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Conrick KM, Mills B, Fuentes M, Graves JM, St. Vil C, Vavilala MS, Bulger EM, Arbabi S, Rowhani-Rahbar A, Moore M. Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach. Health Equity 2024; 8:249-253. [PMID: 38595933 PMCID: PMC11002320 DOI: 10.1089/heq.2023.0044] [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] [Accepted: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan. Methods We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected. Results The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data. Conclusions These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan.
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Affiliation(s)
- Kelsey M. Conrick
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Janessa M. Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | | | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Eileen M. Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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Gonzalez C, Graves JM, Ramos J, Vavilala MS, Moore M. Language access research for community health: provider perspectives on language access techniques and the role of communication technology. J Commun Healthc 2024; 17:7-14. [PMID: 37470760 DOI: 10.1080/17538068.2023.2237351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). METHODS Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. RESULTS Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. CONCLUSIONS Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Joana Ramos
- Washington State Coalition for Language Access (WASCLA), Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
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Harner V, Moore M, Casillas B, Chrivoli J, Lopez Olivares A, Harrop E. Transgender Patient Preferences When Discussing Gender in Health Care Settings. JAMA Netw Open 2024; 7:e2356604. [PMID: 38372999 PMCID: PMC10877454 DOI: 10.1001/jamanetworkopen.2023.56604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Transgender (trans) patients report frequent discriminatory and harmful experiences in health care settings; gender-affirming, competent health care improves trans individuals' health and well-being. Objective To identify factors influencing trans patients' decision-making regarding sharing gender-related information with providers (clinicians, health care organizations, health care systems) and trans patient preferences for gender-related questions, as well as the subsequent impact on health care experiences. Design, Setting, and Participants A qualitative, interpretivist phenomenological study was conducted via telephone or video (using Zoom) in English and Spanish from August 10 to September 11, 2020. Participants were recruited via trans-specific social media groups and email listservs. Interviews were transcribed verbatim and analyzed from October 2020 to January 2022 using thematic analysis by a majority trans research team. Main Outcomes and Measures Semistructured interviews explored patient health care experiences and preferences. Results Participants included 27 trans and/or nonbinary adults (mean [SD] age, 30.9 [10.4] years; range, 21-69 years) from 13 US states. Four themes were identified: (1) impact of provider behaviors, (2) engaging in relational risk assessment, (3) receiving affirming vs medically competent care, and (4) "how are you going to fit [me] into your system?" The first theme reflected the impact of provider actions, including level of flexibility in care and interpersonal interactions, ability to explain medical relevance of gender-related questions, and preparedness to work with trans patients. Second, respondents weighed a variety of implicit or explicit safety cues when deciding whether and how to share information with providers. Third, participants spoke at length about affirming and medically competent care, noting that they have had to prioritize one over the other. Last, participants reported their needs often being at odds with health care system norms and standards of care. Conclusion and Relevance In this qualitative study of trans patient preferences when discussing gender-related information with providers, it was found that equitable, gender-affirming, and competent health care requires flexibility and responsiveness to patient preferences. It requires provider humility and engagement, as well as institutional policies that support competent and gender-affirming spaces. Future research could identify additional roles that providers, administrators, and systems can play in ensuring competent care for trans patients.
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Affiliation(s)
- Vern Harner
- School of Social Work, University of Washington, Seattle
- Now with School of Social Work and Criminal Justice, University of Washington, Tacoma
| | - Megan Moore
- School of Social Work, Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Boi Casillas
- School of Social Work, University of Washington, Seattle
| | - Jess Chrivoli
- School of Social Work, University of Washington, Seattle
| | | | - Erin Harrop
- Graduate School of Social Work, University of Denver, Denver, Colorado
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Conrick KM, Porter SF, Gause E, Prater L, Rowhani-Rahbar A, Rivara FP, Moore M. Integration of extreme risk protection orders into the clinical workflow: Qualitative comparison of clinician perspectives. PLoS One 2023; 18:e0288880. [PMID: 38157372 PMCID: PMC10756559 DOI: 10.1371/journal.pone.0288880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/05/2023] [Indexed: 01/03/2024] Open
Abstract
Extreme risk protection orders (ERPO) seek to temporarily reduce access to firearms for individuals at imminent risk of harming themselves and/or others. Clinicians, including physicians, nurse practitioners, and social workers regularly assess circumstances related to patients' risk of firearm-related harm in the context of providing routine and acute clinical care. While clinicians cannot independently file ERPOs in most states, they can counsel patients or contact law enforcement about filing ERPOs. This study sought to understand clinicians' perspectives about integrating ERPO counseling and contacting law enforcement about ERPOs into their clinical workflow. We analyzed responses to open-ended questions from an online survey distributed May-July of 2021 to all licensed physicians (n = 23,051), nurse practitioners (n = 8,049), and social workers (n = 6,910) in Washington state. Of the 4,242 survey participants, 1,126 (26.5%) responded to at least one of ten open-ended questions. Two coders conducted content analysis. Clinicians identified barriers and facilitators to integrating ERPOs into the clinical workflow; these influenced their preferences on who should counsel or contact law enforcement about ERPOs. Barriers included perceptions of professional scope, knowledge gaps, institutional barriers, perceived ERPO effectiveness and constitutionality, concern for safety (clinician and patient), and potential for damaging provider-patient therapeutic relationship. Facilitators to address these barriers included trainings and resources, dedicated time for counseling and remuneration for time spent counseling, education on voluntary removal options, and ability to refer patients to another clinician. Participants who were hesitant to be the primary clinician to counsel patients or contact law enforcement about ERPOs requested the ability to refer patients to a specialist, such as social workers or a designated ERPO specialist. Results highlight the complex perspectives across clinician types regarding the integration of ERPO counseling into the clinical workflow. We highlight areas to be addressed for clinicians to engage with ERPOs.
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Affiliation(s)
- Kelsey M. Conrick
- School of Social Work, University of Washington, Seattle, Washington, United States of America
- Firearm Injury & Policy Research Program, Seattle, Washington, United States of America
| | - Sarah F. Porter
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Emma Gause
- Firearm Injury & Policy Research Program, Seattle, Washington, United States of America
| | - Laura Prater
- Firearm Injury & Policy Research Program, Seattle, Washington, United States of America
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Frederick P. Rivara
- Firearm Injury & Policy Research Program, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, United States of America
- Harborview Injury Prevention & Research Center, Seattle, Washington, United States of America
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Paterson C, Kavanagh PS, Bacon R, Turner M, Moore M, Barratt M, Chau M. To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies. J Cancer Surviv 2023:10.1007/s11764-023-01508-9. [PMID: 38151586 DOI: 10.1007/s11764-023-01508-9] [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: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer. METHODS A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice. RESULTS 4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention. CONCLUSIONS Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey. IMPLICATIONS FOR CANCER SURVIVORS Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, Australia.
- Central Adelaide Local Health Network, Adelaide, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Moore
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Barratt
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Chau
- South Australia Medical Imaging, Flinders Medical Centre, Adelaide, Australia
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Moore M, Fitzgibbons EJ, Driscoll C, Beswick R. Neonatal bacterial meningitis: hearing screening and audiological monitoring outcomes. Int J Audiol 2023; 62:1101-1107. [PMID: 36409649 DOI: 10.1080/14992027.2022.2145514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study reviewed the outcomes of universal newborn hearing screening (UNHS) and ongoing hearing monitoring in children following recovery from neonatal bacterial meningitis to determine (a) whether screening may be a suitable alternative to diagnostic audiology for detecting permanent childhood hearing loss (PCHL) and (b) whether infants who pass UNHS should be monitored throughout childhood. DESIGN Retrospective analysis of a UNHS database. STUDY SAMPLE Data were extracted from the state-wide UNHS database for all children born in Queensland Australia between 1 September 2004 and 30 June 2020 with the risk factor of bacterial meningitis (in isolation or in combination with other risk factors) identified at the time of the UNHS. This cohort included 231 children. RESULTS Results showed that all post-meningitic infants diagnosed with PCHL had a refer result on the UNHS or were medically excluded from screening. Additionally, no cases of PCHL were identified through the targeted surveillance program following a pass result on UNHS. CONCLUSIONS UNHS may be sufficient to detect PCHL in post-meningitic neonates and routine audiological monitoring may not be required for children who pass the screen.
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Affiliation(s)
- Megan Moore
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - E Jane Fitzgibbons
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Carlie Driscoll
- School of Health and Rehabilitation Services, University of Queensland, Brisbane, Australia
| | - Rachael Beswick
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Rajendran P, Saini S, Kumar N, Vashistha H, Thiruvengadam K, Ramamoorthy T, Gopalaswamy R, Kayesth J, Alavadi U, Moore M, Joshi RP, Ramachandran R, Anand S, Shanmugam S, Padmapriyadarsini C. Establishing proof of concept for utility of Trueprep ®-extracted DNA in line-probe assay testing. Int J Tuberc Lung Dis 2023; 27:742-747. [PMID: 37749831 PMCID: PMC10519390 DOI: 10.5588/ijtld.23.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/01/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES: With an increased demand for rapid, diagnostic tools for TB and drug resistance detection, Truenat® MTB-RIF assay has proven to be a rapid point of care molecular test. The present study aimed to establish a proof of concept of using Trueprep-extracted DNA for line-probe assay (LPA) testing.METHODS: A total of 150 sputum samples (MTB-positive at Truenat sites) were divided into two aliquots. One aliquot was used for DNA extraction using the Trueprep device and MTB testing. The second aliquot of the sample was subjected to GenoLyse® DNA extraction. DNA from both the Trueprep and GenoLyse methods was subjected to first-line (FL) and second-line (SL) LPA testing.RESULTS: Of 139 Trueprep-extracted DNA, respectively 135 (97%) and 105 (75%) had interpretable results by FL and SL-LPA testing. Of 128 GenoLyse-extracted DNA, all 128 (100%) had interpretable FL-LPA results and 114 (89%) had interpretable SL-LPA results.CONCLUSION: The results obtained in this study indicate that Trueprep-extracted DNA can be used in obtaining valid LPA results. However, the study needs to be conducted on a larger sample size before our recommendations can be used for policy-making decisions.
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Affiliation(s)
- P Rajendran
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - S Saini
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - N Kumar
- Central TB Division, Ministry of Health and Family Welfare, New Delhi
| | - H Vashistha
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - K Thiruvengadam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - T Ramamoorthy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - R Gopalaswamy
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - J Kayesth
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | | | - M Moore
- Infectious Disease Detection and Surveillance Project, United States Agency for International Development (USAID), ICF Incorporated, Reston, VA, USA
| | - R P Joshi
- Central TB Division, Ministry of Health and Family Welfare, New Delhi
| | - R Ramachandran
- World Health Organization India Office, New Delhi, India
| | - S Anand
- World Health Organization India Office, New Delhi, India
| | - S Shanmugam
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
| | - C Padmapriyadarsini
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, New Delhi
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Conrick KM, Mills B, Schreuder AB, Wardak W, Vil CS, Dotolo D, Bulger EM, Arbabi S, Vavilala MS, Moore M, Rowhani-Rahbar A. Disparities in Misclassification of Race and Ethnicity in Electronic Medical Records Among Patients with Traumatic Injury. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01783-3. [PMID: 37702973 DOI: 10.1007/s40615-023-01783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
Systems-level barriers to self-reporting of race and ethnicity reduce the integrity of data entered into the medical record and trauma registry among patients with injuries, limiting research assessing the burden of racial disparities. We sought to characterize misclassification of self-identified versus hospital-recorded racial and ethnic identity data among 10,513 patients with traumatic injuries. American Indian/Alaska Native patients (59.9%) and Native Hawaiian/Pacific Islander patients (52.4%) were most likely to be misclassified. Most Hispanic/Latin(x) patients preferred to only be identified as Hispanic/Latin(x) (73.2%) rather than a separate race category (e.g., White). Incorrect identification of race/ethnicity also has substantial implications for the perceived demographics of patient population; according to the medical record, 82.3% of the population were White, although only 70.6% were self-identified as White. The frequency of misclassification of race and ethnicity for persons of color limits research validity on racial and ethnic injury disparities.
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Affiliation(s)
- Kelsey M Conrick
- University of Washington School of Social Work, 4101 15th Ave. NE, Seattle, WA, 98105, USA.
| | - Brianna Mills
- Department of Epidemiology, University of Washington School of Public Health, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Astrid B Schreuder
- Department of Quality Improvement, Harborview Medical Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Wanna Wardak
- Harborview Injury Prevention and Research Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Christopher St Vil
- University at Buffalo School of Social Work, Harborview Injury Prevention and Research Center, Michael Rd., Buffalo, NY, 14215, USA
| | - Danae Dotolo
- University of Washington School of Social Work, Harborview Injury Prevention and Research Center, 4101 15th Ave. NE, Seattle, WA, 98105, USA
| | - Eileen M Bulger
- Harborview Injury Prevention and Research Center, Harborview Medical Center Department of Trauma Surgery, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, Harborview Medical Center Department of Trauma Surgery, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Monica S Vavilala
- University of Washington Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Megan Moore
- University of Washington School of Social Work, Harborview Injury Prevention and Research Center, 4101 15th Ave. NE, Seattle, WA, 98105, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific St., Seattle, WA, 98195, USA
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Conrick KM, Mills B, St Vil C, Dotolo D, Solano E, Bulger EM, Arbabi S, Herrenkohl M, Vavilala MS, Rowhani-Rahbar A, Moore M. Centering patient perspectives to achieve injury-related health equity in trauma care systems: Improving trauma registry data. Injury 2023; 54:110847. [PMID: 37301651 DOI: 10.1016/j.injury.2023.110847] [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: 03/06/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limitations in current data collection systems for patients who experience traumatic injury limit researchers' ability to identify and address disparities in injury and outcomes. We sought to develop and test a patient-centered data-collection system for equity-related data indicators that was acceptable to racially and ethnically diverse patients being treated for traumatic injuries. METHODS Health equity indicators included in this study were race and ethnicity, language, education, employment, housing, and injury address. We conducted interviews with 245 racially and ethnically diverse trauma patients who were treated at a level-1 trauma center in the US in 2019-2020. We first interviewed 136 patients to develop a culturally resonant process and options for the health equity indicators to be added to a revised data collection system for the electronic medical record. English and Spanish interviews were audio-recorded and transcribed verbatim; qualitative analysis was used to assess patient preferences. We then pilot tested the revised data collection system with an additional 109 trauma patients to assess acceptability. Acceptability was defined as having more than 95% of participants self-identify with one of the proposed options for race/ethnicity, language, education, employment, and housing. Injury address (to identify geographic disparities) was pre-defined as acceptable if at least 85% of participants could identify exact address, cross streets, a landmark or business, or zip code of injury. RESULTS A revised data collection system, including culturally resonant indicators and a process to be used by patient registrars to collect health equity data, was pilot tested, refined, and considered acceptable. Culturally resonant question phrasing/answer options for race/ethnicity, language, education, employment, housing status, and injury address were identified as acceptable. CONCLUSIONS We identified a patient-centered data collection system for health equity measures with racially and ethnically diverse patients who have experienced traumatic injury. This system has the potential to increase data quality and accuracy, which is critical to quality improvement efforts and for researchers seeking to identify groups most impacted by racism and other structural barriers to equitable health outcomes and effective intervention points.
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Affiliation(s)
- Kelsey M Conrick
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Brianna Mills
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Christopher St Vil
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; School of Social Work, University at Buffalo, 685 Baldy Hall, University at Buffalo, North Campus, Buffalo, NY 14260-1050, United States.
| | - Danae Dotolo
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Esther Solano
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Eileen M Bulger
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Trauma Surgery, Harborview Medical Center, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Saman Arbabi
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Trauma Surgery, Harborview Medical Center, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Madeline Herrenkohl
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Monica S Vavilala
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Anesthesiology and Pain Medicine, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Megan Moore
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
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Graves JM, Ross N, Gonzalez C, Moore M, Denson V, Vavilala MS. Compassion and Trauma: Occupational Health Experiences of Certified Medical Interpreters in Five U.S. States. Workplace Health Saf 2023; 71:436-444. [PMID: 37191167 DOI: 10.1177/21650799231167586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Medical interpreters play a vital role in fostering understanding and ensuring safety and transparency in healthcare for patients with non-English language preference. Limited research describes work-related experiences of medical interpreters. The purpose of this research was to explore perceptions of occupational health and safety among medical interpreters. A structured, online survey was administered to all certified medical interpreters in Hawaii, New York, New Jersey, California, and Texas. Participants described occupational experiences as an interpreter via an open-ended question. Responses were coded using qualitative thematic analysis. Response text was reviewed, a codebook of descriptive themes developed, and data thematically coded and summarized. Of 981 potential participants, 199 responded (20.3% response rate). Four main themes were identified: Professionalism and Role, Work-Related Challenges, Approaches to Mitigate Vicarious Trauma, and The Rewarding Nature of the Job. Respondents described compassion fatigue, vicarious trauma, intentional emotional distancing from clients, and loneliness. Respondents identified needs for workplace support to ensure professionalism and safeguard interpreter safety. Medical interpreters appreciate their work, yet face challenges, including compassion fatigue and vicarious trauma. Employers and healthcare institutions should support the occupational and emotional needs of medical interpreters as a vital member of the healthcare team.
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Affiliation(s)
| | - Nicole Ross
- College of Nursing (Spokane), Washington State University
- Honors College, Washington State University
| | | | - Megan Moore
- School of Social Work, University of Washington
- Harborview Injury Prevention and Research Center (HIPRC)
| | - Vicki Denson
- College of Nursing (Vancouver), Washington State University
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center (HIPRC)
- School of Medicine, University of Washington
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11
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Afolayan-Oloye O, Moore M, Samarapungavan D, Al-Othman Y, Kanaan HD, Cohn S, Li W, Suliman ST, Putchakayala K, Singh A, Maine G, Bedi DS, Zhang PL. Myeloperoxidase Staining Identifies Endothelial Injury of Peritubular Capillaries and Glomeruli in Renal Antibody-Mediated Rejection. Ann Clin Lab Sci 2023; 53:712-718. [PMID: 37945017] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE It remains unclear if C4d staining is related to any peritubular and glomerular injury during antibody mediated rejection (ABMR). The goal of this study was to determine if myeloperoxidase (MPO) staining can highlight endothelial injury in peritubular capillaries (PTC) and glomeruli. METHODS The study included 12 native negative controls, 19 transplant biopsies with borderline changes (BC) as transplant controls, and one group of renal transplant biopsies with ABMR as the study group (acute/chronic, n=22). All three groups were stained for MPO immunohistochemically, and the MPO expressions in the endothelium of PTC and glomeruli were evaluated and correlated with serum creatinine (SCr). In addition, the ultrastructural layers of the PTC (an index for chronic allograft rejection) were correlated with MPO indices in PTC. RESULTS The negative control group and the transplant controls showed no MPO expression in the endothelium of glomeruli and PTC. However, in the biopsies with ABMR, there were MPO-positive stains in the endothelial cells of glomeruli (15/21 cases, 71.4 %) and PTC (16/22 cases, 72.7 %). There were significant correlations between the peritubular MPO staining versus SCr (r=0.355 and p=0.0106) and glomerular MPO staining versus SCr (r=0.365 and p=0.0092). Furthermore, the layers of PTC by electron microscopy were significantly correlated with MPO scores in PTC (r=0.696, p=0.0001). CONCLUSION Our data suggest that the MPO-positive endothelial injuries are most likely the cause leading to renal graft dysfunction following ABMR.
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Affiliation(s)
| | - Megan Moore
- William Beaumont School of Medicine, Oakland University, Rochester, MI, USA
| | | | - Yazan Al-Othman
- Department of Pathology, Corewell Health (East), Royal Oak, MI, USA
| | - Hassan D Kanaan
- Department of Pathology, Corewell Health (East), Royal Oak, MI, USA
| | - Steven Cohn
- Multi-organ Transplant Center, Corewell Health (East), Royal Oak, MI, USA
| | - Wei Li
- Department of Pathology, Corewell Health (East), Royal Oak, MI, USA
| | - Sarah T Suliman
- Multi-organ Transplant Center, Corewell Health (East), Royal Oak, MI, USA
| | | | - Atul Singh
- Multi-organ Transplant Center, Corewell Health (East), Royal Oak, MI, USA
| | - Gabriel Maine
- Department of Pathology, Corewell Health (East), Royal Oak, MI, USA
| | - Damanpreet S Bedi
- Multi-organ Transplant Center, Corewell Health (East), Royal Oak, MI, USA
| | - Ping L Zhang
- Department of Pathology, Corewell Health (East), Royal Oak, MI, USA
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12
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O'Keeffe D, Hanley S, McNearney O, Finn B, O'Halloran K, Broderick-Farrell C, Meyer F, Rey R, Trujillo J, Moore M. Clinical examination subtleties in diagnosing an unwitnessed foreign body ingestion. Ir Med J 2023; 116:817. [PMID: 37606517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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13
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Abstract
Traumatic brain injury (TBI) affects > 3 million people in the United States annually. Although the number of deaths related to severe TBIs has stabalized, mild TBIs, often termed concussions, are increasing. As evidence indicates that a significant proportion of these mild injuries are associated with long-lasting functional deficits that impact work performance, social integration, and may predispose to later cognitive decline, it is important that we (a) recognize these injuries, (b) identify those at highest risk of poor recovery, and (c) initiate appropriate treatments promptly. We discuss the epidemiology of TBI, the most common persistent symptoms, and treatment approaches.
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Affiliation(s)
- Megan Moore
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 51 North 39th Street, Andrew Mutch Building 4th Floor, Philadelphia, PA 19104, USA
| | - Danielle K Sandsmark
- Department of Neurology, Division of Neurocritical Care, University of Pennsylvania Perelman School of Medicine, 51 North 39th Street, Medical Office Building Suite 205, Philadelphia, PA 19104, USA.
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14
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Avery A, Takagi-Stewart J, Qiu Q, Philipson EB, Moore M, Kroshus E, Weiner BJ, Graves JM, Glang A, Jinguji T, Coppel DB, Sidhu M, Vavilala MS. Effect of RISE bundle implementation on school adoption of a student-centered return-to-learn program in Washington state. NeuroRehabilitation 2023:NRE220200. [PMID: 37125566 DOI: 10.3233/nre-220200] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND Appropriate concussion care in school is vital for full recovery, but school return-to-learn (RTL) programs are lacking and vary in quality. Establishing student-centered RTL programs may reduce disparities in RTL care. OBJECTIVE To examine the effect of RISE Bundle (Return to Learn Implementation Bundle for Schools) implementation on high school adoption of a student-centered RTL program. METHODS A convenience sample of fourteen (4 rural and 10 urban) small and large Washington (WA) State public high schools were enrolled in a stepped-wedge study with baseline, end of study, and monthly measures over the 2021-2022 academic year. Schools identified an RTL champion who led RISE Bundle implementation in 6-week steps. Concussion knowledge and impact of RTL program on concussion care were examined. RESULTS Ten schools (71.4%) successfully completed RISE Bundle implementation and established a functional RTL program. Self-reported concussion knowledge from RTL Champions increased post intervention. Establishing RTL programs facilitated provision of tailored accommodations, and perceived variation and inequities in RTL care were reduced. CONCLUSION RISE Bundle implementation proved feasible, supported the establishment of a functional RTL program, and perceived to reduce disparities in concussion care in rural and urban WA State public high schools of varying sizes.
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Affiliation(s)
- Aspen Avery
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Julian Takagi-Stewart
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Qian Qiu
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Erik B Philipson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Emily Kroshus
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Janessa M Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Ann Glang
- Department of Psychology, University of Oregon, Eugene, O, USA
| | - Thomas Jinguji
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - David B Coppel
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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15
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Conrick KM, Gause E, Rivara FP, Rowhani-Rahbar A, Moore M. Social Workers' Perspectives on Extreme Risk Protection Orders. Soc Work 2023:7142892. [PMID: 37186012 DOI: 10.1093/sw/swad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 05/17/2023]
Abstract
Extreme risk protection orders (ERPOs), which allow for the temporary restriction of firearm access for individuals at substantial risk of harming themselves and/or others, are a promising policy tool to address increasing rates of firearm-related suicide, homicide, and mass shootings. Social workers frequently assess clients at risk of firearm-related harm, positioning social workers to play a key role in ERPO implementation. This study sought to understand social workers' perspectives on ERPOs. Authors invited 6,910 licensed social workers in Washington state to participate in a survey in May and June of 2021 about facilitators and barriers to their willingness to counsel clients' family members, contact law enforcement, or independently file ERPOs for clients at risk of harm to self (HTS) or others (HTO). Of the 1,381 survey participants, most were willing to counsel (96 percent for HTS; 96 percent HTO), contact law enforcement (84 percent for HTS; 87 percent for HTO), or independently file an ERPO (78 percent for HTS; 79 percent for HTO). Common barriers associated with willingness were lack of understanding about the ERPO process and concerns with involving the legal system/law enforcement. Key facilitators included training social workers about ERPOs and availability of legal experts for consultations. Social workers are willing to incorporate ERPOs into their practice for clients, but remaining barriers need to be addressed to support the practice.
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Affiliation(s)
- Kelsey M Conrick
- MPH, is a PhD candidate, School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
| | - Emma Gause
- MS, MA, was a research scientist at the time this study was conducted, Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- MD, MPH, is vice chair and professor of pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- PhD, MD, MPH, is professor of epidemiology, Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Megan Moore
- Sidney Miller endowed associate professor in direct practice, School of Social Work, University of Washington, Seattle, WA, USA
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Kosaraju R, Vandenbogaart E, Core E, Creaser J, Livingston N, Moore M, Kamath M, Deng M. Association of SIPAT Score with Long-Term Psychosocial and Clinical Outcomes in Orthotopic Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.174] [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: 04/05/2023] Open
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17
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Moore M, Afolayan-Oloye O, Kroneman O, Li W, Kanaan HD, Zhang PL. Proteinuria in thrombotic microangiopathy is associated with partial podocytopathy. Ultrastruct Pathol 2023; 47:219-226. [PMID: 36906888 DOI: 10.1080/01913123.2023.2189341] [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] [Indexed: 03/13/2023]
Abstract
BACKGROUND Thrombotic microangiopathy (TMA) results in acute kidney injury, but the cause of heavy proteinuria in this disorder is puzzling. The goal of this study was to determine if there were significant effacement of foot processes and CD133-positive hyperplastic podocytes in TMA to explain the proteinuria. METHODS The study included 12 negative controls (renal parenchyma removed from renal cell carcinoma) and 28 thrombotic microangiopathy due to different etiologies. The percent of foot process effacement was estimated, and proteinuria level was obtained for each TMA case. Both groups of cases were stained for CD133 by immunohistochemical method, and the number of positive CD133 in hyperplastic podocytes was counted and analyzed. RESULTS Nineteen (19) of 28 (68%) TMA cases had nephrotic range proteinuria (urine protein/creatinine >3). Twenty-one (21) of 28 (75%) TMA cases showed positive CD133 staining in scattered hyperplastic podocytes within Bowman's space but was absent in control cases. The percent of foot process effacement (56 ± 4%) correlated with proteinuria (protein/creatinine ratio 4.4 ± 0.6) (r = 0.46, p = .0237) in TMA group. CONCLUSION Our data indicate that the proteinuria in TMA can be associated with significant effacement of foot processes. CD133-positive hyperplastic podocytes can be seen in the majority of TMA cases of this cohort, indicating a partial podocytopathy.
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Affiliation(s)
- Megan Moore
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Olaf Kroneman
- Division of Nephrology, Beaumont Health, Royal Oak, MI, USA
| | - Wei Li
- Department of Pathology, Beaumont Labs, Royal Oak, MI, USA
| | | | - Ping L Zhang
- Department of Pathology, Beaumont Labs, Royal Oak, MI, USA
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18
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Jafri F, Moore M, Metur SP, Klionsky DJ. AutophagosOMES: identification of autophagosomal cargo in CD4 + T cells by proteomics. Autophagy 2023; 19:745-746. [PMID: 36576209 PMCID: PMC9980638 DOI: 10.1080/15548627.2022.2161154] [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: 12/18/2022] [Revised: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Macroautophagy/autophagy, a cellular process that sequesters and breaks down cellular components in the lysosome/vacuole, is important in various events where cell composition undergoes changes. Broadly, autophagy is involved in T cell regulation including maintaining cell homeostasis. One process where a cell alters its composition is in the activation of helper T cells in the immune system. When helper (CD4+) T cells are activated by antigens, they both grow and alter their cellular components to become effector T cells. Autophagy is the process that facilitates the breakdown of these cellular components and is therefore hypothesized to have a role in CD4+ T cell activation. Previous research has concluded that CD4+ T cell activation induces autophagy, providing an avenue for further research aimed at examining the ways in which this induced autophagy affects CD4+ T cell proliferation and function. Toward this end, Zhou et al. researched the autophagosomal cargo present within CD4+ T cells and the impact this cargo has on CD4+ T cell proliferation.
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Affiliation(s)
- Faris Jafri
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Megan Moore
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Shree Padma Metur
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J. Klionsky
- Life Sciences Institute and Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
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19
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Conrick KM, Smith MB, Rooney L, Morgan E, Rowhani-Rahbar A, Moore M. Openness to church-based firearm safety interventions among Protestant Christian firearm owners. Public Health 2023; 216:45-50. [PMID: 36796220 DOI: 10.1016/j.puhe.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Protestant Christians are more likely to own firearms and not store them locked/unloaded compared to those from other religions. This study examines how Protestant Christians view the relationship between their religious and firearm beliefs and how that informs openness to church-based firearm safety interventions. STUDY DESIGN Grounded theory analysis of 17 semi-structured interviews with Protestant Christians. METHODS Interviews, conducted August-October 2020, focused on firearms owned, carrying/discharge/storage behaviors, Christian belief compatibility with firearm ownership, and openness to church-based firearm safety interventions. Audio-recorded interviews were transcribed verbatim and analyzed using grounded theory techniques. RESULTS Participant perspectives varied on firearm ownership motivations and compatibility of Christian values with firearm ownership. Variation in these themes and in openness to church-based firearm safety interventions resulted in clustering of participants into three groups. Group 1 owned firearms for collecting/sporting purposes and intricately connected their Christian identity with firearm ownership, but they were not open to intervention due to perceived high firearm proficiency. Group 2 did not connect their Christian identity to their firearm ownership; some believed these identities were incompatible, so were also not open to intervention. Group 3 owned firearms for protection and believed church, as a community hub, was an excellent location for firearm safety interventions. CONCLUSIONS The clustering of participants into groups varying in openness to church-based firearm safety interventions suggests it is feasible to identify Protestant Christian firearm owners open to intervention. This study presents a first step in coupling firearm owner characteristics with community-based, tailored interventions with promise for efficacy.
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Affiliation(s)
- K M Conrick
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.
| | - M B Smith
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - L Rooney
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - E Morgan
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - M Moore
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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20
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Stadeli KM, Sonett D, Conrick KM, Moore M, Riesenberg M, Bulger EM, Meischke H, Vavilala MS. Perceptions of Prehospital Care for Patients With Limited English Proficiency Among Emergency Medical Technicians and Paramedics. JAMA Netw Open 2023; 6:e2253364. [PMID: 36705920 DOI: 10.1001/jamanetworkopen.2022.53364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Patients with limited English proficiency (LEP) experience disparities in prehospital care. On-scene interactions between patients with LEP and emergency medical services (EMS) providers (ie, firefighters/emergency medical technicians [EMTs] and paramedics) are critical to high-quality care and have been minimally explored. OBJECTIVE To identify EMS-perceived barriers and facilitators to providing high-quality prehospital care for patients with LEP. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semi-structured focus groups were conducted with firefighters/EMTs and paramedics with all levels of experience from urban areas with a high proportion of residents with LEP from July to September 2018. Data were analyzed from July 2018 to May 2019. EXPOSURES Providing prehospital care for patients with LEP. MAIN OUTCOMES AND MEASURES The main outcomes were barriers and facilitators to prehospital care for patients with LEP, assessed using thematic analysis. Four domains of interest were examined: (1) overall impressions of interactions with patients with LEP, (2) barriers and facilitators to communication, (3) barriers and facilitators to providing care, and (4) ideas for improving prehospital care for patients with LEP. RESULTS Thirty-nine EMS providers participated in 8 focus groups: 26 firefighters/EMTs (66%) and 13 paramedics (33%). The median age of participants was 46 years (range, 23-63 years), and 35 (90%) were male. Participants described barriers to optimal care as ineffective interpretation, cultural differences, high-stress scenarios (eg, violent events), unclear acuity of patient's condition, provider bias, and distrust of EMS. Perceived facilitators to optimal care included using an on-scene interpreter, high-acuity disease, relying on objective clinical findings, building trust and rapport, and conservative decision-making regarding treatment and transport. Providers reported transporting most patients with LEP to hospitals regardless of illness severity due to concern for miscommunication and unrecognized problems. Better speed and technology for interpretation, education for communities and EMS providers, and community-EMS interactions outside emergencies were cited as potential strategies for improvement. CONCLUSIONS AND RELEVANCE In this study, EMS providers described many barriers to high-quality care during prehospital emergency response for patients with LEP yet were unaware that these barriers impacted quality of care. Barriers including ineffective interpretation, provider bias, distrust of EMS, and cultural differences may contribute to outcome disparities and overutilization of resources. Future work should focus on the development of targeted interventions to improve modifiable barriers to care, such as improving interpretation and cultural humility and increasing trust.
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Affiliation(s)
- Kathryn M Stadeli
- Department of Surgery, University of California, Davis, Sacramento
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Dylan Sonett
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Physical Sciences Division, University of Washington Bothell, Seattle
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Matthew Riesenberg
- King County Medic One, King County Emergency Medical Services, Seattle, Washington
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Hendrika Meischke
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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21
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Toy C, Stimes G, Moore M, Srivaths P, Arikan AA. Cefepime Dosing in a Critically Ill Neonate Receiving Continuous Renal Replacement Therapy With the Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM). J Pediatr Pharmacol Ther 2023; 28:167-171. [PMID: 37139247 PMCID: PMC10150901 DOI: 10.5863/1551-6776-28.2.167] [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: 01/06/2022] [Accepted: 04/22/2022] [Indexed: 05/05/2023]
Abstract
We report on a former 27-week gestational age infant who was placed on the Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) at 4 months post-menstrual age while receiving cefepime treatment for an Enterobacter cloacae bacteremia and persistent peritonitis secondary to an infected peritoneal dialysis catheter. Using therapeutic drug monitoring while assessing the clearance of cefepime on continuous renal replacement therapy (CRRT), we were able to successfully treat this patient's infection while also minimizing the risk of side effects from this medication. Current literature supports dosing in adult patients on all modalities of CRRT with effluent flow rates of 20 to 25 mL/kg/hr; however, pharmacokinetic data on cefepime dosing in pediatric CRRT are scant. This case report describes the successful dosing strategy used for this patient while on various rates of continuous veno-venous hemodialysis with CARPEDIEM. Therapeutic drug monitoring of cefepime should be considered in critically ill pediatric patients on CARPEDIEM receiving CRRT.
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Affiliation(s)
- Cynthia Toy
- Department of Pharmacy Services (CT, GS, MM), Texas Children's Hospital, Houston, TX
| | - Grant Stimes
- Department of Pharmacy Services (CT, GS, MM), Texas Children's Hospital, Houston, TX
| | - Megan Moore
- Department of Pharmacy Services (CT, GS, MM), Texas Children's Hospital, Houston, TX
| | - Poyyapakkam Srivaths
- Department of Pediatrics, Renal Section (PS, AAA), Baylor College of Medicine, Houston, TX
| | - Ayse Akcan Arikan
- Department of Pediatrics, Renal Section (PS, AAA), Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Section of Critical Care Medicine (AAA), Baylor College of Medicine, Houston, TX
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22
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Conrick KM, Davis A, Rooney L, Bellenger MA, Rivara FP, Rowhani-Rahbar A, Moore M. Extreme Risk Protection Orders in Washington State: Understanding the Role of Health Professionals. J Soc Social Work Res 2023; 14:10.1086/714635. [PMID: 37389407 PMCID: PMC10300622 DOI: 10.1086/714635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Objective Extreme Risk Protection Orders (ERPO) allow a petitioner to file a civil order to temporarily restrict access to firearms among individuals ("respondents") deemed to be at extreme risk of harming themselves, others, or both. Although unable to file ERPOs for their clients in most states, health professionals may play a pivotal role in the ERPO process by recommending an eligible petitioner initiate the process. We describe the process of filing an ERPO when a healthcare, mental health, or social service professional contacted an ERPO petitioner. Method Court documents of ERPOs involving health professionals in Washington State between December 8th, 2016 and May 10th, 2019 were qualitatively analyzed (n=24). We constructed pen portraits from the documents and analyzed them using an inductive qualitative thematic approach. Results Themes included factors influencing the process by which each professional evaluated respondent behaviors, factors considered during assessment, factors influencing interpretation of respondent behaviors and subsequent provider response during a crisis. These influenced the outcome of the crisis event that led to ERPO filing. Conclusions Each professional group differed in their approach to risk assessment of respondent behaviors. Strategies to better coordinate and align approaches may improve the ERPO process.
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Affiliation(s)
- Kelsey M Conrick
- School of Social Work, University of Washington
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Adam Davis
- School of Social Work, University of Washington
| | - Lauren Rooney
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - M Alex Bellenger
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Megan Moore
- School of Social Work, University of Washington
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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Johnson IM, Light MA, Perry TE, Moore M, Lewinson T. Understanding the Ephemeral Moment of COVID Avoidance Hotels: Lessons Learned from Acknowledging Housing as Central to Dignified Later Life. J Gerontol Soc Work 2023; 66:3-28. [PMID: 35695062 PMCID: PMC9744961 DOI: 10.1080/01634372.2022.2087129] [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] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Place and health are intricately bound. COVID has amplified system burdens and health risks within the housing care continuum, in which older adults with chronic illnesses are disproportionately represented. The paper identifies the health experiences of older adults with severe conditions living in and moving through temporary avoidance hotels during the COVID-19 pandemic. An interpretive descriptive approach was taken with qualitative chart data and provider observation to represent the experiences of 14 older avoidance hotel residents living with serious illnesses. Through provider documentation, we illustrate trends pre-pandemic, in the first nine months of the pandemic, and the second nine months. Such trends include strengths and opportunities such as the health-affirming nature of avoidance hotels, their potential in generating continuity of care and permanent housing, and synergy between harm reduction approaches and palliative care. Challenges were also identified in catering to the diverse medical, behavioral, and psychosocial-spiritual needs of older and seriously ill residents and the consequences of geographic dispersion on health care, health behaviors, and informal care networks. Through these strengths and challenges, avoidance hotels present essential lessons in considering future housing and healthcare intervention and implementation that addresses the needs of older seriously ill people facing homelessness and housing precarity.
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Affiliation(s)
- Ian M Johnson
- Dept of Social Work, University of Tennessee College of Social Work, Knoxville, Tennessee, USA
| | - Michael A Light
- Dept of Social Work, Palliative Care Training Center, University of Washington, Seattle, Washington, USA
| | - Tam E Perry
- Wayne State University School of Social Work, Detroit, Michigan, USA
| | - Megan Moore
- Dept of Social Work, University of Washington, Seattle, Washington, USA
| | - Terri Lewinson
- Dartmouth College Institute for Health Policy & Clinical Practice Lebanon, New Hampshire, USA
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24
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Prater L, Rooney L, Bowen AG, Conrick K, Mustafa A, Moore M, Rivara FP, Rowhani-Rahbar A. Civilian Petitioners and Extreme Risk Protection Orders in the State of Washington. Psychiatr Serv 2022; 73:1263-1269. [PMID: 35611513 DOI: 10.1176/appi.ps.202100636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extreme risk protection orders (ERPOs) are civil orders designed to temporarily restrict access to firearms when people are at substantial risk of harm to themselves or others. A minority of ERPOs in the United States have been filed by civilians, with most filed by law enforcement. The authors examined barriers and facilitators to the ERPO filing process from the perspective of the civilian petitioner. METHODS Semistructured interviews of civilian petitioners who filed ERPOs in Washington State from December 2016 to September 2020 were conducted. The interviews examined both barriers and facilitators to filing an ERPO. A descriptive and qualitative approach with inductive-deductive thematic analysis was used to identify and code themes. RESULTS Fifteen civilian petitioners were interviewed. Barriers to ERPO filing included perceived lack of help connecting with social services to address the potential for harmful behavior, confusion regarding the filing and court process, and petitioner distress. Facilitators included having previous legal experience, having assistance from advocates who helped shepherd petitioners through the process, and simplification of the ERPO process. CONCLUSIONS ERPO is a useful tool for suicide and violence prevention, but several barriers may be inhibiting ERPO use among civilian petitioners. Better educational resources and advocacy programs, as well as simplified filing steps, could improve the process and make ERPOs more accessible for civilians.
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Affiliation(s)
- Laura Prater
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Lauren Rooney
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Andrew G Bowen
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Kelsey Conrick
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Ayah Mustafa
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Megan Moore
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Frederick P Rivara
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle (all authors); Department of Psychiatry and Behavioral Science, School of Medicine, University of Washington, Seattle (Prater); School of Social Work, University of Washington, Seattle (Conrick, Moore); Department of Pediatrics (Rivara) and Department of Epidemiology, School of Public Health (Rowhani-Rahbar), University of Washington, Seattle
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25
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Mills J, Moore M, Bates L, Mihas P, Wildes T, Grant S. Living with Multiple Myeloma: Patient and Informal Caregiver Perspectives on the Impact of Physical Function Impairments and COVID-19 Restrictions on Social Activities. J Geriatr Oncol 2022. [PMCID: PMC9595427 DOI: 10.1016/s1879-4068(22)00422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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26
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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Gause EL, Conrick K, Moore M, Rowhani-Rahbar A, Rivara FP. Survey of Washington Clinicians’ Willingness to Use and Preferences Related to Extreme Risk Protection Orders. Prev Med Rep 2022; 28:101883. [PMID: 35855924 PMCID: PMC9287355 DOI: 10.1016/j.pmedr.2022.101883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Emma L. Gause
- Firearm Injury and Policy Research Program, University of Washington, United States
- Corresponding author at: Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States.
| | - Kelsey Conrick
- Firearm Injury and Policy Research Program, University of Washington, United States
- School of Social Work, University of Washington, United States
| | - Megan Moore
- School of Social Work, University of Washington, United States
| | - Ali Rowhani-Rahbar
- Firearm Injury and Policy Research Program, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
| | - Frederick P. Rivara
- Firearm Injury and Policy Research Program, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Department of Pediatrics, University of Washington, United States
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Doos D, Barach P, Alves NJ, Falvo L, Bona A, Moore M, Cooper DD, Lefort R, Ahmed R. The Dangers of Reused Personal Protective Equipment: Healthcare Workers and Workstation Contamination. J Hosp Infect 2022; 127:59-68. [PMID: 35688273 PMCID: PMC9172254 DOI: 10.1016/j.jhin.2022.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
Abstract
Background Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. Methods In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. Results All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. Conclusion PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.
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Affiliation(s)
- D Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - P Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA; University of Queensland, Brisbane, Queensland, Australia
| | - N J Alves
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L Falvo
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Bona
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Moore
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - D D Cooper
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Lefort
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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O'Shea K, Moore M, Coleman L. PO-1513 Radiobiological corrections of dose-volume histograms for treatment gap calculations. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03477-6] [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: 10/18/2022]
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30
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O'Connor P, Moore M, Cronin J. PO-1551 Monte-Carlo modelling of Hp(10) in a superficial treatment room to inform radiation risk assessments. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Vitale G, Gau E, Moore M. 1497: EFFECT OF VASOPRESSOR CHOICE ON ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE IN SEPTIC SHOCK. Crit Care Med 2022. [DOI: 10.1097/01.ccm.0000812312.24093.99] [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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32
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Moore M. A survey-based comparison between clinical training pathways of Irish MPEs and the RP174 “European Guidelines on Medical Physics Expert”. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00566-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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33
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Rooney L, Conrick KM, Bellenger MA, Moore M, Haviland MJ, Gause E, Rivara FP, Rowhani-Rahbar A. Understanding the Process, Context, and Characteristics of Extreme Risk Protection Orders: A Statewide Study. J Health Care Poor Underserved 2021; 32:2125-2142. [PMID: 34803063 DOI: 10.1353/hpu.2021.0186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research summary. Extreme risk protection orders (ERPOs) allow police, family, and household members to file an order to temporarily remove firearms or prevent purchasing among individuals at high risk for harming themselves or others. Using inductive qualitative content analysis, we examined 241 ERPOs filed December 8, 2016 through May 10, 2019 in Washington State. Focusing on recurring themes, we explored the circumstances and behaviors that led to an ERPO filing. Extreme risk protection orders were filed over concerns for domestic violence, mass shooting threats, direct threats to oneself or others, and other concerning behavior with a firearm. Factors at all levels of the social-ecological model were found to play a role in the dangerous behaviors of respondents that led to an ERPO petition. Policy implications. Extreme risk protection orders can serve an important role in both protecting people and facilitating the provision of care for substance use, mental illness, and assistance to vulnerable individuals.
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34
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Young C, Moore M, Gyenes M, Sheehan O, Ahmed S. 105 COVID-19 IN OLDER ADULTS: INPATIENT OUTCOMES IN A LEVEL 3 IRISH HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.105] [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: 02/25/2023] Open
Abstract
Abstract
Background
COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital.
Methods
We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020–19/02/2021 (n = 674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by ‘wave’: (Wave 1 n = 294, 2 n = 105, 3 n = 275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System.
Results
42.3% of COVID patients in our hospital were older persons (n = 285). This remained stable throughout the pandemic (Wave 1 44.2%, Wave 2 44.7%, Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality in Wave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%.
Conclusion
In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65. Older adults were also more likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.
Reference
Zerah et al, Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2021 Feb 25; 76 (3): e4–e12.
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Affiliation(s)
- C Young
- Connolly Hospital Blanchardstown , Dublin, Ireland
| | - M Moore
- Connolly Hospital Blanchardstown , Dublin, Ireland
| | - M Gyenes
- Royal College of Surgeons Ireland , Dublin, Ireland
| | - O Sheehan
- Connolly Hospital Blanchardstown , Dublin, Ireland
| | - S Ahmed
- Connolly Hospital Blanchardstown , Dublin, Ireland
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35
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Dean S, Ainsworth H, Alexander M, Dharmaraj D, O’Connell R, Mitchell P, Torres J, Saqib A, Ladwa R, Pavlakis N, Clarke S, Tay R, Solomon B, John T, Moore M, Yip P, Kao S, Itchins M, Parakh S. P16.02 Atezolizumab, Bevacizumab and Chemotherapy (IMpower150) in Stage IV Non-Small Cell Lung Cancer: The Australian Experience. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Lyons VH, DeCou CR, Niehoff E, Moore M, Rivara FP, Rowhani-Rahbar A. Life experiences preceding high lethality suicide attempts in adolescents at a level I regional trauma center. Suicide Life Threat Behav 2021; 51:836-843. [PMID: 33665874 DOI: 10.1111/sltb.12740] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/31/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe life experiences associated with patterns of medically treated and documented self-directed violence among youth who attempted suicide using highly lethal means to understand precipitating factors among youth using such lethal means. METHOD Using data from a regional, level 1 Trauma center, we identified all youth suicide attempt survivors who received treatment from 2010 to 2018 for a suicide attempt with a firearm, hanging, or jump from height injury (n = 42). We described differences in patient demographics and life experiences associated with patterns of self-directed violence by suicide attempt mechanism. We additionally assessed mechanisms used in any prior suicide attempts to identify potential increasing lethality of mechanism selection. RESULTS There were 42 eligible patients included, of whom 40.5% attempted suicide with a firearm, 26.2% with hanging, 33.3% with jumping injury. A greater proportion of patients with firearm injuries endorsed social support and had fewer preparatory acts, history of self-harming behavior, prior suicide behaviors, and fewer prior attempts compared to patients who attempted suicide with other mechanisms. CONCLUSIONS Given our findings, means safety should remain a key strategy to prevent highly lethal suicidal behavior among adolescents, especially with firearms, given that such attempts may occur prior to formal contact with mental health services.
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Affiliation(s)
- Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Christopher R DeCou
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Elizabeth Niehoff
- Massachusetts General Hospital, Cancer Center Protocol Office, Boston, MA, USA
| | - Megan Moore
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,School of Social Work, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Bishnoi S, Cosman R, Moore M, Eek R, Mant A, Zielinski R, Chan L, Ma Y, Zhang Q, Yau T, Aghmesheh M, Tse A. 981P Preliminary safety and efficacy results from phase Ib study of the anti-CTLA-4 monoclonal antibody (mAb) CS1002 in combination with anti-PD-1 mAb CS1003 in patients with advanced solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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38
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Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord 2021; 54:1328-1357. [PMID: 33864277 PMCID: PMC9035356 DOI: 10.1002/eat.23519] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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: 05/11/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Currently, there is debate in the eating disorders field regarding how to define atypical anorexia (AAN), how prevalent it is in community and clinical settings, and how AAN rates compare with low-weight AN. This systematic review assesses AAN literature from 2007 to 2020, to investigate: (a) the demographic characteristics of AAN studies, (b) the prevalence of AAN compared with AN, (c) the range of operational definitions of AAN and the implications of these definitions, and (d) the proportion of patients with AAN and AN represented in consecutive admission and referral samples. METHOD PsychINFO, CINAHL, PubMed, Greylit.org, and ProQuest databases were searched according to methods for Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic reviews, yielding 3,184 potential articles. Seventy-five eligible studies were coded for sixty-one variables. RESULTS Clinical samples predominantly included younger, female, white samples with limited diversity. In epidemiological designs, AAN was typically as common or more common than AN, and AAN rates varied significantly based on the population studied and operational definitions. In consecutive clinical samples, AAN was frequently less represented. DISCUSSION Although AAN appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap. Additionally, results suggest the need for fine-tuning diagnostic definitions, greater diversity in AAN studies, and increased screening and referral for this vulnerable population.
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Affiliation(s)
- Erin N. Harrop
- Graduate School of Social Work, University of Denver, Denver, Colorado,School of Social Work, University of Washington, Seattle, Washington
| | | | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington
| | - Taryn Lindhorst
- School of Social Work, University of Washington, Seattle, Washington
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Fautrel B, Caporali R, Holdsworth E, Donaghy B, Khalid M, Moore M, Van Beneden K, Piette Y, Romero-Yuste S, Broen J, Taylor PC. POS0305 PHYSICIAN AND PATIENT ATTITUDES TOWARDS TREAT-TO-TARGET, ITS IMPLEMENTATION AND STATED TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN A REAL-WORLD SETTING ACROSS EUROPE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The principles of treat to target (T2T) include defining an appropriate treatment target, assessed at pre-defined intervals, with a commitment to changing therapeutic approach if the target is not met (1). T2T is recommended as a key strategy for the treatment of rheumatoid arthritis (RA).Objectives:To explore attitudes towards T2T, its implementation and stated treatment goals among physicians and their patients with RA.Methods:The Adelphi RA Disease Specific Programme™ was a large, quantitative, point-in-time survey conducted amongst rheumatologists (n=296) and their consulting patients with RA (n=3042) in Europe (France, Germany, Italy, Spain, UK) between Q4 2019–Q3 2020. Physicians were recruited via publicly available lists, completing an online survey and medical record extraction for their next 10–12 consecutive patients. The same patients were invited to voluntarily complete a self-report questionnaire (n=1098, 36% response), collecting data on attitudes towards T2T and treatment goals.Results:Physicians reported that 76% of patients were in remission (DAS28: <2.6) or had low disease activity (DAS28: 2.6 – 3.2), and 24% had moderate-high disease activity (DAS28: >3.2). Patient mean age was 53.0 years (SD 14.0), mean time since diagnosis was 7.2 years (SD 7.2). The proportion of patients currently receiving an advanced therapy (AT; defined as biologic or targeted synthetic DMARD) was 68%, of whom 70% were on a first line AT. No difference was observed between disease activity groups.In the physician survey, 86% of physicians stated they followed T2T principals in at least some of their RA patients, and would utilize a T2T approach in RA patients with moderate-high disease activity (61%), the most uncontrolled patients (37%) and those who do not respond well to initial therapy (34%). In this sample of real-world RA patients, 66% were reported by physicians to be on a T2T plan at the time of data collection. The most common physician-reported targets were remission (DAS28: <2.6) (75%), improvement of quality of life (QoL) (41%) and reduction of pain (31%), with 85% of physicians perceiving these treatment goals were fully or partially met. The most stated reasons for not implementing T2T was physician preference not to adjust current treatment (34%), patient preference not to adjust current treatment (23%), and there are no achievable goals for this patient (16%).Overall, 29% of patients reported they were involved in setting their T2T goals, while 34% stated their T2T goals were set by their physicians only, and 29% perceived no T2T goal had been set (n=620). The most common overall T2T goals from the patient perspective were remission (61%), controlling symptoms (41%), and reducing impact on QoL (34%). Of those patients who acknowledged a T2T goal had been set (n=407), 77% reported their T2T goal was fully or partially achieved.Of 719 patients who had moderate-high disease activity, 57% were on a T2T plan, with 46% of physicians perceiving these treatment goals were fully or partially met. The most common physician-stated reason for not implementing T2T was a lack of achievable targets (29%).Conclusion:Rheumatologists in this study reported a strong belief in T2T. The most common physician-set T2T goals were remission, improvement of QoL and reduction of pain, corresponding with T2T goals as reported by patients. However, a third of patients in this cohort were not aware of a defined T2T objective in their management, which may be a result of a perceived lack of achievable goals by physicians. It may be desirable to promote more patient involvement in defining achievable targets amongst those with moderate-high disease activity who despite best efforts may not reach a clinical state of remission. Further research is needed to identify and understand goals important to RA patients.References:[1]van Vollenhoven R. Treat-to-target in rheumatoid arthritis - are we there yet? Nat Rev Rheumatol. 2019;15(3):180-6.Acknowledgements:This study was funded by Galapagos NV, Belgium.Medical writing support was provided by Gary Sidgwick, PhD (Adelphi Real World, Bollington, UK) and editorial support was provided by Debbie Sherwood, BSc, CMPP (Aspire Scientific, Bollington, UK), both funded by Galapagos NV.Disclosure of Interests:Bruno Fautrel Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Celltrion, Fresenius Kabi, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, UCB, Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Roberto Caporali Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung Bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly, Janssen, MSD, Elizabeth Holdsworth Employee of: Adelphi Real World, Bethany Donaghy Employee of: Adelphi Real World, Mona Khalid Shareholder of: Galapagos, Employee of: Galapagos, Mark Moore Shareholder of: Gilead Sciences, Speakers bureau: Gilead Sciences (only as employee), Paid instructor for: Gilead Sciences (only as employee), Consultant of: Gilead Sciences (only as employee), Grant/research support from: Gilead Sciences (only as employee), Employee of: Gilead Sciences, and previously Sanofi and AstraZeneca, Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, Yves Piette Consultant of: AbbVie, Amgen, Galapagos, Grünenthal and Sandoz, Grant/research support from: Amgen, Mylan and UCB, Susana Romero-Yuste Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Grunenthal, Kern Pharma, Lilly, Roche, Sandoz, Sanofi, UCB, Janssen, Consultant of: AbbVie, Biogen, Fresenius, Galapagos, Gebro, Janssen, Lilly, Grant/research support from: Bristol Myers Squibb, MSD, Novartis, Pfizer, Jasper Broen Shareholder of: Pharming Group, Consultant of: Galapagos, Gilead, Novartis, Peter C. Taylor Consultant of: AbbVie, Biogen, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Pfizer, Roche, Sanofi, Nordic Pharma, Fresenius, UCB, Grant/research support from: Celgene, Galapagos, Gilead, Lilly
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Portanova J, Buchanan D, Moore M, Thompson H. Factors Associated with the Development of Persistent Pain after mTBI. Pain Manag Nurs 2021; 22:592-598. [PMID: 34011466 DOI: 10.1016/j.pmn.2021.04.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent pain after mild traumatic brain injury (mTBI) is widely experienced, yet little is known about who is at risk for experiencing persistent pain after their injury. AIMS The purpose of this study was to 1) determine if there are factors associated with later experiencing persistent pain after mTBI and 2) examine if there are symptom patterns associated with the experience of persistent pain. DESIGN Secondary analysis was conducted using de-identified data from an NIH-funded longitudinal study.SettingsParticipants were enrolled in the emergency department. PARTICIPANTS Participants were aged 21 to 92 and all had experienced mTBI. METHODS We examined baseline characteristics, symptoms, and injury related variables associated with the endorsement of persistent pain among those with mTBI (N = 183) from baseline to 6 months post-injury. In order to identify a persistent pain phenotype, exploratory factor analysis was used to determine which symptoms co-occur with persistent pain. RESULTS Persistent pain was found in 78% of those with mTBI. Those with lower overall health status at day 7 and at 1-month following injury had greater odds of developing persistent pain. Those with higher levels of general health status and physical function health status at day 7 and 1 month, and those with higher levels of overall health related status at 1 month had significantly lesser odds of persistent pain at 6 months. Factor analysis revealed that persistent pain and co-occurring symptoms (anxiety, depression, dizziness, nausea and vomiting, sleep disturbance, poor memory, poor concentration, longer to think and light sensitivity) loaded on one factor, indicating that these symptoms are associated. CONCLUSIONS Those at increased risk for persistent pain should be screened beginning early in the recovery trajectory to reduce their risk of developing persistent pain. Identification of a phenotype offers potential for recognition of symptoms that cluster with persistent pain, improving the ability to treat patients more holistically, and develop interventions to support recovery from injury.
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Affiliation(s)
- Jaclyn Portanova
- University of Washington, Seattle, Washington; Department of Veteran Affairs; Linfield University; Yale University.
| | | | - Megan Moore
- University of Washington, Seattle, Washington
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Khadhouri S, Gallagher K, MacKenzie K, Shah T, Gao C, Moore S, Zimmermann E, Edison E, Jefferies M, Nambiar A, Mannas M, Lee T, Marra G, Gomez Rivas J, Marcq G, Assmus M, Ucar T, Claps F, Boltri M, Montagna GL, Burnhope T, Nkwam N, Austin T, Boxall N, Downey A, Sukhu T, Anton-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green J, Nielsen M, Takwoingi Y, McGrath J, Kasivisvanathan V. 92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study. Br J Surg 2021. [PMCID: PMC8135806 DOI: 10.1093/bjs/znab135.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.
Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.
Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.
Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
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Affiliation(s)
- S Khadhouri
- University of Aberdeen, Aberdeen, United Kingdom
- BURST, London, United Kingdom
| | - K Gallagher
- Western General Hospital, Edinburgh, United Kingdom
- BURST, London, United Kingdom
| | - K MacKenzie
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - T Shah
- Charing Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - C Gao
- Addenbrookes Hospital, Cambridge, United Kingdom
- BURST, London, United Kingdom
| | - S Moore
- Wrexham Maelor Hospital, Wrexham, United Kingdom
- BURST, London, United Kingdom
| | - E Zimmermann
- Torbay and South Devon NHS Foundation Trust, Torbay, United Kingdom
- BURST, London, United Kingdom
| | - E Edison
- Whipps Cross Hospital, London, United Kingdom
- BURST, London, United Kingdom
| | - M Jefferies
- Morriston Hospital, Swansea, United Kingdom
- BURST, London, United Kingdom
| | - A Nambiar
- Freeman Hospital, Newcastle, United Kingdom
- BURST, London, United Kingdom
| | - M Mannas
- University of British Columbia, Vancouver, Canada
| | - T Lee
- University of British Columbia, Vancouver, Canada
| | - G Marra
- University of Turin, Turin, Italy
| | | | - G Marcq
- University of Lille, Lille, France
| | - M Assmus
- University of Alberta, Edmonton, Canada
| | - T Ucar
- Istanbul Medeniyet University, Istanbul, Turkey
| | - F Claps
- University of Trieste, Trieste, Italy
| | - M Boltri
- University of Trieste, Trieste, Italy
| | | | - T Burnhope
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - N Nkwam
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Austin
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - N Boxall
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - A Downey
- Doncaster Royal Infirmary, Doncaster, United Kingdom
| | - T Sukhu
- University of North Carolina Hospitals, Chapel Hill, USA
| | | | - S Rai
- St James University Hospital, Leeds, United Kingdom
| | - Y F Chin
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - M Moore
- University of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - T Drake
- The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - J Green
- Whipps Cross Hospital, London, United Kingdom
| | - M Nielsen
- University of North Carolina Hospitals, Chapel Hill, USA
| | - Y Takwoingi
- University of Birmingham, Birmingham, United Kingdom
| | - J McGrath
- University of Exeter Medical School, Exeter, United Kingdom
| | - V Kasivisvanathan
- University College London, London, United Kingdom
- BURST, London, United Kingdom
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Dailey W, Shunemann R, Yang F, Moore M, Knapp A, Chen P, Deshpande M, Metcalf B, Tompkins Q, Guzman AE, Felisky J, Mitton KP. Differences in activation of intracellular signaling in primary human retinal endothelial cells between isoforms of VEGFA 165. Mol Vis 2021; 27:191-205. [PMID: 33953532 PMCID: PMC8092446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose There are reports that a b-isoform of vascular endothelial growth factor-A 165 (VEGFA165b) is predominant in normal human vitreous, switching to the a-isoform (VEGFA165a) in the vitreous of some diseased eyes. Although these isoforms appear to have a different ability to activate the VEGF receptor 2 (VEGFR2) in various endothelial cells, the nature of their ability to activate intracellular signaling pathways is not fully characterized, especially in retinal endothelial cells. We determined their activation potential for two key intracellular signaling pathways (MAPK, AKT) over complete dose-response curves and compared potential effects on the expression of several VEGFA165 target genes in primary human retinal microvascular endothelial cells (HRMECs). Methods To determine full dose-response curves for the activation of MAPK (ERK1/2), AKT, and VEGFR2, direct in-cell western assays were developed using primary HRMECs. Potential differences in dose-response effects on gene expression markers related to endothelial cell and leukocyte adhesion (ICAM1, VCAM1, and SELE) and tight junctions (CLDN5 and OCLN) were tested with quantitative PCR. Results Activation dose-response analysis revealed much stronger activation of MAPK, AKT, and VEGFR2 by the a-isoform at lower doses. MAPK activation in primary HRMECs displayed a sigmoidal dose-response to a range of VEGFA 165 a concentrations spanning 10-250 pM, which shifted higher into the 100-5,000 pM range with VEGFA 165 b. Similar maximum activation of MAPK was achieved by both isoforms at high concentrations. Maximum activation of AKT by VEGFA 165 b was only half of the maximum activation from VEGFA 165 a. At a lower intermediate dose, where VEGFA 165 a activated intracellular signaling stronger than VEGFA 165 b, the changes in VEGFA target gene expression were generally greater with VEGFA 165 a. Conclusions In primary HRMECs, VEGFA 165 a could maximally activate MAPK and AKT at lower concentrations where VEGFA 165 b had relatively little effect. The timing for maximum activation of MAPK was similar for the isoforms, which is different from that reported for non-retinal endothelial cells. Although differences in VEGFA 165 a and VEGFA 165 b are limited to the sequence of their six C-terminal six amino acids, this results in a large difference in their ability to activate at least two key intracellular signaling pathways and VEGF-target gene expression in primary human retinal endothelial cells.
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Correction to: Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:37. [PMID: 33685389 PMCID: PMC7941694 DOI: 10.1186/s12862-021-01769-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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Abstract
BACKGROUND While sexual dysfunction (SD) in men following traumatic pelvic fracture is common, little is known of how men experience changes in their sexual health after injury. The aims of the present study were to explore the personal and interpersonal impacts of SD in men after pelvic injury and to understood how interactions with the health care system can be optimized to improve patient-centered trauma survivorship care. METHODS Fifteen semistructured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported SD. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed, and intercoder reliability was verified. Inductive thematic analysis was performed to identify notable themes related to patient postinjury sexual health experiences. RESULTS Median age of interviewees was 46 years (interquartile range, 44-54 years), with a median time since injury of 41 months (interquartile range, 22-55 months). Five primary themes were identified from the analysis: (1) effects on self-image and romantic relationships, (2) unknown care pathways and lack of communication, (3) inconsistencies with health care provider priorities, (4) provision of sexual health information and resources, and (5) the importance of setting expectations. Interviewees suggested that improved communication, provision of information related to possible adverse effects of their injuries, and expectation setting would improve posttrauma experiences. CONCLUSION Men's experiences with SD after pelvic trauma can be heavily influenced by their interactions with health care providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences. LEVEL OF EVIDENCE Therapeutic, level V.
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Affiliation(s)
- Niels V Johnsen
- From the Department of Urology (N.V.J.), Vanderbilt University Medical Center, Nashville, Tennessee; Harborview Injury Prevention and Research Center (N.V.J., E.C., T.J., M.S.V., F.P.R., M.M.), Department of Anesthesiology and Pain Medicine (M.S.V.), Department of Pediatrics (F.P.R.), and School of Social Work (M.M.), University of Washington, Seattle, Washington
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Fann JR, Hart T, Ciol MA, Moore M, Bogner J, Corrigan JD, Dams-O'Connor K, Driver S, Dubiel R, Hammond FM, Kajankova M, Watanabe TK, Hoffman JM. Improving transition from inpatient rehabilitation following traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial. Contemp Clin Trials 2021; 104:106332. [PMID: 33652127 DOI: 10.1016/j.cct.2021.106332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Due to challenges that include inconsistent access to follow-up care, persons with TBI being discharged from inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor reintegration into the community, family stress, and other unfavorable outcomes resulting from unmet needs. In a six-center randomized pragmatic comparative effectiveness study, the BRITE trial (Brain Injury Rehabilitation: Improving the Transition Experience, ClinicalTrials.govNCT03422276), we compare the effectiveness of two existing methods for transition from IRF to community living or long-term nursing care. The Rehabilitation Discharge Plan (RDP) includes patient/family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference, for 6 months. Nine hundred patients will be randomized (1:1) to RDP or RTP, with caregivers also invited to participate and contribute caregiver-reported outcomes. Extensive stakeholder input, including active participation of persons with TBI and their families, has informed all aspects of trial design and implementation planning. We hypothesize that RTP will result in better patient- and caregiver-reported outcomes (societal participation, quality of life, caregiver well-being) and more efficient use of healthcare resources at 6-months (primary outcome) and 12-months post-discharge, compared to RDP alone. Planned analyses will explore which participants benefit most from each transition model. With few exclusion criteria and other pragmatic features, the findings of this trial are expected to have a broad impact on improving transitions from inpatient TBI rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03422276.
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Affiliation(s)
- Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States of America.
| | - Tessa Hart
- Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
| | - Megan Moore
- School of Social Work and Harborview Injury Prevention and Research Center, University of Washington, 4101 15(th) Avenue NE, Seattle, WA 98105, United States of America.
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, United States of America.
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America. Kristen.dams-o'
| | - Simon Driver
- Department of Sports Therapy and Research, Baylor Scott and White Research Institute, 3434 Live Oak, Dallas, TX 75204, United States of America.
| | - Rosemary Dubiel
- Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Avenue, Dallas, TX 75246, United States of America.
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indian University School of Medicine, 4141 Shore Drive, Indianapolis, IN 46254, United States of America.
| | - Maria Kajankova
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place Box 1163, New York, NY 10029, United States of America.
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, United States of America.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, United States of America.
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:29. [PMID: 33593286 PMCID: PMC7885224 DOI: 10.1186/s12862-021-01761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is widespread interkingdom signalling between insects and microbes. For example, microbes found in floral nectar may modify its nutritional composition and produce odorants that alter the floral odor bouquet which may attract insect pollinators. Mosquitoes consume nectar and can pollinate flowers. We identified microbes isolated from nectar of common tansy, Tanacetum vulgare, elucidated the microbial odorants, and tested their ability to attract the common house mosquito, Culex pipiens. Results We collected 19 microbial isolates from T. vulgare nectar, representing at least 12 different taxa which we identified with 16S or 26S rDNA sequencing as well as by biochemical and physiological tests. Three microorganisms (Lachancea thermotolerans, Micrococcus lactis, Micrococcus luteus) were grown on culture medium and tested in bioassays. Only the yeast L. thermotolerans grown on nectar, malt extract agar, or in synthetic nectar broth significantly attracted Cx. pipiens females. The odorant profile produced by L. thermotolerans varied with the nutritional composition of the culture medium. All three microbes grown separately, but presented concurrently, attracted fewer Cx. pipiens females than L. thermotolerans by itself. Conclusions Floral nectar of T. vulgare contains various microbes whose odorants contribute to the odor profile of inflorescences. In addition, L. thermotolerans produced odorants that attract Cx. pipiens females. As the odor profile of L. thermotolerans varied with the composition of the culture medium, we hypothesize that microbe odorants inform nectar-foraging mosquitoes about the availability of certain macro-nutrients which, in turn, affect foraging decisions by mosquitoes.
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Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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Duchin ER, Moore M, Carrougher GJ, Min EK, Gordon DB, Stewart BT, Sabel J, Jo-Nes A, Pham TN. Burn patients' pain experiences and perceptions. Burns 2021; 47:1627-1634. [PMID: 33642121 DOI: 10.1016/j.burns.2021.01.010] [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: 08/17/2020] [Revised: 10/12/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Burns are painful injuries associated with a long recovery. Patients may not be receiving sufficient pain management education to optimize their experience and recovery after burn injury. Therefore, we aimed to obtain patients' perspectives about the effectiveness of current burn pain education to inform future efforts. METHODS We used a mixed-methods research design that included both inpatients and outpatients cared for at a single, American Burn Association-verified burn center. Participants were at least 14 years of age with an acute burn who received a minimum of two wound interventions. The interview was designed by clinician stakeholders using a modified Delphi technique and focused on patient respondent's pain experience, understanding and desire to gain knowledge concerning burn pain and its management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis. RESULTS Twenty-one adult burn patients were interviewed. Participants reported experiencing variable levels of pain and pain management effectiveness. Inpatients reported more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Content analysis yielded 3 themes: patient's pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key factors in respondents' pain experiences, with many participants reporting mental anguish in addition to pain. Of participants who had pain expectations, most were matched by their experience (56%), although many individuals (44%) described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around receiving pain education from a provider, whereas negative experiences focused on wound care events. Participants desired more information on sleep and pain medications, alternative treatments, weaning and addiction risk, realistic expectations of recovery timelines, and available mental health services. Written (pamphlet) education ranked as the most desirable delivery method, followed by in-person and video education. CONCLUSIONS Burn patients reported variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain: leverage the high-level of interest in pain to foster education, describe pharmacologic and alternative therapies, offer weaning plans and explanation of addiction risks. APPLICABILITY TO PRACTICE Burn patients' perspectives help inform strategies and content creation for pain-related education materials that burn centers can provide to improve patients' experiences. EXTERNAL FUNDING Project was supported in part by the NIH grant for Insight Student Research Program at the Harborview Injury Prevention and Research Center (R25 HD094336).
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Affiliation(s)
- Emma R Duchin
- Harborview Injury Prevention & Research Center; Scripps College.
| | - Megan Moore
- School of Social Work, University of Washington
| | | | - Emily K Min
- Regional Burn Center, Harborview Medical Center
| | | | | | - Jody Sabel
- Regional Burn Center, Harborview Medical Center
| | - Anne Jo-Nes
- Regional Burn Center, Harborview Medical Center
| | - Tam N Pham
- Regional Burn Center, Harborview Medical Center
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Portanova J, Dreesmann N, Moore M, Buchanan D, Thompson H. Pain and Symptoms after Mild Traumatic Brain Injury: Should Technology Play a Role in Self-Management? Pain Manag Nurs 2021; 22:74-79. [PMID: 33191123 PMCID: PMC7886939 DOI: 10.1016/j.pmn.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Those with mild traumatic brain injury (mTBI) often experience pain and symptoms long after their initial injury. A gap in current knowledge is how persons would prefer to monitor and manage these symptoms following mTBI. AIMS The purpose of this study was to explore self-management strategies to inform design of an informatics tool to support self-management of pain and symptoms following mTBI. DESIGN A qualitative descriptive approach using semi-structured interviews of participants was used. SETTINGS Participants were interviewed by phone. PARTICIPANTS Seven female participants with recent mTBI completed interviews. METHODS A descriptive approach was utilized to determine what the tool should address, and which features should be included in a future tool. Themes were identified using a Qualitative Description analysis approach, which is based in naturalistic inquiry. RESULTS Participants described difficulty coping with symptoms, limited access to or knowledge of treatments and trial and error with compensatory strategies. These challenges often led to difficulty keeping up with work, school and other commitments. All participants indicated that they were interested in a tool that addresses pain, memory and concentration. The main features that participants wanted were pain and symptom tracking as well as suggestions based on tracking information. CONCLUSIONS Patients are interested in using technology to help with self-management of their pain and symptoms following mTBI. Tools that help patients with self-management should integrate into health systems and provide ways to effectively interact with providers during the most vulnerable phases of recovery.
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Affiliation(s)
| | | | - Megan Moore
- University of Washington, Seattle, Washington
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Calderan SV, Black A, Branch TA, Collins MA, Kelly N, Leaper R, Lurcock S, Miller BS, Moore M, Olson PA, Širović A, Wood AG, Jackson JA. South Georgia blue whales five decades after the end of whaling. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01077] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Blue whales Balaenoptera musculus at South Georgia were heavily exploited during 20th century industrial whaling, to the point of local near-extirpation. Although legal whaling for blue whales ceased in the 1960s, and there were indications of blue whale recovery across the wider Southern Ocean area, blue whales were seldom seen in South Georgia waters in subsequent years. We collated 30 yr of data comprising opportunistic sightings, systematic visual and acoustic surveys and photo-identification to assess the current distribution of blue whales in the waters surrounding South Georgia. Over 34000 km of systematic survey data between 1998 and 2018 resulted in only a single blue whale sighting, although opportunistic sightings were reported over that time period. However, since 2018 there have been increases in both sightings of blue whales and detections of their vocalisations. A survey in 2020 comprising visual line transect surveys and directional frequency analysis and recording (DIFAR) sonobuoy deployments resulted in 58 blue whale sightings from 2430 km of visual effort, including the photo-identification of 23 individual blue whales. Blue whale vocalisations were detected on all 31 sonobuoys deployed (114 h). In total, 41 blue whales were photo-identified from South Georgia between 2011 and 2020, none of which matched the 517 whales in the current Antarctic catalogue. These recent data suggest that blue whales have started to return to South Georgia waters, but continued visual and acoustic surveys are required to monitor any future changes in their distribution and abundance.
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Affiliation(s)
- SV Calderan
- Scottish Association for Marine Science (SAMS), Argyll PA37 1QA, UK
| | - A Black
- Government of South Georgia and South Sandwich Islands, Government House, Stanley FIQQ 1ZZ, Falkland Islands
| | - TA Branch
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, WA 98195, USA
| | - MA Collins
- British Antarctic Survey, NERC, High Cross, Cambridge CB3 0ET, UK
| | - N Kelly
- Australian Antarctic Division, Department of Agriculture, Water and the Environment, Kingston, Tasmania 7050, Australia
| | - R Leaper
- International Fund for Animal Welfare, London SE1 8NL, UK
| | - S Lurcock
- South Georgia Heritage Trust, Dundee DD1 5BT, UK
| | - BS Miller
- Australian Antarctic Division, Department of Agriculture, Water and the Environment, Kingston, Tasmania 7050, Australia
| | - M Moore
- Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA
| | - PA Olson
- Southwest Fisheries Science Center, NMFS/NOAA, La Jolla, CA 92037, USA
| | - A Širović
- Texas A&M University at Galveston, Galveston, TX 77553, USA
| | - AG Wood
- British Antarctic Survey, NERC, High Cross, Cambridge CB3 0ET, UK
| | - JA Jackson
- British Antarctic Survey, NERC, High Cross, Cambridge CB3 0ET, UK
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Erlick MR, Vavilala MS, Jaffe KM, Blayney CB, Moore M. Provider Perspectives on Early Psychosocial Interventions after Pediatric Severe Traumatic Brain Injury: An Implementation Framework. J Neurotrauma 2020; 38:513-518. [PMID: 33040670 DOI: 10.1089/neu.2020.7323] [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: 11/12/2022] Open
Abstract
This study created a framework incorporating provider perspectives of best practices for early psychosocial intervention to improve caregiver experiences and outcomes after severe pediatric traumatic brain injury (TBI). A purposive sample of 23 healthcare providers from the emergency, intensive care, and acute care departments, was selected based on known clinical care of children with severe TBI at a level 1 trauma center and affiliated children's hospital. Semistructured interviews and directed content analysis were used to assess team and caregiver communication processes and topics, prognostication, and recommended interventions. Providers recommended a dual approach of institutional and individual factors contributing to an effective framework for addressing psychosocial needs. Healthcare providers recommended interventions in three domains: (1) presenting coordinated, clear messages to caregivers, (2) reducing logistical and emotional burden of care transitions, and (3) assessing and addressing caregiver needs and concerns. Specific family-centered and trauma-informed interventions included: (1) creating and sharing interdisciplinary plans with caregivers, (2) coordinating prognostication meetings and communications, (3) tracking family education, (4) improving institutional coordination and workflow, (5) training caregivers to support family involvement, (6) performing biopsychosocial assessment, and (7) using systematic prompts for difficult conversations and to address family needs at regular intervals. Healthcare workers from a variety of disciplines want to incorporate certain trauma-informed and family-centered practices at each stage of treatment to improve experiences for caregivers and outcomes for pediatric patients with severe TBI. Future research should test the feasibility and effectiveness of incorporating routine psychosocial interventions for these patients.
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Affiliation(s)
- Mariah R Erlick
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | - Kenneth M Jaffe
- Department of Rehabilitation Medicine, University of Washington, Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | - Carolyn B Blayney
- Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, Washington, USA
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington School of Social Work, Seattle, Washington, USA
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