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Dosis A, Husnoo N, Roney S, Hendry C, Bonner C, Kronberga M, Moran E, Ninh V, Jha A, Grey T, Saha AK. A census of general surgery consultants in England and Wales: implications for the current and future surgical workforce. Ann R Coll Surg Engl 2024; 106:150-159. [PMID: 37489525 PMCID: PMC10830335 DOI: 10.1308/rcsann.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION This study aimed to describe the composition of the current general surgical consultant body in England and Wales and quantify levels of inequality within it as well as describe future workforce challenges. METHODS This is an observational study of all general surgical departments in England and Wales. Consultant general surgeons were identified and data regarding their gender, country of undergraduate medical education, subspecialty and private practice were recorded. RESULTS Of the 2,682 consultant general surgeons in England and Wales identified for this study, just 17% are women, with gender inequality most marked in university teaching hospitals and among certain subspecialties. Almost 40% of consultants did not obtain their primary undergraduate degree in the United Kingdom and there are considerably fewer surgeons who studied abroad in university teaching hospitals. Over 40% of current general surgical consultants have been qualified for more than three decades and there is no equivalent sized group of younger consultants. CONCLUSIONS There remains considerable gender and racial inequality in the consultant general surgical workforce, with pockets of a lack of diversity within university or teaching hospital surgical departments and some subspecialties. The proportion of surgeons in their fourth decade of clinical practice represents the largest group of current practising consultants, which points towards an impending workforce crisis should senior clinicians seek to reduce activity or consider taking early retirement.
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Affiliation(s)
- A Dosis
- Yorkshire and the Humber Deanery, UK
| | - N Husnoo
- University of Sheffield & Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Roney
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | | | - C Bonner
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - M Kronberga
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - E Moran
- Yorkshire and the Humber Deanery, UK
| | - V Ninh
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - A Jha
- South Tees Hospitals NHS Foundation Trust, UK
| | - T Grey
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - AK Saha
- Calderdale and Huddersfield NHS Foundation Trust, UK
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Calzada D, Bartra J, Serrano CD, Riggioni S, Moran E, Maselli JP, Silva DL, Ramirez LF, Pascal M, Carnés J, Valero A. Differences in molecular sensitization profiles between a Spanish and Latin American mite allergic patients. J Investig Allergol Clin Immunol 2024; 35:0. [PMID: 38174976 DOI: 10.18176/jiaci.0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVE To analyze the sensitization pattern to Dermatophagoides pteronyssinus and to associate the diagnostic findings and clinical severity in 218 allergic patients from two different continents. METHODS Mite allergic patients were recruited by the Allergology departments from Latin America (n=88: Colombia, Costa Rica and Guatemala) and Spain (N=130). All patients had allergic rhinitis with or without asthma and positive skin prick test results to D. pteronyssinus. Specific IgE levels to D. pteronyssinus, D. farinae, Der p 1, Der p 2, and Der p 23 were quantified by ImmunoCAP system (ThermoFisher Scientific). Allergenic profile was also determined by western blot. Comparative Statistical analysis was performed by GraphPad software. RESULTS Patients recognized most frequently Der p 2 (79%) followed by Der p 1 (73%), and Der p 23 (69%) allergens. The percentage of asthmatic patients increases with the number of sensitizations however none statistically significant differences were found. Interestingly, asthmatic patients presented the highest median levels of total IgE and specific IgE levels of D. pteronyssinus and molecular allergens, mainly Der p 2. Analysing the two different populations, Spanish patients were predominantly sensitized to Der p 2 (88.46%) and Der p 1 (83.84%), whereas Latin American population were more sensitized to Der p 23. CONCLUSION Our data support the relevance of Der p 2 in mite allergy as the major allergen, with the high number of patients sensitized to it and its importance in the development of asthma. Sensitization to Der p 23 was more important in Latin America.
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Affiliation(s)
- D Calzada
- Unidad I+D. LETI Pharma. S.L.u. Madrid, España
| | - J Bartra
- Servicio de Alergología, Hospital Clínic, IDIBAPS Barcelona, RICORS, España
| | - C D Serrano
- Unidad de Alergia, Fundación Valle del Lili. Cali, Colombia
| | - S Riggioni
- Centro Diagnóstico y Tratamiento de Alergia. San José, Costa Rica
| | - E Moran
- Universidad Rafael Landivar, Facultad de Medicina, Catedra de Inmunología, Guatemala City, Guatemala
| | - J P Maselli
- Universidad Rafael Landivar, Facultad de Medicina, Catedra de Inmunología, Guatemala City, Guatemala
| | - D L Silva
- Unidad de Alergia, Fundación Valle del Lili. Cali, Colombia
| | - L F Ramirez
- Unidad de Alergia, Fundación Valle del Lili. Cali, Colombia
| | - M Pascal
- Servicio de Inmunología, CDB, Hospital Clínic, IDIBAPS Barcelona, RICORS, España
| | - J Carnés
- Unidad I+D. LETI Pharma. S.L.u. Madrid, España
| | - A Valero
- Servicio de Alergología, Hospital Clínic, IDIBAPS Barcelona, CIBERES, España
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Woolhandler S, Toporek A, Gao J, Moran E, Wilper A, Himmelstein DU. Administration's Share of Personnel in Veterans Health Administration and Private Sector Care. JAMA Netw Open 2024; 7:e2352104. [PMID: 38236601 PMCID: PMC10797450 DOI: 10.1001/jamanetworkopen.2023.52104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Health care administrative overhead is greater in the US than some other nations but has not been assessed in the Veterans Health Administration (VHA). Objective To compare administrative staffing patterns in the VHA and private (non-VHA) sectors. Design, Setting, and Participants This cross-sectional study was conducted using US employment data from 2019, prior to pandemic-related disruptions in health care staffing, and was carried out between January 14 and August 10, 2023. A nationally representative sample of federal and nonfederal personnel in hospitals and ambulatory care settings from the American Community Survey (ACS), all employees reported in VHA personnel records, and personnel in health insurance carriers and brokers tabulated by the Bureau of Labor Statistics (BLS) were analyzed. Exposure VHA vs private sector health care employment, including 397 occupations grouped into 18 categories. Main Outcome and Measure The proportion of staff working in administrative occupations. Results Among 3 239 553 persons surveyed in the ACS, 122 315 individuals (weighted population, 12 501 185 individuals) were civilians working in hospitals or ambulatory care; of the weighted population, 12 156 988 individuals (mean age, 42.6 years [95% CI, 42.5-42.7 years]; 76.2% [95% CI, 75.9%-76.5%] females) were private sector personnel and 344 197 individuals (mean age, 46.2 years [95% CI, 45.7-46.7 years]; 63.8% [95% CI, 61.8%-65.8%] females) were federal employees. In clinical settings, administrative occupations accounted for 23.4% (95% CI, 23.1%-23.8%) of private sector vs 19.8% (95% CI, 18.1%-21.4%) of VHA personnel. After including 1 000 800 employees at private sector health insurers and brokers and 13 956 VHA Central Office personnel with administrative occupations, administration accounted for 3 851 374 of 13 157 788 private sector employees (29.3%) vs 77 500 of 343 721 VHA employees (22.5%). Physicians represented approximately 7% of personnel in the VHA (7.2% [95% CI, 6.1%-8.2%]) and private sector (6.5% [95% CI, 6.3%-6.7%]), while the VHA deployed more registered nurses (23.7% [95% CI, 21.6%-25.8%] vs 21.2% [95% CI, 20.9%-21.5%]) and social service personnel (6.3% [95% CI, 5.4%-7.1%] vs 4.9% [95% CI, 4.7%-5.0%]) than the private sector. Conclusions and Relevance In this study, administrative occupations accounted for a smaller share of personnel in the VHA compared with private sector care, a difference possibly attributable to the VHA's simpler financing system. These findings suggest that if staffing patterns in the private sector mirrored those of the VHA, nearly 900 000 fewer administrative staff might be needed.
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Affiliation(s)
- Steffie Woolhandler
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Harvard Medical School, Boston, Massachusetts
| | - Andrew Toporek
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs
| | - Jian Gao
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs
| | - Eileen Moran
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs
| | - Andrew Wilper
- Office of the Chief of Staff, Boise Veterans Affairs Medical Center, Boise, Idaho
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - David U. Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, New York
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Harvard Medical School, Boston, Massachusetts
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Gao J, Moran E, Grimm R, Toporek A, Ruser C. The Effect of Primary Care Visits on Total Patient Care Cost: Evidence From the Veterans Health Administration. J Prim Care Community Health 2022; 13:21501319221141792. [PMID: 36564889 PMCID: PMC9793026 DOI: 10.1177/21501319221141792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Since the 1980s, primary care (PC) in the US has been recognized as the backbone of healthcare providing comprehensive care to complex patients, coordinating care among specialists, and rendering preventive services to contain costs and improve clinical outcomes. However, the effect of PC visits on total patient care cost has been difficult to quantify. OBJECTIVE To assess the effect of PC visits on total patient care cost. METHODS This is a retrospective study of over 5 million patients assigned to a PC provider in the Veterans Health Administration (VHA) in each of the 4 fiscal years (FY 2016-2019). The main outcome of interest is total annual patient care cost. We assessed the effect of primary care visits on total patient care cost first by descriptive statistics, and then by multivariate regressions adjusting for severity of illness and other confounders. We conducted in-depth sensitivity analyses to validate the findings. RESULTS On average, each additional in-person PC visit was associated with a total cost reduction of $721 (per patient per year). The first PC visit was associated with the largest savings, $3976 on average, and a steady diminishing return was observed. Further, the higher the patient risk (severity of illness), the larger the cost reduction: Among the top 10% of high-risk patients, the first PC in-person visit was associated with a reduction of $16 406 (19%). CONCLUSIONS These findings, substantiated by our exhaustive sensitivity analyses, suggest that expanding PC capacity can significantly reduce overall health care costs and improve patient care outcomes given the former is a strong proxy of the latter.
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Affiliation(s)
- Jian Gao
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement,Jian Gao, Department of Veterans Affairs,
Office of Productivity, Efficiency and Staffing, Office of Analytics and
Performance Improvement, 67 Veterans Way, Albany, NY 12208, USA.
| | - Eileen Moran
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement
| | | | - Andrew Toporek
- Department of Veterans Affairs, Office
of Productivity, Efficiency and Staffing (OPES), Office of Analytics and Performance
Improvement
| | - Christopher Ruser
- VACT Healthcare System, Yale University
School of Medicine, New Haven, CT, USA
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Moran E, McMichael A, De Souza B, Russell G, Vanoosthuyze K, Zupkosky P. New Razor Technology Improves Appearance and Quality of Life in Men With Pseudofolliculitis Barbae. Cutis 2022; 110:329-334. [PMID: 36735974 DOI: 10.12788/cutis.0669] [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: 01/19/2023]
Abstract
Pseudofolliculitis barbae (PFB) consists of ingrown hairs leading to papules, pustules, and discomfort. This prospective, 12-week clinical study aimed to assess the appearance of males with razor bumps and shaving irritation when using a new razor technology with 2 blades separated by a bridge feature (SkinGuard [Procter & Gamble]). The impact on participants' shave-related itching, burning, and stinging severity, as well as quality of life (QOL), also was assessed. In men with PFB, shaving with the test razor at least 5 times per week over a 12-week period improved the appearance and QOL of males with razor bumps and shaving irritation compared with baseline.
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Affiliation(s)
- Eileen Moran
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
| | - Amy McMichael
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
| | - Brianna De Souza
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
| | - Greg Russell
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
| | - Kristina Vanoosthuyze
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
| | - Pamela Zupkosky
- Ms. Moran and Ms. Zupkosky are from the Gillette World Shaving Headquarters, Boston, Massachusetts. Drs. McMichael and De Souza as well as Mr. Russell are from Wake Forest University School of Medicine, Winston-Salem, North Carolina. Dr. Vanoosthuyze is from Gillette Innovation Centre, The Procter & Gamble Company, Reading, United Kingdom
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6
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Gao J, Moran E, Woolhandler S, Toporek A, Wilper AP, Himmelstein DU. Primary Care's Effects on Costs in the US Veterans Health Administration, 2016-2019: an Observational Cohort Study. J Gen Intern Med 2022; 37:3289-3294. [PMID: 34608563 PMCID: PMC9550907 DOI: 10.1007/s11606-021-07140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Enhancing primary care is a promising strategy for improving the efficiency of health care. Previous studies of primary care's effects on health expenditures have mostly relied on ecological analyses comparing region-wide expenditures rather than spending for individual patients. OBJECTIVE To compare overall medical expenditures for individual patients enrolled vs. those not enrolled in primary care in the Veterans Health Administration (VHA). DESIGN Cohort study with stratification for clinical risk and multivariable linear regression models adjusted for clinical and demographic confounders of expenditures. PARTICIPANTS In total, 6,009,973 VHA patients in fiscal year (FY) 2019-5,410,034 enrolled with a primary care provider (PCP) and 599,939 without a PCP-and similar numbers in FYs 2016-2018. MAIN MEASURES Total annual cost per patient to the VHA (including VHA payments to non-VHA providers) stratified by a composite health risk score previously shown to predict VHA expenditures, and multivariate models additionally adjusted for VHA regional differences, patients' demographic characteristics, non-VHA insurance coverage, and driving time to the nearest VHA facility. Sensitivity analyses explored different modeling strategies and risk adjusters, as well as the inclusion of expenditures by the Medicare program that covers virtually all elderly VHA patients for care not paid for by the VHA. KEY RESULTS Within each health-risk decile, non-PCP patients had higher outpatient, inpatient, and total costs than those with a PCP. After adjustment for health risk and other factors, lack of a PCP was associated 27.4% higher VHA expenditures, $3274 per patient annually (p < .0001). Sensitivity analyses using different risk adjusters and including Medicare's spending for VHA patients yielded similar results. CONCLUSIONS In the VHA system, primary care is associated with substantial cost savings. Investments in primary care in other settings might also be cost-effective.
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Affiliation(s)
- Jian Gao
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs, Albany, NY, USA
| | - Eileen Moran
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs, Albany, NY, USA
| | - Steffie Woolhandler
- City University of New York at Hunter College, New York, NY, USA
- Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
| | - Andrew Toporek
- Office of Productivity, Efficiency, and Staffing, Quality and Patient Safety, Office of Analytics and Performance Integration, Department of Veterans Affairs, Albany, NY, USA
| | - Andrew P Wilper
- Boise Veterans Affairs Medical Center, Boise, ID, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David U Himmelstein
- City University of New York at Hunter College, New York, NY, USA.
- Department of Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA.
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Gao J, Moran E, Higgins DS, Mecher C. Predicting High-risk and High-cost Patients for Proactive Intervention. Med Care 2022; 60:610-615. [PMID: 35640025 DOI: 10.1097/mlr.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is well known that 20% of the patients incur 80% of health care costs and many diseases and complications can be prevented or ameliorated with prompt intervention. One of the well-recognized strategies for cost reduction and better outcomes is to predict or identify high-risk and high-cost (HRHC) patients for proactive intervention. OBJECTIVE The objective of this study was to develop a predictive model that can be used to identify HRHC patients more accurately for proactive intervention. METHODS This is an observational study using fiscal year (FY) 2018 administrative data to predict FY 2019 total cost at the patient level. All 5,676,248 patients who received care in both FYs 2018 and 2019 from the Veterans Health Administration were included in the analyses. The Veterans Health Administration Corporate Data Warehouse was our main data source. With split-sample analyses, 3 sets of patient comorbidities and 5 statistical models were assessed for the highest predictive power. RESULTS The Box-Cox regression using comorbidities designated by the expanded CCSR (Clinical Classifications Software Refined) groups as predictors yielded the highest predictive power. The R2 reached 0.51 and 0.37 for the transformed and raw scale cost, respectively. CONCLUSIONS The predictive model developed in this study exhibits substantially higher predictive power than what has been reported in the literature. The algorithm based on administrative data and a publicly available patient classification system can be readily implemented by other value-based health systems to identify HRHC patients for proactive intervention.
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Affiliation(s)
- Jian Gao
- Department of Veterans Affairs, Office of Productivity, Efficiency, and Staffing, Albany, NY
| | - Eileen Moran
- Department of Veterans Affairs, Office of Productivity, Efficiency, and Staffing, West Haven, CT
| | - Donald S Higgins
- Department of Veterans Affairs, Albany Stratton VA Medical Center, Albany, NY
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Stein MB, O'Keefe S, Mace R, Foley JD, White AE, Ruchensky JR, Curtiss J, Moran E, Evans C, Beck S. Psychology Internship Training Amidst COVID-19: Balancing Training Opportunities, Patient Care, and Risk of Exposure. J Clin Psychol Med Settings 2022; 30:61-71. [PMID: 35717453 PMCID: PMC9206461 DOI: 10.1007/s10880-022-09890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
The emergence of the 2019 novel coronavirus (COVID-19) has dramatically altered how psychologists deliver its training. At least for the time being, virtual care has become the primary method for delivering mental health services. This has allowed patients and clinicians to continue to access and provide services in a way that would have been impossible years ago. Not only has this shift impacted patients, but it has also impacted supervision and training. The impact has been especially profound on inpatient units where the psychiatric and medical acuity is high of patients and the therapeutic milieu is an important aspect of treatment. The purpose of this paper is to review the impact of COVID-19 on pre-doctoral psychology interns during their rotation on an inpatient psychiatry unit at the start of the pandemic (January to June of 2020) and use these experiences to onboard the next class of interns in the new academic year (July 2020 to June 2021) using a hybrid model of in-person and virtual training experiences. At the end of 2020/2021 rotation, we voluntarily asked interns to complete a questionnaire that was developed based on the qualitative experiences of the previous class to assess the effectiveness of this hybrid model. We also surveyed multi-disciplinary staff members who were essential personnel and required to work in person during this time about their experiences of safety and support. With this information, we explore and offer guidance to other inpatient training sites who are likely to encounter similar challenges during this time. In particular, we discuss the integration of virtual technology into this training experience, as well as the restructuring of clinical and supervisory experiences. We highlighted several short-term strategies that we have flexibly adapted to our inpatient unit. The lessons learned herein seek to guide supervisors and trainees alike in adapting their psychology training programs to meet the evolving demands of COVID-19.
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Affiliation(s)
- Michelle B Stein
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital & Harvard Medical School, One Bowdoin Square, 7th floor, Boston, MA, 02114, USA.
| | - Sheila O'Keefe
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan Mace
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jacklyn D Foley
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Allison E White
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jared R Ruchensky
- Department of Psychology and Philosophy, Sam Houston University, Huntsville, TX, USA
| | - Joshua Curtiss
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eileen Moran
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Casey Evans
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stuart Beck
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Moran E. 132 Improving the Long Term Follow Up of Bisphosphonates in the Community. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Bisphosphonates are generally first line treatment for osteoporosis in primary care. However, long term bisphosphonate use has been associated with atypical femoral fractures. Therefore, it is recommended that bisphosphonates are reviewed every 3–5 years. This study set out to assess and improve the long term follow up of bisphosphonates in a GP practice in Leeds.
Method
System One was searched to identify patients prescribed alendronic acid or risedronate in January and February of 2021 from Aire Valley Surgery, a GP practice in Leeds. These patient’s notes were then used to see if they had planned bisphosphate follow up and if this was via a script note, scheduled task, or recall. In March of 2021 a teaching session on osteoporosis and bisphosphonates was delivered to GPs working at the practice. GPs were also asked to make sure that they planned follow up when prescribing bisphosphonates via a script note. System One was searched again to identify patients prescribed alendronic acid or risedronate in April and May of 2021.
Results
Prior to the teaching session 47.9% of patients had planned follow up with 56.4% via script note, 16.4% via scheduled task and 27.3% via recall. Following the teaching session 48.4% of patients had planned follow up with 73.1% via script note, 13.5% via scheduled task and 13.5% via recall.
Conclusions
This study has identified a group of patients who are taking oral bisphosphonates in the community without planned follow up and are therefore more likely to sustain an atypical femoral fracture.
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Affiliation(s)
- E. Moran
- Leeds Teaching Hospital Trust, Leeds, United Kingdom
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10
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Stiver J, Fusco-Gessick B, Moran E, Crook C, Zimmerman ME. Variable objective sleep quality is related to worse spatial learning and memory in young adults. Sleep Med 2021; 84:114-120. [PMID: 34144450 DOI: 10.1016/j.sleep.2021.05.034] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/21/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The majority of research on sleep and cognition has focused on mean markers of sleep across multiple nights; however, variable sleep patterns have become increasingly common in the modern era. The purpose of this study was to examine whether objective intraindividual variability in sleep quantity and quality are related to verbal and visuospatial learning and memory functioning in young adults. METHODS A total of 218 young adult college students were recruited from a university in the Eastern United States, among which 187 participants (70.6% female; mean age = 20.5, SD = 1.5) had complete actigraphy and cognitive performance data. Objective intraindividual means and variabilities of sleep quantity (total sleep time) and sleep quality (percent wake after sleep onset) were measured over a 1- to 2-week timeframe using wrist actigraphy. Verbal and visuospatial learning and memory were assessed using the International Shopping List and Groton Maze Learning tests of the Cogstate computerized test battery. RESULTS Greater intraindividual variability in actigraphy-derived sleep quality was associated with poorer visuospatial learning and memory performance after controlling for mean sleep quality and visuomotor attention and processing speed (ps < 0.05). Actigraphic measures of sleep quantity were not related to any learning and memory measures. CONCLUSION In young adults, intraindividual variability in objective sleep quality was significantly related to visuospatial learning and memory, over and above mean sleep quality. Given these associations, future studies should aim to identify modifiable lifestyle and environmental factors contributing to variable sleep quality.
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Affiliation(s)
- Jordan Stiver
- Department of Psychology, Fordham University, New York, NY, USA.
| | | | - Eileen Moran
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Cara Crook
- Department of Psychology, Fordham University, New York, NY, USA
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Lin WHW, Moran E, Adams RJ, Sievers RE, Hauer D, Godin S, Griffin DE. A durable protective immune response to wild-type measles virus infection of macaques is due to viral replication and spread in lymphoid tissues. Sci Transl Med 2021; 12:12/537/eaax7799. [PMID: 32238577 DOI: 10.1126/scitranslmed.aax7799] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/15/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Infection with wild-type (WT) measles virus (MeV) is an important cause of childhood mortality that leads to lifelong protective immunity in survivors. WT MeV and the live-attenuated MeV used in the measles vaccine (LAMV) are antigenically similar, but the determinants of attenuation are unknown, and protective immunity induced by LAMV is less robust than that induced by WT MeV. To identify factors that contribute to these differences, we compared virologic and immunologic responses after respiratory infection of rhesus macaques with WT MeV or LAMV. In infected macaques, WT MeV replicated efficiently in B and T lymphocytes with spreading throughout lymphoid tissues resulting in prolonged persistence of viral RNA. In contrast, LAMV replicated efficiently in the respiratory tract but displayed limited spread to lymphoid tissue or peripheral blood mononuclear cells. In vitro, WT MeV and LAMV replicated similarly in macaque primary respiratory epithelial cells and human lymphocytes, but LAMV-infected lymphocytes produced little virus. Plasma concentrations of interleukin-1β (IL-1β), IL-12, interferon-γ (IFN-γ), CCL2, CCL11, CXCL9, and CXCL11 increased in macaques after WT MeV but not LAMV infection. WT MeV infection induced more protective neutralizing, hemagglutinin-specific antibodies and bone marrow plasma cells than did LAMV infection, although numbers of MeV-specific IFN-γ- and IL-4-producing T cells were comparable. Therefore, MeV attenuation may involve altered viral replication in lymphoid tissue that limited spread and decreased the host antibody response, suggesting a link between lifelong protective immunity and the ability of WT MeV, but not LAMV, to spread in lymphocytes.
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Affiliation(s)
- Wen-Hsuan W Lin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Eileen Moran
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Robert J Adams
- Department of Molecular and Comparative Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Robert E Sievers
- Department of Chemistry, University of Colorado, Boulder, CO 80309, USA
| | - Debra Hauer
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Diane E Griffin
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abstract
BACKGROUND Telehealth services historically have played a small role in the provision of health care in the United States. However during the coronavirus disease 2019 (COVID-19) pandemic, public and private insurers rapidly expanded access to telehealth in order to reduce exposure and avoid transmission. It is unknown whether telehealth will become a more regular substitute for in-person care beyond the pandemic. OBJECTIVE Our objective was to provide evidence on the value of telehealth by comparing the productivity of physicians and other specialized clinicians who provide telehealth with the productivity of those who do not. RESEARCH DESIGN We conducted a retrospective data analysis of 17,705 unique providers in the areas of internal medicine, cardiology, dermatology, psychiatry, psychology, and optometry practicing in the US veterans affairs health care system during the period 2015 to 2018. For each year, we measured individual providers productivity by the total number of relative value units (RVUs) per full-time equivalent (FTE). We estimated the impact of providing telehealth on RVUs/FTE using fixed effects regression models estimated on a panel dataset of 58,873 provider-year observations and controlling for provider and patient characteristics. RESULTS Overall provider productivity increased in veterans affairs over the period, particularly in cardiology and dermatology. Providers of telehealth had above average productivity by 124 RVUs/FTE, or ∼4% of average total provider productivity. For the highest quartile of telehealth providers, average productivity was 188 RVUs/FTE higher than productivity of other providers. CONCLUSION Strategies that encourage long-term integration of telehealth into provider practices may contribute to overall health care value.
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Affiliation(s)
| | - Kathleen Carey
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Mei-Ling Shen
- Department of Veterans Affairs Office of Productivity, Efficiency, and Staffing, West Haven, CT
| | - Stacy Poe
- Department of Veterans Affairs Office of Productivity, Efficiency, and Staffing, West Haven, CT
| | - Dennis H Oh
- Office of Connected Care, Telehealth Services, Department of Veterans Affairs, Dermatology Service (190), San Francisco VA Health Care System
- Department of Dermatology, University of California, San Francisco, CA
| | - Eileen Moran
- Department of Veterans Affairs Office of Productivity, Efficiency, and Staffing, West Haven, CT
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Moran E. 149 Non-Pharmacological Treatment of Bone Health in Fallers. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
1 in 2 women and 1 in 5 men will suffer a fragility fracture. Research into calcium and vitamin D supplements has found no consistent evidence to suggest that they reduce the risk of osteoporotic fractures. There has been little research to suggest that dietary calcium is effective at reducing the risk osteoporotic fractures, but supplements have been linked to increased risk of cardiovascular disease and urinary stones. Bisphosphonates have been shown to reduce the risk of osteoporotic fractures and are usually taken in combination with calcium and vitamin D supplements given that deficiencies must be corrected prior to starting. This study set out to assess the dietary calcium intake of patients who attend the falls clinic and explore their attitudes towards dietary change, as an alternative or adjunct to a calcium and vitamin D tablet.
Methods
Data was collected during private interviews conducted with patients who attended the falls clinic. The Edinburgh University Centre for Genomic and Experimental research (CGEM) food frequency calculator was used to calculate dietary calcium intake. Microsoft Excel was used to collate and analyse the data.
Results
No association was found between dietary calcium intake, age and sex. We did find that mean dietary calcium intake was significantly less than the recommended daily amount for adults with osteoporosis, with 80% not getting their recommended daily intake (p < 0.05). We identified patients who don’t receive a calcium and vitamin D supplement as an at-risk group who would benefit from advice on sources of dietary calcium and 83% of patients said that they would be interested in a leaflet on sources of dietary calcium.
Conclusion
This study has identified a group of patients who will hopefully benefit from a leaflet on sources of dietary calcium and as result improve their bone health.
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Affiliation(s)
- E Moran
- Huddersfield Royal Infirmary
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Abstract
Measuring primary care (PC) performance and designing payment systems that reward value rather than volume have been a great challenge due in large part to lack of reliable risk adjustment mechanisms pertinent to primary care. Using risk scores designed for total resource needs to assess PC performance or set PC payment rates is inadequate because high-cost patients may not have high needs in PC and vice versa. The greatest challenge in developing a risk algorithm for PC is that significant components of PC providers' workload are unobservable but needed in the modeling. In this study, we sought to overcome this challenge by analyzing 5,172,773 patients in the U.S. Veterans Affairs (VA) healthcare system to identify potential proxies of the unobservable PC workload. By combining the number of PC visits and prescription drug classes, we formed a proxy for the expected PC workload, which enabled us to develop a case-mix algorithm pertaining to primary care. The resultant algorithm with high explanatory power (R2 = 0.702) is based on a publicly available patient classification system to account for patient comorbidities and thus can be used by other health systems to compare PC performance, workload, staffing levels, and to set more equitable payment rates.
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Affiliation(s)
- Jian Gao
- US Department of Veterans Affairs, Albany, USA
| | - Eileen Moran
- US Department of Veterans Affairs, Washington, USA
| | - Amy Schwartz
- Yale University School of Medicine, New Haven, USA
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Abstract
Abstract
Introduction
Sleep misperception is a phenomenon often identified in insomnia literature, in which individuals subjective reporting does not match objective measurements of their own sleep. Research indicates that anxiety symptoms may play a role in sleep misperception. This study assessed the relationship between sleep misperception, sleep quality, and anxiety in a young adult population with sub-clinical insomnia and anxiety symptoms. Linear regression models examined the relationships between sleep quality, anxiety symptoms, and sleep misperception.
Methods
This sample consisted of 130 young adults recruited from a University in the Bronx, NY. Anxiety was assessed using the Beck Anxiety Inventory (BAI), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective measures of sleep were collected via wrist-based actigraphy over a period of 7-14 days. Subjective sleep measures were collected via an online sleep diary. A misperception index was calculated to determine the discrepancy between subjective and objective sleep measures based on a formula established in previous research.
Results
Higher anxiety symptoms were associated with greater sleep disturbance. Higher sleep misperception was not associated with greater sleep disturbance. There was a significant, positive relationship between sleep misperception and anxiety symptoms (r=0.18, p=0.000). Gender emerged as an important covariate, with males exhibiting significantly higher sleep misperception and underestimating TST (M=-0.31, SD=0.22) compared to females (M=-0.18, SD=0.12).
Conclusion
Sleep misperception was not related to sleep quality, but was strongly related to anxiety symptoms in this population. In a sub-clinical young adult sample, sleep misperception is associated with anxiety but not sleep quality, and has significant gender differences. These findings contribute to sleep misperception literature with potential applications in diagnosis and treatment of insomnia and anxiety.
Support
n/a
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Affiliation(s)
| | - E Moran
- Fordham University, Bronx, NY
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Moran E, Baharani J, Dedicoat M, Robinson E, Smith G, Bhomra P, Thien OS, Ryan R. Risk factors associated with the development of active tuberculosis among patients with advanced chronic kidney disease. J Infect 2018; 77:291-295. [PMID: 29928915 DOI: 10.1016/j.jinf.2018.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The risk of developing active TB is greater in those receiving haemodialysis. This study aimed to describe the incidence of active tuberculosis among patients referred for management of kidney disease and dialysis in a high incidence UK city, with the purpose of informing latent TB testing and treatment practice. METHODS Information from the tuberculosis register was cross-referenced with the Department of Renal Medicine patient information system. All patients seen between 1st January 2005 and 1st October 2016 were included in the analyses with the exception of those with prior TB. RESULTS 68 cases of active TB were identified, an incidence of 126/100,000 patient-years (95% CI 97-169). Incidence was lowest in those with CKD 1 or 2 and rose as high as 256/100,000 patient-years (95% CI 183-374) in those receiving renal replacement therapy. 48% of cases were pulmonary and 87% of TB patients gave their ethnicity as either black/black British or Asian/Asian British, significantly more than in the non-TB renal group. Cases occurred steadily over the time period in which patients were in the cohort. CONCLUSION TB incidence was very high among those receiving renal replacement therapy or CKD 4 or 5. Most cases occurred in those of an Asian/Asian British or black/black British background. Testing and treating such patients for latent TB is justified and should include those who have been receiving renal replacement therapy for some years.
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Affiliation(s)
- E Moran
- Dept of Infection, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - J Baharani
- Dept of Renal Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Dedicoat
- Dept of Infection, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Robinson
- Public Health England, Heartlands Hospital, UK
| | - G Smith
- Public Health England, Heartlands Hospital, UK
| | - P Bhomra
- Dept of Infection, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - O S Thien
- Dept of Infection, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Medical Innovation, Research and Development Unit, University Hospitals Birmingham Foundation Trust, Birmingham, UK
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Damush TM, Miech EJ, Sico JJ, Phipps MS, Arling G, Ferguson J, Austin C, Myers L, Baye F, Luckhurst C, Keating AB, Moran E, Bravata DM. Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration. Neurology 2017; 89:2422-2430. [PMID: 29117959 PMCID: PMC5729798 DOI: 10.1212/wnl.0000000000004739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 04/21/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). Methods: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Results: Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. Conclusions: The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care.
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Affiliation(s)
- Teresa M Damush
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT.
| | - Edward J Miech
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Jason J Sico
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Michael S Phipps
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Greg Arling
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Jared Ferguson
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Charles Austin
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Laura Myers
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Fitsum Baye
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Cherie Luckhurst
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Ava B Keating
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Eileen Moran
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
| | - Dawn M Bravata
- From the VA PRIS-M QUERI Center (T.M.D., E.J.M., J.F., C.A., L.M., D.M.B.), VA HSR&D Center for Health Information & Communication Center (CIN 13-416) (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Roudebush VAMC (T.M.D., E.J.M., J.F., C.A., L.M., C.L., D.M.B.), Indiana University School of Medicine (T.M.D., E.J.M., C.A., F.B., D.M.B.), Regenstrief Institute, Inc. (T.M.D., E.J.M., A.B.K., D.M.B.), Indianapolis, IN; VA Connecticut Healthcare System (J.J.S.), West Haven, CT; Yale University School of Medicine (J.J.S., M.S.P., J.F.), New Haven; University of Maryland School of Medicine (M.S.P.), Baltimore; School of Nursing (G.A.), Purdue University, West Lafayette, IN; and VA Office of Productivity, Efficiency, and Staffing (E.M.), West Haven, CT
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Zellner H, Moss O, Hicks-McGarry S, Moran E, Becker E, Peterson S, Foley S. Differences in Respiratory Muscle Strength in Well-nourished versus Malnourished Hospitalized Patients. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.237] [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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Kearney LK, Smith C, Kivlahan DR, Gresen RC, Moran E, Schohn M, Trafton J, Zeiss AM. Mental health productivity monitoring in the Veterans Health Administration: Challenges and lessons learned. Psychol Serv 2017; 15:486-495. [PMID: 28714721 DOI: 10.1037/ser0000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Achieving quality outcomes and cost efficiency within mental health are overarching objectives of the Veterans Health Administration (VHA). The mental health care workforce has long been oriented toward the goal of high quality outcomes; however, cost efficiency has only recently been elevated into this important value equation. With increased demand for access to mental health services within the VHA, leadership sought to advance methods of determining and improving mental health provider productivity. Monitoring of productivity data may also provide data signaling the potential need for additional staffing to keep up with demand for services. This article outlines VHA's development and specification of mental health productivity policy, implementation strategies, and a discussion of challenges and lessons learned for other systems to consider in implementing productivity monitoring. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Lisa K Kearney
- Office of Mental Health Operations, Veterans Health Administration, Department of Veterans Affairs
| | - Clifford Smith
- Mental Health Operations, Veterans Health Administration, Department of Veterans Affairs
| | - Daniel R Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education and Health Services Research and Development Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System
| | - Robert C Gresen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Eileen Moran
- Office of Productivity, Efficiency and Staffing, Veterans Health Administration, Department of Veterans Affairs
| | - Mary Schohn
- Office of Mental Health Operations, Veterans Health Administration, Department of Veterans Affairs
| | - Jodie Trafton
- Office of Mental Health Operations, Veterans Health Administration, Department of Veterans Affairs
| | - Antonette M Zeiss
- Mental Health Services, Veterans Health Administration, Department of Veterans Affairs
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Grigas T, Ovadnevaite J, Ceburnis D, Moran E, McGovern FM, Jennings SG, O’Dowd C. Sophisticated Clean Air Strategies Required to Mitigate Against Particulate Organic Pollution. Sci Rep 2017; 7:44737. [PMID: 28303958 PMCID: PMC5356191 DOI: 10.1038/srep44737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/06/2016] [Accepted: 02/13/2017] [Indexed: 11/16/2022] Open
Abstract
Since the 1980's, measures mitigating the impact of transboundary air pollution have been implemented successfully as evidenced in the 1980-2014 record of atmospheric sulphur pollution over the NE-Atlantic, a key region for monitoring background northern-hemisphere pollution levels. The record reveals a 72-79% reduction in annual-average airborne sulphur pollution (SO4 and SO2, respectively) over the 35-year period. The NE-Atlantic, as observed from the Mace Head research station on the Irish coast, can be considered clean for 64% of the time during which sulphate dominates PM1 levels, contributing 42% of the mass, and for the remainder of the time, under polluted conditions, a carbonaceous (organic matter and Black Carbon) aerosol prevails, contributing 60% to 90% of the PM1 mass and exhibiting a trend whereby its contribution increases with increasing pollution levels. The carbonaceous aerosol is known to be diverse in source and nature and requires sophisticated air pollution policies underpinned by sophisticated characterisation and source apportionment capabilities to inform selective emissions-reduction strategies. Inauspiciously, however, this carbonaceous concoction is not measured in regulatory Air Quality networks.
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Affiliation(s)
- T. Grigas
- School of Physics and Centre for Climate and Air Pollution Studies, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - J. Ovadnevaite
- School of Physics and Centre for Climate and Air Pollution Studies, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - D. Ceburnis
- School of Physics and Centre for Climate and Air Pollution Studies, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - E. Moran
- Met Éireann Glasnevin, Dublin 9, D09 Y921, Ireland
| | - F. M. McGovern
- Environmental Protection Agency, Clonskeagh, Dublin 14, D14 YR62, Ireland.
| | - S. G. Jennings
- School of Physics and Centre for Climate and Air Pollution Studies, Ryan Institute, National University of Ireland Galway, Galway, Ireland
| | - C. O’Dowd
- School of Physics and Centre for Climate and Air Pollution Studies, Ryan Institute, National University of Ireland Galway, Galway, Ireland
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Barry JA, Moran E, Thomas M, Hardiman PJ. Prolactin and hostility in hospitalised patients and healthy women: A systematic review and meta-analysis. J OBSTET GYNAECOL 2016; 35:499-507. [PMID: 25356539 DOI: 10.3109/01443615.2014.970523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review and meta-analysis was to assess any difference in the self-ratings of hostility in mentally healthy women with different levels of prolactin (PRL). Electronic databases (PubMed, MEDLINE, EMBASE and the Cochrane Library) were searched up to 2nd July 2012 for published literature comparing hostility levels in women with different levels of PRL. Keyword pairs ('prolactin' and 'aggression', 'prolactin' and 'hostil*', 'prolactin' and 'anger', and 'prolactin' and 'angry') were entered simultaneously. From 1065 resulting titles, and one unpublished study, 214 articles underwent full-text review by authors JB and EM. Studies were selected based on clinical relevance. Eight comparative studies consisting of 242 female patients with high PRL levels, 207 female patients with normal PRL levels and 127 healthy controls with normal PRL levels were included. Data were analysed using the inverse variance method with a random-effects model. Analysis revealed significantly higher hostility in patients with high PRL compared with that in healthy control women (Z = 1.94, p < 0.05; Hedges' g = 0.72; 95% confidence interval [CI]: -0.01-1.45), significantly higher hostility in patient controls compared with that in healthy controls (Z = 1.94, p < 0.05; Hedges' g = 0.47; 95% CI: 0.00-0.94) and non-significantly higher hostility levels in patients with high PRL compared with that in patients with normal PRL levels (Z = 1.45, p < 0.15; Hedges' g = 0.38; 95% CI: -0.13-0.89). In this meta-analysis, hostility appears to be accounted for partly by PRL levels and also partly by patient status, perhaps due to the stress of being a patient. Methodological considerations and implications for patient care are discussed.
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Affiliation(s)
- J A Barry
- a Institute for Women's Health, University College London Medical School , London , UK
| | - E Moran
- b Department of Neurology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - M Thomas
- c Department of Clinical Biochemistry , Royal Free London Hospital , London , UK
| | - P J Hardiman
- a Institute for Women's Health, University College London Medical School , London , UK
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Affiliation(s)
- E Moran
- North Middlesex Hospital, London N 18, and Clay bury Hospital, Woodford Bridge, Essex
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Ash S, Ternes K, Bisbing T, Min NE, Moran E, York C, McMillan CT, Irwin DJ, Grossman M. Dissociation of quantifiers and object nouns in speech in focal neurodegenerative disease. Neuropsychologia 2016; 89:141-152. [PMID: 27301638 DOI: 10.1016/j.neuropsychologia.2016.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
Quantifiers such as many and some are thought to depend in part on the conceptual representation of number knowledge, while object nouns such as cookie and boy appear to depend in part on visual feature knowledge associated with object concepts. Further, number knowledge is associated with a frontal-parietal network while object knowledge is related in part to anterior and ventral portions of the temporal lobe. We examined the cognitive and anatomic basis for the spontaneous speech production of quantifiers and object nouns in non-aphasic patients with focal neurodegenerative disease associated with corticobasal syndrome (CBS, n=33), behavioral variant frontotemporal degeneration (bvFTD, n=54), and semantic variant primary progressive aphasia (svPPA, n=19). We recorded a semi-structured speech sample elicited from patients and healthy seniors (n=27) during description of the Cookie Theft scene. We observed a dissociation: CBS and bvFTD were significantly impaired in the production of quantifiers but not object nouns, while svPPA were significantly impaired in the production of object nouns but not quantifiers. MRI analysis revealed that quantifier production deficits in CBS and bvFTD were associated with disease in a frontal-parietal network important for number knowledge, while impaired production of object nouns in all patient groups was related to disease in inferior temporal regions important for representations of visual feature knowledge of objects. These findings imply that partially dissociable representations in semantic memory may underlie different segments of the lexicon.
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Affiliation(s)
- Sharon Ash
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Kylie Ternes
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Teagan Bisbing
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Nam Eun Min
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Eileen Moran
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Collin York
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Corey T McMillan
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - David J Irwin
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Center for Neurodegenerative Disease Research, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Murray Grossman
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
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Wagner TH, Upadhyay A, Cowgill E, Stefos T, Moran E, Asch SM, Almenoff P. Risk Adjustment Tools for Learning Health Systems: A Comparison of DxCG and CMS-HCC V21. Health Serv Res 2016; 51:2002-19. [PMID: 26839976 DOI: 10.1111/1475-6773.12454] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare risk scores computed by DxCG (Verisk) and Centers for Medicare and Medicaid Services (CMS) V21. RESEARCH DESIGN Analysis of administrative data from the Department of Veterans Affairs (VA) for fiscal years 2010 and 2011. STUDY DESIGN We regressed total annual VA costs on predicted risk scores. Model fit was judged by R-squared, root mean squared error, mean absolute error, and Hosmer-Lemeshow goodness-of-fit tests. Recalibrated models were tested using split samples with pharmacy data. DATA COLLECTION We created six analytical files: a random sample (n = 2 million), high cost users (n = 261,487), users over age 75 (n = 644,524), mental health and substance use users (n = 830,832), multimorbid users (n = 817,951), and low-risk users (n = 78,032). PRINCIPAL FINDINGS The DxCG Medicaid with pharmacy risk score yielded substantial gains in fit over the V21 model. Recalibrating the V21 model using VA pharmacy data-generated risk scores with similar fit statistics to the DxCG risk scores. CONCLUSIONS Although the CMS V21 and DxCG prospective risk scores were similar, the DxCG model with pharmacy data offered improved fit over V21. However, health care systems, such as the VA, can recalibrate the V21 model with additional variables to develop a tailored risk score that compares favorably to the DxCG models.
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Affiliation(s)
- Todd H Wagner
- Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA. .,Center for Innovation to Implementation, VA Palo Alto, Menlo Park, CA. .,Department of Health Research and Policy, Stanford University, Palo Alto, CA.
| | - Anjali Upadhyay
- Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA
| | - Elizabeth Cowgill
- Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA
| | - Theodore Stefos
- VHA Office of Productivity, Efficiency & Staffing, Bedford, MA
| | - Eileen Moran
- VHA Office of Productivity, Efficiency & Staffing, Bedford, MA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto, Menlo Park, CA.,Division of General Medical Disciplines, Stanford University, Palo Alto, CA
| | - Peter Almenoff
- Department of Veterans Affairs, Operational Analytics and Reporting, Office of Informatics and Analytics, Kansas City, MO.,Department of Veterans Affairs, Office of Secretary, Kansas City, MO.,Department of Veterans Affairs, Center of Innovation, Kansas City, MO.,Vijay Babu Rayudu Endowed Chair in Patient Safety, University of Missouri-Kansas City, Kansas City, MO
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Solaro C, Ponzio M, Moran E, Tanganelli P, Pizio R, Ribizzi G, Venturi S, Mancardi GL, Battaglia MA. The changing face of multiple sclerosis: Prevalence and incidence in an aging population. Mult Scler 2015; 21:1244-50. [DOI: 10.1177/1352458514561904] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022]
Abstract
Objective: To assess multiple sclerosis (MS) incidence from 1998 to 2007, and MS prevalence on 31 December 2007, in the province of Genoa, Italy. Methods: We identified MS cases diagnosed before 31 December 2007 by analyzing archives of hospitals with neurological or rehabilitation wards, the local Italian MS society, family doctor records and requests for oligoclonal band analysis on cerebrospinal fluid (CSF). Results: A total of 1312 MS patients were residing in the province of Genoa on the prevalence day; 431 (32.85%) were men and 881 (67.15%) were women; mean age was 50.6 (± 13.9). The overall crude MS prevalence rate was 148.5/100,000; 103.1/100,000 in men and 189.1/100,000 in women. The crude mean annual MS incidence rate was 6.6 cases/100,000 (4.4/100,000 men; 8.6/100,000 women). Mean age at diagnosis was 39.5 ± 12.3 (men: 39.9 ± 13.0; women: 39.3 ± 11.9). A mean annual incidence of 4 MS patients ≥ 60 was observed. Conclusions: We observed an increased MS prevalence in the province of Genoa, compared to 1997. The mean age at diagnosis was relatively high (39 years old), 18% of our MS patients were over 65, and a notable incidence increase was seen in patients over 60. This has important implications, in terms of the need to organize the health system to better serve elderly MS patients, especially considering comorbidities and different medical needs of elderly MS patients; and to increase awareness within the medical community about the increasing risk of newly-presenting MS in the older population.
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Affiliation(s)
- C Solaro
- Neurology Unit, Head and Neck Department, Azienda Sanitaria Locale 3 - ASL3, Genoa, Italy
| | - M Ponzio
- Research Department, Italian Foundation of Multiple Sclerosis, Genoa, Italy
| | - E Moran
- Neurology Unit, Head and Neck Department, Azienda Sanitaria Locale 3 - ASL3, Genoa, Italy
| | - P Tanganelli
- Neurology Unit, Head and Neck Department, Azienda Sanitaria Locale 3 - ASL3, Genoa, Italy
| | - R Pizio
- Neurology Department - Lavagna Hospital, Genoa, Italy
| | - G Ribizzi
- Neurology Department, San Martino Hospital, Genoa, Italy
| | - S Venturi
- Neurology Department, Galliera Hospital, Genoa, Italy
| | - GL Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genoa; Italy
| | - MA Battaglia
- Department of Life Science, University of Siena, Italy
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Abstract
This study tested the hypothesis that women with higher prolactin feel more hostility, anger and aggression. A total of 66 women with moderate fertility problems were grouped into the 50% who had the highest and the 50% who had the lowest levels of prolactin. Levels of hostility, aggression and anger were compared. Women with higher prolactin levels did not report significantly increased hostility. After Bonferroni correction, women with lower prolactin showed non-significantly increased scores on two measures of state anger, and on a measure of trait temper. When comparing those with the highest and lowest 20% of prolactin levels, those with lower prolactin had non-significantly higher scores on trait temper and outward expression of anger, and non-significantly lower scores for control of anger. Although non-significant, these findings run counter to those of earlier studies on this topic. Implications for future research and patient care are discussed.
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Affiliation(s)
- J. A. Barry
- Institute for Women’s Health, University College London, London, UK
| | - E. Moran
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - H. S. Parekh
- Institute for Women’s Health, University College London, London, UK
| | - T. Morewood
- Institute for Women’s Health, University College London, London, UK
| | - M. Thomas
- Department of Clinical Biochemistry, Royal Free London Hospital, London, UK
| | - P. J. Hardiman
- Institute for Women’s Health, University College London, London, UK
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Barry JA, Folkard A, Denniston AK, Moran E, Ayliffe W. Development and Validation of Quality-of-Life Questionnaires for Birdshot Chorioretinopathy. Ophthalmology 2014; 121:1488-9.e2. [DOI: 10.1016/j.ophtha.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/02/2014] [Accepted: 01/03/2014] [Indexed: 11/26/2022] Open
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Abstract
Veterinary viral vaccines generally comprise either attenuated or chemically inactivated viruses which have been propagated on mammalian cell substrates or specific pathogen free (SPF) eggs. New generation vaccines include chemically inactivated virally-infected whole cell vaccines. The NM57 cell line is a bovine nasal turbinate persistently infected (non-lytic infection) with a strain of the respiratory syncytial virus (RSV). The potential of microcarrier technology for the cultivation in bioreactors of this anchorage dependent cell line for RSV vaccine production has been investigated. Both Cytodex 3 and Cultispher S microcarriers proved most suitable from a selection of microcarriers as growth substrates for this NM57 cell line. Maximum cell densities of 4.12×105 cells ml-1and 5.52×105 cells ml-1 respectively were obtained using Cytodex 3 (3 g l-1) and and Cultispher S (1 g l-1) in 5 l bioreactor cultures. The fact that cell growth was less sensitive to agitation rate when cultured on Cultispher S microcarriers, and that cells were efficiently harvested from this microcarrier by an enzymatic method, suggested Cultispher S is suitable for further evaluation at larger bioreactor scales (>5 l) than that described here.
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Affiliation(s)
- E Moran
- MFM Laboratories Ltd., 4 Warner Dr., Springwood Industrial Estate, Braintree, Essex, CM7 2YW, UK
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Tortolina L, Castagnino N, De Ambrosi C, Moran E, Patrone F, Ballestrero A, Parodi S. A multi-scale approach to colorectal cancer: from a biochemical- interaction signaling-network level, to multi-cellular dynamics of malignant transformation. Interplay with mutations and onco-protein inhibitor drugs. Curr Cancer Drug Targets 2012; 12:339-55. [PMID: 22385511 DOI: 10.2174/156800912800190910] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/23/2011] [Accepted: 12/22/2011] [Indexed: 11/22/2022]
Abstract
This review article is part of a special Current Cancer Drug Targets issue devoted to colorectal cancer and molecularly targeted treatments. In our paper we made an attempt to connect more basic aspects with preclinical, pharmacological / therapeutic and clinical aspects. Reconstruction of a Molecular Interaction Map (MIM) comprising an important part of the G0 - G1 - S cell cycle transition, was a major component of our review. Such a MIM serves also as a convenient / organized database of a large set of important molecular events. The frequency of mutated / altered signaling-proteins indicates the importance of this signaling-network region. We have considered problems at different scale levels. Our MIM works at a biochemical-interaction level. We have also touched the multi-cellular dynamics of normal and aberrant colon crypts. Until recently, dynamic simulations at a biochemical or multi-cellular scale level were considered as a sort of esoteric approach. We tried to convince the reader, also on the basis of a rapidly growing literature, mostly published in high quality journals, that suspicion towards simulations should dissipate, as the limitations and advantages of their application are better appreciated, opening the door to their permanent adoption in everyday research. What is really required is a more interdisciplinary mentality and an interdisciplinary approach. The prize is a level of understanding going beyond mere intuition.
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Affiliation(s)
- L Tortolina
- Department of Internal Medicine, University of Genoa, Genova, Italy
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Stefos T, Burgess JF, Cohen JP, Lehner L, Moran E. Dynamics of the mental health workforce: investigating the composition of physicians and other health providers. Health Care Manag Sci 2012; 15:373-84. [PMID: 22723031 DOI: 10.1007/s10729-012-9203-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022]
Abstract
We evaluate how changes to mental health workforce levels, composition, and degree of labor substitution, may impact typical practice output. Using a generalized Leontief production function and data from 134 U.S. Department of Veterans Affairs (VA) mental health practices, we estimate the q-complementarity/q-substitutability of mental health workers. We look at the entire spectrum of mental health services rather than just outpatient or physician office services. We also examine more labor types, including residents, than previous studies. The marginal patient care output contribution is estimated for each labor type as well as the degree to which physicians and other mental health workers may be substitutes or complements. Results indicate that numerous channels exist through which input substitution can improve productivity. Seven of eight labor and capital inputs have positive estimated marginal products. Most factor inputs exhibit diminishing marginal productivity. Of 28 unique labor-capital pairs, 17 are q-complements and 11 are q-substitutes. Complementarity among several labor types provides evidence of a team approach to mental health service provision. Our approach may serve to better inform healthcare providers regarding more productive mental health workforce composition both in and outside of VA.
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Affiliation(s)
- Theodore Stefos
- VHA Office of Productivity, Efficiency and Staffing, Department of Veterans Affairs (VA), VAMC (518/MSG/VISN1/Building 61), 200 Springs Road, Bedford, MA 01730, USA.
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Pirrotta I, Fernández-Sanjulián J, Moran E, Alario-Franco MA, Gonzalo E, Kuhn A, García-Alvarado F. Driving Curie temperature towards room temperature in the half-metallic ferromagnet K2Cr8O16by soft redox chemistry. Dalton Trans 2012; 41:1840-7. [PMID: 22167010 DOI: 10.1039/c1dt11558h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- I Pirrotta
- Departamento de Química Inorgánica I, Facultad de Químicas, Universidad Complutense de Madrid, 28040, Madrid, Spain
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Gao J, Moran E, Almenoff PL, Render ML, Campbell J, Jha AK. Variations in efficiency and the relationship to quality of care in the veterans health system. Health Aff (Millwood) 2011; 30:655-63. [PMID: 21471486 DOI: 10.1377/hlthaff.2010.0435] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is widespread belief that the US health care system could realize significant improvements in efficiency, savings, and patient outcomes if care were provided in a more integrated and accountable way. We examined efficiency and its relationship to quality of care for medical centers run by the Veterans Health Administration of the Department of Veterans Affairs (VA), a national, vertically integrated health care system that is accountable for a large patient population. After devising a statistical model to indicate efficiency, we found that VA medical centers were highly efficient. We also found only modest variation in the level of efficiency and cost across VA medical centers, and a positive correlation overall between greater efficiency and higher inpatient quality. These findings for VA medical centers suggest that efforts to drive integration and accountability in other parts of the US health care system might have important payoffs in reducing variations in cost without sacrificing quality. Policy makers should focus on what aspects of certain VA medical centers allow them to provide better care at lower costs and consider policies that incentivize other providers, both within and outside the VA, to adopt these practices.
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Affiliation(s)
- Jian Gao
- Office of Productivity, Efficiency, and Staffing, Department of Veterans Affairs, Albany, New York, USA.
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Stefos T, Burgess JF, Mayo-Smith MF, Frisbee KL, Harvey HB, Lehner L, Lo S, Moran E. The effect of physician panel size on health care outcomes. Health Serv Manage Res 2011; 24:96-105. [PMID: 21471580 DOI: 10.1258/hsmr.2011.011001] [Citation(s) in RCA: 16] [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: 11/18/2022]
Abstract
An inadequate supply of primary care providers is leading to a crisis in access. Pressures are being placed on primary care practices to increase panel sizes. The impact of these pressures on clinical processes, patient satisfaction and waiting times is largely unknown, although evidence from recent literature shows that longer waiting time results in higher mortality rates and other adverse outcomes. FY2004, Department of Veterans Affairs primary care patient data are used. GLIMMIX and other generalized linear model models illustrate how expanded panel sizes are correlated with clinical process indicators, patient satisfaction and waiting times, controlling for practice, provider and patient characteristics. We generally find that larger panel sizes are related to statistically significant increases in waiting time. However, larger panel sizes appear to have generally small effects on patient process indicators and satisfaction. Panels with more support staff have lower waiting times and small, improved outcomes. We find panels with older and clinically riskier patients have, on average, slightly lower waiting times and increased likelihoods of positive outcomes than panels with younger, healthier veterans. Female veterans appear to have reduced likelihoods of positive outcomes. Higher priority and female veterans also have lower satisfaction. Further study is needed to analyse the impact of potential panel size endogeneity in this system.
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Affiliation(s)
- Theodore Stefos
- Office of Productivity, Efficiency and Staffing, US Department of Veterans Affairs (VA), Bedford, MA 01730, USA.
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Caffa I, Soncini D, Zoppoli G, Moran E, Patrone F, Ballestrero A, Nencioni A. 1222 POSTER Chemical Screening for Potentiators of Lapatinib Activity in Human Breast Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70834-6] [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: 11/30/2022]
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Schmid AA, Kapoor JR, Miech EJ, Kuehn D, Dallas MI, Kerns RD, Lo AC, Concato J, Phipps MS, Couch CD, Moran E, Williams LS, Goble LA, Bravata DM. A multidisciplinary stroke clinic for outpatient care of veterans with cerebrovascular disease. J Multidiscip Healthc 2011; 4:111-8. [PMID: 21594062 PMCID: PMC3093955 DOI: 10.2147/jmdh.s17154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 04/26/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Managing cerebrovascular risk factors is complex and difficult. The objective of this program evaluation was to assess the effectiveness of an outpatient Multidisciplinary Stroke Clinic model for the clinical management of veterans with cerebrovascular disease or cerebrovascular risk factors. Methods: The Multidisciplinary Stroke Clinic provided care to veterans with cerebrovascular disease during a one-half day clinic visit with interdisciplinary evaluations and feedback from nursing, health psychology, rehabilitation medicine, internal medicine, and neurology. We conducted a program evaluation of the clinic by assessing clinical care outcomes, patient satisfaction, provider satisfaction, and costs. Results: We evaluated the care and outcomes of the first consecutive 162 patients who were cared for in the clinic. Patients had as many as six clinic visits. Systolic and diastolic blood pressure decreased: 137.2 ± 22.0 mm Hg versus 128.6 ± 19.8 mm Hg, P = 0.007 and 77.9 ± 14.8 mm Hg versus 72.0 ± 10.2 mm Hg, P = 0.004, respectively as did low-density lipoprotein (LDL)-cholesterol (101.9 ± 23.1 mg/dL versus 80.6 ± 25.0 mg/dL, P = 0.001). All patients had at least one major change recommended in their care management. Both patients and providers reported high satisfaction levels with the clinic. Veterans with stroke who were cared for in the clinic had similar or lower costs than veterans with stroke who were cared for elsewhere. Conclusion: A Multidisciplinary Stroke Clinic model provides incremental improvement in quality of care for complex patients with cerebrovascular disease at costs that are comparable to usual post-stroke care.
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Affiliation(s)
- Arlene A Schmid
- Department of Veteran Affairs (VA) Health Services Research & Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP)
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Bingener J, Bonin E, Moran E, McConico A, Gostout C. Perforated Peptic Ulcer Disease–A Potential for NOTES Procedures? J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Motta G, Cea M, Carbone F, Augusti V, Moran E, Patrone F, Nencioni A. Current standards and future strategies in immunochemotherapy of non-Hodgkin's lymphoma. J BUON 2011; 16:9-15. [PMID: 21674844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The therapeutic options for B-cell non-Hodgkin's lymphoma (NHL) have dramatically expanded with the advent of immune-based treatments. The monoclonal antibody anti- CD20 rituximab represents the best example of these advances and has quickly become incorporated into the therapeutic armamentarium for this hematological disease. In addition, other antibodies are eventually becoming part of treatment approaches to NHL. Furthermore, the role of therapeutic vaccines continues to be an important ongoing research question. Despite this success, several questions on how to optimize the use of monoclonal antibodies in NHL remain open since the best administration schedules, as well as the optimal duration of immunotherapy still have to be determined. Finally the development of resistance to treatment remains the main limit of this innovative approach, necessitating the development of strategies to circumvent resistance itself. This review will summarize the state of the art of antibody-based immunotherapy of NHL and discuss prospective approaches to improve the benefit of these treatments in patients.
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Affiliation(s)
- G Motta
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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O'Kane CM, Moran E, McAuley DF. S48 NGAL inhibits cytoskeletal re-organisation, MMP-2 production and invasion in alveolar epithelial cells in an in vitro model of acute lung injury. Thorax 2010. [DOI: 10.1136/thx.2010.150912.48] [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: 11/04/2022]
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Castagnino N, Tortolina L, Balbi A, Pesenti R, Montagna R, Ballestrero A, Soncini D, Moran E, Nencioni A, Parodi S. Dynamic Simulations of Pathways Downstream of ERBB-Family, Including Mutations and Treatments: Concordance with Experimental Results. Curr Cancer Drug Targets 2010; 10:737-57. [DOI: 10.2174/156800910793605848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 06/18/2010] [Indexed: 11/22/2022]
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Tripathi OP, Jennings SG, O'Dowd CD, Coleman L, Leinert S, O'Leary B, Moran E, O'Doherty SJ, Spain TG. Statistical analysis of eight surface ozone measurement series for various sites in Ireland. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2010jd014040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- E Moran
- Department of Microbiology and Infectious Disease, John Radcliffe Hospital, Oxford.
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Durán A, Arévalo-López A, Castillo-Martínez E, García-Guaderrama M, Moran E, Cruz M, Fernández F, Alario-Franco M. Magneto-thermal and dielectric properties of biferroic YCrO3 prepared by combustion synthesis. J SOLID STATE CHEM 2010. [DOI: 10.1016/j.jssc.2010.06.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ballestrero A, Cirmena G, Dominietto A, Garuti A, Rocco I, Cea M, Moran E, Nencioni A, Miglino M, Raiola AM, Bacigalupo A, Patrone F. Peripheral blood vs. bone marrow for molecular monitoring of BCR-ABL1 levels in chronic myelogenous leukemia, a retrospective analysis in allogeneic bone marrow recipients. Int J Lab Hematol 2010; 32:387-91. [PMID: 19968720 DOI: 10.1111/j.1751-553x.2009.01198.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Molecular monitoring of the BCR-ABL1 transcript in chronic myelogenous leukemia (CML) using quantitative real-time PCR (RQ-PCR) can be performed using either bone marrow (BM) or peripheral blood (PB). However, a recent report by Stock et al. [International Journal of Oncology 28 (2006) 1099] questioned the reliability of PB samples for BCR-ABL1 detection as performed by RQ-PCR. We report a study on 114 CML patients who received allogeneic stem cell transplantation (ASCT), and who were monitored by RQ-PCR using paired samples of BM and PB: the total number of determinations was 428, with a median follow-up after transplant of 8 years. BCR-ABL1 transcript was undetectable or <0.1%, in 106 (49.57%) and 62 (29%) paired determinations, respectively. BCR-ABL1 was >0.1% in 36 (16.8%) paired determinations and was discordant in 10 (4.7%). Agreement between PB and BM results was quantified by the kappa test (k = 0.85; 95% CI 0.76-0.94). This study shows that BCR-ABL1 RQ-PCR monitoring of CML patients after ASCT with PB is concordant with BM in 95.3% of cases, and thus may be used to monitor the disease. This may be relevant when discussing both quality of life issues and the need for post-transplant monitoring with the patient.
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Affiliation(s)
- A Ballestrero
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa, Italy.
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Cea M, Cagnetta A, Garuti A, Cirmena G, Rocco I, Moran E, Grillo V, Ballestrero A, Patrone F, Nencioni A. Molecular diagnosis and monitoring of chronic myelogenous leukemia: BCR-Abl and more. J BUON 2009; 14:565-573. [PMID: 20148444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current treatment of chronic myelogenous leukemia (CML) is one of the most successful examples of molecularly targeted therapy in cancer. The identification of the fusion oncogene BCR-ABL allowed the discovery of small molecule inhibitors of its tyrosine kinase activity which, in turn, have literally revolutionized the treatment of this disease. However, large part of a successful clinical management of CML relies on appropriate diagnosis, molecular monitoring and identification of mutations potentially leading to drug resistance. These issues are discussed here together with an overview on how patients treated with tyrosine kinase inhibitors should be monitored.
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MESH Headings
- Drug Resistance, Neoplasm
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Protein Kinase Inhibitors/therapeutic use
- Treatment Outcome
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Affiliation(s)
- M Cea
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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Bingener J, Moran E, Gostout C. QS95. Randomized Trials Evaluating the Physiologic Impact of Notes. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.390] [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: 12/01/2022]
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Moran E, Isaacs GS, Naidoo B, Pudifin DJ. Hereditary C1 esterase deficiency in a Zulu kindred. S Afr Med J 2009; 99:40-42. [PMID: 19374086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Moran E. Preventing thromboembolism in medical inpatients--time to catch up with the surgeons? S Afr Med J 2008; 98:860. [PMID: 19177890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Gomperts SN, Rentz DM, Moran E, Becker JA, Locascio JJ, Klunk WE, Mathis CA, Elmaleh DR, Shoup T, Fischman AJ, Hyman BT, Growdon JH, Johnson KA. Imaging amyloid deposition in Lewy body diseases. Neurology 2008; 71:903-10. [PMID: 18794492 PMCID: PMC2637553 DOI: 10.1212/01.wnl.0000326146.60732.d6] [Citation(s) in RCA: 360] [Impact Index Per Article: 22.5] [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: 11/15/2022] Open
Abstract
BACKGROUND Extrapyramidal motor symptoms precede dementia in Parkinson disease (PDD) by many years, whereas dementia occurs early in dementia with Lewy bodies (DLB). Despite this clinical distinction, the neuropsychological and neuropathologic features of these conditions overlap. In addition to widespread distribution of Lewy bodies, both diseases have variable burdens of neuritic plaques and neurofibrillary tangles characteristic of Alzheimer disease (AD). OBJECTIVES To determine whether amyloid deposition, as assessed by PET imaging with the beta-amyloid-binding compound Pittsburgh Compound B (PiB), can distinguish DLB from PDD, and to assess whether regional patterns of amyloid deposition correlate with specific motor or cognitive features. METHODS Eight DLB, 7 PDD, 11 Parkinson disease (PD), 15 AD, and 37 normal control (NC) subjects underwent PiB-PET imaging and neuropsychological assessment. Amyloid burden was quantified using the PiB distribution volume ratio. RESULTS Cortical amyloid burden was higher in the DLB group than in the PDD group, comparable to the AD group. Amyloid deposition in the PDD group was low, comparable to the PD and NC groups. Relative to global cortical retention, occipital PiB retention was lower in the AD group than in the other groups. For the DLB, PDD, and PD groups, amyloid deposition in the parietal (lateral and precuneus)/posterior cingulate region was related to visuospatial impairment. Striatal PiB retention in the DLB and PDD groups was associated with less impaired motor function. CONCLUSIONS Global cortical amyloid burden is high in dementia with Lewy bodies (DLB) but low in Parkinson disease dementia. These data suggest that beta-amyloid may contribute selectively to the cognitive impairment of DLB and may contribute to the timing of dementia relative to the motor signs of parkinsonism.
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Affiliation(s)
- S N Gomperts
- Massachusetts General Hospital, Boston, MA 02114, USA
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Moran E, Cattaneo C, Mishima H, López de Mishima BA, Silvetti SP, Rodriguez JL, Pastor E. Ammonia oxidation on electrodeposited Pt–Ir alloys. J Solid State Electrochem 2007. [DOI: 10.1007/s10008-007-0407-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [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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