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Theivendrampillai S, Cooper J, Lee T, Lau MWK, Marquez C, Straus SE, Fahim C. Canadian public perceptions and experiences with information during the COVID-19 pandemic: strategies to optimize future risk communications. BMC Public Health 2023; 23:796. [PMID: 37118761 PMCID: PMC10141811 DOI: 10.1186/s12889-023-15659-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the spread of misinformation worldwide. The purpose of this study was to explore perceptions of misinformation and preferred sources of obtaining COVID-19 information from those living in Canada. In particular, we sought to explore the perceptions of East Asian individuals in Canada, who experienced stigma related to COVID-19 messaging. METHODS We conducted a qualitative thematic analysis study. Interviews were offered in English, Mandarin and Cantonese. Interviewers probed for domains related to knowledge about COVID-19, preferred sources of information, perceived barriers and facilitators of misinformation, and preferences for communication during a health emergency. Interviews were recorded, translated, transcribed verbatim and analyzed using a framework approach. Transcripts were independently double-coded until > 60% agreement was reached. This study received research ethics approval. RESULTS Fifty-five interviews were conducted. The majority of participants were women (67%); median age was 52 years. 55% of participants were of East-Asian descent. Participants obtained information about COVID-19 from diverse English and non-English sources including news media, government agencies or representatives, social media, and personal networks. Challenges to seeking and understanding information included: encountering misinformation, making sense of evolving or conflicting public health guidance, and limited information on topics of interest. 65% of participants reported encountering COVID-19 misinformation. East Asian participants called on government officials to champion messaging to reduce stigmatizing and racist rhetoric and highlighted the importance of having accessible, non-English language information sources. Participants provided recommendations for future public health communications guidance during health emergencies, including preferences for message content, information messengers, dissemination platforms and format of messages. Almost all participants preferred receiving information from the Canadian government and found it helpful to utilize various mediums and platforms such as social media and news media for future risk communication, urging for consistency across all platforms. CONCLUSIONS We provide insights on Canadian experiences navigating COVID-19 information, where more than half perceived encountering misinformation on platforms when seeking COVID-19 information . We provide recommendations to inform public health communications during future health emergencies.
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Affiliation(s)
| | - Jeanette Cooper
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Taehoon Lee
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | | | - Christine Marquez
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada
| | - Christine Fahim
- Knowledge Translation Program, Unity Health Toronto, Toronto, Canada.
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Hui C, Marquez C, Simiele E, Blomain E, Oh J, Bertaina A, Klein O, Shyr D, Jiang A, Hoppe R, Kovalchuk N, Hiniker S. Volumetric Modulated Arc Therapy Total Body Irradiation (VMAT-TBI) in Pediatric and Adolescent/Young Adult Patients Undergoing Stem Cell Transplantation: Early Outcomes and Toxicities. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.570] [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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3
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Serrano Novillo C, Uroz L, Marquez C. P-244 Novel cleavage parameters to improve embryo selection. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.234] [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: 11/14/2022] Open
Abstract
Abstract
Study question
To study the impact of morphokinetic parameters during blastocyst development in the prediction of embryo ploidy.
Summary answer
Aneuploid embryos have aberrant kinetic behavior; the inclusion of the novel parameter st2 into embryo evaluation systems may improve blastocyst ploidy prediction,
What is known already
Selection of best embryo for transfer is key to success in in vitro fertilization (IVF) treatments and it is mainly based in morphokinetic criteria. Nevertheless, clinical pregnancy rates remain at ≈30%, a relatively low figure. Genetic screening of embryos may seem a great solution for this crossroad, as several studies demonstrate chromosomal alterations as one of the most common causes of abnormal embryos in IVF (and thus, poor clinical outcomes) but is an invasive technique and is not always recommended.
Study design, size, duration
Retrospective analysis of collected data.
Participants/materials, setting, methods
A total of 433 blastocysts from 96 treatments of patients for preimplantation genetic testing cycles were studied
Main results and the role of chance
The use of time-lapse culture systems allowed us to identify novel developmental features related to embryo ploidy. We present a new parameter, st2, detected at the beginning of the first cell cleavage as highly implicated in ploidy status (p < 0.001). Aneuploid embryos present slower developmental rates compared to euploid embryos for all of the key markers found in the study. Moreover, aneuploid embryos present aberrant behaviors and do not have a sequential development. Other previously studied parameters, including t3, t5, tSB, tB, cc2, cc3 and t5-t3 ,also present a strong associaiton with euploid chromosomal content if they take place in the optimal ranges stablished here.
Limitations, reasons for caution
This is a retrospective study that generates strong conclusions, but it could be interesting to test it in a prospective study.
Wider implications of the findings
Our results agree with previous studies showing slower and aberrant developmental rates for aneuploid embryos. In addition, we propose a novel parameter (st2) to include in the daily embryo evaluation for every clinician to avoid the bias described when using external algorithms or models.
Trial registration number
not applicable
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Affiliation(s)
| | - L Uroz
- Gravida, Embryology lab , Barcelona, Spain
| | - C Marquez
- Gravida, Embryology lab , Barcelona, Spain
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Ferreira-Legere LE, Chu A, Rashid M, Sivaswamy A, O'Neill T, Marquez C, Baddeliyanage R, Straus S, Udell JA. Making Informed CHOICES: The Launch of a "Big Data" Pragmatic Trial to Improve Cholesterol Management and Prevent Heart Disease in Ontario. Healthc Q 2020; 22:6-9. [PMID: 32073384 DOI: 10.12927/hcq.2020.26091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cholesterol-lowering statin medications are a safe and effective therapy to lower cholesterol and reduce the risk of cardiovascular events. Yet physician prescribing patterns and patient adherence remain suboptimal in Canada and the United States, often due to pervasive misconceptions. The Community Heart Outcomes Improvement and Cholesterol Education Study (CHOICES) is a pragmatic, registry-based, cluster randomized controlled trial that aims to improve cholesterol management through appropriate statin use in adults and to ultimately reduce cardiovascular events in high-risk communities across Ontario. The trial uses an innovative, multicomponent intervention and implementation approach that includes audit and feedback reports for family physicians and educational materials and tools for patients.
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Affiliation(s)
- Laura E Ferreira-Legere
- A research project manager with the CHOICES trial and the Cardiovascular Research Program at ICES in Toronto
| | - Anna Chu
- A senior epidemiologist with the Cardiovascular Research Program at ICES
| | | | - Atul Sivaswamy
- An analyst with the Cardiovascular Research Program at ICES
| | - Tara O'Neill
- A research assistant with the Cardiovascular Research Program at ICES
| | - Christine Marquez
- A research coordinator with the Knowledge Translation Program at the Li Ka Shing Knowledge Institute of St. Michael's Hospital in Toronto
| | - Richelle Baddeliyanage
- A research assistant with the Knowledge Translation Program at the Li Ka Shing Knowledge Institute of St. Michael's Hospital
| | - Sharon Straus
- director of the Knowledge Translation Program at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, where she is physician-in-chief, and a professor of medicine at the University of Toronto
| | - Jacob A Udell
- A cardiologist and clinician-scientist at Women's College Hospital and the Peter Munk Cardiac Centre of the University Health Network and an associate professor of medicine at the University of Toronto. He is an adjunct scientist at ICES and co-principal investigator for the CHOICES trial. Dr. Udell can be contacted by e-mail at
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Kizito S, Katamba A, Marquez C, Turimumahoro P, Ayakaka I, Davis JL, Cattamanchi A. Quality of care in childhood tuberculosis diagnosis at primary care clinics in Kampala, Uganda. Int J Tuberc Lung Dis 2019; 22:1196-1202. [PMID: 30236188 DOI: 10.5588/ijtld.18.0043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the quality of routine childhood tuberculosis (TB) evaluation in Kampala, Uganda. SETTING AND DESIGN This was a cross-sectional study of children aged <15 years attending six government-run clinics from November 2015 to December 2016. Clinicians completed a standardized patient record form for all child visits. We assessed the following performance indicators of TB evaluation developed based on the Desk Guide of the International Union Against Tuberculosis and Lung Disease, an evidence-based decision aid on childhood TB diagnosis and management for clinicians: proportion screened for TB symptoms or contact history, proportion referred for laboratory evaluation if screen-positive, and proportion treated for TB if test-positive or meeting clinical criteria. RESULTS Of 24 566 consecutive children enrolled, 11 614 (47%) were fully screened for TB symptoms. Of 1747 (15%) children who screened positive, 360 (21%) had sputum examined, including 159 (44%) using smear microscopy, 244 (67%) using Xpert® MTB/RIF, and 52 (14%) using both techniques. Treatment was initiated in 18/20 (80%) children who tested positive. An additional 65 screen-positive children met the clinical criteria for TB; none were initiated on treatment. CONCLUSIONS Large gaps exist along the pathway to diagnosis and treatment of childhood TB. There is an urgent need for enhanced implementation of evidence-based approaches to TB diagnosis to improve outcomes in childhood TB.
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Affiliation(s)
- S Kizito
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - A Katamba
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - C Marquez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California
| | - P Turimumahoro
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - I Ayakaka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J L Davis
- Pulmonary, Critical Care, & Sleep Medicine Section, School of Medicine and Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, and Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
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Gonzalez D, Facchini R, Marquez C, Masur D, McGinley J, Weiss E, Zwerling J. A-83 The Applicability of the Word Accentuation Test (WAT) in a Diverse Spanish Speaking Population: A Pilot Study. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.83] [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: 11/14/2022] Open
Abstract
Abstract
Objective
A valid estimate of premorbid ability (PA) is important when attempting to identify cognitive decline. Measures of PA in English have been widely validated, but there is a lack of PA instruments for Spanish speakers. The findings of a pilot study assessing the feasibility of using the Word Accentuation Test (WAT) as a PA measure in a diverse, traditionally underserved, Spanish speaking population are described.
Method
The WAT was administered as part of comprehensive neuropsychological evaluations and neurobehavioral status exams (NBSE) completed with Spanish speaking patients at Montefiore Medical Center (MMC) in a 6-month period. Sixty-one patients completed the WAT- 12 as part of comprehensive testing (mean age 60 (SD 11.05) range 43-80, 67% female) and 49 during NBSEs within the context of multidisciplinary memory disorders clinics (mean age 74.35 (SD 8.60) range 51-93, 80% female). T-tests and correlations with WAT performances were completed.
Results
Overall, our population correctly read an average of 19.67 (SD 7.61) words. There was no statistical difference by gender or age, but years of education predicted WAT performance (p = .004). For those individuals who had comprehensive cognitive evaluations, WAT scores were correlated with performance on the vocabulary subtest of the EIWA-III (p = .003). All patients without severe dementia were able to complete the task.
Conclusions
Analysis of pilot data from our diverse Spanish population demonstrated that the WAT is an PA appropriate task that appears to have good correlation with years of education and vocabulary performance. Additional research is necessary to validate the measure in this cohort and other cohorts.
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Marquez C, Li Y, Huang CY, Rugo H, Rabow M, Melisko M, Esserman L. Abstract P1-11-18: Measuring severe anxiety in patients with metastatic breast cancer: Living up to the PROMIS. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-11-18] [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: 11/16/2022]
Abstract
Abstract
Purpose/Objective(s):
Symptom burden in the advanced cancer patient can be substantial. PROMIS (Patient Reported Outcome Measurement Information System) is a powerful PRO symptom assessment tool that is increasingly being utilized at the point of care through patient-facing electronic health record (EHR) systems. However, the PROMIS threshold (T-score) for detecting severe anxiety has not been previously validated for patients with advanced breast cancer. The sensitivity/specificity of current expert derive threshold T-score of >/=75 in this specific population is not known. In this study, we compared PROMIS scores with the PRO-CTCAE anxiety instrument—a standard PRO tool used in the setting of clinical trials that assesses anxiety frequency, severity, and interference with usual activities—to examine the best T-score to use for PROMIS to guide management in advanced breast cancer care.
Materials/Methods:
A total of 84 unique visits of 74 English speaking patients on active cancer treatment for metastatic breast cancer were assessed using electronic PROMIS CAT (Computer Adaptive Test) and PRO-CTCAE at the UCSF Carol Buck Breast Cancer Center. Assessment forms were displayed on a touch screen tablet and completed by the patient at check-in for weekly treatment visits. PRO-CTCAE anxiety questions were graded on a scale of 1 (none) to 5 (disabling). Any score of grade >/=4 (severe to disabling) for frequency, severity or interference was defined as severe anxiety.
Results:
There was a strong correlation of PROMIS T-score and maximum PRO-CTCAE grade (highest grade of frequency, severity, or interference); Spearman correlation coefficient = 0.77 (P= <0.001). No patients reached the expert derived severe threshold of PROMIS T-score 75. Highest PROMIS T-score was 69 (range, 33-69). 11 patients reported severe or disabling anxiety by PRO-CTCAE at one visit. Area under the ROC analysis identified a cutoff that maximizes Youden's index at 55.05—sensitivity = 100% (95% CI) and specificity = 63% (95% CI).
Conclusion:
Electronic systems with integrated patient reported outcomes (PROs) along with validated thresholds to identify severe anxiety will allow for systematic identification of symptoms at point of care and the opportunity to respond rapidly to those symptoms most distressing to patients.
Citation Format: Marquez C, Li Y, Huang C-Y, Rugo H, Rabow M, Melisko M, Esserman L. Measuring severe anxiety in patients with metastatic breast cancer: Living up to the PROMIS [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-18.
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Affiliation(s)
- C Marquez
- University of California, San Francisco, San Francisco, CA
| | - Y Li
- University of California, San Francisco, San Francisco, CA
| | - C-Y Huang
- University of California, San Francisco, San Francisco, CA
| | - H Rugo
- University of California, San Francisco, San Francisco, CA
| | - M Rabow
- University of California, San Francisco, San Francisco, CA
| | - M Melisko
- University of California, San Francisco, San Francisco, CA
| | - L Esserman
- University of California, San Francisco, San Francisco, CA
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Albala C, Lera L, Marquez C, Angel B, Saguez R, Moya M. COGNITIVE FRAILTY AND QUALITY OF LIFE IN CHILEAN OLDER PEOPLE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1870] [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: 11/14/2022] Open
Affiliation(s)
| | - L Lera
- INTA, University of Chile
| | | | | | | | - M Moya
- INTA, University of Chile
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9
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Marquez C, Johnson AM, Jassemi S, Park J, Moore JE, Blaine C, Bourdon G, Chignell M, Ellen ME, Fortin J, Graham ID, Hayes A, Hamid J, Hemmelgarn B, Hillmer M, Holmes B, Holroyd-Leduc J, Hubert L, Hutton B, Kastner M, Lavis JN, Michell K, Moher D, Ouimet M, Perrier L, Proctor A, Noseworthy T, Schuckel V, Stayberg S, Tonelli M, Tricco AC, Straus SE. Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study. Implement Sci 2018; 13:84. [PMID: 29929538 PMCID: PMC6014014 DOI: 10.1186/s13012-018-0779-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 11/14/2017] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. METHODS A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. RESULTS Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1-7) and content (Mdn = 4; IQR = 3; range = 1-7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). CONCLUSIONS HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.
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Affiliation(s)
- Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | | | - Sabrina Jassemi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Jamie Park
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Julia E. Moore
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | | | - Gertrude Bourdon
- Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Canada
| | - Mark Chignell
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Moriah E. Ellen
- Ben Gurion University, Beer Sheva, Israel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, and Department of Political Science, McMaster University, Hamilton, Canada
| | - Jacques Fortin
- Agence de la santé et des services sociaux Montérégie, Longueuil, Quebec City Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Anne Hayes
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Jemila Hamid
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Bev Holmes
- Michael Smith Foundation for Health Research, Vancouver, Canada
- Simon Fraser University, Burnaby, BC Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Seniors Health Strategic Clinical Network, Alberta Health Services, Calgary, Canada
| | - Linda Hubert
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Quebec, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - John N. Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, and Department of Political Science, McMaster University, Hamilton, Canada
| | | | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Laure Perrier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Andrea Proctor
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Thomas Noseworthy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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Moore JE, Marquez C, Dufresne K, Harris C, Park J, Sayal R, Kastner M, Kelloway L, Munce SEP, Bayley M, Meyer M, Straus SE. Supporting the implementation of stroke quality-based procedures (QBPs): a mixed methods evaluation to identify knowledge translation activities, knowledge translation interventions, and determinants of implementation across Ontario. BMC Health Serv Res 2018; 18:466. [PMID: 29914466 PMCID: PMC6006745 DOI: 10.1186/s12913-018-3220-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background In 2013, Health Quality Ontario introduced stroke quality-based procedures (QBPs) to promote use of evidence-based practices for patients with stroke in Ontario hospitals. The study purpose was to: (a) describe the knowledge translation (KT) interventions used to support stroke QBP implementation, (b) assess differences in the planned and reported KT interventions by region, and (c) explore determinants perceived to have affected outcomes. Methods A mixed methods approach was used to evaluate: activities, KT interventions, and determinants of stroke QBP implementation. In Phase 1, a document review of regional stroke network work plans was conducted to capture the types of KT activities planned at a regional level; these were mapped to the knowledge to action framework. In Phase 2, we surveyed Ontario hospital staff to identify the KT interventions used to support QBP implementation at an organizational level. Phase 3 involved qualitative interviews with staff to elucidate deeper understanding of survey findings. Results Of the 446 activities identified in the document review, the most common were ‘dissemination’ (24.2%; n = 108), ‘implementation’ (22.6%; n = 101), ‘implementation planning’ (15.0%; n = 67), and ‘knowledge tools’ (10.5%; n = 47). Based on survey data (n = 489), commonly reported KT interventions included: staff educational meetings (43.1%; n = 154), champions (41.5%; n = 148), and staff educational materials (40.6%; n = 145). Survey participants perceived stroke QBP implementation to be successful (median = 5/7; interquartile range = 4–6; range = 1–7; n = 335). Forty-four people (e.g., managers, senior leaders, regional stroke network representatives, and frontline staff) participated in interviews/focus groups. Perceived facilitators to QBP implementation included networks and collaborations with external organizations, leadership engagement, and hospital prioritization of stroke QBP. Perceived barriers included lack of funding, size of the hospital (i.e., too small), lack of resources (i.e., staff and time), and simultaneous implementation of other QBPs. Conclusions Information on the types of activities and KT interventions used to support stroke QBP implementation and the key determinants influencing uptake of stroke QBPs can be used to inform future activities including the development and evaluation of interventions to address barriers and leverage facilitators. Electronic supplementary material The online version of this article (10.1186/s12913-018-3220-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,The Center for Implementation, 20 Northampton Dr, Toronto, ON, M9B 4S6, Canada.
| | - Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Kristen Dufresne
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Charmalee Harris
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jamie Park
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Radha Sayal
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,North York General Hospital, 4001 Leslie St, Toronto, ON, M2K 1E1, Canada
| | - Linda Kelloway
- Cardiac Care Network of Ontario, 4100 Yonge Street, Toronto, ON, M2P 2B5, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Matthew Meyer
- Cardiac Care Network, Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, Ontario, London, N6A 5C1, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
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Pattani R, Marquez C, Dinyarian C, Sharma M, Bain J, Moore JE, Straus SE. The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study. BMC Med 2018; 16:48. [PMID: 29631578 PMCID: PMC5892007 DOI: 10.1186/s12916-018-1032-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the gender parity existing in medical schools for over three decades, women remain underrepresented in academic medical centers, particularly in senior ranks and in leadership roles. This has consequences for patient care, education, research, and workplace culture within healthcare organizations. This study was undertaken to explore the perspectives of faculty members at a single department of medicine on the impact of the existing gender gap on organizational effectiveness and workplace culture, and to identify systems-based strategies to mitigate the gap. METHODS The study took place at a large university department of medicine in Toronto, Canada, with six affiliated hospitals. In this qualitative study, semi-structured individual interviews were conducted between May and September 2016 with full-time faculty members who held clinical and university-based appointments. Transcripts of the interviews were analyzed using thematic analysis. Three authors independently reviewed the transcripts to determine a preliminary list of codes and establish a coding framework. A modified audit consensus coding approach was applied; a single analyst reviewed all the transcripts and a second analyst audited 20% of the transcripts in each round of coding. Following each round, inter-rater reliability was determined, discrepancies were resolved through discussion, and modifications were made as needed to the coding framework. The analysis revealed faculty members' perceptions of the gender gap, potential contributing factors, organizational impacts, and possible solutions to bridge the gap. RESULTS Of the 43 full-time faculty members who participated in the survey (29 of whom self-identified as female), most participants were aware of the existing gender gap within academic medicine. Participants described social exclusion, reinforced stereotypes, and unprofessional behaviors as consequences of the gap on organizational effectiveness and culture. They suggested improvements in (1) the processes for recruitment, hiring, and promotion; (2) inclusiveness of the work environment; (3) structures for mentorship; and (4) ongoing monitoring of the gap. CONCLUSION The existing gender gap in academic medicine may have negative consequences for organizational effectiveness and workplace culture but many systems-based strategies to mitigate the gap exist. Although these solutions warrant rigorous evaluation, they are feasible to institute within most healthcare organizations immediately.
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Affiliation(s)
- Reena Pattani
- Division of General Internal Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M6H2X5 Canada
- Department of Medicine, University of Toronto, Toronto, ON M5G2C4 Canada
| | - Christine Marquez
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Camellia Dinyarian
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Malika Sharma
- Department of Medicine, University of Toronto, Toronto, ON M5G2C4 Canada
- Maple Leaf Medical Clinic, Toronto, ON M5G1K2 Canada
- Casey House, Toronto, ON M4Y1P2 Canada
| | - Julie Bain
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Julia E. Moore
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON M5G2C4 Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St, Toronto, ON M5B 1T8 Canada
- Division of Geriatrics, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M6H2X5 Canada
- Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON M5T3M6 Canada
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Avila-Polo R, Rivas E, Cabrera-Serrano M, Carbonell P, Rojas-Marcos I, Morgado Y, Servian E, Madruga M, Marquez C, Paradas C. Utrophin immunohistochemical expression in neuromuscular disorders. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.434] [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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Rivas E, Avila R, Marquez C, Paradas C, Castellanos F. Pathology of criocopharyngeal muscles in oculopharyngeal muscular dystrophy (OPMD): A quantitative histological and histochemical study. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.197] [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: 10/21/2022]
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Timmings C, Khan S, Moore JE, Marquez C, Pyka K, Straus SE. Ready, Set, Change! Development and usability testing of an online readiness for change decision support tool for healthcare organizations. BMC Med Inform Decis Mak 2016; 16:24. [PMID: 26907792 PMCID: PMC4765048 DOI: 10.1186/s12911-016-0262-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background To address challenges related to selecting a valid, reliable, and appropriate readiness assessment measure in practice, we developed an online decision support tool to aid frontline implementers in healthcare settings in this process. The focus of this paper is to describe a multi-step, end-user driven approach to developing this tool for use during the planning stages of implementation. Methods A multi-phase, end-user driven approach was used to develop and test the usability of a readiness decision support tool. First, readiness assessment measures that are valid, reliable, and appropriate for healthcare settings were identified from a systematic review. Second, a mapping exercise was performed to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a modified Delphi process was used to collect stakeholder ratings of the included measures on domains of feasibility, relevance, and likelihood to recommend. Fourth, two versions of a decision support tool prototype were developed and evaluated for usability. Results Nine valid and reliable readiness assessment measures were included in the decision support tool. The mapping exercise revealed that of the nine measures, most measures (78 %) focused on assessing readiness for change at the organizational versus the individual level, and that four measures (44 %) represented all constructs of organizational readiness. During the modified Delphi process, stakeholders rated most measures as feasible and relevant for use in practice, and reported that they would be likely to recommend use of most measures. Using data from the mapping exercise and stakeholder panel, an algorithm was developed to link users to a measure based on characteristics of their organizational setting and their readiness for change assessment priorities. Usability testing yielded recommendations that were used to refine the Ready, Set, Change! decision support tool . Conclusions Ready, Set, Change! decision support tool is an implementation support that is designed to facilitate the routine incorporation of a readiness assessment as an early step in implementation. Use of this tool in practice may offer time and resource-saving implications for implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0262-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caitlyn Timmings
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Sobia Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Julia E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Kasha Pyka
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, M5B 1W8, Canada. .,University of Toronto, 563 Spadina Crescent, Toronto, M5S 2J7, Canada.
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Albala C, Fuentes P, Lera L, Sanchez H, Angel B, Marquez C. P-054: The increasing burden of dementia in Chile. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30157-1] [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: 10/23/2022]
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Granados Prieto V, Lopez Guerra J, Marquez C, Ramirez G, Cabrera P, Praena-Fernandez J, Ortiz Gordillo M. PO-0759: Modern radiotherapy improves survival in paediatric patients with Ewing sarcoma. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40751-0] [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: 10/23/2022]
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Moore JE, Mascarenhas A, Marquez C, Almaawiy U, Chan WH, D'Souza J, Liu B, Straus SE. Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals. Implement Sci 2014; 9:160. [PMID: 25928538 PMCID: PMC4225038 DOI: 10.1186/s13012-014-0160-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/16/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND As evidence-informed implementation interventions spread, they need to be tailored to address the unique needs of each setting, and this process should be well documented to facilitate replication. To facilitate the spread of the Mobilization of Vulnerable Elders in Ontario (MOVE ON) intervention, the aim of the current study is to develop a mapping guide that links identified barriers and intervention activities to behaviour change theory. METHODS Focus groups were conducted with front line health-care professionals to identify perceived barriers to implementation of an early mobilization intervention targeted to hospitalized older adults. Participating units then used or adapted intervention activities from an existing menu or developed new activities to facilitate early mobilization. A thematic analysis was performed on the focus group data, emphasizing concepts related to barriers to behaviour change. A behaviour change theory, the 'capability, opportunity, motivation-behaviour (COM-B) system', was used as a taxonomy to map the identified barriers to their root causes. We also mapped the behaviour constructs and intervention activities to overcome these. RESULTS A total of 46 focus groups were conducted across 26 hospital inpatient units in Ontario, Canada, with 261 participants. The barriers were conceptualized at three levels: health-care provider (HCP), patient, and unit. Commonly mentioned barriers were time constraints and workload (HCP), patient clinical acuity and their perceived 'sick role' (patient), and lack of proper equipment and human resources (unit level). Thirty intervention activities to facilitate early mobilization of older adults were implemented across hospitals; examples of unit-developed intervention activities include the 'mobility clock' communication tool and the use of staff champions. A mapping guide was created with barriers and intervention activities matched though the lens of the COM-B system. CONCLUSIONS We used a systematic approach to develop a guide, which maps barriers, intervention activities, and behaviour change constructs in order to tailor an implementation intervention to the local context. This approach allows implementers to identify potential strategies to overcome local-level barriers and to document adaptations.
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Affiliation(s)
- Julia E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Alekhya Mascarenhas
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Ummukulthum Almaawiy
- Regional Geriatric Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
| | - Wai-Hin Chan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Jennifer D'Souza
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Barbara Liu
- Regional Geriatric Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada. .,Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. .,Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
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Díaz-Manera J, Alejaldre A, Gonzalez L, Rojas-García R, Olivé M, Llauger J, Gallardo E, Gonzalez-Quereda L, Carbonell P, Marquez C, Muelas N, Vílchez J, Fernández-Torrón R, Lopez de Munain A, Illa I. G.P.143. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.173] [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: 11/24/2022]
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Kastner M, Sawka AM, Hamid J, Chen M, Thorpe K, Chignell M, Ewusie J, Marquez C, Newton D, Straus SE. A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis. Implement Sci 2014; 9:109. [PMID: 25252858 PMCID: PMC4182792 DOI: 10.1186/s13012-014-0109-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 08/11/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians. METHODS The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance. RESULTS The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial. CONCLUSIONS The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.
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Nichols M, Takacs N, Ragsdale J, Levenson D, Marquez C, Roache K, Tarr CL. Listeria monocytogenesInfection in a Sugar Glider (Petaurus breviceps) - New Mexico, 2011. Zoonoses Public Health 2014; 62:254-7. [DOI: 10.1111/zph.12134] [Citation(s) in RCA: 8] [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] [Received: 11/27/2013] [Indexed: 01/15/2023]
Affiliation(s)
- M. Nichols
- New Mexico Department of Health; Epidemiology and Response Division; Santa Fe NM USA
| | - N. Takacs
- New Mexico Department of Agriculture; Veterinary Diagnostic Services; Albuquerque NM USA
| | - J. Ragsdale
- New Mexico Department of Agriculture; Veterinary Diagnostic Services; Albuquerque NM USA
| | - D. Levenson
- Southwest Veterinary Medical Center; Corrales NM USA
| | - C. Marquez
- New Mexico Department of Health; Scientific Laboratory Division; Albuquerque NM USA
| | - K. Roache
- Enteric Diseases Laboratory Branch; Centers for Disease Control and Prevention; Atlanta GA USA
| | - C. L. Tarr
- Enteric Diseases Laboratory Branch; Centers for Disease Control and Prevention; Atlanta GA USA
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Khan S, Timmings C, Moore JE, Marquez C, Pyka K, Gheihman G, Straus SE. The development of an online decision support tool for organizational readiness for change. Implement Sci 2014; 9:56. [PMID: 24886072 PMCID: PMC4030031 DOI: 10.1186/1748-5908-9-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Much importance has been placed on assessing readiness for change as one of the earliest steps of implementation, but measuring it can be a complex and daunting task. Organizations and individuals struggle with how to reliably and accurately measure readiness for change. Several measures have been developed to help organizations assess readiness, but these are often underused due to the difficulty of selecting the right measure. In response to this challenge, we will develop and test a prototype of a decision support tool that is designed to guide individuals interested in implementation in the selection of an appropriate readiness assessment measure for their setting. Methods A multi-phase approach will be used to develop the decision support tool. First, we will identify key measures for assessing organizational readiness for change from a recently completed systematic review. Included measures will be those developed for healthcare settings (e.g., acute care, public health, mental health) and that have been deemed valid and reliable. Second, study investigators and field experts will engage in a mapping exercise to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a stakeholder panel will be recruited and consulted to determine the feasibility and relevance of the selected measures using a modified Delphi process. Fourth, findings from the mapping exercise and stakeholder consultation will inform the development of a decision support tool that will guide users in appropriately selecting change readiness measures. Fifth, the tool will undergo usability testing. Discussion Our proposed decision support tool will address current challenges in the field of organizational change readiness by aiding individuals in selecting a valid and reliable assessment measure that is relevant to user needs and practice settings. We anticipate that implementers and researchers who use our tool will be more likely to conduct readiness for change assessments in their settings when planning for implementation. This, in turn, may contribute to more successful implementation outcomes. We will test this tool in a future study to determine its efficacy and impact on implementation processes.
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Affiliation(s)
- Sobia Khan
- Li Ka Shing Knowledge Institute, St, Michael's Hospital, 30 Bond St, Toronto M5B 1W8, Canada.
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Marquez C, Ingold A, Echeverría N, Acevedo A, Vignoli R, García-Fulgueiras V, Viroga J, Gonzalez O, Odizzio V, Etulain K, Nuñez E, Albornoz H, Borthagaray G, Galiana A. Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization. New Microbes New Infect 2014; 2:58-63. [PMID: 25356345 PMCID: PMC4184659 DOI: 10.1002/nmi2.40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/12/2014] [Accepted: 01/17/2014] [Indexed: 01/17/2023] Open
Abstract
We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and β-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.
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Affiliation(s)
- C Marquez
- Cátedra de Microbiología, Instituto de Química Biológica, Facultad de Ciencias y de Química-UdelaR, Universidad de la RepúblicaMontevideo, Uruguay
| | - A Ingold
- Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaRMontevideo, Uruguay
| | - N Echeverría
- Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaRMontevideo, Uruguay
| | - A Acevedo
- Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaRMontevideo, Uruguay
| | - R Vignoli
- Dpto Bacteriología y Virología, Instituto de Higiene/Facultad de Medicina-UdelaRMontevideo, Uruguay
| | - V García-Fulgueiras
- Dpto Bacteriología y Virología, Instituto de Higiene/Facultad de Medicina-UdelaRMontevideo, Uruguay
| | - J Viroga
- Laboratorio Gram/Microbiología, Sanatorio SemmMautoneMaldonado, Uruguay
| | - O Gonzalez
- Laboratorio Gram/Microbiología, Sanatorio SemmMautoneMaldonado, Uruguay
| | - V Odizzio
- Comité de Infecciones, Sanatorio SemmMautoneMaldonado, Uruguay
| | - K Etulain
- Comité de Infecciones, Sanatorio SemmMautoneMaldonado, Uruguay
| | - E Nuñez
- Unidad de Cuidados Intensivos, Sanatorio SemmMautoneMaldonado, Uruguay
| | - H Albornoz
- Unidad de Cuidados Intensivos, Hospital MacielMontevideo, Uruguay
| | - G Borthagaray
- Facultad de Química-UdelaR, Bioquímica ClínicaMontevideo, Uruguay
| | - A Galiana
- Dpto Microbiología, Hospital Maciel, UDYCIMontevideo, Uruguay
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Ortiz Gordillo M, Lopez Guerra J, Cabrera P, Marquez C, Ramirez G, Quiroga E, Campos B, Praena-Fernandez J, Falcon A, Peinado J. EP-1356: Acute and late toxicity of craniospinal irradiation for medulloblastoma patients. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31474-2] [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: 11/25/2022]
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Kohler J, Rubie H, Castel V, Beiske K, Holmes K, Gambini C, Casale F, Munzer C, Erminio G, Parodi S, Navarro S, Marquez C, Peuchmaur M, Cullinane C, Brock P, Valteau-Couanet D, Garaventa A, Haupt R. Treatment of children over the age of one year with unresectable localised neuroblastoma without MYCN amplification: Results of the SIOPEN study. Eur J Cancer 2013; 49:3671-9. [DOI: 10.1016/j.ejca.2013.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/06/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Straus SE, Moore JE, Uka S, Marquez C, Gülmezoglu AM. Determinants of implementation of maternal health guidelines in Kosovo: mixed methods study. Implement Sci 2013; 8:108. [PMID: 24016149 PMCID: PMC3846581 DOI: 10.1186/1748-5908-8-108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background One of the challenges to implementing clinical practice guidelines is the need to adapt guidelines to the local context and identify barriers to their uptake. Several models of framework are available to consider for use in guideline adaptation. Methods We completed a multiphase study to explore the implementation of maternal health guidelines in Kosovo, focusing on determinants of uptake and methods to contextualize for local use. The study involved a survey, individual interviews, focus groups, and a consensus meeting with relevant stakeholders, including clinicians (obstetricians, midwives), managers, researchers, and policy makers from the national Ministry of Health and the World Health Organization office in Pristina, Kosovo. Results Participants identified several important barriers to implementation. First, lack of communication between clinicians and ministry representatives was seen as leading to duplication of effort in creating or adapting guidelines, as well as substantial mistrust between clinicians and policy makers. Second, there was a lack of communication across clinical groups that provide obstetric care and a lack of integration across the entire healthcare system, including rural and urban centers. This fragmentation was thought to have directly resulted from the war in 1998 – 1999. Third, the conflict substantially and adversely affected the healthcare infrastructure in Kosovo, which has resulted in an inability to monitor quality of care across the country. Furthermore, the impact on infrastructure has affected the ability to access required medications consistently and to smoothly transfer patients from rural to urban centers. Another issue raised during this project was the appropriateness of including guideline recommendations perceived to be ‘aspirational’. Conclusions Implementing clinical practice guidelines in low- and middle-income countries (LMICs) requires consideration of several specific barriers. Particularly pertinent to this study were the effects of recent conflict and the resulting fragmentation of healthcare and communication strategies among relevant stakeholders. However, as Kosovo rebuilds and invests in infrastructure after the conflict, there is a tremendous opportunity to create comprehensive, thoughtful strategies to monitor and improve quality of care. To avoid duplication of effort, it may be beneficial for LMICs to share information on assessing barriers as well as on guideline implementation strategies.
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Affiliation(s)
- Sharon E Straus
- Li Ka Shing Knowledge Institute, St, Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
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Peinado Serrano J, Lopez Guerra J, Cabrera Roldán P, Campos Triviño B, Marquez C, Ramirez G, Quiroga E, Praena J, Gordillo MO. Prognostic factors for survival in medulloblastoma patients. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.143] [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: 11/25/2022] Open
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Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Acad Med 2013; 88:82-9. [PMID: 23165266 PMCID: PMC3665769 DOI: 10.1097/acm.0b013e31827647a0] [Citation(s) in RCA: 283] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To explore the mentor-mentee relationship with a focus on determining the characteristics of effective mentors and mentees and understanding the factors influencing successful and failed mentoring relationships. METHOD The authors completed a qualitative study through the Departments of Medicine at the University of Toronto Faculty of Medicine and the University of California, San Francisco, School of Medicine between March 2010 and January 2011. They conducted individual, semistructured interviews with faculty members from different career streams and ranks and analyzed transcripts of the interviews, drawing on grounded theory. RESULTS The authors completed interviews with 54 faculty members and identified a number of themes, including the characteristics of effective mentors and mentees, actions of effective mentors, characteristics of successful and failed mentoring relationships, and tactics for successful mentoring relationships. Successful mentoring relationships were characterized by reciprocity, mutual respect, clear expectations, personal connection, and shared values. Failed mentoring relationships were characterized by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest, and the mentor's lack of experience. CONCLUSIONS Successful mentorship is vital to career success and satisfaction for both mentors and mentees. Yet challenges continue to inhibit faculty members from receiving effective mentorship. Given the importance of mentorship on faculty members' careers, future studies must address the association between a failed mentoring relationship and a faculty member's career success, how to assess different approaches to mediating failed mentoring relationships, and how to evaluate strategies for effective mentorship throughout a faculty member's career.
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Affiliation(s)
- Sharon E Straus
- Department of Medicine, Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada.
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Menzel P, Geng A, Marquez C, Scala M, Minor D, Abendroth R. Low-dose Conformal Radiation Therapy for Ipilimumab-induced Hypophysitis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.727] [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: 11/24/2022]
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Paradas Lopez C, Cabrera Serrano M, Rivas Infante E, Morales JM, Marquez C, Bader B, Mir P. Neuromuscular Involvement in Choreoacanthocytosis (P07.204). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.204] [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] Open
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Cordero MI, Poirier GL, Marquez C, Veenit V, Fontana X, Salehi B, Ansermet F, Sandi C. Evidence for biological roots in the transgenerational transmission of intimate partner violence. Transl Psychiatry 2012; 2:e106. [PMID: 22832906 PMCID: PMC3337076 DOI: 10.1038/tp.2012.32] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/24/2012] [Accepted: 03/26/2012] [Indexed: 11/09/2022] Open
Abstract
Intimate partner violence is a ubiquitous and devastating phenomenon for which effective interventions and a clear etiological understanding are still lacking. A major risk factor for violence perpetration is childhood exposure to violence, prompting the proposal that social learning is a major contributor to the transgenerational transmission of violence. Using an animal model devoid of human cultural factors, we showed that male rats became highly aggressive against their female partners as adults after exposure to non-social stressful experiences in their youth. Their offspring also showed increased aggression toward females in the absence of postnatal father-offspring interaction or any other exposure to violence. Both the females that cohabited with the stressed males and those that cohabited with their male offspring showed behavioral (including anxiety- and depression-like behaviors), physiological (decreased body weight and basal corticosterone levels) and neurobiological symptoms (increased activity in dorsal raphe serotonergic neurons in response to an unfamiliar male) resembling the alterations described in abused and depressed women. With the caution required when translating animal work to humans, our findings extend current psychosocial explanations of the transgenerational transmission of intimate partner violence by strongly suggesting an important role for biological factors.
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Affiliation(s)
- M I Cordero
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
- Child and Adolescent Service of Psychiatry (SPEA), Hospital University of Geneva, Geneva, CH, Switzerland
| | - G L Poirier
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
| | - C Marquez
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
| | - V Veenit
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
| | - X Fontana
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
| | - B Salehi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
| | - F Ansermet
- Child and Adolescent Service of Psychiatry (SPEA), Hospital University of Geneva, Geneva, CH, Switzerland
| | - C Sandi
- Laboratory of Behavioral Genetics, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, CH, Switzerland
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Iraola V, Gallego M, Aranda T, Lopez-Matas M, Morales M, Saez R, Marquez C, Leonor J, Carnes J. Inhibition Of Human IgE-Allergen Interaction By Antibodies Of Rabbits Immunized With Depigmented-polymerized Allergen Extracts. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.561] [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: 11/25/2022]
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Chennupati S, Marquez C, Fuss M. A Comparison of Tumor Volume Coverage between Intensity Modulated Arc Technique (IMAT) and 7 and 9 Field Intensity Modulated Therapy (IMRT) Posterior Fossa Boost Plans that Spare the Auditory Apparatus (AA) in Pediatric Patients. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1936] [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: 10/15/2022]
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Tanyi J, Kernan C, Kato C, Marquez C, Laub W, Fuss M. Comparison of Image-guidance Modalities for Cranial Stereotactic Radiosurgery (SRS) and Radiotherapy (SRT). Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1458] [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: 10/16/2022]
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Kastner M, Sawka A, Thorpe K, Chignel M, Marquez C, Newton D, Straus SE. Evaluation of a clinical decision support tool for osteoporosis disease management: protocol for an interrupted time series design. Implement Sci 2011; 6:77. [PMID: 21781318 PMCID: PMC3152529 DOI: 10.1186/1748-5908-6-77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/22/2011] [Indexed: 01/06/2023] Open
Abstract
Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care. Methods A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care. Discussion The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.
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Affiliation(s)
- Monika Kastner
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Fabiani A, Trucchi E, Rosa S, Marquez C, Snell HL, Snell HM, Tapia Aguilera W, Gentile G. Conservation of Galápagos land iguanas: genetic monitoring and predictions of a long-term program on the island of Santa Cruz. Anim Conserv 2011. [DOI: 10.1111/j.1469-1795.2011.00442.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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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Kastner M, Lottridge D, Marquez C, Newton D, Straus SE. Usability evaluation of a clinical decision support tool for osteoporosis disease management. Implement Sci 2010; 5:96. [PMID: 21143978 PMCID: PMC3016442 DOI: 10.1186/1748-5908-5-96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/10/2010] [Indexed: 01/06/2023] Open
Abstract
Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines are available, patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions and a series of focus groups were used to develop a functional multifaceted tool that can support clinical decision-making in osteoporosis disease management at the point of care. The objective of our study was to assess how well the prototype met functional goals and usability needs. Methods We conducted a usability study for each component of the tool--the Best Practice Recommendation Prompt (BestPROMPT), the Risk Assessment Questionnaire (RAQ), and the Customised Osteoporosis Education (COPE) sheet--using the framework described by Kushniruk and Patel. All studies consisted of one-on-one sessions with a moderator using a standardised worksheet. Sessions were audio- and video-taped and transcribed verbatim. Data analysis consisted of a combination of qualitative and quantitative analyses. Results In study 1, physicians liked that the BestPROMPT can provide customised recommendations based on risk factors identified from the RAQ. Barriers included lack of time to use the tool, the need to alter clinic workflow to enable point-of-care use, and that the tool may disrupt the real reason for the visit. In study 2, patients completed the RAQ in a mean of 6 minutes, 35 seconds. Of the 42 critical incidents, 60% were navigational and most occurred when the first nine participants were using the stylus pen; no critical incidents were observed with the last six participants that used the touch screen. Patients thought that the RAQ questions were easy to read and understand, but they found it difficult to initiate the questionnaire. Suggestions for improvement included improving aspects of the interface and navigation. The results of study 3 showed that most patients were able to understand and describe sections of the COPE sheet, and all considered discussing the information with their physicians. Suggestions for improvement included simplifying the language and improving the layout. Conclusions Findings from the three studies informed changes to the tool and confirmed the importance of usability testing on all end users to reduce errors, and as an important step in the development process of knowledge translation interventions.
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Affiliation(s)
- Monika Kastner
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Kastner M, Li J, Lottridge D, Marquez C, Newton D, Straus SE. Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups. BMC Med Inform Decis Mak 2010; 10:40. [PMID: 20650007 PMCID: PMC2914714 DOI: 10.1186/1472-6947-10-40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/22/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care. METHODS The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology. RESULTS Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in the patient education component of the osteoporosis tool. Suggestions for modifying the tool included the addition of a percentile graph showing patients' 10-year risk for osteoporosis or fractures, and ensuring that the tool takes no more than 5 minutes to complete. CONCLUSIONS Focus group data revealed the facilitators and barriers to using the osteoporosis tool at the point of care so that it can be optimized to aid physicians in their clinical decision making.
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Affiliation(s)
- Monika Kastner
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.
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Paradas C, Llauger J, Diaz-Manera J, Rojas-Garcia R, De Luna N, Iturriaga C, Marquez C, Uson M, Hankiewicz K, Gallardo E, Illa I. Redefining dysferlinopathy phenotypes based on clinical findings and muscle imaging studies. Neurology 2010; 75:316-23. [DOI: 10.1212/wnl.0b013e3181ea1564] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wu RC, Thorpe K, Ross H, Micevski V, Marquez C, Straus SE. Comparing administration of questionnaires via the internet to pen-and-paper in patients with heart failure: randomized controlled trial. J Med Internet Res 2009; 11:e3. [PMID: 19275979 PMCID: PMC2762767 DOI: 10.2196/jmir.1106] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 11/03/2008] [Accepted: 11/21/2008] [Indexed: 11/13/2022] Open
Abstract
Background The use of the Internet to administer questionnaires has many potential advantages over the use of pen-and-paper administration. Yet it is important to validate Internet administration, as most questionnaires were initially developed and validated for pen-and-paper delivery. While some have been validated for use over the Internet, these questionnaires have predominately been used amongst the healthy general population. To date, information is lacking on the validity of questionnaires administered over the Internet in patients with chronic diseases such as heart failure. Objectives To determine the validity of three heart failure questionnaires administered over the Internet compared to pen-and-paper administration in patients with heart failure. Methods We conducted a prospective randomized study using test-retest design comparing administration via the Internet to pen-and-paper administration for three heart failure questionnaires provided to patients recruited from a heart failure clinic in Toronto, Ontario, Canada: the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Self-Care Heart Failure Index (SCHFI). Results Of the 58 subjects enrolled, 34 completed all three questionnaires. The mean difference and confidence intervals for the summary scores of the KCCQ, MLHFQ, and SCHFI were 1.2 (CI -1.5 to 4.0, scale from 0 to 100), 4.0 (CI -1.98 to 10.04, scale from 0 to 105), and 10.1 (CI 1.18 to 19.07, scale from 66.7 to 300), respectively. Conclusions Internet administration of the KCCQ appears to be equivalent to pen-and-paper administration. For the MLHFQ and SCHFI, we were unable to demonstrate equivalence. Further research is necessary to determine if the administration methods are equivalent for these instruments.
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Affiliation(s)
- Robert C Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Camano P, Zuriarrain O, de Greef J, Poze J, Marquez C, Lopez de Munain A. G.P.7.09 Study of the D4Z4 methylation level at chromosome 4 in Spanish patients with FSHD phenotype and negative molecular diagnosis. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.160] [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: 10/22/2022]
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Russello MA, Hyseni C, Gibbs JP, Cruz S, Marquez C, Tapia W, Velensky P, Powell JR, Caccone A. Lineage identification of Galápagos tortoises in captivity worldwide. Anim Conserv 2007. [DOI: 10.1111/j.1469-1795.2007.00113.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [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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Patel K, Agrimson B, McKenna G, Holland J, Marquez C. 2578. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.991] [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: 10/24/2022]
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Kim E, Sanghvi P, Marquez C, Kim CR, Thomas CR. Evaluation of comparative survival based on the AJCC 5th and 6th editions for breast cancer staging: 25 year experience in two southwest Washington state community cancer programs. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6118] [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: 11/20/2022] Open
Abstract
6118 Background: The revised American Joint Committee on Cancer (AJCC) sixth edition (6th ed.) cancer staging system increased stratification within breast cancer (BC) stages II and III defined by the AJCC 5th ed. system. The specific aim of this study was to determine and compare disease-free survival (DFS) for stage 0-III breast carcinoma between the 5th and 6th editions using retrospective data gathered from 1980–2004 in southwest Washington state (WA). Methods: 4,810 patients (pts) were identified using cancer registries at Saint John Medical Center in Longview, WA and Southwest Washington Medical Center in Vancouver, WA. Patients were restaged retrospectively using the 5th and 6th ed. systems. DFS was determined using the Kaplan-Meier method and compared using the log-rank test. Results: The age at diagnosis ranged 20–99 yrs, with a mean age = 60. The mean length for disease-free follow-up was 224 mos. Stage 0 and stage 1 criteria were unchanged between editions, and 10-yr DFS was 94% and 87% for stage 0 and stage 1, respectively. In stage II pts, 13% (199/1,519) were upstaged to stage III by the 6th ed. criteria, significantly improving the 10-yr DFS for stage II from 66% (5th ed.) to 72% (6th ed; p = 0.003). The majority, 85% (167/199), of pts upstaged were from the 539 classified as stage IIb disease by the 5th ed. This accompanied an increase in the 10-year DFS for stage IIb from 54% (fifth) to 62% (sixth; p = 0.046). The number of pts with stage III disease increased from 313 to 588 in the 6th ed. 10-year DFS increased from 30% to 36% (p = 0.025), respectively. Most of this increase resulted from changes within stage IIIa, as DFS increased from 32% to 41% (p = 0.046). When compared, DFS outcomes between stage IIIb and IIIc were not found to be statistically significant (p = 0.501). Conclusions: The AJCC 6th ed. system for BC provides greater distinctions between stages compared to the 5th ed., and reclassification results in significant changes in projected outcomes. However, the addition of the IIIc substage does not seem to show the same significant distinction when compared to the existing stage IIIb substage in outcomes. No significant financial relationships to disclose.
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Affiliation(s)
- E. Kim
- Case Western Reserve University, Cleveland, OH; Oregon Health and Science University, Portland, OR; Southwest Washington Medical Center, Vancouver, WA; Saint John Medical Center, Longview, WA
| | - P. Sanghvi
- Case Western Reserve University, Cleveland, OH; Oregon Health and Science University, Portland, OR; Southwest Washington Medical Center, Vancouver, WA; Saint John Medical Center, Longview, WA
| | - C. Marquez
- Case Western Reserve University, Cleveland, OH; Oregon Health and Science University, Portland, OR; Southwest Washington Medical Center, Vancouver, WA; Saint John Medical Center, Longview, WA
| | - C. R. Kim
- Case Western Reserve University, Cleveland, OH; Oregon Health and Science University, Portland, OR; Southwest Washington Medical Center, Vancouver, WA; Saint John Medical Center, Longview, WA
| | - C. R. Thomas
- Case Western Reserve University, Cleveland, OH; Oregon Health and Science University, Portland, OR; Southwest Washington Medical Center, Vancouver, WA; Saint John Medical Center, Longview, WA
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Townsley CA, Chan KK, Pond GR, Marquez C, Siu LL, Straus SE. Understanding the attitudes of the elderly towards enrolment into cancer clinical trials. BMC Cancer 2006; 6:34. [PMID: 16466574 PMCID: PMC1382233 DOI: 10.1186/1471-2407-6-34] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 02/08/2006] [Indexed: 11/17/2022] Open
Abstract
Background The optimal cancer treatment for an older population is largely unknown because of the low numbers of elderly patients accrued into clinical trials. This project focuses on the attitudes of the elderly about participation in clinical trials to determine if this is one of the barriers to the involvement of this population in clinical trials. Methods The first phase of this study was a self-administered questionnaire mailed to 425 elderly persons with cancer, selected from Princess Margaret Hospital oncology clinics. The second phase consisted of individual semi-structured interviews with cancer patients to assess their attitudes towards cancer, its management and enrolment into cancer clinical trials. Results Ninety-four patients responded to the survey giving a response rate of 22.1%. Three quarters of respondents stated that they would be willing to participate in a clinical trial. The factors that most influenced older patients' willingness to participate in a cancer study were recommendations from a cancer doctor and the chance that the study treatment may help them feel better. Seventeen survey responders participated in interviews. Common themes from these interviews included patient-physician communication, the referral process, and the role of age in cancer care decision-making. Conclusion Most elderly people, who responded to this survey, are willing to consider participation in cancer clinical trials however, elderly patients do not appear to actively seek clinical trials and few were informed of the availability of clinical trials. Physician barriers and availability of appropriate clinical trials may play a bigger role in preventing accrual of elderly cancer patients into trials.
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Affiliation(s)
- Carol A Townsley
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Kelvin K Chan
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Gregory R Pond
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | | | - Lillian L Siu
- Princess Margaret Hospital (PMH) and University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Toronto General Hospital and University of Toronto, Toronto, Canada
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Chan KK, Siu L, Townsley C, Pond G, Marquez C, Straus S. Willingness of older people with cancer to participate in cancer clinical trials is not a barrier to accrual. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8245] [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: 11/20/2022] Open
Affiliation(s)
- K. K. Chan
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
| | - L. Siu
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
| | - C. Townsley
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
| | - G. Pond
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
| | - C. Marquez
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
| | - S. Straus
- Grand River Regional Cancer Ctr, Kitchener, ON, Canada; Princess Margaret Hosp, UHN, Toronto, ON, Canada; Toronto Gen Hosp, UHN, Toronto, ON, Canada
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Furrer S, Hatt J, Snell H, Marquez C, Honegger R, Rübel A. Comparative study on the growth of juvenile Galapagos giant tortoises (Geochelone nigra) at the Charles Darwin Research Station (Galapagos Islands, Ecuador) and Zoo Zurich (Zurich, Switzerland). Zoo Biol 2004. [DOI: 10.1002/zoo.10130] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Remsen LG, Marquez C, Garcia R, Thrun LA, Neuwelt EA. Efficacy after sequencing of brain radiotherapy and enhanced antibody targeted chemotherapy delivery in a rodent human lung cancer brain xenograft model. Int J Radiat Oncol Biol Phys 2001; 51:1045-9. [PMID: 11704329 DOI: 10.1016/s0360-3016(01)01743-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of sequencing radiation therapy (RT) and antibody targeted chemotherapy (BR96-DOX) in nude rats bearing human lung cancer (B.5 LX-1) intracerebral (i.c.) xenografts. METHODS AND MATERIALS Our approach was to administer RT using 20 Gy single-fraction cranial irradiation either before, concurrent with, or after BR96-DOX treatment via osmotic blood-brain barrier disruption to enhance immunoconjugate delivery. All rats were inoculated with i.c. B.5 LX-1 tumors and were randomly assigned to treatment groups. RESULTS BR96-DOX alone on Day 6 or Day 12 significantly increased survival compared to negative control rats receiving no treatment (25.9 +/- 2.1 and 23.3 +/- 2.5 days vs. 14.8 +/- 1.9 days, p < 0.05). Rats that received chemotherapy before radiation (34.0 +/- 2.0 days) lived the longest compared to the other sequences (RT prior, 29.5 +/- 1.9; RT concurrent, 27.1 +/- 2.1). Histopathology of 39 rat brains did not reveal any neuropathology. CONCLUSIONS Enhanced delivery of immunoconjugates is more effective in combination with RT for the treatment of experimental metastatic brain tumors. Moreover, BR96-DOX administration prior to RT significantly increased survival compared to those receiving RT and chemotherapy concurrently (p < 0.05).
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Affiliation(s)
- L G Remsen
- Department of Neurology, Oregon Health Sciences University, Portland, OR, USA
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Fleury A, Bouteille B, Garcia E, Marquez C, Preux PM, Escobedo F, Sotelo J, Dumas M. Neurocysticercosis: validity of ELISA after storage of whole blood and cerebrospinal fluid on paper. Trop Med Int Health 2001; 6:688-93. [PMID: 11555435 DOI: 10.1046/j.1365-3156.2001.00767.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/20/2022]
Abstract
Cysticercosis is an infestation of Cysticercus cellulosae. When it occurs in the brain, chronic neurological complications can ensue, most commonly seizures. Neurocysticercosis is usually diagnosed by neuroimaging, a technique not available in most endemic countries. Hence immunological tests are valuable for diagnosis and epidemiological surveys. We evaluated the suitability of paper for storing blood and cerebrospinal fluid (CSF) until subsequent testing by enzyme-linked immunosorbent assay (ELISA), by testing whole blood samples on filter paper from 305 patients and CSF samples from 117 patients stored on ordinary white typing paper and on filter paper. Optimal preservation of biological samples is achieved when whole blood is stored on filter paper, CSF on white paper, and when samples are frozen within 1 week after collection. Our results could improve diagnostic capabilities and facilitate epidemiological surveys in endemic countries where immunodiagnostic tests cannot be rapidly performed because of inadequate laboratory infrastructure.
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Affiliation(s)
- A Fleury
- Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Faculté de Médecine, Limoges, France
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Pérez-Castorena AL, Arciniegas A, Martinez F, Marquez C, Villaseñor JL. Chemical constituents of Packera coahuilensis and Packera bellidifolia. BIOCHEM SYST ECOL 2001; 29:203-206. [PMID: 11106849 DOI: 10.1016/s0305-1978(00)00043-0] [Citation(s) in RCA: 8] [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: 12/01/2022]
Affiliation(s)
- AL Pérez-Castorena
- Instituto de Química, Universidad Nacional Autónoma de México, Circuito Exterior, Ciudad Universitaria, 04510, D.F., Coyoacán, Mexico
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