1
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Johnson MA, Parambath A, Shah N, Shah AS. Publication Rates Vary Across Orthopaedic Subspecialties: A Longitudinal Analysis of AAOS Abstracts. Iowa Orthop J 2023; 43:1-7. [PMID: 38213852 PMCID: PMC10777694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Presentation of research at national orthopaedic meetings and subsequent publication are important for both information exchange among surgeons and individual academic advancement. However, the academic landscape and pressures that researchers face may differ greatly across different subspecialties. This study attempts to explore and quantify differences in research presented at national conferences and its implication on ultimate likelihood of publication in peer-reviewed journals. Methods All abstracts from the Annual Meetings of the American Academy of Orthopaedic Surgeons (AAOS) from 2016 and 2017 were reviewed and categorized based on subspecialty focus. Resulting publications were identified using a systematic search of PubMed and Google Scholar databases. Multivariate binary logistic regression modelling was used to assess the predictive value of abstract characteristics on eventual publication. Results A total of 1805 abstracts from the 2016 and 2017 AAOS conferences were reviewed. The overall publication rate of abstracts following the AAOS meetings was 71.6%, with an average time to publication from abstract submission deadline and impact factor of 19.8 months and 2.878, respectively. Statistical differences were observed across subspecialties with respect to publication rate (p<0.001), time to publication (p<0.001), and impact factor (p<0.001). The subspecialty with the highest publication rate, largest impact factor, and shortest average time to publication was Sports Medicine with 83.2%, 3.98, and 17.6 months, respectively; despite lower average sample size (p<0.001) and frequency of multicenter design (p<0.001) compared with other subspecialties. The subspecialty with the lowest publication rate and impact factor was Hand and Wrist with 53.3% and 1.41, respectively. Multivariate logistic regression analysis demonstrates a lower likelihood for internationally authored abstracts (OR: 0.75, p=0.021) and higher likelihood for basic science abstracts (OR: 1.52, p-value=0.023) to reach publication. Conclusion Differences in publication rate across orthopaedic subspecialties were observed with articles in sports medicine more likely to be published, published quickly, and featured in a higher impact factor journals. Understanding these differences, and how they relate to the publication and promotion of novel research, is important for orthopaedic researchers. Level of Evidence: IV.
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Affiliation(s)
| | - Andrew Parambath
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neal Shah
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Apurva S. Shah
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Johnson MA, Weber KL, Parambath A, Shah N, Dardas AZ, Ronen S, Shah AS. A Glass Ceiling in Orthopedic Surgery: Publication Trends by Gender. Orthopedics 2023; 46:e118-e124. [PMID: 36314874 DOI: 10.3928/01477447-20221024-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Women are underrepresented across the field of orthopedic surgery and may face barriers to academic advancement. Research presentation at national meetings and publication record are important drivers of advancement in academic orthopedic surgery. However, little is known regarding potential gender differences in publication after orthopedic conference research presentation. This investigation analyzed research presentations at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 2016 and 2017. Author gender was determined through a search of institutional and professional networking websites for gender-specific pronouns. Resulting publications were identified using a systematic search of PubMed and Google Scholar databases. A total of 1696 of 1803 (94.1%) abstracts from 2016 to 2017 had identifiable gender for both the first and last authors, with 1213 (71.5%) abstracts ultimately being published. There were no differences in average sample size or level of evidence between genders. Abstracts authored by women were significantly less likely to lead to publication compared with those by men (67.1% vs 72.1%, P=.023), with articles authored by women having a longer median time to publication (median, 20 months [interquartile range, 19] vs 17 months [interquartile range, 15]; P=.003). This discrepancy was most apparent in adult reconstruction, with women having a 15.5% lower rate of publication (55.1% [27/49] vs 70.6% [307/435]; P=.026) and lower publication journal impact factor (2.7±1.4 vs 3.4±3.4, P=.040) than men. Potential reasons for these discrepancies, including disproportionate domestic obligations, inadequate mentorship, and bias against female researchers, should be addressed. [Orthopedics. 2023;46(2):e118-e124.].
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3
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Bram JT, Magee LC, Parambath A, Bauer AS, Lawler EA, Miller PE, Shah AS. Glass Ceiling in Hand Surgery: Publication Trends by Gender. Iowa Orthop J 2022; 42:3-9. [PMID: 35821956 PMCID: PMC9210407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women are frequently underrepresented across surgical subspecialties and may face barriers to academic advancement. Abstracts presented at American Society for Surgery of the Hand annual meeting (ASSH-AM) highlight some of the top research in hand surgery. We sought to explore differences in abstract characteristics and publication rates based on senior author gender.Though there have been increasing efforts at inclusivity in orthopedic and plastic surgery, women face several barriers to entering the field, publish less frequently, and are underrepresented in leadership positions. Understanding the stages at which discrepancies in research productivity exist may help to address these challenges. METHODS Abstracts from the 2010-2017 ASSH-AMs were reviewed to determine basic characteristics. Author gender was determined through both a search of institutional websites for gender-specific pronouns and inference of gender based on first name. Subsequent full manuscript publications corresponding to the abstracts were identified through a systematic search of PubMed and Google Scholar. RESULTS A total of 560/620 (90.3%) abstracts from 2010-2017 had an identifiable senior author gender (14.5% female). No differences were noted between male- and female-authored abstracts regarding study design including sample size or level of evidence. Female senior authors were more likely than males to author abstracts focused on pediatrics (19.8% vs 9.4%, p=0.01) and were more likely to collaborate with female first authors (41.3% vs 20.0%, p<0.01). Abstract publication rates were lower for female senior authors versus male senior authors (61.7% vs 74.5%, p=0.02). CONCLUSION The number of abstracts with female senior authors had similar representation to the membership proportion of women in the ASSH. There were few differences in abstract characteristics based on senior author gender, though senior authors tend to collaborate with investigators of the same gender. Abstracts authored by females were published 13% less frequently overall, meriting further exploration. Level of Evidence: III.
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Affiliation(s)
- Joshua T. Bram
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lacey C. Magee
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Parambath
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrea S. Bauer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Ericka A. Lawler
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patricia E. Miller
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Apurva S. Shah
- Division of Orthopaedics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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4
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Lee KC, Morgan AU, Chaiyachati KH, Asch DA, Xiong RA, Do D, Kilaru AS, Lam D, Parambath A, Friedman AB, Meisel ZF, Snider CK, Chisholm DL, Kelly S, Hemmons JE, Abdel-Rahman D, Ebert J, Ghosh M, Reilly J, O'Malley CJ, Hahn L, Mannion NM, Huffenberger AM, McGinley S, Balachandran M, Khan N, Shea JA, Mitra N, Delgado MK. Pulse Oximetry for Monitoring Patients with Covid-19 at Home - A Pragmatic, Randomized Trial. N Engl J Med 2022; 386:1857-1859. [PMID: 35385625 PMCID: PMC9006781 DOI: 10.1056/nejmc2201541] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathleen C Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anna U Morgan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ruiying A Xiong
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Do
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Austin S Kilaru
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Doreen Lam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Parambath
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ari B Friedman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zachary F Meisel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Deena L Chisholm
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sheila Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica E Hemmons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dina Abdel-Rahman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Ebert
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Medha Ghosh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julianne Reilly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lauren Hahn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nancy M Mannion
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann M Huffenberger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan McGinley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mohan Balachandran
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neda Khan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Kit Delgado
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Delgado MK, Morgan AU, Asch DA, Xiong R, Kilaru AS, Lee KC, Do D, Friedman AB, Meisel ZF, Snider CK, Lam D, Parambath A, Wood C, Wilson CM, Perez M, Chisholm DL, Kelly S, O'Malley CJ, Mannion N, Huffenberger AM, McGinley S, Balachandran M, Khan N, Mitra N, Chaiyachati KH. Comparative Effectiveness of an Automated Text Messaging Service for Monitoring COVID-19 at Home. Ann Intern Med 2022; 175:179-190. [PMID: 34781715 PMCID: PMC8722738 DOI: 10.7326/m21-2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although most patients with SARS-CoV-2 infection can be safely managed at home, the need for hospitalization can arise suddenly. OBJECTIVE To determine whether enrollment in an automated remote monitoring service for community-dwelling adults with COVID-19 at home ("COVID Watch") was associated with improved mortality. DESIGN Retrospective cohort analysis. SETTING Mid-Atlantic academic health system in the United States. PARTICIPANTS Outpatients who tested positive for SARS-CoV-2 between 23 March and 30 November 2020. INTERVENTION The COVID Watch service consists of twice-daily, automated text message check-ins with an option to report worsening symptoms at any time. All escalations were managed 24 hours a day, 7 days a week by dedicated telemedicine clinicians. MEASUREMENTS Thirty- and 60-day outcomes of patients enrolled in COVID Watch were compared with those of patients who were eligible to enroll but received usual care. The primary outcome was death at 30 days. Secondary outcomes included emergency department (ED) visits and hospitalizations. Treatment effects were estimated with propensity score-weighted risk adjustment models. RESULTS A total of 3488 patients enrolled in COVID Watch and 4377 usual care control participants were compared with propensity score weighted models. At 30 days, COVID Watch patients had an odds ratio for death of 0.32 (95% CI, 0.12 to 0.72), with 1.8 fewer deaths per 1000 patients (CI, 0.5 to 3.1) (P = 0.005); at 60 days, the difference was 2.5 fewer deaths per 1000 patients (CI, 0.9 to 4.0) (P = 0.002). Patients in COVID Watch had more telemedicine encounters, ED visits, and hospitalizations and presented to the ED sooner (mean, 1.9 days sooner [CI, 0.9 to 2.9 days]; all P < 0.001). LIMITATION Observational study with the potential for unobserved confounding. CONCLUSION Enrollment of outpatients with COVID-19 in an automated remote monitoring service was associated with reduced mortality, potentially explained by more frequent telemedicine encounters and more frequent and earlier presentation to the ED. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- M Kit Delgado
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, and Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.K.D.)
| | - Anna U Morgan
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (A.U.M.)
| | - David A Asch
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Wharton School, and Leonard Davis Institute of Health Economics, University of Pennsylvania, and Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (D.A.A.)
| | - Ruiying Xiong
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, and Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (R.X.)
| | - Austin S Kilaru
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (A.S.K., A.B.F., Z.F.M.)
| | - Kathleen C Lee
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, and Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (K.C.L.)
| | - David Do
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, and Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (D.D.)
| | - Ari B Friedman
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (A.S.K., A.B.F., Z.F.M.)
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (A.S.K., A.B.F., Z.F.M.)
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Doreen Lam
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Andrew Parambath
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Christian Wood
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (C.W., C.M.W., D.L.C.)
| | - Chidinma M Wilson
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (C.W., C.M.W., D.L.C.)
| | - Michael Perez
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Deena L Chisholm
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (C.W., C.M.W., D.L.C.)
| | - Sheila Kelly
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (S.K.)
| | - Christina J O'Malley
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Nancy Mannion
- Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania (N.M., A.M.H., S.M.)
| | - Ann Marie Huffenberger
- Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania (N.M., A.M.H., S.M.)
| | - Susan McGinley
- Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania (N.M., A.M.H., S.M.)
| | - Mohan Balachandran
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Neda Khan
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania (C.K.S., D.L., A.P., M.P., C.J.O., M.B., N.K.)
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (N.M.)
| | - Krisda H Chaiyachati
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, and Center for Health Care Innovation and Center for Connected Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania (K.H.C.)
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6
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Abstract
BACKGROUND Study groups are multicenter collaborations aimed at improving orthopaedic decision-making through higher-powered, more generalizable studies. New research is disseminated through peer-reviewed literature and academic meetings, including the Pediatric Orthopaedic Society of North America (POSNA) annual meeting, which brings together academic and medical professionals in pediatric orthopaedics. The goal of this study was to identify patterns in podium presentations (PP) at the POSNA annual meeting resulting from multicenter study groups during a 15-year period. METHODS A total of 2065 PP from the 2006 to 2020 POSNA annual meetings were identified. The abstracts of each PP were reviewed to determine if they resulted from a multicenter study group and for characteristics including subspecialty focus. PP from 2006 to 2018 were further reviewed for publication in academic journals. Pearson correlation was used to assess change in the number of PP resulting from study groups overtime. Univariate analysis was used to compare characteristics of PP based on study group involvement (significance P<0.05). RESULTS The proportion of PP resulting from study groups increased from 2.2% (n=2) in 2006 to 9.4% in 2020 (n=16) (R2=0.519, P=0.002). Of the PP resulting from study groups, 52.9% focused on spine, 26.5% on hip, 2.9% on sports, and 2.0% on trauma. This is compared with a distribution of 16.7% (P<0.001) spine, 15.9% (P=0.005) hip, 9.5% (P=0.026) sports, and 14.6% (P<0.001) trauma focus of PP not from study groups. There was no difference in publication rate of PP resulting from study groups compared with those that were not (69.1% vs. 66.2%, P=0.621). CONCLUSIONS In the 15-year period from 2006 to 2020, there was a nearly 5-fold increase in the proportion of POSNA PP resulting from study groups. Spine surgery is disproportionately supported by study groups, suggesting that there is an opportunity to establish new study groups across the breadth of pediatric orthopaedics. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | - Mitchell A Johnson
- Perelman School of Medicine at the University of Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Apurva S Shah
- Perelman School of Medicine at the University of Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jason B Anari
- Perelman School of Medicine at the University of Pennsylvania
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
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7
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Meer EA, Herriman M, Lam D, Parambath A, Rosin R, Volpp KG, Chaiyachati KH, McGreevey JD. Design, Implementation, and Validation of an Automated, Algorithmic COVID-19 Triage Tool. Appl Clin Inform 2021; 12:1021-1028. [PMID: 34734403 DOI: 10.1055/s-0041-1736627] [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: 10/19/2022] Open
Abstract
OBJECTIVE We describe the design, implementation, and validation of an online, publicly available tool to algorithmically triage patients experiencing severe acute respiratory syndrome coronavirus (SARS-CoV-2)-like symptoms. METHODS We conducted a chart review of patients who completed the triage tool and subsequently contacted our institution's phone triage hotline to assess tool- and clinician-assigned triage codes, patient demographics, SARS-CoV-2 (COVID-19) test data, and health care utilization in the 30 days post-encounter. We calculated the percentage of concordance between tool- and clinician-assigned triage categories, down-triage (clinician assigning a less severe category than the triage tool), and up-triage (clinician assigning a more severe category than the triage tool) instances. RESULTS From May 4, 2020 through January 31, 2021, the triage tool was completed 30,321 times by 20,930 unique patients. Of those 30,321 triage tool completions, 51.7% were assessed by the triage tool to be asymptomatic, 15.6% low severity, 21.7% moderate severity, and 11.0% high severity. The concordance rate, where the triage tool and clinician assigned the same clinical severity, was 29.2%. The down-triage rate was 70.1%. Only six patients were up-triaged by the clinician. 72.1% received a COVID-19 test administered by our health care system within 14 days of their encounter, with a positivity rate of 14.7%. CONCLUSION The design, pilot, and validation analysis in this study show that this COVID-19 triage tool can safely triage patients when compared with clinician triage personnel. This work may signal opportunities for automated triage of patients for conditions beyond COVID-19 to improve patient experience by enabling self-service, on-demand, 24/7 triage access.
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Affiliation(s)
- Elana A Meer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Maguire Herriman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Doreen Lam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Andrew Parambath
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Roy Rosin
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Kevin G Volpp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Krisda H Chaiyachati
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.,Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - John D McGreevey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Office of the Chief Medical Information Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.,Center for Applied Health Informatics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
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8
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Johnson MA, Halloran K, Carpenter C, Pascual-Leone N, Parambath A, Sharma J, Seltzer R, Ellis HB, Shea KG, Ganley TJ. Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis. Orthop J Sports Med 2021; 9:23259671211010826. [PMID: 33997072 PMCID: PMC8107815 DOI: 10.1177/23259671211010826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of
public health response measures including social distancing, school
cancellations, and cessation of organized sports. Purpose: To examine the impact of COVID-19 and corresponding public health measures on
the characteristics of common pediatric musculoskeletal injuries associated
with sports. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective cohort study comparing patients with
sports injuries presenting to 3 geographically diverse level I pediatric
trauma hospitals and outpatient orthopaedic surgery clinics in the United
States during the COVID-19 pandemic and a prepandemic period at the same
institutions. Patients were included if they presented for care between
February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and
April 15 in 2018 and 2019 (prepandemic cohort). Results: Included were 1455 patients with an average age of 12.1 ± 4.5 years. When
comparing patients presenting in 2018 and 2019 with those presenting in
2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs
11.0 ± 5.2 years; P = .048). Additionally, a decrease in
the proportion of injuries attributed to sports (48.8% vs 33.3%;
P < .001) and those occurring at school (11.9% vs
4.0%; P = .001) was observed. The proportion of injuries
attributable to clavicle fractures increased during the early stages of the
pandemic (13.2% vs 34.7%; P < .001). There was no
statistically significant delay to care in injuries presenting during the
pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175). Conclusion: Across 3 tertiary care institutions, patients were seen without significant
delay during the pandemic. We observed a significant decline in pediatric
musculoskeletal injuries associated with sports during the COVID-19
pandemic. This decrease has been accompanied by a shift in both injury type
and mechanism.
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Affiliation(s)
- Mitchell A Johnson
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kenny Halloran
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | | | | | - Andrew Parambath
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jigyasa Sharma
- Stanford University Medical Center, Stanford, California, USA
| | - Ryan Seltzer
- Stanford University Medical Center, Stanford, California, USA
| | - Henry B Ellis
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Kevin G Shea
- Stanford University Medical Center, Stanford, California, USA
| | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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9
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Abraham V, Cao G, Parambath A, Lawal F, Handumrongkul C, Debs R, DeLisser HM. Involvement of TIMP-1 in PECAM-1-mediated tumor dissemination. Int J Oncol 2018; 53:488-502. [PMID: 29845213 PMCID: PMC6017270 DOI: 10.3892/ijo.2018.4422] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/18/2017] [Accepted: 05/17/2018] [Indexed: 02/07/2023] Open
Abstract
Platelet endothelial cell adhesion molecule-1 (PECAM-1) is expressed on the vascular endothelium and has been implicated in the late progression of metastatic tumors. The activity of PECAM-1 appears to be mediated by modulation of the tumor microenvironment (TME) and promotion of tumor cell proliferation, rather than through the stimulation of tumor angiogenesis. The present study aimed to extend those initial findings by indicating that the presence of functional PECAM-1 on the endothelium promotes a proliferative tumor cell phenotype in vivo, as well as in tumor cell (B16-F10 melanoma and 4T1 breast cancer cell lines) co-culture assays with mouse endothelial cells (ECs) or a surrogate EC line (REN-MP). The pro-proliferative effects were mediated by soluble endothelial-derived factors that were dependent on PECAM-1 homophilic ligand interactions, but which were independent of PECAM-1-dependent signaling. Further analysis of the conditioned media obtained from tumor/EC and tumor/REN-MP co-cultures identified TIMP metallopeptidase inhibitor-1 (TIMP-1) as a PECAM-1-regulated factor, the targeting of which in the tumor cell/REN-MP system inhibited tumor cell proliferation. In addition, TIMP-1 expression was decreased in metastatic tumors from the lungs of PECAM-1-null mice, thus providing evidence of the in vivo significance of co-culture studies. Taken together, these studies indicated that endothelial PECAM-1, through PECAM-1-dependent homophilic binding interactions, may induce release of TIMP-1 from the endothelium into the TME, thus leading to increased tumor cell proliferation.
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Affiliation(s)
- Valsamma Abraham
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gaoyuan Cao
- Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers University, New Brunswick, NJ 08901, USA
| | - Andrew Parambath
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Fareedah Lawal
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Robert Debs
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Horace M DeLisser
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Abraham V, Parambath A, Murarka M, Zoga K, Saeed D, Tran T, Kumar R, DeLisser H. Syndecan‐4 and PECAM‐1‐Dependent Cell Motility. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.676.12] [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: 11/11/2022]
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Abraham V, Parambath A, Joe DS, DeLisser HM. Influence of PECAM-1 ligand interactions on PECAM-1-dependent cell motility and filopodia extension. Physiol Rep 2017; 4:4/22/e13030. [PMID: 27895229 PMCID: PMC5358002 DOI: 10.14814/phy2.13030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 01/31/2023] Open
Abstract
Platelet endothelial cell adhesion molecule (PECAM‐1) has been implicated in angiogenesis through processes that involve stimulation of endothelial cell motility. Previous studies suggest that PECAM‐1 tyrosine phosphorylation mediates the recruitment and then activation of the tyrosine phosphatase SHP‐2, which in turn promotes the turnover of focal adhesions and the extension of filopodia, processes critical to cell motility. While these studies have implicated PECAM‐1‐dependent signaling in PECAM‐1‐mediated cell motility, the involvement of PECAM‐1 ligand binding in cell migration is undefined. Therefore to investigate the role of PECAM‐1 binding interactions in cell motility, mutants of PECAM‐1 were generated in which either homophilic or heparin/glycosaminoglycan (GAG)‐mediated heterophilic binding had been disabled and then expressed in an endothelial cell surrogate. We found that the ability of PECAM‐1 to stimulate cell migration, promote filopodia formation and trigger Cdc42 activation were lost if PECAM‐1‐dependent homophilic or heparin/GAG‐dependent heterophilic ligand binding was disabled. We further observed that PECAM‐1 concentrated at the tips of extended filopodia, an activity that was diminished if homophilic, but not heparin/GAG‐mediated heterophilic binding had been disrupted. Similar patterns of activities were seen in mouse endothelial cells treated with antibodies that specifically block PECAM‐1‐dependent homophilic or heterophilic adhesion. Together these data provide evidence for the differential involvement of PECAM‐1‐ligand interactions in PECAM‐1‐dependent motility and the extension of filopodia.
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Affiliation(s)
- Valsamma Abraham
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Parambath
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debria S Joe
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Horace M DeLisser
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abraham V, Parambath A, DeLisser H. Ligand binding in PECAM‐1‐dependent cell motility (832.8). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.832.8] [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: 11/11/2022]
Affiliation(s)
| | | | - Horace DeLisser
- Medicine University of PennsylvaniaPHILADELPHIAPAUnited States
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