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Alexopoulos AS, Parish A, Olsen M, Batch BC, Moylan C, Crowley MJ. Prescribing of evidence-based diabetes pharmacotherapy in patients with metabolic dysfunction-associated steatohepatitis. BMJ Open Diabetes Res Care 2023; 11:e003763. [PMID: 38030391 PMCID: PMC10689360 DOI: 10.1136/bmjdrc-2023-003763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent in type 2 diabetes (T2D). Pioglitazone and glucagon-like peptide-1 receptor agonists (GLP-1RA) are medications used in T2D that can resolve MASH and should be considered in all patients with T2D and MASH. We assessed prescription rates of evidence-based T2D pharmacotherapy (EBP) in MASH, and ascertained racial/ethnic disparities in prescribing. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study on patients in Duke University Health System with diagnosis codes for T2D and MASH between January 2019 and January 2021. Only patients with ≥1 primary care or endocrinology encounter were included. The primary outcome was EBP, defined as ≥1 prescription for pioglitazone and/or a GLP-1RA during the study period. A multivariable logistic regression model was used to examine the primary outcome. RESULTS A total of 847 patients with T2D and MASH were identified; mean age was 59.7 (SD 12) years, 61.9% (n=524) were female, and 11.9% (n=101) and 4.6% (n=39) were of Black race and Latino/a/x ethnicity, respectively. EBP was prescribed in 34.8% (n=295). No significant differences were noted in the rates of EBP use across racial/ethnic groups (Latino/a/x vs White patients: adjusted OR (aOR) 1.82, 95% CI 0.78 to 4.28; Black vs White patients: aOR 0.76, 95% CI 0.44 to 1.33, p=0.20). CONCLUSIONS EBP prescriptions, especially pioglitazone, are low in patients with T2D and MASH, regardless of race/ethnicity. These data underscore the need for interventions to close the gap between current and evidence-based care.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Maren Olsen
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
| | - Cynthia Moylan
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Matthew J Crowley
- Department of Medicine, Division of Endocrinology, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA
- Department of Medicine, Division of Endocrinology, Durham VA Medical Center, Durham, North Carolina, USA
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Nguyen VT, Sharp MK, Superchi C, Baron G, Glonti K, Blanco D, Olsen M, Vo Tat TT, Olarte Parra C, Névéol A, Hren D, Ravaud P, Boutron I. Biomedical doctoral students' research practices when facing dilemmas: two vignette-based randomized control trials. Sci Rep 2023; 13:16371. [PMID: 37773192 PMCID: PMC10541422 DOI: 10.1038/s41598-023-42121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
Our aim was to describe the research practices of doctoral students facing a dilemma to research integrity and to assess the impact of inappropriate research environments, i.e. exposure to (a) a post-doctoral researcher who committed a Detrimental Research Practice (DRP) in a similar situation and (b) a supervisor who did not oppose the DRP. We conducted two 2-arm, parallel-group randomized controlled trials. We created 10 vignettes describing a realistic dilemma with two alternative courses of action (good practice versus DRP). 630 PhD students were randomized through an online system to a vignette (a) with (n = 151) or without (n = 164) exposure to a post-doctoral researcher; (b) with (n = 155) or without (n = 160) exposure to a supervisor. The primary outcome was a score from - 5 to + 5, where positive scores indicated the choice of DRP and negative scores indicated good practice. Overall, 37% of unexposed participants chose to commit DRP with important variation across vignettes (minimum 10%; maximum 66%). The mean difference [95%CI] was 0.17 [- 0.65 to 0.99;], p = 0.65 when exposed to the post-doctoral researcher, and 0.79 [- 0.38; 1.94], p = 0.16, when exposed to the supervisor. In conclusion, we did not find evidence of an impact of postdoctoral researchers and supervisors on student research practices.Trial registration: NCT04263805, NCT04263506 (registration date 11 February 2020).
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Affiliation(s)
- V T Nguyen
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - M K Sharp
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - C Superchi
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Statistics and Operations Research Department, Barcelona-Tech, UPC, Barcelona, Spain
| | - G Baron
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, 75004, Paris, France
| | - K Glonti
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - D Blanco
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Physiotherapy, Universitat Internacional de Catalunya, Barcelona, Spain
| | - M Olsen
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T T Vo Tat
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, USA
| | - C Olarte Parra
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | | | - D Hren
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Split, Split, Croatia
| | - P Ravaud
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, 75004, Paris, France
| | - I Boutron
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, 75004, Paris, France.
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, 75004, Paris, France.
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, 1 place du Parvis Notre-Dame, Cedex 4, 75089, Paris, France.
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Robinson CG, Schempf T, Williams AM, Muir KW, Woolson S, Olsen M, Rosdahl JA. Glaucoma Knowledge and Disease Severity in a Veteran Population: The Medication Adherence in Glaucoma to Improve Care (MAGIC) Study. Ophthalmol Glaucoma 2023; 6:277-282. [PMID: 36400355 DOI: 10.1016/j.ogla.2022.11.001] [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: 07/15/2022] [Revised: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To assess the relationship between glaucoma knowledge and disease severity. DESIGN Substudy of a randomized controlled trial at a single Veterans Affairs (VA) eye clinic. PARTICIPANTS Veterans with medically treated open-angle glaucoma who self-reported poor medication adherence. METHODS Participants completed a glaucoma knowledge assessment using the 10-question National Eye Health Education Program (NEHEP) Eye-Q Test on glaucoma knowledge. Disease severity was determined using visual field criteria. Multiple linear regression was used to assess the association of NEHEP Eye-Q score and disease severity, adjusting for age, number of glaucoma medications, race, sex, and VA Care Assessment Needs (CAN) score. MAIN OUTCOME MEASURES In this cross-sectional, preintervention analysis, the main outcome was glaucoma knowledge as measured by the NEHEP Eye-Q Test. RESULTS Among the 200 study participants, glaucoma severity was mild in 53 (27%), moderate in 56 (28%), severe in 74 (37%), and indeterminant in 17 (9%). The NEHEP Eye-Q scores were low across all severity levels. Scored out of 10, the mean (standard deviation) NEHEP Eye-Q scores were 6.06 (1.57) for mild, 6.21 (1.47) for moderate, 6.28 (1.82) for severe, and 5.88 (1.93) for indeterminate stage. There was no evidence of a significant association between NEHEP scores and disease severity categories (P = 0.78). A regression model did not identify a significant estimated association between NEHEP Eye-Q scores and disease severity after adjusting for age, CAN risk score, number of glaucoma medications, race, and sex. CONCLUSIONS There was no difference in level of glaucoma knowledge based on disease severity. Education-based interventions may benefit patients across all glaucoma stages. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Tadhg Schempf
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew M Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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Buehne KL, Rosdahl JA, Hein AM, Woolson S, Olsen M, Kirshner M, Sexton M, Bosworth HB, Muir KW. How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial. Ophthalmic Res 2023; 66:489-495. [PMID: 36603568 DOI: 10.1159/000528857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable. METHODS The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization. RESULTS Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups. CONCLUSIONS A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.
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Affiliation(s)
- Kristen L Buehne
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA,
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Malina Sexton
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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Samsa G, Colborn K, Olsen M, Pomann GM, Grambow S, Neely M, Troy J. A Visual Tool to Help Develop a Statistical Analysis Plan for Randomized Trials in Palliative Care. J Pain Symptom Manage 2023; 65:e87-e95. [PMID: 35970489 PMCID: PMC9790025 DOI: 10.1016/j.jpainsymman.2022.08.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023]
Abstract
Collaboration with a statistician about the design of a statistical analysis plan can be enhanced by illustrating how statisticians conceptualize their task. This conceptualization can be represented by a directed acyclic graph (DAG), which illustrates the statistician's approach and also provides an actionable tool to assist in the development of the plan.
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Affiliation(s)
- Gregory Samsa
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC.
| | - Kathryn Colborn
- Department of Surgery (K.C.), University of Colorado School of Medicine, Denver, CO
| | - Maren Olsen
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC
| | - Steven Grambow
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC
| | - Megan Neely
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC
| | - Jesse Troy
- Department of Biostatistics and Bioinformatics (G.S., M.O., G.M.P., S.G., M.N., J.T.), Duke University School of Medicine, Durham NC
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Williams AM, Theophanous C, Muir KW, Rosdahl JA, Woolson S, Olsen M, Bosworth HB, Hung A. Within-Trial Cost-Effectiveness of an Adherence-Enhancing Educational Intervention for Glaucoma. Am J Ophthalmol 2022; 244:216-227. [PMID: 36002073 PMCID: PMC10084845 DOI: 10.1016/j.ajo.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the within-trial cost-effectiveness of a behavioral intervention to improve glaucoma medication adherence. DESIGN Prospective cost-effectiveness analysis of randomized, controlled trial data. METHODS The study setting was a Veterans Affairs (VA) eye clinic. The patient population comprised veterans with medically treated glaucoma and self-reported poor adherence. Participants were randomized to a personalized educational session with a reminder bottle to promote medication adherence or to a control session on general eye health. Costs were assessed from the perspective of the VA payor at 6 months using the VA Managerial Cost Accounting System. Probabilistic sensitivity analyses were conducted using bootstrapped samples. The main outcome measures were the proportion of participants attaining ≥80% adherence as measured by electronic monitor, total intervention and medical resource costs, and incremental cost-effectiveness ratios comparing intervention to control at 6 months. RESULTS Of 200 randomized participants, 95 of 100 assigned to the intervention and 97 of 100 assigned to the control had adherence outcomes at 6 months, and the proportion of adherent patients was higher in the intervention group compared to control (0.78 vs 0.40, P < .0001). All participants had costs at 6 months. The total cost at 6 months was $1,149,600 in the intervention group (n = 100) compared to $1,298,700 in the control group (n = 100). Thus, in a hypothetical cohort of 100 patients, the intervention was associated with cost savings (-$149,100) and resulted in 38 additional patients achieving medication adherence. CONCLUSIONS An adherence-enhancing behavioral intervention was effective and cost saving at 6 months.
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Affiliation(s)
- Andrew M Williams
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Department of Ophthalmology (A.M.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christos Theophanous
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly W Muir
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
| | - Jullia A Rosdahl
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Hayden B Bosworth
- From the Department of Ophthalmology (A.M.W., C.T., K.W.M., J.A.R., H.B.B.), Duke University School of Medicine, Durham, North Carolina, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (K.W.M., S.W., M.O., H.B.B., A.H.), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA; Department of Population Health Sciences (A.H.), Duke University School of Medicine, Durham, NC, United States; Duke-Margolis Center for Health Policy (A.H.), Duke University, Durham, NC, United States
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Jeppesen M, Jensen-Fangel S, Leo-Hansen C, Højte C, Olsen M, Wang M, Bendixen M, Johansen H, Bjørn Jensen C, Pressler T, Skov M, Olesen H, Faurholt-Jepsen D, Lea Katzenstein T, Qvist T. 484 Change in pulmonary infections 12 months after elexacaftor/tezacaftor/ivacaftor introduction: Results from the Danish National Cystic Fibrosis Cohort. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leo-Hansen C, Faurholt-Jepsen D, Højte C, Pressler T, Jeppesen M, Jensen-Fangel S, Olesen H, Ritz C, Qvist T, Olsen M. 126 Change in pulmonary function after introduction of elexacaftor/tezacaftor/ivacaftor: Results from the national cystic fibrosis cohort in Denmark. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Refsgaard L, Skarsø E, Ravkilde T, Nissen H, Berg M, Olsen M, Jakobsen K, Boye K, Kamby C, Lind Laursen K, Jensen I, Bekke S, Matthiessen L, Laugaard Lorenzen E, Thorsen L, Offersen B, Korreman S. OC-0941 Impact of guidelines on nationwide breast cancer treatment planning practices (DBCG RT Nation study). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Parente V, Stark A, Key-Solle M, Olsen M, Sanders LL, Bartlett KW, Pollak KI. Caregiver Inclusivity and Empowerment During Family-Centered Rounds. Hosp Pediatr 2022; 12:e72-e77. [PMID: 35079809 PMCID: PMC9881425 DOI: 10.1542/hpeds.2021-006034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Despite widespread adoption of family-centered rounds, few have investigated differences in the experience of family-centered rounds by family race and ethnicity. The purpose of this study was to explore racial and ethnic differences in caregiver perception of inclusion and empowerment during family-centered rounds. METHODS We identified eligible caregivers of children admitted to the general pediatrics team through the electronic health record. Surveys were completed by 99 caregivers (47 non-Latinx White and 52 Black, Latinx, or other caregivers of color). To compare agreement with statements of inclusivity and empowerment, we used the Wilcoxon rank sum test in unadjusted analyses and linear regression for the adjusted analyses. RESULTS Most (91%) caregivers were satisfied or extremely satisfied with family-centered rounds. We found no differences by race or ethnicity in statements of satisfaction or understanding family-centered rounds content. However, in both unadjusted and adjusted analyses, we found that White caregivers more strongly agreed with the statements "I felt comfortable participating in rounds," "I had adequate time to ask questions during rounds," and "I felt a valued member of the team during rounds" compared with Black, Latinx, and other caregivers of color. CONCLUSIONS Congruent with studies of communication in other settings, caregivers of color may experience barriers to inclusion in family-centered rounds, such as medical team bias, less empathic communication, and shorter encounters. Future studies are needed to better understand family-centered rounds disparities and develop interventions that promote inclusive rounds.
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Affiliation(s)
- Victoria Parente
- Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | - Ashley Stark
- Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | - Mikelle Key-Solle
- Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | - Maren Olsen
- Departments of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Linda L. Sanders
- Department of Pediatrics, Duke University Hospital, Durham, North Carolina
| | | | - Kathryn I. Pollak
- Population Health Sciences, Duke University, Durham, North Carolina,Cancer Prevention and Control, Duke Cancer Institute, Durham, North Carolina
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Huang D, Hegeman R, Roy M, Prout T, Swartz K, Olsen M, Rose S. Metastatic melanoma to the ovary in pregnancy: A case report. Gynecol Oncol Rep 2021; 38:100859. [PMID: 34926752 PMCID: PMC8651785 DOI: 10.1016/j.gore.2021.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022] Open
Abstract
Metastatic melanoma to the ovary is uncommon and can occur years after initial diagnosis. Ovarian metastatic melanoma can mimic various benign lesions on imaging and clinical history is key. If any suspicion in pregnancy, placenta should be evaluated due to possibility of transplacental transmission.
Metastatic melanoma to the ovary is an uncommon presentation. We report a case of metastatic melanoma to the ovary that presented as a growing left adnexal mass during pregnancy and was thought to be benign by imaging and frozen section pathology. Here we discuss the challenges in radiologic and pathologic diagnosis, as well as considerations for the mother and newborn.
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Bowling CB, Berkowitz TSZ, Smith B, Whitson HE, DePasquale N, Wang V, Maciejewski ML, Olsen M. Unintended consequences of COVID-19 social distancing among older adults with kidney disease. J Gerontol A Biol Sci Med Sci 2021; 77:e133-e137. [PMID: 34286836 PMCID: PMC8344603 DOI: 10.1093/gerona/glab211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While social distancing policies protect older adults with advanced chronic kidney disease (CKD) from exposure to COVID-19, reduced social interaction may also have unintended consequences. METHODS To identify subgroups of patients at risk for unintended health consequences of social distancing, we conducted a cross-sectional analysis of data from a national cohort study of older Veterans with advanced CKD (n=223). Characteristics included activities of daily living (ADLs), instrumental ADLs (IADLs), cognition score, depression score, social support, financial stress, symptom burden, and number of chronic conditions. Unintended consequences of social distancing included restricted Life Space mobility, low willingness for video telehealth, reduced in-person contact with caregivers, and food insecurity. We identified subgroups of patients at risk of unintended consequences using model-based recursive partitioning (MoB). RESULTS Participants had a mean age of 77.9 years, 64.6% were white, and 96.9% were male. Overall, 22.4% of participants had restricted Life Space, 33.9% reported low willingness for video telehealth, 19.0% reported reduced caregiver contact, and 3.2% reported food insecurity. For Life Space restriction, four subgroups partitioned (i.e., split) by IADL difficulty, cognition score, and ADL difficulty were identified. The highest rate of restricted Life Space was 54.7% in the subgroup of participants with >3 IADL difficulties For low willingness for telehealth and reduced caregiver contact, separate models identified two subgroups split by cognition score and depression score, respectively. CONCLUSIONS Measures of function, cognition, and depressive symptoms may identify older adults with advanced CKD who are at higher risk for unintended health consequences of social distancing.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.,Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC.,Department of Medicine, Duke University, Durham, NC
| | - Theodore S Z Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC
| | - Battista Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC
| | - Heather E Whitson
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC.,Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC.,Department of Medicine, Duke University, Durham, NC
| | | | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.,Department of Medicine, Duke University, Durham, NC.,Department of Population Health Sciences, Duke University, Durham, NC
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.,Department of Medicine, Duke University, Durham, NC.,Department of Population Health Sciences, Duke University, Durham, NC
| | - Maren Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.,Department of Medicine, Duke University, Durham, NC
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Ulmer CS, McCant F, Stechuchak KM, Olsen M, Bosworth HB. Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease. J Clin Sleep Med 2021; 17:1441-1446. [PMID: 33688827 DOI: 10.5664/jcsm.9228] [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: 01/23/2023]
Abstract
STUDY OBJECTIVES The objectives of this study were to examine the proportion of study participants screening positive for insomnia disorder and/or sleep apnea in veterans engaged in routine health care and known to be at risk for cardiovascular disease and to compare these proportions with those previously documented in medical records. METHODS This was a cross-sectional analysis of baseline data from a randomized clinical intervention trial for patients at risk of cardiovascular disease and a review of study participants' medical records. Participants were veterans ≥ 40 years of age, enrolled in Veterans Affairs primary care, and diagnosed with hypertension and/or hypercholesterolemia. Self-report outcomes were the proportion of patients screening positive for an insomnia disorder and sleep apnea, self-reporting a sleep apnea diagnosis, and endorsing undertreated sleep apnea. Medical record outcomes were the proportion of patients diagnosed with insomnia and sleep apnea. RESULTS Participants (n = 420) were veterans (84.8% male) with a mean age of 61.1 years. More than half of the sample (52.1%) screened positive for sleep apnea without prior self-reported diagnosis. More than one-third of the sample (39%) screened positive for an insomnia disorder. Medical records revealed considerably lower rates, with 3.8% diagnosed with insomnia, 20.5% diagnosed with sleep apnea, and about 1% diagnosed with both conditions. CONCLUSIONS Undiagnosed and undertreated sleep disorders are common among veterans at risk for cardiovascular disease. Most of the sample (82%) screened positive for, or met, study criteria for sleep apnea or an insomnia disorder. Limitations include the use of self-reported sleep apnea treatment adherence, an insomnia disorder diagnosis based on questionnaire score, and a sample comprised primarily of male veterans. Routine sleep disorders screening in veterans at risk for cardiovascular disease could help to identify those at even greater risk because of the adverse effects of undiagnosed or undertreated sleep disorders. CLINICAL TRIAL REGISTRATION Registry; ClinicalTrials.gov; Name: Cardiovascular Intervention Improvement Telemedicine Study; URL: https://clinicaltrials.gov/ct2/show/NCT01142908; Identifier: NCT01142908.
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Affiliation(s)
- Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Felicia McCant
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Maren Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
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14
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Marsault LV, Ravn C, Overgaard A, Frich LH, Olsen M, Anstensrud T, Nielsen J, Overgaard S. Laminar airflow versus turbulent airflow in simulated total hip arthroplasty: measurements of colony-forming units, particles, and energy consumption. J Hosp Infect 2021; 115:117-123. [PMID: 34182062 DOI: 10.1016/j.jhin.2021.06.009] [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: 03/29/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal type of ventilation in operating theatres for joint arthroplasty has been debated for decades. Recently, the World Health Organization changed its recommendations based on articles that have since been criticized. The economic and environmental impact of ventilation is also currently an important research topic but has not been well investigated. AIM To compare how large, high-volume, laminar airflow (LAF) and turbulent airflow (TAF) ventilation systems perform during standardized simulated total hip arthroplasty (THA), as they pertain to colony-forming units (cfu), particle counts, and energy consumption. METHODS Two identical operating theatres were used to perform simulated THA. The only difference was that one was equipped with LAF and the other with TAF. Cfu and particles were collected from key points in the operating theatre, and energy was measured for each simulation. Thirty-two simulations were done in total. FINDINGS LAF had significantly reduced cfu and particle count when compared with TAF, at both 100% and 50% air influx. Furthermore, it was shown that lowering the air influx by 50% in LAF did not significantly affect cfu or particles, although reducing the fresh air influx from 100% to 50% significantly lowered the energy consumption. Most simulations in TAF did not meet the cleanroom requirements. CONCLUSION Cfu were significantly lower in LAF at both 100% and 50% air influx. It is possible to reduce fresh air influx in LAF operating theatres by 50%, significantly reducing energy consumption, while still maintaining cfu and particle counts below the ISO classification threshold required for THA surgery.
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Affiliation(s)
- L V Marsault
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark
| | - C Ravn
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark; Kolding Hospital Lillebaelt, Department of Orthopaedic Surgery and Traumatology, Kolding, Denmark
| | - A Overgaard
- Gentofte-Herlev Hospital, Department of Orthopaedic Surgery and Traumatology, Hellerup, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L H Frich
- University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | | | | | - J Nielsen
- Fournais Energy ApS, Vedbæk, Denmark
| | - S Overgaard
- Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, Odense, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark; Copenhagen University Hospital, Bispebjerg, Department of Orthopaedic Surgery and Traumatology, Copenhagen; University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Denmark.
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15
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Mutter JA, Alig S, Lauer EM, Esfahani MS, Mitschke J, Kurtz DM, Olsen M, Liu CL, Jin MC, Bleul S, Macaulay CW, Neidert NN, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. MATRIX INDUCTION FOLLOWED BY AUTOLOGOUS STEM CELL TRANSPLANT OR WHOLE‐BRAIN IRRADIATION IN PRIMARY CNS LYMPHOMA. 7‐YEAR RESULTS OF THE IELSG32 RANDOMIZED TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.47_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J. A. Mutter
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - S. Alig
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - E. M. Lauer
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. S. Esfahani
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - J. Mitschke
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - D. M. Kurtz
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. Olsen
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - C. L. Liu
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. C. Jin
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - S. Bleul
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - C. W. Macaulay
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - N. N. Neidert
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - D. H. Heiland
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - J. Finke
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - J. Duyster
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - J. Wehrle
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. Prinz
- University Medical Center Freiburg Institute of Neuropathology Freiburg Germany
| | - G. Illerhaus
- Klinikum Stuttgart Department of Hematology/Oncology and Palliative Care Stuttgart Germany
| | - P. C. Reinacher
- University Medical Center Freiburg Department of Stereotactic and Functional Neurosurgery Freiburg Germany
| | - E. Schorb
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. Diehn
- Stanford University Department of Radiation Oncology Stanford California USA
| | - A. A. Alizadeh
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - F. Scherer
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
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16
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Mutter JA, Alig S, Lauer EM, Esfahani MS, Mitschke J, Kurtz DM, Olsen M, Liu CL, Jin MC, Bleul S, Macaulay CW, Neidert NN, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. NONINVASIVE DETECTION, CLASSIFICATION, AND RISK STRATIFICATION OF PRIMARY CNS LYMPHOMAS BY CTDNA PROFILING. Hematol Oncol 2021. [DOI: 10.1002/hon.46_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. A. Mutter
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - S. Alig
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - E. M. Lauer
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. S. Esfahani
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - J. Mitschke
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - D. M. Kurtz
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. Olsen
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - C. L. Liu
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. C. Jin
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - S. Bleul
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - C. W. Macaulay
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - N. N. Neidert
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - D. H. Heiland
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - J. Finke
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - J. Duyster
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - J. Wehrle
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. Prinz
- University Medical Center Freiburg Institute of Neuropathology Freiburg Germany
| | - G. Illerhaus
- Klinikum Stuttgart Department of Hematology/Oncology and Palliative Care Stuttgart Germany
| | - P. C. Reinacher
- University Medical Center Freiburg Department of Stereotactic and Functional Neurosurgery Freiburg Germany
| | - E. Schorb
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. Diehn
- Stanford University Department of Radiation Oncology Stanford California USA
| | - A. A. Alizadeh
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - F. Scherer
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
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17
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Carson JW, Carson KM, Olsen M, Sanders L, Westbrook K, Keefe FJ, Porter LS. Yoga Practice Predicts Improvements in Day-to-Day Pain in Women With Metastatic Breast Cancer. J Pain Symptom Manage 2021; 61:1227-1233. [PMID: 33065208 PMCID: PMC8044267 DOI: 10.1016/j.jpainsymman.2020.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 10/08/2020] [Indexed: 01/24/2023]
Abstract
CONTEXT Women with metastatic breast cancer (MBC) experience a significant symptom burden, including cancer pain. Yoga is a mind-body discipline that has shown promise for alleviating cancer pain, but few studies have included patients with metastatic disease or examined the acute effects of yoga practice. OBJECTIVES To determine whether daily pain changed significantly during a randomized controlled trial of the Mindful Yoga program among women with MBC and whether time spent in yoga practice was related to daily pain. METHODS On alternate weeks during the intervention period, we collected daily measures of pain from a subset of 48 women randomized to either yoga (n = 30) or a support group condition (n = 18). We also assessed daily duration of yoga practice among patients randomized to yoga. RESULTS Pain levels were low for women in both conditions, and no differential treatment effects were found on daily pain. However, among women randomized to yoga, a dose/response relationship was found between yoga practice duration and daily pain. When patients had spent relatively more time practicing yoga across two consecutive days, they were more likely to experience lower pain on the next day. This finding is consistent with an earlier MBC study. Meditation practice showed the strongest association with lower daily pain. CONCLUSION Findings suggest that yoga practice (meditation practice in particular) is associated with acute improvements in cancer pain, and that yoga interventions may be more impactful if tested in a sample of patients with advanced cancer in which pain is relatively elevated.
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Affiliation(s)
- James W Carson
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Kimberly M Carson
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Maren Olsen
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina, USA
| | - Linda Sanders
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Kelly Westbrook
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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18
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Sworder B, Kurtz DM, Alig S, Frank MJ, Macauley CW, Garofalo A, Shukla N, Sahaf B, Esfahani MS, Sheybani N, Schroers-Martin J, Liu CL, Olsen M, Spiegel JY, Oak J, Jin MC, Beygi S, Khodadoust MS, Natkunam Y, Majzner R, Mackall CL, Diehn M, Miklos DM, Alizadeh AA. DETERMINANTS OF RESISTANCE TO ENGINEERED T‐CELL THERAPIES TARGETING CD19 IN LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.6_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- B Sworder
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - D. M Kurtz
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - S Alig
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - M. J Frank
- Stanford University Department of Medicine, Division of Blood and Bone Marrow Transplantation Palo Alto California USA
| | - C. W Macauley
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - A Garofalo
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - N Shukla
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - B Sahaf
- Stanford University Department of Medicine, Division of Blood and Bone Marrow Transplantation Palo Alto California USA
| | - M. S Esfahani
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - N Sheybani
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - J Schroers-Martin
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - C. L Liu
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - M. Olsen
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - J. Y Spiegel
- Stanford University Department of Medicine, Division of Blood and Bone Marrow Transplantation Palo Alto California USA
| | - J Oak
- Stanford University Department of Pathology Palo Alto California USA
| | - M. C Jin
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - S Beygi
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - M. S Khodadoust
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
| | - Y Natkunam
- Stanford University Department of Pathology Palo Alto California USA
| | - R Majzner
- Stanford University Department of Pediatrics Palo Alto California USA
| | - C. L Mackall
- Stanford University Department of Pediatrics Palo Alto California USA
| | - M Diehn
- Stanford University Department of Radiation Oncology Palo Alto California USA
| | - D. M Miklos
- Stanford University Department of Medicine, Division of Blood and Bone Marrow Transplantation Palo Alto California USA
| | - A. A Alizadeh
- Stanford University Department of Medicine, Division of Oncology Palo Alto California USA
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Tveter AT, Osteras N, Nossum R, Mehl Eide RE, Klokkeide Å, Hoegh Matre K, Olsen M, Kjeken I. OP0157-HPR CHANGES IN PAIN AND HAND FUNCTION AFTER MULTIMODAL OCCUPATIONAL THERAPY AND/OR SURGERY IN PATIENTS WITH CARPOMETACARPAL OSTEOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Carpometacarpal osteoarthritis (CMC1 OA) is a subset of hand OA, often leading to pain and functional limitations. The EULAR recommends conservative treatment as first-line management, and a recent study showed significant short-term effect of multimodal occupational therapy on pain and hand function in patients referred to surgical consultation1. However, long-term results are lacking.Objectives:To explore the long-term effect of multimodal occupational therapy on pain and hand function in patients with CMC1 OA, and to assess the differences between those undergoing surgery or not in the two groups.Methods:This project presents secondary analyses of a multicentre RCT. Patients referred by their general practitioner to surgical consultation due to CMC1 OA at three Norwegian hospitals from 2013-2015 were eligible. During the waiting period between referral and surgical consultation, 180 patients were randomized to usual care (information, n=90) or a 3-month multimodal occupational therapy intervention (patient education, hand exercises, orthoses and assistive devices, n=90). Patients were assessed at baseline, and 4 (before surgical consultation), 18 and 24 months. Pain at rest was assessed using a 11-point numeric rating scale, and hand function was self-reported with the MAP-Hand (1-4, 1=no problem). The long-term within- and between-group differences on pain and hand function were assessed using repeated measure ANOVA. Sub-analyses were done among those undergoing surgery or not in the two groups. P-value <0.05.Results:163 patients (63 (8) years, 81% women) were included in the analyses. Both groups showed a significant reduction in pain and improvement in hand function over time (p<0.001), with a significant between-group difference for pain (F (1, 161) = 8.56, p = 0.004), in favour of the intervention group, but not hand function.After 2 years, 22 patients had undergone surgery in the intervention group vs 29 in the control group. No significant difference over time were found in pain or hand function between those undergoing surgery or not in the two groups. However, at the time of the surgical consultation, significantly higher pain (Figure 1) and poorer hand function were reported among those later undergoing surgery in the control group (p≤0.001). Surgery did not lead to further improvement in pain and hand function in the intervention group.Figure 1.Between-group difference on pain over a 2-year period. The control group is marked in light grey and the intervention group in black. Those who underwent surgery are marked with dotted lines, while those who did not are marked with solid lines (n=163)Conclusion:The results showed that the positive effect of multimodal occupational therapy on pain and hand function persisted over the 2-year period, however, no significant between-groups difference over time was found. No significant between-group differences were found when dividing into sub-groups, however, those later undergoing surgery in the control group scored significantly worse on pain and hand function at the time of surgical consultation. The results may imply that patients who would benefit from surgery were identified, and that surgery does not give an additional benefit in patients who have received multimodal occupational therapy. This needs to be further investigated.References:[1]Tveter AT, Østerås N, Nossum R, Eide REM, Klokkeide Å, Hoegh Matre K, et al. Short-term effects of occupational therapy on hand function and pain in patients with carpometacarpal osteoarthritis: secondary analyses from a randomized controlled trial. Arthritis care & research. 2020:10.1002/acr.24543Acknowledgements:We would like to acknowledge Øyvor Andreassen for her contribution throughout the project as a patient representative.Disclosure of Interests:None declared
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Kang JM, Chatterjee A, Rosdahl JA, Bosworth HB, Woolson S, Olsen M, Sexton M, Kirshner M, Muir KW. Health Literacy and Success with Glaucoma Drop Administration. Ophthalmol Glaucoma 2021; 5:26-31. [PMID: 34052458 DOI: 10.1016/j.ogla.2021.05.004] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the relationship between health literacy and successful glaucoma drop administration. DESIGN Substudy of a single-site interventional randomized controlled trial. PARTICIPANTS Veterans receiving care at the Durham Veterans Affairs Eye Clinic who had a diagnosis of open-angle glaucoma were recruited if they endorsed poor drop adherence. METHODS Participants underwent a health literacy evaluation using the Rapid Estimate of Adult Literacy in Medicine (REALM) as well as a qualitative assessment of eye drop administration technique using 3 different criteria: (1) the drop was instilled in the eye, (2) only 1 drop was dispensed, and (3) the bottle was not potentially contaminated. A multivariate logistic regression model was used to assess the association of REALM score and successful drop administration, adjusting for age, disease severity, and Veterans Administration Care Assessment Needs (CAN) score. MAIN OUTCOME MEASURES Successful drop administration. RESULTS Of the 179 participants with REALM scores and observed drop administration, 78% read at a high school level (HSL) or more and 22% read at less than HSL. Of the 179 participants, 87% (n = 156) successfully instilled the drop into the eye (criterion 1). A greater proportion of participants who read at HSL or more successfully instilled the drop in the eye compared with those reading at less than HSL (90.6% vs. 75.0%; P = 0.02). Rates of success with criterion 1 were similar across different levels of visual field severity. Care Assessment Needs scores were not statistically significant between those who did and those did not have successful overall drop technique. CONCLUSIONS Poor health literacy may be associated with decreased successful drop instillation in the eye in patients with glaucoma. Screening for and considering health literacy in developing interventions to improve glaucoma self-management may improve treatment adherence in a vulnerable population.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, Northwestern University, Chicago, Illinois
| | - Ayan Chatterjee
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | | | - Maren Olsen
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina
| | - Malina Sexton
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Kelly W Muir
- Department of Ophthalmology, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
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21
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Rosdahl JA, Hein AM, Bosworth HB, Woolson S, Olsen M, Kirshner M, Hung A, Muir KW. Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study. Clin Trials 2021; 18:343-350. [PMID: 33487050 PMCID: PMC10048058 DOI: 10.1177/1740774520988291] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention. METHODS/DESIGN This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months. DISCUSSION The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
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22
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Kristensen A, Rosberg V, Vishram-Nielsen J, Pareek M, Linneberg A, Giampaoli S, Mancia G, Cesana G, Kuulasmaa K, Salomaa V, Sans S, Ferrieres J, Soderberg S, Moitry M, Olsen M. Simple cardiovascular risk stratification using anthropometric measures instead of serum cholesterol. The MORGAM Prospective Cohort Project. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2913] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular risk stratification in low resource settings.
Purpose
The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined.
Methods
We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke.
Results
The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.03–1.05] per kg/m2; WHR: HR 7.5 [4.0–14.0] per unit; EFM: HR 1.02 [1.01–1.02] per kg) as well as serum total cholesterol (HR 1.20 [1.16–1.24] per mmol/l) were significantly associated with MACE (P<0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P<0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE.
Conclusion
In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - V Rosberg
- Nordsjaellands Hospital, Hilleroed, Denmark
| | - J Vishram-Nielsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Pareek
- Yale New Haven Hospital, Department of Internal Medicine, New Haven, United States of America
| | - A Linneberg
- University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - S Giampaoli
- National Institute of Health, Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Rome, Italy
| | - G Mancia
- University of Milan-Bicocca, Monza, Italy
| | - G Cesana
- University of Milan-Bicocca, Monza, Italy
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - V Salomaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - S Sans
- Catalan Department of Health, Barcelona, Spain
| | - J Ferrieres
- Toulouse Rangueil University Hospital of Toulouse, Department of Cardiology, Toulouse, France
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umea, Sweden
| | - M Moitry
- University Hospital of Strasbourg, Department of Epidemiology and Public Health, Strasbourg, France
| | - M Olsen
- Holbaek Hospital, Department of Internal Medicine, Holbaek, Denmark
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23
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Ejem DB, Barrett N, Rhodes RL, Olsen M, Bakitas M, Durant R, Elk R, Steinhauser K, Quest T, Dolor RJ, Johnson K. Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol. J Palliat Med 2020; 22:90-100. [PMID: 31486728 DOI: 10.1089/jpm.2019.0146] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advance care planning (ACP) improves end-of-life care for patients and their caregivers. However, only one-third of adults have participated in ACP and rates are substantially lower among African Americans than among whites. Importantly, ACP improves many domains of care where there are racial disparities in outcomes, including receipt of goal-concordant care, hospice use, and provider communication. Yet, few studies have examined the effectiveness of ACP interventions among African Americans. The objectives of reducing disparities in the quality of palliative care for older African Americans through improved advance care planning (EQUAL ACP) are as follows: to compare the effectiveness of two interventions in (1) increasing ACP among African Americans and whites and (2) reducing racial disparities in both ACP and end-of-life care; and to examine whether racial concordance of the interventionist and patient is associated with ACP. EQUAL ACP is a longitudinal, multisite, cluster randomized trial and a qualitative study describing the ACP experience of participants. The study will include 800 adults ≥65 years of age (half African American and half white) from 10 primary care clinics in the South. Eligible patients have a serious illness (advanced cancer, heart failure, lung disease, etc.), disability in activities of daily living, or recent hospitalization. Patients are followed for one year and participate in either a patient-guided, self-management ACP approach, including a Five Wishes form or structured ACP with Respecting Choices First Steps. The primary outcome is formal or informal ACP-completion of advance directives, documented discussions with clinicians, and other written or verbal communication with surrogate decision makers about care preferences. Secondary outcomes assessed through after-death interviews with surrogates of patients who die during the study include receipt of goal-concordant care, health services use in the last year of life, and satisfaction with care. EQUAL ACP is the first large study to assess which strategies are most effective at both increasing rates of ACP and promoting equitable palliative care outcomes for seriously ill African Americans.
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Affiliation(s)
- Deborah B Ejem
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nadine Barrett
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ramona L Rhodes
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maren Olsen
- Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Center for Health Services Research, Durham VA Medical Center, Durham, North Carolina
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raegan Durant
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronit Elk
- Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Steinhauser
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tammie Quest
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rowena J Dolor
- Deparment of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Kimberly Johnson
- Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Center for Palliative Care Duke University School of Medicine and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina
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24
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Gravås EMH, Kjeken I, Nossum R, Mehl Eide RE, Klokkeide Å, Hoegh Matre K, Olsen M, Andreassen Ø, Osteras N, Tveter AT. FRI0635-HPR PATIENTS’ MOTIVATION AND GOALS FOR THUMB CARPOMETACARPAL OSTEOARTHRITIS SURGERY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations, but for which there is yet no cure. Evidence-based treatment recommendations state that all patients with hand OA should be offered patient education, hand exercises, and provision of assistive devices and orthoses. Pharmacological therapy is recommended as a symptom relieving supplement. The main indication for CMCJ surgery is pain and poor function, and such surgery should be considered only when other treatment has proven insufficient in relieving pain (1). Previous research has shown that high motivation is a significant predictor for deciding to undergo CMCJ surgery (2), but there is little knowledge regarding which factors that motivates patients for undergoing such surgery.Objectives:The objective of this study was to explore patient goals and motivation for surgery, and factors characterizing patients highly motivated for surgery.Methods:This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question and analysed by linking the content of each goal to domains in the International Classification of Functioning, Disability and Health coding system. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0=no motivation). Activity limitations was self-reported using the Measure of Activity Performance of the Hand (MAP-Hand, score 1 to 4, 1=no activity problems) and the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; score 0-100, 0=no disability). Factors that characterized patients highly motivated for surgery (NRS≥8) were explored with multivariate regression analyses.Results:Mean age of participants was 63 years (SD 7.6) and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with more activity limitations (MAP-Hand; (OR 4.00, p=0.008)), living alone (OR 3.18, p=0.007) and a young age (OR 0.94, p=0.002).Conclusion:Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations and motivation and goals for surgery. According to the EULAR recommendations, previously received conservative and pharmacological treatment should also be evaluated.References:[1] Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.” Ann Rheum Dis. 0; 1-9[2] Gravas, E. M. H., et al. (2019). “Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.” BMC Musculoskelet Disord 20(1): 180.Disclosure of Interests:None declared
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25
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Tveter AT, Kleven L, Osteras N, Nossum R, Mehl Eide RE, Klokkeide Å, Hoegh Matre K, Olsen M, Andreassen Ø, Kjeken I. OP0152-HPR A COST-UTILITY ANALYSIS OF MULTIMODAL OCCUPATIONAL THERAPY IN PATIENTS WITH THUMB BASE OSTEOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patient education, hand exercises, and use of assistive devices and orthoses are regarded as first-line treatment for patients with hand osteoarthritis (OA) (1), however there is limited evidence for the cost-effectiveness of such treatment.Objectives:The objective of this study is to assess the cost-utility of a multimodal occupational therapy treatment delivered in the waiting period before surgical consultation in patients with thumb base OA compared to usual care.Methods:This study presents an economic evaluation assessing the difference in health care use and quality-of-life during a 24-month period in a Norwegian multicenter randomized controlled trial. All patients referred to surgical consultation due to thumb base OA at three departments of rheumatology between 2013 and 2015 were eligible for inclusion. In total, 180 patients were included and randomized to a control group or a multimodal occupational therapy group (90 patients in each group). During the waiting period between referral and actual surgical consultation, the control group continued with usual care which was staying on the waiting list and receiving information on hand OA. The intervention group got information on hand OA, ergonomic principles and use of assistive devices, and they were instructed in home-based hand exercises and received a day and a night orthosis. The intervention group was instructed to use the orthoses and assistive devices as much as possible and perform home exercises three times per week for 12 weeks. The patients were assessed at baseline and after 4, 18 and 24 months. The within-trial economic analysis reports the incremental cost-effectiveness ratio (ICER) reflecting the between-group difference in incremental cost per adjusted life years (QALY) over 24 months. A generic health-related quality of life questionnaire, the EuroQol 5 Dimension, was used to calculate the QALYs at baseline, 4, 18 and 24 months. Costs were collected from different sources, taking a health care perspective; The occupation therapist reported the number of consultations related to the intervention; surgical procedure and post-operative follow-up were collected from patients’ journals; and additional consumption of primary and specialist health care was self-reported by the patient. Sensitivity analyses were performed. The results are presented in a cost-effectiveness plane using bootstrapping. Willingness-to-pay threshold is set to be € 27 500 linked to the severity of this condition.Results:The mean age of the included patients was 63 years (SD 7.6) and 79% were women. There was a total between-group difference in QALYs of 0.07 utilities after 24 months, in favour of the intervention group. Operations constituted the main costs with 22 operations in the intervention group compared to 33 in the control group. The between-group difference in costs due to health care consumption was estimated to € 500 in favour of the intervention group (Figure 1).Conclusion:The results in this within-trial analysis indicate that multimodal occupational therapy in the waiting period before surgical consultation compared to usual care is a cost-effective alternative taking a health care perspective.References:[1]Kloppenburg, M., et al. (2018). “2018 update of the EULAR recommendations for the management of hand osteoarthritis.”Ann Rheum Dis.Disclosure of Interests:None declared
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26
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Abstract
Abstract
Introduction
Evaluation of sleep apnea involves manual annotation of Polysomnography (PSG) file, a time-consuming process subject to interscorer variations. The DOSED algorithm has been shown to be helpful in detecting Central Sleep Apnea (CSA), Obstructive Sleep Apnea (OSA), and Hypopnea when merged into a single event type. This work uses a modified version of DOSED capable of detecting each event type separately.
Methods
The network consists of 3 blocks of 1D convolutional layers followed by 6 blocks of 2D convolutional layers. The network has 2 classification layers, one determines the probability of each class, and the other determines the start and duration time of the event with the highest probability. Four channels from nasal and mouth airflow and position of abdomen and thorax are used as input to the model. The model was trained using 2800 PSG from 4 different cohorts (MESA, MROS, SSC, WSC) and tested on 70 PSG, which have been scored by six technicians (Stanford, U Penn, St Louis).
Results
On an event by event basis, model F1-scores versus a weighted consensus score based on 6 technicians were 0.60 for OSA, 0.43 for CSA, and 0.34 for Hypopnea. Average F1-scores for the 6 technicians were 0.48 (std 0.04) for OSA, 0.29 (std 0.145) for CSA, and 0.54 (std 0.183) for Hypopnea, indicating that the model functions better on an event-by-event basis than an average technician. Correlations between indices/hr for central apnea, obstructive apnea, and hypopnea indicate excellent correlations for apneas, but poor correlation for hypopnea. We are now adding the snoring channel to explore if predictions can be improved.
Conclusion
The result shows that deep learning-based models can detect respiratory events with an accuracy similar to technicians. The poor agreement between technicians from different universities indicates that we need better definitions of hypopnea.
Support
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Affiliation(s)
| | | | | | | | | | | | - P Jennum
- Rigshospitalet, Glostrup, DENMARK
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27
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Olsen M, Sorensen H, Jennum P, Mignot E. 1208 Sleep Stage Prediction And Sleep Disordered Breathing Detection Using Raw Actigraphy And Photoplethysmography From Wearable Consumer Device. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1202] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Wearable, multisensory consumer devices that estimate sleep are prevalent and hold great potential. Most validated actigraphic prediction studies of sleep stages (SS) have only used low resolution (30 sec) data and the Cole-Kripke algorithm. Other algorithms are often proprietary and not accessible or validated. We present an automatic, data-driven deep learning algorithm that process raw actigraphy (ACC) and photoplethysmography (PPG) using a low-cost consumer device at high (25Hz) and low resolution to predict SS and to detect sleep disordered breathing (SDB) events.
Methods
Our automatic, data-driven algorithm is a deep neural network trained and evaluated to predict SS and SDB events on 236 recordings of ACC data from a wrist-worn accelerometer and PPG data from the overlapping PSG. The network was tested on raw ACC and PPG data, which was collected at 25 Hz using the HUAMI Arc2 wristband from 39 participants that underwent a nocturnal polysomnography (PSG).
Results
Overall accuracy (Acc), recall (Re), specificity (Sp), and kappa (κ) per subject on the test dataset the prediction of wake, NREM, REM was Acc=76.6%, Re=72.4%, Sp=78.0%, kappa=0.42. On average, we found a 7 % higher performance using the raw sensor data as input instead of processed, low resolution inputs. PPG was especially useful for REM detection. The network assigned 55.6% of patients to the correct SDB severity group when using an apnea-hypopnea index above 15.
Conclusion
Current results show that SS prediction is significantly improved when using the raw sensor data; it indicates that the system holds promise as a potential pervasive monitoring device for patients with chronic sleep disorders. In contrast the system did not show potential as a sleep apnea screening tool. Additional studies are ongoing to examine the effects of pathology such as sleep apnea and periodic leg movement on SS prediction.
Support
Technical University of Denmark; University of Copenhagen, Copenhagen Center for Health Technology, Klarman Family Foundation.
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Affiliation(s)
- M Olsen
- Technical University of Denmark, Palo Alto, CA
| | - H Sorensen
- Technical University of Denmark, Lyngby, DENMARK
| | - P Jennum
- Danish Center for Sleep Medicine, Glostrup, DENMARK
| | - E Mignot
- Stanford University, Palo Alto, CA
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28
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Janssen K, Aune M, Olsen M, Olsen GH, Berg T. Biological stain collection – Absorbing paper is superior to cotton swabs. Forensic Science International: Genetics Supplement Series 2019. [DOI: 10.1016/j.fsigss.2019.10.054] [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: 10/25/2022]
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29
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Makanza R, Zaman-Allah M, Cairns JE, Eyre J, Burgueño J, Pacheco Á, Diepenbrock C, Magorokosho C, Tarekegne A, Olsen M, Prasanna BM. Correction to: High-throughput method for ear phenotyping and kernel weight estimation in maize using ear digital imaging. Plant Methods 2019; 15:52. [PMID: 31139242 PMCID: PMC6530015 DOI: 10.1186/s13007-019-0431-y] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
[This corrects the article DOI: 10.1186/s13007-018-0317-4.].
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Affiliation(s)
- R. Makanza
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - M. Zaman-Allah
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - J. E. Cairns
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - J. Eyre
- University of Queensland, Brisbane, Australia
| | - J. Burgueño
- International Maize and Wheat Improvement Center (CIMMYT), El Batan, Mexico
| | - Ángela Pacheco
- International Maize and Wheat Improvement Center (CIMMYT), El Batan, Mexico
| | | | - C. Magorokosho
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - A. Tarekegne
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - M. Olsen
- International Maize and Wheat Improvement Center (CIMMYT), PO Box 1041, Nairobi, Kenya
| | - B. M. Prasanna
- International Maize and Wheat Improvement Center (CIMMYT), PO Box 1041, Nairobi, Kenya
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30
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Smith VA, Lindquist J, Miller KEM, Shepherd-Banigan M, Olsen M, Campbell-Kotler M, Henius J, Kabat M, Van Houtven CH. Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group. Front Public Health 2019; 7:122. [PMID: 31179259 PMCID: PMC6538764 DOI: 10.3389/fpubh.2019.00122] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/11/2018] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: In May 2010, the Caregivers and Veterans Omnibus Health Services Act of 2010, was signed into law in the United States, establishing the Program of Comprehensive Assistance for Family Caregivers (PCAFC) provided through the VA Caregiver Support Program (CSP). Prior to this program, over half of family caregivers reported being untrained for the tasks they needed to provide. The training through PCAFC represents the largest effort to train family caregivers in the U.S., and the features of the program, specifically a monthly stipend to caregivers and access to a Caregiver Support Coordinator at each VA medical center nationally, make it the most comprehensive caregiver support program ever enacted in the U.S. Methods: The purpose of this study is to examine the association between PCAFC participation and caregiver well-being following enrollment, comparing participating PCAFC caregivers to caregivers who applied to but were not approved for PCAFC participation (non-participants). Well-being is defined using three diverse but related outcomes: depressive symptoms, perceived financial strain, and perceived quality of the Veteran's health care. Additional well-being measures also examined include the Zarit Burden Inventory and positive aspects of caregiving. Results: The survey sample comprised of 92 caregivers approved for PCAFC and 66 caregivers not approved. The mean age of responding caregivers was 45; over 90% of caregivers were female; and over 80% of caregivers were married in both groups. We find promising trends in well-being associated with PCAFC participation. First, the perception of financial strain declined among participants compared to non-participants. Second, while depressive symptoms did not improve for the PCAFC caregivers, depressive symptoms increased among non-participants. Third, perceived quality of the Veteran's VA healthcare was no different between participants and non-participants. However, the 158 returned surveys reflect only a 5% response rate; hence this evidence is preliminary. Conclusion: Despite cautioning that results be interpreted as preliminary, this study provides unique descriptive information about young caregivers of U.S. post-9/11 Veterans, and offers a first step in filling the evidence gap about how comprehensive caregiver support in the U.S. may affect caregiver well-being. These preliminary findings should be explored and validated in a larger sample.
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Affiliation(s)
- Valerie A Smith
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, United States
| | - Jennifer Lindquist
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
| | - Katherine E M Miller
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Health Policy and Management, University of North Carolina, Chapel Hill, NC, United States
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
| | - Maren Olsen
- Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Margaret Campbell-Kotler
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Jennifer Henius
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Margaret Kabat
- Caregiver Support Program, United States Department of Veterans Affairs, Seattle, WA, United States
| | - Courtney Harold Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, United States.,Health Services Research and Development, Durham VA Health Care System, Durham, NC, United States
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Porter LS, Carson JW, Olsen M, Carson KM, Sanders L, Jones L, Westbrook K, Keefe FJ. Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study. Support Care Cancer 2019; 27:4307-4316. [PMID: 30877596 DOI: 10.1007/s00520-019-04710-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 09/04/2018] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Patients with metastatic breast cancer (MBC) experience high levels of symptoms. Yoga interventions have shown promise for improving cancer symptoms but have rarely been tested in patients with advanced disease. This study examined the acceptability of a comprehensive yoga program for MBC and the feasibility of conducting a randomized trial testing the intervention. METHODS Sixty-three women with MBC were randomized with a 2:1 allocation to yoga or a support group comparison condition. Both interventions involved eight weekly group sessions. Feasibility was quantified using rates of accrual, attrition, and session attendance. Acceptability was assessed with a standardized self-report measure. Pain, fatigue, sleep quality, psychological distress, mindfulness, and functional capacity were assessed at baseline, post-intervention, and 3 and 6 months post-intervention. RESULTS We met goals for accrual and retention, with 50% of eligible patients enrolled and 87% of randomized participants completing post-intervention surveys. Sixty-five percent of women in the yoga condition and 90% in the support group attended ≥ 4 sessions. Eighty percent of participants in the yoga condition and 65% in the support group indicated that they were highly satisfied with the intervention. Following treatment, women in the yoga intervention had modest improvements in some outcomes; however, overall symptom levels were low for women in both conditions. CONCLUSIONS Findings suggest that the yoga intervention content was highly acceptable to patients with MBC, but that there are challenges to implementing an intervention involving eight group-based in-person sessions. Alternative modes of delivery may be necessary to reach patients most in need of intervention.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 90399, Durham, NC, 27708, USA.
| | - James W Carson
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Maren Olsen
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, 27705, USA
| | - Kimberly M Carson
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Linda Sanders
- Department of Medicine, Duke University Medical Center, Box 2628, Durham, NC, 27710, USA
| | - Lee Jones
- Memorial Sloan Kettering Cancer Center, 1250 First Avenue, New York, NY, 10065, and Weill Cornell Medical Center, New York, NY, USA
- Department of Medicine, Duke University Medical Center, Box 3459, Durham, NC, 27710, USA
| | - Kelly Westbrook
- Department of Medicine, Duke University Medical Center, Box 3459, Durham, NC, 27710, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 90399, Durham, NC, 27708, USA
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Abstract
BACKGROUND A variety of study designs are available to evaluate the accuracy of tests, but the terms used to describe these designs seem to lack clarity and standardization. We investigated if this was the case in the diagnostic guidance of the National Institute of Care and Health Excellence (NICE), an influential source of advice on the value of tests. OBJECTIVES To describe the range of study design terms and labels used to distinguish study designs in NICE Diagnostic Guidance and the underlying evidence reports. METHODS We carefully examined all NICE Diagnostic Guidance that has been developed from inception in 2011 until 2018 and the corresponding diagnostic assessment reports that summarized the evidence, focusing on guidance where tests were considered for diagnosis. We abstracted labels used to describe study designs and investigated what labels were used when studies were weighted differently because of their design (in terms of validity of evidence), in relevant sections. We made a descriptive analysis to assess the range of labels and also categorized labels by design features. RESULTS From a total of 36 pieces of guidance, 20 (56%) were eligible and 17 (47%) were included in our analysis. We identified 53 unique design labels, of which 19 (36%) were specific to diagnostic test accuracy designs. These referred to a total of 12 study design features. Labels were used in assigning different weights to studies in seven of the reports (41%) but never in the guidance documents. CONCLUSION Our study confirms a lack of clarity and standardization of test accuracy study design terms. There seems to be scope to reduce and harmonize the number of terms and still capture the design features that were deemed influential by those compiling the evidence reports. This should help decision makers in quickly identifying subgroups of included studies that should be weighted differently because their designs are more susceptible to bias.
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Affiliation(s)
- M. Olsen
- 0000 0004 0435 165Xgrid.16872.3aAmsterdam University Medical Centers, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Z. Zhelev
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, Institute of Health Research, University of Exeter Medical School, St Lukes Campus, Exeter, EX1 2LU UK
| | - H. Hunt
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, Institute of Health Research, University of Exeter Medical School, St Lukes Campus, Exeter, EX1 2LU UK
| | - J. L. Peters
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, Institute of Health Research, University of Exeter Medical School, St Lukes Campus, Exeter, EX1 2LU UK
| | - P. Bossuyt
- 0000 0004 0435 165Xgrid.16872.3aAmsterdam University Medical Centers, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - C. Hyde
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, Institute of Health Research, University of Exeter Medical School, St Lukes Campus, Exeter, EX1 2LU UK
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Mitropoulou A, Gambacorta L, Lemming EW, Solfrizzo M, Olsen M. Extended evaluation of urinary multi-biomarker analyses of mycotoxins in Swedish adults and children. WORLD MYCOTOXIN J 2018. [DOI: 10.3920/wmj2018.2313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Biomarker-based methods are being more and more used to assess dietary exposure of mycotoxins in a population. The aim of the present study was to perform an extended analysis of urinary multiple mycotoxin levels and associations with background characteristics and food groups. Exposure assessment calculations were performed on three urine mycotoxins as described below and the probable daily intake (PDI) was compared with the established tolerable daily intake (TDI) to uncover potential exposure risks. The study population consisted of 250 adults and 50 school children in grade five from two surveys conducted by the Swedish National Food Agency. Six mycotoxins (deoxynivalenol (DON), zearalenone (ZEA), fumonisin B1 (FB1), fumonisin B2 (FB2), ochratoxin A (OTA), and nivalenol (NIV) and four metabolites (deepoxy-deoxynivalenol (DOM-1), aflatoxin M1 (AFM1), α-zearalenol (α-ZOL) and β-zearalenol (β-ZOL) were measured by an ultra-performance liquid chromatography tandem mass spectrometry based method (LC-MS/MS). OTA and DON were the most commonly occurring mycotoxins in urine of both adults and children, 51 and 63%, respectively in adults and 96 and 94%, respectively in children. A positive correlation was found between urinary NIV and total cereal consumption among adults. ZEA, α-ZOL, β-ZOL and FB2 were significantly higher in females than males (P<0.01 for all). Adjusted OTA levels were inversely correlated with income in men. In children, the percentage DOM-1 positive samples were much higher compared to adults, 76 and 8% respectively, indicating a higher capacity to detoxify DON. The small sample size among children made it difficult to study associations between urine mycotoxins levels and food group intake. All PDI estimates [DON (with and without DOM-1), ZEA (with and without α-ZOL and β-ZOL) and FB1] were below the TDI values except for DON exposure in adults, as reported previously, 1.3% of the volunteers were above the TDI.
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Affiliation(s)
- A. Mitropoulou
- National Food Agency, Department of Risk Benefit Assessment, P.O. Box 622, 751 26 Uppsala, Sweden
- Karolinska institute, Institute of Environmental Medicine, Box 210, 171 77 Stockholm, Sweden
| | - L. Gambacorta
- Institute of Sciences of Food Production (ISPA), National Research Council (CNR), Via Amendola 122/O, 70126 Bari, Italy
| | - E. Warensjö Lemming
- National Food Agency, Department of Risk Benefit Assessment, P.O. Box 622, 751 26 Uppsala, Sweden
| | - M. Solfrizzo
- Institute of Sciences of Food Production (ISPA), National Research Council (CNR), Via Amendola 122/O, 70126 Bari, Italy
| | - M. Olsen
- National Food Agency, Department of Risk Benefit Assessment, P.O. Box 622, 751 26 Uppsala, Sweden
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Whitson H, Woolson S, Olsen M, Muir K, McConnell E, Dziadul J, Stelmack J. PREVALENCE AND CONSEQUENCES OF COGNITIVE IMPAIRMENT AMONG VETERANS RECEIVING VISION REHABILITATION: A PILOT STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - K Muir
- Duke University School of Medicine
| | | | - J Dziadul
- Durham Veterans Administration Medical Center
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Porter LS, Gao X, Lyna P, Kraus W, Olsen M, Patterson E, Puleo B, Pollak KI. Pilot randomized trial of a couple-based physical activity videoconference intervention for sedentary cancer survivors. Psychol Health 2018; 37:861-865. [PMID: 30138021 PMCID: PMC9840846 DOI: 10.1037/hea0000608] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Including partners in interventions to increase physical activity (PA) could promote better adherence and longer-term effects. In preparation for a future large-scale randomized controlled trial (RCT), this randomized pilot trial tested the acceptability of a novel couple-based PA intervention for breast and prostate cancer survivors and the feasibility of conducting an RCT testing the intervention. METHOD Twenty cancer survivors (70% female; mean age = 63.0 years, SD = 8.9) and their partners (35% female; mean age = 62.8 years, SD = 7.7) were randomized to either the intervention or waitlist control. Couples in the intervention received four videoconference sessions including training in communication and support skills and behavior change techniques. Measures of PA and partner support for exercise were collected from survivors and partners before randomization and postintervention. Survivors also completed a physical well-being measure, and intervention participants completed a treatment acceptability measure. RESULTS Recruitment was challenging; approximately 18% of eligible survivors and their partners agreed to participate. Ninety-two percent of randomized participants completed postintervention surveys, and 78% of dyads randomized to the intervention arm completed all 4 sessions. Mean acceptability ratings were moderate to high. Mean difference scores suggested that participants in the intervention arm tended to report greater improvements in PA, partner support, and physical well-being than those in the control arm. CONCLUSIONS These preliminary findings suggest that the couple-based PA intervention was acceptable to survivors and their partners and that a large-scale RCT is likely to be feasible with modified recruitment strategies. Recommendations for improving recruitment and conducting a larger study are presented. (PsycINFO Database Record
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Affiliation(s)
- Laura S Porter
- Cancer Control and Population Sciences, Duke Cancer Institute
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute
| | | | - Maren Olsen
- Department of Biostatistics and Bioinformatics
| | | | - Blair Puleo
- Department of Psychiatry and Behavioral Sciences
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Leisner M, Lindorff Riis J, Gniadecki R, Iversen L, Olsen M. Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study. J Eur Acad Dermatol Venereol 2018; 32:2185-2190. [DOI: 10.1111/jdv.15021] [Citation(s) in RCA: 9] [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] [Received: 10/07/2017] [Accepted: 03/28/2018] [Indexed: 12/17/2022]
Affiliation(s)
- M.Z. Leisner
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus N Denmark
| | - J. Lindorff Riis
- Department of Dermatology; Aarhus University Hospital; Aarhus N Denmark
| | - R. Gniadecki
- Department of Dermatology; Bispebjerg Hospital; Copenhagen Denmark
| | - L. Iversen
- Department of Dermatology; Aarhus University Hospital; Aarhus N Denmark
| | - M. Olsen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus N Denmark
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Olesen T, Pareek M, Stidsen J, Blicher M, Rasmussen S, Vishram-Nielsen J, Olsen M. IMPACT OF AGE ON THE ASSOCIATIONS BETWEEN TARGET ORGAN DAMAGE AND HEMODYNAMIC COMPONENTS DERIVED FROM 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT. J Hypertens 2018. [DOI: 10.1097/01.hjh.0000539433.80857.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Makanza R, Zaman-Allah M, Cairns JE, Eyre J, Burgueño J, Pacheco Á, Diepenbrock C, Magorokosho C, Tarekegne A, Olsen M, Prasanna BM. High-throughput method for ear phenotyping and kernel weight estimation in maize using ear digital imaging. Plant Methods 2018; 14:49. [PMID: 29946344 PMCID: PMC6003192 DOI: 10.1186/s13007-018-0317-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/07/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND Grain yield, ear and kernel attributes can assist to understand the performance of maize plant under different environmental conditions and can be used in the variety development process to address farmer's preferences. These parameters are however still laborious and expensive to measure. RESULTS A low-cost ear digital imaging method was developed that provides estimates of ear and kernel attributes i.e., ear number and size, kernel number and size as well as kernel weight from photos of ears harvested from field trial plots. The image processing method uses a script that runs in a batch mode on ImageJ; an open source software. Kernel weight was estimated using the total kernel number derived from the number of kernels visible on the image and the average kernel size. Data showed a good agreement in terms of accuracy and precision between ground truth measurements and data generated through image processing. Broad-sense heritability of the estimated parameters was in the range or higher than that for measured grain weight. Limitation of the method for kernel weight estimation is discussed. CONCLUSION The method developed in this work provides an opportunity to significantly reduce the cost of selection in the breeding process, especially for resource constrained crop improvement programs and can be used to learn more about the genetic bases of grain yield determinants.
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Affiliation(s)
- R. Makanza
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - M. Zaman-Allah
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - J. E. Cairns
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - J. Eyre
- University of Queensland, Brisbane, Australia
| | - J. Burgueño
- International Maize and Wheat Improvement Center (CIMMYT), El Batan, Mexico
| | - Ángela Pacheco
- International Maize and Wheat Improvement Center (CIMMYT), El Batan, Mexico
| | | | - C. Magorokosho
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - A. Tarekegne
- International Maize and Wheat Improvement Center (CIMMYT), PO Box MP163, Harare, Zimbabwe
| | - M. Olsen
- International Maize and Wheat Improvement Center (CIMMYT), PO Box 1041, Nairobi, Kenya
| | - B. M. Prasanna
- International Maize and Wheat Improvement Center (CIMMYT), PO Box 1041, Nairobi, Kenya
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Porter LS, Keefe FJ, Baucom DH, Olsen M, Zafar SY, Uronis H. A randomized pilot trial of a videoconference couples communication intervention for advanced GI cancer. Psychooncology 2017; 26:1027-1035. [PMID: 28691761 PMCID: PMC9915334 DOI: 10.1002/pon.4121] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 06/15/2015] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aims to test the feasibility and preliminary efficacy of a couple-based communication intervention for advanced GI cancer delivered via videoconference. METHODS Thirty-two couples were randomly assigned to either couples communication skills training (CCST) or an education comparison intervention, both delivered via videoconference. Participation was limited to couples who reported communication difficulties at screening. Patients and partners completed measures of relationship functioning and individual functioning at baseline and post-intervention. RESULTS Eighty-eight percent of randomized dyads completed all six sessions and reported high levels of satisfaction with the intervention. Between-group effect sizes suggested that the CCST intervention led to improvements in relationship satisfaction for patients and partners and to improvements in intimacy and communication for patients. CONCLUSIONS A couples-based communication intervention delivered via videoconference is feasible and acceptable in the context of advanced cancer. Preliminary findings suggest that the intervention shows promise in contributing to enhanced relationship functioning. Copyright © 2016 John Wiley & Sons, Ltd.
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Abstract
Isolates of Penicillium commune, Penicillium crustosum, Penicillium expansum, Penicillium roqueforti and Aspergillus versicolor, were inoculated on different food items (hard cheese, crème fraiche, tomato purée, apple and blueberry jam) and incubated at 15 °C for 14 days at 50% relative humidity (RH). After incubation the food samples were divided into 3 subsamples; A was 0-2 cm from the surface and including the fungal colony, subsample B was 2-4 cm and subsample C was the rest from >4 cm from the surface. The subsamples were analysed with a multianalyte method capable of identifying more than several hundreds of fungal metabolites. The outcome showed that mouldy food can contain a cocktail of bioactive secondary metabolites including mycotoxins and sometimes at high concentrations. Measurements of the diffusion of fungal metabolites from the colony on the surface (layer A) into the food (layer B and C) showed that the fungal metabolites do not diffuse more than 2 cm into the inner core of the hard cheese. On the other hand in more liquid foods, such as crème fraiche, fruit jams and tomato purée, the toxins diffused quite readily throughout the entire food sample. The levels of patulin found in the apple jam indicate that the tolerable daily intake for patulin may easily be exceeded even if the mouldy layer A is removed. This limited study calls for more similar studies to be performed to give risk managers a sound basis for advice to consumers.
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Affiliation(s)
- M. Olsen
- National Food Agency, Department of Risk Benefit Assessment, P.O. Box 622, 751 26 Uppsala, Sweden
| | - A. Gidlund
- National Food Agency, Department of Biology, P.O. Box 622, 751 26 Uppsala, Sweden
| | - M. Sulyok
- Center for Analytical Chemistry, Department of Agrobiotechnology (IFA-Tulln), University of Natural Resources and Life Sciences, Vienna (BOKU), Konrad-Lorenz-Str. 20, 3430 Tulln, Austria
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Olsen M, Lewis PM, Morrison Z, McKee MD, Waddell JP, Schemitsch EH. Total hip arthroplasty following failure of core decompression and tantalum rod implantation. Bone Joint J 2017; 98-B:1175-9. [PMID: 27587516 DOI: 10.1302/0301-620x.98b9.37252] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/09/2016] [Indexed: 11/05/2022]
Abstract
AIMS One method of femoral head preservation following avascular necrosis (AVN) is core decompression and insertion of a tantalum rod. However, there may be a high failure rate associated with this procedure. The purpose of this study was to document the clinical and radiological outcomes following total hip arthroplasty (THA) subsequent to failed tantalum rod insertion. PATIENTS AND METHODS A total of 37 failed tantalum rods requiring total hip arthroplasty were identified from a prospective database. There were 21 hips in 21 patients (12 men and nine women, mean age 37 years, 18 to 53) meeting minimum two year clinical and radiographic follow-up whose THAs were carried out between November 2002 and April 2013 (mean time between tantalum rod implantation and conversion to a THA was 26 months, 6 to 72). These were matched by age and gender to individuals (12 men, nine women, mean age 40 years, 18 to 58) receiving THA for AVN without prior tantalum rod insertion. RESULTS There were no functional outcome differences between the two groups. Tantalum residue was identified on all post-operative radiographs in the tantalum group. Linear wear rates were comparable between groups with no evidence of catastrophic wear in either group. CONCLUSION In the short term, tantalum rod implantation does not demonstrate an adverse effect on subsequent total joint replacement surgery. There is however, a high rate of retained tantalum debris on post-operative radiographs and thus there is an unknown risk of accelerated articular wear necessitating longer term study. Cite this article: Bone Joint J 2016;98-B:1175-9.
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Affiliation(s)
- M Olsen
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - P M Lewis
- Cwm Taf University Local Health Board, Prince Charles & Royal Glamorgan Hospitals, South Wales, UK
| | - Z Morrison
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - M D McKee
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - J P Waddell
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - E H Schemitsch
- London Health Sciences Centre, Western University, 339 Windermere Rd, London, ON, Canada
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Oddone EZ, Damschroder LJ, Gierisch J, Olsen M, Fagerlin A, Sanders L, Sparks J, Turner M, May C, McCant F, Curry D, White-Clark C, Juntilla K. A Coaching by Telephone Intervention for Veterans and Care Team Engagement (ACTIVATE): A study protocol for a Hybrid Type I effectiveness-implementation randomized controlled trial. Contemp Clin Trials 2017; 55:1-9. [PMID: 28126455 DOI: 10.1016/j.cct.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/17/2017] [Accepted: 01/21/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A large proportion of deaths and many illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. Health risk assessments (HRAs) are widely available online but have not been consistently used in healthcare systems to activate patients to participate in prevention programs aimed at improving lifestyle behaviors. OBJECTIVES The goal of this study is to test whether adding telephone-based coaching to use of a comprehensive HRA increases at-risk patients' activation and enrollment into a prevention program compared to HRA use alone. METHODS Participants were randomized to either complete an HRA alone or in conjunction with a telephone coaching intervention. To be eligible Veterans had to have at least one modifiable risk factor (current smoker, overweight/obese, or physically inactive). The primary outcome is enrollment and participation in a prevention program by 6months. Secondary outcomes include change in a Patient Activation Measure and Framingham Risk Score. DISCUSSION This study is the first to test a web-based health risk assessment coupled with a health coaching intervention within a large healthcare system. Results from this study will help the Veterans Health Administration (VHA) implement its national plan to include comprehensive health risk assessments as a tool to engage Veterans in prevention. The results will also inform health systems outside VHA who seek to implement Medicare's advisement that health risk assessment become a mandatory component of care under the Affordable Care Act.
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Affiliation(s)
- Eugene Z Oddone
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jennifer Gierisch
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Maren Olsen
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Angela Fagerlin
- VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Linda Sanders
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jordan Sparks
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Marsha Turner
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Carrie May
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Felicia McCant
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - David Curry
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Courtney White-Clark
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Karen Juntilla
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
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Garcia-Mayoral E, Olsen M, Hedeholm R, Post S, Nielsen EE, Bekkevold D. Genetic structure of West Greenland populations of lumpfish Cyclopterus lumpus. J Fish Biol 2016; 89:2625-2642. [PMID: 27753091 DOI: 10.1111/jfb.13167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
In this study, 11 microsatellite markers were used to determine the structure of West Greenlandic lumpfish Cyclopterus lumpus populations across six spawning locations spanning >1500 km and compared with neighbouring populations in Canada and Iceland. To evaluate whether data allow for identification of origin of C. lumpus in Greenlandic waters, genetic assignment analysis was performed for 86 C. lumpus sampled on a feeding migration. Significant structuring with isolation by distance was observed in the West Greenland samples and two major subpopulations, north and south, were suggested. Based on FST values, closer relationships were observed between Greenland and Canada, than Greenland and Iceland. Surprisingly, the North Greenland population showed more similarities with Canadian samples, than did the geographically closer south-west Greenland population. Origin could be assigned for a high proportion of non-spawning fish and demonstrated a marked east-west spatial separation of fish of Greenlandic and Icelandic genotypes.
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Affiliation(s)
- E Garcia-Mayoral
- Danish Technical University, National Institue for Aquatic Resources, Vejlsøvej 39, 8600, Silkeborg, Denmark
| | - M Olsen
- Greenland Institute of Natural Resources, Kivioq 2, 3900, Nuuk, Greenland
| | - R Hedeholm
- Greenland Institute of Natural Resources, Kivioq 2, 3900, Nuuk, Greenland
| | - S Post
- Greenland Institute of Natural Resources, Kivioq 2, 3900, Nuuk, Greenland
| | - E E Nielsen
- Danish Technical University, National Institue for Aquatic Resources, Vejlsøvej 39, 8600, Silkeborg, Denmark
| | - D Bekkevold
- Danish Technical University, National Institue for Aquatic Resources, Vejlsøvej 39, 8600, Silkeborg, Denmark
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Kumar JB, Bosworth HB, Sleath B, Woolson S, Olsen M, Danus S, Muir KW. Quantifying Glaucoma Medication Adherence: The Relationship Between Self-Report, Electronic Monitoring, and Pharmacy Refill. J Ocul Pharmacol Ther 2016; 32:346-54. [DOI: 10.1089/jop.2015.0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaya B. Kumar
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Hayden B. Bosworth
- Department of Medicine, Durham VA Medical Center, Duke University School of Medicine, Durham, North Carolina
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Betsy Sleath
- Eshelman School of Pharmacy, Pharmaceutical Outcomes and Policy, University of North Carolina Chapel Hill, North Carolina
| | - Sandra Woolson
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Maren Olsen
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Susanne Danus
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
- Health Services Research & Development, Durham VA Medical Center, Durham, North Carolina
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Calhoun PS, Datta S, Olsen M, Smith VA, Moore SD, Hair LP, Dedert EA, Kirby A, Dennis M, Beckham JC, Bastian LA. Comparative Effectiveness of an Internet-Based Smoking Cessation Intervention Versus Clinic-Based Specialty Care for Veterans. J Subst Abuse Treat 2016; 69:19-27. [PMID: 27568506 DOI: 10.1016/j.jsat.2016.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 10/20/2015] [Revised: 03/17/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The primary objective of this project was to examine the effectiveness of an Internet-based smoking cessation intervention combined with a tele-health medication clinic for nicotine replacement therapy (NRT) compared to referral to clinic-based smoking cessation care. METHODS A total of 413 patients were proactively recruited from the Durham VA Medical Center and followed for 12 months. Patients were randomized to receive either a referral to VA specialty smoking cessation care (control) or to the Internet intervention and tele-health medication clinic. Primary outcomes included (1) intervention reach, (2) self-reported 7-day point prevalence abstinence rates at 3 months and 12 months, and 3) relative cost-effectiveness. RESULTS Reach of the Internet intervention and use of smoking cessation aids were significantly greater compared to the control. At 3 months-post randomization, however, there were no significant differences in quit rates: 17% (95% CI: 12%–23%) in the Internet-based intervention compared to 12% (95% CI: 8%–17%) in the control arm. Similarly, there were no differences in quit rates at 12 months (13% vs. 16%). While costs associated with the Internet arm were higher due to increased penetration and intensity of NRT use, there were no statistically significant differences in the relative cost effectiveness (e.g., life years gained, quality adjusted life years) between the two arms. CONCLUSIONS Current results suggest that using an electronic medical record to identify smokers and proactively offering smoking cessation services that are consistent with US Public Health Guidelines can significantly reduce smoking in veterans. Novel interventions that increase the reach of intensive treatment are needed to maximize quit rates in this population.
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Affiliation(s)
- Patrick S Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA.
| | - Santanu Datta
- Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA
| | - Maren Olsen
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27705, USA
| | - Valerie A Smith
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA; Department of General Internal Medicine, Duke University Medical Center, Durham, NC, 27705, USA
| | - Scott D Moore
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA
| | - Lauren P Hair
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| | - Eric A Dedert
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA
| | - Angela Kirby
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA
| | - Michelle Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, 27705, USA
| | - Lori A Bastian
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT, 06030, USA; VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, 06516, USA
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Edinger JD, Grubber J, Ulmer C, Zervakis J, Olsen M. A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial. Sleep 2016; 39:237-47. [PMID: 26285003 DOI: 10.5665/sleep.5356] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 07/08/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. METHODS This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care. RESULTS The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (-17.0 min; 95% confidence interval [CI]: -30.9, -3.1; P = 0.02) and greater increases in sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03). CONCLUSIONS A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms. CLINICAL TRIALS REGISTRATION This study is registered with clinicaltrials.gov with identifier # NCT00390572.
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Affiliation(s)
- Jack D Edinger
- National Jewish Health, Denver, CO.,Duke University Medical Centers, Durham, NC
| | | | - Christi Ulmer
- VA, Durham, NC.,Duke University Medical Centers, Durham, NC
| | | | - Maren Olsen
- VA, Durham, NC.,Duke University Medical Centers, Durham, NC
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Janssen K, Olsen M, Olsen GH, Aune M, Berg T. Validation of automated PCR-setup of the Quantifiler ® Trio DNA Quantification kit on the Biomek ® 4000 Laboratory Automation Workstation. Forensic Science International: Genetics Supplement Series 2015. [DOI: 10.1016/j.fsigss.2015.09.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Wallin S, Gambacorta L, Kotova N, Warensjö Lemming E, Nälsén C, Solfrizzo M, Olsen M. Biomonitoring of concurrent mycotoxin exposure among adults in Sweden through urinary multi-biomarker analysis. Food Chem Toxicol 2015; 83:133-9. [DOI: 10.1016/j.fct.2015.05.023] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/01/2023]
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49
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Assersen K, Bie P, Hoilund‐Carlsen P, Olsen M, Greve S, Gam‐Hadberg JC, Braad PE, Diederichsen A, Mickley H, Damkjaer M. Exaggerated Natriuresis in Essential Hypertension is not due to Increase in Renal Medullary Blood Flow. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.808.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Assersen
- EndocrinologyOdense Univ. HospitalOdenseDenmark
- Cardiovascular and Renal Research Univ. of Southern Denmark OdenseDenmark
| | - P. Bie
- Cardiovascular and Renal Research Univ. of Southern Denmark OdenseDenmark
| | | | - M. Olsen
- EndocrinologyOdense Univ. HospitalOdenseDenmark
| | - S. Greve
- EndocrinologyOdense Univ. HospitalOdenseDenmark
| | | | - P E. Braad
- Nuclear Medicine Odense Univ. Hospital OdenseDenmark
| | | | - H. Mickley
- Cardiology Odense Univ. Hospital OdenseDenmark
| | - M. Damkjaer
- PaediatricsOdense Univ. Hospital OdenseDenmark
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50
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Vallurupalli M, Shulman D, Elmore S, Xu M, Dolisca S, Ilcisin L, Judd A, Kolarova T, Lock J, Niu N, Olsen M, Taylor K, Holmer H, Bhatt A, Huang F. Students for global oncology: Building a movement for student education
and engagement in an emerging field. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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