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Pascual Morales C, Vasquez Ponce L, Hernandez Briceño J, Leon Lopez E, Guevara Guevara J, Jimenez Vargas J, Diaz Coronado R, Flores JD, Lazon Ayala M. Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru. J Pediatr Hematol Oncol 2023; 45:e345-e349. [PMID: 36731067 DOI: 10.1097/mph.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/04/2022] [Indexed: 02/04/2023]
Abstract
Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients' data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.
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Affiliation(s)
| | - Liliana Vasquez Ponce
- "Medicina de Precision" Research Center, Universidad de San Martín de Porres, Facultad de Medicina
| | | | | | | | | | | | - Jose D Flores
- Neurosurgery Department, Guillermo Almenara Hospital
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Boyd AD, Ndukwe CI, Dileep A, Everin OF, Yao Y, Welland B, Field J, Baumann M, Flores JD, Shroff A, Groo V, Dickens C, Doukky R, Francis R, Peacock G, Wilkie DJ. Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial. JMIR Mhealth Uhealth 2020; 8:e15900. [PMID: 32579120 PMCID: PMC7381043 DOI: 10.2196/15900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. OBJECTIVE This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. METHODS Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants' blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants' group membership. The primary outcome was a feasibility analysis of recruitment and retention. RESULTS The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients' reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. CONCLUSIONS Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. TRIAL REGISTRATION ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864.
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Affiliation(s)
- Andrew Dallas Boyd
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Chioma Iheanyi Ndukwe
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Anandu Dileep
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Olivia Frances Everin
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Yingwei Yao
- Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Betty Welland
- Patient Advisor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Jerry Field
- Patient Advisor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Matt Baumann
- Patient Advisor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Jose D Flores
- Patient Advisor, Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Adhir Shroff
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Vicki Groo
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, United States
| | - Carolyn Dickens
- Department of Biomedical and Health Information Science, University of Illinois at Chicago, Chicago, United States
| | - Rami Doukky
- Divison of Cardiology, Cook County Health, Chicago, IL, United States
| | - Regeena Francis
- Divison of Cardiology, Cook County Health, Chicago, IL, United States
| | - Geraldine Peacock
- Divison of Cardiology, Cook County Health, Chicago, IL, United States
| | - Diana J Wilkie
- Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
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Shah V, Dileep A, Dickens C, Groo V, Welland B, Field J, Baumann M, Flores JD, Shroff A, Zhao Z, Yao Y, Wilkie DJ, Boyd AD. Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent. Front Public Health 2016; 4:272. [PMID: 28018897 PMCID: PMC5149519 DOI: 10.3389/fpubh.2016.00272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/04/2016] [Accepted: 11/28/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND/AIMS This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. METHODS In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. RESULTS Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. DISCUSSION Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. CONCLUSION MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.
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Affiliation(s)
- Vicki Shah
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
| | - Anandu Dileep
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
| | - Carolyn Dickens
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA; Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Vicki Groo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA; Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Betty Welland
- University of Illinois at Chicago , Chicago, IL , USA
| | - Jerry Field
- University of Illinois at Chicago , Chicago, IL , USA
| | | | - Jose D Flores
- University of Illinois at Chicago , Chicago, IL , USA
| | - Adhir Shroff
- Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Illinois at Chicago , Chicago, IL , USA
| | - Zhongsheng Zhao
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago , Chicago, IL , USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida , Gainesville, FL , USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida , Gainesville, FL , USA
| | - Andrew D Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL , USA
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Boyd AD, Moores K, Shah V, Sadhu E, Shroff A, Groo V, Dickens C, Field J, Baumann M, Welland B, Gutowski G, Flores JD, Zhao Z, Bahroos N, Hynes DM, Wilkie DJ. My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology. JMIR Mhealth Uhealth 2015; 3:e74. [PMID: 26139587 PMCID: PMC4526975 DOI: 10.2196/mhealth.4021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/11/2015] [Accepted: 05/30/2015] [Indexed: 11/13/2022] Open
Abstract
Background Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. Objective Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.
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Affiliation(s)
- Andrew Dallas Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States.
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González-Olivares E, González-Yañez B, Mena-Lorca J, Flores JD. Uniqueness of limit cycles and multiple attractors in a Gause-type predator-prey model with nonmonotonic functional response and Allee effect on prey. Math Biosci Eng 2013; 10:345-367. [PMID: 23458304 DOI: 10.3934/mbe.2013.10.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The main purpose of this work is to analyze a Gause type predator-prey model in which two ecological phenomena are considered: the Allee effect affecting the prey growth function and the formation of group defence by prey in order to avoid the predation. We prove the existence of a separatrix curves in the phase plane, determined by the stable manifold of the equilibrium point associated to the Allee effect, implying that the solutions are highly sensitive to the initial conditions. Trajectories starting at one side of this separatrix curve have the equilibrium point (0,0) as their ω-limit, while trajectories starting at the other side will approach to one of the following three attractors: a stable limit cycle, a stable coexistence point or the stable equilibrium point (K,0) in which the predators disappear and prey attains their carrying capacity. We obtain conditions on the parameter values for the existence of one or two positive hyperbolic equilibrium points and the existence of a limit cycle surrounding one of them. Both ecological processes under study, namely the nonmonotonic functional response and the Allee effect on prey, exert a strong influence on the system dynamics, resulting in multiple domains of attraction. Using Liapunov quantities we demonstrate the uniqueness of limit cycle, which constitutes one of the main differences with the model where the Allee effect is not considered. Computer simulations are also given in support of the conclusions.
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Affiliation(s)
- Eduardo González-Olivares
- Grupo de Ecologia Matematica, Instituto de Matematicas, Pontificia Universidad Catolica de Valparaiso, Valparaiso, Chile.
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Flores JD. Patient billing and open-item accounting. Med Electron 1985; 16:112-3. [PMID: 10273883] [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: 02/12/2023]
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