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Borowsky PA, Yoon K, Eroraha A, Bonsu JM, Kington D, Lawani PE, Smith RN, Bliton JN. General surgery textbooks and surgical disparities. J Natl Med Assoc 2024; 116:145-152. [PMID: 38245468 DOI: 10.1016/j.jnma.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Some academic textbooks have previously disseminated simplistic or even incorrect conceptions of race. Propagation of such ideas in General Surgery could contribute to gaps in quality of care received by minority patients. This study aims to determine whether General Surgery textbooks provide a thorough understanding of racial disparities. METHODS General Surgery texts were drawn from Doody's list, an industry-standard list of textbooks for medical education. Technical guides, atlases, and books for non-General Surgery professionals were excluded. Passages mentioning medical differences amongst racial and ethnic groups were extracted. Six binary classifications were made, based on whether passages (a) described interventions to alleviate difference; (b) addressed environmental mediators of difference; (c) described the contribution of racism or discrimination; (d) used causal language to connect race to difference; (e) referred to known, heritable genetic mechanisms; and (f) directly provided a reference. Types of intervention were also extracted. A heuristic scale was calculated granting one point each for classifications a-c and losing one point for classification d. Three authors performed classifications, and raw agreement and Cohen's kappa were used to assess inter-rater reliability. RESULTS Thirteen textbooks from Doody's list contained 511 passages discussing medical differences among racial/ethnic groups. Among passages, 25% discussed white people, 22% Black people/African Americans, 19% Asians, 9% Latinos, 4% Jewish/Ashkenazi people, 3% Native Americans, and 18% other. Fifteen passages (2.9%) used language indicating race was the cause of medical difference, and only two explicitly discussed racism or discrimination. Most passages (370, 72.3%) received a scale of 0. 120 (23.5%) received a scale of 1, eight (1.2%) received a scale of 2, and zero received a scale of 3. The mean passage scale was 0.24 and is not changing with time (regression coefficient -0.006/year, p = 0.538). Agreement was 91.2% across all categories and overall Kappa was 0.62. CONCLUSIONS General Surgery textbooks do not provide readers with scientifically thorough understanding of health disparities. Teaching more comprehensive conceptions, including systemic causes and the role of racism, may prevent reflexive association of minority patients with poor outcomes. Future editions should include these details where disparities are discussed in an independent, comprehensive section.
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Affiliation(s)
- Peter A Borowsky
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | | | | | - Janice M Bonsu
- Emory University School of Medicine, Department of ORthopaedic Surgery, Atlanta GA, United States
| | - Daniella Kington
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | - Phyllis E Lawani
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Women's Health, Brooklyn, NY, United States
| | - Randi N Smith
- Emory University School of Medicine, Department of Acute Care Surgery, Atlanta GA, United States
| | - John N Bliton
- Jamaica Hospital Medical Center, Department of Surgery, Queens, NY, United States.
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Heo KY, Bonsu JM, Muffly BT, Rieger E, Song J, Ayeni AM, Guild GN, Premkumar A. Complications Rates Among Revision Total Knee Arthroplasty Patients Diagnosed With COVID-19 Postoperatively. J Arthroplasty 2024; 39:766-771.e2. [PMID: 37757979 DOI: 10.1016/j.arth.2023.09.028] [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: 06/06/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic introduced a new set of challenges for the arthroplasty community, including the management of patients diagnosed with COVID-19 following revision total knee arthroplasty (rTKA) and its potential impact on postoperative recovery. This study sought to characterize the risks of postoperative COVID-19 infection among rTKA patients. METHODS A large national database was utilized to query 8,022 total patients who underwent rTKA between 2018 and 2021, of which 60 had a COVID diagnosis within 90 days after surgery (rTKA/COVID positive). These patients were 1:10 propensity-score matched to 600 rTKA patients who did not have a 90-day postoperative COVID diagnosis (rTKA/COVID negative) and 600 COVID positive patients who did not undergo rTKA. Controlling for potential confounders, multivariate logistic regressions were utilized to compare 90-day postoperative complications between groups. RESULTS Compared to rTKA/COVID negativepatients, the rTKA/COVID positive cohort had significantly higher rates of pneumonia (odds ratio [OR] = 6.1, P < .001), pulmonary embolism (PE) (OR = 32.4, P < .001), deep venous thrombosis (DVT) (OR = 32.4, P < .001), and 90-day readmissions (OR = 2.1, P = .02). Similarly, the rTKA/COVID positive cohort had significantly higher rates of pneumonia (OR = 4.3, P = .001), PE (OR = 36.8, P < .001), and DVT (OR = 36.8, P < .001) compared to COVID positive patients who did not undergo rTKA. CONCLUSIONS Revision total knee arthroplasty patients diagnosed with COVID-19 postoperatively had increased rates of thromboembolic events, pneumoniae, and 90-day readmissions. Risk mitigation efforts would suggest extending the prophylactic anticoagulation period for rTKA patients diagnosed with postoperative COVID-19.
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Affiliation(s)
- Kevin Y Heo
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Janice M Bonsu
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Brian T Muffly
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth Rieger
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Joseph Song
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ayomide M Ayeni
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Bliton JN, Paul J, Smith AD, Duran RG, Sola R, Chaudhary S, Fraser Doh K, Koganti D, Dantes G, Hernandez Irizarry RC, Bonsu JM, Welch TT, Richard RA, Smith RN. Increases in adolescent firearm injuries were associated with school closures during COVID-19. Injury 2023; 54:110824. [PMID: 37296010 PMCID: PMC10246889 DOI: 10.1016/j.injury.2023.05.055] [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: 09/29/2022] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mitigation measures, including school closures, were enacted to protect the public during the COVID-19 pandemic. However, the negative effects of mitigation measures are not fully known. Adolescents are uniquely vulnerable to policy changes since many depend on schools for physical, mental, and/or nutritional support. This study explores the statistical relationships between school closures and adolescent firearm injuries (AFI) during the pandemic. METHODS Data were drawn from a collaborative registry of 4 trauma centers in Atlanta, GA (2 adult and 2 pediatric). Firearm injuries affecting adolescents aged 11-21 years from 1/1/2016 to 6/30/2021 were evaluated. Local economic and COVID data were obtained from the Bureau of Labor Statistics and the Georgia Department of Health. Linear models of AFI were created based on COVID cases, school closure, unemployment, and wage changes. RESULTS There were 1,330 AFI at Atlanta trauma centers during the study period, 1,130 of whom resided in the 10 metro counties. A significant spike in injuries was observed during Spring 2020. A season-adjusted time series of AFI was found to be non- stationary (p = 0.60). After adjustment for unemployment, seasonal variation, wage changes, county baseline injury rate, and county-level COVID incidence, each additional day of unplanned school closure in Atlanta was associated with 0.69 (95% CI 0.34- 1.04, p < 0.001) additional AFIs across the city. CONCLUSION AFI increased during the COVID pandemic. This rise in violence is statistically attributable in part to school closures after adjustment for COVID cases, unemployment, and seasonal variation. These findings reinforce the need to consider the direct implications on public health and adolescent safety when implementing public policy.
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Affiliation(s)
| | | | | | | | - Richard Sola
- Morehouse School of Medicine, USA; Grady Memorial Hospital, USA
| | - Sofia Chaudhary
- Children's Healthcare of Atlanta, USA; Emory University School of Medicine, USA
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, USA; Emory University School of Medicine, USA
| | - Deepika Koganti
- Grady Memorial Hospital, USA; Emory University School of Medicine, USA
| | | | | | | | | | | | - Randi N Smith
- Grady Memorial Hospital, USA; Emory University School of Medicine, USA; Emory University Rollins School of Public Health, USA
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Buck B, Chum AP, Patel M, Carter R, Nawaz H, Yildiz V, Ruz P, Wiczer T, Rogers KA, Awan FT, Bhat S, Guha A, Kittai AS, Simonetti OP, Raman SV, Wallace G, Sanchez R, Bonsu JM, Gambril J, Haddad D, Mann J, Wei L, Kola-Kehinde O, Byrd JC, Woyach JA, Addison D. Cardiovascular Magnetic Resonance Imaging in Patients With Ibrutinib-Associated Cardiotoxicity. JAMA Oncol 2023; 9:552-555. [PMID: 36729480 PMCID: PMC9896369 DOI: 10.1001/jamaoncol.2022.6869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023]
Abstract
Importance Ibrutinib has been associated with serious cardiotoxic arrhythmias. In preclinical models, these events are paralleled or proceeded by diffuse myocardial injury (inflammation and fibrosis). Yet whether this is seen in patients or has implications for future cardiotoxic risk is unknown. Objective To assess the incidence and outcomes of myocardial injury among patients with ibrutinib-related cardiotoxicity. Design, Setting, and Participants This cohort study included consecutive patients treated with ibrutinib from 2012 to 2019, phenotyped using cardiovascular magnetic resonance (CMR) from a large US Comprehensive Cancer Center registry. Exposures Ibrutinib treatment for cancer control. Main Outcomes and Measures The primary outcome was the presence of late gadolinium enhancement (LGE) fibrosis. The secondary outcome was the occurrence of major adverse cardiac events (MACE), defined as atrial fibrillation, heart failure, symptomatic ventricular arrhythmias, and sudden death of probable or definite ibrutinib association after CMR. We also assessed parametric-mapping subclinical fibrosis (native-T1, extracellular volume fraction) and inflammation/edema (max-T2) measures. Cardiovascular magnetic resonance measures were compared with those obtained in similar consecutive patients with cancer without ibrutinib treatment (pretreatment controls). Observed measures were also compared with similar-aged broad population rates (general-population controls) and a broader pool of cardiovascular disease (CVD) risk-matched cancer controls. Multivariable regression was used to assess the association between CMR measures and MACE. Results Overall, 49 patients treated with ibrutinib were identified, including 33 imaged after treatment initiation (mean [SD] age, 65 [10] years, 9 [27%] with hypertension, and 23 [69.7%] with index-arrhythmias); median duration of ibrutinib-use was 14 months. The mean (SD) pretreatment native T1 was 977.0 (73.0) ms, max-T2 56.5 (4.0) ms, and 4 (13.3%) had LGE. Posttreatment initiation, mean (SD) native T1 was 1033.7 (48.2) ms, max-T2 61.5 (4.8) ms, and 17 (54.8%) had LGE (P < .001, P = .01, and P < .001, respectively, pre- vs post-ibrutinib treatment). Native T12SDs was elevated in 9 (28.6%), and max-T22SDs in 21 (63.0%), respectively. Cardiovascular magnetic resonance measures were highest in those with suspected toxic effects (P = .01 and P = .01, respectively). There was no association between traditional CVD-risk or cancer-treatment status and abnormal CMR measures. Among those without traditional CVD, 16 (58.6%) had LGE vs 38 (13.3%) in matched-controls (relative-risk, 4.8; P < .001). Over a median follow-up of 19 months, 13 (39.4%) experienced MACE. In multivariable models inclusive of traditional CVD risk factors, LGE (hazard ratio [HR], 4.9; P = .04), and native-T12SDs (HR, 3.3; P = .05) associated with higher risks of MACE. Conclusions and Relevance In this cohort study, myocardial injury was common in ibrutinib users, and its presence was associated with higher cardiotoxic risk.
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Affiliation(s)
- Benjamin Buck
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Aaron P. Chum
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Mitkumar Patel
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Rebecca Carter
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus
| | - Haseeb Nawaz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Vedat Yildiz
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Tracy Wiczer
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Kerry A. Rogers
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Farrukh T. Awan
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
- Division of Hematology/Oncology, University of Texas-Southwestern Medical Center, Dallas
| | - Seema Bhat
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
| | - Adam S. Kittai
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Orlando P. Simonetti
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Department of Biomedical Engineering, The Ohio State University, Columbus
| | - Subha V. Raman
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, Indiana University School of Medicine, Indianapolis
| | - Grant Wallace
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Reynaldo Sanchez
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Janice M. Bonsu
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - John Gambril
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - Devin Haddad
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - James Mann
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
| | - John C. Byrd
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Jennifer A. Woyach
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus
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Yoon K, Eroraha A, Lutton E, Kington D, Bonsu JM, Lawani PE, Smith RN, Bliton JN. What do Trauma Surgery Textbooks Teach About Racial Disparities and the Roots of Violence? Am Surg 2023:31348231161675. [PMID: 36912008 DOI: 10.1177/00031348231161675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This study presents a formal text analysis of trauma surgery textbooks. We examine passages that describe disparities or mechanisms of injury, and we report types of underlying causes and preventative interventions discussed. Trauma textbooks were drawn from an industry-standard list used by medical libraries. Chi-square testing was used to determine whether different types of underlying causes or preventative interventions were discussed by disparity type (those affecting racial minorities vs rural populations) and injury mechanism (accidental injuries vs intentional interpersonal injury). 146 passages were extracted from 7 textbooks, totaling 5576 pages of text. Passages discussing rural disadvantages or unintentional injury were substantially more likely to describe structural risk factors or governmental interventions than those discussing racial disadvantages or intentional injury, respectively. Textbook authors should consider enriching discussion of violence prevention or racial disparities to emphasize structural causes and interventions.
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Affiliation(s)
- Kyung Yoon
- 4129Ross University School of Medicine, Miramar, FL, USA
| | - Ajiri Eroraha
- 4129Ross University School of Medicine, Miramar, FL, USA
| | - Evan Lutton
- Weill Cornell Medical College, New York Presbyterian Hospital, General Surgery Residency, New York NY, USA
| | - Daniella Kington
- 24444Wellstar Atlanta Medical Center, Department of Surgery, Atlanta, GA, USA
| | - Janice M Bonsu
- Emory College of Medicine, Department of Orthopaedic Surgery, Atlanta, GA, USA
| | - Phyllis E Lawani
- 23303Lifebridge Health Sinai Hospital, Department of Obstetrics and Gynecology, Baltimore MD, USA
| | - Randi N Smith
- 1371Emory University, Department of Acute Care Surgery, Atlanta, GA, USA
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Bonsu JM, Feroe AG. What's Important: Public Health in Orthopaedic Surgery. J Bone Joint Surg Am 2022; 104:755-756. [PMID: 34473663 DOI: 10.2106/jbjs.21.00796] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Janice M Bonsu
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Aliya G Feroe
- Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts
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Pernica JM, Arscott-Mills T, Steenhoff AP, Mokomane M, Moorad B, Bapabi M, Lechiile K, Mangwegape O, Batisani B, Mawoko N, Muthoga C, Vanniyasingam T, Ewusie J, Lowe A, Bonsu JM, Gezmu AM, Smieja M, Mazhani L, Stordal K, Thabane L, Kelly MS, Goldfarb DM. Optimising the management of childhood acute diarrhoeal disease using a rapid test-and- treat strategy and/or Lactobacillus reuteri DSM 17938: a multicentre, randomised, controlled, factorial trial in Botswana. BMJ Glob Health 2022; 7:bmjgh-2021-007826. [PMID: 35418412 PMCID: PMC9014020 DOI: 10.1136/bmjgh-2021-007826] [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] [Received: 10/27/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The study aim was to determine if rapid enteric diagnostics followed by the provision of targeted antibiotic therapy ('test-and-treat') and/or Lactobacillus reuteri DSM 17938 would improve outcomes in children hospitalised in Botswana with acute gastroenteritis. METHODS This was a multicentre, randomised, factorial, controlled, trial. Children aged 2-60 months admitted for acute non-bloody diarrhoea to four hospitals in southern Botswana were eligible. Participants were assigned to treatment groups by web-based block randomisation. Test-and-treat results were not blinded, but participants and research staff were blinded to L. reuteri/placebo assignment; this was dosed as 1×108 cfu/mL by mouth daily and continued for 60 days. The primary outcome was 60-day age-standardised height (HAZ) adjusted for baseline HAZ. All analyses were by intention to treat. The trial was registered at Clinicaltrials.gov. RESULTS Recruitment began on 12 June 2016 and continued until 24 October 2018. There were 66 participants randomised to the test-and-treat plus L. reuteri group, 68 randomised to the test-and-treat plus placebo group, 69 to the standard care plus L. reuteri group and 69 to the standard care plus placebo group. There was no demonstrable impact of the test-and-treat intervention (mean increase of 0.01 SD, 95% CI -0.14 to 0.16 SD) or the L. reuteri intervention (mean decrease of 0.07 SD, 95% CI -0.22 to 0.08 SD) on adjusted HAZ at 60 days. CONCLUSIONS In children hospitalised for acute gastroenteritis in Botswana, neither a test-and-treat algorithm targeting enteropathogens, nor a 60-day course of L. reuteri DSM 17938, were found to markedly impact linear growth or other important outcomes. We cannot exclude the possibility that test-and-treat will improve the care of children with significant enteropathogens (such as Shigella) in their stool. TRIAL REGISTRATION NUMBER NCT02803827.
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Affiliation(s)
- Jeffrey M Pernica
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada .,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tonya Arscott-Mills
- Botswana-UPenn Partnership, Gaborone, Botswana.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew P Steenhoff
- Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Margaret Mokomane
- Department of Microbiology, University of Botswana, Gaborone, South-East District, Botswana
| | | | | | | | | | | | | | - Charles Muthoga
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Gaborone, Botswana
| | - Thuvaraha Vanniyasingam
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Amy Lowe
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Janice M Bonsu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alemayehu M Gezmu
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Marek Smieja
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Loeto Mazhani
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Ketil Stordal
- Pediatric Research Institute, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Lehana Thabane
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.,The Research Institute-Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,University of Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Matthew S Kelly
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Bonsu JM, Kola-Kehinde O, Kim L, Ruz P, Campbell CM, Brammer JE, Addison D. Cardiovascular Safety Communications After US Food and Drug Administration Approval of Contemporary Cancer Therapies. JAMA Oncol 2021; 7:1722-1723. [PMID: 34591072 DOI: 10.1001/jamaoncol.2021.4771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Janice M Bonsu
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Onaopepo Kola-Kehinde
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Lisa Kim
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Courtney M Campbell
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Jonathan E Brammer
- Division of Hematology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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9
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Affiliation(s)
- Janice M Bonsu
- The Ohio State University College of Medicine, Columbus, Ohio
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10
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Myers RK, Carey ME, Bonsu JM, Yerys BE, Mollen CJ, Curry AE. Behind the Wheel: Specialized Driving Instructors' Experiences and Strategies for Teaching Autistic Adolescents to Drive. Am J Occup Ther 2021; 75:12501. [PMID: 34781345 DOI: 10.5014/ajot.2021.043406] [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: 11/17/2022] Open
Abstract
IMPORTANCE In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence. OBJECTIVE To examine specialized driving instructors' experiences providing behind-the-wheel instruction to autistic adolescents. DESIGN We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students' strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach. SETTING Telephone interviews. PARTICIPANTS Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated. RESULTS Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students' strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions. CONCLUSIONS AND RELEVANCE Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving. What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.
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Affiliation(s)
- Rachel K Myers
- Rachel K. Myers, PhD, MS, is Research Scientist, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, and Research Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia;
| | - Meghan E Carey
- Meghan E. Carey, MS, is Doctoral Student, Dornsife School of Public Health, Drexel University, Philadelphia, PA. At the time this work was conducted, Carey was Research Coordinator, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Janice M Bonsu
- Janice M. Bonsu, MPH, is Medical Student, Ohio State University College of Medicine, Columbus. At the time this work was conducted, Bonsu was Research Assistant, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Benjamin E Yerys
- Benjamin E. Yerys, PhD, is Scientist, Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, and Assistant Professor, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cynthia J Mollen
- Cynthia J. Mollen, MD, MSCE, is Professor and Chief, Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Faculty, PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison E Curry
- Allison E. Curry, PhD, MPH, is Senior Scientist and Director of Epidemiology, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, and Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Malik AT, Bonsu JM, Roser M, Khan SN, Phieffer LS, Ly TV, Harrison RK, Quatman CE. What Is the Quality of Surgical Care for Patients with Hip Fractures at Critical Access Hospitals? Clin Orthop Relat Res 2021; 479:9-16. [PMID: 32833925 PMCID: PMC7899572 DOI: 10.1097/corr.0000000000001458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Critical access hospitals (CAHs) play an important role in providing access to care for many patients in rural communities. Prior studies have shown that these facilities are able to provide timely and quality care for patients who undergo various elective and emergency general surgical procedures. However, little is known about the quality and reimbursement of surgical care for patients undergoing surgery for hip fractures at CAHs compared with non-CAH facilities. QUESTIONS/PURPOSES Are there any differences in 90-day complications, readmissions, mortality, and Medicare payments between patients undergoing surgery for hip fractures at CAHs and those undergoing surgery at non-CAHs? METHODS The 2005 to 2014 Medicare 100% Standard Analytical Files were queried using ICD-9 procedure codes to identify Medicare-eligible beneficiaries undergoing open reduction and internal fixation (79.15, 79.35, and 78.55), hemiarthroplasty (81.52), and THA (81.51) for isolated closed hip fractures. This database was selected because the claims capture inpatient diagnoses, procedures, charged amounts and paid claims, as well as hospital-level information of the care, of Medicare patients across the nation. Patients with concurrent fixation of an upper extremity, lower extremity, and/or polytrauma were excluded from the study to ensure an isolated cohort of hip fractures was captured. The study cohort was divided into two groups based on where the surgery took place: CAHs and non-CAHs. A 1:1 propensity score match, adjusting for baseline demographics (age, gender, Census Bureau-designated region, and Elixhauser comorbidity index), clinical characteristics (fixation type and time to surgery), and hospital characteristics (whether the hospital was located in a rural ZIP code, the average annual procedure volume of the operating facility, hospital bed size, hospital ownership and teaching status), was used to control for the presence of baseline differences in patients presenting at CAHs and those presenting at non-CAHs. A total of 1,467,482 patients with hip fractures were included, 29,058 of whom underwent surgery in a CAH. After propensity score matching, each cohort (CAH and non-CAH) contained 29,058 patients. Multivariate logistic regression analyses were used to assess for differences in 90-day complications, readmissions, and mortality between the two matched cohorts. As funding policies of CAHs are regulated by Medicare, an evaluation of costs-of-care (by using Medicare payments as a proxy) was conducted. Generalized linear regression modeling was used to assess the 90-day Medicare payments among patients undergoing surgery in a CAH, while controlling for differences in baseline demographics and clinical characteristics. RESULTS Patients undergoing surgery for hip fractures were less likely to experience many serious complications at a critical access hospital (CAH) than at a non-CAH. In particular, after controlling for patient demographics, hospital-level factors and procedural characteristics, patients treated at a CAH were less likely to experience: myocardial infarction (3% (916 of 29,058) versus 4% (1126 of 29,058); OR 0.80 [95% CI 0.74 to 0.88]; p < 0.001), sepsis (3% (765 of 29,058) versus 4% (1084 of 29,058); OR 0.69 [95% CI 0.63 to 0.78]; p < 0.001), acute renal failure (6% (1605 of 29,058) versus 8% (2353 of 29,058); OR 0.65 [95% CI 0.61 to 0.69]; p < 0.001), and Clostridium difficile infections (1% (367 of 29,058) versus 2% (473 of 29,058); OR 0.77 [95% CI 0.67 to 0.88]; p < 0.001) than undergoing surgery in a non-CAH. CAHs also had lower rates of all-cause 90-day readmissions (18% (5133 of 29,058) versus 20% (5931 of 29,058); OR 0.83 [95% CI 0.79 to 0.86]; p < 0.001) and 90-day mortality (4% (1273 of 29,058) versus 5% (1437 of 29,058); OR 0.88 [95% CI 0.82 to 0.95]; p = 0.001) than non-CAHs. Further, CAHs also had risk-adjusted lower 90-day Medicare payments than non-CAHs (USD 800, standard error 89; p < 0.001). CONCLUSION Patients who received hip fracture surgical care at CAHs had a lower risk of major medical and surgical complications than those who had surgery at non-CAHs, even though Medicare reimbursements were lower as well. Although there may be some degree of patient selection at CAHs, these facilities appear to provide high-value care to rural communities. These findings provide evidence for policymakers evaluating the impact of the CAH program and allocating funding resources, as well as for community members seeking emergent care at local CAH facilities. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Azeem Tariq Malik
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Janice M Bonsu
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan Roser
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura S Phieffer
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ryan K Harrison
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- A. T. Malik, S. N. Khan, Division of Spine, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
- J. M. Bonsu, M. Roser, L. S. Phieffer, T. V. Ly, R. K. Harrison, C. E. Quatman, Division of Orthopaedic Trauma, Department of Orthopaedics, the Ohio State University Wexner Medical Center, Columbus, OH, USA
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Myers RK, Bonsu JM, Carey ME, Yerys BE, Mollen CJ, Curry AE. Teaching Autistic Adolescents and Young Adults to Drive: Perspectives of Specialized Driving Instructors. Autism Adulthood 2019; 1:202-209. [PMID: 32292888 DOI: 10.1089/aut.2018.0054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Limited transportation access may curtail education, occupational training, social, and community engagement opportunities for autistic adolescents. Nearly one-third of autistic adolescents obtain a driver's license by age 21 years, which may increase mobility and improve autistic adolescents' transition to independent adulthood. This study examined driving instructors' perspectives and experiences of teaching autistic adolescents to drive to facilitate a safe learning-to-drive process. Methods: We conducted interviews with driving instructors with specialized training to teach autistic adolescents to drive. Participants were recruited through purposive and snowball sampling. Semistructured interviews investigated family engagement; instructor observations; instructors' teaching strategies; and recommendations for improving the learning-to-drive process. A directed content analysis approach informed the development of a coding scheme. Coded transcripts were reviewed to identify themes. Results: We interviewed 17 driving instructors who primarily identified as occupational therapists. Key themes included importance of parent engagement; fostering independence; individualization of instructional strategies; and enhancements to the learning-to-drive process. Parent engagement prepared autistic students to undertake on-road instruction and supported skill development. While some families paradoxically limited adolescents' independence (e.g., heavy supervision while cooking, limiting participation in bicycling or lawn mowing) despite wanting them to pursue licensure, instructors believed that demonstrating independence in such life skills was necessary for safely undertaking on-road instruction. Instructors shared how they individualized assessments and tailored lessons over a prolonged period of time to promote safety and skill acquisition. Specific recommendations for enhancing the learning-to-drive process included standardizing instructional approaches and refining clinical assessment tools to determine driver readiness. Conclusions: Our findings highlight the need for parental engagement to support the learning-to-drive process and to foster the independence necessary to undertake highly individualized driving instruction. Efforts to increase families' access to tools to promote driving readiness and establishing best practices for instructors may enhance the efficiency and standardization of the learning-to-drive process. Lay summary Why was this study done? Becoming licensed to drive increases the independence and mobility of adolescents, potentially improving access to educational, occupational training, social, and community engagement opportunities. Driving instructors are a critical resource for families, particularly for autistic adolescents who may receive training from specialized instructors, such as occupational therapists (OTs). However, little is known about the process and experience of teaching autistic adolescents to drive, which limits the ability to provide adolescents and families with guidance to prepare for and support the learning-to-drive process. What was the purpose of this study? The goal of this study was to examine the experiences and perspectives of driving instructors who provide behind-the-wheel training for autistic adolescents and young adults. What did the researchers do? We conducted semistructured interviews with specialized driving instructors who had experience working with autistic youth. Team members transcribed the interviews, coded them, and summarized common themes. What were the results of the study? We interviewed 17 driving instructors who primarily identified as OTs. Key themes included the importance of parents as partners, the need to encourage independence in daily living skills before driving, and the individualized approach used when working with autistic adolescents. Instructors provided suggestions for enhancing the learning-to-drive process and supporting nonspecialized instructors who also provide training to adolescents. Suggestions included enhancing the use of state-level Vocational Rehabilitation Services to provide financial support for instruction, use of a life skills checklist to identify and promote prerequisite driving skills, parent-supervised practice driving (including commentary driving where adolescents narrate driving instructions to a driver), and individualization of instruction tailored to adolescents' particular needs. What do these findings add to what was already known? These results inform efforts to prepare parents, nonspecialized instructors, and autistic adolescents themselves for undertaking on-road instruction and licensure. Instructors recommended that parents help adolescents develop independence, including skills to use alternative forms of transportation and practice predriving skills, such as navigation. Furthermore, these results highlight the need to establish best practices for instruction and refinement of tools and strategies used by both specialized and general driving instructors. What are potential weaknesses in the study? Our recruitment approach may have led instructors with similar training or opinions to participate, so important aspects of teaching autistic drivers may have not been elicited. We did not interview general driving instructors who may have different perspectives and needs that were not discussed. We were unable to determine how characteristics such as work location, race/ethnicity, or years in practice may have influenced participants' responses. How will these findings help autistic adults now or in the future? Results from this study identify tools, such as a life skills checklist, and practice activities, such as commentary driving, that can be used by families to support autistic adolescents who are learning to drive. This study highlights the need to examine experiences with the learning-to-drive process from autistic adolescents and parents themselves to understand their needs and recommendations for enhancing the process of safely learning to drive.
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Affiliation(s)
- Rachel K Myers
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Violence Prevention Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janice M Bonsu
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Meghan E Carey
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin E Yerys
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cynthia J Mollen
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bonsu JM, Frasso R, Curry AE. Lessons from the field: the conduct of randomized controlled trials in Botswana. Trials 2017; 18:503. [PMID: 29078791 PMCID: PMC5658937 DOI: 10.1186/s13063-017-2237-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background The conduct of randomized controlled trials (RCTs) in low-resource settings may present unique financial, logistic, and process-related challenges. Middle-income countries that have comparable disease burdens to low-income countries, but greater availability of resources, may be conducive settings for RCTs. Indeed, the country of Botswana is experiencing a rapid increase in the conduct of RCTs. Our objective was to explore the experiences of individuals conducting RCTs in Botswana to gain an understanding of the challenges and adaptive strategies to their work. Methods We conducted in-depth interviews with 14 national and international individuals working on RCTs in Botswana. Participants included principal investigators, research coordinators, lab technicians, research assistants, and other healthcare professionals. Interviews were audiotaped, transcribed verbatim, and coded for thematic analysis. Results Five primary themes were identified: ethics board relationships (including delays in the process); research staff management (including staff attrition and career development); study recruitment and retention (including the use of reimbursements); resource availability (including challenges accessing laboratory equipment); and capacity-building (including issues of exporting locally sourced samples). These themes were explored to discuss key challenges and adaptive strategies. Conclusions This study offers a first-hand account of individuals engaged in conducting RCTs in Botswana, a nation that is experiencing a rapid increase in research activities. Findings provide a foundational understanding for researchers in Botswana and trial managers in similar settings when planning RCTs so that the conduct of research does not outpace the ability to manage, support, and regulate it.
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Affiliation(s)
- Janice M Bonsu
- Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,, 370 W. 9th Ave, Columbus, OH, 43201, USA.
| | - Rosemary Frasso
- College of Population Health, Jefferson University, Philadelphia, PA, USA
| | - Allison E Curry
- Center for Research Injury and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Capilla-Gonzalez V, Guerrero-Cazares H, Bonsu JM, Gonzalez-Perez O, Achanta P, Wong J, Garcia-Verdugo JM, Quiñones-Hinojosa A. The subventricular zone is able to respond to a demyelinating lesion after localized radiation. Stem Cells 2014; 32:59-69. [PMID: 24038623 DOI: 10.1002/stem.1519] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/21/2013] [Accepted: 07/24/2013] [Indexed: 01/19/2023]
Abstract
Radiation is a common tool in the treatment of brain tumors that induces neurological deficits as a side effect. Some of these deficits appear to be related to the impact of radiation on the neurogenic niches, producing a drastic decrease in the proliferative capacity of these regions. In the adult mammalian brain, the subventricular zone (SVZ) of the lateral ventricles is the main neurogenic niche. Neural stem/precursor cells (NSCs) within the SVZ play an important role in brain repair following injuries. However, the irradiated NSCs' ability to respond to damage has not been previously elucidated. In this study, we evaluated the effects of localized radiation on the SVZ ability to respond to a lysolecithin-induced demyelination of the striatum. We demonstrated that the proliferation rate of the irradiated SVZ was increased after brain damage and that residual NSCs were reactivated. The irradiated SVZ had an expansion of doublecortin positive cells that appeared to migrate from the lateral ventricles toward the demyelinated striatum, where newly generated oligodendrocytes were found. In addition, in the absence of demyelinating damage, remaining cells in the irradiated SVZ appeared to repopulate the neurogenic niche a year post-radiation. These findings support the hypothesis that NSCs are radioresistant and can respond to a brain injury, recovering the neurogenic niche. A more complete understanding of the effects that localized radiation has on the SVZ may lead to improvement of the current protocols used in the radiotherapy of cancer.
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Affiliation(s)
- Vivian Capilla-Gonzalez
- Brain Tumor Stem Cell Laboratory, Department of Neurosurgery, University of Colima, Colima, Mexico
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