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Darwish M, D'Oria M, Croo A, Melo RG, Meecham L. Prospective Multi-Center Longitudinal Study to Validate Accuracy of the Global Anatomic Staging System (GLASS) Score in Predicting Major Acute Limb Events in Patients With Chronic Limb Threatening Ischemia Undergoing Endovascular Intervention: The PROMOTE-GLASS Study Protocol. Vasc Endovascular Surg 2024:15385744241276690. [PMID: 39226237 DOI: 10.1177/15385744241276690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Developed by the Global Vascular Guidelines committee, the Global Limb Anatomic Staging System (GLASS) is an angiographic scoring system used for quantifying infrainguinal disease extent and predicting treatment success with endovascular techniques (EVT). Currently, no other risk prediction model is available for patients with chronic limb threatening ischemia (CLTI) undergoing EVT. GLASS' validation and adoption outside academic institutions for research are limited. Thus, this longitudinal multicenter prospective study aims to examine GLASS' validity and reliability in predicting major acute limb events and overall survival (OS) in patients with CLTI undergoing EVT. METHODS AND ANALYSIS This prospective, international, multicenter, observational study will include patients with CLTI undergoing EVT (PROMOTE-GLASS) (ClinicalTrials.gov; ID: NCT06186544) identified through routine clinical referrals and emergency visits to vascular units in participating centers. Only patients who are referred for EVT will be recruited. The primary outcomes are immediate technical success, immediate technical failure, and 1-year limb base patency. The secondary outcomes are major adverse limb events, major lower limb amputation, and OS in patients presenting with CLTI who undergo EVT up to 1 year after the procedure. Clinical and imaging data will be analyzed at the end of follow-up to validate risk prediction. This protocol outlines our approach for identifying cases, GLASS score calculation, outcome measures assessment, and a statistical analysis plan. ANTICIPATED IMPLICATIONS PROMOTE-GLASS holds significant implications and can potentially revolutionize clinical decision-making by assisting clinicians in identifying patients who are likely to benefit from EVT. Ultimately, reduce the need for more invasive procedures and improve patient outcomes. Furthermore, PROMOTE-GLASS can provide useful information, including patient selection, for future randomized controlled trials (RCTs) investigating EVT for CLTI. PROMOTE-GLASS anticipated implications on the vascular community are rooted in its potential to improve patient care, inform future research, and address limitations in existing literature regarding CLTI treatment outcomes.
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Affiliation(s)
- Maram Darwish
- Southeast Wales Vascular Network, University Hospital of Wales, Cardiff, UK
- The East Midlands Deanery, Health Education England, Leicester, UK
| | - Mario D'Oria
- Department of Vascular and Endovascular Surgery, University Hospital of Trieste, Trieste, Italy
- Medical School, University of Trieste, Trieste, Italy
| | - Alexander Croo
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ryan Gouveia Melo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
- Department of Angiology and Vascular Surgery, Hospital da Luz Torres de Lisboa, Lisboa, Portugal
| | - Lewis Meecham
- Southeast Wales Vascular Network, University Hospital of Wales, Cardiff, UK
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Bednarek L, Glover S, Ma X, Pittenger C, Pushkarskaya H. Externally orienting cues improve cognitive control in OCD. J Behav Ther Exp Psychiatry 2024; 84:101959. [PMID: 38531125 PMCID: PMC11192454 DOI: 10.1016/j.jbtep.2024.101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/31/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVES An executive overload model of obsessive-compulsive disorder (OCD) posits that broad difficulties with executive functioning in OCD result from an overload on the executive system by obsessive thoughts. It implies that, if individuals with OCD "snap out" of their obsessive thoughts, their performance on neurocognitive tasks will improve. METHODS We test this prediction using the revised Attention Network Test, ANT-R, and distinct subsamples of data from unmedicated OCD and healthy controls (HC). ANT-R includes Simon and Flanker tasks; in both, incongruent trials take longer to resolve ('conflict costs'). On some trials, a warning cue helps participants to respond faster ('alerting benefits'). In OCD (N = 34) and HC (N = 46), matched on age, IQ, and sex, we tested (1) the effect of OCD on alerting benefits, and (2) the effect of OCD on warning cue related reductions in conflict costs. In a distinct subsample of OCD (N = 32) and HC (N = 51), we assessed whether alerting benefits and cue-related reductions in conflict costs are associated differently with different OCD symptoms. RESULTS A warning cue can help individuals with OCD more than HC to improve performance on Simon and Flanker tasks. This effect is positively associated with severity of contamination symptoms. LIMITATIONS This study did not directly assess how distracted participants are by obsessive thoughts. It relied on the ANT-R subtraction measures. Symptom severity was assessed using self-report measures. CONCLUSIONS Difficulties in resolving conflict during decision-making in OCD can be modulated by a warning cue presented immediately before an attentional task.
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Affiliation(s)
- Lora Bednarek
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Stephanie Glover
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States
| | - Xiao Ma
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University, New Haven, CT, United States; Yale Child Study Center, Yale School of Medicine, New Haven, CT, United States; Wu Tsai Institute, Yale University, New Haven, CT, United States; Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT, United States
| | - Helen Pushkarskaya
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
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Hermansen LL, Iversen TF, Iversen P, Viberg B, Overgaard S. The "true" 1-year incidence of dislocation after primary total hip arthroplasty: validation of an algorithm identifying dislocations in the Danish National Patient Register based on 5,415 patients from the Danish Hip Arthroplasty Register. Acta Orthop 2024; 95:380-385. [PMID: 39016045 PMCID: PMC11253031 DOI: 10.2340/17453674.2024.41064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/11/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND AND PURPOSE Dislocations continue to be a serious complication after primary total hip arthroplasty (THA). Our primary aim was to report the "true" incidence of dislocations in Denmark and secondarily to validate a previously developed algorithm designed to identify THA dislocations in the updated version of the Danish National Patient Register (DNPR), based on data from the Danish Hip Arthroplasty Register (DHR). METHODS We included 5,415 primary THAs from the DHR performed from July 1 to December 31, 2019. Version 3 of the DNPR was launched in February 2019, and a combination of data from the DNPR and a comprehensive national review of 1,762 hospital contacts enabled us to identify every dislocation occurring during the 1st year after THA to determine the "true" 1-year incidence of dislocation. The results were presented as proportions with 95% confidence intervals (CI), and validation was performed by calculating sensitivity and predictive values. RESULTS The "true" 1-year incidence of dislocation was 2.8% (CI 2.4-3.3). Of these, 37% suffered recurrent dislocations during the follow-up period. Between-hospital variation ranged from 0.0% to 9.6%. The algorithm demonstrated a sensitivity close to 95%, while maintaining a positive predictive value of above 94%. CONCLUSION The "true" 1-year incidence of dislocation of 2.8% is comparable to earlier findings, and large variation among hospitals continues to be evident. We have proven the algorithm to be valid in the latest DNPR (version 3), enabling it to be employed as a new quality indicator in future annual DHR reports.
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Affiliation(s)
- Lars L Hermansen
- Department of Orthopedics, University Hospital of Southern Denmark, Esbjerg; Department of Regional Health Research, University of Southern Denmark, Odense.
| | | | - Pernille Iversen
- The Danish Clinical Quality Program and Clinical Registries (RKKP)
| | - Bjarke Viberg
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Bispebjerg Hospital; Department of Clinical Research, University of Copenhagen, Denmark
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Jelmini JD, Gribble PA, Abel MG, Whitehurst LN, Heebner NR. The Influence of Emergency Call Volume on Occupational Workload and Sleep Quality in Urban Firefighters. J Occup Environ Med 2024; 66:580-589. [PMID: 38640943 DOI: 10.1097/jom.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
OBJECTIVE The aim of the study is to determine the impact of emergency call volume on exertion, autonomic activity, and sleep among urban structural firefighters. METHODS Thirty-four firefighters wore a wrist-based monitor to track sleep and autonomic parameters and rated their level of perceived exertion (Borg Rating of Perceived Exertion) and subjective sleepiness after a 24-hour shift. Predictive variables included total run time and total run time after 11:59 PM. RESULTS Total run time and sleep duration accounted for Borg Rating of Perceived Exertion and subjective sleepiness, while total run time and total run time after 11:59 PM accounted for sleep durations on-duty. CONCLUSIONS The current results suggest that emergency call volume is associated with indicators of exertion and sleep. As such, call volume tracking is an important consideration for departments to ensure personnel readiness and wellness and provide a method of tracking the occupational demands experienced by firefighters on-duty.
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Affiliation(s)
- Jacob D Jelmini
- From the Sports Medicine Research Institute, College of Health Sciences, University of Kentucky, Lexington, Kentucky (J.D.J., N.R.H.); Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, Kentucky (P.A.G.); First Responder Research Laboratory, Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky (M.G.A.); and Department of Psychology, University of Kentucky, Lexington, Kentucky (L.N.W.)
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Lu E, Baril DT, Arbabi CN, Chou EL, Azizzadeh A, Gupta N. Outcomes of prosthetic upper arm arteriovenous graft vs brachiobasilic fistula for hemodialysis access. J Vasc Surg 2024:S0741-5214(24)01225-4. [PMID: 38909916 DOI: 10.1016/j.jvs.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Primary arteriovenous access such as radiocephalic and brachiocephalic fistulas are initial choices for creating vascular access in dialysis patients. When neither of these choices is an option, upper arm arteriovenous graft or brachiobasilic transposition is recommended. Although primary fistula is better than prosthetic graft for suitable patients, there is little data to guide the best treatment strategy in the absence of suitable vein for primary access creation. This study identifies factors that influence patency rates and compares outcomes of patients treated with brachiobasilic fistula vs upper arm graft in patients who have failed forearm access or are not candidates for primary access. METHODS A prospectively maintained database of patients with dialysis-dependent renal failure from 2010 to 2022 was analyzed. Primary, primary assisted, and secondary patency rates were calculated. Incidence rates of complications and reinterventions were compared. RESULTS There were 148 patients with brachiobasilic fistulas and 157 patients with upper arm grafts. The graft group was older (70.1 ± 14.7 vs 62.5 ± 14.6 years; P = .003) and had a higher incidence of pacemakers (11.9% vs 4.1%; P = .005). Brachiobasilic fistulas had higher 6-month (77.0% vs 64.3%; P = .02) and 1-year (68.2% vs 55.4%; P = .03) primary-assisted patency. Secondary patency rates were better for upper arm grafts at 1-year (82.2% vs 72.3%; P = .05). Access complications of non-maturation and aneurysm were higher in basilic vein transposition (21.6% vs 1.3%; P < .0001; 15.5% vs 6.4%; P = .017). Grafts had higher rates of occlusion (58.0% vs 25.7%; P < .0001). In terms of interventions, upper arm grafts had higher rates of thrombectomy (50.3% vs 18.9%; P < .0001), but there was no difference seen in angioplasty, stent, surgical revision, or steal procedures. Basilic vein transpositions had longer time to cannulation (104.6 ± 81.1 vs 32.5 ± 22.4 days; P < .0001), longer total catheter days (251.1 ± 181.7 vs 72.9 ± 56.3 days; P < .0001), and higher number of procedures to aid maturity (0.7 ± 0.7 vs 0.1 ± 0.3; P < .0001). CONCLUSIONS In this retrospective analysis, when forearm access or primary arteriovenous access is not an option, basilic vein transposition and upper arm grafts have fairly equivalent primary patency. Primary assisted patency is slightly better in basilic vein fistulas, but secondary patency is better in upper arm grafts at 1 year. Basilic fistulas also had longer time to cannulation, longer total catheter days, and more procedures to aid maturity.
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Affiliation(s)
- Eileen Lu
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Donald T Baril
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cassra N Arbabi
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elizabeth L Chou
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ali Azizzadeh
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Navyash Gupta
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Fredericks-Younger J, Greenberg P, Andrews T, Matheson PB, Desjardins PJ, Lu SE, Feldman CA. Leveraging the functionality of Research Electronic Data Capture (REDCap) to enhance data collection and quality in the Opioid Analgesic Reduction Study. Clin Trials 2024; 21:381-389. [PMID: 37961913 PMCID: PMC11090991 DOI: 10.1177/17407745231212190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The Opioid Analgesic Reduction Study is a double-blind, prospective, clinical trial investigating analgesic effectiveness in the management of acute post-surgical pain after impacted third molar extraction across five clinical sites. Specifically, Opioid Analgesic Reduction Study examines a commonly prescribed opioid combination (hydrocodone/acetaminophen) against a non-opioid combination (ibuprofen/acetaminophen). The Opioid Analgesic Reduction Study employs a novel, electronic infrastructure, leveraging the functionality of its data management system, Research Electronic Data Capture, to not only serve as its data reservoir but also provide the framework for its quality management program. METHODS Within the Opioid Analgesic Reduction Study, Research Electronic Data Capture is expanded into a multi-function management tool, serving as the hub for its clinical data management, project management and credentialing, materials management, and quality management. Research Electronic Data Capture effectively captures data, displays/tracks study progress, triggers follow-up, and supports quality management processes. RESULTS At 72% study completion, over 12,000 subject data forms have been executed in Research Electronic Data Capture with minimal missing (0.15%) or incomplete or erroneous forms (0.06%). Five hundred, twenty-three queries were initiated to request clarifications and/or address missing data and data discrepancies. CONCLUSION Research Electronic Data Capture is an effective digital health technology that can be maximized to contribute to the success of a clinical trial. The Research Electronic Data Capture infrastructure and enhanced functionality used in Opioid Analgesic Reduction Study provides the framework and the logic that ensures complete, accurate, data while guiding an effective, efficient workflow that can be followed by team members across sites. This enhanced data reliability and comprehensive quality management processes allow for better preparedness and readiness for clinical monitoring and regulatory reporting.
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Affiliation(s)
| | | | - Tracy Andrews
- Rutgers University, School of Public Health, New Brunswick, NJ, USA
| | | | | | - Shou-En Lu
- Rutgers University, School of Public Health, New Brunswick, NJ, USA
| | - Cecile A Feldman
- Rutgers University, School of Dental Medicine, Newark, NJ, USA
- Rutgers University, School of Public Health, New Brunswick, NJ, USA
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Wahid KA, Sahin O, Kundu S, Lin D, Alanis A, Tehami S, Kamel S, Duke S, Sherer MV, Rasmussen M, Korreman S, Fuentes D, Cislo M, Nelms BE, Christodouleas JP, Murphy JD, Mohamed AS, He R, Naser MA, Gillespie EF, Fuller CD. Associations Between Radiation Oncologist Demographic Factors and Segmentation Similarity Benchmarks: Insights From a Crowd-Sourced Challenge Using Bayesian Estimation. JCO Clin Cancer Inform 2024; 8:e2300174. [PMID: 38870441 PMCID: PMC11214868 DOI: 10.1200/cci.23.00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE The quality of radiotherapy auto-segmentation training data, primarily derived from clinician observers, is of utmost importance. However, the factors influencing the quality of clinician-derived segmentations are poorly understood; our study aims to quantify these factors. METHODS Organ at risk (OAR) and tumor-related segmentations provided by radiation oncologists from the Contouring Collaborative for Consensus in Radiation Oncology data set were used. Segmentations were derived from five disease sites: breast, sarcoma, head and neck (H&N), gynecologic (GYN), and GI. Segmentation quality was determined on a structure-by-structure basis by comparing the observer segmentations with an expert-derived consensus, which served as a reference standard benchmark. The Dice similarity coefficient (DSC) was primarily used as a metric for the comparisons. DSC was stratified into binary groups on the basis of structure-specific expert-derived interobserver variability (IOV) cutoffs. Generalized linear mixed-effects models using Bayesian estimation were used to investigate the association between demographic variables and the binarized DSC for each disease site. Variables with a highest density interval excluding zero were considered to substantially affect the outcome measure. RESULTS Five hundred seventy-four, 110, 452, 112, and 48 segmentations were used for the breast, sarcoma, H&N, GYN, and GI cases, respectively. The median percentage of segmentations that crossed the expert DSC IOV cutoff when stratified by structure type was 55% and 31% for OARs and tumors, respectively. Regression analysis revealed that the structure being tumor-related had a substantial negative impact on binarized DSC for the breast, sarcoma, H&N, and GI cases. There were no recurring relationships between segmentation quality and demographic variables across the cases, with most variables demonstrating large standard deviations. CONCLUSION Our study highlights substantial uncertainty surrounding conventionally presumed factors influencing segmentation quality relative to benchmarks.
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Affiliation(s)
- Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Onur Sahin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Suprateek Kundu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Alanis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Salik Tehami
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Serageldin Kamel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simon Duke
- Department of Radiation Oncology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Mathis Rasmussen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Cislo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John P. Christodouleas
- Department of Radiation Oncology, The University of Pennsylvania Cancer Center, Philadelphia, PA
- Elekta, Atlanta, GA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mohammed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin F. Gillespie
- Department of Radiation Oncology, University of Washington Fred Hutchinson Cancer Center, Seattle, WA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bateson D, Ussher J, Strnadová I, Loblinzk J, David M, Chang EL, Carter A, Sweeney S, Winkler L, Power R, Basckin C, Kennedy E, Jolly H. Working together with people with intellectual disability to make a difference: a protocol for a mixed-method co-production study to address inequities in cervical screening participation. Front Public Health 2024; 12:1360447. [PMID: 38846600 PMCID: PMC11155193 DOI: 10.3389/fpubh.2024.1360447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/12/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Cervical cancer is one of the most preventable cancers yet remains a disease of inequity for people with intellectual disability, in part due to low screening rates. The ScreenEQUAL project will use an integrated knowledge translation (iKT) model to co-produce and evaluate accessible cervical screening resources with and for this group. Methods Stage 1 will qualitatively explore facilitators and barriers to screening participation for people with intellectual disability, families and support people, healthcare providers and disability sector stakeholders (n ≈ 20 in each group). An accessible multimodal screening resource, accompanying supporting materials for families and support people, and trauma-informed healthcare provider training materials will then be co-produced through a series of workshops. Stage 2 will recruit people with intellectual disability aged 25 to 74 who are due or overdue for screening into a single-arm trial (n = 48). Trained support people will provide them with the co-produced resource in accessible workshops (intervention) and support them in completing pre-post questions to assess informed decision-making. A subset will participate in qualitative post-intervention interviews including optional body-mapping (n ≈ 20). Screening uptake in the 9-months following the intervention will be measured through data linkage. Family members and support people (n = 48) and healthcare providers (n = 433) will be recruited into single-arm sub-studies. Over a 4-month period they will, respectively, receive the accompanying supporting materials, and the trauma-informed training materials. Both groups will complete pre-post online surveys. A subset of each group (n ≈ 20) will be invited to participate in post-intervention semi-structured interviews. Outcomes and analysis Our primary outcome is a change in informed decision-making by people with intellectual disability across the domains of knowledge, attitudes, and screening intention. Secondary outcomes include: (i) uptake of screening in the 9-months following the intervention workshops, (ii) changes in health literacy, attitudes and self-efficacy of family members and support people, and (iii) changes in knowledge, attitudes, self-efficacy and preparedness of screening providers. Each participant group will evaluate acceptability, feasibility and usability of the resources. Discussion If found to be effective and acceptable, the co-produced cervical screening resources and training materials will be made freely available through the ScreenEQUAL website to support national, and potentially international, scale-up.
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Affiliation(s)
- Deborah Bateson
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Iva Strnadová
- University of New South Wales, Faculty of Arts Design and Architecture, School of Education, Sydney, NSW, Australia
- University of New South Wales, Disability Innovation Institute, Sydney, NSW, Australia
| | | | - Michael David
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Ee-Lin Chang
- Family Planning Australia, Sydney, NSW, Australia
| | - Allison Carter
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Lauren Winkler
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Rosalie Power
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Caroline Basckin
- University of New South Wales, Faculty of Arts Design and Architecture, School of Education, Sydney, NSW, Australia
| | - Elizabeth Kennedy
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
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Parmar J, L’Heureux T, Lobchuk M, Penner J, Charles L, St. Amant O, Ward-Griffin C, Anderson S. Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing me down". PLoS One 2024; 19:e0298584. [PMID: 38626216 PMCID: PMC11020535 DOI: 10.1371/journal.pone.0298584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/28/2024] [Indexed: 04/18/2024] Open
Abstract
The COVID-19 pandemic has considerably strained health care providers and family caregivers. Double-duty caregivers give unpaid care at home and are employed as care providers. This sequential mixed-method study, a survey followed by qualitative interviews, aimed to comprehensively understand the experiences of these Canadian double-duty caregivers amidst the pandemic and the transition to the endemic phase. The multi-section survey included standardized assessments such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with demographic, employment-related, and care work questions. Data analysis employed descriptive and linear regression modeling statistics, and content analysis of the qualitative data. Out of the 415 respondents, the majority were female (92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 years. 68.9% reported mental health decline over the past year, while 60.7% noted physical health deteriorated. 75.9% of participants self-rated their anxiety as moderate to high. The final regression model explained 36.8% of the variance in participants' anxiety levels. Factors contributing to lower anxiety included more personal supports, awareness of limits, younger age, and fewer weekly employment hours. Increased anxiety was linked to poorer self-rated health, and both perceptions and consequences of blurred boundaries. The eighteen interviewees highlighted the stress of managing additional work and home care during the pandemic. They highlighted the difficulty navigating systems and coordinating care. Double-duty caregivers form a significant portion of the healthcare workforce. Despite the spotlight on care and caregiving during the COVID-19 pandemic, the vital contributions and well-being of double-duty caregivers and family caregivers have remained unnoticed. Prioritizing their welfare is crucial for health systems as they make up the largest care workforce, particularly evident during the ongoing healthcare workforce shortage.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya L’Heureux
- Department of Family Medicine Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Lobchuk
- Helen Glass College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamie Penner
- Helen Glass College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lesley Charles
- Department of Family Medicine Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Oona St. Amant
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Catherine Ward-Griffin
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Sharon Anderson
- Department of Family Medicine Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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García-Vilchis B, Román-López TV, Ramírez-González D, López-Camaño XJ, Murillo-Lechuga V, Díaz-Téllez X, Sánchez-Moncada CI, Espinosa-Méndez IM, Zenteno-Morales D, Espinosa-Valdes ZX, Pradel-Jiménez S, Tapia-Atilano A, Zanabria-Pérez AV, Livas-Gangas F, Aldana-Assad O, Caballero-Sánchez U, Dominguez-Frausto CA, Rentería ME, Medina-Rivera A, Alcauter S, Ruiz-Contreras AE. TwinsMX: Exploring the Genetic and Environmental Influences on Health Traits in the Mexican Population. Twin Res Hum Genet 2024; 27:85-96. [PMID: 38699821 DOI: 10.1017/thg.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
TwinsMX registry is a national research initiative in Mexico that aims to understand the complex interplay between genetics and environment in shaping physical and mental health traits among the country's population. With a multidisciplinary approach, TwinsMX aims to advance our knowledge of the genetic and environmental mechanisms underlying ethnic variations in complex traits and diseases, including behavioral, psychometric, anthropometric, metabolic, cardiovascular and mental disorders. With information gathered from over 2800 twins, this article updates the prevalence of several complex traits; and describes the advances and novel ideas we have implemented such as magnetic resonance imaging. The future expansion of the TwinsMX registry will enhance our comprehension of the intricate interplay between genetics and environment in shaping health and disease in the Mexican population. Overall, this report describes the progress in the building of a solid database that will allow the study of complex traits in the Mexican population, valuable not only for our consortium, but also for the worldwide scientific community, by providing new insights of understudied genetically admixed populations.
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Affiliation(s)
- Brisa García-Vilchis
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Talia V Román-López
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Diego Ramírez-González
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Xanat J López-Camaño
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Vanessa Murillo-Lechuga
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Xóchitl Díaz-Téllez
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | | | - Ian M Espinosa-Méndez
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Diego Zenteno-Morales
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Zaida X Espinosa-Valdes
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Sofia Pradel-Jiménez
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Andrea Tapia-Atilano
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ana V Zanabria-Pérez
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Federica Livas-Gangas
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Oscar Aldana-Assad
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Ulises Caballero-Sánchez
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Miguel E Rentería
- Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alejandra Medina-Rivera
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Sarael Alcauter
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, México
| | - Alejandra E Ruiz-Contreras
- Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias. Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
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11
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English A, McDaid D, Lynch SM, McLaughlin J, Cooper E, Wingfield B, Kelly M, Bhavsar M, McGilligan V, Irwin RE, Bucholc M, Zhang SD, Shukla P, Rai TS, Bjourson AJ, Murray E, Gibson DS, Walsh C. Genomic, Proteomic, and Phenotypic Biomarkers of COVID-19 Severity: Protocol for a Retrospective Observational Study. JMIR Res Protoc 2024; 13:e50733. [PMID: 38354037 PMCID: PMC10868637 DOI: 10.2196/50733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Health organizations and countries around the world have found it difficult to control the spread of COVID-19. To minimize the future impact on the UK National Health Service and improve patient care, there is a pressing need to identify individuals who are at a higher risk of being hospitalized because of severe COVID-19. Early targeted work was successful in identifying angiotensin-converting enzyme-2 receptors and type II transmembrane serine protease dependency as drivers of severe infection. Although a targeted approach highlights key pathways, a multiomics approach will provide a clearer and more comprehensive picture of severe COVID-19 etiology and progression. OBJECTIVE The COVID-19 Response Study aims to carry out an integrated multiomics analysis to identify biomarkers in blood and saliva that could contribute to host susceptibility to SARS-CoV-2 and the development of severe COVID-19. METHODS The COVID-19 Response Study aims to recruit 1000 people who recovered from SARS-CoV-2 infection in both community and hospital settings on the island of Ireland. This protocol describes the retrospective observational study component carried out in Northern Ireland (NI; Cohort A); the Republic of Ireland cohort will be described separately. For all NI participants (n=519), SARS-CoV-2 infection has been confirmed by reverse transcription-quantitative polymerase chain reaction. A prospective Cohort B of 40 patients is also being followed up at 1, 3, 6, and 12 months postinfection to assess longitudinal symptom frequency and immune response. Data will be sourced from whole blood, saliva samples, and clinical data from the electronic care records, the general health questionnaire, and a 12-item general health questionnaire mental health survey. Saliva and blood samples were processed to extract DNA and RNA before whole-genome sequencing, RNA sequencing, DNA methylation analysis, microbiome analysis, 16S ribosomal RNA gene sequencing, and proteomic analysis were performed on the plasma. Multiomics data will be combined with clinical data to produce sensitive and specific prognostic models for severity risk. RESULTS An initial demographic and clinical profile of the NI Cohort A has been completed. A total of 249 hospitalized patients and 270 nonhospitalized patients were recruited, of whom 184 (64.3%) were female, and the mean age was 45.4 (SD 13) years. High levels of comorbidity were evident in the hospitalized cohort, with cardiovascular disease and metabolic and respiratory disorders being the most significant (P<.001), grouped according to the International Classification of Diseases 10 codes. CONCLUSIONS This study will provide a comprehensive opportunity to study the mechanisms of COVID-19 severity in recontactable participants. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50733.
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Affiliation(s)
- Andrew English
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
- National Horizons Centre, Teesside University, Middlesbrough, United Kingdom
| | - Darren McDaid
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Seodhna M Lynch
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Joseph McLaughlin
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Eamonn Cooper
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Benjamin Wingfield
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Martin Kelly
- Western Health Social Care Trust, Londonderry, United Kingdom
| | - Manav Bhavsar
- Western Health Social Care Trust, Londonderry, United Kingdom
| | - Victoria McGilligan
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Rachelle E Irwin
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Magda Bucholc
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Shu-Dong Zhang
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Priyank Shukla
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Taranjit Singh Rai
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Anthony J Bjourson
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Elaine Murray
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - David S Gibson
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry, United Kingdom
| | - Colum Walsh
- Department of Biomedical and Clinical Sciences, Linköping University, Uppsala, Sweden
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12
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Tikmani SS, Brown N, Inayat A, Mårtensson A, Saleem S, Mårtensson T. Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan. BMJ Paediatr Open 2024; 8:e002316. [PMID: 38267220 PMCID: PMC10824045 DOI: 10.1136/bmjpo-2023-002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard. METHODS A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index. RESULTS A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%. CONCLUSION In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively. TRIAL REGISTRATION NUMBER NCT05515211.
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Affiliation(s)
- Shiyam Sundar Tikmani
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Alijaan Inayat
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Andreas Mårtensson
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
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13
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Cai Y, Guo P, Tu J, Hu M, Liu L, Ryan BL, Liao J, Dev R, Li Y, Huang T, Wang R, Kuang L, Huang R, Li X, Melipillán ER, Zhao S, He W, Wang X, Zhang N, Xu DR. Contextualizing the revised Patient Perception of Patient-Centeredness (PPPC-R) scale in primary healthcare settings: a validity and reliability evaluation study. BMC PRIMARY CARE 2024; 25:11. [PMID: 38178035 PMCID: PMC10768460 DOI: 10.1186/s12875-023-02227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND An English version of the Patient Perception of Patient-Centeredness (PPPC) scale was recently revised, and it is necessary to test this instrument in different primary care populations. AIM This study aimed to assess the validity and reliability of a Chinese version of the PPPC scale. DESIGN A mixed method was used in this study. The Delphi method was used to collect qualitative and quantitative data to address the content validity of the PPPC scale by calculating the Content Validity Index, Content Validity Ratio, the adjusted Kappa, and the Item Impact Score. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were used to assess the construct validity of the PPPC scale through a cross-sectional survey. The internal consistency was also assessed. SETTING/PARTICIPANTS In the Delphi consultation, seven experts were consulted through a questionnaire sent by email. The cross-sectional survey interviewed 188 outpatients in Guangzhou city and 108 outpatients in Hohhot City from community health service centers or stations face-to-face. RESULTS The 21 items in the scale were relevant to their component. The Item-level Content Validity Index for each item was higher than 0.79, and the average Scale-level content validity index was 0.97 in each evaluation round. The initial proposed 4-factor CFA model did not fit adequately. Still, we found a 3-factor solution based on our EFA model and the validation via the CFA model (model fit: [Formula: see text], P < 0.001, RMSEA = 0.044, CFI = 0.981; factor loadings: 0.553 to 0.888). Cronbach's α also indicated good internal consistency reliability: The overall Cronbach's α was 0.922, and the Cronbach's α for each factor was 0.851, 0.872, and 0.717, respectively. CONCLUSIONS The Chinese version of the PPPC scale provides a valuable tool for evaluating patient-centered medical service quality.
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Affiliation(s)
- Yiyuan Cai
- Department of Epidemiology and Health Statistics, School of Public Hhealth, Guizhou Medical University, Gui'an, China
| | - Pengfei Guo
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, USA
| | - Jiong Tu
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, China
| | - Mengyao Hu
- Survey Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, Yale Center for Methods in Implementation and Prevention Science, New Haven, USA
| | - Bridget L Ryan
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Jing Liao
- Department of Health Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Rubee Dev
- Faculty of Applied ScienceSchool of Nursing, University of British Columbia, Vancouver, Canada
| | - Yiran Li
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tianyu Huang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Ruilin Wang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Li Kuang
- Department of Health ManagementSchool of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ruonan Huang
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Xinfang Li
- 13Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | | | | | - Wenjun He
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohui Wang
- Department of Social Medicine and Health ManagementSchool of Public Health, Lanzhou University, Lanzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolian Medical University, Hohhot, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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14
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Oliva A, Kaphle A, Reguant R, Sng LMF, Twine NA, Malakar Y, Wickramarachchi A, Keller M, Ranbaduge T, Chan EKF, Breen J, Buckberry S, Guennewig B, Haas M, Brown A, Cowley MJ, Thorne N, Jain Y, Bauer DC. Future-proofing genomic data and consent management: a comprehensive review of technology innovations. Gigascience 2024; 13:giae021. [PMID: 38837943 PMCID: PMC11152178 DOI: 10.1093/gigascience/giae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024] Open
Abstract
Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.
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Affiliation(s)
- Adrien Oliva
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Anubhav Kaphle
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Roc Reguant
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Letitia M F Sng
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Natalie A Twine
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Yuwan Malakar
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, 41 Boggo Rd, Dutton Park QLD 4102, Australia
| | - Anuradha Wickramarachchi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Marcel Keller
- Data61, Commonwealth Scientific and Industrial Research Organisation, Level 5/13 Garden St, Eveleigh NSW 2015, Australia
| | - Thilina Ranbaduge
- Data61, Commonwealth Scientific and Industrial Research Organisation, Building 101, Clunies Ross St, Black Mountain, Canberra, ACT 2601, Australia
| | - Eva K F Chan
- NSW Health Pathology, Sydney, 1 Reserve Road, St Leonards NSW 2065, Australia
| | - James Breen
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Sam Buckberry
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Boris Guennewig
- Sydney Medical School, Brain and Mind Centre, The University of Sydney, Sydney, 94 Mallett St, Camperdown NSW 2050, Australia
| | - Matilda Haas
- Australian Genomics, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
| | - Alex Brown
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Mark J Cowley
- Children’s Cancer Institute, Lowy Cancer Research Centre, Level 4, Lowy Cancer Research Centre Corner Botany & High Streets UNSW Kensington Campus UNSW Sydney, Kensington NSW 2052, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Kensington NSW 2052, Australia
| | - Natalie Thorne
- University of Melbourne, Melbourne, Parkville VIC 3052, Australia
- Melbourne Genomics Health Alliance, Melbourne 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
- Walter and Eliza Hall Institute, Melbourne, 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
| | - Yatish Jain
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
| | - Denis C Bauer
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
- Department of Biomedical Sciences, MQ Health General Practice - Macquarie University, Suite 305, Level 3/2 Technology Pl, Macquarie Park NSW 2109, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Gate 13, Kintore Avenue University of Adelaide, Adelaide SA 5000, Australia
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Fahrni G, Gullo G, Touray A, Fournier S, Jouannic AM, Lu H, Racine D, Muller O, Pozzessere C, Qanadli SD, Rotzinger DC. Investigating the Influence of High-Speed Gantry Rotation in Cardiac CT on Motion Artifacts in Aortic Stenosis Patients Not Premedicated with β-Blockers: The FAST-CCT Randomized Trial Protocol. J Cardiovasc Dev Dis 2023; 10:424. [PMID: 37887871 PMCID: PMC10607475 DOI: 10.3390/jcdd10100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60-65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. METHODS We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. PRIMARY OUTCOME rate of CCTAs with coronary motion artifacts hindering interpretation. SECONDARY OUTCOMES assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. CLINICALTRIALS gov identifier: NCT05709652.
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Affiliation(s)
- Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Giuseppe Gullo
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Aisha Touray
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Stéphane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Anne-Marie Jouannic
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Henri Lu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Damien Racine
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Rue du Grand-Pré 1, 46, 1007 Lausanne, Switzerland;
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (S.F.); (H.L.); (O.M.)
| | - Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
| | - Salah D. Qanadli
- Riviera-Chablais Hospital, Rte du Vieux Séquoia 20, 1847 Rennaz, Switzerland;
- Faculty of Biology and Medicine (FBM), University of Lausanne, 1015 Lausanne, Switzerland
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; (G.G.); (A.T.); (A.-M.J.); (C.P.)
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Gomes BC, Lobo SMA, Sá Malbouisson LM, de Freitas Chaves RC, Domingos Corrêa T, Prata Amendola C, Silva Júnior JM. Trends in perioperative practices of high-risk surgical patients over a 10-year interval. PLoS One 2023; 18:e0286385. [PMID: 37725600 PMCID: PMC10508595 DOI: 10.1371/journal.pone.0286385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/16/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. METHODS The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. RESULTS After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. CONCLUSION In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
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Affiliation(s)
- Brenno Cardoso Gomes
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo-SP, Brasil
- Departamento de Medicina Integrada do Setor de Ciências da Saúde da Universidade Federal do Paraná, Curitiba-PR, Brasil
| | | | | | | | | | | | - João Manoel Silva Júnior
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo-SP, Brasil
- Hospital Israelita Albert Einstein, São Paulo-SP, Brasil
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17
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Wahid KA, Sahin O, Kundu S, Lin D, Alanis A, Tehami S, Kamel S, Duke S, Sherer MV, Rasmussen M, Korreman S, Fuentes D, Cislo M, Nelms BE, Christodouleas JP, Murphy JD, Mohamed ASR, He R, Naser MA, Gillespie EF, Fuller CD. Determining The Role Of Radiation Oncologist Demographic Factors On Segmentation Quality: Insights From A Crowd-Sourced Challenge Using Bayesian Estimation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294786. [PMID: 37693394 PMCID: PMC10491357 DOI: 10.1101/2023.08.30.23294786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Medical image auto-segmentation is poised to revolutionize radiotherapy workflows. The quality of auto-segmentation training data, primarily derived from clinician observers, is of utmost importance. However, the factors influencing the quality of these clinician-derived segmentations have yet to be fully understood or quantified. Therefore, the purpose of this study was to determine the role of common observer demographic variables on quantitative segmentation performance. METHODS Organ at risk (OAR) and tumor volume segmentations provided by radiation oncologist observers from the Contouring Collaborative for Consensus in Radiation Oncology public dataset were utilized for this study. Segmentations were derived from five separate disease sites comprised of one patient case each: breast, sarcoma, head and neck (H&N), gynecologic (GYN), and gastrointestinal (GI). Segmentation quality was determined on a structure-by-structure basis by comparing the observer segmentations with an expert-derived consensus gold standard primarily using the Dice Similarity Coefficient (DSC); surface DSC was investigated as a secondary metric. Metrics were stratified into binary groups based on previously established structure-specific expert-derived interobserver variability (IOV) cutoffs. Generalized linear mixed-effects models using Markov chain Monte Carlo Bayesian estimation were used to investigate the association between demographic variables and the binarized segmentation quality for each disease site separately. Variables with a highest density interval excluding zero - loosely analogous to frequentist significance - were considered to substantially impact the outcome measure. RESULTS After filtering by practicing radiation oncologists, 574, 110, 452, 112, and 48 structure observations remained for the breast, sarcoma, H&N, GYN, and GI cases, respectively. The median percentage of observations that crossed the expert DSC IOV cutoff when stratified by structure type was 55% and 31% for OARs and tumor volumes, respectively. Bayesian regression analysis revealed tumor category had a substantial negative impact on binarized DSC for the breast (coefficient mean ± standard deviation: -0.97 ± 0.20), sarcoma (-1.04 ± 0.54), H&N (-1.00 ± 0.24), and GI (-2.95 ± 0.98) cases. There were no clear recurring relationships between segmentation quality and demographic variables across the cases, with most variables demonstrating large standard deviations and wide highest density intervals. CONCLUSION Our study highlights substantial uncertainty surrounding conventionally presumed factors influencing segmentation quality. Future studies should investigate additional demographic variables, more patients and imaging modalities, and alternative metrics of segmentation acceptability.
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Affiliation(s)
- Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Onur Sahin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Suprateek Kundu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Alanis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Salik Tehami
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Serageldin Kamel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simon Duke
- Department of Radiation Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | | | - Stine Korreman
- Department of Oncology, Aarhus University Hospital, Denmark
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Cislo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John P. Christodouleas
- Department of Radiation Oncology, The University of Pennsylvania Cancer Center, Philadelphia, PA, USA
- Elekta, Atlanta, GA, USA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohammed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lázaro-Figueroa A, Reyes-Pérez P, Morelos-Figaredo E, Guerra-Galicia CM, Estrada-Bellmann I, Salinas-Barboza K, Matuk-Pérez Y, Gandarilla-Martínez NA, Caballero-Sánchez U, Flores-Ocampo V, Montés-Alcántara P, Espinosa-Méndez IM, Moral AZD, Gaspar-Martínez E, Vazquez-Guevara D, Rodríguez-Violante M, Inca-Martinez M, Mata IF, Alcauter S, Rentería ME, Medina-Rivera A, Ruiz-Contreras AE. MEX-PD: A National Network for the Epidemiological & Genetic Research of Parkinson's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.28.23294700. [PMID: 37693616 PMCID: PMC10491355 DOI: 10.1101/2023.08.28.23294700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Parkinson's Disease (PD) has a complex etiology, involving genetic and environmental factors. Most of our current understanding of the disease comes from studies in populations with mostly European ancestry, representing challenges in generalizing findings to other populations with different genetic, social, and environmental contexts. There are scarce studies focused in Latin American populations. The Mexican population is genetically diverse because its admixture from Native American, European, and African ancestries, coupled with the unique environmental conditions, stressing the relevance of establishing genetic studies in this population. Thus, we have established the Mexican Parkinson's Research Network (MEX-PD), a consortium to research the clinical, genetical, environmental, and neurophysiological bases of the phenotypic diversity in Mexican PD patients. Objectives Describing how MEX-PD was established, the methods and instruments and presenting the first results. Methods Patients and controls were recruited from medical centers in 20 states of Mexico. Initial recruitment included neurological evaluation, cognitive assessment, and DNA collection. Results MEX-PD has registered 302 controls and 262 PD patients with a mean age of diagnosis of 61 years (SD=10.86). There were 19.8% PD patients identified with early onset. Levodopa was the most common pharmacological treatment. Conclusions MEX-PD contributes to understand PD nationally. The information gathered here will allow us to understand the prevalence of mental health, neurological symptoms, and cognitive function in the PD Mexican population and how genetical and environmental factors contributes to those outcomes. These will advocate for personalized treatments and improving quality of life in the Mexican population.
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Affiliation(s)
- Alejandra Lázaro-Figueroa
- Lab. Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias, Coord. Psicobiología y Neurociencias, Fac. Psicología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Paula Reyes-Pérez
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Querétaro, México
| | | | | | - Ingrid Estrada-Bellmann
- Movement Disorders Clinic, Neurology Division, Internal Medicine Department, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey. Mexico
| | | | - Yamil Matuk-Pérez
- Facultad de Medicina, Universidad Autónoma de Querétaro. Unidad de Neurociencias, Hospital Ángeles Centro Sur
| | | | - Ulises Caballero-Sánchez
- Lab. Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias, Coord. Psicobiología y Neurociencias, Fac. Psicología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Victor Flores-Ocampo
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Querétaro, México
| | - Pablo Montés-Alcántara
- Lab. Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias, Coord. Psicobiología y Neurociencias, Fac. Psicología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | | | | | - Edith Gaspar-Martínez
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | | | - Mayela Rodríguez-Violante
- Laboratorio Clínico de Enfermedades Neurodegenerativas. Instituto Nacional de Neurología y Neurocirugía, Ciudad de Mexico, Mexico
| | | | - Ignacio F. Mata
- Genomic Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Sarael Alcauter
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Miguel E. Rentería
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Alejandra Medina-Rivera
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Querétaro, México
| | - Alejandra E. Ruiz-Contreras
- Lab. Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias, Coord. Psicobiología y Neurociencias, Fac. Psicología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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19
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Tan N, Forchheimer M, Tate DG, Meade MA, Reber L, Clarke PJ. Social Integration among Adults Aging with Spinal Cord Injury: The Role of Features in the Built and Natural Environment. JOURNAL OF AGING AND ENVIRONMENT 2023; 38:275-289. [PMID: 39190652 PMCID: PMC10961974 DOI: 10.1080/26892618.2023.2203178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
A growing number of adults are aging with spinal cord injury (SCI) acquired earlier in life. Social integration is important for health and participation after SCI. However, little is known about the role of the community built environment for supporting social integration among adults aging with SCI. Using a structured telephone survey with 182 adults aging with SCI in the Midwestern United States, we found that more community built environment facilitators (e.g., curb cuts, automatic doors, paved surfaces) and fewer barriers (e.g., gravel surfaces, crowds) significantly increased the odds of regularly engaging in both formal and informal social activities.
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Affiliation(s)
- Nasya Tan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michelle A Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lisa Reber
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Philippa J Clarke
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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20
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Xu EL, Kim PS, Yee C, Zhang M, Reckrey JM, Lubetsky S, Zhao D, Ornstein KA, Franzosa E. "I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic. J Appl Gerontol 2023; 42:561-570. [PMID: 36283965 PMCID: PMC9597284 DOI: 10.1177/07334648221135584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/15/2022] Open
Abstract
Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers' roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.
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Affiliation(s)
- Emily L Xu
- Department of Medical Education, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patricia S Kim
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Cynthia Yee
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Meng Zhang
- Department of Internal Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer M Reckrey
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Sara Lubetsky
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | - Duzhi Zhao
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
| | | | - Emily Franzosa
- Brookdale Geriatric Research, Education and Clinical Center, New York, NY, USA
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21
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Wahid KA, Lin D, Sahin O, Cislo M, Nelms BE, He R, Naser MA, Duke S, Sherer MV, Christodouleas JP, Mohamed ASR, Murphy JD, Fuller CD, Gillespie EF. Large scale crowdsourced radiotherapy segmentations across a variety of cancer anatomic sites. Sci Data 2023; 10:161. [PMID: 36949088 PMCID: PMC10033824 DOI: 10.1038/s41597-023-02062-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Abstract
Clinician generated segmentation of tumor and healthy tissue regions of interest (ROIs) on medical images is crucial for radiotherapy. However, interobserver segmentation variability has long been considered a significant detriment to the implementation of high-quality and consistent radiotherapy dose delivery. This has prompted the increasing development of automated segmentation approaches. However, extant segmentation datasets typically only provide segmentations generated by a limited number of annotators with varying, and often unspecified, levels of expertise. In this data descriptor, numerous clinician annotators manually generated segmentations for ROIs on computed tomography images across a variety of cancer sites (breast, sarcoma, head and neck, gynecologic, gastrointestinal; one patient per cancer site) for the Contouring Collaborative for Consensus in Radiation Oncology challenge. In total, over 200 annotators (experts and non-experts) contributed using a standardized annotation platform (ProKnow). Subsequently, we converted Digital Imaging and Communications in Medicine data into Neuroimaging Informatics Technology Initiative format with standardized nomenclature for ease of use. In addition, we generated consensus segmentations for experts and non-experts using the Simultaneous Truth and Performance Level Estimation method. These standardized, structured, and easily accessible data are a valuable resource for systematically studying variability in segmentation applications.
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Affiliation(s)
- Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Onur Sahin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Cislo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohammed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simon Duke
- Department of Radiation Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Michael V Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - John P Christodouleas
- Department of Radiation Oncology, The University of Pennsylvania Cancer Center, Philadelphia, PA, USA
- Elekta, Atlanta, GA, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
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22
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Gulmark Hansen FC, Jørgensen MG, Sørensen JA. Treatment of Breast Cancer-Related Lymphedema With Topical Tacrolimus: A Prospective, Open-Label, Single-Arm, Phase II Pilot Trial. J Breast Cancer 2023; 26:46-59. [PMID: 36762782 PMCID: PMC9981991 DOI: 10.4048/jbc.2023.26.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) is a chronic, progressive side effect of breast cancer treatment, occurring in one-third of patients treated with axillary lymph node dissection and nodal radiotherapy. Cluster of differentiation 4-positive (CD4+) cells plays a key role in BCRL by facilitating inflammation and inhibiting lymphangiogenesis. Tacrolimus is an anti-inflammatory and immunosuppressive macrolide that targets CD4+ cells. Treatment of lymphedema with topical tacrolimus has revealed promising results in preclinical trials. This clinical trial was aimed at evaluating the feasibility, safety, and effect of tacrolimus in women with stage I or II BCRL, according to the International Society of Lymphology. METHODS We conducted this open-label, single-arm, phase II pilot trial from September 2020 to April 2021. Eighteen women with BCRL stage I or II BCRL were treated with topical tacrolimus for 6 months and followed up at 3 and 6 months. The primary outcome was arm volume, and secondary outcomes were the lymphedema index (L-Dex), health-related quality of life (HRQoL), lymph flow and function, and safety and feasibility of the trial design. RESULTS The mean lymphedema arm volume and L-Dex reduced significantly by 130.44 ± 210.13 mL (p < 0.05; relative reduction: 3.6%) and 3.54 ± 4.98 (p < 0.05), respectively, and health-related quality of life scores was improved significantly (p < 0.05). According to the MD Anderson scale, in terms of lymph flow and function, three patients (16.7%) showed improvement, while none showed worsening. Lymph flow or function showed no change according to the Arm Dermal Backflow scale. CONCLUSION In this trial, treatment with tacrolimus was safe and feasible in women with stage I or II BCRL. Tacrolimus alleviated BCRL in terms of improved arm volume, L-Dex, and HRQoL. Assessments of lymph flow and function were positive, although inconclusive. Larger randomized controlled trials are required to verify these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04541290.
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Affiliation(s)
- Frederik C. Gulmark Hansen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Mads Gustaf Jørgensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
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23
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Alasfar S, Chiang TPY, Snyder AJ, Ou MT, Boyarsky BJ, Abedon AT, Alejo JL, Cook S, Cochran W, Brigham E, Parker AM, Garonzik-Wang J, Massie AB, Brennan DC, Vannorsdall T, Segev DL, Avery RK. PASC in Solid Organ Transplant Recipients With Self-reported SARS-CoV-2 Infection. Transplantation 2023; 107:181-191. [PMID: 36117251 PMCID: PMC9746234 DOI: 10.1097/tp.0000000000004340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/05/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postacute sequelae of SARS-CoV-2 infection (PASC) is an increasingly recognized phenomenon and manifested by long-lasting cognitive, mental, and physical symptoms beyond the acute infection period. We aimed to estimate the frequency of PASC symptoms in solid organ transplant (SOT) recipients and compared their frequency between those with SARS-CoV-2 infection requiring hospitalization and those who did not require hospitalization. METHODS A survey consisting of 7 standardized questionnaires was administered to 111 SOT recipients with history of SARS-CoV-2 infection diagnosed >4 wk before survey administration. RESULTS Median (interquartile range) time from SARS-CoV-2 diagnosis was 167 d (138-221). Hospitalization for SARS-CoV-2 infection was reported in 33 (30%) participants. Symptoms after the COVID episode were perceived as following: significant trauma (53%), cognitive decline (50%), fatigue (41%), depression (36%), breathing problems (35%), anxiety (23%), dysgeusia (22%), dysosmia (21%), and pain (19%). Hospitalized patients had poorer median scores in cognition (Quick Dementia Rating System survey score: 2.0 versus 0.5, P = 0.02), quality of life (Health-related Quality of Life survey: 2.0 versus 1.0, P = 0.015), physical health (Global physical health scale: 10.0 versus 11.0, P = 0.005), respiratory status (Breathlessness, Cough and Sputum Scale: 1.0 versus 0.0, P = 0.035), and pain (Pain score: 3 versus 0 out of 10, P = 0.003). Among patients with infection >6 mo prior, some symptoms were still present as following: abnormal breathing (42%), cough (40%), dysosmia (29%), and dysgeusia (34%). CONCLUSIONS SOT recipients reported a high frequency of PASC symptoms. Multidisciplinary approach is needed to care for these patients beyond the acute phase.
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Affiliation(s)
- Sami Alasfar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teresa Po-Yu Chiang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Michael T. Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian J. Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aura T. Abedon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L. Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sydney Cook
- Georgetown University School of Medicine, Washington, DC
| | - Willa Cochran
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily Brigham
- Department of Medicine, University of British Columbia, Vancouver, BC
- Vancouver Coastal Health Research Institute, Vancouver, BC
| | - Ann M. Parker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jacqueline Garonzik-Wang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Allan B. Massie
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Daniel C. Brennan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tracy Vannorsdall
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Robin K. Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Staunton H, Cleanthous S, Teodoro V, Barrett L, Braid J, Ewens B, Cano S, Baranello G, Kirschner J, Belter L, Mayhew A. A Mixed-method Approach to Develop an Ambulatory Module of the SMA Independence Scale. J Neuromuscul Dis 2023; 10:1093-1109. [PMID: 37742658 PMCID: PMC10657657 DOI: 10.3233/jnd-230096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Limited qualitative data exist on the symptoms and impacts of spinal muscular atrophy (SMA) experienced by ambulant individuals. An ambulant module of the SMA Independence Scale (SMAIS) was developed to quantify the assistance required to perform everyday mobility-related activities. OBJECTIVE The objective of this study was to develop a patient-centered module that provides key insights into what constitutes independence for ambulant and near-ambulant individuals with SMA. METHODS A stepwise, mixed-method approach was used. Semi-structured interviews were conducted in three waves with individuals with SMA and caregivers of children with SMA who were ambulant or near-ambulant (can walk ≥5 steps with support). Wave 1 interviews (n = 20) focused on concept elicitation. Wave 2 and 3 interviews (n = 15, both) involved completion and cognitive debriefing of items generated based on Wave 1 interviews. Therapeutic area experts were consulted throughout all key steps of the study. In particular, feedback was provided for item refinement and response option decisions. A macro-level preliminary, exploratory analysis, using Rasch Measurement Theory (RMT), provided insight on measurement properties. RESULTS Wave 1 resulted in 42 mobility and 11 instrumental activity of daily living (iADL) items. During Wave 2, participants defined independence as completing a task with supportive aids but without help from another person, leading to item refinement and modifications to the response scale. Lack of conceptual relevance and ceiling effects led to the removal of all iADL items after Wave 2, and 41 mobility items were tested in Wave 3. Final exploratory RMT and item refinement to reduce overlap led to a 27-item set related to mobility tasks. CONCLUSIONS Our study provides preliminary support for using the 27-item SMAIS-Ambulatory Module for ambulant or near-ambulant individuals with SMA. Larger-scale analyses to further assess the psychometric properties of the scale are warranted.
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Affiliation(s)
- Hannah Staunton
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Sophie Cleanthous
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Vanda Teodoro
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Louise Barrett
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Jessica Braid
- Roche Products Ltd, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Bethany Ewens
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Stefan Cano
- Modus Outcomes, 4th Floor St. James House, St. James Square, Cheltenham, GL50 3PR, UK
| | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, & Great Ormond Street Hospital Trust, London, WC1N 3JH, UK
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, University of Freiburg, Faculty of Medicine, 79106, Freiburg, Germany
| | | | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle Upon Tyne, NE1 3BZ, UK
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Bertolotti M, Betti M, Giacchero F, Grasso C, Franceschetti G, Carotenuto M, Odone A, Pacileo G, Ferrante D, Maconi A. Long-Term Survival among Patients Hospitalized for COVID-19 during the First Three Epidemic Waves: An Observational Study in a Northern Italy Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15298. [PMID: 36430015 PMCID: PMC9690296 DOI: 10.3390/ijerph192215298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The mortality rate of hospitalized COVID-19 patients differed strongly between the first three pandemic waves. Nevertheless, their long-term survival has been poorly assessed. The aim of this study was to compare the clinical characteristics and mortality rates of 825 patients with coronavirus disease 2019 (COVID-19) infection who were hospitalized at the Alessandria hub hospital, in Northern Italy, during the first fifty days of the first three pandemic waves. Each subject was followed in terms of vital status for six months from the date of hospital admission or until deceased. Patients admitted during the three waves differed in age (p = 0.03), disease severity (p < 0.0001), Charlson comorbidity index (p = 0.0002), oxygen therapy (p = 0.002), and invasive mechanical ventilation (p < 0.0001). By the end of follow-up, 309 deaths (38.7%) were observed, of which 186 occurred during hub hospitalization (22.5%). Deaths were distributed differently among the waves (p < 0.0001), resulting in being higher amongst those subjects admitted during the first wave. The COVID-19 infection was reported as the main cause of death and patients with a higher mortality risk were those aged ≥65 years [adjusted HR = 3.40 (95% CI 2.20-5.24)], with a higher disease severity [adjusted HR = 1.87 (95%CI 1.43-2.45)], and those requiring oxygen therapy [adjusted HR = 2.30 (95%CI 1.61-3.30)]. In conclusion, COVID-19 patients admitted to our hub hospital during the second and the third waves had a lower risk of long-term mortality than those admitted during the first. Older age, more severe disease, and the need for oxygen therapy were among the strongest risk factors for poor prognosis.
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Affiliation(s)
- Marinella Bertolotti
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Marta Betti
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Fabio Giacchero
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Chiara Grasso
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Genny Franceschetti
- Medical Directorate, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Margherita Carotenuto
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | | | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, Università del Piemonte Orientale and Cancer Epidemiology Unit, CPO-Piemonte, 28100 Novara, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Added value of gadolinium-based contrast agents for magnetic resonance evaluation of adnexal torsion in girls. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3868-3882. [PMID: 35978184 DOI: 10.1007/s00261-022-03642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Ultrasound is the first-line imaging modality to evaluate adnexa in girls with clinical suspicion of torsion. Patients with equivocal ultrasound findings can undergo MRI for better delineation of adnexal pathology. Here, we assess the utility of intravenous contrast in MRI evaluation of adnexal torsion in children. METHODS Two pediatric radiologists (R1, R2) retrospectively reviewed 198 pelvic MRI exams in 172 girls (median age 15 years). Each MRI was reviewed twice. The first review included pre-contrast images only. A second review, at least 1 month later, included both pre- and post-contrast images. Readers concluded if findings were suspicious for torsion or not. Readers' findings were compared to each other's and to surgical and MRI reports and clinical course. RESULTS 198 MRI exams yielded 354 evaluable ovaries. Surgical and pathological reports were available for 47 patients. 11 patients had adnexal torsion. Both readers accurately diagnosed acutely torsed ovaries during pre- and post-contrast reviews (n = 4). However, readers disagreed on torsed paraovarian cysts (n = 4) and chronically/intermittently torsed ovaries (n = 3). In 21 non-torsed ovaries that had lesions, one or both readers concluded that there were pre-contrast features of torsion. In this set with ovarian lesions, contrast helped readers to correctly conclude no torsion (R1 = 8, R2 = 6) more commonly than to incorrectly conclude torsion (1 each), improving post-contrast specificity for each reader. CONCLUSIONS Post-contrast sequences did not provide additional benefit in evaluating acutely torsed ovaries but helped in excluding torsion in patients with adnexal lesions. Therefore, contrast administration should be individualized, potentially reserved only for those with abnormal ultrasound or pre-contrast images.
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The Effects of Modifying Amount and Type of Dietary Carbohydrate on Esophageal Acid Exposure Time and Esophageal Reflux Symptoms: A Randomized Controlled Trial. Am J Gastroenterol 2022; 117:1655-1667. [PMID: 35973185 PMCID: PMC9531994 DOI: 10.14309/ajg.0000000000001889] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/10/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This is the first randomized controlled diet intervention trial to investigate both the amount and type of carbohydrate on symptomatic gastroesophageal reflux disease (GERD). METHODS Ninety-eight veterans with symptomatic GERD were randomly assigned to high total/high simple, high total/low simple, low total/high simple, or low total/low simple carbohydrate diet for 9 weeks. The primary outcomes were esophageal acid exposure time (AET) and total number of reflux episodes derived from 24-hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS). RESULTS Half of the subjects were White and half African American (mean age, 60.0 ± 12.5 years; mean body mass index, 32.7 ± 5.4 kg/m 2 ). There was a significant main effect of diet treatment on AET ( P = 0.001) and on the total number of reflux episodes ( P = 0.003). The change in AET in the high total/low simple group (-4.3% ± 3.8%) differed significantly from the high total/high simple control group (+3.1% ± 3.7%), (P = 0.04). The reduction in simple sugar intake averaged 62 g less per day. Subjects' ratings of symptoms improved in all carbohydrate modification groups, including significant reductions in heartburn frequency, heartburn severity, acid taste in the mouth, lump/pain in the throat or chest, and sleep disturbance. DISCUSSION A modification of dietary carbohydrate intake that targeted a substantial reduction in the intakes of simple sugars improved pH monitoring outcomes and symptoms of GERD that profoundly affect daily life. These findings provide a feasible and clinically applicable contribution to the limited objective data existing for efficacious dietary recommendations in the routine treatment and management of GERD.
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Gender Discrimination, Career Aspirations, and Access to Mentorship Among Medical Students in Brazil. J Surg Res 2022; 279:702-711. [PMID: 35940048 DOI: 10.1016/j.jss.2022.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Gender-based discrimination (GBD) creates a hostile environment that can affect medical students. Mentorship has been recognized as a mitigating factor for GBD. We aimed to investigate the impacts of GBD on career selection and well-being of medical students in Brazil and to explore access to mentorship among these students. METHODS A cross-sectional study was performed using an anonymous survey in Portuguese. The survey was distributed in June 2021 to students enrolled in Brazilian medical schools. It contained 24 questions, including demographics, episodes of GBD experienced by responders and their impact on professional and personal life, and mentorship access. RESULTS Of 953 respondents, 748 (78%) were cisgender women, 194 (20%) cisgender men, and 11 nonbinary (1%). Sixty-six percent (625/953) of students reported experiencing GBD, with cisgender women and nonbinary being more likely to experience it than cisgender men (P < 0.001). Responders who experiences GBD report moderate to severe impact on career satisfaction (40%, 250/624), safety (68%, 427/624), self-confidence (68%, 426/624), well-being (57%, 357/625), and burnout (62%, 389/625). Cisgender women were more likely to report these effects than men counterparts (P < 0.01). Only 21% of respondents (201/953) had mentors in their medical schools. CONCLUSIONS Our findings demonstrate that GBD is widespread among Brazilian medical students affecting their personal and professional lives, and most of them do not have access to a mentor. There is an urgent need to increase access to mentors who could mitigate the adverse effects of GBD and help develop a diverse and inclusive medical workforce.
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Tate DF, Lutes LD, Bryant M, Truesdale KP, Hatley KE, Griffiths Z, Tang TS, Padgett LD, Pinto AM, Stevens J, Foster GD. Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2226561. [PMID: 35972742 PMCID: PMC9382439 DOI: 10.1001/jamanetworkopen.2022.26561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. OBJECTIVE To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. DESIGN, SETTING, AND PARTICIPANTS This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. INTERVENTIONS A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. MAIN OUTCOMES AND MEASURES The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. RESULTS The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). CONCLUSIONS AND RELEVANCE Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571893.
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Affiliation(s)
- Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Lesley D. Lutes
- Department of Psychology, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- The Hull York Medical School, University of York, York, United Kingdom
| | | | - Karen E. Hatley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver Campus, Vancouver, British Columbia, Canada
| | - Louise D. Padgett
- Department of Health Sciences, University of York, York, United Kingdom
| | - Angela M. Pinto
- Department of Psychology, Baruch College/City University of New York, New York
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- WW, Maidenhead, Berkshire, UK
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Alshammari B, AlEnazy A, Alshammari F, Madkhali N, Al-Masaeed M. Investigation of the Level and Factors Influencing Emergency Department Nurses Fatigue: A Case Study of the Saudi Arabian Context. Healthcare (Basel) 2022; 10:healthcare10071294. [PMID: 35885820 PMCID: PMC9318690 DOI: 10.3390/healthcare10071294] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Work-related fatigue is a common health problem among nurses which can affect their performance and decision making. Significance and Aim: The study explores the levels of fatigue and its associated factors among emergency department (ED) nurses in Saudi Arabia. Methods: The study was developed through a cross-sectional quantitative study design. This included the collection of primary quantitative data with a questionnaire prepared and published on REDCap. The study questionnaire was adapted from two tools, namely the OFER 15 and the Copenhagen II tools, respectively. Results: The study established that the Saudi Arabian ED nurses have high acute fatigue (OFER 15 score = 81.11), moderate-high chronic fatigue (OFER 15 score = 74.17), and a high inter-shift recovery index (OFER 15 score = 78.01). In terms of the predictor factors, the study established that for the demographic factors, gender has an impact on chronic and acute fatigue, while work experience impacted acute fatigue and the number of dependents impacted on inter-shift recovery index. On the psycho-social factors, chronic fatigue is influenced by emotional demand (which is a variable used to evaluate the levels to which the nurse is invested, gaining education/skills thus increases job satisfaction) (−0.289), influence at work (−0.310), commitment at the workplace (0.376), rewards (−0.187), stress (0.420), and burnout (0.293), respectively. Acute fatigue is influenced by the emotional demands (0.336), role clarity (−0.128), and the nurses’ well-being and health (−0.034). Finally, the inter-shift recovery index is influenced by the ED nurses’ burnout levels (−0.877). Conclusions: The study indicates a high level of nursing fatigue among the Saudi Arabian ED nurses.
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Affiliation(s)
- Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Correspondence: (B.A.); (A.A.)
| | - Albandry AlEnazy
- Buraidah Central Hospital, Al-Qassim 52361, Saudi Arabia
- Correspondence: (B.A.); (A.A.)
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia;
| | - Norah Madkhali
- Department of Nursing, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia;
| | - Mahmoud Al-Masaeed
- Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia;
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Xu DR, Cai Y, Wang X, Chen Y, Gong W, Liao J, Zhou J, Zhou Z, Zhang N, Tang C, Mi B, Lu Y, Wang R, Zhao Q, He W, Liang H, Li J, Pan J. Improving Data Surveillance Resilience Beyond COVID-19: Experiences of Primary heAlth Care quAlity Cohort In ChinA (ACACIA) Using Unannounced Standardized Patients. Am J Public Health 2022; 112:913-922. [PMID: 35483014 PMCID: PMC9137008 DOI: 10.2105/ajph.2022.306779] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 12/02/2023]
Abstract
We analyzed COVID-19 influences on the design, implementation, and validity of assessing the quality of primary health care using unannounced standardized patients (USPs) in China. Because of the pandemic, we crowdsourced our funding, removed tuberculosis from the USP case roster, adjusted common cold and asthma cases, used hybrid online-offline training for USPs, shared USPs across provinces, and strengthened ethical considerations. With those changes, we were able to conduct fieldwork despite frequent COVID-19 interruptions. Furthermore, the USP assessment tool maintained high validity in the quality checklist (criteria), USP role fidelity, checklist completion, and physician detection of USPs. Our experiences suggest that the pandemic created not only barriers but also opportunities to innovate ways to build a resilient data collection system. To build data system reliance, we recommend harnessing the power of technology for a hybrid model of remote and in-person work, learning from the sharing economy to pool strengths and optimize resources, and dedicating individual and group leadership to problem-solving and results. (Am J Public Health. 2022;112(6):913-922. https://doi.org/10.2105/AJPH.2022.306779).
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Affiliation(s)
- Dong Roman Xu
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yiyuan Cai
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Wang
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yaolong Chen
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenjie Gong
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jifang Zhou
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhongliang Zhou
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Nan Zhang
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chengxiang Tang
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Baibing Mi
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yun Lu
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ruixin Wang
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qing Zhao
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wenjun He
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Huijuan Liang
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jinghua Li
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jay Pan
- Dong (Roman) Xu is with SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China. Yiyuan Cai is with the Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou, China. Xiaohui Wang is with the Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China. Yaolong Chen is with the Institute of Health Data Science, Lanzhou University, Lanzhou, China. Wenjie Gong is with HER Team and the Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China. Jing Liao and Jinghua Li are with the Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Jifang Zhou is with the School of International Business, China Pharmaceutical University, Nanjing, China. Zhongliang Zhou is with the School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China. Nan Zhang and Huijuan Liang are with the School of Health Management, Inner Mongolia Medical University, Hohhot, China. Chengxiang Tang is with the Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Sydney, Australia. Baibing Mi is with the Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. Yun Lu is with the Department of Preventive Medicine, Maternal and Child Health, School of Public Health, Guizhou Medical University, Guizhou, China. Ruixin Wang is with the Department of Health Economics, School of Public Health, Fudan University, Shanghai, China. Jay Pan is with HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Madan K, Sryma PB, Pattnaik B, Mittal S, Tiwari P, Hadda V, Mohan A, Guleria R. Clinical Profile of 327 patients with Sarcoidosis in India: An Ambispective Cohort Study in a Tuberculosis (TB) Endemic Population. Lung India 2022; 39:51-57. [PMID: 34975053 PMCID: PMC8926222 DOI: 10.4103/lungindia.lungindia_960_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Sarcoidosis is a multisystem granulomatous disease with a varied clinical presentation. We describe the clinical characteristics of patients with sarcoidosis from a tuberculosis (TB) endemic setting. Methods: We performed an analysis of the sarcoidosis database at a tertiary care facility in North India. Results: Of the 327 patients, 50.8% were male, with a mean age of 42.8 years (range: 16–70 years). Females were significantly older. 42.6% had comorbidities, of which diabetes (17.1%) was most common. More than half (57.1%) were obese. Serum angiotensin-converting enzyme levels were elevated in 186 (57.9%). Eleven (3.8%) had hypercalcemia, while hypercalciuria was present in 54 (31.7%). The majority (89.9%) were tuberculin skin test negative (<10 mm induration), while 71.9% were tuberculin anergic. 47.7% had normal spirometry, while a restrictive impairment was the most common abnormality (44.6%). Obstruction on spirometry was present in 8.3%. Nearly half (160, 49%) had involvement of an extrapulmonary site. Most patients were (96%) symptomatic. Cough, shortness of breath, fatigue, weight loss, and fever were the predominant symptoms. A majority had Stage 1 (47.7%) sarcoidosis. Two hundred and eighty-seven (87.8%) patients underwent bronchoscopy or endosonographic (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration [EUS-B-FNA]) sampling. A histopathological diagnosis with the demonstration of granulomas was achieved in 90.8%. The diagnostic yield of EBUS-TBNA/EUS-B-FNA was 77.4%. In 13.5% of patients, necrotizing granulomas were present in tissue samples. Conclusion: The clinical profile of patients with sarcoidosis in TB endemic settings has certain differences from nonendemic populations. Bronchoscopy and endosonography allow a confident diagnosis in the majority of patients.
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Affiliation(s)
- Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bijay Pattnaik
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Tran V, Gwenzi F, Marongwe P, Rutsito O, Chatikobo P, Murenje V, Hove J, Munyaradzi T, Rogers Z, Tshimanga M, Sidile-Chitimbire V, Xaba S, Ncube G, Masimba L, Makunike-Chikwinya B, Holec M, Barnhart S, Weiner B, Feldacker C. REDCap mobile data collection: Using implementation science to explore the potential and pitfalls of a digital health tool in routine voluntary medical male circumcision outreach settings in Zimbabwe. Digit Health 2022; 8:20552076221112163. [PMID: 35847527 PMCID: PMC9280838 DOI: 10.1177/20552076221112163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Digital data collection tools improve data quality but are limited by connectivity. ZAZIC, a Zimbabwean consortium focused on scaling up male circumcision (MC) services, provides MC in outreach settings where both data quality and connectivity is poor. ZAZIC implemented REDCap Mobile app for data collection among roving ZAZIC MC nurses. To inform continued scale-up or discontinuation, this paper details if, how, and for whom REDCap improved data quality using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods Data were collected for this retrospective, cross-sectional study for nine months, from July 2019 to March 2020, before COVID-19 paused MC services. Data completeness was compared between paper- and REDCap-based tools and between two ZAZIC partners using two sample, one-tailed t-tests. Results REDCap reached all roving nurses who reported 26,904 MCs from 1773 submissions. REDCap effectiveness, as measured by data completeness, decreased from 89.2% in paper to 76.6% in REDCap app for Partner 1 (p < 0.001, 95% CI: -0.24, -0.12) but increased modestly from 86.2% to 90.3% in REDCap for Partner 2 (p = 0.05, 95% CI: -.007, 0.12). Adoption of REDCap was 100%; paper-based reporting concluded in October 2019. Implementation varied by partner and user. Maintenance appeared high. Conclusion Although initial transition from paper to REDCap showed mixed effectiveness, post-hoc analysis from service resumption found increased REDCap data completeness across partners, suggesting locally-led momentum for REDCap-based data collection. Staff training, consistent mentoring, and continued technical support appear critical for continued use of digital health tools for quality data collection in rural Zimbabwe and similar low connectivity settings.
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Affiliation(s)
- Vi Tran
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Farai Gwenzi
- Zimbabwe Technical Training and Education Center for Health (Zim-TTECH), Harare, Zimbabwe
| | - Phiona Marongwe
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Olbarn Rutsito
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - Pesanai Chatikobo
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | - Vernon Murenje
- Zimbabwe Technical Training and Education Center for Health (Zim-TTECH), Harare, Zimbabwe
| | - Joseph Hove
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - Tinashe Munyaradzi
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | - Zoe Rogers
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Mufuta Tshimanga
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | | | | | | | - Lewis Masimba
- Zimbabwe Technical Training and Education Center for Health (Zim-TTECH), Harare, Zimbabwe
| | | | - Marrianne Holec
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Scott Barnhart
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Weiner
- Department of Health Services, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Caryl Feldacker
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910010. [PMID: 34639311 PMCID: PMC8508318 DOI: 10.3390/ijerph181910010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.
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Parmar J, Anderson S, Duggleby W, Holroyd-Leduc J, Pollard C, Brémault-Phillips S. Developing person-centred care competencies for the healthcare workforce to support family caregivers: Caregiver centred care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1327-1338. [PMID: 32949440 DOI: 10.1111/hsc.13173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Family caregivers (FCGs) are an integral part of the healthcare system. Currently, FCGs provide 70%-90% of the care required by community-dwelling children and adults living with complex chronic conditions and frailty. Despite FCG's contributions and the growing proportion of distressed caregivers, support for FCGs has not been a health system priority. Researchers have proposed training to enhance the competencies of health providers to work effectively with FCGs. In the absence of best practices for the competency indicators for caregiver-centred care, we have developed a competency framework for training the health workforce to support FCGs. The objectives in this paper are fourfold: (a) a brief review of stakeholder engagement that led to the development of the competencies the health workforce needs to support FCGs, (b) a description of the process used to name the competency domains, (c) a report on the Modified Delphi process (conducted 2019) used to validate the domain indicators, and (d) a description of the competency framework. We adopted a caregiver and a multilevel interdisciplinary stakeholder codesign approach throughout the competency development process. The competency domains include: (a) Recognising the Caregiver Role, (b) Communicating with FCGs, (c) Partnering with FCGs, (d) Fostering Resilience in FCGs, (e) Navigating Health and Social Systems and Accessing Resources, and, (f) Enhancing the Culture and Context of Healthcare. Our Caregiver-Centred Care Competencies for the health workforce are only a first step in supporting FCGs in their vital roles. There are few education and training resources to enable and empower health providers to support FCGs, there is an urgent need to develop training resources for the health workforce to recognise and support FCGs.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, AB, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Pollard
- Bachelor of Science in Nursing, McEwan University, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, USA
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Pikkemaat M, Thulesius H, Milos Nymberg V. Swedish Primary Care Physicians' Intentions to Use Telemedicine: A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT). Int J Gen Med 2021; 14:3445-3455. [PMID: 34295177 PMCID: PMC8290350 DOI: 10.2147/ijgm.s319497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 02/02/2023] Open
Abstract
Background Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R2 = 0.54), chronic disease monitoring with digital tools (R2 = 0.47) and artificial intelligence (R2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
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Affiliation(s)
- Miriam Pikkemaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Linnaeus University, Kalmar, Sweden
| | - Veronica Milos Nymberg
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
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Anjos RO, Mugabe VA, Moreira PSS, Carvalho CX, Portilho MM, Khouri R, Sacramento GA, Nery NRR, Reis MG, Kitron UD, Ko AI, Costa F, Ribeiro GS. Transmission of Chikungunya Virus in an Urban Slum, Brazil. Emerg Infect Dis 2021; 26:1364-1373. [PMID: 32568045 PMCID: PMC7323528 DOI: 10.3201/eid2607.190846] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
After a chikungunya outbreak in Salvador, Brazil, we performed a cross-sectional, community-based study of 1,776 inhabitants to determine chikungunya virus (CHIKV) seroprevalence, identify factors associated with exposure, and estimate the symptomatic infection rate. From November 2016 through February 2017, we collected sociodemographic and clinical data by interview and tested serum samples for CHIKV IgG. CHIKV seroprevalence was 11.8% (95% CI 9.8%–13.7%), and 15.3% of seropositive persons reported an episode of fever and arthralgia. Infections were independently and positively associated with residences served by unpaved streets, a presumptive clinical diagnosis of chikungunya, and recall of an episode of fever with arthralgia in 2015–2016. Our findings indicate that the chikungunya outbreak in Salvador may not have conferred sufficient herd immunity to preclude epidemics in the near future. The unusually low frequency of symptomatic disease points to a need for further longitudinal studies to better investigate these findings.
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Specht IO, Rohde JF, Nielsen AK, Larsen SC, Heitmann BL. Changes in Emotional-Behavioral Functioning Among Pre-school Children Following the Initial Stage Danish COVID-19 Lockdown and Home Confinement. Front Psychol 2021; 12:643057. [PMID: 34135810 PMCID: PMC8201075 DOI: 10.3389/fpsyg.2021.643057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/29/2021] [Indexed: 12/03/2022] Open
Abstract
Unintended negative outcomes on child behavior due to lockdown and home confinement following the corona virus disease (COVID-19) pandemic needs highlighting to effectively address these issues in the current and future health crises. In this sub-study of the ODIN-study, the objectives were to determine whether the Danish lockdown and home confinement following the COVID-19 pandemic affected changes in emotional-behavioral functioning of pre-school-aged children using the validated Strength and Difficulties Questionnaire (SDQ) answered by parents shortly before lockdown and 3 weeks into lockdown, and moreover, to examine whether baseline family and social characteristics could predict change in child emotional-behavioral functioning during lockdown. Parents of 40 (82%) children with a mean(SD) age of 5.0(0.7) completed the baseline questionnaire and the lockdown follow-up questionnaire. The SDQ-Total difficulties score (SDQ-TD) and Prosocial Behavioral score (PSB) changed significantly from pre- to lockdown [SDQ-TD mean(SD): 6.0(3.8) and 7.9(5.2); P = 0.02, respectively and PSB mean(SD): 8.5(1.4) and 7.9(1.5); P = 0.03, respectively]. Attending leisure time activities before lockdown was a predicting factor of changes to the worse in the children’s SDQ-TD scores, with a mean difference in SDQ-TD between those with and without activities of 3.16 (95%CI 0.27–6.12); P = 0.03. In conclusion, the study showed a modest decrease in child-emotional behavioral functioning during the COVID-19 lockdown, potentially due to parental stress. Although these results might not be generalizable due to small sample size and selected population, the results point to a need of a greater awareness of child mental wellbeing during a lockdown situation.
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Affiliation(s)
- Ina Olmer Specht
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jeanett Friis Rohde
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Ann-Kristine Nielsen
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Sofus Christian Larsen
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Berit Lilienthal Heitmann
- The Parker Institute, Research Unit for Dietary Studies, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise, and Eating Disorders, University of Sydney, Sydney, NSW, Australia.,The Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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Betti M, Bertolotti M, Ferrante D, Roveta A, Pelazza C, Giacchero F, Penpa S, Massarino C, Bolgeo T, Cassinari A, Mussa M, Chichino G, Maconi A. Baseline clinical characteristics and prognostic factors in hospitalized COVID-19 patients aged ≤ 65 years: A retrospective observational study. PLoS One 2021; 16:e0248829. [PMID: 33760885 PMCID: PMC7990225 DOI: 10.1371/journal.pone.0248829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individual differences in susceptibility to SARS-CoV-2 infection, symptomatology and clinical manifestation of COVID-19 have thus far been observed but little is known about the prognostic factors of young patients. METHODS A retrospective observational study was conducted on 171 patients aged ≤ 65 years hospitalized in Alessandria's Hospital from 1st March to 30th April 2020 with laboratory confirmed COVID-19. Epidemiological data, symptoms at onset, clinical manifestations, Charlson Comorbidity Index, laboratory parameters, radiological findings and complications were considered. Patients were divided into two groups on the basis of COVID-19 severity. Multivariable logistic regression analysis was used to establish factors associated with the development of a moderate or severe disease. FINDINGS A total of 171 patients (89 with mild/moderate disease, 82 with severe/critical disease), of which 61% males and a mean age (± SD) of 53.6 (± 9.7) were included. The multivariable logistic model identified age (50-65 vs 18-49; OR = 3.23 CI95% 1.42-7.37), platelet count (per 100 units of increase OR = 0.61 CI95% 0.42-0.89), c-reactive protein (CPR) (per unit of increase OR = 1.12 CI95% 1.06-1.20) as risk factors for severe or critical disease. The multivariable logistic model showed a good discriminating capacity with a C-index value of 0.76. INTERPRETATION Patients aged ≥ 50 years with low platelet count and high CRP are more likely to develop severe or critical illness. These findings might contribute to improved clinical management.
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Affiliation(s)
- Marta Betti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
- * E-mail:
| | - Marinella Bertolotti
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of “Piemonte Orientale” and Cancer Epidemiology, CPO Piemonte, Novara, Italy
| | - Annalisa Roveta
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Carolina Pelazza
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Fabio Giacchero
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Serena Penpa
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Costanza Massarino
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Tatiana Bolgeo
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonella Cassinari
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Marco Mussa
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Dipartimento Attività Integrate Ricerca Innovazione, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
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Honda S, Sakai R, Inoue E, Majima M, Konda N, Takada H, Kihara M, Yajima N, Nanki T, Yamamoto K, Takeuchi T, Harigai M. Association of methotrexate use and lymphoproliferative disorder in patients with rheumatoid arthritis: Results from a Japanese multi-institutional retrospective study. Mod Rheumatol 2021; 32:16-23. [PMID: 33428479 DOI: 10.1080/14397595.2020.1869370] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the risk factors and clinical characteristics of lymphoproliferative disorder (LPD) in Japanese patients with rheumatoid arthritis (RA). METHODS We enrolled patients with RA aged ≥20 years who visited the participating hospitals between April 2011 and July 2011. We investigated the risk factors for LPD using a Cox proportional hazard model and described pathological features and vital prognosis of LPD in patients with RA. RESULTS We enrolled 9815 patients with the following characteristics at baseline: female 79.4%, median age 63 years; median disease duration 7 years; median DAS28-CRP (3) 3.1; prevalence of MTX use 60.0%. Sixty-eight patients (0.69%) developed LPD in 3-year observation period. Multivariable analysis showed that age by decade (hazard ratio [95% confidence interval], 1.47 [1.18-1.85]) and MTX use at baseline (2.35 [1.25-4.42] for ≤8 mg/week, 4.39 [2.07-9.32] for >8 mg/week versus non-use) were significant risk factors of LPD. Of 55 patients with pathological diagnosis, diffuse large B cell lymphoma was the most frequent (54%). The 5-year mortality of LPD was 24%. The major cause of death was lymphoma (81%). CONCLUSION This nationwide study revealed risk factors, clinical characteristics, and prognosis of LPD in the largest number of Japanese patients with RA.
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Affiliation(s)
- Suguru Honda
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ryoko Sakai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Masako Majima
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoko Konda
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hideto Takada
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mari Kihara
- Department of Rheumatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiro Nanki
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | | | - Tsutomu Takeuchi
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Keio University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Versluijs Y, Brown LE, Ring D. Does a Previsit Phone Call from the Surgeon Reduce Decision Conflict? Telemed J E Health 2021; 27:1282-1287. [PMID: 33538643 DOI: 10.1089/tmj.2020.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is some evidence that previsit strategies can make in-person visits more productive and efficient. We compared between people who received a phone call before a musculoskeletal specialty visit and people who did not with respect to several factors: (1) decision conflict (difficulty deciding between two or more options), (2) perceived clinician empathy after an in-person visit, and (3) arrival for the scheduled in-person appointment. We also recorded the specialist's opinion that the phone call alone could adequately replace an in-person visit while maintaining quality, safety, and effectiveness. Materials and Methods: In this prospective randomized-controlled trial, 122 patients were enrolled and randomized to receive a previsit phone call by an orthopedic surgeon before a scheduled visit or not. After the in-person visit, patients completed a (1) demographic questionnaire including age, gender, race/ethnicity, marital status, level of education, work status, and comorbidities; (2) Decision Conflict Scale; and (3) Jefferson Scale of Patient Perceptions of Physician Empathy. Results: No significant difference was found between the two groups in decision conflict, perceived empathy, or not attending the scheduled visit. Of the 55 successful phone calls, the surgeon felt that 50 (91%) had the potential to safely and effectively replace an in-person visit. Conclusion: Although a previsit phone call did not reduce decision conflict or improve the patient experience as measured after one visit, there may be merit in studying an increased number of touch points, particularly with some subsets of illness featuring substantial stress or misconceptions. The identified potential for the application and transfer of specialty expertise through telephone alone also merits additional study.
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Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, USA.,Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Laura E Brown
- Center for Health Communication, Dell Medical School-The University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, USA
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Amit M, Liu C, Netto Gleber FO, Kini S, Tam S, Benov A, Aashiq M, El-Naggar AK, Moreno AC, Rosenthal DI, Glisson BS, Ferrarotto R, Wong MK, Migden MR, Li G, Khanna A, Goepfert RP, Nagarajan P, Weber RS, Myers JN, Gross ND. Integrating depth of invasion in T classification improves the prognostic performance of the American Joint Committee on Cancer primary tumor staging system for cutaneous squamous cell carcinoma of the head and neck. Eur J Cancer 2020; 144:169-177. [PMID: 33352413 DOI: 10.1016/j.ejca.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The last revision of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual included a specific system for cutaneous squamous cell carcinoma (CSCC) of the head and neck. Here, we assessed the prognostic performance of six candidate modified T-classification models in head and neck CSCC patients. METHODS Analysis of 916 patients with head and neck CSCC given treatment with curative intent at The University of Texas MD Anderson Cancer Center between 1995 and 2019 was performed. The main outcome was disease-specific survival (DSS), and the impact of depth of invasion (DOI) was analyzed using multivariable regression models. Candidate models were developed using the optimal DOI cut points for each AJCC T classification based on goodness of fit of the model and the simplicity of the model. Staging systems were compared using Harrell's concordance index. RESULTS Median age was 70 years (range, 19-97years) and median follow-up time of 22 months (range, 1-250months). The median DOI was 6.0 mm (range, 0.1-70.0 mm). The five-year DSS rate was 80.7% (95%CI, 77.4-83.7%). We found significant association between DOI (hazard ratio, 1.21 [95%CI: 1.01-1.43]) and DSS on multivariable analysis. Based on a low Akaike information criterion score, improvement in the concordance index, and Kaplan-Meier curves, model 6 surpassed the AJCC staging system. CONCLUSIONS Incorporation of DOI in the current AJCC staging system improves discrimination of T classifications in head and neck CSCC patients. LAY SUMMARY The current staging system for head and neck cutaneous squamous cell carcinoma demonstrates wide prognostic variability and provides suboptimal risk stratification. Incorporation of depth of invasion in the T-classification system improves risk prediction and patient counseling. PRECIS We propose improved head and neck cutaneous squamous cell carcinoma T staging that will include depth of invasion and should be considered in future versions of the American Joint Committee on Cancer after external validation.
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Affiliation(s)
- Moran Amit
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Chuan Liu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sameer Kini
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System and Henry Ford Cancer Institute, Detroit, MI, USA
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel
| | - Mohamed Aashiq
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adel K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bonnie S Glisson
- Department of Thoracic and Head/Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Thoracic and Head/Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael K Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael R Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anshu Khanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Farooq A, Bae J, Rice D, Moro A, Paredes AZ, Crisp AL, Windholtz M, Sahara K, Tsilimigras DI, Hyer JM, Merath K, Mehta R, Parasidis E, Pawlik TM. Inside the courtroom: An analysis of malpractice litigation in gallbladder surgery. Surgery 2020; 168:56-61. [DOI: 10.1016/j.surg.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/26/2020] [Accepted: 04/07/2020] [Indexed: 01/10/2023]
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Silva Júnior JM, Chaves RCDF, Corrêa TD, Assunção MSCD, Katayama HT, Bosso FE, Amendola CP, Serpa Neto A, Malbouisson LMS, Oliveira NED, Veiga VC, Rojas SSO, Postalli NF, Alvarisa TK, Lucena BMND, Oliveira RAGD, Sanches LC, Silva UVDAE, Nassar Junior AP. Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil. Rev Bras Ter Intensiva 2020; 32:17-27. [PMID: 32401988 PMCID: PMC7206944 DOI: 10.5935/0103-507x.20200005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
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Affiliation(s)
| | | | | | | | | | | | | | - Ary Serpa Neto
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Neymar Elias de Oliveira
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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Rangabashyam M, Wee HE, Wang W, Mueller S, Karim KABA, Skanthakumar T, Hariraman B, Sommat K, Soong Y, Chua MLK, Tay G, Tan N‐C, Tan HK, Iyer NG. Electronic tumor board presentations as the basis for the development of a head and neck cancer database. Laryngoscope Investig Otolaryngol 2020; 5:46-54. [PMID: 32128430 PMCID: PMC7042654 DOI: 10.1002/lio2.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/27/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multidisciplinary team meetings or tumor boards (TBs) form a pivotal component of oncology practice. The crux of a TB revolves around making treatment decisions based on succinct head and neck cancer (HNC) patient data presentations, which can be challenging and complex. Apart from meticulous TB presentations, discussions and treatment plan documentation is equally important. The aim of this study was to structure an electronic synoptic TB data presentation to address all these areas. The overarching benefits of systematic TB data collection include facilitating audits and research. METHODS We utilized a secure web-based tool that was used for common scientific research purposes but customized to store HNC patient data. The data points were tabulated across eight TB pages: (a) TB scheduling, (b) patient biodata, (c) diagnosis details, (d) index presentation, (e) images, (f) management and histopathology, (g) TB presentation, and (h) TB discussion and decisions. Each data point leads to additional fields by branching logic to permit further relevant data entry. This was integrated within the patient electronic medical records allowing for a direct internal trajectory to recall TB data. RESULTS From October 2015 to October 2018, we recorded over 2000 presentations for 1279 individual patients. This is a quality improvement initiative, and hence, the results are more of a broad analysis of our TB presentation process. The most common cancers were squamous cell (523, 41%), thyroid (207, 16%), and nasopharyngeal (139, 11%) carcinomas. Importantly, this system has formed the basis for a number of clinical and translational research projects and audit outcomes. CONCLUSION Despite TBs being vital to oncologic practice, little attempt has been made to report TB data management. In this study, we present an efficient system that permits the integration of dual functions: TB data presentation and oncologic data collection for research, recall, and audit purposes.
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Affiliation(s)
- Mahalakshmi Rangabashyam
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
| | - Hide E. Wee
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
| | | | - Stefan Mueller
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
| | - Khairul A. B. A. Karim
- Clinical and Research Database Registry, Surgery Academic Clinical Program (ACP), Singapore General HospitalSingapore
| | | | | | - Kiattisa Sommat
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Yoke‐Lim Soong
- Duke‐NUS Medical SchoolSingapore
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Melvin L. K. Chua
- Duke‐NUS Medical SchoolSingapore
- Division of Radiation OncologyNational Cancer Centre SingaporeSingapore
| | - Gerald Tay
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
| | - Ngian ‐Chye Tan
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Hiang Khoon‐ Tan
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
| | - N. Gopalakrishna Iyer
- Division of Surgical OncologyNational Cancer Centre SingaporeSingapore
- SingHealth Duke‐NUS Head and Neck CentreSingapore General HospitalSingapore
- Department of General SurgerySingapore General HospitalSingapore
- Duke‐NUS Medical SchoolSingapore
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Abstract
TwinsMX is a national twin registry in Mexico recently created with institutional support from the Universidad Nacional Autónoma de México. It aims to serve as a platform to advance epidemiological and genetic research in the country and to disentangle the genetic and environmental contributions to health and disease in the admixed Mexican population. Here, we describe our recruitment and data collection strategies and discuss both the progress to date and future directions. More information about the registry is available on our website: https://twinsmxofficial.unam.mx/ (content in Spanish).
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Dai W, Xie S, Zhang R, Wei X, Wu C, Zhang Y, Feng W, Liao X, Mu Y, Zhou H, Cheng X, Jiang Y, He J, Li Q, Yang X, Shi Q. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: a multicentre, prospective, observational cohort study protocol. BMJ Open 2019; 9:e030726. [PMID: 31662377 PMCID: PMC6830688 DOI: 10.1136/bmjopen-2019-030726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patient-reported outcome-based symptom monitoring and alerting have been attractive for patient care after a tumour-removal surgery. However, the implementation parameters of this patient-centred symptom management system in perioperative patients with lung cancer are still lacking. We aim to develop a perioperative symptom scale (PSS) for monitoring, to determine the optimal time points for symptom assessment and to define the alert thresholds for medical intervention. METHODS AND ANALYSIS This study will prospectively recruit 300 patients undergoing lung cancer surgery in six hospitals. The MD Anderson Symptom Inventory-Lung Cancer Module (MDASI-LC) is used to collect longitudinal symptom data preoperatively, daily postoperatively during in-hospital stay and weekly after discharge until 4 weeks or the start of postoperative oncological therapy. Symptoms that change significantly over time will be generated as the PSS. We will determine the optimal time points for follow-up using the generalised linear mixed-effects models. The MDASI-LC interference-measured functional status will be used as the anchor for the alert thresholds. ETHICS AND DISSEMINATION Ethics Committee of Sichuan Cancer Hospital approved this study on 16 October 2017 (No. SCCHEC-02-2017-042). The manuscript is based on the latest protocol of Version 3.0, 15 September 2019. The results of this study will be presented at medical conferences and published in peer-reviewed journals. TRIALS REGISTRATION NUMBER NCT03341377.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Heling Zhou
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Cheng
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanhua Jiang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaojun Yang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kratz AL, Alschuler KN, Ehde DM, von Geldern G, Little R, Kulkarni S, Pickup K, Braley TJ. A randomized pragmatic trial of telephone-delivered cognitive behavioral-therapy, modafinil, and combination therapy of both for fatigue in multiple sclerosis: The design of the "COMBO-MS" trial. Contemp Clin Trials 2019; 84:105821. [PMID: 31400515 DOI: 10.1016/j.cct.2019.105821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fatigue is one of the most common and disabling chronic symptoms in multiple sclerosis (MS). Optimization of available treatments for MS-related fatigue has been stymied by lack of comparative effectiveness research that focuses on real-world treatment delivery methods and potential modification of treatment effect by other chronic MS symptoms or disability level. This report describes the design of a patient centered, comparative effectiveness trial of cognitive behavioral-therapy (CBT), modafinil, and combination therapy of both for fatigue in MS ("COMBO-MS"). METHODS We describe the methods of this pragmatic comparative effectiveness trial that is guided by a team of patient, family, provider, community, and payer stakeholders. Eligible participants with MS and significant fatigue severity are randomly assigned (1:1:1) to received either CBT, modafinil, or a combination of CBT and modafinil for 12 weeks. The primary outcome is change in fatigue impact as measured by the Modified Fatigue Impact Scale (MFIS) at 12 weeks. Secondary outcome measures include ecological momentary assessment (EMA) measures of fatigue intensity, fatigue interference, and fatigability (measured over 7 days' time at baseline and at 12 weeks), and change in MFIS score at 24 weeks. PROJECTED OUTCOMES We hypothesize that combination therapy will more effectively ameliorate fatigue severity than either monotherapy, and that heterogeneity of treatment effects will be found based on depression status, presence of known or suspected sleep disorder, and disease severity. Study findings will assist patients, providers, payers, and policy makers to provide more effective care for managing fatigue in MS.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Kevin N Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Gloria von Geldern
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Roderick Little
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Shubhangi Kulkarni
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kristen Pickup
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tiffany J Braley
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Dai W, Zhang Y, Feng W, Liao X, Mu Y, Zhang R, Wei X, Wu C, Xie S, Li Q, Shi Q. Using patient-reported outcomes to manage postoperative symptoms in patients with lung cancer: protocol for a multicentre, randomised controlled trial. BMJ Open 2019; 9:e030041. [PMID: 31455710 PMCID: PMC6720560 DOI: 10.1136/bmjopen-2019-030041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/18/2019] [Accepted: 08/01/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Surgery is one of the primary treatments for lung cancer. The postoperative symptom burden experienced by patients with lung cancer is substantial, seriously delaying their recovery from surgery and impairing their quality of life. Patient-reported outcome (PRO)-based symptom management is increasingly regarded as an optimal model for patient-centred care. Currently, clinical trial-based evidence involving early-phase (immediately after surgery for up to 1 month) symptom management of lung cancer is lacking. We propose a randomised trial to evaluate the effect of a PRO-based symptom-monitoring programme with overthreshold alerts and responses for postoperative recovery in patients with lung cancer. METHODS AND ANALYSIS The study will recruit 160 patients with lung cancer from six hospitals. The patients will be randomly allocated to the intervention group or control group in a ratio of 1:1. Patients in the intervention group will receive PRO-based symptom management from the specialists when their reported target symptom (pain, coughing, fatigue, disturbed sleep and shortness of breath) scores reach the preset threshold (score ≥4). Patients in the control group will not generate alerts and will follow the standard procedures for symptom management. All patients will receive symptom assessments via the MD Anderson Symptom Inventory-lung cancer module on the day before surgery, daily after surgery and twice a week after discharge until 4 weeks or the start of postoperative oncological treatment. The primary outcome-mean symptom threshold events-will be compared between the intervention and control group via independent sample Student's t-test. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of Sichuan Cancer Hospital on 22 November 2018 (No. SCCHEC-02-2018-045). This manuscript is based on V.2.0, 9 May 2019 of the protocol. The study results will be disseminated in publications in peer-reviewed journals and presentations at academic conferences. TRIALS REGISTRATION NUMBER ChiCTR1900020846.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanqiang Zhang
- Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, China
| | - Wenhong Feng
- Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, Jiangyou, China
| | - Xiaoqing Liao
- Department of Cardiothoracic Surgical Oncology, Dazhu County People's Hospital, Dazhu County, China
| | - Yunfei Mu
- Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chuanmei Wu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaohua Xie
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Graduate School, Chengdu Medical College, Chengdu, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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