Public Health Staff Development Needs in Informatics: Findings From a National Survey of Local Health Departments

CONTEXT

Public health practice is information-intensive and information-driven. Public health informatics is a nascent discipline, and most public health practitioners lack necessary skills in this area.

OBJECTIVE

To describe the staff development needs of local health departments (LHDs) related to informatics.

DESIGN

Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County & City Health Officials.

PARTICIPANTS

A total of 324 LHDs from all 50 states completed the survey (response rate: 50%).

MAIN OUTCOME MEASURE(S)

Outcome measures included LHDs' specific staff development needs related to informatics. Predictors of interest included jurisdiction size and governance type.

RESULTS

Areas of workforce development and improvement in informatics staff of LHDs included using and interpreting quantitative data, designing and running reports from information systems, using and interpreting qualitative data, using statistical or other analytical software, project management, and using geographical information systems. Significant variation in informatics training needs exists depending on the size of the LHD population and governance type.

CONCLUSION

Substantial training needs exist for LHDs across many areas of informatics ranging from very basic to specialized skills and are related to the size of LHD population and governance type.

Ipilimumab and Bevacizumab in Glioblastoma

The median survival in glioblastoma is just over a year, with no standard second-line therapy. Ipilimumab is an immune checkpoint inhibitor that activates the anti-tumour immune response by cytotoxic T-lymphocyte antigen-4 blockade. There is significant evidence supporting its role in the treatment of malignant melanoma, including in patients with brain metastases. The addition of the anti-angiogenesis agent, bevacizumab, seems to offer additional benefit and limit the immune-related side-effects of ipilimumab in melanoma. To date there have been no clinical trials investigating this combination in glioblastoma. In this single practice case series, 20 patients with glioblastoma were consented for and treated with ipilimumab and bevacizumab in combination. Safety, tolerability and the response to treatment were reviewed for all patients. Three patients were treated after palliative first-line radiotherapy, one patient after first-line chemoradiation and 16 patients were treated with recurrent disease. Sixty-five per cent of patients completed four cycles of 3 weekly ipilimumab therapy, administered with 2 weekly bevacizumab. Radiographic responses for patients with recurrent disease were evaluated by Response Assessment in Neuro-oncology (RANO) criteria; 31% of patients showed a partial response, 31% had stable disease and 38% had disease progression. The treatment combination was well tolerated, with treatment terminated before completion due to adverse events in two patients. Autoimmune toxicity was manageable with systemic corticosteroid therapy. Ipilimumab and bevacizumab in combination show promising activity with a predictable and manageable toxicity profile, warranting further clinical studies.

Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies

OBJECTIVES

To conduct a systematic review to determine whether there is an association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) or overactive bladder (OAB) in women.

METHODS

We systematically reviewed English language observational studies on the effect of MetS (or component factors) on the presence of OAB or LUTS in women. We searched PubMed, Web of Science and The Cochrane Library with no date restrictions, checked reference lists and undertook citation searches in PubMed and Google Scholar. Studies were assessed for risk of bias. Because of heterogeneity, results were not pooled, but are reported narratively.

RESULTS

Of 27 included studies, only three looked at the link between MetS and OAB. The rest looked at links between OAB and components of MetS such as obesity or insulin resistance (n = 10), between MetS and urinary symptoms (n = 3) and between urinary symptoms and components of MetS, such as obesity (n = 14). Evidence is currently limited, but it does suggest that there may be important links between MetS and OAB and components of MetS such as obesity.

CONCLUSIONS

The literature on MetS and OAB or LUTS in women is limited, and poor quality. However, the evidence available on obesity appears to support MetS as a contributor and predictor of LUTS in women. Many of the women with LUTS will be overweight and will have features of the MetS, if looked for. This provides not only an opportunity to encourage weight loss as an adjunct to therapy for the OAB symptoms but also a window of opportunity to address cardiovascular risk factors and prevent future cardiovascular morbidity and mortality.

Beacon communities' public health initiatives: a case study analysis

INTRODUCTION

The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community.

BACKGROUND

The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery.

METHODS

Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies.

FINDINGS

Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6).

DISCUSSION

Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value.

CONCLUSIONS

A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach to evaluation at the beginning of implementation made the work more effective. Supporting evaluation to inform future implementations is important.

Synonym-based word frequency analysis to support the development and presentation of a public health quality improvement taxonomy in an online exchange

Word frequency analysis has not been fully explored as an input to public health taxonomy development. We used document analysis, expert review, and user-centered design to develop a taxonomy of public health quality improvement concepts for an online exchange of quality improvement work (www.phqix.org). Online entries were made searchable using a faceted search approach. To present the most relevant facets to users, we analyzed 334 published public health quality improvement documents using word frequency analysis to identify the most prevalent clusters of word meanings. We reviewed the highest-weighted concepts and identified their relationships to quality improvement details in our taxonomy. The meanings were mapped to items in our taxonomy, and presented in order of their weighted percentages in the data. Using this combination of methods, we developed and sorted concepts in the faceted search presentation so that relevant search criteria were accessible to users of the online exchange. Word frequency analysis may be a useful method to incorporate in other taxonomy development and presentationwhen relevant data is available.

Data standards for minimum information collection for antibody therapy experiments

Research groups developing antibody therapies generate diverse data sets; the value of these sets would be compounded when shared or amalgamated. A complete amalgamation of diverse data sets requires data standards for information collection during experiments. We propose to define elements of the data standards in the form of common data elements (CDEs) in order to clarify each experiment's targets and data values. We have created a set of core information elements which we suggest should be collected from antibody therapy experiments. We propose these as a basis for community consultation with a view to defining a set of data standards which can be developed under the auspices of the Antibody Society.

Angiogenesis inhibition with bevacizumab and the surgical management of colorectal cancer

BACKGROUND

Bevacizumab is an angiogenesis inhibitor and a new therapy for the treatment of colorectal cancer. It is a humanized monoclonal antibody that targets vascular endothelial growth factor.

METHODS

This review is based on a literature search of Medline, Pubmed, ISI web of knowledge and other published work for original articles, reviews and abstracts relevant to the surgical management of colorectal cancer with bevacizumab.

RESULTS AND CONCLUSION

Combined with current chemotherapy regimens, bevacizumab offers a significant survival advantage, making it likely to see widespread use. Despite being generally well tolerated, serious toxicities, including wound complications and gastrointestinal perforation, have been reported that affect surgical management. Consideration should be given to the timing of surgical and adjuvant intervention when using this drug.

Radiolabelling of glycosylated MFE-23::CPG2 fusion protein (MFECP1) with 99mTc for quantitation of tumour antibody-enzyme localisation in antibody-directed enzyme pro-drug therapy (ADEPT)

MFECP1 is a glycosylated recombinant fusion protein composed of MFE-23, a high-affinity anti-carcinoembryonic antigen (CEA) single chain Fv (scFv), fused to the enzyme carboxypeptidase G2 (CPG2), and has been constructed for use in antibody-directed enzyme pro-drug therapy (ADEPT). Radiolabelling of glycosylated MFECP1 with technetium-99m was developed for the purpose of determining tumour localisation of MFECP1 in a phase I ADEPT clinical study. The method used was 99mTc-carbonyl [99mTc(H2O)3(CO)3]+ (abbreviated to TcCO) mediated labelling of 99mTc to the hexahistidine (His) tag of MFECP1. MFECP1 fusion protein was labelled with TcCO under a variety of conditions, and this was shown to be a relatively simple and robust method. Tissue biodistribution was assessed in a CEA-expressing LS174T (human colon carcinoma) nude mouse xenograft model. Tissues were taken at 1, 4 and 6 h for assessment of distribution of radioactivity and for measurement of CPG2 enzyme levels. The amount of radioactivity retained by the tumour proved to be an accurate estimation of actual measured enzyme activity, indicating that this radiolabelling method does not appear to damage the antibody-antigen binding or the enzyme activity of MFECP1. However, correlation between CPG2 enzyme activity and measured radioactivity in liver, spleen and kidney was poor, indicating retention of radioactivity in non-tumour sites but loss of enzyme activity. The high retention of technetium radioisotope in normal tissues may limit the clinical applicability of this radiolabelling method for MFECP1; however, these results suggest that this technique does have applicability for measuring the biodistribution of His-tagged recombinant proteins.