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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle
| | - Bonnie W Ramsey
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle
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Lim WX, Khor HM, Lee JK, Ong T. Fracture Liaison Service and Its Role in Secondary Fracture Prevention in Malaysia: A Scoping Review. Malays Orthop J 2023; 17:1-6. [PMID: 37583523 PMCID: PMC10425002 DOI: 10.5704/moj.2307.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Fragility fractures, which occur after a low-trauma injury, increases with advancing age. Such fracture doubles the life-time risk of sustaining another fracture. This risk is highest in the immediate 18 months after the index fracture. However, most patients do not receive the appropriate risk assessment and intervention to reduce this risk. A coordinated model of care termed Fracture Liaison Service (FLS) has been reported to address this treatment gap. Materials and methods This scoping review aims to explore the potential role and delivery of FLS services in Malaysia. Scientific and non-scientific sources relevant to FLS were identified from electronic bibliographic databases, specialist journals and relevant websites. Findings were categorised into themes and presented narratively. Results FLS services remain concentrated in the Klang Valley. Even within FLS services, many do not have extensive coverage to risk assess all fracture patients. These services are multidisciplinary in nature where there are links between different departments, such as orthopaedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services and primary care. FLS was able to increase the number of people undergoing fracture risk assessment and treatment. The importance of FLS was highlighted by local experts and stakeholders. Its implementation and delivery are supported by a number of national guidelines. Conclusion FLS is central to our national efforts to reduce the impending fragility fracture crisis in the coming years. Continued effort is needed to increase coverage within FLS services and across the country. Training, awareness of the problem, research, and policy change will support this endeavour.
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Affiliation(s)
- W X Lim
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - H M Khor
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - J K Lee
- Department of Orthopaedics, Beacon Hospital, Kuala Lumpur, Malaysia
| | - T Ong
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Ong T, Albon D, Amin RS, Bailey J, Bandla S, Britto MT, Flath J, Gamel B, Powers M, Sabadosa KA, Saulitis AK, Thomas LK, Thurmond S, Seid M. Establishing a Cystic Fibrosis Learning Network: Interventions to promote collaboration and data-driven improvement at scale. Learn Health Syst 2023; 7:e10354. [PMID: 37448461 PMCID: PMC10336485 DOI: 10.1002/lrh2.10354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction A learning health network is a type of learning health system in which stakeholders use network organization to improve health and health care. Building on existing resources in the cystic fibrosis (CF) community, the Cystic Fibrosis Learning Network (CFLN) was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. Methods We describe the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. We illustrate the impact of the CFLN experience on chronic care processes and indicators of collaborative infrastructure. Results The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients. Of 6779 patient clinical care visits/quarter, 77% are entered into the CF Foundation Patient Registry within 30 days, providing timely means to track outcomes. Collaborative visit planning is occurring in 93% of clinical care visits to share agenda setting with patients and families. Almost all CFLN teams (94%, n = 34) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, 97% of centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning. Conclusion The CFLN is a maturing, collaborative infrastructure. CFLN centers practice at an advanced level of coproduction. The CFLN fosters interdisciplinary and PFP leadership and the performance of consistent data-driven improvement cycles. CFLN centers are positioned to respond to rapid changes in evidence-based care and advance the practice of QI and implementation science on a broader scale.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Washington, Seattle Children's HospitalSeattleWashingtonUSA
| | - Dana Albon
- Division of Pulmonary Medicine, Department of Internal MedicineUVACharlottesvilleVirginiaUSA
| | - Raouf S. Amin
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
| | - Julianna Bailey
- Division of Pulmonary, Allergy and Critical Care MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Srujana Bandla
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Maria T. Britto
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jonathan Flath
- Cystic Fibrosis Center, Division of Pulmonary, Allergy, Critical Care, and Sleep MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Breck Gamel
- Children's Health Pediatric Cystic Fibrosis Center DallasUTSWDallasTexasUSA
| | - Michael Powers
- Pediatrics Doernbecher Children's HospitalOHSUPortlandOregonUSA
| | | | - Anna K. Saulitis
- Adult and Pediatric Cystic Fibrosis Care CentersRush University Medical CenterChicagoIllinoisUSA
| | - Lacrecia K. Thomas
- Cystic Fibrosis Center Children's of AlabamaChildren's of AlabamaBirminghamAlabamaUSA
| | - Sophia Thurmond
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
| | - Michael Seid
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
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Abstract
Importance Cystic fibrosis, a genetic disorder defined by variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, affects more than 30 000 individuals in the US and approximately 89 000 worldwide. Absent or decreased function of the CFTR protein is associated with multiorgan dysfunction and shortened life expectancy. Observations CFTR is an anion channel in the apical membrane of epithelial cells. Loss of function leads to obstructed exocrine glands. Of people with cystic fibrosis in the US, approximately 85.5% have the gene variant F508del. Manifestations of cystic fibrosis in patients with the F508del gene variant begin in infancy with steatorrhea, poor weight gain, and respiratory symptoms (coughing, wheezing). As people with cystic fibrosis age, chronic respiratory bacterial infections cause loss of lung function and bronchiectasis. With the availability of universal newborn screening in multiple countries including the US, many people with cystic fibrosis are asymptomatic at diagnosis. With multidisciplinary care teams that included dietitians, respiratory therapists, and social workers, treatment of cystic fibrosis can slow disease progression. Median survival has improved from 36.3 years (95% CI, 35.1-37.9) in 2006 to 53.1 years (95% CI, 51.6-54.7) in 2021. Pulmonary therapies for patients with cystic fibrosis consist of mucolytics (eg, dornase alfa), anti-inflammatories (eg, azithromycin), and antibiotics (such as tobramycin delivered by a nebulizer). Four small molecular therapies, termed CFTR modulators, that facilitate CFTR production and/or function have received regulatory approval. Examples are ivacaftor and elexacaftor-tezacaftor-ivacaftor. For example, in patients with 1 F508del variant, the combination of ivacaftor, tezacaftor, and elexacaftor improved lung function from -0.2% in the placebo group to 13.6% (difference, 13.8%; 95% CI, 12.1%-15.4%) and decreased the annualized estimated rate of pulmonary exacerbations from 0.98 to 0.37 (rate ratio, 0.37; 95% CI, 0.25-0.55). Improved respiratory function and symptoms have lasted up to 144 weeks in postapproval observational studies. An additional 177 variants are eligible for treatment with the elexacaftor-tezacaftor-ivacaftor combination. Conclusion Cystic fibrosis affects approximately 89 000 people worldwide and is associated with a spectrum of disease related to exocrine dysfunction, including chronic respiratory bacterial infections and reduced life expectancy. First-line pulmonary therapies consist of mucolytics, anti-inflammatories, and antibiotics, and approximately 90% of people with cystic fibrosis who are 2 years or older may benefit from a combination of ivacaftor, tezacaftor, and elexacaftor.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle
| | - Bonnie W Ramsey
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle
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Ong T, Bell S, Britto MT, Gamel B, McNamara S, Ramsey B, Barton KS. Transforming the nutrition care model for infants with cystic fibrosis: A qualitative study of clinicians' perspectives. Pediatr Pulmonol 2023; 58:1380-1390. [PMID: 36695543 PMCID: PMC10121817 DOI: 10.1002/ppul.26330] [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: 09/02/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Clinician perspectives may inform health service strategies to meet optimal nutrition needs for infants with cystic fibrosis (CF). We conducted a qualitative study with CF-specialized dietitians (registered dietitians [RDs]) and physicians between July to December 2020 to characterize the current state of infant nutrition care delivery and organize input into a conceptual model to inform CF care program strategies. Among 42 participants, 36 completed survey responses and 6 completed interviews; 93% were RDs. Three global themes emerged in the current care model: nutrition management, family centered connections, and collaborative care delivery. Within nutrition management, clinicians emphasized providing education, setting goals, and maintaining adequate follow-up with families. Under family centered connections, clinicians expressed the need to foster relationships with families and link families to resources for assistance to social stressors such as food insecurity. Collaborative care delivery for clinicians interviewed was defined by sharing expertise from across the interdisciplinary team. Based on the timing of this study, clinicians reported compelling examples for various modes of telehealth and home weight monitoring to facilitate and support these domains of nutrition care, including potential advantages for education, supporting family needs, and communication. We integrate these themes to propose a conceptual model to organize complementary in-person and telehealth activities and enhance quality infant CF nutrition care delivery. Future implementation can refine this model through testing of practical telehealth interventions to optimize nutrition outcomes for infants with CF.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Sarah Bell
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Maria T. Britto
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Breck Gamel
- Children’s Health Pediatric Cystic Fibrosis Center Dallas, UTSW, Dallas, Texas, USA
| | | | - Bonnie Ramsey
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - Krysta S. Barton
- Seattle Children’s Research Institute, Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle, Washington, USA
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Chong E, Ong T, Lim WS. Editorial: Front-Door Geriatrics: Frailty-Ready Emergency Department to Achieve the Quadruple Aim. J Frailty Aging 2023; 12:254-257. [PMID: 38008974 DOI: 10.14283/jfa.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- E Chong
- Edward Chong, Tan Tock Seng Hospital, Singapore,
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Thomas L, Gamel B, Noyes S, Lochte R, Saulitis A, Ong T. 91 Cystic Fibrosis Learning Network Learning Structure for Multicenter Spread of Co-Production and Timely Patient Registry Data Entry Practices. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00782-2] [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: 11/06/2022]
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McNamara S, Vajda J, Cassidy J, Bridges G, Guillette C, Sistek K, Goffin B, Brunson A, Ong T. 97 Improving oral glucose tolerance testing rate through a cross-disciplinary quality improvement collaboration. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00788-3] [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: 11/06/2022]
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Ng TS, Lam CL, Ong T. Hospital healthcare utilisation among older adults admitted to a university hospital in the last months of life: A retrospective observational study. Med J Malaysia 2022; 77:585-589. [PMID: 36169070] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Health needs increase in older age. This translates into higher healthcare utilisation and expenditure compared to any other age group. Much of this is driven by frailty and multimorbidity. Many older people spend their last days in hospital. The aim of this study was to explore the utilisation of healthcare services among older adults admitted to a university hospital in the last 6 months of life. MATERIALS AND METHODS Patients aged 70 years and over who died on medical wards of a university hospital in 2019 were included based on a stratified sampling approach using three categories. The categories were which medical ward the patient was admitted under, ICD-10 reported cause of death, and gender. The proportion of patients distributed across all three categories was calculated and 200 patients out of 472 deaths in that year were randomly selected to ensure mirrored proportion distributed across these three categories. Data on demographics and healthcare utilisation were collected. Healthcare utilisation parameters included clinical encounters, radiological investigations, and medical procedures undergone. RESULTS The median age was 83 years with more women (51%) than men. Septicaemia was the commonest cause of death (24.5%), followed by pulmonary disease (21.0%), and cardiovascular disease (19.5%). In the last 6 months before death, median inpatient stay was 9 days. The median number of Emergency Department and outpatient attendance was one episode, respectively, and number of radiology was four investigations. Over one-third of patients had multiple hospital admission. During the terminal admission, the median inpatient stay was 6 days. 45% had a nasogastric tube in-situ. Antibiotics used during the last 24 hours of life and polypharmacy (≥5 medications) were high at 74.5% and 82.5%, respectively. 7% of patients received cardiopulmonary resuscitation. CONCLUSION This study has provided descriptive evidence of hospital care delivered in the last months of life. The majority had contact with a healthcare team prior to their terminal admission. Many during their terminal admission had healthcare procedures, investigations, antibiotics, and issues of polypharmacy during this time. With an aging population, how care is organised and delivered is important in promoting good care in their later years.
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Affiliation(s)
- T S Ng
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - C L Lam
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - T Ong
- University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Leong WH, Chew MY, Lee ZY, Lim CX, Norizam NAIB, Ong RY, Khor HM, Ong T. 1059 PHYSICAL ACTIVITY AMONG OLDER PEOPLE ADMITTED TO A UNIVERSITY HOSPITAL IN MALAYSIA. Age Ageing 2022. [DOI: 10.1093/ageing/afac125.007] [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
Introduction
Physical inactivity is prevalent among hospitalised older people and is associated with poor outcomes. This study aims to determine activity levels in a Malaysian university hospital.
Method
Direct observation of patients admitted to the geriatric medicine ward over 2 weeks between the hours of 8 am-8 pm was performed. Data was collated onto an observation diary which was piloted, and changes made iteratively. A taxonomy of inpatient activity and healthcare staff interaction was created. Observer training was done to ensure familiarity and consistency in the recording. Data was presented descriptively and comparison made between weekday/weekend. Minutes of activity time per-hour (mins/hr) was use to report findings.
Results
Ninety-one patients were observed over 1918.8 hours (weekday, 1579.67 hours; weekends, 363.87 hours). The observed median (Q1,Q3) was 15.1 (9.4, 30.1) hours per-patient. 32.6 minutes per day on average was spent upright, with the rest spent either sitting or lying down. 78.9% of patients’ time was spent doing nothing. Patients’ position was different between weekdays vs weekends, lying, 35.7 vs 40.8 mins/hr; sitting, 23.3 vs 18.2 mins/hr; and standing, 1.1 vs 1.0 mins/hr. Patients spent significantly less proportion of time active at the weekends (weekdays, 28.3% vs weekends, 19.9%). When individual activities were analysed, patients were doing less walking (weekend, 0.4 vs weekday, 0.01 mins/hr, p = 0.01) therapy-supervised exercise (1.1 vs 0.02 mins/hr, p < 0.01), and nursing care (0.6 vs 0.1 mins/hr, p < 0.01) over the weekend. There was also less doctor interaction (weekday, 1.1 vs 0.5 mins/hr, p = 0.04) and no therapist interaction at the weekend. Nursing input was unchanged.
Conclusion
Older people admitted to a university hospital in Malaysia were very inactive. There was further reduction in activity levels and healthcare interaction at the weekend. Maintaining physical activity during hospitalisation is required to ensure best possible recovery from their acute illness.
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Affiliation(s)
- W H Leong
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - M Y Chew
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - Z Y Lee
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - C X Lim
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - N A I B Norizam
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - R Y Ong
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - H M Khor
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
| | - T Ong
- Department of Medicine , Faculty of Medicine, , Malaysia
- University of Malaya , Faculty of Medicine, , Malaysia
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Tai MH, Wan SN, Engkasan J, Ong T. 1042 COMPARISON BETWEEN CAMRY AND JAMAR DYNAMOMETERS IN MEASURING HAND GRIP STRENGTH AMONG OLDER POST-ACUTE COVID-19 OUTPATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.061] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Hand grip strength is a useful measure of muscle function. Many hand dynamometers that are less costly than the gold standard Jamar dynamometer are available but their use in clinical outpatient setting has yet to be validated. This study aimed to determine the inter-instrument reliability between Camry electronic and Jamar hydraulic dynamometers.
Method
A cross-sectional study was conducted on patients aged ≥65 years during their post COVID-19 follow up clinic visit. Hand grip strength was assessed using both Jamar and Camry dynamometers following standard protocol while information on participants’ demographics, health and COVID-19 hospitalizations were collected from hospital electronic medical records. Reliability between both devices was determined using intraclass correlation coefficient (ICC) and devices were compared based on subcategories of participants’ demographics and clinical characteristics.
Results
Ninety-three participants (mean age: 73 ± 6 years, 52.7% males) were recruited in this study. Average grip strength recorded with Jamar dynamometer (18.1 ± 7.4 kg) was higher than Camry dynamometer (19.5 ± 6.6 kg). Sub categorical comparison depicted no significant discrepancy between the devices discovered among male participants (p = 0.262), Malay participants (p = 0.243) and participants aged >70 years (p = 0.090). According to the diagnostic cut-off recommended by Asian Working Group for Sarcopenia (AWGS) 2019, similar number of participants had low grip strength using Jamar (n = 69, 74.2%) and Camry (n = 68, 73.2%) dynamometers. The odds of Camry detecting low grip strength was 0.946 times (95% CI: 0.493–1.817) as compared to Jamar dynamometer. Readings measured using both dynamometers were highly correlated to each other (r = 0.88) with ICC of 0.92, indicating an excellent inter-instrument reliability.
Conclusion
Comparable measures between Jamar and Camry hand dynamometers support the interchangeable use of the devices among older population. Hence, the alternative use of Camry dynamometer is appropriate for the outpatient setting.
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Affiliation(s)
- M H Tai
- School of Medicine, Perdana University-Royal College of Surgeons Ireland , Malaysia
| | - S N Wan
- Department of Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
| | - J Engkasan
- Department of Rehabilitation Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
| | - T Ong
- Department of Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
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Tai MH, Wan SN, Engkasan J, Ong T. 1041 HAND GRIP STRENGTH AMONG POST-ACUTE COVID-19 OLDER ADULTS. Age Ageing 2022. [PMCID: PMC9384237 DOI: 10.1093/ageing/afac126.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Muscle strength is one crucial determinant of functional activity among older adults. While COVID-19 infection is often described as an acute respiratory disease with potential multiorgan involvement, its severe inflammatory nature may lead to changes to structure and function of skeletal muscles. This present study aimed to evaluate grip strength among post COVID-19 elderly with exploration of factors influencing the change in grip strength. Method Patients with history of COVID-19 infection aged ≥65 years were recruited in the COVID-19 follow up clinic. Grip strength was assessed using Jamar dynamometer following standard protocol while baseline clinical information was collected from hospital electronic medical record. Data collected were analysed to evaluate grip strength in relation to participants’ demographics, comorbidity, length of hospital stay and steroids medication use. Total steroids equivalent doses were calculated and dichotomy of 400 mg was selected based on its median. Results Ninety-three participants (mean [SD] age: 73 [6], 52.7% males) were recruited at an average (SD) of 55 (37) days after hospital discharge, with 79.6% participants hospitalized with COVID-19 of clinical category 4. Majority (74.2%) of the participants recorded measurements lower than diagnostic cut-off for low grip strength recommended by Asian Working Group for Sarcopenia (AWGS) 2019. Results showed that increasing age was associated with a decrease in grip strength (r = −0.30, p = 0.003). Besides, increase in hospital stay (r = −0.22, p = 0.035) and Charlson Comorbidity Index (CCI) score (r = −0.42, p = 0.000) were associated with decreasing grip strength measurements. No significant discrepancy in grip strength was observed between subgroups of patients receiving total steroids equivalent doses of <400 mg and ≥ 400 mg (p = 0.881). Conclusion Low grip strength readings were recorded among post COVID-19 elderly particularly patients of older age, with longer hospital stay and higher CCI. This suggests the need for close monitoring and provision of rehabilitation intervention to older adults affected by COVID-19 infection.
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Affiliation(s)
- M H Tai
- School of Medicine, Perdana University-Royal College of Surgeons Ireland , Malaysia
| | - S N Wan
- Department of Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
| | - J Engkasan
- Department of Rehabilitation Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
| | - T Ong
- Department of Medicine , Faculty of Medicine, , Malaysia
- University Malaya Medical Centre , Faculty of Medicine, , Malaysia
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Nay L, Vajda J, McNamara S, Ong T. Sustained Reduction in Time to Data Entry in the Cystic Fibrosis Foundation Registry. Pediatr Qual Saf 2022; 7:e529. [PMID: 35071963 PMCID: PMC8782120 DOI: 10.1097/pq9.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Timely data entry into patient registries is foundational to learning health systems such as the Cystic Fibrosis Learning Network. The US Cystic Fibrosis Foundation Patient Registry (CFFPR) is an established registry that collects encounter data for clinical and research activities. Coordinators manually enter approximately 1,500 encounters annually at our institution, but there is limited evidence for interventions facilitating timely data entry. Our institution aimed to reduce the number of days between a clinical encounter and data entry into the CFFPR from an average of 43 days (range 0 to 183 days) to less than 30 days in a 3-month interval. METHODS Data coordinators tested interventions to address barriers in four themes: accountability, work burden, communication, and visibility using plan-do-study-act cycles. We used statistical process control charts to assess progress on average time of entry. Coordinators provided feedback about acceptability and satisfaction for process changes. RESULTS Initial interventions standardized process and reduced average time to data entry from 42.6 to 22.5 days in 3 months, but this process was not stable in the subsequent 6 months. Subsequent changes to increase metric visibility and improve team communication increased stability and decreased the average time to data entry to 23.0 days. Coordinators reported high satisfaction with process changes and have sustained improved time for over 2 years. CONCLUSIONS This quality improvement project reduced and maintained data entry time by addressing significant barriers without additional personnel. Increased access to near real-time data in CFFPR accelerates learning for clinical care, quality improvement, and research.
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Affiliation(s)
- Laura Nay
- From the Snohomish Health District, Seattle, Wash
| | | | | | - Thida Ong
- Seattle Children’s Hospital, Seattle, Wash
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington. Seattle, Wash
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Ong T, Onchiri FM, Britto MT, Heltshe SL, Kessler LG, Seid M, Ramsey BW. Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis. J Cyst Fibros 2022; 21:115-122. [PMID: 34454845 PMCID: PMC8844148 DOI: 10.1016/j.jcf.2021.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cystic fibrosis (CF)-specialized nutrition care strives to meet normal infant growth, but the relationship of dietitian assessments to weight outcomes is unknown. We characterize nutrition management for inadequate weight gain and assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ). METHODS We used encounter data from 226 infants across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. We identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. We compared center assessments by funnel plot and summarize median WAZ by center. RESULTS Of 2,527 visits, 808 (32%) visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 1953 visits (77%), but varied widely between centers (range 17% - 98%). For inadequate weight gain, most and least common responses were calorie increase (64%) and PERT increase (21%). Funnel plot analysis identified 4 high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (24/30, 80% v. 12/23, 52%) and closer follow up (104/164, 63% v. 60/120, 49%) compared to under-performers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers (WAZHigh 0.33 v. WAZLow -0.15), despite similar patient characteristics. CONCLUSION We characterized multicenter variation in dietitian assessments, identifying opportunities to improve care delivery to target early nutrition outcomes.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA
| | - Frankline M. Onchiri
- Center for Clinical and Translational Research, Seattle Children’s Hospital Research Institute, Seattle, WA
| | - Maria T. Britto
- The James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sonya L. Heltshe
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA,Center for Clinical and Translational Research, Seattle Children’s Hospital Research Institute, Seattle, WA
| | - Larry G. Kessler
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Michael Seid
- The James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Bonnie W. Ramsey
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA,Center for Clinical and Translational Research, Seattle Children’s Hospital Research Institute, Seattle, WA
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15
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Sawicki GS, Van Citters AD, Dieni O, Sabadosa KA, Willis A, Benitez D, Ong T, Dasenbrook EC. Financial impacts of the COVID-19 pandemic on cystic fibrosis care: lessons for the future. J Cyst Fibros 2021; 20 Suppl 3:16-20. [PMID: 34930535 PMCID: PMC8711855 DOI: 10.1016/j.jcf.2021.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 01/22/2023]
Abstract
Background Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. Methods The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. Results Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. Conclusions The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.
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Affiliation(s)
- Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 United States.
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, One Medical Center Drive, Lebanon, NH 03766 United States
| | - Olivia Dieni
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 United States
| | - Kathryn A Sabadosa
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 United States
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD 20814 United States
| | - Debbie Benitez
- Keck Medical Center, University of Southern California, 1510 San Pablo Street Suite #514, Los Angeles, CA 90033 United States
| | - Thida Ong
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, M/S OC 7.720, PO Box 5371, Seattle, WA 98145 United States
| | - Elliott C Dasenbrook
- Cleveland Clinic Respiratory Institute; 9500 Euclid Avenue; A90; Cleveland, OH 44141 United States
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16
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Ong T, Van Citters AD, Dowd C, Fullmer J, List R, Pai SA, Ren CL, Scalia P, Solomon GM, Sawicki GS. Remote monitoring in telehealth care delivery across the U.S. cystic fibrosis care network. J Cyst Fibros 2021; 20 Suppl 3:57-63. [PMID: 34930544 DOI: 10.1016/j.jcf.2021.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, United States.
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Jason Fullmer
- DCMG Pediatric Pulmonology & Sleep Medicine, Dell Children's Medical Group, Austin, TX, United States
| | - Rhonda List
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, United States
| | - Shine-Ann Pai
- Marnie Paul Specialty Care Center, Dell Children's Medical Center of Central Texas, Austin, TX, United States
| | - Clement L Ren
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - George M Solomon
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
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17
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Gifford AH, Ong T, Dowd C, Van Citters AD, Scalia P, Sabadosa KA, Sawicki GS. Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs. J Cyst Fibros 2021; 20 Suppl 3:9-13. [PMID: 34930545 PMCID: PMC8683125 DOI: 10.1016/j.jcf.2021.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. METHODS Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. RESULTS Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. CONCLUSION During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.
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Affiliation(s)
- Alex H Gifford
- Pulmonary Critical Care and Sleep Medicine, University Hospitals, Cleveland, OH, USA.
| | - Thida Ong
- Pediatric Pulmonology, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
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18
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Rosenfeld M, Ong T, Carlin K, McNamara S, Gorry S, Kanter A, Gibson R, Cassidy J, Greene L, Choi M, Reonal R, Culley L, Thompson J. 68: Improving timeliness of CF diagnosis following a positive CF newborn screen in Washington State. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Cassidy J, McNamara S, Gorry S, Hughes R, Vajda J, Hill L, Akers M, Greene L, Ong T. 144: Quality improvement process to improve home spirometer use in a pediatric CF care center. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Ong T, Copeland R, Thiam CN, Cerda Mas G, Marshall L, Sahota O. Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project. Osteoporos Int 2021; 32:921-926. [PMID: 33170309 DOI: 10.1007/s00198-020-05710-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase in workload needs to be considered by any FLS that wants to utilise such a service. INTRODUCTION This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). METHODS The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. RESULTS In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.
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Affiliation(s)
- T Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - R Copeland
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - C N Thiam
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - G Cerda Mas
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - L Marshall
- Department for Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
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21
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Sahota O, van Berkel D, Ong T, Drummond A, Hendrick P, Quraishi N, Salem K. Pelvic fragility fractures-the forgotten osteoporotic fracture! Osteoporos Int 2021; 32:785-786. [PMID: 33491138 PMCID: PMC8026450 DOI: 10.1007/s00198-021-05848-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- O Sahota
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK.
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.
| | - D van Berkel
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Drummond
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - P Hendrick
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - N Quraishi
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Salem
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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22
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Khanna S, Ong T, Chow C, Trombetta C. Giant pulmonary artery aneurysms. Colomb J Anesthesiol 2021. [DOI: 10.5554/22562087.e959] [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: 11/05/2022] Open
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23
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Sahota A, Ong T, Kumar A, Simmonds L, Yoon WW, Salem K, Sahota O. Vertebroplasty for vertebral fragility fractures in the 'very elderly': experience from a regional UK spine unit. Osteoporos Int 2021; 32:395-396. [PMID: 33392717 DOI: 10.1007/s00198-020-05770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Sahota
- Medical School, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, UK
| | - T Ong
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - A Kumar
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - L Simmonds
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - W W Yoon
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Salem
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK.
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24
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Liu FF, Lew A, Andes E, McNamara S, Cassidy J, Whitmore S, Plunkett R, Ong T. Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: A quality improvement project. Pediatr Pulmonol 2020; 55:3328-3336. [PMID: 32644305 DOI: 10.1002/ppul.24951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Guidelines to integrate mental health screening (MHS) into Cystic fibrosis (CF) care has increased adoption across the United States and European CF Centers, however, there has been limited discussion on specific strategies for implementation. OBJECTIVE Share key strategies that led to successful MHS implementation in one pediatric CF center and report implementation and screening outcomes. METHODS Parent partners, mental health experts from the Department of Psychiatry, and the CF clinic team codesigned interventions to support three major stakeholders: (a) patients and families (b) clinic team, and (c) hospital system. The mental health coordinator approached patients (12 and older) to introduce MHS and administered screening and reviewed results using an electronic tablet and digital measurement-feedback system. We used strategies that promoted visibility of screening progress and sharing of data with hospital administration. Descriptive statistics were used to assess prevalence of clinically significant symptoms of anxiety and depression and symptom severity within our sample. RESULTS Over the first 2 years of the project, we exceeded our goal of screening 80% of eligible patients per year (80%-95% screened) and are on a similar trajectory within the first 7 months of year 3. We identified high prevalence of clinically significant symptoms of depression (16%) and anxiety (14%) similar to those found in other chronic illness populations. These data helped us advocate hospital leadership to support the development of new mental health services to address identified needs at our center. CONCLUSION Leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
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Affiliation(s)
- Freda F Liu
- Child and Adolescent Division, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Al Lew
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth Andes
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Sharon McNamara
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Janine Cassidy
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Susan Whitmore
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Rich Plunkett
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington
| | - Thida Ong
- Cystic Fibrosis Center, Seattle Children's Hospital, Seattle, Washington.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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25
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Quittner AL, Abbott J, Hussain S, Ong T, Uluer A, Hempstead S, Lomas P, Smith B. Integration of mental health screening and treatment into cystic fibrosis clinics: Evaluation of initial implementation in 84 programs across the United States. Pediatr Pulmonol 2020; 55:2995-3004. [PMID: 32649006 DOI: 10.1002/ppul.24949] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A large-scale epidemiological study of 6088 individuals with cystic fibrosis (CF) and 4102 caregivers in nine countries documented elevated symptoms of depression and anxiety, leading to international guidelines for annual screening and follow-up. To facilitate national implementation, 84 CF programs funded a mental health coordinators (MHC). Implementation was evaluated after 1 year using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers. METHODS A 45-item internet survey was developed to assess relevant CFIR implementation steps. Surveys were completed in 2016. It assessed five domains tailored to study aims: (a) Intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of individuals, and (e) process of implementation. RESULTS Response rate was 88%, with pediatric and adult programs equally represented. A majority of MHCs were social workers (54.1%) and psychologists (41.9%); 41% had joined the team in the past year. Facilitators across the five domains included universal uptake of screening tools, greater awareness and detection of psychological symptoms, reduced stigma, and positive feedback from patients and families. Barriers included limited staff time, space, and logistics. DISCUSSION This is the largest systematic effort to integrate mental health screening and treatment into the care of individuals with a serious, chronic illness and their caregivers. MHCs implementing screening, interpretation and follow-up reported positive results, and significant barriers. This national implementation effort demonstrated that depression and anxiety can be efficiently evaluated and treated in a complex, chronic disease. Future efforts include recommending the addition of screening scores to national CF Registries and examining their effects on health outcomes.
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Affiliation(s)
| | - Janice Abbott
- School Psychology, University of Lancashire, Preston, UK
| | - Saida Hussain
- Research Institute, Nicklaus Children's Research Institute, Miami, Florida
| | - Thida Ong
- Pediatric Pulmonology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Ahmet Uluer
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Sarah Hempstead
- Clinical Affairs, Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Paula Lomas
- Clinical Affairs, Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Beth Smith
- Department of Psychiatry, State University of New York, Buffalo, New York
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26
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Yee M, Kok Y, Ariyaratne P, Yu Y, Scully O, Tay D, Tang C, Ong T, Suhardi H, Aye K, Kyaw A, Wee E, Lee C. 314P Comprehensive microbial signatures and genomic profiling in tumour samples using next generation sequencing. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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27
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Ong T, Khor HM, Kumar CS, Singh S, Chong E, Ganthel K, Lee JK. The Current and Future Challenges of Hip Fracture Management in Malaysia. Malays Orthop J 2020; 14:16-21. [PMID: 33403058 PMCID: PMC7751988 DOI: 10.5704/moj.2011.004] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/01/2020] [Indexed: 12/27/2022] Open
Abstract
By 2050, it is predicted that six million hip fractures will occur each year of which the majority will happen in Asia. Malaysia is not spared from this predicted rise and its rate of increase will be one of the highest in this region. Much of this is driven by our unprecedented growth in the number of older people. Characteristics of individuals with hip fractures in Malaysia mirror what has been reported in other countries. They will be older multimorbid people who were already at risk of falls and fractures. Outcomes were poor with at least a quarter do not survive beyond 12 months and in those that do survive have limitation in their mobility and activities of daily living. Reviewing how these fractures are managed and incorporating new models of care, such as orthogeriatric care, could address these poor outcomes. Experts have warned of the devastating impact of hip fracture in Malaysia and that prompt action is urgently required. Despite that, there remains no national agenda to highlight the need to improve musculoskeletal health in the country.
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Affiliation(s)
- T Ong
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - H M Khor
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - C S Kumar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - S Singh
- Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Egm Chong
- Department of Geriatric Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - K Ganthel
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - J K Lee
- Department of Orthopaedics, Beacon Hospital, Petaling Jaya, Malaysia
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Ong T, Liu CC, Elder L, Hill L, Abts M, Dahl JP, Evans KN, Parikh SR, Soares JJ, Striegl AM, Whitlock KB, Johnson KE. The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients. Otolaryngol Head Neck Surg 2020; 163:221-231. [PMID: 32204663 DOI: 10.1177/0194599820911728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy-related mortality in outpatient tracheostomy-dependent children (TDC). METHODS An interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community-based nurses on TDC-focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic. The primary outcome was annual unanticipated mortality after hospital discharge from tracheostomy placement before and after the initiative. RESULTS In the 5 years before and after the initiative, 131 children and 155 children underwent tracheostomy placement, respectively. At the end of the study period, the institution sustained Trach Safe practices: (1) surveillance bronchoscopies increased from 104 to 429 bronchoscopies, (2) the course trained 209 community-based nurses, and (3) the survey was used in 488 home ventilator clinic visits to identify near-miss airway events. Prior to the initiative, 9 deaths were unanticipated. After Trach Safe implementation, 1 death was unanticipated. Control chart analysis demonstrates significant special-cause variation in reduced unanticipated mortality. DISCUSSION We describe a system shift in reduced unanticipated mortality for TDC through 3 major practice changes of the Trach Safe Initiative. IMPLICATION FOR PRACTICE Death in a child with a tracheostomy tube at home may represent modifiable tracheostomy-related airway events. Using Trach Safe practices, we address multiple facets to improve safety of TDC out of the hospital.
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Affiliation(s)
- Thida Ong
- Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - C Carrie Liu
- Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Leslie Elder
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Leslee Hill
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew Abts
- Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Kelly N Evans
- Seattle Children's Hospital, Seattle, Washington, USA.,Craniofacial Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay R Parikh
- Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Amanda M Striegl
- Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathryn B Whitlock
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kaalan E Johnson
- Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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van Berkel D, Herschkovich O, Taylor R, Ong T, Sahota O. 88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital. Age Ageing 2020. [DOI: 10.1093/ageing/afz193.03] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures.
Methods
Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018.
Results
103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification.
Conclusions
Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.
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Affiliation(s)
- D van Berkel
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Herschkovich
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Taylor
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Ong
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Sahota
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Desai H, Hershkovich O, Ong T, Marshall L, Sahota O. 89 Poor Attendance for DXA in Older People with A Low Trauma Fragility Fracture: A 6 Year Data Analysis of the Nottingham Fracture Liaison Service. Age Ageing 2020. [DOI: 10.1093/ageing/afz193.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hip Fractures are common and result in significant patient morbidity and increased mortality. Up to 40% of these patients have sustained a previous low-trauma fracture. The Department of Health advises that patients presenting with fragility fracture should have access to ‘Fracture Liaison Services (FLS)’. These are models of care which systematically identify patients at risk, assess bone health, treat patients (if needed) and follow patients up to support medication adherence.
Methods
Demographics of FLS patients between January 2012 and December 2017 was obtained retrospectively from the Nottingham University Hospitals FLS database. We examined DNA rates and further characteristics of these types of patients. Deprivation scores were deprived using the English indices of deprivation 2015 (1–Most deprived; 5-Least deprived). The 2016 cohort of patients were followed-up till January 2019 to assess for re-fractures.
Results
6528 high-risk patients were identified and referred to DXA. Mean (SD) age was 68±10.5 years [Females=5302 (81%)]. 1386 patients (21%) did not attend. High prevalence of non-attendance was in females [1032 patients (74%)] and the most deprived individuals [398 patients (29%)]. Females from the most deprived areas had the highest DNA rate [287 patients (29%)]. All eligible patients >75 years old were referred (n=1542 (100%), [Females=1284 (83%), non-attendance=473 (31%), non-attendance in females=390 (82%), highly deprived females=96 (25%)]. 826 patients were referred in 2016. Median follow-up time was 2.46 years (IQR 0.16–3.00 years). 52 patients (7%) re-fractured. 17 patients (33%) DNA their previous DXA scan [Females=12 patients (71%)].
Conclusions
Nottingham FLS have identified patients with fragility fractures that are high-risk for further fractures. Despite a dedicated FLS there is a DNA of 21%. Many patients that DNA are generally considered as having a high-risk of further fractures; females, older age and more deprived. Further studies are needed to explore why patients do not attend for bone density scanning.
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Affiliation(s)
- H Desai
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - O Hershkovich
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - T Ong
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - L Marshall
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - O Sahota
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
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Ong T, Sahota O, Gladman JRF. The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 2020; 31:363-370. [PMID: 31696271 PMCID: PMC7010649 DOI: 10.1007/s00198-019-05198-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023]
Abstract
Patients hospitalised with vertebral fragility fractures were elderly, multimorbid and frail and lead to poor outcomes. Their hospital treatment needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes. PURPOSE Patients admitted to hospital with vertebral fragility fractures are elderly and have complex care needs who may benefit from specialist multidisciplinary input. To date, their characteristics and outcomes have not been reported sufficiently. This study aims to justify such a service. METHODS Patients admitted with an acute vertebral fragility fracture over 12 months were prospectively recruited from a university hospital in England. Data were collected soon after their admission, at discharge from hospital and 6 months after their hospital discharge on their characteristics, pain, physical functioning, and clinical outcomes. RESULTS Data from 90 participants were analysed. They were mainly elderly (mean age 79.7 years), multimorbid (69% had ≥ 3 comorbid condition), frail (56% had a Clinical Frailty Scale score ≥ 5), cognitively impaired (54% had a MoCA score of < 23) and at high risk of falls (65% had fallen ≥ 2 in the previous year). Eighteen percent died at 6 months. At 6 months post-hospital discharge, 12% required a new care home admission, 37% still reported their pain to be severe and physical functioning was worse compared with their preadmission state. CONCLUSION Patients hospitalised with vertebral fragility fractures were elderly, multimorbid, frail and are susceptible to persistent pain and disability. Their treatment in hospital needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes.
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Affiliation(s)
- T Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - J R F Gladman
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
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Liu CC, Soares JJ, Elder L, Hill L, Abts M, Bonilla-Velez J, Dahl JP, Johnson KE, Ong T, Striegl AM, Whitlock K, Parikh SR. Surveillance endoscopy after tracheostomy placement in children: Findings and interventions. Laryngoscope 2019; 130:1327-1332. [PMID: 31670383 DOI: 10.1002/lary.28247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/30/2019] [Revised: 06/26/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES/HYPOTHESIS The Seattle Children's Hospital implemented the Trach Safe Initiative to improve airway safety in tracheostomy-dependent children (TDC). A key tenet of this initiative is surveillance endoscopy. The objectives of this study were to describe the prevalence of abnormal airway changes in TDC, identify risk factors for these changes, and describe the frequency of airway interventions. STUDY DESIGN Retrospective case series. METHODS This is a review of children 0 to 21 years old who underwent tracheostomy and surveillance endoscopy from February 1, 2014 to January 1, 2019. Descriptive statistics were used to report the prevalence of abnormal airway changes and interventions following tracheostomy. Pearson χ2 tests and logistic regression were used to identify risk factors for the development of abnormal changes. RESULTS There were 127 children identified. The median time from tracheostomy to initial surveillance endoscopy was 1.6 months (interquartile range = 1.3-2.4 months). At initial endoscopy, 86.6% of patients had at least one abnormal airway finding. The most common findings were subglottic edema/stenosis (57.3%), glottic edema (37.3%), and suprastomal granulation tissue (31.8%). Prematurity and a history of failed extubations were significantly associated with abnormal findings on endoscopy (odds ratio [OR] = 7.2, P = .01 and OR = 4.1, P = .03, respectively). Of those with abnormal findings, 32.7% underwent an intervention to improve airway patency and safety. The most common interventions performed were suprastomal granuloma excision (44.4%), steroid injection (22.2%), and balloon dilation of the glottis or subglottis (19.4%). CONCLUSIONS The prevalence of early abnormal airway changes in TDC is high, particularly in young children with a history of prematurity and failed extubation. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1327-1332, 2020.
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Affiliation(s)
- C Carrie Liu
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Jennifer J Soares
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Leslie Elder
- Seattle Children's Hospital, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Leslee Hill
- Seattle Children's Hospital, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Matthew Abts
- Department of Pulmonary and Sleep Medicine, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Juliana Bonilla-Velez
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - John P Dahl
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Kaalan E Johnson
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Thida Ong
- Department of Pulmonary and Sleep Medicine, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Amanda M Striegl
- Department of Pulmonary and Sleep Medicine, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Kathryn Whitlock
- Center for Clinical and Translational Research, Virginia Mason Medical Center, Seattle, Washington, U.S.A
| | - Sanjay R Parikh
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, Washington, U.S.A
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Ong T, Schechter MS. Is It Acceptable to Assess Prenatal Smoking Risk to Infants without Considering Socioeconomic Status? Am J Respir Crit Care Med 2019; 197:965-966. [PMID: 29111767 DOI: 10.1164/rccm.201708-1750le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thida Ong
- 1 University of Washington Seattle, Washington and
| | - Michael S Schechter
- 2 Children's Hospital of Richmond at Virginia Commonwealth University Richmond, Virginia
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Martiniano SL, Daines CL, Dellon EP, Esther CR, Muhlebach MS, Ong T, Rabinowitz EC, Toprak D, Zemanick ET. Highlights from the 2018 North American cystic fibrosis conference. Pediatr Pulmonol 2019; 54:941-948. [PMID: 31091021 DOI: 10.1002/ppul.24356] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
Abstract
The 32nd annual North American Cystic Fibrosis Conference was held in Denver, CO on Oct. 18 to 20, 2018. This review highlights presentations in several topic areas, including the pathophysiology and basic science of cystic fibrosis lung disease, clinical trials, clinical care, and quality improvement. Citations from the conference are by first author and abstract or symposium number, as designated in the previously published supplement.
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Affiliation(s)
- Stacey L Martiniano
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Cori L Daines
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
| | - Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles R Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marianne S Muhlebach
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thida Ong
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Elliot C Rabinowitz
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Demet Toprak
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Quittner A, Muther E, Gruber J, Ong T, Abbott J, Tillman L, Mohabir P, Hempstead S, Lomas P, Smith B. P447 Dissemination and implementation of the mental health guidelines in the United States: results of implementation in year 2 at 120 cystic fibrosis centres. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30739-8] [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: 11/24/2022]
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Ong T, Sahota O, Gladman JRF. 91IS THERE A ROLE FOR AN ORTHOGERIATRIC MODEL OF CARE IN THE MANAGEMENT OF VERTEBRAL FRAGILITY FRACTURES IN HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy200.08] [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: 11/14/2022] Open
Affiliation(s)
- T Ong
- Division of Rehabilitation and Ageing, University of Nottingham
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - J R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham
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Smith CA, Redding GJ, Ong T, Waldhausen JHT. Thoracic insufficiency: A novel surgical approach. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Tan MY, Ong T, Sivam J, Al-Shuft H, Sahota O, Salem K. 32THE ROLE OF DYNAMIC SUPINE-SITTING SPINAL RADIOGRAPHS IN THE MANAGEMENT OF VERTEBRAL FRAGILITY FRACTURES ADMITTED TO HOSPITAL. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Y Tan
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - J Sivam
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - H Al-Shuft
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - K Salem
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust
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Lim PN, Ooi LJ, Ong T, Neighbour C, Sahota O. 22PELVIC FRACTURES IN OLDER PEOPLE ADMITTED TO HOSPITAL: THE CLINICAL BURDEN. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.02] [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: 11/12/2022] Open
Affiliation(s)
- P N Lim
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
- Contributed equally
| | - L J Ooi
- Contributed equally
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - C Neighbour
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
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Taib A, Ong T, Mulvaney E, Neale C, Strawther N, Peters C, Sahota A, Sahota O. 89CAN AN ICE CREAM BASED ORAL NUTRITIONAL SUPPLEMENT HELP ADDRESS THE ISSUE OF MALNUTRITION IN ORTHOGERIATRIC PATIENTS? Age Ageing 2018. [DOI: 10.1093/ageing/afy126.05] [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: 11/14/2022] Open
Affiliation(s)
- A Taib
- Central Manchester University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - E Mulvaney
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust
| | - C Neale
- Department of Catering, Nottingham University Hospitals NHS Trust
| | - N Strawther
- Dietetics and Nutrition, Nottingham University Hospitals NHS Trust
| | - C Peters
- Foundation Programme, Nottingham University Hospitals NHS Trust
| | - A Sahota
- Student Volunteer, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
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Martiniano SL, Toprak D, Ong T, Zemanick ET, Daines CL, Muhlebach MS, Esther CR, Dellon EP. Highlights from the 2017 North American Cystic Fibrosis Conference. Pediatr Pulmonol 2018; 53:979-986. [PMID: 29660839 DOI: 10.1002/ppul.24000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/07/2018] [Indexed: 11/06/2022]
Abstract
The 31st annual North American Cystic Fibrosis Conference (NACFC) was held in Indianapolis, IN on November 2-4, 2017. Abstracts of presentations from the conference were published in a supplement to Pediatric Pulmonology [2017; Pediatr Pulmonol Suppl. 52: S1-S776]. The current review summarizes several major topic areas addressed at the conference: the pathophysiology and basic science of cystic fibrosis (CF) lung disease, clinical trials, clinical management issues, and quality improvement (QI). In this review, we describe emerging concepts in several areas of CF research and care.
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Affiliation(s)
- Stacey L Martiniano
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Demet Toprak
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Cori L Daines
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
| | - Marianne S Muhlebach
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles R Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Riebling P, Kong R, O'Mara E, Luo X, Trifillis P, Ong T. A phase 2 trial of the safety and pharmacokinetics of ataluren in patients aged 2 to 5 years with nonsense mutation Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zemanick ET, Daines CL, Dellon EP, Esther CR, Kinghorn B, Ong T, Muhlebach MS. Highlights from the 2016 North American Cystic Fibrosis Conference. Pediatr Pulmonol 2017; 52:1103-1110. [PMID: 28696526 PMCID: PMC5963883 DOI: 10.1002/ppul.23707] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/23/2017] [Indexed: 01/25/2023]
Abstract
The 30th annual North American Cystic Fibrosis Conference (NACFC) was held in Orlando, FL, on October 27-29, 2016. Abstracts were published in a supplement to Pediatric Pulmonology. This review summarizes several major topic areas addressed at the conference: the pathophysiology of cystic fibrosis (CF) lung disease, clinical trials, clinical management issues, and quality improvement. We sought to provide an overview of emerging concepts in several areas of CF research and care, rather than a comprehensive review of the conference. Citations from the conference are by first author and abstract number or symposium number, as designated in the supplement.
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Affiliation(s)
- Edith T Zemanick
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Cori L Daines
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles R Esther
- Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - BreAnna Kinghorn
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Marianne S Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Campbell CV, Cooper J, Shabir F, Wills E, Ong T. 24AN ENHANCED THERAPY SERVICE FOR PATIENTS WITH FRACTURED NECK OF FEMUR - SERVICE EVALUATION OF A PILOT PROJECT. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.24] [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: 11/15/2022] Open
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Kumar A, Ong T. 148Recruitment Of Older People In Hospital For Research - Challenges And Experience From A Feasibility Study. Age Ageing 2017. [DOI: 10.1093/ageing/afx060.148] [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: 11/12/2022] Open
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Kumar A, Ong T, Simmonds L, Sahota O, Yoon W. 19VERTEBRAL AUGMENTATION FOR OSTEOPOROTIC VERTEBRAL FRACTURES IN THE ‘OLDER-OLD’ PERSON: EXPERIENCE FROM A TERTIARY UK SPINAL UNIT. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.19] [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: 11/13/2022] Open
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Luo X, McIntosh J, Trifillis P, Gill A, Ong T, Riebling P, Souza M, Spiegel R, Peltz S, Muntoni F. Lung function in ataluren-treated, non-ambulatory patients with nonsense mutation Duchenne muscular dystrophy from a long-term extension trial versus untreated patients from a natural history study. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30233-x] [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: 11/24/2022]
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Cogen JD, Oron AP, Gibson RL, Hoffman LR, Kronman MP, Ong T, Rosenfeld M. Characterization of Inpatient Cystic Fibrosis Pulmonary Exacerbations. Pediatrics 2017; 139:peds.2016-2642. [PMID: 28126911 PMCID: PMC5472380 DOI: 10.1542/peds.2016-2642] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary exacerbations lead to significant morbidity and mortality in patients with cystic fibrosis (CF). National consensus guidelines exist, but few studies report current practice in the treatment and monitoring of pulmonary exacerbations. The goal of this study was to characterize consistency and variability in the inpatient management of CF-related pulmonary exacerbations. We focused on the use of guideline-recommended maintenance therapies, antibiotic selection and treatment regimens, use of systemic corticosteroids, and frequency of lung function testing. We hypothesized that significant variability in these treatment practices exists nationally. METHODS This trial was a retrospective cross-sectional study. It included patients with CF aged ≤18 years hospitalized for pulmonary exacerbations between July 1, 2010, and June 30, 2015, at hospitals within the US Pediatric Health Information System database that are also Cystic Fibrosis Foundation-accredited care centers. One exacerbation per patient was randomly selected over the 5-year study period. RESULTS From 38 hospitals, 4827 individual pulmonary exacerbations were examined. Median length of stay was 10.0 days (interquartile range, 6-14.0 days). Significant variation was seen among centers in the use of hypertonic saline (11%-100%), azithromycin (5%-83%), and systemic corticosteroids (3%-61%) and in the frequency of lung function testing. Four different admission antibiotic regimens were used >10% of the time, and the most commonly used admission antibiotic regimen comprised 2 intravenous antibiotics with no additional oral or inhaled antibiotics (29%). CONCLUSIONS Significant variation exists in the treatment and monitoring of pulmonary exacerbations across Pediatric Health Information System-participating, Cystic Fibrosis Foundation-accredited care centers. Results from this study can inform future research working toward standardized inpatient pulmonary exacerbation management to improve CF care for children and adolescents.
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Affiliation(s)
- Jonathan D. Cogen
- Divisions of Pulmonary Medicine and Sleep Medicine and,Address correspondence to Jonathan D. Cogen, MD, MPH, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105. E-mail:
| | - Assaf P. Oron
- Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | | | | | - Matthew P. Kronman
- Infectious Diseases, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and
| | - Thida Ong
- Divisions of Pulmonary Medicine and Sleep Medicine and
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Ong T, Schechter M, Yang J, Peng L, Emerson J, Gibson RL, Morgan W, Rosenfeld M. Socioeconomic Status, Smoke Exposure, and Health Outcomes in Young Children With Cystic Fibrosis. Pediatrics 2017; 139:peds.2016-2730. [PMID: 28093464 PMCID: PMC5260155 DOI: 10.1542/peds.2016-2730] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure are both associated with poorer disease outcomes in cystic fibrosis (CF), and children with low SES are disproportionately exposed to ETS. We analyzed a large cohort of young children with CF to distinguish the impact of SES and ETS on clinical outcomes. METHODS The Early Pseudomonas Infection Control Observational study enrolled Pseudomonas-negative young children with CF <13 years of age. An enrollment survey assessed SES and ETS exposures. Forced expiratory volume in 1 second (FEV1), crackles and wheezes, and weight-for-age percentile were assessed at each clinical encounter over at least 4 years. Repeated measures analyses estimated the association of SES and ETS exposures with longitudinal clinical outcomes, adjusting for confounders. RESULTS Of 1797 participants, 1375 were eligible for analysis. Maternal education was high school or less in 28.1%, 26.8% had household income <$40 000, and 43.8% had Medicaid or no insurance. Maternal smoking after birth was present in 24.8%, more prevalent in household with low SES. In separate models, lower SES and ETS exposure were significantly associated with lower FEV1% predicted, presence of crackles or wheezes, and lower weight percentile. In combined models, effect estimates for SES changed minimally after adjustment for ETS exposures, whereas estimates for ETS exposures were attenuated after adjusting for SES. CONCLUSIONS ETS exposure was disproportionately high in low SES families in this cohort of children with CF. Lower SES and ETS exposure had independent adverse effects on pulmonary and nutritional outcomes. Estimated effect of SES on FEV1 decreased minimally after ETS adjustment, suggesting health disparity risks independent of ETS exposure.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington;
| | - Michael Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University, Children’s Hospital of Richmond at VCU, Richmond, Virginia
| | - Jing Yang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and
| | - Julia Emerson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ronald L. Gibson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Wayne Morgan
- Departments of Pediatrics and Physiology, Pediatric Pulmonary Center, University of Arizona, Tucson, Arizona
| | - Margaret Rosenfeld
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
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Muntoni F, Luo X, Elfring G, Kroger H, Riebling P, Ong T, Spiegel R, Peltz S, McDonald C. Results of North Star ambulatory assessments in the phase 3 ataluren confirmatory trial in patients with nonsense mutation Duchenne muscular dystrophy (ACT DMD). Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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