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Walker TD, Liao YT, Nikahd M, Hyer M, Shahwan KT, Carr DR. Cutaneous Squamous Cell Carcinoma Outcomes in Solid Organ Transplant Recipients: A Matched Retrospective Cohort Study. Dermatol Surg 2024; 50:412-417. [PMID: 38382077 DOI: 10.1097/dss.0000000000004125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Solid organ transplant recipients with cutaneous squamous cell carcinoma (CSCC) have an increased risk of poor outcomes. However, a recent study demonstrated that immunosuppression is not an independent risk factor for these poor outcomes after controlling for primary tumor stage. OBJECTIVE To evaluate whether transplant status is an independent risk factor for poor outcomes in CSCC. MATERIALS AND METHODS A database of CSCCs treated at an academic center over 10 years was used to perform a retrospective cohort study comparing the risk of poor outcomes (local recurrence, regional and distant metastases, and disease-specific death) in solid organ transplant recipients and controls. Subjects were matched on age, tumor stage, sex, tumor site, and time to poor outcome. RESULTS There were 316 tumors from 78 transplant patients and 316 tumors from 262 controls. On multivariate analysis, tumor stage and location on the head and neck were predictive of poor outcomes. There was no significant difference in the risk of poor outcomes in the transplant group versus the control group. CONCLUSION Transplant status was not an independent risk factor for poor squamous cell carcinoma outcomes after controlling for stage, age, sex, site, and time to poor outcome.
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Affiliation(s)
- Trent D Walker
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Yi-Tin Liao
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Melica Nikahd
- Center for Biostatistics, The Ohio State University Medical Center, Columbus, Ohio
| | - Madison Hyer
- Center for Biostatistics, The Ohio State University Medical Center, Columbus, Ohio
| | - Kathryn T Shahwan
- Department of Dermatology, The Ohio State University Medical Center, Columbus, Ohio
- Department of Dermatology, Altru Health System, University of North Dakota Medical School, Grand Forks, North Dakota
| | - David R Carr
- Department of Dermatology, The Ohio State University Medical Center, Columbus, Ohio
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Guerra R, Shahwan KT, Nikahd M, Hyer M, Carr DR. Performance of Staging Systems for Non-Head and Neck Cutaneous Squamous Cell Carcinoma. Dermatol Surg 2024; 50:121-124. [PMID: 37962141 DOI: 10.1097/dss.0000000000003999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The performance of staging systems in non-head and neck cutaneous squamous cell carcinomas has not been well established. OBJECTIVE To evaluate the performance of the American Joint Committee on Cancer 8th Edition and Brigham and Women's Hospital staging systems in non-head and neck squamous cell carcinomas. MATERIALS AND METHODS Eligible tumors were identified and staged from an existing retrospective database. Cumulative incidence function curves of any poor outcome were generated. Distinctiveness, sensitivity, specificity, positive and negative predictive value, and concordance index were calculated. RESULTS 1,042 primary tumors were included, with 38 resulting in any poor outcome and 16 in any major poor outcome. High-stage tumors represented 2.2% and 3.5% of tumors; these accounted for 10/38 of the poor outcomes (26.3%) and 8/16 of the major poor outcomes (50%). High-stage tumors predicted major poor outcomes with a sensitivity of 0.5 and specificity of 0.99 for the Brigham and Women's Hospital system, and a sensitivity of 0.5 and specificity of 0.97 for the American Joint Committee on Cancer 8th edition system. The concordance index for both was 0.74. CONCLUSION Current staging systems can be used to predict poor outcomes in cutaneous squamous cell carcinomas off the head and neck.
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Affiliation(s)
- Ricardo Guerra
- The Ohio State University Medical Center Department of Dermatology, Columbus, Ohio
| | - Kathryn T Shahwan
- The Ohio State University Medical Center Department of Dermatology, Columbus, Ohio
- Altru Health System and University of North Dakota Medical School, Grand Forks, North Dakota
| | - Melica Nikahd
- The Ohio State University Center for Biostatistics, Columbus, Ohio
| | - Madison Hyer
- The Ohio State University Center for Biostatistics, Columbus, Ohio
| | - David R Carr
- The Ohio State University Medical Center Department of Dermatology, Columbus, Ohio
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Rawl SM, Baltic R, Monahan PO, Stump TE, Hyer M, Ennis AC, Walunis J, Renick K, Hinshaw K, Paskett ED, Champion VL, Katz ML. Receipt, uptake, and satisfaction with tailored DVD and patient navigation interventions to promote cancer screening among rural women. Transl Behav Med 2023; 13:879-890. [PMID: 37708322 PMCID: PMC10724168 DOI: 10.1093/tbm/ibad054] [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] [Indexed: 09/16/2023] Open
Abstract
Process evaluation is essential to understanding and interpreting the results of randomized trials testing the effects of behavioral interventions. A process evaluation was conducted as part of a comparative effectiveness trial testing a mailed, tailored interactive digital video disc (DVD) with and without telephone-based patient navigation (PN) to promote breast, cervical and colorectal cancer screening among rural women who were not up-to-date (UTD) for at least one screening test. Data on receipt, uptake, and satisfaction with the interventions were collected via telephone interviews from 542 participants who received the tailored interactive DVD (n = 266) or the DVD plus telephone-based PN (n = 276). All participants reported receiving the DVD and 93.0% viewed it. The most viewed sections of the DVD were about colorectal, followed by breast, then cervical cancer screening. Most participants agreed the DVD was easy to understand, helpful, provided trustworthy information, and gave information needed to make a decision about screening. Most women in the DVD+PN group, 98.2% (n = 268), reported talking with the navigator. The most frequently discussed cancer screenings were colorectal (86.8%) and breast (71.3%); 57.5% discussed cervical cancer screening. The average combined length of PN encounters was 22.2 minutes with 21.7 additional minutes spent on coordinating activities. Barriers were similar across screening tests with the common ones related to the provider/health care system, lack of knowledge, forgetfulness/too much bother, and personal issues. This evaluation provided information about the implementation and delivery of behavioral interventions as well as challenges encountered that may impact trial results.
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Affiliation(s)
- Susan M Rawl
- Simon Comprehensive Cancer Center, School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Timothy E Stump
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Madison Hyer
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alysha C Ennis
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jean Walunis
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Karen Hinshaw
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Victoria L Champion
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Mira L Katz
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Nikahd M, Hyer M, Ruiz ES, Shahwan KT, Carr DR. Survival analyses in cutaneous squamous cell carcinoma: accounting for both competing risks and repeated measures. Arch Dermatol Res 2023; 316:3. [PMID: 37982998 DOI: 10.1007/s00403-023-02740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Melica Nikahd
- Center for Biostatistics, The Ohio State University Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Center for Biostatistics, The Ohio State University Medical Center, Columbus, OH, USA
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn T Shahwan
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA.
- Department of Dermatology, Altru Health System, 3165 Demers Avenue, Grand Forks, ND, 58201, USA.
- Department of Internal Medicine, , University of North Dakota Medical School, Grand Forks, ND, USA.
| | - David R Carr
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA
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Munroe ES, Prevalska I, Hyer M, Meurer WJ, Mosier JM, Tidswell MA, Prescott HC, Wei L, Wang H, Fung CM. High-flow nasal cannula vs non-invasive ventilation in acute hypoxia: Propensity score matched study. medRxiv 2023:2023.09.26.23296167. [PMID: 37808723 PMCID: PMC10557810 DOI: 10.1101/2023.09.26.23296167] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
RATIONALE The optimal treatment for early hypoxemic respiratory failure is unclear, and both high-flow nasal cannula and non-invasive ventilation are used. Determining clinically relevant outcomes for evaluating non-invasive respiratory support modalities remains a challenge. OBJECTIVES To compare the effectiveness of initial treatment with high-flow nasal cannula versus non-invasive ventilation for acute hypoxemic respiratory failure. METHODS We conducted a retrospective cohort study of patients with acute hypoxemic respiratory failure treated with high-flow nasal cannula or non-invasive ventilation within 24 hours of Emergency Department arrival (1/2018-12/2022). We matched patients 1:1 using a propensity score for odds of receiving non-invasive ventilation. The primary outcome was major adverse pulmonary events (28-day mortality, ventilator-free days, non-invasive respiratory support hours) calculated using a Win Ratio. MEASUREMENTS AND MAIN RESULTS 1,265 patients met inclusion criteria. 795 (62.8%) received high-flow oxygen and 470 (37.2%) received non-invasive ventilation. We propensity score matched 736/1,265 (58.2%) patients. There was no difference between non-invasive ventilation vs high-flow nasal cannula in 28-day mortality (17.7% vs 23.1%, p=0.08) or ventilator-free days (median [Interquartile Range]: 28 [25, 28] vs 28 [13, 28], p=0.50), but patients on non-invasive ventilation required treatment for fewer hours (median 7 vs 13, p< 0.001). Win Ratio for composite major adverse pulmonary events favored non-invasive ventilation (1.26, 95%CI 1.06-1.49, p< 0.001). CONCLUSIONS In this observational study of patients with acute hypoxemic respiratory failure, initial treatment with non-invasive ventilation was superior to high-flow nasal cannula for major pulmonary adverse events. Evaluation of composite outcomes is important in the assessment of respiratory support modalities.
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Affiliation(s)
- Elizabeth S Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ina Prevalska
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Madison Hyer
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Mark A. Tidswell
- Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Chan Medical School – Baystate Medical Center, Springfield, MA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Henry Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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Azap L, Azap R, Hyer M, Diaz A, Pawlik TM. The association of upward economic mobility with textbook outcomes among patients undergoing general and cardiovascular surgery. Am J Surg 2023; 225:494-498. [PMID: 36323621 DOI: 10.1016/j.amjsurg.2022.10.012] [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] [Received: 05/30/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND While disadvantaged neighborhoods may be associated with worse outcomes and earlier death, the relationship between economic opportunity and surgical outcomes remains unexplored. METHODS Medicare beneficiaries who underwent AAA, CABG, colectomy or cholecystectomy were identified and stratified into quintiles based on upward economic mobility. Risk-adjusted probability of adverse postoperative outcomes were examined relative to economic mobility. RESULTS Among 1,081,745 Medicare beneficiaries (age: 75.5 years, female: 43.0%, White: 91.3%), risk-adjusted 30-day postoperative mortality decreased in a stepwise fashion from 6.0%(5.9-6.1) in the lowest quintile of upward economic mobility to 5.3%(5.2-5.4) in highest upward economic mobility (lowest vs. highest economic mobilityobility OR:1.14 (95%CI:1.11-1.17)). Similar associations were noted for postoperative complications (OR:1.04, 95%CI:1.02-1.06), extended length-of-stay (OR:1.07, 95%CI:1.06-1.09), and 30-day readmission (OR:1.04, 95%CI:1.02-1.05). Black beneficiaries had a higher risk of post-operative mortality across upward economic mobility quintiles except within the highest upward mobility group (referent, White patients, OR:0.93, 95%CI:0.79-1.09, p=0.355). CONCLUSION Economic upward mobility was associated with post-operative outcomes. Race-based differences were mitigated at the highest levels of upward economic mobility, highlighting the importance of socioeconomics as a health equity lever.
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Affiliation(s)
- Lovette Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Rosevine Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Adrian Diaz
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, James Comprehensive Cancer Center, USA.
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D'Amico R, Dalmacy D, Akinduro JA, Hyer M, Thung S, Mao S, Fareed N, Bose-Brill S. Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes. JAMA Netw Open 2023; 6:e2254765. [PMID: 36745454 DOI: 10.1001/jamanetworkopen.2022.54765] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
IMPORTANCE Gestational diabetes (GD) affects up to 10% of pregnancies and increases lifetime risk of type 2 diabetes 10-fold; postpartum diabetes evaluation and primary care follow-up are critical in preventing and detecting type 2 diabetes. Despite clinical guidelines recommending universal follow-up, little remains known about how often individuals with GD access primary care and type 2 diabetes screening. OBJECTIVE To describe patterns of primary care follow-up and diabetes-related care among individuals with and without GD in the first year post partum. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a private insurance claims database to compare follow-up in the first year post partum between individuals with GD, type 2 diabetes, and no diabetes diagnosis. Participants included postpartum individuals aged 15 to 51 years who delivered between 2015 and 2018 and had continuous enrollment from 180 days before to 366 days after the delivery date. Data were analyzed September through October 2021 and reanalyzed November 2022. MAIN OUTCOMES AND MEASURES Primary care follow-up visits and diabetes-related care (blood glucose testing and diabetes-associated visit diagnoses) were determined by evaluation and management, Current Procedural Terminology, and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, respectively. RESULTS A total of 280 131 individuals were identified between 2015 and 2018 (mean age: 31 years; 95% CI, 27-34 years); 12 242 (4.4%) had preexisting type 2 diabetes and 18 432 (6.6%) had GD. A total of 50.9% (95% CI, 49.9%-52.0%) of individuals with GD had primary care follow-up, compared with 67.2% (95% CI, 66.2%-68.2%) of individuals with preexisting type 2 diabetes. A total of 36.2% (95% CI, 35.1%-37.4%) of individuals with GD had diabetes-related care compared with 56.9% (95% CI, 55.7%-58.0%) of individuals with preexisting diabetes. Only 36.0% (95% CI, 34.4%-37.6%) of individuals with GD connected with primary care received clinical guideline concordant care with blood glucose testing 12 weeks post partum. CONCLUSIONS AND RELEVANCE In this cohort study of postpartum individuals, individuals with GD had lower rates of primary care and diabetes-related care compared with those with preexisting type 2 diabetes, and only 36% of those with GD received guideline-recommended blood glucose testing in the first 12 weeks post partum. This illustrates a missed opportunity for early intervention in diabetes surveillance and prevention and demonstrates the need to develop a multidisciplinary approach for postpartum follow-up.
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Affiliation(s)
- Rachel D'Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Djhenne Dalmacy
- Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Jenifer A Akinduro
- Department of Obstetrics and Gynecology, Indiana University, Bloomington
| | - Madison Hyer
- Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Stephen Thung
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Shengyi Mao
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Naleef Fareed
- Department of Biomedical Informatics, The Ohio State University, Columbus
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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Hani H, Souchereau R, Kachlan A, Dufour J, Aurand A, Mageswaran P, Hyer M, Marras W. Reliability of a Wearable Motion Tracking System for the Clinical Evaluation of a Dynamic Cervical Spine Function. Sensors (Basel) 2023; 23:1448. [PMID: 36772486 PMCID: PMC9920144 DOI: 10.3390/s23031448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Neck pain is a common cause of disability worldwide. Lack of objective tools to quantify an individual's functional disability results in the widespread use of subjective assessments to measure the limitations in spine function and the response to interventions. This study assessed the reliability of the quantifying neck function using a wearable cervical motion tracking system. Three novice raters recorded the neck motion assessments on 20 volunteers using the device. Kinematic features from the signals in all three anatomical planes were extracted and used as inputs to repeated measures and mixed-effects regression models to calculate the intraclass correlation coefficients (ICCs). Cervical spine-specific kinematic features indicated good and excellent inter-rater and intra-rater reliability for the most part. For intra-rater reliability, the ICC values varied from 0.85 to 0.95, and for inter-rater reliability, they ranged from 0.7 to 0.89. Overall, velocity measures proved to be more reliable compared to other kinematic features. This technique is a trustworthy tool for evaluating neck function objectively. This study showed the potential for cervical spine-specific kinematic measurements to deliver repeatable and reliable metrics to evaluate clinical performance at any time points.
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Affiliation(s)
- Hamed Hani
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Reid Souchereau
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Anas Kachlan
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Jonathan Dufour
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Alexander Aurand
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Prasath Mageswaran
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Madison Hyer
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
| | - William Marras
- Spine Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH 43210, USA
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Palmer Kelly E, Myers B, McGee J, Hyer M, Tsilimigras DI, Pawlik TM. Surgeon Strategies to Patient-Centered Decision-making in Cancer Care: Validation and Applications of a Conceptual Model. J Cancer Educ 2022; 37:1719-1726. [PMID: 33942256 DOI: 10.1007/s13187-021-02017-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
We sought to construct and validate a model of cancer surgeon approaches to patient-centered decision-making (PCDM) and compare applications of that model relative to surgical specialties. Ten PCDM strategies were assessed using a cross-sectional survey administered online to 295 board-certified cancer surgeons. Structural equation modeling was used to empirically validate and compare approaches to PCDM. Within the full sample, 7 strategies comprised a latent construct labeled, "physical & emotional accessibility," associated with surgeon approaches to PCDM (β = 0.37, p < .05). Three individual strategies were included: "expectations (Q4)" (β = 0.52, p < .05), "decision preferences (Q5) (β = 0.47, p < .05), and "access medical information (Q3)" (β = 0.75). Surgical specialties for subgroup analysis were classified as general/other (67.6%) or hepato-pancreato-biliary and upper gastrointestinal (HPB/UGI) (34.2%). For general/other surgeons, 7 individual strategies composed the model of surgeon approaches to PCDM, with "time (Q6) (β = 0.70, p < .001) and "therapeutic relationship building (Q9)" (β = 0.69, p < .001) being the strongest predictors. The HPB/UGI model included 2 latent constructs labeled "physical accessibility" (β = 0.72, p < .05) and "creating a decision-making dialogue" (β = 0.62) as well as the individual strategy, "effective communication (Q8)" (β = 0.51, p < .05). Although models of surgeon PCDM varied, there were 4 overlapping strategies, including effective communication. Tailoring models of PCDM may improve surgeon uptake and thus, overall patient satisfaction with their cancer care.
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Affiliation(s)
| | | | | | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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10
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Hani H, Souchereau R, Kachlan A, Harris H, Dufour J, Aurand A, Mageswaran P, Hyer M, Marras W. Reliability of a Wearable Motion System for Clinical Evaluation of Dynamic Lumbar Spine Function. Adv Complement Altern Med 2022; 7:672-683. [PMID: 36816092 PMCID: PMC9934370 DOI: 10.31031/acam.2022.07.000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Low back pain is the leading cause of disability worldwide. Subjective assessments are often used to assess extent of functional limitations and treatment response. However, these measures have poor sensitivity and are influenced by the patient's perception of their condition. Currently, there are no objective tools to effectively assess the extent of an individual's functional disability and inform clinical decision-making. Objective The purpose of this study was to evaluate the reliability of a wearable motion system based on Inertial Measurement Unit (IMU) sensors for use in quantifying low back function. Methods Low back motion assessments were conducted by 3 novice raters on 20 participants using an IMU-based motion system. These assessments were conducted over 3 days with 2 days of rest in between tests. A total of 37 kinematic parameters were extracted from the low back motion assessment in all three anatomical planes. Intra-rater and inter-rater reliability were assessed using Intraclass Correlation Coefficients (ICCs) calculated from repeated measures, mixed-effects regression models. Results Lumbar spine-specific kinematic parameters showed moderate to excellent reliability across all kinematic parameters. The ICC values ranged between 0.84-0.93 for intra-rater reliability and 0.66 - 0.83 for inter-rater reliability. In particular, velocity measures showed higher reliabilities than other kinematic variables. Conclusion The IMU-based wearable motion system is a valid and reliable tool to objectively assess low back function. This study demonstrated that lumbar spine-specific kinematic metrics have the potential to provide good, repeatable metrics to assess clinical function over time.
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Affiliation(s)
- Hamed Hani
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Reid Souchereau
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Anas Kachlan
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Halle Harris
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Jonathan Dufour
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Alexander Aurand
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Prasath Mageswaran
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA
| | - Madison Hyer
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, USA
| | - William Marras
- Spine Research Institute, The Ohio State University, USA,Department of Integrated Systems Engineering, The Ohio State University, USA,Corresponding author: William S Marras, 1971 Neil Avenue, Room 520, Columbus OH, 43210, USA
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Labiner HE, Hyer M, Cloyd JM, Tsilimigras DI, Dalmacy D, Paro A, Pawlik TM. Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery. J Gastrointest Surg 2022; 26:1171-1177. [PMID: 35023035 PMCID: PMC8754363 DOI: 10.1007/s11605-022-05245-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/17/2021] [Accepted: 01/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been increased interest in understanding how social determinants of health (SDH) may affect care both in the medical and surgical setting. We sought to define the impact of various aspects of social vulnerability on the ability of patients to achieve a "textbook outcome" (TO) following hepatopancreatic surgery. METHODS Medicare beneficiaries who underwent hepatopancreatic resection between 2013 and 2017 were identified using the Medicare database. Social vulnerability was defined using the Centers for Disease Control Social Vulnerability Index (SVI), which is comprised of four subthemes: socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). TO was defined as the composite endpoint: absence of 90-day mortality or readmission, absence of an extended length of stay (LOS), and no complications during the index admission. Cluster analysis was used to identify vulnerability cohorts, and multivariable logistic regression was utilized to assess the impact of these SVI subthemes on the likelihood to achieve a textbook outcome. RESULTS Among 37,707 Medicare beneficiaries, 64.9% (n = 24,462) of patients underwent pancreatic resection while 35.1% (n = 13,245) underwent hepatic resection. Median patient age was 72 years (IQR: 68-77), just over one-half were male (51.9%; n = 19,558), and the median CCI was 3 (IQR: 2-8). Cluster analysis revealed five distinct SVI profiles with wide variability in the distribution of SVI subthemes, ranging from 15 (profile 1 IQR: 7-26) to 83 (profile 5 IQR: 66-93). The five profiles were grouped into 3 categories based on median composite SVI: "low vulnerability" (profile 1), "average vulnerability" (profiles 2 and 3), or "high vulnerability" (profiles 4 and 5). The rate of TO ranged from 44.6% in profile 5 (n = 4022) to 49.2% in profile 1 (n = 4836). Multivariable analyses comparing patients categorized into the two average SVI profiles revealed that despite having similar composite SVI scores, the risk of adverse postoperative outcomes was not similar. Specifically, patients from profile 5 had lower odds of achieving a TO (OR 0.89, 95%CI: 0.83-0.95) and higher odds of 90-day mortality (OR 1.29, 95%CI: 1.15-1.44) versus patients in profile 4. CONCLUSION Distinct profiles of SVI subtheme characteristics were independently associated with postoperative outcomes among Medicare beneficiaries undergoing HP surgery, even among patients with similar overall composite SVI scores.
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Affiliation(s)
- Hanna E. Labiner
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Madison Hyer
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Jordan M. Cloyd
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Diamantis I. Tsilimigras
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Djhenne Dalmacy
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Alessandro Paro
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Timothy M. Pawlik
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
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Dalmacy DM, Diaz A, Hyer M, Pawlik TM. Age-Based Left-Digit Bias in the Management of Acute Cholecystitis. J Gastrointest Surg 2021; 25:3239-3241. [PMID: 34173162 DOI: 10.1007/s11605-021-05065-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Djhenne M Dalmacy
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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Beane JD, Hyer M, Mehta R, Onuma AE, Gleeson EM, Thompson VM, Pawlik TM, Pitt HA. Optimal hepatic surgery: Are we making progress in North America? Surgery 2021; 170:1741-1748. [PMID: 34325906 DOI: 10.1016/j.surg.2021.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this analysis was to determine whether optimal outcomes have increased in recent years. Hepatic surgery is high risk, but regionalization and minimally invasive approaches have evolved. Best practices also have been defined with the goal of improving outcomes. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried. Analyses were performed separately for partial (≤2 segments), major (≥3 segments), and all hepatectomies. Optimal hepatic surgery was defined as the absence of mortality, serious morbidity, need for a postoperative invasive procedure or reoperation, prolonged length of stay (<75th percentile) or readmission. Tests of trend, χ2, and multivariable analyses were performed. RESULTS From 2014 to 2018, 17,082 hepatectomies, including 11,862 partial hepatectomies and 5,220 major hepatectomies, were analyzed. Minimally invasive approaches increased from 25.6% in 2014 to 29.6% in 2018 (P < .01) and were performed more frequently for partial hepatectomies (34.2%) than major hepatectomies (14.4%) (P < .01). Operative time decreased from 220 minutes in 2014 to 208 minutes in 2018 (P < .05) and was lower in partial hepatectomies (189 vs 258 minutes for major hepatectomies) (P < .01). Mortality (0.7%) and length of stay (4 days) were lower for partial hepatectomies compared with major hepatectomies (1.9%; 6 days), and length of stay decreased for both partial hepatectomies (5 days in 2014 to 4 days in 2018) and major hepatectomies (6 days in 2014 to 6 days in 2018) (all P < .01). Postoperative sepsis (2.9% in 2014 and 2.4% in 2018), bile leaks (6% in 2014 and 4.8% in 2018), and liver failure (3.7% in 2014 and 3.3% in 2018) decreased for all patients (<.05). On multivariable analyses, overall morbidity decreased for major hepatectomies (OR 0.95, 95% CI 0.91-0.99) and all hepatectomies (OR 0.97, 95% CI 0.94-0.99, both P < .01), and optimal hepatic surgery increased over time for partial hepatectomies (OR 1.05, 95% CI 1.02-1.09) and all hepatectomies (OR 1.04, 95% CI 1.02-1.07, both P < .01). CONCLUSION Over a 5-year period in North America, minimally invasive hepatectomies have increased, while operative time, postoperative sepsis, bile leaks, liver failure, and prolonged length of stay have decreased. Optimal hepatic surgery has increased for partial and all hepatectomies and is achieved more often in partial than in major resections.
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Affiliation(s)
- Joal D Beane
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH.
| | - Madison Hyer
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Rittal Mehta
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Amblessed E Onuma
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Elizabeth M Gleeson
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Timothy M Pawlik
- Department of Surgery, The James Cancer Center, Ohio State University, Columbus, OH
| | - Henry A Pitt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Lansing SS, Diaz A, Hyer M, Tsilimigras D, Pawlik TM. Rural hospitals are not associated with worse postoperative outcomes for colon cancer surgery. J Rural Health 2021; 38:650-659. [PMID: 34014573 DOI: 10.1111/jrh.12596] [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] [Indexed: 01/17/2023]
Abstract
PURPOSE We sought to determine whether colorectal cancer surgery can be done safely at rural hospitals. The current study compared outcomes among rural patients who underwent colon resection at rural and nonrural hospitals. METHODS Medicare beneficiaries who underwent colon resection for cancer between 2013 and 2017 were identified using the Medicare Inpatient Standard Analytic Files. Patients and hospitals were designated as rural based on rural-urban continuum codes. Risk-adjusted postoperative outcomes and hospitalization spending were compared among patients undergoing resection at rural versus nonrural hospitals. RESULTS Among 3,937 patients who resided in a rural county and underwent colon resection for cancer, mean age was 76.3 (SD: 7.1) years and 1,432 (36.4%) patients underwent operative procedure at a rural hospital. On multivariable analyses, no differences in postoperative outcomes were noted among Medicare beneficiaries undergoing colon resection for cancer at nonrural versus rural hospitals. Specifically, the risk-adjusted probability of experiencing a postoperative complication at a nonrural hospital was 15.4% (95% CI: 14.1%-16.8%) versus 16.3% (95% CI: 14.2%-18.3%) at a rural hospital (OR 1.08, 95% CI: 0.85-1.38); 30-day mortality (nonrural: 2.9%, 95% CI: 2.2-3.6 vs rural: 3.5%, 95% CI: 2.4-4.5) was also comparable. In addition, price standardized, risk-adjusted expenditures were similar at nonrural ($18,610, 95% CI: $18,037-$19,183) and rural ($19,010, 95% CI: $18,630-$19,390) hospitals. CONCLUSION Among rural Medicare beneficiaries who underwent a colon resection for cancer, there were no differences in postoperative outcomes among nonrural versus rural hospitals. These findings serve to highlight the importance of policies and practice guidelines that secure safe, local surgical care, allowing rural clinicians to accommodate strong patient preferences while delivering high-quality surgical care.
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Affiliation(s)
- Shan S Lansing
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Adrian Diaz
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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15
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Palmer Kelly E, Hyer M, Paredes AZ, McGee J, Tsilimigras DI, Cloyd J, Ejaz A, Park KU, Pawlik TM. Comparing Surgeon Approaches to Patient-Centered Cancer Care Using Vignette Methodology. J Gastrointest Surg 2021; 25:1307-1315. [PMID: 32519248 DOI: 10.1007/s11605-020-04661-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/22/2020] [Accepted: 05/15/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to characterize surgeon perceptions of patient attachment-related behaviors relative to patient-centered approaches during treatment decision-making within the clinical encounter. METHODS An online survey including clinical vignettes was sent to board-certified surgeons to assess their approach to patient-centered treatment decision-making. Within these vignettes, patient behaviors associated with attachment styles (secure vs 3 insecure subtypes: avoidant, anxious, and fearful) were fixed and patient factors (age, race, occupation, and gender) were randomized. Analysis included repeated measures mixed-effects linear regression. RESULTS Among the 208 respondents, the majority were male (65.4%) and White/Caucasian (84.5%) with an average age of 51.6 years (SD = 9.9). Most surgeons had been in practice for more than 10 years (66.8%) and treated adult patients (77.4%). Surgical specializations included breast (27.2%), HPB (35.0%), and broad-based/general (21.8%). Patient race, age, and gender did not impact surgeons' patient-centered approach to treatment decision-making (all ps > 0.05). However, when the "patient" had a white collar occupation and were securely attached, surgeons reported a greater likeliness to spend equal time presenting all treatment options (p = 0.02 and p < 0.001, respectively) and believe the patient wanted an active role in decision-making (p = 0.01 and p < 0.001, respectively). Surgeons reported being least likely to agree with a patient's treatment decision (p < 0.001) and an increased likelihood of being directive (p = 0.002) when patients exhibited behaviors associated with avoidant attachment. CONCLUSION Attachment-related behaviors were associated with differences in surgeon approaches to patient-centered decision-making. Attachment styles may offer a framework for providers to understand patient behaviors and needs, thereby providing insight on how to tailor their approach and provide optimal patient-centered care.
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Affiliation(s)
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Julia McGee
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Ko Un Park
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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Palmer Kelly E, Hyer M, Tsilimigras D, Pawlik TM. Healthcare provider self-reported observations and behaviors regarding their role in the spiritual care of cancer patients. Support Care Cancer 2021; 29:4405-4412. [PMID: 33439350 DOI: 10.1007/s00520-020-05957-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/02/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The provision of spiritual care by an interprofessional healthcare team is an important, yet frequently neglected, component of patient-centered cancer care. The current study aimed to assess the relationship between individual and occupational factors of healthcare providers and their self-reported observations and behaviors regarding spiritual care in the oncologic encounter. METHODS A cross-sectional survey was administered to healthcare providers employed at a large Comprehensive Cancer Center. Pearson's chi-square test and logistic regression were used to determine potential associations between provider factors and their observations and behaviors regarding spiritual care. RESULTS Among the participants emailed, 420 followed the survey link, with 340 (80.8%) participants completing the survey. Most participants were female (82.1%) and Caucasian (82.6%) with a median age was 35 years (IQR: 31-48). Providers included nurses (64.7%), physicians (17.9%), and "other" providers (17.4%). There was a difference in provider observations about discussing patient issues around religion and spirituality (R&S). Specifically, nurses more frequently inquired about R&S (60.3%), while physicians were less likely (41.4%) (p = 0.028). Also, nurses more frequently referred to chaplaincy/clergy (71.8%), while physicians and other providers more often consulted psychology/psychiatry (62.7%, p < 0.001). Perceived barriers to not discussing R&S topics included potentially offending patients (56.5%) and time limitations (47.7%). CONCLUSION Removing extrinsic barriers and understanding intrinsic influences can improve the provision of spiritual care by healthcare providers.
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Affiliation(s)
- Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Palmer Kelly E, Hyer M, Paredes AZ, Pawlik TM. A mixed-methods approach to comparing perceptions of cancer patients' and cancer care providers' religious and spiritual beliefs, behaviours, and attitudes. Eur J Cancer Care (Engl) 2020; 30:e13390. [PMID: 33368724 DOI: 10.1111/ecc.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/05/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the perceptions of cancer patients' and cancer care providers' religious and spiritual (R&S) beliefs, behaviours, and attitudes. METHODS A concurrent, nested, quantitative dominant, mixed-methods design was utilised. Data were collected from patient and provider groups via online survey. Analyses include chi-square tests of independence and independent t-tests for quantitative data and content analysis for qualitative data. RESULTS The final analytic cohort for the study included 576 participants (npatients = 236, nproviders = 340) with an average age of 47.4 years (SD = 15.0). Over half of participants were partnered (n = 386, 70.1%), female (n = 317, 57.3%) and had an advanced degree (n = 284, 51.2%). The most common diagnosis for patients was breast cancer (n = 103, 43.2%). The most common provider role was nurse (n = 220; 64.7%), while a smaller subset included physicians (n = 61; 17.9%) and "other" providers (n = 59; 17.4%). There was no difference between patients and providers in relation to R&S identity (p = 0.49) or behaviour (p = 0.28). Providers more frequently indicated that patients should receive R&S resources in the hospital (n = 281, 89.7% vs. n = 111, 49.6%, p < 0.001). For resource type, patients most frequently endorsed written resources (n = 93, 83.8%) while providers endorsed relational resources (n = 281, 97.9%). CONCLUSION Aligning patient and provider expectations of spiritual care will contribute to provision of optimal patient-centred cancer care.
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Affiliation(s)
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Abstract
BACKGROUND Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. OBJECTIVE The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. DESIGN A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. RESULTS A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. CONCLUSIONS Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.
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Affiliation(s)
| | | | - Madison Hyer
- Department of Surgery, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, 2647The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis. J Cancer Educ 2020; 35:447-453. [PMID: 30772927 DOI: 10.1007/s13187-019-1481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Palmer E, Paredes A, Hyer M, Pawlik TM. Pastoral care of cancer patients: Defining utilization of services at a comprehensive cancer center. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24171 Background: Addressing the religious/spiritual needs of patients is an important component of comprehensive cancer care. Patients often report that providers infrequently engage them about their needs during treatment. In addition, providers cite inadequate training as a significant barrier to providing spiritual care. While patients may benefit from the presence of a spiritual care specialist during cancer treatment, the utilization and content of these services are not well defined. We sought to characterize utilization of pastoral care (PC) services, as well as delineate differences in PC utilization among patients with cancer. Methods: Data on patients being treated for cancer at a Comprehensive Cancer Center between 2015-2018 were obtained from the electronic medical record. Overall utilization, type of PC services utilized, as well as factors associated with use of PC were assessed. Analyses included descriptive statistics and logistic regression. Results: Among 14,322 cancer patients, roughly one-third (n = 5166, 36.1%) had at least one PC encounter during their cancer treatment. Interventions most frequently provided by PC included supportive presence (93.5%) and active listening (86.6%), while the most frequently explored topics were treatment expectations (59.8%), issues with faith/beliefs (42.9%), and available coping mechanisms (35.4%). Patients diagnosed with colorectal (OR:1.42, 95%CI:1.07-1.89), liver (OR:2.41, 95%CI:1.80-3.24), or pancreatic cancer (OR:1.43, 95%CI:1.02-2.00) were more likely to utilize PC services compared with other cancers. Patients that identified as Catholic (OR:1.47, 95%CI:1.17-1.84) or Christian (OR:1.73, 95%CI:1.39-2.15) were more likely to request PC services (both p < 0.001) than individuals who had no religious preference/affiliation. Among surgical patients (n = 1,174), the majority of encounters with PC services were in the postoperative setting (n = 801, 70.6%). Patients most often reported that PC helped with verbalization of their feelings (93.6%) and helped reduce stress (76.9%). Conclusions: Over one-third of patients with cancer interacted with PC and received services that often addressed both psychosocial and spiritual concerns. Overall PC utilization and types of PC services rendered varied relative to demographic and religious factors. Providers should be aware of varying patient religious/spiritual needs so as to optimize the entire cancer care experience for patients.
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Affiliation(s)
| | | | - Madison Hyer
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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21
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Palmer Kelly E, Paredes AZ, DiFilippo S, Hyer M, Myers B, McGee J, Rice D, Bae J, Tsilimigras DI, Pawlik TM. Do Religious/Spiritual Preferences and Needs of Cancer Patients Vary Based on Clinical- and Treatment-Level Factors? Ann Surg Oncol 2020; 28:59-66. [PMID: 32424588 DOI: 10.1245/s10434-020-08607-2] [Citation(s) in RCA: 2] [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: 03/22/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objective of this study is to characterize the religion and spiritual (R&S) needs of patients who undergo cancer-directed surgery. In addition, we seek to examine how R&S needs vary based on R&S identity and clinical and surgical treatment characteristics. PATIENTS AND METHODS A cross-sectional survey was administered to potential participants who were recruited through outpatient clinics and online. Respondent desires for R&S resources and engagement with the healthcare team around R&S topics were assessed. RESULTS Among 383 potential participants who were identified, 236 respondents were included in the analytic cohort. Mean age was 58.8 (SD 12.10) years, and most participants were female (75.8%) and White/Caucasian (94.1%). The majority (78.4%) identified as currently cancer free. Commonly treated malignancies included breast (43.2%), male reproductive (8.9%), skin (8.5%), and gastrointestinal (GI) (7.2%). Two-thirds of the respondents indicated a desire to have R&S incorporated into their cancer treatment (63.3%). Patients who identified as highly/moderately religious reported wanting R&S more often (highly religious: 95.2% versus moderately religious: 71.4% vs. nonreligious but spiritual: 4.5%). On multivariable analysis, patients who believed their health would improve in the future were more likely to report wanting R&S service (OR 2.2, 95% CI 1.0-4.7) as well as wanting to engage their healthcare providers on R&S topics (OR 2.4, 95% CI 1.2-4.7). In contrast, perception of current or future health status was not associated with patient desire for the actual surgeon/doctor him/herself to be involved in R&S activities (OR 1.83, 95% CI 0.97-3.45). CONCLUSIONS Two-thirds of patients undergoing cancer-directed surgery expressed a desire to have R&S incorporated into their cancer treatment. Incorporating R&S into cancer treatment can help a subset of patients throughout their cancer experience.
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Affiliation(s)
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Myers
- The Ohio State University, Columbus, OH, USA
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Daniel Rice
- Lake Erie College of Osteopathic Medicine, Greensburg, PA, USA
| | - Junu Bae
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Palmer Kelly E, Hyer M, Paredes AZ, McGee J, Cloyd J, Ejaz A, Park KU, Pawlik TM. Assessing Differences in Cancer Surgeon Approaches to Patient-Centered Decision-Making Using Vignette-Based Methodology. Ann Surg Oncol 2020; 27:2149-2156. [PMID: 32318948 DOI: 10.1245/s10434-020-08488-5] [Citation(s) in RCA: 2] [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: 02/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study is to assess surgeon-patient-centered decision-making (PCDM) strategies relative to surgeon and patient factors. METHODS Approaches to PCDM were evaluated using a cross-sectional survey based on clinical vignettes assessing surgeon likeliness (0 = not at all likely, 100 = very likely) to utilize PCDM strategies. Data were analyzed using repeated-measures mixed-effects linear regression. Adjusted estimates are provided as least-squares mean (LSM) values. RESULTS The final analytic sample consisted of 208 respondents (58.5% response rate); the majority of respondents were male (67.7%) and Caucasian (82.0%) with an average age of 51.6 years (standard deviation, SD = 9.9 years, range 34.0-78.0 years). Specialties included breast (18.9%), hepatopancreatobiliary (21.4%), and other (59.7%). Surgeons practicing at academic (versus nonacademic) hospitals were less likely to be directive (LSM: 66.2 vs. 70.3, p = 0.004), spend equal time discussing all treatment options (LSM: 77.9 vs. 82.3, p = 0.001), and make explicit treatment recommendations (LSM: 67.7 vs. 71.7, p = 0.005). Surgeons who specialized in breast cancer (versus other specialties), in practice 10+ years (versus < 10 years), and female (versus male) were more likely to spend time discussing all treatment options (LSM: 82.8 vs. 77.3; 81.6 vs. 78.6; and 82.1 vs. 78.0, all p < 0.05). Surgeons perceived patients who had blue-collar (versus white-collar) jobs as less likely to want active participation in decision-making (LSM: 62.9 vs. 65.6, p = 0.02). CONCLUSION Surgeon approaches to PCDM varied based on a number of surgeon and patient characteristics. Further studies are needed to understand how surgeon PCDM strategies can be tailored to specific care contexts and patient needs.
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Affiliation(s)
| | - Madison Hyer
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ko Un Park
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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Heidsma CM, Hyer M, Tsilimigras DI, Rocha F, Abbott DE, Fields R, Smith PM, Poultsides GA, Cho C, Maithel SK, Pawlik TM. Incidence and impact of Textbook Outcome among patients undergoing resection of pancreatic neuroendocrine tumors: Results of the US Neuroendocrine Tumor Study Group. J Surg Oncol 2020; 121:1201-1208. [PMID: 32185804 DOI: 10.1002/jso.25900] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES We sought to define the incidence and impact of Textbook Outcome (TO) on disease-free survival [DFS] among patients undergoing resection of pancreatic neuroendocrine tumors (PNET). METHODS Patients undergoing resection of a PNET between 2000 and 2016 were identified using a multi-institutional database. TO was defined as no postoperative severe complications (Clavien-Dindo grade ≥ III), no 90-day mortality, no prolonged length-of-hospital stay (LOS) (ie, > 75th percentile), no 90-day readmission after discharge, and R0 resection. The 5-year DFS was calculated and the association with TO was examined. RESULTS Among 821 patients with a PNET, median tumor size was 2.1 cm (IQR 1.4-14.6). Resection consisted of pancreatoduodenectomy (PD) (n = 231, 28.1%), distal pancreatectomy (DP) (n = 492, 59.9%), and enucleation (EN) (n = 98, 11.9%). Overall TO rate was 49.3% (n = 405). The incidence of TO varied by procedure type (PD: 32.5% vs DP: 56.7% vs EN: 52.0%; P < .001). After adjusting for all competing factors, achievement of a TO was independently associated with improved DFS (hazard ratio: 0.54, 95% CI, 0.35-0.81; P = .003). CONCLUSIONS Only one in two patients undergoing resection of a PNET achieved a TO, which varied markedly based on procedure type. Achievement of a TO was associated with improved DFS.
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Affiliation(s)
- Charlotte M Heidsma
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Flavio Rocha
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Wisconsin
| | - Paula M Smith
- Department of Surgery, Division of Surgical Oncology, Vanderbilt University, Nashville, Tennessee
| | | | - Clifford Cho
- Department of Surgery, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Palmer Kelly E, Hyer M, Payne N, Pawlik TM. Does spiritual and religious orientation impact the clinical practice of healthcare providers? J Interprof Care 2020; 34:520-527. [DOI: 10.1080/13561820.2019.1709426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Madison Hyer
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolette Payne
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Paredes A, Hyer M, Palmer E, Lustberg MB, Pawlik TM. Racial/ethnic disparities in hospice utilization among Medicare beneficiaries dying from pancreatic cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.31_suppl.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
41 Background: While racial/ethnic treatment disparities among patients with pancreatic cancer have been documented, variation in other aspects of care including hospice utilization have not. As such, we sought to define the incidence, as well as characterize the timing, of hospice utilization among racial/ethnic minority patients following pancreatectomy for pancreatic cancer. Methods: The Medicare Standard Analytic Files were used to identify white and racial/ethnic minorities (African Americans and Hispanics) who underwent pancreatectomy for pancreatic cancer. Trends and timing related to overall hospice utilization among racial/ethnic minority and white patients were analyzed. Results: Among the 6,530 individuals (median age: 73, IQR 69-78; 51.5% female; 6.6% % racial/ethnic minority) who underwent a pancreatectomy for pancreatic cancer, 64.6% (n = 4221) had died by the end of the follow-period. Among deceased individuals, three-fourths of patients (n = 3149, 74.6%) had used hospice leading up to the time of death. Among individuals who died, age and comorbidity burden were similar among racial/ethnic minority and white patients; racial/ethnic minority patients were less likely, however, to have used hospice services compared with white patients (racial/ethnic minorities: n = 188, 68.9%, whites: n = 2,961, 75.0%; p = 0.024). On multivariable analysis, after controlling for clinical factors, racial/ethnic minority patients remained 27% less likely than whites to initiate hospice services prior to death (OR 0.73, 95%CI 0.56-0.95, p = 0.021). Despite overall lower use of hospice, racial/ethnic minority patients had comparable odds of late hospice utilization (i.e. within 3 days of death) versus white patients (OR 0.75, 95% CI 0.49-1.14, p = 0.18). Conclusions: While most patients undergoing pancreatectomy for pancreatic cancer utilized hospice services prior to death, ethnic/racial minority were less likely to use hospice services than whites. Further research should seek to better understand possible barriers to hospice initiation among racial/ethnic minority patients with cancer.
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Affiliation(s)
| | - Madison Hyer
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Maryam B. Lustberg
- Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Columbus, OH
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Mattos JL, Edwards C, Schlosser RJ, Hyer M, Mace JC, Smith TL, Soler ZM. A brief version of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:1144-1150. [PMID: 31430061 PMCID: PMC6773507 DOI: 10.1002/alr.22392] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/09/2019] [Accepted: 06/27/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) is a valuable instrument in the measurement of olfactory-specific quality of life (QOL). In the clinical setting, patients can be overwhelmed with the time required to complete questionnaires. Our objective was to develop a brief version of the QOD-NS to streamline clinical care and research. METHODS QOD-NS scores from 221 subjects were used to determine which subset of the 17 QOD-NS questions best correlated with total and subdomain QOD-NS scores. An initial pool of 11 questions was made by removing items with ρ < 0.80 to their respective subdomain scores. Next, 500 bootstrapped samples were taken. On each sampe, an all-subsets regression was performed with total QOD-NS scores and QOD-NS subdomain scores as the outcomes. From this, our "top" and "bottom" 10 subsets were identified based on mean r2 value, representation in bootstrap analysis, and number of items. RESULTS All of our top subsets had excellent correlation with total and subdomain QOD-NS scores (mean r2 > 0.90). Our top choice has 7 total questions, is representative of all subdomains, has a mean r2 = 0.92, and was represented in 323 of our 500 bootstrapped samples. The worst-performing subset has 5 items, mean r2 = 0.81, and was represented in only 1 bootstrapped sample. CONCLUSIONS Using less than half of the questions in the QOD-NS, excellent correlations with both total and domain-specific scores are achieved. A brief version of the QOD-NS may prove useful in future clinical and research settings.
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Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Virginia, Charlottesville, VA
- University of Virginia School of Medicine, Charlottesville VA
| | | | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, , USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Butler DC, Schandl C, Hyer M, Erin Presnell S. Aqueous Fluid as a Viable Substitute for Vitreous Fluid in Postmortem Chemistry Analysis. J Forensic Sci 2019; 65:508-512. [PMID: 31483499 DOI: 10.1111/1556-4029.14178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/02/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
Vitreous fluid sampling for postmortem chemistry analysis is discouraged in pediatric forensic cases involving head trauma due to the risk of introducing retinal artifacts. Aqueous fluid is physically separated from the posterior chamber of the eye, and therefore, unlikely to produce vitreal artifact when sampled. Analysis of aqueous fluid is therefore proposed as a substitute for vitreous. Vitreous and aqueous fluid was sampled concurrently from 28 pediatric and 55 adult decedents, and sodium (Na), potassium (K), chloride (Cl), urea nitrogen (UN), creatinine (Cr), and glucose (Glc) concentrations were compared. Significant correlation existed between all analytes regardless of age or postmortem interval, and linear regression equations were derived. Aqueous concentrations were generally higher than vitreous for Na, K, and Cr and were marginally lower for Cl, UN, and Glc. Assuming vitreous fluid as a standard for correlating postmortem chemistry to antemortem serum values, aqueous may be a viable substitute for vitreous when expected differences are considered.
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Affiliation(s)
- Daniel C Butler
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 165 Ashley Ave. MSC 908, Charleston, SC, 29425
| | - Cynthia Schandl
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 165 Ashley Ave. MSC 908, Charleston, SC, 29425
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 460 W 10th Ave, Columbus, 43210, OH, United States
| | - Susan Erin Presnell
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 165 Ashley Ave. MSC 908, Charleston, SC, 29425
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Understanding the Type of Support Offered Within the Caregiver, Family, and Spiritual/Religious Contexts of Cancer Patients. J Pain Symptom Manage 2019; 58:56-64. [PMID: 30878299 DOI: 10.1016/j.jpainsymman.2019.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT/OBJECTIVES We sought to characterize patterns of social support types (i.e., emotional, informational, appraisal, and instrumental) within the caregiver/spouse, family, and spiritual/religious contexts for patients diagnosed with cancer. METHODS Focus groups were conducted with mixed groups of patients with cancer and caregiver/family members at a Midwestern comprehensive cancer center. Participants completed brief demographic questionnaires. Focus groups were moderated using semistructured interviews. The 90-minute discussions were audio-recorded, transcribed, and uploaded into NVivo for analysis using a deductive approach based on four social support types and the constant comparative method. RESULTS Four focus groups were conducted (n = 25). The average age was 58.4 years (SD = 15.1, range 26.0-76.0). Patient participants reported different malignancy types, including breast, gynecologic, skin, oral, and Non-Hodgkin's lymphoma. Participants acknowledged changes within their social network across the cancer journey. Overall, the caregiver/spouse fulfilled all types of social support. Spirituality/religion was often discussed as a form of appraisal social support. Fellow survivors were sources of informational support. Across groups, nondirective/emotional support was most frequently mentioned. CONCLUSION Cancer is a unique experience, and understanding the importance of social support, including types of social support needed from different contexts to best meet the needs of the patient, may promote optimal, patient-centered care across the cancer trajectory.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, USA.
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Palmer Kelly E, Agne JL, Hyer M, Meara A, Olsen G, Pawlik TM. A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice. Eur J Cancer Care (Engl) 2018; 28:e12981. [PMID: 30561074 DOI: 10.1111/ecc.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The patient-physician relationship is a critical component of patient-centred health care. The patient-oncologist relationship is particularly important due to the uncertainties that surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists. METHODS A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: "relationship," "doctor-patient," and "oncology." The included studies explicitly measured the "relationship" as an independent or dependent variable. Data were extracted and analysed. RESULTS The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient-oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n = 10). The few studies that considered the oncologist perspective did not measure their perception of the relationship. CONCLUSIONS The current review demonstrates that current approaches used to assess the patient-oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient-oncologist relationship.
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Affiliation(s)
| | - Julia L Agne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Griffin Olsen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Zollars ES, Hyer M, Wolf B, Chapin R. Measuring lupus arthritis activity using contrasted high-field MRI. Associations with clinical measures of disease activity and novel patterns of disease. Lupus Sci Med 2018; 5:e000264. [PMID: 30094039 PMCID: PMC6069922 DOI: 10.1136/lupus-2018-000264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 11/03/2022]
Abstract
Objective Arthritis in SLE is poorly described, and there is no objective measure for quantification of arthritis. In this pilot study, we aim to assess the utility of the Rheumatoid Arthritis MRI Scoring System (RAMRIS) for the quantification of lupus arthritis. Methods Patients were eligible for entry into the study if they were evaluated at the Medical University of South Carolina Lupus Center and determined by their treating rheumatologist to have active hand arthritis due to SLE. Standard of care lupus activity measures were collected, along with a detailed physical exam. MRIs were obtained using standard musculoskeletal sequences with gadolinium contrast. Semiquantitative scoring of the images used the Outcome Measures in Rheumatology Clinical Trials RAMRIS system. Results RAMRIS demonstrates large amounts of synovitis, tenosynovitis, bone marrow oedema and erosive disease in only a minority of patients. Some patients were not scored as having any synovitis or tenosynovitis. We describe potential features of lupus arthritis that are not captured in the RAMRIS scores and may be contributing to symptoms. Conclusion Lupus arthritis is an entity separate from rheumatoid arthritis and requires the development of new quantitative methods to describe and quantitate it. MRI findings suggest the inadequacy of a typical lupus musculoskeletal measure including swollen/tender joint counts to assess the level of disease activity.
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Affiliation(s)
- Eric S Zollars
- Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madison Hyer
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bethany Wolf
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Russell Chapin
- Division of Musculoskeletal Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
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Mattos JL, Schlosser RJ, DeConde AS, Hyer M, Mace JC, Smith TL, Soler ZM. Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8:777-782. [PMID: 29633540 PMCID: PMC6035764 DOI: 10.1002/alr.22112] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD-NS differentially impact QOL. METHODS Patients with chronic rhinosinusitis (CRS) completed the QOD-NS, 22-item Sino-Nasal Outcome Test (SNOT-22), Medical Outcomes Study Short Form 6-D (SF-6D) health utility measure, and Patient Health Questionnaire-2 (PHQ-2) depression screen. Exploratory factor analysis of the QOD-NS was performed. Associations between QOD-NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS). RESULTS Outcomes were examined on 132 patients. The QOD-NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF-6D and SNOT-22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ-2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD-NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05). CONCLUSION The QOD-NS measures 4 distinct factors. Eating-related questions had the greatest improvement after ESS. Health utility and CRS-specific QOL improvement most strongly associated with factor 2, while PHQ-2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD-NS on varying aspects of QOL.
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Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Adam S. DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, CA, USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Pearce JL, Hyer M, Hyndman RJ, Loughnan M, Dennekamp M, Nicholls N. Exploring the influence of short-term temperature patterns on temperature-related mortality: a case-study of Melbourne, Australia. Environ Health 2016; 15:107. [PMID: 27832786 PMCID: PMC5105247 DOI: 10.1186/s12940-016-0193-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Several studies have identified the association between ambient temperature and mortality; however, several features of temperature behavior and their impacts on health remain unresolved. We obtain daily counts of nonaccidental all-cause mortality data in the elderly (65 + years) and corresponding meteorological data for Melbourne, Australia during 1999 to 2006. We then characterize the temporal behavior of ambient temperature development by quantifying the rates of temperature change during periods designated by pre-specified windows ranging from 1 to 30 days. Finally, we evaluate if the association between same day temperature and mortality in the framework of a Poisson regression and include our temperature trajectory variables in order to assess if associations were modified by the nature of how the given daily temperature had evolved. RESULTS We found a positive significant association between short-term mortality risk and daily average temperature as mortality risk increased 6 % on days when temperatures were above the 90th percentile as compared to days in the referent 25-75th. In addition, we found that mortality risk associated with daily temperature varied by the nature of the temperature trajectory over the preceding twelve days and that peaks in mortality occurred during periods of high temperatures and stable trajectories and during periods of increasing higher temperatures and increasing trajectories. CONCLUSION Our method presents a promising tool for improving understanding of complex temperature health associations. These findings suggest that the nature of sub-monthly temperature variability plays a role in the acute impacts of temperature on mortality; however, further studies are suggested.
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Affiliation(s)
- John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29403 USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29403 USA
| | - Rob J. Hyndman
- Department of Econometrics and Business Statistics, Monash University, Wellington Rd., Clayton, Victoria 3800 Australia
| | - Margaret Loughnan
- School of Geography and Environmental Science, Monash University, Wellington Rd., Clayton, Victoria 3800 Australia
| | - Martine Dennekamp
- Department of Epidemiology and Preventative Medicine, Monash University, 99 Commercial Rd., Melbourne, Victoria 3004 Australia
| | - Neville Nicholls
- School of Geography and Environmental Science, Monash University, Wellington Rd., Clayton, Victoria 3800 Australia
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Fargen KM, Spiotta AM, Hyer M, Lena J, Turner RD, Turk AS, Chaudry I. Comparison of venous sinus manometry gradients obtained while awake and under general anesthesia before venous sinus stenting. J Neurointerv Surg 2016; 9:990-993. [PMID: 27634954 DOI: 10.1136/neurintsurg-2016-012608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/04/2022]
Abstract
IntroductionVenous sinus stenting is a popular treatment strategy for patients with high venous sinus pressure gradients across a site of outflow obstruction. Little is known about the effect of anesthesia on venous sinus pressure measurements.ObjectiveTo compare venous manometry performed in patients under general anesthesia and while awake.MethodsA prospective database was accessed to retrospectively identify patients who had undergone venous sinus stenting. Pressure gradients were compared between those patients who underwent manometry while awake and before stenting under general anesthesia.ResultsThirty patients with both general anesthesia and awake pressure recordings were identified. Pressure measurements were highly variable but overall were higher under general anesthesia by an average of 5.8 mm Hg (1.7; p=0.002). A significant difference between awake and general anesthesia pressure measurements was detected in the sigmoid sinus (5.8 mm Hg (2.0); p=0.005) and the jugular vein (8.1 mm Hg (3.9); p=0.040). Only 11/30 (36.7%) pressure gradients remained within 5 mm Hg of the original awake gradient when repeated under general anesthesia; 9/30 (30%) patients had gradients that were at least 10 mm Hg different across procedures.ConclusionsCalculated pressure gradients were markedly affected by anesthesia. These findings suggest that candidacy for stenting should be determined with venous manometry while patients are awake owing to the unpredictable and highly variable effect of general anesthesia on pressure measurements and an apparent tendency to underestimate the degree of venous outflow obstruction.
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Affiliation(s)
- Kyle M Fargen
- Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madison Hyer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan Lena
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond D Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aquilla S Turk
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Imran Chaudry
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hungerford JP, Hyer M, Turk AS, Turner RD, Chaudry MI, Fargen KM, Spiotta AM. Impact of ASPECT scores and infarct distribution on outcomes among patients undergoing thrombectomy for acute ischemic stroke with the ADAPT technique. J Neurointerv Surg 2016; 9:823-829. [DOI: 10.1136/neurintsurg-2016-012528] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveTo investigate the associations between Alberta Stroke Program Early CT Score (ASPECTS) or distribution and sidedness of acute infarction and clinical outcomes following intervention with a direct aspiration first pass technique (ADAPT).MethodsA review was performed of patients who had undergone thrombectomy with ADAPT for emergent large vessel occlusions of the middle cerebral artery (MCA) between December 2012 and May 2015. Preintervention CT scans were reviewed by a blinded radiologist to calculate ASPECTS and determine the distribution of infarction. Clinical outcomes were compared for subsets of patients depending upon ASPECTS and regional infarction distribution (cortical, subcortical, or both).ResultsOne hundred and fifty-four patients (50% female, mean age 67) underwent thrombectomy using ADAPT for MCA emergent large vessel occlusion. The median presenting National Institute of Health Stroke Scale score was 15. Fifty-five per cent of patients had left-side occlusions. Similar good outcomes were achieved for patients with perfect and non-perfect ASPECTS (modified Rankin Scale (mRS) 0–2: 63% vs 51%, respectively; p=0.20). Similar outcomes were also achieved for patients with ‘poor’ ASPECTS (≤6) compared with those with ASPECTS >6 (mRS 0–2: 52% vs 53%, respectively; p=0.91). Regional distribution and sidedness of core infarction on preintervention CT also did not correlate with worse outcomes.ConclusionsPatients with moderate-sized core infarcts involving various distributions in either hemisphere can potentially achieve similar good outcomes compared with those with no core infarction at presentation. A treatment algorithm for acute ischemic stroke, which employs hardline ASPECTS thresholds or excludes patients with basal ganglia infarcts, might preclude patients who would potentially benefit from mechanical thrombectomy with ADAPT.
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Fargen KM, Ducruet AF, Hyer M, Hirsch JA, Tarr RW. Expanding the social media presence of the Journal of Neurointerventional Surgery: editor's report. J Neurointerv Surg 2016; 9:215-218. [DOI: 10.1136/neurintsurg-2015-012251] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/04/2022]
Abstract
The use of social media is pervasive throughout society and serves many purposes. Traditional forms of advertising are being upended as vendors recognize the unique abilities of social media platforms to target their messages to specific customers. Peer reviewed medical and professional journals are beginning to develop their own initiatives using social media to advertize unique content. We present the nascent Journal of NeuroInterventional Surgery experience.
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Bahamón B, Gao F, Stringer B, Yang Y, Shi J, Burke K, Huck J, Traore T, Bowman D, Danaee H, Millhollen M, Hyer M, Bence N, Ishii Y. 231 Clinical pharmacodynamic assay development for the first in class investigational ubiquitin activating enzyme (UAE) inhibitor MLN7243. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70357-0] [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: 10/24/2022]
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Milhollen M, Hyer M, Ciavarri J, Traore T, Sappal D, Huck J, Shi J, Duffy J, Gavin J, Brownell J, Yang Y, Stringer B, Ishii Y, Koenig E, Lublinsky A, Griffin R, Xia C, Powe J, Fleming P, Bence N. 561 Nonclinical characterization of the first in class investigational ubiquitin activating enzyme inhibitor MLN7243 in cellular and in vivo models of cancer in support of a phase I study. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70687-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Milhollen M, Sappal D, Duffy J, Hoar K, Huck J, Sha P, Koenig E, Hyer M, Ciavarri J, Bence N. 577 Characterization of the cellular mechanism of action of the first in class investigational inhibitor of the Ubiquitin Activating Enzyme, MLN7243. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70703-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Titus-Ernstoff L, Troisi R, Hatch EE, Palmer JR, Hyer M, Kaufman R, Adam E, Noller K, Hoover RN. Birth defects in the sons and daughters of women who were exposed in utero to diethylstilbestrol (DES). ACTA ACUST UNITED AC 2009; 33:377-84. [PMID: 20002218 DOI: 10.1111/j.1365-2605.2009.01010.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prenatal exposure to diethylstilbestrol (DES) is associated with adverse health outcomes, including anatomic anomalies of the reproductive tract in women and of the genitourinary tract in men. The mouse model, which replicates many DES-related effects seen in humans, suggests that prenatal DES exposure causes alterations that may affect the next generation of offspring. We asked women participating in a large, multi-centre study of prenatal DES exposure to report birth defects occurring among 4029 sons and 3808 daughters (i.e., the third generation). A subcohort of 793 third generation daughters was also queried for birth defects. We used logistic regression models to generate odds ratio and 95% confidence intervals for the association between prenatal DES exposure in the mother and birth defects in the offspring. Based on the mothers' reports, overall birth defects were elevated in the sons (OR = 1.53; 95% CI = 1.04, 2.23) and in the daughters (OR = 2.35; 95% CI = 1.44, 3.82). Most estimates of association were imprecise, but daughters appeared to have an excess of heart conditions (OR = 4.56; 95% CI = 1.27, 16.34). Our data suggest a possible association between the mother's prenatal DES exposure and birth defects in their offspring, particularly in daughters. We cannot, however, rule-out the possible influence of reporting bias. In particular, the exposed daughters' elevated risk of cardiac defects may be as a result of the underreporting of these conditions by unexposed mothers.
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Affiliation(s)
- L Titus-Ernstoff
- Departments of Community and Family Medicine and of Pediatrics, Dartmouth Medical School, and the Hood Center for Children and Families, Lebanon, NH 03756 USA.
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Zhang M, Huck J, Hyer M, Ecsedy J, Manfredi M. Effect of Aurora A kinase inhibitor MLN8237 combined with rituximab on antitumor activity in preclinical B-cell non-Hodgkin's lymphoma models. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8553] [Citation(s) in RCA: 7] [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] [Indexed: 11/20/2022] Open
Abstract
8553 Background: Aurora A kinase is a serine/threonine protein kinase that is essential for the successful transit of cells through mitosis. MLN8237 is a selective small molecule inhibitor of Aurora A kinase that has demonstrated anti-tumor activity in animal models of solid human tumors. In this study we explored the anti-tumor effect of MLN8237 in vivo in pre-clinical models of human Diffuse Large B-cell Lymphoma (DLBCL) both as a single agent and in combination with the anti-CD20 monoclonal antibody Rituximab. Methods: Three human DLBCL models were examined in SCID mice. In two of the models (Ly19 & WSU) the tumor cells expressed a constitutively active luciferase, enabling tumor burden analysis in either a subcutaneous or disseminated setting. The third model was a primary DLBCL recently obtained from a patient. Tumor bearing animals were treated for 21 days with MLN8237 (QD PO dosing at 3–20mg/kg), Rituximab (Q7D IV dosing at 10 mg/kg), or the two agents combined. Tumor burden was measured in the disseminated models as a function of luciferase-induced photon flux, and in the subcutaneous models using vernier calipers. Results: MLN8237 induced anti-tumor activity that was dose-dependent in all three models. In LY19 disseminated model, 3 mg/kg of MLN8237 combined with Rituximab induced synergistic anti-tumor activity (n=2); while 10 mg/kg MLN8237 (dosed QD) combined with Rituximab was additive. Importantly, combining MLN8237 with Rituximab led to complete cures in 100% of the animals. In the WSU model, combining MLN8237(3–10mg/kg) with Rituximab resulted in additive tumor growth inhibition. The mean survival endpoint was significantly longer (p=0.003 and <0.001 respectively) in the combination group when compared to the individual group. In the primary lymphoma model, MLN8237(10–20mg/kg) caused a significant anti-tumor effect during treatment period (TGI = 83–95%). Combining MLN8237 and Rituximab in primary model resulted in additive anti-tumor effect. Conclusions: MLN8237 combined with Rituximab was found to reduce tumor burden in an additive and/or synergistic mechanism in multiple DLBCL tumor models. MLN8237 is currently being tested as a single agent in a phase I clinical trail in patients with DLBCL. [Table: see text]
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Affiliation(s)
- M. Zhang
- Millennium: The Takeda Oncology Company, Cambridge, MA
| | - J. Huck
- Millennium: The Takeda Oncology Company, Cambridge, MA
| | - M. Hyer
- Millennium: The Takeda Oncology Company, Cambridge, MA
| | - J. Ecsedy
- Millennium: The Takeda Oncology Company, Cambridge, MA
| | - M. Manfredi
- Millennium: The Takeda Oncology Company, Cambridge, MA
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Troisi R, Hatch EE, Titus-Ernstoff L, Palmer JR, Hyer M, Strohsnitter WC, Robboy SJ, Kaufman R, Herbst A, Adam E, Hoover RN. Birth weight and breast cancer risk. Br J Cancer 2006; 94:1734-7. [PMID: 16641898 PMCID: PMC2361301 DOI: 10.1038/sj.bjc.6603122] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Exploring whether the positive association between birth weight and breast cancer risk differs by other breast cancer risk factors may help inform speculation about biological mechanism. In these data, high birth weight was associated with breast cancer risk in younger and in more educated women, but was not associated overall.
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Affiliation(s)
- R Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
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Titus-Ernstoff L, Troisi R, Hatch EE, Palmer JR, Wise LA, Ricker W, Hyer M, Kaufman R, Noller K, Strohsnitter W, Herbst AL, Hartge P, Hoover RN. Mortality in women given diethylstilbestrol during pregnancy. Br J Cancer 2006; 95:107-11. [PMID: 16786044 PMCID: PMC2360488 DOI: 10.1038/sj.bjc.6603221] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We used Cox regression analyses to assess mortality outcomes in a combined cohort of 7675 women who received diethylstilbestrol (DES) through clinical trial participation or prenatal care. In the combined cohort, the RR for DES in relation to all-cause mortality was 1.06 (95% CI=0.98–1.16), and 1.11 (95% CI=1.02–1.21) after adjusting for covariates and omitting breast cancer deaths. The RR was 1.07 (95% CI=0.94–1.23) for overall cancer mortality, and remained similar after adjusting for covariates and omitting breast cancer deaths. The RR was 1.27 (95% CI=0.96–1.69) for DES and breast cancer, and 1.38 (95% CI=1.03–1.85) after covariate adjustment. The RR was 1.82 in trial participants and 1.12 in the prenatal care cohort, but the DES–cohort interaction was not significant (P=0.15). Diethylstilbestrol did not increase mortality from gynaecologic cancers. In summary, diethylstilbestrol was associated with a slight but significant increase in all-cause mortality, but was not significantly associated with overall cancer or gynaecological cancer mortality. The association with breast cancer mortality was more evident in trial participants, who received high DES doses.
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Affiliation(s)
- L Titus-Ernstoff
- Department of Community and Family Medicine, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
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Norris JS, Bielawska A, Day T, El-Zawahri A, ElOjeimy S, Hannun Y, Holman D, Hyer M, Landon C, Lowe S, Dong JY, McKillop J, Norris K, Obeid L, Rubinchik S, Tavassoli M, Tomlinson S, Voelkel-Johnson C, Liu X. Combined therapeutic use of AdGFPFasL and small molecule inhibitors of ceramide metabolism in prostate and head and neck cancers: a status report. Cancer Gene Ther 2006; 13:1045-51. [PMID: 16763610 DOI: 10.1038/sj.cgt.7700965] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 12/26/2022]
Abstract
As of January 2005, there were 1020 gene therapy clinical trials ongoing worldwide with 675 or 66.2% devoted to cancer gene therapy. The majority are occurring in the US and Europe (http://www.wiley.co.uk/genetherapy/clinical/). At the present time, to our knowledge there are no trials that employ gene delivery of Fas Ligand (FasL). As an important note, and in contrast to somatic cell therapy trials, there are no reported deaths due to therapeutic vector administration in any cancer gene therapy trial. That said, from our studies and from the published literature, the issue of gene delivery remains the major obstacle to successfully employing gene therapy for cancer treatment. Numerous laboratories are studying this with many different approaches. My co-workers and I have focused on the delivery issue by using various approaches that address tumor targeting and transgene expression. In addition, we are focusing on enhancing tumor cell killing via the bystander effect and through use of small molecules to enhance bystander activity.
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Affiliation(s)
- J S Norris
- Department of Microbiology, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA.
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Hatch EE, Herbst AL, Hoover RN, Noller KL, Adam E, Kaufman RH, Palmer JR, Titus-Ernstoff L, Hyer M, Hartge P, Robboy SJ. Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States). Cancer Causes Control 2001; 12:837-45. [PMID: 11714112 DOI: 10.1023/a:1012229112696] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Women exposed prenatally to diethylstibestrol (DES) have an excess risk of clear-cell adenocarcinoma of the vagina and cervix, but the effect on the incidence of squamous neoplasia is uncertain. The purpose of the current study was to evaluate the long-term risk of developing high-grade squamous neoplasia of the genital tract among women exposed prenatally to DES. METHODS A cohort comprising 3,899 DES-exposed and 1,374 unexposed daughters was followed for 13 years (1982 1995) for pathology-confirmed diagnoses of high-grade squamous intraepithelial neoplasia (HSIL) of the genital tract. Poisson regression analysis was used to compute relative risks (RR) and 95% confidence intervals (95% CI), adjusting for age, calendar year, and other covariates. RESULTS The RR (95% CI) among DES-exposed versus unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2-3.8). Adjustment for screening history estimated by the number of years since the last Pap smear had little effect. Risk estimates were higher with earlier intrauterine exposure; the RR (95% CI) for exposure within 7 weeks of the last menstrual period was 2.8 (1.4-5.5). Only two cases of invasive squamous cervical cancer occurred in total, precluding separate analysis. CONCLUSIONS The findings support an association between in-utero DES exposure and high-grade squamous neoplasia, although a role for more intensive screening among DES-exposed women in the production of this excess could not be completely ruled out.
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Affiliation(s)
- E E Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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Hatch EE, Palmer JR, Titus-Ernstoff L, Noller KL, Kaufman RH, Mittendorf R, Robboy SJ, Hyer M, Cowan CM, Adam E, Colton T, Hartge P, Hoover RN. Cancer risk in women exposed to diethylstilbestrol in utero. JAMA 1998; 280:630-4. [PMID: 9718055 DOI: 10.1001/jama.280.7.630] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma (CCA) of the vagina and cervix is well known, yet there has been no systematic study of DES-exposed daughters to determine whether they have an increased risk of other cancers. As many as 3 million women in the United States may have been exposed to DES in utero. OBJECTIVE To determine whether women exposed to DES in utero have a higher risk of cancer after an average of 16 years of follow-up. DESIGN A cohort study with mailed questionnaires and medical record review of reported cancer outcomes. PARTICIPANTS A cohort of 4536 DES-exposed daughters (of whom 81% responded) and 1544 unexposed daughters (of whom 79% responded) who were first identified in the mid-1970s. MAIN OUTCOME MEASURES Cancer incidence in DES-exposed daughters compared with population-based rates and compared with cancer incidence in unexposed daughters. RESULTS To date, DES-exposed daughters have not experienced an increased risk for all cancers (rate ratio, 0.96; 95% confidence interval [CI], 0.58-1.56) or for individual cancer sites, except for CCA. Three cases of vaginal CCA occurred among the exposed daughters, resulting in a standardized incidence ratio of 40.7 (95% CI, 13.1-126.2) in comparison with population-based incidence rates. The rate ratio for breast cancer was 1.18 (95% CI, 0.56-2.49); adjustment for known risk factors did not alter this result. CONCLUSIONS Thus far, DES-exposed daughters show no increased cancer risk, except for CCA. Nevertheless, because exposed daughters included in our study were, on average, only 38 years old at last follow-up, continued surveillance is warranted to determine whether any increases in cancer risk occur during the menopausal years.
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Affiliation(s)
- E E Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7362, USA
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