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Pagidipati NJ, Nelson AJ, Kaltenbach LA, Leyva M, McGuire DK, Pop-Busui R, Cavender MA, Aroda VR, Magwire ML, Richardson CR, Lingvay I, Kirk JK, Al-Khalidi HR, Webb L, Gaynor T, Pak J, Senyucel C, Lopes RD, Green JB, Granger CB. Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes: A Randomized Clinical Trial. JAMA 2023; 329:1261-1270. [PMID: 36877177 PMCID: PMC9989955 DOI: 10.1001/jama.2023.2854] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
Importance Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice. Objective To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]). Design, Setting, and Participants Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies. Interventions Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590). Main Outcomes and Measures The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences). Results Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P < .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]). Conclusions and Relevance A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease. Trial Registration ClinicalTrials.gov Identifier: NCT03936660.
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Affiliation(s)
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, North Carolina
- Victorian Heart Institute, Monash University, Melbourne, Australia
| | | | - Monica Leyva
- Duke Clinical Research Institute, Durham, North Carolina
| | - Darren K. McGuire
- University of Texas Southwestern Medical Center, Dallas
- Parkland Health and Hospital System, Dallas, Texas
| | | | | | | | | | | | | | - Julienne K. Kirk
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | | | - Laura Webb
- Duke Clinical Research Institute, Durham, North Carolina
| | - Tanya Gaynor
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut
| | - Jonathan Pak
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut
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152
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Ellis KR, Young TL, Langford AT. Advancing Racial Health Equity Through Family-Focused Interventions for Chronic Disease Management. Prev Chronic Dis 2023; 20:E27. [PMID: 37055153 PMCID: PMC10109515 DOI: 10.5888/pcd20.220297] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Affiliation(s)
- Katrina R Ellis
- University of Michigan, School of Social Work, 1080 S University, Ann Arbor, MI 48109
| | | | - Aisha T Langford
- NYU Langone Health, Department of Population Health, New York, New York
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153
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Qi PY, Zhang TH, Wang N, Feng YM, Zeng D, Shao WB, Meng J, Liu LW, Jin LH, Zhang H, Zhou X, Yang S. Natural Products-Based Botanical Bactericides Discovery: Novel Abietic Acid Derivatives as Anti-Virulence Agents for Plant Disease Management. J Agric Food Chem 2023; 71:5463-5475. [PMID: 37012216 DOI: 10.1021/acs.jafc.2c08392] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The discovery of natural product-based pesticides is critical for agriculture. In this work, a series of novel tricyclic diterpenoid derivatives decorated with an amino alcohol moiety were elaborately prepared from natural abietic acid, and their antibacterial behavior was explored. Bioassay results indicated that compound C2 exhibited the most promising bioactivity (EC50 = 0.555 μg mL-1) against Xanthomonas oryzae pv. oryzae (Xoo), about 73 times higher than the effect of commercial thiodiazole copper (TC). Results of in vivo bioassays showed that compound C2 displayed significantly higher control of rice bacterial leaf blight (curative activity: 63.8%; protective activity: 58.4%) than TC (curative activity: 43.6%; protective activity: 40.8%), and their bioactivity could be improved maximally 16% by supplementing the auxiliaries. Antibacterial behavior suggested that compound C2 could suppress various virulence factors. Overall, these findings suggested that new botanical bactericide candidates could control intractable plant bacterial diseases by suppressing virulence factors.
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Affiliation(s)
- Pu-Ying Qi
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Tai-Hong Zhang
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Na Wang
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Yu-Mei Feng
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Dan Zeng
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Wu-Bin Shao
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Jiao Meng
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Li-Wei Liu
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Lin-Hong Jin
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Heng Zhang
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Xiang Zhou
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
| | - Song Yang
- National Key Laboratory of Green Pesticide, Key Laboratory of Green Pesticide and Agricultural Bioengineering, Ministry of Education, Center for R&D of Fine Chemicals of Guizhou University, Guiyang 550025, China
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Höglinger M, Wirth B, Carlander M, Caviglia C, Frei C, Rhomberg B, Rohrbasser A, Trottmann M, Eichler K. Impact of a diabetes disease management program on guideline-adherent care, hospitalization risk and health care costs: a propensity score matching study using real-world data. Eur J Health Econ 2023; 24:469-478. [PMID: 35716315 PMCID: PMC10060321 DOI: 10.1007/s10198-022-01486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the impact of a DMP for patients with diabetes mellitus in a Swiss primary care setting. METHODS In a prospective observational study, we compared diabetes patients in a DMP (intervention group; N = 538) with diabetes patients receiving usual care (control group; N = 5050) using propensity score matching with entropy balancing. Using a difference-in-difference (DiD) approach, we compared changes in outcomes from baseline (2017) to 1-year (2017/18) and to 2-year follow-up (2017/19). Outcomes included four measures for guideline-adherent diabetes care, hospitalization risk, and health care costs. RESULTS We identified a positive impact of the DMP on the share of patients fulfilling all measures for guideline-adherent care [DiD 2017/18: 7.2 percentage-points, p < 0.01; 2017/19: 8.4 percentage-points, p < 0.001]. The hospitalization risk was lower in the intervention group in both years, but only statistically significant in the 1-year follow-up [DiD 2017/18: - 5.7 percentage-points, p < 0.05; 2017/19: - 3.9 percentage points, n.s.]. The increase in health care costs was smaller in the intervention than in the control group [DiD 2017/18: CHF - 852; 2017/19: CHF - 909], but this effect was not statistically significant. CONCLUSION The DMP under evaluation seems to exert a positive impact on the quality of diabetes care, reflected in the increase in the measures for guideline-adherent care and in a reduction of the hospitalization risk in the intervention group. It also might reduce health care costs, but only a longer follow-up will show whether the observed effect persists over time.
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Affiliation(s)
- Marc Höglinger
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland.
| | - Brigitte Wirth
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
| | - Maria Carlander
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
| | | | | | | | - Adrian Rohrbasser
- Medbase Health Care Provider, Winterthur, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Klaus Eichler
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401, Winterthur, Switzerland
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155
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Cuéllar DI, De Los Reyes A, Llamas-Olier A. Modified dynamic risk stratification system further predicts individual outcome in patients with intermediate-risk papillary thyroid cancer. Ann Endocrinol (Paris) 2023; 84:242-248. [PMID: 35483449 DOI: 10.1016/j.ando.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We assessed the contribution of initial treatment response to further refining prediction of individual outcomes in intermediate-risk papillary thyroid cancer (PTC) on the American Thyroid Association (ATA) risk stratification system. Dynamic risk stratification (DRS) as originally proposed by Tuttle et al. in 2010 was modified to also include serum antithyroglobulin antibodies (TgAb) as a surrogate marker of the likelihood of persistent disease, specifically in patients with thyroglobulin assay interference by TgAb. METHODS Three hundred and seventy-three patients with ATA intermediate-risk PTC were enrolled retrospectively upon reviewing medical records. Patients were followed at the National Cancer Institute in Bogota, Colombia after being treated with total thyroidectomy and I-131 therapy between 2009 and 2013. Best response to initial therapy was classified as excellent, indeterminate, biochemically incomplete or structurally incomplete. Final disease status after a median follow-up of 7.1 years was classified as no evidence of disease (NED), indeterminate, or persistent disease (either biochemically or structurally). The rate of recurrence was determined in excellent responders. RESULTS Excellent response was achieved by 164 patients (43.9%). At a median follow-up of 42 months, 19 (11.6%) had experienced recurrence. 87.4% of initially excellent responders available at the final checkpoint were NED, compared to 28% of those with biochemically or structurally incomplete response and to 60.2% of all ATA intermediate-risk PTC patients in our cohort. CONCLUSIONS Modified DRS further predicted individual outcomes in intermediate-risk PTC, potentially allowing ongoing management to be tailored accordingly.
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Affiliation(s)
- Diana Isabel Cuéllar
- Clinical and Epidemiological Cancer Research Unit, Instituto Nacional de Cancerología, Bogotá Calle 1 9-85 Bogotá, Colombia.
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156
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Soilemezi D, Palmar‐Santos A, Navarta‐Sánchez MV, Roberts HC, Pedraz‐Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. Health Expect 2023; 26:670-682. [PMID: 36573594 PMCID: PMC10010098 DOI: 10.1111/hex.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. OBJECTIVE This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. METHODS A mixed-methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta-ethnography approach was used to analyse and synthesize cross-national findings. RESULTS A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. CONCLUSIONS Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings.
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Affiliation(s)
- Dia Soilemezi
- Department of Psychology, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
| | - Ana Palmar‐Santos
- Nursing Department, Faculty of MedicineUniversidad Autónoma de MadridMadridSpain
| | | | - Helen C. Roberts
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Academic Geriatric Medicine, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Azucena Pedraz‐Marcos
- Unidad de Investigación en Cuidados y Sistemas de SaludThe Carlos III Health Institute (ISCIII)MadridSpain
- Grupo de investigación ISCiiiResearch Network on Chronicity, Primary Care, and Health Promotion (RICAPPS)TenerifeSpain
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
- Nursing and Healthcare, Department of Public HealthAarhus UniversityAarhusDenmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University CollegeAarhusDenmark
| | - Line K. Bragstad
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | - Ellen G. Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM)University of OsloOsloNorway
- Department of Occupational Therapy, Prosthetics and OrthoticsOslo Metropolitan UniversityOsloNorway
| | | | - Mari Carmen Portillo
- National Institute for Health Research Applied Research Collaboration Wessex, Long Term Conditions, SouthamptonUK
- Faculty of Environmental and Life Sciences, School of Health SciencesUniversity of SouthamptonSouthamptonUK
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157
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Comiti VP. Chapitre 1. Santé publique et prise en charge des maladies. Journal international de bioéthique et d'éthique des sciences 2023; 33:27-33. [PMID: 37015862 DOI: 10.3917/jibes.333.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The history of environmental damages is linked to the development of diseases. Conversely, individual and collective protection measures for the living environment. Were often beneficial to health.
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158
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Liu M, Liu SJ, Chen MJ, Ning T. A new modality of colorectal cancer screening based on chronic disease management. BMC Gastroenterol 2023; 23:78. [PMID: 36932326 PMCID: PMC10024352 DOI: 10.1186/s12876-023-02698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND To develop a new modality of colorectal cancer screening based on chronic disease management (CDM) to improve the participation rate of screening, and maximize the benefits of limited resources. METHODS Patients under CDM were assigned to screening intervention group (SI) and screening control group1 (SC1), residents from natural community were assigned to screening control group2 (SC2). A parallel controlled community intervention study was performed. Only SI would achieve "one-to-one" intervention services. Meanwhile, 200 subjects were selected from each of the three groups for the Knowledge-Attitude-Practice (KAP) questionnaire before and after intervention, named questionnaire intervention group(QI), questionnaire control group1(QC1) and questionnaire control group2(QC2). The outcome of the intervention was evaluated using the difference-in-differences method and multiple regression analysis. RESULTS The preliminary screening participation rate was 43.63%(473/1084) in SI, 14.32%(132/922) in SCI, and 5.87%(105/1789) in SC2. The baseline questionnaire showed low knowledge scores in the three questionnaire groups with no statistically significant differences, while attitude scores in QI and QC1 were significantly higher than QC2. The differences between baseline and terminal showed QI increased larger in knowledge and attitude scores than QC1 and QC2, while no difference was detected between QC1 and QC2. CONCLUSION The colorectal cancer screening model based on chronic disease management effectively improved the screening participation rate, and the "one-to-one" intervention and the inherent characteristics of the patient population under CDM were the core elements of the new modality.
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Affiliation(s)
- Mo Liu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China
| | - Shi-Jun Liu
- Medical Department, Fengtai District You' anmen Community Health Service Center, Beijing, 100069, China
| | - Ming-Jun Chen
- Medical Department, Fengtai District You' anmen Community Health Service Center, Beijing, 100069, China
| | - Tingting Ning
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, 100050, China.
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159
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Bruttomesso D. Technology in the Changing Management of Diabetes in Children. N Engl J Med 2023; 388:1052-1054. [PMID: 36920764 DOI: 10.1056/nejme2301252] [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] [Indexed: 03/16/2023]
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160
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Waeijen-Smit K, DiGiandomenico A, Bonnell J, Ostridge K, Gehrmann U, Sellman BR, Kenny T, van Kuijk S, Peerlings D, Spruit MA, Simons SO, Houben-Wilke S, Franssen FME. Early diagnostic BioMARKers in exacerbations of chronic obstructive pulmonary disease: protocol of the exploratory, prospective, longitudinal, single-centre, observational MARKED study. BMJ Open 2023; 13:e068787. [PMID: 36868599 PMCID: PMC9990620 DOI: 10.1136/bmjopen-2022-068787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) play a pivotal role in the burden and progressive course of chronic obstructive pulmonary disease (COPD). As such, disease management is predominantly based on the prevention of these episodes of acute worsening of respiratory symptoms. However, to date, personalised prediction and early and accurate diagnosis of AECOPD remain unsuccessful. Therefore, the current study was designed to explore which frequently measured biomarkers can predict an AECOPD and/or respiratory infection in patients with COPD. Moreover, the study aims to increase our understanding of the heterogeneity of AECOPD as well as the role of microbial composition and hostmicrobiome interactions to elucidate new disease biology in COPD. METHODS AND ANALYSIS The 'Early diagnostic BioMARKers in Exacerbations of COPD' study is an exploratory, prospective, longitudinal, single-centre, observational study with 8-week follow-up enrolling up to 150 patients with COPD admitted to inpatient pulmonary rehabilitation at Ciro (Horn, the Netherlands). Respiratory symptoms, vitals, spirometry and nasopharyngeal, venous blood, spontaneous sputum and stool samples will be frequently collected for exploratory biomarker analysis, longitudinal characterisation of AECOPD (ie, clinical, functional and microbial) and to identify host-microbiome interactions. Genomic sequencing will be performed to identify mutations associated with increased risk of AECOPD and microbial infections. Predictors of time-to-first AECOPD will be modelled using Cox proportional hazards' regression. Multiomic analyses will provide a novel integration tool to generate predictive models and testable hypotheses about disease causation and predictors of disease progression. ETHICS AND DISSEMINATION This protocol was approved by the Medical Research Ethics Committees United (MEC-U), Nieuwegein, the Netherlands (NL71364.100.19). TRIAL REGISTRATION NUMBER NCT05315674.
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Affiliation(s)
- Kiki Waeijen-Smit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Antonio DiGiandomenico
- Discovery Microbiome, Vaccines and Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Jessica Bonnell
- Discovery Microbiome, Vaccines and Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Kristoffer Ostridge
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology (R&I), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ulf Gehrmann
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology (R&I), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bret R Sellman
- Discovery Microbiome, Vaccines and Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Tara Kenny
- Discovery Microbiome, Vaccines and Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | | | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
| | | | - Frits M E Franssen
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
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161
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Lazar N, Steen VD. Mental Health Considerations in Chronic Disease. Rheum Dis Clin North Am 2023; 49:389-399. [PMID: 37028842 DOI: 10.1016/j.rdc.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Each person who presents for scleroderma-focused care not only has their own psychosocial stressors in their day-to-day life but they also have scleroderma symptom-specific stressors as well as their own mental health reactions throughout their journey with this disease course. There are many actions patients can take to help and support themselves when they are faced with any of the mental health and social determinants of health stressors associated with this rare, chronic illness. Using the scleroderma specialty providers to inform, discuss, and address these areas with their patients can assist with more effective symptom and disease self-management.
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Affiliation(s)
| | - Virginia D Steen
- Georgetown University - School of Medicine, Washington, DC 20007, USA
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Wang Y, Wu Y, Chu H, Xu Z, Sun X, Fang H. Association between Health-Related Quality of Life and Access to Chronic Disease Management by Primary Care Facilities in Mainland China: A Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:4288. [PMID: 36901304 PMCID: PMC10001723 DOI: 10.3390/ijerph20054288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The integration of chronic disease management (CDM) services into the essential public health services offered by primary care facilities has been a major strategy in China's healthcare reform since 2009. We aimed to measure the percentage of patients with chronic diseases in China who believed that they could easily obtain CDM services at a nearby primary care facility in mainland China and determine its association with the EQ visual analog scale (EQ-VAS) score and the utility index of the 5-level EQ-5D version (EQ-5D-5L). A cross-sectional survey was conducted nationwide between 20 June 2022 and 31 August 2022, involving 5525 patients with chronic diseases from 32 provincial-level administrative divisions, of which 48.1% (n = 2659) were female with a median age of 55.0 years. The median EQ-VAS score was 73.0 and the utility index of the EQ-5D-5L was 0.942. A majority of patients reported definite (24.3%) or mostly (45.9%) easy access to CDM services from nearby primary care facilities. Multivariable logistic regression analysis revealed that easy access to CDM services in primary care facilities was positively associated with higher HRQoL. Our findings indicate that, as of 2022, approximately 70% of patients with chronic diseases in mainland China had easy access to CDM services provided by primary care facilities, which was significantly and positively associated with their health status.
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Affiliation(s)
- Yang Wang
- School of Public Health, Peking University, Beijing 100191, China
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Zhijie Xu
- Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100191, China
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163
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Raaijmakers LHA, Schermer TR, Wijnen M, van Bommel HE, Michielsen L, Boone F, Vercoulen JH, Bischoff EWMA. Development of a Person-Centred Integrated Care Approach for Chronic Disease Management in Dutch Primary Care: A Mixed-Method Study. Int J Environ Res Public Health 2023; 20:3824. [PMID: 36900842 PMCID: PMC10001916 DOI: 10.3390/ijerph20053824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
To reduce the burden of chronic diseases on society and individuals, European countries implemented chronic Disease Management Programs (DMPs) that focus on the management of a single chronic disease. However, due to the fact that the scientific evidence that DMPs reduce the burden of chronic diseases is not convincing, patients with multimorbidity may receive overlapping or conflicting treatment advice, and a single disease approach may be conflicting with the core competencies of primary care. In addition, in the Netherlands, care is shifting from DMPs to person-centred integrated care (PC-IC) approaches. This paper describes a mixed-method development of a PC-IC approach for the management of patients with one or more chronic diseases in Dutch primary care, executed from March 2019 to July 2020. In Phase 1, we conducted a scoping review and document analysis to identify key elements to construct a conceptual model for delivering PC-IC care. In Phase 2, national experts on Diabetes Mellitus type 2, cardiovascular diseases, and chronic obstructive pulmonary disease and local healthcare providers (HCP) commented on the conceptual model using online qualitative surveys. In Phase 3, patients with chronic conditions commented on the conceptual model in individual interviews, and in Phase 4 the conceptual model was presented to the local primary care cooperatives and finalized after processing their comments. Based on the scientific literature, current practice guidelines, and input from a variety of stakeholders, we developed a holistic, person-centred, integrated approach for the management of patients with (multiple) chronic diseases in primary care. Future evaluation of the PC-IC approach will show if this approach leads to more favourable outcomes and should replace the current single-disease approach in the management of chronic conditions and multimorbidity in Dutch primary care.
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Affiliation(s)
- Lena H. A. Raaijmakers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tjard R. Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Science Support Office, Gelre Hospitals, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Mandy Wijnen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester E. van Bommel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Pharos, Dutch Centre of Expertise on Health Disparities, P.O. Box 13318, 3507 LH Utrecht, The Netherlands
| | - Leslie Michielsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Research Group Innovation of Care and Services, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Floris Boone
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jan H. Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik W. M. A. Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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164
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Tran TTY, Cheng HW, Nguyen VH, Yeh SD. Modification of the Helper Component Proteinase of Papaya Ringspot Virus Vietnam Isolate to Generate Attenuated Mutants for Disease Management by Cross Protection. Phytopathology 2023; 113:334-344. [PMID: 36129763 DOI: 10.1094/phyto-05-22-0168-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Papaya (Carica papaya) production is seriously limited by papaya ringspot virus (PRSV) worldwide, including in Vietnam. Control of PRSV by cross protection is dependent on the availability of effective mild strains. Here, an infectious cDNA clone was constructed from PRSV isolate TG5 from South Vietnam. Site-directed mutagenesis with point mutations on the essential motifs of the helper component proteinase (HC-Pro) was performed, with or without deleting five amino acids (d5) from its N-terminal region. Mutants TG-d5, TG-d5I7, and TG-d5L206 containing d5, d5 + F7I, and d5 + F206L, respectively, induced mild mottling followed by symptomless recovery on papaya and infected Chenopodium quinoa without lesion formation. Each mutant accumulated in papaya at reduced levels with a zigzag pattern and was stable beyond six monthly passages. The cross-protection effectiveness of the three mutants in papaya against TG5 was investigated, each with 60 plants from three independent trials. The results showed that each mutant provided complete protection (100%) against TG5, 1 month after the challenge inoculation, as verified by the lack of severe symptoms and lack of local lesions in C. quinoa. Further tests revealed that TG-d5I7 also confers high levels of protection against other severe PRSV isolates from South Vietnam, including isolates DN (97%) and ST2 (50%). However, TG-d5I7 is ineffective or less effective (0 to 33%) against seven other severe PRSV strains from different geographic origins, including the isolate HN from North Vietnam. Our results indicate that the protection by the three mutants is highly strain-specific and suitable for the control of PRSV in South Vietnam.
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Affiliation(s)
- Thi-Thu-Yen Tran
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Southern Horticultural Research Institute, Tiengiang, Vietnam
| | - Hao-Wen Cheng
- Advanced Plant Biotechnology Center, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Van-Hoa Nguyen
- Southern Horticultural Research Institute, Tiengiang, Vietnam
| | - Shyi-Dong Yeh
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Advanced Plant Biotechnology Center, National Chung Hsing University, Taichung, Taiwan, R.O.C
- Vietnam Overseas Agricultural Science and Technology Innovation Center, National Chung Hsing University, Taichung, Taiwan, R.O.C
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Abstract
Plant viruses cause significant losses in agricultural crops worldwide, affecting the yield and quality of agricultural products. The emergence of novel viruses or variants through genetic evolution and spillover from reservoir host species, changes in agricultural practices, mixed infections with disease synergism, and impacts from global warming pose continuous challenges for the management of epidemics resulting from emerging plant virus diseases. This review describes some of the most devastating virus diseases plus select virus diseases with regional importance in agriculturally important crops that have caused significant yield losses. The lack of curative measures for plant virus infections prompts the use of risk-reducing measures for managing plant virus diseases. These measures include exclusion, avoidance, and eradication techniques, along with vector management practices. The use of sensitive, high throughput, and user-friendly diagnostic methods is crucial for defining preventive and management strategies against plant viruses. The advent of next-generation sequencing technologies has great potential for detecting unknown viruses in quarantine samples. The deployment of genetic resistance in crop plants is an effective and desirable method of managing virus diseases. Several dominant and recessive resistance genes have been used to manage virus diseases in crops. Recently, RNA-based technologies such as dsRNA- and siRNA-based RNA interference, microRNA, and CRISPR/Cas9 provide transgenic and nontransgenic approaches for developing virus-resistant crop plants. Importantly, the topical application of dsRNA, hairpin RNA, and artificial microRNA and trans-active siRNA molecules on plants has the potential to develop GMO-free virus disease management methods. However, the long-term efficacy and acceptance of these new technologies, especially transgenic methods, remain to be established.
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Affiliation(s)
- Satyanarayana Tatineni
- U.S. Department of Agriculture-Agricultural Research Service and Department of Plant Pathology, University of Nebraska-Lincoln, Lincoln, NE 68583
| | - Gary L Hein
- Department of Entomology, University of Nebraska-Lincoln, Lincoln, NE 68583
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166
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Buehne KL, Rosdahl JA, Hein AM, Woolson S, Olsen M, Kirshner M, Sexton M, Bosworth HB, Muir KW. How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial. Ophthalmic Res 2023; 66:489-495. [PMID: 36603568 DOI: 10.1159/000528857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable. METHODS The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a "smart bottle" (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization. RESULTS Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups. CONCLUSIONS A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.
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Affiliation(s)
- Kristen L Buehne
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA,
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron M Hein
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Woolson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Maren Olsen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Miriam Kirshner
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Malina Sexton
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hayden B Bosworth
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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167
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Boonstra M, Kloosterman M, van der Schaaf I, Roudijk R, van Dam P, Loh P. ECG-based techniques to enhance clinical practice in cardiac genetic disease management. J Electrocardiol 2023; 76:55-60. [PMID: 36436475 DOI: 10.1016/j.jelectrocard.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Inherited cardiomyopathies are associated with a broad spectrum of potentially lethal phenotypes characterized by structural and electrical myocardial remodeling. Increased awareness and genetic cascade screening lead to more genotype-positive, yet phenotype-negative individuals to be evaluated and followed up. The predictive value of genetic testing is hampered by incomplete penetrance and high variability in disease onset, progression and severity. CLINICAL CHALLENGES Dilated cardiomyopathy usually manifests with symptoms of heart failure and ventricular arrhythmias (VA) develop in advanced disease. In arrhythmogenic cardiomyopathy (ACM), electrical remodeling can precede structural and functional changes and life-threatening VA can be the first disease manifestation. Early signs and symptoms may be subtle and go unnoticed. Physicians are in great need of appropriate screening and risk-stratification strategies. Task Force Criteria (TFC) were established to standardize the clinical diagnosis of ACM but risk-stratification remains challenging. Accurate prediction of disease progression in variation carriers is currently beyond the capabilities of diagnostic tests. PROPOSED DIAGNOSTIC TECHNIQUES We propose three ECG-based techniques; isopotential mapping, inverse ECG and CineECG, to enhance risk-stratification in ACM. With the use of isopotential mapping abnormal spatio-temporal activation and repolarization may be identified. Furthermore, by combining subject specific ≥12‑lead ECG data with cardiothoracic imaging using inverse ECG techniques, the direct link between ECG and cardiac anatomy can be obtained. CONCLUSION New ECG techniques may prove more sensitive to detect early de- and repolarization abnormalities in yet asymptomatic variation carriers. Early electrical signs of disease progression may be identified prior to symptoms. Furthermore, individualized risk-stratification may be enhanced.
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Affiliation(s)
- Machteld Boonstra
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon Kloosterman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Iris van der Schaaf
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rob Roudijk
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Peter van Dam
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Loh
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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168
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Monhart Z. Clinical assessment and management of patients with multimorbidity. Vnitr Lek 2023; 69:173-180. [PMID: 37468312 DOI: 10.36290/vnl.2023.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Internal medicine specialists, also known as general internal medicine specialists are specialist physicians trained to manage particularly complex or multisystem disease conditions that single-organ-disease specialists may not be trained to deal with. The management of multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience in appropriate diagnostic and therapeutic procedures. Multimorbidity is associated with a decline in many aspects of health and in consequence with an increase in hospital admissions, polypharmacy, and use of health care and social resouces. When prescribing medicine to patients with multimorbidity, all the risks and benefits, as well as possible interactions should be carefully considered. The prescription appropriateness can be assessed by validated tools like STOPP-START criteria. Beneficial part of good prescribing is deprescribing - planned and supervised process of dose reduction or withdrawal of medications that are no longer needed in the circumstances of the patient.
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169
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Venechuk G, Allen LA, Thompson JS, Morris MA, Matlock DD, McIlvennan CK, Dickert NW, Tietbohl C. Trust and activation in defining patient-clinician interactions for chronic disease management. Patient Educ Couns 2023; 106:113-119. [PMID: 36167759 DOI: 10.1016/j.pec.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Patient-clinician relationship quality and patient activation can both improve patient health outcomes, but prior work has primarily examined these factors independently. We examine how these two factors shape patient behavior in the setting of ambulatory heart failure care, where serial intensification of multiple medications is central to chronic care delivery. METHODS We used content analysis to analyze 22 in-depth patient interviews and 32 audio-recorded clinic visits collected for the EPIC-HF Trial. This was a secondary analysis providing qualitative depth to the parent RCT. RESULTS We identified a typology of patient activation and patient-clinician relationship quality, with four types: Supported, Skeptical, Deferential, and Unempowered. Types were sensitive to time and context; a given patient might occupy multiple types throughout the course of a single clinic visit. The effects of patient-activation and the patient-clinician relationship appeared to be bidirectional, with each influencing the other. CONCLUSION Patient-clinician relationship quality and patient activation are dominant in shaping clinical interactions and disease management. This interaction is dynamic, and patients may change types depending on time, place, or context. PRACTICE IMPLICATIONS These findings suggest that both patient activation and high relationship quality work together to create a supportive environment for chronic care, where intermittent skepticism, deference or empowerment may be useful at particular times or in certain situations.
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Affiliation(s)
- Grace Venechuk
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Sociology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Larry A Allen
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Jocelyn S Thompson
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Megan A Morris
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Daniel D Matlock
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Colleen K McIlvennan
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Neal W Dickert
- Division Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Tietbohl
- Colorado Program for Patient Centered Decisions, Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO 80045, USA
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170
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Comiti VP. [Not Available]. J Int Bioethique Ethique Sci 2023; 33:27-33. [PMID: 36997349 DOI: 10.54695/jibes.333.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The history of environmental damages is linked to the development of diseases. Conversely, individual and collective protection measures for the living environment. Were often beneficial to health.
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171
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Sakthivel K, Manigundan K, Sharma SK, Singh R, Das MM, Devi V, Gautam RK, Nakkeeran S, Kumar A. Diversity of Antimicrobial Peptide Genes in Bacillus from the Andaman and Nicobar Islands: Untapped Island Microbial Diversity for Disease Management in Crop Plants. Curr Microbiol 2022; 80:45. [PMID: 36538096 DOI: 10.1007/s00284-022-03086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 10/09/2022] [Indexed: 12/29/2022]
Abstract
Taxonomic and functional characterization of a total of 90 bacterial isolates representing bulk and rhizosphere soils of diverse niches of Andaman and Nicobar Islands, India were carried out. Twelve bacterial isolates were found promising for the biological suppression of agriculturally important fungal and bacterial plant pathogens such as Ralstonia solanacearum, Xanthomonas oryzae pv. oryzae, and Colletotrichum gloeosporioides. The 16S rRNA gene sequence analysis revealed their identity as belonging to Bacillus subtilis, Bacillus amyloliquefaciens, and Lysinibacillus sphaericus. The isolates were positive for plant growth promotion (PGP) traits including siderophore production, and nutrient solubilization especially phosphorous, zinc, and potassium. Interestingly, the PCR test confirmed the presence of 62 antimicrobial peptides (AMP) biosynthesis genes specific to the genus Bacillus. Whilst all tested species of Bacillus harboured the bacD biosynthesis gene, the B. subtilis (Ba_Abi), and B. amyloliquefaciens (Ba_Abi) harboured the maximum AMP biosynthesis genes analysed in the study. Upon in planta evaluation, the biocontrol potential of the bacterial isolates against leaf spot disease of chilli was observed. The study culminated in the isolation and identification of diverse Bacillus species for exploitation as bioinoculants for plant health management programmes.
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Affiliation(s)
- Krishnan Sakthivel
- Division of Field Crop Improvement and Protection, ICAR- Central Islands Agricultural Research Institute, Port Blair, Andaman & Nicobar Islands, 744 101, India
| | - Kaari Manigundan
- Centre for Drug Discovery and Development, Sathyabama Institute of Science and Technology, Chennai, 600 119, India
| | - Sushil Kumar Sharma
- ICAR - National Bureau of Agriculturally Important Microorganisms, Maunath Bhanjan, Uttar Pradesh, 275 003, India
| | - Reena Singh
- Division of Field Crop Improvement and Protection, ICAR- Central Islands Agricultural Research Institute, Port Blair, Andaman & Nicobar Islands, 744 101, India
| | - Manisha Mohan Das
- Division of Field Crop Improvement and Protection, ICAR- Central Islands Agricultural Research Institute, Port Blair, Andaman & Nicobar Islands, 744 101, India
| | - Varsha Devi
- Division of Field Crop Improvement and Protection, ICAR- Central Islands Agricultural Research Institute, Port Blair, Andaman & Nicobar Islands, 744 101, India
| | - Raj Kumar Gautam
- Division of Field Crop Improvement and Protection, ICAR- Central Islands Agricultural Research Institute, Port Blair, Andaman & Nicobar Islands, 744 101, India
| | - Sevugapperumal Nakkeeran
- Center for Plant Molecular Biology, Tamil Nadu Agricultural University, Coimbatore, Tamil Nadu, 641 003, India
| | - Aundy Kumar
- Division of Plant Pathology, ICAR-Indian Agricultural Research Institute, New Delhi, 110012, India.
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172
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Riedl R, Robausch M, Berghold A. Disease Management Program in patients with type 2 diabetes mellitus, long-term results of the early and established program cohort: A population-based retrospective cohort study. PLoS One 2022; 17:e0279090. [PMID: 36512601 PMCID: PMC9746970 DOI: 10.1371/journal.pone.0279090] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the long-term follow up of the early and the effectiveness of the established program of the Austrian Disease Management Program (DMP) 'Therapie aktiv-Diabetes im Griff' for patients with type 2 diabetes mellitus concerning mortality, major macrovascular complications, costs and process quality of care parameters. METHODS We conducted a propensity score matched cohort study based on routine health insurance data for type 2 diabetic patients. The observational period from the matched early program cohort starts from January 1, 2009 to December 31, 2017 and includes 7181 DMP participants and 21543 non-participants. In the established matched program cohort, 3087 DMP participants and 9261 non-participants were observed within January 1, 2014 to December 31, 2017. RESULTS In the early program cohort, 22.1% of the patients in the DMP-group and 29.7% in the control-group died after 8 years follow-up (HR = 0.70; 95% CI: 0.66-0.73). A difference of € 1070 (95% bootstrap-T interval: € 723 - € 1412) in mean total costs per year was observed. In the established program cohort, 10.4% DMP participants died 4 years after enrollment, whereas in the control-group 11.9% of the patients died (HR = 0.88, 95% CI: 0.78-0.99). Healthcare utilization is higher in the DMP-group (75%-96%) compared to the control-group (63%-90%). CONCLUSIONS The 8-year long-term follow up of the DMP program showed a relevant improvement of survival and healthcare costs of patients with type 2 diabetes. The established program cohort had improved survival and quality of care. Our findings indicate that the DMP "Therapie aktiv" provides a long-term advantage for type 2 diabetes patients.
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Affiliation(s)
- Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Martin Robausch
- Controlling Department (ÄIRCON), Lower Austria Health Insurance Fund, St. Pölten, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- * E-mail:
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O'Connor G, Quintero MA, Deo SK, Abreu MT, Daunert S. Bacterial Quorum-Sensing Molecules in Serum: A Potential Tool for Crohn's Disease Management. Clin Transl Gastroenterol 2022; 13:e00547. [PMID: 36413804 PMCID: PMC9780115 DOI: 10.14309/ctg.0000000000000547] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
Crohn's disease (CD) is an idiopathic inflammatory condition of the gastrointestinal tract with the primary method of diagnosis and follow-up being colonoscopy. A disturbed host-microbiome interaction, including the presence of pathobionts, is implicated in initiation and perpetuation of inflammation. As such, we hypothesized that bacterial quorum-sensing (QS) molecules (QSMs), small molecules bacteria generate to regulate gene expression, would be elevated in patients with CD. We collected serum at the time of colonoscopy from patients with CD and healthy controls, determining through biosensors for QSMs that patients with CD had significantly elevated levels of QSMs in serum. Expansion of these studies may allow for QSM levels in serum to serve as a biomarker for intestinal inflammation in patients with CD.
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Affiliation(s)
- Gregory O'Connor
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Dr. JT Macdonald Biomedical Nanotechnology Institute, University of Miami, Miami, Florida, USA
| | - Maria A. Quintero
- Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sapna K. Deo
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Dr. JT Macdonald Biomedical Nanotechnology Institute, University of Miami, Miami, Florida, USA
| | - Maria T. Abreu
- Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sylvia Daunert
- Department of Biochemistry and Molecular Biology, University of Miami, Miller School of Medicine, Miami, Florida, USA
- Dr. JT Macdonald Biomedical Nanotechnology Institute, University of Miami, Miami, Florida, USA
- University of Miami Clinical and Translational Science Institute, Miami, Florida, USA
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174
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Willey VJ, Crowley MJ. Observational Evaluations of Disease Management Programs for Diabetes: The Proof Is in the Concept. Diabetes Care 2022; 45:2808-2810. [PMID: 36455130 PMCID: PMC9998843 DOI: 10.2337/dci22-0030] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
| | - Matthew J. Crowley
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC
- Division of Endocrinology, Department of Medicine, Duke University School of Medicine, Durham, NC
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175
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Mohan V, Singh AK, Zargar AH, Almeida A, Bhalla AK, Mohan JC, Dalal J, Sahay M, Mohanan PP, Maitra S, Ghosh S, Jeloka T, Kaul U, Sakhuja V, Das MK. Cardiorenal disease management in type 2 diabetes: An expert consensus. Diabetes Metab Syndr 2022; 16:102661. [PMID: 36375366 DOI: 10.1016/j.dsx.2022.102661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM The interplay between cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes (T2D) is well established. We aim at providing an evidence-based expert opinion regarding the prevention and treatment of both heart failure (HF) and renal complications in people with T2D. METHOD ology: The consensus recommendations were developed by subject experts in endocrinology, cardiology, and nephrology. The criteria for consensus were set to statements with ≥80% of agreement among clinicians specialized in endocrinology, cardiology, and nephrology. Key expert opinions were formulated based on scientific evidence and clinical judgment. RESULTS Assessing the risk factors of CVD or CKD in people with diabetes and taking measures to prevent HF or kidney disease are essential. Known CVD or CKD among people with diabetes confers a very high risk for recurrent CVD. Metformin plus lifestyle modification should be the first-line therapy (unless contraindicated) for the management of T2D. Glucagon-like peptide 1 (GLP-1) agonists can be preferred in people with atherosclerotic cardiovascular disease (ASCVD) or with high-risk indicators, along with sodium-glucose cotransporter-2 inhibitors (SGLT2i), whereas SGLT2i are the first choice in HF and CKD. The GLP-1 agonists can be used in people with CKD if SGLT2i are not tolerated. CONCLUSION Current evidence suggests SGLT2i as preferred agents among people with T2D and HF, and for those with T2D and ASCVD. SGLT2i and GLP-1RA also lower CV outcomes in those with diabetes and ASCVD, and the treatment choice should depend on the patient profile.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr.Mohan's Diabetes Specialities Centre, Chennai, India. http://www.drmohans.com
| | - Awadhesh Kumar Singh
- Department of Endocrinology, G.D. Hospital and Diabetes Institute, Kolkata, India
| | | | - Alan Almeida
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Jamshed Dalal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital & Osmania Medical College, Hyderabad, India
| | | | - Sanjay Maitra
- Department of Nephrology, Apollo Hospitals, Hyderabad, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata, India
| | | | | | - Vinay Sakhuja
- Department of Cardiology and Dean, Academics and Research, Batra Hospital and Medical Research Center, New Delhi, India
| | - Mrinal Kanti Das
- Department of Cardiology, C.K. Birla Hospitals (BMB/CMRI), Kolkata, India
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176
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Ramos-Lopez O, Martinez-Urbistondo D, Vargas-Nuñez JA, Martinez JA. The Role of Nutrition on Meta-inflammation: Insights and Potential Targets in Communicable and Chronic Disease Management. Curr Obes Rep 2022; 11:305-335. [PMID: 36258149 PMCID: PMC9579631 DOI: 10.1007/s13679-022-00490-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Accepted: 08/27/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Chronic low-grade inflammation may contribute to the onset and progression of communicable and chronic diseases. This review examined the effects and eventual mediation roles of different nutritional factors on inflammation. RECENT FINDINGS Potential nutritional compounds influencing inflammation processes include macro and micronutrients, bioactive molecules (polyphenols), specific food components, and culinary ingredients as well as standardized dietary patterns, eating habits, and chrononutrition features. Therefore, research in this field is still required, taking into account critical aspects of heterogeneity including type of population, minimum and maximum intakes and adverse effects, cooking methods, physiopathological status, and times of intervention. Moreover, the integrative analysis of traditional variables (age, sex, metabolic profile, clinical history, body phenotype, habitual dietary intake, physical activity levels, and lifestyle) together with individualized issues (genetic background, epigenetic signatures, microbiota composition, gene expression profiles, and metabolomic fingerprints) may contribute to the knowledge and prescription of more personalized treatments aimed to improving the precision medical management of inflammation as well as the design of anti-inflammatory diets in chronic and communicable diseases.
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Affiliation(s)
- Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Universidad 14418, UABC, Parque Internacional Industrial Tijuana, 22390, Tijuana, Baja California, Mexico.
| | | | - Juan A Vargas-Nuñez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, 28222, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - J Alfredo Martinez
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049, Madrid, Spain
- Department of Nutrition, Food Science, Physiology and Toxicology, Centre for Nutrition Research, University of Navarra, 31009, Pamplona, Spain
- Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), 28029, Madrid, Spain
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177
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Xiao Z, Han X. Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 25:e44256. [PMID: 37103993 PMCID: PMC10176143 DOI: 10.2196/44256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/15/2022] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Long-term daily health monitoring and management play a more significant role in telehealth management systems nowadays, which require evaluation indicators to present patients' general health conditions and become applicable to multiple chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS). METHODS We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure and Wanfang, a Chinese medical database, and searched papers published from January 1, 2015, to July 1, 2022, regarding randomized controlled trials on the effectiveness of the telehealth system on patients with chronic diseases. The narrative review summarized the questionnaire indicators presented in the selected studies. In the meta-analysis, Mean Difference (MD) and Standardized Mean Difference (SMD) with a 95% CI were pooled depending on whether the measurements were the same. Subgroup analysis was conducted if the heterogeneity was significant, and the number of studies was sufficient. RESULTS Twenty RCTs with 4153 patients were included in the qualitative review. Seventeen different questionnaire-based outcomes were found, within which quality of life, psychological well-being (including depression, anxiety, and fatigue), self-management, self-efficacy, and medical adherence were most frequently used. Ten RCTs with 2095 patients remained in meta-analysis. Compared to usual care, telehealth system can significantly improve the quality of life (SMD 0.44; 95% CI 0.16-0.73; P=.002), whereas no significant effects were found on depression (SMD -0.25; 95% CI -0.72 to 0.23; P=.30), anxiety (SMD -0.10; 95% CI -0.27 to 0.07; P=.71), fatigue (SMD -0.36; 95% CI -1.06 to 0.34; P<.001), and self-care (SMD 0.77; 95% CI -0.28-1.81; P<.001). In the subdomains of quality of life, telehealth statistically significantly improved physical functioning (SMD 0.15; 95% CI 0.02 to 0.29; P=.03), mental functioning (SMD 0.37; 95% CI 0.13-0.60; P=.002), and social functioning (SMD 0.64; 95% CI 0.00-1.29; P=.05), while there was no difference on cognitive functioning (MD 8.31; 95% CI -7.33 to 23.95; P=.30) and role functioning (MD 5.30; 95% CI -7.80 to 18.39; P=.43). CONCLUSIONS TCDMS positively affected patients' physical, mental, and social quality of life across multiple chronic diseases. However, no significant difference was found in depression, anxiety, fatigue, and self-care. Subjective questionnaires had the potential ability to evaluate the effectiveness of long-term telehealth monitoring and management. However, further well-designed experiments are warranted to validate TCDMS's effects on subjective outcomes, especially when tested among different chronically ill groups.
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Affiliation(s)
- Ziyan Xiao
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiuping Han
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
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178
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Bousquet J, Toumi M, Sousa-Pinto B, Anto JM, Bedbrook A, Czarlewski W, Valiulis A, Ansotegui IJ, Bosnic-Anticevich S, Brussino L, Canonica GW, Cecchi L, Cherrez-Ojeda I, Chivato T, Costa EM, Cruz AA, Del Giacco S, Fonseca JA, Gemicioglu B, Haahtela T, Ivancevich JC, Jutel M, Kaidashev I, Klimek L, Kvedariene V, Kuna P, Larenas-Linnemann DE, Lipworth B, Morais-Almeida M, Mullol J, Papadopoulos NG, Patella V, Pham-Thi N, Regateiro FS, Rouadi PW, Samolinski B, Sheikh A, Taborda-Barata L, Ventura MT, Yorgancioglu A, Zidarn M, Zuberbier T. The Allergic Rhinitis and Its Impact on Asthma (ARIA) Approach of Value-Added Medicines: As-Needed Treatment in Allergic Rhinitis. J Allergy Clin Immunol Pract 2022; 10:2878-2888. [PMID: 35934308 DOI: 10.1016/j.jaip.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Drug repurposing is a major field of value-added medicine. It involves investigating and evaluating existing drugs for new therapeutic purposes that address unmet healthcare needs. Several unmet needs in allergic rhinitis could be improved by drug repurposing. This could be game-changing for disease management. Current medications for allergic rhinitis are centered on continuous long-term treatment, and medication registration is based on randomized controlled trials carried out for a minimum of 14 days with adherence of 70% or greater. A new way of treating allergic rhinitis is to propose as-needed treatment depending on symptoms, rather than classical continuous treatment. This rostrum will discuss existing clinical trials on as-needed treatment for allergic rhinitis and real-world data obtained by the mobile health app MASK-air, which focuses on digitally-enabled, patient-centered care pathways.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; University Hospital Montpellier, Montpellier, France; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Mondher Toumi
- Public Health, Aix-Marseille University, Marseille, France
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal; RISE-Health Research Network, University of Porto, Porto, Portugal
| | - Josep M Anto
- ISGlobaL, Barcelona Institute for Global Health, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | | | | | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino and Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele and Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmonology, Espiritu Santo University, Samborondón, Ecuador
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Elísio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy
| | - Joao A Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal; RISE-Health Research Network, University of Porto, Porto, Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Igor Kaidashev
- Poltava State Medical University, Poltava Oblast, Ukraine
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, México
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
| | | | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, Institut de Recherche Bio-Médicale des Armées, Bretigny, France
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; ENT Department, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology, and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Luis Taborda-Barata
- UBIAir-Clinical and Experimental Lung Centre, University of Beira Interior, Covilhã, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | | | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
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179
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Rossing P, Caramori ML, Chan JC, Heerspink HJ, Hurst C, Khunti K, Liew A, Michos ED, Navaneethan SD, Olowu WA, Sadusky T, Tandon N, Tuttle KR, Wanner C, Wilkens KG, Zoungas S, de Boer IH. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2022; 102:S1-S127. [PMID: 36272764 DOI: 10.1016/j.kint.2022.06.008] [Citation(s) in RCA: 191] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
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180
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Perry J, Powers SC, Haskell B, Plummer C. Simulated Home Visit to Promote Chronic Disease Management Competencies in Prelicensure Nursing Students. Nurse Educ 2022; 47:E132-E135. [PMID: 35667048 DOI: 10.1097/nne.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conducting a best possible medication history (BPMH), while using effective patient communication skills, falls within the nursing scope of practice and is recommended at all care levels. Nursing students should be taught these skills before entering clinical practice, but evidence about effective teaching strategies is limited. APPROACH A standardized patient-facilitated home visit simulation was utilized in a prelicensure nursing program to practice a BPMH while using effective patient communication skills. OUTCOMES All students correctly identified medications listed on the patient history, and most identified omitted medications (90.1%), transposed medications (91.6%), and incorrect medication usage (91.6%). All students demonstrated effective patient communication skills-using open-ended questions and inquiring about medication usage. CONCLUSION Incorporating a standardized patient-facilitated home visit BPMH simulation allows students the opportunity to practice and achieve BPMH competency essential for nurses.
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Affiliation(s)
- Julie Perry
- Assistant Professors (Drs Perry, Powers, and Haskell) and Associate Professor (Dr Plummer), School of Nursing, Vanderbilt University, Nashville, Tennessee
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181
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Affiliation(s)
- Rahul Gupta
- From the White House Office of National Drug Control Policy (R.G., J.A.C., D.R.H.) and the Office of the Assistant Secretary for Health, Office of the Secretary, Department of Health and Human Services (R.L.L.) - both in Washington, DC; and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (J.A.C.)
| | - Rachel L Levine
- From the White House Office of National Drug Control Policy (R.G., J.A.C., D.R.H.) and the Office of the Assistant Secretary for Health, Office of the Secretary, Department of Health and Human Services (R.L.L.) - both in Washington, DC; and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (J.A.C.)
| | - Javier A Cepeda
- From the White House Office of National Drug Control Policy (R.G., J.A.C., D.R.H.) and the Office of the Assistant Secretary for Health, Office of the Secretary, Department of Health and Human Services (R.L.L.) - both in Washington, DC; and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (J.A.C.)
| | - David R Holtgrave
- From the White House Office of National Drug Control Policy (R.G., J.A.C., D.R.H.) and the Office of the Assistant Secretary for Health, Office of the Secretary, Department of Health and Human Services (R.L.L.) - both in Washington, DC; and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (J.A.C.)
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182
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Bello JC, Higgins DS, Sakalidis ML, Quesada-Ocampo LM, Martin F, Hausbeck MK. Clade-Specific Monitoring of Airborne Pseudoperonospora spp. Sporangia Using Mitochondrial DNA Markers for Disease Management of Cucurbit Downy Mildew. Phytopathology 2022; 112:2110-2125. [PMID: 35585721 DOI: 10.1094/phyto-12-21-0500-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Management of cucurbit downy mildew (CDM) caused by Pseudoperonospora cubensis, relies on an intensive fungicide program. In Michigan, CDM occurs annually due to an influx of airborne sporangia and timely alerts of airborne inoculum can assist growers in assessing the need to initiate fungicide sprays. This research aimed to improve the specific detection of airborne P. cubensis sporangia by adapting quantitative real-time polymerase chain reaction (qPCR) assays to distinguish among P. cubensis clades I and II and P. humuli in spore trap samples from commercial production sites and research plots. We also evaluated the suitability of impaction spore traps compared with Burkard traps for detection of airborne sporangia. A multiplex qPCR assay improved the specificity of P. cubensis clade II detection accelerating the assessment of field spore trap samples. After 2 years of monitoring, P. cubensis clade II DNA was detected in spore trap samples before CDM symptoms were first observed in cucumber fields (July and August), while P. cubensis clade I DNA was not detected in air samples before or after the disease onset. In some commercial cucumber fields, P. humuli DNA was detected throughout the growing season. The Burkard spore trap appeared to be better suited for recovery of sporangia at low concentrations than the impaction spore trap. This improved methodology for the monitoring of airborne Pseudoperonospora spp. sporangia could be used as part of a CDM risk advisory system to time fungicide applications that protect cucurbit crops in Michigan.
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Affiliation(s)
- Julian C Bello
- Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824
| | - Douglas S Higgins
- Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824
| | - Monique L Sakalidis
- Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824
- Department of Forestry, Michigan State University, East Lansing, MI 48824
| | - Lina M Quesada-Ocampo
- Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, NC 27695-7613
| | - Frank Martin
- U.S. Department of Agriculture-Agriculture Research Service, Salinas, CA 93905
| | - Mary K Hausbeck
- Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824
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Lopez-Olivo MA, Foreman JT, Leung C, Lin HY, Westrich-Robertson T, Hofstetter C, des Bordes JKA, Lyddiatt A, Leong A, Willcockson IU, Peterson SK, Suarez-Almazor ME. A randomized controlled trial evaluating the effects of social networking on chronic disease management in rheumatoid arthritis. Semin Arthritis Rheum 2022; 56:152072. [PMID: 35872394 PMCID: PMC9862615 DOI: 10.1016/j.semarthrit.2022.152072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Social networking has been shown to improve health outcomes in certain patient populations. While patients with rheumatoid arthritis (RA) increasingly use social networking to communicate with peers, the effects of these interactions are largely unknown. METHODS In a randomized controlled trial, we compared RA patients who participated in a social networking group moderated by peer leaders and who had access to a static website offering RA materials with a control group, who only had access to the website. The primary outcomes were patients' RA knowledge, self-efficacy and empowerment. Secondary outcomes included participation in desired health behaviors, and satisfaction with peer support, among others. Follow-up assessments were conducted at 3 and 6 months. Participants who never signed in were excluded from the primary analysis. RESULTS 105 participants were randomized to each group. Mean age was 52 (±12.4) and 92.4% were females. Knowledge scores improved in both groups, but only in the control group the differences observed at 3 and 6 months were significant (p≤0.02). Self-efficacy scores also improved in both groups, but only the differences observed at 6 months in the Facebook group were significant (p=0.02). When comparing groups, at 3 months the knowledge improvements observed in the control group were greater compared with those observed in the Facebook group (mean difference 0.4 versus 0.1; respectively, p=0.03). No other differences were observed in secondary outcomes between the 2 groups, except in peer support satisfaction. The Facebook® group reported greater peer support satisfaction in 3 out 5 subscales compared with the control group (p≤0.04). CONCLUSION Peer support satisfaction was higher in participants using an online social network, but this was not translated into greater disease knowledge or empowerment.
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Affiliation(s)
- Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jessica T Foreman
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cheuk Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Heather Y Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Jude K A des Bordes
- Department of Family Medicine, McGovern Medical School, Houston, TX, United States
| | - Anne Lyddiatt
- Musculoskeletal Group, Cochrane Collaboration, Ontario, Canada
| | - Amye Leong
- Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade, Santa Barbara, CA, United States
| | - Irmgard U Willcockson
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria E Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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184
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Abstract
This paper considers recent methodological developments in the treatment effects literature, describes their value for applied evaluation work, and suggests next steps. It pays particular attention to documenting the presence of treatment effect heterogeneity, to the quest to attach treatment effect heterogeneity to particular subgroups and other moderators, and to the recent application of machine learning methods in this domain.
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Affiliation(s)
- Jeffrey Smith
- Department of Economics, 5228University of Wisconsin-Madison, Madison, WI, USA
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185
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Kim S. Effect of primary care-level chronic disease management policy on self-management of patients with hypertension and diabetes in Korea. Prim Care Diabetes 2022; 16:677-683. [PMID: 35985963 DOI: 10.1016/j.pcd.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 07/04/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Abstract
AIMS This study aimed to evaluate the effect of introducing a regional chronic disease management project on the self-management of patients with hypertension and diabetes. METHODS This study included 174,546 patients. The relationship between introducing chronic disease management in a region and the self-awareness of disease status was analyzed using a generalized estimating equation model. Poisson regression analysis was used to evaluate the effect of policy adoption on medication adherence and risk-reduction behavior in patients with hypertension and diabetes. Finally, we used a difference-in-differences model to assess the net effectiveness of policies. RESULTS Overall, regions with policies implemented showed more condition awareness and drug adherence than those without; however, this was only significant in regions where patients and physicians were incentivized. Risk-reduction behavior for patients with diabetes was higher in regions with policies implemented than in those without. The policy had a net effect of significantly and non-significantly increasing disease awareness and medication adherence, respectively. CONCLUSION Chronic disease management policies at the primary care level that incentivized both patients and physicians improved patient self-management. However, the effects on patients with diabetes and hypertension differed. Future studies should account for additional patient outcomes, including long-term impact assessments and clinical outcomes.
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Affiliation(s)
- Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
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186
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Kumar S, Arnold M, James G, Padman R. Developing a common data model approach for DISCOVER CKD: A retrospective, global cohort of real-world patients with chronic kidney disease. PLoS One 2022; 17:e0274131. [PMID: 36173958 PMCID: PMC9521926 DOI: 10.1371/journal.pone.0274131] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To describe a flexible common data model (CDM) approach that can be efficiently tailored to study-specific needs to facilitate pooled patient-level analysis and aggregated/meta-analysis of routinely collected retrospective patient data from disparate data sources; and to detail the application of this CDM approach to the DISCOVER CKD retrospective cohort, a longitudinal database of routinely collected (secondary) patient data of individuals with chronic kidney disease (CKD).
Methods
The flexible CDM approach incorporated three independent, exchangeable components that preceded data mapping and data model implementation: (1) standardized code lists (unifying medical events from different coding systems); (2) laboratory unit harmonization tables; and (3) base cohort definitions. Events between different coding vocabularies were not mapped code-to-code; for each data source, code lists of labels were curated at the entity/event level. A study team of epidemiologists, clinicians, informaticists, and data scientists were included within the validation of each component.
Results
Applying the CDM to the DISCOVER CKD retrospective cohort, secondary data from 1,857,593 patients with CKD were harmonized from five data sources, across three countries, into a discrete database for rapid real-world evidence generation.
Conclusions
This flexible CDM approach facilitates evidence generation from real-world data within the DISCOVER CKD retrospective cohort, providing novel insights into the epidemiology of CKD that may expedite improvements in diagnosis, prognosis, early intervention, and disease management. The adaptable architecture of this CDM approach ensures scalable, fast, and efficient application within other therapy areas to facilitate the combined analysis of different types of secondary data from multiple, heterogeneous sources.
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Affiliation(s)
- Supriya Kumar
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States of America
- * E-mail:
| | - Matthew Arnold
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Glen James
- Formerly Cardiovascular, Renal, Metabolism & Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States of America
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187
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Tian Y, Huang Y, Zhang X, Tang G, Gao Y, Zhou Z, Li Y, Wang H, Yu X, Li X, Liu Y, Yan G, Wang J, Cao Y. Self-Assembled Nanoparticles of a Prodrug Conjugate Based on Pyrimethanil for Efficient Plant Disease Management. J Agric Food Chem 2022; 70:11901-11910. [PMID: 36111893 DOI: 10.1021/acs.jafc.2c04489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Self-assembled nanotechnology is a promising strategy for improving the effective utilization of pesticides due to its distinct advantages. Herein, an amide-bonded prodrug conjugate based on pyrimethanil (PYR) and butyric acid (BA) was successfully synthesized by the nucleophilic substitution reaction and subsequently self-assembled into spherical nanoparticles (PB NPs) with an average size of 85 nm through the solvent exchange method without using any toxic adjuvant. The results showed that PB NPs based on PYR and BA had a synergistic antimicrobial activity against S. sclerotiorum on plant leaves due to good photostability, low volatilization, good surface activity, and improved retention. Additionally, PB NPs could be used by plant cells as nutrients to promote the growth of plants and thus reduced the toxicity of PYR to plant. Therefore, this prodrug conjugate self-assembly nanotechnology would provide a promising strategy for improving the effective utilization rates of pesticides and reducing their toxicities to plants.
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Affiliation(s)
- Yuyang Tian
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Yuqi Huang
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Xiaohong Zhang
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Gang Tang
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Yunhao Gao
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Zhiyuan Zhou
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Yan Li
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Huachen Wang
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Xueyang Yu
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Xuan Li
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Yulu Liu
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Guangyao Yan
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Jialu Wang
- College of Plant Protection, China Agricultural University, Beijing 100093, China
| | - Yongsong Cao
- College of Plant Protection, China Agricultural University, Beijing 100093, China
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188
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Michalak A, Kasztelan-Szczerbińska B, Cichoż-Lach H. Impact of Obesity on the Course of Management of Inflammatory Bowel Disease—A Review. Nutrients 2022; 14:nu14193983. [PMID: 36235636 PMCID: PMC9573343 DOI: 10.3390/nu14193983] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
It is already well-known that visceral adipose tissue is inseparably related to the pathogenesis, activity, and general outcome of inflammatory bowel disease (IBD). We are getting closer and closer to the molecular background of this loop, finding certain relationships between activated mesenteric tissue and inflammation within the lumen of the gastrointestinal tract. Recently, relatively new data have been uncovered, indicating a direct impact of body fat on the pattern of pharmacological treatment in the course of IBD. On the other hand, ileal and colonic types of Crohn’s disease and ulcerative colitis appear to be more diversified than it was thought in the past. However, the question arises whether at this stage we are able to translate this knowledge into the practical management of IBD patients or we are still exploring the scientific background of this pathology, having no specific tools to be used directly in patients. Our review explores IBD in the context of obesity and associated disorders, focusing on adipokines, creeping fat, and possible relationships between these disorders and the treatment of IBD patients.
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189
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Liebenberg D, Gordhan BG, Kana BD. Drug resistant tuberculosis: Implications for transmission, diagnosis, and disease management. Front Cell Infect Microbiol 2022; 12:943545. [PMID: 36211964 PMCID: PMC9538507 DOI: 10.3389/fcimb.2022.943545] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 01/17/2023] Open
Abstract
Drug resistant tuberculosis contributes significantly to the global burden of antimicrobial resistance, often consuming a large proportion of the healthcare budget and associated resources in many endemic countries. The rapid emergence of resistance to newer tuberculosis therapies signals the need to ensure appropriate antibiotic stewardship, together with a concerted drive to develop new regimens that are active against currently circulating drug resistant strains. Herein, we highlight that the current burden of drug resistant tuberculosis is driven by a combination of ongoing transmission and the intra-patient evolution of resistance through several mechanisms. Global control of tuberculosis will require interventions that effectively address these and related aspects. Interrupting tuberculosis transmission is dependent on the availability of novel rapid diagnostics which provide accurate results, as near-patient as is possible, together with appropriate linkage to care. Contact tracing, longitudinal follow-up for symptoms and active mapping of social contacts are essential elements to curb further community-wide spread of drug resistant strains. Appropriate prophylaxis for contacts of drug resistant index cases is imperative to limit disease progression and subsequent transmission. Preventing the evolution of drug resistant strains will require the development of shorter regimens that rapidly eliminate all populations of mycobacteria, whilst concurrently limiting bacterial metabolic processes that drive drug tolerance, mutagenesis and the ultimate emergence of resistance. Drug discovery programs that specifically target bacterial genetic determinants associated with these processes will be paramount to tuberculosis eradication. In addition, the development of appropriate clinical endpoints that quantify drug tolerant organisms in sputum, such as differentially culturable/detectable tubercle bacteria is necessary to accurately assess the potential of new therapies to effectively shorten treatment duration. When combined, this holistic approach to addressing the critical problems associated with drug resistance will support delivery of quality care to patients suffering from tuberculosis and bolster efforts to eradicate this disease.
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190
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Connelly L, Fiorentini G, Iommi M. Supply-side solutions targeting demand-side characteristics: causal effects of a chronic disease management program on adherence and health outcomes. Eur J Health Econ 2022; 23:1203-1220. [PMID: 35091855 DOI: 10.1007/s10198-021-01421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
We estimate the effects of a chronic disease management program (CDMP) which adapts various supply-side interventions to specific demand-side conditions (disease-staging) for patients with chronic kidney disease (CKD). Using a unique dataset on the entire population of the Emilia-Romagna region of Italy with hospital-diagnosed CKD, we estimate the causal effects of the CDMP on adherence indicators and health outcomes. As CKD is a progressive disease with clearly-defined disease stages and a treatment regimen that can be titrated by disease severity, we calculate dynamic, severity-specific, indicators of adherence as well as several long-term health outcomes. Our empirical work produces statistically significant and sizeable causal effects on many adherence and health outcome indicators across all CKD patients. More interestingly, we show that the CDMP produces larger effects on patients with early-stage CKD, which is at odds with some of the literature on CDMP that advocates intensifying interventions for high-cost (or late-stage) patients. Our results suggest that it may be more efficient to target early-stage patients to slow the deterioration of their health capital. The results contribute to a small, recent literature in health economics that focuses on the marginal effectiveness of CDMPs after controlling either for supply- or demand-side sources of heterogeneity.
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Affiliation(s)
- Luke Connelly
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.
- Dipartimento di Sociologia e Diritto dell'Economia, Università di Bologna, Bologna, Italy.
| | | | - Marica Iommi
- Scuola Superiore di Politiche per la Salute, Università di Bologna, Bologna, Italy
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191
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Liu Y, Li J, Yang J. [Strengthen the chronic disease management for rheumatic diseases to improve the overall health outcomes]. Zhonghua Nei Ke Za Zhi 2022; 61:973-976. [PMID: 36008289 DOI: 10.3760/cma.j.cn112138-20211220-00901] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Y Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - J Li
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200001, China
| | - Jing Yang
- Department of Immunology, Mianyang Hospital, Mianyang Central Hospital, University of Electronic Science and Technology School of Medicine, Mianyang 621099, China
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192
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Abstract
Bacterial diseases are a constant threat to crop production globally. Current management strategies rely on an array of tactics, including improved cultural practices; application of bactericides, plant activators, and biocontrol agents; and use of resistant varieties when available. However, effective management remains a challenge, as the longevity of deployed tactics is threatened by constantly changing bacterial populations. Increased scrutiny of the impact of pesticides on human and environmental health underscores the need for alternative solutions that are durable, sustainable, accessible to farmers, and environmentally friendly. In this review, we discuss the strengths and shortcomings of existing practices and dissect recent advances that may shape the future of bacterial disease management. We conclude that disease resistance through genome modification may be the most effective arsenal against bacterial diseases. Nonetheless, more research is necessary for developing novel bacterial disease management tactics to meet the food demand of a growing global population.
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Affiliation(s)
- Anuj Sharma
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
| | - Peter Abrahamian
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
- Gulf Coast Research and Education Center, University of Florida, Wimauma, Florida, USA
- Plant Pathogen Confirmatory Diagnostic Laboratory, USDA-APHIS, Beltsville, Maryland, USA
| | - Renato Carvalho
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
| | - Manoj Choudhary
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
| | - Mathews L Paret
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
- North Florida Research and Education Center, University of Florida, Quincy, Florida, USA
| | - Gary E Vallad
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
- Gulf Coast Research and Education Center, University of Florida, Wimauma, Florida, USA
| | - Jeffrey B Jones
- Department of Plant Pathology, University of Florida, Gainesville, Florida, USA;
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193
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Diouf MB, Festus R, Silva G, Guyader S, Umber M, Seal S, Teycheney PY. Viruses of Yams (Dioscorea spp.): Current Gaps in Knowledge and Future Research Directions to Improve Disease Management. Viruses 2022; 14:v14091884. [PMID: 36146691 PMCID: PMC9501508 DOI: 10.3390/v14091884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Viruses are a major constraint for yam production worldwide. They hamper the conservation, movement, and exchange of yam germplasm and are a threat to food security in tropical and subtropical areas of Africa and the Pacific where yam is a staple food and a source of income. However, the biology and impact of yam viruses remains largely unknown. This review summarizes current knowledge on yam viruses and emphasizes gaps that exist in the knowledge of the biology of these viruses, their diagnosis, and their impact on production. It provides essential information to inform the implementation of more effective virus control strategies.
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Affiliation(s)
- Mame Boucar Diouf
- INRAE, UR ASTRO, F-97170 Petit-Bourg, France
- CIRAD, UMR AGAP Institut, F-97130 Capesterre-Belle-Eau, France
- UMR AGAP Institut, University Montpellier, CIRAD, INRAE, Institut Agro, F-97130 Capesterre-Belle-Eau, France
| | - Ruth Festus
- Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, UK
| | - Gonçalo Silva
- Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, UK
| | | | - Marie Umber
- INRAE, UR ASTRO, F-97170 Petit-Bourg, France
| | - Susan Seal
- Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, Kent ME4 4TB, UK
| | - Pierre Yves Teycheney
- CIRAD, UMR PVBMT, F-97410 Saint Pierre, France
- UMR PVBMT, Université de la Réunion, F-97410 Saint-Pierre, France
- Correspondence: ; Tel.: +33-262-492-819
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194
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Lee SA, Park H, Kim W, Song SO, Lim H, Chun SY. The Effect of Chronic Disease Management Program on the Risk of Complications in Patients With Hypertension in Korea. J Korean Med Sci 2022; 37:e243. [PMID: 35942556 PMCID: PMC9359918 DOI: 10.3346/jkms.2022.37.e243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data. METHODS We used National Health Insurance Service data (2011-2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used. RESULTS Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68-0.82; stroke: HR, 0.75; 95% CI, 0.72-0.78; CKD: HR, 0.90; 95% CI, 0.85-0.96; HF: HR, 0.56; 95% CI, 0.52-0.61). CONCLUSION The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.
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Affiliation(s)
- Sang Ah Lee
- BigData Strategy Department, National Health Insurance Service, Wonju, Korea
| | - Hyeki Park
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Public Health, Graduate School, College of Medicine, Yonsei University, Seoul, Korea
| | - Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Sun Ok Song
- Division of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyunsun Lim
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sung-Youn Chun
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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195
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Abstract
Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment. The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Waleed AlHabeeb, P.O. Box 2925, Riyadh 11461, Saudi Arabia (e-mail: )
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196
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Neparidze N, Wang R, Zeidan AM, Podoltsev NA, Shallis RM, Ma X, Davidoff AJ, Huntington SF. Changes in multiple myeloma treatment patterns during the early COVID-19 pandemic period. Leukemia 2022; 36:2136-2139. [PMID: 35761025 PMCID: PMC9243711 DOI: 10.1038/s41375-022-01633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Natalia Neparidze
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Amer M Zeidan
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- National Cancer Institute, NIH, Rockville, MD, USA
| | - Scott F Huntington
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
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Sisterson MS. Mitigating an Epidemic of Resistance with Integrated Disease Management Tactics: Conflicting Management Recommendations from Insecticide Resistance and Epidemiological Models. Phytopathology 2022; 112:1753-1765. [PMID: 35230149 DOI: 10.1094/phyto-09-21-0386-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Insect-transmitted plant pathogens threaten crop production worldwide. Because a single feeding bout may be sufficient for a vector to transmit a pathogen that kills the plant, treatment thresholds for vectors of plant pathogens are low. For many vector species, overreliance on chemical controls has resulted in evolution of insecticide resistance. Analysis of complementary insecticide resistance and epidemiological models indicated that tactics for delaying resistance evolution conflict with tactics for limiting pathogen spread. Insecticide resistance models support maintaining untreated refuges that serve as a source of susceptible insects that reduce the likelihood of mating among rare resistant insects. In contrast, epidemiological models indicate that movement of vectors from untreated areas to insecticide-treated areas contributes to pathogen spread. Accordingly, epidemiological models support area-wide insecticide spray programs, although resistance models indicate that such an approach is likely to lead to rapid resistance. To mitigate risk of insecticide resistance, additional management approaches must be integrated into plant disease management strategies. The resistance and epidemiological models were used to evaluate effects of integrating application of insecticides with two additional management strategies: deployment of partially resistant plants (plants that are not immune to infection but have lower acquisition and inoculation rates than susceptible plants) and mating disruption (reduced vector birth rate in mating disruption-treated areas). Deployment of partially resistant plants reduced the risk that untreated areas served as a source of inoculative vectors. Mating disruption reduced the risk of resistance by suppressing growth of insecticide-resistant populations and benefited disease management by reducing vector abundance. Simulation results indicated that by targeting multiple aspects of the plant-pathogen-vector system, pathogen spread could be suppressed and resistance delayed. Implementation of such an approach will require innovations in vector control and sustained efforts in plant breeding.
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Affiliation(s)
- Mark S Sisterson
- U.S. Department of Agriculture-Agricultural Research Service, San Joaquin Valley Agricultural Sciences Center, Parlier, CA 93648-9757
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Huang J, Xu Y, Cao G, He Q, Yu P. Impact of multidisciplinary chronic disease collaboration management on self-management of hypertension patients: A cohort study. Medicine (Baltimore) 2022; 101:e29797. [PMID: 35838997 DOI: 10.1097/md.0000000000029797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To explore the effect of the interdisciplinary chronic disease management (CDM) model on patients with hypertension. In this intervention study, the subjects were divided into CDM and control groups. Blood pressure control was monitored in both groups. After 1 year of follow-up, the endpoint events of patients and their knowledge, confidence, and behavior in response to the disease were assessed. When compared with the control group, patients in the CDM group obtained higher scores for self-perception and management assessment, and their blood pressure control was also better after discharge. The quality of life and the satisfaction level of patients in the control group were lower than those in the CDM group, while the unplanned readmission rate, incidence of complications, and the average length of hospital stay in the control group were higher than those in the CDM group. CDM model was beneficial to blood pressure control in hypertensive patients. It had also improved the quality of life and the satisfaction level of the hypertensive patients. Our study highlights the importance of the CDM model in the prognosis of hypertensive patients.
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Affiliation(s)
- Jinding Huang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Yulan Xu
- Nursing department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Guilan Cao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Qin He
- Department of Public Health Branch, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Puliang Yu
- Key Laboratory of Metallurgical Equipment and Control Technology of Ministry of Education, Wuhan University of Science and Technology, Wuhan, China
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Meharg DP, Jenkins CR, Maguire GP, Jan S, Shaw T, Dennis SM, McKeough Z, Lee V, Gwynne KG, McCowen D, Rambaldini B, Alison JA. Implementing evidence into practice to improve chronic lung disease management in Indigenous Australians: the breathe easy, walk easy, lungs for life (BE WELL) project (protocol). BMC Pulm Med 2022; 22:239. [PMID: 35729525 PMCID: PMC9210710 DOI: 10.1186/s12890-022-02033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strong evidence exists for the benefits of pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD), however the availability of culturally safe PR for Aboriginal and Torres Strait Islander (Indigenous) Peoples is limited. The study aims to determine whether PR can be implemented within Aboriginal Community Controlled Health Services (ACCHS) to improve outcomes for Indigenous people with COPD. METHODS Multi-centre cohort study using participatory action research guided by the Knowledge-to-Action Framework. ACCHS supportive of enhancing services for chronic lung disease will be recruited. Aboriginal Health Workers (AHW) and the exercise physiologist (EP) or physiotherapist (PT) within these ACCHS will attend a workshop aimed at increasing knowledge and skills related to management of COPD and the provision of PR. Indigenous people with COPD will be invited to attend an 8-week, twice weekly, supervised PR program. OUTCOMES AHW, EP/PT knowledge, skills and confidence in the assessment and management of COPD will be measured before and immediately after the BE WELL workshop and at 3, 6 and 12 months using a survey. PR participant measures will be exercise capacity (6-minute walk test (6MWT), health-related quality of life and health status at commencement and completion of an 8-week PR program. Secondary outcomes will include: number, length and cost of hospitalisations for a COPD exacerbation in 12-months prior and 12-months post PR; local contextual factors influencing implementation of PR; specific respiratory services provided by ACCHS to manage COPD prior to project commencement and at project completion. Repeated measures ANOVA will be used to evaluate changes in knowledge and confidence over time of AHWs and EP/PTs. Paired t-tests will be used to evaluate change in patient outcomes from pre- to post-PR. Number of hospital admissions in the 12 months before and after the PR will be compared using unpaired t-tests. DISCUSSION Pulmonary rehabilitation is an essential component of best-practice management of COPD and is recommended in COPD guidelines. Indigenous peoples have limited access to culturally safe PR programs. This study will evaluate whether PR can be implemented within ACCHS and improve outcomes for Indigenous people with COPD. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001337369, Registered 2nd September 2017 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373585&isClinicalTrial=False.
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Affiliation(s)
- David P Meharg
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- Poche Centre for Indigenous Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christine R Jenkins
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Kensington, NSW, 2052, Australia
| | - Graeme P Maguire
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, 6102, Australia
| | - Stephan Jan
- The George Institute for Global Health, Newtown, NSW, 2042, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Sarah M Dennis
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
- South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, 2170, Australia
| | - Zoe McKeough
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Vanessa Lee
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia.
- Sydney Local Health District, Camperdown, NSW, 2050, Australia.
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200
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Abstract
Objectives: To assess the effectiveness of continuity of care policies by identifying the impact of a chronic disease management program on the continuity of care in patients with hypertension in South Korea. Methods: The propensity score matching method was used to control selection bias, and the difference-in-differences method was used to compare the impact on the treatment and control groups according to the policy intervention. Results: The continuity of care index of hypertensive patients using the difference-in-differences analysis outcome of the chronic disease management program was higher than that of the non-participating hypertensive patients. Conclusion: Continuous treatment is vital for chronic diseases such as hypertension. However, the proportion of those participating in the intervention was low. Encouraging more hypertensive patients to participate in policy intervention through continuous research and expanding the policy to appropriately reflect the increasing number of chronic diseases is necessary.
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Affiliation(s)
- Woo-Ri Lee
- Department of Health Administration, Yonsei University, Wonju, South Korea
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University, Wonju, South Korea
- *Correspondence: Ki-Bong Yoo,
| | - Jiyun Jeong
- Institute of Health and Welfare, Yonsei University, Wonju, South Korea
| | - Jun Hyuk Koo
- Yonsei University Wonju Industry-Academic Cooperation Foundation, Wonju, South Korea
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