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Hoffman M, Dunsmore V, Cliby W, Chi D, Wheeler S, Clarke-Pearson D. Surgical training of gynecologic oncology fellows: Long-term trends and implications for future education. Gynecol Oncol 2024; 184:254-258. [PMID: 38696840 DOI: 10.1016/j.ygyno.2024.04.017] [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: 01/08/2024] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES The surgical training of gynecologic oncology (GO) fellows is critical to providing excellent care to women with gynecologic cancers. We sought to evaluate changes in techniques and surgical volumes over an 18-year period among established GO fellowships across the US. METHODS We emailed surveys to 30 GO programs that had trained fellows for at least 18 years. Surveys requested the number of surgical cases performed by a fellow for seventeen surgical procedures over each of five-time intervals. A One-Way Analysis of Variance was conducted for each procedure, averaged across institutions, to examine whether each procedure significantly changed over the 18-year span. RESULTS 14 GO programs responded and were included in the analysis using SPSS. We observed a significant increase in the use of minimally invasive (MIS) procedures (robotic hysterectomy (p < .001), MIS pelvic (p = .001) and MIS paraaortic lymphadenectomy (p = .008). There was a concurrent significant decrease in corresponding "open" procedures. There was a significant decrease in all paraaortic lymphadenectomies. Complex procedures (such as bowel resection) remained stable. However, there was a wide variation in the number of cases reported with extremely small numbers for some critical procedures. CONCLUSIONS The experience of GO fellows has shifted toward increased use of MIS. While these trends in care are appropriate, they do not diminish the need in many patients for complex open procedures. These findings should help spur the development of innovative training to maintain the ability to provide these core, specialty-defining procedures safely.
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Affiliation(s)
- Mitchel Hoffman
- Moffitt Cancer Center, University of South Florida, Tampa, FL, United States of America
| | - Victoria Dunsmore
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, United States of America
| | - William Cliby
- Mayo Clinic, Rochester, MN, United States of America
| | - Dennis Chi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Stephanie Wheeler
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, United States of America
| | - Daniel Clarke-Pearson
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
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Adsul P, Islam J, Chebli P, Kranick J, Nash S, Arem H, Wheeler S, Lopez-Pentecost M, Foster V, Sharma RK, Felder T, Risendal B, Chavarria EA, Kwon S, Hirschey R, Trinh-Shevrin C. Identifying research practices toward achieving health equity principles within the Cancer Prevention and Control Research Network. Cancer Causes Control 2023; 34:15-21. [PMID: 36826623 PMCID: PMC9950692 DOI: 10.1007/s10552-023-01674-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Although there is national recognition for health equity-oriented research, there is limited guidance for researchers to engage partnerships that promote health equity in cancer research. The Cancer Prevention and Control Research Network's (CPCRN) Health Equity Work Group developed a toolkit to guide researchers in equitable collaborations. METHODS The CPCRN's Health Equity Work Group collectively outlined health and racial equity principles guiding research collaborations with partners that include communities, community-based organizations, implementing partners in the clinical setting including providers and health care organizations, and policy makers. Using a network-wide survey to crowdsource information around ongoing practices, we leveraged and integrated the network's experience and collaborations. RESULTS Data from the survey formed the preliminary basis for the toolkit, with a focus on sharing fiscal resources with partners, training and capacity building, collaborative decision-making, community-driven research agenda setting, and sustainability. The final toolkit provides reflection considerations for researchers and collated exemplary resources, supported by the contemporary research. CONCLUSIONS The toolkit provides a guide to researchers at all experience levels wanting to engage in equitable research collaborations. Future efforts are underway to evaluate whether and how researchers within and outside CPCRN are able to incorporate these principles in research collaborations.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
- Cancer Control and Populations Sciences Research Program, Cancer Research Facility (CRF), University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
| | | | - Perla Chebli
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Julie Kranick
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Sarah Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Hannah Arem
- MedStar Health Research Institute, Washington, DC, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Victoria Foster
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Rashmi K Sharma
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Betsy Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Enmanuel A Chavarria
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Simona Kwon
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, Section for Health Equity, New York, NY, USA
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Beam TA, Klepser DG, Klepser ME, Bright DR, Klepser N, Schuring H, Wheeler S, Langerveld A. COVID-19 host genetic risk study conducted at community pharmacies: Implications for public health, research and pharmacists' scope of practice. Res Social Adm Pharm 2023; 19:1360-1364. [PMID: 37567834 PMCID: PMC10264161 DOI: 10.1016/j.sapharm.2023.06.003] [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: 08/12/2022] [Revised: 03/06/2023] [Accepted: 06/10/2023] [Indexed: 08/13/2023]
Abstract
Community pharmacists serve a large, diverse population of patients, resulting in the potential to utilize community pharmacies as recruitment sites for clinical research. Beyond traditional roles as one of the most accessible health care professionals in the US healthcare system, pharmacists have played a major role in the response to the COVID-19 pandemic, administering hundreds of thousands of vaccines and tests. However, less emphasis is placed on the ability to leverage community pharmacies as research-focused partners for clinical studies. In this study, we demonstrate the feasibility and workflow of recruiting study participants from community pharmacies and confirm genetic markers of COVID-19 susceptibility. Specific genetic markers include those associated with COVID-19 infection risk (ACE2, TMEM27, and RAVER1), difficulty breathing (NOTCH4), and hospitalization (OAS3). In addition, collaboration with a clinical laboratory allowed for a more seamless consenting process without substantial training needs or workflow disruption at the community pharmacy site. The COVID-19 pandemic has demonstrated that the expansion of pharmacists' scope of practice is a key factor in managing the population health crisis; this study demonstrates that pharmacies can also advance clinical research studies by serving as sites for patient recruitment from a large, diverse, and ambulatory study population.
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Affiliation(s)
- Teresa A Beam
- Manchester University College of Pharmacy, Natural and Health Sciences 10627 Diebold Road, Fort Wayne, IN, 46845, USA.
| | - Donald G Klepser
- University of Nebraska Medical Center, 986120, Omaha, NE, 68198-6120, USA.
| | - Michael E Klepser
- Ferris State University College of Pharmacy, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA.
| | - David R Bright
- Ferris State University College of Pharmacy, 220 Ferris Dr, Big Rapids, MI, 49307, USA.
| | - Nicklas Klepser
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA; 15811 Louis Dr, Omaha, NE, 68118, USA.
| | - Hannah Schuring
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA.
| | | | - Anna Langerveld
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA.
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Hassan AM, Chu CK, Liu J, Angove R, Rocque G, Gallagher KD, Momoh AO, Caston NE, Williams CP, Wheeler S, Offodile Ii AC. A nationwide cross-sectional study on the association of patient-level factors with financial anxiety in the context of chronic medical conditions. Sci Rep 2023; 13:10363. [PMID: 37365187 DOI: 10.1038/s41598-023-36282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Patient-level characteristics associated with the prevalence and severity of financial anxiety have yet to be described. We conducted a cross-sectional analysis of survey data assessing financial anxiety in patients with chronic medical conditions in December 2020. 1771 patients (42.6% response rate) participated in the survey. Younger age (19-35 age compared to ≥ 75 age) (β, 5.86; 95% CI 2.10-9.63), male sex (β, - 1.9; 95% CI - 3.1 to - 0.73), Hispanic/Latino race/ethnicity (compared with White patients) (β, 2.55; 95% CI 0.39-4.71), household size ≥ 4 (compare with single household) (β, 4.54; 95% CI 2.44-6.64), household income of ≥ $96,000-$119,999 (compared with ≤ $23,999) (β, - 3.2; 95% CI - 6.3 to 0.04), single marital status (compared with married) (β, 2.18; 95% CI 0.65-3.71), unemployment (β, 2.07; 95% CI 0.39-3.74), high-school education (compared with advanced degrees) (β, 3.10; 95% CI 1.32-4.89), lack of insurance coverage (compared with private insurance) (β, 6.05; 95% CI 2.66-9.45), more comorbidities (≥ 3 comorbidities compared to none) (β, 2.95; 95% CI 1.00-4.90) were all independently associated with financial anxiety. Patients who are young, female, unmarried, and representing vulnerable sub-populations are at elevated risk for financial anxiety.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Carrie K Chu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | | | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anaeze C Offodile Ii
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
- Department of Health Policy Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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Miller K, Gunn E, Cochran A, Burstein H, Friedberg J, Wheeler S, Frankel P. Use of Large Language Models and Artificial Intelligence Tools in Works Submitted to Journal of Clinical Oncology. J Clin Oncol 2023:JCO2300819. [PMID: 37200609 DOI: 10.1200/jco.23.00819] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Kathy Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
| | - Emilie Gunn
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
| | - Angela Cochran
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
| | - Hal Burstein
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
- Dana-Farber Cancer Institute, Boston, MA
| | - Jonathan Friedberg
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
- University of Rochester Medical Center-Wilmot Cancer Institute, Rochester, NY
| | - Stephanie Wheeler
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul Frankel
- American Society of Clinical Oncology, Journal of Clinical Oncology, Alexandria, VA
- City of Hope, Duarte, CA
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Chebli P, Adsul P, Kranick J, Rohweder CL, Risendal BC, Bilenduke E, Williams R, Wheeler S, Kwon SC, Trinh-Shevrin C. Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network. Cancer Causes Control 2023; 34:371-387. [PMID: 36781715 PMCID: PMC9925365 DOI: 10.1007/s10552-023-01668-0] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023]
Abstract
Reflecting their commitment to advancing health equity, the Cancer Prevention and Control Research Network (CPCRN) established a Health Equity Workgroup to identify and distill guiding principles rooted in health equity, community-engaged participatory research (CBPR), social determinants of health, and racial equity frameworks to guide its collective work. The Health Equity Workgroup utilized a multi-phase, participatory consensus-building approach to: (1) identify recurrent themes in health and racial equity frameworks; (2) capture perspectives on and experiences with health equity research among CPCRN members through an online survey; (3) engage in activities to discuss and refine the guiding principles; and (4) collect case examples of operationalizing equity principles in cancer research. Representatives from all CPCRN centers endorsed nine core principles to guide the Network's strategic plan: (1) Engage in power-sharing and capacity building with partners; (2) Address community priorities through community engagement and co-creation of research; (3) Explore and address the systems and structural root causes of cancer disparities; (4) Build a system of accountability between research and community partners; (5) Establish transparent relationships with community partners; (6) Prioritize the sustainability of research benefits for community partners; (7) Center racial equity in cancer prevention and control research; (8) Engage in equitable data collection, analysis, interpretation, and dissemination practices; and (9) Integrate knowledge translation, implementation, and dissemination into research plans. Dissemination products, such as toolkits and technical assistance workshops, reflecting these principles will foster knowledge transfer to intentionally integrate health and racial equity principles in cancer prevention and control research.
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Affiliation(s)
- Perla Chebli
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA.
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Populations Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Julie Kranick
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy C Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Emily Bilenduke
- Department of Psychology Denver, University of Colorado Denver, Denver, CO, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Simona C Kwon
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
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Jackson B, Wheeler S, Yanguela J, LeBlanc M, Kuo TM, Baggett C, Reeder-Hayes K. Abstract P1-06-04: IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-06-04] [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: 03/06/2023]
Abstract
Abstract
BACKGROUND: The impact of treatment delays on cancer outcomes has been well documented, but few published studies explicitly attempt to identify subgroups which would benefit the most from potential interventions improving timeliness of care. Using the state of North Carolina and breast cancer as an example, we sought to quantify race-specific associations between frontline treatment delay and breast cancer mortality, and estimate the potential impact of improvements in timeliness by racial sub-group. METHODS: We conducted a retrospective cohort study, utilizing multipayer insurance claims linked to cancer registry data from the Cancer Information and Population Health Resource, of females diagnosed with stage I-III breast cancer from 2004 to 2014. Our exposure of interest was treatment delay, defined as initial cancer directed therapy received ≥ 60 days after diagnosis. Our outcome was death certificate identified breast cancer mortality within 5-years of follow-up. To quantify the association between treatment delay and mortality we estimated hazard ratios (HR) and 95% confidence limits (CL) where non-breast cancer deaths were treated as competing events. We then simulated the effect of treating all patients within 60 days using inverse probability of treatment weighting (IPTW), and estimated the potential impact by comparing the simulated data with observed data. Models were adjusted for age and stage at diagnosis, tumor grade, hormone receptor status, and modality of first treatment. Models were stratified by race, dichotomized as Black or non-Black, and geographic subregion for evaluation. RESULTS: Our analytic cohort comprised 21,200 patients, of whom 19% were Black. Treatment delays >60 days were twice as frequent among Black compared with non-Black patients (13.5% vs. 6.5%). We found a positive association between treatment delay and breast cancer mortality in the overall cohort (HR=1.3; CL: 1.1, 1.6). The association differed between Black (HR=1.4; CL: 1.1, 1.8) and Non-Black (HR=1.2; CL: 0.9, 1.6) patient subgroups. For both racial groups, the strength of the relationship between treatment delay and mortality varied across geographic subregions. The estimated potential improvement in 5-year cumulative breast cancer mortality from delivering timely care to all patients differed in magnitude across sub-populations. The magnitude of potential improvement in breast cancer mortality at 5 years in the overall analytic cohort was 0.3% (5-year risk of breast cancer mortality in observed cohort: 7.2% vs 6.9% with simulated universal timely treatment). In the Black subcohort, the potential decrease in mortality for timely treatment was 1.0% (observed: 12.3% vs simulated: 11.4%), while in the non-Black population the potential decrease was 0.1% (observed: 6.1% vs simulated: 5.9%). CONCLUSIONS: The magnitude of association between delayed treatment of stage I-III breast cancer and breast cancer mortality differed between Black and non-Black patients, highlighting that interventions to avert treatment delays may have a meaningful impact for this group. Further research is needed to identify factors underlying this difference, which may include a direct effect of differences in timeliness, or downstream differences in the intensity and quality of cancer care beyond the 60-day landmark for delayed patients. Our findings suggest that comprehensive intervention at the state level to improve the timeliness of breast cancer treatment could potentially reduce breast cancer mortality, and that targeting such intervention to patient groups with larger projected benefit, such as Black patients, may be a more efficient use of resources. We have illustrated how a counterfactual approach may be useful in identifying subgroups where focused intervention efforts may yield greater improvements in outcomes.
Citation Format: Bradford Jackson, Stephanie Wheeler, Juan Yanguela, Matthew LeBlanc, Tzy-Mey Kuo, Christopher Baggett, Katherine Reeder-Hayes. IMPACTS OF TREATMENT DELAY ON BREAST CANCER MORTALITY AND BENEFIT OF TIMELY CARE IN BLACK AND NON-BLACK WOMEN [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-04.
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Affiliation(s)
- Bradford Jackson
- 1Cancer Information & Population Health Resource, UNC Lineberger Comprehensive Cancer Center
| | - Stephanie Wheeler
- 2UNC Department of Health Policy And Management, UNC Lineberger Comprehensive Cancer Center
| | | | | | - Tzy-Mey Kuo
- 5Cancer Information & Population Health Resource, UNC Lineberger Comprehensive Cancer Center
| | - Christopher Baggett
- 6Cancer Information & Population Health Resource, UNC Lineberger Comprehensive Cancer Center
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Kala R, Heiberger N, Mallin H, Wheeler S, Langerveld A. Reproducible method for assessing the effects of blue light using in vitro human skin tissues. Int J Cosmet Sci 2023; 45:95-107. [PMID: 36333965 DOI: 10.1111/ics.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION High-intensity visible light (HEV), also referred to as blue light, has a wavelength of 400-500 nm and accounts for approximately one-third of the visible light. Blue light is also emitted from electronic devices and artificial indoor lighting. Studies have shown that exposure of human skin cells to light emitted from electronic devices, even as short as 1 h, can cause an increase in reactive oxygen species (ROS), apoptosis and necrosis. Despite comprising a significant portion of the light spectrum, the effects of HEV light have not been studied as extensively. This is in part due to a lack of suitable in vitro testing methods. This work was conducted in order to develop a reproducible testing method for assessing the effects of blue light on the skin. METHODS Testing was performed using a full thickness, 3D in vitro skin tissue model. Different exposure protocols were tested to (1) determine the biological effects of blue light on the skin and (2) to identify an appropriate exposure for routine testing of cosmetic materials that may protect the skin from blue light damage. Gene expression and protein biomarkers were measured using qPCR, ELISA and immunohistochemical (IHC) methods. RESULTS Our work demonstrates that daily exposure to blue light produced dose-and-time-dependent changes in biomarkers associated with skin damage. Exposure to blue light for 6 h for 5 consecutive days (total intensity of 30 J/cm2 ) increased the expression of genes that regulate inflammation and oxidative stress pathways and decreased the expression of genes that maintain skin barrier and tissue integrity. Exposure to blue light significantly increased protein biomarkers associated with ageing, inflammation and tissue damage. IHC staining confirmed changes in collagen, filaggrin and NQO1 protein expression. Treatment with ascorbic acid inhibited the effects of blue light, demonstrating a role in protection from blue light. CONCLUSION Our results showed that consistent blue light exposure produced skin damage via alterations in biological pathways that are associated with skin ageing. This work provides a new, reproducible in vitro testing method for assessing the effects of blue light on human skin using gene expression, protein ELISA and IHC staining.
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Caston NE, Waters AR, Williams CP, Biddell C, Spees L, Gallagher K, Angove R, Anderson E, Balch A, Wheeler S, Rocque GB. Patient-reported discrimination among limited-resourced cancer survivors: a brief report. J Psychosoc Oncol 2022; 41:630-641. [PMID: 36519613 PMCID: PMC10617020 DOI: 10.1080/07347332.2022.2154186] [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: 12/23/2022]
Abstract
PURPOSE Healthcare discrimination has been associated with health disparities including lower cancer screenings, higher medical mistrust, and strained patient-provider relationships. Our study sought to understand patient-reported discrimination among cancer survivors with limited resources living in the United States. DESIGN AND METHODS We used cross-sectional survey data distributed by the Patient Advocate Foundation (PAF) in 12/2020 and 07/2021. Respondents reported source and reason of healthcare discrimination. Age, sex, race and ethnicity, annual household income, Rural-Urban Commuting Area (RUCA), Area Deprivation Index (ADI), employment status, cancer type, and number of comorbidities were independent variables of interest. The association between these variables and patient-reported healthcare discrimination was estimated using risk ratios (RRs) and 95% confidence intervals (CIs) from a multivariable modified Poisson regression model with robust standard errors. FINDINGS A total of 587 cancer survivors were included in our analysis. Most respondents were female (72%) and aged ≥56 (62%); while 33% were Black, Indigenous, or Person of Color. Overall, 23% reported receipt of discrimination, with the majority reporting doctor, nurse, or healthcare provider as the source (58%). Most common reasons for discrimination included disease status (42%), income/ability to pay (36%), and race and ethnicity (17%). In the adjusted model, retired survivors were 62% less likely to report discrimination compared to those employed (RR 0.38; 95% CI 0.23-0.64). Additionally, survivors with ≥3 comorbidities were 86% more likely to report discrimination compared to those survivors with no non-cancer comorbidities (RR 1.86; 95% CI 1.26-2.72). IMPLICATIONS Cancer survivors with limited resources reported substantial discrimination most often from a healthcare provider and most commonly for disease status and income. Discrimination should be mitigated to provide equitable and high-quality cancer care.
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Affiliation(s)
- Nicole E. Caston
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Courtney P. Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Caitlin Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | - Lisa Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | | | | | | | - Alan Balch
- Patient Advocate Foundation, Hampton, VA, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | - Gabrielle B. Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
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Hassan AM, Chu CK, Liu J, Angove R, Rocque G, Gallagher KD, Momoh AO, Caston NE, Williams CP, Wheeler S, Butler CE, Offodile AC. Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study. Support Care Cancer 2022; 30:7665-7678. [PMID: 35689108 PMCID: PMC9187333 DOI: 10.1007/s00520-022-07204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/03/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. METHODS We conducted a cross-sectional analysis of nationwide survey data assessing telemedicine use in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) in December 2020. Patients were characterized as financially distressed by self-reporting limited financial resources to manage out-of-pocket costs, psychological distress, and/or adaptive coping behaviors. Primary study outcome was telemedicine utilization during the pandemic. Secondary outcomes were telemedicine utilization volume and modality preferences. Multivariable and Poisson regression analyses were used to identify factors associated with telemedicine use. RESULTS A convenience sample of 627 patients with cancer responded to the PAF survey. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (19-35 age compared to ≥ 75 age) (OR, 6.07; 95% CI, 1.47-25.1) and more comorbidities (≥ 3 comorbidities compared to cancer only) (OR, 1.79; 95% CI, 1.13-2.65) were factors associated with telemedicine adoption. Younger age (19-35 years) (incidence rate ratios [IRR], 1.78; 95% CI, 24-115%) and higher comorbidities (≥ 3) (IRR; 1.36; 95% CI, 20-55%) were factors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95% CI, 1.03-1.05). CONCLUSIONS The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially distressed patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Carrie K Chu
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Jun Liu
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | | | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles E Butler
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Anaeze C Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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Kala R, Heiberger N, Mallin H, Wheeler S, Langerveld A. 621 Validated method for assessing the effects of blue light on human skin. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.631] [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: 10/17/2022]
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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Kala R, Heiberger N, Wheeler S, Mallin H, Langerveld A. LB801 High-Energy Visible (HEV) Light: Blue Light Poses Potential Harmful Effects on Human Skin Cells. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.150] [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: 11/27/2022]
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14
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Kadoya K, Wheeler S, Kala R, Mehta R. LB811 Exosomes from human neonatal fibroblasts conditioned media play an important role in skin rejuvenation. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Painschab MS, Kohler R, Kimani S, Mhango W, Kaimila B, Zuze T, Mithi V, Kasonkanji E, Mumba N, Nyasosela R, Wheeler S, Gopal S. Comparison of best supportive care, CHOP, or R-CHOP for treatment of diffuse large B-cell lymphoma in Malawi: a cost-effectiveness analysis. Lancet Glob Health 2021; 9:e1305-e1313. [PMID: 34303416 PMCID: PMC8403678 DOI: 10.1016/s2214-109x(21)00261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cost-effectiveness data for cancer treatment are needed from sub-Saharan Africa, where diffuse large B-cell lymphoma (DLBCL) is a common, curable cancer. In high-income countries, the standard of care for DLBCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemoimmunotherapy. Rituximab is often not available in sub-Saharan Africa due to perceived unaffordability, and treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) is common. We aimed to evaluate the cost-effectiveness of treatment in Malawi, comparing best supportive care, CHOP, or R-CHOP in patients with DLBCL. METHODS For this cost-effectiveness analysis, we used published Malawi microcosting data, clinical data from a prospective cohort treated with CHOP, and clinical trial data evaluating R-CHOP. We used a decision-tree model to calculate costs per disability-adjusted life-year (DALY) averted from the health system perspective for the treatment of patients with DLBCL with best supportive care, CHOP, or R-CHOP, running the model on a per-patient basis and a Malawi population-level basis. We used the WHO definitions of cost-effective (three times the GDP per capita of the country) and extremely cost-effective (equal to the GDP per capita of the country) as willingness-to-pay thresholds for Malawi. FINDINGS On a per-patient level, compared with best supportive care, CHOP was estimated to avert a mean 7·4 DALYs at an incremental cost of US$1384, for an incremental cost-effectiveness ratio (ICER) of $189 per DALY averted, which is substantially lower than the willingness-to-pay threshold (extremely cost-effective). Compared with CHOP, R-CHOP was estimated to avert 2·8 DALYs at an incremental cost of $3324, resulting in an ICER of $1204 per DALY averted, which is slightly higher than the cost-effective willingness-to-pay threshold. In probabilistic sensitivity analyses, CHOP remained cost-effective for DLBCL treatment in more than 99% of simulations, whereas R-CHOP was lower than the threshold in 46% of simulations. INTERPRETATION We estimated CHOP to be cost-effective for DLBCL treatment in Malawi, and that the addition of rituximab might be cost-effective. Despite upfront costs, DLBCL treatment is probably a prudent investment relative to other accepted health interventions in sub-Saharan Africa. FUNDING National Institutes of Health.
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Affiliation(s)
- Matthew S Painschab
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Project Malawi, Lilongwe, Malawi.
| | - Racquel Kohler
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Stephen Kimani
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Bongani Kaimila
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Takondwa Zuze
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Victor Mithi
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Noel Mumba
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | - Stephanie Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
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Painschab M, Kohler R, Kimani S, Wheeler S, Gopal S. Abstract 75: Cost-effectiveness Analysis of CHOP and R-CHOP Treatment of Diffuse Large B-cell Lymphoma in Malawi. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Cost-effectiveness data for cancer treatment are needed from sub-Saharan Africa (SSA), where diffuse large B-cell lymphoma (DLBCL) is a common, curable cancer. In high-income countries, the standard of care for DLBCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemoimmunotherapy. Rituximab is often not available in SSA due to cost, and treatment with CHOP is common.
Methods: We evaluated the cost-effectiveness of DLBCL treatment using Malawi-specific data. Clinical data were from a prospective observational cohort treated with CHOP, as well as a clinical trial of R-CHOP. We used a decision-tree model to calculate costs per disability adjusted life year (DALY) averted from the health system perspective and estimated a willingness to pay (WTP) threshold of three times GDP per capita.
Results: On a per-patient level, compared to no chemotherapy, CHOP is estimated to avert 7·9 DALYS, at an incremental cost of $1,500, for an incremental cost-effectiveness ratio (ICER) of $194 per DALY averted, which is well below WTP. In probabilistic sensitivity analysis, CHOP was cost-effective for DLBCL in >99% of simulations. Compared to CHOP, R-CHOP is estimated to avert 2·9 DALYs, at an incremental cost of $3,198 and ICER of $1,104 per DALY averted, which is at the WTP threshold and was below WTP in 45% of simulations.
Conclusion: CHOP is cost-effective for DLBCL in Malawi, and the addition of rituximab may be cost-effective. Future studies in SSA and other LMIC settings should include rigorous economic evaluation to promote continued cancer treatment investments and prioritization.
Citation Format: Matthew Painschab, Racquel Kohler, Stephen Kimani, Stephanie Wheeler, Satish Gopal. Cost-effectiveness Analysis of CHOP and R-CHOP Treatment of Diffuse Large B-cell Lymphoma in Malawi [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 75.
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Affiliation(s)
| | | | - Stephen Kimani
- 1University of North Carolina at Chapel Hill,
- 2UNC Project Malawi,
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Rocque G, Wheeler S, Williams GR. The missing voice in multidisciplinary tumor boards. J Geriatr Oncol 2021; 12:1157-1158. [PMID: 33722503 DOI: 10.1016/j.jgo.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, USA.
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Halalau A, Fuller W, Wheeler S. Canagliflozin Reduces the Risk of Kidney Failure in Patients with Type 2 Diabetes Mellitus and Nephropathy: The CREDENCE Randomized Trial. J Gen Intern Med 2021:10.1007/s11606-020-06216-z. [PMID: 33547569 DOI: 10.1007/s11606-020-06216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Halalau
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA.
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
| | - William Fuller
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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19
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Georgelin D, Jonqua F, Makowiecka K, Wheeler S, Baudouin C, Brémond-Gignac D, Labbé A. [Prevalence of visual impairment in school-age children: Data analysis from PlanVue® pilot project]. J Fr Ophtalmol 2021; 44:358-366. [PMID: 33494974 DOI: 10.1016/j.jfo.2020.08.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the prevalence of visual disturbances among school-aged children in prioritized education zones in France. METHODS The PlanVue® pilot project was designed to detect and manage visual disturbances in school-aged children in the prioritized education areas of the city of Nanterre, France. During this pilot study, a cohort of 515 children aged 4 to 13 years underwent a school vision screening between January and March 2019, consisting of an overall evaluation of the child's visual behavior, measurement of uncorrected visual acuity in each eye, objective refraction with a photoscreener and strabismus screening. If the examination was abnormal as determined by impaired vision or an algorithm based on the abnormalities found, the children were referred to an ophthalmologist. RESULTS Decreased visual acuity was found in 20% of school-aged children. Out of the 515 children screened, 22% were referred to an ophthalmologist. Among these children, 13% were diagnosed with amblyopia, 73% with spherical ametropia, 57% with astigmatism and 2% with strabismus. Of the entire population screened, 12% of the children needed optical correction but had not received glasses. CONCLUSION This study confirms the high prevalence of uncorrected refractive errors among school-age children. A screening program carried out in a school environment by paramedical professionals might make it possible to considerably reduce the rate of uncorrected visual disorders and their consequences.
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Affiliation(s)
- D Georgelin
- Service d'ophtalmologie, Hôpital Ambroise Paré, AP-HP, IHU FOReSIGHT, Université de Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles De Gaulle, 92100 Boulogne Billancourt; Service d'Ophtalmologie, Centre Hospitalier Universitaire Necker-Enfants Malades, APHP, Inserm 1138, T17, Université de Paris, 149, rue de Sèvres, 75015 Paris
| | - F Jonqua
- Association CADET, 8 rue Nina Berberova, 92100 Boulogne-Billancourt
| | - K Makowiecka
- Centre Point Vision La Défense, 77, esplanade du Général de Gaulle, 92800 Puteaux
| | - S Wheeler
- Helen Keller International Europe, 12, rue Vivienne, 75002 Paris
| | - C Baudouin
- Service d'ophtalmologie, Hôpital Ambroise Paré, AP-HP, IHU FOReSIGHT, Université de Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles De Gaulle, 92100 Boulogne Billancourt; Service d'ophtalmologie 3, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, Université de Versailles Saint-Quentin-en-Yvelines, 28, rue de Charenton, 75012 Paris
| | - D Brémond-Gignac
- Association CADET, 8 rue Nina Berberova, 92100 Boulogne-Billancourt; Service d'Ophtalmologie, Centre Hospitalier Universitaire Necker-Enfants Malades, APHP, Inserm 1138, T17, Université de Paris, 149, rue de Sèvres, 75015 Paris
| | - A Labbé
- Service d'ophtalmologie, Hôpital Ambroise Paré, AP-HP, IHU FOReSIGHT, Université de Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles De Gaulle, 92100 Boulogne Billancourt; Service d'ophtalmologie 3, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, Université de Versailles Saint-Quentin-en-Yvelines, 28, rue de Charenton, 75012 Paris.
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Harris H, Dotters-Katz S, Wheeler S, Swamy G, Hughes B. Cohorting prenatal care during the COVID-19 pandemic. Am J Obstet Gynecol 2020. [PMCID: PMC7683948 DOI: 10.1016/j.ajog.2020.08.170] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Williamson KM, Wheeler S, Kerr J, Bennett J, Freeman P, Kohlhagen J, Peel AJ, Eby P, Merritt T, Housen T, Dalton C, Durrheim DN. Hendra in the Hunter Valley. One Health 2020; 10:100162. [PMID: 33117876 PMCID: PMC7582210 DOI: 10.1016/j.onehlt.2020.100162] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
In June 2019 the first equine case of Hendra virus in the Hunter Valley, New South Wales, Australia was detected. An urgent human and animal health response took place, involving biosecurity measures, contact tracing, promotion of equine vaccinations and investigation of flying fox activity in the area. No human or additional animal cases occurred. Equine vaccination uptake increased by over 30-fold in the surrounding region in the three months following the case. Black flying fox and grey-headed flying fox species were detected in the Valley. The incident prompted review of Hendra virus resources at local and national levels. This event near the “horse capital of Australia”, is the southernmost known equine Hendra case. Management of the event was facilitated by interagency collaboration involving human and animal health experts. Ongoing One Health partnerships are essential for successful responses to future zoonotic events. In June 2019 the southernmost known equine case of Hendra virus was detected in the Hunter Valley, Australia. This signified an increase in potential equine and human populations at risk of infection. Interagency collaboration between animal and human health experts is essential in managing Hendra virus spillover events.
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Affiliation(s)
- K M Williamson
- Hunter New England Population Health, Newcastle, NSW, Australia.,Australian National University, Canberra, ACT, Australia
| | - S Wheeler
- Hunter New England Population Health, Newcastle, NSW, Australia.,Australian National University, Canberra, ACT, Australia
| | - J Kerr
- Hunter Local Land Services, NSW, Australia
| | - J Bennett
- Hunter Local Land Services, NSW, Australia
| | - P Freeman
- NSW Department of Primary Industries, NSW, Australia
| | - J Kohlhagen
- Hunter New England Population Health, Newcastle, NSW, Australia
| | - A J Peel
- Griffith University, Brisbane, QLD, Australia
| | - P Eby
- Griffith University, Brisbane, QLD, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - T Merritt
- Hunter New England Population Health, Newcastle, NSW, Australia
| | - T Housen
- Australian National University, Canberra, ACT, Australia
| | - C Dalton
- Hunter New England Population Health, Newcastle, NSW, Australia
| | - D N Durrheim
- Hunter New England Population Health, Newcastle, NSW, Australia
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Kamanga G, Hoffman I, Malata A, Wheeler S, Chilongozi D, Babich S. Perspectives about policy implementation: A learning opportunity from the 2003-2013 Malawi HIV/AIDS Policy. Malawi Med J 2019; 30:54-60. [PMID: 30627329 PMCID: PMC6307070 DOI: 10.4314/mmj.v30i2.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/17/2022] Open
Abstract
Introduction Malawi published its first ever HIV and AIDS policy in 2003. The implementation of the policy provided a very necessary and historic step in Malawi's organized response towards HIV and AIDS. Many achievements were registered in the period this policy was implemented. However, some components of the policy were not well-implemented. Our study explored barriers to implementation of provider initiated HIV testing and counseling (PITC) for sexually transmitted infections (STI) within general outpatient settings. Malawi also launched a revised HIV and AIDS Policy in December 2013. Although not part of this policy analysis, future years of implementation may face related issues observed during the implementation of the 2003–2013 policy. Methods This is a non-experimental, descriptive study using a case study design. We examined the implementation of provider initiated HIV testing and counseling component of the Malawi HIV and AIDS policy from 2003–2013 focusing on STI and outpatient clinic settings. We sought to understand perspectives of various stakeholders and users of the policy. We conducted in-depth interviews with policy makers, health care worker supervisors, health care workers and health rights activists. Results Major problems which affected the implementation of the 2003–2013 HIV policy were: selective prioritization of policies by government, lack of involvement of implementers in the policy making process, non-awareness of health workers about the existence of the policy, lack of healthcare worker training, unsatisfactory supervision of policy implementation, poor harmonization of policies, lack of clarity about guidance to those directly implementing, unclear roles and reporting authority among the main national coordinating units. Conclusion Good leadership, effective coordination, involvement of key players in the policy making process, dissemination to primary users and decentralization or empowerment of local supervisors is key to successful policy implementation.
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Affiliation(s)
| | - Irving Hoffman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | | | - Stephanie Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | | | - Suzanne Babich
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
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Brenner A, Rhode J, Yang JY, Baker D, Drechsel R, Plescia M, Reuland DS, Wroth T, Wheeler S. Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial. Cancer 2018; 124:3346-3354. [PMID: 30004577 PMCID: PMC6446899 DOI: 10.1002/cncr.31566] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 12/01/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)-based outreach programs for Medicaid beneficiaries. METHODS In a patient-level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow-up care. The primary outcome was FIT return. RESULTS In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%-13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow-up colonoscopy; 66.7% (n = 10) completed follow-up colonoscopy. CONCLUSIONS A health department-based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost-effectiveness of these interventions.
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Affiliation(s)
- Alison Brenner
- University of North Carolina School of Medicine, Division of General Medicine & Clinical Epidemiology, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jewels Rhode
- University of North Carolina School of Medicine, Division of General Medicine & Clinical Epidemiology, Chapel Hill, NC
| | - Jeff Y Yang
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
| | - Dana Baker
- Community Care Partners of Greater Mecklenburg, Charlotte, NC
| | | | - Marcus Plescia
- Mecklenburg County Public Health Department, Charlotte, NC
| | - Daniel S Reuland
- University of North Carolina School of Medicine, Division of General Medicine & Clinical Epidemiology, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tom Wroth
- Community Care Network of North Carolina, Raleigh, NC
| | - Stephanie Wheeler
- University of North Carolina School of Medicine, Division of General Medicine & Clinical Epidemiology, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
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Abstract
In recognition of the important ethical issues posed by qualitative research in health care, the authors present key questions to aid ethical review. The purpose is to assist lay and professional members of research ethics committees in their assessment of applications involving qualitative research methods and to inform researchers intending to submit such applications for ethical approval. For the benefit of those less familiar with this type of research, the authors include an overview of different types of qualitative research, together with an explanation of terms commonly used by qualitative researchers.
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Smith ER, Hudgens M, Sheahan AD, Miller WC, Wheeler S, Nelson JAE, Dube Q, Van Rie A. Timing of HIV Seroreversion Among HIV-Exposed, Breastfed Infants in Malawi: Type of HIV Rapid Test Matters. Matern Child Health J 2018; 21:248-252. [PMID: 27632218 PMCID: PMC5290052 DOI: 10.1007/s10995-016-2152-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Rapid HIV serological tests are a cost-effective, point-of-care test among HIV exposed infants but cannot distinguish between maternal and infant antibodies. The lack of data on the timing of decay of maternal antibodies in young infants hinders the potential use of rapid tests in exposed infants. We aimed to determine the time to seroreversion for two commonly used rapid tests in a prospective cohort of HIV-exposed breastfeeding infants ages 3–18 months of life. Methods We collected data on the performance of two commonly used rapid tests (Determine and Unigold) in Malawi between 2008 and 2012 or at the University of North Carolina between 2014 and 2015. Time to seroreversion was estimated for both rapid tests using the Kaplan–Meier product limit estimator which allows for interval censored data. Results At 3 months of age, 3 % of infants had seroreverted according to Determine and 7 % had seroreverted according to Unigold. About one in four infants had achieved seroreversion by 4 months using Unigold, but only about one in twelve infants by 4 months when using Determine. More than 95 % of all infants had seroverted by 7 months according to Unigold and by 12 months according to the Determine assay. Discussion We show that the time of seroreversion depends greatly on the type of test used. Our results highlight the need for recommendations to specify the timing and type of test used in the context of infant HIV detection in resource-poor settings, and base the interpretation of test result on knowledge of time to seroreversion of the selected test.
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Affiliation(s)
- Emily R Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Anna D Sheahan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings Schools of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Julie A E Nelson
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Queen Dube
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Annelies Van Rie
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
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Mukherjee S, Andal R, Hentzen C, Hejnal M, Wheeler S, Clinard V, Prescott J, Coldren C, Ho H, Knight K, Lennon P, Andreatta M, Sathanoori M, Chandra P. Prevalence of mycoplasma genitalium in a screening population. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2017.08.040] [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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Louie M, Spencer J, Wheeler S, Ellis V, Toubia T, Schiff LD, Siedhoff MT, Moulder JK. Comparison of the levonorgestrel-releasing intrauterine system, hysterectomy, and endometrial ablation for heavy menstrual bleeding in a decision analysis model. Int J Gynaecol Obstet 2017; 139:121-129. [DOI: 10.1002/ijgo.12293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/11/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Michelle Louie
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Jennifer Spencer
- Department of Health Policy and Management; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Stephanie Wheeler
- Department of Health Policy and Management; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Victoria Ellis
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Tarek Toubia
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Lauren D. Schiff
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Matthew T. Siedhoff
- Department of Obstetrics and Gynecology; Cedars-Sinai Medical Center; Los Angeles CA USA
| | - Janelle K. Moulder
- Department of Obstetrics and Gynecology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
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Abstract
Purpose In response to the increasing cancer burden in Kenya, this study identified
barriers to patients seeking access to cancer testing and treatment and to
clinicians in delivering these services. Policy recommendations based on
findings are presented. Methods This qualitative study used semistructured key informant interviews.
Purposive sampling was used to recruit 14 participants: seven oncology
clinicians and seven support and advocacy leaders for patients with cancer.
Qualitative analysis was used to identify themes. Results Seven barriers to cancer testing and treatment were identified: high cost of
testing and treatment, low level of knowledge about cancer among population
and clinicians, poor health-seeking behaviors among population, long
distances to access diagnostic and treatment services, lack of decentralized
diagnostic and treatment facilities, poor communication, and lack of better
cancer policy development and implementation. Conclusion Kenyans seeking cancer services face significant barriers that result in late
presentation, misdiagnosis, interrupted treatment, stigma, and fear. Four
policy recommendations to improve access for patients with cancer are (1)
improve health insurance for patients with cancer; (2) establish testing and
treatment facilities in all counties; (3) acquire diagnosis and treatment
equipment and train health personnel to screen, diagnose, and treat cancer;
and (4) increase public health awareness and education about cancer to
improve diagnoses and treatment. Effective cancer testing and treatment
options can be developed to address cancer in a resource-constrained
environment like Kenya. An in-depth look at effective interventions and
policies being implemented in countries facing similar challenges would
provide valuable lessons to Kenya’s health sector and
policymakers.
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Affiliation(s)
- Louise K Makau-Barasa
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Sandra B Greene
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Nicholas A Othieno-Abinya
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Stephanie Wheeler
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Asheley Skinner
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Antonia V Bennett
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
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Cotton CC, Erim D, Eluri S, Palmer SH, Green DJ, Wolf WA, Runge TM, Wheeler S, Shaheen NJ, Dellon ES. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2017; 15:841-849.e1. [PMID: 27940272 PMCID: PMC5440206 DOI: 10.1016/j.cgh.2016.11.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 10/31/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. METHODS We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. RESULTS In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. CONCLUSIONS In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life.
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Affiliation(s)
- Cary C. Cotton
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - Daniel Erim
- University of North Carolina at Chapel Hill, Gillings School of Public Heath, Department of Health Policy and Management, Chapel Hill, NC, USA
| | - Swathi Eluri
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - Sarah H. Palmer
- University of North Carolina at Chapel Hill, Gillings School of Public Heath, Department of Health Policy and Management, Chapel Hill, NC, USA
| | - Daniel J. Green
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - W Asher Wolf
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - Thomas M. Runge
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- University of North Carolina at Chapel Hill, Gillings School of Public Heath, Department of Health Policy and Management, Chapel Hill, NC, USA
| | - Nicholas J. Shaheen
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
| | - Evan S. Dellon
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA
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Brown LAE, Thomas K, Reskovic Luksic V, Bernard AB, Montilla Padilla I, Savelev A, Tufaro V, Nossikoff A, Ingimarsdottir IJ, Almeida Morais L, Meel R, Surkova E, Moharem-Elgamal S, Macabeo RAM, Cueva Recalde JF, Teixeira R, Petrovic M, Mahmoud HM, Lavanco V, De Kleijn MC, Vertes V, Kozan H, Padron-Encalada R, Zheng AW, Main SE, Jancis RSC, Steadman CD, Carpenter JP, Senaratne DNS, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ljubas Macek J, Pasalic M, Ostojic Z, Matasic R, Veceric S, Separovic Hanzevacki J, Martinez C, Dulgheru RE, Reskovic V, Lancellotti P, Jimenez Lopez-Guarch C, Velazquez Martin M, Nuche Berenguer J, Jimenez J, Solis J, Alonso S, Lopez Gude MJ, Perez Vela JL, Escribano Subias P, Tregubov AV, Shubik YV, Bandera F, Generati G, Alfonzetti E, Guazzi M, Evrev D, Razboynikov R, Atanasova A, Angelov K, Lazarova G, Radkova M, Stamboliyski G, Simova I, Kalionsky R, Hadjidekov G, Plachkov I, Petkov R, Gatzov P, Donova T, Hellgren Johansson L, Flachskampf FA, Galrinho A, Moura Branco L, Abreu J, Timoteo AT, Pinto-Teixeira P, Aguiar-Rosa S, Rio P, Portugal G, Cruz-Ferreira R, Nethononda R, Peters F, Libhaber E, Essop MR, Bidviene J, Brunello G, Veronesi F, Cavalli G, Cherata D, Romeo G, Badano LP, Muraru D, Tawfik M, Samir R, Amin M, Abol Maaty M, Pestano NSP, Estanislao IHE, Gayan Ordas J, Lacambra I, Pelegrin Diaz J, Dinis P, Monteiro R, Santos M, Botelho A, Quintal N, Goncalves L, Giga V, Boskovic N, Rakocevic I, Trifunovic D, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Stepanovic J, Hassan M, Nagy M, Samaan A, Kharabish A, Philip P, Wagdy K, Elmaghawry M, Elguindy A, Yacoub M, Leo AL, Pasotti E, Faletra FF, Moccetti T, Houthuizen P, Bracke FALE, Lopata RGP, Nogradi A, Porpaczy A, Minier T, Czirjak L, Komocsi A, Faludi R, Sade LE, Turgay O, Pirat B, Muderrisoglu H, Barreiro-Perez M, Diaz-Pelaez E, Martin-Garcia A, Cruz-Gonzalez I, Jimenez-Candil J, Sanchez PL. HIT Poster session 3P915Direct access to transthoracic echocardiography in a district general hospital: are referrals appropriate?P916Surveillance echocardiography for valve disease; have the AHA valve guidelines translated in clinical practice? A retrospective study from a large general hospital in the United KingdomP917Effects of immediate echo guided AV and VV CRT optimization on left ventricular function and hemodynamicsP9183D echocardiography estimation of ventricular performance : correlation between 3D strain and elastancesP919 Right ventricular reverse remodeling after balloon pulmonary angioplasty in patients with non operable chronic thromboembolic pulmonary hypertensionP920Pseudonormal and restrictive left ventricular filling patterns are associated with lower effectiveness of pulmonary vein isolation in patients with paroxysmal atrial fibrillationP921Impact of new guidelines on diastolic dysfunction classification of HFrEF patients and correlation with cardiopulmonary exercise test functional parametersP922Prevalence of proximal DVT on compression ultrasound in patients with acute pulmonary embolism and it's diagnostic utility as a rule-in point-of-care testP923Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prosthesesP924New insights into the mechanics of left ventricular systolic and diastolic function in severe aortic stenosisP925Comparison of cardiac magnetic resonance and echocardiography for evaluation of mitral regurgitation severity in patients with rheumatic heart diseaseP926Tricuspid annulus remodeling in patients with permanent atrial fibrillation and functional tricuspid regurgitationP927Assessment of ventricular electromechanical dyssynchrony in CRT candidatesP928Native aortic valve infective endocarditis due to streptococcus sanguinis in a patient with possible behcets disease, patent foramen ovale and thymomaP929GLS is associated with conduction abnormalities in patients with type 1-myotonic dystrophyP930Descending aortic mechanics and stroke: a two-dimensional echocardiographic speckle tracking studyP931Correlation between prognostic markers of stress echocardiography and angiographic severity of coronary artery disease in patients after primary PCIP932A novel method for calculating the mitral valve area in patients with rheumatic mitral stenosisP933Three dimensional printing of cardiac anatomical structures from three dimensional echocardiograpfic images: preliminary experienceP934Reliability of fully automated calculation of global longitudinal strain by commercially available software: implications for daily practiceP935Global longitudinal strain is a suitable tool to unmask the subclinical left ventricular dysfunction in patients with systemic sclerosisP936Concomitant use of echocardiographic strain analysis and treadmill stress testing to predict coronary artery diseaseP937Cardiac-CT and transoesophageal echocardiography comparison for left atrial appendage clots detection in patients referred for left atrial interventional procedures. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew258] [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: 11/14/2022] Open
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Baran D, Kirchartz T, Wheeler S, Dimitrov S, Abdelsamie M, Gorman J, Ashraf RS, Holliday S, Wadsworth A, Gasparini N, Kaienburg P, Yan H, Amassian A, Brabec CJ, Durrant JR, McCulloch I. Reduced voltage losses yield 10% efficient fullerene free organic solar cells with >1 V open circuit voltages. Energy Environ Sci 2016; 9:3783-3793. [PMID: 28066506 PMCID: PMC5171224 DOI: 10.1039/c6ee02598f] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/08/2016] [Indexed: 05/20/2023]
Abstract
Optimization of the energy levels at the donor-acceptor interface of organic solar cells has driven their efficiencies to above 10%. However, further improvements towards efficiencies comparable with inorganic solar cells remain challenging because of high recombination losses, which empirically limit the open-circuit voltage (Voc) to typically less than 1 V. Here we show that this empirical limit can be overcome using non-fullerene acceptors blended with the low band gap polymer PffBT4T-2DT leading to efficiencies approaching 10% (9.95%). We achieve Voc up to 1.12 V, which corresponds to a loss of only Eg/q - Voc = 0.5 ± 0.01 V between the optical bandgap Eg of the polymer and Voc. This high Voc is shown to be associated with the achievement of remarkably low non-geminate and non-radiative recombination losses in these devices. Suppression of non-radiative recombination implies high external electroluminescence quantum efficiencies which are orders of magnitude higher than those of equivalent devices employing fullerene acceptors. Using the balance between reduced recombination losses and good photocurrent generation efficiencies achieved experimentally as a baseline for simulations of the efficiency potential of organic solar cells, we estimate that efficiencies of up to 20% are achievable if band gaps and fill factors are further optimized.
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Affiliation(s)
- D Baran
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK . ; IEK5-Photovoltaics , Forschungszentrum Jülich , 52425 Jülich , Germany .
| | - T Kirchartz
- IEK5-Photovoltaics , Forschungszentrum Jülich , 52425 Jülich , Germany . ; Faculty of Engineering and CENIDE , University of Duisburg-Essen , Carl-Benz-Straße 199 , 47057 Duisburg , Germany
| | - S Wheeler
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - S Dimitrov
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - M Abdelsamie
- King Abdullah University of Science and Technology (KAUST) , KSC , Thuwal 23955-6900 , Saudi Arabia
| | - J Gorman
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - R S Ashraf
- King Abdullah University of Science and Technology (KAUST) , KSC , Thuwal 23955-6900 , Saudi Arabia
| | - S Holliday
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - A Wadsworth
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - N Gasparini
- Institute of Materials for Electronics and Energy Technology (I-MEET) , Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - P Kaienburg
- IEK5-Photovoltaics , Forschungszentrum Jülich , 52425 Jülich , Germany .
| | - H Yan
- Department of Chemistry and Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration & Reconstruction , Hong Kong University of Science and Technology , Clear Water Bay , Kowloon , Hong Kong , China
| | - A Amassian
- King Abdullah University of Science and Technology (KAUST) , KSC , Thuwal 23955-6900 , Saudi Arabia
| | - C J Brabec
- Institute of Materials for Electronics and Energy Technology (I-MEET) , Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - J R Durrant
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK .
| | - I McCulloch
- Department of Chemistry and Centre for Plastic Electronics , Imperial College London , London , SW7 2AZ , UK . ; King Abdullah University of Science and Technology (KAUST) , KSC , Thuwal 23955-6900 , Saudi Arabia
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Ota T, Senaratne DNS, Preston NK, Ferrara F, Djikic D, Villemain O, Takahashi L, Niki K, Patrascu N, Benyounes N, Popa E, Diego Bellavia DB, Sundqvist M, Wei-Ting C, Papachristidis A, Djordjevic-Dikic A, Volpi C, Reis L, Nieto Tolosa J, Nishikawa H, D'angelo M, Testuz A, Mo YJ, Hashemi N, Toyota K, Nagamine K, Koide Y, Nomura T, Kurata J, Murakami Y, Kozuka Y, Ohshiro C, Thomas K, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ring L, Gargani L, Carannante L, Russo V, D'alto M, Marra AM, Cittadini A, D'andrea A, Vriz O, Bossone E, Mujovic N, Dejanovic B, Peric V, Marinkovic M, Jankovic N, Orbovic B, Simic D, Sitefane F, Pernot M, Malekzadeh-Milani G, Baranger J, Bonnet D, Boudjemline Y, Uejima T, Nishikawa H, Semba H, Sawada H, Yamashita T, Sugawara M, Kayanuma H, Inoue K, Yagawa M, Takamisawa I, Umemura J, Yoshikawa T, Tomoike H, Mihalcea DJ, Mihaila S, Lungeanu L, Trasca LF, Bruja R, Neagu MS, Albu S, Cirstoiu M, Vinereanu D, Van Der Vynckt C, Gout O, Cohen A, Enache R, Jurcut R, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Sonia Dell'oglio SD, Attilio Iacovoni AI, Calogero Falletta CF, Giuseppe Romano GR, Sergio Sciacca SS, Lissa Sugeng LS, Joseph Maalouf JM, Michele Pilato MP, Michele Senni MS, Cesare Scardulla CS, Francesco Clemenza FC, Salman K, Tornvall P, Ugander M, Chen ZC, Wang JJ, Fisch S, Liao RL, Roper D, Casar Demarco D, Papitsas M, Tsironis I, Byrne J, Alfakih K, Monaghan MJ, Boskovic N, Rakocevic I, Giga V, Tesic M, Stepanovic J, Nedeljkovic I, Aleksandric S, Kostic J, Beleslin B, Altman M, Annabi MS, Abouchakra L, Cucchini U, Muraru D, Badano LP, Ernande L, Derumeaux G, Teixeira R, Fernandes A, Almeida I, Dinis P, Madeira M, Ribeiro J, Puga L, Nascimento J, Goncalves L, Cambronero Sanchez FJ, Pinar Bermudez E, Gimeno Blanes JR, De La Morena Valenzuela G, Uejima T, Takahashi L, Semba H, Sawada H, Yamashita T, Lopez Fernandez T, Irazusta Cordoba FJ, Rosillo Rodriguez SO, Dominguez Melcon FJ, Meras Colunga P, Gemma D, Moreno Gomez R, Moreno Yanguela M, Lopez Sendon JL, Nguyen V, Mathieu T, Kerneis C, Cimadevilla C, Kubota N, Codogno I, Tubiana S, Estrellat C, Vahanian A, Messika-Zeitoun D, Ondrus T, Van Camp G, Di Gioia G, Barbato E, Bartunek J, Penicka M, Johnsson J, Gomez A, Alam M, Winter R. Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view for assessing for prolapseP629Right atrial volume by two-dimensional echocardiography in healthy subjectsP630Disturbance of inter and intra atrial conduction assessed by tissue doppler imaging in patients with medicaly controlled hypertension and prehypertension.P631Liver stiffness by shear wave elastography, new noninvasive and quantitative tool for acute variation estimation of central venous pressure in real-time?P632Weak atrial kick contribution is associated with a risk for heart failure decompensationP633Usefulness of wave intensity analysis in predicting the response to cardiac resynchronization therapyP634Early subclinical left ventricular systolic and diastolic dysfunction in gestational hypertension and preeclampsiaP635Clinical comparison of three different echocardiographic methods for left ventricular ejection fraction and LV end diastolic volume measurementP636Assessment of right ventricular-arterial coupling parameters by 3D echocardiography in patients with pulmonary hypertension receiving specific vasodilator therapyP637Prediction of right ventricular failure after left ventricular assist device implant: assessing usefulness of standard and strain echocardiographyP638Kinematic analysis of diastolic function using the novel freely available software Echo E-waves - feasibility and reproducibilityP639Evaluation of coronary flow velocity by Doppler echocardiography in the treatment of hypertension with the ARB: correlation to the histological cardiac fibrosisP640The clinical significance of limited apical ischaemia and the prognostic value of stress echocardiography - A contemporary study from a high volume centerP641Effects of intermediate stenosis of left anterior descending coronary artery on survival in patients with chronic total occlusion of right coronary arteryP642Left ventricular remodeling after a first myocardial infarction in patients with preserved ejection fraction at dischargeP643Left atrial size and acute coronary syndromes. Let is make simple.P644Influence of STEMI reperfusion strategy on systolic and diastolic functionP645Aortic valve resistance risk-stratifies low-gradient severe aortic stenosisP646Does permanent pacemaker implantation complicate the prognosis of patients after transcatheter aortic valve implantation?P647Influence of metabolic syndrome and diabetes on progression of calcific aortic valve stenosis - The COFRASA - GENERAC StudyP648Low referral for aortic valve replacement accounts for worse long-term outcome in low versus high gradient severe aortic stenosis with preserved ejection fractionP649The impact of right ventricular function from aortic valve replacement: A randomised study comparing minimally invasive aortic valve surgery and conventional open heart surgery. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew250] [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: 11/14/2022] Open
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Mayer D, Deal A, Crane J, Chen R, Asher G, Hanson L, Wheeler S, Gerstel A, Green M, Birken S, Rosenstein D. Using Survivorship Care Plans to Enhance Communication and Cancer Care Coordination: Results of a Pilot Study. Oncol Nurs Forum 2016; 43:636-45. [DOI: 10.1188/16.onf.636-645] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wheeler S. Book Reviews : Tschudin V ed 1994: Ethics: education and research. London: Scutari Press. 142pp. £12.99 (PB). ISBN 1 873853 11 4. Nurs Ethics 2016. [DOI: 10.1177/096973309500200313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stephanie Wheeler
- Institute of Health and Community Services, Bournemouth University, UK
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Nielsen M, Georgieva M, Erim D, Smith-Bindman R, Loo R, Ng C, Garg T, Raynor M, Wheeler S. PD25-04 A COMPARISON OF EVALUATION STRATEGIES IN PATIENTS WITH ASYMPTOMATIC MICROSCOPIC HEMATURIA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mukherjee S, Ma Z, Wheeler S, Sathanoori M, Coldren C, Prescott JL, Kozyr N, Bouzyk M, Correll M, Ho H, Chandra PK, Lennon PA. Chromosomal microarray provides enhanced targetable gene aberration detection when paired with next generation sequencing panel in profiling lung and colorectal tumors. Cancer Genet 2016; 209:119-29. [PMID: 26880400 DOI: 10.1016/j.cancergen.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/24/2015] [Accepted: 12/27/2015] [Indexed: 12/12/2022]
Abstract
The development of targeted therapies based on specific genomic alterations has altered the treatment and management of lung and colorectal cancers. Chromosomal microarray (CMA) has allowed identification of copy number variations (CNVs) in lung and colorectal cancers in great detail, and next-generation sequencing (NGS) is used extensively to analyze the genome of cancers for molecular subtyping and use of molecularly guided therapies. The main objective of this study was to evaluate the utility of combining CMA and NGS for a comprehensive genomic assessment of lung and colorectal adenocarcinomas, especially for detecting drug targets. We compared the results from NGS and CMA data from 60 lung and 51 colorectal tumors. From CMA analysis, 33% were amplified, 89% showed gains, 75% showed losses and 41% demonstrated loss of heterozygosity; pathogenic variants were identified in 81% of colon and 67% lung specimens through NGS. KRAS mutations commonly occurred with loss in TP53 and there was significant loss of BRCA1 and NF1 among male patients with lung cancer. For clinically actionable targets, 23% had targetable CNVs when no pathogenic variants were detected by NGS. The data thus indicate that combining the two approaches provides significant benefit in a routine clinical setting not available by NGS alone.
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Affiliation(s)
| | - Z Ma
- PathGroup, Nashville, TN, USA
| | | | | | | | | | | | | | | | - H Ho
- PathGroup, Nashville, TN, USA
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Wheeler S, Grotegut C, Swamy G. 3: Aspirin for preeclampsia prevention, latency and chorioamnionitis in preterm premature rupture of membranes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2015.09.036] [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: 10/22/2022]
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Durham D, Robinson W, Lee S, Wheeler S, Bowling J, Henderson L. Abstract PR07: Disparities in time to diagnostic follow up after screening mammography. Cancer Epidemiol Biomarkers Prev 2015. [DOI: 10.1158/1538-7755.disp14-pr07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Screening mammography has been associated with as much as a 20% reduction in breast cancer mortality among women ages 40-74 years. An understudied dimension of screening that may impact mortality is time until follow-up after a positive mammogram. The primary objective of this study is to compare by race and insurance type the time to follow up after a positive screening mammogram.
Methods: We use 1995-2010 data from the Carolina Mammography Registry (CMR), a population-based registry. The data are collected from women and the radiologist interpreting the mammogram and include patient demographics, patient risk factors (breast density, family history of breast cancer, menopausal status), the imaging examination performed, the reason for the visit, the radiologists' assessment and recommendation for follow-up. The data are linked with cancer outcomes from the North Carolina Central Cancer Registry and abstracted pathology reports. In this study we included women ages 18 and older with a positive screening mammogram. A mammogram was positive if the Breast Imaging Reporting and Data System (BI-RADS) score was 0, 4, 5, or 3 with recommendation for biopsy evaluation. We defined time to diagnostic follow-up as number of days from the initial positive screening mammogram until the date of the first follow-up event (additional breast imaging or biopsy) before a cancer diagnosis or benign pathology result. We describe time to diagnostic follow-up for the cohort, by racial/ethnic status, and by insurance type (Medicare only, Medicaid, Medicare and Medicaid, Medicare and other insurer, all other insurers including private insurers, and No Insurance). We use Cox proportional hazards to estimate hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the association between insurance type and diagnostic follow-up adjusting for race, patient residence, education, and imaging practice.
Results: Of 97,304 positive screening mammograms included in the study, the majority of the sample was White, non-Hispanic (80%), Black, non-Hispanic (13%), Hispanic (1%), Multi-racial/other (1%), and Native American (<1%). About 64% of the population reported insurance type as any other insurer including private insurers such as those offering HMO, PPO, or veterans benefit plans. About 18% of the study population reported having Medicare with another form of insurance, followed by Medicare alone (7%), Medicaid (3%), Medicaid with Medicare (3%), No insurance (2%). Median time until diagnostic follow-up after a positive screening mammogram for the study population was 11 days. White non-Hispanics and Hispanics experienced a median follow-up of 11 days while Native Americans experienced a median follow-up of 16 days. Black and Asian women experienced median follow-up of 9 days. Those reporting Medicare experienced a median follow-up of 14 days while those reporting Medicaid experienced median follow-up of 8 days (p<0001). Those reporting any other insurer including private insurance experienced median follow-up of 8.5 days (p<0001). The hazard of diagnostic follow-up for those with Medicare with another form of insurance is 1.5 times the rate of those reporting all other insurers, controlling for other covariates in the model (95% CI 1.40-1.61). Women reporting Medicare only experience diagnostic follow-up at 1.2 times the rate of those reporting all other insurers (95% CI 1.13-1.34). Uninsured women in this group were 29% less likely to have diagnostic follow-up (HR 0.71 95% CI: 0.61-0.83).
Discussion: In this breast cancer screening population women reporting Medicare alone or with supplemental insurance have increased hazard of diagnostic time until follow-up after a positive mammogram when compared to other women. The study may have a positive impact on maximizing the benefits of cancer screening and reducing disparities in breast cancer care.
This abstract was also presented as Poster B72.
Citation Format: Danielle Durham, Whitney Robinson, Sheila Lee, Stephanie Wheeler, James Bowling, Louise Henderson. Disparities in time to diagnostic follow up after screening mammography. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR07.
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Affiliation(s)
| | | | - Sheila Lee
- The University of North Carolina at Chapel, Chapel Hill, NC
| | | | - James Bowling
- The University of North Carolina at Chapel, Chapel Hill, NC
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Coathup V, Wheeler S, Smith L. A method comparison of a food frequency questionnaire to measure folate, choline, betaine, vitamin C and carotenoids with 24-h dietary recalls in women of reproductive age. Eur J Clin Nutr 2015; 70:346-51. [PMID: 26419194 DOI: 10.1038/ejcn.2015.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/21/2015] [Accepted: 08/03/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to conduct a method comparison of a modified food frequency questionnaire (FFQ), designed to estimate usual dietary intake of selected micronutrients and antioxidants including folate, choline, betaine, vitamin C and carotenoids (α-carotene, β-carotene, lutein, lycopene and β-cryptoxanthin) with 24-h dietary recalls (24-HR) in women of reproductive age. SUBJECTS/METHODS Sixty-four British women of reproductive age (18-40 years) were recruited in Oxford, UK and provided complete dietary data for analysis. METHODS We compared micronutrient estimates from the FFQ against estimates derived from three multiple-pass, 24-HR interviews, by evaluating Pearson's correlation coefficients and Bland-Altman plots. RESULTS Median intakes of most nutrients were higher when measured by FFQ compared with 24-HR. Strong correlation coefficients were observed for folate (r=0.80) and choline (r=0.68), whereas moderate correlation coefficients were observed for vitamin C (0.50) and lycopene (0.43). Weak correlation coefficients were observed for betaine (0.39) and other carotenoids (r=0.26-0.38). Bland-Altman plots indicated that there was a large amount of variability in the FFQ estimates of nutrient intakes compared to those using 24-HR, particularly for carotenoids. CONCLUSIONS The findings indicate that this FFQ estimated higher mean intakes for most nutrients. Pearson's correlation coefficients were comparable with previous research; however, the Bland-Altman plots suggest a high variability in mean nutrient estimates between the FFQ and 24-h. We recommend further investigation of the validity of this FFQ before use.
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Affiliation(s)
- V Coathup
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, UK
| | - S Wheeler
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - L Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, UK
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Wutzke J, Wheeler S, Chandler H, O'Connell D, Barysauskas C, Barton B, Mullen M. 52 Central Venous Pressure Monitoring Through a Vascular Access Port Device. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nagaratnam K, Monkhouse A, Jones H, Wheeler S, Beal J, Singh S. P112: Reporting of non-motor symptoms and cognitive impairment in Parkinson's disease clinic attenders. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70287-6] [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: 11/26/2022]
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Nagaratnam K, Monkhouse A, Jones H, Wheeler S, Beal J, Singh S. 43 * PATIENTS' AND PHYSICIANS' REPORTING OF NON-MOTOR SYMPTOMS IN PARKINSON'S DISEASE CLINIC ATTENDEES. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.43] [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: 11/14/2022] Open
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Kornder JM, Blyth S, Chan A, Elliott H, L'Heureux R, Sobolyeva R, Wand R, Wheeler S. Fly My Stemi Away: the Stemi Launch Helicopter Primary PCI Experience in Fraser Health Authority. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.180] [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: 10/26/2022] Open
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Wheeler S, Moore K, Forsberg CW, Riley K, Floyd JS, Smith NL, Boyko EJ. Mortality among veterans with type 2 diabetes initiating metformin, sulfonylurea or rosiglitazone monotherapy. Diabetologia 2013; 56:1934-43. [PMID: 23797633 DOI: 10.1007/s00125-013-2958-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESES Despite oral hypoglycaemic medications being the most commonly used pharmacological treatments for type 2 diabetes, research is limited on their comparative safety, particularly their effects on overall mortality. We compared mortality risk with monotherapy initiation of four oral hypoglycaemic medications in a nationwide cohort of US veterans with type 2 diabetes. METHODS We identified new users of oral hypoglycaemic medication monotherapy between 2004 and 2009 who received care for at least 1 year from the Veterans Health Administration.Patients were followed until initial monotherapy discontinuation,addition of another diabetes pharmacotherapy, death or end of follow-up. Mortality HRs were estimated using Cox regression adjusted for potential confounding factors. RESULTS Among new users of metformin, sulfonylureas and rosiglitazone (185,360 men, 7,812 women), 4,256 (2.2%) died during follow-up. Average duration of medication use ranged from 1.4 to 1.7 years. Significantly higher mortality risk was seen for glibenclamide (known as glyburide in the USA and Canada) (HR 1.38, 95% CI 1.27, 1.50) or glipizide (HR 1.55,95% CI 1.43, 1.67) compared with metformin monotherapy,and for glipizide compared with rosiglitazone (HR 1.27, 95%CI 1.01, 1.59) or glibenclamide monotherapy (HR 1.12, 95%CI 1.02, 1.23). A significant sex–rosiglitazone interaction was seen (p=0.034) compared with metformin monotherapy, with women having a higher HR (HR 4.36, 95% CI 1.34, 14.20)than men (HR 1.19, 95% CI 0.95, 1.49). CONCLUSIONS/INTERPRETATIONS Significantly higher mortality was associated with glibenclamide, glipizide and rosiglitazone use compared with metformin, and with glipizide use compared with rosiglitazone or glibenclamide. The potential for residual confounding by indication should be considered in interpreting these results.
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Hoit G, Hinkewich C, Tiao J, Porgo V, Moore L, Moore L, Tiao J, Wang C, Moffatt B, Wheeler S, Gillman L, Bartens K, Lysecki P, Pallister I, Patel S, Bradford P, Bradford P, Kidane B, Holmes A, Trajano A, March J, Lyons R, Kao R, Rezende-Neto J, Leblanc Y, Rezende-Neto J, Vogt K, Alzaid S, Jansz G, Andrusiek D, Andrusiek D, Bailey K, Livingston M, Calthorpe S, Hsu J, Lubbert P, Boitano M, Leeper W, Williamson O, Reid S, Alonazi N, Lee C, Rezende-Neto J, Aleassa E, Jennings P, Jennings P, Mador B, Hoffman K, Riley J, Vu E, Alburakan A, Alburakan A, Alburakan A, Mckee J, Bobrovitz N, Gabbe B, Gabbe B, Hodgkinson J, Hodgkinson J, Ali J, Ali J, Grant M, Roberts D, Holodinsky J, Cooper C, Santana M, Kruger K, Hodgkinson J, Waggott M, Da Luz L, Banfield J, Santana M, Dorigatti A, Birn K, Bobrovitz N, Zakirova R, Davies D, Das D, Gamme G, Pervaiz F, Almarhabi Y, Brainard A, Brown R, Bell N, Bell N, Jowett H, Jowett H, Bressan S, Hogan A, Watson I, Woodford S, Hogan A, Boulay R, Watson I, Howlett M, Atkinson P, Chesters A, Hamadani F, Atkinson P, Azzam M, Fraser J, Doucet J, Atkinson P, Muakkassa F, Sathivel N, Chadi S, Joseph B, Takeuchi L, Bradley N, Al Bader B, Kidane B, Harrington A, Nixon K, Veigas P, Joseph B, O’Keeffe T, Bracco D, Rezende-Neto J, Azzam M, Lin Y, Bailey K, Bracco D, Nash N, Alhabboubi M, Slobogean G, Spicer J, Heidary B, Joos E, Berg R, Berg R, Sankarankutty A, Zakrison T, Babul S, Lockhart S, Faux S, Jackson A, Lee T, Bailey K, Pemberton J, Green R, Tallon J, Moore L, Turgeon A, Boutin A, Moore L, Reinartz D, Lapointe G, Turgeon A, Stelfox H, Turgeon A, Nathens A, Neveu X, Stelfox H, Turgeon A, Nathens A, Neveu X, Moore L, Turgeon A, Bratu I, Gladwin C, Voaklander D, Lewis M, Vogt K, Eckert K, Williamson J, Stewart TC, Parry N, Gray D, L’Heureux R, Ziesmann M, Kortbeek J, Brindley P, Hicks C, Fata P, Engels P, Ball C, Paton-Gay D, Widder S, Vogt K, Hernandez-Alejandro R, Gray D, Vanderbeek L, Forrokhyar F, Anatharajah R, Howatt N, Lamb S, Sne N, Kahnamoui K, Lyons R, Walters A, Brooks C, Pinder L, Rahman S, Walters A, Kidane B, Parry N, Donnelly E, Lewell M, Mellow R, Hedges C, Morassutti P, Bulatovic R, Morassutti P, Galbraith E, McKenzie S, Bradford D, Lewell M, Peddle M, Dukelow A, Eby D, McLeod S, Bradford P, Stewart TC, Parry N, Williamson O, Fraga G, Pereira B, Sareen J, Doupe M, Gawaziuk J, Chateau D, Logsetty S, Pallister I, Lewis J, O’Doherty D, Hopkins S, Griffiths S, Palmer S, Gabbe B, Xu X, Martin C, Xenocostas A, Parry N, Mele T, Rui T, Abreu E, Andrade M, Cruz F, Pires R, Carreiro P, Andrade T, Lampron J, Balaa F, Fortuna R, Issa H, Dias P, Marques M, Fernandes T, Sousa T, Inaba K, Smith J, Okoye O, Joos E, Shulman I, Nelson J, Parry N, Rhee P, Demetriades D, Ostrofsky R, Butler-Laporte G, Chughtai T, Khwaja K, Fata P, Mulder D, Razek T, Deckelbaum D, Bailey K, Pemberton J, Evans D, Anton H, Wei J, Randall E, Sobolev B, Scott BB, van Heest R, Frankfurter C, Pemberton J, McKerracher S, Stewart TC, Merritt N, Barber L, Kimmel L, Hodgson C, Webb M, Holland A, Gruen R, Harrison K, Hwang M, Hsee L, Civil I, Muizelaar A, Baillie F, Leeper T, Stewart TC, Gray D, Parry N, Sutherland A, Hart M, Gabbe B, Tuma F, Coates A, Farrokhyar F, Faidi S, Gastaldo F, Paskar D, Reid S, Faidi S, Petrisor B, Bhandari M, Loh WL, Ho C, Chong C, Rodrigues G, Gissoni M, Martins M, Andrade M, Cunha-Melo J, Rizoli S, Abu-Zidan F, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K, Gabbe B, Simpson P, Smith K, Cox S, Cameron P, Evans D, West A, Barratt L, Rozmovits L, Livingstone B, Vu M, Griesdale D, Schlamp R, Wand R, Alhabboubi M, Alrowaili A, Alghamdi H, Fata P, Essbaiheen F, Alhabboubi M, Fata P, Essbaiheen F, Chankowsky J, Razek T, Stephens M, Vis C, Belton K, Kortbeek J, Bratu I, Dufresne B, Guilfoyle J, Ibbotson G, Martin K, Matheson D, Parks P, Thomas L, Kirkpatrick A, Santana M, Kline T, Kortbeek J, Stelfox H, Lyons R, Macey S, Fitzgerald M, Judson R, Cameron P, Sutherland A, Hart M, Morgan M, McLellan S, Wilson K, Cameron P, Sorvari A, Chaudhry Z, Khawaja K, Ali A, Akhtar J, Zubair M, Nickow J, Sorvari A, Holodinsky J, Jaeschke R, Ball C, Blaser AR, Starkopf J, Zygun D, Kirkpatrick A, Roberts D, Ball C, Blaser AR, Starkopf J, Zygun D, Jaeschke R, Kirkpatrick A, Santana M, Stelfox H, Stelfox H, Rizoli S, Tanenbaum B, Stelfox H, Redondano BR, Jimenez LS, Zago T, de Carvalho RB, Calderan TA, Fraga G, Campbell S, Widder S, Paton-Gay D, Engels P, Ferri M, Santana M, Kline T, Kortbeek J, Stelfox H, Nathens A, Lashoher A, McFarlan A, Ahmed N, Booy J, McDowell D, Nasr A, Wales P, Roberts D, Mercado M, Vis C, Kortbeek J, Kirkpatrick A, Lall R, Stelfox H, Ball C, Niven D, Dixon E, Stelfox H, Kirkpatrick A, Kaplan G, Hameed M, Ball C, Qadura M, Sne N, Reid S, Coates A, Faidi S, Veenstra J, Hennecke P, Gardner R, Appleton L, Sobolev B, Simons R, van Heest R, Hameed M, Sobolev B, Simons R, van Heest R, Hameed M, Palmer C, Bevan C, Crameri J, Palmer C, Hogan D, Grealy L, Bevan C, Palmer C, Jowett H, Boulay R, Chisholm A, Beairsto E, Goulette E, Martin M, Benjamin S, Boulay R, Watson I, Boulay R, Watson I, Watson I, Savoie J, Benjamin S, Martin M, Hogan A, Woodford S, Benjamin S, Chisholm A, Ondiveeran H, Martin M, Atkinson P, Doody K, Fraser J, Leblanc-Duchin D, Strack B, Naveed A, vanRensburg L, Madan R, Atkinson P, Boulva K, Deckelbaum D, Khwaja K, Fata P, Razek T, Fraser J, Verheul G, Parks A, Milne J, Nemeth J, Fata P, Correa J, Deckelbaum D, Bernardin B, Al Bader B, Khwaja K, Razek T, Atkinson P, Benjamin S, Sproul E, Mehta A, Galarneau M, Mahadevan P, Bansal V, Dye J, Hollingsworth-Fridlund P, Stout P, Potenza B, Coimbra R, Madan R, Marley R, Salvator A, Pisciotta D, Bridge J, Lin S, Ovens H, Nathens A, Abdo H, Dencev-Bihari R, Parry N, Lawendy A, Ibrahim-Zada I, Pandit V, Tang A, O’Keeffe T, Wynne J, Gries L, Friese R, Rhee P, Hameed M, Simons R, Taulu T, Wong H, Saleem A, Azzam M, Boulva K, Razek T, Khwaja K, Mulder D, Deckelbaum D, Fata P, Plourde M, Chadi S, Forbes T, Parry N, Martin G, Gaunt K, Bandiera G, Bawazeer M, MacKinnon D, Ahmed N, Spence J, Sankarankutty A, Nascimento B, Rizoli S, Ibrahim-Zada I, Aziz H, Tang A, Friese R, Wynne J, O’keeffe T, Vercruysse G, Kulvatunyou N, Rhee P, Sakles J, Mosier J, Wynne J, Kulvatunyou N, Tang A, Joseph B, Rhee P, Khwaja K, Fata P, Deckelbaum D, Razek T, Dias P, Issa H, Fortuna R, Sousa T, Abreu E, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Norman D, Li J, Pemberton J, Al-Oweis J, Khwaja K, Fata P, Deckelbaum D, Razek T, Albuz O, Karamanos E, Vogt K, Okoye O, Talving P, Inaba K, Demetriades D, Elhusseini M, Sudarshan M, Deckelbaum D, Fata P, Razek T, Khwaja K, MacPherson C, Sun T, Pelletier M, Hameed M, Khalil MA, Azzam M, Valenti D, Fata P, Deckelbaum D, Razek T, Brown R, Simons R, Evans D, Hameed M, Inaba K, Vogt K, Okoye O, Gelbard R, Moe D, Grabo D, Demetriades D, Inaba K, Karamanos E, Okoye O, Talving P, Demetriades D, Inaba K, Karamanos E, Pasley J, Teixeira P, Talving P, Demetriades D, Fung S, Alababtain I, Brnjac E, Luz L, Nascimento B, Rizoli S, Parikh P, Proctor K, Murtha M, Schulman C, Namias N, Goldman R, Pike I, Korn P, Flett C, Jackson T, Keith J, Joseph T, Giddins E, Ouellet J, Cook M, Schreiber M, Kortbeek J. Trauma Association of Canada (TAC) Annual Scientific Meeting. The Westin Whistler Resort & Spa, Whistler, BC, Thursday, Apr. 11 to Saturday, Apr. 13, 2013Testing the reliability of tools for pediatric trauma teamwork evaluation in a North American high-resource simulation settingThe association of etomidate with mortality in trauma patientsDefinition of isolated hip fractures as an exclusion criterion in trauma centre performance evaluations: a systematic reviewEstimation of acute care hospitalization costs for trauma hospital performance evaluation: a systematic reviewHospital length of stay following admission for traumatic injury in Canada: a multicentre cohort studyPredictors of hospital length of stay following traumatic injury: a multicentre cohort studyInfluence of the heterogeneity in definitions of an isolated hip fracture used as an exclusion criterion in trauma centre performance evaluations: a multicentre cohort studyPediatric trauma, advocacy skills and medical studentsCompliance with the prescribed packed red blood cell, fresh frozen plasma and platelet ratio for the trauma transfusion pathway at a level 1 trauma centreEarly fixed-wing aircraft activation for major trauma in remote areasDevelopment of a national, multi-disciplinary trauma crisis resource management curriculum: results from the pilot courseThe management of blunt hepatic trauma in the age of angioembolization: a single centre experienceEarly predictors of in-hospital mortality in adult trauma patientsThe impact of open tibial fracture on health service utilization in the year preceding and following injuryA systematic review and meta-analysis of the efficacy of red blood cell transfusion in the trauma populationSources of support for paramedics managing work-related stress in a Canadian EMS service responding to multisystem trauma patientsAnalysis of prehospital treatment of pain in the multisystem trauma patient at a community level 2 trauma centreIncreased mortality associated with placement of central lines during trauma resuscitationChronic pain after serious injury — identifying high risk patientsEpidemiology of in-hospital trauma deaths in a Brazilian university teaching hospitalIncreased suicidality following major trauma: a population-based studyDevelopment of a population-wide record linkage system to support trauma researchInduction of hmgb1 by increased gut permeability mediates acute lung injury in a hemorrhagic shock and resuscitation mouse modelPatients who sustain gunshot pelvic fractures are at increased risk for deep abscess formation: aggravated by rectal injuryAre we transfusing more with conservative management of isolated blunt splenic injury? A retrospective studyMotorcycle clothesline injury prevention: Experimental test of a protective deviceA prospective analysis of compliance with a massive transfusion protocol - activation alone is not enoughAn evaluation of diagnostic modalities in penetrating injuries to the cardiac box: Is there a role for routine echocardiography in the setting of negative pericardial FAST?Achievement of pediatric national quality indicators — an institutional report cardProcess mapping trauma care in 2 regional health authorities in British Columbia: a tool to assist trauma sys tem design and evaluationPatient safety checklist for emergency intubation: a systematic reviewA standardized flow sheet improves pediatric trauma documentationMassive transfusion in pediatric trauma: a 5-year retrospective reviewIs more better: Does a more intensive physiotherapy program result in accelerated recovery for trauma patients?Trauma care: not just for surgeons. Initial impact of implementing a dedicated multidisciplinary trauma team on severely injured patientsThe role of postmortem autopsy in modern trauma care: Do we still need them?Prototype cervical spine traction device for reduction stabilization and transport of nondistraction type cervical spine injuriesGoing beyond organ preservation: a 12-year review of the beneficial effects of a nonoperative management algorithm for splenic traumaAssessing the construct validity of a global disability measure in adult trauma registry patientsThe mactrauma TTL assessment tool: developing a novel tool for assessing performance of trauma traineesA quality improvement approach to developing a standardized reporting format of ct findings in blunt splenic injuriesOutcomes in geriatric trauma: what really mattersFresh whole blood is not better than component therapy (FFP:RBC) in hemorrhagic shock: a thromboelastometric study in a small animal modelFactors affecting mortality of chest trauma patients: a prospective studyLong-term pain prevalence and health related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomized controlled trialDescribing pain following trauma: predictors of persistent pain and pain prevalenceManagement strategies for hemorrhage due to pelvic trauma: a survey of Canadian general surgeonsMajor trauma follow-up clinic: Patient perception of recovery following severe traumaLost opportunities to enhance trauma practice: culture of interprofessional education and sharing among emergency staffPrehospital airway management in major trauma and traumatic brain injury by critical care paramedicsImproving patient selection for angiography and identifying risk of rebleeding after angioembolization in the nonoperative management of high grade splenic injuriesFactors predicting the need for angioembolization in solid organ injuryProthrombin complex concentrates use in traumatic brain injury patients on oral anticoagulants is effective despite underutilizationThe right treatment at the right time in the right place: early results and associations from the introduction of an all-inclusive provincial trauma care systemA multicentre study of patient experiences with acute and postacute injury carePopulation burden of major trauma: Has introduction of an organized trauma system made a difference?Long-term functional and return to work outcomes following blunt major trauma in Victoria, AustraliaSurgical dilemma in major burns victim: heterotopic ossification of the tempromandibular jointWhich radiological modality to choose in a unique penetrating neck injury: a differing opinionThe Advanced Trauma Life Support (ATLS) program in CanadaThe Rural Trauma Team Development Course (RTTDC) in Pakistan: Is there a role?Novel deployment of BC mobile medical unit for coverage of BMX world cup sporting eventIncidence and prevalence of intra-abdominal hypertension and abdominal compartment syndrome in critically ill adults: a systematic review and meta-analysisRisk factors for intra-abdominal hypertension and abdominal compartment syndrome in critically ill or injured adults: a systematic review and meta-analysisA comparison of quality improvement practices at adult and pediatric trauma centresInternational trauma centre survey to evaluate content validity, usability and feasibility of quality indicatorsLong-term functional recovery following decompressive craniectomy for severe traumatic brain injuryMorbidity and mortality associated with free falls from a height among teenage patients: a 5-year review from a level 1 trauma centreA comparison of adverse events between trauma patients and general surgery patients in a level 1 trauma centreProcoagulation, anticoagulation and fibrinolysis in severely bleeding trauma patients: a laboratorial characterization of the early trauma coagulopathyThe use of mobile technology to facilitate surveillance and improve injury outcome in sport and physical activityIntegrated knowledge translation for injury quality improvement: a partnership between researchers and knowledge usersThe impact of a prevention project in trauma with young and their learningIntraosseus vascular access in adult trauma patients: a systematic reviewThematic analysis of patient reported experiences with acute and post-acute injury careAn evaluation of a world health organization trauma care checklist quality improvement pilot programProspective validation of the modified pediatric trauma triage toolThe 16-year evolution of a Canadian level 1 trauma centre: growing up, growing out, and the impact of a booming economyA 20-year review of trauma related literature: What have we done and where are we going?Management of traumatic flail chest: a systematic review of the literatureOperative versus nonoperative management of flail chestEmergency department performance of a clinically indicated and technically successful emergency department thoracotomy and pericardiotomy with minimal equipment in a New Zealand institution without specialized surgical backupBritish Columbia’s mobile medical unit — an emergency health care support resourceRoutine versus ad hoc screening for acute stress: Who would benefit and what are the opportunities for trauma care?A geographical analysis of the Early Development Instrument (EDI) and childhood injuryDevelopment of a pediatric spinal cord injury nursing course“Kids die in driveways” — an injury prevention campaignEpidemiology of traumatic spine injuries in childrenA collaborative approach to reducing injuries in New Brunswick: acute care and injury preventionImpact of changes to a provincial field trauma triage tool in New BrunswickEnsuring quality of field trauma triage in New BrunswickBenefits of a provincial trauma transfer referral system: beyond the numbersThe field trauma triage landscape in New BrunswickImpact of the Rural Trauma Team Development Course (RTTDC) on trauma transfer intervals in a provincial, inclusive trauma systemTrauma and stress: a critical dynamics study of burnout in trauma centre healthcare professionalsUltrasound-guided pediatric forearm fracture reduction with sedation in the emergency departmentBlock first, opiates later? The use of the fascia iliaca block for patients with hip fractures in the emergency department: a systematic reviewRural trauma systems — demographic and survival analysis of remote traumas transferred from northern QuebecSimulation in trauma ultrasound trainingIncidence of clinically significant intra-abdominal injuries in stable blunt trauma patientsWake up: head injury management around the clockDamage control laparotomy for combat casualties in forward surgical facilitiesDetection of soft tissue foreign bodies by nurse practitioner performed ultrasoundAntihypertensive medications and walking devices are associated with falls from standingThe transfer process: perspectives of transferring physiciansDevelopment of a rodent model for the study of abdominal compartment syndromeClinical efficacy of routine repeat head computed tomography in pediatric traumatic brain injuryEarly warning scores (EWS) in trauma: assessing the “effectiveness” of interventions by a rural ground transport service in the interior of British ColumbiaAccuracy of trauma patient transfer documentation in BCPostoperative echocardiogram after penetrating cardiac injuries: a retrospective studyLoss to follow-up in trauma studies comparing operative methods: a systematic reviewWhat matters where and to whom: a survey of experts on the Canadian pediatric trauma systemA quality initiative to enhance pain management for trauma patients: baseline attitudes of practitionersComparison of rotational thromboelastometry (ROTEM) values in massive and nonmassive transfusion patientsMild traumatic brain injury defined by GCS: Is it really mild?The CMAC videolaryngosocpe is superior to the glidescope for the intubation of trauma patients: a prospective analysisInjury patterns and outcome of urban versus suburban major traumaA cost-effective, readily accessible technique for progressive abdominal closureEvolution and impact of the use of pan-CT scan in a tertiary urban trauma centre: a 4-year auditAdditional and repeated CT scan in interfacilities trauma transfers: room for standardizationPediatric trauma in situ simulation facilitates identification and resolution of system issuesHospital code orange plan: there’s an app for thatDiaphragmatic rupture from blunt trauma: an NTDB studyEarly closure of open abdomen using component separation techniqueSurgical fixation versus nonoperative management of flail chest: a meta-analysisIntegration of intraoperative angiography as part of damage control surgery in major traumaMass casualty preparedness of regional trauma systems: recommendations for an evaluative frameworkDiagnostic peritoneal aspirate: An obsolete diagnostic modality?Blunt hollow viscus injury: the frequency and consequences of delayed diagnosis in the era of selective nonoperative managementEnding “double jeopardy:” the diagnostic impact of cardiac ultrasound and chest radiography on operative sequencing in penetrating thoracoabdominal traumaAre trauma patients with hyperfibrinolysis diagnosed by rotem salvageable?The risk of cardiac injury after penetrating thoracic trauma: Which is the better predictor, hemodynamic status or pericardial window?The online Concussion Awareness Training Toolkit for health practitioners (CATT): a new resource for recognizing, treating, and managing concussionThe prevention of concussion and brain injury in child and youth team sportsRandomized controlled trial of an early rehabilitation intervention to improve return to work Rates following road traumaPhone call follow-upPericardiocentesis in trauma: a systematic review. Can J Surg 2013. [DOI: 10.1503/cjs.005813] [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: 11/01/2022] Open
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Paoletti L, Reifsnider O, Wheeler S, Carpenter M, Nietert P, Mayorga M, Silvestri G. Utilizing a Computer Predictive Model to Evaluate Cost-effectiveness of Smoking Cessation Interventions and Smoking Related Illnesses. Chest 2011. [DOI: 10.1378/chest.1113245] [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: 11/01/2022] Open
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Smith CS, Francovich C, Morris M, Hill W, Langlois-Winkle F, Rupper R, Roth C, Wheeler S, Vo A. Toward an ecological perspective of resident teaching clinic. Adv Health Sci Educ Theory Pract 2010; 15:771-778. [PMID: 18766451 DOI: 10.1007/s10459-008-9134-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 08/05/2008] [Indexed: 05/26/2023]
Abstract
Teaching clinic managers struggle to convert performance data into meaningful behavioral change in their trainees, and quality improvement measures in medicine have had modest results. This may be due to several factors including clinical performance being based more on team function than individual action, models of best practice that are over-simplified for real patients with multiple chronic diseases, and local features that influence behavior but are not aligned with core values. Many are looking for a new conceptual structure to guide them. In this paper we briefly review several theories of action from the social and complexity sciences, and synthesize these into a coherent 'ecological perspective'. This perspective focuses on stabilizing features and narrative, which select for behaviors in clinic much like organisms are selected for in an ecosystem. We have found this perspective to be a useful guide for design, measurement, and joint learning in the teaching clinic.
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Wheeler S, Bowen JD, Maynard C, Lowy E, Sun H, Sales AE, Smith NL, Fihn SD. Women Veterans and Outcomes after Acute Myocardial Infarction. J Womens Health (Larchmt) 2009; 18:613-8. [DOI: 10.1089/jwh.2008.1073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephanie Wheeler
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
| | - Jennie D. Bowen
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
| | - Charles Maynard
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
- Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Elliot Lowy
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
| | - Haili Sun
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
| | - Anne E. Sales
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
| | - Nicholas L. Smith
- Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Stephan D. Fihn
- VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, Washington
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Guzman R, Buchbinder S, Mansergh G, Vittinghoff E, Marks G, Wheeler S, Colfax GN. Communication of HIV viral load to guide sexual risk decisions with serodiscordant partners among San Francisco men who have sex with men. AIDS Care 2007; 18:983-9. [PMID: 17012089 DOI: 10.1080/09540120500497908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to estimate frequency and correlates of discussing HIV viral load (VL) with serodiscordant sex partners to guide decisions about sexual activities among men who have sex with men (MSM). We conducted a cross-sectional survey of 573 San Francisco MSM. Among 507 who knew their HIV status, 397 (78%) were familiar with the term 'viral load', and half (n=199) had a serodiscordant partner in the prior year. These 199 respondents (n=130 [65%] HIV-positive; n=69 [35%] HIV-negative) were the focus of this analysis. A majority (n=111, 56%) discussed VL in the prior year with serodiscordant partners specifically to guide decisions about sexual risk behaviour. Discussion was more common among HIV-positive than HIV-negative participants (adjusted odds ratio [AOR], 3.5; 95% confidence interval [CI], 1.6-7.6), and African Americans compared to whites (AOR, 3.7; 95% CI, 1.5-9.5). HIV-negative men who discussed VL were more concerned about becoming infected, but also more willing to engage in risky behaviour with a partner whose VL is undetectable, than men not discussing VL. Some HIV-negative men may be discussing VL to engage in higher risk behaviour upon learning of an HIV-positive partner's undetectable VL. Interventions targeting MSM should explain that while risk of transmission is likely reduced with a low blood plasma VL, it is not necessarily eliminated.
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Affiliation(s)
- R Guzman
- AIDS Office, San Francisco Department of Public Health, San Francisco, CA 94102, USA.
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Smith CS, Morris M, Hill W, Francovich C, McMullin J, Christiano J, Chavez L, Roth C, Vo A, Wheeler S, Milne C. Testing the exportability of a tool for detecting operational problems in VA teaching clinics. J Gen Intern Med 2006; 21:152-7. [PMID: 16390510 PMCID: PMC1484646 DOI: 10.1111/j.1525-1497.2006.00313.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE This study tests the exportability of a unique CCA tool to identify site-specific operational problems at 5 different VA teaching clinics. DESIGN We used the CCA tool at 5 teaching clinics to identify group preference differences between the above groups. We averaged the CCA results for all 5 sites. We compared each site with the averages in order to isolate each site's most anomalous responses. Major operational problems were independently identified by workgroups at each site. Cultural consensus analysis performance was then evaluated by comparison with workgroup results. PARTICIPANTS Twenty patients, 10 residents, 10 faculty, members, and 10 administrators at each site completed the CCA. Workgroups included at minimum: a patient, resident, faculty member, nurse, and receptionist or clinic administrator. APPROACH Cultural consensus analysis was performed at each site. Problems were identified by multidisciplinary workgroups, prioritized by anonymous multivoting, and confirmed by limited field observations and interviews. Cultural consensus analysis results were compared with workgroup results. RESULTS The CCA detected systematic, group-specific preference differences at each site. These were moderately to strongly associated with the problems independently identified by the workgroups. The CCA proved to be a useful tool for exploring the problems in depth and for detecting previously unrecognized problems. CONCLUSIONS This CCA worked in multiple VA sites. It may be adapted to work in other settings or to better detect other clinic problems.
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Affiliation(s)
- C Scott Smith
- NW Regional Faculty Development Center, VAMC, Boise, ID 83702, USA.
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