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Khanom A, Evans BA, Alanazy W, Couzens L, Fagan L, Fogarty R, John A, Khan T, Kingston MR, Moyo S, Porter A, Richardson G, Rungua G, Williams V, Snooks H. Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary. Health Expect 2024; 27:e14061. [PMID: 38678592 PMCID: PMC11056205 DOI: 10.1111/hex.14061] [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: 05/14/2023] [Revised: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. AIM This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. DESIGN A qualitative study was carried out using semi-structured telephone interviews. SETTING This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). METHOD We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. RESULTS Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. CONCLUSION Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. PATIENT OR PUBLIC CONTRIBUTION The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.
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Affiliation(s)
| | - Bridie A. Evans
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | | | - Ann John
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Mark R. Kingston
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | - Alison Porter
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
| | | | | | | | - Helen Snooks
- Swansea University Medical School, ILS 2Swansea UniversitySwanseaUK
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2
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Leal Rato M, Chen B, Francis A, Messina S, Miron M, Sharawakanda Y, O'Sullivan E, Cooper S, Fisniku L, Halfpenny C, Martin R, Hobart J, Rashid W, Hemingway C, Williams V, Hacohen Y, Dobson R, Ramdas S, Leite MI, Palace J, Geraldes R. A study of referral bias in NMOSD and MOGAD cohorts. Mult Scler Relat Disord 2024; 85:105553. [PMID: 38552551 DOI: 10.1016/j.msard.2024.105553] [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: 09/21/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare disorders often seen in highly specialized services or tertiary centres. We aimed to assess if cohort characteristics depend on the origin of the referral catchment areas serviced by our centre (i.e. local, regional or national). METHODS Retrospective cohort study using a national referral service database including local (Oxfordshire), regional (Oxfordshire and neighbouring counties), and national patients. We included patients with the diagnosis of NMOSD, seronegative NMOSD or MOGAD, followed at the Oxford Neuromyelitis Optica Service. RESULTS We included 720 patients (331 with MOGAD, 333 with aquaporin-4 antibody (AQP4)-NMOSD, and 56 with seronegative NMOSD. The distribution of diagnoses was similar across referral cohorts. There were no significant differences in the proportion of pediatric onset patients, sex, or onset phenotype; more White AQP4-NMOSD patients were present in the local than in the national cohort (81 % vs 52 %). Despite no differences in follow-up time, more relapsing MOGAD disease was present in the national than in the local cohort (42.9 % vs. 24 %, p = 0.029). CONCLUSION This is the first study assessing the impact of potential referral bias in cohorts of NMOSD or MOGAD. The racial difference in the AQP4-NMOSD cohorts likely reflects the variation in the population demographics rather than a referral bias. The over representation of relapsing MOGAD patients in the national cohort probably is a true referral bias and highlights the need to analyze incident cohorts when describing disease course and prognosis. It seems reasonable therefore to compare MOGAD and NMOSD patients seen withing specialised centres to general neurology services, provided both use similar antibody assays.
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Affiliation(s)
- Miguel Leal Rato
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Bo Chen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK; Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Anna Francis
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Madalina Miron
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Yvonne Sharawakanda
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | | | | | - Leonora Fisniku
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Roswell Martin
- Gloucestershire Royal Hospitals NHS Trust, Gloucester, UK
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Waqar Rashid
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital, London, UK
| | - Victoria Williams
- Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Yael Hacohen
- Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University London, UK
| | - Sithara Ramdas
- Department of Paediatric Neurology, Children's Hospital, John Radcliffe Hospital, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford OX3 9DU, UK.
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Giardina E, Camaño P, Burton-Jones S, Ravenscroft G, Henning F, Magdinier F, van der Stoep N, van der Vliet PJ, Bernard R, Tomaselli PJ, Davis MR, Nishino I, Oflazer P, Race V, Vishnu VY, Williams V, Sobreira CFR, van der Maarel SM, Moore SA, Voermans NC, Lemmers RJLF. Best practice guidelines on genetic diagnostics of facioscapulohumeral muscular dystrophy: Update of the 2012 guidelines. Clin Genet 2024. [PMID: 38685133 DOI: 10.1111/cge.14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
The gold standard for facioscapulohumeral muscular dystrophy (FSHD) genetic diagnostic procedures was published in 2012. With the increasing complexity of the genetics of FSHD1 and 2, the increase of genetic testing centers, and the start of clinical trials for FSHD, it is crucial to provide an update on our knowledge of the genetic features of the FSHD loci and renew the international consensus on the molecular testing recommendations. To this end, members of the FSHD European Trial Network summarized the evidence presented during the 2022 ENMC meeting on Genetic diagnosis, clinical outcome measures, and biomarkers. The working group additionally invited genetic and clinical experts from the USA, India, Japan, Australia, South-Africa, and Brazil to provide a global perspective. Six virtual meetings were organized to reach consensus on the minimal requirements for genetic confirmation of FSHD1 and FSHD2. Here, we present the clinical and genetic features of FSHD, specific features of FSHD1 and FSHD2, pros and cons of established and new technologies (Southern blot in combination with either linear or pulsed-field gel electrophoresis, molecular combing, optical genome mapping, FSHD2 methylation analysis and FSHD2 genotyping), the possibilities and challenges of prenatal testing, including pre-implantation genetic testing, and the minimal requirements and recommendations for genetic confirmation of FSHD1 and FSHD2. This consensus is expected to contribute to current clinical management and trial-readiness for FSHD.
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Affiliation(s)
- Emiliano Giardina
- Genomic Medicine Laboratory UILDM, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Biomedicine & Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Pilar Camaño
- Molecular Diagnostics Platform, Biogipuzkoa Health Research Institute, Hospital Universitario Donostia, San Sebastián, Spain
- CIBERNED, CIBER, Spanish Ministry of Science & Innovation, Carlos III Health Institute, Madrid, Spain
| | | | - Gina Ravenscroft
- Harry Perkins Institute of Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Franclo Henning
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Nienke van der Stoep
- Department of Clinical Genetics, Leiden University Medical Center, The Netherlands
| | | | - Rafaëlle Bernard
- Aix Marseille Univ, INSERM, Marseille Medical Genetics, Marseille, France
- Centre Hospitalier Universitaire Timone Adultes, Biogénopôle, Service de Génétique Médicale, Marseille, France
| | - Pedro J Tomaselli
- Department of Neurosciences, Division of Neurology, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Mark R Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Genome Medicine Development, Clinical Genome Analysis, Medical Genome Center (MGC), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Piraye Oflazer
- Department of Neurology, Koç University Hospital Muscle Center, Koç University Medical Faculty, Istanbul, Turkey
| | - Valerie Race
- Clinical Laboratory Geneticist, Human Genetics, UZ Leuven, Leuven, Belgium
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Delhi, India
| | | | - Cláudia F R Sobreira
- Department of Neurosciences, Division of Neurology, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Steve A Moore
- Senator Paul D. Wellstone Muscular Dystrophy Specialized Research Center, Department of Pathology, Roy J. And Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Nicol C Voermans
- Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
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Black BJ, Ghazal RE, Lojek N, Williams V, Rajput JS, Lawson JM. Phenotypic Screening of Prospective Analgesics Among FDA-Approved Compounds using an iPSC-Based Model of Acute and Chronic Inflammatory Nociception. Adv Sci (Weinh) 2024; 11:e2303724. [PMID: 38189546 PMCID: PMC10953557 DOI: 10.1002/advs.202303724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/26/2023] [Indexed: 01/09/2024]
Abstract
Classical target-based drug screening is low-throughput, largely subjective, and costly. Phenotypic screening based on in vitro models is increasingly being used to identify candidate compounds that modulate complex cell/tissue functions. Chronic inflammatory nociception, and subsequent chronic pain conditions, affect peripheral sensory neuron activity (e.g., firing of action potentials) through myriad pathways, and remain unaddressed in regard to effective, non-addictive management/treatment options. Here, a chronic inflammatory nociception model is demonstrated based on induced pluripotent stem cell (iPSC) sensory neurons and glia, co-cultured on microelectrode arrays (MEAs). iPSC sensory co-cultures exhibit coordinated spontaneous extracellular action potential (EAP) firing, reaching a stable baseline after ≈27 days in vitro (DIV). Spontaneous and evoked EAP metrics are significantly modulated by 24-h incubation with tumor necrosis factor-alpha (TNF-α), representing an inflammatory phenotype. Compared with positive controls (lidocaine), this model is identified as an "excellent" stand-alone assay based on a modified Z' assay quality metric. This model is then used to screen 15 cherry-picked, off-label, Food and Drug Administration (FDA)-approved compounds; 10 of 15 are identified as "hits". Both hits and "misses" are discussed in turn. In total, this data suggests that iPSC sensory co-cultures on MEAs may represent a moderate-to-high-throughput assay for drug discovery targeting inflammatory nociception.
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Affiliation(s)
- Bryan James Black
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Rasha El Ghazal
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Neal Lojek
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Victoria Williams
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Jai Singh Rajput
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
| | - Jennifer M. Lawson
- Department of Biomedical EngineeringFrancis College of EngineeringUniversity of Massachusetts LowellLowellMA01854USA
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5
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Sewell B, Farr A, Akbari A, Carson-Stevens A, Dale J, Edwards A, Evans BA, John A, Torabi F, Jolles S, Kingston M, Lyons J, Lyons RA, Porter A, Watkins A, Williams V, Snooks H. The cost of implementing the COVID-19 shielding policy in Wales. BMC Public Health 2023; 23:2342. [PMID: 38008730 PMCID: PMC10680245 DOI: 10.1186/s12889-023-17169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. METHODS The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales). RESULTS At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person. CONCLUSION This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Angela Farr
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Bridie Angela Evans
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ann John
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Mark Kingston
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Jane Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alison Porter
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alan Watkins
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Victoria Williams
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Helen Snooks
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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6
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Reeves SM, Williams V, Blacker D, Woods RL. Further evaluation of narrative description as a measure of cognitive function in Alzheimer's disease. Neuropsychology 2023; 37:801-812. [PMID: 36548079 PMCID: PMC10448628 DOI: 10.1037/neu0000884] [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: 08/26/2023] Open
Abstract
OBJECTIVE The narrative description (ND) test objectively measures the ability to understand and describe visual scenes. As subtle differences in speech occur early in cognitive decline, we analyzed linguistic features for their utility in detecting cognitive impairment and predicting downstream decline. METHOD Participants (n = 52) with normal cognition to mild dementia performed the ND test (watched twenty 30-s video clips and described the visual content). Cognitive function was followed for up to 5 years. We computed simple linguistic features such as content efficiency, speech rate, and part of speech and unique word counts. We examined (a) relationships between cognitive status and ND score and linguistic features; (b) ability to discriminate early cognitive impairment from normal cognition using ND score and linguistic features; and (c) whether ND score and linguistic features were associated with future cognitive functional decline. RESULTS Many of the linguistic-feature metrics were related to cognitive status. Many of the linguistic features could distinguish between the cognitively normal group and the mild cognitive impairment (MCI) and Dementia groups. The area under the curve (AUC) for ND score alone was 0.74, with a nonsignificant increase to 0.78 when adding mean word length. Among participants with subjective cognitive decline (SCD) at the first visit, a smaller number of words plus more interjections or a lower ND score at baseline were predictive of future cognitive decline. CONCLUSIONS While many linguistic features were associated with cognitive status, and some were able to detect early cognitive impairment or predictive of future cognitive decline, all the features we tested seem to have been captured by the ND score. Thus, adding linguistic measures to the ND test score did not add to its value in assessing current or predicting future cognitive status. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Stephanie M Reeves
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Victoria Williams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Russell L Woods
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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7
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Corrigendum to "Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in wales? Results of EVITE immunity, a linked data retrospective study" [Public Health 218 (2023) 12-20]. Public Health 2023; 222:229. [PMID: 37463828 PMCID: PMC11021201 DOI: 10.1016/j.puhe.2023.06.001] [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: 07/20/2023]
Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - J Dale
- The University of Warwick, Medical School, Coventry CV4 7AL, UK
| | - A Edwards
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, SA2 8PP, Swansea, UK
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
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Chen B, Gomez-Figueroa E, Redenbaugh V, Francis A, Satukijchai C, Wu Y, Messina S, Sa M, Woodhall M, Paul F, Robertson NP, Lim M, Wassmer E, Kneen R, Huda S, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin RJ, Dobson R, Cooper SA, Williams V, Waters P, Chen JJ, Pittock SJ, Ramdas S, Leite MI, Flanagan EP, Geraldes R, Palace J. Do Early Relapses Predict the Risk of Long-Term Relapsing Disease in an Adult and Paediatric Cohort with MOGAD? Ann Neurol 2023; 94:508-517. [PMID: 37394961 DOI: 10.1002/ana.26731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD. METHODS A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. "Early relapses" were defined as attacks within the first 12 months from onset, with "very early relapses" defined within 30 to 90 days from onset and "delayed early relapses" defined within 90 to 365 days. "Long-term relapses" were defined as relapses beyond 12 months. Cox regression modeling and Kaplan-Meier survival analysis were used to estimate the long-term relapse risk and rate. RESULTS Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any "early relapses" were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026). INTERPRETATION The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508-517.
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Affiliation(s)
- Bo Chen
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Enrique Gomez-Figueroa
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Mexico
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Anna Francis
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | | | - Yan Wu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Mario Sa
- Department of Paediatric Neurology, Oxford University NHS Foundation Trust, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Neil P Robertson
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Ming Lim
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK
- Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Evangeline Wassmer
- Women and Children's Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Kneen
- Department of Paediatric Neurology, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Saif Huda
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Camilla Blain
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher Halfpenny
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Southampton General Hospital, Southampton, UK
| | - Eoin O'Sullivan
- Department of Paediatric Neurology, Great Ormond St. Hospital for Children, London, UK
| | - Jeremy Hobart
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Leonora K Fisniku
- Department of Neurology, University Hospitals Plymouth National Health Service Foundation Trust, Devon, UK
| | - Roswell J Martin
- Department of Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Dobson
- Department of Neurology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | - Sarah A Cooper
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Victoria Williams
- Department of Neurology, University Hospitals Sussex National Health Service Foundation Trust, Brighton, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John J Chen
- Department of Neurology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Sean J Pittock
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN
| | - Sithara Ramdas
- Centre MS and Autoimmune Neurology, Department Neurology, Mayo Clinic, Rochester, MN
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Eoin P Flanagan
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health 2023; 218:12-20. [PMID: 36933354 PMCID: PMC9928733 DOI: 10.1016/j.puhe.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - A Edwards
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK.
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
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Wade T, Roberts N, Ban JW, Waweru-Siika W, Winston H, Williams V, Heneghan CJ, Onakpoya IJ. Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews. J Hosp Infect 2023; 131:43-53. [PMID: 36130626 DOI: 10.1016/j.jhin.2022.09.008] [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: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). OBJECTIVE A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. METHODS Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. RESULTS Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. CONCLUSION Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - J-W Ban
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - W Waweru-Siika
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - H Winston
- Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, Ontario, Canada
| | - C J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - I J Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Tan C, Linkenheld-Struk A, Williams V, Kozak R, Dhabaan G, Maze dit Mieusement L, Salt N, Maguire F, Chan AK, Leis JA. The role of the environment in transmission of vancomycin-resistant Enterococcus: A proof-of-concept study. Antimicrob Steward Healthc Epidemiol 2022; 2:e178. [PMID: 36386008 PMCID: PMC9641505 DOI: 10.1017/ash.2022.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Charlie Tan
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Rob Kozak
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ghulam Dhabaan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Finlay Maguire
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrienne K. Chan
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A. Leis
- Division of Infectious Diseases, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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12
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Normanno N, Apostolidis K, Wolf A, Al Dieri R, Deans Z, Fairley J, Maas J, Martinez A, Moch H, Nielsen S, Pilz T, Rouleau E, Patton S, Williams V. Access and quality of biomarker testing for precision oncology in Europe. Eur J Cancer 2022; 176:70-77. [PMID: 36194905 DOI: 10.1016/j.ejca.2022.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 07/18/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Predictive biomarkers are essential for selecting the best therapeutic strategy in patients with cancer. The International Quality Network for Pathology, the European Cancer Patient Coalition and the European Federation of Pharmaceuticals Industries and Associations evaluated the access to and quality of biomarker testing across Europe. METHODS Data sources included surveys of 141 laboratory managers and 1.665 patients, and 58 in-depth interviews with laboratory managers, physicians and payers. Four access metrics (laboratory access, test availability, test reimbursement, test order rate) and three quality metrics (quality scheme participation, laboratory accreditation, test turnaround time) were applied to rank the results. RESULTS The access to precision medicines is higher in countries with public national reimbursement processes in place. Lack of diagnostic laboratory infrastructure, inefficient organization and/or insufficient public reimbursement narrow the access to single biomarker tests in many European countries. In countries with limited public reimbursement, pharma and patients' out of pocket were the primary funding sources for testing. Uptake of multi-biomarker next generation sequencing (NGS) is highly varied, ranging from 0% to >50%. Financial constraints, a lack of NGS testing capabilities and the failure to include NGS testing in the guidelines represent the main barriers to NGS implementation. The quality of biomarker testing is highest in Western and Northern Europe, with more than 90% of laboratories participating in quality assurance schemes. CONCLUSIONS Our data clearly indicate the need for a call to action to ensure the clinical implementation of precision medicine in Europe.
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Affiliation(s)
- Nicola Normanno
- Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
| | | | | | - Raed Al Dieri
- European Society of Pathology (ESP), Brussels, Belgium
| | | | | | - Jörg Maas
- Deutsche Gesellschaft für Pathologie E.V. (DGP), Berlin, Germany
| | | | - Holger Moch
- University Hospital and University, Zurich, Switzerland
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Heller S, Sanna G, Williams V. 004 Dermato myo myelitis: a case of concurrent anti-synthetase syndrome and NMOSD. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 50 year old Afro-Caribbean gentleman with a background of Ro52 and MDA5 antibody positive anti- synthetase syndrome on prednisolone and mycophenolate mofetil presented with a tight band like pain around his thorax and abdominal pain. Examination identified severe dysaesthesia with a T6 spinal level, as well as lower limb and truncal weakness. MRI showed an expansile T2 hyperintense lesion from C7 to T8 with patchy enhancement in keeping with a NMOSD. He had no optic nerve involvement, confirmed by OCT. The weakness and dysaesthesia responded rapidly to high dose methylprednisolone however he developed constipation, recurrent neuropathic pain and tonic spasms. Serum AQP4 antibodies were present. At presentation serum CK was also raised.Up to 25% of patients with NMOSD have co-existing autoimmunity. However, there are very few reports of anti-synthetase syndrome and NMOSD. Ro-antibodies are well documented in studies on Sjögren’s disease and transverse myelitis. Patients with autoimmune connective tissue diseases who develop neurological symptoms should be investigated for neurological autoantibodies too as they are at risk of multiple autoimmune disorders. Furthermore, neurologists should be observant to other systems when presented with a patient with NMOSD as they may have other diseases which are currently asymptomatic or minimally symptomatic.
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Porter A, Bell F, Brady M, Brown S, Carson-Stevens A, Duncan E, England L, Evans B, Foster T, Gallanders J, Gunson I, Harrington B, Harris-Mayes R, Kingston M, Lyons R, Miller E, Newton A, Quinn T, Rosser A, Siriwardena N, Snooks H, Spaight R, Watkins A, Williams V. PP45 ‘Every day was a learning curve’: the experience of implementing COVID-19 triage protocols in UK ambulance services – a qualitative study. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTRIM is an evaluation of the models used to triage and manage emergency ambulance service care for patients with suspected Covid-19 during the first wave of the pandemic in 2020. We aimed to understand experiences and concerns of clinical and managerial staff about implementation of triage protocols in call centre and on-scene.MethodsResearch paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and ED clinical staff from one hospital per site. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from the implicit and explicit ideas within participants’ accounts, following the six stages of analysis described by Braun and Clarke, conducted by a group of researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updates several times a dayThe ambulance service as part of the wider healthcare system - changes in other parts of the healthcare system left ambulance services as the default optionPeaks and troughs of demand - demand fluctuated greatly over time, with workload varying across the ambulance service, including an increased role for clinical advisorsA stretched system - resources to respond to patient demand were stretched thinner by staff sickness and isolation, longer job times, and increased handover delays at EDEmotional load of responding to the pandemic - particularly for call centre staffDoing the best they can in the face of uncertainty - in the face of a rapidly evolving situation unlike any which ambulance services had faced beforeDiscussionImplementing triage protocols in response to the Covid-19 pandemic was a complex and process which had to be actively managed by a range of front line staff, dealing with external pressures and a heavy emotional load.
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Walker J, Farag M, Josephs D, Williams V, Holmes P. 011 A case of a neurological immune-related adverse event associated with ipilimumab/nivolumab. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractWe present an unusual movement disorder due to immune checkpoint inhibitors which responded rapidly to prednisolone.BackgroundImmune checkpoint inhibitors (ICIs) have revolutionised the scope of cancer therapy but can induce autoimmune effects on healthy organs, termed immune-related adverse events (irAEs). Their pathophysiology relies on the same mechanisms that confer anti-tumour activity and can affect any organ in the body. Neurological irAEs (n-irAEs) although rare, are potentially fatal. Differentiating n-irAEs from paraneoplastic syndromes and other neurological disorders can be challenging.CaseWe present a case of n-irAE in a patient with metastatic renal cell carcinoma treated with two cycles of ipilimumab/nivolumab. Following the second cycle, the patient developed subacute onset of postural and rest tremor, predominantly affecting her upper limbs, head and tongue, of variable amplitude, with bradykinesia of foot tapping. Her gait was broad-based. MRI brain was unremarkable. CSF was lymphocytic (WBC 103 cells, 90% lymphocytes) with elevated protein (1.30g/L), normal CSF:serum glucose ratio, negative CSF culture and viral PCR. She was treated for ICI-associated neurotoxicity and responded rapidly to high-dose steroids.ConclusionPhysicians should be aware of the diverse presentations of n-irAEs, including unusual movement disorders. Close collaboration between neurologists and oncologists is imperative in the management of these patients.
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Hamadani M, Coleman M, Boccia R, Duras J, Hutchings M, Zinzani PL, Cordoba R, Oreiro MB, Williams V, Stouffs M, Langmuir P, Sancho JM. P1104: A PHASE 1 STUDY EVALUATING SAFETY AND EFFICACY OF PARSACLISIB IN COMBINATION WITH BENDAMUSTINE + OBINUTUZUMAB IN PATIENTS WITH RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA (CITADEL-102). Hemasphere 2022. [PMCID: PMC9431125 DOI: 10.1097/01.hs9.0000847284.03476.7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Raftopoulos R, Williams V, Brex P, O’Sullivan E. 066 Clinical and imaging findings in MOG antibody positive patients presenting to Kings College Hospital. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We identified all patients testing positive for MOG antibodies at KCH and reviewed their clinical phenotype and imaging findings. 22 patients tested positive for MOG antibodies between Jan 2015 and Aug 2019 (11 female, mean age 39 (SD 18)). The majority of patients 15/22 presented with optic neuritis, 3 patients bilateral, 2 bilateral sequential. Other presentations included LETM (2), ADEM(2), brain stem syndrome (1), lower cord/conus syndrome (1) seizures (1). Mean logMar visual acuity at nadir in patients present- ing with an optic neuritis was 0.69 (SD 0.58). Mean logMar visual acuity at recovery was logMAR 0.1 (SD 0.54), 12/15 eyes had documented optic disc swelling. MRI brain was performed in 20 patients and was normal in 10, 6 had non-specific white matter changes the remainder had inflammatory brainstem and ADEM –like changes. MRI orbits was performed in 13 patients, 4 had bilateral optic nerve involvement and 5 had longitudinally extensive optic nerve lesions. Spinal cord imaging was performed in 9 patients, 2 had a LETM, 1 multifocal signal change and the remainder normal imaging. The cervical cord was the most frequently involved region of the spinal cord. 5 patients developed relapses (all optic neuritis), 3 relapses occurred off treatment.r.raftopoulos@ucl.ac.uk
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Williams V, Brown N, Moore JX, Farrell D, Perumean-Chaney S, Schleicher E, Fontaine K, Demark-Wahnefried W, Pekmezi D. Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study. JMIR Form Res 2022; 6:e30974. [PMID: 35188468 PMCID: PMC8902653 DOI: 10.2196/30974] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. OBJECTIVE The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. METHODS A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants' gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann-Whitney U tests were used to compare demographic factors on website use. RESULTS Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). CONCLUSIONS Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity.
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Affiliation(s)
- Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nashira Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin Xavier Moore
- Department of Population Health Sciences, Augusta University, Augusta, GA, United States
| | | | - Suzanne Perumean-Chaney
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
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19
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Perry MW, Kobulinsky LR, Seybert AL, Kreider MS, Williams V, Smithburger PL. Inter‐institutional
COVID
‐19 Patient Simulation During a Remote Acute Care Advanced Pharmacy Practice Experience. J Am Coll Clin Pharm 2022; 5:442-449. [PMID: 35464784 PMCID: PMC9015639 DOI: 10.1002/jac5.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022]
Abstract
Introduction Faculty and staff from Duquesne University and the University of Pittsburgh Schools of Pharmacy created a simulation activity focused on the care of critically ill patients with coronavirus disease 2019 (COVID‐19). Students on remote, short‐term‐care advanced pharmacy practice experiences (APPE) rotations from both universities worked in comingled teams and completed two educational electronic health record reviews, complex simulation sessions, and debriefs. Individually, students completed two educational electronic health record reviews and verbal patient presentations before and after the simulation sessions. Objectives Evaluate the effects of a simulation activity during a remote short‐term‐care APPE on student confidence and knowledge surrounding the care of a critically ill patient with COVID‐19. Methods Student knowledge surrounding COVID‐19 short‐term‐care treatment principles was assessed through pre‐/postcase‐based multiple‐choice examinations and an intermittent clinical examination (ICE). Student confidence and perceptions were gathered through anonymous pre‐/postsurveys. The written examination and patient presentation recordings were compared from baseline to the final assessment using the Wilcoxon signed‐rank test. Results In total, 92 students participated in the activity. There was a statistically significant improvement from baseline to the final assessment (preassessment median [interquartile range (IQR)]: 55.3% [50%‐60.5%]; postassessment median [IQR]: 68.4 [60.5%‐73.7%]; P < .001) on the written examination. ICE total scores improved from baseline (preassessment median [range]: 33 [28‐36] vs postassessment median [range]: 36.5 [29.5‐43.52]; P = .004) as well as the objective (P < .001), plan (P < .001), and monitoring (P < .001) subdomain scores. Student confidence reported on surveys improved from baseline in all domains. Conclusion Remote simulation sessions improve student knowledge and confidence and provide an opportunity for students to experience caring for patients with COVID‐19 in a safe environment. Collaboration between schools of pharmacy can be successfully employed to leverage resources and expertise to expand opportunities for students.
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Affiliation(s)
| | | | - Amy L. Seybert
- University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania
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20
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Satukijchai C, Mariano R, Messina S, Sa M, Woodhall MR, Robertson NP, Ming L, Wassmer E, Kneen R, Huda S, Jacob A, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin R, Dopson R, Cooper SA, Williams V, Waters PJ, Ramdas S, Leite MI, Palace J. Factors Associated With Relapse and Treatment of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease in the United Kingdom. JAMA Netw Open 2022; 5:e2142780. [PMID: 35006246 PMCID: PMC8749481 DOI: 10.1001/jamanetworkopen.2021.42780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Longer-term outcomes and risk factors associated with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are not well established. OBJECTIVE To investigate longer-term risk of relapse and factors associated with this risk among patients with MOGAD. DESIGN, SETTING, AND PARTICIPANTS This large, single-nation, prospective cohort study was conducted among 276 patients with MOGAD at 5 health care centers in the UK. Data from January 1973 to March 2020 were collected from 146 patients at Oxford and its outreach sites, 65 patients at Liverpool, 32 patients at a children's hospital in Birmingham, 22 patients at a children's hospital in London, and 11 patients at Cardiff, Wales. Data were analyzed from April through July 2020. MAIN OUTCOMES AND MEASURES Risk of relapse and annualized relapse rate were evaluated according to different baseline features, including onset age, onset phenotype, and incident vs nonincident group, with the incident group defined as patients diagnosed with antibodies against myelin oligodendrocyte glycoprotein before a second attack. Time to next relapse among patients experiencing relapse was measured and compared between the maintenance therapy subgroup and each first-line treatment group. The no-treatment group was defined as the off-treatment phase among patients who were relapsing, which could occur between any attack or between the last attack and last follow-up. RESULTS Among 276 patients with MOGAD, 183 patients were identified as being part of the incident group. There were no differences in mean (SD) onset age between total and incident groups (26.4 [17.6] years vs 28.2 [18.1] years), and female patients were predominant in both groups (166 [60.1%] female patients vs 106 [57.9%] female patients). The most common presentation overall was optic neuritis (ON) (119 patients among 275 patients with presentation data [43.3%]), while acute disseminated encephalomyelitis (ADEM), brain, or brainstem onset was predominant among 69 patients aged younger than 12 years (47 patients [68.1%]), including 41 patients with ADEM (59.4%). In the incident group, the 8-year risk of relapse was 36.3% (95% CI, 27.1%-47.5%). ON at onset was associated with increased risk of relapse compared with transverse myelitis at onset (hazard ratio [HR], 2.66; 95% CI, 1.01-6.98; P = .047), but there was no statistically significant difference with adjustment for a follow-on course of corticosteroids. Any TM at onset (ie, alone or in combination with other presentations [ie, ON or ADEM, brain, or brain stem]) was associated with decreased risk of relapse compared with no TM (HR, 0.41; 95% CI, 0.20-0.88; P = .01). Young adult age (ie, ages >18-40 years) was associated with increased risk of relapse compared with older adult age (ie, ages >40 years) (HR, 2.71; 95% CI, 1.18-6.19; P = .02). First-line maintenance therapy was associated with decreased risk of relapse when adjusted for covariates (prednisolone: HR, 0.33; 95% CI, 0.12-0.92; P = .03; prednisolone, nonsteroidal immunosuppressant, or combined: HR, 0.51; 95% CI, 0.28-0.92; P = .03) compared with the no-treatment group. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that onset age and onset phenotype should be considered when assessing subsequent relapse risk and that among patients experiencing relapse, prednisolone, first-line immunosuppression, or a combination of those treatments may be associated with decreased risk of future relapse by approximately 2-fold. These results may contribute to individualized treatment decisions.
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Affiliation(s)
- Chanjira Satukijchai
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Neuroscience Center, Bangkok International Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Mario Sa
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mark R. Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Neil P. Robertson
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Lim Ming
- Children’s Neurosciences, Evelina London Children’s Hospital at Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, United Kingdom
| | - Evangeline Wassmer
- Birmingham Women’s and Children’s National Health Service Foundation Trust, Birmingham, United Kingdom
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Rachel Kneen
- Alder Hey Children's National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Anu Jacob
- Department of Neurology, Walton Centre National Health Service Foundation Trust, Liverpool, United Kingdom
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Camilla Blain
- St George’s University Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Christopher Halfpenny
- University Hospitals Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Eoin O'Sullivan
- Department of Ophthalmology, Kings College Hospital, London, United Kingdom
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
- University Hospitals Plymouth National Health Service Foundation Trust, United Kingdom
| | - Leonora K. Fisniku
- University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Roswell Martin
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom
| | - Ruth Dopson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom
- Royal London Hospital, Barts Health National Health Service Foundation Trust, United Kingdom
| | - Sarah A. Cooper
- University Hospitals Sussex National Health Service Foundation Trust, Brighton, United Kingdom
| | - Victoria Williams
- Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Patrick J. Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Sithara Ramdas
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
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21
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Miranda A, Shield PW, Williams V, Starkey D, Kelly MA. Training undergraduate students for rapid on-site evaluation of fine needle aspiration cytology samples using a simulation based education activity. Cytopathology 2021; 33:321-327. [PMID: 34932830 DOI: 10.1111/cyt.13092] [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: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Demand for rapid onsite evaluation (ROSE) of fine needle aspiration (FNA) cytology is rising and the role is increasingly being performed by non-medical cytologists. Undergraduate training for cytologists has traditionally focused on laboratory-based procedural activities and their theoretical underpinning, with minimal attention given to communication and other skills required to operate in an interprofessional setting. We evaluated the effectiveness and student reaction to a simulation-based education (SBE) exercise in ROSE designed to fill this void. METHODS We designed and evaluated a SBE exercise based on FNA ROSE across two tertiary institutions with 79 students. The exercise accurately reproduced the demands on cytologists operating as part of a multi-disciplinary team in a time- pressured environment. FINDINGS Pre- and post-simulation questionnaires indicated an improvement in technical knowledge related to the procedure. Students' perception of their competence and confidence in their role also improved significantly post simulation. Students uniformly found the exercise engaging and a valuable addition to their curriculum. DISCUSSION The simulation successfully provided a pseudo-clinical environment that highlighted the realities of practising technical and diagnostic tasks under time- pressure and interacting with other health professionals to provide an optimal patient outcome. The exercise is useful supplement to on-the-job training for ROSE.
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Affiliation(s)
- A Miranda
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - P W Shield
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Sullivan Nicolaides Pathology, Brisbane, Australia
| | - V Williams
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - D Starkey
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - M A Kelly
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
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22
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Asthana S, Herd P, Williams V. WLS-ILIAD: New Longitudinal Resource for Cognitive and Dementia Data. Innov Aging 2021. [PMCID: PMC8682297 DOI: 10.1093/geroni/igab046.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
One of the distinctive strengths of WLS is the availability of Henmon-Nelson IQ scores on all participants while in high school, followed by prospective collection of data through cognitive batteries of varying size and sophistication. Launched in 1993, the initial longitudinal cognitive testing included 8 abstract reasoning items followed by the administration of larger cognitive batteries in 2004 and 2011 comprised of a 10-item word recall test, digit ordering task, phonemic and category fluency, as well as repeated and new items from the WAIS-R similarities task first administered in the 1993 survey. In 2018, with R01 funding from NIA, the scope of cognitive testing expanded significantly and includes administration of a phone-based cognitive screening measure, and a comprehensive in-person neuropsychological assessment for individuals identified at risk for dementia targeting a range of cognitive domains, including memory, language, attention, visuospatial abilities, and executive functioning.
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Affiliation(s)
- Sanjay Asthana
- University of Wisconsin, Madison, Wisconsin, United States
| | - Pamela Herd
- Georgetown University, Georgetown University, District of Columbia, United States
| | - Victoria Williams
- Division of Geriatrics and Gerontology, UW-Madison,, University of Wisconsin-Madison, Wisconsin, United States
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23
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Luong L, Beder M, Nisenbaum R, Orkin A, Wong J, Damba C, Emond R, Lena S, Wright V, Loutfy M, Bruce-Barrett C, Cheung W, Cheung YK, Williams V, Vanmeurs M, Boozary A, Manning H, Hester J, Hwang SW. Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. Can J Public Health 2021; 113:117-125. [PMID: 34919211 PMCID: PMC8678973 DOI: 10.17269/s41997-021-00591-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/25/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. METHODS The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). RESULTS The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06-0.75) during T2 and 0.14 times lower (95% CI: 0.04-0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. CONCLUSION During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.
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Affiliation(s)
- Linh Luong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aaron Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Cynthia Damba
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Ryan Emond
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Suvendrini Lena
- Department of Medicine, Women's College Hospital, Toronto, ON, Canada.,The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vanessa Wright
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto & Maple Leaf Medical Clinic, Toronto, ON, Canada
| | | | - Wilfred Cheung
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Yick Kan Cheung
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Victoria Williams
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Miriam Vanmeurs
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | | | | | - Joe Hester
- Anishnawbe Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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24
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Nana M, Moore S, Loganathan R, Williams V, Rahman M, Jennings E, Dixon A, Bondugulapati LNR. Very low-calorie diet in patients with longstanding type 2 diabetes mellitus: a study of real-world outcomes. Br J Diabetes 2021. [DOI: 10.15277/bjd.2021.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction: There is a paucity of evidence regarding the efficacy of a very low-calorie diet (VLCD) in the real-world setting. We evaluated outcomes in patients with type 2 diabetes mellitus (T2DM) who underwent VLCD.
Methods: This retrospective observational study included all patients who had undergone VLCD from 2014 to 2017 (n=61). The VLCD consisted of an eight-week 800 kcal/day dietary restriction. Metabolic parameters and medications were recorded at baseline, immediately post-VLCD and at 6 and 12 months.
Results: There was a significant reduction in weight of 9.96 kg (p<0.001) immediately post-VLCD, with net weight loss sustained to 12 months (p<0.05). There was a significant reduction in body mass index (BMI) sustained to 12 months (p<0.05). Paired HbA1c data were available for 38 patients. There was a significant reduction in HbA1c of 13.29 mmol/mol immediately post-VLCD (p<0.001), however no significant reduction was observed at 12 months (p>0.05). 78.7% patients had a reduction in T2DM medication burden post-VLCD, sustained in 44.3% of patients at 12 months. Analysis of patients with T2DM diagnosis duration >6 years demonstrated statistically significant weight loss sustained to 12 months (p<0.001).
Conclusion: Our results demonstrate sustained reduction in BMI and weight, reduction in medication burden and temporary reduction in HbA1c in patients with T2DM undertaking a VLCD in the real-world setting
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25
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Williams V, Kovacs-Litman A, Muller MP, Hota S, Powis JE, Ricciuto DR, Mertz D, Katz K, Castellani L, Kiss A, Linkenheld-Struk A, Leis JA. Impact of COVID-19 on hospital hand hygiene performance: a multicentre observational study using group electronic monitoring. CMAJ Open 2021; 9:E1175-E1180. [PMID: 34906993 PMCID: PMC8687486 DOI: 10.9778/cmajo.20210072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reliable reports on hand hygiene performance throughout the COVID-19 pandemic are lacking as most hospitals continue to rely on direct observation to measure this quality indicator. Using group electronic hand hygiene monitoring, we sought to assess the impact of COVID-19 on adherence to hand hygiene. METHODS Across 12 Ontario hospitals (5 university and 7 community teaching hospitals), a group electronic hand hygiene monitoring system was installed before the pandemic to provide continuous measurement of hand hygiene adherence across 978 ward and 367 critical care beds. We performed an interrupted time-series study of institutional hand hygiene adherence in association with a COVID-19 inpatient census and the Ontario daily count of COVID-19 cases during a baseline period (Nov. 1, 2019, to Feb. 29, 2020), the pre-peak period of the first wave of the pandemic (Mar. 1 to Apr. 24, 2020), and the post-peak period of the first wave (Apr. 25 to July 5, 2020). We used a Poisson regression model to assess the association between the hospital COVID-19 census and institutional hand hygiene adherence while adjusting for the correlation within inpatient units. RESULTS At baseline, the rate of hand hygiene adherence was 46.0% (6 325 401 of 13 750 968 opportunities) and this improved beginning in March 2020 to a daily peak of 79.3% (66 640 of 84 026 opportunities) on Mar. 30, 2020. Each patient admitted with COVID-19 was associated with improved hand hygiene adherence (incidence rate ratio [IRR] 1.0621, 95% confidence interval [CI] 1.0619-1.0623). Increasing Ontario daily case count was similarly associated with improved hand hygiene (IRR 1.0026, 95% CI 1.0021-1.0032). After peak COVID-19 community and inpatient numbers, hand hygiene adherence declined and returned to baseline. INTERPRETATION The first wave of the COVID-19 pandemic was associated with significant improvement in hand hygiene adherence, measured using a group electronic monitoring system. Future research should seek to determine whether strategies that focus on health care worker perception of personal risk can achieve sustainable improvements in hand hygiene performance.
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Affiliation(s)
- Victoria Williams
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Adam Kovacs-Litman
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Matthew P Muller
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Susy Hota
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Jeff E Powis
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Daniel R Ricciuto
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Dominik Mertz
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Kevin Katz
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Lucas Castellani
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Alex Kiss
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Amber Linkenheld-Struk
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont.
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Hannah C, Williams V, Fuller LC, Forrestel A. The Impact of the COVID-19 Pandemic on Global Health Dermatology. Dermatol Clin 2021; 39:619-625. [PMID: 34556251 PMCID: PMC8165086 DOI: 10.1016/j.det.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Claire Hannah
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA; Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Williams
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA; Merck & Co, Inc, Upper Gwynedd, PA, USA
| | - Lucinda Claire Fuller
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Amy Forrestel
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA.
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Snooks H, Watkins AJ, Bell F, Brady M, Carson‐Stevens A, Duncan E, Evans BA, England L, Foster T, Gallanders J, Gunson I, Harris‐Mayes R, Kingston M, Lyons R, Miller E, Newton A, Porter A, Quinn T, Rosser A, Siriwardena AN, Spaight R, Williams V. Call volume, triage outcomes, and protocols during the first wave of the COVID-19 pandemic in the United Kingdom: Results of a national survey. J Am Coll Emerg Physicians Open 2021; 2:e12492. [PMID: 34378000 PMCID: PMC8328888 DOI: 10.1002/emp2.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES During the first wave of the COVID-19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used. METHODS Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1-July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis. RESULTS Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range -0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range -3.7% to -25.5%). Suspected COVID-19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place. CONCLUSIONS Call volumes were highly variable. Case mix and workload changed significantly as COVID-19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics.
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Affiliation(s)
| | | | - Fiona Bell
- Yorkshire Ambulance Service NHS TrustWakefieldUK
| | - Mike Brady
- Welsh Ambulance Services NHS TrustTrust HeadquartersDenbighshireWalesUK
| | | | - Edward Duncan
- Nursing Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
| | | | | | - Theresa Foster
- East of England Ambulance Service NHS TrustMelbournCambridgeshireUK
| | - John Gallanders
- Swansea University Medical SchoolSwanseaUK
- Unaffiliated ‐ Patient and Public Contributor
| | - Imogen Gunson
- West Midlands Ambulance Service NHS TrustWest MidlandsUK
| | | | | | | | | | | | | | - Tom Quinn
- Kingston University and St George'sUniversity of LondonLondonUK
| | - Andy Rosser
- West Midlands Ambulance Service NHS TrustWest MidlandsUK
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28
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Hogan FL, Williams V, Knapper S. FLT3 Inhibition in Acute Myeloid Leukaemia - Current Knowledge and Future Prospects. Curr Cancer Drug Targets 2021; 20:513-531. [PMID: 32418523 DOI: 10.2174/1570163817666200518075820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/12/2020] [Accepted: 03/29/2020] [Indexed: 12/20/2022]
Abstract
Activating mutations of FMS-like tyrosine kinase 3 (FLT3) are present in 30% of acute myeloid leukaemia (AML) patients at diagnosis and confer an adverse clinical prognosis. Mutated FLT3 has emerged as a viable therapeutic target and a number of FLT3-directed tyrosine kinase inhibitors have progressed through clinical development over the last 10-15 years. The last two years have seen United States Food and Drug Administration (US FDA) approvals of the multi-kinase inhibitor midostaurin for newly-diagnosed FLT3-mutated patients, when used in combination with intensive chemotherapy, and of the more FLT3-selective agent gilteritinib, used as monotherapy, for patients with relapsed or treatment-refractory FLT3-mutated AML. The 'second generation' agents, quizartinib and crenolanib, are also at advanced stages of clinical development. Significant challenges remain in negotiating a variety of potential acquired drug resistance mechanisms and in optimizing sequencing of FLT3 inhibitory drugs with existing and novel treatment approaches in different clinical settings, including frontline therapy, relapsed/refractory disease, and maintenance treatment. In this review, the biology of FLT3, the clinical challenge posed by FLT3-mutated AML, the developmental history of the key FLT3-inhibitory compounds, mechanisms of disease resistance, and the future outlook for this group of agents, including current and planned clinical trials, is discussed.
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Affiliation(s)
- Francesca L Hogan
- Department of Haematology, University Hospital of Wales, Cardiff, United Kingdom
| | - Victoria Williams
- Department of Haematology, University Hospital of Wales, Cardiff, United Kingdom
| | - Steven Knapper
- School of Medicine, Cardiff University, Cardiff, United Kingdom
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29
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Leis JA, Powis JE, McGeer A, Ricciuto DR, Agnihotri T, Coyle N, Williams V, Moore C, Salt N, Wong L, McCreight L, Sivaramakrishna S, Junaid S, Cao X, Muller M. Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study. Clin Infect Dis 2021; 71:e680-e685. [PMID: 32270865 DOI: 10.1093/cid/ciaa412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking. METHODS A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. RESULTS After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47-1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months (P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53-1.04]; P = .08). CONCLUSIONS The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH.
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Affiliation(s)
- Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.,Michael Garron Hospital, Toronto, Canada
| | - Allison McGeer
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Sinai Health Systems, Toronto, Canada
| | | | | | | | | | | | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | | | - Xinghan Cao
- Sunnybrook Research Institute, Toronto, Canada
| | - Matthew Muller
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
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30
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Wilcock D, Jicha G, Blacker D, Albert MS, D’Orazio LM, Elahi FM, Fornage M, Hinman JD, Knoefel J, Kramer J, Kryscio RJ, Lamar M, Moghekar A, Prestopnik J, Ringman JM, Rosenberg G, Sagare A, Satizabal CL, Schneider J, Seshadri S, Sur S, Tracy RP, Yasar S, Williams V, Singh H, Mazina L, Helmer KG, Corriveau RA, Schwab K, Kivisäkk P, Greenberg SM. MarkVCID cerebral small vessel consortium: I. Enrollment, clinical, fluid protocols. Alzheimers Dement 2021; 17:704-715. [PMID: 33480172 PMCID: PMC8122220 DOI: 10.1002/alz.12215] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023]
Abstract
The concept of vascular contributions to cognitive impairment and dementia (VCID) derives from more than two decades of research indicating that (1) most older individuals with cognitive impairment have post mortem evidence of multiple contributing pathologies and (2) along with the preeminent role of Alzheimer's disease (AD) pathology, cerebrovascular disease accounts for a substantial proportion of this contribution. Contributing cerebrovascular processes include both overt strokes caused by etiologies such as large vessel occlusion, cardioembolism, and embolic infarcts of unknown source, and frequently asymptomatic brain injuries caused by diseases of the small cerebral vessels. Cerebral small vessel diseases such as arteriolosclerosis and cerebral amyloid angiopathy, when present at moderate or greater pathologic severity, are independently associated with worse cognitive performance and greater likelihood of dementia, particularly in combination with AD and other neurodegenerative pathologies. Based on this evidence, the US National Alzheimer's Project Act explicitly authorized accelerated research in vascular and mixed dementia along with frontotemporal and Lewy body dementia and AD itself. Biomarker development has been consistently identified as a key step toward translating scientific advances in VCID into effective prevention and treatment strategies. Validated biomarkers can serve a range of purposes in trials of candidate interventions, including (1) identifying individuals at increased VCID risk, (2) diagnosing the presence of cerebral small vessel disease or specific small vessel pathologies, (3) stratifying study participants according to their prognosis for VCID progression or treatment response, (4) demonstrating an intervention's target engagement or pharmacodynamic mechanism of action, and (5) monitoring disease progression during treatment. Effective biomarkers allow academic and industry investigators to advance promising interventions at early stages of development and discard interventions with low success likelihood. The MarkVCID consortium was formed in 2016 with the goal of developing and validating fluid- and imaging-based biomarkers for the cerebral small vessel diseases associated with VCID. MarkVCID consists of seven project sites and a central coordinating center, working with the National Institute of Neurologic Diseases and Stroke and National Institute on Aging under cooperative agreements. Through an internal selection process, MarkVCID has identified a panel of 11 candidate biomarker "kits" (consisting of the biomarker measure and the clinical and cognitive data used to validate it) and established a range of harmonized procedures and protocols for participant enrollment, clinical and cognitive evaluation, collection and handling of fluid samples, acquisition of neuroimaging studies, and biomarker validation. The overarching goal of these protocols is to generate rigorous validating data that could be used by investigators throughout the research community in selecting and applying biomarkers to multi-site VCID trials. Key features of MarkVCID participant enrollment, clinical/cognitive testing, and fluid biomarker procedures are summarized here, with full details in the following text, tables, and supplemental material, and a description of the MarkVCID imaging biomarker procedures in a companion paper, "MarkVCID Cerebral small vessel consortium: II. Neuroimaging protocols." The procedures described here address a range of challenges in MarkVCID's design, notably: (1) acquiring all data under informed consent and enrollment procedures that allow unlimited sharing and open-ended analyses without compromising participant privacy rights; (2) acquiring the data in a sufficiently wide range of study participants to allow assessment of candidate biomarkers across the various patient groups who might ultimately be targeted in VCID clinical trials; (3) defining a common dataset of clinical and cognitive elements that contains all the key outcome markers and covariates for VCID studies and is realistically obtainable during a practical study visit; (4) instituting best fluid-handling practices for minimizing avoidable sources of variability; and (5) establishing rigorous procedures for testing the reliability of candidate fluid-based biomarkers across replicates, assay runs, sites, and time intervals (collectively defined as the biomarker's instrumental validity). Participant Enrollment Project sites enroll diverse study cohorts using site-specific inclusion and exclusion criteria so as to provide generalizable validation data across a range of cognitive statuses, risk factor profiles, small vessel disease severities, and racial/ethnic characteristics representative of the diverse patient groups that might be enrolled in a future VCID trial. MarkVCID project sites include both prospectively enrolling centers and centers providing extant data and samples from preexisting community- and population-based studies. With approval of local institutional review boards, all sites incorporate MarkVCID consensus language into their study documents and informed consent agreements. The consensus language asks prospectively enrolled participants to consent to unrestricted access to their data and samples for research analysis within and outside MarkVCID. The data are transferred and stored as a de-identified dataset as defined by the Health Insurance Portability and Accountability Act Privacy Rule. Similar human subject protection and informed consent language serve as the basis for MarkVCID Research Agreements that act as contracts and data/biospecimen sharing agreements across the consortium. Clinical and Cognitive Data Clinical and cognitive data are collected across prospectively enrolling project sites using common MarkVCID instruments. The clinical data elements are modified from study protocols already in use such as the Alzheimer's Disease Center program Uniform Data Set Version 3 (UDS3), with additional focus on VCID-related items such as prior stroke and cardiovascular disease, vascular risk factors, focal neurologic findings, and blood testing for vascular risk markers and kidney function including hemoglobin A1c, cholesterol subtypes, triglycerides, and creatinine. Cognitive assessments and rating instruments include the Clinical Dementia Rating Scale, Geriatric Depression Scale, and most of the UDS3 neuropsychological battery. The cognitive testing requires ≈60 to 90 minutes. Study staff at the prospectively recruiting sites undergo formalized training in all measures and review of their first three UDS3 administrations by the coordinating center. Collection and Handling of Fluid Samples Fluid sample types collected for MarkVCID biomarker kits are serum, ethylenediaminetetraacetic acid-plasma, platelet-poor plasma, and cerebrospinal fluid (CSF) with additional collection of packed cells to allow future DNA extraction and analyses. MarkVCID fluid guidelines to minimize variability include fasting morning fluid collections, rapid processing, standardized handling and storage, and avoidance of CSF contact with polystyrene. Instrumental Validation for Fluid-Based Biomarkers Instrumental validation of MarkVCID fluid-based biomarkers is operationally defined as determination of intra-plate and inter-plate repeatability, inter-site reproducibility, and test-retest repeatability. MarkVCID study participants both with and without advanced small vessel disease are selected for these determinations to assess instrumental validity across the full biomarker assay range. Intra- and inter-plate repeatability is determined by repeat assays of single split fluid samples performed at individual sites. Inter-site reproducibility is determined by assays of split samples distributed to multiple sites. Test-retest repeatability is determined by assay of three samples acquired from the same individual, collected at least 5 days apart over a 30-day period and assayed on a single plate. The MarkVCID protocols are designed to allow direct translation of the biomarker validation results to multicenter trials. They also provide a template for outside groups to perform analyses using identical methods and therefore allow direct comparison of results across studies and centers. All MarkVCID protocols are available to the biomedical community and intended to be shared. In addition to the instrumental validation procedures described here, each of the MarkVCID kits will undergo biological validation to determine whether the candidate biomarker measures important aspects of VCID such as cognitive function. Analytic methods and results of these validation studies for the 11 MarkVCID biomarker kits will be published separately. The results of this rigorous validation process will ultimately determine each kit's potential usefulness for multicenter interventional trials aimed at preventing or treating small vessel disease related VCID.
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Affiliation(s)
- Donna Wilcock
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Gregory Jicha
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H Chan School of Public Health and Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lina M. D’Orazio
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Fanny M. Elahi
- Center for Memory and Aging, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Myriam Fornage
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School and Human Genetics Center, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jason D. Hinman
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Janice Knoefel
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Joel Kramer
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Richard J. Kryscio
- Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40504, USA
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jillian Prestopnik
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - John M. Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Gary Rosenberg
- Center for Memory and Aging, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Abhay Sagare
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Sandeepa Sur
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Victoria Williams
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Herpreet Singh
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lidiya Mazina
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Karl G. Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Pia Kivisäkk
- Alzheimer’s Clinical and Translational Research Unit, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Steven M. Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
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Wade T, Heneghan C, Roberts N, Curtis D, Williams V, Onakpoya I. Healthcare-associated infections and the prescribing of antibiotics in hospitalized patients of the Caribbean Community (CARICOM) states: a mixed-methods systematic review. J Hosp Infect 2021; 110:122-132. [PMID: 33524426 DOI: 10.1016/j.jhin.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) and variation in antibiotic prescribing pose a significant public health challenge in hospitals of low-resource countries. AIM To critically appraise and synthesize the evidence on HCAI and the prescribing of antibiotics in Caribbean Community (CARICOM) states. METHODS All primary qualitative and quantitative studies that addressed HCAI, and the prescribing of antibiotics in hospitalized patients of CARICOM states were included. Ovid Medline, Embase, Global Health, and regional databases were searched. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Findings were presented in narrative and table formats. FINDINGS Twenty-one studies met the inclusion criteria for this mixed-methods systematic review (MMSR). Studies were from four different CARICOM states: Trinidad and Tobago, Jamaica, Haiti, and Antigua and Barbuda. Intensive care units (ICUs) had the highest rate of infections (67% over four years). Surgical site infections were discussed by seven studies and ranged from 1.5% to 7.3%. For inpatients with contaminated or infected wounds, rates ranged from 29% to 83%. Empiric and prophylactic therapies were common and inappropriately prescribed. Resources and training for healthcare workers in infection control and antimicrobial stewardship were insufficient. Few qualitative studies existed, so it was not possible to integrate evidence from qualitative and quantitative paradigms. CONCLUSION Evidence from CARICOM states shows high rates of HCAI and inappropriately prescribed antibiotics, primarily in ICUs. Disease surveillance, infection control, and antimicrobial stewardship programmes require urgent evidence-based improvements.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - C Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - D Curtis
- Usha Kundu, MD College of Health, University of West Florida, Pensacola, FL, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, ON, Canada
| | - I Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Martell L, McDonald JD, Barragan B, Ziegler S, Williams V. Examining Cultural Identification and Alcohol Use Among American Indian and Caucasian College Students. Am Indian Alsk Native Ment Health Res 2020; 27:23-36. [PMID: 33253407 DOI: 10.5820/aian.2702.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Previous research consistently concludes American Indians (AI) demonstrate higher levels of alcohol use than Caucasians (CA); however, recent research suggests AIs may be drinking at similar or lower rates than CAs. Little research has examined cultural identification as a contributing factor to alcohol use. This study sought to examine cultural identification and its relationship to alcohol use between AI and CA college students. Participants consisted of 56 AI and 87 CA college students who selfreported on past 6-month alcohol consumption and how they culturally identified per the Orthogonal Theory of Biculturalism. CAs reported a significantly higher average daily alcohol consumption than AIs who identified as Marginal, Traditional, and Assimilated. This research represents a compelling anecdotal and empirical socio-cultural paradigm shift from the "AIs drink more" mindset among college students. Further, understanding the relationship between cultural identification and alcohol use enhances assessment, diagnostic, and intervention efforts for both AIs and CAs.
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Abbas UL, Hallmark CJ, McNeese M, Hemmige V, Gathe J, Williams V, Wolf B, Rodriguez-Barradas MC. Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response. Open Forum Infect Dis 2020; 7:ofaa348. [PMID: 33072804 PMCID: PMC7545115 DOI: 10.1093/ofid/ofaa348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
A strategy titled “Ending the HIV Epidemic: A Plan for America” aims to reduce human immunodeficiency virus (HIV) incidence in the United States by at least 90% by 2030, using diagnosis, treatment, and prevention strategies. Texas is a Southern state that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished, which could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua, and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.
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Affiliation(s)
- Ume L Abbas
- Baylor College of Medicine, Houston, Texas, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Camden J Hallmark
- Division of Disease Prevention and Control, Houston Health Department, Houston, Texas, USA
| | - Marlene McNeese
- Division of Disease Prevention and Control, Houston Health Department, Houston, Texas, USA
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Kovacs-Litman A, Muller MP, Powis JE, Ricciuto D, McGeer A, Williams V, Kiss A, Leis JA. Association between hospital outbreaks and hand hygiene: Insights from electronic monitoring. Clin Infect Dis 2020; 73:e3656-e3660. [PMID: 32936910 DOI: 10.1093/cid/ciaa1405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) is an important patient safety measure linked to prevention of healthcare-associated infection yet how outbreaks affect HH performance has not been formally evaluated. METHODS A controlled interrupted time series was performed across five acute-care academic hospitals using group electronic monitoring. This system captures 100% of all hand sanitizer and soap dispenser activations via a wireless signal to a wireless hub divided by a previously validated estimate of the number of daily HH opportunities per patient bed multiplied by the hourly census of patients on the unit. Daily HH adherence 60 days prior and 90 days following outbreak on inpatient units was compared to control units not in outbreak over the same period, using a Poisson regression model adjusting for correlation within hospitals and units. Predictors of HH improvement were assessed in this multivariate model. RESULTS In the 60 days prior to outbreak, units destined for outbreak had significantly lower HH adherence compared to control units (IRR of 0.91 (95% CI 0.90-0.93; p <0.0001). Following outbreak, the HH adherence among outbreak units increased above controls (IRR 1.04, 95% CI = 1.02-1.06; p <0.0001). Greater improvements were noted for outbreaks on surgical units, involving antibiotic-resistant organisms and enteric outbreaks, as well as those where healthcare workers became ill. CONCLUSIONS Hospital outbreaks tend to occur on units with lower HH adherence and are associated with rapid improvements in HH performance. Group electronic monitoring of HH could be used to develop novel prospective feedback interventions designed to avert hospital outbreaks.
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Affiliation(s)
| | - Matthew P Muller
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jeff E Powis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Dan Ricciuto
- Division of Infectious Diseases, Lakeridge Health, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sinai Health System, Toronto, Ontario, Canada
| | | | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Zayed MG, Williams V, Glendenning AC, Bulger JK, Hewes T, Porter A, Snooks H, John A. Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey. Emerg Med J 2020; 37:752-755. [PMID: 32883751 PMCID: PMC7691809 DOI: 10.1136/emermed-2019-208967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022]
Abstract
Background Self-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed. Methods A structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically. Results All 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported. Conclusion Practice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.
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Affiliation(s)
| | - Victoria Williams
- Hillary Rodham Clinton School of Law, Swansea University, Swansea, UK
| | | | | | - Tom Hewes
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
| | - A John
- Swansea University Medical School, Swansea University, Swansea, UK
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Danhauer JL, Johnson CE, Finnegan D, Lamb M, Lopez IP, Meuel C, Pecile A, Williams V, Gavin RB, Karns SR, Latiolais LN. A National Survey of Pediatric Otolaryngologists and Early Hearing Detection and Intervention Programs. J Am Acad Audiol 2020; 17:708-21. [PMID: 17153719 DOI: 10.3766/jaaa.17.10.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Follow-up rates for babies identified for hearing loss from early hearing detection and intervention programs (EHDIPs) and newborn hearing screening programs (NHSPs) in the United States do not meet the goals posited by the Centers for Disease Control. Pediatric otolaryngologists (PED-ENTs) play a vital role in EHDIPs and can positively influence parents' compliance with professionals' recommendations for their babies. This national study used a 19-item questionnaire and postal survey to assess PED-ENTs' knowledge about, experience with, and attitudes toward NHSPs. Of 565 surveys mailed (36 were undeliverable), 233 were returned for a 44% response rate. Most of these PED-ENTs had adequate knowledge about, participated in, and expressed positive attitudes toward NHSPs; however, some could benefit from additional information about national EHDI benchmarks and poor follow-up rates. Audiologists should ally with PED-ENTs locally and nationally to strengthen EHDIPs and prevent loss of children with hearing impairment to follow-up.
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Affiliation(s)
- Jeffrey L Danhauer
- Department of Speech and Hearing Sciences, 1036 Harder South, University of California Santa Barbara, Santa Barbara, CA 93106, USA.
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Williams V, McManus B, Brooks‐Russell A, Yost E, Olds D, Tung G. Associations between Cross‐Sector Collaboration and Family Outcomes in Evidence‐Based Nurse Home Visiting. Health Serv Res 2020; 55:31-31. [PMCID: PMC7440420 DOI: 10.1111/1475-6773.13367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2024] Open
Abstract
Home‐visiting prevention programs must coordinate with other community providers to be most effective. However, the associations between collaboration and program outcomes are not well understood. This study aimed to examine the associations between cross‐sector collaboration in Nurse‐Family Partnership (NFP), a model home‐visiting program, and client‐level outcomes. We used 2018 survey data with NFP supervisors that assessed agency‐level collaboration, as measured by relational coordination and structural integration with nine community provider types (including obstetrics care, substance use treatment, and child welfare). We paired the collaboration survey data with NFP program implementation data from 2014 to 2019 (n = 36,901) to examine outcomes including client retention, client smoking cessation, and childhood injury. We used random‐intercept models with nurse‐level random effects, controlling for client‐level demographics and health, nurse‐level demographics, and agency‐level administrative and geographic factors. NFP is an evidence‐based prenatal and early infancy home‐visitation program delivered by nurses to low‐income, first‐time mothers. NFP is implemented by over 250 agencies across the United States by public health departments, nonprofit organizations, and health care systems. Sample NFP clients were on average 23 years old and predominately single. Of sample clients, 47.5% were white, 33% were African American, 11.5% reported another race, and 8% declined reporting; 31% of clients identified as Hispanic. Consistent with past research, we found unmarried women and those visited by nurses who ceased employment with NFP prior to the client’s child’s birth were more likely to drop out of the NFP program, while older women and high school graduates were more likely to remain in NFP. Greater relational coordination with substance use treatment providers (OR: 1.148, P < .001) and stronger structural integration with CPS (OR: 1.056, P < .001) were associated with improved client retention at birth, even after adjusting for multilevel factors. Structural integration with CPS remains significantly associated with client retention at 12‐months postpartum. Greater nurse coordination with the Special Supplemental Nutrition Program for Women, Infants, and Children—WIC (OR: 1.090, P < .05) as well as with substance use treatment providers (OR: 1.115, P < .05) was associated with increased prenatal smoking cessation. Stronger nurse coordination with WIC (OR: 0.875, P < .01) and greater integration with mental health providers (OR: 0.969, P < .01) were associated with decreased probability of self‐reported emergency department (ED) use for childhood injury, while greater structural integration with WIC (OR: 1.022, P < .05) was associated with increased probability of ED use. Improving health care through relationships with other care providers is necessary to enhance the experience and outcomes of patients, particularly among high‐need complex populations. This study provides early results suggesting cross‐sector collaboration in a home‐visiting setting that bridges health care and addresses social determinants of health has potential to improve the retention of clients. More research is needed to understand how collaboration may improve maternal‐reported behaviors like smoking cessation and ED use for childhood injury. Our findings inform efforts to increase efficient delivery of prevention programs like NFP through intentional collaboration with cross‐sectors, as well as for future agency development for NFP expansion, especially as the program moves toward integration with health care delivery systems. Blue Meridian Partners.
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Affiliation(s)
| | - B. McManus
- Colorado School of Public HealthAuroraCOUSA
| | | | - E. Yost
- Nurse‐Family PartnershipDenverCOUSA
| | - D. Olds
- University of ColoradoAuroraCOUSA
| | - G. Tung
- Colorado School of Public HealthAuroraCOUSA
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Hirst JA, Farmer AJ, Williams V. How point-of-care HbA 1c testing changes the behaviour of people with diabetes and clinicians - a qualitative study. Diabet Med 2020; 37:1008-1015. [PMID: 31876039 PMCID: PMC7318570 DOI: 10.1111/dme.14219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
AIM To explore adults with diabetes and clinician views of point-of-care HbA1c testing. METHODS Adults with diabetes and HbA1c ≥ 58 mmol/mol (7.5%) receiving HbA1c point-of-care testing in primary care were invited to individual interviews. Participants were interviewed twice, once prior to point-of-care testing and once after 6 months follow-up. Clinicians were interviewed once. A thematic framework based on an a priori framework was used to analyse the data. RESULTS Fifteen participants (eight women, age range 30-70 years, two Asians, 13 white Europeans) were interviewed. They liked point-of-care testing and found the single appointment more convenient than usual care. Receiving the test result at the appointment helped some people understand how some lifestyle behaviours affected their control of diabetes and motivated them to change behaviours. Receiving an immediate test result reduced the anxiety some people experience when waiting for a result. People thought there was little value in using point-of-care testing for their annual review. Clinicians liked the point-of-care testing but expressed concerns about costs. CONCLUSIONS This work suggests that several features of point-of-care testing may encourage behavioural change. It helped some people to link their HbA1c result to recent lifestyle behaviours, thereby motivating behavioural change and reinforcing healthy lifestyle choices.
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Affiliation(s)
- J. A. Hirst
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - A. J. Farmer
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - V. Williams
- School of NursingNipissing UniversityNorth BayONUSA
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Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Evans B, Morcam C, Webb N, Davies R, Smith E, Shankland H, Leopold N, Harris W, Hudson C, Edwards R. Integrated care of older people (iCOP): an service delivering comprehensive geriatric assessment on the acute assessment unit at Singleton Hospital. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.249] [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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Orlandella RM, Bail JR, Behring M, Halilova KI, Johnson R, Williams V, Norian LA, Demark-Wahnefried W. Body fat indices and survival in immunotherapy-treated patients with cancer. Cancer 2020; 126:3156-3157. [PMID: 32286680 DOI: 10.1002/cncr.32889] [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] [Received: 01/22/2020] [Accepted: 02/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Rachael M Orlandella
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer R Bail
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Behring
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karina I Halilova
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roman Johnson
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lyse A Norian
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama
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Kozak R, Prost K, Yip L, Williams V, Leis JA, Mubareka S. Severity of coronavirus respiratory tract infections in adults admitted to acute care in Toronto, Ontario. J Clin Virol 2020; 126:104338. [PMID: 32278299 PMCID: PMC7142695 DOI: 10.1016/j.jcv.2020.104338] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
Coronaviruses represent a significant burden in acute care settings. Female gender and smoking were associated with poor prognosis. All cause mortality in our cohort was similar to what is observed for influenza virus.
Background The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA respiratory viruses. Human coronaviruses (CoVs) are a major cause of respiratory and gastrointestinal tract infections with associated morbidity and mortality. Objectives The objective of our study was to characterize the epidemiology of CoVs in our tertiary care centre, and identify clinical correlates of disease severity. Study design A cross-sectional study was performed of 226 patients admitted with confirmed CoV respiratory tract infection between 2010 and 2016. Variables consistent with a severe disease burden were evaluated including symptoms, length of stay, intensive care unit (ICU) admission and mortality. Results CoVs represented 11.3% of all positive respiratory virus samples and OC43 was the most commonly identified CoV. The majority of infections were community-associated while 21.6% were considered nosocomial. The average length of stay was 11.8 days with 17.3% of patients requiring ICU admission and an all-cause mortality of 7%. In a multivariate model, female gender and smoking were associated with increased likelihood of admission to ICU or death. Conclusion This study highlights the significant burden of CoVs and justifies the need for surveillance in the acute care setting.
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Affiliation(s)
- Robert Kozak
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Karren Prost
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Lily Yip
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Victoria Williams
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jerome A Leis
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Lin M, Beliavsky A, Katz K, Powis JE, Ng W, Williams V, Science M, Groves H, Muller MP, Vaisman A, Hota S, Johnstone J, Leis JA. What can early Canadian experience screening for COVID-19 teach us about how to prepare for a pandemic? CMAJ 2020; 192:E314-E318. [PMID: 32144097 DOI: 10.1503/cmaj.200305] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Molly Lin
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Alina Beliavsky
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Kevin Katz
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Jeff E Powis
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Wil Ng
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Victoria Williams
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Michelle Science
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Helen Groves
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Mathew P Muller
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Alon Vaisman
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Susy Hota
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Jennie Johnstone
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont
| | - Jerome A Leis
- Department of Medicine (Lin, Beliavsky, Katz, Powis, Muller, Vaisman, Hota, Leis), University of Toronto; North York General Hospital (Katz, Ng), Toronto, Ont.; Michael Garron Hospital (Powis), East York, Ont.; Sunnybrook Health Sciences Centre (Williams, Leis); Hospital for Sick Children (Science, Groves); Sinai Health System (Johnstone); Departments of Paediatrics (Science, Groves), and Laboratory Medicine and Pathobiology (Katz, Johnstone), University of Toronto; Unity Health Toronto (Muller); University Health Network (Vaisman, Hota), Toronto, Ont.
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Johnson R, Bail JR, Behring M, Orlandella R, Williams V, Halilova KI, Hoenemeyer TW. Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis. Front Oncol 2020; 10:240. [PMID: 32195183 PMCID: PMC7066257 DOI: 10.3389/fonc.2020.00240] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roman Johnson
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer R Bail
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Behring
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rachael Orlandella
- Graduate Biomedical Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Karina I Halilova
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Teri W Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
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Moore JX, Carter SJ, Williams V, Khan S, Lewis-Thames MW, Gilbert K, Howard G. Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study. Prev Med 2020; 132:105989. [PMID: 31954141 PMCID: PMC7048236 DOI: 10.1016/j.ypmed.2020.105989] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 12/19/2019] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
Abstract
It is unclear how resting myocardial workload, as indexed by baseline measures of rate-pressure product (RPP) and physical activity (PA), is associated with the overall risk of cancer mortality. We performed prospective analyses among 28,810 men and women from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We used a novel physical health (PH) composite index and categorized participants into one of four groups based on combinations from self-reported PA and RPP: 1) No PA and High RPP; 2) No PA and Low RPP; 3) Yes PA and High RPP; and 4) Yes PA and Low RPP. We examined the association between baseline PH composite and cancer mortality adjusted for potential confounders using Cox regression. A total of 1191 cancer deaths were observed over the 10-year observation period, with the majority being lung (26.87%) and gastrointestinal (21.49%) cancers. Even after controlling for sociodemographics, health behaviors, baseline comorbidity score, and medications, participants with No PA and High RPP had 71% greater risk of cancer mortality when compared to participants with PA and Low RPP (adjusted HR: 1.71, 95% CI: 1.42-2.06). These associations persisted after examining BMI, smoking, income, and gender as effect modifiers and all-cause mortality as a competing risk. Poorer physical health composite, including the novel RPP metric, was associated with a nearly 2-fold long-term risk of cancer mortality. The physical health composite has important public health implications as it provides a measure of risk beyond traditional measure of obesity and physical activity.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA; Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA.
| | - Stephen J Carter
- School of Public Health, Department of Kinesiology, Indiana University, Bloomington, IN, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Victoria Williams
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Marquita W Lewis-Thames
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Keon Gilbert
- Department of Behavioral Science and Health Education, Saint Louis University, St. Louis, MO, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
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Porter A, Badshah A, Black S, Fitzpatrick D, Harris-Mayes R, Islam S, Jones M, Kingston M, LaFlamme-Williams Y, Mason S, McNee K, Morgan H, Morrison Z, Mountain P, Potts H, Rees N, Shaw D, Siriwardena N, Snooks H, Spaight R, Williams V. Electronic health records in ambulances: the ERA multiple-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care.
Objective
We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised.
Design and setting
We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop.
Results
We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care.
Limitations
Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality.
Conclusions
Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need.
Future work
There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records.
Study registration
This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Anisha Badshah
- Department of Human Resources and Organisational Behaviour, University of Greenwich, London, UK
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - David Fitzpatrick
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Matthew Jones
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark Kingston
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Suzanne Mason
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine McNee
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | | | - Henry Potts
- Centre for Health Informatics and Multiprofessional Education, University College London, London, UK
| | - Nigel Rees
- Pre-Hospital Emergency Research Unit, Welsh Ambulance Service NHS Trust, Swansea, UK
| | - Debbie Shaw
- East Midlands Ambulance Service NHS Trust, Lincoln, UK
| | - Niro Siriwardena
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rob Spaight
- East Midlands Ambulance Service NHS Trust, Lincoln, UK
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Reeves S, Williams V, Costela FM, Palumbo R, Umoren O, Christopher MM, Blacker D, Woods RL. Narrative video scene description task discriminates between levels of cognitive impairment in Alzheimer's disease. Neuropsychology 2020; 34:437-446. [PMID: 31999169 DOI: 10.1037/neu0000621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The process of interpreting and acting upon the visual environment requires both intact cognitive and visual systems. The narrative description (ND) task, initially developed to detect changes in ecologically relevant visual function in people with impaired vision, is an objective measure of the ability to perceive, understand, and describe a visual scene in a movie clip. OBJECTIVE Because the ND task draws heavily on semantic and working memory ability in addition to basic visual perception, we aimed to assess the discriminative performance of this task across levels of cognitive impairment. METHOD We recruited 56 participants with cognitive status ranging from normal cognition to mild dementia (median age 82, range 66 to 99 years) to watch 20 30-s video clips and describe the visual content without time constraints. These verbal responses were transcribed and processed to generate ND shared word scores using a "wisdom of the crowd," natural-language processing approach. We compared ND scores across diagnostic groups, and used linear mixed models to examine decrements in task performance. RESULTS There was a stepwise decline of ND scores with increasing levels of cognitive impairment. Additional analyses showed that ND performance was highly related to performance on the Montreal Cognitive Assessment (MoCA) and domain-specific neuropsychological tests for semantic fluency and set shifting. Other models demonstrated differences in ND performance related video content between cognitively normal and impaired participants. CONCLUSION The ND test was able to detect decrements in task performance between levels of cognitive impairment and was related to other global neuropsychological measures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Victoria Williams
- Infection Prevention & Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A Leis
- Infection Prevention & Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Corpus C, Williams V, Salt N, Agnihotri T, Morgan W, Robinson L, Maze Dit Mieusement L, Cobbam S, Leis JA. Prevention of respiratory outbreaks in the rehabilitation setting. BMJ Open Qual 2019; 8:e000663. [PMID: 31673641 PMCID: PMC6797241 DOI: 10.1136/bmjoq-2019-000663] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/27/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory viral (RV) outbreaks in rehabilitation facilities can jeopardise patient safety, interfere with patient rehabilitation goals and cause unit closures that impede patient flow in referring facilities. Problem Despite education about infection prevention practices, frequent RV outbreaks were declared each year at our rehabilitation facility. Methods Before and after study design. The primary outcome was the number of bed closure days due to outbreak per overall bed days. Process measures included delays in initiation of transmission-based precautions, RV testing and reporting of staff to occupational health and safety (OHS). Balancing measures included the number of isolation days and staff missed work hours. Interventions Based on comprehensive analysis of prior outbreaks, the following changes were implemented: (1) clear criteria for initiation of transmission-based precautions, (2) communication to visitors to avoid visitation if infectious symptoms were present, (3) exemption of staff absences if documented due to infectious illness, (4) development of an electronic programme providing guidance to staff about whether they should be excluded from work due to infectious illness. Results The number of bed closure days due to outbreak per overall bed days dropped from 2.8% to 0.5% during the intervention season and sustained at 0.6% during the postintervention season (p<0.001). There were fewer delays in initiation of droplet and contact precautions (28.8% to 15.5%, p=0.005) and collection of RV testing (42.9% to 20.3%, p<0.001), better reporting to OHS (9 vs 28.8 reports per 100 employees; p<0.001) and fewer isolation days (7.8% vs 7.3%; p=0.02) without a significant increase in missed work hours per 100 hours worked (4.0 vs 3.9; p=0.12). Conclusion This Quality Improvement study highlights the process changes that can prevent respiratory outbreaks in the rehabilitation setting.
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Affiliation(s)
- Carla Corpus
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Wendy Morgan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lawrence Robinson
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Sonja Cobbam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
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Nunnery D, Bonavire K, Williams V, Sastre L. Infant Feeding Practices and Social Determinants of Health of Women in Rural Nicaragua. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.047] [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]
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50
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Porter A, Black S, Dale J, Harris-Mayes R, Lawrenson R, Lyons R, Mason S, Morrison Z, Potts H, Siriwardena N, Rees N, Snooks H, Williams V. PP32 Electronic records in ambulances – an observational study (ERA). Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999abs.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe introduction of information technology (IT) in emergency ambulance services to electronically capture, interpret and store patient data can support out of hospital care. Although electronic health records (EHR) in ambulances and other digital technology are encouraged by national policy across the UK, there is considerable variation across services in terms of implementation. We aimed to understand how electronic records can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care.MethodsWe conducted a mixed-methods study with four work packages (WPs): a rapid literature review, a telephone survey of all 13 freestanding UK ambulance services, detailed case studies in four selected sites, and a knowledge sharing workshop.ResultsWe found considerable variation in hardware and software. Services were in a state of constant change, with services transitioning from one system to another, reverting to paper, or upgrading. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. Clinicians continued to use indirect data input approaches such as first writing on a glove. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care.ConclusionsRealising the full benefits of EHR requires engagement with other parts of the local health economy, dealing with the challenges of interoperability. Clinicians and data managers are likely to want very different things from a data set, and need to be presented with only the information that they need.
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