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Cai CX, Nishimura A, Bowring MG, Westlund E, Tran D, Ng JH, Nagy P, Cook M, McLeggon JA, DuVall SL, Matheny ME, Golozar A, Ostropolets A, Minty E, Desai P, Bu F, Toy B, Hribar M, Falconer T, Zhang L, Lawrence-Archer L, Boland MV, Goetz K, Hall N, Shoaibi A, Reps J, Sena AG, Blacketer C, Swerdel J, Jhaveri KD, Lee E, Gilbert Z, Zeger SL, Crews DC, Suchard MA, Hripcsak G, Ryan PB. Similar Risk of Kidney Failure among Patients with Blinding Diseases Who Receive Ranibizumab, Aflibercept, and Bevacizumab: An Observational Health Data Sciences and Informatics Network Study. Ophthalmol Retina 2024:S2468-6530(24)00118-0. [PMID: 38519026 DOI: 10.1016/j.oret.2024.03.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To characterize the incidence of kidney failure associated with intravitreal anti-VEGF exposure; and compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab. DESIGN Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network. SUBJECTS Subjects aged ≥ 18 years with ≥ 3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion). METHODS The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate. MAIN OUTCOME MEASURES Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure. RESULTS Of the 6.1 million patients with blinding diseases, 37 189 who received ranibizumab, 39 447 aflibercept, and 163 611 bevacizumab were included; the total treatment exposure time was 161 724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100 000 persons (range, 0-2389), and incidence rate 742 per 100 000 person-years (range, 0-2661). The meta-analysis HR of kidney failure comparing aflibercept with ranibizumab was 1.01 (95% confidence interval [CI], 0.70-1.47; P = 0.45), ranibizumab with bevacizumab 0.95 (95% CI, 0.68-1.32; P = 0.62), and aflibercept with bevacizumab 0.95 (95% CI, 0.65-1.39; P = 0.60). CONCLUSIONS There was no substantially different relative risk of kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk of kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Akihiko Nishimura
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary G Bowring
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erik Westlund
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jia H Ng
- Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Paul Nagy
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Jody-Ann McLeggon
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Internal Medicine Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Asieh Golozar
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | | | - Evan Minty
- O'Brien Center for Public Health, Department of Medicine, University of Calgary, Canada
| | - Priya Desai
- Technology / Digital Solutions, Stanford Health Care and Stanford University School of Medicine, Palo Alto, California
| | - Fan Bu
- Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - Brian Toy
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Michelle Hribar
- National Eye Institute, National Institutes of Health, Bethesda, Maryland; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Laurence Lawrence-Archer
- Odysseus Data Services, Inc., Cambridge, Massachusetts; OHDSI Center at the Roux Institute, Northeastern University, Boston, Massachusetts
| | - Michael V Boland
- Mass Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Kerry Goetz
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nathan Hall
- Janssen Research and Development, Titusville, New Jersey
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, New Jersey
| | - Jenna Reps
- Janssen Research and Development, Titusville, New Jersey
| | - Anthony G Sena
- Janssen Research and Development, Titusville, New Jersey; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Joel Swerdel
- Janssen Research and Development, Titusville, New Jersey
| | - Kenar D Jhaveri
- Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Donald and Barbara School of Medicine at Hofstra/Northwell, New York
| | - Edward Lee
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Zachary Gilbert
- Roski Eye Institute, Keck School of Medicine, University of Southern California; Los Angeles, California
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc A Suchard
- VA Informatics and Computing Infrastructure, US Department of Veterans Affairs, Salt Lake City, Utah; Department of Biostatistics, University of California - Los Angeles, Los Angeles, California
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, New Jersey
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Hwang TS, Thomas M, Hribar M, Chen A, White E. The Impact of Documentation Workflow on the Accuracy of the Coded Diagnoses in the Electronic Health Record. Ophthalmol Sci 2024; 4:100409. [PMID: 38054107 PMCID: PMC10694743 DOI: 10.1016/j.xops.2023.100409] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 12/07/2023]
Abstract
Objective To determine the impact of documentation workflow on the accuracy of coded diagnoses in electronic health records (EHRs). Design Cross-sectional study. Participants All patients who completed visits at the Casey Eye Institute Retina Division faculty clinic between April 7, 2022 and April 13, 2022. Main Outcome Measures Agreement between coded diagnoses and clinical notes. Methods We assessed the rate of agreement between the diagnoses in the clinical notes and the coded diagnosis in the EHR using manual review and examined the impact of the documentation workflow on the rate of agreement in an academic retina practice. Results In 202 visits by 8 physicians, 78% (range, 22%-100%) had an agreement between the coded diagnoses and the clinical notes. When physicians integrated the diagnosis code entry and note composition, the rate of agreement was 87.9% (range, 62%-100%). For those who entered the diagnosis codes separately from writing notes, the agreement was 44.4% (22%-50%, P < 0.0001). Conclusion The visit-specific agreement between the coded diagnosis and the progress note can vary widely by workflow. The workflow and EHR design may be an important part of understanding and improving the quality of EHR data. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas S. Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Merina Thomas
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Michelle Hribar
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Elizabeth White
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
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Cai CX, Halfpenny W, Boland MV, Lehmann HP, Hribar M, Goetz KE, Baxter SL. Advancing Toward a Common Data Model in Ophthalmology: Gap Analysis of General Eye Examination Concepts to Standard Observational Medical Outcomes Partnership (OMOP) Concepts. Ophthalmol Sci 2023; 3:100391. [PMID: 38025162 PMCID: PMC10630664 DOI: 10.1016/j.xops.2023.100391] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023]
Abstract
Purpose Evaluate the degree of concept coverage of the general eye examination in one widely used electronic health record (EHR) system using the Observational Health Data Sciences and Informatics Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Design Study of data elements. Participants Not applicable. Methods Data elements (field names and predefined entry values) from the general eye examination in the Epic foundation system were mapped to OMOP concepts and analyzed. Each mapping was given a Health Level 7 equivalence designation-equal when the OMOP concept had the same meaning as the source EHR concept, wider when it was missing information, narrower when it was overly specific, and unmatched when there was no match. Initial mappings were reviewed by 2 graders. Intergrader agreement for equivalence designation was calculated using Cohen's kappa. Agreement on the mapped OMOP concept was calculated as a percentage of total mappable concepts. Discrepancies were discussed and a final consensus created. Quantitative analysis was performed on wider and unmatched concepts. Main Outcome Measures Gaps in OMOP concept coverage of EHR elements and intergrader agreement of mapped OMOP concepts. Results A total of 698 data elements (210 fields, 488 values) from the EHR were analyzed. The intergrader kappa on the equivalence designation was 0.88 (standard error 0.03, P < 0.001). There was a 96% agreement on the mapped OMOP concept. In the final consensus mapping, 25% (1% fields, 31% values) of the EHR to OMOP concept mappings were considered equal, 50% (27% fields, 60% values) wider, 4% (8% fields, 2% values) narrower, and 21% (52% fields, 8% values) unmatched. Of the wider mapped elements, 46% were missing the laterality specification, 24% had other missing attributes, and 30% had both issues. Wider and unmatched EHR elements could be found in all areas of the general eye examination. Conclusions Most data elements in the general eye examination could not be represented precisely using the OMOP CDM. Our work suggests multiple ways to improve the incorporation of important ophthalmology concepts in OMOP, including adding laterality to existing concepts. There exists a strong need to improve the coverage of ophthalmic concepts in source vocabularies so that the OMOP CDM can better accommodate vision research. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William Halfpenny
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Michael V. Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Harold P. Lehmann
- Division of Health Sciences Informatics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Biomedical Informatics and Data Science, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Hribar
- Office of Data Science and Health Informatics, National Eye Institute, National Institute of Health, Bethesda, Maryland
- Department of Ophthalmology, Casey Eye Institute, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Kerry E. Goetz
- Office of Data Science and Health Informatics, National Eye Institute, National Institute of Health, Bethesda, Maryland
| | - Sally L. Baxter
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
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Sherif NA, Chew EY, Chiang MF, Hribar M, Gao J, Goetz KE. Artificial intelligence at the national eye institute. Curr Opin Ophthalmol 2022; 33:579-584. [PMID: 36206110 PMCID: PMC9555870 DOI: 10.1097/icu.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights the artificial intelligence, machine learning, and deep learning initiatives supported by the National Institutes of Health (NIH) and the National Eye Institute (NEI) and calls attention to activities and goals defined in the NEI Strategic Plan as well as opportunities for future activities and breakthroughs in ophthalmology. RECENT FINDINGS Ophthalmology is at the forefront of artificial intelligence-based innovations in biomedical research that may lead to improvement in early detection and surveillance of ocular disease, prediction of progression, and improved quality of life. Technological advances have ushered in an era where unprecedented amounts of information can be linked that enable scientific discovery. However, there remains an unmet need to collect, harmonize, and share data in a machine actionable manner. Similarly, there is a need to ensure that efforts promote health and research equity by expanding diversity in the data and workforce. SUMMARY The NIH/NEI has supported the development artificial intelligence-based innovations to advance biomedical research. The NIH/NEI has defined activities to achieve these goals in the NIH Strategic Plan for Data Science and the NEI Strategic Plan and have spearheaded initiatives to facilitate research in these areas.
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Affiliation(s)
- Noha A Sherif
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - James Gao
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Kerry E Goetz
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Senathirajah Y, Hribar M. Human Factors and Organizational Issues Section Synopsis IMIA Yearbook 2021. Yearb Med Inform 2021; 30:100-104. [PMID: 34479383 PMCID: PMC8416209 DOI: 10.1055/s-0041-1726524] [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: 10/28/2022] Open
Abstract
OBJECTIVE To select the best papers that made original and high impact contributions in the area of human factors and organizational issues in biomedical informatics in 2020. METHODS A rigorous extraction process based on queries from Web of Science® and PubMed/Medline was conducted to identify the scientific contributions published in 2020 that address human factors and organizational issues in biomedical informatics. The screening of papers on titles and abstracts independently by the two section editors led to a total of 1,562 papers. These papers were discussed for a selection of 12 finalist papers, which were then reviewed by the two section editors, two chief editors, and by three external reviewers from internationally renowned research teams. RESULTS The query process resulted in 12 papers that reveal interesting and rigorous methods and important studies in human factors that move the field forward, particularly in clinical informatics and emerging technologies such as brain-computer interfaces. This year three papers were clearly outstanding and help advance in the field. They provide examples of applying existing frameworks together in novel and highly illuminating ways, showing the value of theory development in human factors. Emerging themes included several which discussed physician burnout, mobile health, and health equity. Those concerning the Corona Virus Disease 2019 (Covid-19) were included as part of that section. CONCLUSION The selected papers make important contributions to human factors and organizational issues, expanding and deepening our knowledge of how to apply theory and applications of new technologies in health.
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Affiliation(s)
- Yalini Senathirajah
- U. Pittsburgh School of Medicine, Dept. of Biomedical Informatics, Pittsburgh, PA, USA
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Sinsky CA, Rule A, Cohen G, Arndt BG, Shanafelt TD, Sharp CD, Baxter SL, Tai-Seale M, Yan S, Chen Y, Adler-Milstein J, Hribar M. Metrics for assessing physician activity using electronic health record log data. J Am Med Inform Assoc 2021; 27:639-643. [PMID: 32027360 PMCID: PMC7075531 DOI: 10.1093/jamia/ocz223] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/13/2022] Open
Abstract
Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention. We also illustrate sample use cases for these measures for multiple stakeholders. Finally, standardization of EHR log data measure specifications, as outlined here, will foster cross-study synthesis and comparative research.
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Affiliation(s)
- Christine A Sinsky
- Department of Medicine, American Medical Association, Chicago, Illinois, USA
| | - Adam Rule
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Oregon, USA
| | - Genna Cohen
- Department of Medicine, Mathematica, Washington, DC, USA
| | - Brian G Arndt
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Tait D Shanafelt
- Division of Hematology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Christopher D Sharp
- Division of Hematology, Department of Medicine, Stanford University, Stanford, California, USA.,Division of General Internal Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Sally L Baxter
- Department of Biomedical Informatics, University of California, San Diego, San Diego, California, USA.,Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, San Diego, California, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA
| | - Sherry Yan
- Department of Medicine, Sutter Health, Walnut Creek, California, USA
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michelle Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Oregon, USA
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Galvez J, Eisenhower M, England W, Wartman E, Simpao A, Rehman M, Lustig R, Hribar M. An Interactive Virtual Reality Tour for Adolescents Receiving Proton Radiation Therapy: Proof-of-Concept Study. JMIR Perioper Med 2019; 2:e11259. [PMID: 33393932 PMCID: PMC7728405 DOI: 10.2196/11259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Child life therapists provide patient education for children undergoing radiation therapy to assist in coping with and understanding their treatment. OBJECTIVE This proof-of-concept study aimed to determine the feasibility of incorporating a 360-degree video tour via a virtual reality system for children scheduled to receive radiation therapy. The secondary objective was to qualitatively describe each subject's virtual reality experience. METHODS Children aged ≥13 years scheduled to receive proton radiation therapy were included in the study. Subjects watched the 360-degree video of the radiation therapy facility in an immersive virtual reality environment with a child life therapist experienced in coaching children receiving radiation therapy and completed a survey after the tour. RESULTS Eight subjects consented to participate in the study, and six subjects completed the 360-degree video tour and survey. All the enrolled patients completed the tour successfully. Two subjects did not complete the survey. Two subjects requested to pause the tour to ask questions about the facility. Five subjects said the tour was helpful preparation before undergoing proton radiation therapy. Subjects stated that the tour was helpful because "it showed [them] what's to come" and was helpful to see "what it's like to lay in the machine." One subject said, "it made me feel less nervous." Six subjects stated that they would like to see this type of tour available for other areas of the hospital, such as diagnostic imaging rooms. None of the subjects experienced nausea or vomiting. CONCLUSIONS The 360-degree video tour allowed patients to explore the treatment facility in a comfortable environment. Participants felt that the tour was beneficial and would appreciate seeing other parts of the hospital in this manner.
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Affiliation(s)
- Jorge Galvez
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Melanie Eisenhower
- Department of Child Life, Education and Creative Arts Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - William England
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elicia Wartman
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Allan Simpao
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mohamed Rehman
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert Lustig
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, OR, United States
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Eden KB, Scariati P, Klein K, Watson L, Remiker M, Hribar M, Forro V, Michaels L, Nelson HD. Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening. J Womens Health (Larchmt) 2015; 24:1013-20. [PMID: 26360918 DOI: 10.1089/jwh.2015.5256] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. METHODS The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. RESULTS After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. CONCLUSIONS Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.
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Affiliation(s)
- Karen B Eden
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | | | - Krystal Klein
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Lindsey Watson
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Mark Remiker
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - Michelle Hribar
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
| | - Vanessa Forro
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - LeAnn Michaels
- 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon
| | - Heidi D Nelson
- 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon.,4 Providence Cancer Center , Providence Health and Services, Portland, Oregon
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Fromme EK, Kenworthy-Heinige T, Hribar M. Developing an easy-to-use tablet computer application for assessing patient-reported outcomes in patients with cancer. Support Care Cancer 2010; 19:815-22. [PMID: 20512360 DOI: 10.1007/s00520-010-0905-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 05/03/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND In order to be practically useful, computer applications for patients with cancer must be easily usable by people with limited computer literacy and impaired vision or dexterity. We describe the usability development process for an application that collects quality of life and symptom information from patients with cancer. METHODS Usability testing consisted of user testing with cancer patients to identify initial design problems and a survey to compare the computer application's ease of use between elderly and younger patients. RESULTS In user-testing phase, seven men aged 56 to 77 with prostate cancer were observed using the application and interviewed afterwards identifying several usability concerns. Sixty patients with breast, gastrointestinal, or prostate cancer participated in the ease of use survey, with 40% (n=24) aged 65 or older. Younger patients reported significantly higher scores than elderly patients (14.0 vs. 10.8, p = .001), even when prior computer and touch screen use was controlled. CONCLUSION Elderly users reported lower ease of use scores than younger users; however, their average rating was quite high-10.8 on a scale of -16 to +16. It may be unrealistic to expect elderly or less computer literate users to rate any application as positively as younger, more computer savvy users-perhaps it is enough that they rate the application positively and can use it without undue difficulties. We hope that our process can serve as a model for how to bridge the fields of computer usability and healthcare.
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Affiliation(s)
- Erik K Fromme
- Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., L586, Portland, OR 97239, USA.
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Hribar M, Bloc A, van der Goot FG, Fransen L, De Baetselier P, Grau GE, Bluethmann H, Matthay MA, Dunant Y, Pugin J, Lucas R. The lectin-like domain of tumor necrosis factor-alpha increases membrane conductance in microvascular endothelial cells and peritoneal macrophages. Eur J Immunol 1999. [PMID: 10540321 DOI: 10.1002/(sici)1521-4141(199910)29:10<3105::aid-immu3105>3.3.co;2-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Herein, we show that TNF exerts a pH-dependent increase in membrane conductance in primary lung microvascular endothelial cells and peritoneal macrophages. This effect was TNF receptor-independent, since it also occurred in cells isolated from mice deficient in both types of TNF receptors. A TNF mutant in which the three amino acids critical for the lectin-like activity were replaced by an alanine did not show any significant effect on membrane conductance. Moreover, a synthetic 17-amino acid peptide of TNF, which was previously shown to exert lectin-like activity, also increased the ion permeability in these cells. The amiloride sensitivity of the observed activity suggests a binding of TNF to an endogenous ion channel rather than channel formation by TNF itself. This may have important implications in mechanisms of TNF-mediated vascular pathology.
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Affiliation(s)
- M Hribar
- Division of Medical Intensive Care, Department of Internal Medicine, University of Geneva, Geneva, Switzerland
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van der Goot FG, Pugin J, Hribar M, Fransen L, Dunant Y, De Baetselier P, Bloc A, Lucas R. Membrane interaction of TNF is not sufficient to trigger increase in membrane conductance in mammalian cells. FEBS Lett 1999; 460:107-11. [PMID: 10571070 DOI: 10.1016/s0014-5793(99)01294-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tumor necrosis factor TNF can trigger increases in membrane conductance of mammalian cells in a receptor-independent manner via its lectin-like domain. A lectin-deficient TNF mutant, lacking this activity, was able to bind to artificial liposomes in a pH-dependent manner, but not to insert into the bilayer, just like wild type TNF. A peptide mimicking the lectin-like domain, which can still trigger increases in membrane currents in cells, failed to interact with liposomes. Thus, the capacity of TNF to trigger increases in membrane conductance in mammalian cells does not correlate with its ability to interact with membranes, suggesting that the cytokine does not form channels itself, but rather interacts with endogenous ion channels or with plasma membrane proteins that are coupled to ion channels.
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Affiliation(s)
- F G van der Goot
- Department of Biochemistry, Sciences II, University of Geneva, Switzerland.
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Hribar M, Bloc A, van der Goot FG, Fransen L, De Baetselier P, Grau GE, Bluethmann H, Matthay MA, Dunant Y, Pugin J, Lucas R. The lectin-like domain of tumor necrosis factor-alpha increases membrane conductance in microvascular endothelial cells and peritoneal macrophages. Eur J Immunol 1999; 29:3105-11. [PMID: 10540321 DOI: 10.1002/(sici)1521-4141(199910)29:10<3105::aid-immu3105>3.0.co;2-a] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Herein, we show that TNF exerts a pH-dependent increase in membrane conductance in primary lung microvascular endothelial cells and peritoneal macrophages. This effect was TNF receptor-independent, since it also occurred in cells isolated from mice deficient in both types of TNF receptors. A TNF mutant in which the three amino acids critical for the lectin-like activity were replaced by an alanine did not show any significant effect on membrane conductance. Moreover, a synthetic 17-amino acid peptide of TNF, which was previously shown to exert lectin-like activity, also increased the ion permeability in these cells. The amiloride sensitivity of the observed activity suggests a binding of TNF to an endogenous ion channel rather than channel formation by TNF itself. This may have important implications in mechanisms of TNF-mediated vascular pathology.
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Affiliation(s)
- M Hribar
- Division of Medical Intensive Care, Department of Internal Medicine, University of Geneva, Geneva, Switzerland
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Lucas R, Garcia I, Donati YR, Hribar M, Mandriota SJ, Giroud C, Buurman WA, Fransen L, Suter PM, Nunez G, Pepper MS, Grau GE. Both TNF receptors are required for direct TNF-mediated cytotoxicity in microvascular endothelial cells. Eur J Immunol 1998; 28:3577-86. [PMID: 9842900 DOI: 10.1002/(sici)1521-4141(199811)28:11<3577::aid-immu3577>3.0.co;2-#] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The conditions under which tumor necrosis factor-alpha (TNF) induces apoptosis in primary microvascular endothelial cells (MVEC) were investigated. In the absence of sensitizing agents, TNF induced apoptosis after 3 days of incubation in confluent MVEC. In contrast, upon addition of the transcriptional inhibitor actinomycin D (Act. D), confluence was no longer required and apoptosis occurred already after 16 h. To assess the role of either TNF receptor (TNFR) type in apoptosis, MVEC isolated from mice genetically deficient in TNFR1 (Tnfr1o mice) or TNFR2 (Tnfr2o mice) were incubated with TNF in the presence or absence of Act. D. Under sensitized conditions, Tnfr2o MVEC were lysed like controls, whereas Tnfr1o MVEC were completely resistant, indicating an exclusive role for TNFR1. In contrast, in the absence of Act. D, confluent monolayers of wild-type cells were lysed by TNF, but both Tnfr1o and Tnfr2o MVEC were resistant to TNF-mediated toxicity, indicating a requirement for both TNFR types. Overexpression of the anti-apoptotic protein bcl-xL in MVEC led to a protection against the direct, but not the sensitized cytotoxicity of TNF. In conclusion, in pathophysiologically relevant conditions, both TNFR appear to be required for TNF-induced apoptosis in MVEC.
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Affiliation(s)
- R Lucas
- Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, University Medical Center, University of Geneva, Switzerland.
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Stuhec M, Kodre A, Hribar M, Glavic-Cindro D, Arcon I, Drube W. Configuration interaction in argon KL resonances. Phys Rev A 1994; 49:3104-3105. [PMID: 9910599 DOI: 10.1103/physreva.49.3104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Kodre A, Hribar M, Arcon I, Glavic-Cindro D, Stuhec M, Frahm R, Drube W. Search for multiple K+L photoionization in solid transition elements by x-ray-absorption spectroscopy. Phys Rev A 1992; 45:4682-4687. [PMID: 9907549 DOI: 10.1103/physreva.45.4682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Hamoudi AC, Qualman SJ, Marcon MJ, Hribar M, McClung HJ, Murray RD, Cannon HJ. Do regional variations in prevalence of cryptosporidiosis occur? The central Ohio experience. Am J Public Health 1988; 78:273-5. [PMID: 3341496 PMCID: PMC1349175 DOI: 10.2105/ajph.78.3.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We screened 2,780 consecutive stool specimens submitted for routine ova and parasite examination to assess the prevalence of cryptosporidiosis in a pediatric patient population in central Ohio. The stools were prepared by formalin-ethyl acetate concentration followed by cold Kinyoun acid-fast stain of the sediment. In addition, 912 consecutive intestinal biopsies were monitored for the presence of the parasite. Cryptosporidium oocysts were found in only 0.3 per cent of stool specimens (seven specimens from three patients) and in none of the intestinal biopsies. Due to this low prevalence of cryptosporidiosis, we conclude that routine screening of stool specimens for Cryptosporidium sp. is unnecessary in our patient population. Screening should be targeted to immune compromised patients and patients with persistent diarrhea and no apparent etiology. Our study also supports the concept that there are geographic variations in the prevalence of cryptosporidiosis.
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Affiliation(s)
- A C Hamoudi
- Children's Hospital, Department of Laboratory Medicine, Columbus, OH 43205
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