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Petersen RC, Weintraub S, Sabbagh M, Karlawish J, Adler CH, Dilworth-Anderson P, Frank L, Huling Hummel C, Taylor A. A New Framework for Dementia Nomenclature. JAMA Neurol 2023; 80:1364-1370. [PMID: 37843871 DOI: 10.1001/jamaneurol.2023.3664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 10/17/2023]
Abstract
Importance Nomenclature in the field of neurodegenerative diseases presents a challenging problem. Inconsistent use of terms such as Alzheimer disease and dementia has compromised progress in clinical care, research, and development of therapeutics. Dementia-associated stigma further contributes to inconsistent and imprecise language. The result is a lack of clarity that produces confusion with patients and the general public and presents communication challenges among researchers. Therefore, the Advisory Council on Research, Care, and Services of the National Plan to Address Alzheimer's Disease authorized a committee to make recommendations for improvement. Objective To establish a systematic neurodegenerative disease framework for information collection and communication to standardize language usage for research, clinical, and public health purposes. Evidence Review The Dementia Nomenclature Initiative organized into 3 major stakeholder working groups: clinicians, researchers, and the public (including individuals living with dementia and family caregivers). To inform the work, the initiative completed a narrative literature review of dementia nomenclature evolution over the last century across the PubMed, CINAHL, PsycInfo, and Scopus databases (January 1, 2000, through July 31, 2020). Initiative working groups used the results as a foundation for understanding current challenges with dementia nomenclature and implications for research, clinical practice, and public understanding. The initiative obtained additional input via focus groups with individuals living with dementia and caregivers, with separate groups for race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic or Latino, and White) as an initial assessment of the meaning of dementia-related terms to these groups. Findings From working group deliberations, the literature review, and focus group input, the initiative developed a framework clearly separating the clinical syndromic presentation experienced by affected individuals from possible underlying pathophysiologies. In the framework, domains of clinical impairment, such as cognitive, behavioral, motor, and other neurologic features, are graded by level of impairment between none and severe. Next, biomarker information describes underlying disease processes, explains the syndrome, and identifies possible disease labels: Alzheimer disease, frontotemporal degeneration, dementia with Lewy bodies, or vascular cognitive impairment dementia. Conclusions and Relevance The Dementia Nomenclature Initiative established a framework to guide communication about cognitive impairment among older adults. Wider testing and refinement of the framework will subsequently improve the information used in communicating about cognitive impairment and the way in which the information is used in clinical, research, and public settings.
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Affiliation(s)
- Ronald C Petersen
- Department of Neurology, Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota
| | - Sandra Weintraub
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marwan Sabbagh
- Alzheimer's and Memory Disorders Program, Barrow Neurological Institute, Phoenix, Arizona
| | - Jason Karlawish
- Penn Memory Center, Departments of Medicine, Medical Ethics, and Health Policy, and Neurology, University of Pennsylvania, Philadelphia
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix
| | | | - Lori Frank
- New York Academy of Medicine, New York, New York
| | | | - Angela Taylor
- Strategic Partnerships, Lewy Body Dementia Association, Lilburn, Georgia
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Frank L, Concannon TW, Harrison JM, Zelazny S. Policy Decisionmaking in Long-Term Care: Lessons from Infection Control During the COVID-19 Pandemic. Rand Health Q 2023; 10:4. [PMID: 37333671 PMCID: PMC10273890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The COVID-19 pandemic focused attention on long-term care facilities' need for infection-control policies that balanced community safety and individual well-being. Infection-control policies were often developed, implemented, and mandated without the input or involvement of those who are most affected: residents and their family members, administrators, and staff. This failure led to declines in residents' physical and mental health. The pandemic exposed an opportunity-and an imperative-to reimagine long-term care in a way that is centered on the needs and preferences of those who receive care, their family members, and those who provide care. This study lays the groundwork for cultural change and a move toward inclusive policy decisionmaking in long-term care through a review of infection-control policy decisions and action items proposed in guided discussions with a diversity of stakeholders-long-term care residents, direct care staff, and consumer advocates to facility administrators, clinicians, researchers, and industry organizations. Transforming the culture of long-term care to elevate the needs of residents will require attention to facility leadership, along with steps to increase inclusiveness, transparency, and accountability in decisionmaking.
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Predmore Z, Chen EK, Concannon TW, Schrandt S, Bartlett SJ, Bingham CO, Xie RZ, Chapman RH, Frank L. Treatment goals for rheumatoid arthritis: patient engagement and goal collection. J Comp Eff Res 2023; 12:e220097. [PMID: 36976963 PMCID: PMC10402807 DOI: 10.57264/cer-2022-0097] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
Aim: We developed the Patient-Engaged Health Technology Assessment strategy for survey-based goal collection from patients to yield patient-important outcomes suitable for use in multi-criteria decision analysis. Methods: Rheumatoid arthritis patients were recruited from online patient networks for proof-of-concept testing of goal collection and prioritization using a survey. A Project Steering Committee and Expert Panel rated the feasibility of scaling to larger samples. Results: Survey respondents (n = 47) completed the goal collection exercise. Finding effective treatments was rated by respondents as the most important goal, and reducing stiffness was rated as the least important. Feedback from our steering committee and expert panel support the approach's feasibility for goal identification and ranking. Conclusion: Goals relevant for treatment evaluation can be identified and rated for importance by patients to permit wide input from patients with lived experience of disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lori Frank
- RAND Corporation, Arlington, VA, USA
- The New York Academy of Medicine, New York, NY, USA
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Ball DE, Mattke S, Frank L, Murray JF, Noritake R, MacLeod T, Benham‐Hermetz S, Kurzman A, Ferrell P. A framework for addressing Alzheimer's disease: Without a frame, the work has no aim. Alzheimers Dement 2022; 19:1568-1578. [PMID: 36478657 DOI: 10.1002/alz.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
Confronting Alzheimer's disease (AD) involves patients, healthcare professionals, supportive services, caregivers, and government agencies interacting along a continuum from initial awareness to diagnosis, treatment, support, and care. This complex scope presents a challenge for health system transformation supporting individuals at risk for, or diagnosed with, AD. The AD systems preparedness framework was developed to help health systems identify specific opportunities to implement and evaluate focused improvement programs. The framework is purposely flexible to permit local adaptation across different health systems and countries. Health systems can develop solutions tailored to system-specific priorities considered within the context of the overall framework. Example metric concepts and initiatives are provided for each of ten areas of focus. Examples of funded projects focusing on screening and early detection are provided. It is our hope that stakeholders utilize the common framework to generate and share additional implementation evidence to benefit individuals with AD.
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Affiliation(s)
- Daniel E. Ball
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
| | - Soeren Mattke
- Center for Economic and Social Research University of Southern California Los Angeles California USA
| | - Lori Frank
- The New York Academy of Medicine New York New York USA
| | - James F. Murray
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
| | - Ryoji Noritake
- Health and Global Policy Institute, Grand Cube 3F, Otemachi Financial City Global Business Hub Tokyo Tokyo Japan
| | - Timothy MacLeod
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- Bridgeable Toronto Ontario USA
| | | | - Alissa Kurzman
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- High Lantern Group Philadelphia Pennsylvania USA
- World Economic Forum New York New York USA
| | - Phyllis Ferrell
- Davos Alzheimer's Collaborative Philadelphia Pennsylvania USA
- Eli Lilly and Company Lilly Corporate Center Indianapolis Indiana USA
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Kajjimu J, Lyon M, Angella N, Janat N, Mwanje W, Frank L, Tagg A, Leff R. 195 Satisfaction of Patients With Emergency Care Services Received in Sub-Saharan Africa: A Systematic Review. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baiz S, Frank L, Drake E, Kania S. North American Veterinary Dermatology Forum (NAVDF) Abstracts April 28-30 2022. Vet Dermatol 2022; 33:272-295. [PMID: 35661295 DOI: 10.1111/vde.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
- S Baiz
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - L Frank
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - E Drake
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - S Kania
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA
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Bartlett SJ, Bingham C, Predmore Z, Concannon T, Chen E, Schrandt S, Xie R, Chapman R, Frank L. POS1569-PARE TESTING A NEW APPROACH TO IDENTIFY AND ASSESS PATIENT-VALUED TREATMENT GOALS IN RHEUMATOID ARTHRITIS (RA): A PATIENT-ENGAGED HEALTHCARE VALUATION STRATEGY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCommon approaches to valuing health technologies often fail to capture outcomes that matter to patients and families. The treatment goals of people living with rheumatoid arthritis (RA) include common trial endpoints but also include other facets of disease impact. Identifying a feasible and rigorous approach to inclusion of the patient perspective is needed as trialists increasingly seek to incorporate patient-important outcomes in trial design and as varied patient-centered value assessment frameworks emerge. No standard approach is available to systemically identify and quantify patient-important outcomes, nor to include those outcomes in deliberative decision-making. We developed the Patient-Engaged Healthcare Valuation strategy, using principles of goal attainment scaling to frame survey-based goal collection directly from adults.ObjectivesTo develop and test a goal-based method for collecting RA patient input for use in clinical trials and value assessment and evaluating the feasibility of this approach in people with RA.MethodsPatient goals and domains were identified from (1) a literature review (2010-2020) of patient outcomes, goals, and preferences in RA, and (2) discussions with patients and clinicians during two meetings with a steering committee (SC) consisting of clinicians, outcomes researchers, patients/advocates, and health economists. These goals informed the development of a draft survey. Adults with RA were recruited from online patient networks to rate goal importance and suggest additional goals. SC members reviewed the survey findings and assessed feasibility of scaling up goal collection for HTA.ResultsOf 135 articles identified, 17 were retained. An inductive and iterative approach was used to identify and thematically group the final set of 36 goals into 4 domains. The draft survey was cognitively debriefed with 4 adults with RA. The first survey was administered to 20 participants; results informed item revisions and additions for the second round of data collection (n=27).The 47 respondents were mostly White (87%), college-educated (72%) women (93%) living with RA for an average of 15 years; 75% rated their RA as moderate to severe. Free-text goals added in round 1 include: 1) finding specialists who listen to patient input on symptoms; 2) addressing loneliness or isolation; and 3) finding support from or helping others with RA. All Symptom and Life Impact goals were rated as Important or Very Important by ≥85% of participants; endorsement for Management and Treatment goals was somewhat more variable, with ≥85% endorsing these as Somewhat to Very Important. Results suggested that domains match key goals. Steering committee ratings supported the feasibility of this method.ConclusionGoals relevant for RA treatment evaluation can be efficiently identified and rated for importance by patients. Patient-important goals can be incorporated into deliberative healthcare valuation using this method to permit “crowd-sourced” input from people living with RA and to capture heterogeneous patient perspectives in healthcare valuation.Table 1.Top Goals based on rating as “Very Important” by >70% of subjects, from set of 36. “My goals for living with RA are to…”GoalsNot ImportantSomewhat ImportantImportantVery ImportantSymptom Managementimprove the quality of my life with RA0% (0)0% (0)23% (11)77% (36)manage my RA pain0% (0)2% (1)11% (5)87% (41)reduce how my RA pain interferes with my life0% (0)9% (4)17% (8)74% (35)Life Impactreduce the ways in which RA interferes with my life0% (0)2% (1)21% (10)77% (36)be independent in my daily functioning0% (0)4% (1)15% (4)81% (22)Managing my RAfeel like I can manage my RA0% (0)2% (1)26% (12)72% (34)Treatment Featuresunderstand my RA treatment options0% (0)4% (2)21% (10)74% (35)have the information I need to make treatment decisions0% (0)0% (0)19% (9)81% (38)know what to expect with my RA treatment0% (0)2% (1)23% (11)74% (35)find treatments that are effective0% (0)0% (0)6% (3)94% (44)AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsNone declared
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Dawson WD, Smith E, Booi L, Mosse M, Lavretsky H, Reynolds CF, Cummings J, Brannally P, Hynes W, Lenze EJ, Manes F, Ayadi R, Frank L, Chapman SB, Robertson IH, Rubenstein L, Jraissati J, Ibáñez A, Fillit H, Jeste DV, Rao A, Berk M, Storch EA, Santuccione Chadha A, Eyre HA. Investing in Late-Life Brain Capital. Innov Aging 2022; 6:igac016. [PMID: 35602311 PMCID: PMC9116879 DOI: 10.1093/geroni/igac016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Within many societies and cultures around the world, older adults are too often undervalued and underappreciated. This exacerbates many key challenges that older adults may face. It also undermines the many positive aspects of late life that are of tremendous value at both an individual and societal level. We propose a new approach to elevate health and well-being in late life by optimizing late-life Brain Capital. This form of capital prioritizes brain skills and brain health in a brain economy, which the challenges and opportunities of the 21st-century demands. This approach incorporates investing in late-life Brain Capital, developing initiatives focused on building late-life Brain Capital.
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Affiliation(s)
- Walter D Dawson
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
| | - Erin Smith
- Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
- Department of Medicine, Stanford Hospital, Stanford, California, USA
| | - Laura Booi
- Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds, UK
| | - Maia Mosse
- Department of Medicine, Stanford Hospital, Stanford, California, USA
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Patrick Brannally
- Alzheimer’s Disease Data Initiative, Gates Ventures, Redwood City, California, USA
| | - William Hynes
- Department of Medicine, Stanford Hospital, Stanford, California, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA
| | - Facundo Manes
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Rym Ayadi
- Euro-Mediterranean Economists Association, Barcelona, Spain
| | - Lori Frank
- RAND Corporation, Arlington, Virginia, USA
| | - Sandra Bond Chapman
- Center for BrainHealth®, The University of Texas at Dallas, Dallas, Texas, USA
| | - Ian H Robertson
- Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
- Center for BrainHealth®, The University of Texas at Dallas, Dallas, Texas, USA
| | - Lori Rubenstein
- Australian Research Alliance for Children and Youth (ARACY), Canberra, Australian Capital Territory, Australia
| | - Jorge Jraissati
- IESE Center for Public Leadership and Government, IESE Business School, Madrid, Spain
| | - Agustin Ibáñez
- Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, California, USA
- Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Howard Fillit
- Alzheimer’s Drug Discovery Foundation (ADDF), New York City, New York, USA
- Departments of Geriatric Medicine, Palliative Care and Neuroscience, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Dilip V Jeste
- Departments of Psychiatry and Neurosciences, University of California San Diego, La Jolla, California, USA
- IBM-UC San Diego Center for Artificial Intelligence for Healthy Living, University of California San Diego, La Jolla, California, USA
| | - Anitha Rao
- Neurocern, Chicago, Illinois, USA
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Michael Berk
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Harris A Eyre
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
- Neuroscience-inspired Policy Initiative, Organisation for Economic Co-operation and Development (OECD) and the PRODEO Institute, Paris, France
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Maluski M, Engelhorn A, Weidemann B, Radek C, Flügge M, Moer J, Frank L, Sell D, Raasch J, Barth C, Schultz A, Schallenberg S, Mockel-Tenbrinck N, Assenmacher M. Process Development and Manufacturing: FINAL FORMULATION AND FILLING OF CAR T CELL DRUG PRODUCTS USING A FULLY-AUTOMATED AND FUNCTIONALLY-CLOSED MANUFACTURING SYSTEM. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Frank L, Jennings LA, Petersen RC, Majid T, Gilmore-Bykovskyi A, Schicker L, Karlawish J. Participation of persons with dementia and their caregivers in research. J Am Geriatr Soc 2021; 69:1784-1792. [PMID: 34245586 DOI: 10.1111/jgs.17340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The National Institute on Aging, in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act, convened a 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers. This review article addresses research participation by persons living with dementia (PLWD) and their care partners in two different ways: as research participants with input on outcomes studied and as engaged research partners. RESULTS This article summarizes each of the topics presented at this Summit session, followed by reflection from the session panelists. Lee Jennings examined collection of outcomes directly from PLWD and the potential for individualized outcomes to enhance measurement in intervention trials. Ron Petersen discussed the impact of nomenclature on research and clinical care, and how and why investigators should be mindful of the connection between dementia nomenclature and the conduct of dementia research. Tabassum Majid examined strategies for engagement in research, including specific examples of involving PLWD and their care partners (including staff in assisted living and skilled nursing facilities), and the potential for this research engagement to improve our understanding of interventions in dementia. CONCLUSIONS Research participation by PLWD and their care partners is evolving. This review summarizes three areas of opportunity and steps for researchers to work with PLWD and their care partners to design and conduct research that enhances knowledge based on what we learn from PLWD and their care partners, and creates knowledge with them.
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Affiliation(s)
- Lori Frank
- RAND Corporation, Santa Monica, California, USA
| | - Lee A Jennings
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | | | | | - Jason Karlawish
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, Chan AW, Basch E, Bell J, Bennett A, Bhatnagar V, Blazeby J, Bottomley A, Brown J, Brundage M, Campbell L, Cappelleri JC, Draper H, Dueck AC, Ells C, Frank L, Golub RM, Griebsch I, Haywood K, Hunn A, King-Kallimanis B, Martin L, Mitchell S, Morel T, Nelson L, Norquist J, O'Connor D, Palmer M, Patrick D, Price G, Regnault A, Retzer A, Revicki D, Scott J, Stephens R, Turner G, Valakas A, Velikova G, von Hildebrand M, Walker A, Wenzel L. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ Open 2021; 11:e045105. [PMID: 34193486 PMCID: PMC8246371 DOI: 10.1136/bmjopen-2020-045105] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients' symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item's importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
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Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Madeleine King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Olalekan Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jill Bell
- Oncology Digital Health, AstraZeneca, Gaithersburg, Maryland, USA
| | - Antonia Bennett
- Cancer Outcomes Research Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jane Blazeby
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Bottomley
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Michael Brundage
- Department of Oncology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Joseph C Cappelleri
- Global Biometrics & Data Management-Statistics, Pfizer Inc, New York City, New York, USA
| | | | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | | | | | - Kirstie Haywood
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | | | | | - Thomas Morel
- Patient-Centered Outcomes Research, UCB Pharma, Brussels, Belgium
| | - Linda Nelson
- Value Evidence and Outcomes-Patient Centered Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Josephine Norquist
- Center for Observational Real-world Evidence (CORE), Patient-Centered Endpoints & Strategy, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Michael Palmer
- Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Donald Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jane Scott
- Johnson and Johnson, Janssen Global Services LLC, High Wycombe, UK
| | | | - Grace Turner
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Antonia Valakas
- EMD Serono Inc, Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maria von Hildebrand
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lari Wenzel
- University of California, Irvine, California, USA
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Harrison J, Maslow K, Tambor E, Phillips L, Frank L, Herndon L, Epstein-Lubow G. Engaging Stakeholders in the Design and Conduct of Embedded Pragmatic Clinical Trials for Alzheimer's Disease and Alzheimer's Disease-Related Dementias. J Am Geriatr Soc 2021; 68 Suppl 2:S62-S67. [PMID: 32589275 PMCID: PMC7375262 DOI: 10.1111/jgs.16630] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022]
Abstract
Embedded pragmatic clinical trials (ePCTs) of nondrug interventions for Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are conducted in real-world clinical settings and designed to generate an evidence base to inform clinical and policy decisions about care for this vulnerable population. The ePCTs exist within a complex ecosystem of relationships between researchers, payors, policymakers, healthcare systems, direct care staff, advocacy groups, families, caregivers, and people living with dementia (PLWD). Because the rapid increase of the number of Americans with AD/ADRD outpaces curative treatments, there is an urgent need to mobilize the power of these relationships to improve dementia care and address a mounting public health crisis. Stakeholder engagement in ePCTs is essential to generate research questions, establish the relevancy of trials to the intended end users, and understand the factors that influence dissemination and implementation in real-world clinical settings. The process of including stakeholders in ePCTs for dementia is similar to stakeholder engagement in ePCTs for other diseases and conditions; however, the unique nature of embedded research, prevalence of caregiver and provider burden, and the progressive worsening of cognitive impairment in PLWD must be approached with additional strategies. This article presents key considerations of stakeholder engagement for ePCTs in AD/ADRD and main activities of the stakeholder engagement team in the National Institute on Aging IMPACT Collaboratory to move the field forward. J Am Geriatr Soc 68:S62-S67, 2020.
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Affiliation(s)
- Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Katie Maslow
- The Gerontological Society of America, Washington, DC, USA
| | - Ellen Tambor
- Center for Medical Technology Policy, Baltimore, Maryland, USA
| | - Louise Phillips
- Person Living with Dementia, NIA IMPACT Collaboratory Stakeholder Engagement Team, USA
| | | | - Laurie Herndon
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Gary Epstein-Lubow
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Butler Hospital, Providence, Rhode Island, USA
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Frank L. Research Engagement With Persons Living With Dementia: Putting Lessons Learned Into Practice. Innov Aging 2020. [PMCID: PMC7743195 DOI: 10.1093/geroni/igaa057.2585] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In the US few research initiatives actively engage persons living with dementia (PLWD) as partners in the research. The 2017 Summit actively engaged multiple types of stakeholder groups, including one for Persons Living with Dementia (PLWD), and was the first large-scale US research meeting to actively engage PLWD in planning and conduct of the meeting. The PLWD conducted a self-evaluation of their work that yielded best practices, meeting the need for guidelines for engaging with PLWD. The 2020 Summit presented the opportunity to test best practices. Some were implemented by the group conveners, like use of video-enabled meetings. Others were implemented with the PLWD, including decisions about governance structure for the group. The use of learnings from the first Summit in engaging with PLWD in the following Summit supported refinement of some engagement practices, yielding a list of recommendations for future work.
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Affiliation(s)
- Lori Frank
- RAND Corporation, Arlington, Virginia, United States
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Rosen AC, Alber J, Al‐Janabi OM, Arias JJ, Bardach SH, Blacker D, Denny SS, Dorociak K, Edwards DF, Erickson CM, Fargo K, Frank L, Gleason CE, Goldman J, Green RC, Grill JD, Heidebrink JL, Henderson VW, Hummel CH, Jwa AS, Karlawish J, Lah JJ, Langbaum JB, Langston AH, Largent EA, Lee AKW, Lingler J, Milne R, Moore RC, Mozersky J, Nosheny RL, Parker MW, Roberts JS, Rogalski EJ, Rumbaugh M, Saykin AJ, Shapiro R, Stites SD, Tyrone J, Vogel B, Walter S, Wang L, Wijsman E, Aggarwal NT. The formation of the advisory group on risk evaluation education for dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.045562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Allyson C Rosen
- VA Medical Center‐Palo Alto Palo Alto CA USA
- Stanford University School of Medicine Stanford CA USA
| | | | | | | | | | - Deborah Blacker
- Massachusetts General Hospital Harvard Medical School Boston MA USA
| | - Sharon S Denny
- The Association for Frontotemporal Degeneration Radnor PA USA
| | | | - Dorothy Farrar Edwards
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Claire M Erickson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | | | - Carey E Gleason
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Robert C Green
- Harvard Medical School Boston MA USA
- Brigham and Women's Hospital Boston MA USA
| | | | | | - Victor W Henderson
- Department of Health Research and Policy Stanford University Stanford CA USA
| | | | | | | | - James J Lah
- Emory Goizueta Alzheimer's Disease Research Center Atlanta GA USA
| | | | | | | | | | | | | | | | | | - Rachel L Nosheny
- Center for Imaging of Neurodegenerative Diseases San Francisco Veterans Affairs Medical Center San Francisco CA USA
| | | | | | | | - Malia Rumbaugh
- VA Puget Sound Health Care System University of Washington Seattle WA USA
| | | | | | | | - Jamie Tyrone
- Beating Alzheimer's by Embracing Science Ramona CA USA
| | - Briana Vogel
- University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - Sarah Walter
- Alzheimer’s Therapeutic Research Institute/USC San Diego CA USA
| | - Li‐San Wang
- University of Pennsylvania Philadelphia PA USA
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15
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Santana MJ, Manalili K, Zelinsky S, Brien S, Gibbons E, King J, Frank L, Wallström S, Fairie P, Leeb K, Quan H, Sawatzky R. Improving the quality of person-centred healthcare from the patient perspective: development of person-centred quality indicators. BMJ Open 2020; 10:e037323. [PMID: 33122312 PMCID: PMC7597468 DOI: 10.1136/bmjopen-2020-037323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE International efforts are being made towards a person-centred care (PCC) model, but there are currently no standardised mechanisms to measure and monitor PCC at a healthcare system level. The use of metrics to measure PCC can help to drive the changes needed to improve the quality of healthcare that is person centred. OBJECTIVE To develop and validate person-centred care quality indicators (PC-QIs) measuring PCC at a healthcare system level through a synthesis of the evidence and a person-centred consensus approach to ensure the PC-QIs reflect what matters most to people in their care. METHODS Existing indicators were first identified through a scoping review of the literature and an international environmental scan. Focus group discussions with diverse patients and caregivers and interviews with clinicians and experts in quality improvement allowed us to identify gaps in current measurement of PCC and inform the development of new PC-QIs. A set of identified and newly developed PC-QIs were subsequently refined by Delphi consensus process using a modified RAND/UCLA Appropriateness Method. The international consensus panel consisted of patients, family members, community representatives, clinicians, researchers and healthcare quality experts. RESULTS From an initial 39 unique evidence-based PC-QIs identified and developed, the consensus process yielded 26 final PC-QIs. These included 7 related to structure, 16 related to process, 2 related to outcome and 1 overall global PC-QI. CONCLUSIONS The final 26 evidence-based and person-informed PC-QIs can be used to measure and evaluate quality incorporating patient perspectives, empowering jurisdictions to monitor healthcare system performance and evaluate policy and practice related to PCC.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Alberta Strategy for Patient-oriented Research, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Susan Brien
- Health Quality Ontario, Toronto, Ontario, Canada
| | | | - Jenny King
- Picker Institute Europe, Oxford, Oxfordshire, UK
| | - Lori Frank
- RAND Corporation, Arlington, Virginia, USA
| | - Sara Wallström
- Center for Person Centered Care, Gothenburg, Sweden
- University of Gothenburg, Gothenburg, Sweden
| | - Paul Fairie
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kira Leeb
- Victorian Agency for Health Information, Melbourne, Victoria, Australia
| | - Hude Quan
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard Sawatzky
- Trinity Western University School of Nursing, Langley, British Columbia, Canada
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16
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Heckert A, Forsythe LP, Carman KL, Frank L, Hemphill R, Elstad EA, Esmail L, Lesch JK. Researchers, patients, and other stakeholders' perspectives on challenges to and strategies for engagement. Res Involv Engagem 2020; 6:60. [PMID: 33042576 PMCID: PMC7539495 DOI: 10.1186/s40900-020-00227-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is growing interest in patient and stakeholder engagement in research, yet limited evidence about effective methods. Since 2012, the Patient-Centered Outcomes Research Institute (PCORI) has funded patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders as research partners in study planning, conduct, and dissemination. This requirement, unique among large healthcare research funders in the US, provides an opportunity to learn about challenges encountered and specific strategies used by PCORI-funded study teams. The primary objective of this study is to describe -- from the perspective of PCORI investigators and research partners-the most common engagement challenges encountered in the first two years of the projects and promising strategies to prevent and overcome these challenges. METHODS Descriptive information about investigators, partners, and their engagement was collected from investigators via annual (N = 235) and mid-year (N = 40) project progress reporting to PCORI, and from their partners (N = 260) via voluntary survey. Qualitative data were analyzed using content and thematic analyses. RESULTS Investigators and partners most often described engagement challenges in three domains: (1) infrastructure to support engagement, (2) building relationships, and (3) maintaining relationships. Infrastructure challenges related to financial and human resources, including funding support and dedicated staff, identifying diverse groups of partners, and partners' logistical needs. Challenges for both building and maintaining relationships encompass a variety of aspects of authentic, positive interactions that facilitate mutual understanding, full participation, and genuine influence on the projects. Strategies to prevent or mitigate engagement challenges also corresponded overall to the same three domains. Both groups typically described strategies more generally, with applicability to a range of challenges rather than specific actions to address only particular challenges. CONCLUSION Meaningful engagement of patients and other stakeholders comes with challenges, as does any innovation in the research process. The challenges and promising practices identified by these investigators and partners, related to engagement infrastructure and the building and maintenance of relationships, reveal actionable areas to improve engagement, including organizational policies and resources, training, new engagement models, and supporting engagement by viewing it as an investment in research uptake and impact.
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Affiliation(s)
- Andrea Heckert
- Present Address, Independent Consultant, Portland, OR USA
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | - Laura P. Forsythe
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | - Kristin L. Carman
- Public and Patient Engagement, Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
| | | | - Rachel Hemphill
- Evaluation & Analysis, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC 20036 USA
| | | | - Laura Esmail
- Present Address, Independent Consultant, Paris, France
- Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, 1828 L St NW, Suite 900, Washington, DC, USA
| | - Julie Kennedy Lesch
- Public and Patient Engagement, Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
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Droege L, Perschel F, Stütz N, Gafron A, Frank L, Busjahn A, Henrich W, Verlohren S. Risikostratifizierung zur Vorhersage präeklampsie-assoziierter Schwangerschaftskomplikationen mittels sFlt-1/PlGF-Quotient in der klinischen Routine. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L.A Droege
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - F.H Perschel
- Charité – Universitätsmedizin Berlin, Institut für Laboratoriumsmedizin, Klinische Chemie und Pathobiochemie
| | - N Stütz
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - A Gafron
- Evangelisches Krankenhaus Paul Gerhardt Stift Wittenberg, Klinik für Gynäkologie und Geburtshilfe
| | - L Frank
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - A Busjahn
- HealthTwist GmbH, Biomedizinischer Forschungscampus
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - S Verlohren
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
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18
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Frank L, Gafron A, Henrich W, Verlohren S, Dröge L. Plazentagewicht bei Frauen mit Präeklampsie und IUGR: Korrelation zum sFlt-1/PlGF Level. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Frank
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - A Gafron
- Evangelisches Krankenhaus Paul Gerhardt Stift Wittenberg, Klinik für Gynäkologie und Geburtshilfe
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - S Verlohren
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - L.A Dröge
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
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19
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Droege L, Eidmann J, Frank L, Henrich W, Verlohren S. Präpartale Hyponatriämie bei Schwangeren mit präeklampsie-assoziierten Schwangerschaftskomplikationen. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L.A Droege
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - J Eidmann
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - L Frank
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
| | - S Verlohren
- Charité – Universitätsmedizin Berlin, Klinik für Geburtsmedizin
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20
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Lutter C, Tischer T, Hotfield T, Frank L, Enz A, Simon M, Schoffl V. Current Trends in Sport Climbing Injuries after the Inclusion into the Olympic Program. Analysis of 633 Injuries within the years 2017/18. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.02.2020.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- C. Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - T. Tischer
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - T. Hotfield
- Department of Orthopedics, University Medical Center, Erlangen, Germany
| | - L. Frank
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Germany
| | - A. Enz
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - M. Simon
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Germany
| | - V. Schoffl
- Department of Trauma Surgery, Friedrich Alexander University Erlangen-Nuremberg, Germany
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
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21
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Schoffl V, Schoffl I, Frank L, Kupper T, Simon M, Lutter C. Tendon Injuries in the Hands in Rock Climbers:Epidemiology, Anatomy, Biomechanics and Treatment An Update. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.02.2020.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- V. Schoffl
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany
- Department of Trauma Surgery, Friedrich Alexander University of Erlangen-Nuremberg, FRG, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA
- SSchool of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
| | - I. Schoffl
- School of Clinical and Applied Sciences, Leeds Becket University, Leeds, UK
- Department of Pediatric Cardiology, Friedrich Alexander University Erlangen-Nuremberg, FRG, Germany
| | - L. Frank
- Medical School, Friedrich Alexander University Erlangen-Nuremberg, FRG, Germany
| | - T. Kupper
- Institute of Occupational and Social Medicine, RWTH Aachen Technical University, FRG, Germany
| | - M. Simon
- Section Sportsorthopedics and Sportsmedicine, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany
| | - C. Lutter
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, FRG, Germany
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Frank L, Shubeck E, Schicker M, Webb T, Maslow K, Gitlin L, Hummel CH, Kaplan EK, LeBlanc B, Marquez M, Nicholson BP, O'Brien G, Phillips L, Van Buren B, Epstein-Lubow G. The Experiences of Persons Living with Dementia Planning for a Dementia Research Meeting. Lessons Learned From the National Research Summit on Care, Services, and Supports for Persons With Dementia and Their Caregivers. Am J Geriatr Psychiatry 2020; 28:434-442. [PMID: 31767451 DOI: 10.1016/j.jagp.2019.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A stakeholder group for persons living with dementia (PLWD) was convened to support the work of a major US dementia research meeting. The objectives of this examination are to present the steps used to implement the Group and guidance for both PLWD and researchers for partnering on research conference planning and participation. METHODS PLWD met monthly to provide input into the agenda for the 2017 Research Summit on Dementia Care and some Group members also presented at the Summit. Following the Summit, the Group reviewed their contributions and completed an evaluation of the Group process, identifying best practices to support future efforts. RESULTS Group members were initially unsure about participating due to concerns about ability to contribute and concerns about disease progression. Members reported that participation was a positive experience, however, identifying Group-led governance and attention to Group work process as important contributors. In addition to giving input to the Summit and having the opportunity to interact with researchers, sharing personal experiences with each other was part of the value of the Group to members. Careful Group selection and attention to governance were among the Best Practices members. CONCLUSION Despite initial uncertainty among members about participating as a Stakeholder Group to inform a national research meeting, members developed a successful process for governance, convening, and providing input to a major national research meeting. Group's self-evaluation yielded specific strategies likely to be useful in formation and implementation of future partnerships between researchers and persons living with dementia.
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Affiliation(s)
| | | | - Melanie Schicker
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Teresa Webb
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Katie Maslow
- The Gerontological Society of America (KM), Washington, DC
| | - Laura Gitlin
- Drexel University College of Nursing and Health Professions (LG), Philadelphia, PA
| | - Cynthia Huling Hummel
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Edward K Kaplan
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Brian LeBlanc
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Myriam Marquez
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Brenda P Nicholson
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Greg O'Brien
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Louise Phillips
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Brian Van Buren
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB) Chicago, IL
| | - Gary Epstein-Lubow
- Alpert Medical School of Brown University, Brown University School of Public Health, and Butler Hospital
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Frank L, Shubeck E, Maslow K, Epstein-Lubow G. Meta-issues: On Writing Scientific Manuscripts With a Stakeholder Group of Persons Living With Dementia. Am J Geriatr Psychiatry 2020; 28:445-447. [PMID: 31901427 DOI: 10.1016/j.jagp.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Katie Maslow
- The Gerontological Society of America (KM), Washington, DC
| | - Gary Epstein-Lubow
- Alpert Medical School of Brown University, Brown University School of Public Health, and Butler Hospital, Providence, RI (GEL)
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Frank L, Shubeck E, Schicker M, Webb T, Maslow K, Gitlin L, Hummel CH, Kaplan EK, LeBlanc B, Marquez M, Nicholson B, O'Brien G, Phillips L, Van Buren B, Epstein-Lubow G. Contributions of Persons Living With Dementia to Scientific Research Meetings. Results From the National Research Summit on Care, Services, and Supports for Persons With Dementia and Their Caregivers. Am J Geriatr Psychiatry 2020; 28:421-430. [PMID: 31784409 DOI: 10.1016/j.jagp.2019.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Inclusion of patients in research activities has increased in the United States but no guidelines for inclusion of individuals with cognitive impairment exist. The experiences from the Persons Living with Dementia (PLWD) Stakeholder Group that formed to support the first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers provided a test of feasibility of this type of participation for a major research meeting and an opportunity to understand specific contributions of the Group. METHODS The PLWD Stakeholder Group was formed by Summit co-chairs as one of six stakeholder groups charged with providing input into the Summit agenda and meeting recommendations. Members were recruited through clinician/researchers with personal knowledge of potential members. Following the Summit, Group members convened to review Group contributions to the Summit agenda, list of speakers, and Summit research recommendations. RESULTS The PLWD Group influenced the content of the Summit agenda and some Group members were invited to contribute through Summit presentations. The Group influenced Summit outcomes: of the 58 research recommendations that emerged, 30 express ideas contributed by the PLWD. CONCLUSIONS The Stakeholder Group for PLWD proved feasible to implement and impacted the agenda and output of a major national research meeting on dementia.
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Affiliation(s)
| | | | - Melanie Schicker
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Teresa Webb
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Katie Maslow
- The Gerontological Society of America (KM), Washington, DC
| | - Laura Gitlin
- Drexel University College of Nursing and Health Professions (LG), Philadelphia, PA
| | - Cynthia Huling Hummel
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Edward K Kaplan
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Brian LeBlanc
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Myriam Marquez
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Brenda Nicholson
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Greg O'Brien
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Louise Phillips
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Brian Van Buren
- Persons Living with Dementia Stakeholder Group, Care of E Shubeck, Alzheimer's Association (MS, TW, CHH, EKK, BL, MM, BN, GO, LP, BVB), Chicago, IL
| | - Gary Epstein-Lubow
- Alpert Medical School of Brown University, Brown University School of Public Health, and Butler Hospital, Providence, RI
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van Vuuren S, Frank L. Review: Southern African medicinal plants used as blood purifiers. J Ethnopharmacol 2020; 249:112434. [PMID: 31812645 DOI: 10.1016/j.jep.2019.112434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMALOGICAL RELEVANCE Blood purification practices, also referred to as blood cleansing or detoxification, is an ancient concept which is widespread amongst African traditional medicine, but for which no modern scientific basis exists. There prevails considerable ambiguity in defining what a blood purifier is. AIM OF THE STUDY The purpose of this review is to firstly define what a blood purifier is in the context of African traditional medicine and compare to other cultural and westernized interpretations. Thereafter, this study identifies traditionally used medicinal plants used as blood purifiers in southern Africa and correlates these species to scientific studies, which may support evidence for these "blood purifying plant species". MATERIALS AND METHODS Ethnobotanical books and review articles were used to identify medicinal plants used for blood purification. Databases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to source scientific articles. An evaluation was made to try correlate traditional use to scientific value of the plant species. RESULTS One hundred and fifty nine plant species have been documented as traditional remedies for blood purification. Most of the plant species have some pharmacological activity, however, very little link to the traditional use for blood purification. There has been some justification of the link between blood purification and the use as an antimicrobial and this has been explored in many of the plant species identified as blood purifiers. Other pharmacological studies specifically pertaining to the blood require further attention. CONCLUSION Irrespective of the ambiguity of interpretation, medicinal plants used to "cleanse the blood", play an important holistic role in traditional medicine and this review with recommendations for further study provides some value of exploring this theme in the future.
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Affiliation(s)
- S van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
| | - L Frank
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
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Frank L, Morton SC, Guise JM, Jull J, Concannon TW, Tugwell P. Engaging Patients and Other Non-Researchers in Health Research: Defining Research Engagement. J Gen Intern Med 2020; 35:307-314. [PMID: 31713031 PMCID: PMC7048327 DOI: 10.1007/s11606-019-05436-2] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
With the increase in patient and consumer activism through the late twentieth century and into this century, patient roles in research evolved into a new model of research engagement, with patients serving as active advisors and co-leading or leading clinical research. By requiring active engagement of patients and other stakeholders, several government research funders have advanced this model, particularly in Canada, the United States (US), United Kingdom (UK), and Australia. A consortium of individuals from these countries formed a Multi-Stakeholder Engagement (MuSE) consortium to examine critical issues in engaged research, establish consensus on definitions, and provide guidance for the field, beginning with an overview of how to involve stakeholders in health research (Concannon et al. J Gen Intern Med. 2019;34(3):458-463) and continuing here with an examination of definitions of research engagement. The political and advocacy roots of engaged research are reflected in definitions. Engagement is conceptualized with reference to research project goals, from informing specific clinical decisions to informing health-system level decisions. Political and cultural differences across countries are evident. Some of these government funders focus on empirical rather than ethical rationales. In countries with centralized health technology assessment, the link between societal values and engaged research is explicit. Ethical rationales for engagement are explicit in most of the published literature on research engagement. Harmonization of definitions is recommended so that research engagement elements, methods, and outcomes and impacts can be clearly examined and understood, and so that the field of research engagement can proceed from a clear conceptual foundation. Specific recommendations for terminology definitions are provided. Placing engaged research on a continuum from specific clinical decisions to more global public and social justice concerns clarifies the type of engaged research, supports appropriate comparisons, and improves the rigor of engaged research methods. The results help identify knowledge gaps in this growing field.
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Affiliation(s)
| | - Sally C Morton
- Department of Statistics, College of Science, Virginia Tech, Blacksburg, VA, USA
| | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics & Clinical Epidemiology, Emergency Medicine, Oregon Health & Science University School of Medicine and the OHSU-PSU School of Public Health, Portland, OR, USA
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | - Peter Tugwell
- Canada Research Chair in Health Equity, University of Ottawa Centre for Global Health, Ottawa, ON, Canada
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Santos-Hövener C, Kuntz B, Frank L, Koschollek C, Ellert U, Hölling H, Thamm R, Schienkiewitz A, Lampert T. The health situation of children and adolescents with migration background in Germany. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Although more than one third of minors living in Germany have a migration background (MB), valid data on the health of this population are still lacking. The German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS wave 2, 2014-2017) provides population-based data to make reliable statements on the health of adolescents with and without MB.
Methods
Survey data from KiGGS wave 2 are used to describe the general health status, mental health and the prevalence of allergic diseases in 3-to 17-year-old children and adolescents (n = 13,568). To determine overweight, body height and weight are measured (n = 3,463). In addition to MB (without/one-sided/two-sided), the socio-economic status (SES) and the length of stay of the parents in Germany are taken into account.
Results
Children and adolescents with two-sided MB show a physician-diagnosed atopic dermatitis (3.5%vs.6.9%) and attention deficit hyperactivity disorder (ADHD) (1.5%vs.5.1%) less frequently than their peers without MB, but more often a moderate or poor general health status (6.1%vs.3.9%). Adolescents with two-sided MB are also more often affected by overweight than those without MB (22.1%vs.12.2%). If only participants with MB are considered, their health situation is often associated with the SES and partly also with the length of stay of the parents.
Discussion
Health differences between children and adolescents with and without MB vary by the observed indicator. The heterogeneity of children and adolescents with MB, which can be partly determined by the SES or the length of stay of the parents, should be considered in target-group-specific interventions.
Main messages
The vast majority of children and adolescents in Germany grow up healthy and a MB is not per se associated with a poorer health status. Our results suggest that considering MB as the sole determinant of health to reflect the impact of migration on health is insufficient.
Key messages
Migration background is not per se associated with a poorer health status. Socioeconomic status and parents’ length of stay are derminants associated with poorer health outcomes among children and adolescents with migration background.
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Affiliation(s)
- C Santos-Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - B Kuntz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - L Frank
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - C Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - U Ellert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - H Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - R Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - A Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - T Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Frank L, Wesson Ashford J, Bayley PJ, Borson S, Buschke H, Cohen D, Cummings JL, Davies P, Dean M, Finkel SI, Hyer L, Perry G, Powers RE, Schmitt F. Genetic Risk of Alzheimer's Disease: Three Wishes Now That the Genie is Out of the Bottle. J Alzheimers Dis 2019; 66:421-423. [PMID: 30282369 PMCID: PMC6218128 DOI: 10.3233/jad-180629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The availability and increasing popularity of direct-to-consumer genetic testing for the presence of an APOE4 allelle led the Alzheimer's Foundation of America Medical, Scientific and Memory Screening Advisory Board to identify three critical areas for attention: 1) ensure consumer understanding of test results; 2) address and limit potential negative consequences of acquiring this information; and 3) support linking results with positive health behaviors, including potential clinical trial participation. Improving access to appropriate sources of genetic counseling as part of the testing process is critical and requires action from clinicians and the genetic testing industry. Standardizing information and resources across the industry should start now, with the input of consumers and experts in genetic risk and health information disclosure. Direct-to-consumer testing companies and clinicians should assist consumers by facilitating consultation with genetic counselors and facilitating pursuit of accurate information about testing.
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Affiliation(s)
- Lori Frank
- Health and Aging Policy Fellow/American Political Science Association Congressional Fellow; Senior Advisor, PCORI, Bethesda, MD, USA
| | - J Wesson Ashford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA and War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Peter J Bayley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA and War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Soo Borson
- University of Washington School of Medicine, University of Washington, Seattle, WA, USA and University of Minnesota, Minneapolis, MN, USA
| | - Herman Buschke
- The Saul R. Korey Department of Neurology and Dominick P. Purpura Department of Neuroscience, Lena and Joseph Gluck Distinguished Scholar in Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donna Cohen
- Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - Jeffrey L Cummings
- Center for Neurodegeneration and Translational Neuroscience, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NY, USA
| | - Peter Davies
- Litwin-Zucker Center for Alzheimer's Disease & Memory Disorders, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Margaret Dean
- Texas Tech University Health Sciences Center, Internal Medicine, Amarillo, TX, USA
| | - Sanford I Finkel
- Department of Psychiatry, University of Chicago Medical School, Chicago, IL, USA
| | - Lee Hyer
- Department of Psychiatry, Mercer School of Medicine, Macon, GA, USA
| | - George Perry
- Brain Health Consortium, Department Biology and Chemistry, University of Texas at San Antonio, San Antonio, TX, USA
| | - Richard E Powers
- Departments of Pathology and Psychiatry, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Frederick Schmitt
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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Burke R, Frank L, Sun F, Golden A, O’Hare A, Fabiny A. INSIGHTS FROM THE EXECUTIVE BRANCH: FELLOW EXPERIENCES IN FEDERAL AGENCIES AND ORGANIZATIONS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Burke
- Denver VA Medical Center/University of Colorado, Denver, Colorado, United States
| | - L Frank
- The Patient Centered Outcomes Research Institute, Washington, DC, USA
| | - F Sun
- Michigan State University, East Lansing, MI, USA
| | - A Golden
- University of Central Florida and Orlando VA, Orlando, FL, USA
| | | | - A Fabiny
- San Francisco VA, San Francisco, CA, USA
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Calvert M, Kyte D, Mercieca-Bebber R, Slade A, Chan AW, King MT, Hunn A, Bottomley A, Regnault A, Chan AW, Ells C, O'Connor D, Revicki D, Patrick D, Altman D, Basch E, Velikova G, Price G, Draper H, Blazeby J, Scott J, Coast J, Norquist J, Brown J, Haywood K, Johnson LL, Campbell L, Frank L, von Hildebrand M, Brundage M, Palmer M, Kluetz P, Stephens R, Golub RM, Mitchell S, Groves T. Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trial Protocols: The SPIRIT-PRO Extension. JAMA 2018; 319:483-494. [PMID: 29411037 DOI: 10.1001/jama.2017.21903] [Citation(s) in RCA: 452] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance. Objective To develop international, consensus-based, PRO-specific protocol guidance (the SPIRIT-PRO Extension). Design, Setting, and Participants The SPIRIT-PRO Extension was developed following the Enhancing Quality and Transparency of Health Research (EQUATOR) Network's methodological framework for guideline development. This included (1) a systematic review of existing PRO-specific protocol guidance to generate a list of potential PRO-specific protocol items (published in 2014); (2) refinements to the list and removal of duplicate items by the International Society for Quality of Life Research (ISOQOL) Protocol Checklist Taskforce; (3) an international stakeholder survey of clinical trial research personnel, PRO methodologists, health economists, psychometricians, patient advocates, funders, industry representatives, journal editors, policy makers, ethicists, and researchers responsible for evidence synthesis (distributed by 38 international partner organizations in October 2016); (4) an international Delphi exercise (n = 137 invited; October 2016 to February 2017); and (5) consensus meeting (n = 30 invited; May 2017). Prior to voting, consensus meeting participants were informed of the results of the Delphi exercise and given data from structured reviews evaluating the PRO protocol content of 3 defined samples of trial protocols. Results The systematic review identified 162 PRO-specific protocol recommendations from 54 sources. The ISOQOL Taskforce (n = 21) reduced this to 56 items, which were considered by 138 international stakeholder survey participants and 99 Delphi panelists. The final wording of the SPIRIT-PRO Extension was agreed on at a consensus meeting (n = 29 participants) and reviewed by external group of experts during a consultation period. Eleven extensions and 5 elaborations to the SPIRIT 2013 checklist were recommended for inclusion in clinical trial protocols in which PROs are a primary or key secondary outcome. Extension items focused on PRO-specific issues relating to the trial rationale, objectives, eligibility criteria, concepts used to evaluate the intervention, time points for assessment, PRO instrument selection and measurement properties, data collection plan, translation to other languages, proxy completion, strategies to minimize missing data, and whether PRO data will be monitored during the study to inform clinical care. Conclusions and Relevance The SPIRIT-PRO guidelines provide recommendations for items that should be addressed and included in clinical trial protocols in which PROs are a primary or key secondary outcome. Improved design of clinical trials including PROs could help ensure high-quality data that may inform patient-centered care.
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Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Rebecca Mercieca-Bebber
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madeleine T King
- Sydney Medical School, Faculty of Medicine and School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | | | - Andrew Bottomley
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | - An-Wen Chan
- University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Ells
- Panel on Research Ethics, Toronto, Ontario, Canada
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, England
| | | | | | | | | | | | - Gary Price
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Jane Scott
- Janssen Global Services, Johnson and Johnson, High Wycombe, England
| | | | | | | | | | | | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, England
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC
| | - Maria von Hildebrand
- Patient Partner, Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | | | | | - Paul Kluetz
- US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Stephens
- National Cancer Research Institute Consumer Forum, London, England
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Khachaturian AS, Hoffman DP, Frank L, Petersen R, Carson BR, Khachaturian ZS. Zeroing out preventable disability: Daring to dream the impossible dream for dementia care: Recommendations for a national plan to advance dementia care and maximize functioning. Alzheimers Dement 2017; 13:1077-1080. [PMID: 28935202 DOI: 10.1016/j.jalz.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ara S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, MD, USA.
| | - David P Hoffman
- Bureau of Community Integration and Alzheimer's Disease, Division of Long Term Care, New York State Department of Health, Office of Health Insurance Programs, Albany, NY, USA
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington DC, USA
| | - Ronald Petersen
- Alzheimer's Disease Research Center, Mayo Clinic, Rochester, MN, USA
| | | | - Zaven S Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association, Rockville, MD, USA
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Wengler A, Frank L, Lampert T, Santos-Hövener C. Die Definition des Migrationshintergrunds im Rahmen des Gesundheitsmonitorings des Robert Koch-Instituts. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - L Frank
- Robert Koch-Institut, Berlin
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Frank L, Yesil-Jürgens R, Santos-Hövener C, Lampert T. Maßnahmen zur Einbindung von Kindern und Jugendlichen mit Migrationshintergrund in die KiGGS Welle 2. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- L Frank
- Robert Koch-Institut, Berlin
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Forsythe L, Heckert A, Margolis MK, Schrandt S, Frank L. Methods and impact of engagement in research, from theory to practice and back again: early findings from the Patient-Centered Outcomes Research Institute. Qual Life Res 2017; 27:17-31. [PMID: 28500572 PMCID: PMC5770504 DOI: 10.1007/s11136-017-1581-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [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] [Accepted: 04/17/2017] [Indexed: 11/01/2022]
Abstract
PURPOSE Since 2012, PCORI has been funding patient-centered comparative effectiveness research with a requirement for engaging patients and other stakeholders in the research, a requirement that is unique among the US funders of clinical research. This paper presents PCORI's evaluation framework for assessing the short- and long-term impacts of engagement; describes engagement in PCORI projects (types of stakeholders engaged, when in the research process they are engaged and how they are engaged, contributions of their engagement); and identifies the effects of engagement on study design, processes, and outcomes selection, as reported by both PCORI-funded investigators and patient and other stakeholder research partners. METHODS Detailed quantitative and qualitative information collected annually from investigators and their partners was analyzed via descriptive statistics and cross-sectional qualitative content and thematic analysis, and compared against the outcomes expected from the evaluation framework and its underlying conceptual model. RESULTS The data support the role of engaged research partners in refinements to the research questions, selection of interventions to compare, choice of study outcomes and how they are measured, contributions to strategies for recruitment, and ensuring studies are patient-centered. CONCLUSIONS The evaluation framework and the underlying conceptual model are supported by results to date. PCORI will continue to assess the effects of engagement as the funded projects progress toward completion, dissemination, and uptake into clinical decision making.
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Kirwan JR, de Wit M, Frank L, Haywood KL, Salek S, Brace-McDonnell S, Lyddiatt A, Barbic SP, Alonso J, Guillemin F, Bartlett SJ. Emerging Guidelines for Patient Engagement in Research. Value Health 2017; 20:481-486. [PMID: 28292494 DOI: 10.1016/j.jval.2016.10.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 09/06/2016] [Accepted: 10/03/2016] [Indexed: 05/16/2023]
Abstract
There is growing recognition that involving patients in the development of new patient-reported outcome measures helps ensure that the outcomes that matter most to people living with health conditions are captured. Here, we describe and discuss different experiences of integrating patients as full patient research partners (PRPs) in outcomes research from multiple perspectives (e.g., researcher, patient, and funder), drawing from three real-world examples. These diverse experiences highlight the strengths, challenges, and impact of partnering with patients to conceptualize, design, and conduct research and disseminate findings. On the basis of our experiences, we suggest basic guidelines for outcomes researchers on establishing research partnerships with patients, including: 1) establishing supportive organizational/institutional policies; 2) cultivating supportive attitudes of researchers and PRPs with recognition that partnerships evolve over time, are grounded in strong communication, and have shared goals; 3) adhering to principles of respect, trust, reciprocity, and co-learning; 4) addressing training needs of all team members to ensure communications and that PRPs are conversant in and familiar with the language and process of research; 5) identifying the resources and advanced planning required for successful patient engagement; and 6) recognizing the value of partnerships across all stages of research. The three experiences presented explore different approaches to partnering; demonstrate how this can fundamentally change the way research work is conceptualized, conducted, and disseminated; and can serve as exemplars for other forms of patient-centered outcomes research. Further work is needed to identify the skills, qualities, and approaches that best support effective patient-researcher partnerships.
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Affiliation(s)
- John R Kirwan
- University of Bristol Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK
| | - Maarten de Wit
- Department of Medical Humanities, VU University, Amsterdam, The Netherlands
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington DC USA
| | - Kirstie L Haywood
- Royal College of Nursing Research Institute, Warwick Medical School, Warwick University, Coventry, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | | | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investicacions Médiques, CIBER en Epdiemiología y Salud Pública (CIBERESP). Barcelona, Spain
| | - Francis Guillemin
- Faculté de Médecine, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respirology. McGill University, Montreal, QC.
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Frank L, Ide K, Beaton C. Using CR-POSSUM to plan HDU admissions for high-risk patients undergoing colonic resections. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, 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Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
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- Imperial College Healthcare NHS Trust
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- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
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- Mid Staffordshire NHS Foundation Trust
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- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
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- Tunbridge Wells and Maidstone NHS Trust
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- Tunbridge Wells and Maidstone NHS Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
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- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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Rall KK, Frank L, Riess O, Wallwiener D, Brucker SY. Einzelbasen-Polymorphismen im Östrogenrezeptor-α als Hinweis auf eine mögliche Fehlfunktion des Rezeptors und Ursache für das Mayer-Rokitansky-Küster-Hauser-Syndrom (MRKHS). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jensen RE, Snyder CF, Basch E, Frank L, Wu AW. All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record. J Comp Eff Res 2016; 5:561-567. [PMID: 27586855 DOI: 10.2217/cer-2016-0026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.
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Affiliation(s)
- Roxanne E Jensen
- Department of Oncology, Georgetown University, Washington DC, USA.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Claire F Snyder
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Albert W Wu
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kuntz B, Frank L, Manz K, Rommel A, Lampert T. Soziale Determinanten der Schwimmfähigkeit von Kindern und Jugendlichen in Deutschland. Ergebnisse aus KiGGS Welle 1. Dtsch Z Sportmed 2016. [DOI: 10.5960/dzsm.2016.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Forsythe LP, Ellis LE, Edmundson L, Sabharwal R, Rein A, Konopka K, Frank L. Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned. J Gen Intern Med 2016; 31:13-21. [PMID: 26160480 PMCID: PMC4700002 DOI: 10.1007/s11606-015-3450-z] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/28/2015] [Accepted: 06/05/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. OBJECTIVE We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-Centered Outcomes Research Institute (PCORI), and identify early contributions and lessons learned. DESIGN A self-report instrument was completed by researchers between 6 and 12 months following project initiation. PARTICIPANTS Forty-seven principal investigators or their designees (94 % response rate) participated in the study. MAIN MEASURES Self-report of types of stakeholders engaged, stages and levels of engagement, facilitators and barriers to engagement, lessons learned, and contributions from engagement were measured. KEY RESULTS Most (83 %) reported engaging more than one stakeholder in their project. Among those, the most commonly reported groups were patients (90 %), clinicians (87 %), health system representatives (44 %), caregivers (41 %), and advocacy organizations (41 %). Stakeholders were commonly involved in topic solicitation, question development, study design, and data collection. Many projects engaged stakeholders in data analysis, results interpretation, and dissemination. Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data. Investigators often identified communication and shared leadership strategies as "critically important" facilitators (53 and 44 % respectively); lack of stakeholder time was the most commonly reported challenge (46 %). Most challenges were only partially resolved. Early lessons learned included the importance of continuous and genuine partnerships, strategic selection of stakeholders, and accommodation of stakeholders' practical needs. CONCLUSIONS PCORI Pilot Projects investigators report engaging a variety of stakeholders across many stages of research, with specific changes to their research attributed to engagement. This study identifies early lessons and barriers that should be addressed to facilitate engagement. While this research suggests potential impact of stakeholder engagement, systematic characterization and evaluation of engagement at multiple stages of research is needed to build the evidence base.
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Affiliation(s)
- Laura P Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), 1919 M St NW, suite 250, Washington, DC, 20036, USA.
| | - Lauren E Ellis
- Patient-Centered Outcomes Research Institute (PCORI), 1919 M St NW, suite 250, Washington, DC, 20036, USA
| | | | | | | | - Kristen Konopka
- Patient-Centered Outcomes Research Institute (PCORI), 1919 M St NW, suite 250, Washington, DC, 20036, USA
| | - Lori Frank
- Patient-Centered Outcomes Research Institute (PCORI), 1919 M St NW, suite 250, Washington, DC, 20036, USA
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Divito D, Bondin M, Kirschner SK, Stojanovska J, Ibrahim E, Frank L. Chemotherapy induced cardiomyopathy: an overview, imaging features, and future prospective. Cancer Imaging 2015. [PMCID: PMC4601765 DOI: 10.1186/1470-7330-15-s1-p21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Forsythe LP, Frank L, Walker KO, Anise A, Wegener N, Weisman H, Hunt G, Beal A. Patient and clinician views on comparative effectiveness research and engagement in research. J Comp Eff Res 2015; 4:11-25. [PMID: 25565066 DOI: 10.2217/cer.14.52] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS Describe and compare patient and primary care clinician attitudes about comparative effectiveness research (CER) and inclusion of patients and clinicians as partners in clinical research. MATERIALS & METHODS Online survey of patients (n = 900) and primary care clinicians (n = 750) from opt-in survey panels. RESULTS Nearly half (45%) of clinicians were not familiar with CER, but after reviewing a definition of CER, most (76%) agreed that it can improve patient care. Patients and clinicians indicated interest in engagement as research partners (66% and 55%, respectively). Lack of time was the most commonly endorsed barrier. CONCLUSION Attitudes toward CER and engagement in clinical research were generally favorable. Identified facilitators and barriers point to strategies for enhancing patient and clinician engagement in research.
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Affiliation(s)
- Laura P Forsythe
- The Patient-Centered Outcomes Research Institute (PCORI), 1828 L St NW, Suite 900, Washington, DC 20036, USA
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Frank L, Mann S, Johnson J, Levine C, Downey R, Griffits C, Wakshlag J. Plasma chemistry before and after two consecutive days of racing in sled dogs: associations between muscle damage and electrolyte status. Comparative Exercise Physiology 2015. [DOI: 10.3920/cep150020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exercising long distance endurance sled dogs display plasma biochemistry changes characterised by elevations in creatine kinase (CK) and aspartate aminotransferase (AST), hypoproteinemia, hypoglobulinemia and decreases in sodium and potassium. The aim of this study was to compare resting to day 2 racing plasma biochemistry and associations between electrolytes and markers of muscle damage in well-conditioned sled dogs during a stage-stop race. Blood samples were obtained from 23 dogs prior to the start and on day 2, immediately after racing. Results showed significant decreases in potassium (day 0 – 4.7±0.3 and day 2 – 4.2±0.3 mEq/l), total protein (day 0 – 6.0±0.3 and day 2 – 5.5±0.4 g/dl) and albumin concentrations (day 0 – 3.9±0.2 and day 2 – 3.6±0.3 g/dl). Increases in AST (day 0 – 24±7 and day 2 – 137±97 U/l) and CK activities (day 0 – 129±39 and day 2 – 2,047±2,021 U/l) were also observed. Plasma sodium concentrations were not significantly different after day 2 of racing (day 0 – 153±5.2 and day 2 – 151±4.1). Alterations in plasma electrolytes, and increases in AST, CK, alanine aminotransferase and urea nitrogen were similar to those observed in long distance endurance sled dogs. A strong negative association was observed between plasma potassium and increases in plasma CK activity on day 2 (R2=0.69). The maintenance of sodium concentrations with a concurrent potassium decline, suggests sodium conservation via the renin-angiotensin-aldosterone pathway as previously shown in endurance sled dogs. The negative correlation between muscle damage and plasma potassium warrants further investigation regarding its relationship to rhabdomyolysis.
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Affiliation(s)
- L. Frank
- Cornell University Veterinary Specialists, 880 Canal Street, Stamford, CT 06902, USA
| | - S. Mann
- Cornell University College of Veterinary Medicine, Department of Population Medicine, Ithaca, NY 14853, USA
| | - J. Johnson
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY 14853, USA
| | - C. Levine
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY 14853, USA
| | - R. Downey
- Annamaet Petfood, 41 Daniels Road, Sellersville, PA 18960, USA
| | - C. Griffits
- Traveling Vet, 7640 W 1st St, Loveland, CO 80537, USA
| | - J. Wakshlag
- Cornell University College of Veterinary Medicine, Department of Clinical Sciences, Ithaca, NY 14853, USA
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Gordon MF, Lenderking WR, Duhig A, Chandler J, Lundy JJ, Miller DS, Piault-Louis E, Doody RS, Galasko D, Gauthier S, Frank L. Development of a patient-reported outcome instrument to assess complex activities of daily living and interpersonal functioning in persons with mild cognitive impairment: The qualitative research phase. Alzheimers Dement 2015; 12:75-84. [PMID: 26079412 DOI: 10.1016/j.jalz.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/11/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION As drug development research efforts move toward studying patients earlier in the course of Alzheimer's disease (AD), it is important to incorporate the patient's perspective into measurement of outcomes. METHODS This article summarizes the qualitative work of the Patient-Reported Outcome Consortium's Cognition Working Group in the development of a new self-reported outcome measure in persons with mild cognitive impairment (MCI) due to suspected AD, herein referred to as MCI. RESULTS The draft measure captures the patient's voice for two functional domains, complex activities of daily living and interpersonal functioning. DISCUSSION This work represents a series of initial steps in the development of this rating scale. The next steps are to conduct psychometric analysis and evaluate the role of insight.
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Affiliation(s)
| | | | | | | | | | | | | | - Rachelle S Doody
- Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, USA
| | - Douglas Galasko
- University of California, San Diego, School of Medicine, San Diego, CA, USA
| | | | - Lori Frank
- Patient-Centered Outcomes Research Institute (PCORI), Washington, D.C, USA
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Frank L, Forsythe L, Ellis L, Schrandt S, Sheridan S, Gerson J, Konopka K, Daugherty S. Conceptual and practical foundations of patient engagement in research at the patient-centered outcomes research institute. Qual Life Res 2015; 24:1033-41. [PMID: 25560774 PMCID: PMC4412554 DOI: 10.1007/s11136-014-0893-3] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/02/2022]
Abstract
PURPOSE To provide an overview of PCORI's approach to engagement in research. METHODS The Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 to fund patient-centered comparative effectiveness research. Requirements for research funding from PCORI include meaningful engagement of patients and other stakeholders in the research. PCORI's approach to engagement in research is guided by a conceptual model of patient-centered outcomes research (PCOR), that provides a structure for understanding engagement in research. RESULTS To understand and improve engagement in research PCORI is learning from awardees and other stakeholders. Those efforts are described along with PCORI's capacity building and guidance to awardees via the Engagement Rubric. PCORI's unique model of engaging patients and other stakeholders in merit review of funding applications is also described. Additional support for learning about engagement in research is provided through specific research funding and through PCORI's major infrastructure initiative, PCORnet. CONCLUSION PCORI requires engagement of stakeholders in the research it funds. In addition PCORI engages stakeholders in activities including review of funding applications and establishment of CER research infrastructure through PCORnet. The comprehensive approach to engagement is being evaluated to help guide the field toward promising practices in research engagement.
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Affiliation(s)
- Lori Frank
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street NW 9th Floor, Washington, DC, 20036, USA,
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Bayley PJ, Kong JY, Mendiondo M, Lazzeroni LC, Borson S, Buschke H, Dean M, Fillit H, Frank L, Schmitt FA, Peschin S, Finkel S, Austen M, Steinberg C, Ashford JW. Findings from the National Memory Screening Day program. J Am Geriatr Soc 2015; 63:309-14. [PMID: 25643739 DOI: 10.1111/jgs.13234] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report experience with a large, nation-wide public memory screening program. DESIGN Descriptive study of community-dwelling elderly adults. SETTING Local community sites (48 sites agreed to provide data) throughout the United States participating in National Memory Screening Day in November 2010. PARTICIPANTS Of 4,369 reported participants, 3,064 had complete data records and are included in this report. MEASUREMENTS Participants completed a questionnaire that included basic demographic information and a question about subjective memory concerns. Each site selected one of seven validated cognitive screening tests: Mini-Cog, General Practitioner assessment of Cognition, Memory Impairment Screen, Kokmen Short Test of Mental Status, Mini-Mental State Examination, Montreal Cognitive Assessment, Saint Louis University Mental Status Examination. RESULTS Overall, 11.7% failed one of the seven screening tests. As expected, failure rates were higher in older and less-educated participants (P's < .05). Subjective memory concerns were associated with a 40% greater failure rate for persons of similar age and education but no memory concerns (odds ratio = 1.4, 95% confidence interval = 1.07-1.78), although only 11.9% of those who reported memory concerns (75% of all participants) had detectible memory problems. CONCLUSION Screening for cognitive impairment in community settings yielded results consistent with expected effects of age and education. The event attracted a large proportion of individuals with memory concerns; 88.1% were told that they did not have memory problems detectible with the tests used. Further studies are needed to assess how participants respond to and use screening information, whether this information ultimately influences decision-making or outcomes, and whether memory screening programs outside healthcare settings have public health value.
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Affiliation(s)
- Peter J Bayley
- War Related Illness and Injury Study Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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McMullen CK, Safford MM, Bosworth HB, Phansalkar S, Leong A, Fagan MB, Trontell A, Rumptz M, Vandermeer ML, Brinkman WB, Burkholder R, Frank L, Hommel K, Mathews R, Hornbrook MC, Seid M, Fordis M, Lambert B, McElwee N, Singh JA. Patient-centered priorities for improving medication management and adherence. Patient Educ Couns 2015; 98:102-10. [PMID: 25448313 PMCID: PMC5595249 DOI: 10.1016/j.pec.2014.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment. METHODS Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions. RESULTS Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not. CONCLUSION Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research. PRACTICE IMPLICATIONS Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.
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Affiliation(s)
- Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR USA.
| | - Monika M Safford
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Shobha Phansalkar
- Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
| | - Amye Leong
- Healthy Motivation, Santa Barbara, CA USA
| | - Maureen B Fagan
- Center for Patients and Families, Brigham and Women's Hospital and Harvard Medical School, Boston, MA USA
| | - Anne Trontell
- Agency for Health Care Research and Quality, Rockville, MD USA
| | - Maureen Rumptz
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR USA
| | | | | | | | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, USA
| | - Kevin Hommel
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | | | - Mark C Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - Michael Seid
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | | | - Bruce Lambert
- Center for Communication and Health, Northwestern University, Chicago, USA
| | | | - Jasvinder A Singh
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA; Birmingham Veterans Affairs Medical Center, Birmingham, USA
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Frank L, Nebesářová J, Vancová M, Paták A, Müllerová I. Imaging of tissue sections with very slow electrons. Ultramicroscopy 2014; 148:146-150. [PMID: 25461591 DOI: 10.1016/j.ultramic.2014.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/29/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022]
Abstract
The examination of thin sections of tissues with electron microscopes is an indispensable tool. Being composed of light elements, samples of living matter illuminated with electrons at the usual high energies of tens or even hundreds of kiloelectronvolts provide very low image contrasts in transmission or scanning transmission electron microscopes. Therefore, heavy metal salts are added to the specimen during preparation procedures (post-fixation with osmium tetroxide or staining). However, these procedures can modify or obscure the ultrastructural details of cells. Here we show that the energy of electrons used for the scanned transmission imaging of tissue sections can be reduced to mere hundreds or even tens of electronvolts and can produce extremely high contrast even for samples free of any metal salts. We found that when biasing a sufficiently thin tissue section sample to a high negative potential in a scanning transmission electron microscope, thereby reducing the energy of the electrons landing on the sample, and collecting the transmitted electrons with a grounded detector, we obtain a high contrast revealing structure details not enhanced by heavy atoms. Moreover, bombardment with slow electrons sensitively depolymerises the resin in which the tissue is embedded, thereby enhancing the transmitted signal with no observable loss of structure details. The use of low-energy electrons requires ultrathin sections of a thickness of less than 10nm, but their preparation is now possible. Ultralow energy STEM provides a tool enabling the observation of very thin biological samples without any staining. This method should also be advantageous for examination of 2D crystals, thin films of polymers, polymer blends, etc.
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Affiliation(s)
- L Frank
- Institute of Scientific Instruments AS CR, v.v.i., Královopolská 147, 61264 Brno, Czech Republic.
| | - J Nebesářová
- Biology Centre AS CR, v.v.i., Branišovská 31, 37005 České Budějovice, Czech Republic
| | - M Vancová
- Biology Centre AS CR, v.v.i., Branišovská 31, 37005 České Budějovice, Czech Republic
| | - A Paták
- Institute of Scientific Instruments AS CR, v.v.i., Královopolská 147, 61264 Brno, Czech Republic
| | - I Müllerová
- Institute of Scientific Instruments AS CR, v.v.i., Královopolská 147, 61264 Brno, Czech Republic
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