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Nevedal AL, Widerquist MAO, Reardon CM, Arasim M, Jackson GL, White B, Burns M, Fix GM, DeLaughter K, Cutrona SL, Gifford AL, Jasuja GK, Hogan TP, King HA, Henderson B, Damschroder LJ. Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration. Implement Sci 2024; 19:34. [PMID: 38715094 PMCID: PMC11075255 DOI: 10.1186/s13012-024-01361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility. METHODS A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.'s factors influencing sustainment. RESULTS After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a "liminal" stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support. CONCLUSIONS We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.
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Affiliation(s)
- Andrea L Nevedal
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Marilla A Opra Widerquist
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Caitlin M Reardon
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Maria Arasim
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of General Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Timothy P Hogan
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Blake Henderson
- Innovation Ecosystem, United States Veterans Health Administration, Washington, DC, USA
| | - Laura J Damschroder
- Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA
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Cutrona SL, White L, Miano D, Damschroder LJ, Hogan TP, Gifford AL, White B, King HA, Opra Widerquist MA, Orvek E, DeLaughter K, Nevedal AL, Reardon CM, Henderson B, Vega R, Jackson GL. Supporting Veteran's Administration Medical Center Directors' Decisions When Adopting Innovative Practices: Development and Implementation of the "QuickView" and "WishList" Tools. Perm J 2023; 27:79-91. [PMID: 37545198 PMCID: PMC10502382 DOI: 10.7812/tpp/23.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Since 2015, the Veterans Health Administration (VHA) Diffusion of Excellence Program has supported spread of practices developed by frontline employees. Shark Tank-style competitions encourage "Sharks" nationwide (VHA medical center/regional directors) to bid for the opportunity to implement practices at their institutions. Methods The authors evaluated bidding strategies (2016-2020), developing the "QuickView" practice comparator to promote informed bidding. Program leaders distributed QuickView and revised versions in subsequent competitions. Our team utilized in-person observation, online chats after the competition, bidder interviews, and bid analysis to evaluate QuickView use. Bids were ranked based on demonstrated understanding of resources required for practice implementation. Results Sharks stated that QuickView supported preparation before the competition and suggested improvements. Our revised tool reported necessary staff time and incorporated a "WishList" from practice finalists detailing minimum requirements for successful implementation. Bids from later years reflected increased review of facilities' current states before the competition and increased understanding of the resources needed for implementation. Percentage of bids describing local need for the practice rose from 2016 to 2020: 4.7% (6/127); 62.1% (54/87); 78.3% (36/46); 80.6% (29/36); 89.7% (26/29). Percentage of bids committing specific resources rose following QuickView introduction: 81.1% (103/127) in 2016, 69.0% (60/87) in 2017, then 73.9% (34/46) in 2018, 88.9% (32/36) in 2019, and 89.7% (26/29) in 2020. Discussion In the years following QuickView/WishList implementation, bids reflected increased assessment before the competition of both local needs and available resources. Conclusion Selection of a new practice for implementation requires an understanding of local need, necessary resources, and fit. QuickView and WishList appear to support these determinations.
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Affiliation(s)
- Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Danielle Miano
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Timothy P Hogan
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Section of General Internal Medicine, Department of Health Law, Policy & Management, Boston University, Boston, MA, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Andrea L Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Diffusion of Excellence, Office of Discovery, Education and Affiliate Networks, VHA, Washington, DC, USA
| | - Ryan Vega
- Office of Discovery, Education and Affiliate Networks, VHA, Bedford, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
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Kaitz J, DeLaughter K, Deeney C, Cutrona SL, Hogan TP, Gifford AL, Jackson GL, White B, King H, Reardon C, Nevedal A, Henderson B, Fix GM. Leveraging Organizational Conditions for Innovation: A Typology of Facility Engagement in the Veterans Health Administration Shark Tank-Style Competition. Perm J 2023:1-8. [PMID: 36946078 DOI: 10.7812/tpp/22.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/23/2023]
Abstract
Introduction The development and spread of innovation are known challenges in health care. The US Veterans Health Administration (VHA) created a "Shark Tank"-style competition directed at frontline employees. In this annual, systemwide competition, employees submit innovations to the competition, and winning innovations receive support for implementation in other facilities. Method A multiple case study design was used to understand facility engagement in the competition, and the relationship between engagement and organizational conditions. The authors created a typology to describe the relationship between facility engagement in the competition and organizational conditions for innovation. Results Overall, there was high participation in the VHA's competition across all 130 facilities. The authors identified 7 mutually exclusive types of facility engagement. Discussion As expected, facilities with the most established conditions for innovation were the most engaged in the competition. Additionally, other facilities had various ways to be involved. Consequently, there may be benefit to the VHA tailoring how they work with facilities, based on organizational conditions. Larger facilities with ongoing research and more resources may be more suited to develop innovations, whereas smaller facilities could benefit from a focus on adoption. Conclusion These insights are valuable to the VHA and can be used by other health care systems to tailor innovation programs and allocate resources based on diverse needs across a vast health care system.
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Affiliation(s)
- Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Christine Deeney
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Heather King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caitlin Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Department of Veterans Affairs, VHA Innovation Ecosystem/Diffusion of Excellence, Washington, DC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Reardon CM, Damschroder L, Opra Widerquist MA, Arasim M, Jackson GL, White B, Cutrona SL, Fix GM, Gifford AL, DeLaughter K, King HA, Henderson B, Vega R, Nevedal AL. Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool. Implement Sci Commun 2023; 4:6. [PMID: 36647162 PMCID: PMC9842210 DOI: 10.1186/s43058-022-00386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/13/2021] [Accepted: 12/18/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed. The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors "Shark Tank" competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices. METHODS In June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses. RESULTS A representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1-4. CONCLUSIONS The initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.
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Affiliation(s)
- Caitlin M. Reardon
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Laura Damschroder
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Marilla A. Opra Widerquist
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Maria Arasim
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - George L. Jackson
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Family Medicine & Community Health, Duke University, Durham, USA
| | - Brandolyn White
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA ,grid.168645.80000 0001 0742 0364Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA ,grid.189504.10000 0004 1936 7558Department of Health Law, Policy & Management, Boston University, Boston, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA
| | - Heather A. King
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA
| | - Blake Henderson
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Ryan Vega
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Andrea L. Nevedal
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
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Ling R, White B, Roberts J, Cretikos M, Howard MV, Haber PS, Lintzeris N, Reeves P, Dunlop AJ, Searles A. Depot buprenorphine as an opioid agonist therapy in New South Wales correctional centres: a costing model. BMC Health Serv Res 2022; 22:1326. [PMID: 36348369 PMCID: PMC9644557 DOI: 10.1186/s12913-022-08687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background In 2019 daily liquid methadone and sublingual buprenorphine-naloxone were primary opioid agonist treatments for correctional centres in New South Wales, Australia. However, both had significant potential for diversion to other patients, and their daily administration was resource intensive. An alternative treatment in the form of subcutaneous depot buprenorphine became a viable option following a safety trial in 2020 – the UNLOC-T study. Depot preparation demonstrated advantages over current treatments as more difficult to divert and requiring fewer administrations. This paper reports the results of economic modelling of staffing costs in medication administration comparing depot buprenorphine, methadone, and sublingual buprenorphine provision in UNLOC-T trial facilities. Methods The costing study adopted a micro-costing approach involving the synthesis of cost data from the UNLOC-T clinical trial as well as data collected from Justice Health and Forensic Mental Health Network records. Labour and materials data were collected during site observations and interviews. Costs were calculated from two payer perspectives: a) the New South Wales (state) government which funds custodial and health services; and b) the Australian Commonwealth government, which pays for medications. The analysis compared the monthly-per-patient cost for each of the three medications in trial-site facilities during July 2019. This was followed by simulation of depot buprenorphine implementation across the study population. Costs associated with medical assessment and reviews were excluded. Results The monthly-per-patient New South Wales government service costs of depot buprenorphine, methadone and sublingual buprenorphine were: $151, $379 and $1,529 respectively while Commonwealth government medication costs were $434, $80 and $525. The implementation simulation found that service costs of depot buprenorphine declined as patients transitioned from weekly to monthly administration. Costs of treatment using the other medications increased as patient numbers decreased alongside fixed costs. At 12 months, monthly-per-patient service costs for depot buprenorphine, methadone and sublingual buprenorphine—which would be completely phased out by month 13—were $92, $530 and $2,162 respectively. Conclusions Depot buprenorphine was consistently the least costly of the treatment options. Future modelling could allow for dynamic patient populations and downstream impacts for participants and the state health system. Trial registration ACTRN12618000942257. Registered 4 June 2018.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08687-8.
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Purnat TD, Bertrand-Ferrandis C, Yau B, Ishizumi A, White B, Briand S, Ngueyn T. Training health professionals in infodemic management to mitigate the harm caused by infodemics. Eur J Public Health 2022; 32:ckac129.324. [PMCID: PMC9832944 DOI: 10.1093/eurpub/ckac129.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background Due to their multifaceted impacts on health and society, understanding and controlling infodemics to support uptake of vaccines, public health and social measures, treatments, and health behaviours is rapidly becoming a priority for many health authorities. WHO has developed a comprehensive training programme to support health professionals in the new field of expertise of managing infodemics. Objectives The WHO infodemic management multiformat and transdisciplinary training program builds the skills and knowledge needed to prepare for and respond to infodemics. The trainings are built on WHO competency framework for building an infodemic response workforce. The methodology used relies on human-centred and emotional design evidence and practice and uses evaluation for continuous learning design improvement. Results Since November 2020, three WHO global trainings organized online with US Centers for Disease Control and Prevention, UNICEF and other partners, including four-week-long simulation exercises, creating a network of 772 infodemic managers in 133 countries. A “train-the-trainers” companion package was prepared and by April 2022 delivered in Iran and Malaysia. Deep dive training modules on specialist infodemic management practice topics have been prepared for use at country level. In addition, a comprehensive set of self-paced free online courses enhances infodemic literacy and resilience to misinformation. Between December 2021 and April 2022, the OpenWHO Infodemic Management 101 course reached over 17 000 enrolments. The training programme will be updated based on evaluations, the feedback from field responders and the updated to the WHO competency framework for infodemic management workforce. Conclusions The WHO multiformat blended training program allows an efficient and rapid dissemination of infodemic management skills and knowledge. Key messages • A global network of trained infodemic managers is ready to support national preparedness and response planning. • Skills and knowledge in infodemic management are accessible to all thanks to free online courses.
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Affiliation(s)
- TD Purnat
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | | | - B Yau
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - A Ishizumi
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - B White
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - S Briand
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - T Ngueyn
- High Impact Events Preparedness, WHO, Geneva, Switzerland
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Purnat TD, Ishizumi A, Yau B, White B, Bertrand-Ferrandis C, Briand S, Nguyen T. Delivering actionable infodemic insights and recommendations for the COVID-19 pandemic response. Eur J Public Health 2022; 32:ckac129.645. [PMCID: PMC9593848 DOI: 10.1093/eurpub/ckac129.645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Issue The COVID-19 pandemic and current recovery efforts have been complicated by a parallel infodemic. The infodemic has manifested itself in the rapid spread of questions, concerns and misinformation that can affect population attitudes and behavior harmful to health -promoting stigma and discrediting science, non-recommended treatments and cures, politicizing health programs and eroding trust in health workers and health systems. Description WHO's COVID-19 Pillar 2 (risk communication, community engagement and infodemic management) developed an integrated public health infodemic insights methodology for weekly analysis of social media, traditional media and other data sources to identify, categorize, and understand the key concerns and narratives expressed, and inform risk communication and response activities. Results The infodemic characterization, integrated analysis and insights generation consisted of a 3-step mixed-methods approach. First, data was collected from publicly available social and news media and categorized into categories of conversations by a COVID-19 public health taxonomy. Second, the dataset was analyzed and compared week-on-week to identify changes in narratives and conversation sentiment. Third, the digital infodemic intelligence was reviewed by a group of subject matter experts and triangulated with other data sources to derive infodemic insights and provide recommendations for action for the week. The methodology has been applied to inform COVID-19 response, COVID-19 vaccine demand promotion, and preparing for mass gatherings or mass immunization campaigns. Lessons The methodology for infodemic intelligence generation and integration has introduced evidence-based analytical practices for generation of infodemic insights and recommendations for action into the work of WHO. It must be further adapted for use by different health programmes and preparedness functions, and is described WHO Field Infodemiology Manual. Key messages • Health authorities can use infodemic insights to respond to people’s concerns, questions and information deficits in a timely and effective manner. • An evidence-based methodology has been developed and validated to generate infodemic insights and recommendations for action during an acute health event or emergency.
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Affiliation(s)
- TD Purnat
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - A Ishizumi
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - B Yau
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - B White
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | | | - S Briand
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - T Nguyen
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
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Ishizumi A, Dunn AG, Purnat T, Yau B, Bertrand-Ferrandis C, White B, Briand S, Nguyen T. Measuring the burden of infodemics on health outcomes through harmonized global metrics. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/problem
Infodemics happen when an excess of information makes it difficult for people to discern what they see and hear to make good health decisions. Several challenges limit the usefulness of applying infodemiology research to the practice of managing infodemics including inconsistency in how information exposure is measured and a lack of focus on assessing associations with health behaviors.
Description of the problem
In 2021, WHO partnered with the University of Sydney to develop a study toolkit. We sought to create novel tools for measuring information exposure that can be easily deployed, linked to surveys measuring health behaviors, and implements a standardized study protocol so that data can be directly synthesized into a global analysis of information risk factors associated with health behaviors.
Results
A web-based study platform was developed, comprising tools for capturing information exposures within studies that link to health behavior surveys. The first tool is a smartphone application that asks users to actively record relevant information they see or hear in diary. The second application is a web browser plugin that passively tracks webpages with relevant keywords. Because localized studies follow a standardized protocol and de-identified participant data are recorded in a common format, local study investigators can opt-in to contributing study data to support global surveillance efforts.
Lessons
Through standardization of measurement tools and relevant study protocols, the toolkit can be used to quickly collect and synthesize data for global or regional analysis of infodemics, including in Europe. Validation of the toolkit in the field is needed to inform its open-source release.
Key messages
• A toolkit for measuring information risk factors associated with behavioral outcomes was developed.
• Global collaboration using the toolkit can improve synthesisability of studies investigating infodemic burden of disease.
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Affiliation(s)
- A Ishizumi
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - AG Dunn
- Biomedical Informatics and Digital Health, University of Sydney , Sydney, Australia
| | - T Purnat
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - B Yau
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | | | - B White
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - S Briand
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - T Nguyen
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
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Dan J, Concha J, Sprow G, Feng R, Afarideh M, Kodali N, Vazquez T, Diaz D, White B, Werth V. 238 Cutaneous dermatomyositis area and severity index activity score (CDASI-A) and associated patient-reported outcomes in a phase 2 clinical trial in dermatomyositis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vazquez T, Sharma M, Feng R, Diaz D, Kodali N, Dan J, Grinnell M, Keyes E, Sprow G, White B, Werth V. 068 Lenabasum reduces IFNγ and pIRF3 in dermatomyositis skin: Biomarker results from a double-blind phase 3 international randomized controlled trial. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Werth V, White B, Dgetluck N, Hally K, Constantine S, Aggarwal R, Fiorentino D, Lundberg IE, Oddis CV. OP0162 EFFICACY AND SAFETY OF LENABASUM IN THE PHASE 3 DETERMINE TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSafe and effective treatments are of significant unmet need in DM. Lenabasum, a CB2 agonist that activates resolution of inflammation, improved skin disease, patient-reported outcomes, and biomarkers in a Phase 2 study of DM patients with active skin disease.ObjectivesTo evaluate the efficacy and safety of lenabasum in a Phase 3 double-blind study in DM.MethodsDM patients ≥ 18 years old with active skin with or without muscle involvement were enrolled in 55 sites in North America, Europe, and Asia-Pacific. Stable doses of background immunosuppressants were allowed. Subjects were randomized 2:1:2 to lenabasum 20 mg BID, lenabasum 5 mg BID, or placebo BID for 52 weeks, with visits ≤ 8 weeks apart. The study was stopped after all subjects completed Week 28. Some subjects had completed Week 52 by then. The primary efficacy endpoint was Total Improvement Score (TIS) at Week 28 and a secondary efficacy endpoint was TIS at Week 52, for lenabasum 20 mg BID vs placebo.Results175 subjects (69 lenabasum 20 mg BID, 35 lenabasum 5 mg BID, 71 placebo BID) received study drug; 167 completed Week 28, and 103 completed Week 52. The most common reasons for study discontinuation were study stopped by Sponsor (34.3%), withdrawal of consent (4.5%), and adverse events (AEs, 3.9%), with similar rates among groups. Baseline demographics and disease measurements were similar among groups and in total subjects were (mean or %): age 52.0 years; 81.1% female, 75.4% White; MMT-8 133.3; CDASI activity score 23.4; HAQ-DI 0.84, MDGA 5.55, EMGA 5.23; and PtGA 5.12. Corticosteroids were used by 48.1% and 38.0%, immunoglobulins by 5.8% and 7.0%, and other immunosuppressives by 51.0% and 54.9%, and monoclonal antibodies by 8.7% and 7.0% of lenabasum and placebo groups at baseline, respectively. The primary efficacy endpoint was not met - mean (SD) TIS score was 28.3 (19.75) vs 27.2 (19.23) at Week 28 for lenabasum 20 mg BID vs placebo, p = 0.3311, MMRM. Week 52 values were 40.6 (16.88) vs 34.8 (19.94), p = 0.2290. When analyses were restricted to subjects with muscle weakness at baseline (MMT8 < 142), TIS scores and treatment differences were greater and reached nominal statistical significance at Week 40, p = 0.0172. Mean (SD) improvements in CDASI activity score were numerically greater but not statistically different between lenabasum 20 mg BID group vs placebo at Week 28 [-7.1 (7.76) vs -5.8 (8.88) points, p = 0.2775] and Week 52 [-10.0 (9.45) vs -6.2 (12.8) points, p = 0.0932]. When restricting analysis of participants without muscle weakness (MMT-8 = 150), improvement in CDASI activity score was greater in the lenabasum 20 mg BID group vs placebo at Week 28, p = 0.0461, and Week 52 p = 0.0059.Treatment-emergent AEs (TEAEs) occurred in 87.0%, 85.7%, and 87.3% of lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups, with no deaths. Related TEAEs leading to withdrawal of study product were infrequent, occurring in 1.4%, 0%, and 2.0% of subjects in the same groups. Serious TEAEs occurred in 11.6%, 8.6%, and 4.2% of subjects in the lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups. No serious TEAE preferred term occurred in more than 1 subject in any group. TEAE occurring in ≥ 10% of lenabasum 20 mg BID subjects were (% lenabasum vs % placebo): dermatomyositis (flare) 27.5% vs 40.8%; diarrhea 14.5% vs 8.5%; dizziness 13.0% vs 4.2%; nausea 11.6% vs 4.2%; headache 10.1% vs 14.1%; and arthralgia 10.1% vs 2.8%.ConclusionAlthough, primary or secondary endpoints were not met in the study, subgroup analysis of patients with muscle weakness and without muscle weakness, showed improvement in muscle strength and rash, respectively in lenabasum 20 mg BID group vs placebo. Lenabasum was administered safely and was well-tolerated in this study.Disclosure of InterestsVictoria Werth Speakers bureau: University of Pennsylvania, who own the copyright for the CLASI and SDASI, Consultant of: AbbVie, Amgen, Argenx, AstraZeneca, Biogen, BMS, Celgene, Chrysalis, CSL Behring, Cugene, Eli Lilly, EMD Serono, Genentech, GSK, Incyte, Idera, Janssen, Kirin, Medimmune, Medscape, Nektar, Octapharma, Pfizer, Principa, Regeneron, Resolve, and Viela Bio, Grant/research support from: AstraZeneca, Biogen, Celgene, Corbus Pharmaceuticals, Genentech, Gilead, Janssen, Pfizer, Syntimmune, and Viela Bio, Barbara White Shareholder of: Corbus Pharmaceuticals, Employee of: Previous employee of Corbus Pharmaceuticals, Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Kathleen Hally Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Scott Constantine Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Rohit Aggarwal Consultant of: For Abbvie, Q32, Alexion, AstraZeneca, BMS, Boehringer Ingelheim, Corbus, Csl Behring, EMD Serono, Galapagos, Janssen, Kezar, Jubliant, Kyverna, Mallinckrodt, Merck, Novartis, Octapharma, Pfizer, Octazyme, Roivant, Scipher., Grant/research support from: BMS, Mallinkrodt, EMD Serono, Q32, Pfizer, David Fiorentino Consultant of: Corbus Pharmaceuticals, Grant/research support from: Corbus Pharmaceuticals, Ingrid E. Lundberg Shareholder of: Roche and Novartis., Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Chester V Oddis Consultant of: Corbus Pharmaceuticals
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Dan J, Patel J, Sprow G, Concha J, Feng R, Kodali N, Vazquez T, Diaz D, White B, Werth V. AB1485 PATIENT-REPORTED OUTCOMES AND BIOMARKERS ASSOCIATED WITH THE CUTANEOUS DERMATOMYOSITIS AREA AND SEVERITY ACTIVITY (CDASI-A) SCORE IN A PHASE 2 CLINICAL TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRetrospective reviews of clinical databases from two sites have identified strong relationships between patient-reported outcomes and skin activity in dermatomyositis (DM), as measured by CDASI-A.1,2 No studies validate these associations in a controlled setting. Additionally, the relationship between the PROMIS-29 Short Form and skin activity in DM has not been assessed. Previous investigations have demonstrated a correlation between IL-31 and itch in DM.3 IFN-β and IFN-γ are known type I and II interferons, which are critical drivers of DM pathogenesis.4ObjectivesTo assess correlations between CDASI-A, quality of life (QoL), and biomarkers of disease activity in a double-blind, randomized, placebo-controlled clinical trial.MethodsData were retrospectively collected from five visits of a Phase 2 trial evaluating Lenabasum, a cannabinoid receptor type 2 agonist. Quality of life assessments extracted from the trial included Patient Global Assessment (PtGA) scores, PROMIS domains, and Skindex domains. Skindex question 10, regarding itch, was included in the analysis as a separate domain. Physician Global Assessment scores were also evaluated. Additionally, biomarkers derived from skin samples via IHC/PCR collected at visits 1 and 6 were assessed for predictors of CDASI-A response and association with disease activity. Analysis used linear mixed effect models to account for within subject-variability and repeated measures, where applicable. Analysis was performed without regard to treatment arm, as our goal was to correlate CDASI, QoL, and biomarkers among all subjects.ResultsData from 22 subjects with DM and a combined total of 110 visits were included. Biopsies were collected from 12 subjects. Improvement in CDASI-A significantly correlated with Skindex-S, Skindex-E, Skindex-F, Skindex-Itch, PtGA global skin, PtGA global skin, PtGA global skin, and PtGA global skin, with p < 0.001. Improvement in PROMIS social role (p = 0.046) correlated with improvement in CDASI-A. Worsening of PROMIS fatigue (p = 0.019) and pain (p < 0.001) correlated with improvement in CDASI-A. Decreases in PGA overall disease, PGA skin activity, and PGA global skin all correlated with improvement of CDASI-A (p < 0.001). Change in IL-31 protein area positively correlated with change in disease activity (p = 0.047). A positive relationship between changes in IFN-β and IFN-γ protein area and disease activity trended towards significance.ConclusionIn accordance with previous investigations from our group, well-established measures of QoL correlated significantly with CDASI-A. These findings support that CDASI-A reflects both clinical and patient-reported aspects of skin disease and is an appropriate outcome in DM clinical trials. Additionally, Skindex and PtGA scores may better relate to skin activity as measured by the CDASI compared to PROMIS domains. IL-31, a cytokine previously associated with itch in DM,3 correlated significantly with CDASI-A in our study. Trends for IFN-β and IFN-γ reduction with disease improvement support their role in the pathogenesis of DM. This study helps define patient-reported outcomes and biomarkers that may be informative in DM trials.References[1]Goreshi R, et al. J Am Acad Dermatol. 2011;65(6):1107-1116[2]Robinson ES, et al. Br J Dermatol. 2015;172(1):169-174.[3]Patel J, et al. J Invest Dermatol. 2021;141(9):2151-2160.[4]Wong D, et al. PLoS One. 2012;7(1):e29161Disclosure of InterestsJoshua Dan: None declared, Jay Patel: None declared, Grant Sprow: None declared, Josef Concha: None declared, Rui Feng: None declared, Nilesh Kodali: None declared, Thomas Vazquez: None declared, DeAnna Diaz: None declared, Barbara White Shareholder of: Corbus Pharmaceuticals, Victoria Werth Speakers bureau: University of Pennsylvania, which owns the copyright for the CDASI, Grant/research support from: Corbus Pharmaceuticals
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Werth V, Concha J, Burroughs J, Okawa J, Feng R, Jobanputra A, Borucki R, Hally K, Hejazi E, Tillinger M, Constantine S, Dgetluck N, White B. POS0315 LONG-TERM SAFETY AND EFFICACY OF LENABASUM DURING 3 YEARS IN AN OPEN-LABEL EXTENSION (OLE) OF A PHASE 2 STUDY OF LENABASUM IN REFRACTORY SKIN DISEASE IN DERMATOMYOSITIS (DM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is a synthetic, non-immunosuppressive, selective cannabinoid receptor type 2 agonist that activates resolution of inflammation. Lenabasum had acceptable safety and tolerability and improved efficacy outcomes in the initial 16-week double-blinded, randomized, placebo-controlled Part A of Phase 2 trial JBT101-DM-001 (NCT02466243) in DM subjects with refractory skin involvement. In that study, lenabasum or placebo was added to stable background treatment, with immunosuppressive therapies allowed.Objectives:To assess long-term safety and efficacy in DM subjects in this study.Methods:Subjects who completed Part A of the Phase 2 study (n = 22) were eligible to receive oral lenabasum 20 mg BID in an open-label extension (OLE) that assessed safety and efficacy at 4 weeks, then every 8 weeks.Results:20/22 (91%) eligible subjects enrolled in the OLE, following a mean interval of 31 weeks from the end of Part A, during which they continued to receive standard-of care treatments, to the start of the OLE during which lenabasum 20 mg BID was added. 17/20 (85%) subjects were on stable baseline immunosuppressive drugs. At the time of this data cut-off, 17 subjects were still enrolled, 17 had completed 140 months (2.7 years), and 15 had completed 156 months (3 years) of OLE dosing.All OLE subjects experienced at least 1 adverse event (AE), with 118 AEs during the OLE through Dec 2020. Most AEs were mild (n = 111, 94%), with 2 severe AEs (fatigue and metastatic prostate cancer) considered unrelated to lenabasum. AEs occurring in ≥ 3/20 OLE subjects were: URI (n = 5); fatigue (n = 4); nausea (n = 3); common cold (n = 3); UTI (n = 3); and DM flare (n = 3). No serious AEs related to lenabasum have been reported in this OLE to date. No subject discontinued the OLE because of an AE related to lenabasum.Improvement was seen in multiple physician- and patient-reported efficacy outcomes. CDASI activity score improved through the first 15 months of lenabasum treatment in the OLE and remained stable thereafter, with an improvement of ~20 points from the beginning of the study maintained from Month 15 through Year 3 in the OLE. CDASI damage score increased through the first year of the OLE, even though skin activity was decreasing, but lessened thereafter, returning after 3 years to about the same level it was at the beginning of the OLE. Other outcomes shown in Figure 1 followed the same general pattern as CDASI activity score, with improvement through the first 12-16 months of the OLE, then stability thereafter. Of note, 2 subjects had disease flares shortly after stopping lenabasum for conclusion of the OLE.Conclusion:Lenabasum continues to have a favorable safety and tolerability profile in the OLE of the Phase 2 trial JBT101-DM-001 with no serious AEs or study discontinuations related to lenabasum. The CDASI activity score and multiple other physician and patient-reported outcomes improved and have remained stable, showing durability of improvement in these patients with refractory skin disease. Skin damage was reversible and began to improve once skin activity stabilized. The limitations of attributing this improvement to lenabasum in the setting of open-label dosing is acknowledged. These data support further testing of lenabasum for the treatment of DM, and a Phase 3 study of lenabasum in DM is ongoing.Figure 1.Change from Baseline in Selected Efficacy Outcomes in OLE of Phase 2 Trial JBT101-DM-001Disclosure of Interests:Victoria Werth Grant/research support from: Investigator for Corbus Pharmaceuticals and received funding to conduct trials, Josef Concha: None declared, Julie Burroughs: None declared, Joyce Okawa: None declared, Rui Feng: None declared, Anisha Jobanputra: None declared, Robert Borucki: None declared, Kathleen Hally Employee of: Employee of Corbus Pharmaceuticals, Emily Hejazi: None declared, Michael Tillinger Employee of: Employee of Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals
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Richarz S, Stevenson K, White B, Thomson P, Jackson A, Isaak A, Kingsmore D. Early-cannulation arteriovenous grafts are safe and effective in avoiding recurrent tunneled central catheter infection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and a further TCVC. Theoeretically, insertion of an early-cannualtion graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr).
Methods
Retrospective comparison of two cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39).
Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions.
Results
18/299 patients identified from 2012-2020 had an ecAVG implanted as treatment for a TCVCi. In a one-year time-period (1/1/2015 -31/12/2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/ 1000 HD days, p < 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/ 1000 HD days, p = 0.000).
Conclusion
An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - K Stevenson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - P Thomson
- Department of Nephrology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Jackson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Isaak
- Department of Vascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Kingsmore
- Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech T, Stevens W, Gordon J, Kafaja S, Matucci-Cerinic M, Distler O, Lee EB, Levy Y, Jun JB, Constantine S, Dgetluck N, White B, Furst D, Denton C. OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is an oral CB2 agonist that attenuates inflammation and fibrosis in SSc animal models and showed clinical benefit with acceptable safety in a Phase 2 trial in dcSSc.Objectives:Test efficacy and safety of lenabasum in a Phase 3 trial in dcSSc.Methods:Subjects ≥18 years old with disease duration ≤ 6 years were randomized 1:1:1 to lenabasum 5 mg, 20 mg, or placebo (PBO), all BID, with stable background immunosuppressant therapy (IST) allowed. The primary efficacy endpoint was ACR CRISS score, and secondary endpoints were ΔmRSS, ΔHAQ-DI, and ΔFVC, all at Week 52 for lenabasum 20 mg vs PBO.Results:363 adults were dosed; 37 (10%) stopped study drug early, with only 1 subject (PBO cohort) stopping due to adverse event (AE). Baseline demographics were similar among groups. Disease duration was ≤ 3 years in 60% and 66%, mean mRSS score was 22.0 and 23.3, and background IST was used by 89% and 84% of lenabasum 20 mg and PBO groups, respectively.Safety results showed serious AEs and severe AEs occurred in 9.2% and 5.8% vs 14.6% and 13.0%, respectively, of lenabasum 20 mg and PBO groups.Efficacy results (Table) demonstrated:Table 1.Primary and secondary efficacy endpoints and post-hoc analyses, Week 52Group, by IST treatmentCohortNΔmRSS, mean (SD)ΔFVC% mean (SD)ΔFVC, mL mean (SD)ΔHAQ-DI mean (SD)ACR CRISS medianmITT population, MMRM primary analysis methodAllPlacebo123-8.1 (7.72)-1.0 (8.68)-51 (317)-0.13 (0.468)0.887Lenabasum 20 mg120-6.7 (6.59)-1.6 (6.91)-78 (265)-0.13 (0.436)0.888Placebo subjects, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417All ISTPlacebo97-8.9 (7.07)-1.0 (9.2)-43 (330)-0.17 (0.474)0.936MMF, no other ISTPlacebo29-10.7 (8.1)-0.58 (7.1)-37 (235)-0.12 (0.456)0.935MMF ≤ 2 years, no other ISTPlacebo23-11.7 (8.1)-0.3 (6.0)-41 (197)-0.13 (0.495)0.935Non-MMF ≤ 2 yearsPlacebo24-6.7 (6.2)-1.4 (7.87)-52 (281)-0.15 (0.357)0.931Post-hoc comparisons, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417Lenabasum 20 mg10-6.3 (6.02)-2.3 (5.58)-99 (209)-0.06 (0.498)0.811Established IST1Placebo26-6.1 (5.35)-4.6 (10.11)-170 (350)-0.17 (0.445)0.619Lenabasum 20 mg38-7.4 (5.08)-0.4 (5.70)2-21 (233)3-0.07 (0.357)0.941Established IST, subjects with ILDPlacebo22-5.9 (5.28)-3.7 (5.43)-133 (206)-0.10 (0.372)0.553Lenabasum 20 mg33-7.2 (5.70)-1.0 (10.5)-47 (365)-0.06 (0.391)0.8192 P = 0.0386 two-sample t-test; 3 P = 0.0481 two-sample t-test; other comparisons were not significant• No significant differences were seen in primary and secondary efficacy endpoints. Primary MMRM analyses with treatment-by-time-by-subgroup interactions showed that background mycophenolate (MMF) significantly influenced the outcome•oSubjects on no IST with disease duration ≤3 years were only 7% of PBO subjects and showed little improvement on PBO, in line with other dcSSc trials in which IST was restricted. Post-hoc subgroup analyses of these subjects on no IST suggested improvement in ΔmRSS and ΔHAQ-DI, for lenabasum 20 mg vs PBO•uUnexpectedly high improvement occurred in PBO subjects receiving IST, notably those on MMF started within 2 years of baseline•nPost-hoc analyses of subjects on established IST (MMF or, if no MMF, ≥ 1 non-MMF IST started > 2 years before baseline) suggested improvement in ΔFVC% (nominal P = 0.0386) and ΔFVC mL (nominal P = 0.0481) for lenabasum 20 mg vs PBO. Improvement in FVC was also seen in subjects on established IST who had ILD at baseline, lenabasum 20 mg vs PBO•mACR CRISS score demonstrated a ceiling effect and correlated most highly with ΔmRSS (r = -0.739) and moderately with MDGA (-0.432), HAQ-DI (-0.362), FVC% (0.366), and PtGA (-0.288)Conclusion:Lenabasum was safely used in this study. Unexpectedly high improvement on background IST, especially MMF, has not been previously reported at this level. The primary endpoint was not met. Post-hoc analyses showed greater improvement in lenabasum- vs PBO-treated subjects who were not on background IST and those on established IST, including subjects with ILD.Disclosure of Interests:Robert Spiera Consultant of: Abbvie, Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Formation Biologics, Mitsubishi Tanabe, Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Formation Biologics, Sanofi, Inflarx, Astra Zeneca, Kadmon, Masataka Kuwana Speakers bureau: Boehringer-Ingelheim, Chugai, Janssen, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, Grant/research support from: Boehringer-Ingelheim, Chugai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%). Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc, Consultant of: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: NIH, Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Laura Hummers Consultant of: CSL Behring, Boehringer Ingelheim, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Corbus, Boehringer Ingelheim, Medpace, Kadmon, Cumberland, CSL Behring, Tracy Frech Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Wendy Stevens Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jessica Gordon Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Research funding for EICOS Pharmaceuticals and Cumberland Pharmaceuticals., Suzanne Kafaja Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Marco Matucci-Cerinic Consultant of: Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Oliver Distler Consultant of: Consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB., Eun Bong Lee Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Yair Levy Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jae-Bum Jun Consultant of: Consultant to Boehringer Ingelheim Korea, Jeil Pharma, Dae Woong Pharma, Kwangdong Pharma, and Sama Pharma., Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals, Daniel Furst Consultant of: Corbus, Galapagos, Pfizer, CSL Behring, Mitsubishi Tanabi, Actelion, Amgen, Novartis, Roche/Genentech, Gilead, Talaris, and Boehringer Ingelheim., Grant/research support from: grants from Corbus, Galapagos, GSK, Pfizer, Talaris, CSL Behring, Mitsubishi Tanabi, Christopher Denton Consultant of: Consultancy fees and/or honoraria from Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics
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Kashinath K, Mustafa M, Albert A, Wu JL, Jiang C, Esmaeilzadeh S, Azizzadenesheli K, Wang R, Chattopadhyay A, Singh A, Manepalli A, Chirila D, Yu R, Walters R, White B, Xiao H, Tchelepi HA, Marcus P, Anandkumar A, Hassanzadeh P. Physics-informed machine learning: case studies for weather and climate modelling. Philos Trans A Math Phys Eng Sci 2021; 379:20200093. [PMID: 33583262 DOI: 10.1098/rsta.2020.0093] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Machine learning (ML) provides novel and powerful ways of accurately and efficiently recognizing complex patterns, emulating nonlinear dynamics, and predicting the spatio-temporal evolution of weather and climate processes. Off-the-shelf ML models, however, do not necessarily obey the fundamental governing laws of physical systems, nor do they generalize well to scenarios on which they have not been trained. We survey systematic approaches to incorporating physics and domain knowledge into ML models and distill these approaches into broad categories. Through 10 case studies, we show how these approaches have been used successfully for emulating, downscaling, and forecasting weather and climate processes. The accomplishments of these studies include greater physical consistency, reduced training time, improved data efficiency, and better generalization. Finally, we synthesize the lessons learned and identify scientific, diagnostic, computational, and resource challenges for developing truly robust and reliable physics-informed ML models for weather and climate processes. This article is part of the theme issue 'Machine learning for weather and climate modelling'.
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Affiliation(s)
- K Kashinath
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
| | - M Mustafa
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
| | - A Albert
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - J-L Wu
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Caltech, Pasadena, CA, USA
| | - C Jiang
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- University of California, Berkeley, CA, USA
| | | | | | - R Wang
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- UC San Diego, La Jolla, CA, USA
| | - A Chattopadhyay
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Rice University, Houston, TX, USA
| | - A Singh
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - A Manepalli
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - D Chirila
- Alfred Wegener Institute, Bremerhaven, Germany
| | - R Yu
- UC San Diego, La Jolla, CA, USA
| | - R Walters
- Northeastern University, Boston, MA, USA
| | - B White
- Terrafuse Inc., Berkeley, CA, USA
| | - H Xiao
- Virginia Tech, Blacksburg, VA, USA
| | | | - P Marcus
- University of California, Berkeley, CA, USA
| | - A Anandkumar
- Caltech, Pasadena, CA, USA
- NVIDIA, Santa Clara, California, USA
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Richarz S, Stevenson K, White B, Thomson PC, Jackson A, Isaak A, Kingsmore DB. Early-Cannulation Arteriovenous Grafts Are Safe and Effective in Avoiding Recurrent Tunneled Central Catheter Infection. Ann Vasc Surg 2021; 75:287-293. [PMID: 33819582 DOI: 10.1016/j.avsg.2021.01.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). DESIGN Retrospective comparison of 2 cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39). METHODS Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions. RESULTS Eighteen of 299 patients identified from 2012 to 2020 had an ecAVG implanted as treatment for a TCVCi. In a 1-year time-period (January 1, 2015-December 31, 2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with a TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/1000 HD days, P< 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/1000 HD days, P= 0.000). CONCLUSIONS An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland.
| | - K Stevenson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elisabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Department of Nephrology, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Jackson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Isaak
- Department of Vascular and Endovascular Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - D B Kingsmore
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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18
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Gartrell B, White B. Re: Re: Surviving clinical errors in practice. N Z Vet J 2021; 69:190-191. [PMID: 33689588 DOI: 10.1080/00480169.2021.1887691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- B Gartrell
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - B White
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Crowe K, White B, Khanna N, Cooke B, Kingsmore DB, Jackson A, Stevenson KS, Kasthuri R, Thomson PC. Epidemiology of bloodstream infections in a Scottish haemodialysis population with focus on vascular access method. J Hosp Infect 2021; 110:37-44. [PMID: 33484781 DOI: 10.1016/j.jhin.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Infection is the second highest cause of mortality in end-stage renal disease, with a significant proportion relating to haemodialysis (HD) vascular access-related infection (VARI). AIM To report the rate and antimicrobial resistance (AMR) of all-source bloodstream infections (BSIs) by vascular access type in a Scottish HD cohort. METHODS Retrospective analysis was undertaken of data on adult patients attending seven HD units during 2017. Total HD days for each vascular access type were calculated. BSIs were analysed with rates expressed per 1000 HD days. AMR was verified using health board microbiology databases. FINDINGS Excluding contaminant organisms, there was an overall BSI rate of 0.57 per 1000 HD days. The highest all-source and vascular access-related infection (VARI) BSI rates per 1000 HD days were in the non-tunnelled central venous catheter (CVC) group (3.11 and 2.07 respectively), followed by tunnelled CVC (1.10 and 0.67), arteriovenous graft (0.51 and 0.31), and finally arteriovenous fistula (0.29 and 0.02). The non-VARI BSI rates were lowest in the arteriovenous graft group. Staphylococci comprised the majority of events, with Staphylococcus aureus implicated in 29%. Gram-negative BSIs were prevalent, particularly in CVC groups, and associated with higher mortality. Multidrug-resistant (MDR) S. aureus and carbapenem resistance were relatively low. MDR Gram-negatives were high compared with the Scottish population. CONCLUSION Arteriovenous fistula access is confirmed as having lowest all-source and VARI BSI rates, and arteriovenous graft access the lowest non-VARI BSI rates. Staphylococci remain the prevailing genus; however, the contributions of Gram-negative BSIs, the higher mortality, and proportion of MDR organisms in this group are notable.
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Affiliation(s)
- K Crowe
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - B White
- Queen Elizabeth University Hospital, Glasgow, UK
| | - N Khanna
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Cooke
- Forth Valley Royal Hospital, Larbert, UK
| | | | - A Jackson
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - R Kasthuri
- Queen Elizabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Queen Elizabeth University Hospital, Glasgow, UK
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Samuels-Kalow M, Dorner S, Cash R, Dutta S, White B, Ciccolo G, Brown D, Camargo C. 104 Associations between Neighborhood Disadvantage Measures and COVID-19 Case Clusters. Ann Emerg Med 2020. [PMCID: PMC7598564 DOI: 10.1016/j.annemergmed.2020.09.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seaton RA, Ritchie ND, Robb F, Stewart L, White B, Vallance C. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother 2020; 74:2119-2121. [PMID: 30989175 DOI: 10.1093/jac/dkz122] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bone and joint infection contributes significantly to clinical activity within outpatient parenteral antimicrobial therapy (OPAT) services. The OVIVA (oral versus intravenous antibiotics for bone and joint infection) randomized study has challenged the practice of prolonged intravenous therapy, because non-inferiority of oral antibiotic therapy was demonstrated, thereby implying that early transition to oral therapy is an appropriate alternative to prolonged intravenous therapy. We examine the caveats to the study and discuss the implications for OPAT practice, highlighting the importance of careful oral antibiotic selection with attention to bioavailability, bone penetration, drug interactions, compliance and toxicity monitoring. We emphasize that ambulatory antibiotic therapy (whether intravenous or oral) in this patient group requires expert multidisciplinary management, monitoring and follow-up, and ideally should be undertaken within existing OPAT or, more accurately, complex outpatient antibiotic therapy (COpAT) services.
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Affiliation(s)
- R A Seaton
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - N D Ritchie
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - F Robb
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - L Stewart
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - B White
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - C Vallance
- Outpatient Parenteral Antimicrobial Therapy Service, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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Jackson G, Cutrona S, White B, Reardon C, Orvek E, Nevedal A, Lindquist J, Gifford A, King H, DeLaughter K, Henderson B, Vega R, Damschroder L. Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- G. Jackson
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - S. Cutrona
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System Durham NC United States
| | - C. Reardon
- VA Ann Arbor Healthcare System Ann Arbor MI United States
| | - E. Orvek
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - A. Nevedal
- VA Palo Alto Health Care System Menlo Park CA United States
| | - J. Lindquist
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - A. Gifford
- VA Boston Healthcare System Boston MA United States
- Boston University Boston MA United States
| | - H. King
- Duke University Durham NC United States
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - K. DeLaughter
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. Henderson
- United States Veterans Health Administration Innovation Ecosystem Washington DC United States
| | - R. Vega
- Veterans Health Administration (VHA) Innovation Ecosystem Washington DC United States
| | - L. Damschroder
- VA Ann Arbor Healthcare System Ann Arbor MI United States
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Nevedal AL, Reardon CM, Jackson GL, Cutrona SL, White B, Gifford AL, Orvek E, DeLaughter K, White L, King HA, Henderson B, Vega R, Damschroder L. Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study. Implement Sci Commun 2020; 1:61. [PMID: 32885216 PMCID: PMC7427879 DOI: 10.1186/s43058-020-00053-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual "Shark Tank" competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. METHODS Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. RESULTS Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. CONCLUSIONS Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA's DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.
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Affiliation(s)
- Andrea L. Nevedal
- Center for Innovation to Implementation, VHA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025 USA
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
| | - George L. Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Brandolyn White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Section of General Internal Medicine & Department of Health Law, Policy & Management, Boston University, 715 Albany St., Talbot Building, T2W, Boston, MA 02118 USA
| | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
| | - Heather A. King
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Blake Henderson
- Diffusion of Excellence, VHA Innovation Ecosystem, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Ryan Vega
- VHA Office of Discovery, Education and Affiliate Networks, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Laura Damschroder
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
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Chintalacharuvu S, Zang P, White B, Atamas S. AB0152 LENABASUM, A CB2 AGONIST, INHIBITS INFLAMMASOME ACTIVATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Upregulation of the innate immune response via the activity of Toll-like receptors and the NLRP3 inflammasome have been suggested as initiating events that can drive fibrosis in systemic sclerosis (SSc) (Pharmacol Ther. 2018;192:163). Lenabasum, a cannabinoid receptor type 2 agonist, is known to activate the resolution phase of acute human innate immune responses triggered through Toll-like receptor activation, favoring production of pro-resolving lipid mediators, reducing inflammatory infiltrates, and increasing bacterial clearance (Clin Pharmacol Ther. 2018;104:675). Given the potential importance of inflammasome activation in the pathogenesis of SSc, the question remained whether lenabasum inhibits inflammasome activation.Objectives:Assess effects of lenabasum on IL-1β and IL-18 production induced by inflammasome activation.Methods:Primary human macrophages were derived from monocytes, stimulated with LPS and ATP to active inflammasomes and cultured with lenabasum. Levels of IL-1β and IL-18 were measured in cell supernatants by ELISA. Separately, human PBMC were activated with 0.1 µg/ml LPS ± 10 µM lenabasum for 24 hours, and effects of lenabasum on the levels of IL-1β and other pro-inflammatory cytokines were measured.Results:Lenabasum significantly inhibited IL-1β and IL-18 secretion by monocyte-derived macrophages, with IC50= 66.73 ± 3.92 nM and 349.23 ± 21.27 nM, respectively. A control inflammasome activation inhibitor, MCC950, which showed IC50= 18.33 ± 1.22 nM for IL-1 β inhibition and IC50= 21.43 ± 0.81 nM for IL-8 inhibition.Conclusion:Lenabasum inhibits inflammasome activation, which could contribute to potential therapeutic efficacy in SSc and other autoimmune diseases.References:[1]Henderson, J., S. Bhattacharyya, J. Varga, and S. O’Reilly. 2018. ‘Targeting TLRs and the inflammasome in systemic sclerosis’, Pharmacol Ther, 192: 163-69.[2]Motwani, M. P., F. Bennett, P. C. Norris, A. A. Maini, M. J. George, J. Newson, A. Henderson, A. J. Hobbs, M. Tepper, B. White, C. N. Serhan, R. MacAllister, and D. W. Gilroy. 2018. ‘Potent Anti-Inflammatory and Pro-Resolving Effects of Anabasum in a Human Model of Self-Resolving Acute Inflammation’, Clin Pharmacol Ther, 104: 675-86.Disclosure of Interests:Subba Chintalacharuvu Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Ping Zang Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Sergei Atamas Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc.
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Denton C, Bloom B, Dgetluck N, White B, Spiera R. AB0568 BASELINE EUROPEAN PATIENT DEMOGRAPHICS AND DISEASE CHARACTERISTICS IN A PHASE 3 STUDY OF SAFETY AND EFFICACY OF LENABASUM, A CB2 AGONIST, IN DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:We previously presented on the baseline characteristics of a large cohort of diffuse cutaneous systemic sclerosis (dcSSc) patients enrolled in a Phase 3 trial of lenabasum, a selective cannabinoid receptor type 2 (CB2) agonist. Lenabasum, was safe and well-tolerated in a prior Phase 2 study in dcSSc patients and associated with improvements in ACR Combined Response Index Systemic Sclerosis (CRISS) score and multiple secondary efficacy outcomes.Objectives:We now report on the background standard of care and baseline disease characteristics of European (EU) patients in order to assess variability by geographic regions.Methods:The RESOLVE-1 Phase 3 study was designed with input from study investigators and regulatory authorities. An important intent of the design was to have eligibility criteria that allow testing of efficacy and safety of lenabasum in an inclusive group of dcSSc subjects to maximize relevance to patients in current practice. The study is ongoing and remains blinded.Results:Primary efficacy outcome is the ACR CRISS score at 12 months, comparing lenabasum 20 mg BID to placebo. Key inclusion criteria are males and females ≥ 18 years of age with dcSSc and disease duration ≤ 6 years who are on stable standard of care medicines, with background stable immunosuppressive mediations allowed. Baseline mRSS needed to be ≥ 15 if disease duration was > 3 to ≤ 6 years at enrollment. The study enrolled 110 EU subjects over 15 months who received ≥ 1 dose of study drug at 20 sites in 7 countries. Baseline characteristics as shown in Table 1. The majority were middle-aged, female, and white, and 80% were on immunosuppressive drugs in EU region; methotrexate (MTX) used in 30% of subjects, mycophenolate/mycophenolic acid (MMF) used in 46% of subjects, and 43% of subjects took ≥ 2 concurrent immunosuppressive drugs. There were regional differences in background immunosuppressive with use of MTX, MMF and corticosteroids highest in EU, NA and Asia, respectively.Table 1.Patient Baseline Demographics and Disease Characteristics by Regions (Blinded)Characteristic at First DoseMean (SD) or %RegionEuropeUS, CA, AU, ILAsiaN =110 (30.1%)N = 189 (51.8%)N = 66 (18.1%)Years of age51 ± 11.751 ± 13.549 ± 13.2Female75%78%71%ILD55%40%58%Caucasian101 (91.8%)148 (78.3%)0 (0.0%)Asian2 (1.8%)10 (5.3%)66 (100.0%)Black2 (1.8%)16 (8.5%)0 (0.0%)Other5 (4.6%)15 (7.9%)0 (0.0%)Any immunosuppressive drug80%89%79%≥ 2 immunosuppressive drugs43%48%38%Mycophenolate46%70%26%Corticosteroids31%31%53%Methotrexate30%22%23%Other31%41%26%Modified Rodnan Skin Score21.9 ± 7.7523.8 ± 8.4120.0 ± 7.72Physician Global Assessment5.9 ± 1.575.3 ± 1.565.0 ± 1.50Patient Global Assessment4.9 ± 2.025.0 ± 2.254.8 ± 1.89HAQ-DI with aids/devices1.0 ± 0.691.3 ± 0.760.7 ± 0.77Forced vital capacity % predicted83.2 ± 18.9277.5 ± 16.4182.5 ± 14.73Conclusion:This is the first Phase 3 study to use ACR CRISS as the primary efficacy outcome, a composite outcome of multiple clinically relevant measures of SSc, and the largest interventional study to date in diffuse cutaneous SSc. While the use of background immunosuppressive therapies is significant irrespective of geographic regions, MTX use is highest in the EU. Benefits of having inclusive eligibility criteria are that they facilitated timely full enrollment and will make the study more relevant to real-world practice. This study provides a model for future Phase 3 trials in dcSSc and will afford valuable information regarding scleroderma care in practice as well as evaluating the efficacy and safety of lenabasum.Disclosure of Interests:Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Bradley Bloom Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe
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White B, Billari W, Musiol J, Anderson C. 3:09 PM Abstract No. 43 Below-the-ankle interventions for critical limb ischemia: safety and efficacy in an office-based practice. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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White B, Nordin A, Fry A, Ahmad A, McPhail S, Roe C, Rous B, Smittenaar R, Shelton J. Geographic variation in the use of lymphadenectomy and external-beam radiotherapy for endometrial cancer: a cross-sectional analysis of population-based data. BJOG 2019; 126:1456-1465. [PMID: 31449731 DOI: 10.1111/1471-0528.15914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To quantify geographic variation in the use of lymphadenectomy and/or external-beam radiotherapy (EBRT) for endometrial cancer in England. DESIGN Cross-sectional analysis of population-based data. SETTING English cancer registry data, linked to chemotherapy, radiotherapy and hospital episodes statistics data. POPULATION Twenty-two thousand four hundred and eighty-three women with endometrial cancer presenting without clinical or radiological evidence of distant metastatic spread, diagnosed in England from 2013 to 2016. METHODS Proportions of patients receiving lymphadenectomy and/or EBRT were compared across 19 Cancer Alliances, to identify variations in clinical practice. Two separate logistic regression models assessed the impact on variation of adjustment for tumour and patient characteristics. MAIN OUTCOME MEASURES Receipt of lymphadenectomy, receipt of EBRT. RESULTS There was substantial variation by Cancer Alliance in the adjusted proportion of women with endometrial cancer receiving lymphadenectomy (range 5% [95% CI 4-6%] to 48% [95% CI 45-52%]) and EBRT (range 10% [95% CI 7-12%] to 31% [95% CI 28-33%]), after adjusting for variation in pathological grade, age, comorbidities, deprivation, ethnic group and (EBRT only) FIGO stage. Different approaches to clinical practice were identified; (i) one Cancer Alliance had significantly higher than average lymphadenectomy and significantly lower than average EBRT use, (ii) three had high use of both lymphadenectomy and EBRT, (iii) one had low lymphadenectomy use and high EBRT use, and (iv) three had low use of both lymphadenectomy and EBRT. CONCLUSIONS Lymphadenectomy is probably used to triage for EBRT when lymphadenectomy use is high and EBRT use is low. This is probably a result of variation in local endometrial cancer management guidelines, suggesting that UK recommendations should be clarified. TWEETABLE ABSTRACT There is geographic variation in England in the use of lymphadenectomy and radiotherapy to treat endometrial cancer.
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Affiliation(s)
- B White
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Nordin
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,East Kent Hospitals University Foundation NHS Trust, Queen Elizabeth The Queen Mother Hospital, Margate, UK
| | - A Fry
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Ahmad
- Cancer Research UK, London, UK
| | - S McPhail
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - C Roe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - B Rous
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - R Smittenaar
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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Werth V, Pearson D, Okawa J, Feng R, Concha J, Patel B, Hejazi E, Cornwall C, Constantine S, White B. 610 Safety and efficacy of lenabasum in refractory skin-predominant dermatomyositis subjects treated on an open-label extension of trial JBT101-DM-001. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ashenfelter J, Balantekin AB, Baldenegro C, Band HR, Bass CD, Bergeron DE, Berish D, Bignell LJ, Bowden NS, Bricco J, Brodsky JP, Bryan CD, Bykadorova Telles A, Cherwinka JJ, Classen T, Commeford K, Conant AJ, Cox AA, Davee D, Dean D, Deichert G, Diwan MV, Dolinski MJ, Erickson A, Febbraro M, Foust BT, Gaison JK, Galindo-Uribarri A, Gilbert CE, Gilje KE, Glenn A, Goddard BW, Hackett BT, Han K, Hans S, Hansell AB, Heeger KM, Heffron B, Insler J, Jaffe DE, Ji X, Jones DC, Koehler K, Kyzylova O, Lane CE, Langford TJ, LaRosa J, Littlejohn BR, Lopez F, Lu X, Martinez Caicedo DA, Matta JT, McKeown RD, Mendenhall MP, Miller HJ, Minock JM, Mueller PE, Mumm HP, Napolitano J, Neilson R, Nikkel JA, Norcini D, Nour S, Pushin DA, Qian X, Romero-Romero E, Rosero R, Sarenac D, Seilhan BS, Sharma R, Surukuchi PT, Trinh C, Tyra MA, Varner RL, Viren B, Wagner JM, Wang W, White B, White C, Wilhelmi J, Wise T, Yao H, Yeh M, Yen YR, Zhang A, Zhang C, Zhang X, Zhao M. First Search for Short-Baseline Neutrino Oscillations at HFIR with PROSPECT. Phys Rev Lett 2018; 121:251802. [PMID: 30608854 DOI: 10.1103/physrevlett.121.251802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 06/09/2023]
Abstract
This Letter reports the first scientific results from the observation of antineutrinos emitted by fission products of ^{235}U at the High Flux Isotope Reactor. PROSPECT, the Precision Reactor Oscillation and Spectrum Experiment, consists of a segmented 4 ton ^{6}Li-doped liquid scintillator detector covering a baseline range of 7-9 m from the reactor and operating under less than 1 m water equivalent overburden. Data collected during 33 live days of reactor operation at a nominal power of 85 MW yield a detection of 25 461±283 (stat) inverse beta decays. Observation of reactor antineutrinos can be achieved in PROSPECT at 5σ statistical significance within 2 h of on-surface reactor-on data taking. A reactor model independent analysis of the inverse beta decay prompt energy spectrum as a function of baseline constrains significant portions of the previously allowed sterile neutrino oscillation parameter space at 95% confidence level and disfavors the best fit of the reactor antineutrino anomaly at 2.2σ confidence level.
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Affiliation(s)
- J Ashenfelter
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - A B Balantekin
- Department of Physics, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - C Baldenegro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H R Band
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - C D Bass
- Department of Physics, Le Moyne College, Syracuse, New York 13214, USA
| | - D E Bergeron
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - D Berish
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - L J Bignell
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - N S Bowden
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Bricco
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - J P Brodsky
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C D Bryan
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - A Bykadorova Telles
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J J Cherwinka
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - T Classen
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Commeford
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A J Conant
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - A A Cox
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - D Davee
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - D Dean
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - G Deichert
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - M V Diwan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A Erickson
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - B T Foust
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J K Gaison
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - A Galindo-Uribarri
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C E Gilbert
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K E Gilje
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - A Glenn
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B W Goddard
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - B T Hackett
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K Han
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - S Hans
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A B Hansell
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - K M Heeger
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - B Heffron
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - J Insler
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Ji
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D C Jones
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - K Koehler
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - O Kyzylova
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - C E Lane
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - T J Langford
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J LaRosa
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - F Lopez
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - X Lu
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D A Martinez Caicedo
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - J T Matta
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - R D McKeown
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - M P Mendenhall
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H J Miller
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - J M Minock
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - P E Mueller
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H P Mumm
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - J Napolitano
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Neilson
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J A Nikkel
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - D Norcini
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - S Nour
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - D A Pushin
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - X Qian
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - E Romero-Romero
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - R Rosero
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Sarenac
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - B S Seilhan
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Sharma
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P T Surukuchi
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - C Trinh
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - M A Tyra
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - R L Varner
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - B Viren
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J M Wagner
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - W Wang
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - B White
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - C White
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - J Wilhelmi
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Wise
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - H Yao
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - M Yeh
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A Zhang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Zhang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Zhang
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - M Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
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Everett CM, Morgan P, Smith VA, Woolson S, Edelman D, Hendrix CC, Berkowitz T, White B, Jackson GL. Interpersonal continuity of primary care of veterans with diabetes: a cohort study using electronic health record data. BMC Fam Pract 2018; 19:132. [PMID: 30060736 PMCID: PMC6066924 DOI: 10.1186/s12875-018-0823-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022]
Abstract
Background Continuity of care is a cornerstone of primary care and is important for patients with chronic diseases such as diabetes. The study objective was to examine patient, provider and contextual factors associated with interpersonal continuity of care (ICoC) among Veteran’s Health Administration (VHA) primary care patients with diabetes. Methods This patient-level cohort study (N = 656,368) used electronic health record data of adult, pharmaceutically treated patients (96.5% male) with diabetes at national VHA primary care clinics in 2012 and 2013. Each patient was assigned a “home” VHA facility as the primary care clinic most frequently visited, and a primary care provider (PCP) within that home clinic who was most often seen. Patient demographic, medical and social complexity variables, provider type, and clinic contextual variables were utilized. We examined the association of ICoC, measured as maintaining the same PCP across both years, with all variables simultaneously using logistic regression fit with generalized estimating equations. Results Among VHA patients with diabetes, 22.3% switched providers between 2012 and 2013. Twelve patient, two provider and two contextual factors were associated with ICoC. Patient characteristics associated with disruptions in ICoC included demographic factors, medical complexity, and social challenges (example: homeless at any time during the year OR = 0.79, CI = 0.75–0.83). However, disruption in ICoC was most likely experienced by patients whose providers left the clinic (OR = 0.09, CI = 0.07–0.11). One contextual factor impacting ICoC included NP regulation (most restrictive NP regulation (OR = 0.79 CI = 0.69–0.97; reference least restrictive regulation). Conclusions ICoC is an important mechanism for the delivery of quality primary care to patients with diabetes. By identifying patient, provider, and contextual factors that impact ICoC, this project can inform the development of interventions to improve continuity of chronic illness care.
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Affiliation(s)
- Christine M Everett
- Duke University School of Medicine, Physician Assistant Program
- , 800 South Duke Street, Durham, NC, 27701, USA.
| | - Perri Morgan
- Duke University School of Medicine, Physician Assistant Program
- , 800 South Duke Street, Durham, NC, 27701, USA
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Woolson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - David Edelman
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cristina C Hendrix
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Clinical Health Systems & Analytics Division, Duke University School of Nursing, Durham, NC, USA
| | - Theodore Berkowitz
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Brandolyn White
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Fogarty H, Byrne M, O’Connell NM, Ryan K, White B, O’Donnell JS, Lavin M. Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding. Ir Med J 2018; 111:757. [PMID: 30489053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.
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Affiliation(s)
- H Fogarty
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - M Byrne
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - N M O’Connell
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - K Ryan
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - B White
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - J S O’Donnell
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
- Haemostasis Research Group, Irish Centre for Vascular Biology, Royal College of Surgeons Ireland, Dublin, Ireland
| | - M Lavin
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
- Haemostasis Research Group, Irish Centre for Vascular Biology, Royal College of Surgeons Ireland, Dublin, Ireland
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Werth V, Hejazi E, Pena S, Haber J, Feng R, Patel B, Concha J, Constantine S, White B. 605 Study of safety and efficacy of lenabasum, a cannabinoid receptor type 2 agonist, in refractory skin-predominant dermatomyositis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Panca M, Viner RM, White B, Pandya T, Melo H, Adamo M, Batterham R, Christie D, Kinra S, Morris S. Cost-effectiveness of bariatric surgery in adolescents with severe obesity in the UK. Clin Obes 2018; 8:105-113. [PMID: 29224241 DOI: 10.1111/cob.12232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/25/2017] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
Evidence shows that surgery for severe obesity in adults improves health and psychological functioning, and is cost-effective. Data on bariatric surgery for adolescents with severe obesity are extremely limited, with no evidence on cost-effectiveness. We evaluated the lifetime cost-effectiveness of bariatric surgery compared with no surgery in adolescents with severe obesity from the UK's National Health Service perspective. Eighteen adolescents with body mass index ≥40 kg m-2 who underwent bariatric surgery (laparoscopic Roux en Y Gastric Bypass [RYGB] [N = 9], and laparoscopic Sleeve Gastrectomy [SG] [N = 9]) at University College London Hospitals between January 2008 and December 2013 were included. We used a Markov cohort model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and no surgery. Mean cost of RYGB and SG procedures were £7100 and £7312, respectively. For RYGB vs. no surgery, the incremental cost/QALY was £2018 (95% CI £1942 - £2042) for males and £2005 (95% CI £1974 - £2031) for females. For SG vs. no surgery, the incremental cost/QALY was £1978 (95% CI £1954 - £2002) for males and £1941 (95% CI £1915 - £1969) for females. Bariatric surgery in adolescents with severe obesity is cost-effective; it is more costly than no surgery however it markedly improved quality of life.
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Affiliation(s)
- M Panca
- Research Department of Primary Care & Population Health, UCL Institute of Epidemiology & Health Care, London, UK
| | - R M Viner
- Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
| | - B White
- UCLH Adolescent Diabetes & Obesity, UCL Institute of Child Health, London, UK
| | - T Pandya
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - H Melo
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - M Adamo
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - R Batterham
- Department of Medicine, UCL Centre for Obesity Research, Rayne Institute, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - D Christie
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - S Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Morris
- Department of Applied Health Research, UCL Institute of Epidemiology & Health Care, London, UK
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Hinz D, Seumois G, Gholami AM, Greenbaum JA, Lane J, White B, Broide DH, Schulten V, Sidney J, Bakhru P, Oseroff C, Wambre E, James EA, Kwok WW, Peters B, Vijayanand P, Sette A. Lack of allergy to timothy grass pollen is not a passive phenomenon but associated with the allergen-specific modulation of immune reactivity. Clin Exp Allergy 2017; 46:705-19. [PMID: 26662458 DOI: 10.1111/cea.12692] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Timothy grass (TG) pollen is a common seasonal airborne allergen associated with symptoms ranging from mild rhinitis to severe asthma. OBJECTIVE The aim of this study was to characterize changes in TG-specific T cell responses as a function of seasonality. METHODS Peripheral blood mononuclear cells (PBMCs) obtained from allergic individuals and non-allergic controls, either during the pollen season or out of season, were stimulated with either TG extract or a pool of previously identified immunodominant antigenic regions. RESULTS PBMCs from allergic subjects exhibit higher IL-5 and IL-10 responses in season than when collected out of season. In the case of non-allergic subjects, as expected we observed lower IL-5 responses and robust production of IFN-γ compared to allergic individuals. Strikingly, non-allergic donors exhibited an opposing pattern, with decreased immune reactivity in season. The broad down-regulation in non-allergic donors indicates that healthy individuals are not oblivious to allergen exposure, but rather react with an active modulation of responses following the antigenic stimulus provided during the pollen season. Transcriptomic analysis of allergen-specific T cells defined genes modulated in concomitance with the allergen exposure and inhibition of responses in non-allergic donors. CONCLUSION AND CLINICAL RELEVANCE Magnitude and functionality of T helper cell responses differ substantially in season vs. out of season in allergic and non-allergic subjects. The results indicate the specific and opposing modulation of immune responses following the antigenic stimulation during the pollen season. This seasonal modulation reflects the enactment of specific molecular programmes associated with health and allergic disease.
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Affiliation(s)
- D Hinz
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - G Seumois
- Division of Signaling and Gene Expression, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - A M Gholami
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - J A Greenbaum
- Bioinformatics Core Facility, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - J Lane
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - B White
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - D H Broide
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - V Schulten
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - J Sidney
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - P Bakhru
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - C Oseroff
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - E Wambre
- Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - E A James
- Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - W W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - B Peters
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - P Vijayanand
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - A Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
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Lavin M, Ryan K, White B, Byrne M, O'Connell NM, O’Donnell JS. A role for intravenous immunoglobulin in the treatment of Acquired Von Willebrand Syndrome associated with IgM gammopathy. Haemophilia 2017; 24:e22-e25. [DOI: 10.1111/hae.13374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M. Lavin
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
- Department of Molecular and Cellular Therapeutics; Irish Centre for Vascular Biology; Royal College of Surgeons in Ireland; Ireland
| | - K. Ryan
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
| | - B. White
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
| | - M. Byrne
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
| | - N. M. O'Connell
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
| | - J. S. O’Donnell
- National Coagulation Centre; St. James's Hospital; Dublin Ireland
- Department of Molecular and Cellular Therapeutics; Irish Centre for Vascular Biology; Royal College of Surgeons in Ireland; Ireland
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Kabrhel C, Rosovsky R, Baugh C, Zheng H, Connors J, White B, Giordano N, Deadmon E, Kreger C, Parry B, Hagan S. 410 A Novel Protocol Increases the Proportion of Pulmonary Embolism Patients Safely Discharged from the Emergency Department Without Hospital Admission. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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White B, Romano S, Judd R, Kim R, Kim H, Klem I, Heiner J, Shah D, Jue J, Indorkar R, Farzaneh-Far A. 5008Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of death in patients with reduced ejection fraction: a multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murphy N, O'Mahony B, Flanagan P, Noone D, White B, Bergin C, Norris S, Thornton L. Progression of hepatitis C in the haemophiliac population in Ireland, after 30 years of infection in the pre-DAA treatment era. Haemophilia 2017; 23:712-720. [PMID: 28752601 DOI: 10.1111/hae.13244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prior to the introduction of viral inactivation of factor concentrates and screening of blood, 225 people with haemophilia became infected with hepatitis C (HCV) in Ireland. AIM Our aim was to assess liver disease progression and mortality in this population after 30 years of infection. METHODS Demographic and clinical data were collected from medical records in five hepatology units and one infectious disease unit retrospectively in 2005, and on four subsequent occasions. RESULTS The participation rate was 73% (165/225). Eighty three percent of patients, who had been tested for RNA (n = 106/128), developed chronic HCV infection. Thirty four percent were co-infected with HIV. All-cause mortality, after approximately 30 years of infection with chronic HCV, was 44% in HIV positive patients and 29% in HIV negative patients. Liver-related mortality was 12.5% and did not vary significantly by HIV status. Thirty seven percent of patients had developed advanced liver disease, including 20% with cirrhosis and 9% with hepatocellular carcinoma. In the pre-interferon-free direct acting antivirals era, 57% (n = 60/106) of patients were treated for HCV, 65% of whom achieved a sustained virological response. Successfully treated patients had few adverse liver outcomes. CONCLUSION After 30 years of infection, 40% of the patients who had evidence of chronic HCV had developed advanced liver disease, such as cirrhosis and HCC, or had died from liver-related causes. This proportion is high relative to similar international cohorts despite good anti-HCV treatment uptake and responses.
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Affiliation(s)
- N Murphy
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - B O'Mahony
- Irish Haemophilia Society, Dublin, Ireland
| | - P Flanagan
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - D Noone
- Irish Haemophilia Society, Dublin, Ireland
| | - B White
- St James's Hospital, Dublin, Ireland
| | - C Bergin
- St James's Hospital, Dublin, Ireland
| | - S Norris
- St James's Hospital, Dublin, Ireland
| | - L Thornton
- HSE Health Protection Surveillance Centre, Dublin, Ireland
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39
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Morgan P, Everett CM, Smith VA, Woolson S, Edelman D, Hendrix CC, Berkowitz TSZ, White B, Jackson GL. Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus. Inquiry 2017; 54:46958017712762. [PMID: 28617196 PMCID: PMC5558456 DOI: 10.1177/0046958017712762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.
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Affiliation(s)
| | | | - Valerie A Smith
- 1 Duke University, Durham, NC, USA.,2 Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sandra Woolson
- 2 Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - David Edelman
- 1 Duke University, Durham, NC, USA.,2 Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Cristina C Hendrix
- 1 Duke University, Durham, NC, USA.,2 Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | - George L Jackson
- 1 Duke University, Durham, NC, USA.,2 Durham Veterans Affairs Medical Center, Durham, NC, USA
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40
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Edwards KD, Fernandez-Pozo N, Drake-Stowe K, Humphry M, Evans AD, Bombarely A, Allen F, Hurst R, White B, Kernodle SP, Bromley JR, Sanchez-Tamburrino JP, Lewis RS, Mueller LA. A reference genome for Nicotiana tabacum enables map-based cloning of homeologous loci implicated in nitrogen utilization efficiency. BMC Genomics 2017; 18:448. [PMID: 28625162 PMCID: PMC5474855 DOI: 10.1186/s12864-017-3791-6] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco (Nicotiana tabacum) is an important plant model system that has played a key role in the early development of molecular plant biology. The tobacco genome is large and its characterisation challenging because it is an allotetraploid, likely arising from hybridisation between diploid N. sylvestris and N. tomentosiformis ancestors. A draft assembly was recently published for N. tabacum, but because of the aforementioned genome complexities it was of limited utility due to a high level of fragmentation. RESULTS Here we report an improved tobacco genome assembly, which, aided by the application of optical mapping, achieves an N50 size of 2.17 Mb and enables anchoring of 64% of the genome to pseudomolecules; a significant increase from the previous value of 19%. We use this assembly to identify two homeologous genes that explain the differentiation of the burley tobacco market class, with potential for greater understanding of Nitrogen Utilization Efficiency and Nitrogen Use Efficiency in plants; an important trait for future sustainability of agricultural production. CONCLUSIONS Development of an improved genome assembly for N. tabacum enables what we believe to be the first successful map-based gene discovery for the species, and demonstrates the value of an improved assembly for future research in this model and commercially-important species.
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Affiliation(s)
- K. D. Edwards
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | | | - K. Drake-Stowe
- Crop Science Department, North Carolina State University, Raleigh, NC USA
| | - M. Humphry
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | - A. D. Evans
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | - A. Bombarely
- Boyce Thompson Institute, Ithaca, NY USA
- Present address Department of Horticulture, Virginia Tech, Blacksburg, VA USA
| | - F. Allen
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | - R. Hurst
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | - B. White
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | - S. P. Kernodle
- Crop Science Department, North Carolina State University, Raleigh, NC USA
| | - J. R. Bromley
- Plant Biotechnology Division, British American Tobacco, Cambridge, UK
| | | | - R. S. Lewis
- Crop Science Department, North Carolina State University, Raleigh, NC USA
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Castro JJ, Gomez A, White B, Loften JR, Drackley JK. Changes in the intestinal bacterial community, short-chain fatty acid profile, and intestinal development of preweaned Holstein calves. 2. Effects of gastrointestinal site and age. J Dairy Sci 2016; 99:9703-9715. [PMID: 27720148 DOI: 10.3168/jds.2016-11007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/01/2016] [Indexed: 12/28/2022]
Abstract
The objective of this work was to assess the effects of age and gastrointestinal location (rumen vs. colon) on bacterial community diversity and composition, as well as short-chain fatty acid profiles of preruminant male Holstein calves on an intensive milk replacer feeding program. Thirty-two calves were fed at 2% of their body weight (dry matter basis) from d 10 until harvest. Sixteen calves were euthanized at 2wk and another 16 at 4wk of age to collect digesta samples from the rumen and colon. The rumen and colon bacterial communities of preruminant calves showed a similar degree of diversity (i.e., Shannon index) whereas composition differed considerably. The colonic bacterial population was characterized by dominance of lactic acid bacteria such as Lactobacillus, Streptococcus, Enterococcus, and Bifidobacterium. In addition, colonic short-chain fatty acid and lactic acid concentrations were between 50 and 850% higher than in the rumen, indicating greater fermentative activity in the colon. On the other hand, in the rumen, no genus over-dominated and more variation was present among calves. Because of an active reticular groove and low starter grain intake during the first 1 to 3wk of life, ruminal fermentation may not contribute to significant metabolizable energy supply until after 4wk of life in intensively fed calves. Until then, calf hindgut fermentation, characterized by high abundance of lactic acid bacteria along with increased lactate and butyrate concentrations, could be beneficial for intestinal health and survival of the calf during the first weeks of life.
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Affiliation(s)
- J J Castro
- Department of Animal Sciences, University of Illinois, Urbana 61801
| | - A Gomez
- Institute for Genomic Biology, University of Illinois, Urbana 61801
| | - B White
- Department of Animal Sciences, University of Illinois, Urbana 61801; Institute for Genomic Biology, University of Illinois, Urbana 61801
| | - J R Loften
- Milk Specialties Global Animal Nutrition, Eden Prairie, MN 55344
| | - J K Drackley
- Department of Animal Sciences, University of Illinois, Urbana 61801.
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Rogg J, Huckman R, Lev M, Raja A, White B. 108 The Effect of Shifting Bottlenecks on Wait Times for Patients Undergoing Head Computed Tomography in the Emergency Department. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sonis J, Mort E, Natsui S, Goldsmith A, Joseph T, White B, Raja A, Aaronson E. 18 Listening to Our Patients' Concerns: A Call to Focus Experience Efforts on Communication and Compassion. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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44
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Brady S, Healy E, Gang Q, White B, Jacob S, Houlden H, Holton J. The utility of immunohistochemistry in the assessment of myopathies with tubular aggregates and cylindrical spirals. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Parker M, Willmott L, White B, Williams G, Cartwright C. Medical education and law: withholding/withdrawing treatment from adults without capacity. Intern Med J 2016; 45:634-40. [PMID: 25828677 DOI: 10.1111/imj.12759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Law is increasingly involved in clinical practice, particularly at the end of life, but undergraduate and postgraduate education in this area remains unsystematic. We hypothesised that attitudes to and knowledge of the law governing withholding/withdrawing life-sustaining treatment from adults without capacity (the WWLST law) would vary and demonstrate deficiencies among medical specialists. AIMS We investigated perspectives, knowledge and training of medical specialists in the three largest (populations and medical workforces) Australian states, concerning the WWLST law. METHODS Following expert legal review, specialist focus groups, pre-testing and piloting in each state, seven specialties involved with end-of-life care were surveyed, with a variety of statistical analyses applied to the responses. RESULTS Respondents supported the need to know and follow the law. There were mixed views about its helpfulness in medical decision-making. Over half the respondents conceded poor knowledge of the law; this was mirrored by critical gaps in knowledge that varied by specialty. There were relatively low but increasing rates of education from the undergraduate to continuing professional development (CPD) stages. Mean knowledge score did not vary significantly according to undergraduate or immediate postgraduate training, but CPD training, particularly if recent, resulted in greater knowledge. Case-based workshops were the preferred CPD instruction method. CONCLUSIONS Teaching of current and evolving law should be strengthened across all stages of medical education. This should improve understanding of the role of law, ameliorate ambivalence towards the law and contribute to more informed deliberation about end-of-life issues with patients and families.
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Affiliation(s)
- M Parker
- School of Medicine, Mayne Medical School, University of Queensland, Brisbane, Queensland, Australia
| | - L Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - B White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - G Williams
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - C Cartwright
- Cartwright Consulting Australia Pty Ltd, Gold Coast, Queensland, Australia.,ASLaRC Aged Services Unit, Southern Cross University, Lismore, New South Wales, Australia
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46
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White B, Doyle J, Colville S, Nicholls D, Viner RM, Christie D. Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success. Clin Obes 2015; 5:312-24. [PMID: 26541244 DOI: 10.1111/cob.12119] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/16/2015] [Indexed: 01/20/2023]
Abstract
The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.
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Affiliation(s)
- B White
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Paediatric and Adolescent Medicine, University College London Hospital, London, UK
| | - J Doyle
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
| | - S Colville
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
| | - D Nicholls
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital, London, UK
| | - R M Viner
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Paediatric and Adolescent Medicine, University College London Hospital, London, UK
| | - D Christie
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
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47
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Badenoch-Jones E, White B, Lynham A. The Australian litigation landscape – oral and maxillofacial surgery and general dentistry (oral surgery procedures): a review of litigation cases. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Lavin M, Jenkins PV, Keenan C, White B, Betts DR, O'Donnell JS, O'Connell NM. X-linked moyamoya syndrome associated with severe haemophilia A. Haemophilia 2015; 22:e51-4. [PMID: 26422091 DOI: 10.1111/hae.12806] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M Lavin
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland.,National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
| | - P V Jenkins
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland.,National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
| | - C Keenan
- National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
| | - B White
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland.,National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
| | - D R Betts
- Department of Clinical Genetics, Our Lady's Children's Hospital, Dublin, Ireland
| | - J S O'Donnell
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland.,National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
| | - N M O'Connell
- Haemostasis Research Group, Institute of Molecular Medicine, Trinity Centre for Health Sciences, St James's Hospital, Trinity College Dublin, Dublin, Ireland.,National Centre for Hereditary Coagulation Disorders, St James's Hospital, Dublin, Ireland
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Kiely JB, Olszanski A, Both S, Low D, White B. SU-E-J-155: Automatic Quantitative Decision Making Metric for 4DCT Image Quality. Med Phys 2015. [DOI: 10.1118/1.4924240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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