and play a part in guiding the adaptive response to physical training. Exercise in the heat has been shown to further increase accumulation of RONS in systemic circulation; however, a high antioxidative response or heat acclimatization mechanisms could attenuate this response. In a previous study, we found reduced RONS concentrations in trained athletes following strenuous cycling in the heat. Therefore, this secondary analysis assessed whether these reduced RONS serum concentrations are induced by an increased serum antioxidant capacity. Methods: Twelve male cyclists (V̇O_2peak: 60 …

Pemberian Antibiotik Dini Berpengaruh Terhadap Mortalitas Covid-19?, Muchlis Achsan Udji Sofro

Jurnal Penyakit Dalam Indonesia

Coronavirus disease 2019 (COVID-19) merupakan infeksi saluran napas yang diakibatkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data di seluruh dunia sampai akhir Juni 2022 menunjukkan bahwa COVID-19 telah menyebabkan 6,2 juta kematian dengan jumlah 530 juta kasus.

Cutaneous Adverse Drug Reaction Among Hiv-Infected Patients Starting Antituberculosis Treatment, Alvina Widhani, Teguh Harjono Karjadi, Evy Yunihastuti, Desi Salwani, Angga Pramudita, Saut Horas Nababan, Mirna Nurasri Praptini, Prionggo Mondrowinduro

Jurnal Penyakit Dalam Indonesia

Introduction. Treatment of tuberculosis (TB) in HIV patients is complicated due to numerous comorbidities and possible adverse effects. One of which is cutaneous adverse drug reaction (CADR). This adverse event is often difficult to manage because of multiple medications the patients get. The objective of this study was to know the prevalence and risk factors of CADR among HIV-infected patients starting anti-TB treatment. Methods. This retrospective study reviewed data from medical records of new patients at Working Group on AIDS outpatient clinic at Cipto Mangunkusumo Hospital, Indonesia in January 2008-December 2010 that had started anti-TB treatment. Risk factors of CADR …

Determinant Factors Of Cognitive Frailty In Elderly Patients, Valencia Santoso, Rensa Rensa

Jurnal Penyakit Dalam Indonesia

Introduction. Physical frailty and cognitive impairment have a strong relationship and there are differences in factors associated with cognitive frailty. This research aimed to determine the prevalence of cognitive frailty and identify factors associated with cognitive frailty in the elderly population in hospital polyclinic. Methods. A cross-sectional study with secondary data on patients aged ≥60 years in the Internal Medicine Polyclinic of Atma Jaya Hospital, Jakarta, from May 2020 to May 2021. The independent variables of this study were age, cardiovascular disease, type 2 diabetes mellitus, dyslipidemia, risk of malnutrition, risk of depression, and functional status. The alternative criteria by …

Effectiveness Of Garlic Extract (Allium Sativum) To Reduce Level Of Malondialdehyde Serum And Improve Quality Of Life In Patients With Chronic Hemodialysis: A Randomized Double-Blind Placebo-Controlled Trial, Amelia Istiqomah, Zulkhair Ali, Irsan Saleh

Jurnal Penyakit Dalam Indonesia

Introduction. Study reported that malondialdehyde (MDA) levels as an in vivo marker of oxidative stress were increased in patients undergoing hemodialysis. Antioxidants allicin compounds contained in garlic (Allium sativum) are known to have antioxidant activity by inducing antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and inhibiting prooxidant enzymes (nitric oxide synthase, xanthine, NADPH oxidase, and cyclooxygenase). This study aimed to investigate the effectiveness of Allium sativum to reduce level of MDA serum and improve quality of life in patients with chronic hemodialysis. Methods. This study was a crossover randomized double-blind placebo-controlled trial. The subjects were 40 chronic kidney …

Effect Of Advance Care Planning On Heart Failure Patients: An Evidence Based Case Report, Hamzah Shatri, Nandika Nurfitria, Dika Sinulingga, Vinandia Irvianita, Edward Faisal, Rudi Putranto, Diah Martina

Jurnal Penyakit Dalam Indonesia

Despite the advances in medical therapy, heart failure remains a disease that requires attention due to the course of the illness; it can lead to unpredictable, progressive, and fatal conditions. Existing therapy aims to improve the condition and prevent disease progression, with a balanced secondary therapy for various conditions that can trigger acute decompensated heart failure. Advances in technology and therapy may increase the prevalence of patients with heart failure, including prolonging the refractory phase of the disease. There are recommendations for advance care planning to support patient therapy and improve the quality of life of patients with heart failure. …

Kecubung Intoxication: A Case Report On A 16-Year-Old Male At Kuningan District, Monica Djaja Saputera, Jessica Djaja Saputera

Jurnal Penyakit Dalam Indonesia

Kecubung (angel’s trumpet) is a plant with hallucinogen effect which contain a tropane alkaloid, which are widely grown in Indonesia and is widely abused by several groups of adolescents aged 18 years in East Nusa Tenggara. Kecubung intoxication is a common case in Indonesia, but rarely reported and hard to make a definitive diagnosis due to lack of the toxicology screening assessment. Besides, an antidote of this case also not available in this country. We present a case of 16-years old male who visited the emergency room with fluctuating level of consciousness accompanied by anxiety, anger, and a visual hallucination. …

Value Of Heart Rate Variability, Neutrophil-Lymphocyte Ratio And Quality Of Life Of Patients With Depressive Symptoms In Acute Myocardial Infarction, Hamzah Shatri, Mizanul Adli, Muhadi Muhadi, Murdani Abdullah, Cosphiadi Irawan, Rudi Putranto, Sukamto Koesnoe, Ika Prasetya Wijaya

Jurnal Penyakit Dalam Indonesia

Introduction. Major depression criteria can be found in more than 20% of coronary heart patients and more than 30% acute coronary syndrome patients have significant depressive symptoms. Several studies have shown that reduction of hearth rate variability (HRV) and enhancement of neutrophil lymphocyte ratio (NLR) can cause enhancement of morbidity and mortality in myocardial infarction patients. On the other hand, depression can cause reduction of HRV, enhancement of NLR and reduction of quality of life. This study aimed to determine differences in HRV, NLR and quality of life between acute myocardial infarction (AMI) patients with depressive symptoms and AMI patients …

Physical Exercise As Cytokine Modulator In Inflammatory Immune Response: A Systematic Review, Kartika Ratna Pertiwi, Evy Yulianti, Ukhti Jamil Rustiasari

Jurnal Keolahragaan

Physical exercise contributes to maintain our health, through its role in inflammatory immune response. Cytokines are proteins that mediate communication between immune cells, either as pro- or anti-inflammation agents. Nonetheless, the dominance of pro- over anti-inflammatory cytokines during a workout, is harmful to health. This systematic review aimed at determining the effect of physical activity in modulating pro- and anti-inflammatory cytokines during immune response. Following Preferred Reporting Items for Systematic Reviews (PRISMA) guideline, literature searching was conducted in 3 databases which were PUBMED/MEDLINE, DOAJ and GARUDA, using keywords, citation tracking and snowballing. Inclusion and exclusion criterias were used to screen, …

Small Extracellular Vesicle-Mediated Itgb6 Sirna Delivery Downregulates The Αvβ6 Integrin And Inhibits Adhesion And Migration Of Recipient Prostate Cancer Cells, Shiv Ram Krishn, Vaughn Garcia, Nicole M Naranjo, Fabio Quaglia, Christopher D Shields, Maisha A Harris, Andrew V Kossenkov, Qin Liu, Eva Corey, Dario C Altieri, Lucia R Languino

Department of Cancer Biology Faculty Papers

The αVβ6 integrin, an epithelial-specific cell surface receptor absent in normal prostate and expressed during prostate cancer (PrCa) progression, is a therapeutic target in many cancers. Here, we report that transcript levels of ITGB6 (encoding the β6 integrin subunit) are significantly increased in metastatic castrate-resistant androgen receptor-negative prostate tumors compared to androgen receptor-positive prostate tumors. In addition, the αVβ6 integrin protein levels are significantly elevated in androgen receptor-negative PrCa patient derived xenografts (PDXs) compared to androgen receptor-positive PDXs. In vitro, the androgen receptor-negative PrCa cells express high levels of the αVβ6 integrin compared to androgen receptor-positive PrCa cells. Additionally, …

Haircare Practice And Dandruff Problems Among Indonesian Medical Students, Jessica Rosemary Wikanto, Lorettha Wijaya, Yunisa Astiarani, Regina Regina

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Dandruff is an understated hair and scalp problem that causes striking social and concentration issues among medical students. Haircare practice among them may or may not be related to the dandruff incident.

Methods: A cross-sectional study was conducted on 74 pre-clinical medical students at Atma Jaya Catholic University of Indonesia. Trained health staff assessed dandruff prevalence by physical examination, and the haircare practice was measured using a questionnaire. Bivariate analysis was utilized to assess the association between haircare practice and dandruff prevalence’s.

Result: Among respondents, 85.1% of them have dandruff. Respondents who shampooed less than five …

Clinicodemographic And Laboratory Characteristics Of Cutaneous Tuberculosis At Tertiary Referral Hospital In West Java, Indonesia, Anisa Sediadini, Hendra Gunawan, Risa Miliawati Nurul Hidayah

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Cutaneous tuberculosis (TB) is a chronic infectious disease affecting the skin caused by Mycobacterium tuberculosis (M. tuberculosis). It constitutes 1–1.5% of extrapulmonary TB, with Indonesia being the third-highest TB burden country worldwide. Cutaneous TB is difficult to diagnose due to its varied presentations. This study aimed to describe the clinicodemographic and laboratory characteristics of cutaneous TB in a tertiary referral hospital in West Java, Indonesia.

Methods: This was a descriptive retrospective cross-sectional study. Data were obtained from the medical record of patients with cutaneous TB in the Tropical Dermatology Clinic of Hasan Sadikin Hospital Bandung, West Java, …

The Difference In Transepidermal Water Loss (Tewl) Values Between Sun-Exposed And Non-Sun-Exposed Skin Among Male Medical Students, Ihsany Arafiasetyanto Prihadi, Endra Yustin Ellistasari, Arie Kusumawardani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Transepidermal Water Loss (TEWL) is the amount of water released from the human body into the atmosphere through a diffusion process per unit of time. Changes in TEWL indicate impaired skin barrier function. Exposure to ultraviolet light for an extended period can cause photoaging, characterized by rough and dry skin (xerosis cutis). TEWL will increase significantly in the skin exposed to ultraviolet radiation. This study aims to determine the difference in the TEWL values among male medical students in the sun-exposed and non-sun-exposed skin areas.

Methods: An analytical observational cross-sectional study was conducted at the Dermatology and …

Risk Factors For Hiv-Positive Status In Condyloma Acuminata, Izazi Hari Purwoko, Putri Laksmi Karim, Suroso Adi Nugroho, Theresia Toruan, Fitriani .

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Condyloma acuminata (CA) is a sexually transmitted infection (STI) caused by human papillomavirus (HPV), especially types 6 and 11. The number of HPV infections increases in immunosuppressed conditions, such as human immunodeficiency virus (HIV) infection. Risk factors in CA patients such as gender, sexual partner, sexual orientation, and sexual intercourse can increase HIV status.

Methods: This is a descriptive-analytic study with a cohort retrospective design. The subjects are all CA patients who visited the polyclinic STI Dr. Mohammad Hoesin, General Hospital, Palembang, Indonesia, between 2016-2020. The number of CA patients included in the study were 115 patients …

A Case Of Longitudinal Melanonychia In A Child: Benign Or Malignant?, Heffi Anindya Putri, Ennesta Asri, Qaira Anum

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Longitudinal melanonychia (LM) describes a longitudinal brown-to-black band of discoloration affecting a finger, thumb, or toenail. Discoloration of the nails can be a sign of benign or malignant nail disorders. Although nail melanoma rarely occurs in children, health practitioners should be aware of melanonychia. Dermoscopy and histopathology are helpful in the diagnosis.

Case Illustration: A case of LM in a thirteen-year-old girl was reported with a complaint of brownish-black discoloration, sometimes painful, on her right thumb since 1 year ago. She had no history of trauma, nail damage, or bleeding tendency. Dermatological examination found a homogeneous brownish-black …

Seborrheic Keratosis Profile At Dr. Hasan Sadikin Central General Hospital Bandung 2015-2019, Eva Krishna Sutedja, Resti Gradia, Tri Aswila Latifah

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Seborrheic keratosis (SK) is adults’ most prevalent benign skin tumor. SK originates from the proliferation of keratinocyte cells with varying morphology and degree of pigmentation. The lesions often resemble other types of malignancy. There are still many discrepancies in SK in Indonesia; hence, SK needs further understanding. This study aimed to describe the profile of seborrheic keratosis cases based on age, sex, location of lesions, and therapy at Dr. Hasan Sadikin Central General Hospital, Bandung, for five years

Methods: This was a retrospective descriptive study with total sampling. Secondary data were collected from medical records of SK …

Non-Pustular Annular Psoriasis With Signs Of High Disease Activity, Nevi Yasnova, Windy Keumala Budianti, Melody Febriana Andardewi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Non-pustular annular psoriasis is a rare condition in which a type of plaque psoriasis appears with ring-like lesions and a clearer central appearance. The disease activities in psoriasis may be evaluated clinically. It is essential to provide a more meaningful approach to treatment management.

Case illustration: A 33-year-old woman complained of a one-year history of multiple erythematous, scaly, and annular plaques with central clearing. Some lesions were surrounded by discrete pinpoint papules on several parts of her body. The lesions worsened during seven weeks of topical and systemic therapy.

Discussion: Psoriasis is a chronic, multisystem inflammatory …

Association Between Early Antibiotic Administration And In-Hospital Mortality In Moderate And Severe Covid-19 Patients, Lie Khie Chen, Jason Nathanael, Sharifah Shakinah, Adeline Pasaribu, Robert Sinto, Leonard Nainggolan, Adityo Susilo

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with moderate and severe COVID-19 generally receive antibiotic therapy with consideration of the possibility of co-infection or secondary bacterial infection which clinically is difficult to distinguish from COVID-19 symptoms. Overuse of antibiotics can lead to an increased risk of bacterial resistance to antibiotics which is associated with poor outcomes in COVID-19 patients. This study aimed to assess the effect of early antibiotic administration on mortality in moderate and severe COVID-19 patients. Methods. An observational study with a retrospective cohort design was conducted at Dr. Cipto Mangunkusumo Hospital. Data were obtained from medical records of patients admitted from March …

Second-Line Therapy Tyrosine Kinase Inhibitor For Chronic Phase Chronic Myeloid Leukemia Resistant To Imatinib, Chici Pratiwi, Wulyo Rajabto

Jurnal Penyakit Dalam Indonesia

Since the era of tyrosine kinase inhibitor (TKI) therapy, there has been an increase in the median survival of chronic myeloid leukemia. Nevertheless, nowadays there were several cases of chronic myeloid leukemia that are resistant to the first-line TKIs, so that several second-line TKIs were introduced. Assessment of the therapeutic response was performed using a complete peripheral blood examination, bone marrow aspiration cytogenetic examination, and quantitative BCR-ABL examination. The treatment failure criteria were applied based on the ELN criteria. In selecting the second line TKI should be based on the results of mutation analysis and consider the safety profile of …

Evaluation Of The Efficacy Of The Anti-Ulcer Oral Mucosal Protective Agent Radoralex® In The Prevention And Treatment Of Radiation-Induced Oral Mucosal Reactions Induced During Treatment Of Nasopharyngeal Carcinoma, Jun Yin, Jirui Xie, Jiawei Lin, Chengyin Weng, Shun Lu, Peng Xu, Shuo Zhang, Cheng Luo, Yecai Huang, Lu Li, Jinyi Lang, Mei Feng

Faculty, Staff and Student Publications

The aim of this study was to evaluate the efficacy and safety of antiulcer oral mucosal protectant-RADoralex® in the prevention and treatment of radiation-induced oral mucosal reactions elicited during intensity-modulated radiation therapy (IMRT). for locally advanced nasopharyngeal carcinoma (NPC). A total of 90 patients with locally advanced NPC who developed post-treatment grade 1 oral mucositis were selected for this study. They were randomly assigned to the experimental group (n = 44) treated by mouth rinsing with the RADoralex® during radiochemotherapy and the control group (n = 43) treated by mouth rinsing with sodium bicarbonate solution, and the patients’ oral mucosal …

Habitat Imaging Biomarkers For Diagnosis And Prognosis In Cancer Patients Infected With Covid-19, Muhammad Aminu, Divya Yadav, Lingzhi Hong, Elliana Young, Paul Edelkamp, Maliazurina Saad, Morteza Salehjahromi, Pingjun Chen, Sheeba J Sujit, Melissa M Chen, Bradley Sabloff, Gregory Gladish, Patricia M De Groot, Myrna C B Godoy, Tina Cascone, Natalie I Vokes, Jianjun Zhang, Kristy K Brock, Naval Daver, Scott E Woodman, Hussein A Tawbi, Ajay Sheshadri, J Jack Lee, David Jaffray, D Code Team, Carol C Wu, Caroline Chung, Jia Wu

Faculty, Staff and Student Publications

OBJECTIVES: Cancer patients have worse outcomes from the COVID-19 infection and greater need for ventilator support and elevated mortality rates than the general population. However, previous artificial intelligence (AI) studies focused on patients without cancer to develop diagnosis and severity prediction models. Little is known about how the AI models perform in cancer patients. In this study, we aim to develop a computational framework for COVID-19 diagnosis and severity prediction particularly in a cancer population and further compare it head-to-head to a general population.

METHODS: We have enrolled multi-center international cohorts with 531 CT scans from 502 general patients and …

A Pilot Intervention Combining Assessment And Feedback With Communication Training And Behavioral Nudges To Increase Hpv Vaccine Uptake., Andrea Bradley-Ewing, Brian R. Lee, Jason N. Doctor, Georgann Meredith, Kathy Goggin, Angela Myers

Manuscripts, Articles, Book Chapters and Other Papers

Human papillomavirus (HPV) causes >40,000 cancer diagnoses each year, yet vaccination rates remain low because widespread implementation of strategies to increase vaccinations has not occurred. Behavioral nudges have demonstrated efficacy in improving uptake of desired behaviors in health care settings but have not been tested for increasing HPV vaccinations. We assessed the impact of an intervention combining behavioral nudges with other proven strategies (i.e., assessment and feedback, provider communication training) on HPV vaccination rates and parental satisfaction in four Midwestern pediatric, outpatient practices. Practices were randomly assigned to receive either assessment and feedback or assessment and feedback combined with vaccine …