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Northrup V, Maybank A, Carson N, Rahmeh T. The Value of Next-Generation Sequencing in the Screening and Evaluation of Hematologic Neoplasms in Clinical Practice. Am J Clin Pathol 2020; 153:639-645. [PMID: 31875888 DOI: 10.1093/ajcp/aqz203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The implementation of next-generation sequencing (NGS) in routine clinical hematology practice remains limited. We evaluate the clinical value of NGS in the screening, diagnosis, and follow-up in hematologic neoplasms. METHODS A targeted NGS panel was used to assess a total of 178 patients for questionable or previously diagnosed myeloid neoplasms. RESULTS Gene variants were identified in 53% of patients. Novel variants were identified in 29% of patients and variants of unknown significance in 34%. Bone marrow samples yielded a higher number of variants than in peripheral blood. NGS is a more sensitive test than conventional cytogenetics. In several cases, NGS played a key role in the screening, diagnostics, prognostic stratification, and the clinical follow-up of a wide variety of myeloid neoplasms. CONCLUSIONS NGS is an effective tool in the evaluation of suspected and confirmed hematologic neoplasms and could become part of the routine workup of patients.
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Affiliation(s)
- Victoria Northrup
- Dalhousie Medicine New Brunswick, Saint John, Canada
- Departments of Laboratory Medicine, Saint John Regional Hospital, Saint John, Canada
- Research Services, Saint John Regional Hospital, Saint John, Canada
| | | | - Nancy Carson
- Departments of Laboratory Medicine, Saint John Regional Hospital, Saint John, Canada
| | - Tarek Rahmeh
- Dalhousie Medicine New Brunswick, Saint John, Canada
- Departments of Laboratory Medicine, Saint John Regional Hospital, Saint John, Canada
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Asghari S, Hurd J, Marshall Z, Maybank A, Hesselbarth L, Hurley O, Farrell A, Kendall CE, Rourke SB, Becker M, Johnston S, Lundrigan P, Rosenes R, Bibeau C, Liddy C. Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis. AIDS Care 2018; 30:963-972. [PMID: 29397762 DOI: 10.1080/09540121.2018.1435848] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.
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Affiliation(s)
- Shabnam Asghari
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Jillian Hurd
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Zack Marshall
- b School of Social Work , McGill University , Montreal , QC , Canada
| | - Allison Maybank
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Lydia Hesselbarth
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Oliver Hurley
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Alison Farrell
- a Department of Family Medicine , Memorial University of Newfoundland, Health Sciences Centre , St. John's , NL , Canada
| | - Claire E Kendall
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Sean B Rourke
- d Li Ka Shing Knowledge Institute , St. Michael's Hospital , Toronto , ON , Canada
| | - Marissa Becker
- e Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada
| | - Sharon Johnston
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Phil Lundrigan
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Ron Rosenes
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Christine Bibeau
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
| | - Clare Liddy
- c Bruyere Research Institute , University of Ottawa , Ottawa , ON , Canada
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Minichiello A, Swab M, Chongo M, Marshall Z, Gahagan J, Maybank A, Hot A, Schwandt M, Gaudry S, Hurley O, Asghari S. HIV Point-of-Care Testing in Canadian Settings: A Scoping Review. Front Public Health 2017; 5:76. [PMID: 28459048 PMCID: PMC5394765 DOI: 10.3389/fpubh.2017.00076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/22/2017] [Indexed: 11/18/2022] Open
Abstract
Background HIV point-of-care testing (POCT) was approved for use in Canada in 2005 and provides important public health benefits by providing rapid screening results rather than sending a blood sample to a laboratory and waiting on test results. Access to test results soon after testing (or during the same visit) is believed to increase the likelihood that individuals will receive their results and improve access to confirmatory testing and linkages to care. This paper reviews the literature on the utilization of HIV POCT across Canadian provinces. Methods We searched OVID Medline, Embase, EBM Reviews, PsycINFO, CINAHL, and 20 electronic grey literature databases. All empirical studies investigating HIV POCT programs in Canada published in French or English were included. Results Searches of academic databases identified a total of 6,091 records. After removing duplicates and screening for eligibility, 27 records were included. Ten studies are peer-reviewed articles, and 17 are grey literature reports. HIV POCT in Canada is both feasible and accepted by Canadians. It is preferred to conventional HIV testing (ranging from 81.1 to 97%), and users are highly satisfied with the testing process (ranging between 96 and 100%). Conclusion The majority of studies demonstrate that HIV POCT is feasible, preferred, and accepted by diverse populations in Canada. Losses to follow-up and linkage rates are also good. However, more research is needed to understand how best to scale up HIV POCT in contexts that currently have very limited or no access to testing.
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Affiliation(s)
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Meck Chongo
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Zack Marshall
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.,Department of Social Development Studies and School of Social Work, Renison University College, University of Waterloo, Waterloo, ON, Canada
| | - Jacqueline Gahagan
- Health Promotion Division, Faculty of Health Professions, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Allison Maybank
- Center for Rural Health Studies, Primary Health Care Research Unit, Department of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Aurélie Hot
- Coalition des organismes communautaires québécois de lutte contre le sida, Montreal, QC, Canada
| | - Michael Schwandt
- Faculty of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sonia Gaudry
- CIHR Centre for REACH in HIV/AIDS and CIHR CBR Collaborative: A Program of REACH, Toronto, ON, Canada
| | - Oliver Hurley
- Center for Rural Health Studies, Primary Health Care Research Unit, Department of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Center for Rural Health Studies, Primary Health Care Research Unit, Department of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Asghari S, Maybank A, Hurley O, Modir H, Farrell A, Marshall Z, Kendall C, Johnston S, Hogel M, Rourke SB, Liddy C. Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review. JMIR Res Protoc 2016; 5:e71. [PMID: 27193076 PMCID: PMC4889870 DOI: 10.2196/resprot.5263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. Objective We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. Methods This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. Results A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. Conclusions This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs.
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Affiliation(s)
- Shabnam Asghari
- Primary Healthcare Research Unit, Department of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
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