1
|
Kegelmeyer D, Minarsch RS, Marita K, Hoffmeister A, Schnaterbeck G, Wohl TR, Gokun Y, Kloos A. Step Test Evaluation of Performance on Stairs (STEPS): Assessing Stair Function in Older Adults. J Geriatr Phys Ther 2024:00139143-990000000-00049. [PMID: 38744442 DOI: 10.1519/jpt.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content validity of the STEPS test to determine its usefulness in older adults. METHODS Eighty-two community-dwelling older adults (mean age 81.2 years, 51 females) were assessed on the STEPS test, Timed Up and Go (TUG), 5-times sit to stand (5XSTS), stair self-efficacy (SSE) questionnaire, and time to ascend and descend stairs. Participants repeated the STEPS test 7 to 14 days later for intrarater reliability by the same rater. Spearman rank and intraclass correlations were used to determine the association of measures and intrarater reliability. RESULTS AND DISCUSSION The mean STEPS score was 15.6 (SD = 3.7) out of 20. The STEPS total score demonstrated excellent intra- and interrater reliability. It had moderate to good and significant correlations with TUG, 5XSTS, SSE, and time to ascend and descend measures. Faster performance on the 5XSTS, TUG, and time to ascend and descend correlated with better performance on the STEPS test, indicating validity for assessing balance and mobility during stair negotiation in older adults. Lower SSE correlated with lower observer ratings of performance on stairs (STEPS scores), indicating agreement between participant reports of self-efficacy and observer ratings of performance. Step Test Evaluation of Performance on Stairs items that demonstrated the most frequent loss of points were balance (use of handrail), step continuity, foot placement, and self-propulsion (ascent only). CONCLUSIONS Assessment of older adults' safety and performance on stairs is vital given the increased difficulty of stair navigation and the high risk for injurious falls in this population. This study demonstrates that the STEPS test is a reliable and valid outcome measure for assessing stair performance in older adults.
Collapse
Affiliation(s)
- Deb Kegelmeyer
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Raquel S Minarsch
- Physical Medicine and Rehabilitation, Physical Therapy Division, The Ohio State University, Columbus, Ohio
| | - Katherine Marita
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Audrey Hoffmeister
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | | | - Timothy R Wohl
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Yevgeniya Gokun
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Anne Kloos
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| |
Collapse
|
2
|
Perlow HK, Nalin AP, Handley D, Gokun Y, Blakaj DM, Beyer SJ, Thomas EM, Raval RR, Boulter D, Kleefisch C, Bovi J, Chen WC, Braunstein SE, Raleigh DR, Knisely JPS, Ivanidze J, Palmer JD. A Prospective Registry Study of 68Ga-DOTATATE PET/CT Incorporation Into Treatment Planning of Intracranial Meningiomas. Int J Radiat Oncol Biol Phys 2024; 118:979-985. [PMID: 37871886 DOI: 10.1016/j.ijrobp.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that 68Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy. METHODS AND MATERIALS A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a 68Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion. RESULTS Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation. CONCLUSIONS This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used 68Ga-DOTATATE PET-guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.
Collapse
Affiliation(s)
- Haley K Perlow
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ansel P Nalin
- Ohio State University College of Medicine, Columbus, Ohio
| | - Demond Handley
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Yevgeniya Gokun
- Center for Biostatistics, Ohio State University, Columbus, Ohio
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sasha J Beyer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Evan M Thomas
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raju R Raval
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel Boulter
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William C Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - David R Raleigh
- Department of Radiation Oncology, University of California, San Francisco, California; Departments of Radiation Oncology, Neurological Surgery, and Pathology, University of California, San Francisco, California
| | | | - Jana Ivanidze
- Department of Diagnostic Radiology, Weill Cornell Medicine, New York, New York
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
3
|
Beltrán Ponce S, Gokun Y, Douglass F, Dawson L, Miller E, Thomas CR, Pitter K, Conteh L, Diaz DA. Disparities in outcomes and access to therapy options in hepatocellular carcinoma. J Natl Cancer Inst 2024; 116:264-274. [PMID: 37831897 DOI: 10.1093/jnci/djad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/10/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) disproportionately impacts racial and ethnic minorities and patients with lower socioeconomic status. These social determinants of health (SDH) lead to disparities in access to care and outcomes. We aim to understand the relationship between SDH and survival and locoregional treatment options in HCC. METHODS Using the National Cancer Database, we evaluated survival and access locoregional treatments including non-transplant surgery, liver transplant (LT), and liver-directed radiation therapy (LDRT) in patients with HCC diagnosed between 2004 and 2017. Variables including clinical stage, age, sex, race, income, rurality, year of diagnosis, facility type (FT), Charlson-Deyo score (CD), and insurance were evaluated. Cox proportional hazards multivariable regression and dominance analyses were used for analyses. RESULTS In total, 140 340 patients were included. Worse survival was seen with advanced stage, older age, Black race, rurality, public insurance, treatment at a nonacademic center, and lower income. The top predictors for survival included stage, age, and income. Completion of non-transplant surgery was best predicted by stage, FT, and insurance type, whereas LT was predicted by age, year of diagnosis, and CD score. LDRT utilization was most associated with year of diagnosis, FT, and CD score. CONCLUSION For patients with HCC, survival was predicted primarily by stage, age, and income. The primary sociodemographic factors associated with access to surgical treatments, in addition to FT, were insurance and income, highlighting the financial burdens of health care. Work is needed to address disparities in access to care, including improved insurance access, addressing financial inequities and financial toxicities of treatments, and equalizing care opportunities in community centers.
Collapse
Affiliation(s)
- Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yevgeniya Gokun
- Secondary Data Core, Center for Biostatistics, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | | | - Laura Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Kenneth Pitter
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| | - Lanla Conteh
- Division of Hepatology, Department of Gastroenterology, The Ohio State University Wexner School of Medicine, Columbus, OH, USA
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University Wexner School of Medicine, The James Cancer Center, Columbus, OH, USA
| |
Collapse
|
4
|
Janis JE, Hehr J, Huayllani MT, Khansa I, Gfrerer L, Kavanagh K, Blake P, Gokun Y, Austen WG. Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study. JPRAS Open 2023; 38:152-162. [PMID: 37920284 PMCID: PMC10618225 DOI: 10.1016/j.jpra.2023.09.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Chronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH. Methods A long-term, multicenter, and prospective study was performed. Patients with chronic migraine were recruited at the Ohio State University and Massachusetts General Hospital and included in each treatment group according to their preference (BTA or surgery). Assessment tools including the Migraine Headache Index (MHI), Migraine Disability Assessment Questionnaire (MIDAS) total, MIDAS A, MIDAS B, Migraine Work and Productivity Loss Questionnaire-question 7 (MWPLQ7), and Migraine-Specific Quality of Life Questionnaire (MSQ) version 2.1 were used to evaluate functional outcomes. Patients were evaluated prior to treatment and at 1, 2, and 2.5 years after treatment. Results A total of 44 patients were included in the study (surgery=33, BTA=11). Patients treated surgically showed statistically significant improvement in headache intensity as measured on MIDAS B (p = 0.0464) and reduced disability as measured on MWPLQ7 (p = 0.0120) compared to those treated with BTA injection. No statistical difference between groups was found for the remaining functional outcomes. Mean scores significantly improved over time independently of treatment for MHI, MIDAS total, MIDAS A, MIDAS B, and MWPLQ 7 (p<0.05). However, no difference in mean scores over time was observed for MSQ. Conclusions Headache surgery and targeted BTA injections are both effective means of addressing peripheral trigger sites causing headache pain. However, lower pain intensity and work-related disabilities were found in the surgical group.
Collapse
Affiliation(s)
- Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jason Hehr
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Maria T. Huayllani
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
| | - Kaitlin Kavanagh
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pamela Blake
- Headache Center of River Oaks, Houston, TX, USA
- University of Texas Health Science Center, Houston, TX, USA
| | - Yevgeniya Gokun
- Center for the Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Center, Columbus, OH, USA
| | - William G. Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
| |
Collapse
|
5
|
Douglass F, Gokun Y, Beltran Ponce SE, Elsaid M, Paskett E, Diaz Pardo DA. Impact of the COVID-19 Pandemic on Financial Burden in Those with a Recent History of Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e15-e16. [PMID: 37784733 DOI: 10.1016/j.ijrobp.2023.06.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cancer is well known to create significant financial burden on patients. The pandemic posed novel financial challenges, potentially worsening financial burden. We hypothesized that the financial burden experienced by participants with a recent history of cancer (HC) during the pandemic would be increased compared to participants without history of cancer (NC). MATERIALS/METHODS From June-November 2020, individuals who participated in past Ohio State University (OSU) studies, cancer patients, their caregivers and individuals on OSU community partner listservs were asked to participate in a survey to assess the pandemic's impact on employment and financial concerns (FC). Responses were compiled in a FC score. We wanted to evaluate the impact of a recent cancer diagnosis and treatment, so HC was defined as being diagnosed with cancer within 3 years prior to the survey date. Participants who worked prior to COVID, were matched by propensity score using a 1:2 algorithm to best compare financial burden across HC and NC. Negative binomial multivariable analysis (MVA) was used to compare FC scores of HC to NC, with adjustment for demographic and socioeconomic characteristics. The interaction between HC vs NC and race was examined in MVA. RESULTS Of 32,989 contacted individuals, 9,423 (26.8%) completed the survey. Those with a cancer diagnosis >3 years ago, and/or no full-time employment prior to the pandemic were excluded, leaving a sample of 2,703 participants (449 HC and 2,254 NC). The median age was 54 years for HC and 50 years for NC, 83.7% of HC and 80.0% NC had private insurance, and 4.5% of HC and 6.1% of NC had public insurance, 61.7% of HC and 60.2% of NC had income of $75k+ and 6.0% of HC and 7.2% of NC had income of <35k, 5.8% of HC and 5.2% of NC were Black (p<0.01 for all). Given significant differences in baseline characteristics of both groups, a matched pair-analysis of 1218 participants (421 HC and 797 NC) was performed and utilized for remaining analyses. There were no differences between HC and NC in being paid for a full or part-time job (p = 0.15) or job loss (p = 0.47), due to the pandemic. On MVA, HC were less likely to have financial concerns than NC. Black participants had a 1.55 times higher FC score than white participants, and those with an annual household income < $35K and $35K-50K had 1.8 and 1.5 times higher FC score compared to those with income of $75K or higher (p<0.01 for all). When Black HC were compared to Black NC, HC had 1.6 times higher odds of financial concerns (p = 0.02). CONCLUSION In this selected population, HC were less likely to have financial concerns than NC, potentially due to difference in baseline characteristics that could not be accounted for in MVA. However, those with total income <$50k and Black participants, particularly Black HC, were the groups most likely to have FC during the pandemic. Further analysis should investigate long-term ramifications of increased FC in these vulnerable groups, particularly when pandemic and cancer-related financial burdens are compounded.
Collapse
Affiliation(s)
- F Douglass
- Ohio State School of Medicine, Columbus, OH
| | - Y Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Elsaid
- The Ohio State University, Columbus, OH
| | - E Paskett
- The Ohio State University, Columbus, OH
| | - D A Diaz Pardo
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
6
|
Douglass F, Gokun Y, Beltran Ponce SE, Elsaid M, Paskett E, Pardo DAD. Accessibility and Impact of Telehealth in Rural Populations with a History of Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e15. [PMID: 37784732 DOI: 10.1016/j.ijrobp.2023.06.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) After the COVID-19 pandemic, telehealth (TH) has been increasingly utilized in healthcare delivery. We aim to analyze the preference and availability of TH for participants with a history of cancer (HC) and hypothesize HC in rural areas will have lower access to TH compared to metropolitan residents (metro). MATERIALS/METHODS From June-November 2020, individuals who had participated in past OSU studies, cancer patients, their nominated caregivers and those on OSU community partner listservs were asked to participate in a survey to understand the pandemic's impacts on healthcare access. A follow-up survey was distributed from March-July 2021. Survey data were merged with information from the OSU James Cancer Registry to confirm history of cancer. Only participants with HC were included in this analysis. Participants were asked demographic questions and questions to assess preferences and accessibility regarding TH. Chi-square tests as well as Wilcoxon Rank Sum Test were used to review the bivariate associations between demographic and TH variables with rural/metro residence. RESULTS Of 9,280 who completed the first survey, 7,224 (77.8%) also completed the second survey, and 3,536 were HC (891 rural, 2,645 metro). The median age was 63 years, 63.3% of the participants were women, 89.0% were non-Hispanic white, 15.0% had public health insurance, 53.3% had a college degree or higher, 46.8% of the patients had an income >$75K. In metro areas, more participants were black, had an education of at least a college degree and had higher incomes compared to those in rural areas (p<0.001 for all). Otherwise, there were no differences in patient characteristics between rural and metro HC. When asked TH specific variables, patients in rural areas were less likely to have a smart phone (48.8% vs. 54%), less likely to have internet access (57.8% vs. 62.23%), more likely to be concerned about the cost of internet at home (18% vs. 14.8%), less likely to have participated in video TH visit since the pandemic (27.1% vs. 36.1%) (p<.01 for all). There was no difference in participation in TH by phone, satisfaction with the TH visit, or perception that TH made seeing a provider easier (p>0.05 for all) between rural and metro participants. CONCLUSION Participants in rural areas were less likely to have internet access, which may have a role in their decreased engagement with video TH since the pandemic, compared to metro participants. However, there was no difference in use of telephone visits. Video visits are known to allow a more comprehensive evaluation including visual assessments. Although TH options are desirable for those residing further from medical centers, barriers to completion of successful virtual visits have limited more widespread adoption of TH among this patient population. Future efforts to improve care for rural populations should focus on improving disparities in access to quality telecommunication services and expanded connections with rural providers to provide comprehensive care.
Collapse
Affiliation(s)
- F Douglass
- Ohio State School of Medicine, Columbus, OH
| | - Y Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Elsaid
- The Ohio State University, Columbus, OH
| | - E Paskett
- The Ohio State University, Columbus, OH
| | - D A Diaz Pardo
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
7
|
Raborn LN, Gokun Y, Molina BJ, Janse S, Schoenbrunner AR, Janis JE. Another Day, Another 82 Cents: A National Survey Assessing Gender-based Wage Differences in Board-certified Plastic Surgeons. Plast Reconstr Surg Glob Open 2023; 11:e5196. [PMID: 37588477 PMCID: PMC10427058 DOI: 10.1097/gox.0000000000005196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023]
Abstract
Background Of 7461 actively practicing United States American Board of Plastic Surgery certified plastic surgeons, only 17% are women. In relation to this small number, gender inequities within the field have been the source of national discussions. Our study assessed the status of the gender-based wage-gap in plastic surgery and sought to identify possible causes. Methods An anonymous 43-question survey was distributed to 2981 members of the American Society of Plastic Surgeons in 2021. Male and female responses were compared; an analysis also considering board-certification year was performed. Chi-square and Fisher exact tests were used for bivariate analysis. Continuous variables were compared with two-sample t tests and Wilcoxon rank sum tests. Results Ten percent of contacted American Society of Plastic Surgeons members responded to our survey. Of the 288 respondents, 111 (38.5%) were women, and 177 (61.5%) were men. Men were more likely to have salaries over $400K USD per year (P < 0.0001). Earlier certification year was associated with pay greater than $400K per year (P = 0.0235) but was insignificant once stratified by gender (women: P = 0.2392, men: P = 0.7268). Earlier certification year was associated with production-based and self-determined wages (P = 0.0097), whereas later board-certification year was associated with nonnegotiable salaries (P < 0.0001). Conclusions Women are significantly less likely to make salaries comparable to those of male plastic surgeons, related to shorter careers on average. An increase in female representation and career duration within the field is needed to improve the current wage-gap.
Collapse
Affiliation(s)
- Layne N. Raborn
- From the Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Bianca J. Molina
- Private Practice, The Plastic Surgery Center, Shrewsbury, N.J
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Sarah Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
8
|
Palavalli MH, Huayllani MT, Gokun Y, Lu Y, Janis JE. Surgical Approaches to Orbital Fractures: A Practical and Systematic Review. Plast Reconstr Surg Glob Open 2023; 11:e4967. [PMID: 37197012 PMCID: PMC10185000 DOI: 10.1097/gox.0000000000004967] [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: 10/06/2022] [Accepted: 03/03/2023] [Indexed: 05/19/2023]
Abstract
Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for orbital wall fractures and analyze the literature to compare all major surgical procedures and their complication rates. Method A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms "orbital," "wall," "fracture," and "surgery" with different combinations. Results A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, P < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, P < 0.0001). Conclusion The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.
Collapse
Affiliation(s)
| | | | - Yevgeniya Gokun
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yurong Lu
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
9
|
Bircan E, Politis MD, Gokun Y, Luo C, Leonard H, Bourke J, Bower C, Nembhard WN. Intellectual disabilities and autism among children with congenital heart defects, Western Australia, 1983-2010. BMC Pediatr 2023; 23:106. [PMID: 36870968 PMCID: PMC9985207 DOI: 10.1186/s12887-023-03924-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Children with congenital heart defects (CHDs) are at higher risk of developing an intellectual disability. However, severity of intellectual disabilities among this group of children are largely unknown. Our objective was to determine the risk of intellectual disability (ID), ID severity, and autism among children with CHDs. METHODS We conducted a retrospective cohort study of singleton live births in Western Australia (n = 20,592) between 1983 and 2010. Children with CHDs were identified from the Western Australian Register for Developmental Anomalies (n = 6563) and infants without CHDs were randomly selected from state birth records (n = 14,029). Children diagnosed with ID before 18 years were identified by linkage to statewide Intellectual Disability Exploring Answers database. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from logistic regression models for all CHDs combined and by CHD severity adjusting for potential confounders. RESULTS Of 20,592 children, 466 (7.1%) with CHDs and 187 (1.3%) without CHDs had an ID. Compared to children without CHDs, children with any CHD had 5.26 times (95% CI 4.42, 6.26) the odds of having an ID and 4.76 times (95% CI 3.98, 5.70) the odds of having mild/moderate ID. Children with any CHD had 1.76 times the odds of having autism (95% CI 1.07, 2.88), and 3.27 times the odds of having an unknown cause of ID (95% CI 2.65, 4.05) compared to children without CHD. The risk of having autism (aOR 3.23, 95% CI 1.11, 9.38), and unknown cause of ID (aOR 3.45, 95% CI 2.09, 5.70) was greatest for children with mild CHD. CONCLUSIONS Children with CHDs were more likely to have an ID or autism. Future research should elucidate underlying etiology of ID in children with CHDs.
Collapse
Affiliation(s)
- Emine Bircan
- Arkansas Center for Birth Defects Research and Prevention and the Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR, 72205-7199, USA
| | - Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention and the Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR, 72205-7199, USA
| | - Yevgeniya Gokun
- Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chunqiao Luo
- Data Science Core, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention and the Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR, 72205-7199, USA. .,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| |
Collapse
|
10
|
Prasad RN, Gokun Y, Ritter AR, Jhawar SR, Vudatala S, Wang SJ, Martin D, Diaz DA. Prostate brachytherapy utilization in the COVID-19 era: A cross-sectional study of radiation oncologists in the United States. Brachytherapy 2023; 22:53-57. [PMID: 36347762 PMCID: PMC9489987 DOI: 10.1016/j.brachy.2022.08.016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE Despite advantages such as abbreviated treatment course, brachytherapy (BT) utilization rates for prostate cancer (PC) in the United States (US) are declining. We surveyed practicing US radiation oncologists (ROs) to determine the proportion who offer BT for PC and whether the COVID-19 pandemic influenced practice patterns. MATERIALS AND METHODS From July-October 2021, we surveyed practicing US ROs. Provider demographic and practice characteristics were collected. Questions assessing utilization of BT and external beam (EBRT) for patients of varying risk groups and the effect of the pandemic on practice patterns were administered. Descriptive statistics were reported. The bivariate relationships between provider characteristics and likelihood of offering BT were assessed using the Chi-square test (α < 0.05). RESULTS Six percent of surveyed ROs responded, with 203 meeting inclusion criteria (72% male, 72% white, 53% non-academic, 69% >10 years in practice) and 156 (77%) treating PC. For low-risk, fewer providers offered BT (41% total; 25% low dose rate [LDR], 10% high dose rate [HDR], 6% both) than stereotactic body (SBRT) (54%) and moderately hypofractionated radiation therapy (MHFRT) (83%). For favorable intermediate risk, fewer offered BT (37% total; 21% LDR, 10% HDR, 6% both) than SBRT (48%), MHFRT (87%), and conventionally fractionated EBRT (38%). For high (44%) and very-high (37%) risk, fewer offered EBRT+BT than EBRT alone. For every risk group, academic ROs were significantly more likely to offer BT (all p-values<0.05). <1% of respondents reported increased pandemic-related BT usage. CONCLUSIONS US ROs, particularly in non-academic settings, do not routinely offer BT monotherapy or boost (<50%). Practice patterns were unaffected by COVID-19. Retraining may be critical to increasing utilization.
Collapse
Affiliation(s)
- Rahul N Prasad
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210
| | - Alex R Ritter
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Sachin R Jhawar
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Sundari Vudatala
- Recruitment, Intervention, and Survey Shared Resource, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Shang-Jui Wang
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Douglas Martin
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210.
| |
Collapse
|
11
|
Hinduja A, Gokun Y, Ibekwe E, Senay B, Elmer J. Risk factors for development of cerebral edema following cardiac arrest. Resuscitation 2022; 181:297-303. [PMID: 36280215 DOI: 10.1016/j.resuscitation.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cerebral edema following cardiac arrest is a well-known complication of resuscitation and portends a poor outcome. We identified predictors of post-cardiac arrest cerebral edema and tested the association of cerebral edema with discharge outcome. METHODS We performed a retrospective chart review including patients admitted at a single center between January 2015-March 2020 following resuscitation from in-hospital and out-of-hospital cardiac arrest who had head computed tomography imaging. Our primary outcome was moderate-to-severe cerebral edema, which we defined as loss of grey-white differentiation with effacement of the basal and ambient cisterns and radiographic evidence of uncal herniation. We used logistic regression to test associations of demographic information, clinical predictors and comorbidities with moderate-severe cerebral edema. RESULTS We identified 727 patients who met the inclusion criteria, of whom 102 had moderate-to-severe cerebral edema. We identified six independent predictors of moderate-to-severe cerebral edema: younger age, prolonged arrest duration, pulseless electrical activity/asystole as initial rhythm, unwitnessed cardiac arrest, hyperglycemia on admission, and lower Glasgow coma score on presentation. Of patients with moderate-to-severe cerebral edema, 2% survived to discharge, 56% had withdrawal of life-sustaining therapies and 42% progressed to death by neurological criteria. CONCLUSIONS Our study identified several risk factors associated with the development of cerebral edema following cardiac arrest. Further studies are needed to determine the benefits of early interventions in these high-risk patients.
Collapse
Affiliation(s)
- Archana Hinduja
- Department of Neurology, The Ohio State University, Columbus, OH, United States.
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Elochukwu Ibekwe
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Blake Senay
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Jonathan Elmer
- Department of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, PA, United States
| |
Collapse
|
12
|
Ho C, Perlow H, Ritter A, Gokun Y, Matsui J, Wang J, Damante M, Blakaj D, Beyer S, Thomas E, Lonser R, Hardesty D, Raval R, Palmer J, Elder J. RADT-12. PRE- AND POST-OPERATIVE RADIATION TREATMENT PLANNING FOR PATIENTS RECEIVING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES: A VOLUMETRIC ANALYSIS. Neuro Oncol 2022. [PMCID: PMC9660850 DOI: 10.1093/neuonc/noac209.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Pre-operative stereotactic radiosurgery (SRS) has emerged as a recent treatment option to treat large or symptomatic brain metastases. Compared to post-operative SRS, pre-operative treatment may reduce rates of radiation necrosis (RN) and meningeal disease through treating a smaller treatment volume and by preventing post-operative tumor seeding. We hypothesize that pre-operative radiation volumes will be smaller than post-operative volumes, which in turn may lead to a decreased treatment morbidity.
METHODS
A retrospective analysis was conducted and patients who had surgical resection and post-operative SRS or fractionated stereotactic radiosurgery (FSRT) for a posterior fossa brain metastasis were eligible for inclusion. Both pre-operative and post-operative MRIs were required to allow for accurate radiation target delineation. A pre-operative tumor volume was added for each patient, and the post-operative clinical treatment volume (CTV) used for radiation treatment was included. Pre-operative tumor and post-operative cavity volumes were compared using Wilcoxon signed rank test.
RESULTS
28 patients who received post-operative SRS or FSRT from 1/1/2016-12/31/2020 were included in this analysis. The mean pre-operative tumor volume was 14.9 ccs, and the mean post-operative CTV was 21.0 ccs (p < 0.01). 75% of patients had a smaller initial tumor size compared to the post-operative CTV used for radiation treatment planning. For patients with at least 4 follow up MRIs (n = 8), the size of the post-operative cavity progressively decreased with a mean initial cavity volume of 18.9 ccs and mean follow up volumes of 8.1, 7.1, 6.9, and 6.2 ccs.
CONCLUSIONS
In this study evaluating patients who received post-operative SRS, the pre-operative tumor volume was lower than the post-operative CTV for most patients. Previous studies including PROPS-BM have shown how pre-operative treatment may reduce the risk of RN because smaller radiation volumes are used. Pre-operative radiosurgery for patients with brain metastases requires prospective validation.
Collapse
Affiliation(s)
- Cindy Ho
- The Ohio State University College of Medicine , Columbus , USA
| | - Haley Perlow
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Alex Ritter
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Yevgeniya Gokun
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Jennifer Matsui
- The Ohio State University College of Medicine , Columbus , USA
| | - Joshua Wang
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Mark Damante
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Dukagjin Blakaj
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Sasha Beyer
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Evan Thomas
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Russell Lonser
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Douglas Hardesty
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Raju Raval
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Joshua Palmer
- The Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - James Elder
- The Ohio State University Wexner Medical Center , Columbus , USA
| |
Collapse
|
13
|
Perlow H, Prasad R, Siedow M, Gokun Y, McElroy J, Matsui J, Cadieux C, Eiler D, Odou S, Addington M, Ivanidze J, Bovi J, Kleefisch C, Zoller W, Palmer J. RADT-31. 68GA-DOTATATE PET VERSUS MRI-BASED TREATMENT PLANNING FOR POST-OPERATIVE AND INTACT MENINGIOMA: A DOSIMETRIC ANALYSIS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Nearly all meningiomas express somatostatin receptor 1/2 (SSTR1/SSTR2); therefore, SSTR ligands such as 68Ga-DOTATATE can be utilized for meningioma radiotherapy treatment planning. Incorporation of 68Ga-DOTATATE PET assists with target delineation and may reduce the dose to organs-at-risk (OARs). We hypothesize that 68Ga-DOTATATE PET-based treatment plans will reduce dose to OARs when compared to MRI-based plans.
METHODS
All treatment plans were rendered on computed tomography (CT) planning datasets, using RapidArc and 6MV photon energy. Two arcs were positioned on the coplanar axis with alternated collimator settings of 0 and 90 degrees to promote MLC sparing with a third unique vertex arc chosen independently to spare normal brain tissue and associated organs at risk (OAR). For MRI structures, a 1 cm expansion from the gross tumor volume (GTV) created a clinical treatment volume (CTV)60. A 2 cm expansion created a CTV54. For PET structures, a 1 cm expansion from the GTV created a CTV60. A 3 mm isotropic expansion created planning treatment volumes (PTVs). Plans were optimized such that Dmax to brainstem remained limited to 60Gy or less and Dmax to optic structures was limited to 54Gy or less.
RESULTS
18 meningioma patients were included (9 post-operative, 9 intact). The mean PTV volume using MRI was 258 ccs (306 ccs for post-operative, 210 ccs for intact), and the mean PTV volume using PET was 60 ccs (97 ccs for post-operative, 91 ccs for intact). The mean radiation dose to both optic nerves, the optic chiasm, both hippocampi, and the brainstem was reduced favoring PET-based treatment plans for both post-operative and intact patients.
CONCLUSION
Our study shows that incorporation of 68Ga-DOTATATE PET can reduce dose to OARs for post-operative and intact patients, and this difference may translate to reduced toxicity. 68Ga-DOTATATE PET guided radiation treatments are worthy of future prospective investigation.
Collapse
Affiliation(s)
- Haley Perlow
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Rahul Prasad
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Michael Siedow
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Yevgeniya Gokun
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Joseph McElroy
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Jennifer Matsui
- The Ohio State University College of Medicine , Columbus , USA
| | - Catherine Cadieux
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Daniel Eiler
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Sean Odou
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Mark Addington
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | | | - Joseph Bovi
- Medical College of Wisconsin , Milwaukee, WI , USA
| | | | - Wesley Zoller
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Joshua Palmer
- The Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center , Columbus, OH , USA
| |
Collapse
|
14
|
Perlow H, Prasad R, Siedow M, Gokun Y, Matsui J, Blakaj D, Beyer S, Thomas E, Raval R, Chakravarti A, Prevedello D, Hardesty D, Elder J, Palmer J. RADT-35. A PROSPECTIVE REGISTRY STUDY OF 68GA-DOTATATE PET INCORPORATION INTO TREATMENT PLANNING OF INTRACRANIAL MENINGIOMAS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction
The current standard for meningioma radiation planning involves MRI-based image guidance. SSTR ligands such as 68Ga-DOTATATE are being explored for meningioma radiotherapy treatment planning due to universal expression of somatostatin receptor 1/2 in meningioma tissue. We hypothesize that 68Ga-DOTATATE PET utilization can reduce the risk of local failure (LF) through precise radiation planning and may also suggest that patients who have local PET avidity after a perceived GTR may be poor observation candidates.
METHODS
A single institution prospective registry study was created and included intracranial meningioma patients who received a 68Ga-DOTATATE PET scan to assist with radiation oncologist decision-making. These were ordered for all meningioma patients as a departmental standard. Patients who received a PET scan from 1/1/2018-2/25/2022 were eligible for inclusion.
RESULTS
60 patients were treated in this prospective registry. 22%, 72%, and 7% were World Health Organization (WHO) high, intermediate, and low-risk, respectively. After completing their PET scan, 48, 11, and 1 patient(s) proceeded with RT, observation, or redo craniotomy. The median follow up was 16 months (IQR 8.3-23.1). 3 patients (5%) experienced LF between 9.2-28.5 months after diagnosis. 2 patients with LF had PET-avid disease in their post-operative cavity and elected for observation prior to recurrence, and 1 high-risk patient with multifocal disease experienced LF 2 years after a second radiation course and multiple previous recurrences. LF rates after radiation were 0%, 0%, and 8% in the low, intermediate, and high-risk cohorts, respectively. There were no Grade 3 or higher toxicities attributed to PET-guided radiation.
CONCLUSION
This is the largest known population of intracranial meningioma patients followed by physicians who utilized 68Ga-DOTATATE PET guided therapy. Only 1 patient experienced LF after receiving PET-guided radiation therapy, likely due to a radioresistant histology. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision-making and improve patient outcomes.
Collapse
Affiliation(s)
- Haley Perlow
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Rahul Prasad
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Michael Siedow
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Yevgeniya Gokun
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Jennifer Matsui
- The Ohio State University College of Medicine , Columbus , USA
| | - Dukagjin Blakaj
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Sasha Beyer
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Evan Thomas
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Raju Raval
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | | | - Daniel Prevedello
- The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Douglas Hardesty
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - James Elder
- The Ohio State University Wexner Medical Center , Columbus , USA
| | - Joshua Palmer
- The Department of Radiation Oncology, The James Cancer Hospital, Ohio State University Wexner Medical Center , Columbus, OH , USA
| |
Collapse
|
15
|
Perlow H, Prasad R, Siedow M, Gokun Y, McElroy J, Matsui J, Cadieux C, Eiler D, Odou S, Addington M, Ivanidze J, Bovi J, Kleefisch C, Zoller W, Palmer J. 68Ga-DOTATATE PET vs. MRI-Based Treatment Planning for Post-Operative and Intact Meningioma: A Dosimetric Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2190] [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: 11/30/2022]
|
16
|
Ramsey ML, Li SS, Lara LF, Gokun Y, Akshintala VS, Conwell DL, Heintz J, Kirkby SE, McCoy KS, Papachristou GI, Patel A, Singh VK, Hart PA. Cystic fibrosis transmembrane conductance regulator modulators and the exocrine pancreas: A scoping review. J Cyst Fibros 2022; 22:193-200. [PMID: 36008229 DOI: 10.1016/j.jcf.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in subjects with cystic fibrosis (CF); however, the effects on pancreatic manifestations are not well characterized. We hypothesized that CFTR modulators would improve measures of exocrine pancreatic function and outcomes. METHODS We performed a systematic search to identify studies reporting measures of the exocrine pancreas in humans treated with CFTR modulators. Only studies reporting baseline and on-treatment assessments were included. RESULTS Of 630 identified studies, 41 met inclusion criteria. CFTR modulators reduced acute pancreatitis events by 85% overall (rate ratio 0.15, 95% confidence interval (CI) 0.04, 0.52), with a greater effect seen in the subgroup with pancreas sufficient CF (PS-CF) (rate ratio 0.13 (95% CI 0.03, 0.53). Among 293 subjects with baseline and on-treatment evaluation of pancreas sufficiency, 253 were pancreas insufficient at baseline and 54 (21.3%) converted to pancreas sufficiency. Of 32 subjects with baseline FE-1 values <200 mcg/g, 16 (50%) increased to ≥200 mcg/g. Serum trypsin decreased by a mean of 565.9 ng/mL (standard deviation (SD) 311.8), amylase decreased by 38.2 U/L (SD 57.6), and lipase decreased by 232.3 U/L (SD 247.7). CONCLUSIONS CFTR modulator use reduces acute pancreatitis frequency and improves indirect measures of exocrine pancreas function. Future interventional studies that evaluate the mechanism and impact of CFTR modulators on acute pancreatitis and pancreas sufficiency in patients with CFTR dysfunction are warranted.
Collapse
Affiliation(s)
- Mitchell L Ramsey
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan S Li
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, USA
| | - Luis F Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, USA
| | - Venkata S Akshintala
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Heintz
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephen E Kirkby
- Division of Pulmonary and Critical Care Medicine, The Ohio State University Wexner Medical Center, USA
| | - Karen S McCoy
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alpa Patel
- Division of Pediatric Pulmonology and Sleep Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
17
|
Lowe L, Castillo F, Gokun Y, Williams DK, Israel M, Yates C. Static and Dynamic Balance Assessment in Healthy and Concussed Adolescent Athletes. Clin J Sport Med 2022; 32:385-390. [PMID: 34596064 PMCID: PMC8958180 DOI: 10.1097/jsm.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the utilization of the Y Balance Test (YBT) alongside the Balance Error Scoring System (BESS) during examination of healthy adolescent athletes (14-18 year old) as well as those with acute and chronic concussion. DESIGN A repeated-measures study of balance in a cross-sectional convenience sample of adolescents participating in high-school athletics. SETTING Data were collected on healthy athletes in their school setting for comparison purposes and on concussed athletes in the physical therapy rehabilitation center at the hospital. PARTICIPANTS Participants were a convenience sample of male and female athletes between the ages of 14 to 18 year old [180 healthy (111 male, 69 female) and 44 (28 male, 16 female) with concussion]. ASSESSMENT OF RISK FACTORS All participants were cleared for participation by preparticipation examination or by the treating sport medicine physician. MAIN OUTCOME MEASURES Healthy athletes performed the YBT, a dynamic assessment of balance. Athletes with concussion also performed the BESS, a static assessment of balance. RESULTS Means for each YBT reach direction were statistically different for both healthy males and females ( P < 0.05). Within both the acute and chronic subsets of the concussed sample, some participants performed over the median value for the BESS but not the YBT. CONCLUSIONS These data may suggest that dynamic balance testing in conjunction with static balance testing could be valuable in both the acute and chronic phases of concussion to ensure a comprehensive assessment of the necessary balance skills for athletic play.
Collapse
Affiliation(s)
- Leah Lowe
- Department of Physical Therapy, University of Central Arkansas, USA
| | | | - Yevgeniya Gokun
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, USA
| | - David K Williams
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, USA
| | - Michael Israel
- Sports Medicine Clinic, Arkansas Children’s Hospital, USA
| | - Charlotte Yates
- Department of Physical Therapy, University of Central Arkansas, USA
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, USA
| |
Collapse
|
18
|
Perlow HK, Siedow M, Gokun Y, McElroy J, Matsui J, Zoller W, Beyer S, Arnett A, Blakaj D, Boulter D, Fritz J, Miller E, Raval R, Kleefisch C, Bovi J, Palmer JD. 68Ga-DOTATATE PET-based Radiation Contouring Creates More Precise Radiation Volumes for Meningioma Patients. Int J Radiat Oncol Biol Phys 2022; 113:859-865. [PMID: 35460804 DOI: 10.1016/j.ijrobp.2022.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/26/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiation treatment planning for meningiomas traditionally involves MRI contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base, sagittal sinus, or post resection. Advanced PET imaging using 68Ga-DOTATATE PET, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesize that 68Ga-DOTATATE PET scan-based treatment planning will lead to smaller radiation volumes and will detect additional areas of disease compared to standard MRI alone. METHODS Our data evaluated retrospective, deidentified, and blinded gross tumor volume (GTV) contour delineation with 7 central nervous system (CNS) specialists (4 CNS radiation oncologists and 3 neuroradiologists) for 25 patients diagnosed with a meningioma who received both a 68Ga-DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET were non-sequentially contoured by each physician for each patient. RESULTS The median MRI volume for each physician ranged from 16.94-25.53 ccs. The median PET volume for each physician ranged from 2.09-8.36 ccs. The median PET volume was smaller for each physician. In addition, 7/25 (28%) patients had new non-adjacent areas contoured on PET by at least 6 of the 7 physicians that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI based volumes. CONCLUSION Our study supports that 68Ga-DOTATATE PET imaging may help radiation oncologists create more precise radiation treatment volumes through finding undetected areas of disease not seen on MRI. 68Ga-DOTATATE PET guided treatment planning should be studied prospectively.
Collapse
Affiliation(s)
- Haley K Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Siedow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yevgeniya Gokun
- The Ohio State University, Center for Biostatistics, Columbus, OH, USA
| | - Joseph McElroy
- The Ohio State University, Center for Biostatistics, Columbus, OH, USA
| | | | - Wesley Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrea Arnett
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Boulter
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joel Fritz
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric Miller
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raju Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Joseph Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
19
|
Zhang K, Navari L, Li A, Lee S, Gokun Y, Cho MJ, Skoracki R, Park KU. QIM22-207: Physical Therapy Assessment for Management of Breast Cancer Related Lymphedema After Axillary Lymph Node Dissection. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin Zhang
- 1 College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ladan Navari
- 1 College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amy Li
- 2 The Ohio State University, Columbus, OH
| | - Sandy Lee
- 3 The Ohio State University Wexner Medical Center, Columbus, OH
| | - Yevgeniya Gokun
- 3 The Ohio State University Wexner Medical Center, Columbus, OH
| | - Min-Jeong Cho
- 3 The Ohio State University Wexner Medical Center, Columbus, OH
| | - Roman Skoracki
- 3 The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ko Un Park
- 3 The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
20
|
Fakhouri F, Kannengiesser S, Pfeuffer J, Gokun Y, Kolipaka A. Free-breathing MR elastography of the lungs: An in vivo study. Magn Reson Med 2022; 87:236-248. [PMID: 34463400 PMCID: PMC8616792 DOI: 10.1002/mrm.28986] [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: 04/29/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Lung stiffness alters with many diseases; therefore, several MR elastography (MRE) studies were performed earlier to investigate the stiffness of the right lung during breathhold at residual volume and total lung capacity. The aims of this study were 1) to estimate shear stiffness of the lungs using MRE under free breathing and demonstrate the measurements' repeatability and reproducibility, and 2) to compare lung stiffness under free breathing to breathhold and as a function of age and gender. METHODS Twenty-five healthy volunteers were scanned on a 1.5 Tesla MRI scanner. Spin-echo dual-density spiral and a spin-echo EPI MRE sequences were used to measure shear stiffness of the lungs during free breathing and breathhold at midpoint of tidal volume, respectively. Concordance correlation coefficient and Bland-Altman analyses were performed to determine the repeatability and reproducibility of the spin-echo dual-density spiral-derived shear stiffness. Repeated measures analyses of variances were used to investigate differences in shear stiffness between spin-echo dual-density spiral and spin-echo EPI, right and left lungs, males and females, and different age groups. RESULTS Free-breathing MRE sequence was highly repeatable and reproducible (concordance correlation coefficient > 0.86 for both lungs). Lung stiffness was significantly lower in breathhold than in free breathing (P < .001), which can be attributed to potential stress relaxation of lung parenchyma or breathhold inconsistencies. However, there was no significant difference between different age groups (P = .08). The left lung showed slightly higher stiffness values than the right lung (P = .14). There is no significant difference in lung stiffness between genders. CONCLUSION This study demonstrated the feasibility of free-breathing lung MRE with excellent repeatability and reproducibility. Stiffness changes with age and during the respiratory cycle. However, gender does not influence lungs stiffness.
Collapse
Affiliation(s)
- Faisal Fakhouri
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA.,Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | | | - Josef Pfeuffer
- MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Yevgeniya Gokun
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH 43210, USA
| | - Arunark Kolipaka
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, 43210, USA.,Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| |
Collapse
|
21
|
Nash J, Shahwan KT, Chung C, Abidi N, Gokun Y, Pan X, Carr DR. Grading of differentiation in cutaneous squamous cell carcinoma: Evaluation of interrater and intrarater reliability. J Am Acad Dermatol 2021; 87:895-897. [DOI: 10.1016/j.jaad.2021.12.015] [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] [Received: 06/29/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
|
22
|
Perlow H, Yang M, Siedow M, Gokun Y, McElroy J, Matsui J, Beyer S, Arnett A, Boulter D, Fritz J, Miller E, Blakaj D, Zoller W, Cadieux C, Eiler D, Addington M, DiConstanzo D, Grecula J, Raval R, Chakravarti A, Palmer J. NIMG-62. 68(GA)DOTATATE PET-BASED RADIATION CONTOURING CREATES SMALLER AND MORE PRECISE RADIATION VOLUMES FOR MENINGIOMA PATIENTS. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
PURPOSE
Radiation treatment planning for meningiomas conventionally involves MRI contrast enhanced images to define residual tumor. However, the gross tumor volume may be difficult to delineate for patients with a meningioma in the skull base, sagittal sinus, or post resection. Advanced PET imaging using 68(GA)DOTATATE PET, which has been shown to be more sensitive and specific than MRI imaging, can be used for target volume delineation in these circumstances. We hypothesize that 68(GA)DOTATATE PET scan-based treatment planning will lead to smaller radiation volumes and will detect additional areas of disease compared to standard MRI alone.
METHODS
Our data evaluated retrospective, deidentified, and blinded gross tumor volume (GTV) contour delineation with 7 CNS specialists (3 neuroradiologists, 4 CNS radiation oncologists) for 26 patients diagnosed with a meningioma who received both a 68(GA)DOTATATE PET and an MRI for radiation treatment planning. Both the MRI and the PET were non-sequentially contoured by each physician for each patient.
RESULTS
The mean MRI volume for each physician ranged from 24.14-35.52 ccs. The mean PET volume for each physician ranged from 10.59-20.54 ccs. The PET volumes were significantly smaller for 6 out of the 7 physicians. In addition, 7/26 (27%) patients had new non-adjacent areas contoured on PET by at least 6 of the 7 physicians that were not contoured by these physicians on the corresponding MRI. These new areas would not have been in the traditional MRI based volumes.
CONCLUSION
Our study supports that 68(GA)DOTATATE PET imaging can help radiation oncologist create smaller and more precise radiation treatment volumes. Utilization of 68(GA)DOTATATE PET may find undetected areas of disease which in turn can improve local control and progression free survival. 68(GA)DOTATATE PET guided treatment planning should be studied prospectively.
Collapse
Affiliation(s)
- Haley Perlow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Yang
- Ohio State University School of Medicine, Columbus, OH, USA
| | - Michael Siedow
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yevgeniya Gokun
- The Ohio State University, Center for Biostatistics, Columbus, OH, USA
| | | | | | - Sasha Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrea Arnett
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Boulter
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joel Fritz
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric Miller
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wesley Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine Cadieux
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Eiler
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Addington
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dominic DiConstanzo
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raju Raval
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Arnab Chakravarti
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Joshua Palmer
- The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
23
|
Christian LM, Webber S, Gillespie S, Strahm AM, Schaffir J, Gokun Y, Porter K. Maternal Depressive Symptoms, Sleep, and Odds of Spontaneous Early Birth: Implications for Racial Inequities in Birth Outcomes. Sleep 2021; 44:6279824. [PMID: 34019675 DOI: 10.1093/sleep/zsab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Delivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37-38 weeks). Approximately 70% of cases of shortened gestation are spontaneous - without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact. METHODS This study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 Black, 182 White) who completed psychosocial assessment in mid-pregnancy. RESULTS Adjusting for key covariates, Black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR (95% CI) = 1.89 (1.01, 3.53), p=0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor [39.2% versus 15.7%, [OR (95% CI) = 2.69 (1.27, 5.70), p = 0.01]. A higher proportion of Black women met criteria for both risk factors (23% of Black women versus 11% of White women; p=0.004), with a lower proportion experiencing neither risk factor (40.7% of Black versus 64.3% of White women; p < 0.001). CONCLUSIONS Additive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.
Collapse
Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Department of Psychology, The Ohio State University, Columbus, OH, USA.,Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shannon Webber
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yevgeniya Gokun
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
24
|
ELHassan NO, Young SG, Gokun Y, Wan F, Nembhard WN. Trends in prevalence and spatiotemporal distribution of gastroschisis in Arkansas, 1998-2015. Birth Defects Res 2020; 112:1484-1494. [PMID: 33179872 PMCID: PMC8756334 DOI: 10.1002/bdr2.1772] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Arkansas (AR) had the highest prevalence of gastroschisis in a recent study including 15 U.S. states. Our objective was to evaluate trends in prevalence and the spatiotemporal distribution of gastroschisis in AR. METHODS Infants with gastroschisis, born 1998-2015, were identified from the Arkansas Reproductive Health Monitoring System. Birth record data were used as denominators for calculations. Maternal residence at delivery was geocoded for spatial analyses. Annual prevalence rates (PRs) were calculated. Joinpoint regression analysis was performed to examine trends in gastroschisis and report the annual percent changes (APCs) in PRs. Spatiotemporal analyses identified counties with unusually high PRs of gastroschisis. Poisson regression, including county, year, and county*year indicators, was fit to evaluate the PRs of gastroschisis, while adjusting for county-level maternal variables. RESULTS We identified 401 cases of gastroschisis among 694,459 live births. The overall PR of gastroschisis was 5.8/10,000 live births. The prevalence of gastroschisis had a significant APC of +5.3% (p < .0001) between 1998 and 2012, followed by a nonsignificant yearly average decrease of -17% through 2015 (p = 0.2). The Emerging Hot Spot Analysis and SaTScan identified an overlapping five-county cluster from 2006 to 2013. Poisson regression model, including county (inside vs. outside cluster), time (before vs. after 2006), and county*time indicators, was fit to evaluate the PRs of gastroschisis. The model did not confirm the presence of a spatiotemporal cluster, once it adjusted for county-level maternal characteristics (p = .549). CONCLUSION Close monitoring of rates of gastroschisis is warranted to determine if the PRs of gastroschisis continue to decline in AR.
Collapse
Affiliation(s)
- Nahed O ELHassan
- Department of Pediatrics (Neonatology), Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
| | - Sean G Young
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yevgeniya Gokun
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Biostatistics, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Fei Wan
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Biostatistics, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Division of Public Health Sciences, Washington University in St. Louis, St Louis, Missouri, USA
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Little Rock, Arkansas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Heath, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
25
|
Bonasso PC, Dassinger MS, Mehl SC, Gokun Y, Gowen MS, Burford JM, Smith SD. Timing of enterostomy closure for neonatal isolated intestinal perforation. J Pediatr Surg 2020; 55:1535-1541. [PMID: 31954555 DOI: 10.1016/j.jpedsurg.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost. METHODS Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons. RESULTS Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44-2.53; p < .0001). The median length of stay for A1 was 95 days (95% CI: 78-102 days) versus A2 length of stay of 67 days (95% CI: 56-76 days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR: 0.78; 95% CI for RR: 0.64-0.95; p-value = 0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (p < 0.001). CONCLUSION Neonates with IIP have a 28 day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22 day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions. TYPE OF STUDY Prognosis Study. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Patrick C Bonasso
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - M Sidney Dassinger
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven C Mehl
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yevgeniya Gokun
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marie S Gowen
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Burford
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Samuel D Smith
- Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
26
|
Divine H, Jones M, Gokun Y, McIntosh T. Impact of Curricular Integration Between Patient Care Laboratory and Introductory Pharmacy Practice Experience on Documentation. Am J Pharm Educ 2020; 84:7232. [PMID: 32226066 PMCID: PMC7092783 DOI: 10.5688/ajpe7232] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Objective. To assess the impact of curricular changes made through vertical integration between Patient Care Laboratory and Introductory Pharmacy Practice Experience (IPPE) courses on documentation outcomes. Methods. Curricular changes to address student pharmacist documentation deficiencies were developed by laboratory and experiential faculty members. A documentation activity using subjective, objective, assessment, plan (SOAP) notes completed in one IPPE rotation block, pre-intervention, were graded and compared to SOAP notes from the same IPPE rotation block in the subsequent year, post-intervention, using a standard checklist. Chi square test (or Fisher exact test when appropriate) was used to evaluate the relationship between each question's score and different timepoints. Wilcoxon rank sum test was used to compare total scores between the two groups of students. Results. Significant improvement among student pharmacists' SOAP note scores were observed in the post-intervention cohort (n=52) compared to pre-intervention cohort (n=52) following curricular changes. Specific SOAP note components that revealed significant improvements between years were drug therapy problem identified, proposed drug therapy problem resolution, follow-up plan identified, overall impression, and addressing a pharmacist-specific intervention. Conclusion. Collaboration between laboratory and experiential education faculty members are integral to the identification of gaps in student pharmacists' application of simulated activities into actual experiences and in the achievement of educational outcomes. Curricular quality improvements can be implemented and assessed quickly through vertically integrated courses.
Collapse
Affiliation(s)
- Holly Divine
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Mikael Jones
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| | - Yevgeniya Gokun
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tera McIntosh
- University of Kentucky College of Pharmacy, Lexington, Kentucky
| |
Collapse
|
27
|
Lowe LM, Gokun Y, Williams DK, Yates C. SPATIOTEMPORAL PARAMETERS OF ADOLESCENT GAIT WHEN PERFORMING A VISUOSPATIAL MEMORY TASK. Int J Sports Phys Ther 2019; 14:753-760. [PMID: 31598413 PMCID: PMC6769276] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Accurate assessment of recovery following mild traumatic brain injury in adolescents can be difficult. When compared to single-task models, dual-task models that combine cognitive and motor demands may more accurately identify residual deficits that manifest during daily life and athletic play in adolescents with concussion. Previous studies have examined gait changes during a concurrent auditory task, or cognitive task. PURPOSE The purpose of this study was to collect and present data from a sample of healthy 14-18 year old male and female athletes on spatiotemporal parameters of gait for walking with and without a concurrent visuospatial memory task presented on a hand-held tablet. STUDY DESIGN A two-way repeated measures study of spatiotemporal gait parameters in a cross-sectional convenience sample of adolescent subjects participating in high school athletics. METHODS Subjects comprised a total of 178 adolescent athletes (128 males; 50 females) ages 14-18 years old at six area high schools. Subjects were instructed to walk "how you normally do" on the GAITRite® portable gait analysis walkway for three undivided and three divided attention trials performing a visuospatial memory task on a hand-held tablet. RESULTS Significant differences (p < 0.0001) were present between males and females during typical gait in each of the measured parameters except step length (p = 0.0715). Female participants walked with a significantly faster gait velocity (by 0.21 m/s) than male participants (p < 0.0001). The females spent a significantly smaller (-2.27%) percent of the gait cycle in double limb support (p < 0.0001) and a significantly greater (+1.10%) percent of the gait cycle in single limb support (p < 0.0001) than did the males. Both groups experienced a similar, dual-task cost during the divided attention trials (p < 0.0001) for each of the four gait parameters. Previous studies have shown that adults decrease their gait velocity by approximately 33% when performing a task on a hand-held device. The current study revealed that adolescents decreased their gait velocity by 8-9% by shortening their step length by 7.4 centimeters (p < 0.0001), increased the percent of the gait cycle spent in double limb support (2.73%, p < 0.0001) and decreased the percent of the gait cycle spent in single limb support (1.38%, p < 0.0001) during the dual-task. CONCLUSION These data provide preliminary reference values specific to the adolescent population for the dual-task cost during a visuospatial memory task. More research is needed to determine the dual-task cost during a visuospatial memory task for adolescents with concussion. LEVEL OF EVIDENCE 2b.
Collapse
Affiliation(s)
- Leah M Lowe
- Department of Physical Therapy, University of Central Arkansas, Conway, AR, USA
| | - Yevgeniya Gokun
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | |
Collapse
|
28
|
Linares AM, Rayens MK, Gomez ML, Gokun Y, Dignan MB. Intention to Breastfeed as a Predictor of Initiation of Exclusive Breastfeeding in Hispanic Women. J Immigr Minor Health 2016; 17:1192-8. [PMID: 24903355 DOI: 10.1007/s10903-014-0049-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exclusive breastfeeding (EBF) is the most efficacious form of infant feeding and nutrition. Hispanic mothers in the US are more likely than mothers of other racial/ethnic groups to supplement with formula in the first 2 days of life. The purpose of this study was to explore infant feeding intentions during the prenatal period as a predictor of EBF at postpartum discharge in a sample of Hispanic women (n = 99). At discharge, 51 % of the women were EBF, 44 % were breastfeeding and supplementing with formula, and 5 % were feeding only formula. Intention to breastfeed was found to be a strong and potentially modifiable predictor of breastfeeding behavior, showing a significant association with EBF upon discharge from the hospital after birth when linked with acceptance of pregnancy and method of delivery. Prenatal care offers a unique opportunity to enhance intentions to breastfeed that may lead to improved EBF in this health vulnerable population.
Collapse
Affiliation(s)
- Ana M Linares
- College of Nursing, University of Kentucky, 315 College of Nursing Building, Lexington, KY, 40536-0230, USA,
| | | | | | | | | |
Collapse
|
29
|
Tovar EG, Dekker RL, Chung ML, Gokun Y, Moser DK, Lennie TA, Rayens MK. Self-efficacy mediates the relationship of depressive symptoms and social support with adherence in patients with heart failure. J Health Psychol 2016; 21:2673-2683. [DOI: 10.1177/1359105315583369] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor self-care is common among adults with heart failure and leads to poor health outcomes. Low self-efficacy, depression, and low social support are associated with poor self-care, but knowledge about these relationships in heart failure is limited. Secondary data analysis of cross-sectional data from 346 adults with heart failure measuring self-efficacy, depressive symptoms, social support, and self-care adherence was conducted. Tests of mediation using multiple linear regressions indicate that self-efficacy fully mediates the relationships between depression and adherence, and social support and adherence. Bolstering self-efficacy may have a greater impact on self-care adherence than targeting either depression or social support alone.
Collapse
|
30
|
Ereshefsky BJ, Al-Hasan MN, Gokun Y, Martin CA. Comparison of ß-lactam plus aminoglycoside versus ß-lactam plus fluoroquinolone empirical therapy in serious nosocomial infections due to Gram-negative bacilli. J Chemother 2016; 29:30-37. [PMID: 27376664 DOI: 10.1080/1120009x.2016.1154684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We sought to compare clinical cure on day 7 and a 28-day all-cause mortality in patients who received an anti-pseudomonal ß-lactam with a fluoroquinolone or an aminoglycoside for treatment of nosocomial bacteremia or pneumonia due to Gram-negative bacilli while in the ICU. This retrospective cohort study was conducted in critically ill patients at an academic medical centre from January 2005 to August 2011. A total of 129 patients (83 receiving aminoglycoside and 46 receiving fluoroquinolone combinations) were included. Seven-day clinical cure rates were 74% and 72% for fluoroquinolone and aminoglycoside groups, respectively (p = 0.84). There was no significant difference in the odds of clinical cure with a fluoroquinolone as compared to an aminoglycoside combination (adjusted odds ratio 2.4, 95% confidence interval [CI] 0.7-9.0). There was no significant difference in 28-day mortality in patients who received a fluoroquinolone or an aminoglycoside combination (22% vs. 18%, adjusted hazard ratio 0.82, 95% CI 0.29-2.28).
Collapse
Affiliation(s)
| | - Majdi N Al-Hasan
- b Division of Infectious Diseases, UK HealthCare , Lexington , KY , USA
| | - Yevgeniya Gokun
- c Department of Pharmacy Practice and Science , University of Kentucky College of Pharmacy , Lexington , KY , USA
| | - Craig A Martin
- a Department of Pharmacy Services , UK HealthCare , Lexington , KY , USA.,c Department of Pharmacy Practice and Science , University of Kentucky College of Pharmacy , Lexington , KY , USA
| |
Collapse
|
31
|
Abstract
Purpose. To compare the retail distribution and density per population of electronic and conventional cigarettes in smoke-free communities with and without e-cigarette restrictions. Design. A cross-sectional study with field observations of retail tobacco stores. Setting. Two Central Kentucky counties with 100% smoke-free workplace regulations; counties selected on the basis of whether e-cigarette use was restricted. Subjects. Fifty-seven tobacco retailers in two counties, including conventional retailers and stand-alone e-cigarette stores. Measures. Type and location of store and products sold; addresses of stores and schools geocoded with ArcGIS. Analysis. Bivariate comparisons between counties, rates and confidence intervals for frequency of tobacco retailers and e-cigarette stores per population. Results. Fifty-three percent of tobacco retailers sold e-cigarettes. E-cigarette availability did not differ by whether smoke-free regulation covered e-cigarettes. Rates of tobacco retailers and e-cigarette distributors per 10,000 were 8.29 and 4.40, respectively, in the two-county area. Of the 40 schools, 88% had a tobacco retailer and 68% had an e-cigarette distributor within 1 mile. Conclusion. In this exploratory study, e-cigarette use restriction was not related to store availability. For a relatively new product, e-cigarettes were readily available in retail outlets and close to schools.
Collapse
|
32
|
Abstract
Objective Exposure to radon is associated with approximately 10% of U.S. lung cancer cases. Geologic rock units have varying concentrations of uranium, producing fluctuating amounts of radon. This exploratory study examined the spatial and statistical associations between radon values and geological formations to illustrate potential population-level lung cancer risk from radon exposure. Method This was a secondary data analysis of observed radon values collected in 1987 from homes (N = 309) in Kentucky and geologic rock formation data from the Kentucky Geological Survey. Radon value locations were plotted on digital geologic maps using ArcGIS and linked to specific geologic map units. Each map unit represented a package of different types of rock (e.g., limestone and/or shale). Log-transformed radon values and geologic formation categories were compared using one-way analysis of variance. Results Observed radon levels varied significantly by geologic formation category. Of the 14 geologic formation categories in north central Kentucky, four were associated with median radon levels, ranging from 8.10 to 2.75 pCi/L. Conclusion Radon potential maps that account for geologic factors and observed radon values may be superior to using observed radon values only. Knowing radon-prone areas could help target population-based lung cancer prevention interventions given the inequities that exist related to radon. We examine spatial and statistical associations between radon and rock formations. Observed radon levels vary significantly by geologic formation category. Four rock types are associated with high radon levels. Mapping both rock formations and radon values may be better than radon alone.
Collapse
Affiliation(s)
- Ellen J. Hahn
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
- Corresponding author at: University of Kentucky College of Nursing, 751 Rose St.Lexington, KY 40536-0232, United States.
| | - Yevgeniya Gokun
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | | | | | - Heather Robertson
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | - Amanda Wiggins
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| | - Mary Kay Rayens
- Clean Indoor Air Partnership, College of Nursing, University of Kentucky, United States
| |
Collapse
|
33
|
Alexander KM, Divine HS, Hanna CR, Gokun Y, Freeman PR. Implementation of personalized medicine services in community pharmacies: perceptions of independent community pharmacists. J Am Pharm Assoc (2003) 2015; 54:510-7, 5 p following 517. [PMID: 25148656 DOI: 10.1331/japha.2014.13041] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the perceptions of independent community pharmacists within a regional independent community pharmacy cooperative on implementing personalized medicine services at their pharmacies and to gauge the pharmacists' self-reported knowledge of pharmacogenomic principles. DESIGN Descriptive, exploratory, nonexperimental study. SETTING American Pharmacy Services Corporation (APSC), 2011-12. PARTICIPANTS Pharmacists (n = 101) affiliated with the independent pharmacies of APSC. INTERVENTION Single-mode survey. MAIN OUTCOME MEASURES Independent community pharmacists' interest in implementing personalized medicine services, perceived readiness to provide such services, and perceived barriers to implementation. RESULTS 101 completed surveys were returned for data analysis. The majority of pharmacists surveyed (75%) expressed interest in offering personalized medicine services. When asked to describe their knowledge of pharmacogenomics and readiness to implement such services, more than 50% said they were not knowledgeable on the subject and would not currently be comfortable making drug therapy recommendations to physicians or confident counseling patients based on results of genetic screenings without further training and education. Respondents identified cost of providing the service, reimbursement issues, current knowledge of pharmacogenomics, and time to devote to the program as the greatest barriers to implementing personalized medicine services. CONCLUSION The majority of independent community pharmacists are interested in incorporating personalized medicine services into their practices, but they require further education before this is possible. Future initiatives should focus on the development of comprehensive education programs to further train pharmacists for provision of these services.
Collapse
|
34
|
Butler KM, Begley K, Riker C, Gokun Y, Anderson D, Adkins S, Record R, Hahn EJ. Smoke-free coalition cohesiveness in rural tobacco-growing communities. J Community Health 2014; 39:592-8. [PMID: 24338076 DOI: 10.1007/s10900-013-9804-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.
Collapse
Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, 423 College of Nursing, University of Kentucky, Lexington, KY, 40536, USA,
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Swope R, Glover K, Gokun Y, Fraser JF, Cook AM. Evaluation of headache severity after aneurysmal subarachnoid hemorrhage. Interdisciplinary Neurosurgery 2014. [DOI: 10.1016/j.inat.2014.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Ickes M, Gokun Y, Rayens MK, Hahn EJ. Comparing Two Observational Measures to Evaluate Compliance With Tobacco-Free Campus Policy. Health Promot Pract 2014; 16:210-7. [DOI: 10.1177/1524839914561060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite potential benefits of tobacco-free campus policies, compliance remains a challenge. Observational measures hold the most promise in determining compliance with these policies. There is need for further study to determine validity of observational measures of compliance with tobacco-free campus policies. The purpose of this study was to determine the validity of two observational measures of compliance with a tobacco-free campus policy: direct observation of violators and cigarette butts. Data collection took place over a 1-year time period. Direct observation was operationally defined as the number of observed violators in hot spots. A cigarette butt protocol previously found to be reliable was used to count the number of butts in campus hot spots. Results indicated a positive relationship between number of violators observed per visit and number of cigarette butts collected. Although most of the hot spots exhibited two or fewer violators per visit and 100 butts or fewer per collection, the data points outside this range supported a positive association between observed violators per visit and cigarette butts. The findings support that direct observation of violators is a valid measure of compliance compared to cigarette butts. Given available resources, using one or the other as evaluation measures is warranted.
Collapse
Affiliation(s)
- Melinda Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Yevgeniya Gokun
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
37
|
Mudd-Martin G, Rayens MK, Lennie TA, Chung ML, Gokun Y, Wiggins AT, Biddle MJ, Bailey AL, Novak MJ, Casey BR, Moser DK. Fatalism moderates the relationship between family history of cardiovascular disease and engagement in health-promoting behaviors among at-risk rural Kentuckians. J Rural Health 2014; 31:206-16. [PMID: 25252080 DOI: 10.1111/jrh.12094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE In rural communities that experience high rates of cardiovascular disease (CVD) morbidity and mortality, family history education may enhance risk awareness and support engagement in healthy behaviors but could also engender fatalism. This study was conducted to assess if the relationship between family history and adherence to healthy lifestyle behaviors is moderated by fatalism. METHODS Baseline data were obtained from 1,027 adult participants in the HeartHealth in Rural Kentucky study. Multiple linear regression was used to determine whether fatalism moderated the relationship between high-risk family history of CVD and adherence to healthy lifestyle behaviors, controlling for sociodemographic variables and CVD risk factors. The relationship between family history and healthy behaviors was assessed for subgroups of participants divided according to the upper and lower quartiles of fatalism score. FINDINGS The relationship between high-risk family history of CVD and adherence to healthy behaviors was moderated by fatalism. Among those with the highest quartile of fatalism scores, high-risk family history predicted greater adherence to healthy behaviors, while among those in the lowest quartile, and among those with the middle 50% of fatalism scores, there was no association between family history and healthy behavior scores. CONCLUSIONS Family history education can provide people at increased risk for CVD important information to guide health practices. This may be particularly relevant for those with a high degree of fatalistic thinking. In rural communities with limited health resources, family history education, combined with assessment of fatalism, may support better targeted interventions to enhance engagement in healthy behaviors.
Collapse
Affiliation(s)
- Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hardin-Fanning F, Gokun Y. Gender and age are associated with healthy food purchases via grocery voucher redemption. Rural Remote Health 2014; 14:2830. [PMID: 25063239 PMCID: PMC4331127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Grocery vouchers that specifically target foods associated with reduced cardiovascular disease (CVD) risk result in increased consumption of those foods. In regions with disproportionately high CVD rates, there is little research concerning the impact of vouchers on purchases of risk-reducing foods when there are no restrictions placed on grocery voucher redemption. Since many food assistance programs place few restrictions on type of foods that can be purchased, identifying demographic factors associated with purchasing habits is a prerequisite to promoting healthy eating. The purpose of this study was to determine the associations of age, gender, education and income level with purchasing of healthful foods through the use of a grocery voucher in a rural food desert (poverty rate of ≥20% and ≥33% of residents living >16 km from a large grocery store) with high rates of chronic disease. METHODS The effectiveness of an intervention that included a media campaign, a $5 grocery voucher, local heart healthy food branding and a grocery store event was tested. Brief nutritional articles were published in both local newspapers during four consecutive weeks. These articles explained the physiological actions of healthy foods and listed a health-promoting recipe. During the fourth week of the media campaign, a voucher for a $5 grocery gift card redeemable at one of either community grocery stores was also printed in both local newspapers. In each store, foods that are known to be associated with a reduced risk of CVD were marked with a blue logo. Participants (N=311) completed a questionnaire that assessed demographics and usual servings of fruits, vegetables and grains. Participants received a $5 grocery card and a list of labelled foods. Returned grocery receipts were stapled to the questionnaires to analyse the relationship between demographics and food choices. RESULTS Participants who bought at least one labelled food item were older (M=48.5, SD=14.7) than those who did not buy any of these items (M=42.3, SD=16.4; p=0.0008). There was a significant association between labelled food purchases and gender, with 47% of male participants purchasing at least one labelled food item compared with 63% of females in the study (p = 0.008). There were no significant associations between purchase of labelled food items and either education or income. The significant predictors were age (p=0.003) and gender (p=0.01). For every 10 year increase in age, there was a 29% increase in the likelihood that at least one labelled food item would be purchased. Male participants were 48% less likely to purchase at least one designated food item than female participants were. CONCLUSIONS Younger adults and men may be less responsive to media-based educational strategies, heart-healthy food labelling and grocery vouchers to defray the cost of healthy eating than older adults and women. Previous studies show that concerns about cost and availability of foods are greater factors in the decision to purchase these foods than demographic characteristics. However, age and gender are associated with the likelihood of using grocery vouchers for the purchase of healthful foods. Additional research is needed to determine whether different educational strategies paired with food labelling and grocery vouchers may be successful strategies to promote purchase of healthful foods, particularly for men and younger adults.
Collapse
Affiliation(s)
| | - Yevgeniya Gokun
- University of Kentucky College of Nursing, Lexington, Kentucky , USA.
| |
Collapse
|
39
|
Hardin-Fanning F, Gokun Y. Gender and age are associated with healthy food purchases via grocery voucher redemption. Rural Remote Health 2014. [DOI: 10.22605/rrh2830] [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: 11/03/2022] Open
|
40
|
Sigurdardottir AO, Svavarsdottir EK, Rayens MK, Gokun Y. The Impact of a Web-Based Educational and Support Intervention on Parents’ Perception of Their Children’s Cancer Quality of Life. J Pediatr Oncol Nurs 2014; 31:154-65. [DOI: 10.1177/1043454213515334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this exploratory study was to (1) describe the development of an evidence-based web educational and support intervention for families of children with cancer and (2) assess the favorability of the website, and whether there was any impact on the cancer communication aspect of the quality of life instrument. In the study, 38 persons participated—15 mothers, 12 fathers, and 11 children. The favorability score of the website was found to be very high. The mothers rated the website most favorable, followed closely by the fathers. Furthermore, even though it was not significant, an increase was found in the mothers’ evaluation of cancer communication based on the Pediatric Quality of Life Questionnaire (PedsQL) after the intervention as compared with before. The findings suggest that the use of an evidence-based website is feasible, appears to enhance cancer knowledge and might, in that way, contribute to better management of the cancer situation for the families.
Collapse
Affiliation(s)
- Anna Olafia Sigurdardottir
- Landspitali–The National University Hospital, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Erla Kolbrun Svavarsdottir
- Landspitali–The National University Hospital, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | | |
Collapse
|
41
|
Rose SA, Gokun Y, Talbert J, Conigliaro J. Screening and management of obesity and perception of weight status in Medicaid recipients. J Health Care Poor Underserved 2014; 24:34-46. [PMID: 23727963 DOI: 10.1353/hpu.2013.0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We sought to identify any correlations among primary care provider weight screening and counseling, patient weight perception, and weight loss attempt. METHODS We performed a cross-sectional analysis of obesity-related questions from 2009 and 2010 Kentucky Medicaid Adult Patient and Provider survey data. RESULTS 1,510 patients [46% obese (body mass index (BMI) ≥30 kg/m2), 26% overweight (BMI 25 to <30), 26% normal weight (BMI 18 to <25), and 2% underweight (BMI<18)] and 787 providers (41% primary care) met criteria. Patients and providers differed on report of physician weight loss counseling (46% versus 92%). Patient report of physician weight loss counseling and weight loss attempt were positively correlated (77% with versus 38% without counseling, p<.01). One-fifth of patients underperceived their weight. Patients reporting physician weight counseling were less likely to underperceive their weight (13% versus 23%, p<.0001). CONCLUSIONS Weight loss attempt and accurate weight perception were positively correlated with physician weight discussion.
Collapse
Affiliation(s)
- Stephanie A Rose
- College of Medicine, University of Kentucky, Louisville, KY, USA.
| | | | | | | |
Collapse
|
42
|
Tovar E, Rayens MK, Gokun Y, Clark M. Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support. J Health Psychol 2013; 20:1405-15. [DOI: 10.1177/1359105313512514] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Depression and diabetes have been linked in a variety of ways, and the presence of depression in those with diabetes can negatively affect adherence to care recommendations. A sample of 201 participants with Type 2 Diabetes completed a cross-sectional survey that assessed depressive symptoms, adherence, self-efficacy, social support, and personal characteristics. Multiple regression analysis was used to test whether self-efficacy and social support mediate the relationship between depressive symptoms and adherence. The findings suggest complete mediation via self-efficacy and some types of social support. Intervening to bolster self-efficacy and social support may decrease the negative effect of depression on adherence.
Collapse
|
43
|
Mudd-Martin G, Martinez MC, Rayens MK, Gokun Y, Meininger JC. Sociocultural tailoring of a healthy lifestyle intervention to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Prev Chronic Dis 2013; 10:E200. [PMID: 24286274 PMCID: PMC3843568 DOI: 10.5888/pcd10.130137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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] [Indexed: 12/04/2022] Open
Abstract
Background Suboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. We describe a community–academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos. Community Context The community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. This growth underscores the need for socioculturally appropriate health resources. Methods Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted. Outcomes Postintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk. Feedback indicated the program was socioculturally acceptable and responsive to community needs. Interpretation These findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. The project highlights contributions of community-based processes in tailoring interventions that are appropriate for community contexts.
Collapse
Affiliation(s)
- Gia Mudd-Martin
- University of Kentucky College of Nursing, 533 College of Nursing Building, 760 Rose St, Lexington, KY 40536-0232. E-mail:
| | | | | | | | | |
Collapse
|
44
|
Walsh KA, Lewis DA, Clifford TM, Hundley JC, Gokun Y, Angulo P, Davis GA. Risk factors for venous thromboembolism in patients with chronic liver disease. Ann Pharmacother 2013; 47:333-9. [PMID: 23482730 DOI: 10.1345/aph.1r496] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pharmacologic prophylaxis for venous thromboembolism (VTE) in patients with chronic liver disease (CLD) presents a unique challenge because of coagulopathies associated with the disease. When evaluating whether these patients require VTE prophylaxis upon hospitalization, it would be advantageous if risk factors for the development of VTE in this population were known. OBJECTIVE To evaluate risk factors associated with the development of VTE in patients with CLD. METHODS A retrospective case-control study was conducted. Patients admitted to the University of Kentucky Chandler Hospital from October 2006 to July 2010 with a diagnosis of CLD and VTE were matched in a 1:3 fashion with CLD patients without VTE. The primary objective was to determine whether there were significant differences in laboratory values between the 2 groups. RESULTS During this time, 27 patients with CLD (1.0%) were diagnosed with VTE. These patients had significantly lower median aspartate aminotransferase (AST) (47 vs 70 U/L, p = 0.04), alanine transaminase (ALT) (24.5 vs 36 U/L, p = 0.02), albumin (2.1 vs 2.4 g/dL, p = 0.02) and hematocrit (Hct) (28.3% vs 32%, p = 0.03) values compared to the control patients. Patients with albumin lower than 1.9 g/dL had a 5.1 times greater risk of VTE compared to patients with albumin of 2.8 g/dL and higher (OR 5.14, 95% CI 1.05-25.2). CONCLUSIONS Patients with CLD who developed VTE had significantly lower AST, ALT, albumin, and Hct compared to those of control patients. Studies are necessary to further examine the significance of this finding.
Collapse
Affiliation(s)
- Kelly A Walsh
- University of Kentucky Chandler Medical Center/UKHealthCare, Lexington, KY, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
The use of generic antiepileptic drugs (AEDs) in patients with epilepsy is controversial. The purpose of this study is to identify patient characteristics associated with increased odds of receiving a generic AED product. A large commercial database was used to identify patients with a primary diagnosis of epilepsy who were prescribed an AED during a three-month window. Data analysis found that those ≥65 years old had 15.7% greater odds of receiving a generic AED (OR = 1.157; 95% CI = 1.056-1.268). Patients with Medicaid were found to have 2.44 times the odds of having had a generic AED prescription (OR = 2.44; CI = 2.168-2.754). Patients residing in the Northeast had 12.6% decreased odds of receiving a generic AED (OR = 0.874; C I= 0.821-0.931). These patient characteristics could signify certain health care disparities and may represent potential confounders to future observational studies.
Collapse
Affiliation(s)
- Jennifer Meyer
- University of Kentucky College of Pharmacy, Lexington, KY, USA.
| | - David Fardo
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Steven T. Fleming
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Claudia Hopenhayn
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Yevgeniya Gokun
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Melody Ryan
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| |
Collapse
|
46
|
Black EP, Policastri A, Garces H, Gokun Y, Romanelli F. A pilot common reading experience to integrate basic and clinical sciences in pharmacy education. Am J Pharm Educ 2012; 76:25. [PMID: 22438597 PMCID: PMC3305934 DOI: 10.5688/ajpe76225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/18/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To use a common reading experience that engages students in academic discourse both before and during a PharmD degree program and introduces students to basic science and ethical foundations in health care. DESIGN First-year (P1) pharmacy students were assigned a nonfiction text to read during the summer prior to admission to be followed by facilitated discussions. Activities using the text were integrated into the first-year curriculum. Pre-experience and post-experience student and faculty survey instruments were administered. ASSESSMENT Students and faculty members reported that 3 first-year courses used the text. Students noted that the text's historical perspective enhanced their understanding of both healthcare delivery and clinical research. Most students (78%) recommended continuation of the common reading experience activity. CONCLUSION Students and participating faculty members found the common reading experience, which provided a hub for discussion around issues such as health literacy and ethical treatment of patients, to be a positive addition to the curriculum. Future intentions for this project include expansion across all healthcare colleges at the university.
Collapse
Affiliation(s)
- Esther P Black
- Pharmaceutical Sciences, University of Kentucky College of Pharmacy, 789 S. Limestone Street, Lexington, KY 40536, USA.
| | | | | | | | | |
Collapse
|