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Pope E, McCullough M, Smith JG, Kim B. Knowledge, practice and attitudes regarding substance use disorder treatment and harm reduction strategies among pharmacists: a scoping review protocol. BMJ Open 2024; 14:e080338. [PMID: 38418243 PMCID: PMC10910657 DOI: 10.1136/bmjopen-2023-080338] [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: 09/27/2023] [Accepted: 01/22/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pharmacists provide a spectrum of services and comprehensive medication management for patients with substance use disorders (SUDs) with many providing timely and increased access to care for patients. Prior studies have evaluated other healthcare professionals' attitudes, knowledge and practice in regard to SUD treatment and harm reduction services. However, no reviews to date summarise the available literature on the attitudes, knowledge and practice in regard to SUD treatment and harm reduction services from the pharmacist perspective. This scoping review aims to systematically map the extent, range and nature of available evidence and identify and describe gaps in knowledge, practice and attitudes towards SUD treatment among pharmacists with the goal of providing information for meaningful integration of pharmacists into SUD care. METHODS AND ANALYSIS We will use the framework proposed by Arksey and O'Malley (2005) updated with recommendations by Levac et al (2010) and the Joanna Briggs Institute (2020). The protocol is registered via Open Science Framework (https://osf.io/92dek). We will search for peer-reviewed literature containing empirical evidence investigating SUD treatment or harm reduction with outcomes pertaining to the knowledge, practice or attitudes of pharmacists. Findings will be guided and assessed by research objectives and summarised using descriptive statistics and thematically for quantitative and qualitative findings, respectively. This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. ETHICS AND DISSEMINATION Our findings will provide crucial information and support for future interventions and programmes which aim to meaningfully integrate pharmacists into SUD care. We will disseminate findings at conferences and publish in a peer-reviewed journal. In addition, we will integrate feedback on search strategy, data extraction and our dissemination approach from multidisciplinary collaborators including those within our team's institution and outside experts with clinical or administrative knowledge in SUD care.
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Affiliation(s)
- Elle Pope
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Megan McCullough
- VA Bedford Healthcare System, Bedford, Massachusetts, USA, Bedford, MA, USA
- University of Massachusetts-Lowell, Lowell, MA, USA
| | - Jason G Smith
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Bo Kim
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Pope E, Sehgal N. Characterizing industry payments to US teaching hospitals and affiliated physicians: a cross-sectional analysis of the Open Payments datasets from 2016 to 2022. Health Aff Sch 2023; 1:qxad031. [PMID: 38756245 PMCID: PMC10986265 DOI: 10.1093/haschl/qxad031] [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] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/27/2023] [Indexed: 05/18/2024]
Abstract
Industry payments to US teaching hospitals are common; however, little is known about whether these financial relationships influence affiliated physicians to engage in similar financial relationships with industry. Using national hospital, physician, and industry payment data we investigated trends in industry payments made to US teaching hospitals and affiliated physicians to characterize the magnitude and nature of payments. In addition, we assessed if physicians may be influenced to accept higher value industry payments depending on the value of promotional payments accepted by the teaching hospital they affiliate with. We found that physicians with a US teaching hospital affiliation are associated with accepting higher value industry payments as the total value of industry payments of the teaching hospital increases. Our findings varied by specialty, with surgeons accepting the highest value payments. These results highlight the need for greater public disclosure and awareness of payments to better manage and mitigate industry-biased clinical decision making.
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Affiliation(s)
- Elle Pope
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA 02130, United States
| | - Neil Sehgal
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, United States
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Pope E, Sehgal N. The Role of Physician Networks and Receipt of Opioid-Related Payments. J Gen Intern Med 2023; 38:1812-1820. [PMID: 36376628 PMCID: PMC10272029 DOI: 10.1007/s11606-022-07870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid-related promotional payments are associated with increased prescribing of the promoted drug, but little is known about whether physicians receiving payments influence peers to accept similar payments. OBJECTIVE We examine the association of physician network-level position among peers and the acceptance of opioid-related promotional payments using national publicly available datasets from 2015. Design National cross-sectional data from the Centers for Medicare and Medicaid Services (CMS) National Downloadable File and Open Payment data. SUBJECTS Physicians who shared Medicare patients with at least two other physicians in 2015. MAIN MEASURES Modified Poisson's regressions are used to estimate the adjusted incidence rate ratio (aIRR) for social network position (i.e., degree, betweenness, and transitivity) and number of peers with payments as a function of individual receipt of opioid-related promotional payment and among those with payments, those who have five or more payments, and those who have $100 or more in payments. KEY RESULTS Physicians with opioid-related payments were significantly more likely to have at least one peer with an opioid-related payment (IRR: 2.5, 95% CI: 2.3-2.8), but had fewer shared patients (i.e., top quartile compared to the first quartile for degree centrality: 0.4, 95% CI: 0.3-0.4) and belonged to less cohesive networks (i.e., top quartile compared to the first quartile for betweenness centrality: 0.9, 95% CI: 0.8-0.9). CONCLUSIONS Our study demonstrates that physicians receiving opioid-related payments are more likely to cluster within physician networks.
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Affiliation(s)
- Elle Pope
- University of Maryland School of Public Health, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA.
| | - Neil Sehgal
- University of Maryland School of Public Health, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA
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Courtier N, Williamson K, Brown P, Pope E, Chivers E, Mundy LA. A personal journey to build leadership skills through collaboration to support radiography research and evidence-based practice. J Med Imaging Radiat Sci 2022; 53:S15-S17. [PMID: 35909060 PMCID: PMC9715992 DOI: 10.1016/j.jmir.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022]
Abstract
Introduction The Covid-19 pandemic continues to impact on how radiotherapy is delivered, how staff do their job and how patients are cared for. Part of the UK NHS response to the covid-19 crisis was to accelerate final year radiotherapy students into work as therapeutic radiographers. The study objective is to explore the experiences of a cohort of new registrants who started work in May 2020. Methods In depth interviews were conducted remotely with newly qualified therapeutic radiography registrants regarding their first 12 months working in UK NHS cancer centres. Data were analysed within and across cases using a framework analysis and synthesised thematically. Results Eleven radiographers were interviewed, working across six different sites. Key generated themes are the risk of impaired professional socialisation due to incongruence between students’ expectations and the reality in clinical departments. We use Bridges Transitional Model to show how a combination of the disrupted/undefined end to university and a perceived lack of recognition of professional knowledge, skills and values evident in our data may leave participants stuck in a middle stage of the transition process. Slower than expected professional development led to demotivation, which was also associated with rising covid-19 case numbers. Conclusion The covid-19 pandemic accentuated and heightened the existing challenge of professional integration and socialisation faced by new therapeutic radiography staff. Demotivation and potentially attrition are more likely in this environment. Compassionate leadership that fosters the mentorship of junior cohorts as part of a flexible preceptorship package could mitigate these risks.
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Affiliation(s)
- N Courtier
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - K Williamson
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - P Brown
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - E Pope
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - E Chivers
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - LA Mundy
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
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Pope E, Sehgal N. Effects and Trends in Opioid-Related Promotional Payments Between 2014 and 2019: a Panel Data Analysis Among Prescribers in Medicare Part D. J Gen Intern Med 2022; 37:3509-3511. [PMID: 35212878 PMCID: PMC9550901 DOI: 10.1007/s11606-022-07457-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Elle Pope
- School of Public Health, University of Maryland, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA.
| | - Neil Sehgal
- School of Public Health, University of Maryland, 4200 Valley Drive, 3310C, College Park, MD, 20742-2611, USA
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Sehgal NJ, Yue D, Pope E, Wang RH, Roby DH. The Association Between COVID-19 Mortality And The County-Level Partisan Divide In The United States. Health Aff (Millwood) 2022. [DOI: 10.1377/hlthaff.2022.00085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lucky AW, Pope E. Pregnancy in epidermolysis bullosa: long-awaited guidelines of care. Br J Dermatol 2021; 186:602-603. [PMID: 34841510 DOI: 10.1111/bjd.20897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- A W Lucky
- Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital and, The University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - E Pope
- Division of Paediatric Dermatology, The Hospital for Sick Children and Professor of Pediatrics, University of Toronto, Toronto, ON, Canada
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Ramien ML, Bahubeshi A, Lara-Corrales I, Pope E, Levy ML, Nopper AJ, Shear NH, Eichenfield L. Blistering severe cutaneous adverse reactions in children: proposal for paediatric-focused clinical criteria. Br J Dermatol 2021; 185:447-449. [PMID: 33730370 DOI: 10.1111/bjd.20063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M L Ramien
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,University of Ottawa, Ottawa, ON, Canada
| | | | - I Lara-Corrales
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - E Pope
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - M L Levy
- Department of Pediatrics and Medicine (Dermatology), Dell Medical School, University of Texas, Austin, TX, USA.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, TX, USA
| | - A J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - N H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, University of California, San Diego, CA, USA
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Courtier N, Brown P, Mundy L, Pope E, Chivers E, Williamson K. Expectations of therapeutic radiography students in Wales about transitioning to practice during the Covid-19 pandemic as registrants on the HCPC temporary register. Radiography (Lond) 2021; 27:316-321. [PMID: 32943355 PMCID: PMC7476453 DOI: 10.1016/j.radi.2020.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Covid-19 crisis continues to profoundly impact on radiotherapy practice in the UK. We explore the views of therapeutic radiographer students on entering their first post in unique circumstances as a means to evaluate the support that may minimise negative impacts on their transition to practitioners. METHOD Focus groups were conducted outside of students' final year educational programme and immediately prior to them starting work. Qualitative data were analysed using a framework analysis. RESULTS Emergent themes from the eleven participants were: Covid-19 as a layer on top of underlying anxieties; Degree of readiness for imminent psychological, emotional and practical challenges; Feeling valued as a health professional/radiographer at this time; A mixed student and qualified staff professional identity as HCPC temporary registrants. CONCLUSION Uncertainties related to Covid-19 were seen to add a destabilising component to existing anxieties and challenges. In this context, there are significant risks of impaired professional socialisation due to incongruence between students' expectations and the reality in clinical departments. IMPLICATIONS FOR PRACTICE Informed academic support and flexible clinical preceptorship that address anxieties and congruence barriers are vital to guide new practitioners through a health crisis that presents significant challenges but also opportunity for professional development.
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Affiliation(s)
- N Courtier
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK.
| | - P Brown
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - L Mundy
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - E Pope
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - E Chivers
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - K Williamson
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
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Affiliation(s)
- E. Pope
- The Hospital for Sick Kids 555 University Avenue Toronto ON Canada M5G 1X8
- Department of Paediatrics University of Toronto Toronto ON Canada
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11
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Shmuylovich L, Paller A, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom W, Hedlund K, Ahmad R, Garcia-Romero M, Irfan M, Kollman K, Hunt R, Stein S, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennet H, Cordoro K, Bercovitch L, Chiu Y. 385 Patterning of linear morphea on the face and neck: Blaschkoid or not? J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Previous studies suggest that the type and combination of comorbidities may impact diabetes care, but their cost implications are less clear. This study characterized how diabetes patients' health care utilization and costs may vary according to comorbidity type classified on the basis of the Piette and Kerr framework. METHODS We conducted a retrospective observational study of privately insured US adults newly diagnosed with type 2 diabetes (n = 138,466) using the 2014-2016 Optum Clinformatics® Data Mart. Diabetes patients were classified into five mutually exclusive comorbidity groups: concordant only, discordant only, both concordant and discordant, any dominant, and none. We estimated average health care costs of each comorbidity group by using generalized linear models, adjusting for patient demographics, region, insurance type, and prior-year costs. RESULTS Most type 2 diabetes patients had discordant conditions only (27%), dominant conditions (25%), or both concordant and discordant conditions (24%); 7% had concordant conditions only. In adjusted analyses, comorbidities were significantly associated with higher health care costs (p < 0.0001) and the magnitude of the association varied with comorbidity type. Diabetes patients with dominant comorbidities incurred substantially higher costs ($38,168) compared with individuals with both concordant and discordant conditions ($20,401), discordant conditions only ($9173), concordant conditions only ($9000), and no comorbidities ($3365). More than half of the total costs in our sample (53%) were attributable to 25% of diabetes patients who had dominant comorbidities. CONCLUSIONS Diabetes patients with both concordant and discordant conditions and with clinically dominant conditions incurred substantially higher health costs than other diabetes patients. Our findings suggest that diabetes management programs must explicitly address concordant, discordant, and dominant conditions because patients may have distinctly different health care needs and utilization patterns depending on their comorbidity profiles. The Piette and Kerr framework may serve as a screening tool to identify high-need, high-cost diabetes patients and suggest targets for tailored interventions. FUNDING Sanofi.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Elle Pope
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Fang Liz Zhou
- Real World Evidence and Clinical Outcomes, Sanofi, Bridgewater, NJ, USA
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Marwaha A, Malach J, Shugar A, Hedges S, Weinstein M, Parkin PC, Pope E, Lara-Corrales I, Kannu P. Genotype-phenotype data from a case series of patients with mosaic neurofibromatosis type 1. Br J Dermatol 2018; 179:1216-1217. [PMID: 29957862 DOI: 10.1111/bjd.16929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Marwaha
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - J Malach
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - A Shugar
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - S Hedges
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - M Weinstein
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - P C Parkin
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - E Pope
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - I Lara-Corrales
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
| | - P Kannu
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G1X8, Canada
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Stasiulis E, Gladstone B, Boydell K, O'Brien C, Pope E, Laxer RM. Children with facial morphoea managing everyday life: a qualitative study. Br J Dermatol 2018; 179:353-361. [PMID: 29451694 DOI: 10.1111/bjd.16449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Facial morphoea is a chronic inflammatory skin disorder, typically presenting in childhood and adolescence, which can be disfiguring, and which has been suggested to cause mild-to-moderate impairment in quality of life. OBJECTIVES To explore the everyday experiences of children with facial morphoea by examining the psychosocial impact of living with facial morphoea and how children and their families manage its impact. METHODS We used a qualitative, social constructionist approach involving focus groups, in-depth interviews and drawing activities with 10 children with facial morphoea aged 8-17 years and 13 parents. Interpretive thematic analysis was utilized to examine the data. RESULTS Children and parents reported on the stress of living with facial morphoea, which was related to the lack of knowledge about facial morphoea and the extent to which they perceived themselves as different from others. Self-perceptions were based on the visibility of the lesion, different phases of life transitions and the reactions of others (e.g. intrusive questioning and bullying). Medication routines, and side-effects such as weight gain, added to the stress experienced by the participants. To manage the impact of facial morphoea, children and their parents used strategies to normalize the experience by hiding physical signs of the illness, constructing explanations about what 'it' is, and by connecting with their peers. CONCLUSIONS Understanding what it is like to live with facial morphoea from the perspectives of children and parents is important for devising ways to help children with the disorder achieve a better quality of life. Healthcare providers can help families access resources to manage anxiety, deal with bullying and construct adequate explanations of facial morphoea, in addition to providing opportunities for peer support.
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Affiliation(s)
- E Stasiulis
- Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, Toronto, ON, Canada
| | - B Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - K Boydell
- Child and Youth Mental Health Research Unit, The Hospital for Sick Children, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Black Dog Institute, University of South Wales, Randwick, NSW, Australia
| | - C O'Brien
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - E Pope
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - R M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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Bruckner A, Fairclough D, Feinstein J, Lara-Corrales I, Lucky A, Tolar J, Pope E. Reliability and validity of the instrument for scoring clinical outcomes of research for epidermolysis bullosa (iscorEB). Br J Dermatol 2018. [DOI: 10.1111/bjd.16627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bruckner A, Fairclough D, Feinstein J, Lara-Corrales I, Lucky A, Tolar J, Pope E. 大疱性表皮松解研究流程成果评分工具(iscorEB)的可靠性和有效性. Br J Dermatol 2018. [DOI: 10.1111/bjd.16646] [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: 11/27/2022]
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Blumenthal S, Chiu Y, Baselga-Torres E, Burrows P, Ciliberto H, Cottrell C, Pope E, Streicher J, Tollefson M, Drolet B. 766 The phenotypic spectrum of vascular anomalies associated with postzygotic mosaic variants in G-proteins. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.776] [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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Chambers J, Pope E, Bungay K, Cohen J, Ciarametaro M, Dubois R, Neumann PJ. A Comparison of Coverage Restrictions for Biopharmaceuticals and Medical Procedures. Value Health 2018; 21:400-406. [PMID: 29680096 DOI: 10.1016/j.jval.2017.10.007] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/27/2017] [Accepted: 10/10/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Differences in payer evaluation and coverage of pharmaceuticals and medical procedures suggest that coverage may differ for medications and procedures independent of their clinical benefit. We hypothesized that coverage for medications is more restricted than corresponding coverage for nonmedication interventions. METHODS We included top-selling medications and highly utilized procedures. For each intervention-indication pair, we classified value in terms of cost-effectiveness (incremental cost per quality-adjusted life-year), as reported by the Tufts Medical Center Cost-Effectiveness Analysis Registry. For each intervention-indication pair and for each of 10 large payers, we classified coverage, when available, as either "more restrictive" or as "not more restrictive," compared with a benchmark. The benchmark reflected the US Food and Drug Administration label information, when available, or pertinent clinical guidelines. We compared coverage policies and the benchmark in terms of step edits and clinical restrictions. Finally, we regressed coverage restrictiveness against intervention type (medication or nonmedication), controlling for value (cost-effectiveness more or less favorable than a designated threshold). RESULTS We identified 392 medication and 185 procedure coverage decisions. A total of 26.3% of the medication coverage and 38.4% of the procedure coverage decisions were more restrictive than their corresponding benchmarks. After controlling for value, the odds of being more restrictive were 42% lower for medications than for procedures. Including unfavorable tier placement in the definition of "more restrictive" greatly increased the proportion of medication coverage decisions classified as "more restrictive" and reversed our findings. CONCLUSIONS Therapy access depends on factors other than cost and clinical benefit, suggesting potential health care system inefficiency.
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Affiliation(s)
- James Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Elle Pope
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Kathy Bungay
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Joshua Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | | | - Robert Dubois
- National Pharmaceutical Council, Washington, DC, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Olchanski N, Hansen RN, Pope E, D'Cruz B, Fergie J, Goldstein M, Krilov LR, McLaurin KK, Nabrit-Stephens B, Oster G, Schaecher K, Shaya FT, Neumann PJ, Sullivan SD. Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value. Open Forum Infect Dis 2018. [PMID: 29516023 PMCID: PMC5833316 DOI: 10.1093/ofid/ofy031] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Indexed: 01/11/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts. The objectives of the discussion were to (1) review the current state of clinical, epidemiology, and economic data related to severe RSV disease; (2) review new cost-effectiveness estimates of RSV immunoprophylaxis in US preterm infants, including a review of the field’s areas of agreement and disagreement; and (3) identify needs for further research.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Ryan N Hansen
- University of Washington School of Pharmacy, Seattle, Washington
| | - Elle Pope
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Brittany D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatology-Perinatal Medicine, Loma Linda University, Loma Linda, California
| | - Leonard R Krilov
- Pediatric Infectious Disease, NYU Winthrop Hospital, Mineola, New York
| | - Kimmie K McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Fadia T Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Sean D Sullivan
- University of Washington School of Pharmacy, Seattle, Washington
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Sibbald C, Pope E. Systematic review of cases of cutaneous T-cell lymphoma transformation in pityriasis lichenoides and small plaque parapsoriasis. Br J Dermatol 2016; 175:807-9. [DOI: 10.1111/bjd.14605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Sibbald
- Department of Dermatology; University of Toronto; Toronto ON Canada
| | - E. Pope
- Department of Dermatology; University of Toronto; Toronto ON Canada
- Division of Dermatology; The Hospital for Sick Children; Toronto ON Canada
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Garcia-Romero M, Laxer R, Pope E. Correlation of clinical tools to determine activity of localized scleroderma in paediatric patients. Br J Dermatol 2015; 174:408-10. [DOI: 10.1111/bjd.14001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M.T. Garcia-Romero
- Department of Paediatric Medicine; Dermatology Section; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - R. Laxer
- Departments of Paediatrics and Medicine; Division of Rheumatology; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - E. Pope
- Department of Paediatric Medicine; Dermatology Section; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
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Sibbald C, Randhawa H, Branson H, Pope E. Neurocutaneous melanosis and congenital melanocytic naevi: a retrospective review of clinical and radiological characteristics. Br J Dermatol 2015; 173:1522-4. [PMID: 26075503 DOI: 10.1111/bjd.13949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Sibbald
- University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
| | - H Randhawa
- Division of Dermatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - H Branson
- Department of Medical Imaging, Division of Neuroradiology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - E Pope
- Division of Dermatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Langley A, Pope E. Propranolol and central nervous system function: potential implications for paediatric patients with infantile haemangiomas. Br J Dermatol 2014; 172:13-23. [PMID: 25175684 DOI: 10.1111/bjd.13379] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 12/12/2022]
Abstract
Given its improved safety profile compared with systemic corticosteroids, propranolol has become the mainstay treatment of infantile haemangioma (IH) worldwide. There is evidence, mainly from adult volunteer studies, that propranolol use is associated with central nervous system (CNS) effects. Impairment to short- and long-term memory, psychomotor function, sleep quality and mood with relatively low doses and durations of treatment have been reported. The exact magnitude of CNS effects resulting from propranolol use, especially in the early developmental stages and for prolonged periods of use, is not currently known. These effects may not be readily recognizable and require specialized assessment of cognitive function not routinely performed. Furthermore, there may be a delay between exposure and cognitive defects. The evidence to date provides a strong rationale to proceed with caution when prescribing propranolol for IH: treatment should be used only when indicated (in the presence of ulceration, impairment of a vital function or risk of permanent disfigurement) and for a limited duration, and the benefits of treatment should be weighed carefully against potential adverse events before treatment is initiated. This narrative review describes the evidence for an effect of propranolol use on CNS function from volunteer and patient studies, including IH.
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Affiliation(s)
- A Langley
- The Hospital for Sick Children, Toronto, ON, Canada
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Pope E, Chakkittakandiyil A, Lara-Corrales I, Maki E, Weinstein M. Expanding the therapeutic repertoire of infantile haemangiomas: cohort-blinded study of oral nadolol compared with propranolol. Br J Dermatol 2012; 168:222-4. [PMID: 22762503 DOI: 10.1111/j.1365-2133.2012.11131.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ho N, Pope E, Weinstein M, Greenberg S, Webster C, Krafchik B. A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0·1% vs. clobetasol propionate 0·05% in childhood vitiligo. Br J Dermatol 2011; 165:626-32. [DOI: 10.1111/j.1365-2133.2011.10351.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [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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Lara-Corrales I, Xi N, Pope E. Childhood psoriasis treatment: evidence published over the last 5 years. Rev Recent Clin Trials 2011; 6:36-43. [PMID: 20868348 DOI: 10.2174/157488711793980174] [Citation(s) in RCA: 14] [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: 05/04/2010] [Accepted: 08/10/2010] [Indexed: 11/22/2022]
Abstract
Psoriasis is a common skin condition seen in pediatrics. Treatment modalities used to treat psoriasis in children are different from those prevailing in the adult population and require adequate testing in pediatric subjects. This article reviews the published evidence on the different treatment modalities for pediatric psoriasis over the past 5 years.
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Affiliation(s)
- I Lara-Corrales
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Szauter K, Ordas A, Laxer R, Pope E, Wherrett D, Alman B, Mink M, Boyd C, Csiszar K, Hinek A. A novel fibrotic disorder associated with increased dermal fibroblast proliferation and downregulation of genes of the microfibrillar network. Br J Dermatol 2010; 163:1102-15. [DOI: 10.1111/j.1365-2133.2010.09911.x] [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] [Indexed: 01/11/2023]
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Luca NJC, Lara-Corrales I, Pope E. Factors Predictive of Hospital Admission in Paediatric Patients with Eczema Herpeticum. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.65ab] [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: 11/14/2022] Open
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Chen J, Chao Y, Chen L, Li C, Reece W, Khan R, Pope E, Otero JC. Phase I study of pemetrexed plus cisplatin in unresectable, advanced gastric carcinoma in Taiwan. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14009 Background: Phase I of this Phase I/II study (H3E-AA-S038) was conducted to determine the recommended dose of pemetrexed (PT) when given with cisplatin (Cis) to patients with unresectable, advanced gastric carcinoma. Methods: Patients 18 to 70 years of age, with stage IV disease or post-surgery recurrence, no prior palliative chemotherapy, and an ECOG performance status of 0 or 1 were included. Patients received PT and Cis on Day 1 every 21 days. Cis was dosed at 75 mg/m2. PT dosage was planned at 600, 700, 800, and 900 mg/m2. Vitamin B12 and folic acid supplementation, and dexamethasone (or equivalent corticosteroid) prophylaxis were required. The initial number of patients to be enrolled per dose level (DL) was 3. If 0/3 patients had dose-limiting toxicity (DLT), PT dose was escalated. If 1/3 patients had DLT, 3 more patients were enrolled at that DL. If ≥2 patients had DLT, the dose was not escalated further. The recommended dose of PT for Phase II was the highest dose at which <2/6 patients experienced DLT. The following toxicities were defined as DLT: death due to toxicity; neutropenia [<0/5 × 109/L for ≥5 days, or <1.0 × 109/L with fever (≥38.5 ºC)]; thrombocytopenia (<10.0 × 109/L, or <50.0 × 109/L with bleeding); AST or ALT >20 × ULN; and non-hematological toxicities of CTC grade 3 or 4 (except nausea and vomiting). Intra-patient dose escalation was not permitted. Results: Sixteen patients were enrolled. The mean (±SD) age of enrolled patients was 52.8 (±10.0) years, and the majority were male (62.5%). At DL1, 0/3 patients experienced DLT. At DL2, 1/6 patients had DLT. At DL3, 3/7 patients had DLT, and so PT dose was not escalated. All DLTs occurred in cycle 1; 2 involved neutropenia, 1 tumor hemorrhage, and 1 hypokalemia. Grade 3/4 toxicities were experienced by 12/16 (75%) patients, including 9 (56%) hematological and 10 (63%) non-hematological events. Five out of thirteen (38%) patients with measurable disease had a RECIST response (2 had a complete response, 1 each at DL1 and DL2; 3 had a partial response, 2 at DL2 and 1 at DL3). At this interim analysis, 2 patients were still on therapy. Conclusions: The recommended dose of PT is 700 mg/m2. Phase II will examine response and safety of PT plus Cis in advanced gastric carcinoma. [Table: see text]
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Affiliation(s)
- J. Chen
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - Y. Chao
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - L. Chen
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - C. Li
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - W. Reece
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - R. Khan
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - E. Pope
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
| | - J. C. Otero
- Chang Gung Memorial Hospital, Taipei, Taiwan Republic of China; Taipei Veterans General Hospital, Taipei, Taiwan Republic of China; National Health Research Institute, Taipei, Taiwan Republic of China; Eli Lilly and Company, Sydney, Australia; Eli Lilly Asia, Hong Kong, Hong Kong Special Administrative Region of China; Eli Lilly and Company, Indianapolis, IN
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Damiani P, Gomez M, Cole A, Pope E, Aguilar R, Hammond B, Nel L, Cortez C, Vaccaro J, Sarrat E, Markey E, Dresser B. 204THE PRODUCTION OF INTRACYTOPLASMIC SPERM INJECTION LION
(PANTHERA LEO) EMBYROS USING SPERMATOZOA COLLECTED BY PERCUTANEOUS EPIDIDYMAL
SPERM ASPIRATION FROM VASECTOMIZED MALES. Reprod Fertil Dev 2004. [DOI: 10.1071/rdv16n1ab204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Contraception and/or sterilization methods have become an essential component of many captive animal management programs. Sterilization techniques are considered to be the last resort if a viable contraceptive cannot be attained and are generally not considered reversible. The African lion (Panthera leo) is one species in which sterilization techniques have been routinely applied. The objective of this study was to develop and evaluate a method for the collection of spermatozoa from male lions that have been previously rendered sterile by vasectomy. Percutaneous epididymal sperm aspiration (PESA) is a technique in which spermatozoa are aspirated from the epididymis and no surgical incision is required. In the present study, two lions (12 and 19 yrs old) were anesthetized and PESA was attempted. A 21-gauge needle attached to a 10-mL syringe (Norm-Ject) filled with 2–3mL of Tyrodes HEPES medium was gently inserted into the head of the epididymis and aspirated gently until spermatozoa were noted. Spermatozoa were visually assessed for motility (grade 1–5; 1=few motile sperm to 5=all motile), sperm concentrations were determined and then the sperm were cryopreserved. The total sperm concentration collected from the older (19yr) male was lower than that obtained from the younger (12yr) lion (0.08×106sperm/mL v. 65.5×106sperm/mL, respectively). Furthermore, more motile spermatozoa (grade 3) were collected from the younger individual compared to the older male (grade 1). Sperm samples from the 12-yr-old lion were frozen by multi-step addition of TEST yolk buffer+glycerol. Lionesses (n=3) were subjected to laparoscopic oocyte retrieval after gonadotropin treatment. A total of 38 oocytes were retrieved and 74% (28/38) were mature as determined by extrusion of the first polar body. Mature oocytes were subjected to ICSI using frozen-thawed spermatozoa obtained by PESA. More than 60% (17/28) of the injected oocytes cleaved and 100% (17/17) reached the morula stage by Day 5 or 6 of IVC. Embryos were cryopreserved and were subsequently transferred (n=15) into one lioness. We have demonstrated that it is possible to collect viable spermatozoa from sterile male lions using the PESA technique. Spermatozoa collected were motile and could be cryopreserved and functional for assisted reproductive techniques. This technique could be applied to other infertile or sterile males whose genetic background would benefit a current conservation program.
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Abstract
In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research) and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes); data analysis (Tesch’s method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.
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Pope E, Nel E, Poggenpoel M. The experience of registered nurses nursing in the general adult intensive care unit. A phenomenological qualitative research study. Curationis 1998; 21:32-8. [PMID: 10222900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research) and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes); data analysis (Tesch's method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.
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Abstract
Deferiprone (L1) is the first clinically available oral iron chelator and it has been proven to be effective for the treatment of transfusional iron overload in thalassemic patients. Because many of these patients have impaired compliance with their medications, effective means of continuous monitoring of compliance are crucial. Saliva drug monitoring has the potential advantage of an easy, noninvasive approach, assuming that it represents serum levels. However, drugs have variable correlations between saliva and serum concentration. We compared serum and saliva levels of L1 at various time points after ingestion of a 75 mg/kg/day dose in nine thalassemic patients. A highly significant correlation between serum-free L1 and saliva levels (r = 0.97, p = 0.0003) was found. Pharmacokinetic profiles were similar using serum and saliva monitoring. We conclude that saliva can be substituted for serum in monitoring L1 levels.
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Affiliation(s)
- E Pope
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
BACKGROUND Pemoline is a central nervous system stimulant used in treating children with attention deficit-hyperactivity disorder. Hepatotoxicity has been commonly reported in association with pemoline; however, only two reports of cases of fatal liver failure have been published. OBJECTIVES We report on a 14-year-old boy who received concomitant pemoline and methylphenidate in whom fulminant liver failure occurred and for whom liver transplantation failed. Other causes of fulminant liver failure were ruled out, and the liver biopsy was suggestive of drug toxicity. We estimated the probability that these three cases represent an increased risk of fulminant liver failure associated with pemoline. RESULTS Based on the three known cases of fatal liver failure associated with pemoline use, we calculated that a child receiving pemoline has a relative risk of development of fulminant liver failure of 45.3 (95% confidence interval, 4.1 to 510). This highly significant association (p < 0.001) suggests causation. CONCLUSIONS Because pemoline has been widely used in recent years, further studies are needed to better quantify this risk in children with attention deficit-hyperactivity disorder.
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Affiliation(s)
- M Berkovitch
- Division of Clinical Pharmacology/Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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Barrett RJ, Pope E. What is your diagnosis? Circumscribed metallic foreign body in the pelvic canal. J Am Vet Med Assoc 1992; 201:1093-4. [PMID: 1429143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R J Barrett
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia 65211
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Pope E. Toxoplasmosis. Midwives Chron 1992; 105:300-3. [PMID: 1305941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
The percentages of change in cross-sectional area and dorsoventral height of the rima glottidis were measured after seven types of laryngoplasty in 30 postmortem canine specimens. The mean increases in area after each procedure were, in decreasing order, bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures 350% +/- 42%, bilateral placement of arytenoid abduction sutures 318% +/- 40%, bilateral cricothyroid disarticulation before placement of arytenoid abduction sutures 255% +/- 51%, modified castellated laryngofissure 244% +/- 30%, unilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of an arytenoid abduction suture 161% +/- 25%, unilateral placement of an arytenoid abduction suture 151% +/- 24% and unilateral cricothyroid disarticulation before placement of an arytenoid abduction suture 108% +/- 25%. Bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures resulted in a significantly greater increase in rima glottidis area than modified castellated laryngofissure and all unilateral arytenoid abduction techniques. Modified castellated laryngofissure resulted in a significantly greater increase than unilateral placement of an arytenoid abduction suture and cricothyroid disarticulation before placement of an arytenoid abduction suture. Bilateral disarticulation of the cricothyroid joint before placement of arytenoid abduction sutures resulted in significant collapse of the dorsoventral height of the rima glottidis.
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Affiliation(s)
- S Lozier
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia
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Abstract
Four chlorhexidine diacetate (CHD) antiseptic wound lavage preparations were evaluated in vivo to determine their effects on second intention wound healing in the dog in vitro to determine their relative antibacterial activity against Staphylococcus intermedius. Chlorhexidine was diluted to 0.05% in sterile water, 0.9% sodium chloride, lactated Ringers solution (LRS), and LRS that was allowed to form a precipitate with CHD. Control solutions included sterile water and LRS. There were no significant differences in wound contraction or epithelialization. All 0.05% CHD preparations provided 100% bacterial kill.
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Affiliation(s)
- S Lozier
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia
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Muss HB, Case D, Cooper MR, Richards F, Spurr CL, Resnick MI, Zekan P, Nelson EC, Puckett JB, Pope E. Cytotoxic chemotherapy and androgen priming in patients with advanced carcinoma of the prostate. A phase II trial of the Piedmont Oncology Association. Am J Clin Oncol 1985; 8:396-400. [PMID: 4061374 DOI: 10.1097/00000421-198510000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Twenty-three patients with advanced prostatic cancer refractory to hormonal therapy were entered into a phase II study of cytotoxic chemotherapy combined with androgen priming. Patients received vincristine 0.5 mg on day 1; fluoxymesterone 10 mg p.o. TID, days 1-5; methotrexate 4 mg/m2 p.o., days 1-7; and cyclophosphamide 500 mg/m2 I.V., day 8. Patients entered had no prior chemotherapy, most were symptomatic but ambulatory (18/23), and almost all had bone metastases (22/23). There were two stable responses and 14 progressions in 16 patients evaluable for response. Hematologic and gastrointestinal toxicities were substantial. Androgen priming was an unsatisfactory method of improving response in this trial.
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Powell BL, Jackson DV, Scarantino CW, Pope E, Choplin R, Craig JB, Atkins JN, Cooper MR, Hopkins JO, McMahan R, Muss HB, Richards F, Stuart JJ, White DR, Zekan P, Spurr CL, Capizzi RL. Sequential hemibody and local irradiation with combination chemotherapy for small cell lung carcinoma: a preliminary analysis. Int J Radiat Oncol Biol Phys 1985; 11:457-62. [PMID: 2982771 DOI: 10.1016/0360-3016(85)90175-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sequential hemibody irradiation (SHB) was integrated with combination chemotherapy and local irradiation (LRT) in the induction and consolidation phases of a therapeutic protocol for small cell lung carcinoma (SCLC). Forty-one previously untreated patients were entered into this program. Among 38 evaluable patients (20 with limited disease [LD] and 18 with extensive disease [ED], the overall response rate was 63% (90% in LD and 33% in ED patients). The estimated overall survival is 8.1 months. The major toxicity has been myelosuppression--especially thrombocytopenia. The frequency of previously described "acute radiation syndromes" and radiation pneumonitis associated with hemibody irradiation have been substantially decreased at the current dosage with premedication and shielding techniques. The integration of SHB as a systemic therapy with combination chemotherapy and LRT is a feasible program for sequential administration of non-cross-resistant agents in SCLC and may be beneficial in patients with limited disease.
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Pope E. Where do they keep things? A two-week induction programme. NATNEWS 1984; 21:19. [PMID: 6569988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Hopkins J, Richards F, Case D, Pope E, Jackson DV, Stuart JJ, Muss HB, White DR, Cooper MR, Spurr CL. A phase II study of dibromodulcitol (DBD) in stage IV melanoma. Am J Clin Oncol 1984; 7:555-6. [PMID: 6507378 DOI: 10.1097/00000421-198410000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Twenty-four patients were evaluated in a non-randomized study to assess the effectiveness of dibromodulcitol (DBD) in Stage IV melanoma. Patients received 100 mg/m2 of DBD orally for 35 days. The dose was escalated to 130 mg/m2 and then to 160 mg/m2 if no significant hematologic toxicity occurred. There were no objective responses, including six patients who had had no prior chemotherapy. Five patients (21%) remained stable. Median survival was 151 days. Survival favored females, nonvisceral involvement pretherapy, and patients with a disease-free interval (DFI) of greater than 1 year. None of these advantages was statistically significant. Toxicity was predominantly hematologic, but nausea, vomiting, shortness of breath, and diarrhea were also seen. Oral DBD, using this dose and schedule, does not appear efficacious in advanced disseminated melanoma.
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Muss HB, Richards F, Jackson DV, Cooper MR, White DR, Stuart JJ, Ramseur W, Christian RM, Wells HB, Pope E, Spurr CL. Vincristine, doxorubicin, and cyclophosphamide versus low-dose intravenous cyclophosphamide, methotrexate, and 5-fluorouracil in advanced breast cancer: a randomized trial of the Piedmont Oncology Association. Cancer 1982; 50:2269-74. [PMID: 6754062 DOI: 10.1002/1097-0142(19821201)50:11<2269::aid-cncr2820501107>3.0.co;2-l] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eighty-one evaluable patients with recurrent or metastatic breast cancer were randomized to receive either vincristine 1 mg/m2, doxorubicin 40 mg/m2 on day one and cyclophosphamide 200 mg/m2 orally days 3-6 (VAC); or cyclophosphamide 350 mg/m2, methotrexate 20 mg/m2, and 5-fluorouracil 350 mg/m2 (CMF) intravenously, all on day 1. Courses of each of the above regimens were repeated every three weeks. Twenty-one of 45 patients (47%) on VAC and seven of 44 patients (16%) on CMF had complete or partial response (P less than 0.05). The duration of response was six months for CMF and nine months for VAC. Hematologic toxicity was minimal for both groups but three patients receiving VAC developed cardiac toxicity. Overall survival projections at this time indicate no differences between the VAC or CMF treated patients.
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Savill PM, Pope E. Experience in a child health clinic. Br Med J 1979; 1:1014. [PMID: 435911 PMCID: PMC1598654 DOI: 10.1136/bmj.1.6169.1014-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Pope E. RES MEDICINAE ET CIVITATIS. Can Med Assoc J 1934; 31:194-197. [PMID: 20319619 PMCID: PMC403502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Pope E. THE EXAMINATION OF MEDICAL STUDENTS. Can Med Assoc J 1933; 29:427-428. [PMID: 20319278 PMCID: PMC403066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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