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Coleman BC, Rubinstein SM, Salsbury SA, Swain M, Brown R, Pohlman KA. The World Federation of Chiropractic Global Patient Safety Task Force: a call to action. Chiropr Man Therap 2024; 32:15. [PMID: 38741191 DOI: 10.1186/s12998-024-00536-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The Global Patient Safety Action Plan, an initiative of the World Health Organization (WHO), draws attention to patient safety as being an issue of utmost importance in healthcare. In response, the World Federation of Chiropractic (WFC) has established a Global Patient Safety Task Force to advance a patient safety culture across all facets of the chiropractic profession. This commentary aims to introduce principles and call upon the chiropractic profession to actively engage with the Global Patient Safety Action Plan beginning immediately and over the coming decade. MAIN TEXT This commentary addresses why the chiropractic profession should pay attention to the WHO Global Patient Safety Action Plan, and what actions the chiropractic profession should take to advance these objectives. Each strategic objective identified by WHO serves as a focal point for reflection and action. Objective 1 emphasizes the need to view each clinical interaction as a chance to improve patient safety through learning. Objective 2 urges the implementation of frameworks that dismantle systemic obstacles, minimizing human errors and strengthening patient safety procedures. Objective 3 supports the optimization of clinical process safety. Objective 4 recognizes the need for patient and family engagement. Objective 5 describes the need for integrated patient safety competencies in training programs. Objective 6 explains the need for foundational data infrastructure, ecosystem, and culture. Objective 7 emphasizes that patient safety is optimized when healthcare professionals cultivate synergy and partnerships. CONCLUSIONS The WFC Global Patient Safety Task Force provides a structured framework for aligning essential considerations for patient safety in chiropractic care with WHO strategic objectives. Embracing the prescribed action steps offers a roadmap for the chiropractic profession to nurture an inclusive and dedicated culture, placing patient safety at its core. This commentary advocates for a concerted effort within the chiropractic community to commit to and implement these principles for the collective advancement of patient safety.
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Affiliation(s)
- Brian C Coleman
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Michael Swain
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | | | - Katherine A Pohlman
- Research Center, Parker University, 2540 Walnut Hill Lane, 75229, Dallas, TX, USA.
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Curry ZA, Andrew MN, Chiang M, Goldstein R, Zafonte R, Ryan CM, Coleman BC, Schneider JC. Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups. Am J Phys Med Rehabil 2024:00002060-990000000-00481. [PMID: 38709650 DOI: 10.1097/phm.0000000000002512] [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: 05/08/2024]
Abstract
OBJECTIVE Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups. DESIGN Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups. RESULTS Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis. CONCLUSION Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.
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Affiliation(s)
- Zachary A Curry
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Michael N Andrew
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Michael Chiang
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Richard Goldstein
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Surgery, Shriners Children's, 51 Blossom Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Emergency Medicine, Yale School of Medicine, 464 Congress Street, New Haven, CT 06519, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA 02129, USA; Rehabilitation Outcomes Center at Spaulding, Spaulding Rehabilitation, 300 1st Avenue, Charlestown, MA 02129, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Graham SE, Coleman BC, Zhao X, Lisi AJ. Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis. Chiropr Man Therap 2023; 31:29. [PMID: 37563677 PMCID: PMC10416500 DOI: 10.1186/s12998-023-00497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics. METHODS A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005-2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex. RESULTS The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005-FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6). CONCLUSION We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.
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Affiliation(s)
- Sarah E Graham
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Brian C Coleman
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Xiwen Zhao
- Yale Center for Analytical Sciences, New Haven, CT, USA
| | - Anthony J Lisi
- VA Connecticut Healthcare System, West Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
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Coleman BC, Lisi AJ, Abel EA, Runels T, Goulet JL. Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration. N Am Spine Soc J 2023; 14:100233. [PMID: 37440983 PMCID: PMC10333712 DOI: 10.1016/j.xnsj.2023.100233] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023]
Abstract
Background Low back pain (LBP) is a common reason individuals seek healthcare. Nonpharmacologic management (NPM) is often recommended as a primary intervention, and earlier use of NPM for LBP shows positive clinical outcomes. Our purpose was to evaluate how timing of engagement in NPM for LBP affects downstream LBP visits during the first year. Methods This study was a secondary analysis of an observational cohort study of national electronic health record data. Patients entering the Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort with LBP from October 1, 2016 to September 30, 2017 were included. Exclusive patient groups were defined by engagement in NPM within 30 days of entry ("very early NPM"), between 31 and 90 days ("early NPM"), or not within the first 90 days ("no NPM"). The outcome was time, in days, to the final LBP follow-up after 90 days and within the first year. Cox proportional hazards regression was used to model time to final follow up, controlling for additional demographic and clinical covariables. Results The study population included 44,175 patients, with 16.7% engaging in very early NPM and 13.1% in early NPM. Patients with very early NPM (5.2 visits, SD=4.5) or early NPM (5.7 visits, SD=4.6) had a higher mean number of LBP visits within the first year than those not receiving NPM in the first 90 days (3.2 visits, SD = 2.5). The very early NPM (HR=1.50, 95% CI: 1.46-1.54; median=48 days, IQR=97) and early NPM (HR=1.27, 95% CI: 1.23-1.30; median=88 days, IQR=92) had a significantly shorter time to final follow-up than the no NPM group (median=109 days, IQR=150). Conclusions Veterans Health Administration patients receiving NPM for LBP within the first 90 days after initially seeking care demonstrate a significantly faster time to final follow-up visit within the first year compared to those who do not.
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Affiliation(s)
- Brian C. Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Anthony J. Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Erica A. Abel
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Tessa Runels
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - Joseph L. Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
- Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
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C. Coleman B, Finch D, Wang R, L. Luther S, Heapy A, Brandt C, J. Lisi A. Extracting Pain Care Quality Indicators from U.S. Veterans Health Administration Chiropractic Care Using Natural Language Processing. Appl Clin Inform 2023; 14:600-608. [PMID: 37164327 PMCID: PMC10411229 DOI: 10.1055/a-2091-1162] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is common in the Veterans Health Administration (VHA), and there is growing national use of chiropractic services within the VHA. Rapid expansion requires scalable and autonomous solutions, such as natural language processing (NLP), to monitor care quality. Previous work has defined indicators of pain care quality that represent essential elements of guideline-concordant, comprehensive pain assessment, treatment planning, and reassessment. OBJECTIVE Our purpose was to identify pain care quality indicators and assess patterns across different clinic visit types using NLP on VHA chiropractic clinic documentation. METHODS Notes from ambulatory or in-hospital chiropractic care visits from October 1, 2018 to September 30, 2019 for patients in the Women Veterans Cohort Study were included in the corpus, with visits identified as consultation visits and/or evaluation and management (E&M) visits. Descriptive statistics of pain care quality indicator classes were calculated and compared across visit types. RESULTS There were 11,752 patients who received any chiropractic care during FY2019, with 63,812 notes included in the corpus. Consultation notes had more than twice the total number of annotations per note (87.9) as follow-up visit notes (34.7). The mean number of total classes documented per note across the entire corpus was 9.4 (standard deviation [SD] = 1.5). More total indicator classes were documented during consultation visits with (mean = 14.8, SD = 0.9) or without E&M (mean = 13.9, SD = 1.2) compared to follow-up visits with (mean = 9.1, SD = 1.4) or without E&M (mean = 8.6, SD = 1.5). Co-occurrence of pain care quality indicators describing pain assessment was high. CONCLUSION VHA chiropractors frequently document pain care quality indicators, identifiable using NLP, with variability across different visit types.
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Affiliation(s)
- Brian C. Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Dezon Finch
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
| | - Rixin Wang
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Stephen L. Luther
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Alicia Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Anthony J. Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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Kerns RD, Burgess DJ, Coleman BC, Cook CE, Farrokhi S, Fritz JM, Goertz C, Heapy A, Lisi AJ, Rhon DI, Vining R. Self-Management of Chronic Pain: Psychologically Guided Core Competencies for Providers. Pain Med 2022; 23:1815-1819. [PMID: 35642906 PMCID: PMC9629397 DOI: 10.1093/pm/pnac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Robert D Kerns
- Department of Psychiatry
- Department of Neurology
- Department of Psychology, Yale University, New Haven, Connecticut
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Diana J Burgess
- VA Health Services Research and Development Service (HSR&D) Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Chad E Cook
- Departments of Orthopedics and Population Health Sciences, and the Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shawn Farrokhi
- Department of Defense–Department of Veterans Affairs (DOD-VA) Extremity Trauma and Amputation Center of Excellence and Naval Medical Center, San Diego, California
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, College of Health, The University of Utah, Salt Lake City, Utah
| | - Christine Goertz
- Department of Orthopaedics, Duke University School of Medicine, and Core Faculty Member, Duke-Margolis Center for Health Policy, Durham, North Carolina
| | - Alicia Heapy
- Department of Psychiatry
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
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Rhon DI, Fritz JM, Kerns RD, McGeary DD, Coleman BC, Farrokhi S, Burgess DJ, Goertz CM, Taylor SL, Hoffmann T. TIDieR-telehealth: precision in reporting of telehealth interventions used in clinical trials - unique considerations for the Template for the Intervention Description and Replication (TIDieR) checklist. BMC Med Res Methodol 2022; 22:161. [PMID: 35655144 PMCID: PMC9161193 DOI: 10.1186/s12874-022-01640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/20/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Recent international health events have led to an increased proliferation of remotely delivered health interventions. Even with the pandemic seemingly coming under control, the experiences of the past year have fueled a growth in ideas and technology for increasing the scope of remote care delivery. Unfortunately, clinicians and health systems will have difficulty with the adoption and implementation of these interventions if ongoing and future clinical trials fail to report necessary details about execution, platforms, and infrastructure related to these interventions. The purpose was to develop guidance for reporting of telehealth interventions.
Methods
A working group from the US Pain Management Collaboratory developed guidance for complete reporting of telehealth interventions. The process went through 5-step process from conception to final checklist development with input for many stakeholders, to include all 11 primary investigators with trials in the Collaboratory.
Results
An extension focused on unique considerations relevant to telehealth interventions was developed for the Template for the Intervention Description and Replication (TIDieR) checklist.
Conclusion
The Telehealth Intervention guideline encourages use of the Template for the Intervention Description and Replication (TIDieR) checklist as a valuable tool (TIDieR-Telehealth) to improve the quality of research through a reporting guide of relevant interventions that will help maximize reproducibility and implementation.
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Roytman GR, Coleman BC, Corcoran KL, Goertz C, Long C, Lisi A. TEMPORARY REMOVAL: Changes in the Use of Telehealth and Face-To-Face Chiropractic Care in the Department of Veterans Affairs before and after the COVID-19 Pandemic. J Manipulative Physiol Ther 2021; 44:584-590. [PMID: 35249749 PMCID: PMC8742605 DOI: 10.1016/j.jmpt.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 11/01/2022]
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Coleman BC, Purcell N, Geda M, Luther SL, Peduzzi P, Kerns RD, Seal KH, Burgess DJ, Rosen MI, Sellinger J, Salsbury SA, Gelman H, Brandt CA, Edwards RR. Assessing the impact of the COVID-19 pandemic on pragmatic clinical trial participants. Contemp Clin Trials 2021; 111:106619. [PMID: 34775101 PMCID: PMC8585559 DOI: 10.1016/j.cct.2021.106619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022]
Abstract
Characterizing the impacts of disruption attributable to the COVID-19 pandemic on clinical research is important, especially in pain research where psychological, social, and economic stressors attributable to the COVID-19 pandemic may greatly impact treatment effects. The National Institutes of Health - Department of Defense - Department of Veterans Affairs Pain Management Collaboratory (PMC) is a collective effort supporting 11 pragmatic clinical trials studying nonpharmacological approaches and innovative integrated care models for pain management in veteran and military health systems. The PMC rapidly developed a brief pandemic impacts measure for use across its pragmatic trials studying pain while remaining broadly applicable to other areas of clinical research. Through open discussion and consensus building by the PMC's Phenotypes and Outcomes Work Group, the PMC Coronavirus Pandemic (COVID-19) Measure was iteratively developed. The measure assesses the following domains (one item/domain): access to healthcare, social support, finances, ability to meet basic needs, and mental or emotional health. Two additional items assess infection status (personal and household) and hospitalization. The measure uses structured responses with a three-point scale for COVID-19 infection status and four-point ordinal rank response for all other domains. We recommend individualized adaptation as appropriate by clinical research teams using this measure to survey the effects of the COVID-19 pandemic on study participants. This can also help maintain utility of the measure beyond the COVID-19 pandemic to characterize impacts during future public health emergencies that may require mitigation strategies such as periods of quarantine and isolation.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States of America.
| | - Natalie Purcell
- San Francisco VA Health Care System, San Francisco, CA, United States of America; Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mary Geda
- Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Stephen L Luther
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, United States of America; College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Peter Peduzzi
- Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States of America; Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, CA, United States of America; Departments of Medicine and Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States of America
| | - Marc I Rosen
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - John Sellinger
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States of America
| | - Hannah Gelman
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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Ly VT, Coleman BC, Coulis CM, Lisi AJ. Exploring the application of the Charlson Comorbidity Index to assess the patient population seen in a Veterans Affairs chiropractic residency program. J Chiropr Educ 2021; 35:199-204. [PMID: 33428733 PMCID: PMC8528440 DOI: 10.7899/jce-20-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/17/2020] [Accepted: 07/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Chiropractic trainees require exposure to a diverse patient base, including patients with multiple medical conditions. The Veterans Affairs (VA) Chiropractic Residency Program aims for its doctor of chiropractic (DC) residents to gain experience managing a range of multimorbid cases, yet to our knowledge there are no published data on the comorbidity characteristics of patients seen by VA DC residents. We tested 2 approaches to obtaining Charlson Comorbidity Index (CCI) scores and compared CCI scores of resident patients with those of staff DCs at 1 VA medical center. METHODS Two processes of data collection to calculate CCI scores were developed. Time differences and agreement between methods were assessed. Comparison of CCI distribution between resident DC and staff DCs was done using 100 Monte Carlo simulation iterations of Fisher's exact test. RESULTS Both methods were able to calculate CCI scores (n = 22). The automated method was faster than the manual (13 vs 78 seconds per patient). CCI scores agreement between methods was good (κ = 0.67). We failed to find a significant difference in the distribution of resident DC and staff DC patients (mean p = .377; 95% CI, .375-.379). CONCLUSION CCI scores of a VA chiropractic resident's patients are measurable with both manual and automated methods, although automated may be preferred for its time efficiency. At the facility studied, the resident and staff DCs did not see patients with significantly different distributions of CCI scores. Applying CCI may give better insight into the characteristics of DC trainee patient populations.
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Halloran SM, Coleman BC, Kawecki T, Long CR, Goertz C, Lisi AJ. Characteristics and Practice Patterns of U.S. Veterans Health Administration Doctors of Chiropractic: A Cross-sectional Survey. J Manipulative Physiol Ther 2021; 44:535-545. [DOI: 10.1016/j.jmpt.2021.12.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
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Coleman BC, Goulet JL, Higgins DM, Bathulapalli H, Kawecki T, Ruser CB, Bastian LA, Martino S, Piette JD, Edmond SN, Heapy AA. ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration. Pain Med 2021; 22:2597-2603. [PMID: 33944953 DOI: 10.1093/pm/pnab161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE We describe the most frequently used musculoskeletal diagnoses in Veterans Health Administration (VHA) care. We report the number of visits and patients associated with common musculoskeletal ICD-10 codes and compare trends across primary and specialty care settings. DESIGN Secondary analysis of a longitudinal cohort study. SUBJECTS Veterans included in the Musculoskeletal Diagnosis Cohort with a musculoskeletal diagnosis from October 1, 2015 through September 30, 2017. METHODS We obtained counts and proportions of all musculoskeletal diagnosis codes used and the number of unique patients with each musculoskeletal diagnosis. Diagnosis use was compared between primary and specialty care settings. RESULTS Of over 6,400 possible ICD-10 M-codes describing "Diseases of the Musculoskeletal System and Connective Tissue", 5,723 codes were used at least once. The most frequently used ICD-10 M-code was "Low Back Pain" (18.3%) followed by "Cervicalgia" (3.6%). Collectively, the 100 most frequently used codes accounted for 80% of M-coded visit diagnoses, and 95% of patients had at least one of these diagnoses. The most common diagnoses (spinal pain, joint pain, osteoarthritis) were used similarly in primary and specialty care settings. CONCLUSION A diverse sample of all available musculoskeletal diagnosis codes were used; however, less than 2% of all possible codes accounted for 80% of the diagnoses used. This trend was consistent across primary and specialty care settings. The most frequently used diagnosis codes describe the types of musculoskeletal conditions, among a large pool of potential diagnoses, that prompt veterans to present to VHA for musculoskeletal care.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA.,Boston University School of Medicine, Boston, MA
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Todd Kawecki
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Christopher B Ruser
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Steve Martino
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - John D Piette
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.,University of Michigan School of Public Health, Ann Arbor, MI
| | - Sara N Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Alicia A Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
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Coleman BC, Kean J, Brandt CA, Peduzzi P, Kerns RD. Adapting to disruption of research during the COVID-19 pandemic while testing nonpharmacological approaches to pain management. Transl Behav Med 2020; 10:827-834. [PMID: 32885815 PMCID: PMC7499692 DOI: 10.1093/tbm/ibaa074] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has slowed research progress, with particularly disruptive effects on investigations of addressing urgent public health challenges, such as chronic pain. The National Institutes of Health (NIH) Department of Defense (DoD) Department of Veterans Affairs (VA) Pain Management Collaboratory (PMC) supports 11 large-scale, multisite, embedded pragmatic clinical trials (PCTs) in military and veteran health systems. The PMC rapidly developed and enacted a plan to address key issues in response to the COVID-19 pandemic. The PMC tracked and collaborated in developing plans for addressing COVID-19 impacts across multiple domains and characterized the impact of COVID-19 on PCT operations, including delays in recruitment and revisions of study protocols. A harmonized participant questionnaire will facilitate later meta-analyses and cross-study comparisons of the impact of COVID-19 across all 11 PCTs. The pandemic has affected intervention delivery, outcomes, regulatory and ethics issues, participant recruitment, and study design. The PMC took concrete steps to ensure scientific rigor while encouraging flexibility in the PCTs, while paying close attention to minimizing the burden on research participants, investigators, and clinical care teams. Sudden changes in the delivery of pain management interventions will probably alter treatment effects measured via PMC PCTs. Through the use of harmonized instruments and surveys, we are capturing these changes and plan to monitor the impact on research practices, as well as on health outcomes. Analyses of patient-reported measures over time will inform potential relationships between chronic pain, mental health, and various socioeconomic stressors common among Americans during the COVID-19 pandemic.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, USA.,Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - Jacob Kean
- Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, USA.,Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, USA.,Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA.,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Peter Peduzzi
- Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Robert D Kerns
- Pain Management Collaboratory Coordinating Center, Yale School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Coleman BC, Fodeh S, Lisi AJ, Goulet JL, Corcoran KL, Bathulapalli H, Brandt CA. Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization. Chiropr Man Therap 2020; 28:47. [PMID: 32680545 PMCID: PMC7368704 DOI: 10.1186/s12998-020-00335-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic spinal pain conditions affect millions of US adults and carry a high healthcare cost burden, both direct and indirect. Conservative interventions for spinal pain conditions, including chiropractic care, have been associated with lower healthcare costs and improvements in pain status in different clinical populations, including veterans. Little is currently known about predicting healthcare service utilization in the domain of conservative interventions for spinal pain conditions, including the frequency of use of chiropractic services. The purpose of this retrospective cohort study was to explore the use of supervised machine learning approaches to predicting one-year chiropractic service utilization by veterans receiving VA chiropractic care. METHODS We included 19,946 veterans who entered the Musculoskeletal Diagnosis Cohort between October 1, 2003 and September 30, 2013 and utilized VA chiropractic services within one year of cohort entry. The primary outcome was one-year chiropractic service utilization following index chiropractic visit, split into quartiles represented by the following classes: 1 visit, 2 to 3 visits, 4 to 6 visits, and 7 or greater visits. We compared the performance of four multiclass classification algorithms (gradient boosted classifier, stochastic gradient descent classifier, support vector classifier, and artificial neural network) in predicting visit quartile using 158 sociodemographic and clinical features. RESULTS The selected algorithms demonstrated poor prediction capabilities. Subset accuracy was 42.1% for the gradient boosted classifier, 38.6% for the stochastic gradient descent classifier, 41.4% for the support vector classifier, and 40.3% for the artificial neural network. The micro-averaged area under the precision-recall curve for each one-versus-rest classifier was 0.43 for the gradient boosted classifier, 0.38 for the stochastic gradient descent classifier, 0.43 for the support vector classifier, and 0.42 for the artificial neural network. Performance of each model yielded only a small positive shift in prediction probability (approximately 15%) compared to naïve classification. CONCLUSIONS Using supervised machine learning to predict chiropractic service utilization remains challenging, with only a small shift in predictive probability over naïve classification and limited clinical utility. Future work should examine mechanisms to improve model performance.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Samah Fodeh
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Anthony J Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kelsey L Corcoran
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, 11-ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
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Paster BJ, Dewhirst FE, Coleman BC, Lau CN, Ericson RL. Phylogenetic analysis of cultivable oral treponemes from the Smibert collection. Int J Syst Bacteriol 1998; 48 Pt 3:713-22. [PMID: 9734025 DOI: 10.1099/00207713-48-3-713] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dr. Robert Smibert from the Virginia Polytechnic Institute, USA, isolated and collected over 200 strains of oral treponemes over a 20-year period. Dr. Smibert, Dr. W.E.C. Moore and Dr. L.V. Moore separated these isolates and reference strains into different groups on the basis of cellular fatty acid analysis. In this study, the 16S rRNA genes were sequenced for 47 strains that were representative of these groups. Five distinct species were identified on the basis of 16S rRNA sequence comparisons; two of these species are newly named and three have not yet been characterized. The first species, designated Treponema Smibert-1, was represented by the single strain D4B-1 and was later identified as the newly described Treponema maltophilum. However, strain D4B-1 possessed a different flagellar arrangement to that of T. maltophilum. The second species, Treponema Smibert-2, was represented by nine isolates that possessed identical 16S rRNA gene sequences. The closest relatives of this species were Treponema Smibert-3 and Treponema Smibert-4 at approximately 90% sequence similarity. Within Treponema Smibert-2, there was no correlation between phylogenetic analysis and cellular fatty acid analysis since six different cellular fatty acid groups represented the nine strains. Treponema Smibert-3 (strain D36ER-1) and Treponema Smibert-4 (D62CR-12) were each represented by only a single strain and were closely related to each other at 98% sequence similarity. Strain D36ER-1 of Treponema Smibert-3 was identified as belonging to the not-yet-cultivated phylotype 20 [Choi, B.K., Paster, B.J., Dewhirst, F.E. & Göbel, U.B. (1994). Infect Immun 62, 1889-1895]. Strain D62CR-12 of Treponema Smibert-4 was nearly identical in sequence to the newly described Treponema amylovorum. The fifth species, Treponema Smibert-5, was represented by a single strain, D120CR-1, and was closely related at about 98% sequence similarity to the three subspecies of Treponema socranskii. The polygenetic analyses of strains of Treponema vincentii and of subspecies of T. socranskii are also reported. The closest oral relatives of T. vincentii were Treponema medium at 98.7% sequence similarity and Treponema denticola at 91.5% sequence similarity. T. socranskii subspp. socranskii, buccale and paredis formed three separate phylogenetic branches with sequence similarities of about 98% to each other. The closest relative of the subspecies of T. socranskii and of Smibert-5 was Smibert-2 at about 86% sequence similarity. Historic reference strains Fuji, 'Treponema ambigua', Fm, Ichelson-2, N-39, TD2, TRRD, MRB, IPP, Jethro and T32A, as well as an unkown strain designated only as Treponema oralis, were identified as strains of T. denticola. Reference strains Fuji, Jethro, T32A, and IPP plus three isolates of the Smibert collection were also contaminated with a mycoplasma as determined by 16S rRNA comparative analysis. Consequently, spirochaetal cultures should be screened for mycoplasmas. There are presently at least ten species of cultivable oral species of treponema with the cut-off for separate species designation at about 98% sequence similarity. However, DNA-DNA reassociation experiments are necessary to differentiate species when 16S rDNA sequence similarities are at about this level.
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Affiliation(s)
- B J Paster
- Department of Molecular Genetics, Forsyth Dental Center, Boston, MA 02115, USA.
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