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Mulumba KY, Mariano ER, Leng JC, Kou A, Hunter OO, Tamboli M, Memtsoudis SG, Mudumbai SC. Changing a clinical pathway to increase spinal anesthesia use for elective hip arthroplasty: a single-centre historical cohort study. Can J Anaesth 2023; 70:211-218. [PMID: 36482246 DOI: 10.1007/s12630-022-02371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE International consensus recommendations support neuraxial anesthesia as the preferred anesthetic technique for total hip arthroplasty. We hypothesized that an institutional initiative to promote spinal anesthesia within a clinical pathway would result in increased use of this technique. METHODS We reviewed primary unilateral total hip arthroplasty data between June 2017 and June 2019-one year before vs one year after implementation. The primary outcome was rate of spinal anesthesia use. Secondary outcomes included postoperative pain scores and opioid use, rates of postoperative complications, and unplanned resource use. We built a run chart-tracking rates of spinal anesthesia; compared postoperative outcomes based on anesthetic technique; and developed a mixed model, multivariable logistic regression with margins analysis evaluating the use of spinal anesthesia. RESULTS The final sample included 172 patients (87 before and 85 after implementation) with no significant differences in baseline characteristics. For the primary outcome, 42/87 (48%) patients received spinal anesthesia before implementation compared with 48/85 (56%) postimplementation (unadjusted difference, 8%; 95% confidence interval, -7 to 23; P = 0.28). There were no differences in secondary outcomes. Factors associated with receipt of spinal anesthesia included American Society of Anesthesiologists Physical Status II (vs III), lower body mass index, and shorter case duration. Using a reduced mixed model, the average marginal effect was 10.7%, with an upper 95% confidence limit of 25.7%. CONCLUSION Implementation of a clinical pathway change to promote spinal anesthesia for total hip arthroplasty may not have been associated with increased use of spinal anesthesia, but utilization rates can vary widely. Baseline spinal anesthesia usage at our institution was higher than the USA national average, and many factors may influence choice of anesthesia technique. Patients who receive spinal anesthesia have decreased opioid requirements and pain scores postoperatively.
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Affiliation(s)
- Kabungo Y Mulumba
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA.
| | - J C Leng
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - Alex Kou
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - Oluwatobi O Hunter
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
| | - Mallika Tamboli
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stavros G Memtsoudis
- Departments of Anesthesiology and Public Health, Weill Cornell Medical College, New York, NY, USA
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Seshadri C Mudumbai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA
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Sun K, Szymonifka J, Tian H, Chang Y, Leng JC, Mandl LA. Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients? J Rheumatol 2019; 46:1634-1639. [PMID: 31043540 DOI: 10.3899/jrheum.181148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients. METHODS Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient Reported Outcomes Measurement Information System (PROMIS) short forms. TCM users and nonusers were compared. Factors independently associated with TCM use were identified using multivariable logistic regression. RESULTS Among 230 participants, median age was 57 years (range 20-97), 65% were women, 71% had ≤ high school education, 70% were on Medicaid insurance, 47% lived in the United States for ≥ 20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse self-reported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with nonusers. In multivariable analysis, TCM use was associated with belief in TCM, female sex, ≥ 20 years of US residency, reporting Western medicine as ineffective, and shorter rheumatic disease duration. CONCLUSION Among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.
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Affiliation(s)
- Kai Sun
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA. .,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine.
| | - Jackie Szymonifka
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine
| | - Henghe Tian
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine
| | - Yaju Chang
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine
| | - Jennifer C Leng
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine
| | - Lisa A Mandl
- From the Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; New York University Sackler Institute of Graduate Biomedical Sciences; Division of Rheumatology, Department of Medicine, New York University School of Medicine; Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; Division of Rheumatology, Department of Medicine, Hospital for Special Surgery; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,K. Sun, MD, MS, Medical Instructor, Division of Rheumatology, Department of Medicine, Duke University School of Medicine; J. Szymonifka, MS, Graduate Research Assistant, New York University Sackler Institute of Graduate Biomedical Sciences; H. Tian, MD, Clinical Instructor, Division of Rheumatology, Department of Medicine, New York University School of Medicine; Y. Chang, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, Mount Sinai Beth Israel; J.C. Leng, MD, MPH, Assistant Attending, Immigrant Health and Cancer Disparities Center, Memorial Sloan Kettering Cancer Center; L.A. Mandl, MD, MPH, Assistant Professor, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medicine
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Abstract
We aimed to assess a key risk factor for lung cancer, smoking, in a vulnerable group, Chinese livery drivers in New York City (NYC). This is a nested cohort study conducted in the summer/fall of 2014 within a larger NIMHD-funded R24 program, the Taxi Network. The Taxi Network Needs Assessment (TNNA) survey was administered to a broad demographic of drivers. This study reports on the TNNA survey smoking-related results among NYC Chinese livery drivers. 97 drivers participated. Mean age was 44.7 years, 2.1% were English proficient, and 23.4% were living below the poverty line. Most were insured (82.5%), had a PCP (82.5%), and had had a routine check-up within the past year (79%). 73% were current or former smokers. Culturally and linguistically tailored smoking cessation interventions, strategies to mitigate exposure to air pollution, and programs to facilitate lung cancer screening should be developed and implemented for high-risk Chinese livery drivers.
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Affiliation(s)
- Jennifer C Leng
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Lei Lei
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Shu Fang Lei
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Zhiying Zhu
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Nancy Mo
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Brian Sou
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Imran Mujawar
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Ramanadhan S, Davis MM, Armstrong R, Baquero B, Ko LK, Leng JC, Salloum RG, Vaughn NA, Brownson RC. Participatory implementation science to increase the impact of evidence-based cancer prevention and control. Cancer Causes Control 2018; 29:363-369. [PMID: 29417296 PMCID: PMC5858707 DOI: 10.1007/s10552-018-1008-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [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: 06/29/2017] [Accepted: 01/31/2018] [Indexed: 01/28/2023]
Abstract
It is critical to accelerate the integration of evidence-based programs, practices, and strategies for cancer prevention and control into clinical, community, and public health settings. While it is clear that effective translation of existing knowledge into practice can reduce cancer burden, it is less clear how best to achieve this. This gap is addressed by the rapidly growing field of implementation science. Given that context influences and is influenced by implementation efforts, engaging stakeholders in the co-production of knowledge and solutions offers an opportunity to increase the likelihood that implementation efforts are useful, scalable, and sustainable in real-world settings. We argue that a participatory implementation science approach is critical, as it supports iterative, ongoing engagement between stakeholders and researchers to improve the pathway between research and practice, create system change, and address health disparities and health equity. This article highlights the utility of participatory implementation science for cancer prevention and control research and addresses (a) the spectrum of participatory research approaches that may be of use, (b) benefits of participatory implementation science, and
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Affiliation(s)
- Shoba Ramanadhan
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave, LW 601, Boston, MA, 02215, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network, Department of Family Medicine and OHSU-PSU School of Public Health, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd, Mail code L222, Portland, OR, 97239-3098, USA
| | - Rebecca Armstrong
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Barbara Baquero
- Department of Community and Behavioral Health, College of Public Health, University of Iowa Prevention Research Center, University of Iowa, 145 N. Riverside Drive, CPHB N418, Iowa City, IA, 52242, USA
| | - Linda K Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Department of Health Services, University of Washington School of Public Health, 1100 Fairview Ave. N., M3-B232, Seattle, WA, 98109-1024, USA
| | - Jennifer C Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Clinical and Translational Research Building, 2004 Mowry Road, Suite 2243, PO Box 100177, Gainesville, FL, 32610-0177, USA
| | - Nicole A Vaughn
- Department of Health and Exercise Science, School of Health Professions, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, USA
- Department of Biomedical Sciences, Cooper University Medical School of Rowan University, Camden, NJ, USA
- Department of Family Medicine, Rowan University School of Medicine, Glassboro, NJ, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, MO, USA
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