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Taylor JY, Jones-Patten A, Prescott L, Potts-Thompson S, Joyce C, Tayo B, Saban K. The race-based stress reduction intervention (RiSE) study on African American women in NYC and Chicago: Design and methods for complex genomic analysis. PLoS One 2024; 19:e0295293. [PMID: 38598554 PMCID: PMC11006145 DOI: 10.1371/journal.pone.0295293] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/19/2023] [Indexed: 04/12/2024] Open
Abstract
RiSE study aims to evaluate a race-based stress-reduction intervention as an effective strategy to improve coping and decrease stress-related symptoms, inflammatory burden, and modify DNA methylation of stress response-related genes in older AA women. This article will describe genomic analytic methods to be utilized in this longitudinal, randomized clinical trial of older adult AA women in Chicago and NYC that examines the effect of the RiSE intervention on DNAm pre- and post-intervention, and its overall influence on inflammatory burden. Salivary DNAm will be measured at baseline and 6 months following the intervention, using the Oragene-DNA kit. Measures of perceived stress, depressive symptoms, fatigue, sleep, inflammatory burden, and coping strategies will be assessed at 4 time points including at baseline, 4 weeks, 8 weeks, and 6 months. Genomic data analysis will include the use of pre-processed and quality-controlled methylation data expressed as beta (β) values. Association analyses will be performed to detect differentially methylated sites on the targeted candidate genes between the intervention and non-intervention groups using the Δβ (changes in methylation) with adjustment for age, health behaviors, early life adversity, hybridization batch, and top principal components of the probes as covariates. To account for multiple testing, we will use FDR adjustment with a corrected p-value of <0.05 regarded as statistically significant. To assess the relationship between inflammatory burden and Δβ among the study samples, we will repeat association analyses with the inclusion of individual inflammation protein measures. ANCOVA will be used because it is more statistically powerful to detect differences.
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Affiliation(s)
- Jacquelyn Y. Taylor
- Center for Research on People of Color, Columbia University School of Nursing, New York, New York, United States of America
| | - Alexandria Jones-Patten
- Center for Research on People of Color, Columbia University School of Nursing, New York, New York, United States of America
| | - Laura Prescott
- Center for Research on People of Color, Columbia University School of Nursing, New York, New York, United States of America
| | - Stephanie Potts-Thompson
- Center for Research on People of Color, Columbia University School of Nursing, New York, New York, United States of America
| | - Cara Joyce
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Bamidele Tayo
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States of America
| | - Karen Saban
- Marcella Niehoff School of Nursing, Center for Translational Research and Education, Loyola University Chicago, Maywood, Illinois, United States of America
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Belin RJ, Desa TB, Wroblewski I, Joyce C, Perez-Tamayo A, Schwartz J, Steen LH, Lopez JJ, Lewis BE, Leya FS, Tuchek M, Bakhos M, Mathew V. Diastolic dysfunction and clinical outcomes after transcatheter or surgical aortic valve replacement in patients with atypical aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2024; 25:318-326. [PMID: 38488066 DOI: 10.2459/jcm.0000000000001597] [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: 03/19/2024]
Abstract
BACKGROUND Diastolic dysfunction is a predictor of poor outcomes in many cardiovascular conditions. At present, it is unclear whether diastolic dysfunction predicts adverse outcomes in patients with atypical aortic stenosis who undergo aortic valve replacement (AVR). METHODS Five hundred and twenty-three patients who underwent transcatheter AVR (TAVR) (n = 303) and surgical AVR (SAVR) (n = 220) at a single institution were included in our analysis. Baseline left and right heart invasive hemodynamics were assessed. Baseline transthoracic echocardiograms were reviewed to determine aortic stenosis subtype and parameters of diastolic dysfunction. Aortic stenosis subtype was categorized as typical (normal flow, high-gradient) aortic stenosis, classical, low-flow, low-gradient (cLFLG) aortic stenosis, and paradoxical, low-flow, low-gradient (pLFLG) aortic stenosis. Cox proportional hazard models were utilized to examine the relation between invasive hemodynamic or echocardiographic variables of diastolic dysfunction, aortic stenosis subtype, and all-cause mortality. Propensity-score analysis was performed to study the relation between aortic stenosis subtype and the composite outcome [death/cerebrovascular accident (CVA)]. RESULTS The median STS risk was 5.3 and 2.5% for TAVR and SAVR patients, respectively. Relative to patients with typical aortic stenosis, patients with atypical (cLFLG and pLFLG) aortic stenosis displayed a significantly higher prevalence of diastolic dysfunction (LVEDP ≥ 20mmHg, PCWP ≥ 20mmHg, echo grade II or III diastolic dysfunction, and echo-PCWP ≥ 20mmHg) and, independently of AVR treatment modality, had a significantly increased risk of death. In propensity-score analysis, patients with atypical aortic stenosis had higher rates of death/CVA than typical aortic stenosis patients, independently of diastolic dysfunction and AVR treatment modality. CONCLUSION We demonstrate the novel observation that compared with patients with typical aortic stenosis, patients with atypical aortic stenosis have a higher burden of diastolic dysfunction. We corroborate the worse outcomes previously reported in atypical versus typical aortic stenosis and demonstrate, for the first time, that this observation is independent of AVR treatment modality. Furthermore, the presence of diastolic dysfunction does not independently predict outcome in atypical aortic stenosis regardless of treatment type, suggesting that other factors are responsible for adverse clinical outcomes in this higher risk cohort.
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Affiliation(s)
- Rashad J Belin
- Department of Cardiology, Mercyhealth Heart and Vascular Center; Janesville, Wisconsin and Rockford, Illinois
| | - Travis B Desa
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Igor Wroblewski
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Cara Joyce
- Department of Biostatistics, Loyola University of Chicago, Maywood, Illinois
| | - Anthony Perez-Tamayo
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jeffrey Schwartz
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Lowell H Steen
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - John J Lopez
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Bruce E Lewis
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Ferdinand S Leya
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Michael Tuchek
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Mamdouh Bakhos
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Verghese Mathew
- Department of Cardiology, Northshore Medical Group, Chicago, Illinois, USA
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Heiferman DM, Riedy LN, Rezaii EG, Nuru M, Sloane D, Joyce C, Moore ME, Shanker RM, Grahnke KA, Malina GEK, Szujewski CC, Leonetti JP, Anderson DE. Is There a Plateau to the Learning Curve for Acoustic Neuroma Resection?-Experience and Outcomes from a Single Interdisciplinary Team Over Thirty Years. J Neurol Surg B Skull Base 2024; 85:67-74. [PMID: 38274479 PMCID: PMC10807962 DOI: 10.1055/a-1993-7906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective The evolution of acoustic neuroma (AN) care continues to shift focus on balancing optimized tumor resection and control with preservation of neurological function. Prior learning curve analyses of AN resection have demonstrated a plateau between 20 and 100 surgeries. In this study of 860 consecutive AN surgeries, we investigate the presence of an extended learning curve tail for AN resection. Methods A retrospective cohort study of AN resections by a single interdisciplinary team between 1988 and 2018 was performed. Proportional odds models and restricted cubic splines were used to determine the association between the timing of surgery and odds of improved postoperative outcomes. Results The likelihood of improved postoperative House-Brackmann (HB) scores increased in the first 400 procedures, with HB 1 at 36% in 1988 compared with 79% in 2004. While the probability of a better HB score increased over time, there was a temporary decrease in slope of the cubic spline between 2005 and 2009. The last 400 cases continued to see improvement in optimal HB outcomes: adjusted odds of HB 1 score were twofold higher in both 2005 to 2009 (adjusted odds ratio [aOR]: 2.11, 95% confidence interval [CI]: 1.38-3.22, p < 0.001) and 2010 to 2018 (aOR: 2.18, 95% CI: 1.49-3.19, p < 0.001). Conclusion In contrast to prior studies, our study demonstrates the steepest growth for learning, as measured by rates of preservation of facial function outcomes (HB 1), occurs in the first 400 AN resections. Additionally, improvements in patient outcomes continued even 30 years into practice, underlining the importance of lifelong learning.
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Affiliation(s)
- Daniel M. Heiferman
- Department of Neurological Surgery, Edward-Elmhurst Healthcare, Naperville, Illinois, United States
| | - Loren N. Riedy
- Department of Neurobiology, University of Chicago, Chicago, Illinois, United States
| | - Elhaum G. Rezaii
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Mohammed Nuru
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Dayna Sloane
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Cara Joyce
- Clinic Research Office, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Mary E. Moore
- Clinic Research Office, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Rachyl M. Shanker
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Kurt A. Grahnke
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Giselle E. K. Malina
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | | | - John P. Leonetti
- Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Douglas E. Anderson
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
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Lacy SC, Kinno M, Joyce C, Yu MD. Direct Oral Anticoagulants in Patients With Cardiac Amyloidosis: A Systematic Review and Meta-Analysis. Int J Heart Fail 2024; 6:36-43. [PMID: 38303916 PMCID: PMC10827702 DOI: 10.36628/ijhf.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 02/03/2024]
Abstract
Background and Objectives Atrial fibrillation is common in patients with cardiac amyloidosis. However, the optimal anticoagulation strategy to prevent thromboembolic events in patients with cardiac amyloidosis and atrial fibrillation is unknown. This systematic review and meta-analysis compares direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in patients with cardiac amyloidosis and atrial fibrillation. Methods We performed a systematic literature review to identify clinical studies of anticoagulation therapies for patients with cardiac amyloidosis and atrial fibrillation. The primary outcomes of major bleeding and thrombotic events were reported using random effects risk ratios (RRs) with 95% confidence interval (CI). Results Our search yielded 97 potential studies and evaluated 14 full-text articles based on title and abstract. We excluded 10 studies that were review articles or did not compare anticoagulation. We included 4 studies reporting on 1,579 patients. The pooled estimates are likely underpowered due to small sample sizes. There was no difference in bleeding events for patients with cardiac amyloidosis and atrial fibrillation treated with DOACs compared to VKAs with a RR of 0.64 (95% CI, 0.38-1.10; p=0.10). There were decreased thrombotic events for patients with cardiac amyloidosis and atrial fibrillation treated with DOACs compared to VKAs with a RR of 0.50 (95% CI, 0.32-0.79; p=0.003). Conclusions This systematic review and meta-analysis suggests that DOACs are as safe and effective as VKAs in patients with cardiac amyloidosis and atrial fibrillation. However, more data are needed to investigate clinical differences in anticoagulation therapy in this patient population.
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Affiliation(s)
- Spencer C. Lacy
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Cara Joyce
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mingxi D. Yu
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
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DiGrazia GN, Aktan SL, Sechrist EM, Rehn J, Joyce C, Siddiqui MH. CT Findings in Laryngeal Trauma and the Clinical Implications. Clin Neuroradiol 2023; 33:1123-1131. [PMID: 37410170 DOI: 10.1007/s00062-023-01323-w] [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: 09/28/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries a high morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. METHODS A retrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. RESULTS The median patient age was 40 years old with a strong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had a higher correlation with requiring urgent airway management. CONCLUSION Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.
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Affiliation(s)
- Gianna N DiGrazia
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA.
| | - Serra L Aktan
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Emma M Sechrist
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Justina Rehn
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Cara Joyce
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Mariah H Siddiqui
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
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Thorndyke A, Joyce C, Samra M, Cotiguala L, Trotter C, Aguirre O, Chon WJ, Sodhi R, Lopez-Soler RI. Risk Factors for CMV and BK Infections in an Elderly Veteran Population Following Kidney Transplantation: Implications for Immunosuppression Induction and Management. Biomedicines 2023; 11:3060. [PMID: 38002060 PMCID: PMC10669083 DOI: 10.3390/biomedicines11113060] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Cytomegalovirus (CMV) and BK Polyomavirus (BKPyV) are the most common opportunistic pathogens following kidney transplantation. We evaluated 102 patients with a median age of 63 at Edward Hines VA Hospital from November 2020 to December 2022. Our primary interest was the incidence of CMV and BKPyV infections, as well as CMV and BKPyV coinfection. Secondary interests included time to infection, rejection, and graft and patient survival. There were no statistically significant differences in patient age, donor age, race, transplant type, incidence of delayed graft function, or induction in both cohorts (any infection (N = 46) vs. those without (N = 56)). There was a 36% (37/102) incidence of CMV, a 17.6% (18/102) of BKPyV and an 8.8% (9/102) incidence of coinfection. There was a decreased incidence of CMV infection in Basiliximab induction versus antithymocyte globulin (21% and 43%). CMV risk status had no effect on the incidence of CMV infection following transplant. African American recipients had a lower incidence of BKPyV infection (12% vs. 39%), yet a higher incidence was observed in those with high cPRA (50% vs. 14%). Most CMV and/or BKPyV infections occurred within the first six months post-transplant (54%). Immunosuppression management of the elderly should continually be evaluated to reduce opportunistic infections post-transplant.
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Affiliation(s)
- Anne Thorndyke
- Department of Pharmacy, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA; (A.T.); (L.C.)
| | - Cara Joyce
- Department of Medicine, Stritch School of Medicine, Maywood, IL 60153, USA; (C.J.); (W.J.C.); (R.S.)
| | - Manpreet Samra
- Department of Medicine, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA;
| | - Laura Cotiguala
- Department of Pharmacy, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA; (A.T.); (L.C.)
| | - Christine Trotter
- Section of Transplantation, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA; (C.T.); (O.A.)
| | - Oswaldo Aguirre
- Section of Transplantation, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA; (C.T.); (O.A.)
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, IL 60153, USA
| | - W. James Chon
- Department of Medicine, Stritch School of Medicine, Maywood, IL 60153, USA; (C.J.); (W.J.C.); (R.S.)
- Department of Medicine, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA;
| | - Rupinder Sodhi
- Department of Medicine, Stritch School of Medicine, Maywood, IL 60153, USA; (C.J.); (W.J.C.); (R.S.)
| | - Reynold I. Lopez-Soler
- Section of Transplantation, Edward Hines VA Jr. Hospital Hines, Hines, IL 60141, USA; (C.T.); (O.A.)
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, IL 60153, USA
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Lee DD, Joyce C, Duehren S, Fernandez L. Oxygen saturation during donor warm ischemia time and outcome of donation after circulatory death (DCD) liver transplantation with static cold storage: A review of 1114 cases. Liver Transpl 2023; 29:1192-1198. [PMID: 37076131 DOI: 10.1097/lvt.0000000000000162] [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] [Received: 11/21/2022] [Accepted: 04/07/2023] [Indexed: 04/21/2023]
Abstract
The donor operation and the hemodynamics during declaration resulting in donor warm ischemia time have been linked to the outcomes in donation after circulatory death (DCD) liver transplantation (LT). Scrutiny of the donor hemodynamics at the time of withdrawal of life support concluded that a functional donor warm ischemia time may be associated with LT graft failure. Unfortunately, the definition for functional donor warm ischemia time has not reached a consensus-but has almost always incorporated time spent in a hypoxic state. Herein, we reviewed 1114 DCD LT cases performed at the 20 highest volume centers during 2014 and 2018. Donor hypoxia began within 3 minutes of withdrawal of life support for 60% of cases and within 10 minutes for 95% of cases. Graft survival was 88.3% at 1 year and 80.3% at 3 years. Scrutinizing the time spent under hypoxic conditions (oxygen saturation ≤ 80%) during the withdrawal of life support, we found an increasing risk of graft failure as hypoxic time increased from 0 to 16 minutes. After 16 minutes and up to 50 minutes, we did not find any increased risk of graft failure. In conclusion, after 16 minutes of time in hypoxia, the risk of graft failure in DCD LT did not increase. The current evidence suggests that an over-reliance on hypoxia time may lead to an unnecessary increase in DCD liver discard and may not be as useful for predicting graft loss after LT.
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Affiliation(s)
- David D Lee
- Department of Surgery, Division of Transplantation, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Cara Joyce
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Sarah Duehren
- Department of Surgery, Division of Transplantation, Strich School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Luis Fernandez
- Department of Surgery, Division of Transplantation, Strich School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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Sink J, Joyce C, Liebo MJ, Wilber DJ. Long-Term Outcomes of Cardiac Sarcoid: Prognostic Implications of Isolated Cardiac Involvement and Impact of Diagnostic Delays. J Am Heart Assoc 2023; 12:e028342. [PMID: 37750587 PMCID: PMC10727252 DOI: 10.1161/jaha.122.028342] [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: 09/29/2022] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
Background Isolated cardiac sarcoid (iCS) is reported to have more severe clinical presentation and greater risk of adverse events compared with cardiac sarcoid (CS) with extracardiac involvement (nonisolated CS). Delays in diagnosing specific organ involvement may play a role in these described differences. Methods and Results A retrospective observational study of patients with CS over a 20-year period was conducted. Objective evidence of organ involvement and time of onset based on consensus criteria were identified. CS was confirmed by histology in all patients from myocardium only (iCS) or extracardiac tissue (nonisolated CS). The primary end point was a composite of mortality, orthotopic heart transplant, and durable left ventricular assist device implantation. CS was isolated in 9 of 50 patients (18%). Among baseline characteristics, iCS and nonisolated CS differed significantly only in the frequency of sustained ventricular tachycardia at presentation (78% versus 37%; P=0.03) and delay in CS diagnosis >6 months (67% versus 5%; P<0.01). A nonsignificant trend toward lower left ventricular ejection fraction and more frequent heart failure in iCS was observed. Over a median follow-up of 9.7 years (95% CI, 6.8-10.8), 18 patients reached the primary end point (13 deaths, 2 orthotopic heart transplants, and 3 durable left ventricular assist device implantations). The 1-, 5-, and 10-year event-free survival rates were 96% (95% CI, 85%-99%), 79% (95% CI, 64%-88%), and 58% (95% CI, 40%-73%), respectively, without differences between groups. There were no significant predictors of the primary end point, including delayed CS diagnosis. Conclusions Long-term outcomes were similar between iCS and nonisolated CS in patients with histologically documented sarcoid. Diagnostic delays may contribute to differences in the dominant clinical presentation, despite similar outcomes.
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Affiliation(s)
- Joshua Sink
- Loyola University Chicago Stritch School of MedicineMaywoodILUSA
- Present address:
Department of MedicineNorthwestern UniversityChicagoILUSA
| | - Cara Joyce
- Department of MedicineLoyola University of Chicago Stritch School of MedicineMaywoodILUSA
| | - Max J. Liebo
- Section of Advanced Heart Failure, Division of Cardiology, Department of MedicineLoyola University Chicago Stritch School of MedicineMaywoodILUSA
| | - David J. Wilber
- Department of MedicineLoyola University of Chicago Stritch School of MedicineMaywoodILUSA
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Sheean P, O'Connor P, Joyce C, Wozniak A, Vasilopoulos V, Formanek P. Applying the Global Leadership Initiative on Malnutrition criteria in patients admitted with SARS-CoV-2 infection using computed tomography imaging. Nutr Clin Pract 2023; 38:1009-1020. [PMID: 37312258 DOI: 10.1002/ncp.11024] [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: 01/26/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Patients with low muscle mass and acute SARS-CoV-2 infection meet the Global Leadership Initiative on Malnutrition (GLIM) etiologic and phenotypic criteria to diagnose malnutrition, respectively. However, available cut-points to classify individuals with low muscle mass are not straightforward. Using computed tomography (CT) to determine low muscularity, we assessed the prevalence of malnutrition using the GLIM framework and associations with clinical outcomes. METHODS A retrospective cohort was conducted gathering patient data from various clinical resources. Patients admitted to the COVID-19 unit (March 2020 to June 2020) with appropriate/evaluable CT studies (chest or abdomen/pelvis) within the first 5 days of admission were considered eligible. Sex- and vertebral-specific skeletal muscle indices (SMI; cm2 /m2 ) from healthy controls were used to determine low muscle mass. Injury-adjusted SMI were derived, extrapolated from cancer cut-points and explored. Descriptive statistics and mediation analyses were completed. RESULTS Patients (n = 141) were 58.2 years of age and racially diverse. Obesity (46%), diabetes (40%), and cardiovascular disease (68%) were prevalent. Using healthy controls and injury-adjusted SMI, malnutrition prevalence was 26% (n = 36/141) and 50% (n = 71/141), respectively. Mediation analyses demonstrated a significant reduction in the effect of malnutrition on outcomes in the presence of Acute Physiology and Chronic Health Evaluation II, supporting the mediating effects of severity of illness intensive care unit (ICU) admission, ICU length of stay, mechanical ventilation, complex respiratory support, discharge status (all P values = 0.03), and 28-day mortality (P = 0.04). CONCLUSIONS Future studies involving the GLIM criteria should consider these collective findings in their design, analyses, and implementation.
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Affiliation(s)
- Patricia Sheean
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Paula O'Connor
- Parkinson School of Health Sciences and Public Health, Maywood, Illinois, USA
| | - Cara Joyce
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Amy Wozniak
- Clinical Research Office, Loyola University Chicago, Maywood, Illinois, USA
| | - Vasilios Vasilopoulos
- Department of Radiology (3D lab), Loyola University Medical Center, Maywood, Illinois, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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MacConnell AE, Davis W, Burr R, Schneider A, Dugas LR, Joyce C, Salazar DH, Garbis NG. An objective assessment of the impact of tendon retraction on sleep efficiency in patients with full-thickness rotator cuff tears: a prospective cohort study. Clin Shoulder Elb 2023; 26:169-174. [PMID: 37316178 DOI: 10.5397/cise.2022.01438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors. METHODS Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waistworn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system. RESULTS This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P>0.1), with each cohort of patients demonstrating a generally high sleep efficiency. CONCLUSIONS The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P>0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears. Level of evidence: Level II.
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Affiliation(s)
- Ashley E MacConnell
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - William Davis
- 55th Operational Medical Readiness Squadron, United States Air Force, Offutt Air Force Base, NE, USA
| | - Rebecca Burr
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Andrew Schneider
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
| | - Lara R Dugas
- Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - Cara Joyce
- Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - Dane H Salazar
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Nickolas G Garbis
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
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Semler M, Pax L, McNamara KF, Joyce C, Shore J, Morey C, Gawne E, Clark NM. Reported HIV-related stigma according to race and ethnicity. AIDS Care 2023:1-8. [PMID: 37128634 DOI: 10.1080/09540121.2023.2206097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
People living with HIV/AIDS (PLWHA) have long experienced structural, community, and personal stigma. We explored differences in experienced HIV-related stigma according to race/ethnicity using quantitative and qualitative measures. Sixty-four patients were enrolled in this study (22 White and 42 people of color [POC]). POC scored higher than White PLWHA on all 12 survey statements, with statistically significant differences in disclosure concerns and with one of the statements on public attitudes towards PLWHA. Common themes in the qualitative interview were HIV disclosure concerns and fear of rejection. These data demonstrate that stigma continues to be a significant concern for PLWHA, particularly POC, meaningfully impacting their lives. By acknowledging and working to reduce negative perceptions about PLWHA, physicians may improve care for their patients by developing more trusting relationships.
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Affiliation(s)
- Matthew Semler
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Laura Pax
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Cara Joyce
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, Maywood, IL, USA
| | | | - Craig Morey
- Loyola University Medical Center, Maywood, IL, USA
| | | | - Nina M Clark
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
- Infectious Disease & Immunology Research Institute, Loyola University Chicago, Maywood, IL, USA
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Swanson GR, Schwartz BA, Joyce C, Keshavarzian A. Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection. Alcohol Clin Exp Res 2023; 47:908-918. [PMID: 37526580 DOI: 10.1111/acer.15052] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. METHOD We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). RESULTS By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). CONCLUSION Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.
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Affiliation(s)
- Garth R Swanson
- Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
- Section of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin A Schwartz
- Section of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Cara Joyce
- Department of Medicine, Loyola University Stritch School of Medicine, Chicago, Illinois, USA
| | - Ali Keshavarzian
- Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
- Section of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Afshar M, Adelaine S, Resnik F, Mundt MP, Long J, Leaf M, Ampian T, Wills GJ, Schnapp B, Chao M, Brown R, Joyce C, Sharma B, Dligach D, Burnside ES, Mahoney J, Churpek MM, Patterson BW, Liao F. Deployment of Real-time Natural Language Processing and Deep Learning Clinical Decision Support in the Electronic Health Record: Pipeline Implementation for an Opioid Misuse Screener in Hospitalized Adults. JMIR Med Inform 2023; 11:e44977. [PMID: 37079367 PMCID: PMC10160938 DOI: 10.2196/44977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/01/2023] [Accepted: 03/26/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The clinical narrative in electronic health records (EHRs) carries valuable information for predictive analytics; however, its free-text form is difficult to mine and analyze for clinical decision support (CDS). Large-scale clinical natural language processing (NLP) pipelines have focused on data warehouse applications for retrospective research efforts. There remains a paucity of evidence for implementing NLP pipelines at the bedside for health care delivery. OBJECTIVE We aimed to detail a hospital-wide, operational pipeline to implement a real-time NLP-driven CDS tool and describe a protocol for an implementation framework with a user-centered design of the CDS tool. METHODS The pipeline integrated a previously trained open-source convolutional neural network model for screening opioid misuse that leveraged EHR notes mapped to standardized medical vocabularies in the Unified Medical Language System. A sample of 100 adult encounters were reviewed by a physician informaticist for silent testing of the deep learning algorithm before deployment. An end user interview survey was developed to examine the user acceptability of a best practice alert (BPA) to provide the screening results with recommendations. The planned implementation also included a human-centered design with user feedback on the BPA, an implementation framework with cost-effectiveness, and a noninferiority patient outcome analysis plan. RESULTS The pipeline was a reproducible workflow with a shared pseudocode for a cloud service to ingest, process, and store clinical notes as Health Level 7 messages from a major EHR vendor in an elastic cloud computing environment. Feature engineering of the notes used an open-source NLP engine, and the features were fed into the deep learning algorithm, with the results returned as a BPA in the EHR. On-site silent testing of the deep learning algorithm demonstrated a sensitivity of 93% (95% CI 66%-99%) and specificity of 92% (95% CI 84%-96%), similar to published validation studies. Before deployment, approvals were received across hospital committees for inpatient operations. Five interviews were conducted; they informed the development of an educational flyer and further modified the BPA to exclude certain patients and allow the refusal of recommendations. The longest delay in pipeline development was because of cybersecurity approvals, especially because of the exchange of protected health information between the Microsoft (Microsoft Corp) and Epic (Epic Systems Corp) cloud vendors. In silent testing, the resultant pipeline provided a BPA to the bedside within minutes of a provider entering a note in the EHR. CONCLUSIONS The components of the real-time NLP pipeline were detailed with open-source tools and pseudocode for other health systems to benchmark. The deployment of medical artificial intelligence systems in routine clinical care presents an important yet unfulfilled opportunity, and our protocol aimed to close the gap in the implementation of artificial intelligence-driven CDS. TRIAL REGISTRATION ClinicalTrials.gov NCT05745480; https://www.clinicaltrials.gov/ct2/show/NCT05745480.
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Affiliation(s)
- Majid Afshar
- University of Wisconsin - Madison, Madison, WI, United States
| | | | - Felice Resnik
- University of Wisconsin - Madison, Madison, WI, United States
| | - Marlon P Mundt
- University of Wisconsin - Madison, Madison, WI, United States
| | - John Long
- University of Wisconsin - Madison, Madison, WI, United States
| | - Margaret Leaf
- University of Wisconsin - Madison, Madison, WI, United States
| | - Theodore Ampian
- University of Wisconsin - Madison, Madison, WI, United States
| | - Graham J Wills
- University of Wisconsin - Madison, Madison, WI, United States
| | | | - Michael Chao
- University of Wisconsin - Madison, Madison, WI, United States
| | - Randy Brown
- University of Wisconsin - Madison, Madison, WI, United States
| | - Cara Joyce
- Loyola University Chicago, Chicago, IL, United States
| | - Brihat Sharma
- University of Wisconsin - Madison, Madison, WI, United States
| | | | | | - Jane Mahoney
- University of Wisconsin - Madison, Madison, WI, United States
| | | | | | - Frank Liao
- University of Wisconsin - Madison, Madison, WI, United States
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Tenfelde S, Joyce C, Tell D, Masinter L, Wallander- Gemkow J, Garfield L. Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool. J Midwifery Womens Health 2023; 68:179-186. [PMID: 36565235 PMCID: PMC10089952 DOI: 10.1111/jmwh.13461] [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: 02/17/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Patients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low-income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population. METHODS This is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks' gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21-84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance. RESULTS In our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created. DISCUSSION An easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.
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Affiliation(s)
- Sandi Tenfelde
- Loyola University Chicago, Marcella Niehoff School of Nursing, 2160 South First Avenue, Maywood, IL, 60153
| | - Cara Joyce
- Loyola University Chicago, School of Public Health, 2160 South First Avenue, Maywood, IL, 60153
| | - Dina Tell
- Loyola University Chicago, Marcella Niehoff School of Nursing, 2160 South First Avenue, Maywood, IL, 60153
| | - Lisa Masinter
- AllianceChicago, Health Research and Education Team, Chicago, IL, 225 West Illinois Street, Chicago, IL, 60654
| | - Jena Wallander- Gemkow
- AllianceChicago, Health Research and Education Team, Chicago, IL, 225 West Illinois Street, Chicago, IL, 60654
| | - Lindsey Garfield
- Loyola University Chicago, Marcella Niehoff School of Nursing, 2160 South First Avenue, Maywood, IL, 60153
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Krishnan K, Su A, Sigman G, Joyce C, Rech MA, Long CM. It's a Hard Knock Life: How Kids With Mild Traumatic Brain Injuries Are Treated. Pediatr Emerg Care 2023; 39:74-79. [PMID: 36719387 DOI: 10.1097/pec.0000000000002611] [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: 02/03/2023]
Abstract
OBJECTIVES The diagnosis and treatment of mild traumatic brain injuries (mTBIs) by emergency medicine providers is greatly varied. Because of the frequency and long-term consequences associated with pediatric head injuries, it is crucial that adequate counseling is provided in acute care settings. The purpose of our study is to evaluate existing practices at Loyola University Medical Center emergency department to address inconsistencies in diagnostic or discharge practices and determine future quality improvement measures. METHODS A retrospective cohort study was conducted at an academic hospital emergency department of patient records from 2017 to 2020. Demographic, diagnostic, and discharge data were summarized, and Pearson χ2 tests and Fisher exact tests were performed to determine associations among patient characteristics and provider practices. RESULTS A total of 1160 patients met inclusion criteria for analysis. In terms of diagnostic procedure, 31.6% of providers did not uniformly use existing screening criteria, such as PECARN, to determine if CT scans were needed for mTBI evaluation. Most discharge instructions were based on a generalized template on epic (91.9%). Only a minority of providers prepared patient-specific instructions through written, verbal, or other supplemental materials. The most common formats included epic only (46.1%), epic and personalized written instructions (20.2%), and epic and verbal instructions (12.4%). Follow-up care instructions were provided to 93% of patients who received discharged instructions, mainly for primary care (96.7%), sports medicine (1.58%), neurology (0.65%), or other providers (1.11%). CONCLUSIONS There is a lack of consistency in the evaluation and education of mTBI in pediatric patients. There is a need for personalized discharge instructions to ensure adequate patient and parent understanding and compliance. Further studies looking at long-term outcomes in these patients would also be beneficial.
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Affiliation(s)
- Kavita Krishnan
- From the Loyola University Chicago, Stritch School of Medicine
| | - Alice Su
- From the Loyola University Chicago, Stritch School of Medicine
| | | | - Cara Joyce
- From the Loyola University Chicago, Stritch School of Medicine
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Creadore A, Manjaly P, Tkachenko E, Li DG, Kaffenberger B, Shinkai K, Rosenbach M, Joyce C, Mostaghimi A. The utility of augmented teledermatology to improve dermatologist diagnosis of cellulitis: a cross-sectional study. Arch Dermatol Res 2022; 315:1347-1353. [PMID: 36580098 PMCID: PMC9798350 DOI: 10.1007/s00403-022-02517-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
Dermatology consultation for cases of presumed cellulitis improves diagnostic accuracy and management. However, access to in-person consultation remains limited, a gap that could be filled with teledermatology. Augmented teledermatology may improve outcomes. In this cross-sectional study, 20 dermatologists (60% of whom reported conducting inpatient consults > 1 month per year) reviewed 10 real-life cases representing either cellulitis or pseudocellulitis as diagnosed by in-person dermatology consultation. For each case, respondents recorded their diagnosis, confidence, and management decisions after viewing the history and standard teledermatology photos, the responses to a physician-reported cellulitis questionnaire, and finally thermal images. Overall mean diagnostic accuracy increased from 84 ± 4% with the history and physical to 89 ± 3% when adding a cellulitis questionnaire and thermal images (p = 0.23). Accuracy for cellulitis cases specifically significantly increased from 76 ± 6% to 88 ± 4% when adding a cellulitis questionnaire and thermal images (p = 0.049). Accuracy for pseudocellulitis was consistently ≥ 94%. Augmented teledermatology with a standardized questionnaire and thermal images improved diagnostic accuracy for cases of cellulitis and may increase physician confidence. Dermatologists were able to accurately diagnose regardless of experience with inpatient consults, increasing the pool of potential dermatologists who could diagnose cellulitis remotely.
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Affiliation(s)
- Andrew Creadore
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA ,grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Priya Manjaly
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA ,grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Elizabeth Tkachenko
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - David G. Li
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - Benjamin Kaffenberger
- grid.412332.50000 0001 1545 0811Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kanade Shinkai
- grid.266102.10000 0001 2297 6811Department of Dermatology, University of California, San Francisco, CA USA
| | - Misha Rosenbach
- grid.25879.310000 0004 1936 8972Department of Dermatology, University of Pennsylvania, Philadelphia, PA USA
| | - Cara Joyce
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
| | - Arash Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave., Boston, MA 02115 USA
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de Bustros P, Baldea A, Sanford A, Joyce C, Adams W, Bouchard C. Review of culprit drugs associated with patients admitted to the burn unit with the diagnosis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome. Burns 2022; 48:1561-1573. [PMID: 34924230 PMCID: PMC9124451 DOI: 10.1016/j.burns.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/10/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are severe and potentially lethal adverse drug reactions characterized by acute inflammation of the skin, mucous membranes, and ocular surface that typically occurs within weeks of a culprit drug ingestion. The purpose of this study is to report a retrospective trend analysis of SJS spectrum diagnoses and associated culprit drugs in patients admitted to the Loyola University Medical Center (LUMC) Burn Unit, the major referral center in the Chicagoland region for patients with SJS disease spectrum. METHODS The electronic medical records (EMR) of 163 patients with a diagnosis of SJS/TENS admitted to the LUMC Burn Unit from 2000 to 2019 were reviewed. Clinical data in addition to the well-established algorithm of drug causality for epidermal necrolysis (ALDEN) allowed us to identify the single most probable culprit drug in 131 cases. RESULTS From 2000 to 2019, the most common spectrum classification was TENS (48.1%), followed by SJS (33.6%) and SJS-TEN Overlap Syndrome (18.3%). Anticonvulsants were found to be the most probable culprit class in 30% of cases followed by Trimethoprim-Sulfamethoxazole in 19% of cases. Beta-lactams were the most probable culprit class in 11% of cases while NSAIDs and allopurinol were each the most probable culprit class/drug in 8.4% of cases. CONCLUSIONS This is one of the largest single center series of SJS/TENS cases in the United States. Further study into culprit drug distribution by region as well as continuous monitoring of trends is crucial in order to advise prescribing practices.
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Affiliation(s)
| | - Anthony Baldea
- Department of Surgery, Loyola University Medical Center, United States
| | - Arthur Sanford
- Department of Surgery, Loyola University Medical Center, United States
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago, United States
| | - William Adams
- Department of Public Health Sciences, Loyola University Chicago, United States
| | - Charles Bouchard
- Department of Ophthalmology, Loyola University Medical Center, United States.
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Jawahar A, El-Bulbul J, Adams W, Joyce C, Yacoub J, Goldberg A. Safety profile of Gadoterate meglumine on the renal function of patients with severe kidney disease. Clin Imaging 2022; 91:126-131. [DOI: 10.1016/j.clinimag.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
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Dadrass F, Joyce C, Lake E. LB958 A retrospective study of skin biopsy diagnostic accuracy among dermatologists throughout the day: Do physicians experience diagnostic or procedure fatigue? J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Bulbul JE, Hashem A, Grybowski D, Joyce C, Rashad E, Gabriel MS, Wagner RH, Savir-Baruch B. Effect of hormonal therapy on 18F-fluciclovine PET/CT in the detection of prostate cancer recurrence, localization of metastatic disease, and correlation with prostate-specific antigen. Urol Oncol 2022; 40:379.e9-379.e16. [DOI: 10.1016/j.urolonc.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/04/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
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Gros SAA, Santhanam AP, Block AM, Emami B, Lee BH, Joyce C. Retrospective Clinical Evaluation of a Decision-Support Software for Adaptive Radiotherapy of Head and Neck Cancer Patients. Front Oncol 2022; 12:777793. [PMID: 35847951 PMCID: PMC9279735 DOI: 10.3389/fonc.2022.777793] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical need for an automated decision-support software platform for adaptive radiation therapy (ART) of head and neck cancer (HNC) patients. Methods We tested RTapp (SegAna), a new ART software platform for deciding when a treatment replan is needed, to investigate a set of 27 HNC patients’ data retrospectively. For each fraction, the software estimated key components of ART such as daily dose distribution and cumulative doses received by targets and organs at risk (OARs) from daily 3D imaging in real-time. RTapp also included a prediction algorithm that analyzed dosimetric parameter (DP) trends against user-specified thresholds to proactively trigger adaptive re-planning up to four fractions ahead. The DPs evaluated for ART were based on treatment planning dose constraints. Warning (V95<95%) and adaptation (V95<93%) thresholds were set for PTVs, while OAR adaptation dosimetric endpoints of +10% (DE10) were set for all Dmax and Dmean DPs. Any threshold violation at end of treatment (EOT) triggered a review of the DP trends to determine the threshold-crossing fraction Fx when the violations occurred. The prediction model accuracy was determined as the difference between calculated and predicted DP values with 95% confidence intervals (CI95). Results RTapp was able to address the needs of treatment adaptation. Specifically, we identified 18/27 studies (67%) for violating PTV coverage or parotid Dmean at EOT. Twelve PTVs had V95<95% (mean coverage decrease of −6.8 ± 2.9%) including six flagged for adaptation at median Fx= 6 (range, 1–16). Seventeen parotids were flagged for exceeding Dmean dose constraints with a median increase of +2.60 Gy (range, 0.99–6.31 Gy) at EOT, including nine with DP>DE10. The differences between predicted and calculated PTV V95 and parotid Dmean was up to 7.6% (mean ± CI95, −2.7 ± 4.1%) and 5 Gy (mean ± CI95, 0.3 ± 1.6 Gy), respectively. The most accurate predictions were obtained closest to the threshold-crossing fraction. For parotids, the results showed that Fx ranged between fractions 1 and 23, with a lack of specific trend demonstrating that the need for treatment adaptation may be verified for every fraction. Conclusion Integrated in an ART clinical workflow, RTapp aids in predicting whether specific treatment would require adaptation up to four fractions ahead of time.
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Affiliation(s)
- Sebastien A. A. Gros
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
- *Correspondence: Sebastien A. A. Gros,
| | - Anand P. Santhanam
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alec M. Block
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Bahman Emami
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Brian H. Lee
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Cara Joyce
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Joyce C, Halverson T, Gonzalez C, Brubaker L, Wolfe AJ. The Urobiomes of Adult Women With Various Lower Urinary Tract Symptoms Status Differ: A Re-Analysis. Front Cell Infect Microbiol 2022; 12:860408. [PMID: 35755842 PMCID: PMC9218574 DOI: 10.3389/fcimb.2022.860408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/11/2022] [Indexed: 01/26/2023] Open
Abstract
The discovery of the urinary microbiome (urobiome) has created opportunities for urinary health researchers who study a wide variety of human health conditions. This manuscript describes an analysis of catheterized urine samples obtained from 1,004 urobiome study participants with the goal of identifying the most abundant and/or prevalent (common) taxa in five clinically relevant cohorts: unaffected adult women (n=346, 34.6%), urgency urinary incontinence (UUI) (n=255, 25.5%), stress urinary incontinence (SUI) (n=50, 5.0%), urinary tract infection (UTI) (n=304, 30.4%), and interstitial cystitis/painful bladder syndrome (IC/PBS) (n=49, 4.9%). Urine was collected via transurethral catheter and assessed for microbes with the Expanded Quantitative Urine Culture (EQUC) technique. For this combined analytic cohort, the mean age was 59 ± 16; most were Caucasian (n=704, 70.2%), Black (n=137, 13.7%), or Hispanic (n=130, 13.0%), and the mean BMI was 30.4 ± 7.7. Whereas many control or IC/PBS cohort members were EQUC-negative (42.4% and 39.8%, respectively), members of the other 3 cohorts were extremely likely to have detectable microbes. The detected urobiomes of the controls and IC/PBS did not differ by alpha diversity or genus level composition and differed by only a few species. The other 3 cohorts differed significantly from the controls. As expected, Escherichia was both prevalent and highly abundant in the UTI cohort, but other taxa also were prevalent at more moderate abundances, including members of the genera Lactobacillus, Streptococcus, Staphylococcus, Corynebacterium, Actinomyces, and Aerococcus. Members of these genera were also prevalent and highly abundant in members of the UUI cohort, especially Streptococcus anginosus. Intriguingly, these taxa were also detected in controls but at vastly lower levels of both prevalence and abundance, suggesting the possibility that UUI-associated symptoms could be the result of an overabundance of typical urobiome constituents. Finally, prevalence and abundance of microbes in the SUI cohort were intermediate to those of the UUI and control cohorts. These observations can inform the next decade of urobiome research, with the goal of clarifying the mechanisms of urobiome community composition and function. There is tremendous potential to improve diagnosis, evaluation and treatment for individuals affected with a wide variety of urinary tract disorders.
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Affiliation(s)
- Cara Joyce
- Dept. of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Thomas Halverson
- Dept. of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Caroline Gonzalez
- Dept. of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Linda Brubaker
- Dept. of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, United States
| | - Alan J. Wolfe
- Dept. of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States,*Correspondence: Alan J. Wolfe,
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Bresler L, Westbay LC, Hekman L, Joyce C, Fitzgerald CM. Acupuncture for female bladder pain syndrome: a randomized controlled trial. Can J Urol 2022; 29:11154-11161. [PMID: 35691037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Growing evidence supports acupuncture for several pain conditions including chronic prostatitis. This study aimed to determine the safety, tolerability, and effectiveness of acupuncture in reducing pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS). MATERIALS AND METHODS This prospective randomized single-blinded study compared electro-acupuncture (EA) to minimal acupuncture (MA) after 6 weekly treatments and again after 6 weeks of no treatment. Pain was assessed using the Brief Pain Inventory-Short Form (worst pain, average pain, pain severity, pain interference) and the Pain Catastrophizing Scale (PCS). Physical exams evaluated pelvic floor muscle tenderness. Mixed-effects models were used to estimate adjusted means over follow up. RESULTS Patients were randomized to EA (n = 11) or MA (n = 10). There were no adverse events. Both groups' worst pain improved at 6 weeks, -2.91 ± 0.59 and -2.09 ± 0.68 for EA and MA respectively with no difference between groups (p = 0.37). Results were similar at 12 weeks. The EA group had greater improvement in pain interference at 6 weeks, -3.28 ± 0.51 versus -1.67 ± 0.58 (p = 0.049). The between group difference was not maintained at 12 weeks (p = 0.13). Average pain and pain severity showed no difference between groups (p > 0.05). The PCS improved overall at 6 weeks, -6.2 ± 2.5 (p = 0.03), with no difference between groups (p = 0.39). On physical exam, only the EA group showed a significant decrease in levator ani tenderness (p = 0.031) after treatment. CONCLUSIONS Both EA and MA showed improvement in worst pain scores, however EA showed greater improvement in pain interference and pelvic floor muscle tenderness in women with IC/BPS.
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Affiliation(s)
- Larissa Bresler
- Department of Urology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lauren C Westbay
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lauren Hekman
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Cara Joyce
- Department of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
- Department of Orthopedic Surgery and Rehabilitation, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Afshar M, Sharma B, Dligach D, Oguss M, Brown R, Chhabra N, Thompson HM, Markossian T, Joyce C, Churpek MM, Karnik NS. Development and multimodal validation of a substance misuse algorithm for referral to treatment using artificial intelligence (SMART-AI): a retrospective deep learning study. The Lancet Digital Health 2022; 4:e426-e435. [PMID: 35623797 PMCID: PMC9159760 DOI: 10.1016/s2589-7500(22)00041-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 01/02/2023]
Abstract
Background Substance misuse is a heterogeneous and complex set of behavioural conditions that are highly prevalent in hospital settings and frequently co-occur. Few hospital-wide solutions exist to comprehensively and reliably identify these conditions to prioritise care and guide treatment. The aim of this study was to apply natural language processing (NLP) to clinical notes collected in the electronic health record (EHR) to accurately screen for substance misuse. Methods The model was trained and developed on a reference dataset derived from a hospital-wide programme at Rush University Medical Center (RUMC), Chicago, IL, USA, that used structured diagnostic interviews to manually screen admitted patients over 27 months (between Oct 1, 2017, and Dec 31, 2019; n=54 915). The Alcohol Use Disorder Identification Test and Drug Abuse Screening Tool served as reference standards. The first 24 h of notes in the EHR were mapped to standardised medical vocabulary and fed into single-label, multilabel, and multilabel with auxillary-task neural network models. Temporal validation of the model was done using data from the subsequent 12 months on a subset of RUMC patients (n=16 917). External validation was done using data from Loyola University Medical Center, Chicago, IL, USA between Jan 1, 2007, and Sept 30, 2017 (n=1991 adult patients). The primary outcome was discrimination for alcohol misuse, opioid misuse, or non-opioid drug misuse. Discrimination was assessed by the area under the receiver operating characteristic curve (AUROC). Calibration slope and intercept were measured with the unreliability index. Bias assessments were performed across demographic subgroups. Findings The model was trained on a cohort that had 3·5% misuse (n=1 921) with any type of substance. 220 (11%) of 1921 patients with substance misuse had more than one type of misuse. The multilabel convolutional neural network classifier had a mean AUROC of 0·97 (95% CI 0·96–0·98) during temporal validation for all types of substance misuse. The model was well calibrated and showed good face validity with model features containing explicit mentions of aberrant drug-taking behaviour. A false-negative rate of 0·18–0·19 and a false-positive rate of 0·03 between non-Hispanic Black and non-Hispanic White groups occurred. In external validation, the AUROCs for alcohol and opioid misuse were 0·88 (95% CI 0·86–0·90) and 0·94 (0·92–0·95), respectively. Interpretation We developed a novel and accurate approach to leveraging the first 24 h of EHR notes for screening multiple types of substance misuse. Funding National Institute On Drug Abuse, National Institutes of Health.
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Bashir M, Joyce C, Bolduan A, Sehgal V, Smith M, Charous S. Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study. AJNR Am J Neuroradiol 2022; 43:592-596. [PMID: 35332018 PMCID: PMC8993190 DOI: 10.3174/ajnr.a7451] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. MATERIALS AND METHODS A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. RESULTS The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. CONCLUSIONS Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.
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Affiliation(s)
- M.H. Bashir
- From the Department of Radiology (M.H.B., V.S.)
| | - C. Joyce
- Loyola University Medical Center (C.J.), Maywood, Illinois
| | - A. Bolduan
- Vanderbilt University Medical Center (A.B.), Nashville, Tennessee
| | - V. Sehgal
- From the Department of Radiology (M.H.B., V.S.)
| | - M. Smith
- Diagnostic Imaging Alliance of Louisville (M.S.), Louisville, Kentucky
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Borgese M, Joyce C, Anderson EE, Churpek MM, Afshar M. Bias Assessment and Correction in Machine Learning Algorithms: A Use-Case in a Natural Language Processing Algorithm to Identify Hospitalized Patients with Unhealthy Alcohol Use. AMIA Annu Symp Proc 2022; 2021:247-254. [PMID: 35308909 PMCID: PMC8861719] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Unhealthy alcohol use represents a major economic burden and cause of morbidity and mortality in the United States. Implementation of interventions for unhealthy alcohol use depends on the availability and accuracy of screening tools. Our group previously applied methods in natural language processing and machine learning to build a classifier for unhealthy alcohol use. In this study, we sought to evaluate and address bias through the use-case of our classifier. We demonstrated the presence of biased unhealthy alcohol use risk underestimation among Hispanic compared to Non-Hispanic White trauma inpatients, 18- to 44-year-old compared to 45 years and older medical/surgical inpatients, and Non-Hispanic Black compared to Non-Hispanic White medical/surgical inpatients. We further showed that intercept, slope, and concurrent intercept and slope recalibration resulted in minimal or no improvements in bias-indicating metrics within these subgroups. Our results exemplify the importance of integrating bias assessment early into the classifier development pipeline.
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Affiliation(s)
- Marissa Borgese
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | | | | | | | - Majid Afshar
- Loyola University Chicago, Chicago, IL
- University of Wisconsin, Madison, WI
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27
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To D, Joyce C, Kulshrestha S, Sharma B, Dligach D, Churpek M, Afshar M. The Addition of United States Census-Tract Data Does Not Improve the Prediction of Substance Misuse. AMIA Annu Symp Proc 2022; 2021:1149-1158. [PMID: 35308901 PMCID: PMC8861711] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Predictors from the structured data in the electronic health record (EHR) have previously been used for case-identification in substance misuse. We aim to examine the added benefit from census-tract data, a proxy for socioeconomic status, to improve identification. A cohort of 186,611 hospitalizations was derived between 2007 and 2017. Reference labels included alcohol misuse only, opioid misuse only, and both alcohol and opioid misuse. Baseline models were created using 24 EHR variables, and enhanced models were created with the addition of 48 census-tract variables from the United States American Community Survey. The absolute net reclassification index (NRI) was applied to measure the benefit in adding census-tract variables to baseline models. The baseline models already had good calibration and discrimination. Adding census-tract variables provided negligible improvement to sensitivity and specificity and NRI was less than 1% across substance groups. Our results show the census-tract added minimal value to prediction models.
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Affiliation(s)
- Daniel To
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Cara Joyce
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Sujay Kulshrestha
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Brihat Sharma
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Dmitry Dligach
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
- Department of Computer Science, Loyola University Chicago, Chicago, IL
| | - Matthew Churpek
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Majid Afshar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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28
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Uprichard SL, O’Brien A, Evdokimova M, Rowe CL, Joyce C, Hackbart M, Cruz-Pulido YE, Cohen CA, Rock ML, Dye JM, Kuehnert P, Ricks KM, Casper M, Linhart L, Anderson K, Kirk L, Maggiore JA, Herbert AS, Clark NM, Reid GE, Baker SC. Antibody Response to SARS-CoV-2 Infection and Vaccination in COVID-19-naïve and Experienced Individuals. Viruses 2022; 14:370. [PMID: 35215962 PMCID: PMC8878640 DOI: 10.3390/v14020370] [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: 01/07/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/25/2022] Open
Abstract
Understanding the magnitude of responses to vaccination during the ongoing SARS-CoV-2 pandemic is essential for ultimate mitigation of the disease. Here, we describe a cohort of 102 subjects (70 COVID-19-naïve, 32 COVID-19-experienced) who received two doses of one of the mRNA vaccines (BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)). We document that a single exposure to antigen via infection or vaccination induces a variable antibody response which is affected by age, gender, race, and co-morbidities. In response to a second antigen dose, both COVID-19-naïve and experienced subjects exhibited elevated levels of anti-spike and SARS-CoV-2 neutralizing activity; however, COVID-19-experienced individuals achieved higher antibody levels and neutralization activity as a group. The COVID-19-experienced subjects exhibited no significant increase in antibody or neutralization titer in response to the second vaccine dose (i.e., third antigen exposure). Finally, we found that COVID-19-naïve individuals who received the Moderna vaccine exhibited a more robust boost response to the second vaccine dose (p = 0.004) as compared to the response to Pfizer-BioNTech. Ongoing studies with this cohort will continue to contribute to our understanding of the range and durability of responses to SARS-CoV-2 mRNA vaccines.
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Affiliation(s)
- Susan L. Uprichard
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Amornrat O’Brien
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
| | - Monika Evdokimova
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
| | - Cynthia L. Rowe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
| | - Cara Joyce
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA;
| | - Matthew Hackbart
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
| | - Yazmin E. Cruz-Pulido
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
| | - Courtney A. Cohen
- Viral Immunology Branch, Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (C.A.C.); (M.L.R.); (J.M.D.); (A.S.H.)
- The Geneva Foundation, Tacoma, WA 98042, USA
| | - Michelle L. Rock
- Viral Immunology Branch, Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (C.A.C.); (M.L.R.); (J.M.D.); (A.S.H.)
- The Geneva Foundation, Tacoma, WA 98042, USA
| | - John M. Dye
- Viral Immunology Branch, Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (C.A.C.); (M.L.R.); (J.M.D.); (A.S.H.)
| | - Paul Kuehnert
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, MD 21702, USA; (P.K.); (K.M.R.)
| | - Keersten M. Ricks
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, MD 21702, USA; (P.K.); (K.M.R.)
| | - Marybeth Casper
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
| | - Lori Linhart
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
| | - Katrina Anderson
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
| | - Laura Kirk
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
| | - Jack A. Maggiore
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA;
| | - Andrew S. Herbert
- Viral Immunology Branch, Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (C.A.C.); (M.L.R.); (J.M.D.); (A.S.H.)
| | - Nina M. Clark
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Gail E. Reid
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (M.C.); (L.L.); (K.A.); (L.K.); (N.M.C.); (G.E.R.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Susan C. Baker
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; (A.O.); (M.E.); (C.L.R.); (M.H.); (Y.E.C.-P.); (S.C.B.)
- Infectious Disease and Immunology Research Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
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Nguyen B, Aulivola B, Joyce C, Schneck MJ. Abstract TP83: Benefit Of Multimodal Intraoperative Neuromonitoring Techniques During Carotid Procedures. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Carotid intervention is done for reduction of stroke risk. Intraoperative neuromonitoring (IOM), including electroencephalography (EEG), somatosensory evoked potential (SSEP), and cerebral oximetry/near-infrared spectroscopy (NIRS) may be used to guide operative decision-making and minimize the risk of perioperative complications. The utility of combining IOM methods is unclear. Therefore, we sought to investigate the value of multimodal IOM for carotid interventions.
Methods:
A retrospective review of all patients undergoing carotid intervention from January 1, 2012 to December 31, 2019 at a single academic medical center was done. Patients with acute stroke undergoing catheter directed thrombectomy were excluded. Data collected included: patient demographics, IOM parameters, surgical intervention with endpoints of 30-day post-operative complications. Surrogate end-points of IOM change and intraoperative hemodynamic interventions were also assessed. Efficacy and diagnostic value of each IOM modality alone, and in combination, were assessed using multivariable logistic regression.
Results:
409 carotid interventions in 311 patients meeting inclusion criteria were identified. Patients were 63.3% male, 36.7% female, 83.4% white, 7.1% Hispanic, and 5.9% other. 162(39.6%) interventions were performed for ipsilateral symptoms including 111(27.1%) ipsilateral stroke, 91(22.3%) TIA. Use of a single versus multiple IOM modalities was not associated with a reduction in post-operative neurologic events. Changes in SSEP demonstrated a 2.97 odds ratio for predicting neurologic adverse events (AE), though this was not statistically significant.
Conclusion:
IOM changes were associated with an increase in AEs but IOM impact on intraoperative changes in surgical plans were infrequent. It is unclear whether IOM had a significant impact on procedural modifications though this may reflect an underpowered sample size. The low impact of IOM on outcome raises the question of cost-effectiveness of these techniques in reducing intraoperative complications from carotid procedures.
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Han JJ, Desai S, Li SJ, Lee KJ, Mita C, Joyce C, Mostaghimi A. Placebo group regrowth rate in alopecia areata clinical trials: A systematic review and meta-analysis. J Am Acad Dermatol 2021; 87:389-390. [PMID: 34902493 DOI: 10.1016/j.jaad.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jane J Han
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; School of Medicine, Tufts University, Boston, Massachusetts
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; School of Medicine, Tufts University, Boston, Massachusetts
| | - Karen J Lee
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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31
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Strotman P, Reif T, Cahill C, Joyce C, Nystrom LM. Local Infiltrative Analgesia is Equivalent to Fascia Iliaca Block for Perioperative Pain Management for Prophylactic Cephalomedullary Nail Fixation. Iowa Orthop J 2021; 41:12-18. [PMID: 34924865 PMCID: PMC8662925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Impending pathologic fractures of the femur due to metastatic bone disease are treated with prophylactic internal fixation to prevent fracture, maintain independence, and improve quality of life. There is limited data to support an optimal perioperative pain regimen. METHODS A proof of concept comparative cohort analysis was performed: 21 patients who received a preoperative fascia iliacus nerve block (FIB) were analyzed retrospectively while 9 patients treated with local infiltrative analgesia (LIA) were analyzed prospectively. Primary outcomes included: visual analog scale (VAS) pain scores, narcotic requirements and hospital length of stay. Patient cohorts were compared via two-sample t-tests and Fischer's exact tests. Differences in VAS pain scores, length of stay and morphine milligram equivalents (MME) were assessed with Wilcoxon rank sum. RESULTS The LIA group had more patients treated with preoperative narcotics (p=0.042). There were no significant differences between the FIB and LIA groups in MME utilized intraoperatively (30.0 vs 37.5, p=0.79), on POD 0 (38.0 vs 30.0, p=0.93), POD 1 (46.0 vs 55.5, p=0.95) or POD 2 (40.0 vs 60.0 p=0.73). There were no significant differences in analog pain scale at any time point or in hospital length of stay (78 vs 102 hours, p=0.86). CONCLUSION Despite an increased number of patients being on preoperative narcotics in the LIA group, use of LIA compared with FIB is not associated with an increase in VAS pain scores, morphine milligram equivalents (MME), or length of hospital stay in patients undergoing prophylactic internal fixation of impending pathologic femur fractures.Level of Evidence: III.
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Affiliation(s)
- Patrick Strotman
- Department of Orthopedic Surgery, DuPage Medical Group, Elmhurst, IL, USA
| | - Taylor Reif
- Department of Orthopedic Surgery, Hospitals for Special Surgery, New York, NY, USA
| | - Cathleen Cahill
- Department of Orthopedic Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Cara Joyce
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Lukas M. Nystrom
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Muir C, Michel A, Joyce C, Nguyen T. Assessment of Interpretation Modality and Patient Comprehension in Spanish-speaking Limited English Proficiency (LEP) Patients Presenting to the Emergency Department. J Health Care Poor Underserved 2021; 32:2143-2153. [PMID: 34803064 DOI: 10.1353/hpu.2021.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Provider-patient language discrepancies with limited English proficiency (LEP) patients can lead to misunderstandings about diagnoses and follow-up care. OBJECTIVES To assess interpretation modalities used in the emergency department (ED) in terms of patient satisfaction and understanding of discharge diagnosis. METHODS Spanish-speaking LEP patients completed a survey assessing overall satisfaction and discharge diagnosis comprehension. Modalities included in-person (interpreter or physician/nurse), remote (phone or video), or combination. Differences in proportions with correctly identified diagnoses were compared by modality using Fisher's exact test. RESULTS Patients preferred a Spanish-speaking staff member (52%) or in-person interpreter (33%) over other modalities. Almost 74% of surveyed patients accurately described their discharge diagnosis. Diagnostic accuracy was increased among patients using remote modalities alone compared with in-person alone or combination (p=.02). CONCLUSION Taking into account patient preferences and diagnostic accuracy, this study suggests the utility of having different interpreter modalities available for Spanish-speaking LEP ED patients.
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Edwards T, Banyard H, Pigott B, Haff G, Joyce C. Sprint acceleration profiles of junior Australian football players: Intra-individual determinants of performance. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tadokoro K, Wolf C, Toth J, Joyce C, Singh M, Germanwala A, Patel C. Ki-67/MIB-1 and Recurrence in Pituitary Adenoma. J Neurol Surg B Skull Base 2021; 83:e580-e590. [DOI: 10.1055/s-0041-1735874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objectives Ki-67/MIB-1 is a marker of cellular proliferation used as a pathological parameter in the clinical assessment of pituitary adenomas, where its expression has shown utility in predicting the invasiveness of these tumors. However, studies have shown variable results when using Ki-67/MIB-1 association with recurrence. The purpose of this study is to determine if a high Ki-67/MIB-1 labeling index (LI) is predictive of recurrence in pituitary adenomas.
Methods A retrospective chart review was performed for patients undergoing pituitary adenoma resection with at least 1 year of follow-up. Additionally, systematic data searches were performed and included studies that correlated recurrence rate to Ki-67/MIB-1 LI. Our institutional data were included in a synthesis with previously published data.
Results Our institutional review included 79 patients with a recurrence rate of 26.6%. We found that 8.8% of our patients had a high Ki-67/MIB-1 LI (>3%); however, high Ki-67/MIB-1 was not associated with recurrence. The systematic review identified 244 articles and 49 full-text articles that were assessed for eligibility. Quantitative analysis was performed on 30 articles including our institutional data and 18 studies reported recurrence by level of Ki-67/MIB-1 LI. Among studies that compared Ki-67/MIB-1 ≥3 vs. <3%, 10 studies reported odds ratios (OR) greater than 1 of which 6 were statistically significant. A high Ki-67/MIB-1 had higher odds of recurrence via the pooled odds ratio (OR = 4.15, 95% confidence interval [CI]: 2.31–7.42).
Conclusion This systematic review suggests that a high Ki-67/MIB-1 should prompt an increased duration of follow-up due to the higher odds of recurrence of pituitary adenoma.
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Affiliation(s)
- Kent Tadokoro
- Department of Otolaryngology—Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois United States
| | - Colten Wolf
- Department of Otolaryngology—Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois United States
| | - Joseph Toth
- State University of New York Upstate Medical University, Syracuse, New York, United States
| | - Cara Joyce
- Department of Biostatistics, Loyola University Stritch School of Medicine, Maywood, Illinois, United States
| | - Meharvan Singh
- Department of Cell and Molecular Physiology, Loyola University Chicago, Chicago, Illinois United States
| | - Anand Germanwala
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Chirag Patel
- Department of Otolaryngology—Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois United States
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Abstract
Importance Perceived stigma among patients with alopecia is associated with impaired quality of life; however, the magnitude of laypersons' stigma toward individuals with alopecia is unknown. Objective To determine the prevalence and magnitude of laypersons' stigma toward individuals with varying degrees of alopecia and whether stigma increases with increased severity of alopecia. Design, Setting, and Participants This was a cross-sectional study using an internet survey administered to a convenience sample of adult respondents in the US participating on the Amazon Mechanical Turk platform. Portrait images of 6 individuals without hair loss were created using artificial intelligence and stock images. Each portrait was edited to create 2 additional versions, 1 with scalp hair loss and 1 with complete hair loss, for a total of 18 images. On January 9 to 10, 2020, the survey presented each internet respondent with 1 randomly selected portrait to be used in answering a series of stigma-related questions from 3 domains: stereotypes, social distance, and disease-related myths; the third domain was presented only to respondents who believed that the individual pictured had a medical condition. Main Outcomes and Measures The main outcome was the prevalence and magnitude of stigma of laypersons toward individuals with alopecia and the percentage of laypersons who believed the individual pictured had a medical condition as recorded in survey responses. Results The survey was completed by 2015 respondents (99.9% completion rate) with a mean age of 37 (range, 18-78) years; 1014 (50.3%) were men; 1596 (79.2%) were White; and 1397 (69.3%) had a college or postcollege education. Endorsement of every stigma item increased as alopecia severity increased (2.4%-27.6%). Absolute change on the stereotype (0.5-0.6) and social distance scales (0.2-0.5) also increased, indicating more stigma. The percentage of respondents believing the individual pictured had a medical condition increased as alopecia severity increased (33.6%-75.7%; P < .001). Among the subgroup of respondents who were asked to rate their agreement with disease-related myths, the absolute change on the myth scale decreased as alopecia severity increased, indicating decreased stigma (-0.7 to -1.2). Conclusions and Relevance This cross-sectional survey study found that stigmatizing attitudes of laypersons toward patients with alopecia exist across a multitude of social and professional scenarios. Stigma prevalence and magnitude vary by alopecia severity and possibly by whether alopecia is believed to be a medical condition.
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Affiliation(s)
- Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Chicago, Illinois
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Associate Editor, JAMA Dermatology
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Creadore A, Desai S, Li SJ, Lee KJ, Bui ATN, Villa-Ruiz C, Lo K, Zhou G, Joyce C, Resneck JS, Seiger K, Mostaghimi A. Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US. JAMA Dermatol 2021; 157:181-188. [PMID: 33439219 DOI: 10.1001/jamadermatol.2020.5173] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity (PE) investment and increased use of nonphysician clinicians (NPCs). Objective To determine appointment success and wait times for patients with various insurance types at clinics with and without PE ownership. Design, Setting, and Participants In this study, PE-owned US clinics were randomly selected and matched with 2 geographically proximate clinics without PE ownership. Researchers called each clinic 3 times over a 5-day period to assess appointment/clinician availability for a fictitious patient with a new and changing mole. The 3 calls differed by insurance type specified, which were Blue Cross Blue Shield (BCBS) preferred provider organization, Medicare, or Medicaid. Main Outcomes and Measures Appointment success and wait times among insurance types and between PE-owned clinics and control clinics. Secondary outcomes were the provision of accurate referrals to other clinics when appointments were denied and clinician and next-day appointment availability. Results A total of 1833 calls were made to 204 PE-owned and 407 control clinics without PE ownership across 28 states. Overall appointment success rates for BCBS, Medicare, and Medicaid were 96%, 94%, and 17%, respectively. Acceptance of BCBS (98.5%; 95% CI, 96%-99%; P = .03) and Medicare (97.5%; 95% CI, 94%-99%; P = .02) were slightly higher at PE-owned clinics (compared with 94.6% [95% CI, 92%-96%] and 92.8% [95% CI, 90%-95%], respectively, at control clinics). Wait times (median days, interquartile range [IQR]) were similar for patients with BCBS (7 days; IQR, 2-22 days) and Medicare (7 days; IQR, 2-25 days; P > .99), whereas Medicaid patients waited significantly longer (13 days; IQR, 4-33 days; P = .002). Clinic ownership did not significantly affect wait times. Private equity-owned clinics were more likely than controls to offer a new patient appointment with an NPC (80% vs 63%; P = .001) and to not have an opening with a dermatologist (16% vs 6%; P < .001). Next-day appointment availability was greater at PE-owned clinics than controls (30% vs 21%; P = .001). Conclusions and Relevance Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership. Although the use of dermatologists and NPCs was similar regardless of clinic ownership, PE-owned clinics were more likely than controls to offer new patient appointments with NPCs.
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Affiliation(s)
- Andrew Creadore
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sheena Desai
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Sara J Li
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Karen J Lee
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Ai-Tram N Bui
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Camila Villa-Ruiz
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kelly Lo
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Chicago, Illinois
| | - Jack S Resneck
- Department of Dermatology, University of California School of Medicine, San Francisco
| | - Kira Seiger
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Brigham and Women's Hospital, Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Maureen Sheean P, Robinson P, Bartolotta MB, Joyce C, Adams W, Penckofer S. Associations Between Cholecalciferol Supplementation and Self-Reported Symptoms Among Women With Metastatic Breast Cancer and Vitamin D Deficiency: A Pilot Study. Oncol Nurs Forum 2021; 48:352-360. [PMID: 33856003 DOI: 10.1188/21.onf.352-360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the potential effect of cholecalciferol supplementation to reduce symptom burden for women with metastatic breast cancer (MBC). SAMPLE & SETTING 11 clinically stable women with estrogen receptor-positive MBC were recruited from a single cancer center for this phase 1, nonrandomized study (NCT02186015). METHODS & VARIABLES Women with insufficient serum 25-hydroxyvitamin D (25[OH]D) levels qualified to receive high-dose repletion therapy. Clinical and questionnaire data on common symptoms and quality of life were obtained prior to and following supplementation. RESULTS Serum 25(OH)D increased significantly pre- versus postintervention. Trends for improvements in endocrine symptoms, bone pain, and fatigue were observed following the intervention. IMPLICATIONS FOR NURSING Women achieved normal serum 25(OH)D levels after eight weeks of supplementation and reported reduced symptom burden. Vitamin D may be a low-cost supportive care therapy; however, future studies should be considered.
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Kwak R, Joyce C, Werchniak AE, Lin JY, Tsibris HC. Clinical and histologic features associated with lentigo maligna clearance after imiquimod treatment. J DERMATOL TREAT 2021; 33:1995-1999. [PMID: 34315342 DOI: 10.1080/09546634.2021.1962001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imiquimod cream may be used as a non-surgical treatment for lentigo maligna or as adjuvant therapy following excision to decrease the risk of recurrence. OBJECTIVES To evaluate histologic and clinical factors associated with clinical clearance of lentigo maligna treated with imiquimod. METHODS We performed a retrospective review of all patients diagnosed with lentigo maligna and treated with imiquimod between 1997 and 2019 at our academic institution. RESULTS We observed clinical clearance in 93% (66/71) of participants who received adjuvant imiquimod following surgery and 79% (19/24) in the primary non-surgical treatment group over a median of 38 months of follow-up. In the adjuvant therapy group, positive surgical margins were associated with a decreased rate of clinical clearance when compared to cases with close (<1 mm) margins or background melanocytic dysplasia (83.3 vs. 100%, p = .01). The presence of an inflammatory response during treatment was associated with increased clearance (94.1 vs. 66.7%, p = .02). CONCLUSIONS Adjuvant imiquimod treatment may decrease LM recurrence rates in cases with background melanocytic dysplasia or close margins. LM cases with positive surgical margins need close clinical follow-up given higher recurrence rates.
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Affiliation(s)
- R Kwak
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - C Joyce
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | | | - J Y Lin
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H C Tsibris
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Madsen N, Joyce C, Vlasses F, Burkhart L. Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population. J Interprof Care 2021; 36:500-508. [PMID: 34353211 DOI: 10.1080/13561820.2021.1941816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care-coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.
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Affiliation(s)
- Nancy Madsen
- School of Nursing/DeKalb, Northern Illinois University, US
| | - Cara Joyce
- Health Informatics and Data Science Parkinson School of Health Sciences and Public Health Maywood, Illinois, US
| | - Frances Vlasses
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US
| | - Lisa Burkhart
- Marcella Niehoff School of Nursing, Loyola University Chicago, Illinois, US.,Research Health Scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Junior VA Hospital, Hines, IL, US
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40
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Sink J, Joyce C, Wilber D. ISOLATED CARDIAC SARCOIDOSIS: A SINGLE CENTER REVIEW OF CLINICAL MANIFESTATIONS AND OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burkhart L, Coglianese M, Kaelin J, Moorhead S, Joyce C. Communicating Spiritual Care in the Electronic Health Record. Comput Inform Nurs 2021; 39:538-546. [PMID: 34623338 DOI: 10.1097/cin.0000000000000707] [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
Chaplains must document their ministry of care in electronic health records that primarily focus on the physical dimension of care. Creating chaplain documentation that reflects the spiritual dimension of care requires chaplains to participate in the screen design. This article describes how chaplain documentation was designed and refined using psychometric methods. The resulting system successfully supported chaplain workflow, provided an ability to aggregate chaplain workload, and integrated the chaplain into the interprofessional team by structuring, linking, and sharing both the chaplain and nursing assessment of spiritual distress in the electronic health record. Documentation used 5-point Likert scales to measure different dimensions of patient spirituality. Reliability and validity were further evaluated as part of a workshop at an Association of Professional Chaplains annual meeting. Findings supported interrater reliability and the ability to predict and discriminate change pre and post encounter. Documentation screen content is presented.
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Affiliation(s)
- Lisa Burkhart
- Author Affiliations : Marcella Niehoff School of Nursing, Loyola University Chicago (Dr Burkhart); Parkinson School of Health Sciences and Public Health, Loyola University Chicago (Dr Joyce); Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital (Dr Burkhart); and Loyola University Medical Center, Maywood (Ms Coglianese and Mr Kaelin), IL; and College of Nursing, University of Iowa (Dr Moorhead)
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Knott K, Toslak IE, Siddique F, Joyce C, Shah R, Lomasney L. Radiographic evaluation of reactive osteitis in traumatic injury of sacroiliac joints. Clin Imaging 2021; 76:175-179. [PMID: 33957383 DOI: 10.1016/j.clinimag.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 12/31/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES After traumatic Sacroiliac (SI) joint injury, follow up radiographic imaging can demonstrate subchondral bone resorption resembling inflammatory sacroiliitis. No studies have described the incidence of marginal SI post-traumatic osteitis, the probable temporal relationship to the initial traumatic injury, or the possible effect of unilateral hardware fixation on the contralateral SI joint. METHODS A Level 1 trauma center imaging database was queried to identify patients with pelvic bony trauma between 2005 and 2017 with CT baseline preserved SI cortication and unilateral/bilateral traumatic SI diastasis. Serial radiographs were retrospectively evaluated by 2 musculoskeletal-trained radiologists at initial, 6 weeks, 3 months and 6 months following trauma, with documentation of diastasis, subchondral resorption, and operative fixation. RESULTS 206 SI joints in 106 total patients met inclusion criteria. There was a statistically significant association between injury and presence of resorption at 6 weeks post-trauma for the right SI joint only. There was no other statistically significant relationship between injury and presence of resorption at any other post-trauma evaluation. There was no statistical relationship between resorption and surgical fixation. There was a statistically significant increased incidence of resorption in the post-traumatic population when compared to an atraumatic population undergoing CT pelvis study for non-SI related indications as well as compared to the incidence of inflammatory sacroiliitis in a general population. CONCLUSIONS This study confirms an incidence of sub-acute subchondral bone resorption following traumatic joint injury above that expected for a general, non-traumatic population. Accurate interpretation of this traumatic finding minimizes inappropriate consultation and intervention for inflammatory sacroiliitis.
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Affiliation(s)
- Kemp Knott
- Department of Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston, TX 77030, United States of America
| | - Iclal Erdem Toslak
- Department of Radiology, Antalya Training and Research Hospital, Varlik Mahallesi Kazim Karabekir Cd., 07100 Antalya, Turkey
| | - Faizah Siddique
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Cara Joyce
- Clinical Research Office, Loyola University Chicago Health Sciences Division, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States of America
| | - Ricki Shah
- United Imaging Consultants, 5800 Foxridge Dr, Mission, KS 66202, United States of America
| | - Laurie Lomasney
- Departments of Radiology and Orthopaedic Surgery and Rehabilitation, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States of America.
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Small W, Kim YS, Joyce C, Surucu M, Leshyk M, Harkenrider MM, Potkul RK, Liotta M, Winder A, Altoos B. Uterine perforation during brachytherapy for cervical cancer: Complications, outcomes, and best practices for forward treatment planning and management. Brachytherapy 2021; 20:557-564. [PMID: 33741275 DOI: 10.1016/j.brachy.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to determine the incidence of uterine perforations, review the associated complications, and propose guidelines for management of perforations after brachytherapy. METHODS AND MATERIALS A retrospective chart review was conducted for all patients with cervical cancer who received single or multiple high-dose-rate brachytherapy implants between April 2006 and May 2017 at a single academic institution. CT and MRI images were retrospectively evaluated to record incidences of uterine perforation of tandem during brachytherapy. Acute and long-term complications during and after treatment were scored using the Common Terminology Criteria for Adverse Events, Version 4.0, of the National Cancer Institute. RESULTS A total of 123 patients were included in the study. Perforations were observed in 22 patients (17.9%) with 31 (6.4%) of the 482 total implants. Of the different categories of adverse events, only the rate of acute infectious complications among those with perforations (n = 3, 13.6%) versus those without perforations (n = 3, 3.0%) was significant (p = 0.040). Two of the three perforated patients with acute infections had mild urinary tract infections, and all resolved without complications or treatment delays. The remaining one patient had a frank perforation of the anterior uterine wall with a subsequent Grade 3 pyometra infection despite administration of prophylactic antibiotics and 1-week treatment delay. This case was eventually resolved with cervical dilation and evacuation of fluid. Long-term complications were not different between the two arms. CONCLUSIONS Patients with cervical cancer with uterine perforations may be able to safely proceed with brachytherapy treatment without delay or need for prophylactic antibiotics in the acute setting. Further validating data would be able to assist in establishing a new standard of care and help prevent unnecessary and harmful breaks during treatment.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL.
| | - Yo Sup Kim
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Cara Joyce
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Mark Leshyk
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
| | - Ronald K Potkul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Margaret Liotta
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Abigail Winder
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Basel Altoos
- Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL
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Kulshrestha S, Dligach D, Joyce C, Gonzalez R, O'Rourke AP, Glazer JM, Stey A, Kruser JM, Churpek MM, Afshar M. Comparison and interpretability of machine learning models to predict severity of chest injury. JAMIA Open 2021; 4:ooab015. [PMID: 33709067 PMCID: PMC7935500 DOI: 10.1093/jamiaopen/ooab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Trauma quality improvement programs and registries improve care and outcomes for injured patients. Designated trauma centers calculate injury scores using dedicated trauma registrars; however, many injuries arrive at nontrauma centers, leaving a substantial amount of data uncaptured. We propose automated methods to identify severe chest injury using machine learning (ML) and natural language processing (NLP) methods from the electronic health record (EHR) for quality reporting. Materials and Methods A level I trauma center was queried for patients presenting after injury between 2014 and 2018. Prediction modeling was performed to classify severe chest injury using a reference dataset labeled by certified registrars. Clinical documents from trauma encounters were processed into concept unique identifiers for inputs to ML models: logistic regression with elastic net (EN) regularization, extreme gradient boosted (XGB) machines, and convolutional neural networks (CNN). The optimal model was identified by examining predictive and face validity metrics using global explanations. Results Of 8952 encounters, 542 (6.1%) had a severe chest injury. CNN and EN had the highest discrimination, with an area under the receiver operating characteristic curve of 0.93 and calibration slopes between 0.88 and 0.97. CNN had better performance across risk thresholds with fewer discordant cases. Examination of global explanations demonstrated the CNN model had better face validity, with top features including “contusion of lung” and “hemopneumothorax.” Discussion The CNN model featured optimal discrimination, calibration, and clinically relevant features selected. Conclusion NLP and ML methods to populate trauma registries for quality analyses are feasible.
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Affiliation(s)
- Sujay Kulshrestha
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois, USA.,Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Dmitriy Dligach
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.,Department of Computer Science, Loyola University Chicago, Chicago, Illinois, USA
| | - Cara Joyce
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Richard Gonzalez
- Burn and Shock Trauma Research Institute, Loyola University Chicago, Maywood, Illinois, USA.,Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Joshua M Glazer
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Anne Stey
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | | | - Matthew M Churpek
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Majid Afshar
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Wang H, Hou W, Perera A, Bettler C, Beach JR, Ding X, Li J, Denning MF, Dhanarajan A, Cotler SJ, Joyce C, Yin J, Ahmed F, Roberts LR, Qiu W. Targeting EphA2 suppresses hepatocellular carcinoma initiation and progression by dual inhibition of JAK1/STAT3 and AKT signaling. Cell Rep 2021; 34:108765. [PMID: 33626345 PMCID: PMC7954228 DOI: 10.1016/j.celrep.2021.108765] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/11/2020] [Revised: 12/07/2020] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains one of the deadliest malignancies worldwide. One major obstacle to treatment is a lack of effective molecular-targeted therapies. In this study, we find that EphA2 expression and signaling are enriched in human HCC and associated with poor prognosis. Loss of EphA2 suppresses the initiation and growth of HCC both in vitro and in vivo. Furthermore, CRISPR/CAS9-mediated EphA2 inhibition significantly delays tumor development in a genetically engineered murine model of HCC. Mechanistically, we discover that targeting EphA2 suppresses both AKT and JAK1/STAT3 signaling, two separate oncogenic pathways in HCC. We also identify a small molecule kinase inhibitor of EphA2 that suppresses tumor progression in a murine HCC model. Together, our results suggest EphA2 as a promising therapeutic target for HCC.
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MESH Headings
- Animals
- Antineoplastic Agents/pharmacology
- Benzamides/pharmacology
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/enzymology
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/pathology
- Cell Line, Tumor
- Databases, Genetic
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Janus Kinase 1/genetics
- Janus Kinase 1/metabolism
- Liver Neoplasms/drug therapy
- Liver Neoplasms/enzymology
- Liver Neoplasms/genetics
- Liver Neoplasms/pathology
- Male
- Mice, Inbred C57BL
- Molecular Targeted Therapy
- Niacinamide/analogs & derivatives
- Niacinamide/pharmacology
- Phosphorylation
- Proto-Oncogene Proteins c-akt/metabolism
- Receptor, EphA2/antagonists & inhibitors
- Receptor, EphA2/genetics
- Receptor, EphA2/metabolism
- Retrospective Studies
- STAT3 Transcription Factor/genetics
- STAT3 Transcription Factor/metabolism
- Signal Transduction
- Tumor Burden/drug effects
- Xenograft Model Antitumor Assays
- Mice
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Affiliation(s)
- Hao Wang
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Wei Hou
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Aldeb Perera
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Carlee Bettler
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Jordan R Beach
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Xianzhong Ding
- Department of Pathology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Jun Li
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Mitchell F Denning
- Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Asha Dhanarajan
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Scott J Cotler
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Jun Yin
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fowsiyo Ahmed
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Wei Qiu
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA; Department of Cancer Biology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
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Elman SA, Joyce C, Braudis K, Chong BF, Fernandez AP, Furukawa F, Hasegawa M, Kim HJ, Li SJ, Lian CG, Szepietowski JC, Werth VP, Merola JF. Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus. JAMA Dermatol 2021; 156:901-906. [PMID: 32584927 DOI: 10.1001/jamadermatol.2020.1698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Classification criteria are the standardized definitions that are used to enroll uniform cohorts for research studies. They emphasize high specificity and are distinct from diagnostic criteria. No universally recognized classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in observational and interventional clinical studies across the field. Objective To create and validate classification criteria for DLE using 12 previously defined candidate criteria items. Design, Setting, and Participants For this diagnostic study, candidate criteria items were prospectively applied by dermatologists and dermatopathologists at clinical visits of patients with DLE or a condition that could be confused for DLE, termed a DLE mimicker, at academic dermatology practices across the United States, Poland, Japan, and South Korea. Data were collected from December 1, 2017, to February 1, 2019, and analyzed from March 1 to September 19, 2019. Main Outcomes and Measures Clinical features among these 2 groups were calculated and compared with χ2 or Fisher exact tests. Candidate models were identified using best subsets logistic regression analysis. Improvement tests, fit statistics, and discrimination were considered to choose a final model. Results Nine sites contributed 215 patients, 15 of whom had missing or incomplete data. The final model for DLE classification criteria includes only clinical variables: atrophic scarring (3 points), location in the conchal bowl (2 points), preference for the head and neck (2 points), dyspigmentation (1 point), follicular hyperkeratosis and/or plugging (1 point), and erythematous to violaceous in color (1 point), with an area under the receiving operating characteristic curve of 0.91 (95% CI, 0.87-0.95). A score of at least 5 points yields a sensitivity of 84.1% and a specificity of 75.9% in the classification of DLE, with increasing scores yielding higher specificity. Conclusions and Relevance These findings provide the initial validation of classification criteria for DLE for use in observational and clinical trials.
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Affiliation(s)
- Scott A Elman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cara Joyce
- Department of Public Health Sciences, Loyola University, Chicago, Illinois
| | - Kara Braudis
- Department of Dermatology, University of Missouri, Columbia
| | - Benjamin F Chong
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
| | | | - Fukumi Furukawa
- Department of Dermatology, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Minoru Hasegawa
- Division of Medicine, Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hee Joo Kim
- Department of Dermatology, Gachon Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Sara J Li
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine G Lian
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, University of Medicine, Wroclaw, Poland
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kulshrestha S, Dligach D, Joyce C, Baker MS, Gonzalez R, O’Rourke AP, Glazer JM, Stey A, Kruser JM, Churpek MM, Afshar M. Prediction of severe chest injury using natural language processing from the electronic health record. Injury 2021; 52:205-212. [PMID: 33131794 PMCID: PMC7856032 DOI: 10.1016/j.injury.2020.10.094] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/23/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma injury severity scores are currently calculated retrospectively from the electronic health record (EHR) using manual annotation by certified trauma coders. Natural language processing (NLP) of clinical documents in the EHR may enable automated injury scoring. We hypothesize that NLP with machine learning can discriminate between cases of severe and non-severe injury to the thorax after trauma. METHODS Clinical documents from a trauma center were examined between 2014 and 2018. Severe chest injury was defined as a thorax abbreviated injury score (AIS) >2 and served as the reference standard for supervised learning. Free text unigrams and concept unique identifiers (CUIs) from the Unified Medical Language Systems (UMLS) were extracted from clinical documents collected at one hour, four hours, and eight hours after patient arrival to the emergency department. Logistic regression models with elastic net regularization were tuned to maximize area under the receiver operating characteristic curve (AUROC) using 10-fold cross-validation on the training dataset (80%) and tested on a hold-out 20% dataset. RESULTS There were 6,891 traumas that met inclusion criteria. The complete data corpus consisted of 473,694 documents. Models trained using the first hour of data had a mean AUROC of 0.88 (95%CI [0.86, 0.89]); model discrimination and reclassification from the first hour significantly improved after eight hours with a mean AUROC of 0.94 (95%CI [0.93, 0.95]). Performance of models using CUIs were similar to unigrams (p>0.05). Models demonstrated excellent clinical face validity. CONCLUSIONS Both CUIs and unigrams demonstrated excellent discrimination in predicting severity of chest injury using the first eight hours of clinical documents. Our model demonstrates that automated anatomical injury scoring is feasible and may be used for aggregation of data for trauma research and quality programs.
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Affiliation(s)
- Sujay Kulshrestha
- Burn and Shock Trauma Research Institute, Loyola University Chicago, CTRE Building 115, Room 315, 2160 South 1st Avenue, Maywood, IL, USA,Department of Surgery, Loyola University Medical Center, EMS Building 110, Room 3210, 2160 South 1st Avenue, Maywood, IL, USA
| | - Dmitriy Dligach
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, CTRE Building 115, Room 126, 2160 South 1st Avenue, Maywood, IL, USA,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL, USA,Department of Computer Science, Loyola University Chicago, 1052 West Loyola Avenue, Chicago, IL, USA
| | - Cara Joyce
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, CTRE Building 115, Room 126, 2160 South 1st Avenue, Maywood, IL, USA,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, 2160 South 1st Avenue, Maywood, IL, USA
| | - Marshall S. Baker
- Department of Surgery, Loyola University Medical Center, EMS Building 110, Room 3210, 2160 South 1st Avenue, Maywood, IL, USA,Edward Hines Jr. Veterans Affairs Hospital, 5000 South Fifth Avenue, Hines, IL, USA
| | - Richard Gonzalez
- Burn and Shock Trauma Research Institute, Loyola University Chicago, CTRE Building 115, Room 315, 2160 South 1st Avenue, Maywood, IL, USA,Department of Surgery, Loyola University Medical Center, EMS Building 110, Room 3210, 2160 South 1st Avenue, Maywood, IL, USA
| | - Ann P. O’Rourke
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, MC 3236, Madison, WI, USA
| | - Joshua M. Glazer
- Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Suite 310, MC 9123, Madison, WI, USA
| | - Anne Stey
- Division of Trauma and Surgical Critical Care, Department of Surgery, Northwestern University, 76 North St. Clair Street, Suite 650, Chicago, IL, USA
| | - Jacqueline M. Kruser
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University, 633 North St. Clair Street, 20th Floor, McGaw M-335, Chicago, IL, USA,Department of Medical Social Sciences, Northwestern University, 633 North St. Clair Street, 19th Floor, Chicago, IL, USA
| | - Matthew M. Churpek
- Department of Medicine, University of Wisconsin, 8007 Excelsior Drive, Madison, WI, USA
| | - Majid Afshar
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, CTRE Building 115, Room 126, 2160 South 1st Avenue, Maywood, IL, USA,Department of Health Informatics and Data Science, Loyola University Chicago, 2160 South First Avenue, Maywood, IL, USA
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48
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Afshar M, Dligach D, Sharma B, Cai X, Boyda J, Birch S, Valdez D, Zelisko S, Joyce C, Modave F, Price R. Development and application of a high throughput natural language processing architecture to convert all clinical documents in a clinical data warehouse into standardized medical vocabularies. J Am Med Inform Assoc 2021; 26:1364-1369. [PMID: 31145455 DOI: 10.1093/jamia/ocz068] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Natural language processing (NLP) engines such as the clinical Text Analysis and Knowledge Extraction System are a solution for processing notes for research, but optimizing their performance for a clinical data warehouse remains a challenge. We aim to develop a high throughput NLP architecture using the clinical Text Analysis and Knowledge Extraction System and present a predictive model use case. MATERIALS AND METHODS The CDW was comprised of 1 103 038 patients across 10 years. The architecture was constructed using the Hadoop data repository for source data and 3 large-scale symmetric processing servers for NLP. Each named entity mention in a clinical document was mapped to the Unified Medical Language System concept unique identifier (CUI). RESULTS The NLP architecture processed 83 867 802 clinical documents in 13.33 days and produced 37 721 886 606 CUIs across 8 standardized medical vocabularies. Performance of the architecture exceeded 500 000 documents per hour across 30 parallel instances of the clinical Text Analysis and Knowledge Extraction System including 10 instances dedicated to documents greater than 20 000 bytes. In a use-case example for predicting 30-day hospital readmission, a CUI-based model had similar discrimination to n-grams with an area under the curve receiver operating characteristic of 0.75 (95% CI, 0.74-0.76). DISCUSSION AND CONCLUSION Our health system's high throughput NLP architecture may serve as a benchmark for large-scale clinical research using a CUI-based approach.
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Affiliation(s)
- Majid Afshar
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Dmitriy Dligach
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.,Department of Computer Science, Loyola University, Chicago, Illinois, USA
| | - Brihat Sharma
- Department of Computer Science, Loyola University, Chicago, Illinois, USA
| | - Xiaoyuan Cai
- Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
| | - Jason Boyda
- Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
| | - Steven Birch
- Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
| | - Daniel Valdez
- Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
| | - Suzan Zelisko
- Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
| | - Cara Joyce
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - François Modave
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ron Price
- Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA.,Informatics and Systems Development, Health Sciences Division, Loyola University Chicago, Maywood, Illinois, USA
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Jefferson IS, Robinson SK, Surprenant D, Whittington A, Arshanapalli A, Tung-Hahn E, Joyce C, Moy L, Lee K, O'Brien E, Tung R, Alam M. Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair. Arch Dermatol Res 2021; 313:793-797. [PMID: 33433713 DOI: 10.1007/s00403-020-02181-z] [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: 11/02/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.
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Affiliation(s)
- Itisha S Jefferson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA.
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA.
| | - Shamika Kayo Robinson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - David Surprenant
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Adam Whittington
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Division of Dermatology, Advocate Aurora Health, Fond du Lac, WI, USA
| | - Ashish Arshanapalli
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- United Dermatology Associates, Mansfield, TX, USA
| | - Eleanor Tung-Hahn
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Cara Joyce
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Statistics, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Moy
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Kristin Lee
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Ellie O'Brien
- Northwestern Simulation Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Tung
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Florida Dermatology and Skin Cancer Centers, Winter Haven, FL, USA
| | - Murad Alam
- Departments of Dermatology, Otolaryngology and Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair Suite 1600, Chicago, IL, 60611, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Peacock E, Joyce C, Craig LS, Lenane Z, Holt EW, Muntner P, Krousel-Wood M. Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension. J Hypertens 2021; 39:153-161. [PMID: 32675745 PMCID: PMC7752228 DOI: 10.1097/hjh.0000000000002590] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/06/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to determine the association of low antihypertensive medication adherence with decline in health-related quality of life (HRQOL) over 1 year. METHODS We used data from older men and women with hypertension (n = 1525) enrolled in the Cohort Study of Medication Adherence among Older Adults. Adherence was measured using the validated self-report four-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) (low adherence = score ≥1) and prescription refill-based proportion of days covered (PDC) (low adherence = PDC < 0.80). We defined decline in HRQOL as a decrease in Mental Component Summary (MCS) or Physical Component Summary (PCS) score (from the RAND 36-Item Health Survey 1.0 administered at two time points - at the time of adherence assessment and 1 year later) equivalent to the minimal important difference (MID) for each respective summary score, calculated as the average of MID estimates derived from distribution and anchor-based approaches. RESULTS The prevalence of low adherence was 38.6% using the K-Wood-MAS-4 and 23.9% using PDC. On the basis of mean MID estimates of 4.40 for MCS and 5.16 for PCS, 21.8 and 25.2% of participants experienced a decline in MCS and PCS, respectively, over 1 year. Low adherence was associated with a decline in MCS for K-Wood-MAS-4 [prevalence ratio = 1.32, 95% confidence interval (95% CI) 1.08-1.62, P = 0.008], but not PDC (prevalence ratio = 1.17, 95% CI 0.94-1.47, P = 0.168). Low adherence was not associated with decline in PCS (K-Wood-MAS-4: prevalence ratio = 0.95, 95% CI 0.79-1.16; PDC: prevalence ratio = 1.10, 95% CI 0.90-1.35). CONCLUSION Low self-report medication adherence is associated with decline in mental HRQOL over 1 year in older adults with hypertension.
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Affiliation(s)
- Erin Peacock
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Cara Joyce
- Loyola University Stritch School of Medicine, Chicago, Illinois
| | - Leslie S. Craig
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Zachary Lenane
- San Mateo County Behavioral Health and Recovery Services, San Mateo, California
| | | | - Paul Muntner
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Marie Krousel-Wood
- Tulane University School of Medicine, New Orleans, Louisiana
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Ochsner Health System, New Orleans, Louisiana, USA
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