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Ketkar A, Willey V, Glasser L, Dobie C, Wenziger C, Teng CC, Dube C, Hirpara S, Cunningham D, Verduzco-Gutierrez M. Assessing the Burden and Cost of COVID-19 Across Variants in Commercially Insured Immunocompromised Populations in the United States: Updated Results and Trends from the Ongoing EPOCH-US Study. Adv Ther 2024; 41:1075-1102. [PMID: 38216825 PMCID: PMC10879378 DOI: 10.1007/s12325-023-02754-0] [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: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION/METHODS EPOCH-US is an ongoing, retrospective, observational cohort study among individuals identified in the Healthcare Integrated Research Database (HIRD®) with ≥ 12 months of continuous health plan enrollment. Data were collected for the HIRD population (containing immunocompetent and immunocompromised [IC] individuals), individual IC cohorts (non-mutually exclusive cohorts based on immunocompromising condition and/or immunosuppressive [IS] treatment), and the composite IC population (all unique IC individuals). This study updates previous results with addition of the general population cohort and data specifically for the year of 2022 (i.e., Omicron wave period). To provide healthcare decision-makers the most recent trends, this study reports incidence rates (IR) and severity of first SARS-CoV-2 infection; and relative risk, healthcare utilization, and costs related to first COVID-19 hospitalizations in the full year of 2022 and overall between April 2020 and December 2022. RESULTS These updated results showed a 2.9% prevalence of immune compromise in the population. From April 2020 through December 2022, the overall IR of COVID-19 was 115.7 per 1000 patient-years in the composite IC cohort and 77.8 per 1000 patient-years in the HIRD cohort. The composite IC cohort had a 15.4% hospitalization rate with an average cost of $42,719 for first COVID-19 hospitalization. Comparatively, the HIRD cohort had a 3.7% hospitalization rate with an average cost of $28,848 for first COVID-19 hospitalization. Compared to the general population, IC individuals had 4.3 to 23 times greater risk of hospitalization with first diagnosis of COVID-19. Between January and December 2022, hospitalizations associated with first COVID-19 diagnosis cost over $1 billion, with IC individuals (~ 3% of the population) generating $310 million (31%) of these costs. CONCLUSION While only 2.9% of the population, IC individuals had a higher risk of COVID-19 hospitalization and incurred higher healthcare costs across variants. They also disproportionately accounted for over 30% of total costs for first COVID-19 hospitalization in 2022, amounting to ~ $310 million. These data highlight the need for additional preventive measures to decrease the risk of developing severe COVID-19 outcomes in vulnerable IC populations.
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Affiliation(s)
| | | | - Lisa Glasser
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Casey Dobie
- Xcenda, a Cencora company, Conshohocken, PA, USA
| | | | | | - Christine Dube
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Sunny Hirpara
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
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Ketkar A, Willey V, Pollack M, Glasser L, Dobie C, Wenziger C, Teng CC, Dube C, Cunningham D, Verduzco-Gutierrez M. Assessing the risk and costs of COVID-19 in immunocompromised populations in a large United States commercial insurance health plan: the EPOCH-US Study. Curr Med Res Opin 2023; 39:1103-1118. [PMID: 37431293 DOI: 10.1080/03007995.2023.2233819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To estimate the prevalence of patients with an immunocompromising condition at risk for COVID-19, estimate COVID-19 prevalence rate (PR) and incidence rate (IR) by immunocompromising condition, and describe COVID-19-related healthcare resource utilization (HCRU) and costs. METHODS Using the Healthcare Integrated Research Database (HIRD), patients with ≥1 claim for an immunocompromising condition of interest or ≥2 claims for an immunosuppressive (IS) treatment and COVID-19 diagnosis during the infection period (1 April 2020-31 March 2022) and had ≥12 months baseline data were included. Cohorts (other than the composite cohort) were not mutually exclusive and were defined by each immunocompromising condition. Analyses were descriptive in nature. RESULTS Of the 16,873,161 patients in the source population, 2.7% (n = 458,049) were immunocompromised (IC). The COVID-19 IR for the composite IC cohort during the study period was 101.3 per 1000 person-years and the PR was 13.5%. The highest IR (195.0 per 1000 person-years) and PR (20.1%) were seen in the end-stage renal disease (ESRD) cohort; the lowest IR (68.3 per 1000 person-years) and PR (9.4%) were seen in the hematologic or solid tumor malignancy cohort. Mean costs for hospitalizations associated with the first COVID-19 diagnosis were estimated at nearly $1 billion (2021 United States dollars [USD]) for 14,516 IC patients, with a mean cost of $64,029 per patient. CONCLUSIONS Immunocompromised populations appear to be at substantial risk of severe COVID-19 outcomes, leading to increased costs and HCRU. Effective prophylactic options are still needed for these high-risk populations as the COVID-19 landscape evolves.
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Affiliation(s)
| | | | | | - Lisa Glasser
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
| | | | | | - Chia-Chen Teng
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Christine Dube
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
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Dube C, McCurdy BR, Sacco J, Gao J, Silveira K, Karapetyan T, Niu Y, Tinmouth J. A75 COLONOSCOPY COLORECTAL CANCER DETECTION - HOW DOES IT VARY BY INDICATION, SETTING AND PATIENT DEMOGRAPHIC? J Can Assoc Gastroenterol 2023. [PMCID: PMC9991392 DOI: 10.1093/jcag/gwac036.075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Because of limited access to gastrointestinal (GI) endoscopy during the COVID-19 pandemic, there is a need to prioritize procedures to avoid negative health impacts from delays. Ontario Health (OH) has provided guidance to facilities to prioritize colonoscopies in people with an abnormal fecal immunochemical test (FIT) result, based on the high likelihood to detect invasive colorectal cancer (CRC) and recommends FIT for screening people at average risk of CRC and those with prior low-risk adenoma. Purpose To measure the invasive CRC detection rate (CDR) of colonoscopies performed in Ontario by indication, setting, age, and sex over a 31-month period before and during the COVID-19 pandemic. Method We calculated the CDRs among outpatients ages 18 and over who had colonoscopies performed in a hospital or private clinic setting from June 2019 to December 2021. We identified hospital colonoscopies from OH’s GI Endoscopy Data Submission Portal and clinic colonoscopies from Ontario Health Insurance Plan (OHIP) data (OHIP code E749A). Invasive CRC was identified from the Ontario Cancer Registry (OCR) as: ICD-O-3 codes C18.0, C18.2-C18.9, C19.9, C20.9, a morphology indicative of CRC, microscopically confirmed and with a pathology report. CRCs were included if diagnosed 7 days before and up to 183 days after colonoscopy. Colonoscopy volumes and CDRs were stratified by age and sex (all volumes), and, for hospital colonoscopies, by indication. Result(s) During the study period, 984,109 colonoscopies were performed (638,900 in hospitals; 345,209 in clinics). Patients who had their colonoscopies in clinics were younger than those who had them in hospitals (Table 1). In both settings, colonoscopies were evenly distributed by sex. Overall, 12,021 CRCs were detected (CDR: 1.22%); 9,451 CRCs in hospitals (CDR: 1.48%), and 2,570 CRCs in clinics (CDR: 0.74%). CDRs at any age were lower in clinics as compared to hospitals. In hospitals, CDRs by colonoscopy indication were: 5.16% for FIT+, 1.93% in symptomatic patients, 0.52% in surveillance, 0.70% in average-risk screening, and 0.35% in screening due to family history. FIT+ colonoscopies accounted for the smallest proportion of colonoscopies (6.2%) but the 2nd largest proportion of CRCs detected (Figure 1). Hospital-based CDR increased during the period of observation from 1.23% pre-pandemic (June-December 2019) to 1.55% during the pandemic (January-December 2021). Clinic CDR was 0.71% pre-pandemic and 0.75% during the pandemic. Image ![]()
Conclusion(s) In Ontario, colonoscopy yield (CDR) is highest in FIT+ patients; just over one in 20 colonoscopies will yield a diagnosis of CRC. In contrast, primary screening and surveillance indications have very low CRC yields. The overall yield of colonoscopies in clinics, for all age groups, is lower than in hospital setting. There was a slight increase in CDR during the pandemic compared to before the pandemic, in both settings. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Ontario Health - Cancer Care Ontario Disclosure of Interest None Declared
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Affiliation(s)
- C Dube
- Medicine, The Ottawa Hospital, Ottawa,Ontario Health - Cancer care Ontario
| | | | - J Sacco
- Ontario Health - Cancer care Ontario
| | - J Gao
- Ontario Health - Cancer care Ontario
| | | | | | - Y Niu
- Ontario Health - Cancer care Ontario
| | - J Tinmouth
- Ontario Health - Cancer care Ontario,Medicine, Sunnybrook Hospital, Toronto, Canada
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Roda C, Stiell I, Dube C, Macdonald B, Moloo H, DeBuck A, McCurdy J. A76 PHYSICIANS PERCEIVED VALUE OF COMPUTED TOMOGRAPHY SCANS FOR INFLAMMATORY BOWEL DISEASE PATIENTS IN THE EMERGENCY DEPARTMENT: A SURVEY OF CANADIAN PHYSICIANS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991189 DOI: 10.1093/jcag/gwac036.076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Despite concerns regarding the risks of ionizing radiation from computed tomography (CT) imaging, the rates of abdominal pelvic CT (APCT) utilization in the emergency department (ED) continues to increase for patients with inflammatory bowel disease (IBD). Purpose To determine the factors that drive decisions on when to perform APCT imaging in the ED for patients with IBD and to determine if differences exist between physician specialties. Method We performed a quantitative, web-based survey between November 2021 and August 2022. Structured questions for Crohn’s disease (CD) and ulcerative colitis (UC) were developed with input from stakeholders in gastroenterology, surgery, and emergency medicine. Surveys were disseminated to Canadian physicians in each of the three specialities through personal emails, and by newsletter from national specialty organizations. Between specialty comparisons were performed by Chi-squared and Fisher exact tests where appropriate. Result(s) A total of 208 participants responded to our survey: median age 44 years (IQR 37-50), 132 (63%) male, and 141 (68%) in an academic practice. Survey participants included 81 (39%) gastroenterologists, 35 (17%) surgeons and 92 (44%) emergency physicians. There were significant differences between specialties in the perceived rates of positive findings from APCT imaging. In UC, gastroenterologists felt inflammation alone was more common than emergency physicians and bowel obstruction and septic complications less common than surgeons and emergency physicians. In CD, surgeons felt bowel obstructions, septic complications and bowel perforations were more common compared with gastroenterologists and emergency physicians. There were significant differences between specialties in the types of clinical presentations that drove decisions to arrange APCT imaging (Figure 1a&b). In UC, gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding, abdominal pain without peritoneal findings and fever than surgeons and emergency physicians. In CD, there were similar practice patterns between specialities except gastroenterologists were less likely to order APCT imaging for diarrhea with rectal bleeding than surgeons. Image ![]()
Conclusion(s) Our survey identified key differences between physician specialties in the perceived rates of positive findings from APCT imaging and practice patterns of CT utilization. These findings will help to guide the development of future multidisciplinary consensus guidelines for the appropriateness of CT imaging in the ED for patients with IBD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | | | - H Moloo
- Surgery, The Ottawa Hospital , Ottawa
| | - A DeBuck
- Surgery, Mount Sinai Hospital, Toronto, Canada
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Tinmouth J, Paramalingam A, Bellini A, Cotterchio M, Dekker E, Doctorow R, Hassan C, Haddad E, Lofters A, MacIntosh D, Martin J, McCurdy B, Murray I, Naglie H, Paroschy-Harris C, Rabeneck L, Stogios C, Telford JJ, Venkatesh R, Wong C, Zenlea T, Dube C. A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages & intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs.
Aims
To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline.
Methods
ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine & achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement.
Results
Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year & lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table).
Conclusions
Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma.
Funding Agencies
Ontario Health (Cancer Care Ontario)
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Affiliation(s)
- J Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - A Bellini
- William Osler Health Centre-Brampton Civic Hospital, Toronto, ON, Canada
| | | | - E Dekker
- Universiteit van Amsterdam Faculteit Geneeskunde, Amsterdam, Noord-Holland, Netherlands
| | | | - C Hassan
- Poliambulatorio Nuovo Regina Margherita, Roma, Lazio, Italy
| | - E Haddad
- Chatham-Kent Health Alliance, Chatham, ON, Canada
| | - A Lofters
- Women’s College Hospital, Toronto, ON, Canada
| | - D MacIntosh
- Queen Elizabeth II Health Science Centre, Halifax, NS, Canada
| | - J Martin
- Grand River Hospital, Kitchener, ON, Canada
| | | | - I Murray
- Intestinal Health Institute, Unionville, ON, Canada
| | - H Naglie
- General Public, Toronto, ON, Canada
| | - C Paroschy-Harris
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | | | | | - J J Telford
- University of British Columbia, Vancouver, BC, Canada
| | | | - C Wong
- University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - T Zenlea
- Women’s College Hospital, Toronto, ON, Canada
| | - C Dube
- Ottawa Hospital Civic Campus, Ottawa, ON, Canada
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Tateyama Y, Techasrivichien T, Musumari PM, Macwan’gi M, Zulu R, Dube C, Suguimoto SP, Ono-Kihara M, Kihara M. Prevalence and correlates of elevated HbA1c in rural Zambia: A population-based cross-sectional study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) poses a serious challenge to the health systems in sub-Saharan Africa. In Zambia, the estimated prevalence of DM among adults was 4.2% in 2016. However, little is known about its magnitude among the rural population. To address this gap, we investigated the prevalence of DM and its correlates among rural residents in Zambia.
Methods
In 2016, we recruited 690 rural residents aged 25-64 of Mumbwa district by multistage, clustered, household sampling. Questionnaire survey was conducted along with anthropometric and biological measurements including HbA1c. Data analysis was adjusted for complex sampling.
Results
The prevalence of elevated HbA1c (≥5.7) was 41% (Men 34%, Women 48%). DM, defined as HbA1c ≥ 6.5%, was present in 2.6% of the participants. Sixteen percent of men and 37% of women were overweight or obese (BMI≥25). In multivariable analysis, high cooking oil intake and obesity (BMI≥30) were associated with higher odds of elevated HbA1c (adjusted odds ratio [AOR]=1.76 and 3.30), but the association was inverse for alcohol intake (AOR≈0.55). By gender, obesity was positively associated with an elevated HbA1c in both genders (AOR= men 6.57, women 2.11). Secondary education was inversely (AOR=0.52), and high sugar intake was positively (AOR=1.66) associated with elevated HbA1c in men. Older age and high cooking oil intake were positively associated (AOR=1.89 and 2.14), and alcohol intake (AOR=0.46) was inversely associated with elevated HbA1c in women.
Conclusions
More than 40% of rural residents in Zambia had elevated HbA1c. The risk factor profile was different between genders. Obesity increased the odds of elevated HbA1c in both genders, but the odds was disproportionately higher in men than in women. The reasons for such gender difference remain unknown, but we speculate that it might be explained by the early onset of obesity in women. Such gender difference should be addressed in health interventions in this population.
Key messages
Over 40% of rural residents in Zambia are at risk of prediabetes or diabetes. Health interventions should address the gender difference in the risk of elevated HbA1c.
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Affiliation(s)
- Y Tateyama
- Kyoto University Health Service, Kyoto, Japan
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - T Techasrivichien
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - P M Musumari
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - M Macwan’gi
- Institute of Economic and Social Research, The University of Zambia, Lusaka, Zambia
| | - R Zulu
- Institute of Economic and Social Research, The University of Zambia, Lusaka, Zambia
| | - C Dube
- Ndola District Health Office, Ndola, Zambia
| | - S P Suguimoto
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - M Ono-Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - M Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
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Bishay K, Calo N, Scaffidi MA, Walsh CM, Anderson J, Rostom A, Dube C, Keswani RN, Heitman S, Hilsden RJ, Shorr R, Grover SC, González Moreno E, Forbes N. A147 ENDOSCOPIST FEEDBACK IS ASSOCIATED WITH IMPROVEMENTS IN COLONOSCOPY QUALITY INDICATORS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Colonoscopy quality indicators such as adenoma detection rate (ADR) are surrogates for the effectiveness of screening-related colonoscopy. Endosocpist feedback may be associated with improvements in ADR and other quality indicators.
Aims
To conduct a systematic review and meta-analysis to determine whether an association exists between endoscopist feedback and improvements in colonoscopy quality indicators.
Methods
An electronic and manual search was conducted through May 2019 for studies reporting on endoscopist feedback and associations with ADR or other colonoscopy quality indicators. Studies primarily assessing the effect of audit and feedback on trainees and studies that included interventions other then feedback were excluded from the analysis. Pooled rate ratios (RR) and weighted mean differences (WMD) were calculated using DerSimonian and Laird random effects models. Subgroup, sensitivity and meta-regression analyses were performed to assess for potential methodological or clinical factors associated with outcomes.
Results
Of 1,326 initial studies, 12 studies were included in the meta-analysis for ADR, representing 33,184 colonoscopies. Endoscopist feedback was associated with an improvement in ADR (RR 1.21, 95% confidence interval, CI, 1.09 to 1.34). Low performers derived a greater benefit from feedback (RR 1.62, 95% CI 1.18 to 2.23) compared to moderate performers (RR 1.19, 95% CI 1.11 to 1.29), while high performers did not derive a significant benefit (RR 1.06, 95% CI 0.99 to 1.13). Feedback was not associated with increases in withdrawal time (WMD +0.43 minutes, 95% CI -0.50 to +1.36 minutes) or improvements in cecal intubation rate (RR 1.00, 95% CI 0.99 to 1.01).
Conclusions
Endoscopist feedback is associated with modest improvements in ADR. Routine audit and feedback may be a feasible strategy to optimize outcomes in screening colonoscopy.
Funding Agencies
None
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Affiliation(s)
- K Bishay
- University of Toronto, Toronto, ON, Canada
| | - N Calo
- University of Toronto, Toronto, ON, Canada
| | | | - C M Walsh
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children and The Wilson Centre, Toronto, ON, Canada
| | - J Anderson
- Dept. of Gastroenterology, Cheltenham Hospital, Cheltenham, United Kingdom
| | - A Rostom
- University of Ottawa, Ottawa, ON, Canada
| | - C Dube
- Medicine, the Ottawa hospital, Ottawa, ON, Canada
| | | | - S Heitman
- University of Calgary, Calgary, AB, Canada
| | | | - R Shorr
- University of Ottawa, Ottawa, ON, Canada
| | - S C Grover
- Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | | | - N Forbes
- University of Calgary, Calgary, AB, Canada
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Maxwell CM, Rostom A, Dube C, Bridges R, Heitman S, Forbes N, Hilsden RJ. A30 DEVELOPMENT OF A DEFINITION AND RULES FOR CAUSAL ATTRIBUTION OF POST-COLONOSCOPY BLEEDING (PCB). J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Rostom
- University of Ottawa, Ottawa, ON, Canada
| | - C Dube
- University of Ottawa, Ottawa, ON, Canada
| | - R Bridges
- University of Calgary, Calgary, AB, Canada
| | - S Heitman
- University of Calgary, Calgary, AB, Canada
| | - N Forbes
- University of Calgary, Calgary, AB, Canada
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Mack D, Epstein M, Dube C, Clark R, Lapane K. LESS IS MORE: POTENTIAL OVERSCREENING FOR BREAST CANCER IN U.S. NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Mack
- University of Massachusetts Medical School
| | - M Epstein
- University of Massachusetts Medical School
| | - C Dube
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - R Clark
- University of Massachusetts Medical School
| | - K Lapane
- University of Massachusetts Medical School
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10
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Murthy S, Le Gal G, Benchimol EI, Hae R, Burke S, Rostom A, Dube C. A197 A PREDICTION MODEL OF RISK OF HARBOURING ADVANCED COLORECTAL NEOPLASMS IN LOW TO MODERATE RISK PERSONS OVER AGE 50. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Murthy
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - G Le Gal
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - E I Benchimol
- Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - R Hae
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - S Burke
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - A Rostom
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - C Dube
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Cenin D, Tinmouth J, Dube C, McCurdy B, Paszat L, Rabeneck L, Lansdorp-Vogelaar I. A198 PERSONALIZING THE AGE TO STOP COLORECTAL CANCER SCREENING IN CANADA BASED ON COMORBIDITY AND PRIOR SCREENING HISTORY: MODEL ESTIMATES OF HARMS AND BENEFITS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Cenin
- Erasmus MC, Rotterdam, Netherlands
| | - J Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Dube
- The Ottawa Hospital, Ottawa, ON, Canada
| | - B McCurdy
- Cancer Care Ontario, Toronto, ON, Canada
| | - L Paszat
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Rabeneck
- Cancer Care Ontario, Toronto, ON, Canada
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Heron V, Martel M, Bessissow T, Chen Y, Desilets E, Dube C, Lu Y, Ménard C, McNabb-Baltar J, Parmar R, Rostom A, Barkun AN. A51 COMPARISON OF THE BOSTON BOWEL PREPARATION SCALE WITH AN AUDITABLE APPLICATION OF THE US MULTI-SOCIETY TASK FORCE GUIDELINES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Heron
- McGill University, Montréal, QC, Canada
| | - M Martel
- McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Y Chen
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD
| | - E Desilets
- Gastroenterology, Université de Sherbrooke, St-Basile-le-Grand, QC, Canada
| | - C Dube
- medicine, the ottawa hospital, Ottawa, ON, Canada
| | - Y Lu
- McGill University, Montréal, QC, Canada
| | - C Ménard
- Medecine, CHUS, Sherbrooke, QC, Canada
| | - J McNabb-Baltar
- Brigham and Women’s Hospital, Harvard Medical School, Montreal, QC, Canada
| | - R Parmar
- Internal Medicine, McGill, Montreal, QC, Canada
| | - A Rostom
- University of Ottawa, Ottawa, ON, Canada
| | - A N Barkun
- Gastroenterology, McGill University, The Montreal General Hospital, GI Division, Montreal, QC, Canada
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Abunassar MJ, Chatterjee A, Marginean C, Martel G, Murthy S, Dube C, Rostom A, James PD. A324 FOUR OR MORE EUS-FNA PASSES FOR PANCREATIC SOLID LESIONS IS ASSOCIATED WITH INCREASED RISK WITHOUT IMPROVING DIAGNOSTIC YIELD: RESULTS FROM THE OTTAWA HOSPITAL EUS RYSE QA INITIATIVE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Abunassar
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
| | - A Chatterjee
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
| | - C Marginean
- The University of Ottawa, The Ottawa Hospital, Department of Pathology, Ottawa, ON, Canada
| | - G Martel
- The University of Ottawa, The Ottawa Hospital, Department of Surgery, Division of Hepatobiliary Surgery, Ottawa, ON, Canada
| | - S Murthy
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
| | - C Dube
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
| | - A Rostom
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
| | - P D James
- The University of Ottawa, The Ottawa Hospital, Department of Medicine, Division of Gastroenterology, Ottawa, ON, Canada
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Dube C, Young V, Anderson M, Barton B, Leahy I. The Unique Role of the Pediatric Clinical Research Nurse in Anesthesia: An Interdisciplinary Collaboration. J Perianesth Nurs 2016; 32:352-355. [PMID: 28739067 DOI: 10.1016/j.jopan.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
Abstract
This article describes the distinctive function of the pediatric clinical research nurse (CRN) in the anesthesia setting. The pediatric CRN in anesthesia acts as a liaison between families and the research team and is the major nexus between the principal investigator or anesthesiologist on a study, and the collaborating surgeons from many different departments. This is unique because the CRNs collaborate with physicians in specialties that can include plastics, urology, neurosurgery, orthopaedics, otolaryngology, cardiology, critical care, and many other departments. The profession requires a breath of knowledge ranging from clinical understanding of diseases, surgical procedures, and recovery to cognitive and developmental stages, to expertise in the research protocol process. Our objective was to describe these specialized activities of the pediatric anesthesia CRN, with focus on care coordination, communication, and continuity of care. Defining this role will enhance the quality of clinical research conducted by the CRN in anesthesia and may influence the development of novel medical treatments.
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Maxwell LG, Buckley GM, Kudchadkar SR, Ely E, Stebbins EL, Dube C, Morad A, Jastaniah EA, Sethna NF, Yaster M. Pain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children's hospitals. Paediatr Anaesth 2014; 24:1132-40. [PMID: 25069627 PMCID: PMC4184973 DOI: 10.1111/pan.12489] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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] [Accepted: 06/22/2014] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain, and this pain is often under-treated. The purpose of this prospective, clinical observational cohort study was to assess the incidence of pain, prescribed analgesics, methods of analgesic delivery, and patient/parent satisfaction in pediatric patients undergoing cranial surgery at three major university children's hospitals. METHODS After obtaining IRB and parental consent (and when applicable, patient assent), children who underwent cranial surgery for cancer, epilepsy, vascular malformations, and craniofacial reconstruction were studied. Neither intraoperative anesthetic management nor postoperative pain management was standardized, but were based on institutional routine. Patients were evaluated daily by a study investigator and by chart review for pain scores using age appropriate, validated tools (FLACC, Faces Pain Scale-Revised, Wong-Baker Faces Scale or Self-Report on a 0-10 scale), for patient/parent satisfaction using a subset of the NRC Picker satisfaction tool and in adolescents a modified QoR-40, and for the frequency, mode of administration, and type of analgesic provided. Finally, the incidence of opioid-induced side effects, specifically nausea, vomiting, pruritus, altered level of consciousness, and need for emergency diagnostic radiologic studies for altered neurologic examination were recorded. Data are provided as mean ± SD. RESULTS Two hundred children (98:102 M:F), averaging 7.8 ± 5.8 years old (range 2 months-18.5 years) and 32.2 ± 23.0 kg (range 4.5-111.6 kg) undergoing craniectomy (51), craniotomy (96), and craniofacial reconstruction (53) were studied. Despite considerable variation in mode and route of analgesic administration, there were no differences in average pain score, length of hospital stay, or parental satisfaction with care. Interestingly, opioid-induced side effects were not related to total daily opioid consumption, site of surgery, or method of opioid delivery. The most common side effect was vomiting. No patient developed respiratory depression or altered mental status secondary to analgesic therapy. Regardless of age or procedure, once eating, most patients were treated with oral oxycodone and/or acetaminophen. CONCLUSIONS Despite considerable variation in modality and route of analgesic administration, there were no differences in average pain score, length of stay, or parental satisfaction with care. Pain scores were low, side effects were minimal, and parental satisfaction was high, providing equipoise for future blinded prospective randomized trials in this patient population.
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Affiliation(s)
- Lynne G. Maxwell
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - George M. Buckley
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, USA
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, USA
| | - Elizabeth Ely
- Department of Nursing, The Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Emily L. Stebbins
- Departments of Anesthesiology and Pediatrics, University of Vermont, Fletcher Allen Health Care, Burlington, USA
| | - Christine Dube
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
| | - Athir Morad
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, USA
| | - Ebaa A. Jastaniah
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, USA
| | - Navil F. Sethna
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
| | - Myron Yaster
- Departments of Anesthesiology, Critical Care Medicine, Pediatrics, and Neurosurgery, The Johns Hopkins University, Baltimore, USA
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Miyano S, Dube C, Kayama N, Ishikawa N, Nozaki I, Syakantu G. Association between tuberculosis treatment outcomes and the mobile antiretroviral therapy programme in Zambia. Int J Tuberc Lung Dis 2013; 17:540-5. [PMID: 23394080 DOI: 10.5588/ijtld.12.0432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Free antiretroviral therapy (ART) services in Zambia were introduced in hospitals beginning in 2005 and in selected rural health centres (RHCs) beginning in 2007 through the mobile ART programme. OBJECTIVE To analyse the impact of scaling up ART services on tuberculosis (TB) treatment outcomes in Mumbwa District, Zambia. DESIGN TB patients registered at all RHCs in the district between July 2006 and September 2009 were reviewed. RHCs were divided into two groups: 'ART sites', which provided ART services after 2007, and 'non-ART sites', which did not provide such services even after 2007. A before-after comparison analysis of TB patients was conducted between the groups. RESULTS A total of 732 patients were enrolled (median age 34.5 years; female 44.4%). The overall human immunodeficiency virus (HIV) testing rate was 72.3% and 66.7% of these patients were HIV-positive. The TB treatment success rate at the ART sites increased significantly compared to non-ART sites after the mobile ART programme was started (P < 0.01). The HIV testing acceptance rate also increased dramatically at ART sites, which facilitated intensified case finding (P = 0.02). CONCLUSION Scaling up ART services in rural health facilities through the mobile ART programme was found to be associated with greatly improved anti-tuberculosis treatment outcomes.
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Affiliation(s)
- S Miyano
- Japan International Cooperation Agency, Zambia Office, Lusaka, Zambia.
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17
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Forgie R, Dube C, Roy L, Yip A, Pelletier M, Brown C, Parrott J, Hassan A. 557 Long-Term Results Following Mitral Valve Repair Surgery Performed at a Small-Volume Cardiac Surgery Center Between 1991 and 2008. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Dube C, Sekuler R. On the Nature of Prototype Effects in Visual Working Memory for Motion. J Vis 2012. [DOI: 10.1167/12.9.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Petit G, Bigras A, Dube C, Malo FC, Surprenant MC, Salvail M, Gagnon M. P1-S6.47 Description and evaluation of a regional condom access program for community organizations. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.271] [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: 11/04/2022]
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20
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Lane AA, McAfee SL, Kennedy J, Dube C, Attar EC, Ballen KK, Dey BR, Spitzer TR, Chen YB. High-dose chemotherapy with busulfan and cyclophosphamide and autologous stem cell rescue in patients with Hodgkin lymphoma. Leuk Lymphoma 2011; 52:1363-6. [PMID: 21612379 DOI: 10.3109/10428194.2011.572324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Dube S, Zindi P, Mbanga J, Dube C. A Study of Scavenging Poultry Gastrointestinal and Ecto-parasites in Rural Areas of Matebeleland Province, Zimbabwe. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/ijps.2010.911.915] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tanih NF, Dube C, Green E, Mkwetshana N, Clarke AM, Ndip LM, Ndip RN. An African perspective on Helicobacter pylori: prevalence of human infection, drug resistance, and alternative approaches to treatment. Ann Trop Med Parasitol 2010; 103:189-204. [PMID: 19341534 DOI: 10.1179/136485909x398311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Helicobacter pylori is a Gram-negative, micro-aerophilic, motile, curved rod that inhabits the gastric mucosa of the human stomach. It chronically infects thousands of millions of people world-wide, and is one of the most genetically diverse of bacterial species. Infection with the bacterium leads to chronic gastritis, peptic ulceration, gastric cancers and gastric mucosa-associated lymphoid-tissue (MALT) lymphoma. The prevalence of infection appears to be partly determined by geographical and socio-demographic factors, being higher in Africa than elsewhere. Current treatment, based on potent combinations that each consist of a proton-pump inhibitor and two antibiotics, is successful in 80%-90% of patients. Some undesirable side-effects, poor patient compliance and drug resistance are, however, associated with significant levels of treatment failure and with contra-indications for some patients. Antibiotic resistance in H. pylori is a growing global concern that merits the urgent attention of public-health authorities. Numerous pieces of clinical evidence have revealed that eradication of the organism from a patient results in improvement of gastritis and drastically decreases the frequency of relapse of gastric and duodenal ulcers. Natural products, including medicinal plants and honey, may offer useful alternatives in the treatment of H. pylori-related infections.
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Affiliation(s)
- N F Tanih
- Microbial Pathogenicity and Molecular Epidemiology Research Group, Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, P.M.B. X1314, Alice 5700, South Africa
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Ulrickson M, Aldridge J, Kim HT, Hochberg EP, Hammerman P, Dube C, Attar E, Ballen KK, Dey BR, McAfee SL, Spitzer TR, Chen YB. Busulfan and cyclophosphamide (Bu/Cy) as a preparative regimen for autologous stem cell transplantation in patients with non-Hodgkin lymphoma: a single-institution experience. Biol Blood Marrow Transplant 2009; 15:1447-54. [PMID: 19822305 DOI: 10.1016/j.bbmt.2009.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been established as a standard form of therapy for patients with non-Hodgkin lymphoma (NHL). While many high-dose chemotherapy combinations are used, no single regimen has proved superior over another. Here, we report our single center's experience in patients with NHL undergoing ASCT with the combination of busulfan and cyclophosphamide (Bu/Cy). This study is a retrospective analysis of 78 consecutive patients with NHL who underwent ASCT with Bu/Cy at Massachusetts General Hospital Cancer Center. Data were collected through review of electronic medical records. A total of 78 patients with NHL underwent ASCT with Bu/Cy preparative therapy between 1996 and 2006. Median follow-up for survivors was 5.0 years (range, 6 months to 12 years). Significant transplantation-associated complications included 9 documented bacterial infections, 4 cases of engraftment syndrome, 3 cases of hepatic veno-occlusive disease (VOD), 6 cases of cardiac complications, and 2 cases of pulmonary fibrosis. The 100-day treatment-related mortality (TRM) was 1%. At 3 years, progression-free survival (PFS) was 48% (95% confidence interval [CI]=37% to 59%) and overall survival (OS) was 65% (95% CI=53% to 74%). Our data indicate that in patients with NHL undergoing ASCT, Bu/Cy has efficacy and toxicity comparable to that of other reported regimens.
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Affiliation(s)
- Matthew Ulrickson
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Dube C, Nkosi TC, Clarke AM, Mkwetshana N, Green E, Ndip RN. Helicobacter pylori antigenemia in an asymptomatic population of Eastern Cape Province, South Africa: public health implications. Rev Environ Health 2009; 24:249-255. [PMID: 19891122 DOI: 10.1515/reveh.2009.24.3.249] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Helicobacter pylori is a major cause of such upper gastrointestinal diseases as gastritis, peptic ulcer, and gastric cancer. The risk of infection is increased in those living in the developing world, which has been ascribed to precarious hygiene standards, crowded households, and deficient sanitation common in this part of the world. Fecal samples were collected from 356 apparently healthy subjects, consisting of 168 males and 188 females aged from 3 months to > or = 60 years (Mean = 31 years). A standardized questionnaire describing demographic characteristic including age, sex, household hygiene, socioeconomic status, and so on was applied. A sandwich-type enzyme immunoassay amplification technology (Amplified IDEIA Hp StAR, Oxoid, UK) was used to analyze the fecal samples for the detection of H. pylori antigens using monoclonal antibodies specific for H. pylori antigens. Fisher's exact test was used to assess the univariate association between H. pylori infection and the possible risk factors. Odds ratio (OR) and the corresponding 95% confidence interval (CI) were calculated to measure the strength of association using EPI INFO 3.41 package. P values of < .05 were required for significance. H. pylori antigen was detected in 309 of the 356 subjects giving an overall prevalence of 86.8%. Prevalence increased with age from 75.9% in children < 12 years age to 100% in young adults aged 25-47 years and subjects aged > or = 60 years (P < .05). H. pylori prevalence was higher in females than in males. Of 188 females who participated in the study, H. pylori antigen was detected in 172 (91.5%) versus 144 (85.7%) 168 males (P > .05). Interestingly, H. pylori antigen was detected more often (100%) in the high socioeconomic group than in those of low socioeconomic group (85.9%) (P > .05). The results of this study have revealed a high prevalence of H. pylori antigens in fecal samples of asymptomatic individuals in the Nkonkobe municipality, an indication of active infection. Socioeconomic status, contaminated water, and poor sanitation may play a role in H. pylori transmission in this population. This finding is of public health and epidemiologic significance.
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Affiliation(s)
- C Dube
- Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, Alice, South Africa
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Abstract
Helicobacter pylori are Gram-negative micro-aerophilic motile curve rods that inhabit the gastric mucosa of the human stomach. The bacterium chronically infects billions of people worldwide and is one of the most genetically diverse of bacterial species. More than half of the world population in both developed and developing countries are infected with this organism. Infection usually occurs without overt clinical symptoms, particularly in poor communities. If untreated, the infection can last for decades without causing symptoms. In some communities, however, infection with the organism causes peptic and duodenal ulcers, gastritis, duodenitis, and gastric cancers. How H. pylori initially enters the stomach is not known, but contaminated food particles and water are suspected, with the former physically shielding it from stomach acid. Similarly, the route of transmission of this pathogen is unknown. Several reports have suggested the possibility of waterborne transmission as the organism can survive for a few days in fresh cold water, salt water, distilled water, and tap water. Knowledge of the epidemiology and mode of transmission of H. pylori is important to prevent its spread and may be useful in identifying high risk populations.
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Affiliation(s)
- C Dube
- Microbial Pathogenicity and Molecular Epidemiology Research Group, Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
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Duffy CM, Allen SM, Dube C, Wool MS. Barriers to discussions of fertility issues prior to cancer treatment. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20550] [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: 11/20/2022] Open
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27
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Conti I, Dube C, Rollins BJ. Chemokine-based pathogenetic mechanisms in cancer. Novartis Found Symp 2004; 256:29-41; discussion 41-52, 266-9. [PMID: 15027482] [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: 04/29/2023]
Abstract
The chemokine system has evolved primarily to control the trafficking of leukocytes during immune or inflammatory responses. However, through their expression of chemokine ligands and receptors, cancers have commandeered various aspects of this host defence system in order to enhance their growth. Although engineered over-expression of some tumour-derived chemokines can stimulate host antitumour respones, this is unlikely to be the reason that tumour cells express them. Rather, a growing body of clinical and laboratory evidence indicates that cancer cells may secrete chemokines in order to attract host cells that supply the tumours with growth and angiogenic factors. In addition, chemokine receptor expression by tumour cells may permit them to use the host's pre-existing leukocyte trafficking system to invade target tissues during metastatic spread. Together, these observations suggest that therapies directed against chemokine ligands or receptors may be beneficial in cancer.
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Affiliation(s)
- Ilaria Conti
- Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02116, USA
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Daly C, Dube C, Rollins BJ. Chemokine influences on adaptive immunity and malignancies of the immune system. Ernst Schering Res Found Workshop 2004:11-30. [PMID: 14699791 DOI: 10.1007/978-3-662-05403-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- C Daly
- Department of Medical Oncology, Dana-Farber Cancer Institute, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Dube C, Bender RA, Chen K, Toth Z, Eghbal-Ahmadi M, Soltesz I, Baram TZ. Prolonged febrile seizures: neuroanatomical and functional consequences. Acta Neurol Scand 2002. [DOI: 10.1034/j.1600-0404.2000.00202-21.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Park E, Eaton CA, Goldstein MG, DePue J, Niaura R, Guadagnoli E, MacDonald Gross N, Dube C. The development of a decisional balance measure of physician smoking cessation interventions. Prev Med 2001; 33:261-7. [PMID: 11570829 DOI: 10.1006/pmed.2001.0879] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Decreasing the prevalence of smoking is an important health care goal, and there is evidence that physicians' advice to quit is an important motivator for patients. However, fewer than half of smokers report that they have ever been advised to quit. This study was conducted to develop a decisional balance measure for physician delivery of smoking cessation interventions. METHODS This study included a convenience sample of 155 primary care physicians. A decisional balance measure was developed using item generation and development, pilot testing, and principal components analyses. Validity was established by relating the decisional balance measure to a previously validated item of counseling behavior and to physician stage of readiness to deliver smoking cessation counseling. RESULTS Based on principal components analyses and item analyses, the final measure consisted of 10 Pro and 10 Con items with coefficient alpha of 0.83 and 0.86. The Pros and Cons scales were significantly associated with self-reported counseling to patients who smoke and to stage of readiness to deliver smoking cessation counseling. CONCLUSIONS A decisional balance measure of physician smoking cessation interventions can be used to assist investigators in developing effective interventions to enhance the delivery of smoking cessation interventions in primary care settings.
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Affiliation(s)
- E Park
- The Centers for Behavioral and Preventive Medicine, Brown Medical School and the Miriam Hospital, Providence, Rhode Island, USA
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31
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Sateia MJ, Owens J, Dube C, Goldberg R. Advancement in sleep medicine education. Sleep 2000; 23:1021-3. [PMID: 11145317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- M J Sateia
- Dartmouth Medical School, Sleep Disorders Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Dube C, Chen K, Eghbal-Ahmadi M, Brunson K, Soltesz I, Baram TZ. Prolonged febrile seizures in the immature rat model enhance hippocampal excitability long term. Ann Neurol 2000; 47:336-44. [PMID: 10716253 PMCID: PMC3139468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Febrile seizures (FSs) constitute the most prevalent seizure type during childhood. Whether prolonged FSs alter limbic excitability, leading to spontaneous seizures (temporal lobe epilepsy) during adulthood, has been controversial. Recent data indicate that, in the immature rat model, prolonged FSs induce transient structural changes of some hippocampal pyramidal neurons and long-term functional changes of hippocampal circuitry. However, whether these neuroanatomical and electrophysiological changes promote hippocampal excitability and lead to epilepsy has remained unknown. By using in vivo and in vitro approaches, we determined that prolonged hyperthermia-induced seizures in immature rats caused long-term enhanced susceptibility to limbic convulsants that lasted to adulthood. Thus, extensive hippocampal electroencephalographic and behavioral monitoring failed to demonstrate spontaneous seizures in adult rats that had experienced hyperthermic seizures during infancy. However, 100% of animals developed hippocampal seizures after systemic administration of a low dose of kainate, and most progressed to status epilepticus. Conversely, a minority of normothermic and hyperthermic controls had (brief) seizures, none developing status epilepticus. In vitro, spontaneous epileptiform discharges were not observed in hippocampal-entorhinal cortex slices derived from either control or experimental groups. However, Schaeffer collateral stimulation induced prolonged, self-sustaining, status epilepticus-like discharges exclusively in slices from experimental rats. These data indicate that hyperthermic seizures in the immature rat model of FSs do not cause spontaneous limbic seizures during adulthood. However, they reduce thresholds to chemical convulsants in vivo and electrical stimulation in vitro, indicating persistent enhancement of limbic excitability that may facilitate the development of epilepsy.
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Affiliation(s)
- C Dube
- Department of Anatomy and Neurobiology, University of California at Irvine, 92697-4475, USA
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Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are important agents in the management of arthritic and inflammatory conditions, and are among the most frequently prescribed medications in North America and Europe. However, there is overwhelming evidence linking these agents to a variety of gastrointestinal (GI) toxicities. OBJECTIVES To review the effectiveness of common interventions for the prevention of NSAID induced upper GI toxicity. SEARCH STRATEGY A literature search was conducted, according to the Cochrane methodology for identification of randomized controlled trials in electronic databases, including MEDLINE from 1966 to January 2000, Current Contents for 6 months prior to January 2000, Embase to Febuary 1999, and a search of the Cochrane Controlled Trials Register from 1973 to 1999. Recent conference proceedings were reviewed and content experts and companies were contacted. SELECTION CRITERIA Randomized controlled clinical trials (RCTs) of prostaglandin analogues (PA), H2-receptor antagonists (H2RA) or proton pump inhibitors (PPI) for the prevention of chronic NSAID induced upper GI toxicity were included. DATA COLLECTION AND ANALYSIS Two independent reviewers extracted data regarding population characteristics, study design, methodological quality and number of patients with endoscopic ulcers, ulcer complications, symptoms, overall drop-outs, drop outs due to symptoms. Dichotomous data was pooled using Revman V3.1. Heterogeneity was evaluated using a chi square test. MAIN RESULTS Thirty-three RCTs met the inclusion criteria. All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 ug/day was superior to 400 ug/day for the prevention of endoscopic gastric ulcers (RR=0.18, and RR=0. 38 respectively, p=0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at 800ug/day than 400ug/day (p=0.0012). Misoprostol was the only prophylactic agent documented to reduce ulcer complications. Standard doses of H2RAs were effective at reducing the risk of endoscopic duodenal (RR=0.24; 95% CI: 0.10-0. 57) but not gastric ulcers(RR=0.73; 95% CI:0.50-1.09). Both double dose H2RAs and PPIs were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR=0.44; 95% CI:0.26-0.74 and RR=0.37;95% CI;0.27-0.51 respectively for gastric ulcer), and were better tolerated than misoprostol. REVIEWER'S CONCLUSIONS Misoprostol, PPIs, and double dose H2RAs are effective at preventing chronic NSAID related endoscopic gastric and duodenal ulcers. Lower doses of misoprostol are less effective and are still associated with diarrhea. Only Misoprostol 800ug/day has been directly shown to reduce the risk of ulcer complications.
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Affiliation(s)
- A Rostom
- University of Ottawa Department of Medicine, A1 - Endoscopy Unit, Ottawa Hospital - Civic Campus, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y-4E9.
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Dube C. The physician's role in preventing alcohol and drug abuse. Med Health R I 1999; 82:95-8. [PMID: 10193139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- C Dube
- Center for Alcohol Studies, Brown University School of Medicine, Providence, RI 02912, USA.
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Alario A, Riggs S, Dube C, Lewis D. Developing and Evaluating an Integrated Substance-Abuse Curriculum for Implementation in a Primary Care Setting. J Health Care Poor Underserved 1992. [DOI: 10.1353/hpu.2010.0077] [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: 11/11/2022]
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