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Ay A, Savaş EH, Sumengen AA, Koyuncu İE, Erkul M, Semerci R. A qualitative exploration of nurses' views on technology-based interventions in pediatric oncology care. J Pediatr Nurs 2024; 79:205-212. [PMID: 39293202 DOI: 10.1016/j.pedn.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/29/2024] [Accepted: 09/13/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVES Recent technological advancements offer tools for pediatric oncology care, but their integration into clnical practice is still under research. This study aimed to explore pediatric oncology nurses' perspectives on integrating technology-based interventions into care. METHODS A descriptive phenomenological qualitative study was conducted with 13 pediatric oncology nurses. The focus groups were led by the research members, and each group included four to five participants. Nurses were asked to discuss their perceptions of the technology-based intervention, the type of technology used in the clinic, and the advantages and disadvantages of the technology. The focus groups were audio-recorded and professionally transcribed. The transcripts were analyzed thematically by two study team members using MAXQDA. The Consolidated Criteria for Reporting Qualitative Research were followed. RESULTS The mean age of nurses was 38.46 ± 5.23 years and 92.3 % had more than 10 years of professional experience. As a result of the focus group interviews, three main themes and seven sub-themes were identified. These main themes included: (i) Need for competence and training for technology-based interventions, (ii) Effectiveness of technology-based interventions in pediatric patient care, and (iii) Challenges in integrating technology-based interventions into care. CONCLUSION The study found that from the perspective of pediatric oncology nurses, technology-based interventions have multifaceted benefits and are effective in improving patient outcomes and care; however, nurses' limited ability to use technology-based interventions restricts them from integrating their care. IMPLICATIONS TO PRACTICE It is recommended that nurses should be trained on technology-based interventions and the safe use of these interventions.
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Affiliation(s)
- Ayşe Ay
- Başkent University, Faculty of Health Sciences, Department of Nursing, Ankara, Türkiye.
| | | | - Aylin Akça Sumengen
- The University of Alabama, Capstone College of Nursing, Tuscaloosa, AL, USA.
| | - İlçim Ercan Koyuncu
- Başkent University, Faculty of Health Sciences, Department of Nursing, Ankara, Türkiye.
| | - Münevver Erkul
- Antalya Bilim University, Faculty of Health Sciences, Department of Nursing, Antalya, Türkiye.
| | - Remziye Semerci
- Koç University, School of Nursing, Department of Pediatric Nursing, Istanbul, Türkiye.
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Straw I, Brass I, Mkwashi A, Charles I, Soares A, Steer C. Insights From a Clinically Orientated Workshop on Health Care Cybersecurity and Medical Technology: Observational Study and Thematic Analysis. J Med Internet Res 2024; 26:e50505. [PMID: 38990611 PMCID: PMC11273071 DOI: 10.2196/50505] [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: 07/03/2023] [Revised: 11/28/2023] [Accepted: 05/17/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Health care professionals receive little training on the digital technologies that their patients rely on. Consequently, practitioners may face significant barriers when providing care to patients experiencing digitally mediated harms (eg, medical device failures and cybersecurity exploits). Here, we explore the impact of technological failures in clinical terms. OBJECTIVE Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice. METHODS A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data. RESULTS Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized. CONCLUSIONS Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care.
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Affiliation(s)
- Isabel Straw
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Irina Brass
- Department of Science, Technology, Engineering and Public Policy, University College London, London, United Kingdom
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Chan YN, Cho Y, Hirschey R, Piepmeier A, Bender CM, Anderson RA, Foster MC, Bryant AL. Cancer-related cognitive impairment in older adults with acute myeloid leukemia treated with hypomethylating agents and venetoclax chemotherapy: a longitudinal descriptive study. Support Care Cancer 2024; 32:485. [PMID: 38960966 PMCID: PMC11311204 DOI: 10.1007/s00520-024-08673-2] [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] [Received: 01/18/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE To explore cancer-related cognitive impairment (CRCI) in older adults with acute myeloid leukemia (AML) receiving venetoclax in combination with hypomethylating agents or low-dose cytarabine chemotherapy. METHODS This study is a longitudinal, qualitative descriptive study. Participants were recruited using purposive sampling. Semi-structured interviews were conducted among 11 older adults with AML at cycle 2, cycle 4, and cycle 7 of chemotherapy. An early end-of-study interview was conducted for those who changed treatment plans during the study follow-up. RESULTS A total of 22 transcripts were included for thematic analysis. Four themes emerged: (1) CRCI experiences, (2) impact of CRCI, (3) CRCI coping strategies, and (4) perceived CRCI-related factors. Older adults with AML experienced challenges in memory, language, and attention both intermittently and daily. These cognitive changes impacted their emotion, daily activities, social connection, and their caregivers' responsibilities. Hence, these older adults with AML developed problem-solving and emotional coping strategies to cope with CRCI. Older adults with AML also identified demographic, physiology/clinical, psychological, and other factors that might contribute to CRCI. CONCLUSION This study offers important insight for clinicians to understand how older adults with AML experience CRCI and how it impacts their daily routines. It indicates that clinicians should ask patients about their experience with cognitive changes at each encounter to provide support or coping strategies as needed to prevent CRCI from further hindering their quality of life.
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MESH Headings
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/psychology
- Leukemia, Myeloid, Acute/complications
- Aged
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Male
- Female
- Longitudinal Studies
- Sulfonamides/administration & dosage
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Middle Aged
- Cognitive Dysfunction/etiology
- Qualitative Research
- Adaptation, Psychological
- Cytarabine/administration & dosage
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Affiliation(s)
- Ya-Ning Chan
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Youngmin Cho
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aaron Piepmeier
- Department of Exercise Science, Elon University, Elon, NC, USA
| | | | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Matthew C Foster
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chen D, Parsa R, Hope A, Hannon B, Mak E, Eng L, Liu FF, Fallah-Rad N, Heesters AM, Raman S. Physician and Artificial Intelligence Chatbot Responses to Cancer Questions From Social Media. JAMA Oncol 2024; 10:956-960. [PMID: 38753317 PMCID: PMC11099835 DOI: 10.1001/jamaoncol.2024.0836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 05/19/2024]
Abstract
Importance Artificial intelligence (AI) chatbots pose the opportunity to draft template responses to patient questions. However, the ability of chatbots to generate responses based on domain-specific knowledge of cancer remains to be tested. Objective To evaluate the competency of AI chatbots (GPT-3.5 [chatbot 1], GPT-4 [chatbot 2], and Claude AI [chatbot 3]) to generate high-quality, empathetic, and readable responses to patient questions about cancer. Design, Setting, and Participants This equivalence study compared the AI chatbot responses and responses by 6 verified oncologists to 200 patient questions about cancer from a public online forum. Data were collected on May 31, 2023. Exposures Random sample of 200 patient questions related to cancer from a public online forum (Reddit r/AskDocs) spanning from January 1, 2018, to May 31, 2023, was posed to 3 AI chatbots. Main Outcomes and Measures The primary outcomes were pilot ratings of the quality, empathy, and readability on a Likert scale from 1 (very poor) to 5 (very good). Two teams of attending oncology specialists evaluated each response based on pilot measures of quality, empathy, and readability in triplicate. The secondary outcome was readability assessed using Flesch-Kincaid Grade Level. Results Responses to 200 questions generated by chatbot 3, the best-performing AI chatbot, were rated consistently higher in overall measures of quality (mean, 3.56 [95% CI, 3.48-3.63] vs 3.00 [95% CI, 2.91-3.09]; P < .001), empathy (mean, 3.62 [95% CI, 3.53-3.70] vs 2.43 [95% CI, 2.32-2.53]; P < .001), and readability (mean, 3.79 [95% CI, 3.72-3.87] vs 3.07 [95% CI, 3.00-3.15]; P < .001) compared with physician responses. The mean Flesch-Kincaid Grade Level of physician responses (mean, 10.11 [95% CI, 9.21-11.03]) was not significantly different from chatbot 3 responses (mean, 10.31 [95% CI, 9.89-10.72]; P > .99) but was lower than those from chatbot 1 (mean, 12.33 [95% CI, 11.84-12.83]; P < .001) and chatbot 2 (mean, 11.32 [95% CI, 11.05-11.79]; P = .01). Conclusions and Relevance The findings of this study suggest that chatbots can generate quality, empathetic, and readable responses to patient questions comparable to physician responses sourced from an online forum. Further research is required to assess the scope, process integration, and patient and physician outcomes of chatbot-facilitated interactions.
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Affiliation(s)
- David Chen
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rod Parsa
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Hope
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ernie Mak
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network Toronto, Toronto, Ontario, Canada
| | - Ann M. Heesters
- Department of Clinical and Organizational Ethics, University Health Network, Toronto, Ontario, Canada
- The Institute for Education Research, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Srinivas Raman
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Innominato PF, Macdonald JH, Saxton W, Longshaw L, Granger R, Naja I, Allocca C, Edwards R, Rasheed S, Folkvord F, de Batlle J, Ail R, Motta E, Bale C, Fuller C, Mullard AP, Subbe CP, Griffiths D, Wreglesworth NI, Pecchia L, Fico G, Antonini A. Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study. JMIR Res Protoc 2024; 13:e52957. [PMID: 38687985 PMCID: PMC11094600 DOI: 10.2196/52957] [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: 09/21/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. OBJECTIVE This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. METHODS This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). RESULTS This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. CONCLUSIONS In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52957.
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Affiliation(s)
- Pasquale F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Warwick Medical School & Cancer Research Centre, University of Warwick, Coventry, United Kingdom
- Chronotherapy, Cancers and Transplantation Research Unit, Faculty of Medicine, Université Paris-Saclay, Villejuif, France
| | - Jamie H Macdonald
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Wendy Saxton
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Laura Longshaw
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Rachel Granger
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Iman Naja
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | | | - Ruth Edwards
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Solah Rasheed
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Frans Folkvord
- PredictBy, Barcelona, Spain
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Rohit Ail
- Health Innovation, Samsung, Staines, United Kingdom
| | - Enrico Motta
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | - Catherine Bale
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Claire Fuller
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Anna P Mullard
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Christian P Subbe
- Acute and Critical Care Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Dawn Griffiths
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Nicholas I Wreglesworth
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Fico
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alessio Antonini
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
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Zhang G, Liu X, Zeng Y. Advancements in oncology nursing: Embracing technology-driven innovations. Asia Pac J Oncol Nurs 2024; 11:100399. [PMID: 38465238 PMCID: PMC10920149 DOI: 10.1016/j.apjon.2024.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
- Guolong Zhang
- Respiratory Intervention Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuanhui Liu
- Department of Industrial Design, Hangzhou City University, Hangzhou, China
| | - Yingchun Zeng
- School of Medicine, Hangzhou City University, Hangzhou, China
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Oppong BA, Lustberg MB, Nolan TS, Relation T, Park KU, Healy E, Trance A, Klemanski DL. Utilization of cancer survivorship services during the COVID-19 pandemic in a tertiary referral center. J Cancer Surviv 2023; 17:1708-1714. [PMID: 35895236 PMCID: PMC9326963 DOI: 10.1007/s11764-022-01231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND All Commission on Cancer-accredited comprehensive cancer centers offer survivorship programs (SPs) to women upon completion of treatment. These SPs can include clinical and non-clinical programming such as physical rehabilitation, emotional and psychosocial support, nutrition, and exercise programming. Concern about the availability and access to these programs during the COVID-19 pandemic has been described in recent literature. We sought to identify the impact of the COVID-19 pandemic on participation in these supportive services for breast cancer patients within a single institution. METHODS The Ohio State University tertiary care center offers clinical and non-clinical breast cancer support services. Descriptive statistics were utilized to summarize referral and patient participation data from January 2019 through July 2021. Data from calendar year 2019 was used as a normative comparison for pre-COVID-19. In-person and telehealth use was tracked longitudinally. RESULTS During the lockdown due to the COVID-19 pandemic (March through May 2020), provider referrals to SPs declined by 10%, while the overall total for the calendar year modestly increased from 1195 in 2019 to 1210 in 2020, representing a 1.3% increase. Psycho-oncology referrals increased from 280 to 318 (13.5%). The most significant change of participation rates in non-clinical SPs during the pandemic was utilization of exercise content, which increased by 220% from 2019 to 2020. The total proportion of breast cancer participants choosing an exercise program increased from 16.8% in 2019 to 42.2% in 2021, making it the most selected program area overall. Previously, nutrition was the most selected program area as it comprised 42.5% of overall utilization in 2019. CONCLUSION The pandemic's potential to place barriers to participation in SPs is a legitimate concern. We found a modest decline in provider referrals to clinical services during the lockdown period, while patient-directed participation increased with more survivors engaging in exercise-based programs. Transitioning to virtual platforms served to maintain access for patients. IMPLICATIONS FOR CANCER SURVIVORS As we grapple with the COVID-19 pandemic, patients with cancer deserve increased attention due to the expected stressors associated with the diagnosis. Those in the survivorship stage utilize services for psychosocial support, and the observed increase in utilization of SPs suggests an elevated need for connectivity. To meet this need, telehealth platforms have been expanded to allow for continued participation. It remains to be seen whether this will be sustained post-COVID-19 or whether reduced human contact will create new needs for programming.
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Affiliation(s)
- Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| | - Maryam B Lustberg
- Department of Medical Oncology, The Ohio State University, Columbus, OH, USA
| | - Timiya S Nolan
- Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Theresa Relation
- MetroHealth Systems and Case Western Reserve University, Cleveland, OH, USA
| | - Ko Un Park
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Erin Healy
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Annie Trance
- Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, OH, USA
| | - Dori L Klemanski
- Cancer Support Services, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital, Columbus, OH, USA
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Singleton AC, Estapé T, Ee C, Hyun KK, Partridge SR. Editorial: Digital health quality, acceptability, and cost: steps to effective continuity of cancer care. Front Digit Health 2023; 5:1264638. [PMID: 37636592 PMCID: PMC10455910 DOI: 10.3389/fdgth.2023.1264638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Anna C. Singleton
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tanie Estapé
- Department of Psychosocial Oncology, FEFOC Foundation, Barcelona, Spain
| | - Carolyn Ee
- The National Institute of Complementary Medicine, Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Karice K. Hyun
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R. Partridge
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Crul M, Terkola R, Bardin C, Lizeaga Cundin G, Zeinab N, Blakemore R, Fry A, Bloomfield D, Woolmore A, Levy J. Pilot study of a European oncology regimen reference library and matching algorithm. Eur J Hosp Pharm 2023; 30:227-231. [PMID: 34285110 PMCID: PMC10359787 DOI: 10.1136/ejhpharm-2021-002763] [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] [Received: 03/12/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES As yet, there is no European data standard for naming and describing oncology regimens. To enable real-world cancer treatment data comparisons, the Oncology Data Network created a unified reference database for systemic anti-cancer regimens used in practice across Europe. Data are extracted from clinical systems and mapped to a single standard called the "Core Regimen Reference Library (CRRL)". An automated matching algorithm has been designed based on: drug combinations; administration schedule; and dosing and route of administration. Incomplete matches are flagged for expert review. The aim of this pilot study is to have an expert pharmacist panel test the algorithm's feasibility by comparing computerised and manual matching of regimens that are currently in use in different European countries. METHODS The combined team pooled a diverse sample of 47 reference regimens used in Europe for solid and haematological cancers. These were then codified to the developed common data standard and the algorithm was used to match them to the CRRL. The expert pharmacist panel from the European Society of Oncology Pharmacy (ESOP) selected 12 regimens from the sample set, ranging from simple to complex, and performed a single-blind test of the algorithm, by systematically matching each original regimen to the CRRL. RESULTS ESOP validated the algorithm's feasibility based on full concurrence between manual and computer matches thereby validating the algorithm rules and logic with regard to what defines the core characteristics of a regimen and how to compare similarities and differences. CONCLUSIONS ESOP's validation of the matching algorithm and approach to curating a master library provides confidence in their utility for reliable comparison of real-world regimen usage across Europe.
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Affiliation(s)
- Mirjam Crul
- Clinical Pharmacology and Pharmacy, VUMC, Amsterdam, The Netherlands
| | - Robert Terkola
- Pharmacy, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Christophe Bardin
- Clinical Pharmacy, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | | | | | - Anna Fry
- IQVIA, Durham, North Carolina, USA
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Papachristou N, Kotronoulas G, Dikaios N, Allison SJ, Eleftherochorinou H, Rai T, Kunz H, Barnaghi P, Miaskowski C, Bamidis PD. Digital Transformation of Cancer Care in the Era of Big Data, Artificial Intelligence and Data-Driven Interventions: Navigating the Field. Semin Oncol Nurs 2023; 39:151433. [PMID: 37137770 DOI: 10.1016/j.soncn.2023.151433] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To navigate the field of digital cancer care and define and discuss key aspects and applications of big data analytics, artificial intelligence (AI), and data-driven interventions. DATA SOURCES Peer-reviewed scientific publications and expert opinion. CONCLUSION The digital transformation of cancer care, enabled by big data analytics, AI, and data-driven interventions, presents a significant opportunity to revolutionize the field. An increased understanding of the lifecycle and ethics of data-driven interventions will enhance development of innovative and applicable products to advance digital cancer care services. IMPLICATIONS FOR NURSING PRACTICE As digital technologies become integrated into cancer care, nurse practitioners and scientists will be required to increase their knowledge and skills to effectively use these tools to the patient's benefit. An enhanced understanding of the core concepts of AI and big data, confident use of digital health platforms, and ability to interpret the outputs of data-driven interventions are key competencies. Nurses in oncology will play a crucial role in patient education around big data and AI, with a focus on addressing any arising questions, concerns, or misconceptions to foster trust in these technologies. Successful integration of data-driven innovations into oncology nursing practice will empower practitioners to deliver more personalized, effective, and evidence-based care.
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Affiliation(s)
- Nikolaos Papachristou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | - Nikolaos Dikaios
- Centre for Vision Speech and Signal Processing, University of Surrey, Guildford, UK; Mathematics Research Centre, Academy of Athens, Athens, Greece
| | - Sarah J Allison
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK; School of Bioscience and Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | | | - Taranpreet Rai
- Centre for Vision Speech and Signal Processing, University of Surrey, Guildford, UK; Datalab, The Veterinary Health Innovation Engine (vHive), Guildford, UK
| | - Holger Kunz
- Institute of Health Informatics, University College London, London, UK
| | - Payam Barnaghi
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, UK
| | - Christine Miaskowski
- School of Nursing, University California San Francisco, San Francisco, California, USA
| | - Panagiotis D Bamidis
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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Haque MDR, Rubya S. An Overview of Chatbot-Based Mobile Mental Health Apps: Insights From App Description and User Reviews. JMIR Mhealth Uhealth 2023; 11:e44838. [PMID: 37213181 DOI: 10.2196/44838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. OBJECTIVE In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. METHODS We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. RESULTS We found that although chatbots' personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. CONCLUSIONS Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings.
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Affiliation(s)
- M D Romael Haque
- Department of Computer Science, Marquette University, Milwaukee, WI, United States
| | - Sabirat Rubya
- Department of Computer Science, Marquette University, Milwaukee, WI, United States
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12
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Morton C, Sullivan R, Sarker D, Posner J, Spicer J. Revitalising cancer trials post-pandemic: time for reform. Br J Cancer 2023; 128:1409-1414. [PMID: 36959378 PMCID: PMC10035974 DOI: 10.1038/s41416-023-02224-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
The COVID-19 pandemic posed significant risk to the health of cancer patients, compromised standard cancer care and interrupted clinical cancer trials, prompting dramatic streamlining of services. From this health crisis has emerged the opportunity to carry forward an unexpected legacy of positive reforms to clinical cancer research, where conventionally convoluted approvals processes, inefficient trial design, procedures and data gathering could benefit from the lessons in rationalisation learned during the pandemic.
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Affiliation(s)
- Cienne Morton
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK.
| | | | - Debashis Sarker
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - John Posner
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - James Spicer
- Department of Medical Oncology, Guy's & St Thomas NHS Foundation Trust, London, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
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13
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Gvozdanovic A, Jozsa F, Fersht N, Grover PJ, Kirby G, Kitchen N, Mangiapelo R, McEvoy A, Miserocchi A, Patel R, Thorne L, Williams N, Kosmin M, Marcus HJ. Integration of a personalised mobile health (mHealth) application into the care of patients with brain tumours: proof-of-concept study (IDEAL stage 1). BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000130. [PMID: 36579146 PMCID: PMC9791405 DOI: 10.1136/bmjsit-2021-000130] [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: 01/05/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Brain tumours lead to significant morbidity including a neurocognitive, physical and psychological burden of disease. The extent to which they impact the multiple domains of health is difficult to capture leading to a significant degree of unmet needs. Mobile health tools such as Vinehealth have the potential to identify and address these needs through real-world data generation and delivery of personalised educational material and therapies. We aimed to establish the feasibility of Vinehealth integration into brain tumour care, its ability to collect real-world and (electronic) patient-recorded outcome (ePRO) data, and subjective improvement in care. Design A mixed-methodology IDEAL stage 1 study. Setting A single tertiary care centre. Participants Six patients consented and four downloaded and engaged with the mHealth application throughout the 12 weeks of the study. Main outcome measures Over a 12-week period, we collected real-world and ePRO data via Vinehealth. We assessed qualitative feedback from mixed-methodology surveys and semistructured interviews at recruitment and after 2 weeks. Results 565 data points were captured including, but not limited to: symptoms, activity, well-being and medication. EORTC QLQ-BN20 and EQ-5D-5L completion rates (54% and 46%) were impacted by technical issues; 100% completion rates were seen when ePROs were received. More brain cancer tumour-specific content was requested. All participants recommended the application and felt it improved care. Conclusions Our findings indicate value in an application to holistically support patients living with brain cancer tumours and established the feasibility and safety of further studies to more rigorously assess this.
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Affiliation(s)
- Andrew Gvozdanovic
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Felix Jozsa
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Naomi Fersht
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Patrick James Grover
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Andrew McEvoy
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anna Miserocchi
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Lewis Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Norman Williams
- University College London Division of Surgery and Interventional Science, London, UK
| | - Michael Kosmin
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hani J Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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14
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Keenan HL, Duke SL, Wharrad HJ, Doody GA, Patel RS. Usability: An introduction to and literature review of usability testing for educational resources in radiation oncology. Tech Innov Patient Support Radiat Oncol 2022; 24:67-72. [PMID: 36262375 PMCID: PMC9574480 DOI: 10.1016/j.tipsro.2022.09.001] [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: 07/21/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 11/20/2022] Open
Abstract
Usability, or the ease with which something can be used, is a key aspect in ensuring end-users can achieve the best possible outcomes from a given educational resource. Ideally usability testing should take place iteratively throughout the design of the resource, and there are several approaches for undertaking usability testing described in the wider literature. Within radiation oncology education, the extent to which usability testing occurs remains unclear. This literature review aimed to assess current practice and provide a practical introduction to usability testing for educational resource design within radiation oncology. Two web databases were searched for articles describing planned or completed usability testing during the design of a radiation oncology educational resource. Fifteen studies were identified. Data was gathered describing the type of usability testing performed, the number of cycles of testing and the number of test subjects. Articles described design of educational resources for both patients and trainees, with the number of test subjects ranging from 8 to 18. Various testing methods were used, including questionnaires, think aloud studies and heuristic evaluation. Usability testing comprised a range of single cycle through to several rounds of testing. Through illustrative examples identified in the literature review, we demonstrate that usability testing is feasible and beneficial for educational resources varying in size and context. In doing so we hope to encourage radiation oncologists to incorporate usability testing into future educational resource design.
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Affiliation(s)
- Heather L. Keenan
- School of Clinical Medicine, University of Cambridge, United Kingdom
| | - Simon L. Duke
- School of Clinical Medicine, University of Cambridge, United Kingdom
- Education Centre, University of Nottingham, United Kingdom
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15
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Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach JJ, Hwang DY. Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury. Neurology 2022; 99:e1446-e1455. [PMID: 35853748 PMCID: PMC9576301 DOI: 10.1212/wnl.0000000000200937] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Breakdowns in clinician-family communication in neurologic intensive care units (neuroICUs) are common, particularly for goals-of-care decisions to continue or withdraw life-sustaining treatments while considering long-term prognoses. Shared decision-making interventions (decision aids [DAs]) may prevent this problem and increase patient-centered care, yet none are currently available. We assessed the feasibility, acceptability, and perceived usefulness of a DA for goals-of-care communication with surrogate decision makers for critically ill patients with severe acute brain injury (SABI) after hemispheric acute ischemic stroke, intracerebral hemorrhage, or traumatic brain injury. METHODS We conducted a parallel-arm, unblinded, patient-level randomized, controlled pilot trial at 2 tertiary care US neuroICUs and randomized surrogate participants 1:1 to a tailored paper-based DA provided to surrogates before clinician-family goals-of-care meetings or usual care (no intervention before clinician-family meetings). The primary outcomes were feasibility of deploying the DA (recruitment, participation, and retention), acceptability, and perceived usefulness of the DA among surrogates. Exploratory outcomes included outcome of surrogate goals-of-care decision, code status changes during admission, patients' 3-month functional outcome, and surrogates' 3-month validated psychological outcomes. RESULTS We approached 83 surrogates of 58 patients and enrolled 66 surrogates of 41 patients (80% consent rate). Of 66 surrogates, 45 remained in the study at 3 months (68% retention). Of the 33 surrogates randomized to intervention, 27 were able to receive the DA, and 25 subsequently read the DA (93% participation). Eighty-two percent rated the DA's acceptability as good or excellent (median acceptability score 2 [IQR 2-3]); 96% found it useful for goals-of-care decision making. In the DA group, there was a trend toward fewer comfort care decisions (27% vs 56%, p = 0.1) and fewer code status changes (no change, 73% vs 44%, p = 0.02). At 3 months, fewer patients in the DA group had died (33% vs 69%, p = 0.05; median Glasgow Outcome Scale 3 vs1, p = 0.05). Regardless of intervention, 3-month psychological outcomes were significantly worse among surrogates who had chosen continuation of care. DISCUSSION A goals-of-care DA to support ICU shared decision making for patients with SABI is feasible to deploy and well perceived by surrogates. A larger trial is feasible to conduct, although surrogates who select continuation of care deserve additional psychosocial support. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov NCT03833375. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that the use of a DA explaining the goals-of-care decision and the treatment options is acceptable and useful to surrogates of incapacitated critically ill patients with ischemic stroke, intracerebral hemorrhage, or traumatic brain injury.
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Affiliation(s)
- Susanne Muehlschlegel
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT.
| | - Kelsey Goostrey
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Julie Flahive
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Qiang Zhang
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Jolanta J Pach
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT
| | - David Y Hwang
- From the Departments of Neurology (S.M., K.G.), Anesthesiology (S.M.), Surgery (S.M.), and Population and Quantitative Health Sciences (J.F.), University of Massachusetts Chan Medical School, Worcester; and Division of Neurocritical Care and Emergency Neurology (Q.Z., J.J.P., D.Y.H.), Department of Neurology, Yale School of Medicine, New Haven, CT
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16
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Faihs V, Figalist C, Bossert E, Weimann K, Berberat PO, Wijnen-Meijer M. Medical Students and Their Perceptions of Digital Medicine: a Question of Gender? MEDICAL SCIENCE EDUCATOR 2022; 32:941-946. [PMID: 36276758 PMCID: PMC9584022 DOI: 10.1007/s40670-022-01594-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/02/2023]
Abstract
Digital technologies play an essential role in the medical sector of today and the future. In a cross-sectional online survey at a German medical university, male students more frequently reported keeping themselves informed about digital medicine outside of their studies across all clinical years of study. While female students self-assessed their knowledge in different fields of digital medicine as worse than their male peers in the first clinical years of study, no more gender differences could be found towards the final year. However, students of both genders showed a strong desire for further education on the topic of digital medicine.
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Affiliation(s)
- Valentina Faihs
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Dermatology and Allergy Biederstein, TUM School of Medicine, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Christina Figalist
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Eileen Bossert
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katja Weimann
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marjo Wijnen-Meijer
- TUM Medical Education Center, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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17
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Hall RK, Morton S, Wilson J, Kim DH, Colón-Emeric C, Scialla JJ, Platt A, Ephraim PL, Boulware LE, Pendergast J. Development of an Administrative Data-Based Frailty Index for Older Adults Receiving Dialysis. KIDNEY360 2022; 3:1566-1577. [PMID: 36245660 PMCID: PMC9528369 DOI: 10.34067/kid.0000032022] [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: 01/03/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
Background Frailty is present in ≥50% of older adults receiving dialysis. Our objective was to a develop an administrative data-based frailty index and assess the frailty index's predictive validity for mortality and future hospitalizations. Methods We used United States Renal Data System data to establish two cohorts of adults aged ≥65 years, initiating dialysis in 2013 and in 2017. Using the 2013 cohort (development dataset), we applied the deficit accumulation index approach to develop a frailty index. Adjusting for age and sex, we assessed the extent to which the frailty index predicts the hazard of time until death and time until first hospitalization over 12 months. We assessed the Harrell's C-statistic of the frailty index, a comorbidity index, and jointly. The 2017 cohort was used as a validation dataset. Results Using the 2013 cohort (n=20,974), we identified 53 deficits for the frailty index across seven domains: disabilities, diseases, equipment, procedures, signs, tests, and unclassified. Among those with ≥1 deficit, the mean (SD) frailty index was 0.30 (0.13), range 0.02-0.72. Over 12 months, 18% (n=3842) died, and 55% (n=11,493) experienced a hospitalization. Adjusted hazard ratios for each 0.1-point increase in frailty index in models of time to death and time to first hospitalization were 1.41 (95% confidence interval, 1.37 to 1.44) and 1.33 (95% confidence interval, 1.31 to 1.35), respectively. For mortality, C-statistics for frailty index, comorbidity index, and both indices were 0.65, 0.65, and 0.66, respectively. For hospitalization, C-statistics for frailty index, comorbidity index, and both indices were 0.61, 0.60, and 0.61, respectively. Data from the 2017 cohort were similar. Conclusions We developed a novel frailty index for older adults receiving dialysis. Further studies are needed to improve on this frailty index and validate its use for clinical and research applications.
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Affiliation(s)
- Rasheeda K Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Sarah Morton
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Jonathan Wilson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts
| | - Cathleen Colón-Emeric
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Julia J Scialla
- Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Alyssa Platt
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Patti L Ephraim
- Institute of Health System Science, Northwell Health, New York, New York
| | - L Ebony Boulware
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
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18
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Dascalu A, Walker BN, Oron Y, David EO. Non-melanoma skin cancer diagnosis: a comparison between dermoscopic and smartphone images by unified visual and sonification deep learning algorithms. J Cancer Res Clin Oncol 2022; 148:2497-2505. [PMID: 34546412 PMCID: PMC8453469 DOI: 10.1007/s00432-021-03809-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Non-melanoma skin cancer (NMSC) is the most frequent keratinocyte-origin skin tumor. It is confirmed that dermoscopy of NMSC confers a diagnostic advantage as compared to visual face-to-face assessment. COVID-19 restrictions diagnostics by telemedicine photos, which are analogous to visual inspection, displaced part of in-person visits. This study evaluated by a dual convolutional neural network (CNN) performance metrics in dermoscopic (DI) versus smartphone-captured images (SI) and tested if artificial intelligence narrows the proclaimed gap in diagnostic accuracy. METHODS A CNN that receives a raw image and predicts malignancy, overlaid by a second independent CNN which processes a sonification (image-to-sound mapping) of the original image, were combined into a unified malignancy classifier. All images were histopathology-verified in a comparison between NMSC and benign skin lesions excised as suspected NMSCs. Study criteria outcomes were sensitivity and specificity for the unified output. RESULTS Images acquired by DI (n = 132 NMSC, n = 33 benign) were compared to SI (n = 170 NMSC, n = 28 benign). DI and SI analysis metrics resulted in an area under the curve (AUC) of the receiver operator characteristic curve of 0.911 and 0.821, respectively. Accuracy was increased by DI (0.88; CI 81.9-92.4) as compared to SI (0.75; CI 68.1-80.6, p < 0.005). Sensitivity of DI was higher than SI (95.3%, CI 90.4-98.3 vs 75.3%, CI 68.1-81.6, p < 0.001), but not specificity (p = NS). CONCLUSION Telemedicine use of smartphone images might result in a substantial decrease in diagnostic performance as compared to dermoscopy, which needs to be considered by both healthcare providers and patients.
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Affiliation(s)
- A Dascalu
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, 6 Matmon Cohen Street, 6209406, Tel Aviv, Israel.
| | - B N Walker
- Sonification Lab, School of Psychology and School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Y Oron
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, 6 Matmon Cohen Street, 6209406, Tel Aviv, Israel
| | - E O David
- Department of Computer Science, Bar-Ilan University, Ramat-Gan, Israel
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19
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de Jong AJ, Grupstra RJ, Santa-Ana-Tellez Y, Zuidgeest MGP, de Boer A, Gardarsdottir H. Which decentralised trial activities are reported in clinical trial protocols of drug trials initiated in 2019-2020? A cross-sectional study in ClinicalTrials.gov. BMJ Open 2022; 12:e063236. [PMID: 36038171 PMCID: PMC9438113 DOI: 10.1136/bmjopen-2022-063236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Decentralised clinical trial activities-such as participant recruitment via social media, data collection through wearables and direct-to-participant investigational medicinal product (IMP) supply-have the potential to change the way clinical trials (CTs) are conducted and with that to reduce the participation burden and improve generalisability. In this study, we investigated the decentralised and on-site conduct of trial activities as reported in CT protocols with a trial start date in 2019 or 2020. DESIGN We ascertained the decentralised and on-site conduct for the following operational trial activities: participant outreach, prescreening, screening, obtaining informed consent, asynchronous communication, participant training, IMP supply, IMP adherence monitoring, CT monitoring, staff training and data collection. Results were compared for the public versus private sponsors, regions involved, trial phases and four time periods (the first and second half of 2019 and 2020, respectively). SETTING Phases 2, 3 and 4 clinical drug trial protocols with a trial start date in 2019 or 2020 available from ClinicalTrials.gov. OUTCOME MEASURES The occurrence of decentralised and on-site conduct of the predefined trial activities reported in CT protocols. RESULTS For all trial activities, on-site conduct was more frequently reported than decentralised conduct. Decentralised conduct of the individual trial activities was reported in less than 25.6% of the 254 included protocols, except for decentralised data collection, which was reported in 68.9% of the protocols. More specifically, 81.9% of the phase 3 protocols reported decentralised data collection, compared with 73.3% and 47.0% of the phase 2 and 4 protocols, respectively. For several activities, including prescreening, screening and consenting, upward trends in reporting decentralised conduct were visible over time. CONCLUSIONS Decentralised methods are used in CTs, mainly for data collection, but less frequently for other activities. Sharing best practices and a detailed description in protocols can drive the adoption of decentralised methods.
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Affiliation(s)
- Amos J de Jong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Renske J Grupstra
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Yared Santa-Ana-Tellez
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mira G P Zuidgeest
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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20
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Brown JC, Brighton E, Campbell N, McCleary NJ, Abrams TA, Cleary JM, Enzinger PC, Ng K, Rubinson D, Wolpin BM, Yurgelun MB, Meyerhardt JA. Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study. BMJ Open Sport Exerc Med 2022; 8:e001353. [PMID: 35722047 PMCID: PMC9152931 DOI: 10.1136/bmjsem-2022-001353] [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] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer. Methods This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%. Results Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3-77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4-22.4). Conclusion These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy. Trial registration number NCT03331406.
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Affiliation(s)
- Justin C Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.,Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Elizabeth Brighton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy Campbell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Thomas A Abrams
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James M Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Peter C Enzinger
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Douglas Rubinson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew B Yurgelun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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21
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Brown RC, Coombes JS, Jungbluth Rodriguez K, Hickman IJ, Keating SE. Effectiveness of exercise via telehealth for chronic disease: a systematic review and meta-analysis of exercise interventions delivered via videoconferencing. Br J Sports Med 2022; 56:bjsports-2021-105118. [PMID: 35715175 DOI: 10.1136/bjsports-2021-105118] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases. DESIGN Systematic review incorporating meta-analysis. DATA SOURCES PubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus. ELIGIBILITY CRITERIA The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Trials analysing participants with chronic disease undergoing aerobic and/or resistance exercise training over videoconferencing, with exercise capacity and/or quality of life outcomes were included. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life. Risk of bias was analysed using the Downs and Black quality checklist and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS Thirty-two trials were included in this review, of which 12 were comparator trials. Small-moderate between-group (videoconferencing vs comparator) effects favouring videoconferencing were seen for studies using a non-exercising comparator for exercise capacity (standardised mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=<0.001) and quality of life (SMD=0.400, 95% CI 0.099 to 0.701; p=0.009). Small effects favouring videoconferencing were observed for studies using an exercising comparator for quality of life (SMD=0.271, 95% CI 0.028 to 0.515; p=0.029) and exercise capacity (SMD=0.242, 95% CI 0.059 to 0.426; p=0.009). Moderate risk of bias was identified for included studies (16.3±3.6/28), with GRADE certainty ratings of 'low' (quality of life) and 'moderate' (exercise capacity). Session attendance was 70% and was reported in 23 trials. No serious adverse events relating to videoconferencing were found. Nine trials documented the total number of technical issues that occurred in 17% of the sessions. Positive satisfaction outcomes were associated with ease of access and usefulness of technology. CONCLUSION In patients with chronic disease, videoconferencing exercise interventions appear to be feasible and effective for improving exercise capacity and quality of life. More robust methodology is needed in future studies to improve the certainty of the evidence. PROSPERO REGISTRATION NUMBER CRD42020191243.
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Affiliation(s)
- Riley Cc Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Klaus Jungbluth Rodriguez
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Mater Research Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Research on Exercise, Physical Activity and Health, The University of Queensland, St Lucia, Queensland, Australia
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22
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Yang J, Barabash T, Rajendran L, Mahar AL, Hsu AT, James PD, Gotlib Conn L, Wright FC, Ludwig C, Kosyachkova E, Deleemans J, Coburn NG, Hallet J. Patient-centered outcomes for gastrointestinal cancer care: a scoping review protocol. BMJ Open 2022; 12:e061309. [PMID: 35701055 PMCID: PMC9198790 DOI: 10.1136/bmjopen-2022-061309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Following a cancer diagnosis, patients and their caregivers face crucial decisions regarding goals of care and treatment, which have consequences that can persist throughout their cancer journey. To foster informed and value-driven treatment choices, evidence-based information on outcomes relevant to patients is needed. Traditionally, clinical studies have largely focused on a few concrete and easily measurable outcomes such as survival, disease progression and immediate treatment toxicities. These outcomes do not capture other important factors that patients consider when making treatment decisions. Patient-centred outcomes (PCOs) reflect the patients' individual values, preferences, needs and circumstances that are essential to directing meaningful and informed healthcare discussions. Often, however, these outcomes are not included in research protocols in a standardised and practical fashion. This scoping review will summarise the existing literature on PCOs in gastrointestinal (GI) cancer care as well as the tools used to assess these outcomes. A comprehensive list of these PCOs will be generated for future efforts to develop a core outcome set. METHODS AND ANALYSIS This scoping review will follow Arksey and O'Malley's expanded framework for scoping reviews. We will systematically search Medline, Embase, CINAHL, Cochrane Library and APA PsycINFO databases for studies examining PCOs in the context of GI cancer. We will include studies published in or after the year 2000 up to the date of the final searches, with no language restrictions. Studies involving adult patients with GI cancers and discussion of any PCOs will be included. Opinion pieces, protocols, case reports and abstracts will be excluded. Two authors will independently perform two rounds of screening to select studies for inclusion. The data from full texts will be extracted, charted and summarised both quantitatively and qualitatively. ETHICS AND DISSEMINATION No ethics approval is required for this scoping review. Results will be disseminated through scientific publication and presentation at relevant conferences.
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Affiliation(s)
- Joanna Yang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tori Barabash
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
| | - Luckshi Rajendran
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy T Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Paul D James
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Tory Trauma Research Program, Sunnybrook Research Institute Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Frances C Wright
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Claire Ludwig
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Julie Deleemans
- Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Natalie G Coburn
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Cancer Program, Sunnybrook Research Institute, Evaluative Clinical Sciences Platform, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
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23
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Trager RJ, Cupler ZA, DeLano KJ, Perez JA, Dusek JA. Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA. BMJ Open 2022; 12:e058769. [PMID: 35697464 PMCID: PMC9196200 DOI: 10.1136/bmjopen-2021-058769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/24/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that utilisation of CSMT for newly diagnosed rLBP is associated with reduced odds of benzodiazepine prescription through 12 months' follow-up. DESIGN Retrospective cohort study. SETTING National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query. PARTICIPANTS Adults aged 18-49 with an index diagnosis of rLBP were included. Serious aetiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded. Patients were assigned to cohorts according to CSMT receipt or absence. Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation. OUTCOME MEASURES The number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months' follow-up prematching and postmatching. RESULTS After matching, there were 9206 patients (mean (SD) age, 37.6 (8.3) years, 54% male) per cohort. Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). After matching, the OR (95% CI) of benzodiazepine prescription at 3 months was 0.56 (0.50 to 0.64), at 6 months 0.61 (0.55 to 0.68) and 12 months 0.67 (0.62 to 0.74). Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings. CONCLUSIONS These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. Benzodiazepine prescription for rLBP should be further examined in a randomised trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kayla J DeLano
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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24
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de las Heras B, Daehnke A, Saini KS, Harris M, Morrison K, Aguilo A, Chico I, Vidal L, Marcus R. Role of decentralized clinical trials in cancer drug development: Results from a survey of oncologists and patients. Digit Health 2022; 8:20552076221099997. [PMID: 35646380 PMCID: PMC9136463 DOI: 10.1177/20552076221099997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
As a result of the unprecedented challenges imposed by the COVID-19 pandemic on enrollment to cancer clinical trials, there has been an urgency to identify and incorporate new solutions to mitigate these difficulties. The concept of decentralized or hybrid clinical trials has rapidly gained currency, given that it aims to reduce patient burden, increase patient enrollment and retention, and preserve quality of life, while also increasing the efficiency of trial logistics. Therefore, the clinical trial environment is moving toward remote collection and assessment of data, transitioning from the classic site-centric model to one that is more patient-centric.
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Affiliation(s)
- Begoña de las Heras
- Labcorp Drug Development Inc., Burlington, North Carolina, USA,Madrid Medical Doctors Association, Spain,Begoña de las Heras
| | - Adam Daehnke
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Kamal S Saini
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Melissa Harris
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | | | - Ariel Aguilo
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Isagani Chico
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Laura Vidal
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
| | - Robin Marcus
- Labcorp Drug Development Inc., Burlington, North Carolina, USA
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25
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Mir O, Ferrua M, Fourcade A, Mathivon D, Duflot-Boukobza A, Dumont S, Baudin E, Delaloge S, Malka D, Albiges L, Pautier P, Robert C, Planchard D, de Botton S, Scotté F, Lemare F, Abbas M, Guillet M, Puglisi V, Di Palma M, Minvielle E. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med 2022; 28:1224-1231. [PMID: 35469070 DOI: 10.1038/s41591-022-01788-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/16/2022] [Indexed: 01/02/2023]
Abstract
Strategies that individualize the care of cancer patients receiving oral anticancer agents offer opportunities to improve treatment adherence and patient care. However, the impact of digital remote monitoring systems in this setting has not been evaluated. Here, we report the results of a phase 3 trial (CAPRI, NCT02828462) to assess the impact of a nurse navigator-led program on treatment delivery for patients with metastatic cancer. Patients receiving approved oral anticancer agents were randomized (1:1) to an intervention combining a nurse navigator-led follow-up system and a web portal-smartphone application on top of usual care, or to usual symptom monitoring at the discretion of the treating oncologist, for a duration of 6 months. The primary objective included optimization of the treatment dose. Secondary objectives were grade ≥3 toxicities, patient experience, rates and duration of hospitalization, response and survival, and quality of life. In 559 evaluable patients the relative dose intensity was higher in the experimental arm (93.4% versus 89.4%, P = 0.04). The intervention improved the patient experience (Patient Assessment of Chronic Illness Care score, 2.94 versus 2.67, P = 0.01), reduced the days of hospitalization (2.82 versus 4.44 days, P = 0.02), and decreased treatment-related grade ≥3 toxicities (27.6% versus 36.9%, P = 0.02). These findings show that patient-centered care through remote monitoring of symptoms and treatment may improve patient outcomes and experience.
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Affiliation(s)
- Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France. .,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France.
| | - Marie Ferrua
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Aude Fourcade
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Delphine Mathivon
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Adeline Duflot-Boukobza
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Sarah Dumont
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Eric Baudin
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, France
| | | | - David Malka
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | | | - Caroline Robert
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - David Planchard
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - Florian Scotté
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - François Lemare
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - May Abbas
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Marilène Guillet
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Vanessa Puglisi
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Mario Di Palma
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Etienne Minvielle
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France.,i3-Centre de Recherche en Gestion, Institut Interdisciplinaire de l'Innovation (UMR 9217), École polytechnique, Palaiseau, France
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26
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Briggs LG, Labban M, Alkhatib K, Nguyen DD, Cole AP, Trinh QD. Digital technologies in cancer care: a review from the clinician's perspective. J Comp Eff Res 2022; 11:533-544. [PMID: 35416050 DOI: 10.2217/cer-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Physicians are increasingly utilizing digital health technologies (DHT) such as smartphone applications, network-enabled wearable devices, web-based communication platforms, videoconferencing, chatbots, artificial intelligence and virtual reality to improve access to, and quality of, care. DHT aid in cancer screening, patient education, shared decision-making, promotion of positive health habits, symptom monitoring and intervention, patient-provider communication, provision of psychological support and delivery of effective survivorship care. This narrative review outlines how physicians may utilize digital health to improve or augment their delivery of cancer care. For the full potential of DHT to be realized, experts must develop appropriate solutions to issues surrounding the regulation, liability, quality, security, equity and reimbursement of DHT.
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Affiliation(s)
- Logan G Briggs
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Muhieddine Labban
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Khalid Alkhatib
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David-Dan Nguyen
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alexander P Cole
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Quoc-Dien Trinh
- Center for Surgery & Public Health, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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27
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He Y, Han X, Zou W, Liu X, Sun N, Zhou F. Telerehabilitation programmes for patients with cancer and survivors: a protocol for a systematic review. BMJ Open 2022; 12:e058981. [PMID: 35393328 PMCID: PMC8991069 DOI: 10.1136/bmjopen-2021-058981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The global cancer burden is a major public health problem. Cancer rehabilitation is an essential component of survivorship care for preventing complications, decreasing symptoms and improving functional quality of life (QOL). In addition to pre-existing challenges, the COVID-19 pandemic has greatly affected cancer rehabilitation programmes and their delivery to patients. This comprehensive systematic review will assess the efficacy and safety of telerehabilitation on functional outcomes and QOL in patients with cancer and survivors. METHODS AND ANALYSIS This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The following key electronic bibliographic databases will be searched from their inception to April 2021: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). We will include randomised controlled trials (RCTs) published in English that examine the effects of telerehabilitation programmes on patients with cancer and survivors. The terms 'telerehabilitation', 'neoplasm', 'RCT' and their analogous terms will be used in our search strategy. Two reviewers will independently complete the study screening, selection, data extraction and quality rating. The PEDro scale will be used to assess the methodological quality of the included studies. Narrative or quantitative synthesis will be conducted on the basis of the final data. The planned start and end dates for the study are 1 March 2021 and 1 May 2022, respectively. ETHICS AND DISSEMINATION Ethical approval will not be required for this review, and the results will be disseminated in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021243467.
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Affiliation(s)
- Yu He
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
| | - Xiaochai Han
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenchen Zou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xuemin Liu
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
| | - Nianyi Sun
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
- Department of Rehabilitation, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
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28
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González-Escamilla M, Pérez-Ibave DC, Burciaga-Flores CH, Ortiz-Murillo VN, Ramírez-Correa GA, Rodríguez-Niño P, Piñeiro-Retif R, Rodríguez-Gutiérrez HF, Alcorta-Nuñez F, González-Guerrero JF, Vidal-Gutiérrez O, Garza-Rodríguez ML. Epidemiological Algorithm for Early Detection of COVID-19 Cases in a Mexican Oncologic Center. Healthcare (Basel) 2022; 10:healthcare10030462. [PMID: 35326940 PMCID: PMC8950794 DOI: 10.3390/healthcare10030462] [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: 01/14/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
An early detection tool for latent COVID-19 infections in oncology staff and patients is essential to prevent outbreaks in a cancer center. (1) Background: In this study, we developed and implemented two early detection tools for the radiotherapy area to identify COVID-19 cases opportunely. (2) Methods: Staff and patients answered a questionnaire (electronic and paper surveys, respectively) with clinical and epidemiological information. The data were collected through two online survey tools: Real-Time Tracking (R-Track) and Summary of Factors (S-Facts). Cut-off values were established according to the algorithm models. SARS-CoV-2 qRT-PCR tests confirmed the positive algorithms individuals. (3) Results: Oncology staff members (n = 142) were tested, and 14% (n = 20) were positives for the R-Track algorithm; 75% (n = 15) were qRT-PCR positive. The S-Facts Algorithm identified 7.75% (n = 11) positive oncology staff members, and 81.82% (n = 9) were qRT-PCR positive. Oncology patients (n = 369) were evaluated, and 1.36% (n = 5) were positive for the Algorithm used. The five patients (100%) were confirmed by qRT-PCR. (4) Conclusions: The proposed early detection tools have proved to be a low-cost and efficient tool in a country where qRT-PCR tests and vaccines are insufficient for the population.
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Affiliation(s)
- Moisés González-Escamilla
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Diana Cristina Pérez-Ibave
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Carlos Horacio Burciaga-Flores
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Vanessa Natali Ortiz-Murillo
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero S/N, Mitras Centro Monterrey, Monterrey 64460, Mexico;
| | - Genaro A. Ramírez-Correa
- Department of Molecular Science, The University of Texas Rio Grande Valley School of Medicine, McAllen, TX 78504, USA;
- Department of Pediatrics, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Patricia Rodríguez-Niño
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Rafael Piñeiro-Retif
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Hazyadee Frecia Rodríguez-Gutiérrez
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Fernando Alcorta-Nuñez
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Juan Francisco González-Guerrero
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - Oscar Vidal-Gutiérrez
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
| | - María Lourdes Garza-Rodríguez
- Centro Universitario Contra el Cáncer, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Av. Francisco I. Madero S/N, Mitras Centro, Monterrey 64460, Mexico; (M.G.-E.); (D.C.P.-I.); (C.H.B.-F.); (P.R.-N.); (R.P.-R.); (H.F.R.-G.); (F.A.-N.); (J.F.G.-G.); (O.V.-G.)
- Department of Molecular Science, The University of Texas Rio Grande Valley School of Medicine, McAllen, TX 78504, USA;
- Correspondence: ; Tel.: +52-811-801-4350
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Pilot implementation to assess the feasibility and care team impact of an app-based interactive care plan to remotely monitor breast cancer survivors. J Cancer Surviv 2022; 16:13-23. [PMID: 35107791 PMCID: PMC8809246 DOI: 10.1007/s11764-021-01136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/06/2021] [Indexed: 01/22/2023]
Abstract
Purpose
To assess the feasibility of an app-based, electronic health record (EHR)-integrated, interactive care plan (ICP) for breast cancer (BC) survivors. Methods A single-arm pilot study was conducted with female BC survivors. ICP tasks included quarterly quality of life (QOL) questionnaire; monthly assessments of fatigue, insomnia, sexual dysfunction, hot flashes, and recurrence symptoms; and daily activity reminders. Embedded decision trees escalated recurrence symptoms to providers. On-demand education was available for self-management of treatment-related toxicities. The primary objective was to assess patients’ engagement with ICP tasks against feasibility thresholds of 75% completion rate. Secondary objectives were evaluation of the system’s functionality to track and escalate symptoms appropriately, and care team impact measured by volume of escalation messages generated. We report preliminary results 6 months after the last patient enrolled. Results Twenty-three patients enrolled August to November 2020. Mean age was 50.1 years. All patients engaged with at least one ICP task. The monthly average task completion rates were 62% for the QOL questionnaire, 59% for symptom assessments, and 37% for activity reminders. Task completion rate decreased over time. Eleven of 253 symptoms and QOL questionnaires (4.3%) generated messages for care escalation. Conclusion Implementation of an app-based, EHR-integrated ICP in BC survivors was feasible and created minimal provider burden; however, patient engagement was below the feasibility threshold suggesting that changes may enhance broad implementation and adoption. Implications for Cancer Survivors An ICP may facilitate remote monitoring, symptom control, and recurrence surveillance for cancer survivors as strategies to enhance patient engagement are applied. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01136-1.
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30
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Jacobsen M, Rottmann P, Dembek TA, Gerke AL, Gholamipoor R, Blum C, Hartmann NU, Verket M, Kaivers J, Jäger P, Baermann BN, Heinemann L, Marx N, Müller-Wieland D, Kollmann M, Seyfarth M, Kobbe G. Feasibility of Wearable-Based Remote Monitoring in Patients During Intensive Treatment for Aggressive Hematologic Malignancies. JCO Clin Cancer Inform 2022; 6:e2100126. [PMID: 35025669 DOI: 10.1200/cci.21.00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Intensive treatment protocols for aggressive hematologic malignancies harbor a high risk of serious clinical complications, such as infections. Current techniques of monitoring vital signs to detect such complications are cumbersome and often fail to diagnose them early. Continuous monitoring of vital signs and physical activity by means of an upper arm medical wearable allowing 24/7 streaming of such parameters may be a promising alternative. METHODS This single-arm, single-center observational trial evaluated symptom-related patient-reported outcomes and feasibility of a wearable-based remote patient monitoring. All wearable data were reviewed retrospectively and were not available to the patient or clinical staff. A total of 79 patients (54 inpatients and 25 outpatients) participated and received standard-of-care treatment for a hematologic malignancy. In addition, the wearable was continuously worn and self-managed by the patient to record multiple parameters such as heart rate, oxygen saturation, and physical activity. RESULTS Fifty-one patients (94.4%) in the inpatient cohort and 16 (64.0%) in the outpatient cohort reported gastrointestinal symptoms (diarrhea, nausea, and emesis), pain, dyspnea, or shivering in at least one visit. With the wearable, vital signs and physical activity were recorded for a total of 1,304.8 days. Recordings accounted for 78.0% (63.0-88.5; median [interquartile range]) of the potential recording time for the inpatient cohort and 84.6% (76.3-90.2) for the outpatient cohort. Adherence to the wearable was comparable in both cohorts, but decreased moderately over time during the trial. CONCLUSION A high adherence to the wearable was observed in patients on intensive treatment protocols for a hematologic malignancy who experience high symptom burden. Remote patient monitoring of vital signs and physical activity was demonstrated to be feasible and of primarily sufficient quality.
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Affiliation(s)
- Malte Jacobsen
- Faculty of Health, University Witten/Herdecke, Witten, Germany.,Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Pauline Rottmann
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna L Gerke
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Rahil Gholamipoor
- Department of Computer Science, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christopher Blum
- Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Niels-Ulrik Hartmann
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Marlo Verket
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Paul Jäger
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ben-Niklas Baermann
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Dirk Müller-Wieland
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Markus Kollmann
- Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Melchior Seyfarth
- Faculty of Health, University Witten/Herdecke, Witten, Germany.,Department of Cardiology, Helios University Hospital of Wuppertal, Wuppertal, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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31
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E-santé, digitalisation ou transformation numérique : impact sur les soins de support en oncologie. Bull Cancer 2022; 109:598-611. [DOI: 10.1016/j.bulcan.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
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32
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Yang K, Nambudiri VE. Anticipating Ambulatory Automation: Potential Applications of Administrative and Clinical Automation in Outpatient Healthcare Delivery. Appl Clin Inform 2021; 12:1157-1160. [PMID: 34965607 PMCID: PMC8716189 DOI: 10.1055/s-0041-1740259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Kevin Yang
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Vinod E. Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, United States,Address for correspondence Vinod E. Nambudiri, MD, MBA Department of Dermatology, Brigham and Women's Hospital221 Longwood Avenue, Boston, MA 02115United States
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Hibino M, Hamashima C, Iwata M, Terasawa T. Effectiveness of decision aids on cancer-screening decision-making: an umbrella review protocol. BMJ Open 2021; 11:e051156. [PMID: 34880016 PMCID: PMC8655570 DOI: 10.1136/bmjopen-2021-051156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Although systematic reviews have shown how decision aids about cancer-related clinical decisions improve selection of key options and shared decision-making, whether or not particular decision aids, defined by their specific presentation formats, delivery methods and other attributes, can perform better than others in the context of cancer-screening decisions is uncertain. Therefore, we planned an overview to address this issue by using standard umbrella review methods to repurpose existing systematic reviews and their component comparative studies. METHODS AND ANALYSIS We will search PubMed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects from inception through 31 December 2021 with no language restriction and perform full-text evaluation of potentially relevant articles. We will include systematic reviews of randomised controlled trials or non-randomised studies of interventions that assessed a decision aid about cancer-screening decisions and compared it with an alternative tool or conventional management in healthy average-risk adults. Two reviewers will extract data and rate the study validity according to standard quality assessment measures. Our primary outcome will be intended and actual choice and adherence to selected options. The secondary outcomes will include attributes of the option-selection process, achieving shared decision-making and preference-linked psychosocial outcomes. We will qualitatively assess study, patient and intervention characteristics and outcomes. We will also take special care to investigate the presentation format, delivery methods and quality of the included decision aids and assess the degree to which the decision aid was delivered and used as intended. If appropriate, we will perform random-effects model meta-analyses to quantitatively synthesise the results. ETHICS AND DISSEMINATION Ethics approval is not applicable as this is a secondary analysis of publicly available data. The review results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021235957.
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Affiliation(s)
- Masaya Hibino
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Chisato Hamashima
- Health Policy Section, Department of Nursing, Faculty of Medical Technology, Teikyo University, Itabashi-ku, Tokyo, Japan
| | - Mitsunaga Iwata
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Hesse BW, Kwasnicka D, Ahern DK. Emerging digital technologies in cancer treatment, prevention, and control. Transl Behav Med 2021; 11:2009-2017. [PMID: 34850933 PMCID: PMC8824462 DOI: 10.1093/tbm/ibab033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.
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Affiliation(s)
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia and Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - David K Ahern
- Digital Behavioral Health and Informatics Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02215, USA
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35
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Scarfò L, Karamanidou C, Doubek M, Garani-Papadatos T, Didi J, Pontikoglou C, Ling J, Payne C, Papadaki HΑ, Rosenquist R, Stavroyianni N, Payne S, Ghia P, Natsiavas P, Maramis C, Stamatopoulos K. MyPal ADULT study protocol: a randomised clinical trial of the MyPal ePRO-based early palliative care system in adult patients with haematological malignancies. BMJ Open 2021; 11:e050256. [PMID: 34728446 PMCID: PMC8565565 DOI: 10.1136/bmjopen-2021-050256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The systematic collection of electronic patient-reported outcome (ePRO) in the routine care of patients with chronic haematological malignancies such as chronic lymphocytic leukaemia (CLL) and myelodysplasia syndromes (MDS) can constitute a very ambitious but worthwhile challenge. MyPal is a Horizon 2020 Research & Innovation Action aiming to meet this challenge and foster palliative care for patients with CLL or MDS by leveraging ePRO systems to adapt to the personal needs of patients and caregiver(s). METHODS AND ANALYSIS In this interventional randomised trial, 300 patients with CLL or MDS will be recruited across Europe. Patients will be randomly allocated to early palliative care using the MyPal system (n=150) versus standard care including general palliative care if needed (n=150). Patients in the experimental arm will be given access to the MyPal digital health platform which consists of purposely designed software available on smartphones and/or tablets. The platform entails different functionalities including physical and psychoemotional symptom reporting via regular questionnaire completion, spontaneous self-reporting, motivational messages, medication management and a personalised search engine for health information. Data on patients' activity (daily steps and sleep quality) will be automatically collected via wearable devices. ETHICS AND DISSEMINATION The integration of ePROs via mobile applications has raised ethical concerns regarding inclusion criteria, information provided to participants, free and voluntary consent, and respect for their autonomy. These have been carefully addressed by a multidisciplinary team. Data processing, dissemination and exploitation of the study findings will take place in full compliance with European Union data protection law. A participatory design was adopted in the development of the digital platform involving focus groups and discussions with patients to identify needs and preferences. The protocol was approved by the ethics committees of San Raffaele (8/2020), Thessaloniki 'George Papanikolaou' Hospital (849), Karolinska Institutet (20.10.2020), University General Hospital of Heraklion (07/15.4.2020) and University of Brno (01-120220/EK). TRIAL REGISTRATION NUMBER NCT04370457.
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Affiliation(s)
- Lydia Scarfò
- Internal Medicine, Vita Salute San Raffaele University, Milan, Italy
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christina Karamanidou
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Michael Doubek
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Jana Didi
- Department of Haematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Charalampos Pontikoglou
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Julie Ling
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Cathy Payne
- Head Office, European Association for Palliative Care, Vilvoorde, Belgium
| | - Helen Α Papadaki
- Department of Hematology, University of Crete School of Medicine, Heraklion, Crete, Greece
- Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Sheila Payne
- International Observatory on End of Life Care, University of Lancaster, Lancaster, UK
| | - Paolo Ghia
- Strategic Research Program on CLL, IRCCS San Raffaele Hospital, Milan, Italy
- Medical Oncology, Vita Salute San Raffaele University, Milan, Italy
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Christos Maramis
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, Thessaloniki, Greece
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Lin CMA, Ng N, Orman A, Clement ND, Deehan DJ. Reliability of patient-reported comorbidities: a systematic review and meta-analysis. Postgrad Med J 2021; 99:postgradmedj-2021-140857. [PMID: 34645695 DOI: 10.1136/postgradmedj-2021-140857] [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: 07/17/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
Self-reported questionnaires have become a widely adopted method of reviewing patients in clinical practice. This systematic review aimed to determine the reliability of patient-reported comorbidities and to identify which patient factors influence the reliability. Included studies assessed the reliability of at least one patient-reported comorbidity against their medical record or clinical assessment as gold standard. Twenty-four eligible studies were included in the meta-analysis. Only endocrine diseases (Cohen's Kappa Coefficient (CKC) 0.81 (95% CI 0.76 to 0.85)), consisting of diabetes mellitus (CKC 0.83 (95% CI 0.80 to 0.86)) and thyroid disease (CKC 0.68 (95% CI 0.50 to 0.86)), showed good-to-excellent reliability. Factors most frequently reported to influence concordance included age, sex and educational level.This systematic review demonstrated poor-to-moderate reliability for most systems, except for endocrine which showed good-to-excellent reliability. Although patient self-reporting can be a useful guide to clinical management, several patient factors were demonstrated to affect reliability therefore it should be avoided as a standalone measure.
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Affiliation(s)
| | - Nathan Ng
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alexander Orman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicholas D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - David J Deehan
- Musculoskeletal Department, Freeman Hospital, Newcastle upon Tyne, UK
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Labban M, Briggs L, Cole AP, Trinh QD. Measuring What Matters: Patient-Reported Outcome and Experience Measures for Men Undergoing Radical Prostatectomy. Eur Urol Focus 2021; 7:913-915. [PMID: 34556455 DOI: 10.1016/j.euf.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Patient-reported outcome and experience measures capture a reliable representation of a patient's functional outcomes and quality of life. However, they are only helpful if the data are easily comprehensible to patients and are accessible to providers, patients, and payers. If we want to ensure that these metrics are fair, accurate, and relevant, then physicians should be leaders in developing and adopting these tools.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Logan Briggs
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Ji M, Xie W, Huang R, Qian X. Forecasting Erroneous Neural Machine Translation of Disease Symptoms: Development of Bayesian Probabilistic Classifiers for Cross-Lingual Health Translation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189873. [PMID: 34574795 PMCID: PMC8466164 DOI: 10.3390/ijerph18189873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Machine translation (MT) technologies have increasing applications in healthcare. Despite their convenience, cost-effectiveness, and constantly improved accuracy, research shows that the use of MT tools in medical or healthcare settings poses risks to vulnerable populations. OBJECTIVES We aimed to develop machine learning classifiers (MNB and RVM) to forecast nuanced yet significant MT errors of clinical symptoms in Chinese neural MT outputs. METHODS We screened human translations of MSD Manuals for information on self-diagnosis of infectious diseases and produced their matching neural MT outputs for subsequent pairwise quality assessment by trained bilingual health researchers. Different feature optimisation and normalisation techniques were used to identify the best feature set. RESULTS The RVM classifier using optimised, normalised (L2 normalisation) semantic features achieved the highest sensitivity, specificity, AUC, and accuracy. MNB achieved similar high performance using the same optimised semantic feature set. The best probability threshold of the best performing RVM classifier was found at 0.6, with a very high positive likelihood ratio (LR+) of 27.82 (95% CI: 3.99, 193.76), and a low negative likelihood ratio (LR-) of 0.19 (95% CI: 0.08, 046), suggesting the high diagnostic utility of our model to predict the probabilities of erroneous MT of disease symptoms to help reverse potential inaccurate self-diagnosis of diseases among vulnerable people without adequate medical knowledge or an ability to ascertain the reliability of MT outputs. CONCLUSION Our study demonstrated the viability, flexibility, and efficiency of introducing machine learning models to help promote risk-aware use of MT technologies to achieve optimal, safer digital health outcomes for vulnerable people.
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Affiliation(s)
- Meng Ji
- School of Languages and Cultures, University of Sydney, Sydney 2006, Australia;
- Correspondence:
| | - Wenxiu Xie
- Department of Computer Science, City University of Hong Kong, Hong Kong 518057, China;
| | - Riliu Huang
- School of Languages and Cultures, University of Sydney, Sydney 2006, Australia;
| | - Xiaobo Qian
- School of Computer Science, South China Normal University, Guangzhou 510631, China;
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Wubben N, van den Boogaard M, van der Hoeven JG, Zegers M. Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study. BMJ Open 2021; 11:e050134. [PMID: 34380728 PMCID: PMC8359489 DOI: 10.1136/bmjopen-2021-050134] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members. DESIGN Qualitative study. SETTING Two Dutch tertiary centres. PARTICIPANTS 19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay. RESULTS Three themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family. CONCLUSIONS Interviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients' values and needs in the decision-making process.
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Affiliation(s)
- Nina Wubben
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | | | - Marieke Zegers
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Zhu J, Wei Z, Suryavanshi M, Chen X, Xia Q, Jiang J, Ayodele O, Bradbury BD, Brooks C, Brown CA, Cheng A, Critchlow CW, Devercelli G, Gandhi V, Gondek K, Londhe AA, Ma J, Jonsson-Funk M, Keenan HA, Manne S, Ren K, Sanders L, Yu P, Zhang J, Zhou L, Bao Y. Characteristics and outcomes of hospitalised adults with COVID-19 in a Global Health Research Network: a cohort study. BMJ Open 2021; 11:e051588. [PMID: 34362806 PMCID: PMC8350974 DOI: 10.1136/bmjopen-2021-051588] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine age, gender, and temporal differences in baseline characteristics and clinical outcomes of adult patients hospitalised with COVID-19. DESIGN A cohort study using deidentified electronic medical records from a Global Research Network. SETTING/PARTICIPANTS 67 456 adult patients hospitalised with COVID-19 from the USA; 7306 from Europe, Latin America and Asia-Pacific between February 2020 and January 2021. RESULTS In the US cohort, compared with patients 18-34 years old, patients ≥65 had a greater risk of intensive care unit (ICU) admission (adjusted HR (aHR) 1.73, 95% CI 1.58 to 1.90), acute respiratory distress syndrome(ARDS)/respiratory failure (aHR 1.86, 95% CI 1.76 to 1.96), invasive mechanical ventilation (IMV, aHR 1.93, 95% CI, 1.73 to 2.15), and all-cause mortality (aHR 5.6, 95% CI 4.36 to 7.18). Men appeared to be at a greater risk for ICU admission (aHR 1.34, 95% CI 1.29 to 1.39), ARDS/respiratory failure (aHR 1.24, 95% CI1.21 to 1.27), IMV (aHR 1.38, 95% CI 1.32 to 1.45), and all-cause mortality (aHR 1.16, 95% CI 1.08 to 1.24) compared with women. Moreover, we observed a greater risk of adverse outcomes during the early pandemic (ie, February-April 2020) compared with later periods. In the ex-US cohort, the age and gender trends were similar; for the temporal trend, the highest proportion of patients with all-cause mortality were also in February-April 2020; however, the highest percentages of patients with IMV and ARDS/respiratory failure were in August-October 2020 followed by February-April 2020. CONCLUSIONS This study provided valuable information on the temporal trends of characteristics and outcomes of hospitalised adult COVID-19 patients in both USA and ex-USA. It also described the population at a potentially greater risk for worse clinical outcomes by identifying the age and gender differences. Together, the information could inform the prevention and treatment strategies of COVID-19. Furthermore, it can be used to raise public awareness of COVID-19's impact on vulnerable populations.
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Affiliation(s)
- Julia Zhu
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Zhongyuan Wei
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Manasi Suryavanshi
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Xiu Chen
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Qian Xia
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Jenny Jiang
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Olulade Ayodele
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Brian D Bradbury
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Corinne Brooks
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Carolyn A Brown
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Alvan Cheng
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Cathy W Critchlow
- Research & Development Strategy & Operations, Amgen, Inc, Thousand Oaks, California, USA
| | - Giovanna Devercelli
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Vivek Gandhi
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kathleen Gondek
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Ajit A Londhe
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Junjie Ma
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Michele Jonsson-Funk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hillary A Keenan
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Sudhakar Manne
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kaili Ren
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Lynn Sanders
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Peter Yu
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Jie Zhang
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Linyun Zhou
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Ying Bao
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
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Leite ML, de Loiola Costa LS, Cunha VA, Kreniski V, de Oliveira Braga Filho M, da Cunha NB, Costa FF. Artificial intelligence and the future of life sciences. Drug Discov Today 2021; 26:2515-2526. [PMID: 34245910 DOI: 10.1016/j.drudis.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/12/2021] [Accepted: 07/01/2021] [Indexed: 12/23/2022]
Abstract
Over the past few decades, the number of health and 'omics-related data' generated and stored has grown exponentially. Patient information can be collected in real time and explored using various artificial intelligence (AI) tools in clinical trials; mobile devices can also be used to improve aspects of both the diagnosis and treatment of diseases. In addition, AI can be used in the development of new drugs or for drug repurposing, in faster diagnosis and more efficient treatment for various diseases, as well as to identify data-driven hypotheses for scientists. In this review, we discuss how AI is starting to revolutionize the life sciences sector.
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Affiliation(s)
- Michel L Leite
- Genomic Sciences and Biotechnology Program, Universidade Católica de Brasília SGAN 916 Modulo B, Bloco C, 70.790-160, Brasília, DF, Brazil; Department of Molecular Biology, Biological Sciences Institute, University of Brasília, Campus Darcy Ribeiro, Block K, 70.790-900, Brasilia, Federal District, Brazil
| | - Lorena S de Loiola Costa
- Genomic Sciences and Biotechnology Program, Universidade Católica de Brasília SGAN 916 Modulo B, Bloco C, 70.790-160, Brasília, DF, Brazil
| | - Victor A Cunha
- Genomic Sciences and Biotechnology Program, Universidade Católica de Brasília SGAN 916 Modulo B, Bloco C, 70.790-160, Brasília, DF, Brazil
| | - Victor Kreniski
- Apple Developer Academy, Universidade Católica de Brasília, Brasilia, Brazil
| | | | - Nicolau B da Cunha
- Genomic Sciences and Biotechnology Program, Universidade Católica de Brasília SGAN 916 Modulo B, Bloco C, 70.790-160, Brasília, DF, Brazil
| | - Fabricio F Costa
- Genomic Sciences and Biotechnology Program, Universidade Católica de Brasília SGAN 916 Modulo B, Bloco C, 70.790-160, Brasília, DF, Brazil; Apple Developer Academy, Universidade Católica de Brasília, Brasilia, Brazil; Cancer Biology and Epigenomics Program, Ann & Robert H Lurie Children's Hospital of Chicago Research Center and Northwestern University's Feinberg School of Medicine, 2430 N. Halsted St, Box 220, Chicago, IL 60614, USA; MATTER Chicago, 222 W. Merchandise Mart Plaza, Suite 12th Floor, Chicago, IL 60654, USA; Genomic Enterprise, San Diego, CA 92008, USA; Genomic Enterprise, New York, NY 11581, USA.
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Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer. Curr Treat Options Oncol 2021; 22:81. [PMID: 34213651 DOI: 10.1007/s11864-021-00872-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related to cancer and its' treatments. The evaluation of sleep and circadian disorders requires an understanding of how these symptoms cluster with other cancer-related symptoms and potentiate each other. A thorough evaluation of these symptoms and disorders utilizing validated diagnostic tools, directed review of clinical information, and diagnostic testing is recommended. Treatment of sleep and circadian disturbance in cancer patients should be based on the findings of a detailed evaluation, including specific treatment of primary sleep and circadian disorders, and utilize integrative and personalised management of cancer-related symptoms through multiple pharmacologic and non-pharmacologic modalities. Recognition, evaluation, and treatment of sleep and circadian rhythm disturbance in cancer may lead to improved symptom management, quality of life, and outcomes.
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Affiliation(s)
- Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA.
| | - Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, Warwick Medical School, Gibbet Hill, Coventry, UK
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pasquale F Innominato
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
- Cancer Chronotherapy Team, Warwick Medical School, Coventry, UK
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Zelnick LR, Shlipak MG, Soliman EZ, Anderson A, Christenson R, Lash J, Deo R, Rao P, Afshinnia F, Chen J, He J, Seliger S, Townsend R, Cohen DL, Go A, Bansal N. Prediction of Incident Atrial Fibrillation in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort Study. Clin J Am Soc Nephrol 2021; 16:1015-1024. [PMID: 34597264 PMCID: PMC8425618 DOI: 10.2215/cjn.01060121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Atrial fibrillation (AF) is common in CKD and associated with poor kidney and cardiovascular outcomes. Prediction models developed using novel methods may be useful to identify patients with CKD at highest risk of incident AF. We compared a previously published prediction model with models developed using machine learning methods in a CKD population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We studied 2766 participants in the Chronic Renal Insufficiency Cohort study without prior AF with complete cardiac biomarker (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T) and clinical data. We evaluated the utility of machine learning methods as well as a previously validated clinical prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology [CHARGE]-AF, which included 11 predictors, using original and re-estimated coefficients) to predict incident AF. Discriminatory ability of each model was assessed using the ten-fold cross-validated C-index; calibration was evaluated graphically and with the Grønnesby and Borgan test. RESULTS Mean (SD) age of participants was 57 (11) years, 55% were men, 38% were Black, and mean (SD) eGFR was 45 (15) ml/min per 1.73 m2; 259 incident AF events occurred during a median of 8 years of follow-up. The CHARGE-AF prediction equation using original and re-estimated coefficients had C-indices of 0.67 (95% confidence interval, 0.64 to 0.71) and 0.67 (95% confidence interval, 0.64 to 0.70), respectively. A likelihood-based boosting model using clinical variables only had a C-index of 0.67 (95% confidence interval, 0.64 to 0.70); adding N-terminal pro-B-type natriuretic peptide, high-sensitivity troponin T, or both biomarkers improved the C-index by 0.04, 0.01, and 0.04, respectively. In addition to N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, the final model included age, non-Hispanic Black race/ethnicity, Hispanic race/ethnicity, cardiovascular disease, chronic obstructive pulmonary disease, myocardial infarction, peripheral vascular disease, use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, calcium channel blockers, diuretics, height, and weight. CONCLUSIONS Using machine learning algorithms, a model that included 12 standard clinical variables and cardiac-specific biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T had moderate discrimination for incident AF in a CKD population.
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Affiliation(s)
- Leila R. Zelnick
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Michael G. Shlipak
- Department of Medicine, University of California, San Francisco, California
| | - Elsayed Z. Soliman
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Amanda Anderson
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | | | - James Lash
- Division of Nephrology, University of Illinois–Chicago, Chicago, Illinois
| | - Rajat Deo
- Departments of Medicine and Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Panduranga Rao
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Farsad Afshinnia
- Department of Medicine, Division of Nephrology, University of Michigan, Oakland, California
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Stephen Seliger
- Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Raymond Townsend
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie L. Cohen
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan Go
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
- Kaiser Permanente Northern California, Oakland, California
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Banerjee R, Shah N, Dicker AP. Next-Generation Implementation of Chimeric Antigen Receptor T-Cell Therapy Using Digital Health. JCO Clin Cancer Inform 2021; 5:668-678. [PMID: 34110929 DOI: 10.1200/cci.21.00023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy is a paradigm-shifting immunotherapy modality in oncology; however, unique toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome limit its ability to be implemented more widely in the outpatient setting or at smaller-volume centers. Three operational challenges with CAR-T therapy include the following: (1) the logistics of toxicity monitoring, ie, with frequent vital sign checks and neurologic assessments; (2) the specialized knowledge required for toxicity management, particularly with regard to CRS and immune effector cell-associated neurotoxicity syndrome; and (3) the need for high-quality symptomatic and supportive care during this intensive period. In this review, we explore potential niches for digital innovations that can improve the implementation of CAR-T therapy in each of these domains. These tools include patient-facing technologies and provider-facing platforms: for example, wearable devices and mobile health apps to screen for fevers and encephalopathy, electronic patient-reported outcome assessments-based workflows to assist with symptom management, machine learning algorithms to predict emerging CRS in real time, clinical decision support systems to assist with toxicity management, and digital coaching to help maintain wellness. Televisits, which have grown in prominence since the novel coronavirus pandemic, will continue to play a key role in the monitoring and management of CAR-T-related toxicities as well. Limitations of these strategies include the need to ensure care equity and stakeholder buy-in, both operationally and financially. Nevertheless, once developed and validated, the next-generation implementation of CAR-T therapy using these digital tools may improve both its safety and accessibility.
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Nina Shah
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Adam P Dicker
- Department of Radiation Oncology, Jefferson University, Philadelphia, PA.,Jefferson Center for Digital Health, Jefferson University, Philadelphia, PA
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Williams H, Steinberg S, Berzin R. The Development of a Digital Patient-Reported Outcome Measurement for Adults With Chronic Disease (The Parsley Symptom Index): Prospective Cohort Study. JMIR Form Res 2021; 5:e29122. [PMID: 33999007 PMCID: PMC8235288 DOI: 10.2196/29122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background The monitoring and management of chronic illness has always been a challenge. Patient-reported outcome measures (PROMs) can be powerful tools for monitoring symptoms and guiding treatment of chronic diseases, but the available PROM tools are either too broad or too disease specific for the needs of a primary care practice focused on longitudinal care. Objective In this study we describe the development and preliminary validation of the Parsley Symptom Index (PSI). Methods This prospective cohort study took place from January 5, 2018, to June 05, 2020, among a sample of 4621 adult patients at Parsley Health. After a review of literature, followed by binning and winnowing of potential items, a 45-item PROM that also served as a review of systems (ROS) was developed. The PSI was deployed and completed by patients via an online portal. Construct and face validity was performed by clinicians, tested on patients, and feasibility was measured by response rate, completion rate, and percentage of missing data. Results The response rate for 12,175 collected PSIs was 93.72% (4331/4621) with a 100% item completion rate. A confirmatory factor analysis confirmed the model structure was satisfactory by a Comparative Fit Index of 0.943, Tucker–Lewis index of 0.938, and root mean square error of approximation of 0.028. Conclusions A 45-item ROS-style PROM designed to capture chronic disease symptoms was developed, and preliminary validation suggests that the PSI can be deployed, completed, and helpful to both patients and clinicians.
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Affiliation(s)
- Hants Williams
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, United States
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Hartl D, de Luca V, Kostikova A, Laramie J, Kennedy S, Ferrero E, Siegel R, Fink M, Ahmed S, Millholland J, Schuhmacher A, Hinder M, Piali L, Roth A. Translational precision medicine: an industry perspective. J Transl Med 2021; 19:245. [PMID: 34090480 PMCID: PMC8179706 DOI: 10.1186/s12967-021-02910-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023] Open
Abstract
In the era of precision medicine, digital technologies and artificial intelligence, drug discovery and development face unprecedented opportunities for product and business model innovation, fundamentally changing the traditional approach of how drugs are discovered, developed and marketed. Critical to this transformation is the adoption of new technologies in the drug development process, catalyzing the transition from serendipity-driven to data-driven medicine. This paradigm shift comes with a need for both translation and precision, leading to a modern Translational Precision Medicine approach to drug discovery and development. Key components of Translational Precision Medicine are multi-omics profiling, digital biomarkers, model-based data integration, artificial intelligence, biomarker-guided trial designs and patient-centric companion diagnostics. In this review, we summarize and critically discuss the potential and challenges of Translational Precision Medicine from a cross-industry perspective.
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Affiliation(s)
- Dominik Hartl
- Novartis Institutes for BioMedical Research, Basel, Switzerland.
- Department of Pediatrics I, University of Tübingen, Tübingen, Germany.
| | - Valeria de Luca
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Anna Kostikova
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jason Laramie
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Scott Kennedy
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Enrico Ferrero
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Richard Siegel
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Martin Fink
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | | | | | - Markus Hinder
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Luca Piali
- Roche Innovation Center Basel, Basel, Switzerland
| | - Adrian Roth
- Roche Innovation Center Basel, Basel, Switzerland
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Woodford J, Månberg J, Cajander Å, Enebrink P, Harila-Saari A, Hagström J, Karlsson M, Placid Solimena H, von Essen L. Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden. BMJ Open 2021; 11:e041350. [PMID: 34155002 PMCID: PMC8039225 DOI: 10.1136/bmjopen-2020-041350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking. METHODS AND ANALYSIS An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70570236.
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Affiliation(s)
- Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jenny Månberg
- Child and Adolescent Psychiatry, Region Vasternorrland, Sundsvall, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Arja Harila-Saari
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mathilda Karlsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Placid Solimena
- International Maternal and Child Health Care, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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48
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Rafiei R, Williams C, Jiang J, Aungst TD, Durrer M, Tran D, Howald R. Digital Health Integration Assessment and Maturity of the United States Biopharmaceutical Industry: Forces Driving the Next Generation of Connected Autoinjectable Devices. JMIR Mhealth Uhealth 2021; 9:e25406. [PMID: 33621188 PMCID: PMC8088878 DOI: 10.2196/25406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/23/2020] [Accepted: 02/13/2021] [Indexed: 11/24/2022] Open
Abstract
Autoinjectable devices continue to provide real-life benefits for patients with chronic conditions since their widespread adoption 30 years ago with the rise of macromolecules. Nonetheless, issues surrounding adherence, patient administration techniques, disease self-management, and data outcomes at scale persist despite product design innovation. The interface of drug device combination products and digital health technologies formulates a value proposition for next-generation autoinjectable devices to power the delivery of precision care at home and achieve the full potential of biologics. Success will largely be dependent on biopharma’s digital health maturity to implement this framework. This viewpoint measures the digital health maturity of the top 15 biopharmaceutical companies in the US biologics autoinjector market and establishes the framework for next-generation autoinjectable devices powering home-based precision care and the need for formal digital health training.
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Affiliation(s)
| | | | | | - Timothy Dy Aungst
- Department of Pharmacy Practice, MCPHS University, Worcester, MA, United States
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49
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Abstract
OBJECTIVE To project the prevalence of obesity in 2040 among individuals 19 years and older in South Korea. DESIGN, SETTING, AND PARTICIPANTS Using the 'Population Health Model-body mass index' (BMI) microsimulation model, the prevalence of obesity in Korean adults 19 years and older was projected until 2040. The model integrated individual survey data from the Korea Health Panel Survey of 2011 and 2012, population statistics based on resident registration, population projections and complete life tables categorised by sex and age. Birth rate, life expectancy and international migration were based on a medium growth scenario. The base population of Korean adults in 2012, devised through data aggregation, was 39 842 730. The prediction equations were formulated using BMI as the dependent variable; the individual's sex, age, smoking status, physical activity and preceding year's BMI were used as predictive factors. OUTCOME MEASURE BMI categorised by sex. RESULTS The median BMI for Korean adults in 2040 was expected to be 23.55 kg/m2 (23.97 and 23.17 kg/m2 for men and women, respectively). According to the Korean BMI classification, 70.05% of all adults were expected to be 'preobese' (ie, have BMIs 23-24.9 kg/m2) by 2040 (81.23% of men and 59.07% of women) and 24.88% to be 'normal'. CONCLUSIONS We explored the possibility of applying and expanding on the concept of microsimulation in the field of healthcare by combining data sources available in Korea and found that more than half of the adults in this study population will be preobese, and the proportions of 'obesity' and 'normal' will decrease compared with those in 2012. The results of our study will aid in devising healthy strategies and spreading public awareness for preventing this condition.
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Affiliation(s)
- Yoon-Sun Jung
- Department of Public Health, Graduate School, Korea University, Seoul, Korea (the Republic of)
| | - Young-Eun Kim
- Big Data Department, National Health Insurance Service, Wonju, Korea (the Republic of)
| | - Dun-Sol Go
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea (the Republic of)
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea (the Republic of)
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50
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Sugiyama Y, Naiki T, Tasaki Y, Kataoka T, Mimura Y, Kondo Y, Etani T, Iida K, Nozaki S, Ando R, Osaga S, Yasui T, Kimura K. Effectiveness of continuous monitoring by activity tracker of patients undergoing chemotherapy for urothelial carcinoma. Cancer Treat Res Commun 2020; 25:100245. [PMID: 33291048 DOI: 10.1016/j.ctarc.2020.100245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is difficult to objectively evaluate chemotherapy-related adverse events early in elderly patients with urothelial carcinoma. A delayed response causes a reduction in quality of life (QoL). Wearable activity systems that objectively record life logs have recently been used. OBJECTIVES This study was undertaken to verify the reliability and effectiveness of a wearable activity system (Fitbit) to monitor subjective symptoms in an objective manner during chemotherapy for elderly patients with urothelial cancer (UC). MATERIALS AND METHODS This was a cohort prospective study. Elderly patients with UC were enrolled who received short hydration gemcitabine and cisplatin (shGC) combination therapy at Nagoya City University Hospital from January 2018 to March 2020. A Fitbit was used to monitor heart rate, distance moved, and cardio zone time. Heart rate was also monitored by an oscillometric method. The relationship between Fitbit recordings and perceived adverse events, such as fatigue, constipation and nausea, observed during chemotherapy was investigated using a general linear mixed effects model. RESULTS Twenty-one of 28 inpatients were enrolled and observed for a total of 824 days. A significant, moderately strong correlation was found between two measurements of heart rate (Pearson's r = 0.65, p < 0.05). The measurement of fatigue using Fitbit was effective (p = 0.03). CONCLUSION Fitbit monitoring can measure the QoL of a patient and was useful for monitoring elderly patients with UC undergoing shGC therapy in an outpatient setting. Fitbit may be useful for monitoring outpatients and their QoL during chemotherapy.
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Affiliation(s)
- Yosuke Sugiyama
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan; Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Yoshihiko Tasaki
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan; Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Tomoya Kataoka
- Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Yoshihisa Mimura
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
| | - Yuki Kondo
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
| | - Toshiki Etani
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Keitaro Iida
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Satoshi Nozaki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University Hospital, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciencesy, Nagoya, Japan
| | - Kazunori Kimura
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan; Department of Clinical Pharmaceutics, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
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